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HomeMy WebLinkAbout2026-00048947 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 1111 III 11 III1II 10111 01111DM I11Il11111111011 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X004340649 u, 2 U21 1 1 1 U116 U2 1 U, 1 u2 1 U, 1 U2 1 1 14 u1 1 u2 1-i *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY 0$500 OR LESS TYPE OF REPORT 0 A No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW Elgin Police Department ONE PERSON'S 0$501-S1,500 ®ON SCENE 2 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash 0 AMENDED YR 2026I 2026-00048947 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 rn DOUGLAS AVE Elgin 05:53 0 ❑ RELATED ®Y ❑N 08 14 2026 ®AM ❑YES ®NO U1 -< _ _ g PRIVATE mo /day/yr ❑PM FLOW CONDITION m FT!MI N E S W SLADE AVE COUNTY PROPERTY ❑Y ® N DOORING Ely #OF MOTOR 0 SLOW 1 (n ❑ Kane HIT ❑Y ® N WITH VEHICLES INVLD 0 STOPPED U2 --I ® &RUN AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N 51 FREE FLOW # LNS 0 Qg3 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EDUCE 0 uuv 0!Cy 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 n FOR DAMAGEDAREA(S) FROf'rr TOWED U1 Q NAME(LAST,FIRST,M) Orozco. Manuel.A. 0 mo /7 1 9 9 6 Hyundai Elantra 2010 00-NONE ©,: © i 0 DUE 7o CRASH ® El 13-UNDER CARRIAGE } FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) O O THERDISTRACTED 0 ]$I U2 2 m M 1 8 SYTM❑Y ®SNE❑UNK VEH. O AT CRASH 0 15-99-UNKNOWN 9 16•TOP 3 *Distraction Value ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 7 :i1 a 4 COM VEH 0 Ea 1 0 ~ ELGIN IL 60123 A 1 0 FIRST CONTACT 12 7_; _5 *IIYes.SeeSidebar U1 Z AE88092 IL 2026 Isui TELEPHONE IL D 0 KM H DU4AD8AU912640 GEICO ❑Y ®N U2 1- .5 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER RSUR m Elgin Fire 99 9 MOJICA.JOAQUIN 6185833164 1 r o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER RESPONDER 2 ou m x DRIVER ❑ PARKED 0 DRIVERLESS ❑ FED 0 PEDAL 0 EWES 0 i My 0 IIGV 0 DV 1 9 6 2 Hyundai Santa Fe 2013 00-NONE O1 Qj O DUE TO CRASH rg D 2 x o 13-UNDER CARRIAGE I 1 FIRE 0 ® U2 C c M 2 8 SYSTEM IN 0 ENGAGED 0 15-OTHER 9,IS-TOP 3 X ❑Y ®N 0 UNK VEH. AT CRASH 99-UNKNOWN *0istracu n Value 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s-il��:- COM VEH ❑ ® U1 CO FIRST CONTACT 12 Y _, .5 •(ryes,See Sidebar = ELGIN C n IL 60120 B 1 0 FH30327 IL 2026 IL D 0 SXYZW3LA8DG024655 STATE FARM ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = 99 9 Same 0519426-SFP-13 BAc $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 997 < Refused RESPONDER U1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)((ADDRESS)(TELEPHONE) (EMS) (HOSPITAL) 2 3 04 / U1 1 D / / 2 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z N 1 ® 11 1 81 ,41 ,026 05 53 ®❑pM in a Work Zone? ®N DIRP co 1 t PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 7 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ®AM U1 C) 2 0 08 20 81 ,41 ,026 05 57 pNl ❑ 0 Construction >E en Z 3 0 ❑CITATIONS ISSUED ❑PENDING SECTION CITATION NO. EMS ARRIVED TIME 3 ®AM ❑Maintenance U2 -a, ARREST NAME 81 /41 /026 06 01 ❑PM ' 1 ® 11 1 0 CITATIONS ISSUED ❑PENDING UtilitySLMT NSECTION CITATION NO. ROAD CLEARANCE TIME o ❑ AM U, 30 r 2 El ARREST NAME 81 r 41 ,026 07 00 [M PM El Unknown work zone type n 7 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 0 - ❑AM Workers present? ❑Y 30 1579-Payleitner. Madison 102 , , ❑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 cf 1.mHas r more than pounds(example:truck or truck trailer -I 1. Hasa weight rating10 000 r }----r----, x - } INDICATE NORTH IIOn):o Z1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C i_ j 1! hbr ro 1310nt6.i - } (example:shuttle or charter bus):or 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I O } } } transporting employees in the course of their employment(example:employee transporter-usually a van type vehicle or passenger car):or w L 4. Is used or designated to transport between 9 and 15 passengers,including N --- ----; - } } } g po passen rs,includi the driver, for direct compensation(example:large van used for specific purpose):or ____a____. P` _ t l. I. I t 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m /� placarding(example:placards will be displayed on the vehicle). XICARRIER NAME Z r r -:- ''. 'N i —I IJ T2 _ ADDRESS 0 CCITY/STATE/ZIP0C _ i. i. i. i. MOTOR CARR.ID 0 Interstate 0 Intrastate ' ❑ Not in Comm./Govt. ❑ Not in Comm./Other 00 ------- --1 - USDOT NO. ILCC NO. C m XI Source of above Z . own tank)? 0 Yes 0 No 0 UnknownT. 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 Xl 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 Bronze 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 DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® DISABLING DAMAGE Redmons/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE