HomeMy WebLinkAbout2026-00043638 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111
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DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X004313203
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INVESTIGATING AGENCY DAMAGE TO ANY ❑5500 OR LESS TYPE OF REPORT ® q No Injury 1 Drive Away
AGENCY CRASH REPORT NO. TRFW
Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 2
VEHICLE/PROPERTY ®OVER 51,500 El NOT ON SCENE(DESK REPORT)
El AMENDED ❑ B Injury and for Tow Due To Crash YR 202612026-00043638 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15
® ❑ RELATED ❑Y ®N 07 21 2026 ®AM ❑YES ®NO U1 -<
RANDALL RD Elgin09:58
_ _ g PRIVATE mo !day/yr ❑PM FLOW CONDITION m
1 00..x.,!MI N E S W HO S Rd COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 1 (n
® pp Kane HIT&RUN ❑V ® N WITH VEHICLES INVLD ® STOPPED U2 —I
❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ❑ FREE FLOW # LNS O
tg:DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EWES ❑uuv ❑!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 n
0 7 /
Nissan Rogue 2018 00-NONE 11 Oi-1 DUE TO CRASH ❑ EN
13-UNDER CARRIAGE 10 , 2 FIRE 0 NI E
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 4 rn
M 2 4 ❑Y SYSTEM IN ENGAGED 15-OTHER 9 76.TOP 3 _
El N ❑UNK VEH. AT CRASH 99-UNKNOWN `Distraction Value ALGN
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s,_iL B j,.4 COM VEH 0 El 4 0
I— 0 1 FIRST CONTACT 12 7i __5 *u Yes.See Sidebar Ut
Z ED11985 IL 2027 REAR
TELEPHONE
IL D KN MAT2MV7J P505815 First Chicago ❑Y ®N U2 m
13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
Elgin Fire Same PALI 343475-00 1 r
o HOSPITAL(TAKEN TO) INCIDENT IF IC OWNER STREET,CITY,STATE,ZIP PHONE NUMBER
RESPONDER D
Refused ❑Y El 2 0
m g DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NMv 0 NCV 0 DV
!1 9 8 1 Chevrolet Corvette 1989 00-NONE +i_"i ,z-- DUE DUE TO CRASH ❑ C 2
o 13-UNDER CARRIAGE 10;1 2 FIRE ❑ ® U2 C
c
M 2 4 SYSTEM IN ENGAGED 15-OTHER 9 16.70P 3 3 X
❑Y ❑N DUNK VEH. AT CRASH 99-UNKNOWN `Distraction Value Ut
POINT OF 8 1I 4
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR S iL_ COM VEH ❑ ® CO
FIRST CONTACT 6 Y :j= _5 •If Yes.See Sidebar C
~ 0 1 0 UNCLEJN IL 2027 aR0 N
M
IL D 1 G 1 YY3185K5113684 State Farm ❑Y ®N RDEF
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X
Same 0266046SFP13 BAC
$
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 <
Refused RESPONDER U1 =
(UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)/(ADDRESS)/(TELEPHONE) (EMS) (HOSPITAL)
1 0
E/ MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z
N 1 ® 11 1 07/21 /2026 09 58 ®❑PM in a Work Zone? ®N DIRP co
1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 1
T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ®AM U1
v 2 28 99 07/21 /2026 10 08 ❑PM 0 Construction
*
R 3 0 0 CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 1
®AM ❑Maintenance U2
a ® 11 1 ARREST NAME Torres,Alfredo 11-601 298001409 07/21 /2026 10 15 ❑PM El Utility SLMT
o N 0 CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME
AM 45
r 2 El ARREST NAME 07/21 /2026 10 34 [�PM ElUnknown work zone type U1
2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑AM Workers present? ❑Y 45
298-Lopez, Mirko 702 275-Engelke 08 / 11 /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••--, , Hoppa7Rd. ; 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----; _ combination):or
h / INDICATE NORTH p0
I BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C
1` '( 111
(example:shuttle or charter bus):or
r (( N r 3. Is designed to carry 15 or fewer passen ers and o rated a contract carrier O
} } 1-
. transporting employees In the course of their employment(example:employee
Not To Scale Itransporter-usually a van type vehicle or passenger car):or CO
__ __ I , _ 4. Is used or designated to transport between 9 and 15 passengers,including tC/t
} } } g po passen rs,includi the driver,
for direct compensation(example:large van used for specific purpose):or O
l. } } } t 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m
1 1 , placarding(example:placards will be displayed on the vehicle). XI
l
\ ` an, CARRIER NAME Z
ffi .c,�PakrYt •eot
\ \ %*, ADDRESS D
\ *.;•s, rn
\\\ N CITY/STATE/ZIP g
\ - MOTOR CARR.ID 0 Interstate 0 Intrastate 5
' I ❑ Not in Comm./Govt. 0 Not in Comm./Other
; _Y____.; - USDOT NO. ILCC NO. m
XI
Source of above z
. IDOT PERMIT NO. WIDELOAD-; ❑Yes 0 No =
TRAILER VIN 1 m
to
LOCAL USE ONLY TRAILER VIN 2 m
a
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
Silver Red
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 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/TO.
DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE