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HomeMy WebLinkAbout2026-00049560 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 0110 II I111111101111111II 1111 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X004345788 u, 9 U21 3 4 1 U1 7 U2 1 U,99 1_12 1 U1 99 U2 1 1 11 U1 1 U2 1 *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 El$501-$1.500 ❑ON SCENE 3 VEHICLE/PROPERTY El OVER$1,500 El NOT ON SCENE(DESK REPORT) El AMENDED ❑ B Injury and for Tow Due To Crash YR 202612026-00049560 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME LILLIAN ST Elgin03: SECONDARY CRASH 15 ® ❑ RELATED ❑Y ®N 08 16 2026 DAM ❑YES ®NO U1 10 _ _ PRIVATE mo /day/yr ®PM FLOW CONDITION m FT N E S W S MCLEAN BLVD COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR El SLOW 1 cn ❑ Kane HIT&RUN ®Y ❑ N WITH VEHICLES INVLD ® STOPPED U2 —I Igi AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST IZI N ❑ FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uuv 0!CV 0 ov DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 FOR DAMAGEDAREA(S) MOM TOWED U1 0 Unknown / / Honda Odyssey 2005 00-NONE ©t ,z OUETOCRASH ❑ VI NAME(LAST,FIRST,M) mo yr 13-UNDER CARRIAGE 10,I ! 2 FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED U2 4 < U 1 3 SYSTEM IN O ENGAGED 0 15-OTHER 9 76.TOP 3 ❑ _ ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN `Distraction Value ALGN r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s, iI 6 1�.4 C.OM VEH ❑ 0 1 0 12 0 1 FIRST CONTACT 7_;___5 *uYes.SeeSidebar Ut0 Z H113528 IL 2025 E TELEPHONE . STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED 1 1/ 5FNRL38795B097922 NIA ®Y ❑N U2 m 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 Garnica.Gregorio NIA 1 rn `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER RESPONDER 99 t, g DRIVER ❑ PARKED 0 DRIVERLESS ❑ PED 0 PEDAL ❑EWES 0 uv 0 N v 0 Dv BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) U1 m m FOR DAMAGEDAREA(S) FRO TOWED Y N ' NAME(LAST,FIRST,M) Lagerstrom, Rhonda, L. 0 8 ! / Yr FRONT TOWED!1 9 6 4 Chevrolet Impala 2010 00-NONE 'o,� t2 c,�2 FIRE TO CRASH ®® U2 2 cXj o mo 13-UNDER CARRIAGE0 c F 2 3 SYSTEM IN 0 ENGAGED 0 15-OTHER 9.16-TOP 3 X ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN `Distracion Value 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8 1 6 .I. 4 COM VEH ❑ ® Ut CO FIRST CONTACT 6 O7 ,�=Q)OS •IfYes.See Sidebar C ELGIN IL 60123 0 1 0 LK1H2R MO aR 0 fn Z IL 0 2G 1 WB5EK6A1150639 State Farm ❑Y ®N RDEF M EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X 99 9 Same 1658766-SFP-25 BAc $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPONDER ut = KNIT) (SEAT) (DOB) (SEX) {SART) (AIR) (INJI (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 0 Y U2 Z N 1 ® 11 1 08 r 16 /2026 03 12 ®PM in a Work Zone? ®N DIRP co 1 t PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 7 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 � 2 ❑ 03 03 N 3 ❑ 0 CITATIONS ISSUED 0 PENDING • + / 0 PM• ❑Construction SECTION CITATION NO. EMS ARRIVED TIME ❑AM ❑Maintenance U2 7 —a, ARREST NAME ! / ID PM ' oN ® 11 1 ❑ •CITATIONS ISSUED 0 PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ❑Utility SLMT t 2 ❑ ARREST NAME AM 7 r 1 ❑❑PM ❑Unknown work zone type U1 n OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 0 ❑AM Workers present? ❑Y 30 471-Evans, Lakysha 701 275-Engelke r / ❑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---•r••--, , A CMV is defined as any motor vehicle used to transport passengers or property and: Z -,1 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer -< `-----I-----' .'1 - ` INDICATE NORTH combination):or -I BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C i_ m - } • (example:shuttle or charter bus):or C) I I I R 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- y a van type L L.___a.._.� 4alsnosedordestlnatedto ransehrtbetweeicle or n9 and r15r) ssen rs,indudingthedrrver, C 1 • } • for direct compensation(examp large van used for specific purpose):or 0 .a .I. _ \ ""' unl2 i. • i. ,_ 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m rt � placarding(example:placards will be displayed on the vehicle). XI ;r Q s CARRIER NAME —I \ ADDRESS 0'� 1 i umema T. i a ! CITY/STATE/ZIP 0 MOTOR CARR.ID 0 Interstate 0 Intrastate I I T I ❑ Not in Comm./Govt. 0 Not in Comm./Other r • USDOT NO. ILCC NO. rn Source of above z . xi 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 v TRAILER WIDTH(S) 0-96" 97-102" >102' m TRAILER 1 ❑ ❑ 0 Z TRAILER 2 ❑ 0 0 O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. Z Blue,Dark White u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT 9 TOWED BY/TO: _ . SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY/TO. DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE