HomeMy WebLinkAbout2026-00030243 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets IIIIII 11 IIII
11111111 liii lUll 1IUUUU
DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X00424:6 8.
u, 1 U21 3 4 1 U1 2 U2 1 U, 1 1_12 1 U, 1 U2 1 1 10 u1 3 U2 1 *P 0119*
INVESTIGATING AGENCY DAMAGE TO ANY ❑5500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away
AGENCY CRASH REPORT NO. TRFW '
Elgin Police Department ONE PERSON'S ❑$501-S1.500 ®ON SCENE 14
VEHICLE/PROPERTY ®OVER 51,500 ❑NOT ON SCENE(DESK REPORT) El B Injury and f or Tow Due To Crash
El AMENDED
YR 2026I 2026-00030243 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n
® ❑ RELATED ®Y 0 N 05 27 2026 ®AM ❑YES ®NO U1 -<
N MCLEAN BLVD Elgin06:16
_ _ g PRIVATE mo /day/yr ❑PM FLOW CONDITION m
FT!MI N E S W EAGLE RD COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 1 (n
❑ Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD DO
U2 —I
lgi AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0
Qg3 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEON. 0 EWES 0 uuv 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 00 0
0 5 FOR DAMAGEDAREA(S) ROM TOWED U1 Q
yrNAME(LAST,FIRST,M) Sallee.Cailee.S. mo / /1 9 9 0 Toyota Highlander 2021 00-NONE EN
13-UNDER CARRIAGE „_' 00 DUE TOCRASH ❑
) FIRE ❑ IE
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 10 O DISTRACTED 0 0U2 00 M
F 2 SYTM IN ENGAGE4 ❑Y ®SNE❑UNK VEH. 0 ATCRASHD 0 99-UNKNOWN 9 16•TOP 3 `Distraction Value 9 ALGN 2
•
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF $ :i1 a �i, COM VEH 0 j$J 1
~ ELGIN IL 60120 0 1 FIRST CONTACT 1 7_; __5 *II Yee.See Sidebar U1 0
Z CF86340 IL 2026 E
TELEPHONE
IL D STDCZRBH8MS069564 STATE FARM ❑Y ®N U2 m
13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
99 9 Same 1308048-SFP-13 1 r
o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER
RESPONDER D
Refused El El 2 0
p;rg- DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NOV 0 NOV ❑Dv
yr 2
0 13-UNDER CARRIAGE )} E FIRE 0 ® U2 C
c
F 2 6 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16-TOPO3 * X
❑Y i N DUNK VEH. AT CRASH 99-UNKNOWN 0istraeion Value 9 0
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8 1 j 14 COM VEH ❑ ® U1 CO
F,,, FIRST CONTACT 1 O7 —SOS •If Yes.See Sidebar
ELGIN IL 60123 0 1 DT36152 IL 2027 I9 N
IL D JHMFA362385004737 AMERICAN ALLIANCE ❑Y ®N RDEF
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 =
99 9 MENDEZ GUTIERREZ.OMAR.A. ILAA-11386331-00 BAG $
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
E/ MOST EVNT Loc DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z
N 1 ® 11 4 Charles Miller Realty LIGHT POLE 05,27 ,2026 06 16 ®❑PM AM in a Work Zone? ®N DIRP co
1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 7
T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 C)
v 2 ❑ 558 N MCLEAN BLVD Elgin IL 60123 2 99 , , ❑PM El Construction *
3 ❑ 22 CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 1
❑AM ❑Maintenance U2
oEl 11 4 ARREST NAME Sallee.Cailee.S. 11-901 1506-506 / r ❑PM SLMT
o N
❑CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME El Utility
35
t 2 43 2 ARREST NAME AM
T El1 r ❑❑PM ❑Unknown work zone type U1
2 2 3 0 18 2 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑AM Workers present? ❑Y 35
1506-Nunez. Maria 601 331-Ziegler r / ❑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
N ADDITIONAL UNITS FORMS.
r -- r••--, , A CMV is defined as any motor vehicle used to transport passengers or property and: Z
Not To scale I 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer -<
;.__-_r-_--; I [. ( comWrtatlon)or -I
INDICATE NORTH -I
i BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver
EAOLEMD J
urtrrz _ (example:shuttle or charter bus):or
A 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I O
} I- . transporting employees In the course of their employment(example:employee 73
t,MD — — — transporter-usually a van type vehicle or passenger car):or w
L -----}----+ C
GYij, IVY / - } I- } 4. Is used or designated to transport between 9 and 1 passengers,including the driver,
r i I for direct compensation(example:large van used fors specific purose):or
_ < < • 5. Is anyvehicle used to transport anyhazardous material(HAZMAT)that requires m
I P.0.1. m
Pc
placarding(example:placards will be displayed on the vehicle). XI
M
tUNIT2Qo CARRIER NAME Z
•II; ADDRESS O
�', 11
CITY/STATE/ZIP 00
_ MOTOR CARR.ID 0 Interstate ❑ Intrastate
' ❑ Not in Comm./Govt. ❑ Not in Comm./Other 00
USDOT NO. ILCC NO. m
XI
Source of above z
. MCS 0 Yes 0 No 0 Unknown Out of Service 0 Yes ❑No 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' -n
TRAILER 1 ❑ ❑ 0 Z
TRAILER 2 ❑ 0 0 o
u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w
White 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