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HomeMy WebLinkAbout2026-00044128 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 I0110 II Hill 1111 III I IIIIII DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X004319B3! u, 1 U21 3 4 1 U1 2 U2 1 U, 1 1_12 1 U1 1 U2 1 1 10 u1 3 U2 1 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY El$500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW ' Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 14 VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and for Tow Due To Crash El AMENDED YR 2026I 2026-00044128 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 —n ® ❑ RELATED ®Y 0 N 07 23 2026 ®AM ❑YES ®NO U1 -< BIG TIMBER RD 1 N RANDALL RD Elgin10:19 g PRIVATE mo /day/yr ❑PM FLOW CONDITION m ® ©!MI N E s bigtimber rdln randall rd COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 7 co Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD ❑ STOPPED U2 —I 0 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 0 C) T�TOWED U1 0mo Kiel. David.G. Nissan Maxima 2009 00-NONE ©, >2 �/DUE TOCRASH ® ❑ NAME(LAST,FIRST,M) yr 13-UNDER CARRIAGE 10.I 2 FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 0 m M 2 8 ❑Y 0 N SYSTEM®UNK VEH. 9 AT CRASH D 9 99-UNKNOWN 9 16•TOP 3 *Distraction Value 9 ALGN = r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s, i�S �i 4 COM VEH 0 0 1 0 F. FIRST CONTACT 1 7 ;—_;__5 *Irves.See Sidebar U1 Z SOUTH ELGIN IL 60177 0 1 0 FH80536 IL 2026 REAR TELEPHONE IL D 1 N4AA51 E79C812793 State Farm ❑Y Igl N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Same 0832084SFP13 1 r "o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER XI Refused ❑Y 0 N 2 0 N DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 IIMV 0 NCV 0 Dv !1 9 y 8 2 Freightliner Cdt�scadia 126 2018 00-NONE ,._j Qi:-_, DUE TO CRASH ❑ ® 20 C 0 13-UNDER CARRIAGE 1a) I. E FIRE ID ® U2 C M 2 4SYSTEM IN 9 ENGAGED 9 15-OTHER 9 16.TOP 3 X 0Y ❑N ®UNK VEH. AT CRASH 99-UNKNOWN *Oistraceonvalue 9 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8_I� 4 COM VEH ® ❑ U1 CO FIRST CONTACT 12 7._d .5 •If Yes.See Sidebar C ELGIN IL 60123 0 1 0 PG73879 IN 2027 I 0 Si) Z IL A 3AKBG DFG6JSJ N3320 Safeco Insurance Company ❑Y ®N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER 1 = XPO Logistics Freigh 6524239 SAC E 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 LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 El 11 4 07,23 l2026 10 19 ®❑PM in a Work Zone? NJ N DIRP > co 1 I PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME ❑AM If YES check one below: U1 6 C1 o", T 2 0 2 06 , , ❑PM ❑Construction * R 3 0 $I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 3 ❑AM 0 Maintenance U2 o1El 11 4 ARREST NAME Kiel. David.G. 11-902 410000836 / ! El Pm SLMT o N 0 CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ' ❑Utility r 2 ❑ ARREST NAME AM 1 / ❑❑PM 0 Unknown work zone type U1 45 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑qM Workers present? ❑Y 45 410-DeLeon.Jessica 502 275-Engelke 08 ( 18,2026 01 30 ®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 I1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer - i- }--_.r-_--; } INDICATE NORTH combination):or —I p1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C L _ } (example:shuttle or charter bus):or * , 3. Is designed tocarry 15 or fewer passengers and operated a contract carrier O ----------- A� I I I I I I ll ,r s } r } transportingemployees in the course of their employment73 J �_ transporter- a van vehicle or (example:employee Po usually type passenger car):or CO °`""'"" } } 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 L i l. i i t 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires 'D ' placarding(example:placards will be displayed on the vehicle). XI __ _ -I �: - a CARRIER NAME XPO Logistics Feight Z �-- ' - - - - ADDRESS 3200 INDUSTRIES RD w CITY/STATE/ZIP RICHMOND/IN/47374 0 { I I I I I I1-1 MOTOR CARR.ID 0 Interstate ® Intrastate I I I I I I 0 Not in Comm./Govt. Not in Comm./Other .... ....1 - USDOT NO. 241829 ILCC NO. rn XI Source of above z . -I Were HAZMAT placards on vehicle? 0 Yes ® No = If Yes,Name on placard O 4 digit UN NO. 1 digit Hazard class No. Xl Xl Did HAZMAT spill from vehicle(do NOT consider FUEL from vehicle's Z own tank)? 0 Yes ® No 0 Unknown Did HAZMAT Regulations violation contribute to the crash? r ❑ Yes ❑ No 0 Unknown g D Did Carrier Safety Regulations(MCS)violation contribute to the crash? A ❑ Yes II ❑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'7 0 Yes ®No 2 TRAILER VIN 1 7F21 C4829S2027485 m to LOCAL USE ONLY TRAILER VIN 2 m v TRAILER WIDTH(S) 0-96" 97-102" >102' T TRAILER 1 ® 0 0 Z TRAILER 2 0 0 0 O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 60 ft. 2 ft. Z Gray Turquoise u 1 TOWED TOTAL VEHICLE LENGTH 60 ft. NO.OF AXLES 4 DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT 3 TOWED BYITO. _Redmons/Impound Lot Garage . SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY/TO: DUE TO ® VEHICLE CONFIG. 5 CARGO BODY TYPE LOAD TYPE