Loading...
HomeMy WebLinkAbout2026-00006156 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 1111 III 11 III1II DIII II II lID 11 HO IlIH 101110 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X+ 125771 u, 1 U21 3 4 1 U1 3 U2 1 U, 1 1_12 1 U, 1 U2 1 1 15 u1 1 u2 1 *P 0119* INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW ' DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT El A No Injury 1 Drive Away Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 14 VEHICLE/PROPERTY ®OVER 51,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash El AMENDED YR 202612026-00006156 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 rn ® ❑ RELATED ®Y 0 N 02 01 2026 ®AM ❑YES ®NO U1 W HIGHLAND AVE Elgin 11:51 _ _ g PRIVATE mo /day/yr ❑PM FLOW CONDITION m FTlMI N E S W N MCLEAN BLVD COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 15 ❑ Kane HIT&RUN ❑Y ® N WITH VEHICLESOT, INVLD ❑ STOPPED U2 -I igl AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 Qg3 DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EWES ❑NOV ❑!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 16 C) FOR DAMAGEDAREA(S) FROr'1T TOWED U1 Q Lo ez Garcia.Giselle 1 1 / yr 13-UNDER CARRIAGE ©i FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) O O DISTRACTED ID 0U2 16 r<rl F 2 SY 15-OTHER 5 ❑Y ®SNEM DUNK VEH. O AT CRASH IN D O 99-UNKNOWN 9 76•TOP 3 `Distraction Value 9 ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF $,_iL a 4 COM VEH ❑ El 1 0 ~ ELGIN N I L 60123 B 1 0 FIRST CONTACT 12 7 ; _5 *Irves.See Sidebar U1 Z ED79603 IL 2026 REAR 7 TELEPHONE IL D 0 JH4CL96844C000320 State Farm ElJ Y N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Elgin Fire Same 3874674-SFP-13 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Provena St.Joseph ❑Y El 2 0 m E{ DRIVER ❑ PARKED 0 DRIVERLESS ❑ PED 0 PEDAL 0 EWES 0 M/V 0 NOV 0 Dv CIRCLE NUMBER(S) U1 2 0 0 4 Ford Explorer 2006 00-NONE O, Q1.O DUE TO CRASH rg ❑ 2 x o Yr 13-UNDER CARRIAGE I 1 FIRE ❑ ® U2 C F 2 5 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16.TOP 3 X ❑Y ION DUNK VEH. AT CRASH 99-UNKNOWN *Oistracuon Value 9 g POINT OF s i COM VEH ❑ ® U1 CO N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR 1 5 1:._ C FIRST CONTACT 11 7 -L-5 C. If Yes.See Sidebar Z West Chicago IL 60185 0 1 FN97912 IL 2026 I 9 Sn Z IL D 0 1 FMEU73E86UB06770 American Alliance ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Same I LAA-0835685-02 BAc $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPONDER u1 = (UNIT) (SEAT) (DOE) (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)1(A.DDRESS)!(TELEPHONE) (EMS) (HOSPITAL) U1 1 D 1 0 co U EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME ®AM Did crash occur ❑Y U2 Z N 1 ® 11 4 21 112 /26 11 51 ❑PM in a Work Zone? ®N DIRP D 1 t PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 3 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ®AM U1 2 ❑ 25 99 21 112 /26 11 51 ❑PM ❑Construction * R 3 ❑ $I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 1 ®AM ❑Maintenance U2 o ® 11 4 ARREST NAME Lopez Garcia,Giselle 11-305-A 447000872 21 /12 /26 11 57 ❑PM SLMT o N 0 CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • ❑Utility El AM t 2 El ARREST NAME 21 /12 /26 12 42 ®PM 0 Unknown work zone type U1 30 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑AM Workers present? ❑Y 30 447-Collins, Dominique 601 31 1 01 /026 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 N.zMawn7e1w 1. Has a weight rating more than 10,000 pounds(example:truck or truckrtrailer -< i- }--__r-_--; - INDICATE NORTH combination):or p0 i_ i.. -:. CO BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C - } (example:shuttle or charter bus):or X Not To Scale I 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier O I- I- --I-- --J. ` } } } transporting employees In the course of their employment(example:employee transporter-usually a van type vehicle or passenger car):or w L L.___a__ 4. Is used ordesi natedtotrans rtbetween9and15 passengers,including C} } for direct compensation(example:large van used for specificpurpose):or [he driver, 1 Pe ( P 9 Pe or o - .., - 5. Is anyvehicle used to transport anyhazardous material(HAZMAT)that requires w.'rNrpnunmAw placardig(example:placards will be isplayed on the vehicle). XI .Qs unez - -- CARRIER NAME Z ADDRESS 0 w C) CITY/STATE/ZIP g _ MOTOR CARR.ID 0 Interstate 0 Intrastate 1 ❑ Not in Comm./Govt. ❑ Not in Comm./Other 00 -"-------1 - USDOT NO. ILCC NO. C 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 Red 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 DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® DISABLING DAMAGE Redmons/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE