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HomeMy WebLinkAbout2026-00047743 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 0110 II I OH I�� III 11111E11 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X004333953 u, 1 U2 1 1 1 U146 u2 u, 1 1_12 U, 1 U2 4 6 u, 4 U2 *P 0119* INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW ' DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT El A No Injury 1 Drive Away Elgin Police Department ONE PERSON'S ❑5501-51,500 ®ON SCENE 1 VEHICLE/PROPERTY ®OVER 51,500 ❑NOT ON SCENE(DESK REPORT) El AMENDED ® 6 Injury and for Tow Due To Crash YR 202612026-00047743 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 �I 2958 SHAMROCK DR El11:14 ® ❑ RELATED ❑Y ®N 08 08 2026 ❑AM ❑YES ®NO U1 -< _ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION m COUNTY PROPERTY ®Y ❑N DOORING ❑y #OF MOTOR IR SLOW Cl) ❑ FT/MI N E S W Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD ❑ STOPPED U2 --I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST IZI N ❑ FREE FLOW # LNS 0 Qg3 ORNER ❑ PARKED ❑DRNERLESS 0 PED 0 PEDAL 0 EWES 0 MAV 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 1 C) 08 / yr Bhatt. Urvashi. Tesla Y 2026 co-NONE ©1I 01 0 DUE TO CRASH ® ❑ 13-UNDER CARRIAGE 10. 2 FIRE 0 IE C STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 rn F 2 4 SY 15-OTHER ❑Y ®SNE❑UNK VEH. 0 AT CRASH M IN D 0 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�B �i 4 COM VEH 0 j$J 1 0 ~ ELGIN I L 60124 C 1 0 FIRST CONTACT 1 7 ; __5 *Ir Yes.See Sidebar U1 Z 994AC819 IL 2026 REAR TELEPHONE IL 7SAYGDED6TA736268 State Farm ❑Y Il N U2 ni 5 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER RSUR m co Elgin Fire 99 9 Bhatt.Soor 4092575SFP13 1 r o HOSPITAL(TAKEN TO) INCIDENT IF`Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER 2 ou 0 DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 Nuy 0 Ncv 0 CIRCLE NUMBER(S) U1 DV yr ,2 - C o 13-UNDER CARRIAGE 10 I c. 2 FIRE ❑ ❑ U2 C c SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED a SYSTEM IN ENGAGED 15-OTHER 9,16-TOP 3 ❑ 0 SPDR O ❑Y ❑N ❑UNK VEH. AT CRASH 99-UNKNOWN *0istrac( n Value U1 0 - POINT OF s-.;, -4 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR FIRST CONTACT TA—d:=5 C•IO e1sVEH See •Sidebar❑ 0 C CO F` ---,- co M . STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 O ❑Y ❑N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = BAC HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP 996 < RESPNDER❑YD❑N U1 = (UNIT) (SEAT) (D051 (SEX) {SAFT) (AIR) (INJI 1(EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)!(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL) n 1 3 04 / 0 EV MOST EVNT Lot DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z N 1 ® 43 5 08!08 /2026 11 14 ®PM in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 5 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 v t 2 ❑ 15 18 08!08 /2026 11 15 ®PM El Construction Z3 ❑ 0 CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EIAS ARRIVED TIME ❑AM ❑Maintenance U2 ARREST NAME 08/08/2026 11 19 ®PM o N ❑ ❑CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • El Utility SLMT 20 t 2 ARREST NAME AM r 1 ❑❑PM ❑Unknown work zone type U1 El 7 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME Y 2 3 ❑ ❑AM Workers present? ❑ 1558-Lundvick.John 801 341-Cox ! / ❑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 -< combination):or Not To Scale INDICATE NORTH BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver n t _ (example:shuttle or charter bus):or X i i 701 3. Is designed to carry15 or fewer passengers and operated a contract carrier O I- r - , % - } } } transporting employee in the course of their employment(example:employee X 1 i- wit' transporter-usually a van type vehicle or passenger car):or CO i. -- 'I - } } } 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 'OD L i._._.a.....I l. i i t 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m placarding(example:placards will be displayed on the vehicle). ;p —I CARRIER NAME Z ADDRESS 0 Umetlaters CITY/STATE/ZIP 0 _ MOTOR CARR.ID 0 Interstate ❑ Intrastate ' ❑ Not in Comm./GaA. ❑ Not in Comm./Other0 --------- 1 - USDOT NO. ILCC NO. C m XI Source of above z . 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 v TRAILER WIDTH(S) 0-96" 97-102" >102' T TRAILER 1 ❑ ❑ 0 Z TRAILER 2 ❑ 0 0 O u 1 COLOR U_COLOR TRAILER LENGTH(S)1 ft. 2 ft. Z 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_TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: TOWED BY/TO.DUE TO VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE