HomeMy WebLinkAbout2026-00027756 ILLINOIS TRAFFIC CRASH REPORT sheet 1 Df 6 Sheets 01111101111
I0110
II III IM
I
0011/1111
DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X004252514
u, 2 U2 1 1 1 U1 4 U2 U1 1 U2 U, 1 U2 1 5 9 U1 1 U221 *P 0119*
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 ®5501-$1.500 ®ON SCENE 1
VEHICLE/PROPERTY ❑OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash
0 AMENDED YR 202612026-00027756 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 10 71
PRESCOTT AVE Elgin
® ❑ RELATED ❑Y ®N 05 16 2026 E�IAM El YES ElPRIVATE NO U1
mo /day/yr 02:36 ❑PM FLOW CONDITION Ill
010((1 !MI Cl E S W Wanskuck St COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR 0 SLOW 15
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 0
gi DRIVER ID PARKED El DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NW 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 n
1 2 /
Other Other 00-NONE 11 OI_1 OUETOCRASH ® ❑ E
13-UNDER CARRIAGE 1a , 2 FIRE ❑ ® <
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ❑ 14 U2 m
M 5 3 ❑Y SYSTEM IN ENGAGED 15-OTHER 9 76•TOP 3 _
❑N ❑UNK VEH. AT CRASH 99-UNKNOWN `Distraction Value ALGN
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6_iL 6 I,.4 COM VEH ❑ 181 1
H 1 ELGIN IL 60124 A 3 8 FIRST CONTACT 12 7 : _5 *IIYes.See Sidebar U1 0
REAR
Z E
TELEPHONE
IL D YTDC45E2U L2100237 N/A ❑Y ❑N U2 M
13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
Elgin Fire Perez. Danny N/A 1 r
o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER
RESPONDER
2 ou
rg-
p DRIVER I} PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 row 0 NOV 0 DV
yr 13-UNDER CARRIAGE 10;1 t2 E FIRE ❑ ® U2 C
c SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED
a SYSTEM IN ENGAGED 15-OTHER 9 16.TOP 3 ❑ ® SPDR n
❑Y ❑N D UNK VEH. AT CRASH 99-UNKNOWN *Distraction value U1 9 -
POINT OF 8 {I '4
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR 6 �L_ COM VEH ❑ ® CO
FIRST CONTACT 6 Y__{_O ._5 •(ryes.See Sidebar
H DG54158 IL 2027aR 9 fp
M . STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0
JA4AS2AW4BUO24319 State Farm 0 Y ®N RDEF
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X
Cruz.Alejandro 0878882SFP13 SAC E
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)
0
EV MOST EVNT LOS DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z
N 1 ® 18 1 05,16 /2026 02 36 ®❑PM 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 ,,
v 2 ❑ 08 28 05,16 /2026 02 36 ❑PM ❑Construction >F
1
R O ❑ CITATIONS ISSUED tg PENDING SECTION CITATION NO. EMS ARRIVED TIME 5
3 ®AM ❑Maintenance U2
a 1 ® 11 1 ARREST NAME Stana. Mihai.A. 11-1427-H 749407 05/16/2026 02 44 ❑pM 0 Utility SLMT
0 CITATIONS ISSUED RI PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ARM
t 2 ❑ ARREST NAME Stana. Mihai.A. 6-101 749404 05/16 /2026 03 30 MPM ❑Unknown work zone type U1 30
2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 30
1513-Mann. Nathaniel 801 06 , 17/2026 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.
r ----r••--, , ; 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 truck trailer -<
_Ny INDICATE NORTH p1
BY ARROW combination):or
2 Is used or designed to transport more than 15 passengers including the driver
C
- } (example:shuttle or charter bus):or
X
i L.__-a-.-.J. an } } } } transportinggemploo aeeslin the course 5 or fewer passengers
their employment
ment operated bmpy a contract:employee carrier O
employees pbyment(example:employee X
transporter-usually a van type vehicle or passenger car):or w
L L-------- 4. Is used or designated to transport between 9 and 15 passengers,including C} } for direct compensation(example:large van used for specificpurpose):or [he driver,
Pe ( P 9 Pe or O
L L--_-a-...- t l I 1 L 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m
placarding(example:placards will be displayed on the vehicle). XI. 1
CARRIER NAME Z
nekuok?St ADDRESS D
r C)
n
CITY/STATE/ZIP 0
Not MOTOR CARR.ID 0 Interstate 0 Intrastate 5
I r ❑ Not in Comm./Govt. 0 Not in Comm./Other
----------1 USDOT NO. ILCC NO. m
XI
Source of above Z
. Form Number m
m
IDOT PERMIT NO. WIDELOAD'; 0 Yes 0 No 2
TRAILER VIN 1 m
to
LOCAL USE ONLY TRAILER VIN 2 m
a
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
Black Black
u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_
DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT- 9 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