HomeMy WebLinkAbout2026-00048871 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets III HHH 11 IIIIII IIIIII 01111DM
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INVESTIGATING AGENCY DAMAGE TO ANY 0$500 OR LESS TYPE OF REPORT ® q No Injury 1 Drive Away
AGENCY CRASH REPORT NO. TRFW
Elgin Police Department ONE PERSON'S ❑5501-$1.500 ®ON SCENE 2
VEHICLE/PROPERTY ®OVER$1,500
❑NOT ON SCENE(DESK REPORT)
0 AMENDED ❑ B Injury and/or Tow Due To Crash YR 202612026-00048871 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 3 mN LIBERTY ST Elgin08:38
® ❑ RELATED ❑Y ®N 08 13 2026 DAM ❑YES ®NO U1
g PRIVATE mo /day/yr ®PM FLOW CONDITION ITl
•
12 !MI N E S W n liberty/PAGE E AveCOUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR 0 SLOW 3 (/)
® ® O '`7 WITH VEHICLES INVLD 0 STOPPED U2 —I
❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) Cook HIT&RUN ❑Y ® N PEDALCYCLIST®N ® FREE FLOW # LNS 0
183 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 2 n
0 7 /
yr 13-UNDER CARRIAGE i I- FIRE ❑
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) EN
O 2 DISTRACTED 0 0 U2 2 rn
M 2 4 SYTM❑Y OS NEDUNK VEH. 0 ATCRASHD 0 15-99-UUNKNOWN THER O9 16-TOP 3 `Distraction Value 9 ALGN X.
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF ,)1 S I,.4 COM VEH 0 )g! 1 C)
~ ELGIN I L 60123 0 1 0 FIRST CONTACT 10 O7 _; __5 *u Yes.See Sidebar U1 0
Z FN85738 IL 2026 REAR
TELEPHONE
IL D 0 JTJBT20X440047737 GEICO ®Y ❑N U2 m
.9 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
Same 6242 33 85 95 2 r
o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER
RESPONDER D
Refused ❑Y ❑ N 2 eu
N DRIVER ❑ PARKED 0 DRIVERLESS ❑ FED ❑PEDAL 0 EWES ❑iiuv 0 NCv ❑Dv
!1 9 8 7 Toyota RAV4 2020' 00-NONE 11 . t2 DUETO CRASH p (� 2
0 13-UNDER CARRIAGE FIRE ❑ ® U2
c
F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16-TOPO3
❑Y MN ❑UNK VEH. AT CRASH 99-UNKNOWN Oistractlon Value 9 g
8 i1 �I 4
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 5 r_ COM VEH D ® U1 W
FIRST CONTACT 1 7�. _, _5 *If Yes.See Sidebar
POPLAR GROVE IL 61065 0 1 0 EK70307 IL 2025 RE g
IL D 0 2T3RWRFV1 LW060088 PROGRESSIVE ❑Y ®N RDEF
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X
Same 985752751 BAc $
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP 996 <
Refused RESPOND 0 N u1 =
(UNIT) (SEAT) (D081 (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)((ADDRESS)((TELEPHONE) (EMS) (HOSPITAL)
1 3 02 / F 2 3 0 1 0
m
/ / #OCCS D
/ / UI 2 D
/ / 1 0
EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z
N 1 El 11 1 08(13 /2026 08 38 ®PM Ina 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
O 2 0 20 15 ( r 0 PM 0 Construction *
1
Z 3 0 xi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 1
❑AM 0 Maintenance U2
a 1 ® 11 1 ARREST NAME Hernandez. Eduardo 11-708 S1516-000565 r ! El PM SLMT
ljg CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ' ❑Utility
o N 0 AM 30
t 2 El, T ARREST NAME Hernandez. Eduardo 3-707 S1516-000564 ( r pM 0 Unknown work zone type U1
OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME
2 2 3 ID AM Workers present? ❑Y 30
1516-Mancera. Maria 201 - r 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 -<
` ` --I -' I f INDICATE NORTH combination):or —I
73
1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver(example:shuttle or charter bus):or C
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3. Is designed to carry15 or fewer passengers and operated a contract carrier O
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} I.- transporting employee �In the course of their employment(example:employee73
� _— } transporter-usually a van type vehicle or passenger car):or tP
i. i - - _ } 1. 4. Is used or designated to transport between 9 and 15 passengers,including the driver. N
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for direct compensation(example:large van used for specific purpose):or o
L L____a____. 1 r"Oe"N° - l. l. I I t 5. Is any vehicle used to transport anyhazardous material(HAZMAT)thatrequires 'D
placarding(example:placards will be displayed on the vehicle). m
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r-, --t CARRIER NAME Z
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_ __ ADDRESS 'T.
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Not To Scale I I r CITY/STATE/ZIP
Ii. i. i. i. MOTOR CARR.ID 0 Interstate 0 Intrastate 5
1 I r 1 ❑ Not in Comm./Govt. 0 Not in Comm./Other
; _Y_ __; - USDOT NO. ILCC NO. m
XI
Source of above z
. Form Number m
m
IDOT PERMIT NO. WIDELOAD'; ❑Yes 0 No 2
TRAILER VIN 1 m
to
LOCAL USE ONLY TRAILER VIN 2 m
v
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. Z
White Greenw
u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_
DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY/TO:
_ SELECT CODES FROM THE BACK OF CRASH BOOKLET
U 2 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY/TO.
DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE