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HomeMy WebLinkAbout2026-00038619 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets IIIIII 11 IIII 11111111 II I 11111111111111 UU DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X004295638 u, 1 U21 3 4 1 U1 4 U2 1 U, 1 1_12 1 U1 1 U2 1 1 10 u, 1 U2 3 *P 0119* 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 14 VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash 0 AMENDED YR 2026I 2026-00038619 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n ® ❑ RELATED ®Y 0 N 07 01 2026 ❑AM ❑YES ®NO U1 -< E CHICAGO ST Elgin 06:05 _ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION m FTlMI N E S W POPLAR CREEK DR COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 15 ❑ Cook HIT&RUN ❑V ® N WITH VEHICLES INVLD DO U2 —I lgi AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N 51 FREE FLOW # LNS 0 Qg3 DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EWES ❑uuv ❑!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 00 n FOR DAMAGEDAREA(S) FROM TOWED U1 Q Ramos. Hu o 0 3 / yr 13-UNDER CARRIAGE ©i !-O FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) O DISTRACTED ® 0 U2 00 M M 2 8 ❑Y ®SNEM❑UNK VEH. 0 AT CRASH IN ENGAGE0 99-UNTHER KNOWN O9 16-TOP 3 ,Distraction Value 9 ALGN = r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6 1 6 1i 4 COM VEH ❑ Ea 1 0 ELGIN IL 60120 0 1 0 FIRST CONTACT 11 7 ; __5 *lI Yes.See Sidebar U1 Z DB37822 IL 2026 E TELEPHONE IL D 0 1 HGCR3F81 EA006605 Progressive ❑Y ®N U2 m 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Elgin Fire 99 9 Mendez.Juan.A. 872723689 1 r o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER RESPONDER 2 ou p; DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NMv 0 NCv 0 DV CIRCLE NUMBER(S) U1 1 9 9 0 Toyota RAV4 2024 00-NONE 'o,�l t2 ;,-2 DUE FIREO CRASH 0 ® U2 2 C .. 13-UNDER CARRIAGE c M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9.16-TOP 3 X ❑Y i N 0 UNK VEH. AT CRASH 99-UNKNOWN O *Oistracl n value 9 4 POINT OF 8 I 1,:,,,4 COM VEH ❑ ® U1 CO N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR 6 FIRST CONTACT 5 7 —_, S •ICYes,See Sidebar MERRILLVILLE IN 46410 C 1 0 LM7765 IN 2026 REAR 0 C IN D 9 JTM B6RFV4N D527103 Allstate ❑Y123 N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Elgin Fire 99 9 Same 932 995 052 SAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPONDER u1 = (UNIT) (SEAT) (DOB) (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 0 Y U2 Z N 1 ® 11 4 07/01 /2026 06 05 ®AM in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 3 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 C) v 2 0 28 25 07,01 /2026 06 06 ®PM El Construction >F R 3 0 0 CITATIONS ISSUED ElPENDING SECTION CITATION NO. EMS ARRIVED TIME 4 z J ❑AM ❑Maintenance U2 a ® 11 4 ARREST NAME Perez-Castaneda.Joel 11-601-Ax 1561-000358 07/01 /2026 06 10 ®PM SLMT o N 0 CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ❑Utility t 2 El ARREST NAME 07/01 /2026 06 50 0 PM 0 Unknown work zone type 0 AM U1 30 n T OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 0 1561-Sarovic, Mirko 8837 393-Gutierrez 08 ,04/2026 09 00 ®❑PM Workers present? ®N U2 30 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----r----, , Not To Scale 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 c r -' -' r INDICATE NORTH combination):or -< BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C _ } (example:shuttle or charter bus):or A ' 3. Is designed to carry 15 or fewer passengers and operated a contract carrier 0 } } } transporting employees In the course of their employment(example:employee - transporter-usually a van type vehicle or passenger car):or w L }-----}----; - } } } 4. Is used or designated to transport between 9 and 15 passengers,including the driver. w for direct compensation(example:large van used for specific purpose):or ''�' '�)► } I. } t 5. Is any vehicle used to transport any hazardous the vehicle). l(HAZMAT)that requires M -" placarding(example:placards will be displayed on the vehicle). I CARRIER NAME Z I ADDRESS 0 C) CITY/STATE/ZIP 0 MOTOR CARR.ID 0 Interstate El Intrastate I I T ❑ Not in Comm./Govt. Not in Comm./Other0 ; _Y_ __ USDOT NO. ILCC NO. m XI Source of above z . IDOT PERMIT NO. WIDELOAD-; ❑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 White White u 1 TOWED • TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ® DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT' 3 TOWED BY/TO. Arties/Impound Lot Garage . SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® Arties/Impound.Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE