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HomeMy WebLinkAbout2026-00028214 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 I0110 II III flfl 11 ID III IOU 000 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X4235328 u, 1 U21 3 4 1 U1 2 U2 1 U1 1 U2 1 U1 1 U2 1 1 10 U1 3 U2 1 .P0119* 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 51,500 El NOT ON SCENE(DESK REPORT) El B Injury and f or Tow Due To Crash El AMENDED YR 202612026-00028214 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n ® ❑ RELATED PRIVATE ®Y ❑N 05 18 2026 ®AM ❑YES ®NO U1 -< KI M BALL ST 1 CENTER ST Elgin mo /day/yr 08 14 ❑PM FLOW CONDITION m 20 ®!MI N E S © Kimball St/Center St COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 3 Cl) Kane HIT&RUN ❑V ® N WITH VEHICLES INVLD ❑ STOPPED U2 —I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 Ig:DRIVER ❑ PARKED ❑DRIVERLESS 0 RED 0 PEDAL 0 EWES 0 NMV 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 5 C) FOR DAMAGED AREA(S) FROM TOWED U1 Q NAME(LAST,FIRST.M) GUTIERREZ MARROQU I N.SAYDA.Y. mo � yr 1 9 9 $ Chrysler Crossfire 2005 �00-NONE 11, 12• DUE TO CRASH 131 ❑ �.:!UNDER CARRIAGE 101 !:. Y FIRE 0IE STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) O DISTRACTED 0 0 U2 5 M F 2 SY n is-OTHER 4 ❑Y ®SNE M❑UNK VEH. AT CRASH IN n D 99-UNKNOWN 9 16•TOP 3 *Distraction Value 9 ALGN = r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 7 iI 6 �i COM VEH ❑ El 1 0 ~ ELGIN I L 60120 0 1 0 FIRST CONTACT 2 7_• -_5 *II Yes.See Sidebar U1 Z DS84618 IL 2026 E TELEPHONE IL D 0 1 C3AN65L55X055719 MAG N I U M Ely igi N U2 m 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 Same ILS1233563-00 1 r o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused 0 Y El 2 0 m g DRIVER ❑ PARKED 0 DRIVERLESS 0 FED 0 PEDAL 0 EWES 0 NMv 0 NOV 0 Dv CIRCLE NUMBER(S) U1 Honda Pilot 2016 00-NONE 11 _.Oi-_l DUE TO CRASH 0 D 2 x 0 Yr 13-UNDER CARRIAGE FIRE ❑ ® U2 C c F 2 8 SYSTEM IN 0 ENGAGED 0 15-OTHER O9 16-TOP 3 X ❑Y Ni N ❑UNK VEH. AT CRASH 99-UNKNOWN *Distraction Value 0 POINT OF s I 4 COM VEH ❑ ® U1 W N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR FIRST CONTACT 10 Y �� .5 •If Yes.See Sidebar C z ELGIN IL 60123 B 1 0 DR55295 IL 2026 I0 C IL D 0 SFNYF6H58GB103845 STATE FARM ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER 1 = Elgin Fire 99 9 JARAM I LLO.YADI RA 2966190-SFP-13 BAC E 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) 1 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 11 4 05,18 ,2026 08 14 ®❑AM in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 3 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ®AM U1 C) v 2 0 2 28 05,18 ,2026 08 16 ❑PM 0 Construction * 1 R 0 0 CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 7 3 ®AM ❑Maintenance U2 -a, ARREST NAME GUTIERREZ MARROQUIN.SAYDA.Y. 11-901-A 374001376 05,18 i2026 08 22 ❑PM SLMT o U1 ® 11 4 0 CITATIONS ISSUED PENDING Utility o N SECTION CITATION NO. ROAD CLEARANCE TIME ❑ AM U1 30 T 2 ❑ 1 3 ARREST NAME 05 r 18 ,2026 08 59 [�PM 0 Unknown work zone type 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑AM Workers present? ❑Y 30 374-Rizzu-o. Michael 102 331-Ziegler 07 ,07,2026 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••--, , CENTEMST ; A CMV is defined as any motor vehicle used to transport passengers or property and: Z r [ 4140 1. Has or more than pounds(example:truck or truck trailer 1. Has a weight rating10 000 � � INDICATE NORTH combination): BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C -? - } (example:shuttle or charter bus):or n I:,,:.... Not To Scale T. 3. Is designed tocarry15 fewerpassengers andoperated carrier es or by a contract ne i 0 _--J. ill''.) -- - } } } transporting employees in the course of their employment(example:employee X _ UNIT 1 END '� Mr r`,_ )_ _ ' transporter-usually a van type vehicle or passenger car):or L L____a____J KIMEALL93T ��'- ITs - } } } •4. Is used or designated to transport between 9 and 15 passengers,including the driver, (C/) `--- for direct compensation(example:large van used for specific purpose):or O ) 4. .. i. i. i. D t 5. Is any vehicle used to transport anyhazardous material(HAZMAT)that requires placarding(example:placards will be displayed on the vehicle). m qO. _ __ > CARRIER NAME Z ADDRESS 0 n CITY/STATE/ZIP 1 . . . . 1. MOTOR CARR.ID 0 Interstate 0 Intrastate I I T ❑ Not in Comm./Govt. Not in Comm./Other ----- ----4 - USDOT NO. ILCC NO. rn XI Source of above Z . ❑ Yes 0 No 0 Unknown g D Did Carrier Safety Regulations CS)violation contribute to the crash? A M 0 Yes 0 No ❑ 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' T TRAILER 1 ❑ ❑ 0 Z TRAILER 2 ❑ 0 0 O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. Z Gray Gray 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