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HomeMy WebLinkAbout2026-00054994 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 01111101111 0110 II Ill 1OH 110111 DRAC TRFD TRFC WEAT DRVA VIS VEHD LGHT COLL MANV X0043/08 0 u, 1 U21 2 4 1 u, 1 U216 U, 1 1_12 1 u1 2 u2 1 1 11 U1 1 U211 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY ❑$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 1 VEHICLE/PROPERTY [8]OVER$1,500 El NOT ON SCENE(DESK REPORT) (8:1B Injury and/or Tow Due To Crash El AMENDED YR 202612026-00054994 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 3 '1 ® ❑ RELATED ®Y 0 N 09 10 2026 ®AM ❑YES ®NO U1 —< W CHICAGO ST Elgin08:50 _ _ g PRIVATE mo /day/yr ❑PM FLOW CONDITION m FT!MI N E S W N CRYSTAL AVE COUNTY PROPERTY ❑Y 2�1 N DOORING ❑y #OF MOTOR 0 SLOW 15 u) ❑ Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD ® STOPPED U2 --I CO AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ❑ FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EOUES 0 NW 0 ncv 0 ov DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 8 n FOR DAMAGEDAREA(S) FROM TOWED U1 0Brumbau h Cayford.Joel. R. 1 2 / yr 13-UNDER CARRIAGE ©,I 0,: FIRE ❑ al STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 8 m M 2 4 15-OTHER ❑Y ®N SYSTEM ❑UNK VEH. O AT CRASH O 99-UNKNOWN 9 16•TOP 3 *Detraction Value ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6 i�6 4 COM VEH 0 j$J 1 O F. ELGIN I L 60123 0 1 0 FIRST CONTACT 12 7 . _5 *II Yes.See Sidebar U1 Z 6864921 IL 2027 E TELEPHONE IL D 0 1 FMRE11253HA92531 Allstate ❑Y Il N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 Same 802 636 608 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER XI Refused ❑Y ® N 2 0 p; DRIVER ❑ PARKED 0 DRIVERLESS ❑ FED 0 PEDAL ❑EWES ❑NMV 0 NDV ❑DV CIRCLE NUMBER(S) U1 � !1 9 9 7 Ford Explorer 2016 00-NONE 1("j 12..- , DUETO CRASH ❑ ! l 6 �7 o —Yr 13-UNDERCARRIAGE 10,1 2 FIRE ❑ ® U2 C Ti M 2 4SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16•TOP 3 X 0 Y ®N 0 UNK VEH. AT CRASH 99-UNKNOWN *0istracton Value 0 CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POFIRSNT OF T CONTACT 6 80_I L®10•CIOf eV See Sidebar❑ ® Ut CO ELGINZ 60120 0 1 0 MP13384 IL 2027 REAR M IL D 0 1 FM5K8AR8GGB96939 Charter Oak Fire Insuranc ❑Y J N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = 99 9 Elgin Police Dept 81091 6P901 BAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP U1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)!(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL) U2 m ##OCCS y 71 / / U1 1 D / / 1 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z N 1 ® 11 1 09,10 l2026 08 50 ®❑pM in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 3 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 � 2 0 28 10 1 1 ❑PM ❑Construction >F 5 3 R 3 0 $I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME ❑AM 0 Maintenance U2 o1 ® 11 1 ARREST NAME Brumbaugh Cayford.Joel. R. 11-601-Ax 1527000453 / ! El PM SLMT o N ❑CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME El Utility AM T 2 0 ARREST NAME 1 1 ❑❑pM El Unknown work zone type U1 3O 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑AM Workers present? ❑Y 30 1527-Juarez.Jorge 601 320-Cox 10 ,27,2026 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 truckrtrailer -< c ':--- --I -' r INDICATE NORTH combination):or —I CBY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C _ } (example:shuttle or charter bus):or X 7 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I O ® } } } transporting employees In the course of their employment(example:employee X 8 ® transporter-usually a van type vehicle or passenger car):or w 4. Is used or designated to transport between 9 and 15 passengers,including (I) C ---__I. ...I. ? - } } } g po passen rs,includi the driver, I E,Oieyp,Bt for direct compensation(example:large van used for specific purpose):or r C. L L____a____. b - I I I L 5. Is any vehicle used to transport any hazardous material(HAZMAT)thatrequires , lacardi (example:placards will be displayed on the vehicle —1 -__ _ CARRIER NAME Z -aermg0r ADDRESS 0 ;A CITY/STATE/ZIP 0 s - i. 4. MOTOR CARR.ID 0 Interstate 0 Intrastate 0 I I T I ❑ Not in Comm./Govt. 0 Not in Comm./Other --- --1 - USDOT NO. ILCC NO. m XI Source of above z IDOT PERMIT NO. WIDELOAD"; ❑Yes 0 No = 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 Black u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/TO. _Other/Unknown . 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