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HomeMy WebLinkAbout2026-00037598 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 Of 4 Sheets 01111101111 I011011111 1111111111111111 1111 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X054287513 u, 1 u21 1 1 1 u, 4 U2 1 u, 1 u2 1 u, 1 U2 1 4 11 u, 14 U2 1 *P 0119 INVESTIGATING AGENCY DAMAGE TO ANY ❑$500 OR LESS TYPE OF REPORT El A No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW ' Elgin Police Department ONE PERSON'S ❑$501-$1.500 ®ON SCENE 15 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and for Tow Due To Crash 0 AMENDED YR 2026I 2026-00037598 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 I DUNDEE AVE Elgin08:47 ® ❑ RELATED ®Y 0 N 06 27 2026 ❑AM ❑YES ®NO U1 -< _ PRIVATE mo /day/yr ®PM FLOW CONDITION m FT!MI N E S W STEWART AVE COUNTY PROPERTY ❑Y ® N DOORING ICIy #OF MOTOR 0 SLOW 3 Cl) ❑ Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD 0 STOPPED U2 --I CO AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEOAL 0 EWES 0 NIAV 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 00 C) T TOWED U1 Q FOR DAMAGEDAREA(S) FROM Wyskiel. Kenneth 0 5 / yr 13-UNDER CARRIAGE ©i O O FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0U2 OO M M 2 SYTM IN ENGAGETHER 4 ❑Y ®SNE DUNK VEH. O AT CRASH O 99-U15-UNKNOWN O9 16•TOP 3 `Distraction Value 9 ALGN = r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s,_iL 6 �i 4 COM VEH 0 j$J 1 0 ~ ELGIN I N I L 60120 0 1 0 FIRST CONTACT 1 7 ; __5 *Il ves.See Sidebar U1 Z YBB572 IL 2027 REAR TELEPHONE IL D 0 3G7DA03E61 S517530 Country Finacial Inc. ❑v Igl N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 Same P008111736 1 r "o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y ® N 2 0 m t{ DRIVER ❑ PARKED 0 DRIVERLESS ❑ PED 0 PEDAL ❑EWES ❑Nov 0 NCV 0 DV Yr/ 1 9 6 4 Toyota Sienna 2006 00-NONE ,�_' t2 _, DUE TO CRASH ❑ 2 xl 0 13-UNDER CARRIAGE 101 E FIRE ❑ ® U2 C c M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 09 16.70P 3 X ❑Y NJ N ❑UNK VEH. AT CRASH 99-UNKNOWN *Oistraglon Value 9 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF (:),1 6 i!,_4 COM VEH ❑ ® Ut CO H FIRST CONTACT 7 ()I--5 •If Yes.See Sidebar C 60110 0 1 0 FX39741 IL 2027 IO f/) M IL D 0 5TDBA23C06S067176 State Farm ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = 99 9 Same 4046961-SFP-13 BAG $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPONDER ui = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME),(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL) 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 4 61 )71 ,026 08 47 ®AM in a Work Zone? ®N DIRP co 1 t PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 5 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 C) o" 2 ❑ 28 20 1 / ❑PM ❑Construction * Z 3 ❑ lyg CITATIONS ISSUED ❑PENDING SECTION CITATION NO. EMS ARRIVED TIME 5 ❑AM ❑Maintenance U2 a ® 11 4 ARREST NAME Wyskiel. Kenneth 11-601-Ax 1561-000354 / r El PM SLMT o Nu ❑CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ' 0 Utility 0 AM t 2 El ARREST NAME 61 171 ,026 09 20 0 PM ❑Unknown work zone type U1 3O 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 30 1561-Saroyic, Mirko 201 81 , 12 ,26 09 00 ❑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 ----r••--, , ; A CMV is defined as any motor vehicle used to transport passengers or property and: Z 1. as a weight rating more than 10,000 pounds(example:truck or truckrtrailer -< H } Not To Scale I comlNrtatlon)or } r --, I 1 r INDICATE ARROW NORTH C 2 Is used or designed to transport more than 15 passengers including the driver —I I ®' , r rf ` -- - } r r r (example:shuttle or charter bus):or C) 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I O - - } } } transporting employees In the course of their employment(example:employee X -'I transporter-usually a van type vehicle or passenger car):or w I t Y. yi L •-----}----+ 'ri - • } } } 4. Is used or designated to transport between 9 and 15passengers,including the dryer, C I �j-- for direct compensation(example:large van used fors specific purpose):or L i.____a____. X — — _ t i i i 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires •I placarding(example:placards will be displayed on the vehicle). XI I CARRIER NAME Z 1 1 ADDRESS C) 1 I i [ CITY/STATE/ZIP g - i. MOTOR CARR.ID 0 Interstate 0 Intrastate I I T I ❑ Not in Comm./Govt. 0 Not in Comm./Other --- --1 USDOT NO. ILCC NO. m XI Source of above z . IDOT PERMIT NO. WIDELOAD-; ❑Yes 0 No = 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 Blue,Light Blue u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT 2 TOWED BY/TO. _Mies/Impound Lot Garage SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BYlT6 DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE