HomeMy WebLinkAbout2026-00020220 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 Df 4 Sheets 01111101111 0110111111 111111
DRAG TRFD TRFC WEAT DRVA VIS VEHD LGHT COLL MANY X0042071 58
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INVESTIGATING AGENCY DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT El A No Injury 1 Drive Away
AGENCY CRASH REPORT NO. TRFW '
Elgin Police Department ONE PERSON'S ®5501-$1.500 ®ON SCENE 1
VEHICLE/PROPERTY ❑OVER$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and f or Tow Due To Crash
El AMENDED
YR 2026I 2026-00020220 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 2 m169 RT20 WB Elgin 09:55
® ❑ RELATED ❑Y ®N 04 12 2026 DAM ❑YES ®NO U1 -<
_ _ PRIVATE mo !day!yr ®PM FLOW CONDITION m
COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 1 (n
❑ FT/MI NESW Kane HIT&RUN ❑Y ® N WITH VEHICLESOT,
INVLD ❑ STOPPED U2 --I
❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0
Q83 DRIVER 0 PARKED 0 DRIVERLESS ❑ PED 0 PEDAL ❑EWES 0 WIN ❑ncv 0 DJ DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 n
4T TOWED U1
NAME(LAST,FIRST,M) mo yr
JIMENEZ BARRON.YATZARY Dodge Ram 1500(pickup) 2022 00-NONE •
13-UNDER CARRIAGE 0 O2 0 DUE TOCRASH ® ❑
I ; FIRE ❑ al
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 10 O DISTRACTED 0 0 U2 2 m
F 2 4 ❑Y ®N SYSTEM
❑UNK VEH. AT CRASHD 99-UNKNOWN 9 16•TOP 3 ,Distraction Value ALGN 2
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF S, it S 4 COM VEH 0 Ea 1 n
F. FIRST CONTACT 12 7 _ _,__5 *Yves.See Sidebar U10
Z HANOVER PARK IL 60133 0 1 0 4164094B IL 2026 " ' E
TELEPHONE
IL D 1C6RRFFG1NN235979 TOM KEMPER INSURANCE ❑Y ®N U2 • m
in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR
JIMENEZ MARTINEZ. PEDRO 12RA000079825 2 m
`o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER •
RESPONDER
2 X
x DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 l My 0 Ncv 0 Dv
8 Honda Accord 2004 00-NONE 11 11 :-y DUE TO CRASH 0 ® U2 2 73
C
o 13-UNDER CARRIAGE `III
M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER •
911,6•TOP 3 X
❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN O `Distraction Value 0
POINT OF s-.;,•
�i 4 COM VEH D ® U1 CO N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT 5
FIRST CONTACT 2 7_ _, _5 •(ryes,See SidebarC
1= ELGIN IL 60123 0 1 0 FJ34571 IL 2026 REAR 0
Z •
IL D 1 HGCM66524A017553 STATE FARM ❑Y ®N RDEF XI
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 =
Same 2096010-SFP-13 BAC
• $
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 <
Refused RESPONDER
U1 =
(UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)1(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
N 1 ® 24 1 City of Elgin guardrail and pole damage 04,12 ,2026 09 55 ®AM in a Work Zone? ®N DIRP co
I I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 7
T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 C)
2 ❑ 1 3 151 DOUGLAS AVE ELGIN IL 60120 28 11 04,12 ,2026 09 57 PM •
® • ❑Construction *
ry O ❑ 30 3 0 CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 7
3 M
ARREST NAME 04,12/2026 10 04 ®PM ❑Maintenance U2
N
1 El 30 1 UtilitySLMT
0CITATIONS ISSUED PENDING
o SECTION CITATION NO. ROAD CLEARANCE TIME El
T 2 ❑ ARREST NAME 04 r 12 12026 11 49 ®PM ❑Unknown work zone type U1 0 AM
45
n 7 OFFICER ID SIGNATURE BEAT!DIST. SUPERVISOR ID. COURT DATE TIME
2 2 3 ❑ ❑AM Workers present? ❑Y 45
1517-Le Cates. Brittany 401 302-Snow , ❑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
A 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer -<
i- }--__r-_--; ( INDICATE NORTH combination):or -I
N p1
BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C
- } (example:shuttle or charter bus):or
X
L A r vae�arma�ti } } 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
L L.___a____� 4. Is used ordesi natedtotrans rtbetween9and15 passengers,including C
} } for direct compensation(example:large van used for specificpurpose):or [he driver,
Pe ( P 9 Pe or O
bearrrreo,Main
L L____a____.i urarz_ -MIL _ • ,_ �,2- _ _ _ i 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m
_ _ _A.
j (tf��� placarding(example:placards will be displayed on the vehicle).
''. CARRIER NAME Z
ADDRESS 0
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NOf TO Scale CITY/STATE/ZIP n
g
MOTOR CARR.ID 0 Interstate 0 Intrastate
I I T I ❑ Not in Comm./Govt. 0 Not in Comm./Other
-"-------4 USDOT NO. ILCC NO. m
XI
Source of above z
. Form Number
m
Xl
IDOT PERMIT NO. WIDELOAD'; 0 Yes 0 No 2
TRAILER VIN 1 m
co
LOCAL USE ONLY TRAILER VIN 2 m
a
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 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/Impound Lot Garage . SELECT CODES FROM THE BACK OF CRASH BOOKLET
U 2 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY/TO:
DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE