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HomeMy WebLinkAbout2026-00053370 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 Mil II II I flfl 11 II �011110 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X+ 66.58 U110 U21 3 4 1 U1 3 U2 1 U1 1 U2 1 U1 1 U2 1 1 15 u1 1 U2 1 *P 0119* 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 El$501-$1.500 ®ON SCENE 14 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash 0 AMENDED YR 2026I 2026-00053370 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n ST CHARLES ST Elgin04:34 ® ❑ RELATED ®Y 0 N 09 02 2026 ❑AM ❑YES ®NO U1 -< _ _ PRIVATE mo !day/yr ®PM FLOW CONDITION III FT l MI N E S W BLUFF CITY BLVD COUNTY PROPERTY El ® N DOORING Ely #OF MOTOR 0 SLOW 1 (n ❑ Kane HIT&RUN ❑V ® N WITH VEHICLES INVLD ❑ STOPPED U2 --I ® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST IZI N 51 FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EWES ❑uuv ❑!CV ❑Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 0 FOR DAMAGEDAREA(S) FROPtf TOWED U1 Q Kearne Kane.S. 0 6 / yr 13-UNDER CARRIAGE ©,I ,._Z FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED THER ❑ ga U2 0 171 M 2 5 SYTM❑Y ®SNE❑UNK VEH. 0 ATCRASHD 0 15-99-UUNKNOWN 916•TOP3 `Distraction Value ALGN X. r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s it 6 �i 4 COM VEH 0 j$J 1 0 F. 60110 B 1 0 FIRST CONTACT 11 7_;1 -__5 *IIYes.See Sidebar U1 Z FC85545 IL 2027 REAR TELEPHONE IL D 0 19XFC1 F31 M E004970 Allstate ❑Y ®N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Elgin Fire 99 9 Kearney. Daniel.J. 974286860 1 `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER r RESPONDER 2 XI p; DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EWES ❑NMV 0 NCv ❑DV !2 O O O Jeep(after 19681�rokee 2019 00-NONE 11_"1 Qi O DUE TO CRASH 0 ❑ 2 x o y Yr 13-UNDER CARRIAGE 10( ) 2 FIRE 0 ® U2 C F 2 9 SYSTEM IN 0 ENGAGED 0 15-OTHER 9,1,6-TOP 3 X ❑Y NJ 0 UNK VEH. AT CRASH 99-UNKNOWN *Oistraellon Value 9 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8-it 6 1l, COM VEH ❑ ® U1 CO FIRST CONTACT I Y _, _5 •IfYes.See SidebarC n ELGIN I L 60123 0 1 0 BW84031 I L 2026 I 0 Z IL D 0 1 C4PJ LCB5KD466206 Progressive ❑Y J N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Elgin Fire 99 9 Same 998073128 SAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP 996 < Refused RESPONDER U1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)!(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL) 2 6 01 / F 14 4 0 1 0 m / / #OCCS D 71 / / U1 1 D / / 2 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z N 1 ® 11 4 09,02 l2026 04 34 ®AM in a Work Zone? ®N DIRP co 1 t PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 7 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 C) v 2 0 25 28 09,02 ,2026 03 44 El PM El Construction >E R 3 0 gi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. ELMS ARRIVED TIME 1 z J ❑AM ❑Maintenance U2 o ® 11 4 ARREST NAME Kearney. Kane.S. 11-306 1530000861 09,02/2026 03 50 Igi pM' 0 Utility SLMT I$[CITATIONS ISSUED 0 PENDING SECTION CITATION NO. ROAD CLEARANCE TIME 8 N ❑AM 15 F 2 El ARREST NAME Soto.Victoria. N. 6-101* W1530000862 , / ❑PM ElUnknown work zone type U1 2 2 3 0 - OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 15 1530-Soto.Oscar 101 10 ,06,2026 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 4. ADDITIONAL UNITS FORMS. r ----r••--, , N . A CMV is defined as any motor vehicle used to transport passengers or property and: Z II 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer -< Not To Scale INDICATE NORTH combination):or p0 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C .-- r - (example:shuttle or charter bus):or 0 5 or fewer I- I- --I--•--; I transporting employeened to s inthe course passengers their emaployment nd operated xample:employee transporter J } } } 73 transporter-usually a van type vehicle or passenger car):or co L L.___a____� rot } } } •4. Is used or designated to transport between 9 and 15 passengers,including the driver. N + for direct compensation(example:large van used for specific purpose):or `r L L____a____. l_l(�_ _;!? L 5 anyIs any vehdeused to transport hazardous material(HAZMAT)that requires m �; placarding(example:placards will be displayed on the vehicle). � Bluft"?Clty.iglC� IOI - -I CARRIER NAME Z 1 Untt 2 ADDRESS O T. C) CITY/STATE/ZIP MOTOR CARR.ID 0 Interstate 0 Intrastate ❑ Not in Comm./Govt. Not in Comm./Other Y 4, St?Charles?St USDOT NO. ILCC NO. XI Source of above z . own tank)? 0 Yes 0 No 0 Unknown Did HAZMAT Regulations violation contribute to the crash? r ❑ Yes ❑ No 0 Unknown g D Did Carrier Safety Regulations MCS)violation contribute to the crash? A ❑ Yes II El 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'; ❑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' -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 2 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 Other/Unknown VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE