HomeMy WebLinkAbout2026-00036564 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 01111101111
I0110
II III )III IIIIIII III IIII II
DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X004287369*
u, 9 U21 3 4 1 U1 2 U2 1 u,99 u2 1 u,99 u2 1 1 10 u, 3 U2 3 .P0119*
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 202612026-00036564 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 rn
® ❑ RELATED ®Y 0 N 06 23 2026 ❑AM ❑YES ®NO U1 -<
N MCLEAN BLVD Elgin 04:50
_ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION m
FT!MI N E S W TIMBER DR COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 15
❑ Kane HIT&RUN ®Y ❑ N WITH VEHICLESOT,
INVLD DO
U2 --I
El AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0
Qg3 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EouES 0 uuv 0 ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 00 0
0 6 /
yr H yundai 1t... 12
_
13-UNDER CARRIAGE 19 2 EN
FIRE 0 IE
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ® T1
0 U2 00 <<
M 9 SY15-OTHER
9 ❑Y ®SNE El LINK VEH. 0 AT CRASH M IN D 0 99-UNKNOWN 9 16•TOP 3 *Distraction Value 9 ALGN 2
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF $_iL a 4 COM VEH ❑ j$J 1 0
ELGIN IL 60120 0 9 0 FIRST CONTACT 99 T. _5 *IIYes.SeeSidebar U1
ZFZ25006 IL 2027 REAR
TELEPHONE
IL D 0 KMHCT5AE5DU129731 NIA El ❑N U2 I''I
in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
99 9 MORENO VELASCO. NICOL.X. NIA 1 r
o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER
r RESPONDER G0)
m
g DRIVER 0 PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 My 0 NCv 0 Dv CIRCLE NUMBER(S) U1
Mazda CX5 2016 00-NONE ,, ' t2 DUE TO CRASH gi ❑ 2
.. 13-UNDER CARRIAGE I FIRE ❑ El U2
c
F 2 5 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 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 s i1 4 A_, _5 )ryes.See Si ❑ ® U1 COdebar 5 lf�_
COM VEH•
PINGREE GROVE IL 60140-9116 0 1 0 EQ88303 IL 2026 FIRST CONTACT I Y REAR C
IL D 0 JM3KE4CY9G0688536 NIA ❑Y ❑N RDEF
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 =
Elgin Fire 99 9 Same NIA BAG $
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 <
Refused RESPONDER u1 =
(UNIT) (SEAT) (DOOi (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)((ADDRESS)/(TELEPHONE) (EMS) (HOSPITAL)
:A
/ / UI 1 D
/ / 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 06,23 /2026 04 50 ®AM in a Work Zone? ®N DIRP co
1 r 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 0 2 06 06,23 /2026 04 51 ®PM ❑Construction >E
R 3 0 gi CITATIONS ISSUED ElPENDING SECTION CITATION NO. EMS ARRIVED TIME 1
z J ❑AM ❑Maintenance U2
a1 ® 11 4 ARREST NAME Martinez.Zaira 3-707 1561-000348 06/23/2026 04 54 Igi PM• • El Utility SLMT
lgi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. ROAD CLEARANCE TIME
o N AM30
r 2 0 ARREST NAME Martinez,Zaira 3-708 W1561-000349 06/23 /2026 04 51 ®PM ElUnknown work zone type U1
2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM workers present? ❑Y 30
1561-Sarovic• Mirko 502 337-Thompson 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 truck trailer -<
` ' N combination):or —I' o I INDICATE NORTH p1
Ate Tto Scale I I I BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C
i — - } (example:shuttle or charter bus):or
I ''' l { ® 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I O
I- <.__-A----J. r — I. } I.- . transportingemployees yees in the course of their employment(example:employee
_ _ em transporter-usually a van type vehicle or passenger car):or w
i. }-----}. ..; - I. } } 1 •4. Is used or designated to transport between 9 and 15 passengers,including the driver. C
j 1 for direct compensation(example:large van used for specific purpose):or
L L L L 1 t 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires 'D
a placarding(example:placards will be displayed on the vehicle).
m
CARRIER NAME Z
ADDRESS 0
I 4..
CD tn
I I CITY/STATE/ZIP 0
I 'Z' I I ,.I I - MOTOR CARR.ID 0 Interstate 0 Intrastate
I r ❑ Not in Comm./Govt. 0 Not in Comm./Other
--- --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,Dark White
u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_
DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT 9 TOWED BY/TO:
_ SELECT CODES FROM THE BACK OF CRASH BOOKLET
U 2 TOWED DISABLING DAMAGE NOT DAMAGE EXTENT: 2 TOWED BY/TO:
DUE TO ® DISABLING DAMAGE Redmons/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE