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HomeMy WebLinkAbout2026-00027779 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 I0110 11111 1111 �II11111111 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X00423449r u, 1 U21 3 4 1 u, 4 U2 1 u, 1 1_12 1 U1 1 U2 1 1 11 u1 1 U2 1 *P 0 1 1 9* INVESTIGATING AGENCY DAMAGE TO ANY ❑$500 OR LESS TYPE OF REPORT ® A No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW Elgin Police Department ONE PERSON'S ❑$501-$1.500 ®ON SCENE 3 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) 0 AMENDED ❑ B Injury and for Tow Due To Crash YR 202612026-00027779 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 r7 ® ❑ RELATED PRIVATE ❑Y ®N 05 16 2026 ®AM ❑YES ®NO U1 '< BIG TIMBER RD Elgin mo /day/yr 08:39 ❑PM FLOW CONDITION M Ixl 0 ®!MI N E S © North State St COUNTY PROPERTY ❑Y ® N DOORING El #OF MOTOR 0 SLOW 1 (n Kane HIT&RUN ❑V ® 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 ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEOAL ❑EDUCE ❑NW ❑NCv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 0 FOR DAMAGEDAREA(S) FROM TOWED U1 O Cornejo.Zowie. L. 1 1 / yr 13-UNDER CARRIAGE ©i ! 2 FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) EN O 2 DISTRACTED ❑ 0 U2 4 <<Tl F 2 4 ❑Y ®SNEM❑UNK VINEH. 0 AET CRASH 0 99-UUNKNOWN THER 9 76•TOP 3 `Distraction Value ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s, ii_6 1, 4 COM VEH 0 E! 1 O f. FIRST CONTACT 11 7 .— _5 *If Yes.See Sidebar U1 Z Aurora IL 60505 0 1 0 EB75728 IL 2026 TELEPHONE IL D 0 1 N4AL11 DX6C161388 Direct Auto ❑Y ign4 U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 Same 2029503666 2 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y ® N 2 c N DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 row 0 0 0 9 Honda Accord 2008 00-NONE ,�_"j t2 -_, DUE TO CRASH ❑ 2 0 13-UNDER CARRIAGE to l 2 FIRE 0 ® U2 C c M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16-TOP 3 X ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN *0istraellon Value 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s i 6 ....4 COM VEH ❑ ® U1 CO H FIRST CONTACT 6 7 -�'OS •If Yes.See Sidebar C ELGIN IL 60124 0 1 0 A349320 IL 2026 I0 fp IL D 0 1 HGCP26828A103672 AARP1Hartford ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = 99 9 Caribacas. Rendas.S. 55100148545 BAG $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP 996 < Refused RESPONDER u1 = (UNIT) (SEAT) (D081 (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)((ADDRESS)((TELEPHONE) (EMS) (HOSPITAL) 2 3 01 / F 2 4 0 1 0 m / / #OCCS D Xl / / U1 1 D / / 2 O EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 11 1 51 ,61 ,026 08 40 ®❑PM in a Work Zone? ®N DIRP co 1 t PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 3 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 o" 2 28 99 , , ❑PM• ❑Construction * Z 3 ❑ xi CITATIONS ISSUED ❑PENDING SECTION CITATION NO. EMS ARRIVED TIME 3 ❑AM ❑Maintenance U2 a1 ® 11 1 ARREST NAME Cornejo,Zowie. L. 11-601-Ax 495000492 , r El PM SLMT o N ❑CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • 0 Utility 45 r 2 ARREST NAME AM 7 El 1 ❑❑PM El Unknown work zone type U1 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑AM Workers present? ❑Y 45 495-Sjodir.Jacob 501 61 , 61 ,026 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•---, , - ; A CMV is defined as any motor vehicle used to transport passengers or property and: Z r5 1 1. Hasa r more than pounds(example:truck or truck trailer c1. Hasa weight rating10 000 i INDICATE NORTH tan)o p0 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver -< } ,. ,. t- (example:shuttle or charter bus):or 0 ''?T 1 1 B-- mbw'?Read 1 3. Is designedto carry 15 or fewer passengers and operated by a contract carrier I O -Jr--- ---• - } } } transporting employees In the course of their employment(example:employee X transporter-usually a van type vehicle or passenger car):or w L L.___a____� I } 4. Is used ordesi natedtotrans rtbetween9and15passengers,includingthedriver, 1 I } } for direct compensation(examp large van used for speific purose):or 0 L L ___� — ururrr a »' a unmz L L 1 L 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m f ' placarding(example:placards will be displayed on the vehicle). XI I ' CARRIER NAME Z 1 ADDRESS O jf w r 1 CITY/STATE/ZIP 0 _ MOTOR CARR.ID 0 Interstate El Intrastate Not To Softie i 0 1 I r I 1 ❑ Not in Comm./Govt. 0 Not in Comm./Other ‘I. - '-1 - USDOT NO. ILCC NO. 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? 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 VIM 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 ❑ O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. Z Gray Maroon 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 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/TO. DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE