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HomeMy WebLinkAbout2026-00053585 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 U II 1110 1 llI 0 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X 66782- u, 1 U21 2 4 1 U1 2 U2 1 U, 1 1_12 1 U, 1 U2 1 1 15 U1 1 U2 1 *P 0119* INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW ' DAMAGE TO ANY ❑5500 OR LESS TYPE OF REPORT El A No Injury 1 Drive Away Elgin Police Department ONE PERSON'S ❑$501-$1.500 ®ON SCENE 14 VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and for Tow Due To Crash El AMENDED YR 202612026-00053585 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 �I ® ❑ RELATED ' V 0 N 09 03 2026 ❑AM ❑YES ®NO U1 ST CHARLES ST Elgin04:07 _ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION m FT!MI N E S W BENT ST COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 1 cn ❑ Kane HIT&RUN ❑Y ® N WITH VEHICLESOT, INVLD ❑ STOPPED U2 --I CO AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST IZI N ® FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EOUES 0 NW/ 0 ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 0 11 FOR DAMAGEDAREA(S) FRO 1 TOWED U1 Q NAME(LAST,FIRST,M) Oberholtzer•Jennifer. L. mo Nissan Pathfinder 2016 00-NONEEN DUE TO CRASH ❑/ ! yr 13-UNDER CARRIAGE ©I O - FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 10 2 DISTRACTED ❑ gi U2 0 m F 2 SY4 ❑Y ®SNE❑UNK VEH. O AT CRAS IN H O 15-OTHER 99-UNKNOWN 9 16•TOP 3 `Distraction Value 9 ALGN = r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF & it S �i COM VEH 0 0 1 n f. FIRST CONTACT 11 7__,_--_;__-S *Ilves.See Sidebar U1 0 V Z Bartlett IL 0103 0 1 0 Q261150 IL 2027 REAR TELEPHONE IL D 0 5N1AR2MM5GC634251 Auto-Owners Insurance Co ®v 0 N U2 19 . m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 Same 54-694-339-00 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused 0 Y ® N 2 XI p; DRIVER ❑ PARKED 0 DRIVERLESS ❑ PED ❑PEDAL ❑EWES ❑row 0 NOV ❑Dv !1 9 y9r 1FROM TOWED Civic 2020' 00-NONE 111 12..-_t DUE TO CRASH ❑ [gI 2 x o _ 10)13-UNDER CARRIAGE t 2 FIRE 0 ® U2 C il F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9.16-TOP®* X ❑Y i N El VEH. AT CRASH 99-UNKNOWN Oistrac on Value 9 O POINT OF 8-.;,• It COM VEH D ® CO 4 U1 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT 5 FIRST CONTACT 2 7_ _, _-S •IfYes,See Sidebar St Charles IL 60174 C 1 0 DW89044 IL 2027 I 0 D IL D 0 SHHFK7H44LU201876 Unique Insurance Co ❑Y ®N RDEF ZI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = 99 9 Same ILP3478390 BAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPONDER u1 = (UNIT) (SEAT) (0081 (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)1(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL) 1 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z N 1 ® 11 4 09/03 l2026 04 07 ®pm in a Work Zone? ®N DIRP co 1 F PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME ❑AM If YES check one below: U1 3 n T o" 2 ❑ 28 2 1 1 ❑PM_ ❑Construction X R 3 ❑ $I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 5 ❑AM ❑Maintenance U2 C-; 1 ® 11 4 ARREST NAME Oberholtzer.Jennifer. L. 11-601 S1542-001011 / ! ❑PM SLMT MI CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME AM• ,_,Utility F 2 ❑ ARREST NAME Oberholtzer.Jennifer. L. 11-904-B W1542-001012 09/03 l2026 04 07 ®PM ❑Unknown work zone type U1 30 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 30 1542 Chafe. Ethan 401 10 ,20,2026 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. .. 071) A CMV is defined as any motorvehicleusedtotransportpassengersorproperty and: Z 01. Has a weight rating more than 10,000 pounds(example:truck or truck trailer -< c ' i r INDICATE NORTH combination):or —I Not To Scale I BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C - _ } (example:shuttle or charter bus):or X L A 3. Is desgned to carry 15 or fewer passengers and operated by a contract carrier I 0 } } } transporting employees in the course of their employment(example:employee X 9arY78t \\,\.... transporter-usually a van type vehicle or passenger car):or w L L.___a__._� l i _ 1 4. Is used ordesi natedtotrans rtbetween9and15 passengers,including C } } for direct compensation(example:large van used for speific purpoe):o O I I , IL L____a____� HtU)1 ' N L . } } L 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m _ ' t pMcarding(example:placards will be displayed on the vehicle). 1� . 1 -111110 CARRIER NAME Z \\\ g ADDRESS 'n 0 n CITY/STATE/ZIPP MOTOR CARR.ID ❑ Interstate ❑ Intrastate I I T ❑ Not in Comm./Govt. Not in Comm./Other i. --- --4, USDOT NO. ILCC NO. m XI Source of above z . 0 Yes 0 No ❑ Unknown A 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 Silver Gray u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT' 2 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