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HomeMy WebLinkAbout2026-00027823 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 01111101111 10110 ll III flfl 110101100 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X004234726 u, 1 U21 1 1 1 U1 8 U2 1 U, 1 u2 1 U, 1 u2 1 1 9 U1 14 U221 *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 El$501-$1.500 ®ON SCENE 2 VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and for Tow Due To Crash ❑AMENDED YR 202612026-00027823 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 m ® ❑ RELATED ❑Y ®N 05 16 2026 ❑AM ❑YES ®NO U1 —< GRAND BLVD Elgin03:43 _ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION m FTlMI N E S W ADDISON ST COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 15 ❑ Cook HIT&RUN ❑V ® N WITH VEHICLESOT, INVLD ❑ STOPPED U2 --I Igi AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 g DRIVER O PARKED O DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NW 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 C) 1 0 ! yr Ponce. Neto Chevrolet Equinox 2014 00-NONE Q O 0OUE TO CRASH ® ❑ 13-UNDER CARRIAGE I • 0 FIRE ❑ al STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 10 O DISTRACTED 0 0U2 2 m M 2 8 ❑Y ®SNEM D15-OTHER UNK VEH. O AT CRASHIND O 99-UNKNOWN 9 16•TDP�3 ,Distraction Value ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s,;il B �I COM VEH ❑ El 1 C) ~ ELGIN IL 60120 B 1 0 FIRST CONTACT 1 7 : -0 •IIYes.SeeSidebar U1 0 Z V933091 IL 2026 REAR TELEPHONE IL D 2GNALBEK9E6100203 State Farm ❑Y ®N U2 19 . m 5 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Elgin Fire Ponce.Carla. R. 1106511 SFP13 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF IC OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER 2 XI 0 DRIVER I} PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 Nuy 0 NOV 0 Dv yr g 11-.I ©2�.-1 ❑ ® 1 ,'� 0 13-UNDER CARRIAGE 10( I FIRE ❑ ® U2 C Ti SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 ® SPDR C) a SYSTEM IN 0 ENGAGED 0 15-OTHER 9..16-TOP 3 X ❑Y i N ElUNK VEH. AT CRASH 99-UNKNOWN `Distraction Value 4 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF O 14 COM VEH 0 ® U1 W F,,, FIRST CONTACT 7 t. �1 ==QI�.S •If Yes.See Sidebar EF20791 IL 2026 REAR 0 cn M . STATE CLASS COL ID VIN INSURANCE CO. EXPIRED U2 0 1 C4PJXEG2RW212175 State Farm ❑V ®N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Martini.Tanya 3671428sfp13 BAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP U1 = (UNIT) (SEAT) (00B) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME),(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL) 0 O EV MOST EVNT LOG DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2Z u 1 ® 18 1 05,16 ,2026 03 43 ®AM in a Work Zone? ®N DIRP co I NI PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 5 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 C) v 2 0 20 28 05,16 ,2026 03 43 ®PM ❑Construction >F R O 0 ]$I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 5 3 ❑AM ❑Maintenance U2 a ®1 11 1 ARREST NAME Ponce. Neto 11-601 1545-668 05,16,2026 03 45 ®pM SLMT l$!CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME AM• El Utility Ti 2 0 18 1 ARREST NAME Ponce. Neto 11-709-A 1545-669 05 i 16 ,2026 04 30 0 PM 0 Unknown work zone type U1 30 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 30 1 545-Van Eycke. Brier 202 06 ,23,2026 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•---, , I ianonsivai I N : A CMV is defined as any motor vehicle used to transport passengers or property and: Z II 1. Has a weight rating more than 10,000 pounds(example:truck or truck/trailer -< -'- -' Not To Scale . !' INDICATE NORTH combination):or -I lAl BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C - } (example:shuttle or charter bus):or n X L A 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I O } } } transporting employees in the course of their employment(example:employee X transporter-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 -- -- - } } } g po passen rs,includi the driver, for direct compensation(example:large van used for specific purpose):or O __ __ ?.i r - 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 AV .II I II CARRIER NAME Z illli iY ADDRESS O T. 111. rn . r ii. i. i. i. 4. n l 1 CITY/STATE/ZIP g , MOTOR CARR.ID 0 Interstate 0 Intrastate t � 0 Not in I . . ❑ Not in Comm./Other og Y L L 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 to LOCAL USE ONLY TRAILER VIN 2 m v TRAILER WIDTH(S) 0-96" 97-102" >102' -n TRAILER 1 0 0 0 Z TRAILER 2 ❑ 0 0 O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w White Teal 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 DUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY/TO: DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE