HomeMy WebLinkAbout2026-00028803 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 mil 11 11111
fl�l I
1 11��1 �� ��
DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X00423929S
u, 1 U21 3 4 1 u1 9 U2 1 U, 1 u2 1 u1 1 U2 1 1 18 U123 U211 *P 0119
INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW '
DAMAGE TO ANY El$500 OR LESS TYPE OF REPORT ® q No Injury 1 Drive Away
Elgin Police Department ONE PERSON'S ❑$501-$1.500 0 ON SCENE 2
VEHICLE/PROPERTY ®OVER$1,500 ®NOT ON SCENE(DESK REPORT)
El AMENDED ElB Injury and for Tow Due To Crash YR 2026I 2026-00028803 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 2 �I
N RANDALL RD El In04:00
® ❑ RELATED ®Y 0 N 05 20 2026 ❑AM ❑YES ®NO U1 -<
g PRIVATE mo !day/yr ®PM FLOW CONDITION m
_
FT N E S W BIG TIMBER RD COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR 0 SLOW 1 (n
❑ Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD ® STOPPED U2 —I
Egl AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ❑ FREE FLOW # LNS 0
Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EOUES 0 NIA/ 0 ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 6 0
Ford F150 00-NONE
DUE TO CRASH ❑T TOWED U1 Q
201 2
NAME(LAST,FIRST,M) Ramirez Arreola. Lorenzo.A. mo yr 11-_ 12 -
13-UNDERCARRIAGE 1U1 2 EN
FIRE 0 IE
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ❑ 0 U2 6 m
M 2 4 SYSTEM IN ENGAGED 15-OTHER 9 76-TOP 3
❑Y ®N DUNK VEH. 0 AT CRASH 0 99-UNKNOWN `Distraction Value ALGN =
V. CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6 iII 6 li 4 COM VEH ❑ Ea 1 n
F. FIRST CONTACT 6 7_;L-Q,__5 C.
uves.See Sidebar Ut 0
. Z Belivere IL 61008 0 1 4257745B IL 2027
TELEPHONE
IL D 0 1 FTFW1 ET3CKD61037 American Freedom ❑Y Igl N U2 I—
in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
99 9 Same 12-2520679-00 1 r
`o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER
RESPONDER D
Refused ❑Y ® N 2 XI
p; DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uv 0 KCv ❑Dv
!1 9 5 5 Porsche 911 2006 00-NONE 11_"j Q�,-_, DUE TO CRASH ❑ 21 x
...
yr 13-UNDER CARRIAGE 10( I FIRE 0 ® U2 2 C
M 2 4 ❑Y ®SYSTEM IN 0 ENGAGED 0 15-OTHER 9,16-TOP 3 0 X
N ❑UNK VEH. AT CRASH 99-UNKNOWN POINT OF `Oistrac on Value
1i N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR A 6 -4 COM VEH ❑ ®
FIRST CONTACT 12 8 7 _ IfYes.See Sidebar U1 CO
6 •
H Aurora IL 60502 0 1 CZ32103 IL 2025 REAR C
IL D 0 WPOCB299765769581 Essentia Insurance ❑y ®N RDEF XI
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 =
99 9 Same 8R97003 BAc $
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 <
Refused RESPONDER U1 =
(UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)/(ADDRESS)/(TELEPHONE) (EMS) (HOSPITAL)
U2 996 r
m
##occs y
71
/ , U1 1 D
1 0
EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z
N 1 ® 11 1 05 /20 /2026 04 38 ®AM in a Work Zone? ®N DIRP co
1 I PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME ❑AM If YES check one below: U1 3 C)
T 2 ❑ 30 99 O) ! / ❑PM. El Construction
*
R , 3 ❑ $I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. •
EMS ARRIVED TIME 7
❑AM ❑Maintenance U2
-a, ARREST NAME Ramirez Arreola. Lorenzo.A. 11-1402 1515-783 / ! El PM SLMT
o N 1 ® 11 1 El CITATIONS ISSUED 0 PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ' El Utility
AM 45
r 2 ❑ ARREST NAME Ramirez Arreola. Lorenzo.A. 6-101-A 1515-782 / / 0 PM ❑Unknown work zone type U1
n T OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME y
2 2 3 ❑ 1515-BellEck.Stacy 901 337-Thompson 07 ,07 /2026 01 30 ®PM Workers present? ®N U2 45
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 A CMV is defined as any motor vehicle used to transport passengers or property and: Z
Not To Scale Z
- t_Z ' I I I I I I - f 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer
J combination):or —I} -- .r_
INDICATE NORTH p1
BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C
- } (example:shuttle or charter bus):or
— — — T,
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 L.___a____� - - 4. Is used ordesi natedtotrans rtbetween9and15 passengers,including y} } for direct compensation(example:large van used for specificpurpose):or [he driver,
Pe ( P 9 Pe or 0
L I. 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). m
;0
~, I .4.‘ I #*�I wIrVils CARRIER NAME
11. Z
— I II ADDRESS T.
01 n
1
- 1 CITY/STATE/ZIPg
MOTOR CARR.ID 0 Interstate 0 Intrastate
❑ Not in Comm./Govt. ❑ Not in Comm./Other 00
�I. --- --1 - USDOT NO. ILCC NO. C
m
XI
Source of above z
. • m
Did HAZMAT spill from vehicle(do NOT consider FUEL from vehicle's 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 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
Blue Silver
u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_
DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT: 4 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