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HomeMy WebLinkAbout2026-00030294 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 0110 11111 N O 1111111111111 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV XO04251057' u, 1 U21 3 4 1 U1 2 U2 1 U, 1 U2 1 U, 1 U2 1 1 14 U1 16 U2 1 *PO 11 9* INVESTIGATING AGENCY DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 2 VEHICLE/PROPERTY ®OVER 51,500 El NOT ON SCENE(DESK REPORT) ® B Injury and f or Tow Due To Crash 0 AMENDED YR 2026I 2026-00030294 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n ® ❑ RELATED ❑Y ®N 05 27 2026 E�IAM ❑YES ®NO U1 -< N MCLEAN BLVD Elgin11:40 _ _ g PRIVATE mo /day/yr ❑PM FLOW CONDITION m 0 !MI N E S W BigTimber Rd COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ®SLOW 7 Cl) ® Kane HIT&RUN ❑Y ® N WITH VEHICLESOT, INVLD DLO STOPPED U2 —I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ❑ FREE FLOW # LNS O 18:DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EWES ❑uuv ❑!CV ❑Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 5 0 NT�TOWED U1 Q mo Helinski.Jacob.T. Nissan Sentra 2019 00-NONE ©1 Q2 a/DUE TO CRASH ® ❑ O NAME(LAST,FIRST,M) yr 13-UNDER CARRIAGE I FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 2 DISTRACTED 0 Ea U2 5 M M 2 SYTM IN ENGAGE8 ❑Y ®SNE DUNK VEH. O AT CRASHD O 99-UNKNOWN 9 16•TOP 3 *Distraction Value 9 ALGN = r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s, i�S �i COM VEH 0 Ea 1 0 F. ELGIN N I L 60120 C 1 0 FIRST CONTACT 11 7_: __5 *Ilsees.See Sidebar U1 Z DG36939 IL 2027 REAR TELEPHONE IL D 0 3N1AB7AP3KY330097 Progressive ❑Y ®N U2 I— in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 Gilbreath. Haley.J. 981277320 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER RESPONDER 2 XI x DRIVER ❑ PARKED ❑DRIVERLESS 0 FED ❑PEDAL 0 EWES ❑iiMv 0 Kcv ❑Dv !2 0 0 2 NT Peterbilt Moto�76o. 2005 00-NONE 11_"I 0i.O DUE TO CRASH ❑ ® 99 x 13-UNDER CARRIAGE I FIRE ID ® U2 7, M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 1,6-TOP 3 X ❑Y NJ El UNK VEH. AT CRASH 99-UNKNOWN *0istracl Dn Value 9 0 s 4 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6 ,f-_ COM VEH El El U1 CO FIRST CONTACT 1 Y•i1_,__5 •IfYes.See Sidebar Z Charleston IL 61920 0 1 0 P1147410 IL 2027 I 0 Z IL A 7 1XP5DB9X75D841656 SENTRY ❑Y ®N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER 1 = 99 9 Chesterville truckin A0122456001 BAc $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP U1 = (UNIT) (SEAT) (DOS) (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)!{ADDRESS)((TELEPHONE) (EMS) (HOSPITAL) 1 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z N 1 ® 11 1 05,27 l2026 11 40 ®❑AM in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 3 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ®AM U1 � v 2 ❑ 2 18 05,27 ,2026 11 40 ❑PM ❑Construction >F R O ❑ ]$I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 7 3 ❑AM 0 Maintenance U2 oCR 11 1 ARREST NAME Helinski.Jacob.T. 11-901-A 1570-000101 / ! 0 PM SLMT o N - ❑CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ' 0 Utility 0 AM t 2 ElARREST NAME 05 r 27 ,2026 12 20 ®PM 0 Unknown work zone type U1 30 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 30 1570-Tomlin. Eli 500 331-Ziegler 07 , 14,2026 09 00 ❑PM ®N U2 REMEMBER TO USE BLACK INK,PRESS HARD,PRINT LEGIBLY AND COMPLETE ALL REQUIRED FIELDS! A Diagram and Narrative are required on all Type B crashes, LARGE TRUCK, BUS, OR HM VEHICLE even if units have been moved prior to officer's arrival. IF MORE THAN ONE CMV IS INVOLVED,USE SR 1050A l ADDITIONAL UNITS FORMS. r ----r•---, , I % A CMV is defined as any motor vehicle used to transport passengers or property and: Z ' }-----I-----' Not To Scab I r I` I 1 - INDICATE NORTH comas r more than pound (example:truck or truck/trailer 1. Has a weight rating10 000 5 combination):o i BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C '\ _ } (example:shuttle or charter bus):or I-'-I \1 3. Is designed to carry15 or fewer passengers and operated a contract carrier O } } } transporting employee in the course of their employment(example:employee 1"' T r,__`} I I transporter-usually a van type vehicle or passenger car):or w L L.___a____� ��� I HI } } •4. Is used or designated to transport between 9 and 15passen rs,includingthedriver, B�"Oe ° for direct compensation(example:large van used for specific purpose):or O L L.._-a____. - — — — — - i i _ 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires D placarding(example:placards will be displayed on the vehicle). XI — — — — — — — — — — CARRIER NAME Chesterville Trucking LLC z ADDRESS 356 N CR 245 0 III w I I CITY/STATE/ZIP Aurthur I I L/61911 n I - MOTOR CARR.ID El Interstate ❑ Intrastate I I T I El Not in Comm./Govt. El Not in Comm./Other '----------, I I I - % % % % usDOT NO. 0211653 ILCC NO. 302880 m I I x Source of above z . If Yes,Name on placard O 4 digit UN NO. 1 digit Hazard class No. Xl Xl Did HAZMAT spill from vehicle(do NOT consider FUEL from vehicle's Z own tank)? 0 Yes ® No 0 Unknown Did HAZMAT Regulations violation contribute to the crash? r ❑ Yes 0 No 0 Unknown g D Did Carrier Safety Regulations(MCS)violation contribute to the crash? ❑ Yes II No ElUnknown A Was a driver/vehicle Examination Report Form completed? r HAZMAT ❑Yes 0 No ❑Unknown Out of Service ❑Yes ®No 7 MCS ❑Yes 0 No 0 Unknown Out of Service ❑Yes ®No C Z Form Number 0 m Xl IDOT PERMIT NO. 21 1563 WIDELOAD� El Yes ®No = TRAILER VIN 1 1 RN F53A2XN R057349 m co LOCAL USE ONLY TRAILER VIN 2 m v TRAILER WIDTH(S) 0-96" 97-102" >102' m TRAILER 1 IN 0 0 Z TRAILER 2 0 0 0 O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 53 ft. 2 ft. Z Silver White u 1 TOWED TOTAL VEHICLE LENGTH 75 F ft. NO.OF AXLES 2 DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT 3 TOWED BY/TO: Redmons . SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/TO: DUE TO ® VEHICLE CONFIG. 5 CARGO BODY TYPE 4 LOAD TYPE 3