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HomeMy WebLinkAbout2025-00002368 ILLINOIS TRAFFIC CRASH REPORT sheet 1 of 4 Sheets 01111101111 01101100 II 01 1011111 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X003689620 u, 9 U2 1 1 9 U1 99 U2 U199 1_12 U,99 U2 1 5 9 U1 1 U221 *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 ❑NOT ON SCENE(DESK REPORT) 0 AMENDED ❑ B Injury and/or Tow Due To Crash YR 202512025-00002368 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 99 71 ® ❑ RELATED ❑Y ®N 01 11 2025 ❑AM ❑YES ®NO U1 MCCLURE AVE Elgin11:45 _ g PRIVATE mo /day/yr ®PM FLOW CONDITION m 0 !MI Cl S W WingSt COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 15 u) O Cook HIT&RUN ®Y ❑ N WITH VEHICLESOT, INVLD ❑ STOPPED U2 --I 0 AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 18:DRIVER 0 PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NW 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 n / ! FOR DAMAGEDAREA(S) FRONT TOWED U1 O Unknown.O. Unknown Unknown 00-NONE it.. 12 , OUETOCRASH ❑ EN NAME{LAST,FIRST,M) mo yr 13-UNDER CARRIAGE 10 !!. 2 FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 2 m SYSTEM IN ENGAGED 15-OTHER 9 16.TOP 3 M 9 9 ❑Y ❑N ❑UNK VEH. AT CRASH ®-UNKNOWN `Distraction Value ALGN = s 4 COM VEH 0 0 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF _1_B 1i,_ 1 0 I- 0 9 9 FIRST CONTACT 99 7_i _5 *IIYes.See&debar U1 REAR 2 Z ' E TELEPHONE IL Other Unknown ®Y ❑N U2 I— in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Same Unknown 3 r `o HOSPITAL(TAKEN TO) INCIDENT IF IC OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused 0 Y ❑ N 99 0 0 DRIVER X. PARKED 0 DRIVERLESS 0 FED 0 PEDAL 0 EWES 0 My 0 NCv 0 Dv CIRCLE NUMBER(S) U1 yr Honda HR-V 2024 00-NONE O", z j--_, DUE TO CRASH ❑ ® 1 X/ Ti 13-UNDER CARRIAGE 9I ©lc 2 FIRE 0 ® U2 C SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) O DISTRACTED 0 ® SPDR C SYSTEM IN 0 ENGAGED 0 15-OTHER 9.16-TOP 3 9 9 X a ❑Y i N DUNK VEH. AT CRASH 99-UNKNOWN *Distraction Value N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF S i�'`_4 COM VEH ❑ ® Ut CO If Yes.See Sidebar FIRST CONTACT 11 s 7 _5 • F.. FIRST IL 2024 REAR 0 t;p M . STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0 3CZRZ2H57RM700224 Progressive ❑Y ®N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X Gutierrez. Ricardo 950626676 BAC $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP U1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME))(ADDRESS))(TELEPHONE) (EMS) (HOSPITAL) 0 O EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 18 1 01 ,11 /2025 08 41 ®❑AM in a Work Zone? ®N DIRP co 1 r PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 1 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 2 ❑ 28 18 N 3 ❑ 0 CITATIONS ISSUED 0 PENDING + ! ❑PM• ❑Construction SECTION CITATION NO. EMS ARRIVED TIME 1 ❑AM ❑Maintenance U2 z -a, ARREST NAME / / ❑PM ' o N 1 ® 11 1 0 CITATIONS ISSUED 0 PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • ❑Utility SLMT 30 r 2 ARREST NAME AM T 1 r ❑❑PM ❑Unknown work zone type U1 El n OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 ❑ ❑AM Workers present? ❑Y 30 410-DeLeon.Jessica 501 - , / ❑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••--, , n I A CMV is defined as any motor vehicle used to transport passengers or property and: Z 5 jai 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer -< c ` --I -' r INDICATE NORTH combination):or -I , BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C \. _ } (example:shuttle or charter bus):or 0 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I O A } } } transporting employees In the course of their employment(example:employee X transporter-usually a van type vehicle or passenger car):or w L }-----}----; A I - } } } •4. Is used or designated to transport between 9 and 15 passengers,including the driver, ♦ for direct compensation(example:large van used fors specific purose):or L .I. »may� L i i. L 5. Is any vehicle used to transport anyhazardous material(HAZMAT)thatrequires 'D placarding(example:placards will be displayed on the vehicle). XI Streat CARRIER NAME Z ADDRESS 0 r n CITY/STATE/ZIP g MOTOR CARR.ID ElInterstate El Intrastate I I T I I 0 Not in Comm./Gaut. Not in Comm./Other ; _Y_ __ USDOT NO. ILCC NO. m XI Source of above z . Form Number m Xl IDOT PERMIT NO. WIDELOAD'; ❑Yes 0 No 2 TRAILER VIM 1 m co LOCAL USE ONLY TRAILER VIN 2 m v 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 Black u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ElNOT DISABLING DAMAGE DAMAGE EXTENT 9 TOWED BY/TO: _ SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 DUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 3 TOWED BY/TO. DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE