Loading...
HomeMy WebLinkAbout2026-00051803 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 6 Sheets 01111101111 IIIIII II II I OH IIH 11111 DRAG TRFD TRFC WEAT DRVA VIS VEHD LGHT COLL MANY XO04357241 u, 1 U2 15 4 1 U1 2 U2 U, 1 u2 U, 1 U2 1 1 U1 1 U2 *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 ❑5501-51,500 ®ON SCENE 3 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash El AMENDED YR 2026I 2026-00051803 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 m1475 LARKIN AVE El In 07:01 ® ❑ RELATED ❑Y ®N 08 27 2026 ®AM ❑YES ®NO U1 _ g PRIVATE mo /day/yr ❑PM FLOW CONDITION m COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR 0 SLOW Cl) ❑ FT/MI NESW Cook HIT&RUN ❑Y ® N WITH VEHICLES INVLD 0 STOPPED U2 --I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 Qg3 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EOUES 0 uuv 0 ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 0 r4T TOWED U1 Q NAME(LAST,FIRST,M) Mejia-Carranza. Emelina mo yr Chevrolet Trail Blazer 2022 00-NONE 1 DUE TO CRASH ❑ EN 13-UNDER CARRIAGE ©I O - FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 10 2 DISTRACTED ❑ ]$I U2 4 rn F 2 4 ❑Y SYSTEM IN ENGAGED 15-OTHER 9 16.TOP 3 _ ❑N DUNK VEH. AT CRASH ®-UNKNOWN `Distraction Value ALGN r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s,;i�s 4 COM VEH 0 El 1 0 ~ ELGIN I L 60123 0 1 FIRST CONTACT 10 7_•, _5 *II Yes.See&Debar Ut Z FL69298 IL 2026 REAR TELEPHONE IL D KL79MRSLXNB095845 State Farm ®Y ❑N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Carranza de mejia. Elba 3777378-SFP-13 1 r o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER RESPONDER 2 c 0 DRIVER ❑ PARKED 0 DRIVERLESS gi PED 0 PEDAL 0 EWES 0 r My 0 NOV 0 DV yr 00-NONE �". Qi•-_1 DUE TO CRASH ❑ ❑ 73 o 13-UNDER CARRIAGE 10( 12 FIRE ❑ ❑ U2 C c M 1 3 ❑Y ❑N ❑UNK VEH. AT CRASH 99-UNKNOWN *DistractionValue 0 - N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s- : 4 COM VEH 0 0 U1 CO FIRST CONTACT 11 7�- _5 •IfYes.See Sidebar C H ELGINAR- 0)M IL 60123 B IL D 0 ❑Y 0 N RDEF73 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Elgin Fire 1 48 2 Carranza de mejia. Elba BAC 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)((ADDRESS)(TELEPHONE) (EMS) (HOSPITAL) 1 4 09 / F 12 3 0 1 0 m / / #OCCS D 71 / / UI 2 D / / 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 12 1 08/27 /2026 07 01 ®❑PM in a Work Zone? ®N DIRP co I I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 3 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ®AM U1 C) v 2 2 18 08/27 /2026 07 01 ❑PM ❑Construction >F R 3 0 ]$I CITATIONS ISSUED ElPENDING SECTION CITATION NO. EMS ARRIVED TIME z J ®AM ❑Maintenance U2 -a, ARREST NAME Mejia-Carranza. Emelina 11-1002.5 387-1315 08/27/2026 07 05 ❑PM SLMT o U 1 00 CITATIONS ISSUED PENDING Utility o N SECTION CITATION NO. ROAD CLEARANCE TIME • El AM U1 30 F 2 ❑ ARREST NAME 08/27 /2026 07 16 fl PM ❑Unknown work zone type 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 25 387-Root. Mark 602 275-Engelke 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 I, ADDITIONAL UNITS FORMS. r ----r••--, , Not To Scale ; 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 -< c ` --I -' r INDICATE NORTH combination):or .Z-1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C - (example:shuttle or charter bus):or r r r ASk X I- I- --I-- N 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 I Liakiiithiktagfin I ll transporter-usually a van type vehicle or passenger car):or CO C L L.___a__ 4. Is used ordesi natedtotrans rtbetween9and15 passengers,including y} } for direct compensation(example:large van used for specificpurpose):or [he driver, Pe ( P 9 Pe or 0 L ' ___.I urn t i } i t 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m placarding(example:placards will be displayed on the vehicle). XI —1 CARRIER NAME Z ADDRESS 0 w C) CITY/STATE/ZIP g MOTOR CARR.ID 0 Interstate 0 Intrastate 0 I I T I ❑ Not in Comm./Govt. ❑ Not in Comm./Other 0 L.,a.viL_.7 ! - f USDOT NO. ILCC NO. m XI Source of above z . IDOT PERMIT NO. WIDELOADo ❑Yes 0 No = TRAILER VIN 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 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: 2 TOWED BY/T6 DUE TO VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE