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HomeMy WebLinkAbout2026-00002362 ILLINOIS TRAFFIC CRASH REPORT sheet 1 of 4 Sheets 01111101111 I00111101 II11111 111 II II DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X147981 u, 1 u21 1 1 1 u1 2 U2 1 U1 1 U2 1 U1 1 U2 1 5 15 u,23 U2 1 �K P 0119�K 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 2 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and for Tow Due To Crash 0 AMENDED YR 202612026-00002362 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 m646 WING ST El In05:56 ® ❑ RELATED ❑Y ®N 01 13 2026 ®AM ❑YES El NO U1 -< g PRIVATE mo /day/yr ❑PM FLOW CONDITION m _ COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 1 (n ❑ FT!MI N E S W Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD 0 STOPPED U2 --I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 Qg3 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EOUES 0 uuv 0 ucv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 n 0 5 FOR DAMAGEDAREA(S) FRONT TOWED U1 O NAME(LAST,FIRST,M) Bracho De La Torre, Dariana.C. mo Ford Escape2012 00-NONE OUE TO CRASH ® ❑ ! ! yr it. 12 E 13-UNDER CARRIAGE 10l • 2 FIRE ❑ al STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ❑ U2 2]$I m F 2 4 ❑Y SYSTEM IN ENGAGED 15-OTHER 9 16.TOP 3 _ CI N ❑UNK VEH. AT CRASH 99-UNKNOWN `Distraction value ALGN r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF $ iII S i_4 COM VEH 0 �! 1 C) ~ ELGIN I L 60123 B 1 0 FIRST CONTACT 5 7_;LQ_p =II sees.See Sidebar U1 0 Z FR90845 IL 2026 TELEPHONE OTH Other 1 FMCU9DG4CKC31551 None ®Y ❑N U2 m IS EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Same None 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER 73 > Refused ❑Y ElN 2 0 x DRIVER ❑ PARKED 0 DRIVERLESS ❑ PED ❑ CIRCLE NUMBER(S) U1 PEDAL 0 EWES ❑liPAV 0 KDV ❑DV !1 9 8 4 Toyota Camry 2023 00-NONE ,._"j z j-_, DUE TO CRASH 0 ❑ 2 x o 13-UNDERCARRIAGE 10j ©l( 2 FIRE 0 ® U2 C c M 2 4 SYSTEM IN ENGAGED 15-OTHER 9,16-TOPO3 0 X ❑Y ❑N ❑UNK VEH. AT CRASH 99-UNKNOWN O 0istraction Value POINT OF 8 l�i" 4 COM VEH ❑ ® U1 W N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR FIRST CONTACT 12 7 B SOS •IfYes,See Sidebar ZGlendale Heights IL 60139 0 1 0 ER88817 IL 2025 I 0 N D IL D 4T1 H31AK6PU052506 American Alliance ❑Y ®N RDEF 7) EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X Same I LAA1069233-01 BAC $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPONDER U1 = KNIT) (SEAT) (DOB) (SEX) {SART) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)1(ADDRESS)/(TELEPHONE) (EMS) (HOSPITAL) DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ❑ 11 1 Com Ed Utility pole 01 ,13 /2026 05 56 ®❑pM in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 5 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 � ;, 2 ® 31 5 350 SECOND ST ELGIN IL 60123 2 30 , , pM _ ❑ , ❑Construction * R 3 0 $I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 7 ❑AM ❑Maintenance U2 -a, ARREST NAME Bracho De La Torre, Dariana,C. 11-1402-A 298001348 ! ! El Pm SLMT o N ® 11 1 ljg CITATIONS ISSUED 0 PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ❑Utility AM30 r 2 ❑ ARREST NAME Bracho De La Torre. Dariana.C. 6-101 298001350 1 ! 0 pM ElUnknown work zone type U1 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑qM Workers present? ❑Y 30 298-Lopez, Mirko 501 02 ,09,2026 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 I1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer -< ` ` --I -' r a+ INDICATE NORTH combination):or .Z-1 N m i BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C _ } (example:shuttle or charter bus):or ' Not To Scale I I 3. Is designed to car 15 or fewer ssen ers and 0 rated a contract carrier 0 } } } transporting employees In the course of their employment(example:employee 1 transporter-usually a van type vehicle or passenger car):or w L }-----}----; `♦_ - I. } } 1. 4. Is used or designated to transport between 9 and 15 passengers,including the driver, w •for direct compensation(example:large van used for specific purpose):or O L L--_-a-___. zumdroom nusd mom - t i. . i. , 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m 863wryNirp99t 1 1 1 placarding(example:placards will be displayed on the vehicle). ;p —1 I I- - CARRIER NAME Z ADDRESS Unit a T. 1at7P m o Rlmpscl "1 �:, , CITY/STATE/ZIP 0 0 - MOTOR CARR.ID 0 Interstate 0 Intrastate 5 1 I T 1 ❑ Not in Comm./Govt. 0 Not in Comm./Other ; _Y_ __1 USDOT NO. ILCC NO. m 73 Source of above z . ❑ Yes 0 No 0 Unknown M D Did Carrier Safety Regulations MCS)violation contribute to the crash? A ❑ Yes II El Unknown C 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 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 0 0 Z TRAILER 2 ❑ 0 0 O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w Gold Silver u 1 TOWED • TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT 3 TOWED BY/TO. Arties/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 ® Arties/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE