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HomeMy WebLinkAbout2026-00015341 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 01111101111 I00111101011 IIIIIIIII DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X004176858 u, 1 U21 1 1 1 u, 2 U2 1 u, 8 U2 8 u, 1 U2 1 1 15 u,20 U2 1 *P 0119 INVESTIGATING AGENCY DAMAGE TO ANY ❑$500 OR LESS TYPE OF REPORT El A No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW ' Elgin Police Department ONE PERSON'S ❑$501-$1.500 ®ON SCENE 1 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash El AMENDED YR 2026I 2026-00015341 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n ® ❑ RELATED ❑Y ®N 03 20 2026 ®AM ❑YES ®NO U1 WALNUT AVE Elgin08:12 _ _ g PRIVATE mo /day/yr ID PM FLOW CONDITION M 0 !MI N E S Billings St COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 1 (n ® © 9 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 tg:DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EDUES ❑NOV ❑Ncv ❑Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 C) 0 7 / yr Volkswa en Jetta 2008 00-NONE DUE TO CRASH ® ❑ g 11 12 - 13-UNDER CARRIAGE 0 i 2 FIRE ❑ NI 1 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0U2 2 171 F 2 SYTM 6 ❑Y ❑SNE®UNK VEH. 9 AT CRASH 9 99-U 15-UNKNOWN THER 9 6 TOP 3 ,Distraction Value 9 ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF ,i ;,i. 4 COM VEH 0 �! 1 n ~ ELGIN IL 60123 B 1 0 FIRST CONTACT 9 O7 _:�try-_5 •II Yes.See Sidebar U1 0 Z EV20626 IL 2025 REAR TELEPHONE UNK" Other 3VWRM71K98M031306 American Alliance ❑Y Il N U2 m 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER RSUR m co Elgin Fire 1 99 9 Calmo-Lopez. Elmer I LAA-0999960-03 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER RESPONDER 2 N DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EWES ❑row 0 NOV ❑Dv /1 9 6 6 Ford Fusion 2013 00-NONE O Q�-O DUE TO CRASH D 2 0 13-UNDER CARRIAGE 10( I 2 FIRE 0 ® U2 C M 2 5 SYSTEM IN 9 ENGAGED 9 15-OTHER 9,16-TOP 3 X ❑Y ❑N ®UNK VEH. AT CRASH 99-UNKNOWN `Distraction Value 9 POINT OFU1 COO i1i N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR FIRST CONTACT 12 S 7A B " 4 COM VEH 0 ® .5 ••If Yes.See SidebarC BELVIDERE IL 61008 B 1 0 AP74569 IL 2026 IL D 0 3FA6P0H72DR208125 Kemper ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X Elgin Fire 1 99 9 Same 12A0001443459 BAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP 996 < Provena St.Joseph RESPONDER u1 = {UNIT) (SEAT) (DO81 (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME))(ADDRESS)/(TELEPHONE) (EMS) (HOSPITAL) 1 4 1 0 / #OCCS D :A / / UI 3 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 1 03,20 /2026 08 13 0 P Ei M in a Work Zone? ®N DIRP co 1 t PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 5 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ®AM U1 ✓ 2 0 2 99 03,20 /2026 08 13 ❑pm. ❑Construction >F R O 0 xi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 7 3 ®AM ❑Maintenance U2 -a, ARREST NAME Juan-Jimenez. Maria. M. 4 1570000009 03,20/2026 08 15 ❑pM SLMT o U 1 ® 11 1 MI CITATIONS ISSUED 0 PENDING N ® Utility uSECTION CITATION NO. ROAD CLEARANCE TIME AM, 0 t 2 ❑ ARREST NAME Juan-Jimenez. Maria. M. 6-101 1570-0000010 03/20 /2026 08 40 ❑PM ❑Unknown work zone type U1 30 2 23 0 OFFICER ID SIGNATURE BEAT!DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 30 1570-Tomlin. Eli 700 360-Yucaitis 04 , 13,2026 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••--, , MP. ; A CMV is defined as any motor vehicle used to transport passengers or property and: Z Not To Scale I Ilia 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer -< ` ` -'- ' r INDICATE NORTH combination):or .Z-1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C l ® _ (example:shuttle or charter bus):or C) X L A 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 transporter-usually a van type vehicle or passenger car):or w L L.___a._ 4. Is used ordesi natedtotrans transport passengers,including C} } } g po passen rs,includi the driver, for direct compensation(example:large van used for specific purpose):or L L.._-a____. - i 5. Is anyvehicle used to transport anyhazardous material(HAZMAT)thatrequires .a=-;:am a- ro: _ placarding(example:placards will be isplayed on the vehicle). i 2)._ -N r Z CARRIER NAME ADDRESS — C) CITY/STATE/ZIP g MOTOR CARR.ID 0 Interstate 0 Intrastate I I T I I — ❑ Not in Comm./Govt. ❑ Not in Comm./Other 00 ‘I. - '-1 - USDOT NO. ILCC NO. C m XI Source of above z . own tank)? 0 Yes 0 No 0 Unknown Did HAZMAT Regulations violation contribute to the crash? r ❑ Yes ❑ No 0 Unknown g D Did Carrier Safety Regulations MCS)violation contribute to the crash?El❑ Yes II No Unknown C 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 Gray Gray 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 Arties/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE