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HomeMy WebLinkAbout2026-00030630 ILLINOIS TRAFFIC CRASH REPORT sheet 1 of 2 Sheets 01111101111 I0110 11111 fl 1111 0 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X4255460* u, 9 U21 1 1 1 U1 2 U2 1 u,99 1_12 1 u,99 U2 1 5 10 u, 4 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 2 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and for Tow Due To Crash 0 AMENDED YR 202612026-00030630 VENT ADDRESS NO. HIGHWAY or STREET NAME El ❑CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 99 m RT20 RELATED ®Y 0 N 05 28 2026 09:36 ❑AM ❑YES El NO U1 -< Elgin PRIVATE mo /day/yr ®PM FLOW CONDITION Ill FT N E S W LONGCOMMON PKWY COUNTY PROPERTY El ® N DOORING ❑y #OF MOTOR 0 SLOW 17 (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 Q83 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 2 C) FOR DAMAGEDAREA(S) FRObir TOWED U1 O NAME(LAST,FIRST,M) Unknown. Unknown.0. mo yr Unknown Unknown 00-NONE OUETOCRASH ❑11 12 - EN 13-UNDER CARRIAGE 10 2 FIRE 0 IE •STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 2 rn 9 9 Y ID N El VEH.SYSTEM IN ❑ ENGAGED AT CRASH 15-OTHER 99-UNKNOWN 9t6.70P03 _ ALGN r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF $ it 6 jl w Distraction Value COM VEH 0 0 1 n I� 0 9 0 FIRST CONTACT 4 7_;1L O_;_ *I(Yes.See Sidebar U1 0 c REAR Z E TELEPHONE . STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED 1 11/ Unknown ❑Y ❑N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Same Unknown 1 rn `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER r D Y°®N 0 m N DRIVER 0 PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 ivy 0 KCv 0 DV yr O2,. 0 13-UNDER CARRIAGE i FIRE ❑ ® U2 c M 17 4 SYSTEM IN 0 ENGAGED 0 15-OTHER TOPO3 X ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN Distraction value 9 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR PFIRST CONTACT 1NT OF 4 0 I'O_'O COM •Iy gee SidebarH ❑ ® U1 CO ZJoliet IL 60431 0 1 0 MCYGE971 IL 2026 Karr0 C IL Other JYARN10E63A008544 NIA ❑Y ❑N RDEF71 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Elgin Fire Same NIA BAG $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP 996 < Provena St.Joseph RESPONDER u1 = (UNIT) (SEAT) (DOS) (SEX) (SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)!(ADDRESS),(TELEPHONE) (EMS) (HOSPITAL) 2 8 04 / 2 O EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 11 1 05,28 ,2026 09 36 ®AM in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 1 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 2 2 06 05,28 ,2026 09 36 PM ® • ❑Construction >E Z 3 0 0 CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 3 ❑AM 0 Maintenance U2 - u a ARREST NAME 05,28,2026 09 40 ®pM ' , 1 ® 11 1 ElUtility 0 CITATIONS ISSUED ❑PENDING SLMT oSECTION CITATION NO. ROAD CLEARANCE TIME 0 AM r 2 ❑ ARREST NAME 05/28 ,2026 11 00 0 PM El Unknown work zone type , U1 50 T OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 El AM Workers present? D Y 50 1554-Wagener.Vincent 801 - , , ❑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 -< ` ` -' -' © r INDICATE NORTH combination):or .Z-1 _.ryxty.t_ BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C wrtm } (example:shuttle or charter bus):or X 3. Is desgned to} A i carry15 or fewer passengers and operated I a contract carrier O . - - -- } } } transporting employee � �In the course of their employment(example:employee X 0 :T. transporter-usually a van type vehicle or passenger car):or w C i_ .:. .J.,.. ..; - I. } } } •4. Is used or designated to transport between 9 and 15 passengers,including the driver. (I), for direct compensation(example:large van used for specific purpose):or�� O i i 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires 1 placarding(example:placards will be displayed on the vehicle). m 0 CARRIER NAME Z unuammo +M% _ ADDRESST. O C) CITY/STATE/ZIP g MOTOR CARR.ID 0 Interstate 0 Intrastate 0 1 1 r 1 ❑ Not in Comm./Govt. 0 Not in Comm./Other ; _Y_ _-1 - USDOT NO. ILCC NO. m XI Source of above z . If Yes,Name on placard 0 4 digit UN NO. 1 digit Hazard class No. XI Did HAZMAT spill from vehicle(do NOT consider FUEL from vehicle's z own tank)? 0 Yes 0 No 0 Unknown Did HAZMAT Regulations violation contribute to the crash? r ❑ Yes ❑ No 0 Unknown M D Did Carrier Safety Regulations MCS)violation contribute to the crash? A ❑ 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 0 0 Z TRAILER 2 ❑ 0 0 O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w Blue 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 DISABLING DAMAGE DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® Redmons/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE