HomeMy WebLinkAbout2026-00004357 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 6 Sheets 01111101111
10011110 10101100
DRAG TRFD TRFC WEAT DRVA VIS VEHD LGHT COLL MANY X0041 12236
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INVESTIGATING AGENCY DAMAGE TO ANY ❑$500 OR LESS TYPE OF REPORT ® q No Injury 1 Drive Away
AGENCY CRASH REPORT NO. TRFW '
Elgin Police Department ONE PERSON'S El5501-51.500 ®ON SCENE 1
VEHICLE/PROPERTY ®OVER 51,500 ❑NOT ON SCENE(DESK REPORT)
El AMENDED ❑ B Injury and/or Tow Due To Crash YR 202612026-00004357 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 99 m
WI LCOX AVE Elgin
® ❑ RELATED ❑Y ®N 01 22 2026 ❑AM ❑YES ®NO U1 -<
PRIVATE mo /day/yr 06:57 ®PM FLOW CONDITION Ill
Igi25 ®!MI N E 0 W Walnut Ave COUNTY PROPERTY ❑Y ® N DOORING ICI #OF MOTOR IR SLOW 6 Cl)
Kane HIT&RUN ®Y ❑ N WITH VEHICLES INVLD ❑ STOPPED U2 —I
❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST IR N ❑ FREE FLOW # LNS 0
gi DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EOUES 0 uuv 0 ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 n
0 1
yr Express11__ 12 _
13-UNDER CARRIAGE OUE TO CRASH
10l 2 EN E
FIRE 0
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL)THERDISTRACTED 0 0 U2 2 rrl
M 9 9 SYTM❑Y ®S NE El UNK VEH. 0 AT CRASH 0 15-99-UNKNOWN 9 16•TOP 3 ,Distraction Value 9 ALGN 2
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 7 i! 6 Lr.4 COM VEH 0 0 1 C)
~ ELGIN I N I L 60123 0 9 0 FIRST CONTACT 5 7 :,----1'O •II Yes.See Sidebar U1 0
Z4257268B IL 2026 REAR
TELEPHONE
IL D 0 1GCGG25CX91161343 No Insurance ®v ❑N U2 m
5 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
99 9 Salazar Castenado.Telemaco No Insurance 1 rn
`o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER
r RESPONDER ( G0)
g DRIVER 0 PARKED 0 DRIVERLESS 0 PEO 0 PEDAL 0 EWES 0 NMv 0 KCv 0 DV
1 9 9 8 Ford F150 2016 Do-NONE 11_-1 t2..-_1 DUETO CRASH ❑ 2 x
0 13-UNDER CARRIAGE 10 • 2
FIRE ❑ ® U2 C
c
M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16-TOP 3 X
❑Y El N ❑UNK VEH. AT CRASH 99-UNKNOWN `Distraction Value 9 0
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF ,m.„S 1II�.�, 4 COM VEH ❑ ® tit CO
FIRST CONTACT 6 l:l,-{_�__5 •It Yes,See Sidebar C
ELGIN IL 60123 0 1 0 3600387B IL 2026 REAR 0 Si)
IL D 0 1 FTEW1 EGOGFB22879 Country Financial Mutual ❑Y ®N RDEF
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 =
99 9 Same PO10905514 BAc E
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP 996 <
Refused RESPONDER
U1 =
(UNIT) (SEAT) (0081 (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME(((ADDRESS)((TELEPHONE) (EMS) (HOSPITAL)
2 3 08 / F 2 3 0 1 0
m
/ / #OCCS D
Xl
/ / U1 1 D
/ / 2 O
EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z
N 1 ® 11 1 01 ,22 r2026 06 57 ®pm in a Work Zone? ®N DIRP co
1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 1
T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1
o"
2 0 28 99 I ) ❑PM• ❑Construction
1
R 3 0 $I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 1
❑AM 0 Maintenance U2
-a, ARREST NAME Castaneda Munoz.Gerardo 11-1402-A 1563-166 / r El PM SLMT
ou ® 18 1 igiCITATIONS ISSUED 0 PENDING SECTION CITATION NO. ROAD CLEARANCE TIME El AM• El Utility
r 2 El ARREST NAME Castaneda Munoz.Gerardo 11-601-Ax 1563-165 01/22 12026 06 57 ®PM El Unknown work zone type U1 30
n 7 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME
2 2 3 0 1563-Rodriguez.Carlos 701 337-Thompson / / ❑❑PnMn Workers present? ®N U2 30
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.
A CMV is defined as any motor vehicle used to transport passengers or property and: Z
r r 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer -<
} -' I0 r INDICATE NORTH 0
combination)or
1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver exam C
( le:shuttle or charter bus:or
4r] I
[.. . Not To Scale } P ' X
L A I 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier O
} } } transporting employees In the course of their employment(example:employee X
transporter-usually a van type vehicle or passenger car):or w
L I.___a__._J - - - 4. Is used ordesi natedtotrans rtbetween9and15 passengers,including (I)
} } for direct compensation(example:large van used for cific ur mdudi the driver,
Pe ( P 9 Pe purpose):or O
L t i i _ 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires 'D
m
placarding(example:placards will be displayed on the vehicle).
, -1
CARRIER NAME -I
1,4ltox7A7w O
- ADDRESS
T.
C)
��i„ CITY/STATE/ZIP g
��7 _ MOTOR CARR.ID 0 Interstate 0 Intrastate
' 1- I I we' I ° Not in Comm./Govt. Not in Comm./Other
0
i— --- --1 USDOT . ILCC NO. rn
XI
Source of above Z
. If Yes,Name on placard O
4 digit UN NO. 1 digit Hazard class No. Xl
Xl
Did HAZMAT spill from vehicle(do NOT consider FUEL from vehicle's z
own tank)? 0 Yes 0 No 0 Unknown
Did HAZMAT Regulations violation contribute to the crash? r
❑ Yes 0 No 0 Unknown g
D
Did Carrier Safety Regulations MCS)violation contribute to the crash?
❑ Yes II No ElUnknown A
Was a driver/vehicle Examination Report Form completed? r
HAZMAT ❑Yes 0 No ❑Unknown Out of Service ❑Yes ❑No 7
MCS ❑Yes 0 No 0 Unknown Out of Service ❑Yes ❑No C
Z
Form Number 0
m
71
IDOT PERMIT NO. WIDELOAD'; ❑Yes 0 No 2
TRAILER VIN 1 m
co
LOCAL USE ONLY TRAILER VIN 2 m
v
TRAILER WIDTH(S) 0-96" 97-102" >102' T
TRAILER 1 ❑ ❑ 0 Z
TRAILER 2 ❑ 0 0 o
u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. Z
Camouflage 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/T6
DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE