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HomeMy WebLinkAbout2026-00025754 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 1111 III 11 III1II UHhl U� 1111111 IIIh H* III 1111Ul DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X 04223€94 u, 1 U21 1 1 1 U1 2 U2 1 U, 1 1_12 1 U, 1 U2 1 1 10 u1 3 U2 1 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY El$500 OR LESS TYPE OF REPORT El A No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW ' Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 1 VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash 0 AMENDED YR 202612026-00025754 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n DUNDEE AVE Elgin 04:02 ® ❑ RELATED ®Y 0 N 05 06 2026 DAM ❑YES ®NO U1 _ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION III FT!MI N E S W OAKH I LL RD COUNTY PROPERTY ❑Y ® N DOORING Ely #OF MOTOR 0 SLOW 1 CA ❑ Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD 0 STOPPED U2 --I ® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 Qg3 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NIAV 0!Cy 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 99 n T TOWED U1 FOR DAMAGEDAREA(S) FROM 0NAME(LAST,FIRST,M) Duque. mo /1 9 9 8 Toyota Corolla 2009 00-NONE „. Q 0 OUE TO CRASH El -UNDER CARRIAGE FIRE 0VI STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 1U O DISTRACTED 0 ]$I U2 99 m F 2 4 SYTM❑Y ®SNEDUNK VEH. 0 ATCRASHD 99-UUNKNOWN THER9 t6•TOP�3 `Distraction Value ALGN X. r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6_iL 6 ii,4 COM VEH 0 0 1 0 ~ ELGIN I L 60120 0 1 0 FIRST CONTACT 1 7_; __5 *II Yes.See Sidebar U1 Z FR90813 IL 2009 REAR TELEPHONE UNK. Other 0 1 NXBU40E69Z021453 Safeway ❑Y ®N U2 m .5 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m co 99 9 Same 4255145-IL-PP-002 1 r o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER '1 9 8 0 Chevrolet Equinox 2013 00-NONE O"1 2 j"O DUE TO CRASH ❑ !1 2 x 0 13-UNDER CARRIAGE 6 I ©Ic 2 FIRE 0 ® U2 C c M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9.16-TOP 3 X ❑Y ON ❑UNK VEH. AT CRASH 99-UNKNOWN *OistractOn value 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6-iI�1:,-4 COMVEH ❑ ® U1 CO FIRST CONTACT 12 7 _, -5 •If Yes,See Sidebar = ELGIN IL 60120 0 1 0 BM44800 IL 2026 RFJ 0 IL D 0 2GNALDEKXD6278082 Statefarm ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 8 x 99 9 Same 3863471-SFP-13 BAG $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPONDER U1 = (UNIT) (SEAT( (DOB( (SEX) {SAFT) (AIR) (INJI 1(EJCT( (EPTH) PASSENGERS&WITNESS ONLY (NAME(/(ADDRESS)+(TELEPHONE) (EMS) (HOSPITAL) 2 3 09 / :A / / UI 1 D / / 3 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z N 1 ® 11 1 05/06 /2026 04 01 ®PM in a Work Zone? ®N DIRP co 1 I PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME ❑AM If YES check one below: U1 1 C) T o" 2 0 2 99 / / ❑PM• ❑Construction Z 3 0 I!!I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 5 ❑AM Maintenance U2 ❑ o 1 ® 11 1 ARREST NAME Meza Duque.Yenifer 6-101 W1569-000063 / / ❑PM SLMT I$!CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME• • ❑Utility o N AM 30 t 2 ❑ ARREST NAME Meza Duque.Yenifer 11-901 S1569-000062 / / ❑❑pM ❑Unknown work zone type U1 n T OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 ❑ ❑AM Workers present? ❑Y 30 1569 Jaimes.Julian 100 320-Cox r / ❑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••--, , e ; 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-< i- -----------' I l povi'Ave r INDICATE NORTH �mb natbn)or BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C _ (example:shuttle or charter bus):or C) L A 117 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 w� utransporter-usually a van type vehicle or passenger car):or w L --------- 4. Is used or designated to transport between 9 and 15 passengers,including C., - } } for direct compensation(example:large van used for speific purpoe):or the driver, O L I---_-a �4,��jj t i i L 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m _. / placarding(example:placards will be displayed on the vehicle). ;p s / / _ CARRIER NAME Z ADDRESS 'O Not To Scale C CITY/STATE/ZIP 00 MOTOR CARR.ID 0 Interstate ❑ Intrastate I I T I ❑ Not in Comm./Govt. 0 Not in Comm./Other ; _Y_ __.; - USDOT NO. ILCC NO. m XI Source of above z ❑ 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 co 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 Silver Green 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 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/TO. DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE