HomeMy WebLinkAbout2026-00012643 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111
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INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW '
DAMAGE TO ANY 0 5500 OR LESS TYPE OF REPORT ® q No Injury 1 Drive Away
Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 7
VEHICLE/PROPERTY ®OVER 51,500 El NOT ON SCENE(DESK REPORT)
0 AMENDED ❑ B Injury and/or Tow Due To Crash YR 202612026-00012643 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 m® ❑ RELATED 0 Y ®N 03 06 2026 ❑AM ❑YES ®NO U1 -<
S RANDALL RD Elgin PRIVATE mo /day/yr 12:51 ®PM FLOW CONDITION m
03090!MI CI E S W Randall Rd/Otter Creek Ln COUNTY PROPERTY ®Y ElN DOORING Ely #OF MOTOR IR SLOW 15 u)
Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD 0 STOPPED U2 —I
0 AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST IR N ❑ FREE FLOW # LNS 0
18:DRIVER ID PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NW 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) y
N 99
NAME(LAST,FIRST,M) Garcia. Nerlvette mo yr 0FRONT TOWED U1
Land Rover Range Rover 2003 00-NONE 1 DUE TO CRASHEN E
11-_ 0
g 12 -
13-UNDERCARRIAGE 10l 2 FIRE 0 El
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 99 m
F 2 4 SYSTM❑Y IN NE UNK VEH. 0 ATCRASHD 0 99-U 15-UNKNOWN THER9 76•TOP 3 `Distraction Value ALGN X.
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s i� a �r.4 COM VEH 0 Ea 1 n
~ ELGIN I N I L 60124 0 1 0 FIRST CONTACT 5 7 :,-----1'O •II Yes.See Sidebar U1 0
Z FZ76661 IL 2027 REAR
TELEPHONE
IL D 0 SALM El 1433A134809 State Farm ❑Y ISI N U2 m
5 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR
99 9 Caban. !vette 1931684SFP13 2 m
o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER
RESPONDER
2
0 DRIVER H. PARKED 0 DRIVERLESS ❑ PED ❑PEDAL 0 EWES 0
yr _ 13-UNDER CARRIAGE 10,i 12 2 FIRE ❑ ® U2 C
c SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ❑ ® SPDR C)
SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16-TOP 3 0
a ❑Y El ❑UNK VEH. AT CRASH 99-UNKNOWN `Distraction Value
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. s 4 STATE YEAR POINT OF ,._ COM VEH D ® CO
F„ FIRST CONTACT 11 7 ) Ut
, _ If Yes.See Sidebar 5 •
DK14541 IL 2026 REAR0 N
M . STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0
0 5UXCR6CO2P9P30238 Allmerica Financial Allia ❑Y ®N RDEF
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 =
Reinke.Aaron Al CA295599 BAc $
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP
U1 =
(UNIT) (SEAT) (DOBi (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME(!{ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL)
1 3 03 /
/ / UI 2 :A
m
/ / 0
EV MOST EVNT LOG DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z
N 1 ® 18 1 03,06 /2026 12 52 ®pm in a Work Zone? ®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
2 0 30 99
N 3 0 ❑CITATIONS ISSUED 0 PENDING + / ❑PM• ❑Construction
SECTION CITATION NO. EMS ARRIVED TIME 3
❑AM ❑Maintenance U2
a ARREST NAME / / ❑PM '
-
•
o u ® 1 l 1 0 CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ❑Utility SLMT
10
t 2 ARREST NAME AM
7 1 / ❑❑PM 0 Unknown work zone type U1
El
OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME
2 2 3 0 - ❑AM Workers present? ❑Y 10
1569 Jaimes.Julian 702 , / ❑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.
. O.
A CMV is defined as any motor vehicle used to transport passengers or property and: Z
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r 0 .
1. Has a weight rating more than 10,000 pounds(example:truck or truckrtrailer -<
' --I- r INDICATE NORTH combination)or p0
BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C
- (example:shuttle or charter bus):or 0
si r r r
•L • A • N 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier O
J } } } transporting employees in the course of their employment(example:employee X
rter-
enger
or 03
i_ ...l. - I.
4alsuosedordsignatedto tranlly a van type sport betweeicle or n9a d15rprssen rs,includingthedriver, y
Unit?2 vn/n1 } } } for direct compensation(example:large van used for specific purpose):or O
— r
L ( '� l. i. i i 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires 'D
h i
-- ..� O. placarding(example:placards will be displayed on the vehicle). XI
CARRIER NAME —I
ADDRESS
w
0
CITY/STATE/ZIP g
- MOTOR CARR.ID 0 Interstate ElIntrastate
I I . I ( - - ❑ Not in Comm./Govt. ❑ Not in Comm./Other 00
----Y._- Not To Scale ( i. : 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 VIM 1 m
co
LOCAL USE ONLY TRAILER VIN 2 m
v
TRAILER WIDTH(S) 0-96" 97-102" >102' m
TRAILER 1 ❑ ❑ 0 Z
TRAILER 2 ❑ 0 0 o
u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. Z
Blue Gray
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 DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY/T6
DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE