HomeMy WebLinkAbout2026-00047718 ILLINOIS TRAFFIC CRASH REPORT sheet 1 of 4 Sheets 01111101111
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DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X004333950
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INVESTIGATING AGENCY DAMAGE TO ANY El$500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away
AGENCY CRASH REPORT NO. TRFW '
Elgin Police Department ONE PERSON'S ❑5501-51,500 ®ON SCENE 14
VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash
❑AMENDED YR 2026I 2026-00047718 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 2 �I
SLADE AVE Elgin 08:57
® ❑ RELATED ®Y 0 N 08 08 2026 ❑AM YES ®NO U1 -<
_ _ PRIVATE mo /day/yr ®PM FLOW CONDITION MFT!MI N E S W CEDAR AVE COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR 0 SLOW 1 (/)
❑ Kane HIT&RUN ❑V ® N WITH VEHICLES INVLD 0 STOPPED U2 --I
® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N 51 FREE FLOW # LNS 0
DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 Nuv 0!Cy 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 0
_ O 6 /
Dodge Ram 1500(pickup) 2017 00-NONE „ Z , DUETOCRASH ® o
NAME(LAST,FIRST,M) 99 13-UNDER CARRIAGE 10 O,._Z FIRE 0
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL)THERDISTRACTED ❑ 0 U2 O 171
F 9 8 SYTM❑Y ®S NE❑UNK VEH. O AT CRASH 0 15-99-UNKNOWN 9 16•TOP 3 *Distraction Value 9 ALGN 2
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF $_iL 6 I,.4 COM VEH 0 E! 1 0
" �- ELGIN I L 60123 B 4 0 FIRST CONTACT 1 r: __5 *II Yes.See Sidebar u1
Z4035606B IL 2027 REAR
TELEPHONE
IL D 0 3C6JR6DG1 HG521344 Allstate ❑Y ®N U2 1—
.5 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
99 9 Hernandez Benitez. Daniel 811742117 1 r
o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER
RESPONDER
/1 9 6 8 Cadillac XT5 2017 00-NONE O-i Q!'-O DUE TO CRASH rg ❑ 2 x
o yr 13-UNDER CARRIAGE 10( I. 2 FIRE ❑ ® U2 C
M 2 8 SYSTEM IN 0 ENGAGED 0 15-OTHER 9,16-TOP 3 X
❑Y i N DUNK VEH. AT CRASH 99-UNKNOWN `Oistraglon Value 9 3
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8-iI�1:,-4 COMVEH ❑ ® U1 CO
FIRST CONTACT 12 7�_,__.6 •If Yes.See Sidebar
= ELGIN IL 60120 A 1 0 DX45199 IL 2026
IL A 7 1GYKNDRS4HZ129334 StateFarm ❑Y ®N RDEF
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 =
99 9 Baldwin. Roseann 0450068SFP13 BAG $
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP
U1 =
(UNIT) (SEAT) (DOG) (SEX) {SAFT) (AIR) (INJI ,(EJCT( (EPTH) PASSENGERS&WITNESS ONLY (NAME)!{ADDRESS)!(TELEPHONE! (EMS) (HOSPITAL)
1 2 06 /
U2 1 0
EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y
N 1 ❑ 11 4 08/09 /2026 08 57 ®AM 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
2 ® 2 1 23 28 08/08 /2026 08 57 PM
,
® • ❑Construction >E
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R O 0 El CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 7
3 ❑AM ❑Maintenance U2
-a, ARREST NAME Hernandez. Maggie. D. 11-601 1530000841 08/08/2026 09 02 ®PM SLMT
o U 1 ® 11 4 •igiCITATIONS ISSUED 0 PENDING
o N SECTION CITATION NO. ROAD CLEARANCE TIME
AM• ❑Utility
t 2 El ARREST NAME Hernandez. Maggie. D. 11-904-B 1530000840 08/08 /2026 10 28 ®PM 0 Unknown work zone type U1 15
2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 15
1530-Soto.Oscar 981 09 / 14/2026 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 -<
c ` --I -' r INDICATE NORTH combination):or —I
Cedar?Ave1 41 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C
shuttl
or
` ! IV r 3. Is(example:designed to car charter bus):
passengers andoperated car r O
a
tl g r a contract carrier
} r } transporting employees the course of thir employent(example:employee
Not To Scale transporter-usually a van type vehicle or passenger car):or CO
" " 41•JH I
} } 1. •4. Is used or designated to transport between 9 and 15 passengers,including the driver. N
Unit-1
nR 2 for direct compensation(example:large van used for specific purpose):or O
L L____a____1 __ i i t 5. Is an vehicle used to transport hazardous material(HAZMAT)thatrequires
I •D
— — —
t ' i� placarding(example:placards will be anyisplayed on the vehicle). XI
Slade?Ave -
Unit 1 tCARRIER NAME Z
I IT
_ ADDRESS O
I CCITY/STATE/ZIPgn
MOTOR CARR.ID 0 Interstate 0 Intrastate
I I . I ❑ Not in Comm./Govt. 0 Not in Comm./Other
r ----'Y-"'1 - USDOT NO. ILCC NO. rn
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?
❑ Yes II No ElUnknown A
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
21
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' m
TRAILER 1 ❑ ❑ 0 Z
TRAILER 2 ❑ 0 0 O
u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. Z
Silver White
u 1 TOWED •
TOTAL VEHICLE LENGTH ft. NO.OF AXLES_
DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT 3 TOWED BY/TO.
Redmons/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 ® Redmons/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE