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HomeMy WebLinkAbout2026-00043958 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 10110 II Iflfll OI1111111 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X004313146 u, 1 U21 2 1 1 U1 2 U2 1 U, 1 u2 1 U1 1 u2 1 1 15 U1 1 U2 1 *P 0119* INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW ' DAMAGE TO ANY El$500 OR LESS TYPE OF REPORT ® q No Injury 1 Drive Away Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 10 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) 0 AMENDED ❑ B Injury and for Tow Due To Crash YR 202612026-00043958 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 �I ® ❑ RELATED ®Y 0 N 07 22 2026 DAM ❑YES ®NO U1 -< DUNDEE AVE Elgin 04:03 _ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION III FT N E S W COOPER AVE COUNTY PROPERTY ❑Y 2�I N DOORING ❑y #OF MOTOR 0 SLOW 15 u) ❑ Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD 0 STOPPED U2 --I ® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EOUES 0 NW 0 Ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 n FOR DAMAGED AREA(S) FROM TOWED U1 O • NAME(LAST,FIRST.M) mo /1 9 7 7 Hummer H3 2006 00-NONE ©1 Q2 l 01 DUETOCRASH ❑ ENE 13-UNDER CARRIAGE 10 1 2 FIRE ❑ IE STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 ]$I U2 2 rn M 2 4 15-OTHER ❑Y ®N SYSTEM ❑UNK VEH. 0 AT CRASH D 0 99-UNKNOWN 9 16•TOP 3 *Distraction Value ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8, iL 6 I,.4 COM VEH 0 E! 1 O 0 1 0 FIRST CONTACT 12 7_: _-5 *IfYes.See Sidebar Ut Z EV12753 IL 2026 TELEPHONE IL D 0 SGTDN 136068294785 Kemper ❑Y ®N U2 13 . m 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Same 12AU000529303 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y ® N 2 XI x DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NIAV 0 NOV 0 Dv /1 9 9 6 Ford Explorer 2012 00-NONE ,i ` 12 "_, DUE TO CRASH ❑ 2 13-UNDER CARRIAGE • 6 I c 2 FIRE ❑ ® U2 C c STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POFIRSNT OFT CONTACT 1 O 0 �:_5 CIO e1sVSeeSidebarEH ❑ ® U1 CO ELGIN IL 60123 0 1 0 GC26185 IL 2027 REAR Si)0 Z IL D 0 1 FM H K8F8XCGA52168 Kemper ❑Y ®N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X Garcia. Miguel.A. 12RA000043116 BAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP U1 = (UNIT) (SEAT) (DOBI (SEX) {SAFT) (AIR) (INJI 1(EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)((A.DDRESS)!(TELEPHONE) (EMS) (HOSPITAL) 2 6 1 2 / LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ®Y Z N 1 ® 11 1 07,22 /2026 04 05 ®pm 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 � o ' 2 23 18 / / 0 PM ®Construction * R 3 0 $I CITATIONS ISSUED El PENDING SECTION CITATION NO. EMS ARRIVED TIME 5 ❑AM 0 Maintenance U2 -a, ARREST NAME PIZANO CAMPOS.Jose.A. 11-1204-B 476000468 / / ❑PM SLMT 1 ER 1 El ISSUED PENDING Utility o u SECTION CITATION NO. ROAD CLEARANCE TIME 0• t 2 0 ARREST NAME 07/22 /2026 04 53 ®PM 0 Unknown work zone type U1 30 0 AM 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 30 476-Ramos.Clarissa 102 08 / 18/2026 09 00 0 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 r r 1. Has a weight rating more than 10,000 pounds(example:truck or truckrtrailer -< ` -I -' INDICATE NORTH combination):or -I I ® 1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C } I - } r r ,. (example:shuttle or charter bus):or 0 L A I 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier O } } } transporting employees in the course of their employment(example:employee X L }-----}----I. I `"_ - 1 } } } transporter Is nosed or des gnated to transport betweelly a van type vehicle or n 9 and r 1 passengers,including the dryer, y 3`�q0l for direct compensation(example:large van used fors specific purpose):or "'I CeeC»Ave L L____a____. _ t i. i t 5. Is any vehicle used to transport anyhazardous material rn _ placarding(example:placards will be displayed on the vehicle). XI ♦� I - CARRIER NAME Z I ADDRESS O I w I • CITY/STATE/ZIP 0 . MOTOR CARR.ID 0 Interstate 0 Intrastate Not Tb Scale O I I . I ❑ Not in Comm./Govt. 0 Not in Comm./Other �I. --- —1 - USDOT NO. ILCC NO. rn XI Source of above z . 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' 0 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. Z Black Gray u 1 TOWED • TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT: 2 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/Owners Residence VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE