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HomeMy WebLinkAbout2026-00050779 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets Mill III H IIIl 01110 1111DDMM 11111111111111Il DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X004348577 u, 1 U21 2 4 1 U1 2 U2 1 u113 1_12 1 u, 1 U2 1 1 2 u, 1 u2 1 *P 0119 INVESTIGATING AGENCY DAMAGE TO ANY El$500 OR LESS TYPE OF REPORT El A No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW Elgin Police Department ONE PERSON'S 1215501-$1.500 ®ON SCENE 2 VEHICLE/PROPERTY ❑OVER$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash El AMENDED YR 202612026-00050779 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 m ® ❑ RELATED ❑Y ®N 08 22 2026 ❑AM ❑YES ®NO U1 —< NATIONAL ST Elgin03:57 _ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION ITl 0 !MI N E S Times SqCOUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR 0 SLOW 99 (n ® © Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD 0 STOPPED U2 —I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 18:DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NIAV 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 0 1 2 / yr 13-UNDER CARRIAGE 10 1 2 EN FIRE 0 IE < STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ❑ 0 U2 rn F 2 4 SYTM❑Y ®SNE❑UNK VEH. O AT CRASH 0 15-99-UNKNOWN THER9 ,6•TOP 3 `Distraction Value ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s i�S �i 4 COM VEH 0 Ea 1 0 ELGIN I N I L 60123 0 1 0 FIRST CONTACT 11 7_: __5 *II yes.See Sidebar U1 Z FM99662 IL 2027 REAR TELEPHONE IL D 0 SXYPH DA1 XGG027460 State Farm ❑v ®N U2 I' in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 Same 3868155SFP13 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y ® N 2 c ❑ DRIVER ❑ PARKED 0 DRIVERLESS 0 PED N PEDAL 0 EWES 0 Nov 0 KCv 0 DV Yr/ 1 9 5 8 Unknown Unknown 2025 00-NONE 1("j t2 -_, DUE TO CRASH ❑ (� 2 0 13-UNDER CARRIAGE 10 l z FIRE ❑ ® U2 C F 19 3 ❑Y SYSTEM IN 0 ENGAGED 0 ®-OTHER 9 16-TOP 3 0 X ®N ❑UNK VEH. AT CRASH 99-UNKNOWN *Oistraellon Value POINT OF S i1 �I COM VEH ❑ ® U1 CO N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR A 5 C FIRST CONTACT 1 7�-REAR •It Yes,See Sidebar — Chicago IL 60613 B 2 8 0 Si) IL D 0 K6F0002480 NIA ❑Y ❑N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = 2 49 2 Same NIA BAc $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP 996 < Refused RESPONDER U1 = (UNIT) (SEAT) (D08) (SEX) {SAFT) (AIR) (WI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)!(ADDRESS)1(TELEPHONE) (EMS) (HOSPITAL) 1 3 08 / F 2 3 0 1 0 m / / #OCCS D 71 / / UI 2 D / / 1 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ®Y U2 Z N 1 ® 13 1 08,22 /2026 03 57 ®AM in a Work Zone? ❑N DIRP co I 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 14 99 08,22 ,2026 04 05 ®pM ®Construction >E R O 0 ]$I CITATIONS ISSUED PENDING SECTION CITATION NO. EMS ARRIVED TIME 1 J ❑AM ❑Maintenance U2 o ®1 11 1 ARREST NAME Cosio, Baudelia 11-601 1512701 08,22,2026 04 13 ®pM SLMT o N - ❑CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • El Utility 0 AM r 2 El ARREST NAME 081 22 ,2026 04 16 ®PM El Unknown work zone type U1 25 n 7 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME y 2 2 3 0 1512-Juarez-Huichapan.Juan 400 337-Thompson 10 ,06,2026 01 30 ®PM Am Workers present? El 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 Has a weight rating more than 10,000 pounds(example:truck or truck/trailer 1 -I } }---_r__--; } combination):or —I CI INDICATE NORTH p1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C r r r (example:shuttle or charter bus):or 0 78 Nalianalt .. - - , 1 Not To Scale 1 3. Is desgned 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 CO L }-----}----; Pdnt7o17oontxt1 - • } } 1. 4. Is used or designated to transport between 9 and 15 passengers,including the driver, C r 1 for direct compensation(example:large van used for specific purpose):or O i t 5. Is any vehicle used to transport anyhazardous material(HAZMAT)that requires a placarding(example:placards will be displayed on the vehicle). D I m XI I5 , , ,• , , CARRIER NAME Z _ ADDRESS O 3 T. c) I , CITY/STATE/ZIP g MOTOR CARR.ID 0 Interstate ❑ Intrastate l 0❑ Not in Comm./Govt. ❑ Not in Comm./Other 0 --- --1 - USDOT NO. ILCC NO. C m XI Source of above z . • m Did HAZMAT spill from vehicle(do NOT consider FUEL from vehicle's 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 to LOCAL USE ONLY TRAILER VIN 2 m 0 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. w Gray 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 DISABLING DAMAGE DAMAGE EXTENT: 3 TOWED BY/TO. DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE