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HomeMy WebLinkAbout2026-00005169 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 01111101111 M001111011 0I III IOU 110 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X123442' u, 1 U21 2 4 1 u, 3 U2 1 u, 1 1_12 1 1.11 1 U2 1 1 15 u1 1 U2 1 *P 0119* 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 El$501-$1.500 ®ON SCENE 14 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and f or Tow Due To Crash ❑AMENDED YR 2026I 2026-00005169 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n ® ❑ RELATED ®Y 0 N 01 27 2026 ❑AM ❑YES I�NO U1 -< S LIBERTY ST Elgin02:32 _ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION ITl FT!MI N E S W LAUREL ST COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 2 fA ❑ Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD ❑ STOPPED U2 -I ® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N 51 FREE FLOW # LNS 0 Qg3 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EWES 0 MAV 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 n _ mo 0 6 ! yr 13-UNDER CARRIAGE ©I - FIRE ❑ al STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 10 O DISTRACTED 0 0 U2 2 rr1 F 2 9 ❑Y ®SYSNEM❑UNK VEH. O AT CRASH 0 99-UUTHER NKNOWN 9 16•TOP�3 ,Distraction Value ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8 it all 1 es COM VEH 0 j$J 1 n ~ ELGIN I L 60120 0 1 FIRST CONTACT 3 t _:. -OS •II Yes.see Sidebar U1 0 Z FH64213 IL 2026 TELEPHONE IL D 0 3N1AB7AP5EL614509 Safeway Insurance Company ❑Y ISI N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Elgin Fire Ochoa.Jessica. M. 4298184ILPP001 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER 2 �{ DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EWES ❑RIU 0 u v 0 DV /1 9 6 4 Ford F150 2006 00-NONE O, _ Di'O DUE TO CRASH rg ❑ 2 x o yr 13-UNDER CARRIAGE 10� I.. 2 FIRE 0 ® U2 C Ti F 2 5SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16.TOP 3 X 0 Y ®N 0 UNK VEH. AT CRASH 99-UNKNOWN `Oistracuon Value 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s_i S 1� 4 COM VEH ❑ ® U1 CO F,,, FIRST CONTACT 12 Y�� , =5 •)ryes.See Sidebar C ELGIN IL 60120 0 1 3005781B IL 2026 I O C IL D 0 1 FTRX14WX6NA85108 First Chicago Insurance ❑Y ®N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Elgin Fire MENCHACA.ANGELICA ILS106388802 BAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE:ZIP u1 = (UNIT) (SEAT) (DOB) (SEXI {SAFT) (AIR) (INJI (EJCTI (EPTH) PASSENGERS&WITNESS ONLY (NAME),(ADDRESS)(TELEPHONE) (EMS) (HOSPITAL) 1 3 04 / F 2 8 C 1 0 / / #OCCS > 71 / / UI 2 D / / 1 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 11 4 Serna. Maria.S. Fence 01 ,27 ,2026 02 32 ®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 C) 2 0 200 S LIBERTY ST ELGIN IL 60120 23 99 01,27 ,2026 02 39 PM 1 ® • 0 Construction >E R 3 ❑ gi CITATIONS ISSUED ❑PENDING SECTION CITATION NO. EMS ARRIVED TIME 5 z J ❑AM ❑Maintenance U2 15 1 0 11 4 ARREST NAME Escobar.Jaylin. M. 11-1204-B 482000640 01,27,2026 02 42 ®PM SLMT ISI CITATIONS ISSUED 0 PENDING SECTION CITATION NO. ROAD CLEARANCE TIME• • El Utility o N AM 30 Ti 2 El 12 3 ARREST NAME Garcia Nicanor.Alicia 6-101-A 482000639 , , 0 PM 0 Unknown work zone type U1 2 2 3 ❑ 39 3 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑qM Workers present? ❑Y 30 482 Flentye.Jeremy 301 03 ,03,2026 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 -< ` ` - ' I. —I INDICATE NORTH combination)or p3 jug 8I BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C ° ; r r. r- (example:shuttle or charter bus):or a I 1 I } 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier 0 i_ :. -:. L } } transporting employees in the course of their employment(example:employee X �1 •_ transporter-usually a van type vehicle or passenger car):or co L i. __}----; } } 1. •4. Is used or designated to transport between 9 and 15 passengers,including the driver, (I)1 L...raat for direct compensation(example:large van used for specific purpose):or o L L____a____. — ;\ ""k' — — — _ i i 5. Is anyvehicle used to transport anyhazardous material(HAZMAT)that requires m i 'r placarding(example:placards will be displayed on the vehicle). ;p —1 7 i CARRIER NAME ■■.■w, �,..� L � --. r. / i. L __ ADDRESS ` Z IP c� I Not To Scale j D .ti` u.aaw Mtn I CITY/STATE/ZIP 0 MOTOR CARR.ID ❑ Interstate ❑ Intrastate I I T I ❑ Not in Comm./Govt. 0 Not in Comm./Other ; _Y____1 USDOT NO. ILCC NO. m XI Source of above z . MCS 0 Yes 0 No 0 Unknown Out of Service 0 Yes ❑No z Form Number 0 m Xl IDOT PERMIT NO. WIDELOAD'; ❑Yes 0 No 2 TRAILER VIN 1 m co 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 White u 1 TOWED • TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT 3 TOWED BY/TO. Redmons/Impound Lot Garage . SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 3 TOWED BY/TO: DUE ® Redmons/Owners Residence VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE DUETO