HomeMy WebLinkAbout2026-00032465 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets II I11 IIII
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DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY XO04259291
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INVESTIGATING AGENCY DAMAGE TO ANY El$500 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$1,500 ❑NOT ON SCENE(DESK REPORT)
0 AMENDED ❑ B Injury and/or Tow Due To Crash YR 202612026-00032465 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 99 m
® ❑ RELATED PRIVATE ❑Y ®N 06 06 2026 ❑AM ❑YES El NO U1 -<
RT20/LAMBERT LN Elgin mo /day/yr 02:30 ®PM FLOW CONDITION m
01 0 ®/MI N E S ® rt2011ambert In COUNTY PROPERTY ElY ® N DOORING ❑y #OF MOTOR 0 SLOW 1 cn
Cook HIT&RUN ®Y ❑ N WITH VEHICLES INVLD 0 STOPPED U2 --I
0 AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0
183 DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uuv 0!CV 0 ov DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0
/ / FOR DAMAGEDAREA(S) FROhif TOWED U1 0
Unknown.0. Dodge Caravan(inc Grand)2010 00-NONE „ DUE TO CRASH 0EN
NAME(LAST,FIRST,M) mo yr 13-UNDER CARRIAGE 101 12! 2 FIRE 0 IE <
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 m
SYSTEM IN ENGAGED 15-OTHER 9 16.TOP 3
9 9 ❑Y ❑N ❑UNK VEH. AT CRASH ®-UNKNOWN `Distraction Value 9 ALGN =
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s_iL 6 4 COM VEH 0 j$J 1 00
F- 0 9 FIRST CONTACT 12 7_; __5 *IIYes.See Sidebar Ut
Z 9799059 IL 2026 REAR
M TELEPHONE . STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED 1
2D4RN4DE1AR135276 Unknown ❑Y ❑N U2 13 . m
13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
Aguilar.Guillermin,A. Unknown 1 rn
`o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER
RESPONDER D
Refused ❑Y 0 N 99 0
m x DRIVER 0 PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NMV 0 ro v 0 DV
Yr Acura TL 2012 Do-NONE 11 12'- DUE_, TO CRASH 0 (� 2
0 13-UNDER CARRIAGE 10 1 2 FIRE ❑ El U2 C
Ti
M 2 4 SYSTEM IN ENGAGED 15-OTHER 9 16•TOP 3 9
❑Y 0 N 0 UNK VEH. AT CRASH 99-UNKNOWN *Oistractun Value
N POINT OF 8 {I 4 ❑ ® u1 W CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR 6 �L_ COM VEH
FIRST CONTACT 6 Y__{_O _5 •IfYes,See Sidebar
0 1 DC54489 IL 2026 REAR 9 N
IL D 19U UA8F74CA008023 American Alliance ❑Y ®N RDEF M
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X
Same I LAA-1 025594-02 BAC
$
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 <
Refused RESPOND O N U1 =
(UNIT) (SEAT) (DOBi (SEX) {SAFT) (AIR) (INJI 1(EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)((ADDRESS)/(TELEPHONE) (EMS) (HOSPITAL)
2 6 05 /
:A
/ / UI 1 D
/ / 3 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 06/06 /2026 04 20 ®PM in a Work Zone? ®N DIRP co
1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 8
T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 0
Fic 2 ❑ 15 18
N 3 0 ❑CITATIONS ISSUED 0 PENDING ( ( _ ❑PM- 0 Construction
SECTION CITATION NO. EMS ARRIVED TIME ❑AM 0 Maintenance U2 8
-a ARREST NAME / / 0 PM '
o, N ® 11 1 0 CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • 0 Utility SLMT
45
r 2 ❑ ARREST NAME AM
7 ( / ❑❑PM 0 Unknown work zone type U1
n OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME
2 2 3 ° 565-Villagomez• Mireya 401 337-Thompson ( / D PM Workers present? ®N U2 45
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
i- i•____r____; N _ 1.c HaSa eight rating more than10,000pounds{ xamp :truck ortruckrtrailer 1 e le -<
INDICATE NORTH531
BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C
} (example:shuttle or charter bus):or
X
/ 3. is designed tocarry 15 or fewer passengers and operated a contract carrier O
es pa g pe
} } } transporting employees in the course of their employment(example:employee � X
transporter-usually a van type vehicle or passenger car):or w
C
L }-----}----; \� - } } } •4. Is used or designated to transport between 9 and 15 passengers,including the driver,
c"------............__________
for direct compensation(example:large van used fors cific purose):or
LL-__-a-...- - t l I 1 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m
placarding(example:placards will be displayed on the vehicle). m
0
/ / ��a � CARRIER NAME
/ / y...........s..........::....,............ .` ADDRESS D/ p.,. i. i. i. i. rA
`i�aO 4.
CITY/STATE/ZIP 0
f
MOTOR CARR.ID 0 Interstate 0 Intrastate
_ Not To Scale - o
1 I r 1 ❑ Not in Comm./Govt. 0 Not in Comm./Other
� "Y""1 USDOT NO. ILCC NO. m
XI
Source of above z
0 Yes II No ❑ Unknown A
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
to
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
Silver Black
u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_
DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT: 9 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