HomeMy WebLinkAbout2026-00025755 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111
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DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X4223692
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INVESTIGATING AGENCY DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away
AGENCY CRASH REPORT NO. TRFW '
Elgin Police Department ONE PERSON'S El5501-51.500 ®ON SCENE 1
VEHICLE/PROPERTY ®OVER 51,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash
0 AMENDED YR 2026I 2026-00025755 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 99 71
CENTER ST El In 04:07
® ❑ RELATED ®Y 0 N 05 06 2026 ❑AM YES ®NO U1
_ g PRIVATE mo /day/yr ®PM FLOW CONDITION M
FT!MI N E S W ANN ST COUNTY PROPERTY ❑Y ® N DOORING Ely #OF MOTOR 0 SLOW 1 (/)❑ Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD 0 STOPPED U2 —I
CO AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0
0 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 21 PEDAL 0 EWES 0 10AV 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 00 0
FOR DAMAGEDAREA(S) FRONT TOWED U1 Q
1 1 /
yr Schwinn NONE DUE TO CRASH
13-UNDER CARRIAGE 10 12! 2 FIRE 0NI
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTHER TAL(ALL) DISTRACTED 0 0U2 00
M1502 M 5 3 ❑Y ®SNE❑UNK VEH. O ATCRASHD 0 99-UUNKNOWN 9 16•TOP 3 `Distraction Value 9 ALGN
-
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF iL a 4 COM VEH 0 El 1 0
~ 7 FIRST CONTACT 00 7 Elgin I L 60120 0 1 0 _; _5 *uyes.See Sidebar U1 2
REAR
2 Z
TELEPHONE
IL D 0 None ❑Y 0 N U2 m
in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
Elgin Fire 1 49 1 Same N/a 1 rn
`o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER
RESPONDER eM
Refused El El 99 0
x DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL 0 EWES 0, CIRCLE NUMBER(S) U1
uv ❑NCv 0 DV
'1 Yr 9 9 9 Honda Accord 2007 00-NONE till 12 :_y FIREo CRASH ® U2 2 C
0 mo 13-UNDER CARRIAGE IIIEl
c
F 2 4 SYSTEM IN 9 ENGAGED 9 15-OTHER 9,1,6•TOPO3 * X
❑Y ❑N ®UNK VEH. AT CRASH 99-UNKNOWN O Distraction value 9 0
POINT OF 8-.;,•
1( 4 COM VEH D 27 U1 CO
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR �J -
FIRST CONTACT 2 7_.'_,�_5 •(ryes,See Sidebar
— Elgin IL 60120 0 1 0 FJ88057 IL 2026 I 0 Si)c
IL D 0 1 HGCM72647A018227 Allstate ❑Y ®N RDEF
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 =
Elgin Fire 1 99 9 FERNANDEZ.VICENTE.s. 811586921 BAC E
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP
U1 =
(UNIT) (SEAT) (D001 (SEX) {SAFT) (AIR) (INJ) j(EJCT( (EPTH) PASSENGERS&WITNESS ONLY (NAME)((ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL)
2 4 10 /
/ / 03 0
EV MOST EVNT LOG DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z
N 1 ® 13 1 05(O6 /2026 04 07 ®AM in a Work Zone? ®N DIRP co
1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 5
T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1
v 2 ❑ 2 99 05(O6 /2026 04 07 RI ❑Construction >F
1
R O ❑ xi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 7
3 ❑AM ❑Maintenance U2
-a, ARREST NAME JONES. DAVID. L. 11-1002-E W1567000038 05/06/2026 04 13 ®pM CITATIONS ISSUED PENDING SLMT
1 ® 13 1 ❑ Utility
o u SECTION CITATION NO. ROAD CLEARANCE TIME 0 y
T 2 El ARREST NAME 05/06 /2025 04 09 ®PM ❑Unknown work zone type 0 AM U1 25
n 7 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME
2 2 3 ❑ ❑AM Workers present? ❑Y 25
1567-Muehl.Claudia 102 320-Cox / ❑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 truckrtrailer -<
` ` --1 -' r INDICATE NORTH combination):or .Z-1
LBY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C
} I - } e. (example:shuttle or charter bus):or 0
i. i. ......---; I - trans d rtlg em lloyeeslin 5 he course of r he r emplrs oyment example:employee a contract ner 73
u i, } r } transppoorterg-usuallya van vehicle or or 1:0
L L.___a____� 4. Is used ordesi natedtotrans rtbetween9a d15rpassen rs,includingthedriver. N
Cia } } for direct compensation(examp large van used for specific purpose):or
L -a-___. — — — - t i. I 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
Not To Scale J CARRIER NAME Z
_ __ ADDRESS
D
CITY/STATE/ZIP n
MOTOR CARR.ID 0 Interstate ❑ Intrastate
I I T I ❑ Not in Comm./Govt. 0 Not in Comm./Other
------- --1 - USDOT NO. ILCC NO. rn
XI
Source of above z
. own tank)? 0 Yes 0 No 0 Unknown
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?
❑ Yes II No ElUnknown 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' T
TRAILER 1 ❑ ❑ 0 Z
TRAILER 2 ❑ 0 0 O
u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. Z
Bronze Gray
u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_
DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT' 0 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