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HomeMy WebLinkAbout2026-00015158 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 01111101111 I0011110100 00 I TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X604178782 u, 1 U21 3 4 1 U1 3 U2 1 U, 1 1_12 1 U, 1 U2 1 1 10 u1 2 u2 3 *P 0119 INVESTIGATING AGENCY DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT El A No Injury 1 Drive Away AGENCY CRASH REPORT NO. TWO/ ' Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 14 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash El AMENDED YR 2026I 2026-00015158 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 2 �I ® ❑ RELATED ®Y 0 N 03 19 2026 ®AM ❑YES ®NO U1 SHALES PKWY Elgin08:46 _ g PRIVATE mo /day/yr ❑PM FLOW CONDITION m FT!MI N E S W RT20 COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 2 fA ❑ Cook HIT&RUN ❑V ® N WITH VEHICLESOT, INVLD ❑ STOPPED U2 —I Igl AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 Qg3 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEOAL 0 EWES 0 MAV 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 99 n T�TOWED U1 O NAME(LAST,FIRST,M) mo yr Valdez,Jadir, E. Dodge Ram 1500(pickup) 2022 00-NONE ©, >2 �/OUETOCRASH ® ❑ 13-UNDER CARRIAGE 1U 1 2 FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 99 m M 2 SYTM IN ENGAGE9 ❑Y ®SNE❑UNK VEH. 0 ATCRASHD 0 99-UNKNOWN 916•TOP 3 `Distraction Value ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s, i�B �i 4 COM VEH 0 j$J 1 0 ~ ELGIN I N I L 60123 B 1 0 FIRST CONTACT 1 7 ; __5 *II Yes.See Sidebar U1 Z 3866226B IL 2026 REAR TELEPHONE IL D 0 1 C6SRFJTONN332189 American Family ❑Y ®N U2 m 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Elgin Fire 99 9 Valdez Torres, Eden 410868765506 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER RESPONDER 2 XI E{ DRIVER 0 PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NMV 0 NOV 0 Dv !1 9 yf O Toyota Tacoma 2022 00-NONE 0, Qj•O DUE TO CRASH rg ❑ 2 x 13-UNDER CARRIAGE I FIRE ❑ El U2 i F 2 5 SYSTEM IN 0 ENGAGED 0 15-OTHER 9,1,6-TOP 3 x ❑YNi N ElUNK VEH. AT CRASH 99-UNKNOWN *0istracI Dn Value 3 POINT OF s i1 4 COM VEH 0 ® U1 W N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR � 6 �f�_ FIRST CONTACT 11 Y _5 •IfYes.See Sidecar 1= MOSHEIM TN 37818 B 1 0 BQF4571 TN 2026 I 0 TN D 0 3TMAZ5CN8NM188818 Erie ❑Y ®N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X Elgin Fire 99 9 Same Q082022154 SAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Provena St.Joseph RESPONDER U1 = (UNIT) (SEAT) (D081 (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)((ADDRESS)((TELEPHONE) (EMS) (HOSPITAL) :A / / 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 03,19 ,2026 08 47 ®❑PM in a Work Zone? ®N DIRP co 1 r PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 7 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ®AM U1 C) v 2 0 25 28 03,19 ,2026 08 50 ❑PM ❑Construction >E R 3 0 $I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 4 ®AM ❑Maintenance U2 o ® 11 4 ARREST NAME Valdez,Jadir, E. 11-601 S1569000016 03,19/2026 08 53 ❑pM SLMT u • El CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME AM• El Utility r 2 El ARREST NAME Valdez,Jadir, E. 11-306 S1569000018 03/19 /2026 09 34 [�PM 0 Unknown work zone type U1 45 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 45 1569-Jaimes,Julian 401 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 truck trailer -< i- }----------; ® - r INDICATEBY ARROWNORTH combination):or 531 2 Is used or} I I I yl I I _ } (example:shuttle or charter bus):transport morethan 15 passengers including the driver C L L.__-A-. } } } transportingemployeesllnthecoursepo theleemapbyntent example oernaployeerier .,, transporter-usually a van type vehicle or passenger car):or — L L.---a- v"e� — — } } } •4. Is used or designated to transport between 9 and 15 passengers,including the driver, N — — s i; for direct compensation(example:large van used for specific purpose):or O __ j - t i i 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m it placarding(example:placards will be displayed on the vehicle). ;p —1 CARRIER NAME Z ADDRESS O o - -3 CITY/STATE/ZIP g III I I - i. i. i. i. 4. MOTOR CARR.ID 0 Interstate 0 Intrastate ' Not To Scale I 0 Not in Comm./Govt. 0 Not in Comm./Other 00 ----- ----1 USDOT NO. ILCC NO. C 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 White Gray u 1 TOWED • TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT 2 TOWED BY/TO: Arties . 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 VEHICLE CONFIG._CARGO BODY TYPE LOAD TYPE