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HomeMy WebLinkAbout2026-00009946 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 11111111111111111111111111 1111110111101 nil ill 11111111 DRAC TRFD TRFC WEAT DRVA VIS VEHD LGHT COLL MANY X145301 u, 1 U21 6 4 2 U, 2 U2 1 U, 1 1_12 1 u1 2 u2 1 1 11 U1 1 U211 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY ❑$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$1,500 ❑NOT ON SCENE(DESK REPORT) El AMENDED ❑ B Injury and for Tow Due To Crash YR 202612026-00009946 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n ® ❑ RELATED PRIVATE ®Y 0 N 02 20 2026 ®AM ❑YES IX]NO U1 -< KI M BALL ST Elgin mo /day/yr 07:08 ❑PM FLOW CONDITION Ill I 0 0/MI N 0 S W North State St COUNTY PROPERTY ❑Y ® N DOORING Ely #OF MOTOR ElSLOW 15 Cn 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 18:DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑Peoa. ❑EouES ❑NOV ❑ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 T�TOWED U1 0 mo Perez Mendoza. Marco.A. Dodge Avenger 2014 00-NONE ©, >2 �/OUETOCRASH 1:/NAME(LAST,FIRST,M) yr 13-UNDER CARRIAGE 10• I 2 FIRE 0 ® < STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ® 0 U2 m M 2 4 SYSTEM IN ENGAGED 15-OTHER 9 16.TOP 3 9 ALGN = ❑Y ❑N [DUNK VEH. AT CRASH 99-UNKNOWN `Distraction Value r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s i�a 4 COM VEH ❑ Ea 1 00 ~ ELGIN I L 60120 0 1 FIRST CONTACT 12 7_: __5 *II Yes.See Sidebar U1 Z S717865 IL 2026 REAR TELEPHONE IL D 1C3CDZAB8EN117216 Kemper ❑Y ®N U2 M 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR co Mendoza. Flora.A. 12A0000266569 2 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER RESPONDER 2 X m g DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NMV 0 K V 0 DV /1 9 y 7 9 Nissan Juke 2015' 00-NONE 11_"j QM 1.,-_, DUE TO CRASH ❑ 2 x o 13-UNDER CARRIAGE 10( 12 FIRE ❑ ® U2 C F 2 4 ❑Y ❑SYSTEM IN ENGAGED 15-OTHER 9,16-TOP 3 0 X ❑N UNK VEH. AT CRASH 99-UNKNOWN *0istrac on Value N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF S 1 S .I. 4 COM VEH ❑ ® U1 IN FIRST CONTACT 6 O7 ,�=Q)O5 •IfYes.See Sidebar C ELGIN IL 60120 0 1 E713273 IL 2026aR 0 N IL D JN8AF5MV1 FT556402 Geico ❑Y ®N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Same 6170-85-22-52 BAC $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused 0 Y°ND 0 N u1 = KNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)((ADDRESS)/(TELEPHONE) (EMS) (HOSPITAL) 1 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 11 1 02/20 /2026 07 08 ®❑PM in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 3 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 � 0 2 ❑ 28 99 ( / ❑PM, ❑Construction * 3 R 3 ❑ $I CITATIONS ISSUED PENDING SECTION CITATION NO. EMS ARRIVED TIME 3 ❑AM ❑Maintenance U2 o ® 11 1 ARREST NAME Perez Mendoza. Marco.A. 11-601-Ax 414-1114 / / ❑PM SLMT o N ❑CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME El Utility t 2 ❑ 30 ARREST NAMEAM 7 ( / ❑❑PM ❑Unknown work zone type U1 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 30 414-Lara. Saul 601 03 / 17/2026 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 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer -< - ------I-- --' I • I. INDICATE NORTH combination):or -I _ 1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C (example:shuttle or charter bus):or n 3. Is designed tocarry15 fewer passengers and operated a contract carrier O eS or -- } } } transporting employees in the course of their employment(example:employee 73 Not Tp Scale l I I I = transporter-usually a van type vehicle or passenger car):or w 4. Is used or designated to transport between 9 and 15 passengers,including N } } • • for direct compensation(example:large van used for specificpurpose):or [he driver, NNt3 rex.—unt1— — Pe ( P 9 Pe 0 L i.____a____. _ t i i i • 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires — — — — — placarding(example:placards will be displayed on the vehicle). ,Zmt . 1 lit CARRIER NAME Z IADDRESS 0 l E CITY/STATE/ZIP 0 = C MOTOR CARR.ID 0 Interstate 0 Intrastate I I T I ❑ Not in Comm./Govt. 0 Not in Comm./Other I--------'-• - 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 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 Black White 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 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/TO. DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE