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HomeMy WebLinkAbout2026-00047528 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 10110 II I flU 1111�1011000 HI DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X37. u, 9 U21 1 1 1 u, 2 U2 1 U1 99 1_12 1 u,99 U2 1 4 12 u, 13 U2 1 *P 0119 INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW ' DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT ® A No Injury 1 Drive Away Elgin Police Department ONE PERSON'S ❑$501-$1.500 ❑ON SCENE 1 VEHICLE/PROPERTY ®OVER$1,500 ®NOT ON SCENE(DESK REPORT) ❑AMENDED ❑ B Injury and f or Tow Due To Crash YR 202612026-00047528 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 99 71 ® ❑ RELATED ' ' 0 N 08 07 2026 DAM ❑YES ®NO U1 -< RT20 EB Elgin07:00 _ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION m FT!MI N E S W GRACE ENT RAMP COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR IR SLOW 1 (n ❑ Kane HIT&RUN ®Y ❑ N WITH VEHICLES INVLD 0 STOPPED U2 --I ® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ❑ FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EDUCE 0 NOV 0!CV ❑ov DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 02 8 FOR DAMAGEDAREA(S) FROM TOWED U1 Unknown,0. ! ! Unknown Unknown 00-NONE ©, 12 , DUE TOCRASH ❑ VI E NAME(LAST,FIRST,M) mo yr 13-UNDER CARRIAGE IE 10.I !�. 2 FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ® 0 U2 02 m SYSTEM IN ENGAGED 15-OTHER 9 16.TOP 3 9 9 ❑Y ❑N ❑UNK VEH. AT CRASH 99-UNKNOWN `Distraction Value 9 ALGN 2 s 4 COM VEH 0 0 'a- CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF I�S Ii,_ 1 I- 0 9 0 FIRST CONTACT 11 7_: _5 *IIYes.See&debar U1 0 REAR 2 Z ' E TELEPHONE . STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED 1 11/ unknown ❑Y 0 N U2 I— in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 Same unknown 1 rn `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused 0 Y El 99 0 E{ DRIVER ❑ PARKED ❑DRIVERLESS 0 PEO ❑PEOAL 0 EWES ❑ uv 0 NOV ❑Dv !1 9 5 2 Chrysler 300 2021 00-NONE ,._"1 QI,O DUE TO CRASH ❑ Cg 2 73 0Yr 13-UNDER CARRIAGE 10 i I. E FIRE ❑ ® U2 C c M 2 4 SYSTEM IN 9 ENGAGED 9 15-OTHER 9 16.TOP 3 X ❑Y ❑N ®UNK VEH. AT CRASH 99-UNKNOWN `0istracton Value 9 0 POINT OF 8 I I' 4 COM VEH 0 ® U1 W N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR FIRST CONTACT 12 Y :� s l`...S •If Yes.See Sidebar C ZChicago IL 60649 0 1 0 CM89662 IL 2027 REAR 0 Si) Z IL D 0 2C3CCARG 1 M H537525 Rental Car Coverage ❑Y ®N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER 1 = 99 9 Myles Ahead Rental JWNM-YVC2-ins SAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP u1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)!(ADDRESS)/(TELEPHONE) (EMS) (HOSPITAL) U2 996 r m ##occs y 71 / ,, U1 1 D / 01 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 08,07 /2026 09 18 ®PM 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 0 04 20 N 3 ❑ ❑CITATIONS ISSUED 0 PENDING + ! ❑PM• 0 Construction SECTION CITATION NO. EMS ARRIVED TIME ❑AM ❑Maintenance U2 3 -a, u ARREST NAME / / _ 0 PM ' 1 ® 1 1 1UtilitySIMT S' SECTION CITATION NO. ROAD CLEARANCE TIME 0 ❑CITATIONS ISSUED PENDING DI AM t 2 ElARREST NAME 08/07 12026 07 00 ®PM 0 Unknown work zone type U1 30 n 7 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 0 - ❑AM Workers present? ❑Y 30 1567 Muehl,Claudia 401 , / ❑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 .Z-1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C 8119m7213 _ } (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 X transporter-usually a van type vehicle or passenger car):or w L L.___a__._� 4. Is used ordesi natedtotrans rtbetween9and15 passengers,including C } } for direct compensation(example:large van used for specificpurpose):or [he driver, Pe ( P 9 Pe or O i _ 5. Is any vehicle used to transport anyhazardous material(HAZMAT)that requires -U a placarding(example:placards will be displayed on the vehicle). N WWI D CARRIER NAME —I Z ADDRESS Not To Scale D v) C) CITY/STATE/ZIP g MOTOR CARR.ID 0 Interstate 0 Intrastate I I T I ❑ Not in Comm./Govt. 0 Not in Comm./Other ‘I. - --1 - USDOT NO. ILCC NO. m XI Source of above z ) 0 Yes II 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' -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 u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT' 2 TOWED BY/TO: _ . SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 DUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/T6 DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE