HomeMy WebLinkAbout2026-00050959 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 lillii 11 II
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DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X 35O40S
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INVESTIGATING AGENCY DAMAGE TO ANY El 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-$1.500 ®ON SCENE 1
VEHICLE/PROPERTY ElOVER 51,500 El NOT ON SCENE(DESK REPORT) El B Injury and/or Tow Due To Crash
0 AMENDED YR 2026I 2026-00050959 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 —n
DUNDEE AVE Elgin 11:13
® ❑ RELATED ®Y 0 N 08 23 2026 ®AM YES ®NO U1 -<
_ _ PRIVATE mo /day/yr ❑PM FLOW CONDITION Ill
FT!MI N E S W ELMA AVE COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR El SLOW 1 (/)❑ Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD ❑ STOPPED U2 —I
® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0
Qg3 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 KIN 0 ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N L4
FOR DAMAGEDAREA(S) FROM TOWED U1 I�
ORTUNO DEPAZ. DANIEL 0 1 /
yr 13-UNDER CARRIAGE 10.I 2 FIRE 0
tz STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL)THERDISTRACTED 0 0 U2 4 (<Tl
M 2 SYTM 5 ❑Y ®$NE❑UNK VEH. O ATCRASHD 0 99-U15-UNKNOWN 9 16•TOP 3 `Distraction Value 9 ALGN 2
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8, it 4 COM VEH 0 j$J 1 0
" �- EAST DUNDEE IL 60118 B 1 0 FIRST CONTACT 12 7_; __s *IIYes.See Sidebar U1
ZZU14139 IL 2027 E
TELEPHONE
IL D 3N 1 CN7AP5H L816058 STATE FARM ❑Y ®N U2 1—
19 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
1 99 9 Same 2406694-SFP-13 1 r
o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER
RESPONDER D
Refused ❑Y ❑ N 2 0
m g DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 iiuv 0 Ixv 0 Dv CIRCLE NUMBER(S) U1
/1 9 v 2 Honda Accord 2016', oo-NONE ,�_-1 1z..-_, DUETOCRASH ❑ 2
o 13-UNDERCARRIAGE ta;l 2 FIRE ❑ ® U2 C
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F 2 4 SYSTEM IN 0 ENGAGED 15-OTHER 9 16-TOP 3 X
❑Y NJ N ❑UNK VEH. AT CRASH 99-UNKNOWN *0istraellon Value 9 0
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8i 6 ....4 COM VEH D ® u1 CO
F,,, FIRST CONTACT 5 7 -�'OS •(ryes,See Sidebar C
ELGIN IL 60120 0 1 0 Z409039 IL 2025 I 0 Si)
IL D 1 FMCU9GX6G U 674856 ALLSTATE ❑Y ®N RDEF
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER 1 =
1 99 9 Same 811047610 BAc $
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 <
Refused 0 Y°ND
0 N u1 =
(UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJI (EJCTI (EPTH) PASSENGERS&WITNESS ONLY (NAME)/(ADDRESS)/(TELEPHONE) (EMS) (HOSPITAL)
2 3 02 /
UI 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 08/23 /2026 11 30 ®❑PM in a Work Zone? ®N DIRP co
1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 5
T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ®AM U1
v 2 ❑ 28 03 08/23 /2026 11 14 ❑PM ❑Construction >F
A
<w 3 0 xi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 4
®AM 0 Maintenance U2
-a, ARREST NAME ORTUNO DEPAZ. DANIEL 11-601-Ax 435000748 08/23/2026 11 18 ❑PM CITATIONS ISSUED PENDING SLMT
1 ® 1 0 1 0 Utility
NSECTION CITATION NO. ROAD CLEARANCE TIME
o Ely
AM u1 35
T 2 ❑ ARREST NAME 08/23 /2026 11 45 M PM 0 Unknown work zone type
2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑AM Workers present? ❑Y 35
435-Mahan. David 201 275-Engelke 09 / 14/2026 01 30 ®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 r INDICATE NORTH combination):or
!! BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C
I ® r . ,. (example:shuttle or charter bus):or X
L L.___A.._.� I 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I O
I. t t transporting employees in the course of their employment(example:employee X
—
transporter-usually a van type vehicle or passenger car):or w
4. Is used ordesi natedtotrans rtbetween9and15passengers,includingthedriver. C
I I iil } } } for direct compensation(example:large van used for speific purose):or 0
I I " [ID—
< <____a..... t. ® - t . i . t 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m
Z placarding(example:placards will be displayed on the vehicle). ;p
—1
CARRIER NAME Z
Nat To Soe/!J I 1
-. — I L L. L.___-.. ADDRESS 'n
I
CITY/STATE/ZIP
Ii. i. MOTOR CARR.ID 0 Interstate 0 Intrastate
I I T I ❑ Not in Comm./Govt. 0 Not in Comm./Other
; _Y_ _-1 - USDOT NO. ILCC NO. rn
XI
Source of above Z
. 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? 0 Yes 0 No 2
TRAILER VIN 1 m
co
LOCAL USE ONLY TRAILER VIN 2 m
v
TRAILER WIDTH(S) 0-96" 97-102" >102' T
TRAILER 1 ❑ ❑ 0 Z
TRAILER 2 ❑ 0 0 O
u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. 0
Red Red
u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_
DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT- 3 TOWED BY/TO.
_Arties/Impound Lot Garage . SELECT CODES FROM THE BACK OF CRASH BOOKLET
U 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/TO:
DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE