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HomeMy WebLinkAbout2026-00062083 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets II III II IIIIII UHI II II II IIII II III III IIIIII DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X+ 1256/ u, 1 U21 3 4 1 U1 2 U2 1 U, 1 1_12 1 11) 1 U2 1 1 10 u1 3 U2 1 *P 0119* INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW ' DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 14 VEHICLE/PROPERTY ®OVER 51,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash 0 AMENDED YR 202612026-00062083 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n S LIBERTY ST El In 02:33 ® ❑ RELATED ®Y 0 N 10 12 2026 ❑AM ❑YES ®NO U1 _ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION III FT N E S W BLUFFCITY BLVD COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR El SLOW 2 fA ❑ Kane HIT&RUN ❑V ® N WITH VEHICLES INVLD ❑ STOPPED U2 --I CO AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uuv 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 C) FOR DAMAGEDAREA(S) FROM TOWED U1 Q NAME(LAST,FIRST,M) Velasco Rivera.Joel mo / /1 9 yr 9 Cadillac ATS 2018 00-NONE „_' ©'T O DUE TO CRASH ® ❑ E 13-UNDER CARRIAGE ) �:/ FIRE 0 lE STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 10 O DISTRACTED 0 0U2 0 171 M 2 8 ❑Y ®SYN SEDUNK VEH. 0 AT CRASH M IN ENGAGED0 99-UUNKNOWN 9 t6-TOP® `Distraction Value 9 ALGN = r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 7._iL ii,4 COM VEH 0 j$J 1 0 ~ ELGIN IL 60120 B 1 0 FIRST CONTACT 2 ; __5 *IIYes.SeeSidebar U1 Z GC72854 IL 2027 REAR TELEPHONE IL A 7 1 G6AF5RX8J0128104 AllState ❑Y Igl N U2 93 , m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR M Elgin Fire 99 9 Same 923542944 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused El El 2 0 N DRIVER 0 PARKED 0 DRIVERLESS ❑ PED 0 PEDAL 0 EWES 0 iiuv 0 i v 0 Dv $ /1 9 6 3 Ford F150 2005 00-NONE 0. Qi'-0 DUE TO CRASH rg ❑ 2 o Yr 13-UNDER CARRIAGE 10( I 2 FIRE ❑ ® U2 C M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9,16-TOP 3 X ❑Y lYi N DUNK VEH. AT CRASH 99-UNKNOWN *Oistraellon Value 9 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s-il 6 I1:, 4 COM VEH ❑ ® U1 W FIRST CONTACT 12 7� .5 •(ryes.See Sidebar H ELGIN IL 60120 B 1 0 3136383B IL 2027 I 0 C M IL A 7 1 FTPW14595FB42439 All State ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Elgin Fire 99 9 Same 902512717 BAG $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP 996 < Sherman RESPONDER u1 = (UNIT) (SEAT) (DOBi (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)((ADDRESS)((TELEPHONE) (EMS) (HOSPITAL) W 01 / :A / / UI 1 D / / 1 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z N 1 ® 11 4 10/12 /2026 02 33 ®AM in a Work Zone? ®N DIRP co 1 t PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 5 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 v 2 0 2 18 10/12 /2026 02 33 ®PM ❑Construction R O 0 igi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 1 3 ❑AM ❑Maintenance U2 o ® 11 4 ARREST NAME Velasco Rivera.Joel 11-901 W1570-000316 10/12/2026 02 47 Igi PM SLMT o N ❑CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ❑Utility t 2 El ARREST NAME 10(12 /2026 03 16 ®PM 0 Unknown work zone type 0 AM U1 30 n T OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 El ❑AM Workers present? ❑Y 30 1570-Tomlin. Eli 400 337-Thompson / ❑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 ___ ___ _ Not To Scale I + 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer -< c ` -' -' ga r INDICATE NORTH combination):or —I 1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C t- (example:shuttle or charter bus):or 0 1 r X "Li 3. Is desgned to car 15 or fewer passen ers and o rated a contract carrier O , - } } } transport) em to ees In the course of their em ym�ent example:employee � X El ❑ 1 ~ 0 n transporterg-usually a van type vehicle or passenger car):or w__ _- u - } } } •4. Is used or designated to transport between 9 and 15 passengers,including the driver. C t for direct compensation(example:large van used for specific purpose):or O L L--_-a-...- ,� t l I 1 5. Is any vehicle used to transport anyhazardous material(HAZMAT)that requires m placarding(example:placards will be displayed on the vehicle). ;p _I CARRIER NAME Z �el i. __ ADDRESS 0 x. CITY/STATE/ZIP g I - i. 4. MOTOR CARR.ID 0 Interstate ❑ Intrastate 1 I r , ❑ Not in Comm./Govt. Not in Comm./Other , , , ❑ o r ;____Y___..; - USDOT NO. ILCC NO. m 73 Source of above z . —I Were HAZMAT placards on vehicle? 0 Yes 0 No = If Yes,Name on placard O 4 digit UN NO. 1 digit Hazard class No. P3 XI 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 M 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 LOCAL USE ONLY TRAILER VIN 2 m 0 TRAILER WIDTH(S) 0-96" 97-102" >102' -n TRAILER 1 0 0 0 Z TRAILER 2 ❑ 0 0 O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w White Black 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 DUETO TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® Redmons/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE