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HomeMy WebLinkAbout2026-00061305 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets III III 11 IIII mil 11 I l liii U III 1111111H DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X00•1/101199* u, 1 U21 3 4 1 U1 3 U2 1 U, 1 1_12 1 U, 1 U2 1 1 15 u1 1 u2 1 *P 0119* INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW ' DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 14 VEHICLE/PROPERTY ®OVER 61,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash El AMENDED YR 202612026-00061305 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 :1 ® ❑ RELATED ®Y ❑N 10 08 2026 DAM ❑YES ®NO U1 KI M BALL ST Elgin 04:38 _ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION m FT l MI N E S W N SPRING ST COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 1 (n ❑ Kane HIT&RUN ❑V ® N WITH VEHICLES INVLD ❑ STOPPED U2 —1 ® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 Qg3 DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EWES ❑uuv ❑!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 C) FOR DAMAGED AREA(S) FROf'1T TOWED U1 O NAME(LAST,FIRST,M) mo /1 9 9 9 Toyota Corolla 2006 00-NONE ,, 12 DUE TO CRASH ® ❑ 13-UNDER CARRIAGE / ! FIRE ❑ al STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 1U O DISTRACTED 0 0 U2 0 m F 2 SY is-OTHER 5 ❑Y ®SNE❑UNK VEH. 0 AT CRASM IN H 0 99-UNKNOWN 9 76•TOP 3 `Distraction Value ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF T_iL a ii,4 COM VEH 0 j$J 1 0 ~ ELGIN !L 60120 B 1 0 FIRST CONTACT 1 7_; __5 *II Yes.See Sidebar U1 Z Q845280 IL 2027 REAR TELEPHONE IL D 0 1 NXBR32E86Z647784 STATE FARM ❑Y ®N U2 19 . m .5 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR 1-1 Elgin Fire 99 9 KHAN. M U HAM MAD. I. 0638627SFP13 1 r o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER RESPONDER 2 ou m x DRIVER ❑ PARKED 0 DRIVERLESS ❑ FED 0 PEDAL 0 EWES 0 r uv 0 e v 0 DV /1 9 9 4 Honda Accord 2018 oo-NONE 0, z j--_, DUE TO CRASH 0 D 2 x 0 13-UNDER CARRIAGE 9 I ©(. 2 FIRE ❑ ® U2 C c il F 2 4SYSTEM IN 0 ENGAGED 0 15-OTHER 9.16-TOP 3 X 0 Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN *Distraction Value 0 POINT OF 8 i1�I 4 COM VEH ❑ ® U1 W N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR 6 FIRST CONTACT 11 7 _5 •If Yes.See Sidebar Z SOUTH ELGIN IL 60177 0 1 0 AZ20616 IL 2026 I 0 C D IL D 0 1 HGCV1 F48JA199973 HARTFORD ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X Elgin Fire 99 9 DALTON.ALEXANDRIA 34500736862 BAC E 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) :A / / UI 1 D / / 1 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z N 1 ® 11 4 10,81 /026 04 38 ®AM in a Work Zone? ®N DIRP co 1 t PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 3 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 v 2 0 25 15 10,81 /026 04 40 ®pm ❑Construction * R O 0 ]$!CITATIONS ISSUED El PENDING SECTION CITATION NO. EMS ARRIVED TIME 1 3 ❑AM ❑Maintenance U2 -a, ARREST NAME WARS).ZAH I DA 11-306 1580000002 10,81 /026 04 45 !gi pM SLMT 1 ® Utilit 0 Utility 11 4 0 CITATIONS ISSUED SECTION CITATION NO. ROAD CLEARANCE TIME PENDING o N t 2 ElARREST NAME 10/8/ /026 05 47 ®PM 0 Unknown work zone type U1 30 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑qM Workers present? ❑Y 30 1580-Gonzalez. Natalie 101 337-Thompson 11 , 17/2026 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 . 01. as a weight rating more than 10,000 pounds(example:truck or truck trailer -< H } }----i-----; y Not To Scale I - ( combination):or —I , INDICATE NORTH p1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C i_ - } (example:shuttle or charter bus):or 0 ' A Ill 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I O } } } transporting employees In the course of their employment(example:employee X — transporter-usually a van type vehicle or passenger car):or co L L.___a — 4. Is used ordesi natedtotrans rtbetween9and15 passengers,including C} } for direct compensation(example:large van used for specificpurpose):or [he driver, Pe ( P 9 Pe or O L i... -.;- .0' 1 i. < i. L 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires ill - ---i placarding(example:placards will be displayed on the vehicle). m 0 — — — Unit 1 — — — CARRIER NAME 4y:� __ ADDRESS D s, N 1A i iI�.A CITY/STATE/ZIP n ® C MOTOR CARR.ID 0 Interstate 0 Intrastate I I T I J ❑ Not in Comm./Govt. 0 Not in Comm./Other 0 i. --- --; L i. L ' 12 USDOT NO. ILCC NO. C m XI Source of above Z . Form Number m Xl IDOT PERMIT NO. WIDELOAD'; ❑Yes 0 No 2 TRAILER VIN 1 m 'LOCAL USE ONLY TRAILER VIN 2 m v 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 Silver Black u 1 TOWED • TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT 3 TOWED BY/TO. Redmons/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 ® Redmons/Impound Lot Garage VEHICLE CONFIG.—CARGO BODY TYPE_LOAD TYPE