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HomeMy WebLinkAbout2026-00027221 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 01111101111 0110 11111 flfl ID 11111111111 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X004235272 u, 1 U2 1 1 1 U116 u2 U, 1 U2 u, 1 U2 1 1 9 U1 1 U221 *P 0119* INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW ' DAMAGE TO ANY El$500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 1 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) (83B Injury and for Tow Due To Crash 0 AMENDED YR 202612026-00027221 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 mCHIPPEWA DR Elgin ® ❑ RELATED ❑Y ®N 05 13 2026 ❑AM ❑YES ®NO U1 —< PRIVATE mo /day/yr 04:56 ®PM FLOW CONDITION m ®1540!MI O E S W Jefferson Ave COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR 0 SLOW 15 u) Cook 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 18:DRIVER ID PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EOUES 0 NIA/ 0 ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 00 0 5 / yr 13-UNDER CARRIAGE © O FIRE ❑ ® < STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) O O DISTRACTED 0 0 U2 m M 2 5 SY 15-OTHER ❑Y ®SNE❑UNK VEH. O AT CRASM IN H O 99-UNKNOWN 9 76•TOP 3 `Distraction Value ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF $,_iL 6 I,.4 COM VEH 0 Ea 1 O ~ ELGIN I N I L 60120 B 1 0 FIRST CONTACT 12 7 • _-5 *II Yes.See Sidebar U1 Z DE48788 IL 2027 TELEPHONE IL D 0 5NMSH73E78H173396 Progressive ❑v ®N U2 m 5 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m co Elgin Fire 99 9 Same 990425105 1 r 5HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y ® N 3 eu 0 DRIVER X. PARKED 0 DRIVERLESS 0 FED 0 PEDAL 0 EWES 0 Nuy 0 Ncv 0 Dv yr Honda CRV 2008 00-NONE „ �i,O, DUE TO CRASH 0 (� 2 o 13-UNDER CARRIAGE I, FIRE ❑ ® U2 SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) O O DISTRACTED 0 ® SPDR 0 a SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16-TOP 3 ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN *0istraglon Value 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 9,i ' 0 COM VEH ❑ ® U1 CO F,,, FIRST CONTACT 6 7 1-€L®S •)(Yes,See Sidebar DV53897 IL 2026 IZFAR 0 M . STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0 J H LRE48768C038153 Progressive ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = 99 9 Murillo Gomez.Jose 988326725 BAc $ 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) 0 EV MOST EVNT LOG DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 18 1 05,13 ,2026 04 57 ®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 o" 2 0 28 20 1 1 ❑PM ❑Construction >F " 3 ❑ xi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 5 ❑AM 0 Maintenance U2 oD 1 ® 11 1 ARREST NAME Cedeno Aguilera. Renan.A. 11-601 S1569000074 r r El PM SLMT S' N 0 CITATIONS ISSUED TIME PENDING SECTION CITATION NO. ROAD CLEARANCE ' ❑Utility ❑ 30 t 2 El ARREST NAME AM 1 r ❑PM El Unknown work zone type U1 n 7 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 ❑ - ❑AM Workers present? ❑Y 30 1569-Jaimes.Julian 200 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••--, , ; 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 -< ` ' ' r+ I 0 i. INDICATE NORTH combination):or C BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver ai.. - } (example:shuttle or charter bus):or i=i+fir r , r 3. Is designed to carry 15 or fewer passengers and operated a contract carrier O L L____A____� ,w - } I- . transportingemployees In the course of their employment(example:employee X - transportr-usually a van type vehicle or passenger car): r w L }-----}----; -NO •} } } 4. Is used or designated to transport between 9 and 15 passengers,including the driver. N for direct compensation(example:large van used for specific purpose):or O L i t i i 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires 'D placarding(example:placards will be displayed on the vehicle). ,Zmt —1 CARRIER NAME Z ADDRESS 0 - - w CITY/STATE/ZIP 00 a Tr - MOTOR CARR.ID 0 Interstate El Intrastate T Not To Scale I 0 Not in Comm./Govt. 0 Not in Comm./Other �I. - ----1 - USDOT NO. ILCC NO. C m 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 v TRAILER WIDTH(S) 0-96" 97-102" >102' m TRAILER 1 ❑ ❑ 0 Z TRAILER 2 ❑ 0 0 O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. Z Black Silver u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT 3 TOWED BY/TO: _Arties SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 3 TOWED BY/T6 DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE