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HomeMy WebLinkAbout2026-00031217 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 6 Sheets 01111101111 Mil it ll 11111 IIH 111111111 011 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X004254013 u, 2 U29 1 1 1 u116 U2 1 u, 1 1_12 1 u, 1 U2 1 4 9 u, 1 U221 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY El$500 OR LESS TYPE OF REPORT 0 A No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW Elgin Police Department ONE PERSON'S ❑5501-51.500 ®ON SCENE 2 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and for Tow Due To Crash 0 AMENDED YR 2026I 2026-00031217 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 2 m❑ ® RELATED 0 Y ®N 05 31 202612— ❑YES El NO U1 -< 445 OAK ST Elgin PRIVATE mo /day/yr 11:15 ®PM FLOW CONDITION m �O�F !MI N E S ® oak stlElm St COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR SLOW 6 fA Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD DOSTOPPED U2 --I 0 AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 gi DRIVER p PARKED 0 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 FOR DAMAGEDAREA(S) FRONT TOWED U1 Q Bahena.Alejandro mo / 1 9 9 7 Dodge Ram 1500(pickup) 2012 00-NONE ©, • >z o DUE TO CRASH ® 0 al NAME{LAST,FIRST,M) I 13-UNDER CARRIAGE r FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 10 O DISTRACTED ID 0U2 2 m M 2 4 El ONE❑UNK VEH. 0 AT CRASH IN ENGAGED0 99-UUNKNOWN 00-TOP® `DistractionVatuc ALGN 2 CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR FIR23 ST NT OONTACT 12 Oj QiFl O CIOMg See SidaDar❑ U, 1 0 Z ELGIN IL 60123 0 1 0 4260411B IL 2027 REAR TELEPHONE IL D 0 1C6RD7KT2CS344229 UNKNOWN ❑Y ❑N U2 m 5 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Elgin Fire 99 9 Same UNKNOWN 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF`Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Provena St.Joseph ❑Y El 2 0 0 DRIVER I} PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NOV 0 NOV 0 DV CIRCLE NUMBER(S) U1 yr 13-UNDER CARRIAGE 10 t2 2• FIRE ❑ El U2 C Ti SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED a SYSTEM IN 0 ENGAGED 0 15-OTHER 016-TOPO3 • ❑ ® SPDR X ❑Y ®N DUNK VEH. AT CRASH 99-UNKNOWN • 0istracton Value 9 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 0 _..®COM VEH ❑ ® Ut COF,,, FIRST CONTACT 6 0,,O_�_:OS •If Yes See Sidebar 247467C IL 2026 IZF aR 0 Si) M . STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0 1 GT4UWEY3SF243776 AAA ❑Y ®N RDEF 71 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = 99 9 Brandon.Aaron. L. AUT702329110 BAC $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP u1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) OM (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME),{ADDRESS)/(TELEPHONE) (EMS) (HOSPITAL) 0 O EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ❑ 18 1 ComEd Damage to Utility Pole 05,31 ,2026 11 15 0 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 X ;, 2 ® 18 1 350 SECOND ST ELGIN IL 60123 28 19 05,31 ,2026 11 15 1 ®PM . 0 Construction * " 3 D 31 3 0CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 7 z J ❑AM 0 Maintenance U2 o u ® 11 1 ARREST NAME Bahena.Alejandro 11-601-Ax 748613 05,31 r2026 11 21 ®PM SLMT l$!CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME AM 25 • El T 2 ElARREST NAME Bahena.Alejandro 3-707 748615 06 i 01 ,2026 02 00 ❑PM ❑Unknown work zone type U1 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 25 1548-Crandall. Matthew 700 07 ,03,2026 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 -< c ` --I -' r INDICATE NORTH combination):or .Z-1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C - } (example:shuttle or charter bus):or X L L.__-A--- } } } } transporting employeened to s Inthe course passengers5 or fewer thir employment(exampind e :example:employee transportertransporter-usuallya van vehicle or type passenger car):or 73 c0 L 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 0 li"----------"TLIll L ® t l. I 1 . 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires 'D l _ ,,;•• -,..,--ir}un-_ placarding(example:placards will be displayed on the vehicle). m A i CARRIER NAME Z 1 - ADDRESS 'n CITY/STATE/ZIP 00 MOTOR CARR.ID 0 Interstate 0 Intrastate 0 I r ❑ Not in Comm./Govt. 0 Not in Comm./Other ; _Y_ _ 4. - USDOT NO. ILCC NO. m XI Source of above z . Form Number m Xl IDOT PERMIT NO. WIDELOAD'; ❑Yes 0 No 2 TRAILER VIN 1 m co 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 Red Blue u 1 TOWED • TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT 3 TOWED BY/TO. Arties/Impound Lot Garage . SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® DISABLING DAMAGE Arties/Impound.Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE