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HomeMy WebLinkAbout2026-00040704 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 01111101111 I0110 1111111 0 lI IIIIIIIIIII DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X304293320 u, 1 U21 2 4 1 u, 5 U2 1 u, 1 u2 1 u, 1 U2 1 1 10 u, 6 U2 1 *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 N OVER$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and f or Tow Due To Crash El AMENDED YR 2026I 2026-00040704 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 2 �I ELM ST Elgin01:28 ® ❑ RELATED ®Y 0 N 07 08 2026 ❑AM ❑YES IX]NO U1 g PRIVATE mo /day/yr ®PM FLOW CONDITION ITl FT!MI N E S W WASH BURN RN ST COUNTY PROPERTY ❑Y ® N DOORING Ely #OF MOTOR El SLOW 15 u) ❑ Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD 0 STOPPED U2 --I ® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N 51 FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NIA/ 0!CV 0 ov DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 n FOR DAMAGEDAREA(S) FROPtf TOWED U1 0 NAME(LAST,FIRST,M) Miranda.Jessica. M. mo !1 9 8 3 Chevrolet Silverado 2008 00-NONE , DUE TO CRASH ® ❑ 13-UNDER CARRIAGE ©i O - FIRE ❑ N STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) O 2 DISTRACTED 0 N U2 0 171 F 2 4 ❑Y ❑SYSNEM N UNK VINEH. 9 AT CRASH 3 99-UUNKNOWN THER 9 16•TOP 3 *Distraction Value 9 ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s, it 6 �i 4 COM VEH ❑ j$J 1 0 I . ELGIN IL 60123 0 1 0 FIRST CONTACT 11 7_; -__5 *IIYes.SeeSidebar U1 Z 3361111B IL 2026 REAR TELEPHONE IL D 2GCEK13M881168425 American Alliance ❑v ®N U2 m 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m co Martinez. Erik ILAA071555404 1 r "o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER 2 eu p; DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 iiuv 0 NOV 0 Dv !1 9 y8r 3 Mazda CX30 2022 00-NONE ,�_ t2 DUETO CRASH ❑ 2 0 13-UNDER CARRIAGE FIRE 0 N U2 c F 2 4 SYSTEM IN 9 ENGAGED 9 15-OTHER 9 1,6-TOP 3 X ❑Y ❑N Ill UNK VEH. AT CRASH 99-UNKNOWN *Distraction Value 9 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s-iI 6 i_i, COM VEH 0 N U1 CO FIRST CONTACT 1 7�. _, _5 •If Yes,See Sidebar = ELGIN IL 60123 B 1 0 DS26266 IL 2026REAR 0 IL D 3MVDMBCLONM456638 State Farm ❑Y N N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Elgin Fire Same 3390393SFP13 BAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Provena St.Joseph 0 Y°ND 0 N ui = iUPIIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJI 1(EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)1(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL) 1 4 07 / 2 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 N 11 4 07,08 /2026 01 28 ®PM in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 8 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 o" 2 0 06 18 1 1 ❑PM ❑Construction " 3 0 $I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 1 ❑AM ❑Maintenance U2 o u 1 ® 11 4 ARREST NAME Miranda.Jessica. M. 11-802-A 410000827 ! ! El PM SLMT MI CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME El Utility o N 0 AM 25 t 2 El ARREST NAME Miranda.Jessica. M. 4-A 410000828 1 1 pM Unknown work zone type U1 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑AM Workers present? ❑y 25 410-DeLeon.Jessica 701 331-Ziegler 08 , 18,2026 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••--, , I A CMV is defined as any motor vehicle used to transport passengers or property and: Z 01. Has a weight rating more than 10,000 pounds(example:truck or truck trailer - i- -----------; Etm?St _ combination):or -I J INDICATE NORTH I BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C (example:shuttle or charter bus):or n A A. 3. Is designed to carry 15 or fewer passengers and operated a contract carrier 0 N } } } transporting employees In the course of their employmment(example:employee [1transporter-usually a van type vehicle or passenger car):or w L L.___a____J Weehbum931 4. Is used or designated to transport and 15 passengers,including w } } } g po specific p rs,includi the driver, lye for direct compensation(example:large van used fors cific purpose):or O I I �` r -u L �____a____� — _ _ 5 Isanyvehcleusedtotransportanyhazardousmateral(HAZMAT)thatrequires m .... > .. placarding(example:placards will be displayed on the vehicle). ;p D ` l CARRIER NAME Z ADDRESS 'n N- To Scab J T. n " —1 4r1 CITY/STATE/ZIP 1�) " - MOTOR CARR.ID 0 Interstate ❑ Intrastate O I I .4- I ❑ Not in Comm./GaA. Not in Comm./Other Y ❑ o USDOT NO. ILCC NO. rTt Source of above z . -I Were HAZMAT placards on vehicle? 0 Yes 0 No = If Yes,Name on placard O 4 digit UN NO. 1 digit Hazard class No. XI Did HAZMAT spill from vehicle(do NOT consider FUEL from vehicle's z own tank)? 0 Yes 0 No 0 Unknown Did HAZMAT Regulations violation contribute to the crash? r ❑ Yes ❑ No 0 Unknown M D Did Carrier Safety Regulations(MCS)violation contribute to the crash? A ❑ Yes I 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 to LOCAL USE ONLY TRAILER VIN 2 m 0 TRAILER WIDTH(S) 0-96" 97-102" >102' -n TRAILER 1 0 0 0 Z TRAILER 2 ❑ 0 0 O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w Black Gray u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT 3 TOWED BY/TO. _Arties/Owners Residence . SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE