HomeMy WebLinkAbout2026-00059634 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 10110 II IIIIIII1111111001 lI100
DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X004393327
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INVESTIGATING AGENCY DAMAGE TO ANY 0 5500 OR LESS TYPE OF REPORT ® A No Injury 1 Drive Away
AGENCY CRASH REPORT NO. TRFW
Elgin Police Department ONE PERSON'S ®5501-$1.500 ®ON SCENE 2
VEHICLE/PROPERTY ❑OVER$1,500 ❑NOT ON SCENE(DESK REPORT)
0 AMENDED ❑ B Injury and for Tow Due To Crash YR 202612026-00059634 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 rn
® ❑ RELATED ❑Y ®N 10 01 2026 ®AM ❑YES ®NO U1 -<
ROUTE 20 HWY Elgin05:57
_ _ g PRIVATE mo /day/yr ❑PM FLOW CONDITION m
Egi2 ®5 !MI N E S W Shales Pk COUNTY PROPERTY ❑Y ® N DOORING ❑Y #OF MOTOR 0 SLOW 15 u)
Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD ❑ STOPPED U2 -I
❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0
18:DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EDUCE 0 uuv 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 7 n
0 4 FOR DAMAGEDAREA(S) FROF tf TOWED U1 Q
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H undai Sonata 2011 00-NONE • DUE TO CRASH ❑ ❑ E
NAME(LAST,FIRST,M) Morales-Garcia.Omar mo yr y 11. 120
13-UNDER CARRIAGE 101 2 FIRE 0 0
7
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ❑ 0 U2 m
M 2 4 ❑Y SYSTEM IN ENGAGED 15-OTHER 9 16.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 7 iI 6 �i 4 COM VEH ❑ 0 1 0
~ Streamwood I L 60107 0 1 0 FIRST CONTACT 1 7_;- -_5 *II Yes.See Sidebar U1
Z DE69108 IL 2026 E
TELEPHONE
IL D 5NPEC4AC5BH187691 Allstate Insurance ❑Y ®N U2 13 . m
13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR
co
Capote. Patricia 879298113 2 m
`o HOSPITAL(TAKEN TO) INCIDENT IF IC OWNER STREET,CITY.STATE,ZIP PHONE NUMBER
RESPONDER
2 X
m g DRIVER ❑ PARKED 0 DRIVERLESS ❑ PED CIPEDAL ❑EWES O NMV 0 NOV ❑DV
-UNDER CARRIAGE 101 r. y FIRE ❑ El U2 C
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M 2 4 ❑Y ❑N ❑UNK VEH. AT CRASH 99-UNKNOWN *Oistraellon Value 0 -
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8 i 6 i!,_4 COM VEH 0 0 U1 CO
FIRST CONTACT 9 7 -5 C.
If Yes.See Sidebar C
ELGIN IL 60123 0 1 0 FR46699 IL 2027 I 0 fp
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IL D 3GYFNDE32CS537935 Unique Insurance ❑Y J N RDEF XI
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER I =
Same I LP3494351 BAC
$
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 <
Refused RESPONDER ui =
KNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)1(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL)
1 0
EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z
u 1 ® 11 1 10, 11 ,026 05 57 ®❑PM in a Work Zone? ®N DIRP co
1 t PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME ❑AM If YES check one below: U1 7 n
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2 ❑ 20 2 r r ❑PM ❑Construction
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R 3 ❑ $I CITATIONS ISSUED ❑PENDING SECTION CITATION NO. EMS ARRIVED TIME 7
❑AM ❑Maintenance U2
o1 ® 11 1 ARREST NAME Morales-Garcia.Omar 11-709-A 298001441W r r El PM SLMT
o N ❑CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ❑Utility
45
t 2 ❑ ARREST NAME AM
x -rr r ❑❑PM ❑Unknown work zone type U1
n OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME
2 2 3 0 ❑AM Workers present? ❑Y 45
298-Lopez, Mirko 401 320-Cox r , ❑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
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combing rg ore than pound { a p .truck or truckrtra�ler
1. Has a weight ratio m 10 000 5 ex m le' i -<
INDICATE NORTHtan)o P3BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver n
C
_ } (example:shuttle or charter bus):or
- t 3. Is desgned to carry 15 or fewer passengers and operated
�rated a contract carrier O
i. }
} } transporting employees In the course of their employment(example:employee � X
Pad rKTofft transporter-usually a van type vehicle or passenger car):or CO
L i..___a._ - 4. Is used ordesi natedtotrans rt between 9 and 15 passengers,including C u,,,' - } for direct compensation(example:large van used for speific purpoe):or
the driver. O
L L____a..... 0 — _ � 5. Is any vehicle used to transport anyhazardous material(HAZMAT)that requires m
Routerzozrtwy. placarding(example:placards will be isplayed on the vehicle).
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Not To Scale -1 CARRIER NAME Z
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__ ADDRESS
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C)
CITY/STATE/ZIP g
_ MOTOR CARR.ID 0 Interstate 0 Intrastate
' ❑ Not in Comm./Govt. ❑ Not in Comm./Other 00
---"-1 - USDOT NO. ILCC NO. m
m
XI
Source of above z
. MCS ❑Yes 0 No 0 Unknown Out of Service ❑Yes ❑No Z
Form Number 0
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Xl
IDOT PERMIT NO. WIDELOAD? ❑Yes 0 No 2
TRAILER VIN 1 m
'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
Blue,Dark
u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_
DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT' 1 TOWED BY/TO:
_ SELECT CODES FROM THE BACK OF CRASH BOOKLET
U 2 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY/T6
DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE