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HomeMy WebLinkAbout2026-00050976 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 01111101111 I0110 II I OH IIH 01111111111111 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X004351347` u, 1 U21 2 4 1 U, 3 U2 1 U, 1 u2 1 U1 1 u2 1 1 15 U1 1 U2 1 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY El 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-$1.500 ®ON SCENE 14 VEHICLE/PROPERTY ®OVER 51.500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash 0 AMENDED YR 202612026-00050976 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 3 -n JEFFERSON AVE Elgin01:31 ® ❑ RELATED ®Y 0 N 08 23 2026 ❑AM ❑YES El NO U1 —< _ _ g PRIVATE mo !day/yr ®PM FLOW CONDITION m FT N E S W PRESTON AVE COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR El SLOW 15 cn ❑ Kane HIT&RUN ❑V ® N WITH VEHICLES INVLD ❑ STOPPED U2 —I ® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 Qg3 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EWES 0 uuv 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 0 r tf TOWED U1 Ngo N etam, Marie, M. 0 9 / yr 13-UNDER CARRIAGE ©,I ©:. 2 FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 ]$I U2 2 m F 2 5 15-OTHER ❑Y ®N SYSTEM ❑UNK VEH. 0 AT CRASH D 0 99-UNKNOWN 9 16•TOP 3 *Distraction Value ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s, ii_6 I,.4 COM VEH 0 E! 1 0 ~ SchaumburgI L 60194 0 1 0 FIRST CONTACT 12 7 ; _5 *II Yes.See Sidebar Ut Z EM69412 IL 2026 ' E TELEPHONE IL D 0 SFNRL5H6XEB060560 Progressive ❑Y ®N U2 m .5 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Elgin Fire The House of Braids 871042046 1 r o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y El 2 ou m Ei{ DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 nuv 0 Ie v 0 Dv Yr!1 9 9 9 Toyota RAV4 2021 00-NONE ,�_` 12 "_, DUE TO CRASH ❑ 2 0 13-UNDER CARRIAGE o I 2 FIRE ❑ ® U2 C Ti STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR PFIRST CONTACT 9 NT OF Q l Oil O C•tOMs geeSidebarH ❑ ® U1 CO ELGIN I L 60120 B 1 0 FC23147 I L 2027 REAR 0 Si) IL D 0 2T3P1 RFV4MW157941 State Farm ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Elgin Fire Same 3572902SFP13 SAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP 996 < Provena St.Joseph RESPONDER U1 = (UNIT) (SEAT) (D08) (SEX) {SAFT) (AIR) (INJI 1(EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME),(ADDRESS),(TELEPHONE) (EMS) (HOSPITAL) 1 6 03 / LOG DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur IDY U2 Z 1 N 1 ® 11 Q Elgin,City,o. Tree 81 /31 /026 01 31 ®AM in a Work Zone? ®N DIRP co PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME ❑AM If YES check one below: U1 3 T 2 0 41 2 F.; 150 DEXTER CT ELGIN IL 60120 23 28 81 ,31 /026 02 32 ®PM 0 Construction " O ❑ El CITATIONS ISSUED El PENDING SECTION CITATION NO. EMS ARRIVED TIME 1 3 ❑AM ❑Maintenance U2 o ® 11 Q ARREST NAME Ngo Nyetam, Marie, M. 11-904-B 482000746 81 /31 /026 02 35 Igi pM SLMT o N 0 CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ' El Utility 30 t 2 0 31 3 ARREST NAME AM 1 ! ❑❑pM ❑TUnknown work zone type U1 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 0 AM Workers present? ❑Y 30 482-Flentye,Jeremy 201 275-Engelke 10 , 61 /026 01 30 ®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••--, , ; 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 truckrtrailer -< c ` --I -' r INDICATE NORTH combination):or —I BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C z i - } (example:shuttle or charter bus):or X I e '�'""�"'�' 3. Is designed to carry15 or fewer g passengers and operated by a contract carrier 0 - i. } } } transporting employees in the course of their employment(example:employee X transporter-usually a van type vehicle or passenger car):or w L L.___a____.I ,21 4. Is used ordesinatedtotrans rtbetween9and15passengers,includingthedriver, C } } for direct compensation(examp large van used for speific purose):or ':. i______i_.....I. iI � � IIIIIiIIIIIilill , O 'Ni0i( l. } } t 5. Is anyvehicle used to transport anyhazardous material(HAZMAT)that requires rn unnz ,t+1 MO placarding(example:placards will be displayed on the vehicle). XI unnr D CARRIER NAME Z Z ADDRESS D r r T 1 I r Not To Scale 1 CITY/STATE/ZIP n MOTOR CARR.ID 0 Interstate 0 Intrastate I I T I ❑ Not in Comm./Govt. 0 Not in Comm./Other ----------1 - USDOT NO. ILCC NO. m Xl Source of above z . IDOT PERMIT NO. WIDELOADo ❑Yes 0 No = TRAILER VIN 1 m to 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 White White u 1 TOWED • TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT 3 TOWED BY/TO. Arties/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