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HomeMy WebLinkAbout2026-00049253 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets Mill III H IIII 10111 01111DM IflIl II 1lfllIIl DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X0043406 4- u, 9 U21 1 1 8 U116 U2 1 U, 1 u2 1 U, 1 u2 1 1 11 U1 1 U211 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY ❑$500 OR LESS TYPE OF REPORT ® q No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW ' Elgin Police Department ONE PERSON'S El5501-51.500 ®ON SCENE 1 VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) El AMENDED ❑ B Injury and/or Tow Due To Crash YR 202612026-00049253 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 m® ❑ RELATED 0 Y ®N 08 15 2026 ❑AM ❑YES E)PRIVATE NO U1 S RANDALL RD Elgin mo /day/yr 05:45 ®PM FLOW CONDITION m _ COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ®SLOW 15 u) 025co/MI N E O W South St WITH VEHICLES INVLD El STOPPED U2 —I El AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) Kane HIT&RUN I2J Y ElN PEDALCYCLIST®N ❑ FREE FLOW # LNS 0 tg:DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uuv 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 n FOR DAMAGEDAREA(S) FROM TOWED U1 O Mc Elhine Daniel.C. 1 2 / yr 13-UNDER CARRIAGE ©,I :: FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0U2 2 m M 9 SYTM 4 ❑Y ®SNE DUNK VEH. O AT CRASH 0 99-UNK 15- NOWN THER9 16•TOP 3 `Distraction Value 7 ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s, ii_6 I,.4 COM VEH 0 El 1 0 ~ ELGIN I N I L 60123 0 1 0 FIRST CONTACT 12 7 ; _5 *II Yes.See Sidebar Ut Z E226707 IL 2026 REAR TELEPHONE IL D 0 5N1AT2MV8FC774769 Progressive ❑Y IglN U2 I' in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 Same 996320932 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y El 2 As N DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EWES 0 iiuv 0 iv 0 DV '1 9 yf 8 Mitsubishi Outlander 2023 00-NONE 'o,� 12 (,-2 FIRE DUE D CRASH ® U2 2 C o 13-UNDER CARRIAGE El c F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9.1,6•TOP 3 X ❑Y i N ❑UNK VEH. AT CRASH 99-UNKNOWN t *Oistraclion Value 9 0 POINT OF 8 It Ut COM VEH ID El CO 4 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR 6 Im FIRST CONTACT 7 Q _,L_5 •IfYes.See Sidebar Streamwood IL 60107 0 1 0 E204995 IL 2026 I 0 Z M IL D 0 JA4ATWAA5PZ006799 Allstate ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X 99 9 Same 811426827 BAc $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPONDER U1 = (UNIT) (SEAT) (DM (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)1(A.DDRESS)/(TELEPHONE! (EMS) (HOSPITAL) 2 3 04 / :A / / UI 1 D / / 2 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z N 1 ® 11 1 8/ ,5/ /026 05 48 ®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 o" 2 ❑ 28 18 / / ❑PM- ❑Construction R 3 ❑ $I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 1 ❑AM ❑Maintenance U2 a1 ® 11 1 ARREST NAME Mc Elhiney. Daniel.C. 11-601 S1542-000993 / / El PM SLMT S' N ❑CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME 0 Utility 0 AM T 2 El ARREST NAME 81 /5/ /026 05 45 ®PM El Unknown work zone type U1 45 2 2 3 IDOFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 45 1542-Chase. Ethan 702 393-Gutierrez 9/ , 5/ /026 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 0 ADDITIONAL UNITS FORMS. r ----r••--, , ; A CMV is defined as any motor vehicle used to transport passengers or property and: Z II Not To Softie I 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer -< } }--- -----; 1 1 N combination):or —I ii M I I l INDICATE NORTH p0 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C 4 - (example:shuttle or charter bus):or 0 L t_ -A- - r l ‘ ‘4 1 l 1 l 1 I I t3ra. nsporting edmployeeslin5 hecourseeo theire rsmployment exam pal e:employeener X transporter-usually a van type vehicle or passenger car):or CO I. 4. Is used or designated to transport between 9 and 15 passengers,including N}--- ----+ -� - } } } g po passen rs,includi the driver, i for direct compensation(example:large van used for specific purpose):or L____a____. I � t 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires —\ ti- t I t :0 placarding(example:placards will be displayed on the vehicle). m CARRIER NAME Z i I ADDRESS 'n T. iCITY/STATE/ZIP g ..jI _ MOTOR CARR.ID 0 Interstate 0 Intrastate I r I ❑ Not in Comm./Govt. Not in Comm./Other 00 r r -Y- I I USDOT NO I - r . ILCC NO. m t I XI Source of above z . If Yes,Name on placard 0 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 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 Silver Blue 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