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HomeMy WebLinkAbout2026-00045927 ILLINOIS TRAFFIC CRASH REPORT sheet 1 of 4 Sheets _ 01111101111 10110 II Iflfl1I101110000H DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X0014328328 u, 9 U2 1 1 1 u1 2 U2 U,99 1_12 U,99 U2 1 2 9 U1 1 U221 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY ❑$500 OR LESS TYPE OF REPORT El A No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW Elgin Police Department ONE PERSON'S ❑$501-$1.500 ®ON SCENE 2 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and for Tow Due To Crash 0 AMENDED YR 202612026-00045927 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 99 f1 ® ❑ RELATED ❑Y ®N 07 31 2026 ®AM ®YES 0 NO U1 —< PARK ST Elgin06:39 _ _ g PRIVATE mo /day/yr ❑PM FLOW CONDITION m 0 !MI N E s w North Liberty St COUNTY PROPERTY ❑Y ® N DOORING ❑V #OF MOTOR 0 SLOW 2 fA ® O Liberty Kane HIT&RUN ®Y ❑ N WITH VEHICLES INVLD ❑ STOPPED U2 --I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 18:DRIVER I] PARKED I]DRIVERLESS 0 PED p PEDAL 0 EWES 0 NW 0!CV 0 ov DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 n FOR DAMAGEDAREA(S) FRO TOWED U1 Q Unknown.0. ! ! f T Unknown Unknown 00-NONE ©1 ,z DUE TOCRASH ❑ NAME(LAST,FIRST,M) mo yr 13-UNDER CARRIAGE 10 i ! 2 FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 2 m SYSTEM IN ENGAGED 15-OTHER 9 76.TOP 3 9 9 ❑Y El N ❑UNK VEH. AT CRASH 99-UNKNOWN `Distraction Value ALGN = s 4 COM VEH 0 ig! r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR ~ POINT OF I�B � _ 1 0 9 0 FIRST CONTACT 12 7 ; i, 5 *lIVes.See&debar U1 0 2 Z ' E TELEPHONE . STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED 1 Unknown ❑Y ❑N U2 I— .9 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Same Unknown 1 rn `o HOSPITAL(TAKEN TO) INCIDENT IF IC OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y ® N 99 0 mo DRIVER X. PARKED 0 DRIVERLESS 0 FED 0 PEDAL 0 EWES 0 NMV 0 KCV 0 DV yr Q,. O 13-UNDER CARRIAGE 2 FIRE ID El U2 U2 Ti SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 ® SPDR n a SYSTEM IN 0 ENGAGED 0 15-OTHER OE}TOP 3 ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN *Oistractlon value g g N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF O I I4 COM VEH ❑ ® Ut CO F„ FIRST CONTACT 14 OT J S 1 5 •If Yes.See Sidebar C 82944T-B IL 2026 IaR 0 fp M . STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0 1 GCCS1442WK227942 American Alliance ❑Y ®N RDEF X EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER 1 = Espinoza Cortez. Ruben I LAA0289104-09 SAC 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)(ITELEPHONEI (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 07,31 l2026 06 42 ®❑PM 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 2 ❑ 18 1 20 28 N 3 ❑ 0 CITATIONS ISSUED 0 PENDING + ! - ❑PM- ❑Construction >E SECTION CITATION NO. EMS ARRIVED TIME ❑AM ❑Maintenance U2 1 —a, ARREST NAME / / ID PM ' o30N ® 11 1 0 CITATIONS ISSUED 0 PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • El Utility SLMT t 2 ❑ 18 1 ARREST NAMEAM 7 / / ❑❑PM ❑Unknown work zone type U1 n OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 0 ❑AM Workers present? ❑Y 30 470-Berumen. Brian 202 — r ! ❑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 -< c ` --I -' r 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 LA % 3. Is desgned to carry 15 or fewer passengers and operated a contract carrier O \7.l; } } } transporting employees In the course of their employment(example:employee X enger car):or 03 L -----}----; � I I / - } } 4.Is uosed or drter- es gnated to transport betweelly a van type vehicle or n 9 ad 1�ssen rs,ijluding the driver, Olfor direct compensation(example:large van used fors cific purpose:or L L____a____.I --- 'grin- - - _ t i i 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m 1 placarding(example:placards will be displayed on the vehicle). ;p 1 rPark?St I Z D CARRIER NAME ADDRESS 0 trot is scare I w n----- CITY/STATE/ZIP 0 MOTOR CARR.ID 0 Interstate 0 Intrastate I I T I ❑ Not in Comm./Govt. 0 Not in Comm./Other ------- --1 - USDOT NO. ILCC NO. rn 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' T TRAILER 1 ❑ ❑ 0 Z TRAILER 2 ❑ 0 0 O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. Z Green 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 TOWED DISABLING DAMAGE NOT DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® DISABLING DAMAGE Other t Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE