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HomeMy WebLinkAbout2026-00059557 ILLINOIS TRAFFIC CRASH REPORT sheet 1 of 2 Sheets 01111101111 IIIIII II II IIIIIIII IIIII 11111111 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X004399361 u, 1 U21 3 4 2 u116 U2 1 u, 1 u2 1 u, 1 U2 1 5 15 u1 1 U2 1 *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 ®5501-$1.500 ®ON SCENE 3 VEHICLE/PROPERTY ❑OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash 0 AMENDED YR 2026I 2026-00059557 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 r1 CENTER ST El In 07:23 ® ❑ RELATED ®Y 0 N 09 30 2026 12,— ❑YES ®NO U1 _ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION m FT/MI N E S W KIMBALL BALL ST COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR El SLOW 15 u) ❑ Kane HIT&RUN ❑V ® N WITH VEHICLES INVLD ❑ STOPPED U2 --I CO AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST IZI N ® FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EWES 0 uuv 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 n 0varez. yr 13-UNDER CARRIAGE © al ,I �:. 2 FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 ]$I U2 4 <<Tl F 2 SYSTM IN ENGAGEDTHER 4 ❑Y 21 NE ElDUNK VEH. O AT CRASH 0 99-U15-UNKNOWN 9 16-TOP 3 `Distraction Value ALGN = r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s it 6 4 COM VEH ❑ j$J 1 0 ~ Dekalb IL 60115 0 1 0 FIRST CONTACT 12 7_; __6 *uYes.SeeSidebar Ut Z FE76985 IL 2021 TELEPHONE IL D 0 KL4CJ ESBXM 6343845 Geico ❑v ®N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Elgin Fire 99 9 Same 6203986937 2 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Sherman El ® N 2 eu p; DRIVER ❑ PARKED 0 DRIVERLESS ❑ PED ❑PEDAL ❑EWES 0 row 0 i v ❑Dv yr 12 0 13-UNDER CARRIAGE FIRE 0 ® U2 c F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9,16-TOPO3 X ❑Y ®N ElUNK VEH. AT CRASH 99-UNKNOWN O 0istraclIon Value 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8-iI 6 l', 4 COM VEH ❑ ® U1 CO FIRST CONTACT 2 Y _�-`-�•byes,See SidebarC ELGIN IL 60120 0 1 0 BX99098 IL 2026 I 0 IL D 0 1 C4NJDBB7FD147751 State Farm ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X Elgin Fire 99 9 Same 3973520-SFP-13 SAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Sherman RESPONDER u1 = (UNIT) ISEATI (DOB) (SEX) {SAFT) (AIR) (INJI j(EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)((ADDRESS)((TELEPHONE) (EMS) (HOSPITAL) 2 6 10 / :A / / UI 1 D / / 3 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z u 1 ® 11 1 09/30 /2026 07 23 ®AM in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 3 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 C) ✓ 2 0 28 18 09/30 /2026 07 24 ®PM ❑Construction >F 1 R 3 0 0 CITATIONS ISSUED ❑PENDING SECTION CITATION NO. EMS ARRIVE° TIME 5 ❑AM 0 Maintenance U2 a ® 11 1 ARREST NAME Alvarez. Deisy 11-601-Ax 1548000323 09/30/2026 07 27 Igi PM SLMT o N 0 CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME 0 AM - ' El Utility T 2 El ARREST NAME 09/30 /2026 08 20 0 PM El Unknown work zone type U1 25 n T OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 0 1548-Crandall. Matthew no 337-Thompson / / ❑❑PM Workers present? ®N U2 30 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 I 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer -< ` ` ' ' N INDICATE NORTH combination):or p0 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driverC -, NotToSaes ( I I } (example:shuttle or charter bus):or i 3. Is designed to carry 15 or fewer passengers and operated a contract carrier O I- I- --I-----; I j�I transporting employees employment(example:employee X } r } transrter-usuallya van the coursevehicclle or Potype passenger car):or c0 C L L.___a__._.l 4. Is used ordesi natedtotrans rtbetween9and15passengers,includingthedriver, ! } } } for direct compensation(examp large van used for speific purose):or L i.----a-- , - i. i 5. Is any vehicle used to transport anyhazardous material(HAZMAT)that requires •u .y — �« placarding(example:placards will be displayed on the vehicle). ,Zmt / ® —1 CARRIER NAME Z ADDRESS 0 T. C) CITY/STATE/ZIP g MOTOR CARR.ID 0 Interstate 0 Intrastate 0 I I T I ❑ Not in Comm./Govt. 0 Not in Comm./Other --- --1 - USDOT NO. ILCC NO. m XI Source of above z . —I Were HAZMAT placards on vehicle? 0 Yes 0 No = If Yes,Name on placard O 4 digit UN NO. 1 digit Hazard class No. XI 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 M 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 0 0 Z TRAILER 2 ❑ 0 0 O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w Black Black u 1 TOWED • TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT- 3 TOWED BY/TO. Arties/Impound Lot Garage . SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® Arties/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE