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HomeMy WebLinkAbout2026-00034794 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 I0110 111111011 IDOl DO DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV XO04272.23 u, 9 U21 3 4 1 U,16 U2 1 u,99 U2 1 u, 1 U2 1 1 11 u, 1 U211 *P 0119 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 2 VEHICLE/PROPERTY ®OVER$1,500 ®NOT ON SCENE(DESK REPORT) El AMENDED ❑ B Injury and for Tow Due To Crash YR 202612026-00034794 VENT ADDRESS NO. HIGHWAY or STREET NAME ® ❑CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 mRT20 RELATED ❑Y ®N 06 16 2026 03:30 ❑AM YES ®No u1 Elgin PRIVATE mo /day/yr ®PM FLOW CONDITION m 0 !MI N E s Shales Pk COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 15 Cl) © Cook HIT&RUN ®Y ❑ N WITH VEHICLES INVLD ® STOPPED U2 —I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST IZI N ❑ FREE FLOW # LNS 0 Hi DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEOAL ❑EWES ❑uuv ❑!CV ❑ov DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 8 n / / FOR DAMAGEDAREA(S) FROhrr TOWED U1 Q Unknown,O. Mazda CX7 2009 00-NONEit.. !„ 12 , OUE TO CRASH ❑ EN NAME{LAST,FIRST,M) mo yr 13-UNDER CARRIAGE 101 2 FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED U2 8 < 9 9 SYSTEM IN O ENGAGED 0 15-OTHER 9 16.TOP 3 ❑ _ ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN `Distraction Vatuc ALGN r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8_iL 6 4 COM VEH ❑ ZgJ 1 0 1 0 9 FIRST CONTACT 99 7_: _-5 *II Yes.See Sidebar U1 Z EC97168 IL 2027 REAR TELEPHONE . STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED 1 1/ JM3ER29L990218639 Unknown ❑Y ❑N U2 m B EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR co 99 9 Rico,Antonio Unknown 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y ® N 2 .41 �{ DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EWES ❑NMV 0 NCv ❑DV 9 yr 5 Toyota Highlander 2015 00-NONE ,1_"i t2'-_, DUE TO CRASH ❑ 2 0 13-UNDER CARRIAGE 1a 2 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 *Distraction Value 9 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8 iII 6 ..,_4 COM VEH ❑ ® Ut CO FIRST CONTACT 6 Y__{_ -5 •If Yes.See Sidebar — Medinah IL 60157 0 1 BAZ8920 WI 2027 REAR0 Z D IL D 0 STDBKRFH7FS213778 Allstate ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = 99 9 Same 969329587 BAC $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPONDER u1 = KNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJI (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 0 Y U2 Z N 1 ® 11 1 06,16 /2026 04 16 ®PM in a Work Zone? ®N DIRP co 1 t PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 3 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 Eri 2 ❑ 28 99 N 3 ❑ 0 CITATIONS ISSUED 0 PENDING + / ❑PM• ❑Construction SECTION CITATION NO. EMS ARRIVED TIME ❑AM ❑Maintenance U2 3 -a, ARREST NAME / / ID PM ' oN ® 11 1 0 CITATIONS ISSUED 0 PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ❑Utility SLMT r 2 El 45 NAMEAM c- 7 1 / ❑❑PM ❑Unknown work zone type U1 n OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 0 ❑AM Workers present? ❑Y 45 1515 BellEck.Stacy 302 320-Cox , / ❑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 A. I I ADDITIONAL UNITS FORMS. r -- r----, , I : A CMV is defined as any motor vehicle used to transport passengers or property and: Z Not To Scale 1 I I I I ; 1. Has a weight rating more than 10,000 pounds(example:truck or truckrtrailer -< - }---_r__--; I _ } combination):or -< $ INDICATE NORTH p1 E I a? ; BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver _ (example:shuttle or charter bus):or 3. Is designed to carry 15 or fewer passengers and operated �rated a contract carrier I O - --.__A ; — — — ____ — - }} } transporting employees in the course of their employment(example:employee X transporter-usually a van type vehicle or passenger car):or w L L.___a____.l 4. Is used ordesi natedtotrans rtbetween9and15 passengers,including N } } for direct com nation exam I lar a van used for s �cifice ur o ):or the driver, Pe ( P 9 Pe P Pose):or— — 0 L i ? L i i _ 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires 'D placarding(example:placards will be displayed on the vehicle). XI —1 — — CARRIER NAME Z ADDRESS 'n H — D n 1 I CITY/STATE/ZIP d I I I - MOTOR CARR.ID 0 Interstate 0 Intrastate r ; I I ( ❑ Not in Comm./Govt. 0 Not in Comm./Other ri i. .:. .:. : USDOT NO. ILCC NO. m I XI Source of above 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 VIM 1 m co LOCAL USE ONLY TRAILER VIN 2 m v TRAILER WIDTH(S) 0-96" 97-102" >102' T TRAILER 1 ❑ ❑ 0 Z TRAILER 2 ❑ 0 ❑ O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. Z Black Silver u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT: 9 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