Loading...
HomeMy WebLinkAbout2026-00045239 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets III III 11 IIII UHI U� I� Iflifli 11I1 H 1IHUDU DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X00431 53 u, 1 U21 1 1 1 U1 8 U2 1 U, 1 U2 1 U, 1 U2 1 1 12 U1 18 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 ❑5501-51.500 ®ON SCENE 3 VEHICLE/PROPERTY ®OVER 51,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash ❑AMENDED YR 2026I 2026-00045239 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n ® ❑ RELATED ®Y 0 N 07 28 2026 DAM ❑YES ®NO U1 RT20 WB I GRACE ST Elgin 01:41 _ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION ITl 0 !MI N E s rt20 Wbl race st COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR 0 SLOW 7 Cl) ® © g Kane HIT&RUN ❑V ® N WITH VEHICLES INVLD 0 STOPPED U2 --I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N 51 FREE FLOW # LNS 0 gi DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NW 0!CV ❑Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 0 Nissan Sentra 00-NONE 2025 NAME(LAST,FIRST,M) Perez Cruz.Jorge. L. mo yr DUE TO CRASH ® ❑ ©1 12 , 13-UNDER CARRIAGE FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) O �O DISTRACTED 0 ]Si U2 2 rl1 M 2 4 ❑Y ®N SYSE❑UNK VEH. O AT CRASH O 99-UUNKNOWN THER 0916-TO DistractionVatue ALGN = T. CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF D i s 'I COM VEH 0 j$J 1 C) ~ ELGIN I N I L 60120 0 4 0 FIRST CONTACT 8 Q_:,.Q-O6 •If Yes.See&debar U1 0 Z KNT5170 OH 2O26 REAR TELEPHONE IL D 0 3N1AB8DV8SY295024 EAN Holdings LLC ❑Y IlN U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Elgin Fire EAN Holdings 39S208536 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER RESPONDER 21 (,0j m g DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 row 0 NOV ❑DV yr 12 0 13-UNDER CARRIAGE 10 i 2 FIRE 0 ® U2 C c M 2 4 ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN `Oistractlon Value POINT OF s i 4 C.OM VEH ® ❑ U1 CO N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR 6 S_ C FIRST CONTACT 1 7 _, _6 •If Yes.See Sidebar = Capitol Heights MD 20743 0 1 0 0531 F1 MD 2027 I0 Si) MD A 7 4V4NC9EH3LN232670 Transguard Ins Co of Amer ❑Y ®N RDEF71 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X Geva Transportation TCP000205203 BAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP 996 < Refused RESPOND❑N U1 = (UNIT) (SEAT) (DOB) (SEXI {SAFT) (AIR) (WI 1(EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)!(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL) 3 3 11 / LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ID N 1 ® 11 1 07/28 /2026 01 41 ®AM in a Work Zone? ®N DIRP co 1 I 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 0 20 99 / / ❑PM ❑Construction >F 1 3 0 xi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME ❑AM 0 Maintenance U2 7 -, ® 11 1 ARREST NAME Perez Cruz.Jorge. L. 11-905 482000739 / / El PM SLMT o N ❑CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ' 0 Utility r 2 ❑ ARREST NAME AM T / / pM El Unknown work zone type 55 U1 n OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 0 Y 55 482-Flentcy e.Jeremy 401 - / / ❑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 truck trailer -< ` ` --I -' I. INDICATE NORTH combination):or —I BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C - } (example:shuttle or charter bus):or X L A 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I O } } } transporting employees In the course of their employment(example:employee X transporter-usually a van type vehicle or passenger car):or co L i Not To Scale 1 N c -- - } } r 4. Is used or designated to transport between 9 and 15 passengers,including the driver. N for direct compensation(example:large van used for specific purpose):or O awiwiermorcrwisi 440__ "'�� ns u - } 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m placarding(example:placards will be displayed on the vehicle). ;p .............. in s CARRIER NAME —1 Z ADDRESS 0 w CITY/STATE/ZIP I n MOTOR CARR.ID 0 Interstate ❑ Intrastate 0 I I T I ❑ Not in Comm./Govt. 0 Not in Comm./Other ;----- ----.; - USDOT NO. ILCC NO. m XI Source of above z . Form Number m Xl IDOT PERMIT NO. WIDELOAD'; ❑Yes ®No 2 TRAILER VIN 1 m to LOCAL USE ONLY TRAILER VIN 2 m v 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 Blue White u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT 3 TOWED BY/TO. _Mies/Impound Lot Garage SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/T6 DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE