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HomeMy WebLinkAbout2026-00039199 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets II I 111 II I 1 1111 HI U I� III 111111 H HUHIIUI DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X 04295547* U1 1 U21 3 4 1 U1 8 U2 1 u, 1 U2 1 u, 1 U2 1 1 10 U1 13 U2 -3-1 *P 0119 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 El$501-$1.500 ®ON SCENE 1 VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) (8:1B Injury and for Tow Due To Crash El AMENDED YR 202612026-00039199 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 :l KI M BALL ST El 07:37 ® ❑ RELATED ' V 0 N 07 03 2026 ❑AM ❑YES ®NO U1 -< _ _ g PRIVATE mo !day!yr ®PM FLOW CONDITION m FT l MI N E S W DU N DEE AVE COUNTY PROPERTY ❑Y ® N DOORING Ely #OF MOTOR ❑SLOW 15 u) ❑ Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD ❑ STOPPED U2 --I CO AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 Mies 0 uuv 0 ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 n 0 3 ! yr Nissan Versa 2007 00-NONE Q ©i DUE TO CRASH ® ❑ 1 2 13-UNDER CARRIAGE FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) O O DISTRACTED 0 0U2 2 m F 2 SY4 ❑Y ❑SNEM COUNK VEH. 9 AT CRASH IN 9 15-OTHER 99-UNKNOWN 9 ,6•TOP 3 *Distraction Value ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF T :i1 e 4 COM VEH 0 j$J 1 0 ~ ELGIN IL 60120 0 1 0 FIRST CONTACT 12 7_; __5 *Irves.SeeSidebar Ut Z EF55291 IL 2026 E M TELEPHONE IL D 3N1 BC11 EX7L445586 Unique Insurance ❑Y Igl N U2 13 . m 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 Same ILP3390884 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER > Refused 0 Y ElN 1 0 m x DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL 0 EWES 0 !1 9 5 4 R2 Hyundai Santa Fe 2013 00-NONE 11_"1 Qj O DUE TO CRASH ❑ 2 x o 10 13-UNDER CARRIAGE I If. 2 FIRE ID El U2 C M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9,16•TOPO3 ❑Y ®N 0 UNK VEH. AT CRASH 99-UNKNOWN Oistracl n Value 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8-il�( 4 COM VEH ❑ ® U1 W FIRST CONTACT 1 Y -5 •• •If Yes.See Sidebar E LG I N IL 60123 0 1 0 D U 80994 IL 2026 RFJ 0 N IL D SNMZUDLB9HH015477 State Farm ❑Y ®N RDEF M EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X 99 9 Same 1003674-SFP-13 BAc $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP 996 < Refused RESPONDER U1 = NNIT) (SEAT) (0081 (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)1(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 1 07,03 /2026 07 37 ®PM 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 � 0 2 0 06 04 + ) 0 PM ❑Construction * R 3 0 1!>I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 7 ❑AM 0 Maintenance U2 o ® 11 1 ARREST NAME Cardenas Maldonado.Santa 11-708 SO475000740 ! ! El PM SLMT o N 1 0 CITATIONS ISSUED • ❑ PENDING SECTION CITATION NO. ROAD CLEARANCE TIME Utility 35 t 2 0 ARREST NAME AM 1 r ❑❑ 7 PM 0 Unknown work zone type U1 n OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 0 475 Williarts. Brianna 10l - , ! ❑AM Workers present? ❑Y El PM ®N U2 35 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- }--__r-_--; INDICATE NORTH combination):or DI P3 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C i_ —Z ,, \ i i C a - (example:shuttle or charter bus):or 0 I i \ .I�l 3. Is designed to carry15 or fewer` A g passengers and operated by a contract carrier I 0 '8 1r -_• - } } } transporting employees In the course of their employment(example:employee X transporter-usually a van type vehicle or passenger car):or CO L 1 4. Is used or desi nated to trans rt between 9 and 15 ge ng N}--- ----; - } } } g po passen rs,includi the driver, for direct compensation(example:large van used for specific purpose):or O L L____a____. ! - _ t i. i ._ 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires D placarding(example:placards will be displayed on the vehicle). ,Zmt a.r.nA,,. - -- -1 Ir . 1. L. 1... _ CARRIER NAME Z ADDRESS 0V) Not To Scale I CITY/STATE/ZIP • MOTOR CARR.ID 0 Interstate 0 Intrastate I I . I ❑ Not in Comm./Govt. 0 Not in Comm./Other --- --1 USDOT NO. ILCC NO. m XI Source of above z . 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 to 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 Gray u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT 3 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: 2 TOWED BY/T6 DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE