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HomeMy WebLinkAbout2026-00035856 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets II 111 I M 11111111 II I I I III I III II OHIUII DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X004260665 u, 1 U21 3 4 1 U1 3 U2 1 U, 1 1_12 1 U, 1 U2 1 1 10 u1 1 U2 3 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT El 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$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash El AMENDED YR 2026I 2026-00035856 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 rl ® ❑ RELATED ®Y 0 N 06 20 2026 ❑AM ❑YES ®NO U1 '‹ NATIONAL ST Elgin 07:15 _ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION m FT!MI N E S W RAYMOND ST COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 2 fA ❑ Kane HIT&RUN ❑V ® N WITH VEHICLESOT, INVLD ❑ STOPPED U2 -I CO AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 Qg3 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EDUCE 0 uuv 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 C) 0 9 / yr 13-UNDER CARRIAGE ©1 OIL FIRE 0 lE STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL O4-TOTAL(ALL) O O DISTRACTED 0 0 U2 0 m M 2 SYTM IN ENGAGETHER 8 ❑Y ®SNE❑UNK VEH. 0 AT CRASH 0 99-U15- NKNOWN °CI.TOPO `Distraction Value 9 ALGN = T CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF D i a �I COM VEH 0 j$J 1 n ELGIN I L 60120 0 1 0 FIRST CONTACT 11 O7 : __5 *If Yes.See Sidebar U1 0 ZEV21029 IL 2025 REAR TELEPHONE IL D 0 WBAVA33537KX70328 None ❑Y ❑N U2 m B EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m co Elgin Fire 99 9 Same None 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Provena St.Joseph ❑Y El 2 0 E{ DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uv 0 N v 0 DV 1 9 yr 9 Ford F250 2017 00-NONE OI t2 c, z FIRED CRASH 0 ® U2 2 C o 13-UNDER CARRIAGE M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 916-TOP 3 X ❑Y i N ❑UNK VEH. AT CRASH 99-UNKNOWN *Distraction Value 9 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s-iI�1:, 4 COM VEH ❑ ® U1 CO FIRST CONTACT 11 7�_, _5 •IfYes.See Sidebar H ELGIN IL 60123 0 1 0 189659C IL 2026 I 0 C M IL A 7 1 FD7X2A62H EB15332 Progressive ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = 99 9 Same 963659726 BAc $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPONDER u1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)/(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 4 City of Elgin,City Pole SJW corner. 06,20 /2026 07 19 ®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) ;, 2 ❑ 34 3 380 COPPER SPRINGS LN ELGIN IL 60124 25 28 06,20 ,2026 07 16 ®PM , 0 Construction >F R 3 ❑ CITATIONS ISSUED ❑PENDING SECTION CITATION NO. EMS ARRIVED TIME 1 z J ❑AM ❑Maintenance U2 -a, ARREST NAME Yanez,Gary 11-601 1579000003 06/20/2026 07 17 ®PM SLMT o U 1 ® 1 1 4 CITATIONS ISSUED 0 PENDING Utility o N SECTION CITATION NO. ROAD CLEARANCE TIME AM' t 2 0 ARREST NAME Yanez,Gary 11-306 1579000002 06/20 /2026 08 38 ®PM 0 Unknown work zone type U1 30 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 30 1 579-Payleitner. Madison 401 07 , 14,2026 01 30 El NI ®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 truckrtrailer -< i- i•--__r-_--; - combination):or I /sa\ INDICATE NORTH p3 ( N BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C i_ I \✓ _ } (example:shuttle or charter bus):or AK7T 7O�'r'EJ 3. Is designed to carry15 or fewer passengers and operated a contract carrier O I. } . transportingemployees in thecoursee of their employment I - n pbym�ent(example:employee � � 'lJ transporter-usually a van type vehicle or passenger car):or w r C -- -- } } 1 •4. Is used or designated to transport between 9 and 15 passengers,including the driver. N ^ for direct compensation(example:large van used for specific purpose):orsfl- O — — — -— L L____a....� i� t l I I 5. Is any vehicle used to transport anyhazardous material(HAZMAT)that requires m l placarding(example:placards will be displayed on the vehicle). unn 11. D } L ✓ CARRIER NAME Z H - i. i. ADDRESS D I monio ent.J (ft I r n CITY/STATE/ZIPg MOTOR CARR.ID 0 Interstate 0 Intrastate I . ❑ Not in Comm./Govt. 0 Not in Comm./Other ‘I. - --1 - USDOT NO. ILCC NO. m XI Source of above z . 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 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 White White u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ti DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT 3 TOWED BY/TO. _Redmons/Impound Lot Garage . SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY/TO: DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE