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HomeMy WebLinkAbout2026-00033753 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 0110 1111110111111131 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X004269.53 u, 1 U21 1 1 1 U1 7 U2 1 u, 1 1_12 1 U1 1 U2 1 1 10 u, 1 U2 3 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT ® q No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW ' Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 15 VEHICLE/PROPERTY ®OVER 51,500 ❑NOT ON SCENE(DESK REPORT) El AMENDED ElB Injury and/or Tow Due To Crash YR 202612026-00033753 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 rn WAVERLY DR Elgin 04:59 ® ❑ RELATED ®Y 0 N 06 12 2026 ❑AM ❑YES ®NO U1 -< _ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION m FT!MI N E S W HUNTER DR COUNTY PROPERTY :IN Y ® DOORING Ely #OF MOTOR 0 SLOW 1 (/)❑ Cook HIT&RUN ❑V ® N WITH VEHICLES INVLD 0 STOPPED U2 --I ® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 Qg3 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEON. ❑EWES ❑NW ❑!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 n 0 4 / yr 13-UNDER CARRIAGE IE ©,I 0•,: 2FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 2 m F 2 SYTM IN ENGAGEis-OTHER 4 ❑Y ®SNE❑UNK VEH. 0 ATCRASHD 0 99-UNKNOWN 9 16•TOP 3 `Distraction Value 9 ALGN = r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s it S COM VEH 0 Ea 1 n 4 I� FIRST CONTACT 12 7__,--_,__5 *II Yes.See Sidebar U1 0 V Z ELGIN IL 60120 0 1 0 GC72808 IL 2026 REAR TELEPHONE IL D 0 WBA8D9G54HNT90836 MAGNUM INSURANCE AGENCY ❑Y ®N U2 1—IL' - .5 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Elgin Fire 99 9 GAYTAN.JOSE.A. 2022250431 1 r o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER RESPONDER 2 ou m g DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 iiuv 0 NOV 0 DV CIRCLE NUMBER(S) U1 1 9 6 7 Toyota Camry 2018 00-NONE 'o,1 t2 (,�2 FIRE DUE O CRASH 0 ® U2 2 C .. 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 *0istrac on Value 9 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8 Ir..,.t. 4 C.OM VEH ❑ ® Ut co FIRST CONTACT 6 O7 = )OS •If Yes.See Sidebar C ELGIN IL 60120 0 1 0 BK70456 IL 2027 AR Si)0 IL D 0 4T1 B11 H K2J U076035 ALLSTATE ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Elgin Fire 99 9 Same 811645005 SAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused 0 YD®N 9 u1 = (UNIT) (SEAT) (DOBi (SEX) {SAFT) (AIR) (INJI (EJCTI (EPTH) PASSENGERS&WITNESS ONLY (NAME)((ADDRESS)((TELEPHONE) (EMS) (HOSPITAL) 1 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 06/12 /2026 05 02 ®AM in a Work Zone? ®N DIRP co 1 t PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 5 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 C) v 2 0 28 03 06,12 /2026 05 02 ®PM ❑Construction * R 0 ]$I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 5 3 ❑AM ❑Maintenance U2 a ® 11 1 ARREST NAME Gaytan.Jocelyn 11-601 1572000113 06/12/2026 05 06 Igi PM SLMT o N ❑CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • ❑Utility t 2 0 ARREST NAME 06/12 /2026 04 59 ®PM El Unknown work zone type U1 30 0 AM 2 2 3 IDOFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 30 1572-Brunzo.Austin 202 378-Alcorn 07 ,21 /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. .. .. 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 -< i- ---_r__--; I ® INDICATE NORTH combination):or p1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C i_ . I - } (example:shuttle or charter bus):or 0 I i Ali q , 3. Is d ned t carry 15 or fewer passengers and operated a contract carrier I O - ------I----; Hunter?Dr. - } } } transporting employees in the course of thir employment(example:employee transporter-usually a van type vehicle or passenger car):or w __ _-1 i i "'a _ 4. Is used ordesi natedtotrans transport passengers,including rCjt} } } g Po passes rs,includi the driver, i',il for direct compensation(example:large van used for specific purpose):or O L L____a____- }�� _ t } } } 5. Is any vehicle used to transport anyhazardous material(HAZMAT)that requires M %nl' placarding(example:placards will be displayed on the vehicle). —1 CARRIER NAME Z ADDRESST. 01 r . . . . CITY/STATE/ZIP g - MOTOR CARR.ID 0 Interstate ❑ Intrastate I I T 0 Not in Comm./Govt. Not in Comm./Other Not To Scale0 USDOT NO. ILCC NO. m XI Source of above Z . ❑ Yes 0 No 0 Unknown g D Did Carrier Safety Regulations MCS)violation contribute to the crash? A ❑ Yes No ❑ 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'; 0 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' m TRAILER 1 ❑ ❑ 0 Z TRAILER 2 ❑ 0 0 O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. Z White White u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT 2 TOWED BY/TO: . SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/T6 DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE