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HomeMy WebLinkAbout2026-00057830 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets _ 01111101111 0110 II I fl 11 I1UUI I10011lUU00 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X85964 u, 1 u21 3 4 1 Ut U2 1 U,99 1_12 1 U1 1 U2 1 1 10 u, 3 U211 *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 11 VEHICLE/PROPERTY El OVER$1,500 El NOT ON SCENE(DESK REPORT) (8:1B Injury and f or Tow Due To Crash El AMENDED YR 202612026-00057830 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 mRT20 WB El In 07:56 ® ❑ RELATED ®Y 0 N 09 23 2026 ®AM ❑YES ®NO U1 —< _ _ g PRIVATE mo !day,yr ❑PM FLOW CONDITION m FT l MI N E S W S MCLEAN BLVD COUNTY PROPERTY ❑Y ® N DOORING ICIy #OF MOTOR El SLOW 1 0)0 Kane HIT&RUN ❑V ® N WITH VEHICLES INVLD ❑ STOPPED U2 —I ® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N 51 FREE FLOW # LNS 0 g DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EOUES 0 NIA/ 0 ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 3 n FOR DAMAGED AREA(S) FROftf TOWED U1 0 Visbal Salas.Cristian. L. 0 9 / yr 13-UNDER CARRIAGE 10 i ! 2 FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 3 <<it M I 2 4 SY❑Y ®SNEM DUNK VEH. O AT CRASH IN 0 99-UNKNOWN 9 76•TOP 3 *Distraction Value 9 ALGN = r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s,;i�a 4 COM VEH 0 j$J 4 O ~ ELGIN I N I L 60123 0 1 0 FIRST CONTACT 12 7 ; _-5 *If Yes.See Sidebar U1 Z G F12873 I L 2026 TELEPHONE IL D 0 4T4BF3EK7BR212149 American Alliance ❑Y ®N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 Same ILAA109745400 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y El 2 0 g DRIVER ❑ PARKED 0 DRIVERLESS ❑ PED 0 PEDAL 0 EWES 0 uv 0 NOV 0 Dv 2 0 0 2 Yr Kia Motors Coi!i5 2025 00-NONE ,�_"j 12 -_, DUE TO CRASH ❑ 2 o ©-UNDER CARRIAGE 10'1 2 FIRE ID ® C) ® U2 C c M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9,1r. 6-TOP 3 X ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN *0istraglon Value g g POINT OF s i 4 COM VEH ❑ ® U1 CO N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR 5 FIRST CONTACT 6 O7 ,�=QI 4OS •IfYes See Sidebar C BARTLETT IL 60103 0 1 0 FH48143 IL 2026 IAR 0 N IL D 0 KNAG64J7XS5378104 Allstate ❑Y ®N RDEF71 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = 99 9 Lanzi, Dina 811899598 BAc $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP U1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)!{ADDRESS)((TELEPHONE) (EMS) (HOSPITAL) U2 996 r m ##occs y 71 / U1 1 D 1 0 E/ MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z 123 N 1 ® 11 1 09,23 ,2026 08 00 0 PM in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 7 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 C) 0 2 ❑ 28 03 , , 0 PM ❑Construction >F R 3 0 $I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 7 ❑AM 0 Maintenance U2 o1 ® 11 1 ARREST NAME Visbal Salas,Cristian, L. 11-601-Ax 449000436 , r ❑PM SLMT o N ❑CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ❑Utility AM U, 35 t 2 El ARREST NAME 09 r 23 12026 09 00 In PM 0 Unknown work zone type 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑qM Workers present? ❑Y 35 449-Harris,Jacob 602 320-Cox 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 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer -< ` ` -' -' �,' _ INDICATE NORTH combination):or —I A . BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C i i (example:shuttle or charteror Ppr bus): X op)......... . 3 Is designed to carry15 or fewer passengers and operated a contract carrier O L I- --I--. ,� } } } transportingemployees in the course of their employment 1r transporter- a van vehicle or (example:employee w Po usually type passenger car):or c0 L ♦ 4. Is used or designated to transport between 9 and 15 passengers,including C }---..i.. .-; / } } } g Po passen rs,includi the driver, for direct compensation(example:large van used for specific purpose):or o L t ii. , 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m ' placarding(example:placards will be displayed on the vehicle). XI 3 —1 CARRIER NAME Z ADDRESS 0 0 CITY/STATE/ZIP g II Not To Scale 1 < �7 _ MOTOR CARR.ID 0 Interstate 0 Intrastate I r ❑ Not in Comm./Govt. 0 Not in Comm./Other ; _Y_ _-1 - USDOT NO. ILCC NO. 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 White Gray 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 TOWED DISABLING DAMAGE NOT DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® DISABLING DAMAGE Arties/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE