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HomeMy WebLinkAbout2026-00011433 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 01111101111 M00111101011110110 0 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY XO0416OO224 u, 2 U2 1 1 1 U1 4 U2 1 U, 1 1_12 U, 1 U2 1 4 9 U1 1 U221 *P 0119* INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW ' DAMAGE TO ANY ❑$500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away Elgin Police Department ONE PERSON'S ❑$501-51.500 ®ON SCENE 1 VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and f or Tow Due To Crash El AMENDED YR 202612026-00011433 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 2 mSEBRING DR Elgin 08:08 ® ❑ RELATED ❑Y ®N 02 27 2026 ❑AM ❑YES El NO U1 -< g PRIVATE mo !day!yr ®PM FLOW CONDITION m E050 !MI N E S East WaverlyDr COUNTY PROPERTY ❑Y 2�1 N DOORING ❑y #OF MOTOR ❑SLOW 3 (/) ® © Cook HIT&RUN ®Y ❑ N WITH VEHICLESOT, INVLD ❑ STOPPED U2 --I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 18:DRIVER p PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NW 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 0 0 9 ! yr 13-UNDER CARRIAGE I FIRE 0 IE STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 10 O DISTRACTED 0 0 U2 2 m M 2 SY4 ❑Y ®SNE❑UNK VEH. O AT CRASIN H O 99-UNKNOWN 9 16•TOP 3 ,Distraction Value 9 ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s.;i�S �i 4 COM VEH 0 j$J 1 C) m H ELGIN I L 601 20 0 1 0 FIRST CONTACT 1 7 'mR--5 *Il Yes.See Sidebar U1 Z 3463404B IL 2026 E TELEPHONE IL D 0 1 FTEW1 EG1 HKD22758 Geico Insurance ❑v ®N U2 10 . m 5 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m co Same 6050377966 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y El 2 0 0 DRIVER X. PARKED 0 DRIVERLESS 0 FED 0 PEDAL 0 EWES 0 Nuy 0 NOV 0 DV CIRCLE NUMBER(S) U1 yr 12 _ o 13-UNDER CARRIAGE 10;1 c. 2 FIRE 0 El U2 C SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 ® SPDR C) a SYSTEM IN 0 ENGAGED 0 15-OTHER 9..16-TOP 3 X ❑Y NJ N DUNK VEH. AT CRASH 99-UNKNOWN *Oistraelion Value 9 g N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF O I .t.0 COM VEH D ® Ut CO I-. FIRST CONTACT 6 CI�,i-_L"_i )OS •Iryes.See Sidebar 3286023B IL 2026 i 0 N M . STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0 ZFBERFAB3J6J96533 Country Financial ❑V ®N RDEF73 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Nunez.Sharlenne AB9258985 BAC $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP U1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)((ADDRESS)((TELEPHONE) (EMS) (HOSPITAL) 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 18 1 Lewis. David.A. Mailbox 02,27 /2026 08 08 ®AM in a Work Zone? ®N DIRP co I I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 8 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 C) ;, 2 ❑ 1 3 1086 SEBRING DR ELGIN IL 60120 08 28 , , PM 1 ❑ • ❑Construction * ru 3 ❑ 40 3 $!CITATIONS ISSUED ❑PENDING SECTION CITATION NO. EMS ARRIVED TIME 7 -a, ARREST NAME Hernandez. Rodolfo 11-601 748198 ! ! ❑❑AM ❑Maintenance U2 U ER11 1 CITATIONS ISSUED 0 PENDING 1 Utility SLMT o o N SECTION CITATION NO. ROAD CLEARANCE TIME AM• ❑ r 2 El ARREST NAME Hernandez. Rodolfo 11-402-A 748197 02127 /2026 09 00 0 PM ❑Unknown work zone type U1 20 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 20 1500-Chew. Marie 202 269-Mendiola 03 , 18,2026 10 30 ❑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 �11' 1. Has a weight rating more than 10,000 pounds(example:truck or truckrtrailer -< i- -----------' N - } INDICATE NORTH combination):or -1 II BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C i i_ I - } (example:shuttle or charter bus):or 1 Not To Scale : 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I 9 0 \ \ . } 1. transporting employees in the course of their employment(example:employee �emxr.eoao- transporter-usually a van type vehicle or passenger car):or w L L.___a____.I 4. Is used ordesi natedtotrans rtbetween9and15 ssen rs,includingthedriver, m } } } for direct compensation(example large van used for specific purpose):or O L L____a____. I i - t i i 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m ' 1 placarding(example:placards will be displayed on the vehicle). XI 1 .. ` - CARRIER NAME Z ~ •`� ADDRESS0 1 rs'-r - -- = ,..� wa,y� 1 J \ CITY/STATE/ZIP f _ MOTOR CARR.ID ❑ Interstate ❑ Intrastate I ❑ Not in Comm./Govt. ❑ Not in Comm./Other 00 ----------1 USDOT NO. ILCC NO. C 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. w Silver White 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 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE