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HomeMy WebLinkAbout2026-00035774 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets II III HH II11II UHI U l� liii HO DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X00427 955t u, 1 U21 3 4 1 U, 2 U2 1 U, 1 u2 1 U, 1 u2 1 1 11 U1 1 U211 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY ❑5500 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 14 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash 0 AMENDED YR 2026I 2026-00035774 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 16 mBIG TIMBER RD Elgin12:54 ® ❑ RELATED ' V 0 N 06 20 2026 12,— ❑YES El NO U1 -< _ _ g PRIVATE mo !day/yr ®PM FLOW CONDITION MFT!MI N E S W N STATE ST COUNTY PROPERTY ❑Y ® N DOORING Ely #OF MOTOR 0 SLOW 1 (n ❑ Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD 0 STOPPED U2 --I CO AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST IZI N 51 FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uuv 0!CV ❑Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 FOR DAMAGEDAREA(S) FRO Domin uez.Jaime.A. 0 9 ! yr 13-UNDER CARRIAGE ©,I :: FIRE 0 IE < STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 M M 2 4 ❑Y SYSTEM IN ENGAGED 15-OTHER 9 16.TOP 3 _ ❑N ❑UNK VEH. AT CRASH 99-UNKNOWN `Distraction Value ALGN r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s.;i�B 4 COM VEH 0 0 1 00 F. FIRST CONTACT 12 7 ;—, _5 *Irves.See Sidebar U1 V Z Carpentersville IL 60110 0 1 P1197139 IL 2027 REAR TELEPHONE IL A 7 Old Republic ❑ IlN v U2 m 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER RSUR m Ozinga Chicago MWTB31751726 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF IC OWNER STREET,CITY.STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y 0 N 14 0 p; DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NMv 0 N CIRCLE NUMBER(S) U1 v ❑DV !1 9 9 1 Hyundai Tucson 2026 00-NONE 11_"1 Qr O DUE TO CRASH rg ❑ 2 x o 13-UNDER CARRIAGE 10( ) 2 FIRE ❑ ® U2 C F 2 5 SYSTEM IN ENGAGED 15-OTHER 9,16-TOP 3 0 X ❑Y ❑N ❑UNK VEH. AT CRASH 99-UNKNOWN *0istracton Value N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 5 1 S I. COM VEH ❑ ® Ut CO FIRST CONTACT 6 O7 ,�=Q)OS •IfYes.See Sidebar C Z SOUTH ELGIN IL 60177 C 1 0 FY29321 IL 2027 i 0 fp n IL D 5N MJ BCDE8TH675475 Geico ❑Y ®N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Elgin Fire Same 6244318785 BAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP 996 < Refused 0 Y°ND 0 N U1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJI 1(EJCTI (EPTH) PASSENGERS&WITNESS ONLY (NAME),(ADDRESS),(TELEPHONE) (EMS) (HOSPITAL) 3 6 02 / / / 1 0 EV MOST EVNT LOG DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 11 1 06,20 l2026 12 54 ®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 o" 2 ❑ 28 99 , , ❑PM- ElConstruction Z3 ❑ 1!>I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME ❑AM ❑Maintenance U2 5 o ® 11 1 ARREST NAME Dominguez.Jaime.A. 11-601-Ax 1575-10 / ! ❑PM SLMT o N • ❑CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME 0 Utility 45 t 2 ❑ ARREST NAME AM 7 1 r ❑❑PM ❑Unknown work zone type U1 n OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 ❑ 1575-Williamson.Colin 501 331-Ziegler 07 ,07,2026 09 00 ®❑pM Workers present? ®N U2 45 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 l i I J combination):or �----r----, - r / // f// INDICATE NORTH p1 nenmrtaw ` r W a used r designed to transport more than 1 passengers including driver BYARRO 2 Is o de i ed tran o 5 sse rs' udin the C iiii,„1 J - r r (ex mple:shuttle or charter to s):or n < <---- ----; 0 , } } } transporti3. Is ng mployeened to sl5 or fewer In he coursee o their mploynlent example�employeener X ' . transporter-usually a van type vehicle or passenger car):or ryC L L.___a__ } 4. Is used or designated to transport between 9 and 15 passengers,including the driver. C u,ea i N, F } • for direct compensation(example:large van used for specific purpose):or 0 t 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires ill placarding(example:placards will be displayed on the vehicle). m V J CARRIER NAMEr/ ADDRESSDICITY/STATE/ZIP n iJ / - i. 4. MOTOR CARR.ID ❑ Interstate ❑ Intrastate O ❑ Not in Comm./Gout. ❑ Not in Comm./Other O ------- --: USDOT NO. ILCC NO. C m XI Source of above z . If Yes,Name on placard 0 4 digit UN NO. 1 digit Hazard class No. XI 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 M 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 0 0 Z TRAILER 2 ❑ 0 0 O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w White 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: 3 TOWED BY/TO: DUE TO ® Redmons/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE