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HomeMy WebLinkAbout2026-00030944 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 0110 11 III fl I��� II� 110 0 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY XO0425953 u, 1 u21 2 4 1 u, ' U299 u, 1 U2 1 u,99 U2 99 1 11 u, 1 U2 1 *P0119* INVESTIGATING AGENCY DAMAGE TO ANY ❑$500 OR LESS TYPE OF REPORT ® q No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRAP/ ' Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 14 VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) El AMENDED ❑ B Injury and/or Tow Due To Crash YR 202612026-00030944 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 :l SOUTH ST Elgin 04:48 ® ❑ RELATED ®Y 0 N 05 30 2026 ❑AM ❑YES ®NO U1 -< g PRIVATE mo !day!yr ®PM FLOW CONDITION m FT/MI N E $ W S EDISON AVE COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR 0 SLOW 1 cn ❑ Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD 0 STOPPED U2 —I ® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N 51 FREE FLOW # LNS 0 Qg3 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EWES 0 NW 0 NCv 0 DV DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 1 0 FOR DAMAGEDAREA(S) FROM TOWED U1 1� Vega. Miguel.A. 1 1 / yr 13-UNDER CARRIAGE ©,I �:: FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ® 0 U2 1 r<rl M 2 4 SYTM❑Y ®SNE❑UNK VEH. 0 ATCRASHD 0 99-U 15-UNKNOWN THER916•TDP3 `Distraction Value 9 ALGN = r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF IL 6 I,.4 COM VEH 0 E! 1 0 ~ ELGIN I L 60123 0 1 0 FIRST CONTACT 12 7_: __5 *Irves.See Sidebar U1 Z DB35471 IL 2025 REAR M TELEPHONE IL D 0 KM8JM12B98U876160 Allstate ❑Y ®N U2 I' in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Delgado.Claudia 975363342 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER RESPONDER 2 7] m x DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL ❑EWES ❑NerV 0 Nev ❑DV !1 9 yf 5 Chevrolet Malibu 2008 00-NONE 'o,I t2 (,�2 FIRE DUE ID CRASH 0 ® U2 2 C o 13-UNDER CARRIAGE F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9.1 ❑Y I N ❑ ,6•TOP 3 UNK VEH. AT CRASH 99-UNKNOWN *Oistrac on Value 9 4 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8 1 6 .t. 4 COM VEH D ® Ut CO FIRST CONTACT 6 O7 ,�=Q)OS •If Yes,See Sidebar C ELGIN IL 60123 0 1 0 FX54430 IL 2026 aR 4 CI) IL D 0 1G1ZG57B28F218207 Geico ❑Y ®N RDEF M EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X Same 6294811917 BAC $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP 996 < Refused RESPONDER U1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)!(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL) 2 3 08 / F 2 4 0 1 0 m / / ##OCCS y / / U1 1 D / / 2 0 U EV MOST EVNT LOG DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME ❑AM Did crash occur 0 Y U2 Z N 1 ® 11 4 5/ ,0/ ,026 04 48 ®pm in a Work Zone? ®N DIRP co 1 t PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 3 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 � 0 2 ❑ 03 28 ! , ❑PM ❑Construction r' 3 ❑ Ii CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME ❑AM ❑Maintenance U2 3 -a, ARREST NAME Vega. Miguel.A. 3-414 1525001026 , ! ❑PM o u 1 ® 1 1 4 �( U ❑ • Utilit SLMT o N SECTION CITATION NO. ROAD CLEARANCE TIME AM, ❑ y CITATIONS ISSED PENDING t 2 El ARREST NAME Vega. Miguel.A. 11-601-Ax 1525001025 5/ ,0/ /026 05 14 ®PM El Unknown work zone type U1 30 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 30 1525-NavE.Oscar 701 6/ , 3/ ,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 tO50A �� ADDITIONAL UNITS FORMS. r i----r-•--, , / �; 1 . A CMV is defined as any motor vehicle used to transport passengers or property and: p I 01. Hasa weight rating more than 10,000 pounds(example:truck or truck/trailer i- }-----I-----' Not To Scale f - INDICATE NORTH combination):or -I BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C i_ - } (example:shuttle or charter bus):or 0 3. Is designed to carry 15 or fewer passengers and operated a contract carrier 0 -- I �r- } } } transporting employees in the course of their employment(example:employee X I /` transporter-usually a van type vehicle or passenger car):or w ' + . 4. Is used or designated to transport between 9 and 15 passengers,including cC/t ---- ----; - •} } } g Po passen rs,includi the driver, , for direct compensation(example:large van used for specific purpose):or L i.--_•a-___.I - t i I 5. Is any vehicle used to transport anyhazardous material(HAZMAT)thatrequires -u unit 2 - placarding(example:placards will be displayed on the vehicle). XI " T 21. �,,. ' I CARRIER NAME Z ;• - ADDRESS O I w (Unit 1 0 CITY/STATE/ZIP - i. MOTOR CARR.ID ❑ Interstate ❑ Intrastate I I T I I ❑ Not in Comm./Govt. Not in Comm./Other -------1 USDOT NO. ILCC NO. m XI Source of above 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 Blue Silver u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY/TO: _ 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