Loading...
HomeMy WebLinkAbout2026-00050425 ILLINOIS TRAFFIC CRASH REPORT sheet 1 Of 4 Sheets 11111110 lIII I01110 1111DM IIIIIII III IIIIII DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV XS536 u, 1 U21 2 4 1 u, 2 U2 1 u, 1 u2 1 u, 1 U2 1 5 11 u1 1 U2 1 *P 0 1 1 9 INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW ' DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away Elgin Police Department ONE PERSON'S 1215501-$1.500 ®ON SCENE 1 VEHICLE/PROPERTY ❑OVER$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash El AMENDED YR 202612026-00050425 VERY ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 71 CORRON RD Elgin® ❑ RELATED ®Y 0 N 08 20 2026 11:58 12— ❑YES El NO U1 g PRIVATE mo /day/yr ®PM FLOW CONDITION m FT N E S W MCDONALD RD COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR El SLOW 15 u) ❑ Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD ❑ STOPPED U2 —I ® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uuv 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 C) FOR DAMAGEDAREA(S) FRONT TOWED U1 0Kor a. Edyta 0 9 / yr 13-UNDER CARRIAGE ©,I ,•: FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 2O m F 2 SY 15-OTHER 4 ❑Y ®SNE❑UNK VEH. O AT CRASIN H O 99-UNKNOWN 916•TOP 3 `Distraction Value 9 ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF & it S 4 COM VEH 0 j$J 1 C) F. FIRST CONTACT 12 7__,--_,__S *II Ves.See Sidebar U1 0 V Z SAINT CHARLES IL 60175 0 1 0 Z893969 IL 2027 REAR TELEPHONE IL D 5J8TB4H52GL017424 MERCURY INSURANCE ❑Y ®N U2 Rr'I in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m PALCZAK. MICHAEL ILAP0000032079 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER RESPONDER 2 XI p; DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EWES 0 /1 9 5 9 Chevrolet Blazer 2024 00-NONE i1_"j t2�"_, DUE TO CRASH rg ❑ 2 x oy yr 13-UNDER CARRIAGE 10'I c. 2 FIRE ❑ ® U2 C F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9,16-TOP 3 X ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN *Oistraellon Value 9 POINT OF 8 i 4 COM VEH ❑ ® u1 CO N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR 5 FIRST CONTACT 6 O7 ,�=QI,OS C. If Yes.See Sidebar C SAINT CHARLES IL 60175 0 1 0 GB42782 IL 2027aR0 fp Z IL D 3GNKBCR49RS142290 STATE FARM ❑Y ®N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X Same 0583194SFP-LS BAC $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPONDER u1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)1(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 08,20 l2026 11 58 ®AM in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 5 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 C) 0 2 ❑ 23 99 ) ! ❑PM ❑Construction * " 3 0 $I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 5 ❑AM ❑Maintenance U2 o1 ® 11 1 ARREST NAME Korga. Edyta 11-1204-B 1517000614 ! ! El PM SLMT o N Iffi CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • ❑Utility AM 50 r 2 0 ARREST NAME Korga. Edyta 11-601-Ax 1517000613 1 ! 0 pM ElUnknown work zone type U1 2 2 3 ❑ OFFICER ID SIGNATURE BEAT!DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑y 50 1517-Le Cates. Brittany 800 341-Cox 09 , 15,2026 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 I ADDITIONAL UNITS FORMS. r ----r••--, , - ; A CMV is defined as any motor vehicle used to transport passengers or property and: Z i°_r 1 , 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer -< ` ' ' 1 r INDICATE NORTH combination):or N BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C (example:shuttle or charter bus):or n terL2.44 _ 1 I 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 transporter-usually a van type vehicle or passenger car):or w L i. __}----; - I. } } 1 •4. Is used or designated to transport between 9 and 15 passengers,including the driver, N for direct compensation(example:large van used for specific purpose):or L L____a____� t b ;. '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 raomirnawa,,Epn _ CARRIER NAME MB a ADDRESS O T. T1 I r CITY/STATE/ZIP Intrastate g MOTOR CARR.ID ❑ Interstate ❑ I I T I ❑ Not in Comm./Gout. Not in Comm./Other ILCC NO.--- -'� USDOT NO. mx Source of above z . Form Number 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' -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 Gray u 1 TOWED • TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT 3 TOWED BY/TO. Redmons/Impound Lot Garage . SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® DISABLING DAMAGE Redmons/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE