HomeMy WebLinkAbout2026-00000132 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 1111111111111111
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DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X30410 610
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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 El$501-$1.500 ®ON SCENE 2
VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash
0 AMENDED YR 202612026-00000132 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n
N RANDALL RD Elgin 05:41
® ❑ RELATED ®Y 0 N 01 01 2026 12,— ❑YES ®NO U1 -<
_ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION M
FT!MI N E S W W H I G H LAN D AVE COUNTY PROPERTY ❑Y ® N DOORING Ely #OF MOTOR El SLOW 15 t�
❑ Kane HIT&RUN ❑V ® N WITH VEHICLES INVLD ❑ STOPPED U2 —I
® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N 51 FREE FLOW # LNS 0
Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uuv 0!CV 0 ov DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 00 0
FOR DAMAGED AREA(S) FROM TOWED U1 Q T
NAME(LAST,FIRST,M) g mo
/2 0 0 7 Mitsubishi Lancer 2015 00-NONE ,, • 12 , DUE TO CRASH ❑ VI
13-UNDER CARRIAGE FIRE 0
IE
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 10 O DISTRACTED ® 0 U2 00 M
M 2 4 SYIN ENGAGED 15-
❑Y ®SNE❑UNK VEH. O AT CRASH O 99-UUNKNOWN 9 16-TOPO `Distraction Value 9 ALGN =
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6 iI 6 it®COM VEH ❑ Ei 1 C)
I— FIRST CONTACT 1 7__�--_;_OS 'rrYes.See Sidebar Ut 0
Z ELGIN IL 60124 0 1 0 Z178807 IL 2026 REAR
TELEPHONE
IL D 0 JA32V2FW5FU022495 State Farm ❑Y Il N U2 m
13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
99 9 Cowsert. Daryl 0689496-SFP-13 1 r
o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER
RESPONDER
2 73
x DRIVER 0 PARKED 0 DRIVERLESS 0 FED 0 PEDAL 0 EWES 0 NMV 0 NOv 0 Dv
$ /1 9 8 5 Jeep(after 196g)9nd Cherokee 2022 DO-NONE „ `'12' _, DUE TO CRASH rg ❑ 2 73
-
o 13-UNDER CARRIAGE FIRE 0 ® U2
c ®
F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER O9 16-TOP 3 X
❑Y MN DUNK VEH. AT CRASH 99-UNKNOWN `Oistraglon Value 9 0
POINT OF 6 1 C.OM VEH 0 ® Ut W N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR 6 1:_ C
FIRST CONTACT 11 7 _, _5 •IfYes,See Sidebar
Elgin IL 60123 0 1 0 DM39481 IL 2026 I 0 Si)
IL D 0 1 C4RJKBG3N8520390 Bristol West ❑Y ®N RDEF
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 =
99 9 Same GO1 4694715 03 BAG $
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 <
Refused RESPONDER u1 =
(UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ) 1(EJCT( (EPTH) PASSENGERS&WITNESS ONLY (NAME)+(ADDRESS)+(TELEPHONE) (EMS) (HOSPITAL)
1 3 06 /
LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ID
N 1 ® 11 4 01 ,01 /2026 05 41 ®AM in a Work Zone? ®N DIRP co
1 1 PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 5
T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP H .
AM U1
o"
2 0 28 20 / / ❑PM ❑Construction >F
" 3 ❑ j i CITATIONS ISSUED ❑PENDING SECTION CITATION NO. EMS ARRIVED TIME 5
❑AM 0 Maintenance U2
o ® 11 4 ARREST NAME Zaragoza. Derek.J. 11-601-Ax 1561-000183 / / El PM SLMT
I$[CITATIONS ISSUED ❑PENDING NSECTION CITATION NO. ROAD CLEARANCE TIME AM• •
❑Utility
o t 2 El ARREST NAME Zaragoza. Derek.J. 11-709-A 1561-000184 01/01 /2026 06 30 0 PM 0 Unknown work zone type U1 50
2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 50
1561-Sarovic, Mirko 602 320-Cox 02 /03/2026 09 00 ❑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 • A CMV is defined as any motor vehicle used to transport passengers or property and: Z
Y ; II NotTo Scale f 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer -<
--- _
INDICATE NORTH combination):or
BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver —IC
I I - (example:shuttle or charter bus):or 0
' _ N4, I 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier 0
} } . transporting employees in the course of their employment(example:employee
transporter-usually a van type vehicle or passenger car):or w
L L.___a____� _• _ fo4. dieIs ctcorpeni tion(extmpl rtbetvanuedfo15 passengers,rs,):or the driver.I I I l } } } for direct compensation(example large van used for specific purpose):or to
L L____a_____I - l. i. i t 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m
\ 1 placarding(example:placards will be displayed on the vehicle). XI__ CARRIER NAME Z
ADDRESS D
CITY/STATE/ZIP 0
- MOTOR CARR.ID 0 Interstate ❑ Intrastate
o•I I T I — I I ❑ Not in Comm./Govt. ❑ Not in Comm./Other
--- --4 - USDOT NO. ILCC NO. m
XI
Source of above z
IDOT PERMIT NO. WIDELOAD-; ❑Yes 0 No =
TRAILER VIN 1 m
to
LOCAL USE ONLY TRAILER VIN 2 m
0
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
Black Red
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 TOWED DISABLING DAMAGE NOT DAMAGE EXTENT: 3 TOWED BY/TO:
DUE TO ® DISABLING DAMAGE Redmons/Owners Residence VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE