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HomeMy WebLinkAbout2026-00045663 ILLINOIS TRAFFIC CRASH REPORT sheet 1 of 4 Sheets 01111101111 0110 II I fl I I 1 fll 110 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X004329493 u, 9 U2 2 4 1 U1 2 U2 2 U199 U299 U,99 U2 1 5 9 U1 99 U222 *P 0119* INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW ' DAMAGE TO ANY El$500 OR LESS TYPE OF REPORT ® A No Injury 1 Drive Away Elgin Police Department ONE PERSON'S ❑$501-51.500 ®ON SCENE 1 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) 0 AMENDED ❑ B Injury and for Tow Due To Crash YR 202612026-00045663 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 99 f1 307 BENT ST Elgin06:41 ® ❑ RELATED ❑Y ®N 07 30 2026 ®AM ❑YES ®NO U1 -< _ _ g PRIVATE mo /day/yr ❑PM FLOW CONDITION m COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ®SLOW 1 (n ❑ FT!MI N E S W Kane HIT ®Y ❑ N WITH VEHICLES INVLD ❑ STOPPED U2 --I &RUN ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ❑ FREE FLOW # LNS 0 Q83 DRIVER I] PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uuv 0!CV 0 ov DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 7 0 FOR DAMAGEDAREA(S) FRObir�TOWED U1 Unknown. Unknown.0. ! ! Unknown Unknown 00-NONE ©, >2 �/OUETOCRASH ❑ EN NAME(LAST,FIRST.M) mo yr 13-UNDER CARRIAGE 10.I 2 FIRE ❑ IE < STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 m 9 9 SY 15-OTHER ❑Y ❑SNEM COUNK VEH. 9 AT CRASH IN D 9 99-UNKNOWN 9 16•TOP 3 *Distraction Value ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF & i�S �i 4 COM VEH ❑ j$J 2 O ~ Unknown IL 0 9 9 FIRST CONTACT 1 7 . __5 *IIYes.SeeSidebar Ut Z UNKNOWN Unknown ' E TELEPHONE UNK. 0 UNKNOWN Unknown ❑Y ❑N U2 I- 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m co 99 9 Same Unknown 1 rn `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER eM Refused ❑Y ® N 99eM p DRIVER X. PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NMV 0 NCv 0 DV yr 11- 12 -1 ❑ 2 ,� 0 13-UNDER CARRIAGE 10( 2 FIRE ❑ ® U2 C c ® SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ❑ SPDR C) SYSTEM IN 0 ENGAGED 0 15-OTHER 9.16-TOP 3 9 X a ❑Y ❑N ❑UNK VEH. AT CRASH 99-UNKNOWN `Oistraci n Value POINT OF S ) 4 Ut N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR S COM VEH ❑ ® CO F,,, FIRST CONTACT 7 O7 ,�=QI_5 •IfYes.SeeSidebar CM47877 IL 20 99AR 0 Si) M . STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0 1 HGCP26838A131609 Progressive ❑V ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = 99 9 Grissette. Naomi 998359539 BAc $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP U1 = (UNIT) (SEAT) (008) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)1(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL) DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 18 9 07,30 /2026 06 41 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 99 N 3 0 0 CITATIONS ISSUED 0 PENDING + ! ❑PM• ❑Construction SECTION CITATION NO. EMS ARRIVED TIME ❑AM ❑Maintenance U2 3 -a, ARREST NAME / / ❑PM ' o N 1 ® 11 0 CITATIONS ISSUED 0 PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • ❑Utility SLMT 15 r 2ARREST NAME AM 1 r ❑❑PM ❑Unknown work zone type U1 Eln 7 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 0 ❑AM Workers present? ❑Y 15 1527-Juarez.Jorge 401 275-Engelke , ( ❑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 rID combination):or more than pound (example:truck or truckrtrarler 1. Has a weight rating10 000 5 i -< INDICATE NORTH p0 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C E (example:shuttle or charter bus):or 0 3. Is designed to carry15 or fewer passengers and operated a contract carrier O }} } transporting employee �In the course of their employment(example:employee L transporter-usually a van type vehicle or passenger car):or w L L.___a__ 4. Is used ordesi natedtotrans transport passengers,including C} } } g po passen rs,includi the driver, tyY for direct compensation(example:large van used for specific purpose):or O L i_----a----. , " woe' - L i. < i. L 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires r 1 1 1 placarding(example:placards will be displayed on the vehicle). .Zm1 D Of ® CARRIER NAME ® LJ _ __ ADDRESS DO r r T 1 I ': i: : : rn n CITY/STATE/ZIP MOTOR CARR.ID 0 Interstate 0 Intrastate 0 1 I r 1 ❑ Not in Comm./Govt. 0 Not in Comm./Other ; _Y_ _-1 - USDOT NO. ILCC NO. m XI Source of above z . Form Number m Xl IDOT PERMIT NO. WIDELOAD'; ❑Yes 0 No 2 TRAILER VIM 1 m co LOCAL USE ONLY TRAILER VIN 2 m v 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 Gray u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT- 9 TOWED BY/TO: _ . SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/T6 DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE