HomeMy WebLinkAbout2026-00059833 ILLINOIS TRAFFIC CRASH REPORT sheet 1 of 4 Sheets 01111101111 Mil 1 II I111111111111111
DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV XG0439D308
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INVESTIGATING AGENCY DAMAGE TO ANY 0$500 OR LESS TYPE OF REPORT ® q No Injury 1 Drive Away
AGENCY CRASH REPORT NO. TRFW
Elgin Police Department ONE PERSON'S ®5501-$1.500 ®ON SCENE 2
VEHICLE/PROPERTY ❑OVER$1,500 ❑NOT ON SCENE(DESK REPORT)
El AMENDED ❑ B Injury and for Tow Due To Crash YR 202612026-00059833 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n
® ❑ RELATED PRIVATE ❑Y ®N 10 02 2026 ®AM D YES ®NO U1 -<
BIG TIMBER RD Elgin mo /day/yr 06:11 ❑PM FLOW CONDITION III
1�5 0/MI N E s O McLean Blvd COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 1 (n
Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD ❑ STOPPED U2 —I
0 AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS O
18:DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EDUCE 0 NIAV 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) 5 n
Y N
0 5 /
yr 13-UNDER CARRIAGE 101 FIRE 0 0
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ❑ 0 U2 5 M
M 2 4 ❑Y SYSTEM IN ENGAGED 15-OTHER 9 76-TOP 3 _
❑N ❑UNK VEH. AT CRASH 99-UNKNOWN `Distraction value ALGN
T. CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6_iL 6 i 4 COM VEH ❑ 0 1 0
~ Lockport I L 60441 0 1 0 FIRST CONTACT 1 7_; __5 *II Yes.See&debar U1
Z P DA74368 IL 2026 REAR
TELEPHONE
IL D 58ADZ1B15LU069173 GEICO ❑Y ®N U2 m
in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
Thurow.Sue 6123372713 2 r
`o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER
RESPONDER
2 X
p; DRIVER ❑ PARKED 0 DRIVERLESS ❑ PED ❑PEDAL 0 EWES O NIAV 0 N CIRCLE NUMBER(S) U1
v ❑DV
'1 9 9 1 Ford Fusion 2018 00-NONE 0t2..-_, DUE TO CRASH ❑ ❑ 2 73
0 13-UNDER CARRIAGE 10 I 2 FIRE ❑ ID U2 C
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F 2 4 ❑Y ❑N ElUNK VEH. AT CRASH 99-UNKNOWN Oistrac) nvalue 0
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6-it 6 11:, 4 COM VEH 0 0 U1 CO
FIRST CONTACT 11 7� 5 •If Yes.See Sidebar
~ E LG I N
M IL 60123 0 1 0 GE34564 IL 2027
IL D 3FA6P0H76JR184200 State Farm ❑Y ®N RDEF XI
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 =
Same 4016202SFP13 BAC
$
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 <
Refused RESPONDER
u1 =
(UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)((ADDRESS)/(TELEPHONE) (EMS) (HOSPITAL)
1 0
E/ MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z
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N 1 El 11 1 10,21 /026 06 13 ®❑PM in a Work Zone? NJ DIRP D
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)
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2 ❑ 20 2 1 / ❑PM ❑Construction X
Z3 ❑ lyg CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME ❑AM ❑Maintenance U2 7
o ® 11 1 ARREST NAME Doval,Julian,C. 11-709-A 298001442 / / El PM SLMT
o N ❑CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ❑Utility
t 2 ❑ 45
ARREST NAMEAM
x- T ❑PM ❑Unknown work zone type U1
( / ❑
2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑AM Workers present? ❑Y 45
298-Lopez, Mirko 502 360-Yucaitis 11 ( 10/2026 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 -<
c ` --I -' r INDICATE NORTH combination):or —I
' -.,,.,� I I BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C
L _ } (example:shuttle or charter bus):or
,,• ! 3. Is desgned to carry 15 or fewer passengers and operated by a contract carrier O
-_ I _'T -IIngwr } } } transportingemployees In the course of their employment
Apopbymar):or ample:employee X
0. transporter-usually a van type vehicle or passenger car):or c0
a ti 14. Is used or desi nated to trans rt between 9 and 15 ge ng N
} } for direct com nation exam I lar a van used for s �cifice ur o ):or [he driver,
Pe ( P 9 Pe p pose):or O
y i i t 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires
Not To Scalem
I placarding(example:placards will be displayed on the vehicle). m
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I 1 , : :. :.. __:.
CARRIER NAME Z
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ADDRESS 0
uammetva. CD/1
CITY/STATE/ZIP 0
0
• MOTOR CARR.ID 0 Interstate 0 Intrastate
0
I . ❑ Not in Comm./Govt. 0 Not in Comm./Other
; _Y____1 - 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 0 0 Z
TRAILER 2 ❑ 0 0 o
u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w
Tan Gray
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 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/TO.
DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE