Loading...
HomeMy WebLinkAbout2026-00016035 ILLINOIS TRAFFIC CRASH REPORT sheet 1 Df 2 Sheets 01111101111 10011110100100000 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X004175848 u, 1 U21 3 4 1 U116 U2 1 U, 1 1_12 1 U, 1 U2 1 3 11 u1 7 U2 7 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY ❑$500 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 3 VEHICLE/PROPERTY ®OVER 51,500 ❑NOT ON SCENE(DESK REPORT) El AMENDED ❑ B Injury and for Tow Due To Crash YR 202612026-00016035 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 r1 ® ❑ RELATED PRIVATE ❑Y ®N 03 23 202612,— ❑YES ®NO U1 -< S MCLEAN BLVD Elgin mo /day/yr 07:13 ®PM FLOW CONDITION m _ 10(� COUNTY PROPERTY 0 Y ® N DOORING Ely #OF MOTOR El SLOW 15 u) ® ,C.71 MI N E O W Main Ln WITH VEHICLES INVLD IN STOPPED U2 --I El AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) Kane HIT&RUN ❑Y ® N PEDALCYCLIST®N ❑ FREE FLOW # LNS 0 18:DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uuv 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 n 0 6 / yr 13-UNDER CARRIAGE ©,I �:: FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ❑ 0 U2 4 IInn F 2 SYTM IN ENGAGE15-OTHER 5 ❑Y ®S NE❑UNK VEH. 0 AT CRASHD 0 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�6 4 COM VEH 0 0 1 0 F. FIRST CONTACT 12 7 ;—, _5 *Irves.See Sidebar U1 Z SOUTH ELGIN IL 60177 0 1 0 FX93091 IL 2026 REAR TELEPHONE IL D 0 1 G 11 B5SA2DF268982 Progressive ❑Y ®N U2 m 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m co 99 9 Barnum. Kimberly 971052043 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER RESPONDER 2 As N DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uv 0 NOV 0 Dv 2 0 0 8 Ford Explorer 2020 00-NONE 11 12'"_, DUE TO CRASH ❑ (� 2 0 13-UNDER CARRIAGE 10 l E FIRE ❑ ® U2 C c M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16•TOP 3 X ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN *Oistraebon Value 9 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 5 iI 6 4 COM VEH ❑ ® Ut CO FIRST CONTACT 6 Y__{_O��,_._5 •(ryes,See Sidebar H ELGIN IL 60123 0 1 0 FE94411 IL 2026 FIRST M IL D 0 1 FMSK8DHXLGB56099 Auto Club Insurance ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = 99 9 Aguirre Arellano.Jasmin AUT700831331 BAC E 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) U2 996 r m ##occs y 71 / U1 1 D 1 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 11 1 03,23 /2026 07 13 ®pm in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 5 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 0 2 0 28 99 + ) ❑PM• ❑Construction * R 3 0 $I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 5 ❑AM 0 Maintenance U2 -a, ARREST NAME Whitfield. Molly.A. 11-601 1551000352 / 1 El PM 1 ® 1 1 1 ❑CITATIONS ISSUED PENDING SLMT o N SECTION CITATION NO. ROAD CLEARANCE TIME 0 Utilit y 0 AM r 2 ElARREST NAME 03123 12026 07 40 0 PM 0 Unknown work zone type U1 35 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 35 1551-Dede.Joseph 602 269-Mendiola 04 , 14,2026 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 1. Has a weight rating more than 10,000 pounds(example:truck or truckrtrailer -< } i•--__r-_--; INDICATE NORTH combination):or -I BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver n - } (example:shuttle or charter bus):or X L A Not To Scale I 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I O } } } transporting employees in the course of their employment(example:employee X WWITWMPS i- --i-----+ - } } } •transporter. sed or des gnated to transport betweelly a van type vehicle or n 9 and 15passengers,including the driver.enger car):or c0 I for direct compensation(example:large van used fors specific purose):or O l. I I • 5. Is any vehicle used to transport anyhazardous material(HAZMAT)that requires a1 placarding(example:placards will be displayed on the vehicle). XI CARRIER NAME Z - — — — ADDRESS 0 CICITY/STATE/ZIPC)g MOTOR CARR.ID 0 Interstate ❑ Intrastate 5 I I T I wairnn ❑ Not in Comm./Govt. ❑ Not in Comm./Other 0 --- --1 1 C USDOT NO. ILCC NO. m m XI Source of above z . 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 Blue Gray 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: 2 TOWED BY/TO: DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE