Loading...
HomeMy WebLinkAbout2026-00047495 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 I0110111 flU 1111 ff1 101 11011 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X004337435 u, 1 U21 3 4 1 U1 7 U2 1 u, 1 1_12 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 0 A No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 2 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash 0 AMENDED YR 2026I 2026-00047495 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 �I N RANDALL RD El In06:08 ® ❑ RELATED ❑Y ®N 08 07 2026 12,— ❑YES ®NO U1 -< _ _ g PRIVATE mo !day/yr ®PM FLOW CONDITION MFTlMI N E S W HOLM ES RD COUNTY PROPERTY ❑Y ® N DOORING ❑y #OFMOTOR 0 SLOW 15 u) ❑ Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD 0 STOPPED U2 —I CO AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST IZI N ® FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NIAV 0 NCv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N O4 n 0 4 / yr Honda CRV 2013 00-NONE ©, Q DUE TO CRASH ® ❑ NAME(LAST,FIRST,M) O3-UNDER CARRIAGE } FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) O O DISTRACTED 0 ]$a U2 04 <<T1 F 2 5 15-OTHER ❑Y ®N SYSTEM ❑UNK VEH. O AT CRASHO O 99-UNKNOWN 9 16•TOP 3 ,Distraction Value ALGN = r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s_:iL B 4 COM VEH 0 j$J 1 0 F. FIRST CONTACT 12 7_ —,__5 *II Yes.See Sidebar U1 Z Crystal Lake IL 60014 0 1 0 FB85214 IL 2027 REAR TELEPHONE IL D 0 5J6RM4H70DL028724 Geico ❑Y ®N U2 I' in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 Novalinski. Daniel 622414678 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF`Y' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y ® N 2 eu Eg DRIVER ❑ PARKED 0 DRIVERLESS ❑ FED ❑PEDAL 0 EWES 0 Nuv 0 NCv 0 Dv CIRCLE NUMBER(S) U1 !1 9 yf 4 Honda HR-V 2024 100 3-NONE 'o,� 12 c,-2 FIRE DUE o CRASH 0 ® U2 2 C o 13-UNDER CARRIAGE c F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9.1,6•TOP 3 X ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN `Oistraelion Value 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8 1 S .t. 4 COM VEH D ® Ut CO FIRST CONTACT 6 O7 ,�=Q)OS •If Yes,See Sidebar C 60110 0 1 0 FF20597 IL 2026 aR 0 Si) IL D 0 3CZRZ2H75RM772606 WEST BEND ❑Y ®N RDEF71 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER 1 = 99 9 Same HHA540043824 BAC $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPONDER u1 = (UNIT) (SEAT) (DOBI (SEX) {SAFT) (AIR) (INJI 1(EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)!(ADDRESS)!(TELEPHONEI (EMS) (HOSPITAL) 1 6 04 / ' D / / 1 0 EV MOST EVNT LOG DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z N 1 ® 11 4 08,07 l2026 06 10 ®pm 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 s, 0 2 ❑ 28 03 ! ! ❑PM ❑Construction >E Z 3 ❑ 1!>I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 1 ❑AM ❑Maintenance U2 4 1 ® 11 4 ARREST NAME Novalinski.Amy. B. 11-601 1569000128 / ! El PM SLMT ci.o Nu ❑CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • El Utility 45 t 2 ARREST NAME AM 7 1 / ❑❑PM ❑Unknown work zone type U1 El OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 ❑ ❑AM Workers present? ❑Y 45 1569 Jaimes.Julian 900 , / ❑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••--, , i I i ,� A CMV is defined as any motor vehicle used to transport passengers or property and: Z �____r____; I I I ill _ I 1. Hasatbnighr more thanpounds(example:truckortrucktrailer 1. Hasa rating10,000 � -< INDICATE NORTH p3 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C —_ —_ - } (example:shuttle or charter bus):or X 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 73 transporter-usually a van type vehicle or passenger car):or w I. L.___a__ 4. Is used ordesi natedtotrans rtbetween9and15 passengers,including y — — — — - } } } for direct compensation(example:large van used for specificpurpose):or [he driver, Pe ( P 9 Pe or 0 li , .. I I 5. Is anyvehicle used to transport anyhazardous material(HAZMAT)that requires Hamrrtaw I placarding(example:placards will be displayed on the vehicle). XICARRIER NAME XI ADDRESS D to �3 I CITY/STATE/ZIP L Not To Scale I - MOTOR CARR.ID 0 Interstate 0 Intrastate �'`�'- ❑ Not in Comm./Govt. ❑ Not in Comm./Other 0 --- - unn t - USDOT NO. ILCC NO. m XI Source of above z 0 Yes 0 No ❑ Unknown A 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' T TRAILER 1 ❑ ❑ 0 Z TRAILER 2 ❑ 0 0 O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. Z Bronze Silver 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 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY1T6 DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE