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HomeMy WebLinkAbout2026-00023669 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 0110 11 100111 III �11 �� DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X0042132299 u, 1 U21 3 4 1 U1 7 U2 1 U, 1 1_12 1 U, 1 U2 1 1 11 U1 1 U211 *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 8 VEHICLE/PROPERTY ElOVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and for Tow Due To Crash 0 AMENDED YR 2026I 2026-00023669 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 7 m ROUTE 20 EXIT RAMP Elgin ® ❑ RELATED ❑Y ®N 04 27 2026 DAM ❑YES ®NO U1 PRIVATE mo /day/yr 04:16 ®PM FLOW CONDITION m ®25 ®!MI N E S © S Randall Rd COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ®SLOW 16 Cl) Kane HIT&RUN ❑V ® N WITH VEHICLESOT, INVLD ❑ STOPPED U2 —I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ❑ FREE FLOW # LNS 0 (8)DRIVER ❑ PARKED ❑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 n FROhrr TOWED U1 Q Es Abel Peterbilt MotoEs76o. 2018 00-NONE „ _, DUE TO CRASH ❑ ® E arza. NAME(LAST,FIRST,M) p mo yr 13-UNDER CARRIAGE �a:) 2 , 2 FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 2 m M 2 4 ❑Y ®N SYSTEM ❑UNK VEH. AT CRASHD 99-UNKNOWN 9 76•TOP 3 *Distraction Value 9 ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF $ iI S 4 COM VEH ® 0 1 0 ~ Hoffman Estates IL 60169 0 1 0 FIRST CONTACT 12 7 ;1 _5 *II Yes.See Sidebar Ut Z 3399782 IN 2026 TELEPHONE IL A 7 1 XPBD49XXJ D356727 Ohio Insurance ❑Y Igl N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 R&L Carriers. Inc. B-11321 1 rn `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER RESPONDER 20 (,�j N DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uv 0 N v 0 Dv yr 1 9 8 5 Ford Explorer 2000' 00-NONE ,t"i 12--_, DUE TO CRASH ❑ 21 98 o 13-UNDERCARRIAGE 10;I 2 FIRE ❑ ® U2 C It;c F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16.TOP 3 X ❑Y Ni N ❑UNK VEH. AT CRASH 99-UNKNOWN *Distraction Value 9 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8 iII S i,_4 COM VEH 0 ® U1 W FIRST CONTACT 6 Y_{_0 -5 If~ 60110 B 1 0 NONE REAR C 0 M IL D 0 1 FG M U69KXYZA17621 EXEMPT ❑Y ❑N RDEF Xl EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Elgin Fire 99 9 USPS EXEMPT SAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP U1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)!(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL) U2 996 r m ##occs y / ,, U1 1 D 1 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 11 1 41 ,71 ,026 04 16 ®PM in a Work Zone? ®N DIRP co 1 r PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 3 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 � Si 2 0 28 99 + ) ❑PM• ❑Construction * R 3 0 $I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 3 ❑AM 0 Maintenance U2 o ® 11 1 ARREST NAME Esparza.Abel 11-601 1530000690 / ! El PM SLMT S' N ❑CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • 0 Utility r 2 ❑ ARREST NAMEAM c- 7 1 / ❑❑PM 0 Unknown work zone type U1 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 30 1530-Soto.Oscar 981 61 , 12 ,26 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 ADDITIONAL UNITS FORMS. r ----r•---, , CNDA 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 -< Not To Scale I I INDICATE NORTH C BY ARROW combination):or 2 Is used or designed to transport more than 15 passengers including the driver n i_ - } (example:shuttle or charter bus):or 0 L A 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier 0 } } } 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____.l I } } } C •4. Is used or designated to transport between 9 and 1passengers,includingthedriver, ) for direct compensation(example:large van used fors cific purose):or L L--_- -___. i. < i. L 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m I I I placarding(example:placards will be displayed on the vehicle). XI Route?20?Exit?Ramp?to?S?Randall?Rd D CARRIER NAME R&L Carriers. Inc. =1 _ Z Unit 1 - ill}1 - ADDRESS 14949 ROUTE 28W D rn ICITY/STATE/ZIP Alexandria 1 IN 146001 n MOTOR CARR.ID ❑ Interstate ❑ Intrastate I I T I I Not in Comm./Govt. Not in Comm./Other0 USDOT NO. 63391 91 ILCC NO. m S?Randall?Rd 73 Source of above z . MCS 0 Yes 0 No 0 Unknown Out of Service 0 Yes ®No Z Form Number 0 m Xl IDOT PERMIT NO. WIDELOAEP 0 Yes ®No 2 TRAILER VIN 1 1 JJ V482 D7 M L235063 m co LOCAL USE ONLY TRAILER VIN 2 m 0 TRAILER WIDTH(S) 0-96" 97-102" >102' -n TRAILER 1 0 ® 0 Z TRAILER 2 ❑ 0 ❑ O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 636 ft. 2 ft. w Green White u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES 2 DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY/TO: _ SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 0 TOWED BY/TO. DUE TO ® VEHICLE CONFIG. 4 CARGO BODY TYPE 2 LOAD TYPE 9