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HomeMy WebLinkAbout2026-00033212 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 0110 1111110010111000010000 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X 0426a225 u, 1 U21 2 4 1 U, 2 U2 1 U, 1 1_12 1 U, 1 U2 1 1 10 U1 3 U2 1 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT 0 A No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 2 VEHICLE/PROPERTY ®OVER 51,500 El NOT ON SCENE(DESK REPORT) (83B Injury and/or Tow Due To Crash 0 AMENDED YR 202612026-00033212 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 �I ® ❑ RELATED ❑Y ®N 06 10 2026 ®AM ❑YES ®NO U1 -< S STATE ST Elgin08:45 _ _ g PRIVATE mo /day/yr ❑PM FLOW CONDITION m FT!MI N E S W LORD ST COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR 0 SLOW 15 0) ❑ Kane HIT ❑V ® N WITH VEHICLES INVLD ❑ STOPPED U2 --I CO AT RUN AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EWES ❑NIAV ❑!CV ❑Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 n FOR DAMAGEDAREA(S) FROM TOWED U1 Q Klaras.Vick C. 1 1 / yr 13-UNDER CARRIAGE ©i !-O FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 2 DISTRACTED 0 0 U2 4 <<Tl F 2 SYTM 8 ❑Y ®SNE DUNK VEH. 0 AT CRASH 99-UUNKNOWN THER O9 16•TOP 3 `Distraction Value 9 ALGN 2 T. CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s 1 B �i COM VEH 0 0 1 0 ELGIN IL 60123 B 1 0 FIRST CONTACT 11 7 ; __5 *IfYes.SeeSidebar U1 Z DL52843 IL 2026 E TELEPHONE IL D 0 3G NAXU EV9N L288002 Nationwide ❑Y ®N U2 m 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Elgin Fire 99 9 Same 9112J016008 1 r o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y El 2 0 N DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EWES ❑MAV 0 KOV ❑Dv CIRCLE NUMBER(S) U1 !1 9 9 7 Chevrolet Trax 2017 00-NONE 0, 0 O DUE TO CRASH rg ❑ 2 x 13-UNDER CARRIAGE I FIRE ❑ ® U2 F 2 8 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 1,6-TOP 3 X ❑Y lYi N ❑UNK VEH. AT CRASH 99-UNKNOWN *Oi$tracton Value 9 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s-iI 6 i�:- 4 COM VEH ❑ ® U1 CO FIRST CONTACT 12 Y , .5 •(ryes,See Sidebar H ELGIN IL 60123 B 1 0 EQ86451 IL 2027 I 0 C IL D 0 3G NCJ LSB5H L287738 Progressive ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X Elgin Fire 99 9 Same 995306068 BAG $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPONDER u1 = (UNIT) (SEAT) (DOB1 (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)!(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL) UI 2 m / / 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 1 06,10 /2026 08 45 ®❑pM in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 7 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ®AM U1 v 2 ❑ 2 06 06,10 ,2026 08 45 ❑PM ❑Construction * cw O 0 gi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 1 3 ®AM ❑Maintenance U2 aEl 11 1 ARREST NAME Klaras.Vicky.C. 11-801-B 1570000119 06/10/2026 08 51 ❑PM SLMT o N 0 CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ❑Utility AM U1 30 t 2 ❑ ARREST NAME 06/10 /2026 09 17 0 PM ❑Unknown work zone type 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 30 1570-Tomlin. Eli 700 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 ADDITIONAL UNITS FORMS. r ----r••--, , ; A CMV is defined as any motor vehicle used to transport passengers or property and: Z •;. --I-- —1 I [p it _ combination):. Haseiht rating more than 10,000 pounds(example:truck or truck/trailer -< r Not To Scale INDICATE NORTH p3 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C t- (example:shuttle or charter bus):or 0 r r X i i 3. Is designed to carry15 or fewer passengers and operated a contract carrier O I. } } } transporting employee In the course of their employment(example:employee X transporter-usually a van type vehicle or passenger car):or w L --------- } 4. Is used or desi nated to trans rt between 9 and 15 ssen rs,including the driver. C } } for direct compensation(example:large van used for specific purpose):or 0 3 IL n i. < i. y 5. Is any vehicle used to transport an hazardous material(HAZMAT)that requires m placarding(example:placards will be displayed on the vehicle). XI I~i I CARRIER NAME Z t 1] i ADDRESS 0D C) O CITY/STATE/ZIP < MOTOR CARR.ID 0 Interstate 0 Intrastate I I T I ❑ Not in Comm./Govt. 0 Not in Comm./Other ;_----- --1 USDOT NO. ILCC NO. m XI Source of above z . -I Were HAZMAT placards on vehicle? 0 Yes 0 No = 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 0 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? 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 to 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 White Black u 1 TOWED • TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT- 3 TOWED BY/TO: Arties 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 VEHICLE CONFIG._CARGO BODY TYPE LOAD TYPE