HomeMy WebLinkAbout2026-00062072 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 Dt 4 Sheets 01111101111 0110 ll 1111110 1
DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X+ 12506
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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 1215501-$1.500 ®ON SCENE 2
VEHICLE/PROPERTY ❑OVER 51,500 El NOT ON SCENE(DESK REPORT)
0 AMENDED ❑ B Injury and for Tow Due To Crash YR 202612026-00062072 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 rn
® ❑ RELATED PRIVATE ❑Y ®N 10 12 2026 12,—AM ❑YES El NO U1 -<
ST CHARLES ST Elgin mo /day/yr 01:53 ®PM FLOW CONDITION Ill
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®15((1 ,MI N E O W Hammond Ave COUNTY PROPERTY ❑Y ® N DOORING El #OF MOTOR 0 SLOW 15 u)
Kane HIT&RUN ❑V ® N WITH VEHICLES INVLD 0 STOPPED U2 --I
❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST IZI N ® FREE FLOW # LNS 0
18:DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EOUES 0 NOV 0 ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 n
FOR DAMAGEDAREA(S) FRO t TOWED U1 Q
NAME(LAST,FIRST,M) Kakadia.Vasantkumar 0 mo 1 /
/1 9 6 3 Acura M DX 201 5 00-NONE
13-UNDER CARRIAGE 11_' QI 0 DUE TO CRASH ❑
EN E
) FIRE ❑ IE
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 10 0 DISTRACTED 0 0U2 4 <<Tl
M 2 SYTM IN ENGAGE15-OTHER
4 ❑Y ®SNE❑UNK VEH. 0 AT CRASHD 0 99-UNKNOWN 9 16•TOP® *Distraction Value ALGN 2
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF $_iL 6 �i, COM VEH 0 ZgJ 1 0
F. FIRST CONTACT 1 7_;—_;__5 *elves.See Sidebar U.(
.... SOUTH ELGIN IL 60177 0 1 0 LCH7397 TX 2026 REAR
TELEPHONE
IL D 0 5FRYD4H49FB016275 All State ❑v Il N U2 13 . m
in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
99 9 Same 811742943 1 r
`o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER
RESPONDER D
Refused 0 Y El 2 0
N DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NMv 0 NOV 0 DV CIRCLE NUMBER(S) U1
!1 9 9 7 FROM TOWED
Veracruz 2008 00-NONE 11 tz' _, DUE TO CRASH ❑ 2 x
o Yr - 13-UNDER CARRIAGE FIRE ID El U2
II
F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 016-TOP 3 X
❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN *Oistracton Value 0
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF O I ;,.4 COM VEH ❑ ® Ut W
F, FIRST CONTACT 11 7 , _5 •If Yes.See Sidebar C
ELGINZ IL 60120 0 1 0 BC64354 IL 2026 I 0 Si)
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IL D 0 KM8NU13C68U074500 State Farm ❑Y ®N RDEF XI
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 =
99 9 Garcia 277842SFP13 BAC
$
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)
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EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z
u 1 ® 11 1 10,12 ,2026 01 53 ®pm in a Work Zone? ®N DIRP co
1 t PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 1
T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 �
.6 2 04 99 , , ❑PM ❑Construction *
R 3 0 $I CITATIONS ISSUED ❑PENDING SECTION CITATION NO. EMS ARRIVED TIME 1
❑AM 0 Maintenance U2
oER 11 1 ARREST NAME Kakadia.Vasantkumar 11-709-A 1528-000425 / ! ❑PM SLMT
o N 0 CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • 0 Utility
0 AM
t 2 ElARREST NAME 10/12 12026 02 00 0 PM ElUnknown work zone type U1 35
2 2 3 El OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑AM Workers present? ❑Y 35
1528-Rivera. Kevin 401 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
J I I I -<
1. Hasa weight rating more than 10,000 pounds(example:truck or truck/trailer
c ` -' -' r_ _ INDICATE NORTH combination):or -I
A BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C
d _ } (example:shuttle or charter bus):or
._.; I Hnmcnd7Ave ' T,m
3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I 0
I - } } } transporting employees in the course of their employment(example:employee X
transporter-usually a van type vehicle or passenger car):or CO
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4. Is used or designated to transport between 9 and 15 passengers,including C}--- ----; - } } } g po passen rs,includi the driver,
for direct compensation(example:large van used for specific purpose):or O
L I l. ii. , 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m
0 placarding(example:placards will be displayed on the vehicle). m
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CARRIER NAME Z
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I ADDRESS
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4.
I Not To Scats I I 1 Il y��1 jxs,l0 0 Not in Comm./Govt. Not in Comm./Other 00
--- --1 - USDOT NO. ILCC NO. C
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Source of above z
Form Number
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IDOT PERMIT NO. WIDELOAD' ❑Yes 0 No 2
TRAILER VIN 1 m
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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
White White
u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_
DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY/TO:
_ SELECT CODES FROM THE BACK OF CRASH BOOKLET
U 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY/TO
DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE