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HomeMy WebLinkAbout2026-00029983 ILLINOIS TRAFFIC CRASH REPORT sheet 1 of 6 Sheets _ 01111101111 Mil it ll III OH O 11E11111 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY XO04251219 u, 1 U21 3 4 1 U1 6 U2 1 U, 1 1_12 1 U, 1 U2 1 5 14 U1 12 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 0$501-$1.500 ®ON SCENE 3 VEHICLE/PROPERTY ❑OVER$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash El AMENDED YR 202612026-00029983 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n ® ❑ RELATED ®Y 0 N 05 26 2026 ®AM ❑YES ®NO U1 —< S MCLEAN BLVD Elgin01:08 _ _ g PRIVATE mo /day/yr ❑PM FLOW CONDITION m FT l MI N E S W FLEETWOOD DR COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR 0 SLOW 1 (n ❑ Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD ❑ STOPPED U2 —I ® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N 51 FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uuv 0 ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 C) FOR DAMAGEDAREA(S) FROM TOWED U1 I� Rodriguez-Espinosa, Ericka. M. 0 1 / yr 13-UNDER CARRIAGE ©,I �:: FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ❑ ]$I U2 O m F 2 4 SYTM❑Y ®S NE❑UNK VEH. O AT CRASH 0 99-U 15- NKNOWN THER9 16•TOP 3 *Distraction Value ALGN X. r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s, ii_6 1,.4 COM VEH 0 )g! 1 0 ~ St Charles I L 60174 0 1 0 FIRST CONTACT 12 7 ; _5 *lI Yes.See Sidebar U1 Z FQ37460 IL 2026 REAR TELEPHONE IL D 3N1CP5DV7LL483878 Progressive ®Y ❑N U2 13 . m 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Same 988157573 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y ® N 2 c E{ DRIVER 0 PARKED 0 DRIVERLESS ❑ PED 0 PEDAL 0 EWES 0 m v 0 KKv 0 Dv !2 0 0 7 Chevrolet Cruze 2015 00-NONE 0. Q!'-O DUE TO CRASH ❑ 2 x ... y Yr 13-UNDER CARRIAGE 10( ) 2 FIRE ❑ ® U2 C F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9,16-TOP 3 X ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN *Distraction Value 0 POINT OF 8 i1 A -4 COM VEH ❑ ® U1 CO N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR FIRST CONTACT 12 7� B .5 •(ryes,See Sidebar — West Dundee IL 60118 0 1 0 FZ81984 IL 2026 I O N IL D 0 1 G1 PA5SH4F7115155 Geico ❑Y ®N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Ramirez. Maria, D. 6252-92-73-11 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) U2 996 r m ##occs > 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 51 ,61 l026 01 08 ®❑PM 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 0 2 ❑ 05 08 , r ❑PM ❑Construction >E R 3 ❑ 0 CITATIONS ISSUED ❑PENDING SECTION CITATION NO. EMS ARRIVED TIME 5 ❑AM ❑Maintenance U2 —a, ARREST NAME Rodriguez-Espinosa, Ericka, M. 11-708-C 748947 ! ! ❑PM SLMT S' N 1 ® 11 1 igi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ❑Utility AM 35 t 2 ❑ ARREST NAME Rodriguez-Espinosa, Ericka, M. 6-101-B-5 748950 r r a 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 35 1547-Steele,Justin 702 341-Cox 61 , 71 ,026 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. r ----r••--, , A A CMV is defined as any motor vehicle used to transport passengers or property and: Z Not To Scale Nl 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer -< c ` -' -' r INDICATE NORTH combination):or —I r BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C } I I I _ I - } (example:shuttle or charter bus):or X L L.___A.._.� I I I 3. Isdesgnedtocarry15orfewerpassengersandoperatedbyacontrac[carrier 0 } } } transporting employees in the course of their employment(example:employee X II I I '- transporter-usually a van type vehicle or passenger car):or 03 L • �� 4. Is used or designated to transport between 9 and 15 passengers,including rCjt }-----}----l. - } } g po passen rs,includi the driver, for direct compensation(example:large van used for specific purpose):or L L___-a....� ~r r J _ l. l. I. I .. 5. Is any vehicle used to transport hazardous material(HAZMAT)that requires m placarding(example:placards will be anyisplayed on the vehicle). ;p CARRIER NAME Z ADDRESS II T. I 0 CITY/STATE/ZIP g I. I- ' •I I M - MOTOR CARR.ID 0 Interstate 0 Intrastate I I . I I I I ❑ Not in Comm./Govt. 0 Not in Comm./Other � "Y""1 USDOT NO. ILCC NO. m XI Source of above z . x 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 M 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 0 TRAILER WIDTH(S) 0-96" 97-102" >102' -n TRAILER 1 0 0 0 Z TRAILER 2 ❑ 0 0 O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w Red White u 1 TOWED • TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY/TO. Redmons/Impound Lot Garage . SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY/TO: DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE