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HomeMy WebLinkAbout2026-00054694 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 10110 II �I flfl 11 I 1 Ill IDDUOO DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X669778 u, 1 U21 1 1 1 U116 U2 1 U, 1 u2 1 u, 1 U2 1 1 11 U1 1 U2 1 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY ❑5500 OR LESS TYPE OF REPORT 0 A No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 2 VEHICLE/PROPERTY ®OVER 61,500 El NOT ON SCENE(DESK REPORT) El B Injury and f or Tow Due To Crash 0 AMENDED YR 202612026-00054694 VEHT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n RT20 WB I DWIGHT ST El In 05:27 ® ❑ RELATED ❑Y ®N 09 08 2026 ❑AM ❑YES El NO U1 -< g PRIVATE mo !day!yr ®PM FLOW CONDITION m 10 !MI N E Srt20 wbldwi ht St COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ®SLOW 1 (n ® ® ® g Kane HIT&RUN ❑V ® N WITH VEHICLESOT, INVLD ❑ STOPPED U2 -I O AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ❑ FREE FLOW # LNS 0 183 DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EWES ❑uuv ❑!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 n FOR DAMAGEDAREA(S) FROM TOWED U1 1� Gent Kathryn,A. 0 2 / yr 13-UNDER CARRIAGE ©,I �:: FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 2 m F 2 SY n is-OTHER 5 ❑Y ®SNE M❑UNK VEH. AT CRASH IN n D 99-UNKNOWN 9 16•TOP 3 `Distraction Value 9 ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF S,;i�S 4 COM VEH 0 Ea 1 0 F. HuntleyIL 60142 B 1 0 FIRST CONTACT 12 7 ; _5 *IIYes.SeeSidebar U1 Z R835718 IL 2027 REAR TELEPHONE IL D SFNYF4H9XFB023193 Foremost Insurance ❑Y Igl N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Elgin Fire Same A7996919890 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER XI Provena St.Joseph ❑Y El 2 G0) N DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 row 0 I v 0 Dv /1 9 8 6 Subaru Forrester 2022 00-NONE 'o,I t2 (,-2 FIRE DUE O CRASH 0 ® U2 2 C o mo 13-UNDER CARRIAGE c M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9.1,6•TOP 3 X ❑Y ®N DUNK VEH. AT CRASH 99-UNKNOWN *Oistrac on Value 9 0 POINT OF S i 4 COM VEH ❑ ® U1 CO N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR 5 FIRST CONTACT 6 O7 ,�=QIOS •It Yes See Sidebar C Z Schaumburg IL 60194 0 1 0 FD31450 IL 2027 IAR 0 Si) D IL D J F2SKAJC6N H505889 Progressive ❑Y ®N RDEF ZI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Same 993862208 BAC $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP 996 < Refused RESPONDER 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 ❑Y U2 Z u 1 ® 11 1 09/08 ,2026 05 27 ®AM in a Work Zone? ®N DIRP co 1 I 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 28 99 09,08 ,2026 05 28 ®PM ❑Construction >E R O 0 ]$I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 7 3 ❑AM ❑Maintenance U2 -a, ARREST NAME Gentry, Kathryn,A. 11-601 1549-527 09,08,2026 05 57 ®pM SLMT El 1Utility o N 1 SECTION CITATION NO. ROAD CLEARANCE TIME 0 y 0 CITATIONS ISSUED PENDING t 2 El ARREST NAME 09/08 ,2026 06 00 0 PM 0 Unknown work zone type U1 0 AM 40 2 2 3 ❑ OFFICER ID SIGNATURE BEAT!DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 40 1549-Brown, Bryan 601 337-Thompson 10 , 14,2026 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 IADDITIONAL UNITS FORMS. r ----r•---, , - ; A CMV is defined as any motor vehicle used to transport passengers or property and: Z I1. Has a weight rating more than 10,000 pounds(example:truck or truckrtrailer -< i- }--__r-_--; } INDICATE NORTH combination):or —I p1 I BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C w } r r r (example:shuttle or charter bus1 ):or 0 '4 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I O - ------- i }---. } } transporting employees in the course of their employment(example:employee transporter-usually a van type vehicle or passenger car):or co L •:. __}----; I. } } } •4. Is used or designated to transport between 9 and 15 passengers,including the driver. N M for direct compensation(example:large van used for specific purpose):or O i. i _ 5. Is any vehicle used to transport anyhazardous material(HAZMAT)that requires a III placarding(example:placards will be displayed on the vehicle). m _N CARRIER NAME —I ADDRESS 0 U) Dwight?Sti. i. i. i. 4. C) , CITY/STATE/ZIP g MOTOR CARR.ID 0 Interstate 0 Intrastate 1 I r 1 ❑ Not in Comm./Govt. ❑ Not in Comm./Other O ------r----, Not To Scale I - USDOT NO. ILCC NO. C m Source of above z . -I Were HAZMAT placards on vehicle? 0 Yes 0 No = If Yes,Name on placard O 4 digit UN NO. 1 digit Hazard class No. Xl Xl Did HAZMAT spill from vehicle(do NOT consider FUEL from vehicle's Z own tank)? 0 Yes 0 No 0 Unknown Did HAZMAT Regulations violation contribute to the crash? r ❑ Yes 0 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 v TRAILER WIDTH(S) 0-96" 97-102" >102' T TRAILER 1 ❑ ❑ 0 Z TRAILER 2 ❑ 0 ❑ O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w Black Black u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT 3 TOWED BY/TO. _Redmons/Impound Lot Garage . SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/TO: DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE