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HomeMy WebLinkAbout2026-00006475 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 M001111011101111 Hil lI 0 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY XO04127O44 u, 1 U21 1 1 1 U1 5 U2 1 U, 1 1_12 1 U, 1 U2 1 1 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 15 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) El B Injury and/or Tow Due To Crash 0 AMENDED YR 2026I 2026-00006475 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 71 ® ❑ RELATED ®Y 0 N 02 03 2026 ®AM ❑YES ®NO U1 SOUTH ST Elgin07:34 _ _ g PRIVATE mo /day/yr ❑PM FLOW CONDITION ITl FT!MI N E S W S ALFRED AVE COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ®SLOW 15 to ❑ Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD ❑ STOPPED U2 —I ® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ❑ FREE FLOW # LNS 0 Ig3 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EOUES 0 uuv 0 ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 n 0 6 / yr 13-UNDER CARRIAGE ©) ! 2 FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL)THERDISTRACTED 0 ]$I U2 2 rr1 M 2 5 SYTM❑Y ®SNE❑UNK VEH. 0 ATCRASHD 0 15-99-UUNKNOWN 9 16•TOP 3 `Distraction Value ALGN X. r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s, il_6 I,.4 COM VEH 0 E! 4 0 ~ ELGIN I L 60123 0 1 0 FIRST CONTACT 12 7_: __5 *IIYes.See Sidebar U1 Z CW40039 I L 2026 REAR TELEPHONE IL D 0 7FARW2H27ME016831 N/A ®Y ❑N U2 m 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 Same N/A 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER > Refused ❑Y ❑ N 2 c g DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0!My 0 i v ❑Dv !1 9 yf 8 Saturn Outlook 2008 00-NONE „ " 12 "_, DUE TO CRASH 0 ❑ 2 x o y - 13-UNDER CARRIAGE FIRE ❑ ® U2 ll M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER O9 16-TOP 3 X ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN *0istrac on Value 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF S ) .�,.4 COM VEH ❑ ® Ut CO F„ FIRST CONTACT 11 7 _, _5 C.If Yes.See Sidebar C ELGIN IL 60123 0 1 0 FG78414 IL 2026 I 0 Si) IL D 0 5GZEV13738J184344 Falcon ❑Y ®N RDEF Xl EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X 99 9 Nunez Rios, Miguel,A. 0100129966-5 SAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP U1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)!{ADDRESS)((TELEPHONE) (EMS) (HOSPITAL) 2 3 1 0 / :A / / UI 1 D / / 2 0 U EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME ®AM Did crash occur 0 Y U2 Z N 1 CD 11 1 2/ ,/2 /26 07 34 ❑pM in a Work Zone? NJ DIRP co 1 t PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME ❑AM If YES check one below: U1 3 n T o" 2 0 2 20 / / 0 PM, ❑Construction 7 Z 3 ❑ xi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME ❑AM El Maintenance U2 -a, ARREST NAME Rodriguez Magos.Jose.T. 3-707 471-000577 , ! ❑PM SLMT o N 1 ® 11 1 igi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ❑Utility AM 30 t 2 El ARREST NAME Rodriguez Magos,Jose,T. 11-709-A 471-000576 , / 0 PM 0 Unknown work zone type U1 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 30 471-Evans, Lakysha 701 3/ / 0/ ,026 09 00 0 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••--, , 0 ; A CMV is defined as any motor vehicle used to transport passengers or property and: Z r 1. Has a weight rating more than 10,000 pounds(example:truck or truckrtrailer -< ;.--_.r-_--; . I % INDICATE NORTH combination):or p1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C (example:shuttle or charter bus):or I- I- --I-•--I I �th�• transporting mployeened to slin the course passengers5 or fewer thir emplod yment example:employeener X transporter-usually a van type vehicle or passenger car).or w -- -- I I 1 •4. Is used or designated to transport between 9 and 15 passengers,including the driver. C w f for direct compensation(example:large van used for specific purpose):or O < I. t Is any vehicle used to transport anyhazardous materialle),(HAZMAT)that requires L a 5. Is aplacarding(example:placards will be isplayed on the vehicle). XI 'D __----------~ I CARRIER NAME Z _ __ ADDRESS 0 w CITY/STATE/ZIP C _ MOTOR CARR.ID ❑ Interstate ❑ Intrastate I r I ❑ Not in Comm./Govt. Not in Comm./Other r r 0 0 0 :- -------- Not To Scale I - % % % % USDOT NO. ILCC NO. C m XI Source of above z ❑ Yes 0 No 0 Unknown g D Did Carrier Safety Regulations MCS)violation contribute to the crash? A ❑ Yes No ❑ 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'; 0 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 Gray Black 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