HomeMy WebLinkAbout2026-00043650 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 Mil 1 II I flfl 01010 0 10 0
DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X18454
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INVESTIGATING AGENCY DAMAGE TO ANY ®5500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away
AGENCY CRASH REPORT NO. TRFW
Elgin Police Department ONE PERSON'S 0$501-$1.500 ®ON SCENE 2
VEHICLE/PROPERTY ❑OVER 51,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash
El AMENDED
YR 2026I 2026-00043650 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n
® ❑ RELATED PRIVATE ❑Y ®N 07 21 2026 ®AM ❑YES ®NO U1
S RANDALL RD Elgin mo /day/yr 11.09 ❑PM FLOW CONDITION III
COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 15 u)
010 ®/MI O E S W Weld Rd WITH VEHICLES INVLD El STOPPED U2 --I
0 AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) Kane HIT&RUN 21V ElN PEDALCYCLIST IZI N ❑ FREE FLOW # LNS 0
183 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 MA/ 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 5 n
NT TOWED U1 Q
NAME(LAST,FIRST,M) Fernandez. Lisbeth.Z. mo yr Ford Mustang 2010 00-NONE 11 • Oi_, DUE TOCRASH Ely 13-UNDER CARRIAGE 10EN
' 2 FIRE 0
5 <<
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ® 0 U2 T1
F 2 4 ❑Y SYSTEM IN ENGAGED 15-OTHER 9 16.TOP 3 2 ALGN =
❑N ❑UNK VEH. AT CRASH 99-UNKNOWN `Distraction Value
r CITY STATE ZIP INJ EJCT EPTH PLATE NO STATE YEAR POINT OF 7_:il;� _5 *IIYes.See Sidebar Ut 4 COM VEH ❑ El 1 0
F. FIRST CONTACT 12. ,_
V Z Algoinquin IL 60102 0 1 0 EW60156 IL 2026 Is
TELEPHONE
IL D 1ZVBP8EN7A5116210 GEICO ❑Y ®N U2 M
B EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
Santos-Valadez.Angelica 6235836969 1 1-
15 HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER
r5 Refused RESPONDER
L
x DRIVER ❑ PARKED 0 DRIVERLESS ❑ FED 0 PEDAL ❑EWES 0 lily 0 Ncv 0 Dv
� /1 9 yf 3 Ford Bronco 2022 00-NONE 11_' 12'-_1 DUETO CRASH ❑ 2
o 13-UNDER CARRIAGE 10;i 2 FIRE ❑ ® U2 C
c
F 2 4 SYSTEM IN ENGAGED 15-OTHER 9 16-TOP 3 0 X
❑Y ❑N ❑UNK VEH. AT CRASH 99-UNKNOWN *Oistracton Value
POINT OF 8 i 4 COM VEH D ® u1 CO
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR FIRST CONTACT 00 Y.�-`4%,--$ ••If Yes,See Sidebar
C
Z Chicago IL 60645 0 1 0 B691-IS IL 2027 0
Z
IL D 3FMCR9C62NRD23752 State Farm ❑Y ®N RDEF XI
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 =
Hansen.James,O. 0608385SFP13 BAc $
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP
U1 =
(UNIT) (SEAT) (DOBI (SEX) {SAFT) (AIR) (WI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)!(ADDRESS)/(TELEPHONE) (EMS) (HOSPITAL)
2 3 08 /
:A
/ / UI 1 D
/ / 3 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 71 , 11 /026 11 09 0 PM in a Work Zone? ®N DIRP co
1 t 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 45 28 71 ,11 ,026 11 09 1 ❑PM 0 Const action F
R O 0 xi CITATIONS ISSUED El SECTION CITATION NO. EMS ARRIVED TIME 5
3 ®AM ❑Maintenance U2
o ® 11 1 ARREST NAME Fernandez, Lisbeth,Z. 12-610.2-B 298001410 71 ,11 /026 11 15 ❑PM 0 Utility SLMT
o N 0 CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME
AM 45
t 2 ElARREST NAME 71 Ili /026 11 31 M PM 0 Unknown 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 801 81 , 11 ,026 01 30 0 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 -<
` ` -' -' r INDICATE NORTH combination):or .Z-1
' 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
I. } } transporting employees in the course of their employment(example:employee X
transporter-usually a van type vehicle or passenger car):or w
L L.__-a-_-_1 4. Isusedordesinatedtotrans transport passengers, 'CD
} } } 9 Po pe 9 to
. I � EIS3 � � � •
for direct compensation(example:large van used fors specific purpose):or O
L L____a_ 1 za
i - l. i i 5. Is anyvehicle used to transport anyhazardous material(HAZMAT)that requires m
-Unit It 2- I placarding(example:placards will be displayed on the vehicle). ,Z
rt
I I --- Not To Scale
- - - - CARRIER NAME Z
tnnwrrwea ADDRESS O
C)T.
oe. CITY/STATE/ZIP 2
MOTOR CARR.ID 0 Interstate ❑ Intrastate
I I T ❑ Not in Comm./Govt. 0 Not in Comm./Other
� --- --1 USDOT NO. ILCC NO. m
XI
Source of above z
. MCS 0 Yes 0 No 0 Unknown Out of Service 0 Yes ❑No 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
Silver Blue
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 DUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 0 TOWED BY/T6
DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE