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HomeMy WebLinkAbout2026-00019259 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets Mill III H IIII DIII UU 11 HUH1111111111 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY *X0041978,04* u, 1 U21 1 1 1 U1 7 U2 1 U, 1 1_12 1 U, 1 U2 1 1 11 U1 1 U2 1 *P 0 1 1 9* 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 1215501-$1.500 ®ON SCENE 3 VEHICLE/PROPERTY ❑OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash 0 AMENDED YR 202612026-00019259 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 :1 RT20 WB Elgin 04:00 ® ❑ RELATED ❑Y ®N 04 08 2026 12,— ❑YES ®NO U1 '‹ g PRIVATE mo /day/yr ®PM FLOW CONDITION m FT!MI N E S W ILLINOIS EXIT RAMP COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR NI SLOW 2 fA ❑ Cook HIT&RUN ❑V ® N WITH VEHICLES INVLD ❑ STOPPED U2 --I ® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ❑ FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uuv 0!CV ❑Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 n 0 6 / yr 13-UNDER CARRIAGE ©,I ©::0 FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0U2 2 m F 2 4 SYTM❑Y EIS NE ❑UNK VEH. O AT CRASH 0 15-99-UNKNOWN THER9 16•TOP 3 *Distraction Value 5 ALGN X. r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s iL 6 I,.4 COM VEH 0 g! 1 0 ~ Streamwood I L 60107 0 1 0 FIRST CONTACT 12 7_: __5 *ItYes.See Sidebar U1 Z FY97780 IL 2026 REAR TELEPHONE IL D 0 1 G1 PC5SH2C7384535 None ❑v ❑N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Elgin Fire 99 9 Lucena Gallardo. Mariangel.G. None 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER RESPONDER 2 m N DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEOAL 0 EWES 0 iiuv 0 Ncv ❑ CIRCLE NUMBER(S) U1 Dv 0 0 7 Other Other 2008 00-NONE 1("j 12-- , DUE TO CRASH ❑ 2 x o - 13-UNDER CARRIAGE 10;i c. 2 FIRE ❑ ® U2 C c M 2 4SYSTEM IN 0 ENGAGED 0 ®-OTHER 9 16-TOP 3 0 0 Y ®N 0 UNK VEH. AT CRASH 99-UNKNOWN II II *Distraction Value N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POEH FIRSNT OF T CONTACT 15 Y ��L 5 C•IO es/See Sidecar❑ ® U1CO C — Bolingbrook IL 60490 0 1 0 185117H IL 2026 aR 0 Si) IL A 7 1 HTMMAAL38H568196 Travelers Insurance ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X Elgin Fire 99 9 DVBC INC A318082A810 BAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP U1 = (UNIT) (SEAT) (DOBi (SEX) {SAFT) (AIR) (WI 1(EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)/(A.DDRESS)/(TELEPHONE) (EMS) (HOSPITAL) 1 6 02 / / / UI 3 D:A / / 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 /12 /26 04 11 ®AM in a Work Zone? ®N DIRP co 1 t PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 7 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 C) bu 2 0 03 41 41 /12 /26 04 11 ®PM ❑Construction E R 3 ❑ xi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 7 z J ❑AM ❑Maintenance U2 o 1 ® 11 1 ARREST NAME Stewart. Ronaja.A. 11-601-Ax 1512663 41 /12 /26 04 22 Igi PM• ❑Utility SLMT )$!CITATIONS ISSUED 0 PENDING SECTION CITATION NO. ROAD CLEARANCE TIME S' N 0 AM 45 t 2 ❑ ARREST NAME Stewart. Ronaja.A. 3-707 1512664 41 /12 /26 04 30 0 PM 0 Unknown work zone type U1 n 7 OFFICER ID SIGNATURE BEAT!DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 0 1512-Juarez-Huichapan.Juan 400 337-Thompson 51 / 12 /26 01 30 ®PM AM Workers present? ®N U2 45 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 truckrtrailer -< ` ` --I -' r INDICATE NORTH combination):or .Z-1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C } - } r r ,. (example:shuttle or charter bus):or co 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier 0 4-7 0I- <.__-A-.-.� C,', , } } } transport) em to ees In the course of their em i. `.___A \ ' Not To Scale �..r } } } •transporter. sed or des gnated to transport between 9 and 15�passengers,el including the driver. C ROr te.2O ) for direct compensation(example:large van used fors specific purose):or L L___-a..... t i 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m 1 �® placarding(example:placards will be displayed on the vehicle). D un_ C - -- —I CARRIER NAME Z ADDRESS 0 w C) CITY/STATE/ZIP g MOTOR CARR.ID 0 Interstate 0 Intrastate 0 I r ❑ Not in Comm./Govt. 0 Not in Comm./Other ; _Y_._-1 - USDOT NO. ILCC NO. m XI Source of above z . • m 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 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 White White u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT 3 TOWED BY/TO. _Adieu/Impound Lot Garage SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/T6 DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE