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HomeMy WebLinkAbout2026-00014155 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 Of 4 Sheets 1111 III 11 IIIIII MUH U l II I IflflI IDUlfihl DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X 041 r4521 u, 1 U21 2 4 1 u1 2 U2 1 u, 1 u2 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$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash El AMENDED YR 2026I 2026-00014155 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n NESLER RD Elgin 07:52 ® ❑ RELATED ®Y ❑N 03 13 2026 ❑AM ❑YES ®NO U1 _ _ g PRIVATE mo !day!yr ®PM FLOW CONDITION MFT!MI N E S W SOUTH ST COUNTY PROPERTY ❑Y ® N DOORING Ely #OF MOTOR El SLOW 15 ' ❑ Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD ❑ STOPPED U2 --I ® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 Qgl DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL ❑EOUES ❑NOV ❑Ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 n 0 4 / yr Toyota Corolla 2013 00-NONE DUE TO CRASH ® CIy 13-UNDER CARRIAGE ©I 12 FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL TOTAL(ALL) O 2 DISTRACTED 0 0U2 0 171 F 2 8 SYSTEM IN O ENGAGED 0 OTHER 9 6 70P 3 9 ALGN = ❑Y ® ❑N UNK VEH. AT CRASH 9 UNKNOWN `Distraction Vatuc r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 0 i� �'.4 COM VEH 0 j$J 1 n H Z Streamwood IL 60107 B 4 0 FIRST CONTACT 9 O_: __s Yes.see sidebar u, FW23764 I L 2026 ' E TELEPHONE IL D 0 2T1 BU4EE9DC072772 American Alliance ❑Y ®N U2 19 . m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR 1-1 Pingree Grove Fire 99 9 Same ILAA-1124032-00 1 r "o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Provena St.Joseph ❑Y El 2 0 E{ DRIVER ❑ PARKED 0 DRIVERLESS 0 FED 0 PEDAL 0 EWES 0 row 0 Ncv ❑Dv yr Chevrolet Suburban 2023 00-NONE 00j'O DUE TO CRASH rg ❑ 5 x o 13-UNDERCARRIAGE 10,1 I.. 2 FIRE ID El U2 C ll M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16.TOP 3 X ❑Y lYi N ❑UNK VEH. AT CRASH 99-UNKNOWN `Oistracnon Value 9 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s_i s 114 COM VEH ❑ ® U1 CO F,,, FIRST CONTACT 12 Y�� =5 •)ryes.See Sidebar C ELGIN IL 60123 0 1 0 M191017 IL I 0 fp IL D 0 1 GNSKBKD2PR488430 US Specialty Insurance Co ❑Y ®N RDEF X1 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER 1 = Elgin Fire 99 9 Pingree Grove&Coun U24FFS120683-01 BAG E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP ui = (UNIT) (SEAT) (DOBi (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME),(ADDRESS),(TELEPHONE) (EMS) (HOSPITAL) ;p / / UI 1 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 4 03,13 ,2026 07 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 v 2 ❑ 2 28 03,13 ,2026 07 53 1 ®pm ElConstruction >E " O ❑ zi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 2 3 ❑AM ❑Maintenance U2 -a, ARREST NAME Hernandez Lopez. Daicelis. D. 11-901-A S1542-000785 03,13/2026 07 58 Igi pM SLMT ou ® 11 4 lgi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. ROAD CLEARANCE TIME AM ❑Utility t 2 El ARREST NAME Hernandez Lopez. Daicelis. D. 11-601 S1542-000782 03,13 ,2026 09 38 ®PM ❑Unknown work zone type U1 30 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM ❑Y 45 1542-Chase. Ethan 801 320-Cox 04 ,21 ,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 1. Has a weight rating more than 10,000 pounds(example:truck or truckrtrailer - ` ` ' ' / // INDICATE NORTH combination):or -I BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver 0 - (example:shuttle or charter bus):or 3. Is designed to car 15 or fewer ssen ers and o rated a contract carrier O A Not To Scale } } } transporting employees In the course of their employment(example:employee C L }----a----+ _ - } } } •transporter. sed or des gnated to transport betweelly a van type vehicle or n 9 and passengers,15enger r including the driver, 'CII'1 for direct compensation(example:large van used for specific purose):or .D L____a..... ,, - _ s s t 5. Is any vehicle used to transport anyhazardous material(HAZMAT)that requires i•OW, °f' ... . . . . placarding(example:placards will be isplayed on the vehicle). XI *4?/4' — L - Z CARRIER NAME Z ADDRESS 'n n CITY/STATE/ZIP ` MOTOR CARR.ID 0 Interstate 0 Intrastate 1 I r 1 // ❑ Not in Comm./Govt. 0 Not in Comm./Other ; _Y_ __1 USDOT NO. ILCC NO. m XI Source of above z . 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 Gray White u 1 TOWED • TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT 3 TOWED BY/TO. Arties/Impound Lot Garage SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® DISABLING DAMAGE Accurate Towing/Pingree Grove FD VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE