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HomeMy WebLinkAbout2026-00044511 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 01111101111 10110 II Iflfl01111100111000 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X004319866 u, 2 U21 1 1 1 U1 8 U2 1 U, 1 1_12 U, 1 U2 1 4 9 U1 1 U221 *P 0119* INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW ' DAMAGE TO ANY El$500 OR LESS TYPE OF REPORT 0 A No Injury 1 Drive Away Elgin Police Department ONE PERSON'S ❑$501-$1.500 ®ON SCENE 1 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and for Tow Due To Crash 0 AMENDED YR 202612026-00044511 VEHT ADDRESS NO. HIGHWAY or STREET NAME INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n ®CITY TOWNSHIP ❑ RELATED ❑Y ®N 07 25 2026 ®AM ❑YES ®NO U1 —< 161 E CHICAGO ST Elgin 00:46 g PRIVATE mo !day!yr ❑PM FLOW CONDITION m _ _ COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR 0 SLOW 1 (n ❑ FT,MI NESW 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 Qg3 DRIVER 0 PARKED 0 DRIVERLESS 0 RED CI PEDAL 0 EOUES p NIAV p Icy CI Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) y N 2 n FOR DAMAGEDAREA(S) FRO t TOWED U1 Q Garcia Baquiax.Juan.A. 1�0 1 9 9 4 Jeep(after 196�1�rokee 2010 00-NONE ©, O 0DUE TOCRASH ® ❑ NAME(LAST,FIRST.M) q 13-UNDER CARRIAGE I FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) O 'O DISTRACTED ❑ 0 U2 2 m M 2 5 ❑Y ®N SYSTEM ❑UNK VEH. AT CRASH D 99-UNKNOWN 9 76•TOP 3 *Distraction Value 9 ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8 ;il_6 I,.4 COM VEH 0 0 1 O ~ ELGIN I N I L 60123 0 1 0 FIRST CONTACT 12 7 • _-5 *II Yes.See Sidebar U1 Z FB68052 IL 2027 E TELEPHONE IL D 0 1J4PR4GK3AC133431 American Freedom ❑Y Il N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Same 12-2439128-04 1 r 5HOSPITAL(TAKEN TO) INCIDENT IF IC OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y ® N 2 XI m 0 DRIVER X. PARKED 0 DRIVERLESS 0 FED 0 PEDAL 0 EWES 0 NMV 0 NOV 0 DV yr o _ 13-UNDER CARRIAGE 10;1 c. 2 FIRE ❑ ® U2 C c SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED a SYSTEM IN 0 ENGAGED 0 15-OTHER 9.16-TOP®3 * ❑ ® SPDR ❑Y ®N DUNK VEH. AT CRASH 99-UNKNOWN Oistracton Value 3 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF O I ( .t.,,COM VEH D ® U1 CO F,,, FIRST CONTACT 4 O7 �,�-_--)O•((Yes.See Sidebar CY43047 IL 2026 0 N M . STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0 2HGFE2F58NH515021 Statefarm ❑Y ®N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Morales.Crystal.A. 2220950-SFP-13 BAC E 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) 0 EV MOST EVNT LOG DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 18 1 07,25 r2026 00 46 ®❑PM in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 3 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 C) o" 2 ❑ 20 28 , , ❑PM ❑Construction >F 4 R 3 ❑ $I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 3 —a, ARREST NAME Garcia Baquiax.Juan•A. 11-601 74828 , r ❑❑AM ❑Maintenance U2 u 1 21 11 1 ❑Utility SLMT a I$!CITATIONS ISSUED 0 PENDING SECTION CITATION NO. ROAD CLEARANCE TIME AM t 2 El ARREST NAME Garcia Baquiax.Juan.A. 11-708 74829 07/25 ,2026 02 00 [M PM El Unknown work zone type U1 30 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 30 1500-Chew. Marie 101 08 ,31 ,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 truckrtrailer -< ` ` --I -' r INDICATE NORTH combination):or .Z-1 4141 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C (example:shuttle or charter bus):or n 3. Is designed to carry15 or fewer passengers and operated a contract carrier 0 }. -A- --i Not To Scale } } } transporting employees in the course ofo employment caant(example:employee w I transporter-usually a van type vehicle or passenger car):or c0 L L.___a__-_� 4. Is used ordesi natedtotrans rtbetween9and15 passengers,including C I } } } for direct compensation(example::large van used for speific purpoe):or the driver. L L--_-a-..-. - t i. i I L 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires up, J I placarding(example:placards will be displayed on the vehicle). ,Zm) CARRIER NAME Z ADDRESS 0 IT. CITY/STATE/ZIP 0 0 MOTOR CARR.ID 0 Interstate 0 Intrastate 1 I r 1 ❑ Not in Comm./Govt. 0 Not in Comm./Other ; _Y_ _-1 - USDOT NO. ILCC NO. m XI Source of above z . 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 0 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' -n TRAILER 1 ❑ ❑ 0 Z TRAILER 2 ❑ 0 0 o u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w Black Black 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