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HomeMy WebLinkAbout2026-00057821 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 IIIIII II II I IIIIIIIIII 1fl101110000 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV XO014393O13 u, 1 U2 2 4 1 U1 2 U2 1 U, 1 U2 u1 1 U2 2 1 U1 3 U2 *P 0 1 1 9* INVESTIGATING AGENCY DAMAGE TO ANY ®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 15 VEHICLE/PROPERTY El OVER$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash El AMENDED YR 202612026-00057821 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n ® ❑ RELATED PRIVATE ®Y 0 N 09 23 2026 ®AM ❑YES ®NO U1 LARKIN AVE I N WORTH AVE Elgin mo /day/yr 06:34 ❑PM FLOW CONDITION m 020 0/MI N E S © LARKIN AVE I N WORTH AVE COUNTY PROPERTY ❑Y ® N DOORING ❑y #OFMOTOR ❑SLOW Cl) Kane HIT&RUN ❑V ® N WITH VEHICLES INVLD ❑ STOPPED U2 -I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N 51 FREE FLOW # LNS 0 18:DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uuv 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 n FOR DAMAGEDAREA(S) FRONT TOWED U1 Q Franz. Michael.A. 1 1 / yr 13-UNDER CARRIAGE 10.I !�. 2 FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 2 m M 2 SY 15-OTHER 4 ❑Y ®SNE❑UNK VEH. O AT CRASH M IN D O 99-UNKNOWN 9 16•TOP 3 `Distraction Value ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8. i�a �i COM VEH ❑ j$J 1 0 1 . ELGIN IL 60123 0 1 0 FIRST CONTACT 11 7_; __5 *Ilyes.SeeSidebar U1 Z 1387EG IL 2027 REAR TELEPHONE IL D 0 ZACCJABB7HPF57198 Progressive El igiJ N U2 I- 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m co 99 9 Same 987123502 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y El 2 0 0 DRIVER 0 PARKED 0 DRIVERLESS N PED 0 PEDAL 0 EWES 0!My 0 NCV 0 DV yr 12 ,- X1 o 13-UNDER CARRIAGE 10.i 2 FIRE 0 ® U2 C c F Y SYSTEM IN ENGAGED 15-OTHER 9 16-TOP 3 ❑ ❑ ❑UNK VEH. AT CRASH 99-UNKNOWN *Distraction Value 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8-.iI�:--4 COM VEH ❑ ® U1 CO FIRST CONTACT 15 YA-j .5 •IfYes.See Sidebar C ELGIN IL 60123 A 0 0)D 0 ❑y ❑N RDEF73 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X Elgin Fire 1 49 1 SAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Sherman RESPOND Y ❑N U1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME),(ADDRESS),(TELEPHONE) (EMS) (HOSPITAL) 0 EV MOST EVNT LOG DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ®Y U2 Z N 1 ® 12 1 09,23 /2026 06 35 ®❑pM in a Work Zone? ❑N DIRP 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 2 99 09,26 ,2026 06 35 ❑PM ®Construction >F R O ❑ ]$I CITATIONS ISSUED PENDING SECTION CITATION NO. EMS ARRIVED TIME 3 ®AM ❑Maintenance U2 au ® 12 1 ARREST NAME Franz. Michael.A. 11-1002-A 495000518 09/26/2026 06 40 ❑PM SLMT o N 0 CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ' ❑Utility AM U, 35 r 2 ❑ ARREST NAME 09/26 /2026 07 06 0 PM ❑Unknown work zone type 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑AM Workers present? ❑y 35 495-Sjodir.Jacob 601 10 ,20,2026 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. .. .. , 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 truckrtrailercombination):or -< INDICATE NORTH p1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C - } (example:shuttle or charter bus):or X - --___a_.--i kerk}n4Avemte } } } } transportinggemned tploo aeeslin the course 5 or fewer passengers their employment ment operated bmpy a contract:employeerler O employees pbyment(example: X transporter-usually a van type vehicle or passenger car):or CO L L.___a__._. -- - - - 4. Is used ordesi natedtotrans rtbetween9and15passengers,includingthedriver, C Untl�2 r .— — } } • for direct compensation(example:large van used for speific purose):or 0 L L-___a.___.I I . 'r›(!rdrzi 1 - t i I 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m w,/ placarding(example:placards will be displayed on the vehicle). XI —I _ CARRIER NAME Z ADDRESS T. n CITY/STATE/ZIP g I _ MOTOR CARR.ID ❑ Interstate ❑ Intrastate r6 Not To Scale J 0 I r ❑ Not in Comm./Govt. 0 Not in Comm./Other ----- 1 USDOT NO. ILCC NO. m XI Source of above Z . ❑ 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 to LOCAL USE ONLY TRAILER VIN 2 m v TRAILER WIDTH(S) 0-96" 97-102" >102' m TRAILER 1 ❑ ❑ 0 Z TRAILER 2 ❑ 0 ❑ O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. Z Red 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 DISABLING DAMAGE DAMAGE EXTENT: TOWED BY/T6 DUE TO VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE