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HomeMy WebLinkAbout2026-00024451 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 Mil it ll 11111111111100000 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X004222700 u, 1 U21 1 1 2 U1 8 U2 1 U, 1 1_12 1 U+ 1 U2 1 1 10 U1 3 U2 1 *P 0119* INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW ' DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 14 VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash El AMENDED YR 202612026-00024451 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 rn ALFT LN Elgin 04:34 ® ❑ RELATED ®Y 0 N 04 30 2026 12,— ❑YES N NO U1 -< g PRIVATE mo !day!yr ®PM FLOW CONDITION m _ FT!MI N E S W CAPITAL ST COUNTY PROPERTY ❑Y ® N DOORING Ely #OF MOTOR ❑SLOW 1 (n ❑ Kane HIT ❑V ® N WITH VEHICLES INVLD El STOPPED U2 --I El AT RUN AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EOUES 0 uuv 0 ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 00 C) Passat 2012 00-NONE FOR DAMAGEDAREA(S) FRONT TOWED U1 O 0 5 / yr Volkswagen ©+. 12 - 13-UNDER CARRIAGE } I! 2 OUE FIRETO CRASH ® ❑ 0 IE STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) O DISTRACTED 0 0U2 00 M M 2 SY6 ❑Y ElM®UNK VEH. 9 AT CRASHD 9 99-UNKNOWN +6•TOP 3 *Distraction Value 9 ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8,_iL e 4 COM VEH 0 0 1 0 F. FIRST CONTACT 10 7 ;—, _5 *Irves.SeeSidebar U1 Z Chicago IL 60630 B 1 0 EM60513 IL 2027 REAR TELEPHONE IL D 0 1 VWBP7A34CC039826 Geico ❑Y ®N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR Elgin Fire 99 9 Same 6243-12-60-98 2 m `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Sherman 0 Y ElN 2 0 x DRIVER 0 PARKED 0 DRIVERLESS 0 FED 0 PEDAL 0 EWES 0 i uv 0 i v 0 DV !1 9 9 4 Nissan Versa 2020' 00-NONE 0. Q!'-O DUE TO CRASH rg ❑ 2 x 0 13-UNDER CARRIAGE 19( I 2 FIRE El ® U2 C c M 2 5 SYSTEM IN 9 ENGAGED 9 15-OTHER 9,16-TOP 3 X ❑Y ❑N ®UNK VEH. AT CRASH 99-UNKNOWN *Distraction Value 9 0 POINT OF 8 i1 A -4 COM VEH 0 N U1 CO N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR FIRST CONTACT 12 7� B .5 •(ryes,See Sidebar — Huntley IL 60142 0 1 0 CE87309 IL 2020 I 0 N IL D 0 3N1CN8FV4LL849462 State Farm ❑Y ®N RDEF X EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Elgin Fire 99 9 Same 2701433-SFP-13 SAC 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),(A.DDRESS)/(TELEPHONE) (EMS) (HOSPITAL) 2 3 1 2 / M 2 6 B 1 0 m / / #OCCS > 71 / / U1 01 ' D / / 02 0 EV MOST EVNT LOG DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z N 1 ® 11 4 04,30 l2026 04 34 ®AM in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 6 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 C) v 2 0 06 2 04,30 ,2026 04 46 ®pM El Construction3 ❑ xi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 7 z J ❑AM ❑Maintenance U2 o1 ® 11 4 ARREST NAME Martinez Bautista.Jaime 11-708 1567000032 04,30/2026 04 57 Igi pM SLMT o N ❑CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • El Utility 0 AM t 2 ElARREST NAME 04l 30 ,2026 05 24 N PM ElUnknown work zone type U1 25 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑qM Workers present? ❑Y 25 1567-Muehl.Claudia 901 337-Thompson 06 ,02,2026 01 30 ®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 -< i- ;.---.-:-----; ll'`,. i. combination):or INDICATE NORTH N. 1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C (example:shuttle or charter bus):or n T j 1 4, a r,i 3. Is designed to carry 15 or fewer passengers and operated a contract carrier 0 -____A____1 ,••.4.y j i. } } . transportingemployeesinthecourseoftheirem employment(example:employee X transporte -usuall a van type vehicle or passenger car):or CO I. •4. Is used or designated to transport between 9 and 15 passengers,including ((I) I- :g - } ! } for direct compensation(example large van used for speific purpoe):othe diver, __ __ Aill _ t i i t 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m placarding(example:placards will be displayed on the vehicle). ;p . 1 CARRIER NAME Z 17 Itill . 1. L. 1......... ADDRESS 'n o CITY/STATE/ZIP Not To Scale MOTOR CARR.ID 0 Interstate 0 Intrastate I I I ❑ Not in Comm./Govt. 0 Not in Comm./Other i "Y""1 USDOT NO. ILCC NO. m XI Source of above z . If Yes,Name on placard O 4 digit UN NO. 1 digit Hazard class No. Xl Xl Did HAZMAT spill from vehicle(do NOT consider FUEL from vehicle's z own tank)? 0 Yes 0 No 0 Unknown T. 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 VIN 1 m to LOCAL USE ONLY TRAILER VIN 2 m 0 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 Red Blue 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 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