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HomeMy WebLinkAbout2026-00055263 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 IIIIII II II I 11111111 100001 II100 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X 76214 u1 1 u21 3 4 1 u1 5 U2 1 U199 U2 1 U199 U299 1 10 u, 5 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 El$501-$1.500 ®ON SCENE 3 VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) El B Injury and/or Tow Due To Crash ❑AMENDED YR 202612026-00055263 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n ® ❑ RELATED PRIVATE ®Y 0 N 09 11 2026 ®AM El YES ®NO U1 N RANDALL RD/FOX LN Elgin mo /day/yr 11.38 ❑PM FLOW CONDITION m • ®10 0/MI ON E S W N RANDALL RD I FOX LN COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 1 (n Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD ❑ STOPPED U2 —I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS O 183 DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EWES ❑uuv ❑!CV ❑Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 6 n FOR DAMAGEDAREA(S) FRONT TOWED U1 O Stephens,Ton G. 1 2 / yr 13-UNDER CARRIAGE ©it,,I !�. 2 FIRE ❑ tz STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ® 0 U2 6 m M 2 4 SYSTEM IN ENGAGED 15-OTHER 9 16.70P 3 9 ALGN = ❑Y ❑N ❑UNK VEH. AT CRASH 99-UNKNOWN `Distraction Value r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s it 6 ii,4 COM VEH ❑ j$J I 0 f. FIRST CONTACT 11 7_; ;__5 *If Yes.See Sidebar U1 Z West Dundee IL 60118 0 1 0 CV5337 IL 2026 I TELEPHONE IL D 0 KM H DH4AE5FU234286 State Farm ❑Y ®N U2 m 12 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m co Elgin Fire Same 2272985-sfp-13 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑V El 2 0 p; DRIVER ❑ PARKED ❑DRIVERLESS 0 PEO ❑PEDAL 0 EWES ❑i uv 0 i v ❑Dv /1 9 9 3 Tesla Y 2026 00-NONE 'o,�l t2 (,-2 FIRED CRASH ® U2 2 C o 13-UNDER CARRIAGE c F 2 4 SYSTEM IN ENGAGED 15-OTHER 9.16•TOP 3 9 9 X ❑Y ❑N DUNK VEH. AT CRASH 99-UNKNOWN O `Oistraellon Value N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8- 1. 6 j1,4 COM VEH ❑ El U1 W FIRST CONTACT 5 7 —_,SOS •If Yes.See Sidebar SOUTH ELGIN IL 60177 0 1 93226EL IL 2026 I 9 Sn IL D 0 7SAYGDEE5TA759341 State Farm ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER I X Elgin Fire Same 3691941-SFP-13 SAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPONDER u1 = (UNIT) (SEAT) (DM (SEX) {SAFT) (AIR) (INJI 1(EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)/(ADDRESS)((TELEPHONE) (EMS) (HOSPITAL) 1 3 01 / :A / / UI 2 m / / 2 O EV MOST EVNT LOC. DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ID U2 Z N 1 ® 11 1 09,11 /2026 11 38 ®p PM AM in a Work Zone? ®N DIRP D co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 8 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ®AM U1 v 2 0 07 20 09,11 ,2026 11 38 ❑PM ❑Construction >F R 3 0 xi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 1 ®AM ❑Maintenance U2 ® 11 1 ARREST NAME Stephens,Tony,G. 11-801-A 273005500 09/11 /2026 11 42 0 PM SLMT S' N 1 0 CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • 0 Utility 45 t 2 0 ARREST NAME AM .1. 1 / ❑❑PM ❑Unknown work zone type U1 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑AM Workers present? ❑Y 45 273-Tucker,Craig 500 331-Ziegler 10 , 13/2026 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 �____r____; " _ 1omasaor more than pounds(example:truck or truck/trailer -< 1. Has a weight rating10 000 ,-, a .. i ; INDICATE NORTH Win) A tla T BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver 77 l? _ (example:shuttle or charter bus):or f 3. Is designed to carry15 or fewer passengers and operated a contract carrier 0 -- tre ' is 1 ; . r . transporting employee In the courses of their employment(example:employee T ire r . ,� d. transporter-usually a van type vehicle or passenger car):or w L L.___a__...I. i '1`4` ,,e • - 4. Is used ordesi natedtotrans rtbetween9and15passengers,includingthedrver. N I .• - } } } for direct compensation(example:large van used for speific purose).or _i f ,� .-fJ umr: _ _ i. < i. ,_ 5. Is any vehicle used to transport anyhazardous material(HAZMAT)that requires Min Ms ncplacarding(example:placards will be displayed on the vehicle). XI )]bum '''' 5 j •, • #az.C� x.zz ;mrm ' :% : —{ f CARRIER NAME Z _- — - ADDRESS 'O dye may;. 0 �1 �^ r~ k A''`�`7 { CITY/STATE/ZIP g .wr1" MOTOR CARR.ID 0 Interstate 0 Intrastate • L.dckro C-- •5..;,: Not To Sc7o I I T I ❑ Not in Comm./Govt. 0 Not in Comm./Other ------- --4 - USDOT NO. ILCC NO. rn PCI Source of above z . MCS 0 Yes 0 No 0 Unknown Out of Service ❑Yes ❑No 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' T TRAILER 1 ❑ ❑ 0 z ri TRAILER 2 ❑ 0 ❑ o u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w Silver 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 DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® DISABLING DAMAGE Redmons/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE