Loading...
HomeMy WebLinkAbout2026-00056460 ILLINOIS TRAFFIC CRASH REPORT sheet 1 of 2 Sheets 01111101111 IIIIII II II I flfl fl IIIIIIIIIIIIIIII DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X�377938 u, 1 U21 1 1 8 U1 2 U2 1 U1 1 U2 1 U, 1 U2 1 5 15 U12O U2 1 �K P 0119 INVESTIGATING AGENCY DAMAGE TO ANY El$500 OR LESS TYPE OF REPORT 0 A No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW ' Elgin Police Department ONE PERSON'S ❑5501-51.500 ®ON SCENE 15 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) El B Injury and/or Tow Due To Crash 0 AMENDED YR 2026I 2026-00056460 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 71 415 DUNDEE AVE Elgin07:16 ® ❑ RELATED ®Y ❑N 09 16 2026 ❑AM ❑YES ®NO U1 -< _ _ PRIVATE mo /day/yr ®PM FLOW CONDITION m COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 15 u) ❑ FT/MI NESW Kane HIT&RUN ❑Y ® N WITH VEHICLESOT, INVLD ❑ STOPPED U2 --I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 Qg3 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uuv 0!CV ❑Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) 0 0 Y N 0 5 / Bronco 2024 00-NONE ©, O' , DUE TO CRASH ❑ EN O NAME(LAST,FIRST,M) yr 13-UNDER CARRIAGE ) FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 2 DISTRACTED 0 0 U2 2 m M 2 SYTM IN ENGAGE15-OTHER 4 ❑Y ®SNE❑UNK VEH. O AT CRASHD O 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 �i COM VEH 0 Ea 2 O ELGIN I L 60124 C 1 0 FIRST CONTACT 11 7_: __5 *Ilyes.See Sidebar U1 Z EN80489 IL 2027 REAR TELEPHONE IL D 0 3FMCR9G60RRF68422 Progressive ❑v ®N U2 I— in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Elgin Fire 99 9 Same 864197106 2 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused 0 Y El 2 0 m E{ DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NMv 0 NCv ❑DV CIRCLE NUMBER(S) U1 !2 0 0 0 Honda CRV 2021 00-NONE 11' 12 DUE TO CRASH ❑ 2 o 13-UNDER CARRIAGE I FIRE ❑ ® U2 c F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 19-TOP 3 X ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN *Distraction Value 9 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s i1 4.A 5 jf,_ COM VEH ❑ ® U1 CO FIRST CONTACT 1 7�. —�_-5 •If Yes.See Sidebar = Hanover Park IL 60133 0 1 0 CM76889 IL 2026 I0 IL D 0 2HKRW2H58MH679218 Geico ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X Elgin Fire 99 9 Cruz. Edith 6192-95-31-04 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) / / 2 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z N 1 ® 11 1 09/16 /2026 07 16 ®AM in a Work Zone? ®N DIRP co 1 t PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 8 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 C) v 2 ❑ 28 2 09(16 /2026 07 30 ®PM ❑Construction * <ov 3 0 ]$I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 2 z J ❑AM ❑Maintenance U2 -a, ARREST NAME SMITH. DAVID. E. 11-601 S1542-001029 09/16/2026 07 34 igi pM SLMT o U 1 ® 11 1 ljgCITATIONS ISSUED 0 PENDING Utility o N SECTION CITATION NO. ROAD CLEARANCE TIME AM• 0 r 2 ElARREST NAME SMITH. DAVID. E. 11-906 S1542-001030 09(16 /2026 08 00 0 PM 0 Unknown work zone type U1 15 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 30 1542-Chase. Ethan 301 393-Gutierrez 10 ,20/2026 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 ADDITIONAL UNITS FORMS. r ----r••--, , / A CMV is defined as any motor vehicle used to transport passengers or property and: Z r / / combination):or more than pound (example:truck or truck/trailer 1. Has a weight rating10 000 5 i -< INDICATE NORTH tion): -I • BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C i / / - (example:shuttle or charter bus):or X `----a----J. - / / - - transportingdgemloyeeslIn the course of 5 or fewer he r emplrs oyment(example:employee a contract ner X ti GNP '• r ' transportr-usually a van type vehicle or passenger car): r • / 2� / -Tr`_ _ } I- } 4. Is used or designated to transport between9and1�ssen rs,includingthedriver, C J for direct compensation(example:large van used fors specific purpose):or to L L____a____.I / / . , l. i � t 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m ` placarding(example:placards will be displayed on the vehicle). Qttve CARRIER NAME Z / / ADDRESS 0 / / n CITY/STATE/ZIP 0 MOTOR CARR.ID 0 Interstate 0 Intrastate / ❑ Not in Comm./Govt. ❑ Not in Comm./Other 00 :- .---------; USDOT NO. ILCC NO. C HickoryflPi m XI Source of above z . MCS ❑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' -n TRAILER 1 ❑ ❑ 0 Z TRAILER 2 ❑ 0 0 o u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w Black White u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/TO: _ 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