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HomeMy WebLinkAbout2026-00035944 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets II III II IIIIII UHI II II III I IIIII II11111 11 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X604276519' u, 2 U21 1 1 1 U116 U2 1 u, 1 U2 1 U1 1 U2 1 4 14 u1 1 U2 1 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT El A No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW ' Elgin Police Department ONE PERSON'S ❑5501-51,500 ®ON SCENE 1 VEHICLE/PROPERTY ®OVER 51,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash 0 AMENDED YR 2026I 2026-00035944 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n ® ❑ RELATED ®Y 0 N 06 21 2026 ®AM ❑YES ®NO U1 -< BENT ST Elgin 01:55 _ _ g PRIVATE mo /day/yr ID PM FLOW CONDITION M FT l MI N E S W CLEVELAND AVE COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR 0 SLOW 2 fA ❑ Cook HIT ❑V ® N WITH VEHICLES INVLD 0 STOPPED U2 —I CO AT RUN AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST IZI N ® FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED 0 PEDAL 0 EWES ❑NW 0!Cy 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) y N 2 n r rr TOWED U1 Q Zelaya Elvir. Eder Nissan Versa 2007 00-NONE z DUE TO CRASH ® ❑ O NAME(LAST,FIRST,M) y mo yr 13-UNDER CARRIAGE ©i -0 FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 2 THERDISTRACTED 0 ]$I U2 2 rr1 M 2 SYTM 5 ❑Y ®SNE DUNK VEH. 0 AT CRASH 99-UUNKNOWN 9 16•TOP 3 *Distraction Value ALGN - r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s, it a �i 4 COM VEH 0 Ea 2 O ELGIN IL 60120 B 1 0 FIRST CONTACT 11 7_; -__5 *IIYes.SeeSidebar U1 ZES45712 IL 2026 REAR TELEPHONE IL D 3N1BC13E17L359838 All State ®Y ❑N U2 M 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m ce Elgin Fire Paulino-Hernandez. Ricardo 979093624 1 r o HOSPITAL(TAKEN TO) INCIDENT IF IC OWNER STREET,CITY.STATE,ZIP PHONE NUMBER RESPONDER 2 ou E{rg- DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 row 0 NCv 0 DV /2 0 0 7 Chevrolet Silverado 2013 00-NONE O, . 12.._, DUE TO CRASH 0 !1 2 x o _y Yr 13-UNDER CARRIAGE ta,i 2 FIRE ❑ ® U2 C Ti M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16•TOP 3 ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN *Oistraci n Value 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s .i�..__4 COM VEH ❑ ® U1 CO F„ FIRST CONTACT 11 7 _,r_5 •If Yes.See Sidebar C ELGIN IL 60120 0 1 0 3873950B IL 2026 0 N M IL D 1 GC1 KYE85DF175228 Gainsco Auto Insurance ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER 1 = Plata-Herrera.Justin ILPA38108572-0000 BAG $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP Ui = {UNIT) (SEAT) (DOB' (SEX) {SAFT) (AIR) (INJI 1(EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME),(ADDRESS)((TELEPHONE) (EMS) (HOSPITAL) 2 4 08 / :A / / UI 1 D / / 3 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z N 1 ® 11 1 06,21 /2026 01 55 ®❑PM in a Work Zone? ®N DIRP co 1 r PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 1 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ®AM U1 C) 2 0 28 08 06,21 ,2026 O1 55 PM ❑ ❑Construction * Z 3 0 ❑CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVE) TIME 5 ®AM ❑Maintenance U2 ARREST NAME 06/21 /2026 01 59 ❑PM N 1 ® 11 1 0 CITATIONS ISSUED ❑PENDING UtilitySLMT o SECTION CITATION NO. ROAD CLEARANCE TIME El AM 30 r 2 ElARREST NAME 06/21 /2026 02 47 M PM 0 Unknown work zone type U, 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 301545-VanEycke. Brier 401 08 ,02,2026 10 30 El 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 ponds{example:truck or truck trailer -< i- ;--__r-_--; . Not To Scale INDICATE NORTH p0 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C - } (example:shuttle or charter bus):or X L Aid } } }l 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I O transporting employees In the course of their employment(example:employee X enger or CO L -----}----; (IIII - } } transporter. sed or des gnated to translly a van type port betweeicle or n 9 and 15 passengers,ssen rs,including the driver, C } } for direct compensation(examp:large van used for specific purpose):or L L____a____. i i 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m '.'w placarding(example:placards will be displayed on the vehicle). XI leiZ D ., CARRIER NAME —I pp0. I i. 'i. , ' , ' ADDRESS D rA C) CITY/STATE/ZIP g MOTOR CARR.ID 0 Interstate ❑ Intrastate ; .,—,.ram 0 Not in Comm./Gout. 0 Not in Comm./Other ----------1 - USDOT NO. ILCC NO. m XI Source of above z . IDOT PERMIT NO. WIDELOAD-; ❑Yes 0 No = 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 0 0 Z TRAILER 2 ❑ 0 0 o u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w Gray White 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: 1 TOWED BY/TO: DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE