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HomeMy WebLinkAbout2026-00052831 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 01111101111 10110111 flfl 00110 fll 00 0 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X61:90 u, 1 U21 1 1 1 U1 1 U2 1 U, 1 1_12 1 U, 1 U2 1 1 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 ® q No Injury 1 Drive Away Elgin Police Department ONE PERSON'S 1215501-$1.500 ®ON SCENE 1 VEHICLE/PROPERTY ❑OVER$1,500 ❑NOT ON SCENE(DESK REPORT) 0 AMENDED ❑ B Injury and for Tow Due To Crash YR 202612026-00052831 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n ® ❑ RELATED PRIVATE 0 Y ®N 08 31 2026 12,—AM ❑YES El NO U1 -< S STATE ST Elgin mo /day/yr 02:56 ®PM FLOW CONDITION m _ 1 25 ®!MI N E O W Locust St COUNTY PROPERTY ❑Y 21 N DOORING Ely #OF MOTOR 0 SLOW 1 U) Kane HIT&RUN ❑V ® N WITH VEHICLES INVLD 0 STOPPED U2 --I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 18:DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EDUCE 0 NIAV 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 mo 0 f'tr�TOWED U1 WYDRA. DAVID. M. Subaru XV Crosstrek 2.0 2016 00-NONE ©, >2 �/DUE TOCRASH ❑ NAME(LAST,FIRST,M) yr 13-UNDER CARRIAGE 10.I 2 FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 2 m M 2 SY4 ❑Y ®SNE❑UNK VEH. 0 AT CRASH M IN 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, i�a COM VEH 0 Ea 1 C) 4 • F. FIRST CONTACT 12 7 ;—_, - *II Yes.See Sidebar U1 Z OAKWOOD IL 60013 0 1 0 4972214 IL 2026 Ia TELEPHONE IL 0 J F2G PABC4G8320894 State Farm ❑Y Igl N U2 m 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR co 99 9 Same 0615852SFP13 2 m `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused 0 Y ElN 2 0 p; DRIVER ❑ PARKED 0 DRIVERLESS 0 FED 0 PEDAL 0 EWES 0 NMy 0 NCv 0 DV 1 9 yf 9 Toyota Corolla 2016 00-NONE 0. Q!--O DUE TO CRASH ❑ (� 2 73 0 13-UNDER CARRIAGE 10( I E FIRE 0 ® U2 C Ti F 2 4SYSTEM IN 0 ENGAGED 0 15-OTHER 9,16-TOP 3 X 0 Y ®N 0 UNK VEH. AT CRASH 99-UNKNOWN •Oistracl Dn Value U1 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 5 1 S i. COM VEH ❑ ® IN I. FIRST CONTACT 6 O7 ,�=Q)OS •If Yes,See Sidebar C 60110 0 1 0 Q591312 IL aR 0 Si) M IL 0 2T1 BURHEXGC705146 Progressive ❑Y ®N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER 1 = 99 9 Granados.Guillermo 971067753 BAC $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP U1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)!{ADDRESS)((TELEPHONE) (EMS) (HOSPITAL) U2 996 r m ##occs > 71 / ,, U1 1 D 1 0 E/ MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z N 1 ® 11 1 08,31 ,2026 03 00 ®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 � 0 2 03 99 , , 0 PM ❑Construction * Z 3 0 Ii CITATIONS ISSUED El PENDING SECTION CITATION NO. EMS ARRIVED TIME 1 ❑AM ❑Maintenance U2 -a, ARREST NAME WYDRA. DAVID. M. 11-601-Ax 1528-000403 , , El PM o U 1 0 1 1 1 0 CITATIONS ISSUED ❑PENDINGSLMT o N SECTION CITATION NO. ROAD CLEARANCE TIME AM• 0 Utility r 2 El1 1 1 ARREST NAME 08/31 12026 03 00 0 PM El Unknown work zone type U1 30 2 2 3 El OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑AM Workers present? ❑Y 30 1528-Rivera. Kevin 701 09 ,22,2026 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 .A ADDITIONAL UNITS FORMS. r ----r•---, , N : 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 -' r INDICATE NORTH combination):or .Z-1 LOCU9t?St BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C (example:shuttle or charter bus):or n X L 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 transporter-usually a van type vehicle or passenger car):or w L L.___a__ , 4. Is used ordesi natedtotrans rtbetween9and15 passengers,including y} } for direct compensation(example:large van used for specificpurpose):or [he driver, Pe ( P 9 Pe or 0 L -a-___.I t i. i i. L 5. Is any vehicle used to transport anyhazardous material(HAZMAT)that requires -u Unit?lt3 placarding(example:placards will be displayed on the vehicle). Zmt —1 CARRIER NAME Z Cl)co ADDRESS O D Untt?#2 rn ,W O CITY/STATE/ZIP g - MOTOR CARR.ID El Interstate ElIntrastate r Unit?#1 ❑ Not in Comm./Govt. 0 Not in Comm./Other 00 : : --- --1 : : : < Not To Scare XI NO. ILCC NO. m Source of above z Form Number m m IDOT PERMIT NO. WIDELOAD'; 0 Yes 0 No 2 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 Silver White u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY/TO: _ . SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY/T6 DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE