HomeMy WebLinkAbout2026-00053647 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 8 Sheets 01111101111 0110 II I111111110 fll11111
DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X00143/48.93
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INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW '
DAMAGE TO ANY ❑$500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away
Elgin Police Department ONE PERSON'S ❑$501-$1.500 ®ON SCENE 1
VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash
0 AMENDED YR 202612026-00053647 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n
HILL AVE Elgin
® ❑ RELATED ❑Y ®N 09 03 202612,—AM ❑YES El NO U1 -<
PRIVATE mo /day/yr 10:08 ®PM FLOW CONDITION m
_
I 0 ®/MI N E S ® East Hill Ave COUNTY PROPERTY ❑Y 21 N DOORING Ely #OF MOTOR 0 SLOW 1 (n
Kane HIT&RUN ❑V ® N WITH VEHICLES INVLD 0 STOPPED U2 --I
❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0
tg:DRIVER p PARKED El DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NW 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 1 C)
0 8 / Jeep(after 1960rokee 2020 00-NONE 11_' Q I71 DUE TOCRASH ® 0 13-UNDER CARRIAGE ) �:/ FIRE 0
NI
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 10 O DISTRACTED 0 0U2 1 r<rl
M 2 4 SYTM❑Y ®SNE❑UNK VEH. O ATCRASHD 0 99-U 15-UNKNOWN THER918•TOP03 `Distraction Value 9 ALGN X.
CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR FRISTNTOONTACT 14 O'l4;1oCuOM VEH see sidebar I� U1 1 0
Z ELGIN IL 60120 0 1 0 CF81394 IL 2026 I
TELEPHONE
IL D 0 1 C4PJLCB3LD569917 Erie Insurance Exchange ❑Y Il N U2 m
in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
Nieves Caracosa. Maria Q051817578 1 r
`o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER
RESPONDER
2 XI
0 DRIVER X. PARKED 0 DRIVERLESS 0 FED 0 PEDAL 0 EWES 0 NMv 0 NOV 0 DV CIRCLE NUMBER(S) U1
yr 10;j 12 (, E FIRE El ® U2 1 C
o _ 13-UNDER CARRIAGE
c SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED
a SYSTEM IN 0 ENGAGED 0 15-OTHER 9.1,6•TOP3 ❑ ® SPDR n
❑Y i N DUNK VEH. AT CRASH 99-UNKNOWN `0istrac on Value 9 U1 0 -
POINT OF 8 I 4
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR S COM VEH D ® CO
F,,, FIRST CONTACT 6 O7 ,�=QI 05 •IfYes See Sidebar C
CW40013 IL 2026
0 Si)
M . STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0
SFNYF6H34JB007345 Geico Insurance ❑Y ®N RDEF XI
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 =
Kern Luz. Maria 4459-18-11-13 BAc $
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 3 02 / F 2 4 0 1 0
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/ / #OCCS D
/ / UI 2 m
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EV MOST EVNT LOG DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z
N 1 ® 18 1 09/03 /2026 10 08 ®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
2 ❑ 18 1 28 08
/ / 0 PM• ❑Construction 3 >F
R 3 ❑ 1 8 1
El CITATIONS ISSUED 0 PENDING SECTION CITATION NO. ETAS ARRIVED TIME
-a, ARREST NAME Giles. Edwin 11-601 753525 / / ❑❑PM ❑Maintenance U2
' u 1 El 11 1 igi CITATIONS ISSUED ❑PENDING • SLMT
S' N SECTION CITATION NO. ROAD CLEARANCE TIME El AM• 0
Utility
t 2 El ARREST NAME Giles. Edwin 11-501-A-2 749416 09/03 /2026 11 30 0 PM El Unknown work zone type U1 30
2 2 3 ❑ -
OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 30
1500-Chew. Marie 301 10 /02/2026 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
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 truckrtrailer -<
c ` --I -' r INDICATE NORTH combination):or —I
0 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 r X
I- L A 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I O
Not 1b Saga ( - } } } transporting employees in the course of their employment(example:employee X
transporter-usually a van type vehicle or passenger car):or C
i. <_____}____i / IMPS4 • - 1.
} 1} 4. Is used or designated to transport between 9 and 15passen rs,includingthedriver, to
for direct compensation(example:large van used for s specific purpose):or
L L____a____.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). ;p
1 —1
CARRIER NAME Z
ADDRESS D
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C)
CITY/STATE/ZIPg
MOTOR CARR.ID 0 Interstate ❑ Intrastate
0
I I T I ❑ Not in Comm./Govt. 0 Not in Comm./Other
-"-----"1 - USDOT NO. ILCC NO. m
XI
Source of above z
'
. MCS ❑Yes 0 No 0 Unknown Out of Service ❑Yes ❑No 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
Red Black
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 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/TO:
DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE