HomeMy WebLinkAbout2026-00017980 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 1111 III 11 IIIIII UH U II IlU Ifl IIIUllIU
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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 El5501-51.500 ®ON SCENE 14
VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and f or Tow Due To Crash
El AMENDED
YR 2026I 2026-00017980 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n
® ❑ RELATED ®Y 0 N 04 02 2026 ❑AM ❑YES ®NO U1
CAPITAL ST Elgin03:37
_ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION m
FT!MI N E S W ALFT LN COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 1 cn
❑ Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD ❑ STOPPED U2 —I
IgI AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0
Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EWES 0 MAV 0!CV ❑DJ DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0
0
FOR DAMAGEDAREA(S) FROf'tf TOWED U1 Q
MENDEZARANDA. EMMANUEL. B. 1 1 /
yr 13-UNDER CARRIAGE l ! FIRE ❑
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 10 O DISTRACTED 0 0U2 O m
M 2 4 El ®SNE❑ 15-OTHER
UNK VEH. O ATCRASHD O 99-UNKNOWN 9 16•TOP® *Distraction Value ALGN 2
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s_iL B ii,4 COM VEH 0 El 1 0
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ELGIN IL 60123 0 1 0 FIRST CONTACT 1 7_; __5 *llves.SeeSidebar Ut
Z X220713 IL 2026 REAR
TELEPHONE
IL D 0 1ZVBP8AM7E5333131 STATE FARM ❑Y ®N U2 r'I R
in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR
Same 1189843-SFP-13 2 m
`o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER
RESPONDER >
Refused 0 Y El 2 0
x DRIVER ❑ PARKED ❑DRIVERLESS ❑ FED ❑PEDAL ❑EWES O new 0 Ixv ❑Dv
!2 0 0 1 NT Honda CIVIC 2014 Do-NONE 0,' Qj 0DUE TO CRASH rg ❑ 2 73
Yr 13-UNDER CARRIAGE I FIRE ❑ El U2
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M 2 4SYSTEM IN 0 ENGAGED 0 15-OTHER 9,1,6-TOP 3 X
0 Y NJ 0 UNK VEH. AT CRASH 99-UNKNOWN *Distraction Value 0
POINT OF s i1 I 4 COM VEH ❑ ® U1 CO
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR FIRST CONTACT 12 . 6:- •IfYes.See Sidebar
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n CHICAGO IL 60638 0 1 0 FM99507 IL 2026 REAR Z
IL D 0 2HGFG3B58EH511136 GEICO ❑Y ®N RDEF X
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 10 =
Elgin Fire Same 6239-40-35-27 BAC E
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 <
Sherman RESPONDER
u1 =
(UNIT) (SEAT) (008) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME),(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL)
1 0
EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z
u 1 ® 11 1 41 ,12 !26 03 37 ®AM in a Work Zone? ®N DIRP co
1 t PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 5
T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 C)
2 0 11 23 41 ,12 ,26 03 43 ®PM ❑Construction *
4
<w 3 0 ]$I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EI/S ARRIVED TIME 3
❑AM ❑Maintenance U2
-a, ARREST NAME M EN DEZ ARAN DA. EMMANUEL. B. 11-1204-B S1519-000516 41 ,12 !26 03 50 ®PM SLMT
1 ER 1 0 • Utility
oNSECTION CITATION NO. ROAD CLEARANCE TIME ❑CITATIONS ISSUED PENDING
t 2 0 ARREST NAME 41 ,12 126 04 45 ®PM El Unknown work zone type U1 30 0 AM
2 2 3 IDOFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 30
1519-Bae2 a.Guadalupe 901 337-Thompson 51 , 12 ,26 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 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 3. Is designed to carry15 or fewer passengers and operated a contract carrier O
I- <.__-A-.-.� IL y } } transportingemployees in the course of their employment(example:employee
I •—••- transporter-usually a van type vehicle or passenger car):or C
L L.___------ �"*"rD 4. Is used ordesi natedtotrans transport passengers,including N
, - } } } g Po ssen rs,indudi the driver,
for direct compensation(example:large van used for specific purpose):or
L L--_-a-....: E - t i i i. 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires III
1 placarding(example:placards will be displayed on the vehicle). MI
I '1
I CARRIER NAME Z
ADDRESS 0
IcAVITALWeT CD/)
I o
CITY/STATE/ZIP g
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
. —I
Were HAZMAT placards on vehicle? 0 Yes 0 No =
If Yes,Name on placard O
4 digit UN NO. 1 digit Hazard class No. Xl
Xl
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
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
Blue Red
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: 3 TOWED BY/TO:
DUE TO ® DISABLING DAMAGE Redmons/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE