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HomeMy WebLinkAbout2026-00048349 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 01111101111 IIIIII II II I flU 1111 ilU 11101 lU 0 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X004337424 u, 1 U21 1 1 1 U1 7 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 ® q No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW ' Elgin Police Department ONE PERSON'S ❑$501-$1.500 ®ON SCENE 1 VEHICLE/PROPERTY ®OVER 51,500 ❑NOT ON SCENE(DESK REPORT) ❑AMENDED ❑ B Injury and for Tow Due To Crash YR 202612026-00048349 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 �I ® ❑ RELATED ❑Y ®N 08 11 2026 ❑AM ❑YES ®NO U1 -< S RANDALL RD Elgin05:39 _ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION III 1 O !MI N E S W HO S Rd COUNTY PROPERTY 0 Y ® N DOORING ❑y #OF MOTOR 0 SLOW 15 u) ® pp Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD 0 STOPPED U2 —I 0 AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uuv 0 Ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 0 0 5 / yr 13-UNDER CARRIAGE ©, EN I :: FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL)THERDISTRACTED 0 0 U2 4 rn F 2 4 SYTM❑Y ®S NE❑UNK VEH. 0 AT CRASH 0 15-99-UNKNOWN 9 16•TOP 3 *Distraction Value ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s, it B _5 *IrYes.See Sidebar Ut 4 COM VEH 0 Ea 1 0 F. FIRST CONTACT 12 7 ,_ Z Wheaton IL 60189 0 1 0 FE57781 IL 2027 Is TELEPHONE IL D 0 JM3KFBDM9J0351837 State Farm ❑Y Igl N U2 m 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m South Elgin Fire 99 9 Same 1161695-SFP-13 1 r o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y El 2 0 p; DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 i uv 0 Ncv 0 DV !1 9 9 4 Chevrolet Trax 2024 00-NONE 0. Q!'-O DUE TO CRASH ❑ El 2 x 0 Yr 13-UNDER CARRIAGE 10( I 2 FIRE 0 ® U2 C c F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9,16-TOP 3 X ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN *Distraction Value 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 5 1 S .I. 4 COM VEH ❑ ® Ut CO F,,, FIRST CONTACT 6 O7 ,�=Q)OS •IfYes.See Sidebar C ELGIN IL 60123 0 1 0 EJ39064 IL 2027 IAR 0 N IL D 0 KL77LFE27RC180587 Magnum Insurance ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = South Elgin Fire 99 9 Andres. Matthew.J. ILAA-0971450-02 BAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP U1 = (UNIT) (SEAT) (DOS) (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)/(ADDRESS))(TELEPHONE) (EMS) (HOSPITAL) 1 4 01 / M 13 4 0 1 0 U2 996 m / / ##occs > 71 / / UI 2 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 , 11 ,026 05 39 ®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 ❑ 28 03 81 ,11 ,026 05 51 ®pM ❑Construction R 3 ❑ ]$I CITATIONS ISSUED El SECTION CITATION NO. EMS ARRIVED TIME 1 z J ❑AM ❑Maintenance U2 o ® 11 1 ARREST NAME Ferguson.Susan. D. 11-601-Ax 489000579 81 /11 /026 05 58 ®pM SLMT o 45 N ❑CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • ❑Utility t 2 ❑ 11 1 ARREST NAME AM 7 / ! ❑❑pM ❑Unknown work zone type U1 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 45 489-Reynolds.Allison 700 91 , 51 /026 09 00 0 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 I ® ADDITIONAL UNITS FORMS. r ----r••--, , - [._ ; A CMV is defined as any motor vehicle used to transport passengers or property and: > I I H,r„a,,,,.I z r 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer -< ——— —.— ——— combination):or r ----r----, - r INDICATE NORTH -1 , ,- 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 X rter- < <.___a____.1 . 4alsuosedordestlnatedtotrans vehicle rtbetween9andr15r) ssen rs,including[hedriver, C } } } for direct compensation(examp large van used for specific purpose):or L i i. i i. , 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m placarding(example:placards will be displayed on the vehicle). XI —1 CARRIER NAME Z ADDRESS 0 D u. O CITY/STATE/ZIP g :- :- l MOTOR CARR.ID 0 Interstate ElIntrastate I I T ❑ Not in Comm./Govt. Not in Comm./Other i— --- --4 USDOT NO. ILCC NO. m XI Source of above z . IDOT PERMIT NO. WIDELOADo ❑Yes 0 No = 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 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 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/TO. DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE