HomeMy WebLinkAbout2026-00046672 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 01111101111 Mil 1 II I flfl I1111.111111
DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X�-326S30
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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 El$501-$1.500 ®ON SCENE 14
VEHICLE/PROPERTY ®OVER 51,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash
0 AMENDED YR 2026I 2026-00046672 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 rn
® ❑ RELATED ®Y ❑N 08 03 2026 ❑AM ❑YES N NO U1 -<
KI M BALL ST Elgin07:15
_ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION m
FTlMI N E S W N SPRING ST COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 15 u)
❑ Kane HIT&RUN ❑V ® N WITH VEHICLESOT,
INVLD ❑ STOPPED U2 —I
Igl AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N 51 FREE FLOW # LNS 0
Ig3 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EOUES 0 NIA/ 0 ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 00 n
_ mo yr NAME(LAST,FIRST,M) g Q
Diaz Cazares.Angie.G. Honda Civic 2025 00-NONE „ O •, OUETOCRASH ® ❑
13-UNDER CARRIAGE 10:) 2 , 2 FIRE 0 IE
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ❑ !a U2 00 M
M 2 8 El NSNE❑UNK VEH. 0 AT CRASH IN ENGAGED0 99-UUNKNOWN 9 16-TOP 3 `Distraction Value 9 ALGN =
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6 iI 6 4 COM VEH 0 Ea 1 0
~ ELGIN IL 60123 C 1 0 FIRST CONTACT 12 7 ; _-5 *IIYes.See Sidebar U1
ZFM51815 IL 2026 E
TELEPHONE
IL D 0 2HGFE4F84SH303220 State Farm ❑Y IlN U2 m
in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
Elgin Fire 99 9 Same 2083780-SFP-13 1 r
`o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER
RESPONDER D
Sherman ❑Y El 2 0
g DRIVER 0 PARKED 0 DRIVERLESS 0 PED ❑PEDAL 0 EWES 0 NIAV 0 i v 0 DV
!1 9 6 7 Toyota RAV4 2017 00-NONE ,011 12 ._y DUE FIREO CRASH 0 ® U2 2 C
o Yr 13-UNDER CARRIAGE III
Ti
F 2 8 SYSTEM IN 0 ENGAGED 0 15-OTHER 9,1,,6-TOPO3 * X
❑YNi N DUNK VEH. AT CRASH 99-UNKNOWN O Distraction Value 9 0
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6- l 6 1• ( 4 COM VEH 0 N U1 CO
FIRST CONTACT 2 7-'_, _5 •(ryes.See SidebarC
n E LG I N I L 60120 C 1 0 G H 12945 I L 2027 REAR 0
IL D 0 JTM DJ REV9H D129222 Kemper ❑Y N N RDEF XI
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X
Elgin Fire 99 9 Same 12RA000081329 BAC
E
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 <
Sherman RESPONDER
u1 =
(UNIT) (SEAT) (DM (SEXI {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 ❑Y U2 Z
N 1 ® 11 4 08/03 /2026 07 15 ®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 C)
v 2 0 2 06 08,03 /2026 07 15 ®PM ❑Construction *
R 3 0 ]$I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 3
z J ❑AM ❑Maintenance U2
o1 ® 11 4 ARREST NAME Diaz Cazares.Angie.G. 11-601-Ax 1561-000388 08/03/2026 07 19 ®PM SLMT
o N
❑CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ❑Utility
0 AM
T 2 El ARREST NAME 08/03 /2026 08 00 0 PM 0 Unknown work zone type U1 30
n T OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME
2 2 3 0 ❑AM Workers present? 0 Y 30
1561 Sarovic, Mirko 102 378-Alcorn / ❑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
f s a weight rating more than 10,000 pounds(example:truck or truck trailer -I
Mot To Scafe 1. Has r }----'-----; - - - INDICATE ARROW
NORTH
combination):or .Z�1
` I I y I - 1 2 Is used or designed to transport more than 15 passengers including the driver C
r (example:shuttle or charter bus):or 0
r 3. Is tl ned t carry 15 or fewer ssen ers and o rated a contract carrier O
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} } } transporting employees In the courses of their employment(example:employee X
J i i I I I ii transporter-usually a van Type vehicle or passenger car):or CO
L L.___a__..� 4. Is used ordesi natedtotrans rtbetween9and15 passengers,including w} } . for direct compensation(example:large van used for specificpurpose):or [he driver,
I r Pe ( 9 Pe or
e: . . P
L _____a____� — ®' — — — - i. i i 5. Is any vehicle used to transport anyhazardous material(HAZMA that requires m
placarding(example:placards will be displayed on the vehicle). ;p
[Viewing* I I I CARRIER NAME Z
ADDRESS 'n
Id I I I
I CITY/STATE/ZIP
- MOTOR CARR.ID 0 Interstate 0 Intrastate
I I T I ❑ Not in Comm./Govt. 0 Not in Comm./Other
;_...Y._._.• USDOT NO. ILCC NO. m
XI
Source of above z
. IDOT PERMIT NO. WIDELOAD-; ❑Yes 0 No =
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
Gray Blue
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