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HomeMy WebLinkAbout2026-00055202 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 IIIIII II II I flfl O NN fl III 00 DRAC TRFD TRFC WEAT DRVA VIS VEHD LGHT COLL MANY X004386063 u, 1 U21 1 1 1 U1 1 U2 1 U, 1 1_12 1 U, U2 1 1 1 U1 U2 1 *P 0 1 1 9* 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 ❑$501-51.500 ®ON SCENE 1 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and ror Tow Due To Crash El AMENDED YR 2026I 2026-00055202 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH rl 140 S LIBERTY ST Elgin 03:15 ® ❑ RELATED ❑Y ®N 09 11 2026 ®AM ❑YES ®NO U1 -< _ g PRIVATE mo !day!yr ❑PM FLOW CONDITION m COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ®SLOW 1 (n ❑ FT,MI NESW Kane HIT ❑Y ® N WITH VEHICLES INVLD ❑ STOPPED U2 --I &RUN ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST IR N ❑ FREE FLOW # LNS 0 0 DRIVER ❑ PARKED ❑DRIVERLESS N PED ❑PEDAL ❑EWES ❑NIAV ❑!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 0 6 / yr 13-UNDER CARRIAGE IE 101 2 FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 14 U2 2 m M 1 3 SYSTEM IN ENGAGED 15-OTHER 9 16.TOP 3 _ ❑Y ❑N [DUNK VEH. AT CRASH 99-UNKNOWN `Distraction Value ALGN r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6_iL 6 I-: COM VEH ❑ Ea 1 0 ~ ELGIN IL 60120 B 1 0 FIRST CONTACT 00 7_; _5 *Ir sees.See Sidebar U1 20 REAR 2 Z TELEPHONE . STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED 1 1) ( ❑Y ❑N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR .-1 m 1 47 1 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER Ai Provena St.Joseph ❑Y ® N p; DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EWES ❑MAV 0 KCV 0 DV Yr 13-UNDER CARRIAGE 9 I ©Ic 2 FIRE ❑ ® U2 C M 2 5 SYSTEM IN 0 ENGAGED 0 15-OTHER 9.16-TOP 3 X ❑Y NJ N ❑UNK VEH. AT CRASH 99-UNKNOWN *Oistracton Value 9 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s-it 6 I:, COM VEH ❑ ® U1 CO FIRST CONTACT 11 7�� _,__5 •If Yes.See Sidebar ELGIN IL 60120 B 1 0 FY98590 IL 2027 REAR 0 ND Other 0 SYFBURHE7EP114222 Gainsco ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = 99 7 Suarez Lizacano.Jesus ILPA366913250000 BAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP U1 = KNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)((ADDRESS)((TELEPHONE) (EMS) (HOSPITAL) U2 996 r m ##occs y 71 / UI ' D / 1 0 EV MOST EVNT LOG DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 CD 12 1 09,11 ,2026 03 15 ®❑AM in a Work Zone? NJ o1RP co 1 r PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AMU1 0 ' 2 99 99 / ) ❑PM, ❑Construction * 1 R 3 ❑ $I CITATIONS ISSUED ❑PENDING SECTION CITATION NO. EMS ARRIVED TIME 5 ❑AM ❑Maintenance U2 a1 ® 12 1 ARREST NAME Quintero. Ulises 11-208-A-1 S1563-241 , r El PM SLMT S' H • MI CITATIONS ISSUED 0 PENDING SECTION CITATION NO. ROAD CLEARANCE TIME El Utility ❑AM r 2 ElARREST NAME Castillo Bastidas.Jose.J. 6-101 S1563-242 , r DI PM CIUnknown work zone type U1 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑AM Workers present? ❑Y 30 1563-Rodriguez.Carlos 301 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. . 0 r ----r••--, A CMV is defined as any motor vehicle used to transport passengers or property and: Z Not To Scale I 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer -< ` ` ''- ' r INDICATE NORTH combination):or —I CO BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver n _ (example:shuttle or charter bus):or X L A 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I O ▪ I. } } transporting employees in the course of their employment(example:employee X transporter-usually a van type vehicle or passenger car):or w 4. Is used ordesi natedtotrans rtbetween9and15 passengers,including C▪ } } } for direct compensation(example:large van used for specificpurpose):or [he driver, Pe ( P 9 Pe or 0 L l L I _ 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires placarding(example:placards will be displayed on the vehicle). XI —1 CARRIER NAME Z ADDRESS 0 ll CCITY/STATE/ZIPg l0 MOTOR CARR.ID 0 Interstate 0 Intrastate tr r r r r -; 0 I I T I ❑ Not in Comm./Govt. ❑ Not in Comm./Other � --- --1 F - i. USDOT NO. ILCC NO. C XI Source of above Z . • m Did HAZMAT spill from vehicle(do NOT consider FUEL from vehicle's z own tank)? 0 Yes 0 No 0 Unknown Did HAZMAT Regulations violation contribute to the crash? r ❑ Yes 0 No 0 Unknown g D Did Carrier Safety Regulations MCS)violation contribute to the crash? A ❑ 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 VIM 1 m co LOCAL USE ONLY TRAILER VIN 2 m v TRAILER WIDTH(S) 0-96" 97-102" >102' m TRAILER 1 ❑ ❑ 0 Z TRAILER 2 ❑ 0 0 O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. Z Green u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT: TOWED BY/TO: _ . SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 3 TOWED BY/T6 DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE