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HomeMy WebLinkAbout2026-00053491 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 Mil II II I flfl 11001�I��0111111 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X61. u, 1 U21 2 4 1 u, 2 U299 u, 1 U2 1 u1 1 U2 1 1 10 u1 3 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 ❑$501-$1.500 ®ON SCENE 15 VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash El AMENDED YR 2026I 2026-00053491 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 rn ® ❑ RELATED ®Y 0 N 09 03 2026 ®AM ❑YES ®NO U1 S STATE ST Elgin07:59 _ _ g PRIVATE mo /day/yr ❑PM FLOW CONDITION m FTlMI N E S W STANDISH ST COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 15 ❑ Kane HIT&RUN ❑V ® N WITH VEHICLES INVLD ❑ STOPPED U2 —I Igl AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N 51 FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL ❑EWES ❑uuv ❑!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 C) 0 4 / yr O3-UNDER CARRIAGE ©i O! 2 FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) O 2 DISTRACTED 0 0 U2 2 m F 2 SYTM IN ENGAGE15-OTHER 4 ❑Y ®SNE❑UNK VEH. O ATCRASHD O 99-UNKNOWN 9 76•TOP 3 `Distraction Value 9 ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8, it 6 �i COM VEH 0 j$J 1 0 m ~ ELGIN I L 60123 0 1 0 FIRST CONTACT 11 7_:, -__5 *U Yes.See Sidebar U1 Z EW53850 IL 2026 REAR TELEPHONE IL D 0 J M 1 BL1 SFXA1318081 Allstate ❑Y J N U2 I— IL'B EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Elgin Fire 99 9 Rocha,Alfredo,J. 969981253 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER RESPONDER 2 XI N DRIVER ❑ PARKED 0 DRIVERLESS 0 FED 0 PEDAL 0 EWES 0 r uv 0 KCV 0 DV !1 9 9 4 Jeep(after 19681�rokee 2014 00-NONE 0t2..O DUE TO CRASH 0 2 x 0 yr 13-UNDER CARRIAGE 10 I 2 FIRE ❑ El U2 C c F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9,16-TOP 3 X ❑YNi N DUNK VEH. AT CRASH 99-UNKNOWN *Distraction Value g g N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8-it 6 11:, 4 COM VEH ❑ ® U1 co FIRST CONTACT 12 7 .5 •If Yes.See Sidebar H ELGINZ IL 60120 0 1 0 DX84576 IL 2026 I 9 Cl)C M IL D 0 1C4PJMCBOEW211977 State Farm ❑Y ®N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Elgin Fire 99 9 Same 0767187SFP13 BAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP 996 < Refused RESPONDER u1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)/(ADDRESS)/(TELEPHONE) (EMS) (HOSPITAL) 1 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z N 1 ❑ 11 4 Elgin Street Light Pole 91 ,J2 /26 07 59 ®❑PM in a Work Zone? ®N DIRP co 1 t PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 3 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP Ell AM U1 X o, 2 ❑ 36 4 150 DEXTER CT ELGIN IL 60120 2 23 91 ,12 /26 07 59 ❑PM 0 Construction >F N 3 El31 6 El CITATIONS ISSUED El PENDING SECTION CITATION NO. EMS ARRIVED TIME 5 z J ®AM ❑Maintenance U2 o ® 11 4 ARREST NAME Rocha,Shania 11-801-B 449000434 91 /12 /26 08 01 ❑PM SLMT o N 13CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME El Utility AM 35 t 2 El ARREST NAME 91 /12 /26 08 40 MPM 0 Unknown work zone type u, 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑qM Workers present? ❑Y 35 449-Harris,Jacob 701 302-Snow 10 , 13/2026 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 -< 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 X ® T UIOIIRLIDhtPPole 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I O , 1 , } r } transporting -usually avan type vehicle their passenger car):(orxample:employe e r I I C L g 'foil ri� - } i } •4. Is used or designated to transport between 9 and 15 passengers,including the driver. C r for direct compensation(example:large van used for specific purpose):or o _Unit ' t i i t 5. Is any vehicle used to transport anyhazardous material(HAZMAT)that requires ' placarding(example:placards will be displayed on the vehicle). XI —1 CARRIER NAME Z Not To Scale ADDRESS 'nD rn o CITY/STATE/ZIP g - MOTOR CARR.ID 0 Interstate El Intrastate I r ❑ Not in Comm./Govt. 0 Not in Comm./Other --- --1 USDOT NO. ILCC NO. m XI Source of above z . ❑ Yes 0 No 0 Unknown g D Did Carrier Safety Regulations MCS)violation contribute to the crash? A 0 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 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 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/Owners Residence . 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