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HomeMy WebLinkAbout2026-00054684 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 01111101111 I0110 II I Oil I.IIIIIIIIII DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X376165 u, 1 U21 3 4 1 U199 U299 U, 1 1_12 1 U, 1 U2 1 1 10 U1 1 U2 3 *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 El$501-$1.500 ®ON SCENE 3 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and for Tow Due To Crash 0 AMENDED YR 202612026-00054684 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n ® ❑ RELATED ®Y 0 N 09 08 2026 ❑AM ❑YES ®NO U1 S RANDALL RD Elgin04:27 _ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION m FT!MI N E S W BOWES RD COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 1 cn ❑ Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD ❑ STOPPED U2 —I Igl 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 EWES 0 NW 0!CV 0 DV DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 0 FOR DAMAGEDAREA(S) .FROM TOWED U1 Q Luke.Gre or.J. 0 6 / yr 13-UNDER CARRIAGE ©,I �._.,2 2 FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 0 m M 2 SY4 ❑Y ®SNE❑UNK VEH. 0 AT CRAS IN H 0 99-UNKNOWN 9 16•TOP 3 `Distraction Value 9 ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8, i�e 4 COM VEH ❑ El 1 0 ~ Somonauk IL 60552 0 1 0 FIRST CONTACT 12 7_: __5 *Ifves.SeeSidebar Ut Z 4297144B IL 2026 E TELEPHONE DC D 0 1 D7HW48N45S212104 GEICO INSRUANCE ❑Y ®N U2 m I EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 Same 6216970134 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused 0 Y ® N 2 0 E{ DRIVER 0 PARKED 0 DRIVERLESS ❑ PED 0 PEDAL 0 EWES 0 NMV 0 NOV 0 DV BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) U1 m m FOR DAMAGEDAREA(S) FRONT TOWED Y N >. NAME(LAST,FIRST,M) Singh- Kesar 1 0 ! a08y !1 9 yf 0 Hyundai Genesis 2015 00-NONE 11_"1 Qi-O DUE TO CRASH rg ❑ 2 x 0mo 13-UNDER CARRIAGE 10( I 2 FIRE 0 El U2 C II M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9,16-TOP 3 X ❑Y i N DUNK VEH. AT CRASH 99-UNKNOWN *Distraction Value g g POINT OF 8 i1�.-4 COM VEH 0 ® U1 CO N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR FIRST CONTACT 12 7� B .5 •Fryer,See Sidebar = Hanover Park IL 60133 0 1 FZ81039 IL 2027 REAR 0 C IL D 0 KMHGN4JE8FU065922 State Farm ❑Y ®N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = 99 9 Same 3908776SFP-13 BAG $ 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 N 1 ® 11 4 09,08 ,2026 04 27 ®pm in a Work Zone? ®N DIRP co 1 F PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 5 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 � 2 0 18 99 09,08 ,2026 04 28 pM ' ® • ❑Construction >F Z 3 0 0 CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 1 DIAM ❑Maintenance U2 -a ARREST NAME 09,08,2026 04 36 ®pM ' 1 11 4 ElUtility 0 CITATIONS ISSUED ❑PENDING SLMT o, N ® SECTION CITATION NO. ROAD CLEARANCE TIME 0 AM F 2 0 ARREST NAME 09/08 ,2026 05 08 ®PM 0 Unknown work zone type U1 50 o T n OFFICER ID SIGNATURE BEAT!DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 ID - ❑AM Workers present? ❑Y 50 1544 Solis•Yulissa 981 , ❑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 e-----e••--, , - ; 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 -< i- }__-_r-_--; • _ INDICATE NORTH combination):or '.Ill. - I^I' C BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver I I I err (example:shuttle or charter bus):or C) 1 11 X 1 I I 3. Is desgned to carry 15 or fewer passengers and operated by a contract carrier I O } -A- -•i 1 1 ` } } } transporting employees In the course of their employment(example:employee Ilika] • ___ _ transporter-usually a van type vehicle or passenger car):or • C < • I. 4. Is used or designated to transport between 9 and 15 passengers,including C -- -- c } } g po passen rs,includi the driver, ra„: ___- for direct compensation(example:large van used for specific purpose):or a �i e _ t l L 1 L 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m i, placarding(example:placards will be displayed on the vehicle). ;p - . 1 I I ' .. CARRIER NAME Z li o I . - ADDRESS D w C) CITY/STATE/ZIP g __ _ .. _ Not To Scale MOTOR CARR.ID 0 Interstate 0 Intrastate '� ❑ Not in Comm./Govt. ❑ Not in Comm./Other 00 -"-----"1 - USDOT NO. ILCC NO. C m XI Source of above z . 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 Blue White 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: 3 TOWED BY/TO: DUE TO ® Redmons/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE DUE