HomeMy WebLinkAbout2026-00017128 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111
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DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X004207083
u, 1 U2 1 1 1 U1 6 U2 U, 1 1_12 U, 1 U2 1 1 9 U1 1 U221 *P 0119*
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 El$501-$1.500 ®ON SCENE 2
VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) 0 B Injury and f or Tow Due To Crash
0 AMENDED YR 202612026-00017128 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n
N COMMONWEALTH AVE El 09:16
® ❑ RELATED ❑Y ®N 03 29 2026 ®AM ❑YES ®NO U1
_ _ g PRIVATE mo !day,yr ❑PM FLOW CONDITION m
FT!MI N E S W MILL ST COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR IR SLOW 1 (n
❑ Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD 0 STOPPED U2 —I
® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST IR N ❑ FREE FLOW # LNS 0
Qg3 DRIVER O PARKED O DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NW/ 0 ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 0
0 7 /
yr
Sanchez Chavez. Manuel. R. Toyota Corolla 2008 00-NONE 11. (0. DUE TO CRASH ® ❑
13-UNDER CARRIAGE FIRE ❑
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 10 0
DISTRACTED ® 0 U2 2 m
M 2 SYTM IN ENGAGETHER
5 ❑Y ®SNE El LINK VEH. O AT CRASH O 99-U15-UNKNOWN 9 16-TOP® ,Distraction Value 2 ALGN =
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6_i[6 4 COM VEH 0 El 1 0
~ ELGIN N I L 60120 B 1 0 FIRST CONTACT 2 7_;-R--s *Ilves.See Sidebar U1
iVi Z FQ47519 IL 2026
7 TELEPHONE
IL D 2T1 BR32E48C861045 State Farm El ®N U2 m
.0 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
Same 3632281 SFP 13 1 r
o HOSPITAL(TAKEN TO) INCIDENT IF'' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER •
RESPONDER D
Refused ElY ❑ N 1 2 c
p DRIVER X. PARKED 0 DRIVERLESS 0 FED 0 PEDAL 0 EWES 0 Iluy 0 i v 0 Dv
yr ,tl 12 � ❑ 2
oII _ 13-UNDER CARRIAGE 10;1 c. 2 FIRE ID El U2
U2
SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ❑ ® SPDR C)
CT_ SYSTEM IN 0 ENGAGED 0 15-OTHER 9..16-TOP 3
❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN *Distraction Value g 9
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 0.:14 COM VEH ❑ ® Hi CO
F,,, FIRST CONTACT 7 O7 '�-!�1 L.
*UYes.See Sidebar
EW81079 IL 2026 l aR 0
M . STATE CLASS CDL ID VIN • INSURANCE CO. EXPIRED •U2
0
5XXGR4A62EG285398 Allstate ❑Y ®N RDEF71
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER 1 =
Novelli. Michael.A. 811880598 BAc $
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP
U1 =
iUNITI (SEAT) (008) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)!{ADDRESS)/(TELEPHONE) (EMS) (HOSPITAL)
0
EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z
N 1 ® 18 1 03,29 ,2026 09 16 ®❑PM in a Work Zone? ®N DIRP co
1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 1
T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 -,
0 2 ❑ 41 05 , , ❑PM ❑Construction >E
N •
3 ❑ Dyg CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 1
❑AM ❑Maintenance U2
o1 ® 11 1 ARREST NAME Sanchez Chavez. Manuel. R. 12-610.2-B 1574000028 , r El PM SLMT
o N ISI CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ❑Utility
AM 30
t 2 ElARREST NAME Sanchez Chavez. Manuel. R. 11-708 1574000029 , , DI PM ❑Unknown work zone type U1
2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 30
1574-Rosales.Alexander 601 04 ,21 ,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
L ADDITIONALUNITSFORMS.A CMV is defined as any motorvehicleusedtotransportpassengersorproperty and: Zr N I1. Hasa rg ore than pound { a p .truck or truck/trailer
' 1. Has a weight ratio m 10 000 5 ex m leNDICATE NORTHtion)o 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 0l- I- -J.-•--; transporting employeesned to Inthe course passengers5 or fewer thir emplod yment example:employee
transporter} } }
6 ansporter-usually a van type vehicle or passenger car):or CO
L 4. Is used or designated to transport between 9 and 15 passengers,including w
--- ----; - } } g Po passen rs,includi the driver,
ifor direct compensation(example:large van used for specific purpose):or O
L L____a____.l l. i i i t 5. Is any m
vehicle used to transport anyhazardous material(HAZMAT)that requires m
MillaISt.
placarding(example:placards will be displayed on the vehicle). ;p
—1
— — — — — — CARRIER NAME Z
ADDRESS 0
w
CITY/STATE/ZIP g
MOTOR CARR.ID 0 Interstate 0 Intrastate
0
I . ❑ Not in Comm./Govt. 0 Not in Comm./Other
USDOT NO. ILCC NO. m
Not To Scale _ XI
Source of above z
. ❑ Yes 0 No 0 Unknown g
D
Did Carrier Safety Regulations MCS)violation contribute to the crash? A
❑ Yes No ❑ 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'; 0 Yes 0 No 2
TRAILER VIN 1 m
to
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
Gray 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 DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY/TO:
DUE TO ® Redmons/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE