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HomeMy WebLinkAbout2026-00021931 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 01111101111 I0110 1111111111111111010000 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X004204710 u, 1 U21 3 4 1 U116 U2 1 U, 1 u2 1 U, 1 U2 1 1 13 u1 1 u2 1 *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 2 VEHICLE/PROPERTY ®OVER 31,500 El NOT ON SCENE(DESK REPORT) ® B Injury and f or Tow Due To Crash 0 AMENDED YR 2026I 2026-00021931 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 mROUTE 20 HWY Elgin ® ❑ RELATED ❑Y ®N 04 20 2026 ®AM ❑YES IX]NO U1 -< PRIVATE mo /day/yr 10:10 ❑PM FLOW CONDITION m �10 ®!MI N OE S W Kesler Rd COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR SLOW 2 fA Kane HIT&RUN ❑V ® N WITH VEHICLESOT, INVLD DOSTOPPED U2 --I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EWES 0 NOV 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 3 n 0Jerome.So hia. F. Ford Expedition 2016 00-NONE 12 , DUE TO CRASH ® ❑ NAME(LAST,FIRST,M) p mo yr 13-UNDER CARRIAGE ©,I ! 2 �. FIRE ❑ al STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL O4-TOTAL(ALL) 10DISTRACTED ® 0 U2 3 M F 2 4 ❑Y SYSTEM IN ENGAGED 15-OTHER 9 16.TOP 3 5ALGN =El N ❑UNK VEH. AT CRASH 99-UNKNOWN `Distraction Value r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s it a �i 4 COM VEH 0 El 1 0 ELGIN IL 60123 0 1 0 FIRST CONTACT 11 7_; -__S *IIYes.See Sidebar U1 Z DJ99078 IL 2027 REAR TELEPHONE IL D 1 FMJ K1 HTSG EF23669 State Farm ❑Y ®N U2 m 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Jerome.Jerry. D. 2400861 SFP13 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER RESPONDER > Refused ❑Y ® N 2 73 m g DRIVER ❑ PARKED 0 DRIVERLESS 0 FED 0 PEDAL 0 EWES 0 NMv 0 NCV 0 DV CIRCLE NUMBER(S) U1 $ 1 9 9 9 FR Chevrolet CIK 3500 2009 00-NONE 11_"j t2..-_, DUE TO CRASH ❑ ! l 24 ,'a 0 AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED M 2 4 ❑Y SYSTEM IN ENGAGED ®-OTHER 9,16-TOP 3 0 X ❑N ❑UNK VEH. AT CRASH 99-UNKNOWN *Oistraglon Value N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8 -iI�.,.4 COM VEH ❑ ® U1 W FIRST CONTACT 15 Y A .5 •If Yes.See Sidebar REAR- 0 C Z Carpentersville IL 60110 0 1 0 198731 F IL 2026fp D IL D 1GBJC74K29E121018 State Farm ❑Y J N RDEF 7) EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Ceja. Esmeralda J962416A1313 SAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP U1 = KNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)/(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL) U2 996 r m ##occs y / ,, U1 1 m 1 0 EV MOST EVNT DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 11 1 Ceja. Esmeralda Hual-About 16 ft.trailer 04/20 ,2026 10 10 ®❑AM in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 3 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 � 2 0 1611 SACRAMENTO DR Carpentersville 60110 41 20 , , PM ❑ • ❑Construction * R 3 ❑ $I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 7 ❑AM 0 Maintenance U2 oER 11 1 ARREST NAME Jerome.Sophia. F. 12-610.2-B 298001375W / ! ❑PM SLMT o N 0 CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • 0 Utility 50 r 2 ARREST NAME AM 7 1 r ❑❑PM 0 Unknown work zone type U1 El n OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 ❑ ❑AM Workers present? ❑Y 50 298-Lopez, Mirko 901 331-Ziegler , , ❑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 INDICATE NORTH combination):or -I - BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C N - } (example:shuttle or charter bus):or 0 X • 3. Is designed to carry15 or fewer passengers and operated a contract carrier O - <_-------- i ` } } } transporting employee In the coursee of their employment(example:employee X �' transporter-usually a van type vehicle or passenger car):or c 4. Is used or desi nated to trans rt between 9 and 15 ge ng rCjt } } for direct com nation exam I lar a van used for s �cifice ur o ):or [he driver, Co �► Pe ( P 9 Pe P Pose):or O L i.____a____j • I =MI _ i. i t 5. Is any vehicle used to transport anyhazardous material(HAZMAT)that requires Not To Scale placardingXI - _ (example:placards will be isplayed on the vehicle). XI w.n.rrrra. D CARRIER NAME . 1 Z ADDRESS0 w f CITY/STATE/ZIP 0 g - i. MOTOR CARR.ID 0 Interstate 0 Intrastate I I T I ❑ Not in Comm./Govt. 0 Not in Comm./Other ----- --1 - USDOT NO. ILCC NO. rn XI Source of above z . IDOT PERMIT NO. WIDELOAD-; ❑Yes 0 No = TRAILER VIN 1 m co LOCAL USE ONLY TRAILER VIN 2 m 0 TRAILER WIDTH(S) 0-96" 97-102" >102' T TRAILER 1 ❑ ❑ 0 Z TRAILER 2 ❑ 0 0 O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. Z Red White u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ® DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT 3 TOWED BY/TO: _Redmons . SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE