HomeMy WebLinkAbout2026-00056945 ILLINOIS TRAFFIC CRASH REPORT sheet 1 of 4 Sheets 01111101111
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INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW '
DAMAGE TO ANY ❑5500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away
Elgin Police Department ONE PERSON'S ❑$501-$1.500 ®ON SCENE 14
VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and for Tow Due To Crash
0 AMENDED YR 202612026-00056945 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 rl
BIG TIMBER RD EIIn
® ❑ RELATED ®Y 0 N 09 18 2026 07:37 ❑AM ❑YES ®NO U1 -<
g PRIVATE mo /day!yr ®PM FLOW CONDITION m
FTlMI N E S W N MCLEAN BLVD COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ®SLOW 2 fA
❑ 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
Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EWES 0 NIA/ 0!CV 0 DV DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 0
0 5 /
yr 13-UNDER CARRIAGE :: FIRE ❑
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ® ❑ U2 O m
M 2 8SY❑Y ONM❑UNK VEH. O AT CRASH IN O 99-UNKNOWN 9 16•TOP 3 *Distraction Value 6 ALGN 2
r CITY STATE ZIP INJ EJCT EPTH PLATE NO STATE YEAR POINT OF s,.its _4 5 *uYes.See Sidebar Ut COM VEH 0 Ea 1 0
F. FIRST CONTACT 12 7. _
Z Algonquin IL 60102 C 1 0 FH35071 IL 2027 I ,
TELEPHONE
IL D WAU B1 G FF6H 1012098 Progressive ®Y ❑N U2 31 , m
13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
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Elgin Fire Same 862083617 1 r
"o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER
RESPONDER en
Sherman ❑Y ® N 2 0
x DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EWES 0 NMV 0 KV ❑DV CIRCLE NUMBER(S) U1
�1 9 6 7 General MotorSiQoq 2025 00-NONE O Qi-_, DUE TO CRASH ❑ 2
0 13-UNDER CARRIAGE 10( I 2 FIRE ❑ ® U2 C
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M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9,16-TOP 3 X
❑Y i N ❑UNK VEH. AT CRASH 99-UNKNOWN *0istracton Value 9 0
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF
i1i" 4 COM VEH D ® U1 CO
6
FIRST CONTACT 11 8 7 -5 •If Yes.See Sidebar
— Indianapolis IN 46254 0 1 0 TK181 OXR IN 2027 I O C
IN D Allstate ❑y ®N RDEF
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 =
Same 811470531 BAC
$
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)1(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL)
1 0
EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z
N 1 ® 11 4 09,18 /2026 07 37 ®PM in a Work Zone? ®N DIRP co
1 I PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME ❑AM If YES check one below: U1 7 C)
T
0 2 ❑ 2 40 + ) ❑PM ❑Construction X
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3 ❑ Ii CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME ❑AM ❑Maintenance U2
a u 1 ® 11 4 ARREST NAME Ferguson. Nathan 11-901-A 1513001127 / ! El PM SLMT
I$[CITATIONS ISSUED ❑PENDING SECTION CITATION NON . ROAD CLEARANCE TIME AM• ❑Utility
o t 2 ❑ ARREST NAME Ferguson. Nathan 11-601 1513001128 091 18 12026 08 21 ®PM ❑Unknown work zone type U1 45
2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑qM Workers present? ❑Y 45
1513-Mann. Nathaniel 502 337-Thompson 10 +06/2026 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 0 1. Hasor more thanpounds(example:truck or truck/trailer 1. Hasaweight rating10,000 5 -I
I I INDICATE NORTH combination): p3
` I t I - BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C
li. e. rt- (example:shuttle or charter bus):or 0
3. Is designed to carry15 or fewer passengers and operated a contract carrier 0
-1-- ---1 j I ( I r - } } } transporting employee In the course of their employment(example:employee X
wortraanne- <.___a____� 1 1 transporter4. sedord si natedtotransportbetween9a dr15p ssen rs,includingthedriver,
} } } for direct compensation(example large van used for specific purpose):or O
L L.__-a____. i i 5. Is any vehicle used to transport anyhazardous material(HAZMAT)that requires
placarding- m
(example:placards will be displayed on the vehicle). ;p
— — — — �+ - D
CARRIER NAME —I
Z
,k,�i'l 1 � ADDRESS 0
CITY/STATE/ZIP 0
MOTOR CARR.ID 0 Interstate ❑ Intrastate
Not Tb Scale I 0
I I T I ❑ Not in Comm./Govt. 0 Not in Comm./Other
i— --- --4. USDOT NO. ILCC NO. m
XI
Source of above z
. IDOT PERMIT NO. WIDELOAD-; ❑Yes 0 No =
TRAILER VIN 1 m
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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 Gray
u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_
DUE TO ti 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 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/TO:
DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE