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HomeMy WebLinkAbout2026-00043963 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 I0110 II I II 10 IIIIII IIIIII II DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY XOD4,319951 u, 1 U21 3 4 1 U116 U299 u, 1 U2 1 u,99 U2 99 1 11 U, 1 U2 1 *P 0119 INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW ' DAMAGE TO ANY ❑5500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 15 VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and f or Tow Due To Crash El AMENDED YR 202612026-00043963 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 r1 POINT BLVD El In04:29 ® ❑ RELATED ®Y 0 N 07 22 2026 DAM ❑YES ®NO U1 -< g PRIVATE mo !day/yr ®PM FLOW CONDITION m _ FT!MI N E S W N RANDALL RD COUNTY PROPERTY ❑Y ® N DOORING ICIy #OF MOTOR 0 SLOW 1 cn ❑ 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 g DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NIA/ 0!CV 0 ov DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 n FOR DAMAGEDAREA(S) FRCf'rr TOWED U1 Q Pieprz.Grzegorz.J. 0 6 / yr 13-UNDER CARRIAGE ©i O-O FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) O O DISTRACTED ® ❑ U2 O m M 2 8 SY 15-OTHER ❑Y ®N SE❑UNK VEH. O AT CRASM IN H O 99-UNKNOWN 9 16•TIDP 3 `Distraction Value 9 ALGN = r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF S F• FIRST CONTACT 12 7,_;iL S— 4 COM VEH 0 0 1 O _,_-5 *Irves.See Sidebar U1 Z Sleepy Hollow IL 60118 0 1 0 AD38007 IL 2027 Ia 7 TELEPHONE IL D 7 1 HGCV1 F36JA020126 State Farm ❑Y ®N U2 19 . m 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR M PIEPRZ. KAROLINA.J. 2144451-SFP-13 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF IC OWNER STREET,CITY.STATE,ZIP PHONE NUMBER RESPONDER 2 7] g DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 Nuv 0 KCV 0 Dv !1 9 6 9 Ford Explorer 2015' 00-NONE 'o,I t2 c,�2 FIRE DUE O CRASH D ® U2 2 C o 13-UNDER CARRIAGE M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9.1 ❑Y i N ❑ ,6•TOP 3 UNK VEH. AT CRASH 99-UNKNOWN *Oistracton Value 9 4 POINT OF 8 i 4 COM VEH D ® U1 CO N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR 5 FIRST CONTACT 6 O7 ,�=QIOS •If Yes.See Sidebar C Z Joliet IL 60432 0 1 0 EE31630 IL 2026aR9 fn D IL D 0 1 FM5K8AR9FGA41623 Geico ❑Y J N RDEF M EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X Same 6170113911 BAG $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPONDER U1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)1(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 07,22 l2026 04 29 ®pm in a Work Zone? ®N DIRP co 1 t PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 1 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 � o" 2 ❑ 28 17 ) ! ❑PM• ❑Construction >E R 3 ❑ 0 CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 1 ❑AM ❑Maintenance U2 a ®1 11 4 ARREST NAME Pieprz.Grzegorz.J. 11-601-Ax W1525001051 ! ! El PM SLMT o N ❑CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME 0 Utility 0 AM t 2 El ARREST NAME 07)22 12026 05 24 ®PM El Unknown work zone type U1 5O , T OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑Y 50 1525-Nave.Oscar 502 - 1 ! 0 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 - } r _, I0 - ) I combination):or more than pounds(example:truck or truck/trailer 1. Hasa rating10 000 i -< NDICATE NORTH BY ARROW Not To Scale j 2 Is used or designed to transport more than 15 passengers including the driver C (example:shuttle or charter bus):or 0 X ; ; I 3. Is designed to carry15 or fewer passengers and operated a contract carrier O }_---A--- -I ` }} } transporting employee �In the course of their employment(example:employee transporter-usually a van type vehicle or passenger car):or w } } 1. 4. Is used or designated to transport between 9 and 15 passengers,including the driver. N •for direct compensation(example:large van used for specific purpose):or O __ __ I `..r _ t i. < i. , 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m placarding(example:placards will be displayed on the vehicle). ;p —1 - _unit2�urgt1_ _ _ _ CARRIER NAME Z ADDRESS 0 o CITY/STATE/ZIP g MOTOR CARR.ID El Interstate El Intrastate r17wrrasma O r ; ❑ Not in Comm./Govt. 0 Not in Comm./Other �I. ------1 - USDOT NO. ILCC NO. rn XI Source of above z . own tank)? 0 Yes 0 No 0 Unknown Did HAZMAT Regulations violation contribute to the crash? r ❑ Yes 0 No 0 Unknown g D Did Carrier Safety Regulations MCS)violation contribute to the crash? A ❑ Yes II El 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'; ❑Yes 0 No 2 TRAILER VIN 1 m co LOCAL USE ONLY TRAILER VIN 2 m v 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 Gray White u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT 3 TOWED BY/TO: _ . SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY/T6 DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE