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HomeMy WebLinkAbout2026-00035318 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets IUI III H IIII DIII U ll liii 1DDII 1IDDIUUlIDUU DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X004276433 u, 1 U21 2 4 1 U, 2 U2 1 U, 1 1_12 1 U, 1 U2 1 1 15 U1 1 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$1,500 El NOT ON SCENE(DESK REPORT) El Injury and/or Tow Due To Crash El AMENDED YR 202612026-00035318 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 r1 ST CHARLES ST Elgin 01:56 ® ❑ RELATED ' V 0 N 06 18 2026 ❑AM ❑YES El NO U1 -< _ _ g PRIVATE mo !day!yr ®PM FLOW CONDITION MFT!MI N E S W BENT ST COUNTY PROPERTY ❑Y ® N DOORING Ely #OF MOTOR ❑SLOW 1 (n ❑ Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD ❑ STOPPED U2 --I ® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 Qg3 DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EWES ❑NIAV ❑!CV 0 DV DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 n FOR DAMAGEDAREA(S) FRObrr TOWED U1 Q Johnson. Ro er. E. 1 1 / yr 13-UNDER CARRIAGE ©,I !�. 2 FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ® ❑ U2 EN 2 I'll M 2 SY4 ❑Y ❑STM NE CD UNK VEH. 9 AT CRASH 9 99-UNK 15- NOWN THER9 16•TOP 3 *Distraction Value 9 ALGN X. r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s it 6 ii,4 COM VEH 0 j$J 1 0 Fl ELGIN IL 60120 0 1 0 FIRST CONTACT 11 7_; __5 *IrYes.SeeSidebar U1 Z P972450 IL 2026 REAR TELEPHONE IL D 0 1 FMCUOG9ODUB13401 State Farm ❑Y Il N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 1 99 9 Same 1058013-SFP-13 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused 0 Y ❑ N 2 XI p; DRIVER ❑ PARKED 0 DRIVERLESS 0 FED 0 PEDAL 0 EWES 0 N4v 0 i v 0 Dv !2 0 0 7 Ford Explorer 2004 00-NONE 1("1 12 NT--_, DUE TO CRASH rg ❑ 2 x o Yr 13-UNDER CARRIAGE 'I FIRE El ® U2 II F 2 4 SYSTEM IN 9 ENGAGED 9 15-OTHER 9 1,6.TOP 3 X ❑Y ❑N ®UNK VEH. AT CRASH 99-UNKNOWN *0istraellon Value 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s-iI 6 ij:, 4 COM VEH ❑ ® U1 CO FIRST CONTACT 2 7�. -5 •If Yes.See Sidebar n E LG I N IL 60120 0 1 0 GB71784 IL 2026 aR IL D 0 1 FMDU75W14ZA22842 Kemper ❑Y ®N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = 1 99 9 Ramos.Juan.S. 12RA000101972 BAC $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP U1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJI 1(EJCTI (EPTH) PASSENGERS&WITNESS ONLY (NAME)((ADDRESS)((TELEPHONE) (EMS) (HOSPITAL) 2 3 07 / :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 06,18 /2026 01 56 ®PM in a Work Zone? ®N DIRP co 1 r PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME ❑AM If YES check one below: U1 7 C) T 0 2 0 2 15 , 1 ❑PNI 0 Construction Z 3 0 xi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 1 ❑AM ❑Maintenance U2 a ® 11 4 ARREST NAME Johnson. Roger. E. 11-901-A 1571000006 , / ❑PM SLMT o N ❑CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ' ❑0 Am Utility r 2 El ARREST NAME 061 1 8 12026 01 56 ®PM 0 Unknown work zone type U1 35 n T OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 ° ® Workers present? 35 1571-Rosas-Pereyra.Gerardo 401 367-Stein 07 , 13,2026 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 r ADDITIONAL UNITS FORMS. 111 r ----r••--, , Not To Scale II . 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 - INDICATE NORTH combination):or —I p1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C (example:shuttle or charter bus):or n 3. Is designed to carry15 or fewer passengers and operated a contract carrier O I1 - }} } transporting employee in the course of their employment(example:employee transporter-usually a van type vehicle or passenger car):or COL }-----}----; J - } } } 4. Is used or designated to transport between 9 and 1 passen rs,including the driver, C for direct compensation(example:large van used fors specific purpose):or < H — Lk 71 m < ____a _. �___ _ } } } any t 5. Is any vehicle used to transport hazardous material(HAZMAT)that requires placarding(example:placards will be displayed on the vehicle). XI ,' ® CARRIER NAME Z ADDRESS 0 w ICITY/STATE/ZIP g _ MOTOR CARR.ID 0 Interstate ❑ Intrastate I I • I I 0 Not in Comm./Govt. Not in Comm./Other 0 • USDOT NO. ILCC NO. C m Xl Source of above z . ❑ 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 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 Gray 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 DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® DISABLING DAMAGE Redmons/Owners Residence VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE