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HomeMy WebLinkAbout2026-00034757 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 I0110 111111011 XO 101111 II DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV O4272424 u, 1 U21 2 4 1 u, 3 U2 1 u, 1 1_12 1 u, 1 U2 1 1 10 u, 3 U2 1 *P 0119 INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW ' DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 14 VEHICLE/PROPERTY ®OVER 51,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash El AMENDED YR 202612026-00034757 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 rn E CHICAGO ST Elgin 02:27 ® ❑ RELATED ®Y 0 N 06 16 2026 ❑AM ❑YES IX]NO U1 -< g PRIVATE mo !day!yr ®PM FLOW CONDITION Ill FT N E S W WOODVIEW DR COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR 0 SLOW 1 (n ❑ Cook HIT ❑Y ® N WITH VEHICLES INVLD 0 STOPPED U2 —I ® &RUN AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST IZI N 51 FREE FLOW # LNS 0 Qg3 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EDUES 0 wuv 0 ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 n _ 0 5 / yr 13-UNDER CARRIAGE ©it),I �:: FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 ]$I U2 2 rn F 2 8 SYTM❑Y ®SNE❑UNK VEH. 0 AT CRASH 0 15-99-UUNKNOWN THER9 16•TOP 3 `Distraction Value ALGN - r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s, ii_6 I,.4 COM VEH 0 E! 2 O ~ ELGIN N I L 60120 0 1 0 FIRST CONTACT 12 7 ; _5 *IIYes.See Sidebar U1 Z FG98351 IL 2027 REAR TELEPHONE IL D 0 2HGFA1 F50AH325598 State Farm ❑v Igl N U2 13 . m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Carreno-Vazquez. Rafael. R. 3116513SFP13 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER RESPONDER 2 XI m E{ DRIVER ❑ PARKED 0 DRIVERLESS ❑ PED 0 PEDAL 0 EWES 0 NAV 0 ICV ❑Dv yr Q 2 �1 0 13-UNDER CARRIAGE 1a j ©( 2 FIRE ❑ ® U2 C F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9,16•Top 3 X ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN *0istraellon Value 0 s . 4 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF i1 6 II COM VEH ❑ ® U1 CO FIRST CONTACT 1 Y _, _5 •byes,See Sidebar H CAROL STREAM IL 60188 0 1 0 FX33549 IL 2027 I 0 IL D 0 3N1AB9CV3TY216917 Geico ❑Y ®N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Garcia.Theresa, M. 6162245192 BAG $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP u1 = (UNIT) (SEAT) (DOBi (SEX) {SAFT) (AIR) (INJI 1(EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)!(ADDRESS)/(TELEPHONE) (EMS) (HOSPITAL) 2 4 09 / :A / / UI 1 D / / 3 0 EV MOST EVNT LOG DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 11 4 6/ ,6/ l026 02 27 ®PM 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 ❑ 1 3 23 28 ! , ❑PM• ElConstruction >F R 3 0 El CITATIONS ISSUED ElPENDING SECTION CITATION NO. EMS ARRIVED TIME 7 ❑AM ❑Maintenance U2 o1 ® 11 4 ARREST NAME Carreno Mojica. Elizabeth 11-904-B 482000710 , ! ❑PM SLMT o N ❑CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ❑Utility 30 t 2 ARREST NAME AM 7 El / ❑❑PM ❑Unknown work zone type U1 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑AM Workers present? ❑y 35 482-Flentye.Jeremy 302 331-Ziegler 71 112 ,26 01 30 ®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 rcombination):or more than pounds(example:truck or truck/trailer 1. Hasa weight rating10 000 5 � -< INDICATE NORTH BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver n t - } (example:shuttle or charter bus):or X L --I-- AJ.40 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I O SO } } } transporting employees in the course of their employment(example:employee X enger C i. -----}----; - I. } } •transporter. sed or des gnated to transport betweelly a van type vehicle or n 9 and 15rpassen passengers,including the driver, j0 for direct compensation(example:large van used for specific purpose):or � L a- t i 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m --- placarding(example:placards will be displayed on the vehicle). XI -1 0 - CARRIER NAME Z i I ADDRESS 'Z /4# 1T.Not To Scale j 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 ;------ --1 - USDOT NO. ILCC NO. m XI Source of above z ' . MCS ❑Yes 0 No 0 Unknown Out of Service ❑Yes ❑No 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 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 3 TOWED BY/TO. _Redmons/Impound Lot Garage . SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/TO: DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE