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HomeMy WebLinkAbout2025-00000260 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 01111101111 I01101100 00 DRAG TRFD TRFC WEAT DRVA VIS VEHD LGHT COLL MANY X40a€81571 u, 1 U2 1 1 1 U116 U2 U, 1 U2 u, 1 U2 1 6 U1 1 U2 *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 1 VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash 0 AMENDED YR 202512025-00000260 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n VARSITY DR Elgin ® ❑ RELATED PRIVATE ❑Y ®N 01 02 2025 ®AM ❑YES ®NO U1 mo /day/yr �$"�� ❑PM FLOW CONDITION m 093110!MI O E S W Maroon Dr COUNTY PROPERTY ❑Y ® N DOORING El #OF MOTOR 0 SLOW 0) Cook HIT&RUN ❑V ® N WITH VEHICLES INVLD 0 STOPPED U2 --I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 tg 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 2 0 0 6 FOR DAMAGEDAREA(S) FRONT TOWED U1 Q Kia Motors Co tima 2010 00-NONE ©t O , OUE TO CRASH ® ❑ / yr "1`F' 13-UNDER CARRIAGE 10 , 2 FIRE 0 ® < STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ❑ 0 U2 m M 2 5 ❑Y SYSTEM IN ENGAGED 15-OTHER 9 16.TOP 3 _ ❑N DUNK VEH. AT CRASH 99-UNKNOWN `Distraction Value ALGN r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF iL 6 I, 4 COM VEH 0 )g! 1 0 I . ELGIN N I L 60120 0 1 0 FIRST CONTACT 11 7_: __5 *rives.See Sidebar U1 Z DM39051 IL 2023 REAR TELEPHONE IL D KNAGG4A81A5407641 None ❑Y ❑N U2 r IL' 1 R 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 Same None 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF IC OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y El 2 rg- 0 DRIVER ❑ PARKED 0 DRIVERLESS 0 FED 0 PEDAL 0 EWES 0 N4y 0 Ncv 0 DV yr 12 - C1 o 13-UNDER CARRIAGE 10.i t, 2 FIRE ❑ ❑ U2 C c SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED a SYSTEM IN ENGAGED 15-OTHER 9,16-TOP3 ❑ 0 SPDR 0 ❑Y ❑N ❑UNK VEH. AT CRASH 99-UNKNOWN `(Distraction Value U1 0 - POINT OF s-.;, 4 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR ED FIRST CONTACT YA='+:=5 COM•I sVEH.See •Sidebar❑ ❑ C E co M . STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 O ❑Y ❑N RDEF73 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X BAC HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 995 < RESP❑YO❑N NDER U1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)!(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL) 0 / / U2 r m Pj 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 43 2 01 ,02 r2025 08 07 ®❑PM in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 1 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 2 ❑ 19 28 ! ! ❑PM ❑Construction * Z3 0 I!!I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME ❑AM 0 Maintenance U2 -a, ARREST NAME Salazar.Carlos.J. 11-601 752542 ! r ❑PM SLMT o u 1 0 BI CITATIONS ISSUED 0 PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ❑Utility o N DI AM 30 F 2 El ARREST NAME Salazar.Carlos.J. 11-708 752541 ! ! PM 0 Unknown work zone type U1 n 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM ❑Y 402-Free. Richard 302 01 !20 l2025 09 00 ❑PM Workers present? ®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. I r ----r••--, , JQOy A CMV is defined as any motor vehicle used to transport passengers or property and: Z IA' 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer -< ` ` ' ' I. INDICATE NORTH combination):or p0 ' Vera' or. ' BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C � '�III I _ (example:shuttle or charter bus):or n III X 3. Is designed to carry15 or fewer passengers and operated a contract carrier O ` ------I----; Not To Scale I - } } . transporting employee in the course of their employment(example:employee X enger car):or CO L }-----}----; II\ - } } 1 •transporter sed or des gnated to transport betweelly a van type vehicle or n 9 and 15 passen including the driver, for direct compensation(example:large van used fors specific purose):or L I; L 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). XI m I1 - —I I CARRIER NAME Z _ ADDRESS 0 J 1 4. - CITY/STATE/ZIP g Maroon9Of MOTOR CARR.ID 0 Interstate 0 Intrastate I I T I — — ❑ Not in Comm./Govt. 0 Not in Comm./Other I �t i USDOT NO. ILCC NO. m 1 XI Source of above Z . ❑ Yes 0 No 0 Unknown g D Did Carrier Safety Regulations MCS)violation contribute to the crash? A 0 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 VIM 1 m co LOCAL USE ONLY TRAILER VIN 2 m 0 TRAILER WIDTH(S) 0-96" 97-102" >102' T TRAILER 1 ❑ ❑ 0 Z TRAILER 2 ❑ 0 0 O u 1 COLOR U_COLOR TRAILER LENGTH(S)1 ft. 2 ft. Z Gray 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_TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: TOWED BY/TO: DUE TO VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE