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HomeMy WebLinkAbout2026-00050991 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 0110 II I OH IIH U OH HI IOU DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY XO04351395 u, 1 U21 3 4 1 U1 2 U2 1 U, 1 u2 1 U1 1 u2 1 1 15 u, 1 u2 1 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY El$500 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 N OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash 0 AMENDED YR 2026I 2026-00050991 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n N STATE ST Elgin 03:31 ® ❑ RELATED ®Y 0 N 08 23 2026 ❑AM ❑YES ®NO U1 -< _ _ PRIVATE mo /day/yr NPM FLOW CONDITION ITI FT/MI N E S W KIMBALL BALL ST COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR IR SLOW 2 CA ❑ Kane HIT&RUN ❑V ® N WITH VEHICLES INVLD 0 STOPPED U2 --I ® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST IR N ❑ FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EWES ❑uuv ❑!CV ❑Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 n 0 8 FOR DAMAGEDAREA(S) FROr'1T TOWED U1 Q NAME(LAST,FIRST.M) Zuniga Avila. Lourdes mo Nissan Sentra 2006 00-NONE DUE TO CRASH ® ❑ / / yr ©1 12 , 13-UNDER CARRIAGE FIRE ❑ IE STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) O 2 THERDISTRACTED 0 0U2 4 M F 2 5 SYTM❑Y NSNE❑UNK VEH. O AT CRASH 0 15-99-UNKNOWN 9 76•TOP 3 `Distraction Value 9 ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s, it 6 �i 4 COM VEH ❑ N 1 0 I= FIRST CONTACT 11 7_:,___;__5 *IrYes.SeeSidebar U1 Z Geneva IL 60134 B 1 0 FS42119 IL 2026 REAR TELEPHONE IL D 3N 1 CB51 D26L642076 American Alliance ❑Y Il N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Elgin Fire Same I LAA-1114462-00 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Provena St.Joseph ❑Y El 2 GC) E{ DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEOAL 0 EWES ❑row ❑Iry ❑Dv /1 9 yr 3 Dodge Ram 1500(pickup) 2019 00-NONE Q j 2 -Y1 DUE TO CRASH ❑ 2 0 13-UNDERCARRIAGE 10j ©1( 2 FIRE ❑ N U2 C c M 2 5 SYSTEM IN 0 ENGAGED 0 15-OTHER 9,16•TOP 3 X ❑Y i N DUNK VEH. AT CRASH 99-UNKNOWN *Distract Dn Value 9 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8 6 Il, 4 COM VEH ElN U1 COFIRST CONTACT 1 7 • -5 •If Yes.See Sidebar = ELGIN IL 60123 0 1 0 3141942B IL 2026REAR 0 IL 1 C6SRFST2KN858981 State Farm ❑Y N N RDEF71 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = South Elgin Fire Same 1028713-SFP-13 SAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP 996 < Sherman RESPONDER u1 = (UNIT) (SEAT) (DOBI (SEX) {SAFT) (AIR) (INJI (EJCT( (EPTH) PASSENGERS&WITNESS ONLY (NAME)!(ADDRESS)!(TELEPHONEI (EMS) (HOSPITAL) 1 3 04 / / / u1 2 :A D / / 2 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z N 1 N 11 1 8/ /3/ /026 03 31 ®AM in a Work Zone? NCI 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 C) 2 0 2 99 8/ !3/ /026 03 32 ®pM ❑Construction * R ❑ xi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 7 3 ❑AM ❑Maintenance U2 o1 ® 11 1 ARREST NAME Zuniga Avila. Lourdes 11-305-A 1549-498 8/ /3/ /026 03 36 Igi pM SLMT o N - ❑CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ' 0 Utility 0 AM t 2 El ARREST NAME 8/ 1 3/ /026 04 09 ®PM 0 Unknown work zone type U1 3O 2 2 3 ID ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME COAM Workers present? ❑Y 30 1549-Brown. Bryan 601 337-Thompson 9/ / 4/ /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 ADDITIONAL UNITS FORMS. r ----r••--, , I Io. - ; A CMV is defined as any motor vehicle used to transport passengers or property and: Z 4. tut . 0 �____r____; I I _ combination): more than pounds(example:truck ortruckrtrarler 1. Has a rating10 000i -< INDICATE NORTH 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 Not To Scale f ' I I 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I `-----I---•i J Unit 1 - } } } transporting employees to p yees In the course of their employment(example:employee gyp — •) transporter-usually a van type vehicle or passenger car):or CO C 4. Is used or designated to transport between 9 and 15 passengers,including CC/t }--- ----; _ •_ - } ssen rs,indudi the driver, 3'-,,, } } for direct compensationlarge van used for specific purpose): sr (example: 9 Pe P Pose):or L i.____a____� 5 _ t i 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). ;p —1 — — — CARRIER NAME Z r ADDRESS 0 N?State?St T. CITY/STATE/ZIP I = 'IX .E _ i. i. i. MOTOR CARR.ID 0 Interstate 0 Intrastate Iqa► i. I ❑ Not in Comm./Govt. Not in Comm./Other0 --- -'4 USDOT NO. ILCC NO. m XI Source of above Z . If Yes,Name on placard O 4 digit UN NO. 1 digit Hazard class No. Xl Xl 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 Blue Blue 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 DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® DISABLING DAMAGE Arties/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE