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HomeMy WebLinkAbout2026-00016985 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 01111101111 10011110111 0 lU 10 III0 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY XO04181747- u, 1 U21 3 4 1 U1 3 U2 1 U, 1 1_12 1 U, 1 U2 1 1 15 u1 1 u2 1 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY El$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 2 VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash El AMENDED YR 2026I 2026-00016985 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n N STATE ST Elgin01:46 ® ❑ RELATED ®Y 0 N 03 28 2026 ❑AM ❑YES IX]NO U1 '< _ _ PRIVATE mo !day/yr ®PM FLOW CONDITION RIFT/MI N E S W KIMBALL BALL ST COUNTY PROPERTY ❑Y ® N DOORING Ely #OF MOTOR 0 SLOW 1 (n ❑ Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD 0 STOPPED U2 —I ® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EDUES 0 NW ❑!CV ❑DV DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 FROf'tr�TOWED U1 0 mo Padilla Altamirano. Nubia. L. Acura M DX 2012 00-NONE ©, Qz a/DUE TO CRASH ® ❑ O NAME(LAST,FIRST,M) yr 13-UNDER CARRIAGE } : 2 FIRE ❑ al < STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 ]SI U2 rr1 F 2 4 SY❑Y ®N SE❑UNK VEH. ATCRASHM IN n ENGAGED 99-UNKNOWN 016 3 `Distraction Value ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6,_iL 6 I, 4 COM VEH ❑ Ea 1 O w ~ ELGIN I L 60120 0 1 0 FIRST CONTACT 11 7 ; __5 *If Yes.See Sidebar U1 ZDW97279 I L 2026 TELEPHONE IL Other 2HNYD2H68CH507444 None ❑Y ❑N U2 I— in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Jarquin.Alfredo None 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER RESPONDER D Refused ®Y ❑ N 3 2 XI m x DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EWES ❑row 0 Ncv ❑Dv !2 0 0 3 Infiniti JX35 2013 00-NONE al z j-_, DUE TO CRASH rg ❑ 2 x 0o 13-UNDER CARRIAGE 6 I ©(, 2 FIRE 0 ❑ U2 C c F 2 4 0 Y N 0 UNK VEH. AT CRASH 99-UNKNOWN *Distraction Value POINT OF 6 i1�f 4 COM VEH ❑ ❑ U1 CO N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR 6 FIRST CONTACT 11 7 _, _5 •)(Yes.See SidebarC 1= ELGIN IL 60123 0 1 0 DA18104 IL 2026 I 0 Z IL D 5N1ALOMM8DC330722 Allstate ❑Y ®N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Same 966091450 BAC $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP 996 < Refused RESPOND ❑N 3 U1 = (UNIT) (SEAT) (DOBi (SEX) {SAFT) (AIR) (INJI 1(EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME),(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL) 1 4 07 / LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y N 1 ® 11 4 03,28 /2026 01 36 ®pm in a Work Zone? ®N DIRP co 1 r PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME H . AM If YES check one below: U1 3 0 T 0 2 0 25 2 , , ❑PM ❑Construction " 3 0 El CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 1 ❑AM ❑Maintenance U2 -a, ARREST NAME Padilla Altamirano. Nubia. L. 11-306 1574000026 , / ❑PM SLMT o N 1 ® 11 4 CITATIONS ISSUED 0 PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ' ❑Utility AM 30 r 2 El ARREST NAME Padilla Altamirano. Nubia. L. A3 1574000024 , / 0 pM ElUnknown work zone type U1 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 30 1574-Rosales.Alexander 601 04 ,21 ,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 A 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer Z } } ' ' N } INDICATE NORTH combination):or -I BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C } I - } r r r (example:shuttle or charter bus):or 0 . . . j I- I- --I-----; I I\ I .i.l - } i- } transporting employeesned to inthe course passengers or fewer thir emplod yment example:employeerier °3 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, Klmball?St — for direct compensation(example:large van used for specific purpose):or L L-_ __i_. --- — — Untt#2 '''`' — — t i. } 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires placarding(example:placards will be displayed on the vehicle). m -/ CARRIER NAME —I Z — ADDRESS ratSt il I i' ' I I �� it < CITY/STATE/ZIP 0 MOTOR CARR.ID 0 Interstate El Intrastate 1 r Not To Scale j ❑ Not in Comm./Govt. Not in Comm./Other 00 ----------1 USDOT NO. ILCC NO. < m XI Source of above z . own tank)? 0 Yes 0 No 0 Unknown Did HAZMAT Regulations violation contribute to the crash? r ❑ Yes 0 No 0 Unknown M w 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 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. Redmons/Impound Lot Garage . SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE DISABLING DAMAGE NOT DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® Redmons/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE