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HomeMy WebLinkAbout2026-00039080 ILLINOIS TRAFFIC CRASH REPORT sheet 1 Df 2 Sheets III III 11 IIII UHI U Il III111111111111111111 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV XOD42..811/ u, 1 U21 2 7 2 U1 2 U2 1 U1 1 U2 1 U1 1 U2 1 3 10 U, 3 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-$1.500 ®ON SCENE 14 VEHICLE/PROPERTY ❑OVER 51,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash El AMENDED YR 2026I 2026-00039080 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 rl ® ❑ RELATED ®Y ❑N 07 03 2026 ❑AM ❑YES ®NO U1 CONGDON AVE Elgin 01:12 _ _ g PRIVATE mo /day/yr NPM FLOW CONDITION m FTlMI N E S W PRESTON AVE COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 1 (n ❑ Kane HIT&RUN ❑V ® N WITH VEHICLESOT, INVLD ❑ STOPPED U2 —I CO AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 Q$3 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 2 Honda CRV 2014 00-NONE DUE TO CRASH ® ❑ FOR DAMAGEDAREA(S) FRO T TOWED U1 0 NAME(LAST,FIRST,M) Sanchez Orellana. Darltza Yessenia mo yr ©1 12 13-UNDER CARRIAGE 9 I I! 2- FIRE ❑ IE STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) © DISTRACTED 0 0 U2 2 m F 2 SYTM IN ENGAGE4 ❑Y ®SNE❑UNK VEH. O AT CRASHD O 99-UNKNOWN 9 16•TOP 3 *Distraction Value 9 ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8, it S Ii COM VEH 0 0 1 C) I . FIRST CONTACT 11 7__ --_;__-5 *IIYes.See Sidebar U1 0 Z Chicago IL 60641 0 1 0 FE63994 IL 2026 REAR TELEPHONE UNK. D 2HKRM4H58EH128399 Unique Insurance Company ❑Y ®N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Elgin Fire 1 99 9 Same I LP3468109 2 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused 0 Y El 2 eu N DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NW 0 I V 0 DV /2 0 0 7 Hyundai Sonata 2012 00-NONE 0.. Q!'-O DUE TO CRASH rg ❑ 2 x o 13-UNDER CARRIAGE 10( 12 FIRE ❑ N U2 C F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9,16-TOP 3 X ❑Y i N DUNK VEH. AT CRASH 99-UNKNOWN *Oistraellon Value 9 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8-iI�:,-4 COMVEH ❑ N U1 CO FIRST CONTACT 12 7 .5 •If Yes.See Sidebar H ELGIN IL 60120 0 1 0 EM43811 MB 2025 I0 C IL D 0 5NPEC4ABOCH334105 Progressive ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER 1 X Elgin Fire 1 99 9 CAMARENA. MARIA.G. 871496059 BAG $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE;ZIP U1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)/{ADDRESS)((TELEPHONE) (EMS) (HOSPITAL) U2 996 r m ##occs y / ,, U1 1 D 1 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z u 1 ® 11 1 07,03 /2026 01 12 ®AM in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 5 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 C) 2 ❑ 36 1 2 99 07,03 /2026 01 12 PM 1 ® • ❑Construction >F R 3 ❑ igi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 1 z J ❑AM ❑Maintenance U2 aER 11 1 ARREST NAME Sanchez Orellana. Daritza Yessenia 11-901-A 1571000014 07/03/2026 01 19 izi PM SLMT o N AM 0 CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ❑Utility r 2 ❑ 36 1 ARREST NAME 07/03 /2026 01 31 ®PM ❑Unknown work zone type U1 30 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 30 1571-Rosas-Pereyra.Gerardo 201 08 , 10/2026 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 -< ` ` --I -' r INDICATE NORTH combination):or —I Not To Scale I BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C } Gtrrfft+l0 - } e. (example:shuttle or charter bus):or 0 I- <-----I----; transporting mployeened to slin the course of 5 or fewer passengers e e mplanoyment example:employee a contract X 410,i } �,-,i,'•e_'"7 i-i transporter-usually a van type vehicle or passenger car):or co L4. Is used or designated to transport between 9 and 15 passengers,including N �-----;----; �_ - } } } g Po passen rs,indudi the driver, —.:•� ) for direct compensation(example:large van used for specific purpose):or L i — — — — — — L i _ 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires 'D ' placarding(example:placards will be displayed on the vehicle). ,Zmt i. i. 4. .I. l t Ii Ii I-- --I- —I 1CARRIER NAME Z _ ADDRESS 0 0 CITY/STATE/ZIP D MOTOR CARR.ID 0 Interstate 0 Intrastate I I T I ❑ Not in Comm./Govt. 0 Not in Comm./Other ------- --1 - USDOT NO. ILCC NO. rn XI Source of above Z . ❑ Yes ❑ 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 0 No 2 TRAILER VIN 1 m co LOCAL USE ONLY TRAILER VIN 2 m 0 TRAILER WIDTH(S) 0-96" 97-102" >102' T TRAILER 1 ❑ ❑ 0 Z TRAILER 2 ❑ 0 0 O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w Bronze Gold 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 DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® DISABLING DAMAGE Arties/Impound.Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE