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HomeMy WebLinkAbout2026-00045570 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 0110 II I flfl 1101111111100 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X+ 2187/ u, 1 U21 1 1 1 U1 2 U2 1 U, 1 u2 1 U, 1 u2 1 1 10 u1 3 u2 1 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT 0 A No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW ' Elgin Police Department ONE PERSON'S ❑$501-$1.500 ®ON SCENE 1 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash El AMENDED YR 2026I 2026-00045570 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME CAPITAL ST Elgin SECONDARY CRASH 15 ® ❑ RELATED ❑Y ®N 07 29 2026 ❑AM ❑YES ElPRIVATE NO U1 mo /day/yr 07:03 ®PM FLOW CONDITION III 5 FT/vt N E S W Westfield Dr COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 1 cn ® O 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 0 183 DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EWES ❑uuv ❑!CV ❑Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 3 n FOR DAMAGEDAREA(S) FRONT TOWED U1 I� F Patsy.J. 1 1 / yr 13-UNDER CARRIAGE ©i O - FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) O ' 2 DISTRACTED 0 0 U2 3 f<il F 2 SYTM IN ENGAGETHER 4 ❑Y ®S NE DUNK VEH. O AT CRASH 0 99-U15-UNKNOWN 9 16-TOP 3 ,Distraction VaIUE 9 ALGN = r CITY STATE ZIP INJ EJCT EPTH PLATE NO STATE YEAR POINT OF 6, it 6 �i 4 COM VEH 0 0 4 0 f. FIRST CONTACT 11 7. _:L__;__5 *IIYes.See Sidebar U1 Z Carpentersville IL 60110 0 1 0 298278 IL 2027 REAR TELEPHONE IL D 0 1 FMCUOGD5JUA44088 West Bend ❑Y ®N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Same H H D 5608936 18 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF IC OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y El 2 0 N DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL 0 EWES ❑iiuv 0 Ncv ❑Dv /1 9 yf 4 Kia Motors Coilptima 2016 00-NONE „ ` 12' _, DUE TO CRASH ❑ 2 x Ti - 13-UNDER CARRIAGE FIRE 0 ® U2 M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER O9 16-TOP 3 X ❑Y i N ❑UNK VEH. AT CRASH 99-UNKNOWN *OistraCtOn vaiUe 9 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6 i 6 i�-4 COM VEH ❑ ® U1 CO F,,, FIRST CONTACT 1 O Y��_,-=5 •(ryes,See Sidebar C ELGIN IL 60123 0 1 0 FJ34471 IL 2027 R' 0 Si) IL D 0 SXXGT4L31 GG098953 State Farm ❑Y ®N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Same 1393949-SFP-13 BAc $ 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)/(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 co N 1 El 11 1 07/29 /2026 07 03 ®PM in a Work Zone? NJ DIRP > 1 1 PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME ❑AM If YES check one below: U1 1 0o", T 2 0 2 99 1 / 0 PM- ElConstruction * Z 3 0 I!!I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 5 ❑AM 0 Maintenance U2 Fry. y Patsy. 11-902 1575000025 / / El PM ® 11 1 ARREST NAME _ o U CITATIONS ISSUED PENDING UtilitySLMT ' o N SECTION CITATION NO. ROAD CLEARANCE TIME • El 1 2 El ARREST NAME 07/29 /2026 08 00 0 PM El Unknown work zone type U1 300 AM 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 30 1575-Williamson.Colin 901 09 /01 /2026 09 00 ❑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 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer -< c ` --I -' r INDICATE NORTH combination):or —I ® 1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C (example:shuttle or charter bus):or C) r r X I- I- --I-- 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I 0 } } } transporting employees in the course of their employment(example:employee X Not To Scale I 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, ' for direct compensation(example:large van used for specific purpose):or O L L____a____� t i i t 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m 1 placarding(example:placards will be displayed on the vehicle). XI~ CARRIER NAME Z ADDRESS D to C) CITY/STATE/ZIP g MOTOR CARR.ID ❑ Interstate ❑ Intrastate ' ❑ Not in Comm./Govt. ❑ Not in Comm./Other 00 --- "1 - USDOT NO. ILCC NO. C m Source of above z . If Yes,Name on placard 0 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 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 LOCAL USE ONLY TRAILER VIN 2 m 0 TRAILER WIDTH(S) 0-96" 97-102" >102' -n TRAILER 1 ❑ ❑ 0 Z ill TRAILER 2 ❑ 0 0 o u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w Tan Black u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT 3 TOWED BY/TO. _Adieu/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/TO: DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE