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HomeMy WebLinkAbout2026-00061103 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 6 Sheets 01111101111 10110 111111 010000 DRAG TRFD TRFC WEAT DRVA VIS VEHD LGHT COLL MANY X004520 u, 1 U21 3 4 1 U1 4 U2 1 U, 1 1_12 1 U, 1 U2 1 5 11 u1 1 u2 1 *P 0 11 9* INVESTIGATING AGENCY DAMAGE TO ANY ®5500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 2 VEHICLE/PROPERTY El OVER$1,500 El NOT ON SCENE(DESK REPORT) El Injury and f or Tow Due To Crash 0 AMENDED YR 202612026-00061103 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 71 S AIRLITE ST Elgin08:41 ® ❑ RELATED ®Y 0 N 10 07 2026 ❑AM ❑YES El NO U1 _ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION m FT!MI N E S W LARKIN AVE COUNTY PROPERTY ❑Y ® N DOORING Ely #OF MOTOR El SLOW 1 0)0 Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD ® STOPPED U2 —I El AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ❑ FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EDUCE 0 uuv 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 n FOR DAMAGEDAREA(S) FROM TOWED U1 Q Rodriguez,Saturnino 1 2 / yr 13-UNDER CARRIAGE ©,I :: FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 4 m M I 2 SY4 ❑Y ®SNEM DUNK VEH. O AT CRASH IN O 15-OTHER 99-UNKNOWN 9 16•TOP 3 `Distraction Value 9 ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF iL 6 I,.4 COM VEH 0 0 1 0 ~ ELGIN I L 60120 0 1 0 FIRST CONTACT 12 7_: __5 *Yves.See Sidebar Ut Z DY99020 IL 2026 REAR TELEPHONE IL D 5N3ZAONC1AN901845 NIA ❑Y ❑N U2 13 . m 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m co 99 9 Same NIA 1 r o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused 0 Y El 2 eu m g DRIVER ❑ PARKED 0 DRIVERLESS ❑ PED CIPEDAL 0 EWES ❑row ❑KCV ❑Dv !1 9 5 2 Honda Civic 2012 Do-NONE ,� ,z , DUE TO CRASH ❑ p�( 2 0 Yr 13-UNDER CARRIAGE 11 l 2 FIRE 0 ® U2 C Po F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16.TOP 3 X ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN *OistraclIon Value 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8 iII 6 �,_4 COM VEH ❑ ® Ut CO FIRST CONTACT 6 Y__{_O ._5 •)ryes,See Sidebar H ELGIN IL 60123 0 1 5210695 IL 2027 REAR 0 M IL D 2HGFB2F8XCH313149 Geico ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = 99 9 Same 4398-11-10-23 BAc $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 156 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 LOC, DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z u 1 ® 11 1 10,07 /2026 08 41 ®pm in a Work Zone? ®N DIRP co 1 t PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 3 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 0 2 0 03 99 ( ( 0 PM 0 Construction * 1 Z 3 0 xi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 3 ❑AM ❑Maintenance U2 o 1 ® 11 1 ARREST NAME Rodriguez,Saturnino 3-707-A-5 1524-649 ( ! 0 PM SLMT I$!CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME AM' ❑Utility o t 2 0 ARREST NAME Rodriguez,Saturnino 11-1201-A- 1524-651 10/07 12026 08 41 N ®PM 0 Unknown work zone type U1 45 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑qM Workers present? ❑Y 45 1535-Solis, Laura 602 337-Thompson 10 ,27(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 i- i•--__r-_--; _ } combination):or more than pounds(example:truck ortruckrtrarler 1. Has a weight rating10 000 INDICATE NORTH t BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver } } — I I Not To Scale _ (example:shuttle or charter bus):or OT, . I j I- I- --I-- 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I O 1Lwidn7AVei - } } } transporting employees in the course of their employment(example:employee X transporter-usually a van type vehicle or passenger car):or w L 4. Is used or designated to transport between 9 and 15 passengers,including N}--- ----; - •} } } g po pafic purpose): rs,includi the driver, - - - - for direct compensation(example:large van used for specific p or O L i t i i 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires 'D placarding(example:placards will be displayed on the vehicle). ,Zmt W - —I Unit 1_unit 2 CARRIER NAME Z ADDRESS w I II I I CITY/STATE/ZIP 0 MOTOR CARR.ID 0 Interstate 0 Intrastate --- - - 0I I T I ❑ Not in Comm./Govt. ❑ Not in Comm./Other - --- --1 USDOT NO. ILCC NO. rn XI Source of above Z . GVWR/GCWR m 0 <10,000 0 10,000-26,000 0 >26,000 z Were HAZMAT placards on vehicle? 0 Yes 0 No = If Yes,Name on placard O 4 digit UN NO. 1 digit Hazard class No. Xl Xl 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 VIN 1 m to 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 Red White u 1 TOWED • TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT' 1 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: 1 TOWED BY/TO: DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE