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HomeMy WebLinkAbout2026-00051599 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 0110 II I flfl IIH II ID DUO DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X�353178 u, 1 U21 3 4 1 U1 2 U2 1 U,99 U299 U,99 U2 99 1 11 U1 1 U211 *P 0119* 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 3 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) 0 AMENDED ❑ B Injury and/or Tow Due To Crash YR 202612026-00051599 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 �I ® ❑ RELATED ' ' 0 N 08 26 2026 ®AM ❑YES ®NO U1 -< N LIBERTY ST Elgin10:47 g PRIVATE mo /day/yr ❑PM FLOW CONDITION ITl FT l MI N E S W CONGDON AVE COUNTY PROPERTY ❑Y ® N DOORING El #OF MOTOR 0 SLOW 2 rA ❑ Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD 0 STOPPED U2 --I CO AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EWES ❑NW ❑ncv ❑Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 n 0 2 ! yr 13-UNDER CARRIAGE ©,I 0,:0 FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ® ❑ U2 4 rn M 2 4 Y SYSTEM IN ENGAGED 15-OTHER 9 16.TOP 3 9 ALGN = ❑ ❑N ❑UNK VEH. AT CRASH 99-UNKNOWN `Distraction Value r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s it 6 4 COM VEH 0 j$J 1 0 F. Hoffman Estates IL 60169 0 1 FIRST CONTACT 12 7_;1 __5 *IIYes.See Sidebar U1 Z FG92298 IL 2027 REAR TELEPHONE IL D 0 KM8SM4HF3DU014790 Protege ®Y ❑N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 Same I LS 1139307-01 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused 0 Y ® N 2 XI N DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EWES ❑iiuiv 0 v ❑Dv yr Ford F150 2010' oo-NONE 11 12 t2'-_, DUE TO CRASH ❑ 2 0 13-UNDER CARRIAGE to l 2 FIRE 0 El U2 C Ti M 2 4 ❑Y SYSTEM IN ENGAGED 15-OTHER 9 16•TOP 3 9 X 0 N 0 UNK VEH. AT CRASH 99-UNKNOWN *0istrac on Value N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF S I 6 .!,_4 COM VEH ❑ ® U1 CO FIRST CONTACT 6 7 -�-_5 •IfYes.See Sidebar C Z Carpentersville IL 60110 0 1 3044552B IL 2026 REAR 0 t;p D IL D 0 1 FTM F1 CW4AKB35882 StateFarm ❑Y ®N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER 1 = 99 9 Berber Lopez. Ireneo, I. 1416050-SFP-13 SAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP U1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)((A.DDRESS)!(TELEPHONE! (EMS) (HOSPITAL) 2 3 04 / M 2 4 0 1 m / / #OCCS D 71 / / U1 1 D / / 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 4 08/26 l2026 10 47 ®❑PM 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 o" 2 0 28 99 , , 0 PM• ❑Construction * R 3 0 $I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 1 ❑AM 0 Maintenance U2 -a, ARREST NAME Lopez Hernandez,Carlos, R. 11-601-Ax 399004718 / / ❑PM SLMT o N 1 ® 11 4 llg CITATIONS ISSUED 0 PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • 0 Utility AM H 30 r 2 0 ARREST NAME Lopez Hernandez,Carlos, R. 3-707 399004719 , / DI PM 0 Unknown work zone type U1 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 30 399-Kazy-Garey, Daniel 201 331-Ziegler 09 , 15,2026 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 JJJ I ADDITIONAL UNITS FORMS. _- _- J,, ) J I s _ A CMV is defined as any motor vehcle used to transport passengers or property and: Z `I( �� 01. Has a weight rating more than 10,000 pounds{example:truck or truckrtrailer -< c -I- ' r INDICATE NORTH combination):or p3 —— — BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C — — P — 4 (example:shuttle or charter bus):or X ,� I ,,-, a 3. Is designed to carry15 or fewer passengers and operated a contract carrier O I- }____A____1 ' ,->, - : I. } } transportingemployee in the course oftheirem employment(example:employee X I �.'.% transporte -usually a van type vehicle or passenger car):or w -- -- nor,oar } } } •4. Is used or designated to transport between 9 and 15 passengers,including the driver. C I for direct compensation(example:large van used for specific purpose):or O rr 0- i i. 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires III 1 pWcartling(example:placards will be displayed on the vehicle). ;p CARRIER NAME Z l� ADDRESS D rn CICITY/STATE/ZIPgC) MOTOR CARR.ID 0 Interstate ❑ Intrastate I I T I ❑ Not in Comm./Govt. 0 Not in Comm./Other ;____Y____1 USDOT NO. ILCC NO. m XI Source of above z . —I Were HAZMAT placards on vehicle? 0 Yes 0 No = If Yes,Name on placard O 4 digit UN NO. 1 digit Hazard class No. XI XI 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 71 IDOT PERMIT NO. WIDELOAD'; ❑Yes 0 No 2 TRAILER VIM 1 m co 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 Blue 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 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY/TO. DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE