HomeMy WebLinkAbout2026-00044087 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111
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DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X00431 9902
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INVESTIGATING AGENCY DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT ® q No Injury 1 Drive Away
AGENCY CRASH REPORT NO. TRFW
Elgin Police Department ONE PERSON'S ❑$501-$1.500 ®ON SCENE 2
VEHICLE/PROPERTY ®OVER 51,500 ❑NOT ON SCENE(DESK REPORT)
0 AMENDED ❑ B Injury and/or Tow Due To Crash YR 202612026-00044087 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 6 71
575 S STATE ST El In05:47
® ❑ RELATED ❑Y ®N 07 23 2026 ®AM D YES ®NO U1
g PRIVATE mo /day/yr ❑PM FLOW CONDITION M_
COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 1 (n
❑ FT!MI N E S W Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD 0 STOPPED U2 —I
❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST IZI N ® FREE FLOW # LNS 0
Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL ❑EDUCE ❑uuv ❑!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 n
FORDAMAGEDAREA(S) .FROM
Licklider. Robert. mo /1 9 7 1 Ford F650 2026 00-NONE
13-UNDER CARRIAGE „ 12NT TOWED U1 Q
NAME(LAST,FIRST,M) , DUE TO CRASH 0
EN
101 ! 2 FIRE 0
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ❑ 0U2 4 rn
M 2 SYM IN ENGAGE 15-OTHER
4 ❑Y ❑SNE®UNK VEH. 9 AT CRASD 9 99-UNKNOWN 9 16-TOP 3 *Distraction Value 9 ALGN 2
T. CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF $ it 6 �i,4 COM VEH 0 j$J 1 n
I . Loves Park I L 0 1 0 FIRST CONTACT 7 O7 _: __5 *If Yes.See Sidebar U1 0
Z 232424H IL 2026 REAR
TELEPHONE
IL D 7 Liberty Ins Corporation ❑Y ®N U2 m
in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
99 9 Cintas Corp No 2. AS7-651-004227-076 1 r
`o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER
RESPONDER
98
Eg DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NMv 0 N V 0 DV
!2 0 0 5 Ford Mustang 2018 00-NONE ,�_"j t2..-_, DUETO CRASH ❑ 2 73
o 13-UNDER CARRIAGE .I FIRE ❑ ® U2
F 2 4 SYSTEM IN 9 ENGAGED 9 15-OTHER 9I1,6-TOPO3 * X
❑Y ❑N ®UNK VEH. AT CRASH 99-UNKNOWN O Distraction Value 9 0
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8-iI 6 �, 4 COM VEH ❑ ® U1 CO
F,,, FIRST CONTACT 3 7�� —_,A4 •If yes.See Sidebar
ELGIN IL 60123 0 1 0 FD11411 IL 2026 I 9
IL D 0 1 FA6P8THXJ5162752 State Farm ❑Y ®N RDEF XI
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X
99 9 Patino. Ramiro 0146137-SFP-13 BAC
$
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)
/ 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 1 07,23 /2026 05 47 ®❑pM 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
2 0 20 99 ! / ❑PM ❑Construction *
5
R 1 3 0 ]�CITATIONS ISSUED ❑ 5 PENDING SECTION CITATION NO. EMS ARRIVED TIME
❑AM 0 Maintenance U2
a ® 11 1 ARREST NAME Licklider. Robert.C. 11-709-A 1538000438 / / El PM SLMT
o N •
❑CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME 0 Utility
t 2 ❑ ARREST NAME AM
7 / / PM 0 Unknown work zone type 30
U1
n OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME
2 2 3 0 1538-Estrada. Leticia 700 420-Mondek / / ❑❑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.
-1-- A CMV is defined as any motor vehicle used to transport passengers or property and:
0 01. Has a weigh Z
r ,
t rating more than 10,000 pounds(example:truck or truckrtrailer -
~ I ( 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
61 I ; i - (example:shuttle or charter bus):or 0
3. Is designed tocarry5 fewer passengers operated contractcarrier
I- ------I----; y -1 r..,) ' I - transportingemployeeslln the courses thir employment rand pe ated by a ne
} } } ployment(example:employee X
i�,»t transporter-usually a van type vehicle or passenger car):or w
L __I__-- I 4. Is used or designated to transport between 9 and 15 passengers,including y
-- - } } for direct compensation(example:large van used for specificpurpose):or [he driver,
Pe ( P 9 Pe or 0
N. t i i 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires a ~ placarding(example:placards will be displayed on the vehicle).
m
l XI
— — 1 — — CARRIER NAME Z
ADDRESS 0
D
I I Route?20 C)
E/ n
- CITY/STATZIP
MOTOR CARR.ID ❑ Interstate ❑ Intrastate �
l I r I I ❑ Not in Comm./Gout. Not in Comm./Other
--- --4, - USDOT NO. ILCC NO. rn
XI
Source of above z
. ❑ Yes 0 No 0 Unknown 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
v
TRAILER WIDTH(S) 0-96" 97-102" >102' T
TRAILER 1 ❑ ❑ 0 Z
TRAILER 2 ❑ 0 ❑ O
u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. 0
Black
u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_
DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT' 1 TOWED BY/TO:
_ . SELECT CODES FROM THE BACK OF CRASH BOOKLET
U 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/T6
DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE