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HomeMy WebLinkAbout2026-00055209 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 01111101111 I0110 II I flfl 10111110 I 0 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X�-375471 u, 1 U21 1 1 1 U1 2 U2 1 u, 1 1_12 1 u1 1 U2 1 1 10 u, 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 14 VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and f or Tow Due To Crash El AMENDED YR 2026I 2026-00055209 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 2 m® ❑ RELATED ®Y 0 N 09 11 2026 ®AM ❑YES ® PRIVATE NO U1 W BARTLETT RD 1 GIFFORD RD Elgin mo /day/yr 06.19 ❑PM FLOW CONDITION m ®15 ®!MI N E S © W BARTLETT RD I G I FFORD RD COUNTY PROPERTY ❑Y 2g1 N DOORING ❑y #OF MOTOR ❑SLOW 15 co Cook HIT&RUN ❑Y ® N WITH VEHICLES INVLD ❑ STOPPED U2 —I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N 51 FREE FLOW # LNS 0 g DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EDUCE ❑uuv ❑!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 C) FOR DAMAGEDAREA(S) FROPtf TOWED U1 Q NAME(LAST,FIRST,M) Defrenza. Rocco. D. 0 mo 1 / 1 9 8 6 Ford F150 2013 00-NONE „ Oi"_, DUE TOCRASH ® ❑ 13-UNDER CARRIAGE 10 , 2 FIRE ❑ 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 m M 2 4 ❑Y SYSTEM IN ENGAGED 15-OTHER 9 76.TOP 3 _ ❑N ❑UNK VEH. AT CRASH 99-UNKNOWN `Distraction Value ALGN r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF S,_iL S 4 COM VEH 0 j$J 1 0 H I . PINGREE GROVE IL 60140 0 1 0 FIRST CONTACT 12 7 ; _5 *Ir Yes.See Sidebar U1 Z1432966B IL 2026 REAR TELEPHONE IL D 1 FTEX1 EM6DFD21420 State Farm ❑Y ®N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Same 0262877SFP13 1 r "o HOSPITAL(TAKEN TO) INCIDENT IF IC OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D 73 Refused ❑Y ElN 2 0 g DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 r uv 0 NCv 0 Dv 1 9 9 6 Jeep(after 198;;i)ind Cherokee 2023 00-NONE ,�_"j Q�-_, DUE TO CRASH D 2 73 13-UNDER CARRIAGE 10( I 2 FIRE ❑ ❑ U2 C Ti; F 2 5 ❑Y ❑N 0 UNK VEH. AT CRASH 99-UNKNOWN Oistraclj nValue POINT OF s i1 �i" 4 COM VEH 0 0 U1 W N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR FIRST CONTACT 12 7 B !.5 *(ryes,See Sidebar 2 BARTLETT IL 60103 0 1 0 DN46498 IL 2027 I 0 IL D 1 C4RJHAG8P8103838 State Farm ❑Y ®N RDEF M EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER 1 X Same 3580265SFP13 BAc $ 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 LOG DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 El 11 4 09,11 l2026 06 19 ®❑PM in a Work Zone? NJ N DIRP D 1 I PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME ❑AM If YES check one below: U1 5 C) o", T 2 0 2 28 ! ! ❑PM• El Construction Z 3 0 El CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 1 ❑AM ❑Maintenance U2 o1 El 11 4 ARREST NAME Defrenza, Rocco. D. 11-902 298001430 / ! El PM SLMT o N 0 CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • El Utility 45 r 2 0 ARRESTNAME AM T ! r ❑❑PM 0 work zone type U1 % 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑AM Workers present? ❑Y 45 298-Lopez, Mirko 401 360-Yucaitis 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 -< - }__-_r-_--; I. combination):or Y INDICATE NORTH 0 J y i BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C - } (example:shuttle or charter bus):or a T, Not To Scale I 3. Is designed to car 15 otr fewer passengers and operated a contract carrier O } } } transporong employees In the course�of their empbyment(example:employee 1 transporter-usually a van type vehicle or passenger car):or L L.___a__ 4. Is used ordesi natedtotrans transport passengers,includingy} } } g po the driver, ; •ry for direct compensation(example:large van used for specific purpose):or O , L L____a____. i t 5. Is any vehicle used to transport anyhazardous material(HAZMAT)thatrequires M placarding(example:placards will be displayed on the vehicle). m 0 7 '` 1 -IW.7srwtt7Rd. r CARRIER NAME Z ADDRESS 0 C li CITY/STATE/ZIP 00 4%" MOTOR CARR.ID 0 Interstate ❑ Intrastate 5 1 I r ❑ Not in Comm./Govt. 0 Not in Comm./Other --- --1 USDOT NO. ILCC NO. m XI Source of above z . Form Number m Xl IDOT PERMIT NO. WIDELOAD'; ❑Yes 0 No 2 TRAILER VIN 1 m co LOCAL USE ONLY TRAILER VIN 2 m v 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 Silver Gray u 1 TOWED • TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT 3 TOWED BY/TO. Redmons/Impound Lot Garage SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® DISABLING DAMAGE Redmons/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE