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HomeMy WebLinkAbout2026-00045244 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets II III II IIIIII UHI II II IIIIIII II II IIIIIIIIIII DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X�-322.258 u, 1 U21 2 4 1 u, 2 U2 1 u, 1 u2 1 u, 1 U2 1 1 14 u, 1 U2 1 *P 0119 INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW ' DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away Elgin Police Department ONE PERSON'S El5501-51.500 ®ON SCENE 1 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) (8:1B Injury and for Tow Due To Crash 0 AMENDED YR 202612026-00045244 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 3 '1 ® ❑ RELATED ®Y 0 N 07 28 2026 ❑AM ❑YES ®NO U1 -< S LIBERTY ST Elgin02:13 _ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION m FT l MI N E S W DIXON AVE COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ®SLOW 15 u) ❑ Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD ❑ STOPPED U2 --I IgI AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ❑ FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uuv 0 Ncv 0 ov DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 0 FOR DAMAGEDAREA(S) FROPtf TOWED U1 Q Benavides.Alejandro 0 D /1 13-UNDER CARRIAGE ©(O!- FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) EN O 2 DISTRACTED 0 0 U2 0 m M 2 4 SYSTEM IN ENGAGED 15-OTHER 9 16.TOP 3 _ ❑Y ❑N ❑UNK VEH. AT CRASH 99-UNKNOWN `Distraction Value ALGN r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s, i�S �i COM VEH 0 Ea 1 0 H 1- HOFFMAN ESTATES IL 60192 C 1 FIRST CONTACT 11 7_; __s *IrYes.seeSidebar Ut Z GC57074 IL 2027 ' E TELEPHONE IL D 2C4RDGBG4FR570113 Progressive ❑Y ®N U2 I— in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Elgin Fire Konsider It Done 869949678 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF IC OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y ❑ N 2 eu x DRIVER ❑ PARKED 0 DRIVERLESS ❑ PED 0 PEDAL 0 EWES 0 NMV 0 KCV 0 DV '1 9 yr 3 Ford Explorer 2015 00-NONE ,i_"i Qj O DUE TO CRASH ❑ 2 13-UNDER CARRIAGE FIRE ❑ El U2 c M 2 8 SYSTEM IN ENGAGED 15-OTHER 9 16-TOP 3 9 0 X ❑Y ❑N DUNK VEH. AT CRASH 99-UNKNOWN `Oistracuon Value N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s i1 4 5 Lf,_ COM VEH ❑ ® U1 CO FIRST CONTACT 1 7�• -5 • — Elgin IL 60120 C 1 DK44976 IL 2027 REARIf Yes.See Sidebar 0 N IL D 1 FM5K8AR4FGB83460 Kemper ❑Y 123 N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Elgin Fire Same 12RA000092400 BAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPOND 0 N u1 = (UNIT) (SEAT) (DOBI (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)1(ADDRESS)1(TELEPHONE) (EMS) (HOSPITAL) 1 0 EV MOST EVNT LOG DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 11 4 07,28 l2026 02 13 ®pm in a Work Zone? ®N DIRP co 1 I PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME ❑AM If YES check one below: U1 7 n T o" 2 ❑ 2 99 + ! ❑PM• ❑Construction X Z 3 ❑ Igi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 3 ❑AM ❑Maintenance U2 o1 ® 11 4 ARREST NAME Benavides.Alejandro 11-901-A 414-1137 ! ! ❑PM SLMT o N 0 CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ❑AM Utility r 2 ❑ ARREST NAME 1 / ❑❑PM El Unknown work zone type U1 2O 2 2 3 D OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 20 414-Lara. Saul 401 08 1 18,2026 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 truck trailer -< ` i•-- -'- -' r r INDICATE NORTH combination):or A BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C 531 } I - } r r ,. (example:shuttle or charter bus):or < <---- -•-•; I transporting employeened to s 5 or fewer Inthe course passengers rhea emand ployment operated xample:employee transporter : } } } 6ransportet-usually a van Type vehicle or passenger car):or CL L.___a__ 1...___ 4. Is used ordesi natedtotrans transport passengers,including y} } } g Po passen rs,includi the driver, for direct compensation(example:large van used for specific purpose):or o�on i 11` - t - wan— _ _ t } } } 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires h-- -_;- i Mr placardingplacarding(example:placards will be displayed on the vehicle). D -�r -- CARRIER NAME Z 1 — I ADDRESS 0 Not To Scale 1 D w - I CITY/STATE/ZIP g MOTOR CARR.ID 0 Interstate El Intrastate I r ❑ Not in Comm./Govt. 0 Not in Comm./Other --- --1 USDOT NO. ILCC NO. m XI Source of above z . -I Were HAZMAT placards on vehicle? 0 Yes 0 No = If Yes,Name on placard O 4 digit UN NO. 1 digit Hazard class No. Xl Xl 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 White White 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 DISABLING DAMAGE DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® Arties/Impound.Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE