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HomeMy WebLinkAbout2026-00014446 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets Mil l III H IIII 111111111 1111111 DD DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X004158890 u, 1 U21 3 4 2 u, 2 U2 1 u, 1 u2 1 u, 1 U2 1 1 10 u, 3 U2 1 *P 0119 INVESTIGATING AGENCY DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW ' Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 14 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash 0 AMENDED YR 2026I 2026-00014446 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 2 �I N STATE ST Elgin04:02 ® ❑ RELATED ' V 0 N 03 15 2026 ❑AM ❑YES ®NO U1 -< g PRIVATE mo !day/yr ®PM FLOW CONDITION M_ FT N E S W BIG TIMBER RD COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR 0 SLOW 1 0)❑ Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD ❑ STOPPED U2 --I CO AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST IZI N 51 FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EOUES 0 rary 0 ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 00 0 FOR DAMAGED AREA(S) FRO T TOWED U1 Q Rodriguez Chiquito,Alejandro 0 7 / yr 13-UNDER CARRIAGE 16) 2 ' 2 FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ❑ 0U2 00 <<T1 M 2 4 15-OTHER ❑Y ®N SYSTEM ❑UNK VEH. 0 AT CRASHD 0 99-UNKNOWN 9 76•TOP 3 *Distraction Value 9 ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6_iL 6 I,.4 COM VEH 0 j a 1 0 " �- SOUTH ELGIN I L 60177 0 1 0 FIRST CONTACT 12 r ) _5 *IIYes.See Sidebar U1 Z3646382B IL 2026 REAR TELEPHONE IL D 0 1 FTFW1 E89M KD36186 N/A ❑Y ❑N U2 I'Ill 'I in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 Same N/A 2 r o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused 0 Y El 2 eu m x DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEOAL 0 EWES 0 row '1 9 8 0 Tesla Model 3 2019 00-NONE O Z -_, DUE TO CRASH ❑ 2 0 13-UNDER CARRIAGE 9 I ©I( 2 FIRE 0 ® U2 C c M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9.16-TOP 3 X ❑Y NJ N ❑UNK VEH. AT CRASH 99-UNKNOWN *Distraction Value 9 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8 i1I 4 COM VEH ❑ ® U1 CO6 FIRST CONTACT 11 T -5 •If Yes.See Sidebar = Buffalo Grove LA 60089 0 1 0 65812EL IL 2026 I 0 C IL D 0 5YJ3E1 EA3KF412004 State Farm ❑Y ®N RDEF71 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER 1 = 99 9 Same 3103402-SFP-13 BAC $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPONDER u1 = (UNIT) (SEAT) (D00i (SEX) {SART) (AIR) (INJI 1(EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)!(ADDRESS)/(TELEPHONE) (EMS) (HOSPITAL) 1 5 1 1 / ' D / / 1 0 EV MOST EVNT LOG DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z N 1 ® 11 4 03,15 /2026 04 02 ®pm in a Work Zone? ®N DIRP co 1 I PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME H . AM If YES check one below: U1 1 C) T 0 2 ❑ 2 25 , , ❑PM 0 Construction " 3 0 $I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 5 ❑AM 0 Maintenance U2 -a, ARREST NAME Rodriguez Chiquito,Alejandro 3-707 1561-000272 ! ! ❑PM SLMT o u ® 11 4 igiCITATIONS ISSUED 0 PENDING SECTION CITATION NO. ROAD CLEARANCE TIME AM• El Utility t 2 El ARREST NAME Rodriguez Chiquito,Alejandro 11-901 1561-000271 03 r 15 ,2026 04 02 ®PM 0 Unknown work zone type U1 35 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM ❑Y 35 1561-Sarovic• Mirko 501 04 ,07,2026 09 00 ❑PM Workers present? ®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 f - ' 1. Hasa weight rating more than 10,000 pounds(example:truck or truck/trailer i„ J J combination):or —I -----------, - r J J INDICATE NORTH nunmrNwIJ BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C } I - Ir - } r (example:shuttle or charter bus):or r 3. Is designed to carry15 or fewer passengers and operated a contract carrier I 0 l- }-----t-_--; E r I - } } } transportingemployees In the course of their employment pa 9 rpbyment(example:employee X transporter-usually a van type vehicle or passenger car):or lP L L.___a__...l. I. } } 1 •4. Is used or designated to transport between 9 and 15 passengers,including the driver. y for direct compensation(example:large van used for specific purpose):or O ._ 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m placarding(example:placards will be displayed on the vehicle). XI m r J CARRIER NAME Z rr J rxer ADDRESS D r J rn / JJ CITY/STATE/ZIP 0 i J / J - MOTOR CARR.ID 0 Interstate El Intrastate O / r ❑ Not in Comm./Govt. ❑ Not in Comm./Other 0 --- --1 USDOT NO. ILCC NO. m m Xl Source of above z . IDOT PERMIT NO. WIDELOADo ❑Yes 0 No = 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 White 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 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 3 TOWED BY/TO. DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE