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HomeMy WebLinkAbout2026-00030853 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 01111101111 I0110 II III )III IIII IIIIIIIIIIII DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X 4251229 u, 9 U21 1 1 1 u, 8 U2 1 U1 99 1_12 1 u,99 U2 1 4 12 u, 13 U2 1 *P 0119 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 ❑$501-$1.500 ®ON SCENE 3 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash 0 AMENDED YR 202612026-00030853 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 99 m® ❑ RELATED PRIVATE ❑Y ®N 05 30 2026 ®AM El YES ®NO U1 —< RT20 EB Elgin mo /day/yr 00:25 ❑PM FLOW CONDITION M 010�/MI N E S ® Grace St/Rt 20 EB COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR 0 SLOW 1 (n Kane HIT&RUN ®Y ❑ N WITH VEHICLES INVLD 0 STOPPED U2 --I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 g DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uuv 0!CV 0 ov DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 n FOR DAMAGEDAREA(S) FROPtf TOWED U1 O Unknown.0. / / Unknown Unknown 00-NONE ©, 12 , DUE TOCRASH ❑ EN NAME{LAST,FIRST,M) mo yr 13-UNDER CARRIAGE / ! FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) OO. 2 U2 4 < 9 9 SYSTEM IN 9 ENGAGED 9 15-OTHER 9 16-TOP 3 DISTRACTED 0 ]$j = ❑Y ❑N ®UNK VEH. AT CRASH 99-UNKNOWN `Distraction Value 9 ALGN 6 4 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF ,Ii_6 Ii,_ 1 I• 0 9 FIRST CONTACT 11 7_: COM VEH 0 j$J_5 *II Yes.See Sidebar U1 0 REAR 2 Z ' E TELEPHONE . STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED 1 11/ Unknown ❑Y ❑N U2 m B EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m co Same Unknown 1 rn `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER r D Y°N0 N 0 m g DRIVER 0 PARKED ❑DRIVERLESS ❑ PED 0 PEDAL 0 EWES 0 iiuv 0 Yr /2 0 0 8 Pontiac Grand Prix 2008 00-NONE 11_ Oj O DUE TO CRASH ❑ 2 0 13-UNDER CARRIAGE f. FIRE ❑ ® U2 C c M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 0916•TOP 3 X ❑Y 10 N ❑UNK VEH. AT CRASH 99-UNKNOWN *0istraellon Value 9 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6 i 6 I,_4 COM VEH ❑ ® U1 CO FIRST CONTACT 1 7 _, _5 •)ryes.See Sidebar C ELGIN IL 60120 0 1 FL72983 IL 2026 REAR Si)0 IL D 2G2WP552381192533 United Equitable ❑Y ®N RDEF71 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Diana.Sanchez IL0009297 BAc $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP u1 = (UNIT) (SEAT) (008i (SEX) {SAFT) (AIR) (INJ) 1(EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)((ADDRESS)((TELEPHONE) (EMS) (HOSPITAL) 2 3 11 / . DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 CO 11 9 05,30 /2026 00 25 ®❑pM 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 2 0 20 28 N 3 ❑ ❑CITATIONS ISSUED 0 PENDING + / ❑pM, ❑Construction >F SECTION CITATION NO. EMS ARRIVED TIME 3 ❑AM 0 Maintenance U2 —a, ARREST NAME / / El PM ' I ® 1 1 1 ❑CITATIONS ISSUED PENDING UtilitySLMT N SECTION CITATION NO. ROAD CLEARANCE TIME o El AM U, 50 r 2 0 ARREST NAME 05/30 /2026 01 25 0 PM ❑Unknown work zone type n T OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 1534-Santiago.Jorge 401 - / / 0 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 ADDITIONAL UNITS FORMS. r ----r•---, , - ; A CMV is defined as any motor vehicle used to transport passengers or property and: Z 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer -< c ` --I- ' r INDICATE NORTH combination):or -I BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C esseme - (example:shuttle or charter bus):or T, 3. Is designed tocarry 15 or fewer passengers and operated a contract carrier O ` + tletin pa 9 pe by , - } } } transporting employees in the course of their employmentge (example:employee transporter-usually a van type vehicle or passenger car):or w - ...I. °"' um„`i WI } } } •4. Is used or designated to transport between 9 and 1passengers,including[hedriver, C _ for direct compensation(example:large van used fors cific purose):or cm =.ka. ...wrw t i i i. t 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m ——— placarding(example:placards will be displayed on the vehicle). ;p - CARRIER NAME Z ADDRESS 0 0 CITY/STATE/ZIP MOTOR CARR.ID 0 Interstate 0 Intrastate 1 I r 1 ❑ Not in Comm./Govt. 0 Not in Comm./Other ‘I. - --1 - USDOT NO. ILCC NO. m XI Source of above z . ❑ Yes 0 No 0 Unknown g D Did Carrier Safety Regulations MCS)violation contribute to the crash? A 0 Yes II El Unknown C 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. WIDELOAD'; ❑Yes 0 No 2 TRAILER VIN 1 m co LOCAL USE ONLY TRAILER VIN 2 m 0 TRAILER WIDTH(S) 0-96" 97-102" >102' -n TRAILER 1 ❑ ❑ 0 Z TRAILER 2 ❑ 0 0 o u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w Black Blue.Dark u 1 TOWED • TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT' 2 TOWED BY/TO. SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® DISABLING DAMAGE Arties/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE