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HomeMy WebLinkAbout2026-00014486 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 6 Sheets 01111101111 I00111101001 111 11 DRAC TRFD TRFC WEAT DRVA VIS VEHD LGHT COLL MANY XO04178850 u, 9 u210 1 1 2 u1 4 U2 1 U199 1_12 1 u1 2 u2 1 4 9 U1 1 U221 *P 0119* INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW ' DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT El No Injury 1 Drive Away Elgin Police Department ONE PERSON'S ❑$501-$1.500 ®ON SCENE 1 VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) El AMENDED ❑ B Injury and for Tow Due To Crash YR 202612026-00014486 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 2 m 352 BILLINGS ST Elgin10:11 ® ❑ RELATED ❑Y ®N 03 15 2026 ❑AM ❑YES ®NO U1 -< _ _ PRIVATE mo /day/yr ®PM FLOW CONDITION m COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 2 fA ❑ FT!MI N E S W Kane HIT&RUN ®Y ❑ N WITH VEHICLES INVLD DO U2 —I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 Q83 DRIVER O PARKED El DRIVERLESS 0 PED 0 PEDAL 0 EOUES 0 NW 0 ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 n FOR DAMAGEDAREA(S) FRONT TOWED U1 Q NAME(LAST,FIRST,M) mo !1 9 9 8 Lincoln Navigator 1999 00-NONE 1© 12 - , OUETOCRASH ❑ _ 13-UNDER CARRIAGE FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) EN O 2 DISTRACTED 0 0 U2 2 m M 9 SY 15-OTHER 9 ❑Y ®SNE❑UNK VEH. 0 AT CRASM IN H 0 99-UNKNOWN 9 16•TOP 3 `Distraction Value 9 ALGN = r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s, ii_S 1, COM VEH 0 0 1 0 SchaumburgIL 60194 0 9 0 FIRST CONTACT 11 7_: __5 *IrYes.See Sidebar U1 ZCL35246 IL 2026 REAR TELEPHONE IL D 0 5LMPU28A4XLJ26908 Felcon Insurance ❑Y Il N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR 99 9 Same 0100140018-1 2 m `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y ® N 2 X 0 DRIVER X. PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 row 0 KDV 0 DV yr 10 12 ( 2 FIRE 0 U2 C o _ 13-UNDER CARRIAGE IEl SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED a SYSTEM IN 0 ENGAGED 0 15-OTHER 9.1,6•TOP3 ❑ ® SPDR n ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN `0istractlon Value 9 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF ©.' _ t 4 COM VEH ❑ ® Ut CO F,,, FIRST CONTACT 7 Q 6 ,=:.5 *If Yes.See Sidebar 3578737B IL 2026 REAR0 N M . STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0 1 GCJTBFE6B8114437 Progressive ❑Y ®N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = 99 9 Pleitez Hernandez. Luis.J. 864203780 BAc $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP U1 = iUNIT) (SEATI (DOB) (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)!{ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL) 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 18 1 03,15 /2026 10 11 ®AM in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 1 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 Si 2 ❑ 11 1 11 18 ! 1 ❑PM• ❑Construction * R 3 ❑ $I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 1 ❑AM ❑Maintenance U2 -a, ARREST NAME Barrientos Ventura. Uriel 11-404 1540-496 / / ❑PM SLMT u 1 ® 11 5 •igi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. ROAD CLEARANCE TIME AM• El Utility r 2 El ARREST NAME Barrientos Ventura. Uriel 6-101-A 1540-492 031 15 ,2026 11 30 [M PM ❑Unknown work zone type U1 25 n 7 OFFICER ID SIGNATURE BEAT!DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 ❑ 1540-Allahi. Muhammad 701 269-Mendiola 04 , 14,2026 01 30 E PM Workerspresent7 ®N U2 25 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 en w. eunwst Z 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer i- }---.r----; I } combination):or INDICATE NORTH p1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C .I - (example:shuttle or charter bus):or 0 '—3 3. Is designed to carry 15 or fewer passengers and operated a contract carrier O I- <.__-A-.•-J M - . } } } transportingemployees in the course of their employment transportr-usually a van vehicle or (example:employee w type passenger car):or CO L 4. Is used or designated to transport between 9 and 15 passengers,including C}--- ----; - } } } g Po passen rs,includi the driver, .iafor direct compensation(example:large van used for specific purpose):or O n . . , < <____a..... .i t _ } } } ,_ 5. Is any vehicle used to transport anyhazardous material(HAZMAT)that requires m 8 , placarding(example:placards will be displayed on the vehicle). XI m I' —I CARRIER NAME Z oarrrst ADDRESS O — — — C CITY/STATE/ZIP C)0 F�ggg _ i. i. i. i. 4. MOTOR CARR.ID 0 Interstate 0 Intrastate .5 m ❑ Not in Comm./Govt. ❑ Not in Comm./Other 0 ; -- -.--; I _Not To S9a1eJ ILCC NO. 0 USDOT NO. m XI Source of above z . • m Did HAZMAT spill from vehicle(do NOT consider FUEL from vehicle's z own tank)? 0 Yes 0 No 0 Unknown Did HAZMAT Regulations violation contribute to the crash? r ❑ Yes 0 No 0 Unknown g D Did Carrier Safety Regulations MCS)violation contribute to the crash? A ❑ Yes II El 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 Beige White u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT' 2 TOWED BY/TO: _ 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