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HomeMy WebLinkAbout2026-00061766 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets III III 11 IIII UHI U� I� liii flU11f� ��HUU DII DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X0048003 -i u, 9 U21 2 4 1 u, 2 U2 1 U199 u2 1 U199 U2 1 4 15 u, 1 U2 1 .P 0119* INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW ' DAMAGE TO ANY El$500 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$1,500 ❑NOT ON SCENE(DESK REPORT) El B Injury and f or Tow Due To Crash 0 AMENDED YR 202612026-00061766 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 �I ® ❑ RELATED ®Y 0 N 10 10 2026 ❑AM ❑YES ®NO U1 ST CHARLES ST Elgin09:34 _ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION m FT!MI N E S W DWIGHT ST COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 1 (n ❑ Kane HIT&RUN ®Y ❑ N WITH VEHICLES INVLD ❑ STOPPED U2 --I El AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 g DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EDUCE 0 NOV 0!CV 0 ov DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 C) ! ! FOR DAMAGEDAREA(S) FROf4r TOWED U1 Q Unknown.O. Unknown Unknown 00-NONE „ 12 i DUE TOCRASH ❑ EN NAME{LAST,FIRST,M) mo yr 13-UNDER CARRIAGE 101 ! 2 FIRE 0 NI STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED U2 0 < 9 9 SYSTEM IN 9 ENGAGED 9 15-OTHER 9 16.TOP 3 ❑ _ ❑Y ElN ®UNK VEH. AT CRASH ®-UNKNOWN `Distraction Value ALGN $ 4 COM VEH 0 E! r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF -i�B iI2 O H 0 9 0 FIRST CONTACT 99 7_i _5 *lIYes.See Sidebar U1 REAR 2 Z ' E TELEPHONE . STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED 2 111 Unknown ❑Y ❑N U2 I— .5 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Same Unknown 1 rn o HOSPITAL(TAKEN TO) INCIDENT IF`Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER r : Y OE N 0 m g DRIVER 0 PARKED 0 DRIVERLESS 0 PED CIN PEDAL ❑EWES 0 NI,IV 0 v 0 DV !1 9 6 6 Hyundai Elantra 2016 00-NONE 0.,. 2 j--_, DUE TO CRASH 0 ❑ 2 x 0 13-UNDER CARRIAGE 9 I ©). 2 FIRE 0 ® U2 C c F 2 4SYSTEM IN 0 ENGAGED 0 15-OTHER 9.16-TOP 3 X 0 Y ®N 0 UNK VEH. AT CRASH 99-UNKNOWN *Oistraclion Value 0 POINT OF 8 i1�I 4 COM VEH ❑ ® U1 CO N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR FIRST CONTACT 10 7� B .5 •(ryes.See Sidebar — Geneva IL 60134 C 1 0 RSL47 IL 2027 REAR 0 C Z IL D KMHDH4AH9GU511792 State Farm ❑Y 123 N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER 1 = Elgin Fire Same 2443415-sfp-13 BAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP 996 < Provena St.Joseph RESPONDER U1 = (UNIT) (SEAT) (DOS) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)!(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL) DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 CO 11 9 10,10 /2026 09 30 0 AM in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 7 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 ai 2 2 28 10!10 ,2026 09 36 PM ® • ❑Construction * Z 3 0 0 CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 5 ❑AM ❑Maintenance U2 ARREST NAME 10/10/2026 09 40 ®PM o u 1 ® 1 1 4 0 CITATIONS ISSUED ❑PENDINGSLMT o N SECTION CITATION NO. ROAD CLEARANCE TIME • AM• 0 Utility r 2 0 11 4 ARREST NAME 1 0!10 12026 10 05 ®PM 0 Unknown work zone type U1 30 n 7 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 0 - ID AM Workers present? ❑Y 30 1545 VanEycke. Brier 401 , ❑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••--, , I 0 A CMV is defined as any motor vehicle used to transport passengers or property and: 1. Has a weight � -< ___--I--___; _ combination):or rating more than 10,000 pounds(example: xamp :truck or truck/trailer INDICATE NORTH —I p0 Not To Scale 1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driverC } - } r r r (example:shuttle or charter bus):or C lhdt 2l „ / v 3. Is designed to carry15 or fewer passengers and operated a contract carrier O I- <.__-A-.-.J. !lam Q9' - y } } } transportingemployees In the course of their employment(example:employee X ',il�, transporte -usall a van type vehicle or passenger car): r f I 4. Is used or designated to transport between 9 and 15C — } } g po passengers,including the driver, to for direct compensation(example:large van used for specific purpose):or o L L-. __i_. --+ unit unit 1 ® - l. i. . i. L 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m .r I I I placarding(example:placards will be displayed on the vehicle). XI - CARRIER NAME Z ADDRESS V CITY/STATE/ZIP MOTOR CARR.ID ❑ Interstate ❑ Intrastate I I T I ❑ Not in Comm./G . Not in Comm./Other0 ; _Y_ _..; USDOT NO. ILCC NO. m XI Source of above z . Form Number m Xl IDOT PERMIT NO. WIDELOAD'; ❑Yes 0 No 2 TRAILER VIN 1 m co LOCAL USE ONLY TRAILER VIN 2 m a TRAILER WIDTH(S) 0-96" 97-102" >102' -n TRAILER 1 ❑ ❑ 0 Z TRAILER 2 ❑ 0 0 o u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w Silver u 1 TOWED • TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT' 9 TOWED BY/TO. SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® DISABLING DAMAGE Redmons/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE