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HomeMy WebLinkAbout2026-00051983 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 IIIIII II II I flU 1111 lU 00 11 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X004357:56 u, 1 U21 3 4 1 U116 U2 1 U, 1 u2 1 U, 1 U2 1 4 11 U1 11 U211 *P 0119 INVESTIGATING AGENCY DAMAGE TO ANY ❑5500 OR LESS TYPE OF REPORT 0 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$1,500 El NOT ON SCENE(DESK REPORT) El Injury and f or Tow Due To Crash El AMENDED YR 202612026-00051983 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 r1 ® ❑ RELATED ❑Y ®N 08 27 2026 DAM ❑YES ®NO U1 -< S MCLEAN BLVD Elgin09:20 _ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION m FT!MI N E S W BOWES RD COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR 0 SLOW 15 u) ❑ Kane HIT&RUN ❑V ® N WITH VEHICLES INVLD ® STOPPED U2 --I El AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ❑ FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑MUSS ❑NIAV ❑!CV ❑Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 n 0 4 / yr 13-UNDER CARRIAGE ©,I �:: FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 4 <<n M 2 SY4 ❑Y ONM DUNK VEH. O AT CRASH IN O 15-OTHER 99-UNKNOWN 9 16•TOP 3 `Distraction Value 9 ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s it a 4-5 *II Yes.See Sidebar U1 COM VEH 0 El 1 0 F. FIRST CONTACT 12 7, _ Z West Chicago IL 60185 0 1 0 GF13185 IL 2027 I , TELEPHONE IL D 0 1 FAH P25W98G 144601 State Farm ❑Y Igl N U2 31 , m 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m co 99 9 Same 3979815-SFP-13 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused 0 Y El 2 0 p; DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL 0 EWES ❑Nov 0 NOV ❑DV CIRCLE NUMBER(S) U1 1 9$1 Ford Edge 2020 00-NONE 'o,� t2 (,-2 FIRE DUE o CRASH ® U2 2 C o 13-UNDER CARRIAGE c F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9.1,6•TOPS X ❑Y i N ❑UNK VEH. AT CRASH 99-UNKNOWN *Oistraellon Value 9 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. 5 1 S .t. 4 ® Ut COF,,, STATE YEAR POINT OF O,�FIRST CONTACT 6 =Q)OS •(ryes.COMVEH See Sidebar❑ C Z SOUTH ELGIN IL 60177 0 1 0 CA76010 IL 2026 AR Si)0 M IL D 0 2FMPK4J91 LBA47663 All State ❑Y ®N RDEF71 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = 99 9 Same 942524622 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),(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 $) ,71 ,026 09 20 ®AM in a Work Zone? ®N DIRP co 1 t PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 5 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 C) o" 2 ❑ 28 99 + ) 0 PM• ❑Construction * R 3 0 $I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 5 ❑AM ❑Maintenance U2 o1 ® 11 1 ARREST NAME Tumaneng-Smith. Katherine. L. 11-601 1551000410 / ! El PM SLMT o N ❑CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • El Utility 0 AM t 2 El ARREST NAME 8) 171 1026 09 20 0 PM El Unknown work zone type U1 35 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 35 1551-Dede.Joseph 701 337-Thompson 10 , 13,2026 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 ADDITIONAL UNITS FORMS. r ----r••--, , 1 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-- --1 I r INDICATE NORTH combination):or -I BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C ( ' I (example:shuttle or charter bus):or r r r X 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I O - ------I----; Not To Scale .1 - t } } } transporting employees in the course of their employment(example:employee 73 1 - - - transporter-usually a van type vehicle or passenger car):or w L L.___a__...I if 4. Is used ordesi natedtotrans rtbetween9and15passengers,indudingthedrrver, I 4 } } } for direct compensation(example:large van used for speific purose):or L L-. ..i.. - I r y - t i. I 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires 71 ' LI - placarding(example:placards will be displayed on the vehicle). XI m —I - — — —.-_ _ CARRIER NAME Z ? ADDRESS 0 Z — CITY/STATE/ZIP I I r1 I - MOTOR CARR.ID 0 Interstate 0 Intrastate Ti i 1 Bo rillRd ❑ Not in Comm./Govt. ❑ Not in Comm./Other 0 ------- --4 - USDOT NO. ILCC NO. m m Xl Source of above Z . 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'; 0 Yes 0 No 2 TRAILER VIN 1 m co LOCAL USE ONLY TRAILER VIN 2 m 0 TRAILER WIDTH(S) 0-96" 97-102" >102' T TRAILER 1 ❑ ❑ 0 Z TRAILER 2 ❑ 0 0 O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. Z Tan Gray u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT 3 TOWED BY/TO. _Adieu/Impound Lot Garage SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 3 TOWED BY/TO. DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE