HomeMy WebLinkAbout2026-00034198 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111
0110 111111011100VVOOl000
DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X 04269413
u, 1 U21 1 1 1 U1 2 U2 1 u, 1 u2 1 U, 1 U2 1 1 10 u1 3 U2 1 *P 0119*
INVESTIGATING AGENCY DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT 0 A No Injury 1 Drive Away
AGENCY CRASH REPORT NO. TRFW
Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 2
VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and!or Tow Due To Crash
❑AMENDED YR 2026I 2026-00034198 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 7
® ❑ RELATED PRIVATE ❑Y ®N 06 14 2026 ❑AM ❑YES ®NO U1 '<
N STATE ST Elgin mo /day/yr 02:30 ®PM FLOW CONDITION M_
COUNTY PROPERTY ❑Y ® N DOORING Ely #OF MOTOR 0 SLOW 2 fA
0 10 D/MI N E O,N Frazier Ave WITH VEHICLES INVLD 0 STOPPED U2 --I
El AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) Kane HIT&RUN ❑Y ® N PEDALCYCLIST®N ® FREE FLOW # LNS 0
Ig:DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 Peon. 0 EDUES 0 NOV 0 Ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4
FOR DAMAGED AREA(S) FROM 0
NAME(LAST,FIRST,M) VILLARRAGA ORTIZ. DOXON. D. mo 6 /
13-UNDER CARRIAGE FIRE 0
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 10 -O DISTRACTED ❑ ]$I U2 4 <Tl<
)
M 2 8 SYTM❑Y ®SNE DUNK VEH. 0 AT CRASH 0 99-UNK 15- NOWN THER9 t6•TOP® *Distraction Value 9 ALGN X.
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF $_iL a ii,4 COM VEH 0 Ea 1 0
~ ELGIN I L 60123 B 1 0 FIRST CONTACT 2 7_;-R--5 *It Yes.See Sidebar U1
Z CA54625 IL 2027
TELEPHONE
IL D 0 5J6RM4H47GL041142 STATE FARM ®Y ❑N U2 m
.5 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
co
Elgin Fire 99 9 Torres.Jessica 2125176-SFP-13 1 r
o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER
RESPONDER
2 ou
m E{ DRIVER ❑ PARKED 0 DRIVERLESS ❑ FED ❑PEDAL ❑EWES ❑NI AV 0 Ncv ❑DV
/1 9 4 7 Ford F150 2012 00-NONE O-i Q1-0 DUE TO CRASH rg ❑ 2 x
o 13-UNDER CARRIAGE 10) I. 2 FIRE 0 ® U2 C
M 2 5 SYSTEM IN 0 ENGAGED 0 15-OTHER 9,16-TOP 3 X
❑Y i N DUNK VEH. AT CRASH 99-UNKNOWN *Oistraglon Value 9 0
POINT OF 8 i1�t 4 COM VEH 0 ® U1 CO
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR FIRST CONTACT 12 7� B .5 •)ryes.See Sidebar
= Algonquin IL 60102 B 1 0 19389N B IL 2026 I 0 C
Z
IL D 0 1 FTFX1 EF8CFB52280 BRISTOL WEST ❑Y ®N RDEF
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 =
Elgin Fire 99 9 Same G01754316900 BAC
E
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 <
Refused RESPONDER
U1 =
(UNIT? (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJI j(EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)((ADDRESS)((TELEPHONE) (EMS) (HOSPITAL)
1 4 06 /
D
/ / 2 0
EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z
N 1 ® 11 1 ZZA FACTORY ZZA Factory Sign I Lawn 06/14 /2026 02 44 ®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 ,,
2 0 751 N STATE ST ELGIN IL 60123 2 06 06,14 /2026 02 51 pM
® • ❑Construction �F
R O 0 CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 1
3 ❑AM ❑Maintenance U2
-a, ARREST NAME VILLARRAGA ORTIZ. DOXON. D. 3-707 1570-000128 06/14/2026 02 59 Igi pM SLMT
1 ER11 1 lgiCITATIONS ISSUED 0 PENDING Utility
o N SECTION CITATION NO. ROAD CLEARANCE TIME AM• ❑
t 2 El ARREST NAME VILLARRAGA ORTIZ. DOXON. D. 11-801-B 1570-000127 06/14 /2026 03 30 0 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
1570-Tomlin. Eli 500 320-Cox 07 , 14/2026 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.
r ----r••--, , lasilkt-- I A CMV is defined as any motor vehicle used to transport passengers or property and: D
A
��
1. Has a weight rating more than 10,000 pounds(example:truck or truck trader z
i- }-----I-----I Not To Scale : - combination):or —I
-- INDICATE NORTH p1
1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C
(example:shuttle or charter bus):or 0
J r 3. Is designed tocarry 15 or fewer passengers and operated a contract carrier O
f 5
es pa g pe
+ } } } transporting employees In the course of their employment(example:employee
I transporter-usually a van type vehicle or passenger car):or W
I ICI } } } •4. Is used or designated to transport between 9 and 15 passengers,including the driver, C
for direct compensation(example:large van used for specific purpose):or O
L L____a____. 1 I _ } } } L 5. Is any vehicle used to transport anyhazardous material(HAZMAT)that requires
Ir;,-_ placarding(example:placards will be displayed on the vehicle). XI
�l' D
I !!' CARRIER NAME Z
(\ h. HMI _ ADDRESS 0
1 to
r r -:- 1 \ \ \ \\ r r r r -:- CCITY/STATE/ZIPg
- MOTOR CARR.ID 0 Interstate 0 Intrastate
I I T I , n
❑ Not in Comm./Govt. Not in Comm./Other
--- --1 USDOT NO. ILCC NO. m
XI
Source of above z
. —I
Were HAZMAT placards on vehicle? 0 Yes 0 No =
If Yes,Name on placard O
4 digit UN NO. 1 digit Hazard class No. Xl
Xl
Did HAZMAT spill from vehicle(do NOT consider FUEL from vehicle's 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
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
Blue Blue
u 1 TOWED •
TOTAL VEHICLE LENGTH ft. NO.OF AXLES_
DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT 3 TOWED BY/TO.
Redmons . SELECT CODES FROM THE BACK OF CRASH BOOKLET
U 2 TOWED DISABLING DAMAGE NOT DAMAGE EXTENT: 3 TOWED BY/TO.DUE TO ® DISABLING DAMAGE Redmons VEHICLE CONFIG._CARGO BODY TYPE LOAD TYPE