HomeMy WebLinkAbout2026-00047014 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets IIIIII 11 IIII
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DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X004329550
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INVESTIGATING AGENCY DAMAGE TO ANY ❑$500 OR LESS TYPE OF REPORT 0 A No Injury 1 Drive Away
AGENCY CRASH REPORT NO. TRFW
Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 2
VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash
0 AMENDED YR 2026I 2026-00047014 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n
® ❑ RELATED ❑Y ®N 08 05 202612,— ❑YES ®NO U1 -<
S RANDALL RD Elgin PRIVATE mo /day/yr 12:46 ®PM FLOW CONDITION m
•
020 ®!MI O E S W Weld Rd/S RANDALL RD COUNTY PROPERTY ❑Y M N DOORING Elv #OF MOTOR ❑SLOW 1 (n
Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD 0 STOPPED U2 --I
El AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST IZI N ® FREE FLOW # LNS 0
18:DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uuv 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 6 n
FOR DAMAGEDAREA(S) FRONT TOWED U1 Q
Acevedo.Jor e.A. 0 3 /
yr 13-UNDER CARRIAGE 1a./ 2 ' 2 FIRE 0
6
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ❑ 0 U2 m
M 2 SY4 ❑Y ❑STM NE CD UNK VEH. 9 AT CRASH 9 99-UNK 15- NOWN THER9 76•TOP 3 •Distraction Value 9 ALGN •
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF S_iL S 4 COM VEH 0 Ea 1 0
~ HuntleyI L 0 1 0 FIRST CONTACT 12 7_: _5 *Irves.See Sidebar U1
ZGA20726 IL 2026 REAR
TELEPHONE
IL D 7 3GSCL33P88S611434 NO INSURANCE ®Y ❑N U2 m
in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
99 9 Same NO INSURANCE 1 r
o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER
RESPONDER D
Refused ❑Y El 2 ou
N DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 ivy 0 Ncv 0 CIRCLE NUMBER(S) U1
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!1 9$9 Honda CRV 2025 00-NONE 11'f 12 c,�2 FIRE DUE OCRASH rg ® U2 2 C
o 13-UNDER CARRIAGE
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F 2 4 SYSTEM IN 9 ENGAGED 9 15-OTHER 9.16•TOP 3 X
❑Y 0 N ®UNK VEH. AT CRASH 99-UNKNOWN POINT OF •Oistraclj n Value g g
S • 4
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR & t COM VEH El ® Ut W
FIRST CONTACT 7 Q _,�_5 •If Yes.See Sidebar
Z Cary IL 60013 0 1 0 FF27605 IL 2026 Ig (�/�
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IL D 0 7FARS4H49SE017677 Progressive ❑Y ®N RDEF
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 =
99 9 Same 984334922 BAG $
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP 996 <
Refused RESPONDER
U1 =
(UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)!(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL)
2 6 04 /
UI 1 D
/ / 2 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 08/05 /2026 12 46 ®PM in a Work Zone? ®N DIRP co
1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 1
T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1
v 2 0 28 99 08,05 /2026 12 47 El Pm El Construction >E
" 3 ❑ xi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 1
z J ❑AM ❑Maintenance U2
a El 11 1 ARREST NAME Acevedo.Jorge.A. 11-601 1538000454 08/05/2025 12 58 Igi pM 0Utility SLMT
j$!CITATIONS ISSUED 0 PENDING SECTION CITATION NO. ROAD CLEARANCE TIME AM
r 2 El ARREST NAME Acevedo.Jorge.A. 3-707 1538000453 08/05 /2026 01 12 ®PM El Unknown work zone type U1 45
2 2 3 0 -
OFFICER ID SIGNATURE BEAT!DIST. SUPERVISOR ID. COURT DATE TIME ❑AM Workers present? ❑Y 45
1538-Estrada. Leticia 800 275-Engelke 09 ,01 /2026 01 30 ®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 truckrtrailer -<
` ` ' ' r INDICATE NORTH combination)or .Z�1
BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C
II I Not To Sc.!. I - (example:shuttle or charter bus):or C
5 I 3. Is designed to carry15 or fewer passengers and operated a contract carrier O
- }.___A.._.� . } } } transportingemployees in the course of their employment(example:employee X
transportr-usually a van type vehicle or passenger car): r
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I. 4. Is used or designated to transport between 9 and 15 passengers,including N}---..I.. .-; `� - } } } g po passen rs,includi the driver,
for direct compensation(example:large van used for specific purpose):or O
I. L__--a...._I N I y I - t i. i i 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires 'D
placarding(example:placards will be displayed on the vehicle). XI
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— — — — — CARRIER NAME Z
c- - ADDRESS D
II WeId7Rd rn
n
, CITY/STATE/ZIP .>
_ MOTOR CARR.ID ❑ Ita ❑
❑ Notnters in Cotemm./GaA. ❑ Not inIntrastate Comm.lOther
i. -- ----- - USDOT NO. ILCC NO. C
m
XI
Source of above 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
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LOCAL USE ONLY TRAILER VIN 2 m
v
TRAILER WIDTH(S) 0-96" 97-102" >102' m
TRAILER 1 ❑ ❑ 0 Z
TRAILER 2 ❑ 0 ❑ O
u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w
Silver Black
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 Arties t Unknown VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE