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HomeMy WebLinkAbout2026-00014152 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 M001111010 0111 III �lIII0 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X 0416 u, 1 U21 2 4 1 u1 2 U2 1 u, 1 1_12 1 u, 1 U2 1 4 10 u1 3 U2 1 *P 0119 INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW ' DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 14 VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) El Injury and/or Tow Due To Crash El AMENDED YR 202612026-00014152 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 :1 BODE RD El 07:32 ® ❑ RELATED ®Y 0 N 03 13 2026 ❑AM ❑YES 0 NO U1 -< _ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION MFT!MI N E S W SHALES PKWY COUNTY PROPERTY ❑Y ® N DOORING Ely #OF MOTOR 0 SLOW 1 (/)❑ Cook HIT&RUN ❑Y ® N WITH VEHICLES INVLD ❑ STOPPED U2 —I ® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N 51 FREE FLOW # LNS 0 Qg3 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEON. 0 EOUES 0 NW 0 ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 n 0 7 / yr Nissan Altima 2019 00-NONE OUETOCRASH El©1 12 - 13-UNDERCARRIAGE 1 I! 2 FIRE 0 IE STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) EN O DISTRACTED 0 ]$I U2 2 rn F 2 4 SYTM❑Y ®SNE❑UNK VEH. 0 ATCRASHD 0 99-U 15-UNKNOWN THER9 16•TOP 3 `Distraction Value ALGN X. r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s, ii_a 1, 4 COM VEH ❑ �! 1 0 ELGIN N I L 60123 0 1 0 FIRST CONTACT 11 7_: __5 *llYes.See Sidebar U1 ZFN17196 IL 2026 REAR TELEPHONE IL D 1 N4BL4BV4KC231703 Kemper ❑Y ®N U2 13 . m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Same 12RA000010047 1 r o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused El El 2 ou g DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEON. ❑EWES 0 NMv 0 NCV 0 Dv 2 0 0 2 Toyota Camry 2023 00-NONE 11 ' 12 ®DUE TO CRASH rg ❑ 2 x o 13-UNDERCARRIAGE ,IFIRE 0 ® U2 c M 2 4SYSTEM IN 0 ENGAGED 0 15-OTHER 916-TOPO3 0 Y ®N 0 UNK VEH. AT CRASH 99-UNKNOWN 0istraellon Value 0 POINT OF 8 i1 1 CO 4 COM VEH ❑ ® U1 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR 6 FIRST CONTACT 1 Y _,__5 •If Yes.See Sidebar — Streamwood IL 60107 0 1 0 FT76724 IL 2026 I 0 C M IL D 4T1 G 11 BK3PU089044 Progressive ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Taboada. Diego 866806001 BAG $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP u1 = (UNIT? (SEAT) (DO81 (SEX) {SAFT) (AIR) (INJI 1(EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)!(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL) 1 4 02 / ' D / / 1 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z N 1 ® 11 1 03,13 /2026 07 32 ®pm 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 3 C) T o" 2 0 2 28 / / ❑PM- ❑Construction 1 R 3 0 $I CITATIONS ISSUED El PENDING SECTION CITATION NO. EMS ARRIVED TIME 5 ❑AM ❑Maintenance U2 o1 ® 11 1 ARREST NAME Hinojosa Briseno.Cela. E. 11-901-A 1574000012 / / ❑PM SLMT o N ElCITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ❑Utility 30 r 2 ARREST NAME AM T El / ❑❑PM ❑Unknown work zone type U1 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 30 1574-Rosales.Alexander 202 320-Cox 04 ,21 /2016 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 r 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer -< } }---_r__--; combination):or -I INDICATE NORTH p3 A BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C I I } (example:shuttle or charter bus):or 7 N r 3. Is designed to carry15 or fewer passengers and operated a contract carrier O } } } transporting employee in the course of their employment(example:employee transporter-usually a van type vehicle or passenger car):or w L L.___a____J. ma1 Elh•Iss9Ploiy 4. Is used ordesi natedtotrans transport passengers,including C } } } g po passen rs,includi the driver, r i�I for direct compensation(example:large van used for specific purpose):or mn.mro.n ,1110.V o -D L____a_ - t 5. Is any vehicle used to transport anyhazardous material(HAZMAT)that requires ,.__ placarding(example:placards will be isplayed on the vehicle). XI> u�N CARRIER NAME —� I Z ADDRESS 'n V) n CITY/STATE/ZIP : Not To Scale ( I MOTOR CARR.ID 0 Interstate ❑ Intrastate 1 I r 1 ❑ Not in Comm./Govt. 0 Not in Comm./Other --- --1 USDOT NO. ILCC NO. m XI Source of above z . 0 Yes 0 No ❑ Unknown A 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 Black Black 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 TOWED DISABLING DAMAGE NOT DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® DISABLING DAMAGE Arties/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE