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HomeMy WebLinkAbout2026-00011091 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 Df 2 Sheets 01111101111 0 III � IOU 110 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X�153121 u, 1 U21 2 4 1 U, 2 U2 1 U, 1 u2 1 U, 1 U2 8 1 10 U1 3 U2 1 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY ❑$500 OR LESS TYPE OF REPORT El A No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW ' Elgin Police Department ONE PERSON'S ❑$501-$1.500 ®ON SCENE 14 VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash El AMENDED YR 202612026-00011091 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n ® ❑ RELATED ®Y 0 N 02 26 2026 ®AM ❑YES ®NO U1 LARKIN AVE Elgin 09:27 _ _ g PRIVATE mo /day/yr ❑PM FLOW CONDITION m FT!MI N E S W N WORTH AVE COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 2 fA ❑ Kane HIT&RUN ❑V ® N WITH VEHICLES INVLD ❑ STOPPED U2 --I ® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST IZI N ® FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EOUES 0 Nuv ❑lacv ❑Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 99 n FOR DAMAGEDAREA(S) FRO r TOWED U1 0Hernandez Mercedes.Oscar.A. 1 0 / yr 13-UNDER CARRIAGE EN O i FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 2 DISTRACTED 0 0 U2 99 m M 2 SYTM 6 ❑Y ®SNE DUNK VEH. 0 AT CRASH 0 15-99-UUNKNOWN THER O9 16-TOP 3 *Distraction Value ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF Dail 6 �'.4 COM VEH 0 j$J 1 0 ~ ELGIN I N I L 60123 B 1 0 FIRST CONTACT 9 7 . -_5 *If Yes.See&debar U1 V. Z FQ81801 IL 2026 Isui TELEPHONE IL D 0 3CZRZ2H57TM737393 Progressive ❑Y ®N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR • m Elgin Fire 99 9 Same 867583658 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Sherman ❑Y El 2 eu N DRIVER ❑ PARKED ❑DRIVERLESS ❑ FED ❑PEDAL ❑EWES ❑l uv 0 Ncv ❑Dv yr/1 9 9 Chevrolet ClK 1500 2004 00-NONE 01 ' z j;-O DUE TO CRASH 0 Cg 2 x o 13-UNDER CARRIAGE ©I, 2 FIRE ❑ ® U2 C P' M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9116-TOP 3 X ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN O *0istracu n Value 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8- l 6 I.,( 4 COM VEH ❑ ® U1 CO FIRST CONTACT I Y'_,--5 •It Yes,See Sidebar z ELGIN IL 60120 0 1 0 2755283B IL 2026 REAR 0 C IL D 0 1GCEK19T84Z139071 StateFarm ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = 99 9 Same 21822091 SFP13 BAC $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPONDER 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 ❑Y U2 Z N 1 ® 11 4 02,26 /2026 09 28 ®❑PM AM in a Work Zone? ®N DIRP D co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 6 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ®AM U1 0 v 2 2 99 02,26 /2026 09 45 ❑PM ❑Construction * R 3 ❑ 0 CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 7 z J ®AM ❑Maintenance U2 —a, ARREST NAME Hernandez Mercedes, Oscar.A. 11-901 S1569-000005 02/26/2026 09 50 ❑PM SLMT o N 1 ® 11 4 MI CITATIONS ISSUED 0 PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • El Utility AM 30 r 2 ElARREST NAME Hernandez Mercedes.Oscar.A. 6-303-A S1569-000004 , / 0 PM ❑Unknown work zone type U1 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 35 1569-Jaimes.Julian 601 04 , 14,2026 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. .. .. A CMV is defined as any motor vehicle used to transport passengers or property and: Z r ,r• -, , ; N 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer i- }-- -r- --; I I. comb nation):or INDICATE NORTH P1 13. BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C } I - } (example:shuttle or charter bus):or C I- L.___A. _.-: I 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I O sually van vehicle or passenger L -----}----+ I I - 1 •} } } transporteree 73 d or Udesignated to rpansport bes In the course of tiween 9 and c5 passengers,heir employment(example: lrs,irrcludyng the drver, Unit?2 f for direct compensation(example:large van used for specific purpose):or ` -� .D ' 1 nit?1 _ _ 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires �10111NVe placarding(example:placards will be displayed on the vehicle). XI — D .� I - CARRIER NAME Z ADDRESS I CITY/STATE/ZIP g MOTOR CARR.ID 0 Interstate ❑ Intrastate I r I Not To Stile j ❑ Not in Comm./Govt. 0 Not in Comm./Other 00 i— - ----1 USDOT NO. ILCC NO. C m 73 Source of above z . ❑ 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 to 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 White Red 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: 2 TOWED BY/TO. DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE