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HomeMy WebLinkAbout2026-00008373 ILLINOIS TRAFFIC CRASH REPORT sheet 1 of 4 Sheets II III H IIII UH U II IlU I IIII IIIIIIIIIIIII DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X 14 211 u, 1 U21 2 4 1 U116 U299 u, 1 U2 1 u,99 U2 99 4 10 u, 1 u2 3 *P 0119 INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW ' DAMAGE TO ANY ❑5500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away Elgin Police Department ONE PERSON'S ❑$501-$1.500 ®ON SCENE 14 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and for Tow Due To Crash 0 AMENDED YR 202612026-00008373 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 r1 ® ❑ RELATED ®Y 0 N 02 12 2026 ❑AM ❑YES I NO U1 W HIGHLAND AVE Elgin05:56 _ g PRIVATE mo /day/yr ®PM FLOW CONDITION IT1 FT!MI N E S W LARKIN AVE COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 1 (n ❑ Kane HIT&RUN ❑Y ® N WITH VEHICLESOT, INVLD DO U2 —I lgi AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST IZI N 51 FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EWES 0 NW 0!CV 0 DV DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 0 0 4 ! Jeep(after 19680nd Cherokee 2006 00-NONE „_' >z DUE TO CRASH ❑ EN E 13-UNDER CARRIAGE 19 i : 2 FIRE 0 N STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED N 0 U2 0 171 M 2 SY4 ❑Y El ®UNK VEH. 9 AT CRASH M Ihl D 9 99-UNKNOWN 9 16•TOP 3 *Distraction Value 9 ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s_iL B �i, COM VEH 0 j$J 4 0 F Elgin I L 60120 0 1 0 FIRST CONTACT 1 7_; __5 *IIYes.See Sidebar Ut Z 9 SGT7-IQ IL 2026 REAR M TELEPHONE IL D 0 1 J4G R48K96C307170 Kemper N Y ❑N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Beltran Reyes.Alberto 12A0000944102 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER RESPONDER 2 7] p; DRIVER ❑ PARKED 0 DRIVERLESS ❑ PED ❑PEDAL ❑EWES ❑m v 0 i v ❑DV !1 9 5 5 Cadillac CTS 2010 00-NONE O", z j-_, DUE TO CRASH rg ❑ 2 x o • 13-UNDER CARRIAGE I ©Ic 2 FIRE 0 N U2 C c F 2 4 SYSTEM IN 9 ENGAGED 9 15-OTHER 9.16•TOP 3 ❑Y ID NUNK VEH. AT CRASH 99-UNKNOWN *OistractlonValue 9 4 POINT OF 8 i1 II 4 COM VEH 0 N U1 03 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR s FIRST CONTACT 11 7 _, _5 •IfYes,See Sidebar E LG I N IL 60123 0 1 0 B436-000 IL 2026 I 4 CC/) IL D 0 1 G6DS5EV3A0145129 Progressive ❑Y ®N RDEF M EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X Same 864448536 BAG $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP 996 < Refused RESPONDER u1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME),(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL) W 07 / F m / / #OCCS D 7) / / U1 1 D / / 1 0 EV MOST EVNT LOG DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur El U2 Z N 1 ® 11 4 02,12 l2026 05 56 ®pm in a Work Zone? NCI N DIRP co 1 t PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 7 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 � o" 2 0 10 28 1 , ❑PM 0 Construction * <<v 3 0 N CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 4 ❑AM 0 Maintenance U2 o 1 ® 11 4 ARREST NAME Beltran.Alden. F. 12-211-A 15250000936 / ! ❑PM SLMT l$!CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME AM ,_,Utility t 2 El ARREST NAME Beltran.Alden. F. 6-101 15250000934 02,12 ,2026 07 00 ®PM 0 Unknown work zone type U1 30 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 30 1525-NavE.Oscar 601 269-Mendiola 03 ,24,2026 09 00 ❑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 �____r____; N _ 1 Hasatwnightratingmorethan10,000pouds(example:truckortruckrtrarler -< 1. r INDICATE NORTH p3 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C - } (example:shuttle or charter bus):or C) Not To Scale X L A 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I O ,,�, �" transporting employees In the course of their employment(example:employee trL `.__-A----' '�1 I. 4. Is used or d signatedtotransportbetween9a d15rpassen rs,including the driver.or X c0 C — — — — } } • for direct compensation(example:large van used for specific purpose):or L L--_-a-.... w t l I I L 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires O D placarding(example:placards will be displayed on the vehicle). XI /4001' CARRIER NAME Z ADDRESS 'n C) , CITY/STATE/ZIP I i i. 4. MOTOR CARR.ID 0 Interstate ❑ Intrastate I I . I ❑ Not in Comm./Govt. 0 Not in Comm./Other ;....Y. ._.; USDOT NO. ILCC NO. m XI Source of above z . own tank)? 0 Yes 0 No 0 Unknown Did HAZMAT Regulations violation contribute to the crash? r ❑ Yes 0 No 0 Unknown g 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 Z TRAILER 2 ❑ 0 0 o u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. 0 Red Red u 1 TOWED • TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT 1 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 Other/Unknown VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE