HomeMy WebLinkAbout2026-00032258 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets III III 11 IIII
UHI 11 Il III II111111111111111
DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X004259297.
u, 1 U21 13 4 1 u, 8 U2 1 u, 1 1_12 1 u, 1 U2 1 1 15 U1 13 U2 1 *P 0119
INVESTIGATING AGENCY DAMAGE TO ANY El$500 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 3
VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash
El AMENDED YR 202612026-00032258 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n
® ❑ RELATED PRIVATE ®Y 0 N 06 05 2026 DAM ❑YES ®NO U1
RT20 EB 1 LARKIN AVE Elgin mo /day/yr 04:13 ®PM FLOW CONDITION M
00 ®!MI N 0 S W rt20jlarkln ave COUNTY PROPERTY ❑Y ® N DOORING Ely #OF MOTOR ElSLOW 15 u)
Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD ❑ STOPPED U2 --I
❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N 51 FREE FLOW # LNS 0
18:DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EDUCE 0 NIA/ 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 1 0FOR DAMAGEDAREA(S) FROPtf TOWED U1 0NAME(LAST,FIRST,M) y mo
/1 9 4 8 Ford Focus 2018 00-NONE „ 12 , DUE TO CRASH ® ❑
13-UNDER CARRIAGE 101 ! 2 FIRE 0NI
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 3 M
M 2 4 SY❑Y ElM DUNK VEH. O AT CRASHD15-OTHER
O 99-UNKNOWN 9 76•TOP 3 ,Distraction Value 9 ALGN x
T CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF it 6 Ii,4 COM VEH 0 jg! 1 0
~ ELGIN I N I L 60123 0 1 0 FIRST CONTACT 7 t _; __5 •II Yes.see Sidebar U1 0
ZBF81825 IL 2027 REAR
TELEPHONE
IL D 0 1 FADP3K23JL221482 AARP ❑Y ®N U2 I''I
in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
99 9 Same 55PHT242932 1 r
`o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER
RESPONDER D
Refused ❑Y El 2 c
m x DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL 0 EWES 0 Nuv 0 i v 0 Dv
1 9$6 Mitsubishi Outlander 2022 00-NONE ,�_' 12 JD DUE TO CRASH rg ❑ 2 x
o _ 13-UNDER CARRIAGE I FIRE ❑ ® U2
F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9I 1,6.TOP 3 X
❑Y ®N DUNK VEH. AT CRASH 99-UNKNOWN `0istracuon Value 9 0
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s-iI 6 I_i, COM VEH ❑ ® U1 CO
FIRST CONTACT 1 Y _,__5 •)ryes.See Sidebar
Im
= ELGINREAR C n IL 60123 0 1 0 EY82303 IL 2026
IL D 0 JA4J3UA84NZ090483 State Farm ❑Y ®N RDEF
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X
99 9 Same 3404215-SFP-13 BAC
$
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 <
Refused RESPONDER
u1 =
(UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)((A.DDRESS)((TELEPHONE) (EMS) (HOSPITAL)
2 3 05 / M 2 4 0 1 0
m
/ / #OCCS >
/ / U1 1 D
/ / 2 0
EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z
N 1 ® 11 1 06 105 /2026 04 13 ®PM in a Work Zone? ®N DIRP co
1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 2
T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 ,,
o"
2 ❑ 28 20 1 1 ❑PM ❑Construction >F
Z 3 ❑ xi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 4
❑AM ❑Maintenance U2
o ® 11 1 ARREST NAME Bohyer. David.G. 11-601 S1542-000896 / / ID PM SLMT
I$[CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME AM• El Utility
o t 2 ❑ ARREST NAME Bohyer. David.G. 11-709-D S1542-000897 06105 ,2026 05 08 ®PM El Unknown work zone type U1 55
2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 55
1542-Chase. Ethan 702 07 ,21 ,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••--, , ; 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 .Z-1
BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C
i_ V - } (example:shuttle or charter bus):or 0
\\\\\ 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I O
I- <.__-A-.-.J } } } transport) em to ees in the course of their em
\ \ - ng p y pbyment(example:employee X
1 1cale] transporter-usually a van type vehicle or passenger car):orL -----}----; \111 } 1 4. Is used or designated to transport between 9 and 15 passengers,including the driver. N1 } for direct compensation(example:large van used for specific purpose):or O
. �__ �L--_-a-...- tt - 5. Is any vehicle used to transport an hazardous material(HAZMAT)that requires mY rn// placartling(example:placards will be displayed on the vehicle).41 CARRIER NAME Z+ ~ ADDRESS Zitz C)
CITY/STATE/ZIP 0
MOTOR CARR.ID 0 Interstate 0 Intrastate
0
I . ❑ Not in Comm./Govt. 0 Not in Comm./Other
‘I. - --1 - USDOT NO. ILCC NO. m
XI
Source of above z
. MCS ❑Yes 0 No 0 Unknown Out of Service ❑Yes ❑No 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
Silver White
u 1 TOWED •
TOTAL VEHICLE LENGTH ft. NO.OF AXLES_
DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT 3 TOWED BY/TO.
Arties/Impound Lot Garage . 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