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HomeMy WebLinkAbout2026-00021796 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 10110 ll III Ili 101100 111 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY XO04211941 u, 9 U21 1 1 1 U110 U2 1 U199 U2 1 U,99 U2 1 1 12 u, 1 U2 1 *P 0119* INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW ' DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT El No Injury 1 Drive Away Elgin Police Department ONE PERSON'S ®5501-$1.500 ®ON SCENE 1 VEHICLE/PROPERTY ❑OVER$1,500 ❑NOT ON SCENE(DESK REPORT) 0 AMENDED ❑ B Injury and/or Tow Due To Crash YR 202612026-00021796 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 99 71 ® ❑ RELATED PRIVATE ❑Y ®N 04 19 2026 DAM ❑YES ®NO U1 -< RT20 WB Elgin mo /day/yr 03:02 ®PM FLOW CONDITION M_ E050 ®!MI N E s © South Mclean Blvd COUNTY PROPERTY ElY ® N DOORING Ely #OF MOTOR 0 SLOW 1 (n Kane HIT&RUN ®Y ❑ N WITH VEHICLES INVLD 0 STOPPED U2 --I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 �i DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uuv 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 C) / / FOR DAMAGEDAREA(S) FROPtf TOWED U1 O Unknown.O. Honda Accord 2008 00-NONE „ 12 , DUE TOCRASH ❑ EN NAME(LAST,FIRST,M) mo yr 13-UNDER CARRIAGE 10 IE 1 ! 2 FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED U2 2 < IN O ENGAGED 0 15-OTHER 9 16-TOP 3 ❑ ' _ ❑Y El ❑UNK VEH. AT CRASH ®-UNKNOWN `Distraction Value 9 ALGN r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6_iL 6 4 COM VEH 0 j$J 1 0 H 0 9 0 FIRST CONTACT 99 7_• __5 *IIYes.SeeSidebar U1 ZFM95310 IL 2026 REAR TELEPHONE . STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED 1 1 HGCP26408A063167 UNK ❑Y ®N U2 m 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Vasquez Sorto. Diego. F. UNK 1 rn `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y ® N 99 0 x DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 iiuv 0 KCV 0 DV /2 O 0 1 BMW 325 2016 00-NONE „ " 12 "_, DUE TO CRASH 0 2 73 o Yr - 13-UNDER CARRIAGE FIRE ❑ ® U2 Ti M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 016-TOP 3 X ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN *Distraction value g g N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF O I i, 4 COM VEH ❑ ® U1 CO FIRST CONTACT 7 Q j_, _s •If Yes.See Sidebar C ELGIN IL 60120 0 1 0 EZ27164 IL 2027 REAR Si)0 IL D 0 WBA1J9C54GV696448 Magnum ❑Y ®N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Same 12249387600 BAc E 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)((ADDRESS)/(TELEPHONE) (EMS) (HOSPITAL) 2 3 07 / DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 11 9 04/22 /2026 03 02 ®AM in a Work Zone? ®N DIRP co 1 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 ❑ 04 28 N 3 ❑ 0 CITATIONS ISSUED 0 PENDING + / 0 PM- El Construction SECTION CITATION NO. EMS ARRIVED TIME ❑AM 0 Maintenance U2 7 -a ARREST NAME / / El PM ' 1 21 1 1 1 ❑CITATIONS ISSUED ❑PENDING • UtilitySLMT , o N SECTION CITATION NO. ROAD CLEARANCE TIME El 0 AM r 2 0 ARREST NAME 04/22 /2026 03 02 ®PM ElUnknown work zone type U1 55 n T OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 0 ❑AM Workers present? ❑Y 55 1526-Walsh.Jacob 702 337-Thompson / ❑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:C. Z 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer - c ` --I -' s7Meimn7e1b I - ( INDICATE NORTH combination):or —I I BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C - } (example:shuttle or charter bus):or L A I 3. Is designed to carry 15 or fewer passengers and operated a contract carrier O I - . I- . transporting employees in the course of their employment(example:employee X transporter-usually a van type vehicle or passenger car):or w L •:. .}----.l. WTRt p� } } 1 •4. Is used or designated to transport between 9 and 15 passengers,including the driver. (I) i 2 for direct compensation(example:large van used for specific purpose):or O L L____a____.I 1 <i<... - _ L i i _ 5. Is any vehicle used to transport an hazardous material(HAZMAT)that requires Y placarding(example:placards will be displayed on the vehicle). —I • CARRIER NAME Z E87Rt940 ADDRESS 0 o I I CITY/STATE/ZIP g I - MOTOR CARR.ID 0 Interstate 0 Intrastate I I T I I I 0 Not in Comm./Govt. Not in Comm./Other 0 0 I. -------- - USDOT NO. ILCC NO. rn Xl Source of above 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 VIM 1 m co LOCAL USE ONLY TRAILER VIN 2 m 0 TRAILER WIDTH(S) 0-96" 97-102" >102' m TRAILER 1 ❑ ❑ 0 Z TRAILER 2 ❑ 0 0 O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. Z Silver White u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT 9 TOWED BY/TO: _ . SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY/T6 DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE