HomeMy WebLinkAbout2026-00052422 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 6 Sheets 01111101111
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DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X+ 61207*
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INVESTIGATING AGENCY DAMAGE TO ANY ❑$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 4
VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash
❑AMENDED YR 202612026-00052422 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 �7
N LIBERTY ST Elgin 05:09
® ❑ RELATED ®Y 0 N 08 29 2026 ❑AM YES ®NO U1 -<
_ g PRIVATE mo /day/yr ®PM FLOW CONDITION MFT!MI N E S W SUMMIT ST COUNTY PROPERTY :IY ® N DOORING ❑y #OF MOTOR 0 SLOW 1 0)0 Kane HIT&RUN ®Y ❑ N WITH VEHICLES INVLD ❑ STOPPED U2 --I
® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST IZI N 51 FREE FLOW # LNS 0
Qg3 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EWES 0 uuv 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0
T
0 6 /
yr 13-UNDER CARRIAGE 2 FIRE ❑
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ❑ 0 U2 5 <r1<
10.
SYTM
15-
THER
M 2 4 ❑Y ®SNE❑UNK VEH. O AT CRASH 0 99-UUNKNOWN 9 16•TOP 3 `Distraction Value ALGN
-
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR0
F. POINT OF s :i�6 _4 COM VEH El j$J 1 0
FIRST CONTACT 12 7_ —__, _5 *IIYes.See Sidebar U1
Z Carpentersville IL 60110 0 1 0 G D59249 IL 2026 REAR
TELEPHONE
IL D 0 1 G11 F5RR8DF108458 NIA ®Y ❑N U2 m
13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
Same NIA 2 r
o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER
RESPONDER D
Refused 0 Y ® N 2 0
p; DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEOAL 0 EWES 0
/2 O 0 6 Chevrolet Malibu 2024 00-NONE 11_1 12..- 1 DUE TO CRASH ❑ C 2
.. 13-UNDERCARRIAGE 10;1 2 FIRE ❑ ® U2 C
c
M 2 4SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16-TOP 3 X
0 Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN *Oistracuon Value 0
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 -�'OS •(ryes,See Sidebar C
ELGIN IL 60120 0 1 0 GA59249 IL 2026 I Si)0
IL D 0 1 G 1 ZE5STXRF239569 Progressive ❑Y ®N RDEF
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER 1 =
Same 878523105 BAc $
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 <
Refused RESPONDER
U1 =
(UNIT) (SEAT) (DOB1 (SEX) {SAFT) (AIR) (INJI (EJCT( (EPTH) PASSENGERS&WITNESS ONLY (NAME)((ADDRESS)/)TELEPHONE) (EMS) (HOSPITAL)
2 3 09 /
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 08/29 /2026 05 09 ®AM in a Work Zone? ®N DIRP co
1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 3
T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 0
v 2 0 28 11 08/29 /2026 05 16 ®PM 0 Construction
>F
R 3 ❑ xi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 3
z J ❑AM ❑Maintenance U2
a ® 11 4 ARREST NAME Garcia. Ivan 3-707 1556-000210 08/29/2026 05 20 Igi PM• • El Utility SLMT
❑CITATIONS ISSUED I]PENDING SECTION CITATION NO. ROAD CLEARANCE TIME
p N 0 AM 30
T 2 ElARREST NAME Garcia. Ivan 11-407-A 1556-000209 08/29 /2026 05 16 ®PM 0 Unknown work zone type U1
2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 15
1556-Sanchez.Jimena 202 378-Alcorn 09 , 14/2026 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 I ADDITIONAL UNITS FORMS.
r ----r•---, , I I - ; 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 I I I. INDICATE NORTH combination):or A
II i BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C
} .� - } (example:shuttle or charter bus):or C
R I 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier 0
} } } transporting employees in the course of their employment(example:employee
transporter-usually a van type vehicle or passenger car):or w
--_.a Summr'�75't �4. Is used or designated to transport between 9 and 15 passengers,including C- - - - •} } 1. for direct compensation(example:large van used for specificpurpose):or [he driver,
Pe ( P 9 Pe or 0
— — _Unfit Unit 2 — — — < < < t 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires
h i 4: *t m
— — — placarding(example:placards will be displayed on the vehicle). XI
1 CARRIER NAME
14314e St Not To Scale ' Z
I ADDRESST.
0
CITY/STATE/ZIP 0
g
_ i. i. i. i. MOTOR CARR.ID 0 Interstate 0 Intrastate 5
1 I r 1 ❑ Not in Comm./Govt. ❑ Not in Comm./Other 0
I. --- --4. I I USDOT NO. ILCC NO. Cm
PCI
Source of above z
own tank)? 0 Yes 0 No 0 Unknown D
Did HAZMAT Regulations violation contribute to the crash? r
❑ Yes 0 No 0 Unknown g
Did Carrier Safety Regulations I/ICS)violation contribute to the crash?❑ Yes IQNo El Unknown Unknown 0
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
co
LOCAL USE ONLY TRAILER VIN 2 m
0
TRAILER WIDTH(S) 0-96" 97-102" >102' T
TRAILER 1 ❑ ❑ 0 z
ri
TRAILER 2 ❑ 0 0 o
u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w
White Tan
u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_
DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT 3 TOWED BY/TO.
_Adieu/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