HomeMy WebLinkAbout2026-00052876 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 0110
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DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X66$09`
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INVESTIGATING AGENCY DAMAGE TO ANY El$500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away
AGENCY CRASH REPORT NO. TRFW '
Elgin Police Department ONE PERSON'S ❑5501-51,500 ®ON SCENE 1
VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash
El AMENDED
YR 2026I 2026-00052876 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 2 mN RANDALL RD El In 05:52
® ❑ RELATED ❑Y ®N 08 31 2026 ❑AM ❑YES ®NO U1 -<
g PRIVATE mo /day/yr ®PM FLOW CONDITION m
FT l MI N E S W WIN HAVEN DR COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR IR SLOW 7 Cl)
❑ 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
Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 RED 0 PEDAL 0 EOUES 0 NIA/ 0 Ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 FOR DAMAGED AREA(S) FROf4r TOWED U1 0
DEANGELO. BRIAN.G. 1 1 /
yr 13-UNDER CARRIAGE IE
101 12 I• 2 FIRE ❑
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL)THERDISTRACTED 0 0 U2 2 m
M 2 4 SYTM❑Y ®SNEDUNK VEH. O ATCRASHD 0 15-99-UUNKNOWN 9 76•TOP 3 `Distraction Value 9 ALGN X.
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s, it a II COM VEH ❑ Ea 1 C)
m Z ST CHARLES IL 60175 0 1 0 FIRST CONTACT 4 7 _O =II Yes.See siaabar u1
16847RF MI 2026 ' E
TELEPHONE
IL D 0 3C6U RSDJ 1 TG235179 NATIONAL UNION FIRE INS C ❑Y ®N U2 m
13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR
99 9 HERTZ VEHICLES 4805386 2 m
o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER
RESPONDER
2
p; DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED 0 PEDAL 0 EWES ❑
/1 961 International Iho6126r1CAT 2026 00-NONE 0.' 12'•_, DUE TO CRASH ❑ !g► 21
oYr 13-UNDERCARRIAGE 10,i 2 FIRE ❑ ® U2 C
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M 2 4 ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN •Distraction Value
POINT OF s i 4 C.OM VEH ® ❑ U1 CO N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR 5 1:,_ C
FIRST CONTACT 11 / -r_5 •If Yes.See Sidebar
NORTH AURORA IL 60542 0 1 0 3848713 IN 2026 Si)0
IL A 7 3HSDZAPR3TN332888 Company Protective Insura ❑Y ®N RDEF
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 =
99 9 R<RANSFER INC B11321 BAC
$
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE:ZIP
U1 =
(UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (WI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME))(ADDRESS)/(TELEPHONE) (EMS) (HOSPITAL)
1 3 02 / M 2 4 C 1 0
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/ / #OCCS >
71
/ / UI 2 m
/ / 1 0
EV MOST EVNT LOG DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z
N 1 ® 11 1 81 , 11 /026 05 52 ®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)
,
2 ❑ 04 20 81 ,11 /026 05 59 ®PM ❑Construction
F
R O ❑ ]$I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 5
3 ❑AM ❑Maintenance U2
— ® • ❑Utility a, ARREST NAME DEANGELO. BRIAN.G. 11-601-Ax 1576000040 81 /11 /026 06 04 ®PM
o1SLMT
U 11 1 CITATIONS ISSUED 0 PENDING -
o N SECTION CITATION NO. ROAD CLEARANCE •TIME AM y
r 2 El ARREST NAME DEANGELO. BRIAN.G. 11-707-B 1576000041 81 /11 /026 06 24 ®PM El Unknown work zone type U1 45
2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 45
1576-Teachout.Seth 602 337-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••--, , ; 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 —I
p1
BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C
} ''I Not To Scale f - (example:shuttle or charter bus):or 0
L A 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier 0
} } } transporting employees In the course of their employment(example:employee X
.1 transporter-usually a van type vehicle or passenger car):or w
L L.___a____.i "' 7
1°' 4. Is used ordesi natedtotrans rtbetween9and15 passengers,including C
} } for direct com nation exam I lar a van used for s cific ur o ):or the driver,
Pe ( 9 Pe P pos�):or
L L--_-a-___� ` - l. i i L 5. Is any vehicle used to transport anyhazardous material(HAZMA that requires
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.D
placarding(example:placards will be isplayed on the vehicle). m
0
CARRIER NAME R & L TRANSFER INC z
ADDRESS 14949 ST RT 28W O
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Vdn7M7OF i CITY/STATE/ZIP ALEXANDRIA 1 IN 146001 n
M
_ _ _ _ _ - i. i. i. i. MOTOR CARR.ID El Interstate ❑ Intrastate
I I T I 0 Not in Comm./Gout. 0 Not in Comm./Other
;_...Y._._ 1 - USDOT NO. 63391 ILCC NO. m
m
XI
Source of above z
'
. IDOT PERMIT NO. WIDELOAD? ❑Yes ®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
Black Green
u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_
DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT: 3 TOWED BY/TO:
_ SELECT CODES FROM THE BACK OF CRASH BOOKLET
U 2 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/TO.
DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE