HomeMy WebLinkAbout2026-00019990 ILLINOIS TRAFFIC CRASH REPORT sheet 1 of 2 Sheets II III H IIIIII UH UU I IlU IflfHH 11111111111
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INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW '
DAMAGE TO ANY ❑$500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away
Elgin Police Department ONE PERSON'S ❑$501-$1.500 ®ON SCENE 1
VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash
0 AMENDED YR 202612026-00019990 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n
® ❑ RELATED ❑Y ®N 04 11 2026 ❑AM YES ®NO U1 -<
PRESTON AVE Elgin 10:33
_ g PRIVATE mo /day/yr ®PM FLOW CONDITION ITl
0 /MI N E S W Page Ave COUNTY PROPERTY ❑Y ® N DOORING ❑Y #OF MOTOR 0 SLOW 1 (n
® 0 g 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
gi DRIVER p PARKED El DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NUV 0 icy CI Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 n
r'1T�TOWED U1 Q
NAME(LAST,FIRST,M) Ramirez. Flavio. R. mo Ford F150 2017 00-NONE
13-UNDER CARRIAGE 11_' Q •17.�:/1 DUE TO CRASH ® ❑ E
) FIRE ❑
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STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 10 O DISTRACTED 0 0 U2 2 rn
M 9 4 SYTM❑Y ®SNEDUNK VEH. O ATCRASHD 0 15-99-UUNKNOWN THER9 OP 3 `Distraction Value ALGN X.
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6_iL 6 ii,4 COM VEH 0 18! 1 0
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ELGIN I L 60120 0 9 0 FIRST CONTACT 1 7_; __5 *II Yes.See Sidebar Ut
Z2275894B IL 2025 REAR
TELEPHONE
IL D 0 1 FTEW1 CPXH FC83325 Unknown ❑Y 0 N U2 m
in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
Same Unknown 1 r
5HOSPITAL(TAKEN TO) INCIDENT IF IC OWNER STREET,CITY,STATE,ZIP PHONE NUMBER
•
r RESPONDERN
5, CI DRIVER I} PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 iiuy 0 Ncv 0 DV
yr Chevrolet Suburban 2014 00-NONE 'o,� t2 (,-2 FIRE DUE D CRASH ® U2 2 C
o ,, - 13-UNDER CARRIAGE
c SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED
a SYSTEM IN 0 ENGAGED 0 15-OTHER 9.1,6•TOP3 0 ® SPDR n
❑Y ®N DUNK VEH. AT CRASH 99-UNKNOWN *Oistraglon Value 0 -
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 0.:
(�� 4 COM VEH ❑ ® titW
11* FIRST CONTACT 7 CI,' '�-5 *IfYes.See Sidebar
FG52429 IL 2aR 0 N
M . STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED •
U2 0
1 GNSKKE79ER108258 None ❑Y ❑N RDEF71
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 =
Aguirre. Francisco.J. N/A SAC E
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP
U1 =
(UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)((A.DDRESS)(!TELEPHONE) • (EMS) (HOSPITAL)
1 3 03 / M 9 4 0 1 0
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/ / #OCCS D
/ / UI 2 D
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EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z
N 1 ® 18 1 04,11 /2026 10 33 ®pm 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
0
2 0 28 99 / / ❑PM- ❑Construction
Z 3 ❑ xi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EN45ARRIVED TIME 1
❑AM 0 Maintenance U2
o 1 ® 11 1 ARREST NAME Ramirez. Flavio. R. 6-303-A 1547000195 / / ❑PM SLMT
igi CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • 0 Utility
o N 0 AM 30
T 2 El ARREST NAME Ramirez. Flavio. R. 11-402-A 1547000192 / / pM ❑Unknown work zone type U1
2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 30
1547-Steele.Justin 201 05 /04/2026 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
A0ratingmore than pound (example:truck or truckrtrarler -<1. Has a weight 10 000 5
i- ----_r_-_-; _ I. combination):or _,
I
A Not To Scale INDICATE NORTH p0
BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C
I_ I-_ � - } (example:shuttle or charter bus):or 0
L A ` ' 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I O
} } } transporting employees in the course of their employment(example:employee X
transporter-usually a van type vehicle or passenger car):or w
C
I. I..___a__._.1 4. Is used ordesi natedtotrans rtbetween9and15 passengers,including (I)
} } for direct compensation(example:large van used for specificpurpose):or [he driver,
Pe ( P 9 Pe or O
L i r t 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
9207Prearon4Ave - --:' -I
CARRIER NAME Z
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0I1 fn .1 ADDRESS
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:' 0
I CITY/STATE/ZIP g
_ MOTOR CARR.ID 0 Interstate 0 Intrastate
a, , O
r ; r.�' ❑ Not in Comm./Govt. 0 Not in Comm./Other
I. --- --4. - 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 M
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 0 0 Z
TRAILER 2 ❑ 0 0 O
u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w
Tan Black
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 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 3 TOWED BYlT6
DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE