HomeMy WebLinkAbout2026-00050750 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 01111101111
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DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X00435035
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INVESTIGATING AGENCY DAMAGE TO ANY ❑5500 OR LESS TYPE OF REPORT ❑ 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$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash
0 AMENDED YR 2026I 2026-00050750 VERY
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 r1
® ❑ RELATED PRIVATE ®Y 0 N 08 22 2026DAM ❑YES ®NO U1 -<
N LIBERTY ST Elgin mo /day/yr 12:54 ®PM FLOW CONDITION Ill
0 COUNTY PROPERTY ❑Y ® N DOORING Ely #OF MOTOR 0 SLOW 1 (/)01 ®/MI N E p W Linden Ave WITH VEHICLES INVLD 0 STOPPED U2 —I
0 AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) Kane HIT&RUN ❑Y 1� N PEDALCYCLIST 12:1 N 51 FREE FLOW # LNS 0
DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EWES ❑uuv ❑!CV ❑Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 n
mom TOWED U1 O
NAME(LAST,FIRST,M) mo yr
De La Rosa. Linda.S. Nissan Sentra 2013 00-NONE
13-UNDER CARRIAGE „ ! 2 12 , OUE TO CRASH ® ❑
101 FIRE ❑ tz
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 ]$I U2 2 (T7
F 2 5 SYTM❑Y ®SNE❑UNK VEH. O AT CRASH 0 99-U 15- NKNOWN THER9 16•TOP 3 ,Distraction Value ALGN =
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF S i all i 4 COM VEH 0 j$J 1 t;7
H Z Carpentersville I L 60110 0 1 0 FW23772 I L 2026 FIRST CONTACT 6 �:;�REAR
_� •II Yes.See Sidebar u,
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TELEPHONE
IL D 0 3N1AB7AP9DL637001 All State ❑Y ®N U2 m
in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
Elgin Fire 99 9 Same 811897764 1 r
o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER
RESPONDER D
Sherman ❑Y ® N 2 0
p; DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL 0 EWES ❑NMV 0 NCV ❑DV
!1 9 9 9 Honda Accord 2009 00-NONE 'o,I t2 (,-2 FIRE DUE OCRASH 0 ® U2 2 C
o mo 13-UNDER CARRIAGE
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M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9.1,6•TOP 3 X
❑Y ®N 0 UNK VEH. AT CRASH 99-UNKNOWN *Distraction Value 0
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 5 1 6 t. COM VEH 0 ® Ut CO
F,,, FIRST CONTACT 6 O7 ,�AI,- •)ryes.See Sidebar C
ELGIN IL 60123 0 1 0 GD94960 IL 2026 I AR Si)0
IL D 0 1 HGCP36819A038448 First Chicago ❑Y ®N RDEF
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER 1 =
99 9 Mejias Padrino. Eduardo.J. ILV124069801 SAC E
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP
U1 =
(UNIT) (SEAT) (D08) (SEX) {SAFT) (AIR) (INJ) 1(EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)((ADDRESS)(TELEPHONE) (EMS) (HOSPITAL)
2 3 09 /
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 81 ,21 /026 12 54 ®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 0 03 99 81 ,21 /026 12 54 ®PM ElConstrtict on E
R O 0 gi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 1
3 ❑AM ❑Maintenance U2
o ® 11 1 ARREST NAME De La Rosa. Linda.S. 11-601-Ax 1528-000401 81 /21 /026 01 00 Igi PM SLMT
o N -
❑CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • El Utility
0 AM 25
r 2 El 1 1 ARREST NAME 81 /21 /026 01 20 0 PM 0 Unknown work zone type U1
2 2 3 ElOFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? 1:/Y 25
1528-Rivera. Kevin 301 91 / 21 ,026 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
JA.
I ADDITIONAL UNITS FORMS.
r ----r••--, , ) ; A CMV is defined as any motor vehicle used to transport passengers or property and: Z
N -<
1. Has a weight rating more than 10,000 pounds(example:truck or truck/trailer
` ` --I -' r INDICATE NORTH combination):or —I
BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C
- (example:shuttle or charter bus):or
L A 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 X
Unden?Ave transporter-usually a van type vehicle or passenger car):or w
L L.___a__ ` * } } } 4. Is used or designated to transportbetween9and1 ssen rs,includingthedrrver,
I C
for direct compensation(example:large van used fors cific purpose):or
L t i i _ 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m
placarding(example:placards will be displayed on the vehicle). XI
Unit?#2
!I CARRIER NAME Z
Ii. ADDRESS 'n
as C
nUMtN1oar/ 1 CITY/STATE/ZIP 0
_ - i. i. i. i. MOTOR CARR.ID 0 Interstate 0 Intrastate
I I r , , Unit?fK3 ❑ Not in Comm./Govt. 0 Not in Comm./Other 00
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Not To Scale Q USDOT NO. ILCC NO. m
XI
Source of above z
Form Number m
Xl
IDOT PERMIT NO. WIDELOAD'; ❑Yes 0 No 2
TRAILER VIN 1 m
LOCAL USE ONLY TRAILER VIN 2 m
a
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
Black Black
u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_
DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT' 2 TOWED BY/TO.
_Adieu/Impound Lot Garage SELECT CODES FROM THE BACK OF CRASH BOOKLET
U 2 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY1T0:
DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE