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HomeMy WebLinkAbout2026-00033424 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 01111101111 0110 11111100IV 11111111111 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X004265257` u, 1 U21 2 4 1 u, 2 U2 1 u, 8 u2 1 u, 1 U2 1 1 15 u, 1 u2 1 *P 0119 INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW ' DAMAGE TO ANY El$500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away Elgin Police Department ONE PERSON'S El5501-51.500 ®ON SCENE 1 VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash El AMENDED YR 202612026-00033424 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 r1 ® ❑ RELATED ®Y 0 N 06 11 2026 ®AM ❑YES ®NO U1 HEALY ST Elgin06:37 _ _ g PRIVATE mo /day/yr ❑PM FLOW CONDITION m FT!MI N E S W BARRETT ST COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 2 to ❑ Kane HIT&RUN ❑Y ® N WITH VEHICLESOT, INVLD DO U2 --I lgi AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS O Qgl DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EWES 0 uuv 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 C) FOR DAMAGEDAREA(S) •FROM TOWED U1 0Lechu a.Anaelia 1 0 / yr 13-UNDER CARRIAGE ©,I :: FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 2 m F 2 SY8 ❑Y ElM❑UNK VEH. O AT CRASH O IN ENGAGED15-OTHER 99-UNKNOWN 9 16•TOP 3 *Detraction Value ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s i�a 4 COM VEH 0 Ea 1 0 " �- SOUTH ELGIN IL 60177 0 1 0 FIRST CONTACT 12 T_; __s *II Yes.See Sidebar U1 ZDE92351 IL 2027 E TELEPHONE IL D JM3KFBCM9M0367252 Geico ❑Y ®N U2 1-- B EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m co Elgin Fire 99 9 Same 6232851359 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y El 2 0 x DRIVER ❑ PARKED 0 DRIVERLESS ❑ FED ❑PEDAL 0 EWES ❑row 0 NCV ❑Dv +2 0 0 4 Chevrolet Silverado 2016 00-NONE 1 t2 ! 2 FIRE TO CRASH ® U2 2 C o 13-UNDER CARRIAGE0 M 2 8 SYSTEM IN 0 ENGAGED 0 15-OTHER 9.16-TOP 3 X ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN `(Distraction Value 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s-iI�:, COM VEH ❑ ® U1 W FIRST CONTACT 11 7�_, _5 •(ryes.See SidebarC H ELGIN IL 60120 B 1 0 4187259B IL 2026 I 0 Si) M IL D 1GCVKREC7GZ299824 State Farm ❑Y 123 N RDEF71 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER 1 = Elgin Fire 99 9 Same 3830825-SFP-13 BAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Provena St.Joseph RESPONDER u1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)1(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL) 1 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ®Y U2 Z N 1 ® 11 1 06,11 r2026 06 37 ®❑PM in a Work Zone? ❑N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 5 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ®AM U1 C) Eri 2 0 2 23 06,11 r2026 06 39 PM ❑ • ®Construction >F Z 3 ❑ ❑CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 3 ®AM ❑Maintenance U2 ARREST NAME 06/11 /2026 06 42 ❑PM o U 1 ® 1 1 1 ❑CITATIONS ISSUED ❑PENDING Utilit SLMT o N 30 SECTION CITATION NO. ROAD CLEARANCE TIME AM• Ely t 2 El 8 1 ARREST NAME 06 r 11 r2026 07 30 MPM 0 Unknown work zone type U1 2 2 3 ❑ 1 2 OFFICER ID c SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑AM Workers present? ❑Y 30 1573 Beasley. Maltese 301 331-Ziegler / ❑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 e---•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 truckrtrailer -< ` ` --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 } - } (example:shuttle or charter bus):or C L A ji. 4ti 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I O i } . . transporting employees In the course of their employment(example:employee X I transporter-usually a van type vehicle or passenger car):or -- -- fIM1a1- \ } } } •4. Is used or designated to transport between 9 and 15 passengers,including the driver, y l!!}�ir- for direct compensation(example:large van used for specific purpose):or O __ __ �'V^K2.1 •11l2e2 743.2. Iona _ t i i 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m LAMS)AMS) placarding(example:placards will be displayed on the vehicle). XI 1 —I CARRIER NAME Z I r :- :- :-- --:- ADDRESS '.Z V) C) CITY/STATE/ZIP MOTOR CARR.ID ❑ Interstate ❑ Intrastate I I T I ❑ Not in Comm./GaA. Not in Comm./Other i. --- --• - USDOT NO. ILCC NO. m XI Source of above z . m Did HAZMAT spill from vehicle(do NOT consider FUEL from vehicle's z own tank)? 0 Yes 0 No 0 Unknown T. 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 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 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/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