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HomeMy WebLinkAbout2026-00006067 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 Df 2 Sheets III III 11 IIII UH UU I IlU II III H Iflil DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X 123677* u, 1 U21 3 4 1 u1 2 U2 1 u, 1 u2 1 u, 1 U2 1 4 10 u1 3 U2 1 *P 0119 INVESTIGATING AGENCY DAMAGE TO ANY ❑5500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW Elgin Police Department ONE PERSON'S ❑$501-$1.500 ®ON SCENE 2 VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and for Tow Due To Crash El AMENDED YR 202612026-00006067 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 m ® ❑ RELATED ®Y 0 N 01 31 2026 ❑AM ❑YES ®NO U1 S MCLEAN BLVD Elgin06:30 _ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION m FTlMI N E S W FLEETWOOD DR COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 15 ❑ Kane HIT&RUN ❑V ® N WITH VEHICLESOT, INVLD ❑ STOPPED U2 —I Igl AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EWES 0 NIAV 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 C) 0 6 ! yr 13-UNDER CARRIAGE 10 2 FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ❑ 0 U2 2 m F 2 SY 15-OTHER 4 ❑Y ®SNE DUNK VEH. 0 AT CRASH M IN D 0 99-UNKNOWN 9 16•TOP 3 *Distraction Value ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8, i�e 4 COM VEH 0 Ea 1 0 ~ Hanover Park IL 60133 0 1 0 FIRST CONTACT 12 7_: __5 *IIYes.SeeSidebar U1 Z FR58470 IL 2026 REAR TELEPHONE IL D 0 5FRYD4H43GB044803 All State ❑Y ®N U2 93 , m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 Martinez.Juan 942090964 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER RESPONDER 2 eu p; DRIVER 0 PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NMV 0 KCV 0 DV !1 9 6 3 Subaru XV Crosstrek 2.0 2024 00-NONE O z -_, DUE TO CRASH ❑ 2 0 13-UNDER CARRIAGE 9 I ©Ic 2 FIRE 0 ® U2 C c F 2 4SYSTEM IN 0 ENGAGED 0 15-OTHER 9.16-TOP 3 X 0 Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN *OistractIon Value 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8 �1:, 4 COM VEH ❑ ® U1 W FIRST CONTACT 11 ?A_, _5 •If Yes.See Sidebar 4 ELGIN IL 60123 0 1 0 GLMGL19 IL 2026 I 0 C IL D 0 JF2GUADC2RH267704 Erie Insurance ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X 99 9 Same Q042317832 BAc E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Provena St.Joseph RESPONDER u1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME),(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL) 1 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z u 1 ® 11 1 01 ,31 l2026 06 30 ®AM in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 3 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 C) v 2 0 2 99 01,31 ,2026 06 34 ®PM El Construction >F R 3 ❑ ]$I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 1 z J ❑AM ❑Maintenance U2 aER 11 1 ARREST NAME Martinez.Giselle 11-901-A 1528-000346 01,31 l2026 06 37 Igi PM SLMT o N 0 CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • 0 Utility t 2 El ARREST NAME 01 t 31 12026 07 05 ®PM 0 Unknown work zone type 0 AM U1 35 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑AM Workers present? ❑Y 35 1528-Rivera. Kevin 701 337-Thompson 03 ,02,2026 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••--, , N - ; 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 ' y j I I I r INDICATE NORTH combination):or —I BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver } r r r n(example:shuttle or charter bus):or C I- I- --I.----; I I y I I } r } transporting emploned to aeeslin the course of 5 or fewer passengers e ersnantlyment(example:employee a contract rier urmM1 E transporter-usually a van type vehicle or passenger car): rco L L _a____� !=i;`, ` . 4. Is used or designatedtotrans rt between 9 and 15 passengers,including N } } • • for direct compensation(example:large van used for specificpurpose):or [he driver, �, Pe ( P 9 Pe or O L L____a_ — — — — — l. i i L 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m r i placarding(example:placards will be displayed on the vehicle). unn I , i I I Z O Flwt,eod40r _ __ CARRIER NAME ADDRESS D n CITY/STATE/ZIP g I I - MOTOR CARR.ID 0 Interstate 0 Intrastate 5 0 ' ❑ Not in Comm./Govt. Not in Comm./Other I __ • -', Not To Scale I I I 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 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 Black Orange 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 TO ® Redmons/Impound Lot Garage VEHICLE CONFIG.—CARGO BODY TYPE_LOAD TYPE