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HomeMy WebLinkAbout2026-00018261 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 6 Sheets III III 11 IIII UH UU I IlU lIMMO 11 III DDUOO DRAG TRFD TRFC WEAT DRVA VIS VEHD LGHT COLL MANV X004195a06- u, 1 U21 3 4 8 U116 U2 1 U, 1 1_12 1 U, 1 U2 1 5 11 U1 1 U211 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY ❑5500 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 14 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash El AMENDED YR 202612026-00018261 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 rn ® ❑ RELATED ®Y 0 N 04 03 2026 DAM YES ®NO U1 -< CENTER ST Elgin 08:31 _ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION M FT!MI N E S W E CHICAGO ST COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 15 ❑ Kane HIT&RUN ❑V ® N WITH VEHICLES INVLD DO U2 —I lgi AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N 51 FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 MUSS 0 NIAV 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 0 T TOWED U1 0Diaz-Gomez. Enrique Hyundai Elantra 2014 00-NONE 2 0 DUE TO CRASH ® ❑ NAME(LAST,FIRST,M) q mo yr 13-UNDER CARRIAGE ©, :: STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 FIRE ❑ 4 rn M 2 SYTM IN ENGAGE15-OTHER 8 ❑Y ®SNE❑UNK VEH. O ATCRASHD O 99-UNKNOWN 9 16•TOP 3 `Distraction Value ALGN = r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s i�S 4 COM VEH 0 j$J 1 0 ~ ELGIN I L 60120 C 1 0 FIRST CONTACT 12 7_: __5 *lives.See Sidebar U1 Zet78008 IL 2026 REAR TELEPHONE IL D 5NPDH4AE9EH468637 unknown ❑Y ❑N U2 M in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Elgin Fire Vasquez Vasquez. Ronal. F. unknown 1 `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER r RESPONDER 2 eu m �{ DRIVER ❑ PARKED ❑DRIVERLESS ❑ FED ❑PEDAL 0 EWES ❑MAV 0 NCv ❑Dv /1 9 yf 2 Nissan Rogue 2020' 00-NONE 'o,1 t2 (,�2 FIRE DUE OCRASH 0 ® U2 2 C o - 13-UNDER CARRIAGE c F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9..16-TOP 3 X ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN *Oistraelion Value 0 POINT OF S i 4 COM VEH ❑ ® U1 W N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR 5 FIRST CONTACT 6 O7 ,�_Q-4OS •)ryes See Sidebar C Belvidere IL 61008 C 1 0 JJC6477 NC 2026 I AR 0 fp IL D 0 5N1AT2MT5LC721375 USAA ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X Elgin Fire Hernandez.America 055162020E BAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP 996 < Sherman RESPONDER U1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)/(ADDRESS)/(TELEPHONE) (EMS) (HOSPITAL) U2 m ##OCCS > 71 / / U1 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 1 41 //2 /26 08 31 ®AM in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 5 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 C) Eri 2 0 28 19 4/ //2 /26 08 32 ®PM 0 Construction * <w 3 0 ]$I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 5 J ❑AM ❑Maintenance U2 o1 ® 11 1 ARREST NAME Diaz-Gomez. Enrique 11-601-Ax 748558 4/ //2 /26 08 36 Igi• PM• El Utility SLMT I$[CITATIONS ISSUED 0 PENDING SECTION CITATION NO. ROAD CLEARANCE TIME p N AM 30 t 2 ElARREST NAME Diaz-Gomez. Enrique 3-707 748560 41 1 12 /26 09 15 ®PM 0 Unknown work zone type U1 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 30 482-Flentye.Jeremy 1o1 4/ , 9/ /026 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 -< c r -' -, I I r INDICATE NORTHB combination):or �+ C ARROW 2 Is used or designed to transport more than 15 passengers including the driver u - } ,r (example:shuttle or charter bus):or 0 Y A I * 3. Is designed to carry 15 or fewer passengers and operated a contract carrier } } } transporting employees in the course of their employment(example:employee ?i transporter-usually a van type vehicle or passenger car):or w L 4. Is used or designated to transport between 9 and 15 passengers,including N }-----}----; , ! - } } } g po passen rs,includi the driver, ins for direct compensation(example:large van used for specific purpose):or O L E, O81 L i. i. _ 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m placarding(example:placards will be displayed on the vehicle). ;p CARRIER NAME Z I I ' L ADDRESS O ADDR cn T.Not To Scale I CITY/STATE/ZIP MOTOR CARR.ID 0 Interstate 0 Intrastate 0 I I T I ❑ Not in Comm./Govt. 0 Not in Comm./Other ----- ----1 - USDOT NO. ILCC NO. rn Source of above Z . ❑ Yes I 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 VIM 1 m co LOCAL USE ONLY TRAILER VIN 2 m v TRAILER WIDTH(S) 0-96" 97-102" >102' m TRAILER 1 0 0 0 Z 1-1 TRAILER 2 ❑ 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 3 TOWED BY/TO. Redmons/Impound Lot Garage . SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DAMAGE EXTENT: 2 TOWED BY/TO: DUE TO ® DISABLING DAMAGE Redmons/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE