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HomeMy WebLinkAbout2026-00034253 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets II III H IM UHI U I� III II I 111111UU1l1UU DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X004282031 u, 9 u21 3 4 1 Ut 2 U2 1 U199 1_12 1 U,99 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 1 VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and f or Tow Due To Crash El AMENDED YR 202612026-00034253 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 99 m ROUTE 20 Elgin06:24 ® ❑ RELATED ❑Y ®N 06 14 2026 :km ❑YES ®NO U1 g PRIVATE mo /day/yr ®PM FLOW CONDITION m 15 !MI N E S W Bluff CityBlvd COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 15 u) ® OCook HIT&RUN ®Y ❑ N WITH VEHICLESOT, INVLD ® STOPPED U2 --I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ❑ FREE FLOW # LNS 0 18:DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uuv 0!CV 0 ov DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 3 n ! ! T FOR DAMAGEDAREA(S) FROM�TOWED EN U1 0Unknown.0. Unknown Unknown 00-NONE ©, >2 >,/DUE TOCRASH ❑ NAME(LAST,FIRST,M) mo yr 13-UNDER CARRIAGE 10.I 2 FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 3 <<T1 SYSTEM IN ENGAGED 15-OTHER 9 ,6.TOP 3 9 9 ❑Y ❑N ❑UNK VEH. AT CRASH 99-UNKNOWN `Distraction Value ALGN = r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF & i�S 4 COM VEH ❑ )g! 2 O I— 0 9 FIRST CONTACT 12 7_: __5 *IIYes.See&debar Ut Z UNKNOWN Unknown REAR TELEPHONE . STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED 2 111 Unknown ❑Y ❑N U2 I- 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 Same Unknown 1 rn `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER > Refused ❑Y El 99 0 x DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 r uv 0 N v 0 DV !1 9 9 2 Hyundai Santa Fe 2023 00-NONE .1.,-1 12..-_, DUE TO CRASH rg ❑ 2 73 0 13-UNDER CARRIAGE 10'( 2 FIRE 0 El U2 C c F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9,16-TOP 3 X ❑YNi N DUNK VEH. AT CRASH 99-UNKNOWN `Oistracton Value g g N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF S 1 S --4 COM VEH 0 ® U1 CO FIRST CONTACT 6 O7 ,�=Q)OS ••If Yes.See Sidebar C ELGIN IL 60123 B 1 0 EG31868 IL 2026 AR 0 fp Z IL D 0 5NMS2DAJ3PH647276 AAA ❑Y ®N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X Elgin Fire 99 9 Same AUT702075171 BAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Sherman RESPONDER U1 = (UNIT) (SEAT) (DOS) (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 0 Y U2 Z N 1 ® 11 1 06,14 ,2026 06 24 ®AM 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 C) 2 28 18 06,14 ,2026 06 25 PNl ® • ❑Construction >E Z 3 0 0 CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 7 ❑AM ❑Maintenance U2 —a ARREST NAME 06,14,2026 06 36 ®pM 1 ® 1 1 1 ❑CITATIONS ISSUED ❑PENDING UtilitySLMT , o N SECTION CITATION NO. ROAD CLEARANCE TIME 0 t 2 0 ARREST NAME 06 r 14 ,2026 07 04 ®PM El Unknown work zone type U1 0 AM 45 n 7 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 El1579-Payleitner. Madison 302 334-Fries , , ❑❑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••--, , I ; 0 A CMV is defined as any motor vehicle used to transport passengers or property and: z I 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer -< INDICATE NORTH combination):or —I p1 J BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C i f } (example:shuttle or charter bus):or 0 ; / 3. Is desgned to carry 15 or fewer passengers and operated by a contract carrier I O I- I- -A- -•-I _ ` ` ` V ` } r ' transporting -usually avan type vehicle their passenger car):(orxample:employ 03 ee L }-----}----; _ ` �� - } } } •4. Is used or designated to transport between 9 and 15 passengers,including the driver. w _ 1 1 for direct compensation(example:large van used for specific purpose):or O L___-a..... _ ` _` _ t i. i. _ 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m placarding(example:placards will be displayed on the vehicle). ;p 1� CARRIER NAME Z \ �/ ` - __ ADDRESS 'O D <' 0 CITY/STATE/ZIP g Not To Scale I i. MOTOR CARR.ID 0 Interstate 0 Intrastate 1 I 1 ❑ Not in Comm./Govt. Not in Comm./Other 00 ‘I. - --1 / USDOT NO. ILCC NO. <m XI Source of above z . 0 Yes II No ❑ Unknown A 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 u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT 2 TOWED BY/TO: _ SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DAMAGE EXTENT: 2 TOWED BY/TO: DUE TO ® DISABLING DAMAGE Redmons/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE