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HomeMy WebLinkAbout2026-00029683 ILLINOIS TRAFFIC CRASH REPORT sheet 1 Of 2 Sheets 1111 III 11 III1II IIIIII U II III 11111 II 0E10 DRAC TRFD TRFC WEAT DRVA VIS VEHD LGHT COLL MANV X004246711 u, 2 U2 1 1 1 U1 9 U2 1 U, 1 U2 u, 6 u2 1 5 9 U123 U221 *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 El$501-$1.500 ®ON SCENE 13 VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) El AMENDED ❑ B Injury and for Tow Due To Crash YR 202612026-00029683 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 71 682 CONGDON AVE Elgin09:27 ® ❑ RELATED 0 Y ®N 05 24 2026 12,— ❑YES El NO U1 -< _ PRIVATE mo /day/yr ®PM FLOW CONDITION m COUNTY PROPERTY ®Y ❑N DOORING ❑y #OF MOTOR ❑SLOW 1 cn ❑ FT!MI N E S W Kane HIT&RUN ®Y ❑ N WITH VEHICLES INVLD ❑ STOPPED U2 —I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 Qg3 DRIVER t] PARKED ❑DRIVERLESS 0 PED 0 PEOAL 0 EOUES 0 NIIv 0 Ncv 0 ov DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 1 n 0 3 / yr Equinox ©1 12 EN 13-UNDER CARRIAGE 1 O FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 10 DISTRACTED 0 0 U2 0 m M 9 4 ❑Y ® is-OTHER SYSTEM ❑UNK VEH. 0 AT CRASH 0 99-UNKNOWN 9 16•TOP 3 `Distraction Value 9 ALGN = r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s,;il B �i COM VEH 0 j$J 1 0 ~ ELGIN I N I L 60120 0 1 0 FIRST CONTACT 2 7 . -_5 *Ir Ves.See Sidebar U1 Z DN19526 IL 2026 E TELEPHONE IL D 0 2GNALPEK2C6189039 American Alliance ❑Y Il N U2 m 5 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 Cruz Cruz. Hugo ILAA-0849478-04 1 1- 5 HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER 2 0 DRIVER N, PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NMy 0 NCV 0 Dv yr 10;j t2 c•, 2 FIRE ❑ ® U2 1 C o _ 13-UNDER CARRIAGE c SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED a SYSTEM IN 0 ENGAGED 0 15-OTHER 9.1,6•TOP3 ❑ ® SPDR n ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN *0istrac Dn Value 9 4 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF O' ii COM VEH D ® Ut CO F,,, FIRST CONTACT 8 Q B l'L.5 •If Yes.See Sidebar EN50594 IL 2027 I 0 M . STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0 1 HGCR2F56GA143963 Mercury Insurance ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER 1 = 99 9 Realzola.Jose. L. ILAP0000048937 BAc $ 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)1(ADDRESS)/(TELEPHONE) (EMS) (HOSPITAL) 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 18 5 City of Elgin 35 MPH Speed Limit Sign 05,24 /2026 09 27 ®AM in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 5 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 ,, 2 ❑ 43 3 150 DEXTER CT ELGIN IL 60120 28 17 , , PM 1 0 El Construction R 3 ❑ $I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 1 ❑AM ❑Maintenance U2 -a, ARREST NAME Lorenzo Norberto.Jose. M. 11-601 1542000886 ! ! El PM SLMT ou ® 11 5 lgi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. ROAD CLEARANCE TIME AM• ❑Utility t 2 El ARREST NAME Lorenzo Norberto.Jose. M. 11-404 1542000885 05124 /2026 09 27 ®PM El Unknown work zone type U1 35 2 23 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 10 1542 Chafe. Ethan 201 06 , 16,2026 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. A CMV is defined as any motor vehicle used to transport passengers or property and: > Z 1. Has a weight rating more than 10,000 pounds(example:truck or truckrtrailer -< i- ':--- --I-- --I !. INDICATE NORTH combination):or —I P3 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C i_ .:.. -:. i. e. rt- (example:shuttle or charter bus):or 0 X . . . 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier 0 i al I ; i i- i- transporting employees In the course of their employment(example:employee X --J. IN0Mii iiiiREI • transporter-usually a van type vehicle or passenger car):or c0 • Not To Scale 1 C i_ ':. .J.,.. ...I. - l• I- I- I- •4. Is used or designated to transport between 9 and 15 passengers,including the driver. (I) . . . . for direct compensation(example:large van used for specific purpose):or 0 t i. I , 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires 1:1 M placarding(example:placards will be displayed on the vehicle). XI › ; : :• :-- --:- -I CARRIER NAME Z 0 r r• -1- -: tiw i i. i. i... .4_ ADDRESS Atior 1.1n111 (f) ._ _. ____ __,=.4,016.•112 -'---------------..--______________ i. i. i. i. 4. Cr r r 1 CITY/STATE/ZIP g i. i. i. .i. MOTOR CARR.ID 0 Interstate 0 Intrastate .5 0 . . . . 0 Not in Comm./Govt. 0 Not in Comm./Other 0 .:- ‘I. -- - --1 i• i. i. .:. : USDOT NO. ILCC NO. < m XI Source of above z E LiSide of Truck El Papers ID Driver I=I Log Book m . mCS 0 Yes 0 No 0 Unknown Out of Service 0 Yes 0 No E Form Number 0 m Xl IDOT PERMIT NO. WIDELOAD-; El Yes 0 No il m TRAILER VIM 1 co 1 LOCAL USE ONLY TRAILER VIM 2 m 0 TRAILER WIDTH(S) 0-96" 97-102" >102' M -n TRAILER 1 El El 0 Z 4 TRAILER 2 0 0 0 o u i COLOR U 2 COLOR ' TRAILER LENGTH(S)1 ft. 2 Z ft. w White Red -- • TOTAL VEHICLE LENGTH ft. NO.OF AXLES u 'I TOWED —DUE TO Li DISABLING DAMAGE El NOT DISABLING DAMAGE DAMAGE EXTENT- 3 TOWED BY/TO: _ . SELECT CODES FROM THE BACK OF CRASH BOOKLET u 2 TOWED i--, DUE TO _ Li DISABLING DAMAGE Z NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/TO: VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE _ . .