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HomeMy WebLinkAbout2026-00051800 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 1111111111111111 I0110 II I fl U II 0I.I IIIIIIIII DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X61865 u, 1 U21 3 4 1 U1 3 U2 1 U, 1 1_12 1 U, 1 U2 1 1 10 u1 3 U2 1 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY El$500 OR LESS TYPE OF REPORT 0 A No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW ' Elgin Police Department ONE PERSON'S El5501-51.500 ®ON SCENE 1 VEHICLE/PROPERTY 10OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and f or Tow Due To Crash El AMENDED YR 202612026-00051800 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 m® ❑ RELATED I81 Y 0 N 08 27 2026 ®AM ❑YES ® PRIVATENO U1 RANDALL RD 1 W1B 190 EXIT RAMP Elgin mo /day/yr 06:34 ❑PM FLOW CONDITION m 010 0,MI N p S W randall rdlwlb i-90 exit COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 1 cn Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD El STOPPED U2 —I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 183 DRIVER ❑ PARKED ❑ORMERLESS ❑ PED ❑PEDAL ❑MUSS ❑uuv ❑ncv ❑Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 99 n FOR DAMAGEDAREA(S) FROhrr TOWED U1 0VELAZQUEZ.TOBIN.J. 0 3 / yr 13-UNDER CARRIAGE FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) co)., 2 DISTRACTED 0 0U2 99 m M 2 4 ❑Y ®SNEM❑ n 15-OTHER UNK VEH. AT CRASHIN n ENGAGED 99-UNKNOWN 016-TOP 3 `Distraction Value ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF Dail a �'.4 COM VEH 0 Ea 1 0 I . PALATINE I L BOOB? 0 1 FIRST CONTACT 9 7 .- -__5 *Owes.See Sidebar U1 Z EF60696 IL 2026 TELEPHONE IL D J F2SKAXC7M H402941 PROGRESSIVE ❑Y ®N U2 m B EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m co Elgin Fire Same 987812311 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF IC OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y El 2 0 x DRIVER ❑ PARKED ❑DRIVERLESS 0 FED ❑PEDAL 0 EWES ❑NMv 0 Ncv 0 DV yr Q 2 !� �1 0 13-UNDER CARRIAGE 10 j ©( 2 FIRE 0 ® U2 C c F 2 4SYSTEM IN 0 ENGAGED 0 15-OTHER 9,16•TOP 3 X 0 Y Ni N ❑UNK VEH. AT CRASH 99-UNKNOWN *OistraclIon Value U1 0 POINT OF s i1 �r COM VEH ❑ ® CO N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR A 5 FIRST CONTACT 1 Y _, _5 •(ryes.See SidebarC PINGREE GROVE IL 60140-6431 B 1 0 EP36353 IL 2027aR 0 IL D 0 WDDSJ4G B2H N406094 LEMONDADE ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER 1 = Elgin Fire Same LCP9400358655 SAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPOND O N 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 4 08,27 ,2026 06 34 ®❑pM in a Work Zone? ®N DIRP co 1 r PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 6 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 C) 0 2 ❑ 25 99 ! ! ❑PM ❑Construction * R 3 0 0 CITATIONS ISSUED El PENDING SECTION CITATION NO. EMS ARRIVED TIME 1 ❑AM ❑Maintenance U2 a VELAZQUEZ.TOBIN.J. 11-306 244-1861 / , PM -, ARREST NAME ❑ o ui. ® 11 4 0 CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ❑Utility SLMT 45 t 2 0 ARREST NAME AM 7 1 r ❑❑PM 0 Unknown work zone type U1 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 0 AM Workers present? 0 Y 45 244-Blomberg. Michael 502 275-Engelke 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 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 truck trailer -< c ` --I -' r- — — _ INDICATE NORTH combination):or -I 44 t wviwoa—Whernp BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C t07191"1 °' } (example:shuttle or charter bus):or 0 ! _ _ _ _ _ 3. Is designed to car 15 or fewer passengers and operated a contract carrier O } } } transporting employees in the course of their employment(example:employee transporter-usually a van type vehicle or passenger car):or co L 4. Is used or designated to transport between 9 and 15 passengers,including N}-----;----+ } } } g Po passen rs,includi the driver, for direct compensation(example:large van used for specific purpose):or <____A____.: Not To Seale_I N _ t i. < i. i. 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires placarding(example:placards will be displayed on the vehicle). - CARRIER NAME Z ADDRESS w CITY/STATE/ZIP 0 0 MOTOR CARR.ID 0 Interstate ❑ Intrastate I I T I ❑ Not in Comm./Govt. 0 Not in Comm./Other ----------. - USDOT NO. ILCC NO. rn XI Source of above z . ❑ Yes 0 No 0 Unknown E D Did Carrier Safety Regulations MCS)violation contribute to the crash? A ❑ Yes No ❑ 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'; 0 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 0 0 Z ill TRAILER 2 ❑ 0 0 O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. y White Red 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/T6 DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE