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HomeMy WebLinkAbout2026-00032691 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 I0110 11111 IIH I IIIIII III II DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X004259529. u, 1 U21 3 4 1 U1 4 U2 1 U, 1 1_12 1 U, 1 U2 1 1 11 U1 1 U211 *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 El5501-51.500 ®ON SCENE 1 VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) 0 B Injury and/or Tow Due To Crash El AMENDED YR 2026I 2026-00032691 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 �l ® ❑ RELATED PRIVATE ❑Y ®N 06 07 2026DAM ❑YES ®NO U1 -< S RANDALL RD Elgin mo /day/yr 04:28 ®PM FLOW CONDITION ITl • COUNTY PROPERTY ❑Y ® N DOORING ❑Y #OF MOTOR 0 SLOW 15 u) ®2040/MI N E O W Weld Rd WITH VEHICLES INVLD 0 STOPPED U2 —I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) Kane HIT&RUN ❑Y ® N PEDALCYCLIST®N ® FREE FLOW # LNS 0 (i DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EWES ❑NIAV ❑!CV ❑Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 n T�TOWED U1 O NAME(LAST,FIRST,M) Murillo. Rosalia mo yr General Motors 2020 00-NONE ©, © �/DUE TOCRASH ® ❑ 13-UNDER CARRIAGE 10 1 2 FIRE ❑ al STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL)THERDISTRACTED 0 ]$I U2 4 <<Tl F 2 8 SYTM❑Y ®SNEDUNK VEH. O ATCRASHD 0 15-99-UUNKNOWN 9 16•TOP 3 `Distraction Value ALGN X. r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s, it a _5 *If Yes.See Sidebar U1 4 COM VEH 0 j$J 1 0 F. FIRST CONTACT 12 7 Z Streamwood IL 60107 B 1 0 EQ80182 IL 2027 I , TELEPHONE IL D 0 3GKALSEX8LL226327 State Farm ❑Y Igl N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Elgin Fire 99 9 Same 1772356-SFP-13 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused 0 Y ® N 2 c x DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EWES 0 NOV 0 i v 0 Dv /1 9$9 Chevrolet Blazer 2021 00-NONE 'o,� t2 c,�2 FIRE DUE D CRASH ® U2 2 C o 13-UNDER CARRIAGE c F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9.1,6•TOP 3 X ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN *Distraction Value 0 POINT OF 8 i1�1" 4 COM VEH ❑ ® U1 CO N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR 6 FIRST CONTACT 5 Y:1 —_,SOS •If Yes.See Sidebar Chicago IL 60651 0 1 0 CA55021 IL 2027 I0 Si)c IL D 0 3G N KBJ RS4MS553656 Progressive ❑Y ®N RDEF71 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Elgin Fire 99 9 Colon. Rolando 937152681 SAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP 996 < Refused RESPONDER U1 = (UNIT) (SEATI (DOBI (SEX) {SAFT) (AIR) (INJI 1(EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME(((A.DDRESS)!(TELEPHONE) (EMS) (HOSPITAL) 1 4 01 / #OCCS > / / UI 3 D / / 1 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z N 1 ® 11 1 61 /12 /26 04 28 ®AM in a Work Zone? ®N DIRP co 1 T PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 1 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 2 0 28 03 61 /12 /26 04 34 ®PM ElConstruction E <w O 0 ]$I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 1 3 ❑AM ❑Maintenance U2 o ® 11 1 ARREST NAME Murillo. Rosalia 11-601-Ax 489000561 61 /12 /26 04 40 Igi pM SLMT o N ❑CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • ❑Utility T 2 El ARREST NAME 61 /12 /26 05 13 ®PM El Unknown work zone type U1 0 AM 45 2 2 3 El ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 45 489-Reynolds.Allison 800 337-Thompson 71 / 11 /026 09 00 ID 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 unitshave been moved prior to officer's arrival. IF MORE THAN ONE CMV IS INVOLVED,USE SR 1050A r ;I�. I ADDITIONAL UNITS FORMS. I r ----r••--, , I I ; A CMV is defined as any motor vehicle used to transport passengers or property and: z I I 1. Has a weight rating more than 10,000 pounds(example:truck or truck/trailer -< ' i•--_.r-_- I I INDICATE NORTH combination):or —I ® p0 I I BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C } L ; ® J q - (example:shuttle or charter bus):or 0 r r r , F ` A 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier O z- t ' - } } } transporting employees In the course of their employment(example:employee X ,yc —i •> Nat 7b Scale J transporter-usually a van type vehicle or passenger car):or w L L.__-a__ I I I �� } 1.} 4. Is used or designated to transportbetween9andlpassengers,indudingthedrrver, y for direct compensation(example:large van used fors specific purose):or O L i t i i _ 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires 'D placarding(example:placards will be displayed on the vehicle). XI —I CARRIER NAME Z ADDRESS D 0 t CITY/STATE/ZIP g - i. i. i. i. MOTOR CARR.ID 0 Interstate 0 Intrastate I I T I ❑ Not in Comm./Govt. 0 Not in Comm./Other �I. ------1 - USDOT NO. ILCC NO. rn XI Source of above Z . 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 v TRAILER WIDTH(S) 0-96" 97-102" >102' T TRAILER 1 ❑ ❑ 0 Z TRAILER 2 ❑ 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 3 TOWED BY/TO. _Adieu/Impound Lot Garage . SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY1T6 DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE