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HomeMy WebLinkAbout2026-00058589 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 0110 II I 01111111111011111 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X004393O22' u, 1 U21 1 1 1 u1 9 U2 1 u, 1 1_12 1 u, 1 U2 1 1 15 U123 U2 1 .P 0119* INVESTIGATING AGENCY DAMAGE TO ANY ❑$500 OR LESS TYPE OF REPORT ® q No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW ' Elgin Police Department ONE PERSON'S ❑$501-$1.500 ®ON SCENE 7 VEHICLE/PROPERTY ®OVER 51,500 ❑NOT ON SCENE(DESK REPORT) ❑AMENDED ❑ B Injury and/or Tow Due To Crash YR 202612026-00058589 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 14 �I ® ❑ RELATED ❑Y ®N 09 26 2026 ❑AM ❑YES ®NO U1 -< 3191 ROUTE 20 Elgin PRIVATE mo /day/yr 12:41 ®PM FLOW CONDITION m • ®10(()u!MI N E s © ROUTE ZO/NESLER RD COUNTY PROPERTY ®Y ElN DOORING El #OF MOTOR 0 SLOW 15 u) Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD 0 STOPPED U2 —I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N 51 FREE FLOW # LNS 0 18:DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EWES ❑uuv ❑!CV ❑Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 C) FOR DAMAGEDAREA(S) FRONT TOWED U1 Q NAME(LAST,FIRST,M) mo 1 9 8 1 Chevrolet Silverado 2011 00-NONE 11 12 , DUE TO CRASH ❑ EN 13-UNDER CARRIAGE ! 2 FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 0 rr1 10l THER M 2 4 SYTM❑Y ®SNE❑UNK VEH. 0 AT CRASH 0 15-99-UNKNOWN 9 76•TOP 3 ,Distraction Value 9 ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF a _II-6 ii,4 COM VEH ❑ j$J 1 0 F. FIRST CONTACT 6 7_ Q,__5 *uYes.SeeSidebar Ut Z Carpentersville IL 60110 0 1 0 183130C IL 2027 TELEPHONE IL D 0 1 GBOKVCG4BF229771 StateFarm ❑Y Il N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 Acosta. Hortencia E634135C1513 1 rn `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER RESPONDER 98 0 Eg DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EWES ❑NMV 0 NCV ❑DV CIRCLE NUMBER(S) U1 !1 9 yr 7 Toyota Sequoia 2026 00-NONE 11_"j 12 "_, DUE TO CRASH ❑ (� 2 0 13-UNDER CARRIAGE 10'1 2 FIRE ❑ ® U2 C c M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9,1,6-TOPO3 X ❑Y ®N ElUNK VEH. AT CRASH 99-UNKNOWN O 0istraellon Value 9 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s-iI 6 i.,_4 COM VEH D ® U1 CO FIRST CONTACT 3 7 _, _6 •(ryes,See Sidebar = ELGIN IL 60124 0 1 0 FZ48637 IL 2027 I 9 Sn IL D 0 7SVAAABA1TX098213 Farmers Insurance ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = 99 9 EmphasisHR 548848978 BAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP U1 = (UNIT) (SEAT) (D081 (SEX) (SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)!(A.DDRESS)!(TELEPHONE! (EMS) (HOSPITAL) 1 3 06 / M 2 4 0 1 0 m / / #OCCS D 71 / / u1 2 D / / 1 0 EV MOST EVNT LOG DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 11 5 09,26 i2026 12 41 ®AM in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 1 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 C) 2 ❑ 30 99 N 3 o 0 CITATIONS ISSUED 0 PENDING + ) 0 PM• ❑Construction SECTION CITATION NO. EMS ARRIVED TIME ❑AM ❑Maintenance U2 3 -a, ARREST NAME / / ID PM ' o N ® 11 5 0 CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • El Utility SLMT 15 t 2ARRESTNAMEAM 7 ❑PM 0 Unknown work zone type U1 El 1 / ❑ n OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 ❑ ❑AM Workers present? 0 Y 15 1530 Soto.Oscar 801 320-Cox / ❑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 ° BY ARROW combination):or 2 Is used or designed to transport more than 15 passengers including the driver C Not To Scale I _ (example:shuttle or charter bus):or 0 - }----A---.i 1 3. Is designed to carry 15 or fewer passengers and operated a contract carrier I O , - } } } transporting employees In the course of their employmentge � (example:employee X 3191?Route720 1 transporter-usually a van type vehicle or passenger car):or CD L }-----}----+ i - • } I- } •4. Is used or designated to transport between 9 and 15 passengers,including the driver. N for direct compensation(example:large van used for specific purpose):or 0 L____a____. i i _ 5. Is any vehicle used to transport an hazardous material(HAZMAT)thatrequires placarding(example:placards will be displayed on the vehicle). m Lazar?Ln XI_ — — _. ._Unit 2 f _ ltil}] CARRIER NAME Z ADDRESS 0 n CITY/STATE/ZIP g tr C Unit 1 - MOTOR CARR.ID 0 Interstate 0 Intrastate 1 I r 1 ❑ Not in Comm./Govt. 0 Not in Comm./Other -----------1 - USDOT NO. ILCC NO. rn XI Source of above z . • m 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 ❑ 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 v TRAILER WIDTH(S) 0-96" 97-102" >102' T TRAILER 1 ❑ ❑ 0 Z TRAILER 2 ❑ 0 0 O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. Z White 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 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/T6 DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE