HomeMy WebLinkAbout2026-00037793 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets II III H IIII mil U I
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DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X004237498
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INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW '
DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away
Elgin Police Department ONE PERSON'S El5501-51,500 ®ON SCENE 14
VEHICLE/PROPERTY ®OVER 61,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash
0 AMENDED YR 202612026-00037793 VERY
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 rn
BELLEVUE AVE Elgin 04:35
® ❑ RELATED ®Y 0 N 06 28 2026 ❑AM ❑YES N NO U1 -<
g PRIVATE mo !day!yr ®PM FLOW CONDITION III
FTlMI N E S W CONGDON AVE COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 1 (n
❑ Kane HIT&RUN ❑Y N N WITH VEHICLES INVLD ❑ STOPPED U2 -I
® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0
Qg3 DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL 0 EDUCE ❑uuv ❑!Cy ❑Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 00 n
f�rr FRO _ TOWED U1 Q
NAME(LAST,FIRST,M) Banh.Jonathon mo yr Nissan Altima 2020 00-NONE 11_• 12 71 OUETOCRASH ® ❑
13-UNDERCARRIAGE ! �/ FIRE 0 N
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 10 O DISTRACTED 0 0U2 00
M
M 2 8 ❑Y NSNEM❑UNK VEH. O AT CRASH IN ENGAGEO 99-UUNKNOWN 9 76-TOP) ,Distraction Value 9 ALGN =
T. CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6, it 6 it®COM VEH ❑ E! 1 C)
F. FIRST CONTACT 2 7_:T-t-OS •Ir Yes.See Sidebar U1 0
Z ELGIN IL 60124 0 1 0 CQ93519 IL 2026 REAR
TELEPHONE
IL D 0 1 N4BL4EV1 LC134729 National General ❑Y ISI N U2 m
in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
Elgin Fire 99 9 BANH.TOAI. M. 2020533152 1 r
`o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER
RESPONDER
2 XI
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N DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EWES ❑!My 0 NCv ❑DV
yr Chevrolet Cruze 2014 Do-NONE O1 Oj'0 DUE TO CRASH rg ❑ 2 x
o 13-UNDER CARRIAGE 10,i I.. 2 FIRE ❑ N U2 C
c
M 2 8 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16.TOP 3 X
❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN `Distraction Value 9 0
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6_. 6 i!,_4 COM VEH ❑ N u1 W
FIRST CONTACT 2 Y��_, _6 •)ryes.See Sidebar C
ELGIN IL 60120 C 1 0 FM11094 IL 2026 I Si)0
Z
IL D 0 1 G 1 PC5SB2E7225819 American Freedom Inc. ❑Y ®N RDEF Xl
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 =
Elgin Fire 99 9 Same 12-2501089-01 BAC E
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 <
Refused RESPONDER U1 =
(UNIT) (SEAT) (DM (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 Stop sign on Bellevue Ave 6/ ,8/ /026 04 35 ®AM in a Work Zone? NCI 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 ❑ 150 DEXTER CT ELGIN IL 60120 2 28 6/ ,8/ /026 04 36 PM
1
® , ❑Construction >F
c 3 ❑ El CITATIONS ISSUED ❑PENDING SECTION CITATION NO. EMS ARRIVED TIME 3
❑AM ❑Maintenance U2
o1 ® 11 4 ARREST NAME Banh.Jonathon 11-901 1561-000355 6/ /8/ /026 ❑PM SLMT
o N ❑CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ' ❑0 AM Utility
t 2 ❑ ARREST NAME 6/ /8/ /026 04 40 ®PM ❑Unknown work zone type U1 25
2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? D Y 25
1561-Sarovic, Mirko 102 8/ / /2 /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 truck trailer -I I Not To Scale I
} }---_------; combination):or
INDICATE NORTH Hp1
1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driverI L C
t- (example:shuttle or charter bus):or OC
r r X
3. Is designed to carry15 or fewer passengers and operated a contract carrier O
T - } } } transporting employee In the course of their employment(example:employee73
transporter-usually a van type vehicle or passenger car):or w
L -----------; � - I. } 1. 4. Is used or designated to transport between 9 and 15 passenge including the driver, N
•CD for direct compensation(example:large van used fors specific purpose):or o
L L____a____. _ _ i i t 5. Is anyvehicle used to transport anyhazardous material(HAZMAT)that requires:, m
c f+i-,�,,- ill placarding(example:placards will be displayed on the vehicle). XI
CARRIER NAME Z
ADDRESS
D
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CITY/STATE/ZIP
0
MOTOR CARR.ID 0 Interstate ElIntrastate
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
Black White
u 1 TOWED •
TOTAL VEHICLE LENGTH ft. NO.OF AXLES_
DUE TO '' DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT 3 TOWED BY/TO.
Arties/Impound Lot Garage . SELECT CODES FROM THE BACK OF CRASH BOOKLET
U 2 TOWED DISABLING DAMAGE NOT DAMAGE EXTENT: 3 TOWED BY/TO:
DUE TO ® DISABLING DAMAGE Arties/Impound.Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE