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HomeMy WebLinkAbout2026-00047318 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 0110 II Iflfl1I II11100111011 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X004329563 u, 9 U21 1 1 8 U1 4 U2 1 u, 1 u2 1 u1 1 U2 1 1 11 u1 1 U2 1 *P 0 1 1 9* INVESTIGATING AGENCY DAMAGE TO ANY ❑$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 3 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash ❑AMENDED YR 2026I 2026-00047318 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 m® ❑ RELATED PRIVATE ❑Y ®N 08 06 2026 DAM ❑YES ®NO U1 -< N STATE ST Elgin mo /day/yr 07:43 ®PM FLOW CONDITION Ill 12 COUNTY PROPERTY ❑Y ® N DOORING Ely #OF MOTOR 0 SLOW 15 u) ® T)/MI N E OS W 1-90 WITH VEHICLES INVLD 0 STOPPED U2 --I El AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) Kane HIT&RUN ®V ElN PEDALCYCLIST 123 N ® FREE FLOW # LNS 0 DRIVER ❑ 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 2 n FOR DAMAGEDAREA(S) FROM�TOWED U1 0 Unknown / / Acura RDX 2008 00-NONE ©, >2 �/DUE TOCRASH ® ❑ NAME(LAST,FIRST,M) mo yr 13-UNDER CARRIAGE 10. • 2 FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTEDU2 2 < 2 5 SYSTEM IN O ENGAGED O 15-OTHER 916.70P 3 0 _ ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN `Distraction Value 9 ALGN r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s, ii 6 ��.4 C.OM VEH ❑ I! 1 0 I� B 1 0 FIRST CONTACT 12 7_; _-5 *IIYes,See Sidebar U1 Z FG12546 IL 2027 E TELEPHONE . STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED 1 11/ 5J8TB18568A006664 Gainsco 0 Y ®N U2 m 5 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 Ramirez Galviz.Jenny.A. ILPA368635420000 1 rn `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER RESPONDER 99 0 m g DRIVER 0 PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NMv 0 NOV 0 DV yr /1 9 5 9 General Motor rQ�a)p 2005 00-NONE 'o,� t2 (,-2 FIRE DUE D CRASH ® U2 2 C o _ - 13-UNDER CARRIAGE c F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9..16-TOP 3 X ❑Y i N DUNK VEH. AT CRASH 99-UNKNOWN *Oistracton Value 9 4 POINT OF S iITN4 COM VEH D ® U1 W N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR FIRST CONTACT 6 O,�= 05 •IfYesSeeSidebar C Z Crystal Lake IL 60012 0 1 0 EW61534 IL 2026 i AR 0 Z IL D 0 1 G KET12S456157475 State Farm ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = 99 9 Moody.Craig.W. 0606485-SFP-13 SAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP u1 = (UNIT) (SEAT) (0051 (SEX) {SAFT) (AIR) (INJI 1(EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)((A.DDRESS)!(TELEPHONE) (EMS) (HOSPITAL) 2 3 06 / ' D / / 2 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 11 1 81 ,12 /26 07 43 ®AM in a Work Zone? ®N DIRP co 1 I 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 18 81 /12 /26 07 45 PM ® • ❑Construction >E Z 3 ❑ 0 CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 1 ❑AM ❑Maintenance U2 -a ARREST NAME 81 /12 /26 07 48 ®PM " , 1 ® 11 1 ElUtility 0CITATIONS ISSUED ❑PENDING SLMT o uSECTION CITATION NO. ROAD CLEARANCE TIME 0 AM t 2 ElARREST NAME 81 /12 /26 08 19 0 PM ElUnknown work zone type U1 45 n 7 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 ❑ El PM Workers present? 0 Y 45 1542 Chafe. Ethan 501 , / 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 1. Has a weight rating more than 10,000 pounds(example:truck or truckrtrailer -< ` ` -' -' r INDICATE NORTH combination):or —I BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C t- (example:shuttle or charter bus):or C) r r X I- L A 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I O } } } transporting employees in the course of their employment(example:employee X transporter-usually a van type vehicle or passenger car):or w L L.___a____.l 4. Is used ordesinatedtotrans rtbetween9and15 passengers,including C } } for direct compensation(examp::large van used for speific purpoe):ordi the driver, V.... iff" l. I 1 t 5. Is anyvehicle used to transport anyhazardous material(HAZMAT)that requires m r ; placardig(example:placards will be isplayed on the vehicle). XI I CARRIER NAME Z II I ADDRESS 0 € I C) CITY/STATE/ZIPg 'E - MOTOR CARR.ID ❑ Interstate ❑ Intrastate I I T A ❑ Not in Comm./GaA. Not in Comm./Other0 -----T 1 USDOT NO. ILCC NO. rn taltehas 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 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 Black u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT 3 TOWED BY/TO. Arties/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