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HomeMy WebLinkAbout2026-00031858 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 Df 2 Sheets II III HH II11II UHI UU I� III fl11 I1VV1 III 1VV1UU DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY XO04259357 u, 1 u21 3 4 1 u, U299 u, 1 U2 1 u1 99 U2 99 5 11 u, 1 u2 1 *P0119* INVESTIGATING AGENCY DAMAGE TO ANY ❑$500 OR LESS TYPE OF REPORT ® q No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW ' Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 14 VEHICLE/PROPERTY ®OVER 51,500 ❑NOT ON SCENE(DESK REPORT) El AMENDED ElB Injury and for Tow Due To Crash YR 2026I 2026-000 31 8 58 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 r1 ® ❑ RELATED ®Y 0 N 06 03 2026 ❑AM YES ®NO U1 -< E HIGHLAND AVE Elgin 08:26 _ _ g PRIVATE mo !day!yr ®PM FLOW CONDITION m FTlMI N E S W DOUGLASAVE COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 1 (n ❑ Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD DO U2 —I El AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL ❑EWES ❑uuv ❑!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 0 FOR DAMAGEDAREA(S) FROPtf TOWED U1 Q Moore. Reginald. L. 1 1 / yr 13-UNDER CARRIAGE ©,I O'._Z FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ® 0 U2 0 m M 2 SY4 ❑Y ®SNE DUNK VEH. O AT CRASH M IN D 0 99-UNKNOWN 9 16•TOP 3 *Distraction Value 9 ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s i�S �i 4 COM VEH 0 Ea 1 0 SOUTH ELGIN IL 60177 0 1 0 FIRST CONTACT 11 7_: __5 *Ilves.SeeSidebar U1 ZBY18946 IL 2026 E TELEPHONE IL D 0 1 V2RR2CA2MC507840 Progressive ❑Y Igl N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Same 874506172 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y El 2 0 m x DRIVER ❑ PARKED 0 DRIVERLESS 0 FED 0 PEDAL 0 EWES 0 NW 0 NCv 0 DV 2 0 0 7 Honda Accord 2018 00-NONE ,�"j 12 -_, DUE TO CRASH ❑ 2 0 13-UNDER CARRIAGE to l E FIRE ❑ ® U2 C c F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16.TOP 3 X ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN O *0istraction value 9 4 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8 iII S 4 COM VEH D ® U1 W FIRST CONTACT 5 Y (j= 05 •((Yes,See Sidebar C 0 1 0 7147096 IL 2026 aR 4 CI) IL D 0 1 HGCV2F99JA052000 Geico ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Gipson.Jeffrey. M. 6022769811 SAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP U1 = KNIT) (SEAT) (DOB) (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 0 Y U2 Z N 1 ® 11 4 06,03 ,2026 08 26 ®AM in a Work Zone? ®N DIRP co 1 F PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 1 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 C) 5 2 ❑ 03 28 , ) 0 PM ❑Construction * Z 3 0 lyg CITATIONS ISSUED ❑PENDING SECTION CITATION NO. EMS ARRIVED TIME 1 ❑AM ❑Maintenance U2 o ® 11 4 ARREST NAME Moore. Reginald. L. 11-601-Ax 1525001029 / ! El PM SLMT o N 0 CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • El Utility 0 AM F 2 El ARREST NAME 06/03 12026 09 02 ®PM El Unknown work zone type U1 25 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 20 1525-NavE.Oscar 101 337-Thompson 06 ,23,2026 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 ADDITIONAL UNITS FORMS. r -- r••--, , I 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 -< Not To Scale I combination):or ` ' ' I -.- r INDICATE NORTH C E BY ARROW 2 Is used or designed to transport more than 15 i_ g I _ i. e. (example:shuttle or charter bus):or passengers including the driver L A g 3. Is desgned to carry 15 or fewer passengers and operated by a contract career 1 O a I co. - . transporting employees in the course of their employment(example:employee X transporter-usually a van type vehicle or passenger car):or L L.___a C/ `� - I. } 1} 4. Is used or designated to transport between 9 and 15 passengers,including the driver, y for direct compensation(example:large van used for specific purpose):or O L i...__a-___.: _ _ _ _ _ _ _ - t i I 5. Is any vehicle used to transport anyhazardous material(HAZMAT)thatrequires M Unit2 placarding(example:placards will be displayed on the vehicle). XI 1' CARRIER NAME Z ADDRESS 0T.0 lUnit 1 CITY/STATE/ZIP g - i. i. i. i. 4. MOTOR CARR.ID 0 Interstate El Intrastate I I .4-- I ❑ Not in Comm./Govt. Not in Comm./Other "---- '-1 - USDOT NO. ILCC NO. m XI Source of above z . own tank)? 0 Yes 0 No 0 Unknown Did HAZMAT Regulations violation contribute to the crash? r ❑ Yes ❑ 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. WIDELOAD'; ❑Yes 0 No 2 TRAILER VIN 1 m co LOCAL USE ONLY TRAILER VIN 2 m v TRAILER WIDTH(S) 0-96" 97-102" >102' m TRAILER 1 ❑ ❑ 0 Z TRAILER 2 ❑ 0 ❑ O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w Red Black u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT 1 TOWED BY/TO: _ . SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY/T6 DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE