HomeMy WebLinkAbout2026-00033949 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 1111111 H IIIl
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DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X 04269446
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INVESTIGATING AGENCY DAMAGE TO ANY ❑$500 OR LESS TYPE OF REPORT ® q No Injury 1 Drive Away
AGENCY CRASH REPORT NO. TRFW '
Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 14
VEHICLE/PROPERTY ®OVER 51,500 ❑NOT ON SCENE(DESK REPORT)
❑AMENDED ❑ B Injury and for Tow Due To Crash YR 202612026-00033949 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 rn
® ❑ RELATED ®Y ❑N 06 13 2026 ❑AM ❑YES ®NO U1 -<
N SPRING ST Elgin 04:14
_ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION M
E15 ®0 /MI N E S W East Chicago St COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR 0 SLOW 1 (n
g Kane HIT&RUN ❑V ® N WITH VEHICLES INVLD 0 STOPPED U2 --I
❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0
/8:DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 COMES 0 NW 0!CV 0 DJ DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 1 n
FRONT TOWED U1 0
NAME(LAST,FIRST,M) Iracheta. Ivan mo Chevrolet Cruze 2018 00-NONE 11 O i"_, DUE TO CRASH ❑
EN
13-UNDER CARRIAGE 10 2 FIRE ❑
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0U2 1 M
M 2 4 SY❑Y ®SNE❑UNK VEH. 0 ATCRASHO 0 99-UNKNOWN 9 76•TOP 3 `Distraction Value 9 ALGN =
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 7 :il a 4 COM VEH 0 j$J 2 O
~ Rantoul I L 61866 0 1 0 FIRST CONTACT 12 7_; _5 *IIYes.See Sidebar Ut
Z12210WT I L 2026 REAR
TELEPHONE
IL D 0 1 G1 BE5SM8J7217207 Insure On the Spot ❑Y IlN U2 m
in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
99 9 Same ILT6144542 1 r
`o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER
RESPONDER X*
Refused 0 Y ® N 2 c
x DRIVER ❑ PARKED ❑DRIVERLESS ❑ FED 0 PEDAL ❑EWES 0 iiuv 0 NOV 0 DV
9 9 7 y Yr Honda Accord 2025 00-NONE 11_"j Q�-_1 DUE TO CRASH ❑ 2
0 13-UNDER CARRIAGE 10 i 1. 2 FIRE 0 ® U2 C
F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16-TOP 3 X
❑Y NJ N ❑UNK VEH. AT CRASH 99-UNKNOWN *Oistraellon Value 9 0
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8
I 4 COM VEH ❑ ® U1 W
6
FIRST CONTACT 6 7A- I'_5 •If Yes.See Sidebar C
BARTLETT IL 60103 0 1 0 FC22228 IL 2027 PEAR0 Si)
IL D 0 1 HGCY1 F46SA004641 American Family Insurance ❑Y ®N RDEF71
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 =
99 9 Latifi. Belaal.A. 41 1 23-91 321-59 BAC
$
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP
U1 =
(UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJI 1(EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME))(ADDRESS)/(TELEPHONE) (EMS) (HOSPITAL)
1 3 01 /
LOG DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y
Z
N 1 ® 11 1 6/ ,31 /026 04 14 ®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
o"
2 ❑ 28 18 / / ❑PM• ❑Construction *
_
3 ❑ xiCITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 5
❑AM 0 Maintenance U2
o 1 ® 11 1 ARREST NAME Iracheta. Ivan 11-601 S1542-000909 / / ❑PM SLMT
llg CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME AM• El Utility
T 2 0 1 1 1 ARREST NAME Iracheta. Ivan 3-414 S1542-000910 6/ ,31 /026 05 00 ®PM El Unknown work zone type U1 25
2 2 3 ID OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 25
1542-Chase. Ethan 101 320-Cox 71 , 11 ,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 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 -
' }---.r----; - combination):or
INDICATE NORTH p0
BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver n
_ } (example:shuttle or charter bus):or
Not To Scale I 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier O
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} } } transporting employees in the course of their employment(example:employee
transporter-usually a van type vehicle or passenger car):or
L -----}----; - 1- I- } 4. Is used or designated to transport between 9 and 15 passengers,including the driver. N
for direct compensation(example:large van used for specific purpose):or O
L �____a____- i _ l. i. i _ 5. Is an vehicle used to transport hazardous material(HAZMAT)thatrequires 'D
_f____''FYr: placarding(example:placards will be anyisplayed on the vehicle). XI
♦ . 1
- - CARRIER NAME Z
_ __ ADDRESS 0
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CITY/STATE/ZIP g
'� - MOTOR CARR.ID 0 Interstate 0 Intrastate
I I T I ❑ Not in Comm./Govt. Not in Comm./Other
_ __ USDOT NO. ILCC NO. m
XI
Source of above z
. MCS E
0 Yes 0 No 0 Unknown Out of Service 0 Yes ❑No
Form Number 0
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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' m
TRAILER 1 ❑ ❑ 0 Z
TRAILER 2 ❑ 0 0 O
u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. Z
Blue White
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 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY/T6
DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE