HomeMy WebLinkAbout2026-00017556 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets _ II III H
II II UH UU I IlU III1IHHI 100001000
DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X004189525
u, 1 U21 2 4 1 U1 5 U2 1 U, 1 1_12 1 U1 1 U2 1 1 10 U1 3 U211 *P 0119*
INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW '
DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT ® q No Injury 1 Drive Away
Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 14
VEHICLE/PROPERTY ®OVER 51,500 ❑NOT ON SCENE(DESK REPORT)
0 AMENDED ❑ B Injury and/or Tow Due To Crash YR 202612026-00017556 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 21 �I
COOMBS RD Elgin 12:27
® ❑ RELATED ®Y ❑N 03 31 2026 12,— ❑YES ®NO U1 -<
g PRIVATE mo !day!yr ®PM FLOW CONDITION ITl
FT!MI N E S W W HIGHLAND G H LAN D AVECOUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR 0 SLOW 15 u)
❑ Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD ❑ STOPPED U2 —I
® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N 51 FREE FLOW # LNS 0
g DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EWES 0 uuv 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 99 n
0 1
FOR DAMAGEDAREA(S) Mao TOWED U1 O
r
yr
13-UNDER CARRIAGE 12! FIRE 0
10 2 IE
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0U2 99 171
M 2 SY4 ❑Y ❑STM NE 21 UNK VEH. 9 AT CRASH 9 99-UNK 15- NOWN THER9 16•TOP 3 *Distraction Value 9 ALGN X.
t CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s_ - I,.4 COM VEH 0 E! 1 0
~ Nort Port FL 34288 0 1 0 FIRST CONTACT 00 7_; _5 *IIVes.See Sidebar Ut
Z BG58EN FL 2026 REAR
TELEPHONE
FL B 7 1 FT8W3DT3KEE09526 Bristol West ❑Y ®N U2 Ill . m
in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
99 9 Same G01646931601 1 r
`o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER
RESPONDER D
Refused ❑Y ❑ N 2 eu
g DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0!My 0 NOV 0 Dv
/1 9 5 6 Hyundai Tucson 2025 00-NONE O1" 12' _, DUE TO CRASH ❑ 2
0 yr 13-UNDER CARRIAGE o i 2 FIRE 0 ® U2 C
c
M 2 4 SYSTEM IN 9 ENGAGED 9 15-OTHER 9 16-TOP 3 X
❑Y ❑N ®UNK VEH. AT CRASH 99-UNKNOWN *Distraction Value 9 0
POINT OF s i 4 COM VEH ❑ ® U1 W N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR 5 1:._ C
FIRST CONTACT 11 7 - _5 •If Yes,See Sidebar
= Algonquin IL 60102 0 1 0 EY7522 IL 2026aR 0 N
IL D 0 KM8JCDD18SU281249 ALLM ERICA FINANCIAL ALLIA ❑Y ®N RDEF71
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 =
99 9 Same A1CM02148700 BAG $
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 <
Refused RESPOND O N U1 =
(UNIT) (SEAT) (DOB) (SEX) (SAFT) (AIR) (INJI 1(EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME(1(A.DDRESS)!(TELEPHONE) (EMS) (HOSPITAL)
1 3 05 /
/ / UI 2 D:A
/ / 2 O
EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ID U2 Z
N 1 El 11 4 03,31 r2026 12 28 ®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 2 C)
T
o"
2 0 2 99 1 / ❑PM• ❑Construction
1
Z3 ❑ xi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME ❑AM 0 Maintenance U2 5
4 1 ® 11 4 ARREST NAME Morales,Alexander 11-801 WS1569000040 / / El PM SLMT
o Nu ❑CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME •• El Utility
45
t 2 ARREST NAME AM
1 r ❑❑PM ❑Unknown work zone type U1
El
T OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME
2 2 3 0 El AM Workers present? ❑Y 45
1569 Jaimes,Julian 901 , 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 -<
` ` '' -' r INDICATE NORTH combination):or -I
BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C
] I
Z�� _ (example:shuttle or charter bus):or
5
< <----�;-•-•j I - • transporting emplo aeeslin thr e coursr e of he r empintl ment example:employeerier co
+ } } } Y ICY
transporter-usually a van type vehicle or passenger car):or
L L____a____.I.
W ,Io„�N„ `" for direct compensation(example:largevan used forspecificr
} } } 4. Isuss or designatedto transport between andpassengers,including driver.
mpe n(ex mple� � purpose):o
i r )� •OD
L____a_ i 5. Is any vehicle used to transport anyhazardous material(HAZMA that requires
rn
placarding(example:placards will be displayed on the vehicle). ;p
1 I* : I• I-- --I-
CARRIER NAME Z
ADDRESS 'n
I
Not To Scale [ CITY/STATE/ZIP n
MOTOR CARR.ID 0 Interstate 0 Intrastate
I r ❑ Not in Comm./Govt. 0 Not in Comm./Other
----------1 - USDOT NO. ILCC NO. m
XI
Source of above z
0 Yes II No ❑ Unknown A
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
Black Black
u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_
DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT' 0 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/T6
DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE