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HomeMy WebLinkAbout2026-00006105 ILLINOIS TRAFFIC CRASH REPORT sheet 1 of 4 Sheets 01111101111 I0011110110010 0 IOU DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X+ 125765 u, 1 U21 3 3 1 u, 2 u214 u, 1 U2 1 U1 1 U2 1 5 11 u1 1 u2 1 *P 0119 INVESTIGATING AGENCY DAMAGE TO ANY ❑$500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW Elgin Police Department ONE PERSON'S 0$501-$1.500 ®ON SCENE 2 VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash 0 AMENDED YR 2026I 2026-00006105 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 rn ® ❑ RELATED ®Y 0 N 01 31 2026 DAM ❑YES ®NO U1 -< SUMMIT ST Elgin11:34 _ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION Ill FT!MI N E S W N LIBERTY ST COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 1 (n ❑ Kane HIT&RUN ❑Y ® N WITH VEHICLESOT, INVLD DO U2 --I Igi AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 Q83 ORNER ❑ PARKED 0 DRNERLESS 0 PED 0 PEDAL 0 EWES 0 WV 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 rar TOWED U1 0 NAME(LAST,FIRST,M) Macegoza Maceda.Agustina mo yr Ford Escaa 2017 p 00-NONE ++- 12 - 13-UNDER CARRIAGE IE 101 + DUE TO CRASH ❑ EN FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U22 4 ni F 2 SYTM IN ENGAGEis-OTHER 4 ❑Y ®SNE❑UNK VEH. O ATCRASHD O 99-UNKNOWN 9 +6•TOP 3 `Distraction Value 9 ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF it �i,4 COM VEH 0 j$J 1 0 ~ ELGIN I L 60120 0 1 0 FIRST CONTACT 7 O7 _: __5 *If Yes.See Sidebar U1 0 Z EJ46418 IL 2026 REAR TELEPHONE IL D 1 FMCUOGD5HUE13476 Alllstate ❑Y ®N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 Same 969652299 1 1— "6 HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y ® N 2 0 p;rg- DRIVER 0 PARKED 0 DRIVERLESS ❑ PED 0 PEDAL 0 EWES 0 NMv 0 KV 0 DV yr Ford Explorer 2020' 00-NONE O, ©i.O DUE TO CRASH rg ❑ 6 x7 o 13-UNDER CARRIAGE 1,. 2 FIRE 0 ® U2 C M 2 8 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16-TOP 3 X ❑Y lYi N ❑UNK VEH. AT CRASH 99-UNKNOWN *OistrawDn Value 9 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s_i 6 14 COM VEH ❑ ® U1 W FIRST CONTACT 1 O Y�� , =5 •(ryes,See Sidebar C ELGIN IL 60120 0 1 0 M P19083 IL 2026 I 9 N Z IL 1 FM5K8AB3LGC13059 Charters Oaks Fire Insura ❑v ®N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER 1 = 99 9 City of Elgin 8109160P901 BAG $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP U1 = (UNIT) (SEAT) (DOBi (SEXI {SART) (AIR) (INJI 1(EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)!(ADDRESS)/{TELEPHONEI (EMS) (HOSPITAL) 1 6 08 / LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y N 1 ® 11 4 ATT Utility pole was damaged 01 ,31 /2026 11 34 ®AM in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 1 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 2 ❑ 2020 PRODUCTION DR St Charley 60174 75 99 01,31 /2026 11 35 PM ® • ❑Construction >E R O ❑ CITATIONS ISSUED ❑PENDING SECTION CITATION NO. EMS ARRIVED TIME 1 3 ❑AM ❑Maintenance U2 ou1 ® 11 4 ARREST NAME Macegoza Maceda.Agustina 11-907-C W155000230 01/31 /2026 11 38 ®PM SLMT o N • ❑CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME El Utility AM r 2 ❑ 31 3 ARREST NAME 02/01 /2026 ❑❑PM ❑Unknown work zone type U1 3O -r n OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 ❑ - ❑AM Workers present? ❑Y 30 1550-Camacho.Oscar 201 , / ❑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__--; a } INDICATE NORTH combination):or —I p1�� BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C Liberty?St. (example:shuttle or charter bus):or n �____A____. J , , 3. Is designed tocarry 15 or fewer passengers and operated a contract carrier O , - } } } transporting employees in the course of their employment(example:employee � X transporter-usually a van type vehicle or passenger car):or w L Surnrnit?St. 4. Is used or desi nated to trans rt between 9 and 15 ge ng y }-----;----; - } } } g po passes rs,includi [he driver, - - - - for direct compensation(example:large van used for specific purpose):or L L____a____. _ l. 1 t 5. Is any vehicle used to transport anyhazardous material(HAZMAT)that requires '-'� placarding(example:placards will be displayed on the vehicle). m �eA, —w+v "—--- D y,=— '`f CARRIER NAME Z 1 I I ADDRESS CITY/STATE/ZIP n g - i. i. i. 4. MOTOR CARR.ID 0 Interstate 0 Intrastate i< 1 1 . 1 Not To Scale ' 0 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 v 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 Gray Black u 1 TOWED • TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT' 2 TOWED BY/TO. 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