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HomeMy WebLinkAbout2026-00047905 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 01111101111 IIIIII II II I flUH1111111111 fll 1U0 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X0014333991 u, 1 U21 1 1 1 U, 4 U2 1 U, 1 u2 1 U, 1 U2 1 1 11 U1 1 U211 *P 0119* 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 1 VEHICLE/PROPERTY ®OVER 61,500 El NOT ON SCENE(DESK REPORT) El B Injury and/or Tow Due To Crash ❑AMENDED YR 2026I 2026-00047905 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n N STATE ST Elgin 06:54 ® ❑ RELATED ®Y 0 N 08 09 2026 12,— ❑YES ®NO U1 -< _ _ PRIVATE mo /day/yr ®PM FLOW CONDITION m FT!MI N E S W SCHILLER LLER ST COUNTY PROPERTY ❑Y ® N DOORING Ely #OF MOTOR 0 SLOW 2 fA ❑ Kane HIT&RUN ❑V ® N WITH VEHICLES INVLD 0 STOPPED U2 —I ® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 Qg3 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEON. 0 EWES 0 uuv 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 0 0 7 / yr 13-UNDER CARRIAGE ©, :: FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL)THERDISTRACTED 0 0 U2 4 rn F 2 8 SYTM❑Y ®SNEDUNK VEH. O ATCRASHD 0 15-99-UUNKNOWN 9 16•TOP 3 `Distraction Value ALGN X. r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s, it a 4 COM VEH 0 Ea 1 0 " �- GILBERTS LBERTS I L 60136 0 1 0 FIRST CONTACT 12 7 ; _9 *II Yes.See Sidebar U1 Z FJ15646 IL 2026 E TELEPHONE IL D 0 3N 1 AB7AP5GY312952 State Farm ❑Y Igl N U2 m 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Elgin Fire 99 9 Same 3872772-SFP-13 1 r o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused 0 Y El 2 c m E{ DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 iiuv 0 NOV 0 DV CIRCLE NUMBER(S) U1 2 0 0 2 Chevrolet Sllverado 2015 00-NONE 0. Q!'-O DUE TO CRASH rg ❑ 2 x o Yr 13-UNDER CARRIAGE 10( I 2 FIRE 0 ® U2 C M 2 4SYSTEM IN 0 ENGAGED 0 15-OTHER 9,16-TOP 3 X 0 Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN *Oistraellon Value 0 POINT OF s i 4 COM VEH ❑ ® U1 CO N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR 5 I— FIRST CONTACT 6 O7 ,�_QI OS •If Yes.See Sidebar C Aurora IL 60505 0 1 0 557015D IL 2027 I AR0 Si) IL D 0 1GC5K0E82FZ514516 Progressive ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Elgin Fire 99 9 Same 872416491 SAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPONDER U1 = (UNIT) (SEAT) (DO81 (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)!(ADDRESS)!(TELEPHONE! (EMS) (HOSPITAL) 3 3 10 / U1 1 D / / 1 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z u 1 ® 11 1 81 ,12 /26 06 54 ®AM in a Work Zone? ®N DIRP co 1 t PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 1 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 C) 2 0 28 03 81 /12 /26 06 54 ®PM ❑Const action >E R 0 gi CITATIONS ISSUED ❑PENDING SECTION CITATION NO. EMS ARRIVED TIME 1 3 ❑AM ❑Maintenance U2 a ❑ 11 1 ARREST NAME Tinajero. Irene 11-601-Ax 489000577 81 /J2 /26 06 57 Igi PM SLMT o N ❑CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME 0 AM - • El Utility t 2 El1 1 1 ARREST NAME 81 /12 /26 07 19 ®PM ElUnknown work zone type U1 35 2 2 3 El ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 35 489-Reynolds.Allison 500 91 / 51 /026 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 -< ` ` ' ' r INDICATE NORTH combination):or pI BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C i_ L I I t Sccle } (example:shuttle or charter bus):or �airm I r 3. Is desgned to car 15 or fewer ssen ers and o rated a contract carrier O I } } } transporting employees in the courses of their employment(example:employee 73 v transporter-usually a van type vehicle or passenger car):or w L L.___a____� 4. Is used ordesi natedtotrans rtbetween9and15 ge ng N g } } } g po ssen rs,includi [he driver, I f for direct compensation(example:large van used fors specific purpose):or O 1 n l. l. I 1 t 5. Is any vehicle used to transport anyhazardous material(HAZMAT) m placarding(example:placards will be displayed on the vehicle). ;p . 1 - I CARRIER NAME Z I ADDRESS O I C) CITY/STATE/ZIP g - i. i. i.1 MOTOR CARR.ID 0 Interstate 0 Intrastate 0 I I T I ❑ Not in Comm./Govt. 0 Not in Comm./Other I-'--- ----4 - USDOT NO. ILCC NO. m XI Source of above z IDOT PERMIT NO. WIDELOAD"; ❑Yes 0 No = TRAILER VIN 1 m to 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 White Maroon u 1 TOWED • TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT- 3 TOWED BY/TO. Redmons/Impound Lot Garage . SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® DISABLING DAMAGE Redmons/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE