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HomeMy WebLinkAbout2026-00029986 ILLINOIS TRAFFIC CRASH REPORT sheet 1 of 2 Sheets _ 01111101111 011011111 M0101000 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X004251220 u, 1 U21 1 1 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 El 5500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW Elgin Police Department ONE PERSON'S 1215501-$1.500 ®ON SCENE 2 VEHICLE/PROPERTY ❑OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and f or Tow Due To Crash 0 AMENDED YR 202612026-00029986 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n ® ❑ RELATED PRIVATE ❑Y ®N 05 26 2026 ®AM ❑YES IX]NO U1 S MCLEAN BLVD Elgin mo /day/yr 01:40 ❑PM FLOW CONDITION III OO 1C.'J!MI N E O W Fleetwood Dr COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR 0 SLOW 1 cn Kane HIT&RUN ❑V ® N WITH VEHICLES INVLD ❑ STOPPED U2 —I 0 AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS O 18:DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EOUES 0 NW 0 ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 n 0 1 / yr Nissan Kicks 2020 00-NONE OUETOCRASH ® ❑©1 12 E 13-UNDER CARRIAGE 10 1 2 FIRE ❑ al STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ❑ 0U2 4 rn F 2 SY4 ❑Y ®SNE UNK VEH. O AT CRASH M IN ENGAGEDO 99-UNKNOWN 9 16•TOP 3 *Detraction Value ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s i�a �i 4 COM VEH 0 j$J 1 0 St Charles IL 60174 0 1 0 FIRST CONTACT 11 7_; __5 *Il 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 IC OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER XI Refused ❑Y ® N 2 0 g DRIVER 0 PARKED 0 DRIVERLESS ❑ FED 0 PEDAL 0 EWES 0 I uv 0 Ncv 0 Dv 1 9 9 4 Ford Explorer 2020' 00-NONE O1 . 12.._1 DUE TO CRASH ❑ El 6 x o _Yr 13-UNDER CARRIAGE ta,i 2 FIRE ❑ ® U2 C Ti F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16•TOP 3 X ❑Y Ni N ❑UNK VEH. AT CRASH 99-UNKNOWN *Distraction Value 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s ailI B i.',_4 COM VEH ❑ ® U1 CO FIRST CONTACT 11 Y .j5 •IfYes.See Sidebar C ELGINZ IL 60120 0 1 0 MP19081 IL 2025 I O fn M IL D 1 FM5K8ABXLGC13057 Alliant Insurance Service ❑Y ®N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X City of Elgin 8109160P901 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 EV MOST EVNT LOC, DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 11 1 05,26 ,2026 01 08 ®❑PM in a Work Zone? ®N DIRP co 1 t PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 1 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 0 1 2 0 05 08 , ) ❑PM 0 Construction >E N 3 0 $I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 5 ❑AM 0 Maintenance U2 o ® 11 1 ARREST NAME Rodriguez-Espinosa. Ericka. M. 11-601-Ax 748949 / ! El PM SLMT S' N ❑CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME 0 Utility 35 r 2 ARREST NAME AM 7 El r ❑❑PM 0 Unknown work zone type U1 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM ❑Y 35 1547-Steele.Justin 702 341-Cox 06 , 17,2026 09 00 ❑P Workers present?M ®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----r••--, , ; A CMV is defined as any motor vehicle used to transport passengers or property and: Z A 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer -< Not To Scale J N INDICATE NORTH combination):or —I -1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C J _ } (example:shuttle or charter bus):or 0 J r r r r L A I 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier O r } } } transporting employees in the course of their employment(example:employee transporter-usually a van type vehicle or passenger car):or CO L -a- - 4. Is used ordesi natedtotrans rtbetween9and15passengers,indudingthedriver, C n I _ } } } • for direct compensation(example::large van used for speific purose):or L L--_-a-___-I ~� - t i i. L 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m placarding(example:placards will be displayed on the vehicle). ;p letwgilerteicwJ -DI CARRIER NAME Z "2 ADDRESS C) : ill . . . . - CITY/STATE/ZIP MOTOR CARR.ID 0 Interstate El wrt� O 1 I r 1 ❑ Not in Comm./Govt. ❑ Not in Comm./Other 0 � --- --1 - USDOT NO. ILCC NO. m XI Source of above z . If Yes,Name on placard 0 4 digit UN NO. 1 digit Hazard class No. Xl Xl 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 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 Red Black 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