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HomeMy WebLinkAbout2026-00037266 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 10110 ll III 1111111111� 11111011 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X004287398 u, 1 U21 1 1 2 U1 7 U2 1 U, 1 U2 1 U, 1 U2 1 1 6 U1 1 U2 1 *P 0 1 1 9* INVESTIGATING AGENCY DAMAGE TO ANY ❑5500 OR LESS TYPE OF REPORT 0 A No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW Elgin Police Department ONE PERSON'S ❑5501-$1.500 ®ON SCENE 3 VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) (83B Injury and for Tow Due To Crash 0 AMENDED YR 202612026-00037266 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n ® ❑ RELATED PRIVATE ❑Y ®N 06 26 2026 ❑AM ❑YES E)NO U1 -< N RANDALL RD Elgin mo /day/yr 01:55 ®PM FLOW CONDITION m _ 01 On I MI N E O W Fletcher Dr COUNTY PROPERTY ❑Y ® N DOORING Ely #OF MOTOR 0 SLOW 15 Cn Kane HIT&RUN ❑V ® N WITH VEHICLES INVLD 0 STOPPED U2 --I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 18:DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uuv 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 02 n 0 5 / Toyota Camry 2019 00-NONE , 2 , DUE TO CRASH ® ❑ NAME(LAST,FIRST,M) Y O3-UNDER CARRIAGE ©,I O,.-Z FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 02 m M 2 SY n 15-OTHER 4 ❑Y ®SNE❑UNK VEH. AT CRASIN n H 99-UNKNOWN 9 16•TOP 3 `Distraction Value ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s, i�6 4 COM VEH 0 j$J 1 0 I— 60110 0 1 0 FIRST CONTACT 12 7 : _-5 *uYes.See Sidebar U1 Z EV92722 IL 2026 REAR TELEPHONE IL D 0 4T1 B11 HKXKU274413 Progressive ❑Y Il N U2 m .5 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m co 99 9 Same 875349267 2 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y ® N 2 0 0 DRIVER 0 PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 Nuy El NCv 0 Dv yr 10 1 12 (, 2 FIRE ❑ ® U2 C 0 13-UNDER CARRIAGE c M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9.1,6•Top 3 X ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN •Oistrac on Value 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8-�l. 6 j1:, 4 COM VEH ❑ ® U1 CO FIRST CONTACT 00 7�' =5 •(ryes,See Sidebar SOUTH ELGIN Z IL 60177 0 1 0 OSMAN6 IL 2027 D IL D 0 SLMCJ 1 C9XN U L08666 Travelers ❑Y ®N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = 99 9 Osman Construction C BAA8503545 BAC $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP U1 = KNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME){{ADDRESS)((TELEPHONE) (EMS) (HOSPITAL) U2 996 r m ##occs y 71 / U1 1 D 1 0 EV MOST EVNT LOG DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z N 1 ® 43 1 City of Elgin Barrier scrapes 06/26 ,2026 01 56 ®pm in a Work Zone? ®N DIRP co 1 F PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 5 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 � Si 2 ❑ 151 DOUGLAS AVE ELGIN IL 60120 28 03 1 ) PM ❑ • ❑Construction * Z 3 ❑ CITATIONS ISSUED ❑PENDING SECTION CITATION NO. EMS ARRIVED TIME 5 ❑AM ❑Maintenance U2 oEl 11 1 ARREST NAME Etkins. Reynaldo.S. 11-601 W1569000108 / ! El PM SLMT o N • ❑CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME 0 Utility F 2 ❑ 45 ARREST NAMEAM x- 7 ❑PM ❑Unknown work zone type U1 , / ❑ n OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 ❑ 1569-Jaimes.Julian 900 331-Ziegler , / ❑❑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 0 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- }--_.r-_--; INDICATE NORTH combination):or —I p1 f 1 Point?cfflmpad7(Undercerriapa) BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver n I 1 - } (example:shuttle or charter bus):or r 3. Is designed to carry15 or fewer passengers and operated a contract carrier O - -----A ' }---- } } transporting employee �In the course of their employment(example:employee 1 0i ry transporter-usually a van type vehicle or passenger car):or co L L.___a____.l 4IiI1 1 } } } •4. Is used or designated to transport between 9 and 15passengers,induding the drrver, c for direct compensation(example:large van used for specific purpose):or O L t i t 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m z placarding(example:placards will be displayed on the vehicle). XI —1 CARRIER NAME Z ADDRESS 0 w o CITY/STATE/ZIP g MOTOR CARR.ID 0 Interstate 0 Intrastate 1 I r 1 ❑ Not in Comm./Govt. 0 Not in Comm./Other O -- - --, Not To Scale ( - USDOT NO. ILCC NO. C m Source of above Z . ❑ Yes 0 No 0 Unknown g D Did Carrier Safety Regulations MCS)violation contribute to the crash? A ❑ Yes No ❑ 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'; 0 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' m TRAILER 1 ❑ ❑ 0 Z TRAILER 2 ❑ 0 0 o u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. Z Silver Gray u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT 3 TOWED BY/TO. _Redmons/Unknown . SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 0 TOWED BY/T6 DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE