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HomeMy WebLinkAbout2026-00045330 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 Mil 1 II I111111 II HRH DRAC TRFD TRFC WEAT DRVA VIS VEHD LGHT COLL MANY X�-322250 u, 1 U21 3 4 1 U1 1 U2 1 U, 1 1_12 1 U, U2 1 4 1 U1 U2 1 *P 0 1 1 9* INVESTIGATING AGENCY DAMAGE TO ANY ®5500 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 2 VEHICLE/PROPERTY El OVER 51,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash 0 AMENDED YR 202612026-00045330 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH -n ® ❑ RELATED ®Y 0 N 07 28 2026 DAM ❑YES ®NO U1 -< E HIGHLAND AVE Elgin09:06 _ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION m FTlMI N E S W DOUGLAS AVE COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 1 (n ❑ Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD DO U2 --I CO AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST IZI N 51 FREE FLOW # LNS 0 0 DRIVER ❑ PARKED ❑DRIVERLESS PED 0 PEDAL 0 EWES 0 MAU 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 n 0 4 / yr 13-UNDER CARRIAGE ©,I I�. 2 FIRE 0 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 2 m M 2 4 ❑Y SYSTEM IN ENGAGED 15-OTHER 9 16.70P 3 _ ❑N ❑UNK VEH. AT CRASH 99-UNKNOWN `Distraction Value ALGN r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF & i�s li COM VEH ❑ ❑ 1 0 c Z ELGIN IL 60120 B 1 0 FIRST CONTACT 11 7_; __5 *If Yes.See Sidebar U1 REAR TELEPHONE IL D 0 none ❑Y 0 N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 1 52 2 none 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER . Refused RESPONDER XI^ L C) x DRIVER 0 PARKED 0 DRIVERLESS ❑ FED 0 PEON- 0 EWES 0 roAv 0 NCV ❑DV !2 0 9 Dodge Avenger 2010' 00-NONE O1 . 12..-_1 DUE TO CRASH 0 2 x o - 13-UNDER CARRIAGE 10� 2 FIRE ❑ ® U2 C c M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16•TOP 3 X ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN `Distraction Value 9 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF si B i;,_5_4 CO•IfYes.SeM VEHe Sidebar❑ ® U1 toF„ FIRST CONTACT 11 7 ELGIN IL 60120 0 1 0 ED15137 IL 2026 REAR C 0 C IL D 0 1 B3CC5FBOAN129016 FIRST CHICAGO INSURANCE ❑Y 123 N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X 52 2 Same I LV 1256243-00 BAc $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Provena St.Joseph RESPONDER U1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJI (EJCTI (EPTH) PASSENGERS&WITNESS ONLY (NAME)((ADDRESS)/(TELEPHONE) (EMS) (HOSPITAL) 1 0 EV MOST EVNT LOG DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur El U2 Z co N 1 CD 11 4 07,28 ,2026 09 06 ®AM in a Work Zone? NJN o1RP D 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 2 99 99 07,28 /2026 09 11 PM 1 ® • ❑Construction * Z 3 ❑ 0 CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 1 ❑AM ❑Maintenance U2 ARREST NAME 07/28/2026 09 29 ®PM o N 1 ® 12 4 0 CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • El Utility SLMT 30 t 2 ❑ ARREST NAME AM T ( / ❑❑PM ❑Unknown work zone type U1 n OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 ❑ 1544-Solis,Yulissa 101 337-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 A ADDITIONAL UNITS FORMS. r ----r••--, , I - . A CMV is defined as any motor vehicle used to transport passengers or property and: Z hi�� weiAve. ghtrating more than 10,000 pounds(example:truck or truckrtratlerDoug -< 1. Has -I i- }-- -+- --' I r INDICATE NORTH BY ARROW combination):or 2 Is used or designed to transport more than 15 passengers including the driver C r r t- (example:shuttle or charter bus):or 0 I3. Is designed to carry15 or fewer passengers and operated a contract carrier O -- I - } } } transporting employee in the course of their employment(example:employee X transporter-usually a van type vehicle or passenger car):or w L 4. Is used or designated to transport between 9 and 15 passengers,including C -- -- - } } g po passen rs,includi the driver, for direct compensation(example:large van used for specific purpose):or O __ __ I Link i _ L L I ._ 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m ,/ ` ?'r'land ``e• placarding(example:placards will be displayed on the vehicle). ;p 4/ L 1. 1. l. ..... . 1 D CARRIER NAME Z ADDRESS 0 C rn CITY/STATE/ZIP 0 . - MOTOR CARR.ID 0 Interstate 0 Intrastate Not To Scale 1 ❑ Not in Comm./Govt. ❑ Not in Comm./Other 00 :-.:- ‘ --- --; I - L L ` USDOT NO. ILCC NO. C m XI Source of above z . x Did HAZMAT spill from vehicle(do NOT consider FUEL from vehicle's z own tank)? 0 Yes 0 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 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 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 Gray 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