Loading...
HomeMy WebLinkAbout2026-00023706 ILLINOIS TRAFFIC CRASH REPORT sheet 1 of 4 Sheets Mill III H IIIl DIII 01111110ll1111 H 110100 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV XO042135 5 u, 1 u21 1 1 2 u, 8 U2 1 u, 1 u2 1 u, 1 U2 1 5 15 u, 13 U2 1 �K 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 ❑$501-$1.500 ®ON SCENE 3 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash ❑AMENDED YR 2026I 2026-00023706 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 2 mRT20 EB El In07:31 ® ❑ RELATED ®Y 0 N 04 27 2026 ❑AM ❑YES ®NO U1 -< g PRIVATE mo !day/yr ®PM FLOW CONDITION m FT!MI N E S W S RANDALL RD COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 1 (n ❑ Kane HIT&RUN ❑V ® N WITH VEHICLESOT, INVLD DO STOPPED U2 —I ® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N 51 FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EWES 0 NW 0!CV 0 DV DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 1 n FRor'r TOWED U1 0 Ceja. Brian Dodge Ram 1500(pickup) 2016 00-NONE , DUE TO CRASH ❑ EN O NAME(LAST,FIRST,M) mo yr 13-UNDER CARRIAGE ©i O - FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 2 THERDISTRACTED 0 ]$I U2 3 M M 2 4 SYTM❑Y ®S NE❑UNK VEH. O AT CRASH 0 15-99-UNKNOWN 9 16•TOP 3 *Distraction Value 9 ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO STATE YEAR POINT OF s, it �i 4 COM VEH El j$J 1 n I- FIRST CONTACT 11 7. __1�_-6_;__5 *Il Yes.See Sidebar U1 0 Z ELGIN IL 60120 0 1 0 4189639B IL 2026 RER TELEPHONE IL D 0 1 C6RR7FTXGS203426 Bristol West Insurance Co ❑v ®N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR Elgin Fire 99 9 Mendez Dorantes. Elvia GO1 7081345 01 2 m `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER 2 X Ig DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 N,IV 0 NOV 0 DV !1 9 9 4 Nissan Versa 2014 00-NONE „ _.©i,O DUE TO CRASH rg ❑ 2 73 o - 13-UNDER CARRIAGE FIRE 0 ® U2 c M 2 8 SYSTEM IN 0 ENGAGED 0 15-OTHER 016-TOPO3 * X ❑Y ON ❑UNK VEH. AT CRASH 99-UNKNOWN Distraction Value 9 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 0 i s jl;�COM VEH ❑ ® Ut CO FIRST CONTACT 2 7 _, _5 •)ryes.See Sidebar C PINGREE GROVE Z IL 60140 0 1 0 BV37103 IL 2026 I Si)0 IL D 0 3N1CN7AP2EL823920 State Farm ❑Y ®N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Elgin Fire 99 9 Same 3533834-SFP-13 BAG E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP 996 < Refused RESPONDER ui = (UNIT) (SEAT) (005i (SEXI {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)((ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL) 1 3 03 / DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 11 1 I DOT Guardrail north side 04/27 ,2026 07 31 ®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 2 ❑ 2300 S DIRKSEN PKWY Springfield) 62784 20 28 04,27 ,2026 07 41 ®pM • ❑Construction 4 >E " O ❑ gi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 3 3 ❑AM ❑Maintenance U2 o ER 11 1 ARREST NAME Ceja. Brian 11-601 S1542-000844 04/27/2026 07 48 Igi pM ❑Utility SLMT 1$4 CITATIONS ISSUED 0 PENDING SECTION CITATION NO. ROAD CLEARANCE TIME NAM Ti 2 ❑ 22 2 ARREST NAME Ceja. Brian 11-709-A S1542-000844 04/27 /2026 08 41 ®PM El Unknown work zone type U1• 55 2 2 3 ❑ 22 3 OFFICER ID c SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 55 1542 Chase. Ethan 702 337-Thompson 05 , 19,2026 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 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 -< c ` --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 0 \ >.� , \\\\ \\ f• N 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I O I- }.___A_._.; } } } transportingemployees in the course of their employment \ \ \ - pbyment(example:employee X 1 1 1 Not To Scale] transporter-usually a van type vehicle or passenger car):or CO L •-----}----; 1111 114. 4. } 4. 4. Is used or designated to transport between 9 and 15 passengers,including the driver, N 1 } 1 •for direct compensation(example:large van used for specific purpose):or O i ---i t 1 4 __ t 1 4 - } t 5. Is any vehicle used to transport any hazardous material(HAZMAT)thatrequires -u 1 1 1 ., placarding(example:placards will be displayed on the vehicle). ,Zmt / l l 1 4 1 4 CARRIER NAME Z 11 4 6) 1 4 1 -.2— ADDRESS D I I I ietigrn CITY/STATE/ZIP n MOTOR CARR.ID 0 Interstate 0 Intrastate 0 I r ❑ Not in Comm./Govt. 0 Not in Comm./Other 4. --- --1 - USDOT NO. ILCC NO. m XI Source of above z . Form Number m Xl IDOT PERMIT NO. WIDELOAD'; ❑Yes 0 No 2 TRAILER VIN 1 m co LOCAL USE ONLY TRAILER VIN 2 m v 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 Black Red 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 DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® DISABLING DAMAGE Redmons/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE