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HomeMy WebLinkAbout2026-00055056 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 0110 II Iflfl1111101111111I100 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X0043708 1* u, 1 U21 1 1 1 u, 8 U2 1 u, 1 1_12 1 u, 1 U2 1 1 12 u, 13 U2 1 *P 0119 INVESTIGATING AGENCY DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT ® A No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW Elgin Police Department ONE PERSON'S 1215501-$1.500 ®ON SCENE 3 VEHICLE/PROPERTY ❑OVER$1,500 ❑NOT ON SCENE(DESK REPORT) 0 AMENDED ❑ B Injury and/or Tow Due To Crash YR 202612026-00055056 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 7 ® ❑ RELATED PRIVATE ❑Y ®N 09 10 202612,— ❑YES ®NO U1 BOWES RD Elgin mo /day/yr 01:12 ®PM FLOW CONDITION RI • 02040!MI N E S ® South Randall Rd COUNTY PROPERTY ❑Y ® N DOORING Ely #OF MOTOR 0 SLOW 1 (n Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD 0 STOPPED U2 --I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST IZ1 N ® FREE FLOW # LNS 0 (g DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EWES ❑uuv 0!Cy ❑Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 0 5 / yr 13-UNDER CARRIAGE ©,I !�. 2 FIRE 0 (E < STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ❑ ]$I U2 IT1 M 2 4 Y SYSTEM IN ENGAGED 15-OTHER 9 16.70P 3 6 ALGN = ❑ ❑N ❑UNK VEH. AT CRASH 99-UNKNOWN `Distraction Value r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 11 s iL 6 I, 4 COM VEH 0 Ea 1 0 11 Freeport IL 61032 0 1 0 GJ98990 IL FIRST CONTACT 7_ REAR __5 *If Yes.See Sidebar U1 20 2 Z TELEPHONE IL D 2C3KA53G57H871109 AARP Auto ❑v ®N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Same 55100738333 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y ® N 2 eu Eg DRIVER ❑ PARKED ❑DRIVERLESS ❑ FED ❑PEDAL ❑EWES ❑!My 0 Ixv ❑DV /2 O 0 7 Toyota Camry 2025 00-NONE ,o-�l 12 (,-2 FIRED CRASH ® U2 2 C 0 Yr 13-UNDER CARRIAGE IIIEl P. M 2 4 SYSTEM IN ENGAGED 15-OTHER 9.16•TtOP 3 0 X ❑Y ❑N DUNK VEH. AT CRASH 99-UNKNOWN I O `Distraction Value N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF S- l 6 j1:, 4 COM VEH D ® U1 CO FIRST CONTACT 4 7-'_,�_6 •• •)ryes,See Sidebar = ELGIN IL 60120 0 1 0 FC21669 IL Rr C 0 IL D 4T1 DBADK1 SU019757 Progressive ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X Gonzalez.Stephanie 869893378 SAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP u1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ) 1(EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)/(ADDRESS)/(TELEPHONE) (EMS) (HOSPITAL) 2 4 03 / :A / / UI 1 D / / 3 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 11 1 9/ /0/ /026 01 12 ®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 H . AM U1 O 2 0 20 40 / / ❑PM ❑Construction Z3 ❑ !Si CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME ❑AM 0 Maintenance U2 3 o1 ® 11 1 ARREST NAME Reemtsma.Arlyn. D. 11-709-A 345000323 / / El PM SLMT o N ❑CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • ❑Utility T 2 ❑ ARREST NAME AM 7 / / pM El Unknown work zone type 45 U1 n OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑Y 45 345-Gomoll.Geoffrey 801 320-Cox / / ❑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 r co - f 1. Has r more than pound (example:truck or truckrtrarler 1. Has a weight rating10 000 5 INDICATE NORTH combination):o -I BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C - } (example:shuttle or charter bus):or T, L A 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 transporter-usually a van type vehicle or passenger car):or w L L....a....� 4. Is used or designated to transport between 9 and 15 passengers,including C } } for direct compensation(example:large van used for specificpurpose):or [he driver, Pe ( P 9 Pe or • Bowes/Rood L L....a..... _ t i i. , 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires �In trsI POMH7ommpsa� ' placarding(example:placards will be displayed on the vehicle). XI UM 2_ _ _ _ _ —1 CARRIER NAME Z ADDRESS tlr 1 l CITY/STATE/ZIP O _ • MOTOR CARR.ID 0 Interstate 0 Intrastate Not TO Scale ❑ Not in Comm./Govt. ❑ Not in Comm./Other 00 ‘I. - --1 USDOT NO. ILCC NO. C m XI Source of above z . 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 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 Gray Black u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY/TO: _ SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 DUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY/T6 DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE