HomeMy WebLinkAbout2026-00029602 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 101111111 lIIl 11111101111111111 11111110011
DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X004246703
u, 1 U21 1 1 1 U1 8 U2 1 U, 1 U2 1 U, 1 U2 1 1 5 u, 1 u2 1 *P 0 11 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 0$501-$1.500 ®ON SCENE 3
VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash
0 AMENDED YR 202612026-00029602 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 m
1150 S RANDALL RD Elgin02:57
® ❑ RELATED ❑Y ®N 05 24 2026 DAM ❑YES ®NO U1 -<
_ g PRIVATE mo /day/yr ®PM FLOW CONDITION m
COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR 0 SLOW 1 cn
❑ FT/MI NESW Kane HIT ❑Y ® N WITH VEHICLES INVLD 0 STOPPED U2 --I
&RUN
❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0
Qg3 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NIAV 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0
0 9 /
yr 13-UNDER CARRIAGE fal !!. 2 FIRE 0 NI <
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ❑ 0 U2 m
M 2 SY is-OTHER
4 ❑Y ONM DUNK VEH. O AT CRASH IN D O 99-UNKNOWN 9 76•TOP 3 ,Distraction Value 9 ALGN 2
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF �.:,-----1-
il a �i 4 COM VEH 0 j$J 1 0
~ ELGIN I L 60123 0 1 0 FIRST CONTACT 8 7 : -_5 •II Yes.See Sidebar Ut
Z EV61614 IL 2026 E
TELEPHONE
IL D State Farm ®Y ❑N U2 m
13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
Elgin Fire Vazquez. Maria.S. 2460757-SFP-13 1
o HOSPITAL(TAKEN TO) INCIDENT IF IC OWNER STREET,CITY.STATE,ZIP PHONE NUMBER r
RESPONDER D
Sherman El ❑ N 1 2 ou
m Ei{ DRIVER 0 PARKED 0 ORIVERLESS 0 PED 0 PEDAL 0 EWES 0!My 0 NCV 0 DV
yr 1
2
0 13-UNDER CARRIAGE 19( 2 FIRE ID El U2 C
M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16-TOP 3 X
❑Y i N ❑UNK VEH. AT CRASH 99-UNKNOWN `Distracton Value 9 0
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF A s i1 1!::_4 COM VEH 0 ® U1 CO
5
FIRST CONTACT 1 7 -5 •If Yes.See Sidebar
= CHICAGO IL 60618 0 1 0 FAC4-US IL 2026
Z
IL D 19XFC2F73HE027357 USAA ®Y ❑N RDEF71
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 =
Elgin Fire Same USAA 0300989307101 SAC E
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP 996 <
Refused RESPONDER 1 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 0 2 1 05/24 /2026 02 57 ®AM in a Work Zone? ®N DIRP co
1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 1
T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 C)
2 ® 1 2 04 99 05,24 /2026 03 20 PM
,
® • ❑Construction %
R 3 0 CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 1
z J ❑AM ❑Maintenance U2
a1 0 11 1 ARREST NAME Huerta.Christopher 11-601 S1568-000062 05/24/2026 03 40 Igi PM SLMT
l$!CITATIONS ISSUED 0 PENDING SECTION CITATION NO. ROAD CLEARANCE TIME AM ❑Utility
Ti 2 El 2 ARREST NAME Huerta.Christopher 3-707 S1568-000061 05/24 /2026 04 00 0 PM 0 Unknown work zone type U1 45
2 2 3 0 OFFICER ID SIGNATURE BEAT!DIST. SUPERVISOR ID. COURT DATE TIME ❑AZ Workers present? ❑Y 45
1568 Baer.Amkar 700 320-Cox 07 ,07,2026 01 30 go,
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
�____r____; I I _ 1. Hasatwnightratingmorethan10,000pounds(example:truckortrucktrailer -<' J
1. '.INDICATE NORTH p1
N i BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C
o _ } (example:shuttle or charter bus):or
• ' A I I 3. Is desgned to carry 15 or fewer passengers and operated a contract carrier O
I } } } transporting employees In the course of their employment(example:employee
transporter-usually a van type vehicle or passenger car):or w
4. Is used ordesi natedtotrans rtbetween9and15 ge ng y} } • for direct compensation(example:large van used for specificpurpose):or [he driver,
Pe ( P 9 Pe or O
nso'r�nma p - < < < _ 5. Is any vehicle used to transport any hazardous material(HAZMAT)thatrequires M
°e placarding(example:placards will be displayed on the vehicle).
CARRIER NAME Z
I
ADDRESS D
I
_Not To Scale_� I I CITY/STATE/ZIP g
- MOTOR CARR.ID 0 Interstate El Intrastate
' ❑ Not in Comm./Govt. ❑ Not in Comm./Other 00
-"--------1 - USDOT NO. ILCC NO. C
m
XI
Source of above z
. 0 Yes 0 No ❑ Unknown 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
to
LOCAL USE ONLY TRAILER VIN 2 m
0
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
Gray Gray
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 DAMAGE EXTENT: 3 TOWED BY/TO:
DUE TO ® DISABLING DAMAGE Redmons/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE