HomeMy WebLinkAbout2026-00060821 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 0110 11111100lI1111Dl�III00
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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 14
VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) El B Injury and/or Tow Due To Crash
0 AMENDED YR 202612026-00060821 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 3 m
CONGDON AVE El 06:34
® ❑ RELATED ®Y ❑N 10 06 2026 ❑AM ❑YES E)NO U1
_ g PRIVATE mo !day!yr ®PM FLOW CONDITION MFT!MI N E S W LOGAN AVE COUNTY PROPERTY ❑Y ® N DOORING Ely #OF MOTOR 0 SLOW 15 to
❑ 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
l83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uuv 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 00 C)
FOR DAMAGEDAREA(S) FRONT TOWED U1 Q
Cruz Nunez.Salvador 1 2 /
yr 13-UNDER CARRIAGE ) FIRE ❑
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 10 O DISTRACTED 0 0U2 00 M
M 2 3 SYTM❑Y ®SNEDUNK VEH. 0 ATCRASHD 0 99-U 15-UNKNOWN THER9 16•TOP�3 `Distraction Value 9 ALGN X.
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6 iL 6 Ii_4 COM VEH 0 g 1 0
~ ELGIN I L 60123 0 1 0 FIRST CONTACT 2 7_; _-5 *II Yes.See Sidebar Ut
Z EA35756 IL 2027 REAR
TELEPHONE
IL D 0 5TDZA23CX4S073899 Bristol Insurance ❑Y IglN U2 m
in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
99 9 Same G019080702 00 1 r
`o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER
RESPONDER D
Refused ❑Y ® N 2 XI
m g DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NMy 0 NOV 0 DV
!1 9 6 9 Nissan Rogue 2023 00-NONE 11_"j Q1-_, DUE TO CRASH rg ❑ 2 x
oy yr 13-UNDER CARRIAGE 10( 12 FIRE 0 ® U2 C
il
M 2 8 SYSTEM IN 0 ENGAGED 0 15-OTHER 9,16-TOP 3 X
❑Y MN DUNK VEH. AT CRASH 99-UNKNOWN *Oistracton Value 9 0
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6-iI�1:,-4 COM ❑ ® U1 W
FIRST CONTACT 12 7�_,--- •If Yes.See Sidebar
n ELGIN IL 60120 C 1 0 CC88217 IL I C
0
IL D 0 5N1 BT3AA6PC893594 Geico ❑Y ®N RDEF M
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 =
99 9 Same 4347408652 BAc E
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP 996 <
Refused RESPONDER u1 =
(UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) MO (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)!(ADDRESS)+(TELEPHONE) (EMS) (HOSPITAL)
1 3 10 / F 2 3 0 1 0
m
/ / #OCCS D
/ / UI 2 D
/ / 1 0
EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z
N 1 El 11 4 10/61 ,026 06 34 ®AM in a Work Zone? ®N DIRP co
1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 5
T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 C)
0 2 ❑ 28 23 + , ❑PM ❑Construction >F
1 4
R 3 ❑ 0 CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 3
❑AM ❑Maintenance U2
o 1 ® 11 4 ARREST NAME Cruz Nunez.Salvador 11-1204-B 1561-000414 , ! ❑PM SLMT
I$!CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME N El AM ,_,Utility
o T 2 El ARREST NAME Cruz Nunez.Salvador 11-601-Ax 1561-000413 10+61 /026 06 40 ®PM ❑Unknown work zone type U1 25
2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 25
1561-Sarovic• Mirko 102 11 , 21 ,026 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
�____r____� I ftJOf TO$CAI@ _ I combination):or g ore than pound { a p .truck ortruckrtrarler 1. Hasa ratio m 10000 5 ex m le'
NDICATE NORTH PI
BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C
t- (example:shuttle or charter bus):or n
A I 3. Is designed to carry 15 or fewer passengers and operated by a contract corner 1 O
T } } } transporting employees In the course of their employment(example:employee
L L.___a__ -.........,„,1 unit 4alsuorter-sedordesllnatedtotrans vehicle
rtbetween9andr15r) C
ssen rs,induding[hedriver,
_i ill I< t } } for direct compensation(examp large van used for specific purpose):or
L -a t i. i L 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires
placarding(example:placards will be displayed on the vehicle). ,Zmt
0
CARRIER NAME Z
ADDRESS 0
T.
I CITY/STATE/ZIP
MOTOR CARR.ID 0 Interstate ❑ Intrastate
I ❑ Not in Comm./Govt. ❑ Not in Comm./Other 00
i- ----1 USDOT NO. ILCC NO. C
m
XI
Source of above z
. IDOT PERMIT NO. WIDELOAD"; ❑Yes 0 No =
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
Silver Gray
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 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