HomeMy WebLinkAbout2026-00036211 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets II
III II IIIIII UHI
II II liii
IIIIII IIIIIIIIIIII
DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X004278035
u, 1 U21 3 4 1 u1 2 U2 1 u, 1 U2 1 u1 1 U2 1 1 10 u1 3 U2 1 *P0119*
INVESTIGATING AGENCY DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away
AGENCY CRASH REPORT NO. TRFW '
Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 1
VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash
El AMENDED
YR 2026I 2026-00036211 VEHT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 —n
® ❑ RELATED ®Y 0 N 06 22 2026 ❑AM ❑YES ®NO U1
BIG TIMBER RD Elgin04:01
g PRIVATE mo /day/yr ®PM FLOW CONDITION m
FTlMI N E S W N MCLEAN BLVD COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 1 cn
❑ Kane HIT&RUN ❑V ® N WITH VEHICLES INVLD ® STOPPED U2 —I
® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ❑ FREE FLOW # LNS 0
Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EDUCE 0 uuv 0!CV ❑Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 n
1 1 FOR DAMAGEDAREA(S) FRONT TOWED U1 Q
NAME(LAST,FIRST,M) Hernandez. Felix. N. mo / !1 9 8 2 Ford F150 2011 oo-NONE „,_ O'i_, DUE TOCRASH ® ❑
13-UNDER CARRIAGE 10 i , 2 FIRE ❑
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ❑ 0 U2 4 rn
M 2 4 ❑Y ®SNEM❑UNK VEH. AT CRASHIN n ENGAGED 99-UNKNOWN 9 76•TOP 3 *Distraction Value 9 ALGN 2
T CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF S i�S 4 COM VEH 0 j$J 1 0
~ ELGIN I L 60123 0 1 0 FIRST CONTACT 12 7 ; _5 *Irves.See Sidebar U1
Z B4072207 IL 2026 REAR
M TELEPHONE
IL D 1 FTFX1 CF2CFB48955 State Farm ❑Y ®N U2 m
in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
Elgin Fire Noris. Limus 8527543-SFP-13 1 r
`o HOSPITAL(TAKEN TO) INCIDENT IF IC OWNER STREET,CITY,STATE,ZIP PHONE NUMBER
RESPONDER
2 7/
m g DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 r My 0 NCv ❑DV CIRCLE NUMBER(S) U1
!2 0 0 7 Mazda 3 2012 Do-NONE O Qj•O DUE TO CRASH El
13-UNDER CARRIAGE I FIRE ❑ El U2
Ti
M 2 4 SYSTEM IN 9 ENGAGED 9 15-OTHER 9,I. 3
TOP
❑Y El ®UNK VEH. AT CRASH 99-UNKNOWN *0istracton Value 9 0
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8-.i1 S I;-4 COM VEH ❑ ® U1 W
FIRST CONTACT 12 7.._ >_5 •If Yes,See Sidebar
ELGIN IL 60123 0 1 0 FG64043 IL 2026 � 0
IL D J M 1 BL1 V79C1555085 Progressive ❑Y ®N RDEF 71
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X
Elgin Fire Benganovic. Naser 868749221 BAC
E
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP
u1 =
(UNIT) (SEAT) (008) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)!{ADDRESS)/(TELEPHONE) (EMS) (HOSPITAL)
1 0
EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z
N 1 ® 11 1 06,22 ,2026 04 01 ®AM in a Work Zone? ®N DIRP co
1 t PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 7
T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 C)
v 2 ❑ 2 28 06,22 ,2026 04 01 ®PM El Construction
>E
R ❑ gi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 3
3 ❑AM ❑Maintenance U2
o 1 ® 11 1 ARREST NAME Hernandez. Felix. N. 11-901-A S1552000276 06,22,2026 04 05 ®pM SLMT
I$[CITATIONS ISSUED 0 PENDING •
SECTION CITATION NO. ROAD CLEARANCE TIME • ❑Utility
NAM
o r 2 ❑ ARREST NAME Hernandez. Felix. N. 6-101 S1552000375 06,22 ,2026 05 17 ®PM ❑Unknown work zone type U1 40
2 2 3 D OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑AM Workers present? ❑Y 40
1552-Thompson.Ahmad Rashad 501 07 ,21 ,2026 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•---, , ! j j A CMV is defined as any motor vehicle used to transport passengers or property and: z
4
1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer
c ` --I -' r INDICATE NORTH combination):or -I
Blg?Ttmber?Rd BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C
i - - - - } (example:shuttle or charter bus):or 0
X
i I I Untt 2 I.- 3. Is designed tocarry 15 or fewer passengers and operated by a contract carrier I O
I- -A-.-.JI. } transporting employees in the course of their employment(example:employee 731. } transporter-usually a van type vehicle or passenger car):or w
i. L.___------ - - - -
4. Is used ordesi natedtotrans rtbetween9and15 passengers,including C
I. for direct compensation(example:large van used for specificpurpose):or [he driver,
Pe ( P 9 Pe or o
.D
. t 5. Is any vehicle used to transport anyhazardous material(HAZMAT)that requires
I rn
� 1 placarding(example:placards will be displayed on the vehicle). XI
I --
CARRIER NAME Z
Unit I 1 ADDRESS
0
0 I I Not To Scale ( w
CITY/STATE/ZIP I n
IMOTOR CARR.ID ❑ Interstate ❑ Intrastate
IN?Md °?elvp ' ' ' 0 Not in Comm./Govt. 0 Not in Comm./Other
--- -1 USDOT NO. ILCC NO. m
XI
Source of above z
. own tank)? 0 Yes ® 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 ®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
Black 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 TOWED DISABLING DAMAGE NOT DAMAGE EXTENT: 3 TOWED BY/TO:
DUE TO ® DISABLING DAMAGE Redmons/Police Department VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE