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HomeMy WebLinkAbout2026-00036282 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets III III 11 IIII UHI UU II III 1l11UU I11 11HHOO1DD DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X004281977' u, 1 U21 3 4 1 U1 3 U2 1 U, 1 1_12 1 U, 1 U2 1 1 10 u1 1 U2 3 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY ❑$500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW ' Elgin Police Department ONE PERSON'S ❑$501-$1.500 ®ON SCENE 14 VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash El AMENDED YR 2026I 2026-00036282 VENT ADDRESS NO. HIGHWAY or STREET NAME ® ❑CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 r1 RT20 RELATED ®Y 0 N 06 22 2026 07:12 ❑AM ❑YES ®NO U1 Elgin PRIVATE mo /day/yr ®PM FLOW CONDITION m FT!MI N E S W SHALES PKWY COUNTY PROPERTY ❑Y ® N DOORING ICIy #OF MOTOR 0 SLOW 1 (/)❑ Cook 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 Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EDUCE 0 uuv 0!Cy 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 00 C) FRO T TOWED U1 FOR DAMAGEDAREA(S) 0© Delgadillo.Jennifer.A. 0 8 / yr 13-UNDER CARRIAGE ,I �:. 2 FIRE 0 lE STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL)THERDISTRACTED 0 0U2 00 M F 2 8 SYTM❑Y ®SNE El LINK VEH. 0 AT CRASH 0 15-99-UNKNOWN 9 16•TOP 3 *Distraction Value 9 ALGN - r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s, it 6 _5 *II Yes.See Sidebar Ut 4 COM VEH 0 0 1 0 F. FIRST CONTACT 12 7 ,_ Z SOUTH ELGIN IL 60177 C 1 0 EN50788 IL 2027 T's TELEPHONE IL D 0 2G 1 FC1 E35E9220363 State Farm ❑Y Il N U2 I' in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Elgin Fire 99 9 Same 3974266-SFP-13 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused El El 2 0 N DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 iiuv 0 i v 0 Dv /1 9 9 9 Audi A4 2018 00-NONE „ `'Oj.-_, DUE TO CRASH rg ❑ 2 x 0 Yr 13-UNDER CARRIAGE FIRE 0 ® U2 C c M 2 8 SYSTEM IN 0 ENGAGED 0 15-OTHER O9 16-TOP 3 X ❑Y NJ N ❑UNK VEH. AT CRASH 99-UNKNOWN *Distraction Value 9 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 5 I .�,. COM VEH 0 ® Ut CO F„ FIRST CONTACT 11 7 _, _5 C.)ryes.See Sidebar C ELGIN I L 60120 C 1 0 CW31285 I L 2026 0 Si) IL D 0 WAUKMAF43JA147774 Travelers Insurance ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X Elgin Fire 99 9 Same 610216690 203 2 SAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPONDER u1 = (UNIT) (SEAT) (DO81 (SEX) {SAFT) (AIR) (INJI 1(EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)/(ADDRESS)((TELEPHONE) (EMS) (HOSPITAL) 1 6 08 / 7/ / / UI 3 m / / 1 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z N 1 ® 11 4 06/22 /2026 07 12 ®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) ✓ 2 0 28 25 06/22 /2026 07 13 ®PM El Construction 3 ❑ igi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 5 z J ❑AM ❑Maintenance U2 o ® 11 4 ARREST NAME Delgadillo.Jennifer.A. 11-601-Ax 1561-000346 06/22/2026 07 16 ®PM SLMT o N ❑CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ❑Utility T 2 El ARREST NAME 06/22 /2026 07 56 ®PM 0 Unknown work zone type 0 AM U1 45 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 45 1561-Sarovic• Mirko 401 302-Snow 08 /04/2026 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••--, , ; 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 truckrtrailer -< Not To Scare N ; combination):or —I r }----r----, r I. INDICATE NORTH p1 / 1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C r r r (example:shuttle or charter bus):or X / I 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I O }____A____� I — - I. } } } transport) em to eesin the course of their em %► � ` I*I transporters-usually a van type vehicle or passenger carj(orxample:employe e 1 t C -- -- ® _ _ } } } •4. Is used or designated to transport between 9 and 15 passengers,including the driver. N for direct compensation(example:large van used for specific purpose):or o __ __ ® t i 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. . D CARRIER NAME z — — — — ( 1 — — _ ADDRESS 0 — — — — w 1 I li r : :- :- 1- CITY/STATE/ZIP n 0 I 1 _ i. i. i. i. MOTOR CARR.ID 0 Interstate 0 Intrastate . ; ❑ Not in Comm./Govt. 0 Not in Comm./Other I. --- --4. - USDOT NO. ILCC NO. m XI Source of above z . IDOT PERMIT NO. WIDELOADo ❑Yes 0 No = 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 Blue 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 TOWED DISABLING DAMAGE NOT DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® DISABLING DAMAGE Redmons/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE