HomeMy WebLinkAbout2026-00004477 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 01111101111 0
DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X004118590
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INVESTIGATING AGENCY DAMAGE TO ANY El$500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away
AGENCY CRASH REPORT NO. TRFW
Elgin Police Department ONE PERSON'S ❑5501-51.500 ®ON SCENE 3
VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash
0 AMENDED YR 2026I 2026-00004477 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 rn
® ❑ RELATED ®Y 0 N 01 23 2026 DAM ❑YES ®NO U1
BIG TIMBER RD Elgin 03:44
_ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION m
FT!MI N E S W N STATE ST COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 99 Cl)
❑ Kane HIT&RUN ❑V ® N WITH VEHICLESOT,
INVLD DO
U2 —I
lgi AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST IZI N ® FREE FLOW # LNS 0
Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uuv 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 6 0
FOR DAMAGEDAREA(S) FROr T TOWED U1 O
Morales.An el 1 2 /
yr
13-UNDER CARRIAGE 101 2 FIRE ❑ al
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ❑ 0 U2 m
M 2 SYTM IN ENGAGED4 ❑Y ®S NE❑UNK VEH. 0 AT CRASH 0 99-UNKNOWN 9 76•TOP 3 *Distraction Value ALGN 2
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF $_iL a 4 COM VEH ❑ j$J 1 0
~ ELGIN I L 60123 B 1 0 FIRST CONTACT 12 7_; _5 *IIYes.See Sidebar U1
Z FM99364 IL 2026 REAR
TELEPHONE
IA D 0 19UUA65585A051433 Insurance(gm) ❑Y ®N U2 m
in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
Elgin Fire 99 9 Same 139001542375043 1 r
o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER
RESPONDER D
Sherman ®Y ❑ N 3 2 ou
❑ DRIVER 0 PARKED 0 DRIVERLESS El PED 0 PEDAL 0 EWES 0 row 0 RSV 0 DV CIRCLE NUMBER(S) U1
yr 00-NONE 11_"j t2..-_, DUE TO CRASH 0 ® 1 X/
o 13-UNDER CARRIAGE 10'I c. 2 FIRE ❑ ® U2 C
c
M 1 3 SYSTEM IN 0 ENGAGED 0 15-OTHER 9,16-TOP 3 X
❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN `OistractIon Value 0
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s-iI�1:,-4 COM VEH ❑ ® U1 CO
FIRST CONTACT OO 7A-j .5 •IfYes,See Sidebar C
z ELGIN IL 60123 A 1 8
0 Si)
IL D 0 ❑Y ❑N RDEF
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER I X
Elgin Fire 1 50 9 SAC E
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 <
Sherman RESPONDER
Y ig U1 =
(UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)((ADDRESS)((TELEPHONE) (EMS) (HOSPITAL)
0 O
EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z
N 1 ® 12 3 Illinois Department of Transportation (N.State St)Signal Post 01 /23 /2026 03 44 ®AM 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
F. 2 0 1 3 201 N CENTER ST SOUTH HLGIN 60177 28 20 01,23 /2026 03 50 PM
,
® • El Construction
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R O 0 0 CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 7
3 ❑AM ❑Maintenance U2
a ® 12 3 ARREST NAME Morales.Angel 11-601-Ax S1527-000402 01,23/2026 03 40 ®PM• • El Utility SLMT
lgi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. ROAD CLEARANCE TIME AM
o Nt 2 ElARREST NAME Morales.Angel 11-502-A S1527-000403 01/23 /2026 04 27 ®PM ElUnknown work zone type U1 35
2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 0 AM Workers present? ❑Y
1527-Juarez.Jorge 501 337-Thompson 02 , 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
1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer -<
-__-_r_-_-; _ combination):or
rj
$ INDICATE NORTH p0
T BY ARROW2 Is used or designed to transport more than 15 passengers including the driver
u 'Q (example:shuttle or charter bus):orL AI 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I O
.....,,. _ r - . . . transporting employees in the course of their employment(example:employee X
transporter-usually a van type vehicle or passenger car):or w
i. •:. .}----; - p - } } 1 •4. Is used or designated to transport between 9 and 15 passengers,including the driver. N
0 for direct compensation(example:large van used for specific purpose):or
L L____a____.I l : 4 , _ l. l. l I _ 5. Is any vehicle used to transport anyhazardous material(HAZMAT)thatrequires m
�-� I I 1 placarding(example:placards will be displayed on the vehicle). XI
�Ilr l i �s --I1
l _ CARRIER NAME Z
rernmr �� ADDRESS O
Ii. i. i. 4.i. n
Ig 4 CITY/STATE/ZIP g
g i. MOTOR CARR.ID 0 Interstate 0 Intrastate
I I T I ❑ Not in Comm./Govt. 0 Not in Comm./Other
-"-----"1 - 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 3 TOWED BY/TO.
_Adieu/Impound Lot Garage . SELECT CODES FROM THE BACK OF CRASH BOOKLET
U 2 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 4 TOWED BY/T6
DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE