HomeMy WebLinkAbout2026-00041957 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 0110 II If11l111111111111111
DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X0D4303990
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INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW '
DAMAGE TO ANY ❑$500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away
Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 14
VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and f or Tow Due To Crash
0 AMENDED YR 202612026-00041957 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 99 m
DOUGLAS AVE Elgin 09:07
0 ❑ RELATED ®Y ❑N 07 13 2026 ❑AM ❑YES ®NO U1 -<
_ _ g PRIVATE mo !day!yr ®PM FLOW CONDITION m
FT!MI N E S W KI M BALL ST COUNTY PROPERTY ❑Y ® N DOORING El #OF MOTOR 0 SLOW 15 Cn
❑ Kane HIT ®Y ❑ N WITH VEHICLES INVLD 0 STOPPED U2 --I
® &RUN AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N 51 FREE FLOW # LNS 0
Q83 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 00 0
FOR DAMAGEDAREA(S) FRONT TOWED U1 Q
NAME(LAST,FIRST,M) Unknown.O. mo / ! yr Ford Taurus 00-NONE „_ O i_, DUE TO CRASH ❑
EN
13-UNDER CARRIAGE 10 i ' 2 FIRE 0 NI E
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0U2 00 r n<
M 9 9 SYSTEM IN g ENGAGED 0 15-OTHER 9 16-TOP 3 _
❑Y ❑N ®UNK VEH. AT CRASH 99-UNKNOWN `Distraction Value 9 ALGN
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6_;iL 6 _5 4 Yes.See Sidebar Ut COM VEH 0 Ea 1
0
Z FIRST CONTACT 12 7_0 9 0 AQ91146 I L REAR
_
TELEPHONE . STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED 1 1/
NIA ❑Y ❑N U2 m
in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
99 9 Same NIA 1 rn
`o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER
r D Y N
m
N DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 r uv 0 KCV 0 Dv
!1 9 yf 5 Cadillac Escalade 2022 00-NONE ,�_-1 12 NT--_, DUE TO CRASH ❑ C 2 73
o 13-UNDERCARRIAGE 101 2 FIRE 0 El U2 C
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F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16-TOP 3 X
❑Y ON DUNK VEH. AT CRASH 99-UNKNOWN `Oistrac on Value 9 g
6 I 4
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF - 5 i'_ COM VEH
Z FIRST CONTACT 6 Y_i_{_0 -5 •IfYes.See Si ❑ ® Ut CO
n ELGIN IL 60120 C 1 0 EN65894 IL 2026 REAR
C
IL D 0 1 GYS4CKL7N R238365 State Farm ❑Y J N RDEF X
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 =
Elgin Fire 99 9 Same 0512289-SFP-13 SAC E
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 <
Sherman RESPONDER U1 =
(UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJI (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 0 Y U2 Z
N 1 ® 11 4 07,13 ,2026 09 07 ®AM in a Work Zone? ®N DIRP co
1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 3
T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM u1
2 ❑ 28 03 07,13 ,2026 09 11 PM
® , ❑Construction *
Z 3 0 0 CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 3
❑AM ❑Maintenance U2
- N ®a ARREST NAME 07,13,2026 09 13 ®pM '
1 11 4 ElUtility
0 CITATIONS ISSUED ❑PENDING SLMT
o,
SECTION CITATION NO. ROAD CLEARANCE TIME 0 AM
T 2 ElARREST NAME 07 r 13 /2026 09 20 0 PM El work zone type U1 30
n T OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME
2 2 3 ❑ 1561-Saroyic, Mirko 102 337-Thompson , , ❑❑PM Workers present? ®N U2 30
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
Not To Scale , -N� z
1. Has a weight rating more than 10,000 pounds(example:truck or truckrtrailer
i- }--_-r-_--; I l - I. INDICATE
ARROW NORTH
combination):or p0
I1 2 Is used or designed to transport more than 15 passengers including the driver C
i_ .:.. -:. N t- (example:shuttle or charter bus):or 0
I- I- --I-•--; I - transporting empined to oyees inthe course of 5 or fewer passengers
er employment(example:employee a contract ner X
mow. -••.-1 J I I } r } transporterpo -usually a van type vehicle or passenger car): r CD
L L.___a__ 4. Is used ordesi natedtotrans rtbetween9and15 passengers,including C} } for direct compensation(example:large van used for specificpurpose):or [he driver,
— — — — — — — Pe ( P 9 Pe or O
L l. l. I 1 _ 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires 'D
® .. �1 placarding(example:placards will be displayed on the vehicle). XI
—1
CARRIER NAME Z
ADDRESS 0
D
` I Ir w
CITY/STATE/ZIP 0
I i. i. MOTOR CARR.ID 0 Interstate 0 Intrastate 5
I I T I I I ❑ Not in Comm./Govt. ❑ Not in Comm./Other 0
--- --4. USDOT NO. ILCC NO. m
XI
Source of above z
) MCS ❑Yes 0 No 0 Unknown Out of Service ❑Yes ❑No 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
Red Black
u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_
DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY/TO:
_ SELECT CODES FROM THE BACK OF CRASH BOOKLET
U 2 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY/TO.
DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE