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HomeMy WebLinkAbout2026-00023123 ILLINOIS TRAFFIC CRASH REPORT sheet 1 of 2 Sheets 01111101111 I0110 II III III III IIIIII IIIIII DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X 04211934- u, 1 u21 3 4 1 u, 3 U2 1 u, 1 u2 1 u, 1 U2 1 5 15 u1 1 u2 1 *P0119* 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 ❑$501-$1.500 ®ON SCENE 8 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash 0 AMENDED YR 2026I 2026-00023123 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 rl VILLA ST El In08:50 ® ❑ RELATED ❑Y ®N 04 24 2026 ❑AM ❑YES IX]NO U1 _ _ g PRIVATE mo !day/yr ®PM FLOW CONDITION MFT!MI N E S W S LIBERTY ST COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR 0 SLOW 1 0)0 Kane HIT&RUN ❑V ® N WITH VEHICLES INVLD ❑ STOPPED U2 --I ® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EWES 0 uuv 0 ncv 0 DJ DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) 0 Y N 0 4 / yr 13-UNDER CARRIAGE ©,I �:. FIRE 0 ® < STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 ]$I U2 IT1 M 2 4 ❑Y ®Nn 15-OTHER SYSTEM ❑UNK VEH. AT CRASHO 99-UNKNOWN 9 16•TOP 3 *Distraction Value ALGN = r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s it 6 �i 4 COM VEH 0 Ea 1 00 F. FIRST CONTACT 1 7_;,_-_;__5 *If Yes.See Sidebar U1 Z West Chicago IL 60185 0 1 0 CG97156 IL 2026 TELEPHONE IL D 0 3VVLR7RM7SM006400 Standard Fire Insurance ❑Y IlN U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 Eorgoff.Joan. M. 6139761692031 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y ® N 2 XI p; DRIVER ❑ PARKED 0 DRIVERLESS 0 FED 0 PEDAL 0 EWES 0 R4v 0 KCv 0 DV !1 9 8 3 Honda Accord 2009 00-NONE 'o.r 12 (,-2 FIREocRASH ® U2 2 C o Yr 13-UNDER CARRIAGEEl F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9.16•TtOP 3 X ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN •Distraction Value 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF X).�iI- 6 i1;,_4 COM VEH D ® U1CO F,, O7 :-t—_, _5 •It Yes.See Sidebar C ELGIN IL 60120 0 1 0 GB71771 IL 2026 BAR 0 Si)M IL D 0 1 HGCP26429A117229 American Freedom Insuranc ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = 99 9 Same 12247618502 BAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP 996 < Refused RESPONDER u1 = (UNIT) (SEAT) (D051 (SEX) {SAFT) (AIR) OHM 1(EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)/(ADDRESS)/(TELEPHONE) _ (EMS) (HOSPITAL) 2 6 09 / , D / / 4 O EV MOST EVNT LOG DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z N 1 ® 11 4 04/24 /2026 08 53 ®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 v 2 25 2 04,24 /2026 09 15 RI ❑Construction R O ❑ zi CITATIONS ISSUED El PENDING SECTION CITATION NO. EMS ARRIVED TIME 5 3 ❑AM ❑Maintenance U2 -a, ARREST NAME Gallegos Frausto. Brandon 11-601 W1512673 04/24/2026 09 25 lgi pM SLMT oN 1 ® 11 4 •MI CITATIONS ISSUED El PENDING SECTION CITATION NO. ROAD CLEARANCE TIME AM• El Utility t 2 El ARREST NAME Gallegos Frausto. Brandon 11-305-A W1512672 04/24 /2026 09 00 0 PM El Unknown work zone type U1 30 n 7 OFFICER ID SIGNATURE BEAT!DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 0 1512-Juarez-Huichapan.Juan 400 337-Thompson / / ❑❑PM AM Workers present? ®N U2 30 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 -< ` ` --I -' r INDICATE NORTH combination):or —I BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C - } (example:shuttle or charter bus):or X A CD3. 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 ntof 7o_Swf�; 1 transporter-usually a van type vehicle or passenger car):or co - S.A. - I. } } } •4. Is used or designated to transport between 9 and 15 passengers,including the driver. N for direct compensation(example:large van used for specific purpose):or O a1 L .___a____. 0 _ El L L i. L 5. Is any vehicle used to transport any hazardous material(HAZMAT)thatrequires D ,i � _, placarding(example:placards will be displayed on the vehicle). XI CARRIER NAME z ADDRESS O w n CITY/STATE/ZIP g 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 Xl Source of above z . ❑ Yes J No ❑ Unknown A 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' m TRAILER 1 ❑ ❑ 0 Z TRAILER 2 ❑ 0 ❑ O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. Z Black Maroon u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/TO: _ . SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/T6 DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE