HomeMy WebLinkAbout2026-00060137 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets II 111 I M 11111111 IOU
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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 0$501-$1.500 ®ON SCENE 14
VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash
0 AMENDED YR 2026I 2026-00060137 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 2 mBENT ST Elgin02:37
® ❑ RELATED !8I Y 0 N 10 03 2026 12,— ❑YES N NO U1 -<
_ _ g PRIVATE mo !day/yr ®PM FLOW CONDITION m
FT!MI N E S W ST CHARLES ST COUNTY PROPERTY El ® 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 51 FREE FLOW # LNS 0
Qg3 DRIVER ❑ PARKED ❑DRIVERLESS 0 PEO ❑PEDAL ❑EWES ❑uuv ❑Ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 0
FOR DAMAGED AREA(S) FRONT TOWED U1 0Orte a.Jae!.J. 1 1 /
yr 13-UNDER CARRIAGE 1a.) 2 , 2 FIRE 0 N
0
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ❑ 0 U2 m
M 2 4 SYTM IN ENGAGE❑Y ®SNE❑UNK VEH. O AT CRASHD O 99-UNKNOWN 9 16•TOP 3 *Distraction Value 9 ALGN 2
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s :il 4 COM VEH 0 El 1 0
~ ELGIN !L 60120 0 1 0 FIRST CONTACT 12 7_; _5 *IIYes.See Sidebar U1
Z 4308223B IL 2026 Ismi
TELEPHONE
IL D 0 1 FTWF32S9XED50216 NON N Y ❑N U2 m
in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
99 9 Ortega Rosales. Luis 9999999999999 1 r
o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER
RESPONDER
2 ou
N DRIVER ❑ PARKED 0 DRIVERLESS 0 FED 0 PEOAL 0 EWES 0 NMV 0 Ncv 0 DV
!1 9 8 2 Toyota Highlander 2023 00-NONE 1("j 12..-_, DUE TO CRASH rg ❑ 2
0 13-UNDER CARRIAGE 10'I 2 FIRE 0 ® U2 C
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F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9,,16-TOPO3 * X
❑Y ®N 0 UNK VEH. AT CRASH 99-UNKNOWN O Oistraellon Value 9 0
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8
-.! A 14 COM VEH ❑ N U1 CO
FIRST CONTACT 4 7 _SOS •If Yes.See Sidebar
ELGINz IL 60120 0 1 0 EF74381 IL 2027
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IL D 0 STDKDRBHOPS021961 XXXX ❑Y N N RDEF
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 =
Elgin Fire 99 9 Same 000000000 BAG $
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 <
Refused RESPONDER
U1 =
(UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ( 1(EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)((A.DDRESS)((TELEPHONE) (EMS) (HOSPITAL)
2 4 09 /
LOG DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y
N 1 ® 11 1 10,3/ /026 02 37 Z
®AM in a Work Zone? ®N DIRP co
1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 7
T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1
v 2 0 23 28 10,31 /026 02 38 ®PM El Construction
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" O ❑ xi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 5
3 ❑AM ❑Maintenance U2
- ® • 0 Utility a, ARREST NAME Ortega.Jael.J. 11-901-A S1540-000572 10,3/ /026 02 42 !gi PM
oSLMT
U 11 1 N CITATIONS ISSUED 0 PENDING -
o N SECTION CITATION NO. ROAD CLEARANCE TIME AM y
t 2 El ARREST NAME Ortega.Jael.J. 3-707` S1540-000573 10/31 /026 04 02 ®PM 0 Unknown work zone type U1 30
2 2 3 ElOFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 0
qM Workers present? ❑Y 30
1576-Teachout.Seth 401 11 , 10/2026 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
0 ADDITIONAL UNITS FORMS.
r ----r••--, , ; A CMV is defined as any motor vehicle used to transport passengers or property and.
Z
Not To Scale J ; 1. Has a weight rating more than 10,000 pounds(example:truck or truck/trailer
combfnatan)or
r }-- -r----, r INDICATE NORTH �1
BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver -<
g } (example:shuttle or charter bus):or 0
X
- ------I----; / � - transporting mployeened to slin the course passengers5 or fewer thir emplod yment example:employeener X
transporter-usually a van type vehicle or passenger car):or co
4. Is used or designated to transport between 9 and 15 passengers,including rCjt
-- -- - } } } g po passen rs,indudi the driver,
w ■■ for direct compensation(example:large van used for specific purpose):or O
ts__ ' I 1 t 5. Is any vehicle used to transport any hazardous material(HAZMAT)
.. .
placardingI- I- -:- ''. Ilk
(example:placards will be displayed on the vehicle). m
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CARRIER NAME Z
ADDRESS 0
w
n
CITY/STATE/ZIP g
MOTOR CARR.ID 0 Interstate 0 Intrastate
r ; ❑ Not in Comm./Govt. 0 Not in Comm./Other
-----------1 - USDOT NO. ILCC NO. rn
XI
Source of above Z
. 0 Yes 0 No ❑ Unknown A
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
71
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' T
TRAILER 1 ❑ ❑ 0 Z
TRAILER 2 ❑ 0 0 O
u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. Z
Black White
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 DISABLING DAMAGE DAMAGE EXTENT: 3 TOWED BY/TO:
DUE TO ® Redmons/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE