HomeMy WebLinkAbout2026-00048991 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 Df 6 Sheets 01111101111 10110 II I
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DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X004343355
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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 2
VEHICLE/PROPERTY ®OVER 61,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash
0 AMENDED YR 2026I 2026-00048991 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 2
® ❑ RELATED 0 Y ®N 08 14 2026 ❑AM ❑YES ®NO U1 -<
771 N STATE ST Elgin PRIVATE mo /day/yr 12:42 ®PM FLOW CONDITION m
•
ONO,/MI O E S W N STATE ST/FRAZI ER AVE COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ®SLOW 15 Cn
Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD ❑ STOPPED U2 —I
0 AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ❑ FREE FLOW # LNS 0
g DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EWES ❑uuv ❑!CV ❑Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 0
FRONT TOWED U1 Q
NAME(LAST,FIRST,M) Webb. Ian. P. mo General Motort500 2009 00-NONE ,1 . O i_, DUE TOCRASH ❑
EN
13-UNDER CARRIAGE 10 , 2 FIRE 0
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ID0 U2 4 rn
M 2 4 ❑Y SYSTEM IN ENGAGED 15-OTHER 9 76-TOP 3 _
❑N ❑UNK VEH. AT CRASH 99-UNKNOWN `Distraction Value ALGN
T. CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR
F. POINT OF 6 ;:iI 6 4 COM VEH 0 Ea 1 0
FIRST CONTACT 12 7_ , ,__5 *IfYes.See Sidebar U1
Z WEST DUNDEE IL 60118 0 1 0 3062784B IL 2026 REAR
TELEPHONE
IL D 2GTEK29J991128391 Pioneer Specialty Insuran ❑Y ®N U2 m
in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
Elgin Fire Coachman's CCR 05CPP135133401 1 rn
`o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER
RESPONDER
98
g DRIVER ❑ PARKED ❑DRIVERLESS 0 FED ❑PEDAL ❑EWES ❑lily 0 i v ❑Dv
Yr 1 9 6 0 NT Honda Pilot 2006 00-NONE 11_"j Q1,-_, DUE TO CRASH rg ❑ 2 x
o 13-UNDER CARRIAGE 1U) I.. 2 FIRE 0 El U2 C
M 2 5 ❑Y SYSTEM IN ENGAGED 15-OTHER 9 16-TOP 3 3 X
❑N DUNK VEH. AT CRASH 99-UNKNOWN *Oistracton Value
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8
i-II 5 i' 4 COM VEH ❑ ® Ut CO
FIRST CONTACT 6 Y__{_O ._5 •If See Sidebar
Z
n PINGREE GROVE IL 60140 0 1 0 EF74131 IL 2026REAR
IL D 5FNYF18176B021281 State Farm Insurance ❑Y ®N RDEF P3
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 =
Elgin Fire Same 0996468SFP13 BAC
E
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 <
Refused RESPONDER
ui =
(UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)/(ADDRESS)/(TELEPHONE) (EMS) (HOSPITAL)
1 0
EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z
N 1 ® 11 1 08/14 /2026 12 42 ®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 �
✓ 2 28 99 08/14 /2026 12 43 mi pnA ❑Construction
1
R O 0 gi CITATIONS ISSUED El PENDING SECTION CITATION NO. EMS ARRIVED TIME 1
3 ❑AM 0 Maintenance U2
— ® , ❑Utility a, ARREST NAME Webb, Ian, P. 11-601 298001425 08/14/2026 12 45 Igi pM
o1 SLMT
U 11 1 CITATIONS ISSUED PENDING
o N SECTION CITATION NO. ROAD CLEARANCE TIME AM y
' 2 El 11 1 ARREST NAME 08/14 /2026 01 45 ®PM 0 Unknown work zone type U1 30
2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 0 AM Workers present? ❑Y 30
298-Lopez, Mirko 501 09 /08/2026 01 30 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
ADDITIONAL UNITS FORMS.
r ----r••--, , I 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- }-- --I-- --' I • INDICATE NORTH comb rtatbn)or
BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver —I
,L _ } (example:shuttle or charter bus):or 0
0
�', 771?N.?SI ?St. 3. Is designed to carry 15 or fewer passengers and operated a contract carrier O
I- A '- - -- ,
} } transporting employees In the course of their employment(example:employee
'm. } transporter-usually a van type vehicle or passenger car):or w
L L.___a____.l 1:: 4. Is used or designated to transport between9and1�ssen rs,includingthedriver, y
Not To Scale j } } } for direct compensation(example:large van used fors cific purpose):or O
L L-. ..i.. -.. S. _ i } } 5. Is anyvehicle used to transport anyhazardous material(HAZMAT)that requires m
I !" placarding(example:placards will be displayed on the vehicle). XI
CARRIER NAME
f z' P9McP71e1Ynpact-- ADDRESS 0
B, rn
, O
CITY/STATE/ZIP g
_ MOTOR CARR.ID 0 Interstate 0 Intrastate
. I . . I I ❑ Not in Comm./Govt. 0 Not in Comm./Other
0
USDOT NO. ILCC NO. C
XI
Source of above z
. IDOT PERMIT NO. WIDELOAD-; ❑Yes 0 No 2
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 Black
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 TOWED DISABLING DAMAGE NOT DAMAGE EXTENT: 3 TOWED BY/TO:
DUE TO ® DISABLING DAMAGE Other/Owners Residence VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE