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HomeMy WebLinkAbout2026-00048284 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 6 Sheets 01111101111 10110 II I 11111I11100OOI� II111I100 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X0D4337331 u, 1 U2 1 1 1 U, 8 U2 U,99 1_12 U, 1 U2 1 1 9 U1 19 U221 *P 0119* INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW ' DAMAGE TO ANY El$500 OR LESS TYPE OF REPORT ® A No Injury 1 Drive Away Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 1 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) 0 AMENDED ❑ B Injury and/or Tow Due To Crash YR 202612026-00048284 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 3 m BLUFF CITY BLVD Elgin ® ❑ RELATED ' ' 0 N 08 11 2026 ❑AM ❑YES ®NO U1 —< PRIVATE mo /day/yr 01:53 ®PM FLOW CONDITION M_ 0(� COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 2 rn 01 �C.7!MI N E S © Illinois Ave WITH VEHICLESOT, INVLD ® STOPPED U2 --I 0 AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) Cook HIT&RUN IZ Y ❑ N PEDALCYCLIST®N ❑ FREE FLOW # LNS 0 gi DRIVER p PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NW 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 n 0 9 / yr 13-UNDER CARRIAGE .) FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 10 h O DISTRACTED 0 0 U2 EN IE2 m M 2 SYTHER 4 ❑Y ❑SNEM®UNK VEH. 9 AT CRASH IN ENGAGED 9 99-UNKNOWNU 9 16-TOP 3 ,Distraction Value ALGN = r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF $ it s jl COM VEH 0 Ea 1 0 H F. BARTLETT I L 60103 0 1 0 FIRST CONTACT 2 r: __s *IIYes.See Sidebar U1 ZBZ85329 IL 2027 Isui TELEPHONE AR D 0 2C4RC1 L73NR134947 None ❑Y ®N U2 m B EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 Tripamer. Brian None 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER 2 §, p DRIVER I} PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 yr Chevrolet Avalanche 2007 00-NONE O"Oi, t2..-_, DUE TO CRASH ❑ ® 1 a7 .. 13-UNDER CARRIAGE I c 2 FIRE 0 El U2 C c SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 ® SPDR n SYSTEM IN 9 ENGAGED 9 15-OTHER 9.16-TOP 3 9 a ❑Y ❑N ®UNK VEH. AT CRASH 99-UNKNOWN *Oistracton Value POINT OF 8 it A -4ut N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR FIRST CONTACT 1 O 7�='+��=5 COM•IesVSee Sidebar❑ ® CO ~ 2525558B IL 2027 I0 M . STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0 3G N FK12367G 120545 Progressive 0 V ®N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = 99 9 Williamson.Craig. L. 949973481 BAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP U1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJI (EJCTI (EPTH) PASSENGERS&WITNESS ONLY (NAME)/(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL) 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 18 1 08/11 /2026 01 53 ®FM in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 7 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 0 2 20 18 1 / ❑PM- 0 Construction * 7 Z 3 0 DygCITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME ❑AM 0 Maintenance U2 o ® 11 1 ARREST NAME Tripamer. Brian. E. 11-601 1560-623 / / El PM SLMT l$!CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME AM• 0 Utility t 2 0 ARREST NAME Tripamer. Brian. E. 11-404-A 1560-621 08/11 /2026 01 53 ®PM ❑Unknown work zone type U1 30 2 2 3 0 OFFICER ID SIGNATURE BEAT!DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 30 1560-Jones. Bennett 401 275-Engelke 09 ,01 /2026 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 -< ` ` --I -' r INDICATE NORTH combination):or -I BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C _ } (example:shuttle or charter bus):or X I I ( L Is designed pl carry15 or fewer passengers their and operated a contract carrier 0 Not To state J I Jtransporting employees employment(example:employee N I } } } gem to ee in the course�of their � eemclytrwe transporter-usually a van type vehicle or passenger car):or w <.___A -1 UMW/2 4. Is used ordesi natedtotrans transport 15 passengers,including y} } } g po passen rs,includi the driver, UM for direct compensation(example:large van used for specific purpose):or o t i � 5. Is any vehicle used to transport any hazardous material(HAZMA th equir m —— —Wilkie dapped In trelllo—�1 placarding(example:placards will be displayed on the vehicle). XI - . 1 f CARRIER NAME Z i1r .711 ADDRESS O V) () CITY/STATE/ZIP g MOTOR CARR.ID 0 Interstate 0 Intrastate 0 1 I r 1 ❑ Not in Comm./Govt. 0 Not in Comm./Other ; _Y_ __1 - USDOT NO. ILCC NO. m 73 Source of above z . If Yes,Name on placard O 4 digit UN NO. 1 digit Hazard class No. Xl Xl Did HAZMAT spill from vehicle(do NOT consider FUEL from vehicle's 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 Bronze 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 2 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/TO. DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE