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HomeMy WebLinkAbout2026-00015329 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets _ Mill III H IIII 1DIII 0 11110111111 DI 11 DD DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV -Xf)04176a60* u, 1 U21 3 4 1 U1 5 U2 1 U, 1 1_12 1 U, 1 U2 1 1 10 u1 3 U211 *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 El5501-51.500 ®ON SCENE 1 VEHICLE/PROPERTY ®OVER 51,500 El NOT ON SCENE(DESK REPORT) ® B Injury and for Tow Due To Crash El AMENDED YR 202612026-00015329 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n ® ❑ RELATED 181 Y 0 N 03 20 2026 ®AM ❑YES ®NO U1 BLUFF CITY BLVD Elgin06:52 _ _ g PRIVATE mo /day/yr ❑PM FLOW CONDITION m FT!MI N E S W S LIBERTY ST COUNTY ❑ ®PROPERTY Y N DOORING Ely #OF MOTOR NI SLOW 15 Cn ❑ Kane HIT&RUN ❑V ® N WITH VEHICLES INVLD ❑ STOPPED U2 --I ® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ❑ FREE FLOW # LNS 0 Q83 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 2 n 1 0 / yr 13-UNDER CARRIAGE ©i - FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 2 DISTRACTED 0 0U2 2 m M 2 4 ❑Y ® n 15-OTHER SYSTEM ❑UNK VEH. AT CRASH D 99-UNKNOWN 9 16•TOP 3 *Distraction Value ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s, i�a �i COM VEH 0 j$J 1 0 w ~ ELGIN I L 60120 0 1 0 FIRST CONTACT 11 7_: __5 *Ilyes.See Sidebar U1 Z EW69575 IL 2026 REAR TELEPHONE IL D 0 3KPF54AD2RE783489 Allstate ❑Y ®N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 Same 8116547104 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y El 2 c m x DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 Mks 0 NMv 0 NCv 0 Dv 2 0 0 1 Ford Explorer 2010' 00-NONE ,t-1 12..-_i DUETO CRASH ❑ !1 2 o 13-UNDERCARRIAGE 10;1 2 FIRE ❑ ® U2 C c M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16.TOP 3 X ❑Y lYi N ❑UNK VEH. AT CRASH 99-UNKNOWN *Oistraellon Value 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF si S ....4 COM VEH ❑ ® U1 CO FIRST CONTACT 6 7 -�-:6•IT Yes.See Sidebar C ELGIN IL 60120 0 1 0 BM16132 IL 2026 REAR 0 Si) IL D 0 1 FMEU7F82AUA92556 Progressive ❑Y 123 N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = 99 9 CASTELLANOS.JOSE 865485131 BAG $ 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 / ,, U1 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 1 03,20 ,2026 06 53 ®❑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 1 n T 0 2 ❑ 28 2 1 1 ❑PM, ❑Construction * Z 3 0 I!!I CITATIONS ISSUED ❑PENDING SECTION CITATION NO. EMS ARRIVED TIME 1 ❑AM ❑Maintenance U2 a1 ® 11 1 ARREST NAME Ponce. Kyle.A. 11-601-Ax W1573-000017 / r ❑PM SLMT o N ❑CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ❑Utility ARREST NAME AM TT 2 ❑ ❑❑PM 0 Unknown work zone type U1 1 r n OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 ❑ - ❑AM Workers present? ❑Y 30 1573-Beasley. Martese 401 r , ❑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 truck trailer __BiuntzweJ ` ` ' ' r INDICATE NORTH combination):or A BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver n _ } (example:shuttle or charter bus):or 0 A 3. Is designed to carry 15 or fewer passengers and operated by a contract Garner 0 } } } transporting employees In the course of their employment(example:employee y transporter-usually a van type vehicle or passenger car):or w L L.___a__ < 4. Is used ordesi natedtotrans rtbetween9and15 passengers,including C — _ _ _a_ — — — } } } • for direct compensation(example:large van used for speific purpoe):or the driver, O L L____a____� r 1 I — — — - i. < i. ._ 5. Is any vehicle used to transport anyhazardous material(HAZMAT)thatrequires m ` \ placarding(example:placards will be isplayed on the vehicle). ;p r CARRIER NAME Z `iyD ADDRESS 0 w 0 , CITY/STATE/ZIP g 4*- i. i. i. i. 4. MOTOR CARR.ID 0 Interstate El Intrastate 5 , I I I ❑ Not in Comm./Govt. 0 Not in Comm./Other 00 -Y- --4. Not To scalar - mPCI USDOT NO. ILCC NO. Source of above z . 71 Did HAZMAT spill from vehicle(do NOT consider FUEL from vehicle's Z own tank)? 0 Yes 0 No 0 Unknown D Did HAZMAT Regulations violation contribute to the crash? r ❑ Yes 0 No 0 Unknown g Did Carrier Safety Regulations I/ICS)violation contribute to the crash?❑ Yes IQNo El Unknown Unknown 0 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' T TRAILER 1 ❑ ❑ 0 z TRAILER 2 ❑ 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 3 TOWED BY/TO. _Adios/Unknown . SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/TO: DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE