HomeMy WebLinkAbout2026-00008588 ILLINOIS TRAFFIC CRASH REPORT sheet 1 of 2 Sheets 01111101111
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DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X604145209
u1 1 U21 1 1 1 U1 2 U299 u1 1 U2 1 1.1199 U2 99 4 12 U1 13 U2 1 *P 0119
INVESTIGATING AGENCY DAMAGE TO ANY 0$500 OR LESS TYPE OF REPORT ® q No Injury 1 Drive Away
AGENCY CRASH REPORT NO. TRFW '
Elgin Police Department ONE PERSON'S ❑5501-$1.500 ®ON SCENE 1
VEHICLE/PROPERTY ®OVER 51,500 ❑NOT ON SCENE(DESK REPORT)
0 AMENDED ❑ B Injury and/or Tow Due To Crash YR 202612026-00008588 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 r7
N STATE ST Elgin 07:35
® ❑ RELATED ❑Y ®N 02 13 2026 DAM ❑YES E)NO U1
PRIVATE mo /day/yr ®PM FLOW CONDITION m
•
1 0 /MI N E S W WingSt/N.State St COUNTY PROPERTY ❑Y Igl N DOORING ❑Y #OF MOTOR 0 SLOW 1 (n
® �' O 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
183 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 WIN 0!CV 0 DJ DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 n
FOR DAMAGEDAREA(S) I380Prr TOWED U1 O
GONZALEZ BRICENO. MARIELYS.C. 0 3 /
yr 13-UNDER CARRIAGE NI
101 ! 2 FIRE ❑
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ® 0 U2 2 m
F 2 SY4 ❑Y ❑STM NE®UNK VEH. 9 AT CRASH 9 99-U 15-UNKNOWN THER9 16•TOP 3 ,Distraction Value 9 ALGN 2
r COM VEH 0 0 1 n
CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s it a ii,4
~ ELGIN I N I L 60120 0 1 0 FIRST CONTACT 7 tz_: __5 *II Yes.See Sidebar U1 0
Z ER50761 IL 2026 REAR
TELEPHONE
IL D 0 1HGEM22545L048171 Unknown ❑Y ❑N U2 m
13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
Same Unknown 1 r
`o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER
RESPONDER D
Refused 0 Y El 2 As
E{ DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 iiuv 0 i v 0 Dv
yr 12
0 13-UNDER CARRIAGE 10 2 FIRE 0 ® U2 C
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M 2 4 SYSTEM IN 9 ENGAGED 9 15-OTHER 9 16.TOP 3 X
❑Y ❑N ®UNK VEH. AT CRASH 99-UNKNOWN `Oistracton Value 9 4
POINT OF s i 4 CO VEH ❑ ® U1 W N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR 6 IS_. C
FIRST CONTACT 1 7 _,__5 C.
If Yes.See Sidebar
BARTLETT IL 60103 0 1 0 DP14124 IL 2026 I:EaR 4Si)
IL D 0 1 C4RDJDG2NC194061 Erie Insurance Exchange ❑Y ®N RDEF
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 =
Same Q030217608 BAc $
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)((A.DDRESS)(!TELEPHONE) (EMS) (HOSPITAL)
2 3 1 2 / F 2 3 0 1 0
m
/ / #OCCS D
/ / U1 1 D
/ / 2 O
EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z
N 1 ® 10 1 02,13 /2026 07 35 ®AM in a Work Zone? ®N DIRP co
1 I PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME ❑AM If YES check one below: U1 5 C)
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2 0 2 28 / / 0 PM• ❑Construction
R 3 ❑ $I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 5
❑AM 0 Maintenance U2
-a, ARREST NAME GONZALEZ BRICENO. MARIELYS.C. 3-707 15250000942 / / El PM SLMT
o u 1 ® 11 1 igiCITATIONS ISSUED 0 PENDING SECTION CITATION NO. ROAD CLEARANCE TIME AM• 0 Utility
N ® U1
35
r 2 ❑ ARREST NAME GONZALEZ BRICENO. MARIELYS.C. 11 703 B W15250000943 02/13 /2026 08 22 ❑PM El work zone type
2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 35
1525-NavE.Oscar 501 269-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
{{ l . 0 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 truckrtrailer -<
` ` -'- ' . `` r INDICATE NORTH combination):or -I
l Not 7o Scale BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C
it
` } (example:shuttle or charter bus):or
l r r
3. Is d ned t carry 15 or fewer ssen ers and o rated a contract carrier e in o pa 9 pe by\t'
- } } } transporting employees In the course of their employment(example:employee
y a van type
---- 4a isnosedord rter- illnatedtotransehrtbeeicle or n 9andr 15r) ssen rs,includingdryer, c0C
i 1 } } } for direct compensation(examp large van used for specific purpose):or 0
__ \ _ i i _ 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m
placarding(example:placards will be displayed on the vehicle). D
CARRIER NAME —I
` r Z
1 l - _- ADDRESS D
1 C
n
CITY/STATE/ZIP g
11 - i. i. i. i. MOTOR CARR.ID 0 Interstate 0 Intrastate
I I T I ( ❑ Not in Comm./Govt. Not in Comm./Other
I I I 1
} USDOT NO. ILCC NO. m
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. w
Silver White
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 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY/TO.
DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE