Loading...
HomeMy WebLinkAbout2025-00001122 ILLINOIS TRAFFIC CRASH REPORT sheet 1 of 4 Sheets 01111101111 I01101100 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X00a690304 * u, 1 U21 2 4 10 U1 4 U2 1 u, 1 1_12 1 u, 1 U2 1 2 15 U1 11 U2 1 *P 0119 INVESTIGATING AGENCY DAMAGE TO ANY 0$500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW Elgin Police Department ONE PERSON'S ID$501-$1.500 ®ON SCENE 2 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash 0 AMENDED YR 202512025-00001122 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 rl ® ❑ RELATED ®Y 0 N 01 06 2025 ®AM ❑YES ®NO U1 SUMMIT ST Elgin 06:42 _ _ g PRIVATE mo /day/yr ID PM FLOW CONDITION ITl FT l MI N E S W PRESTON AVE COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 15 u) ❑ Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD ❑ STOPPED U2 —I ® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST IZI N 51 FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EDUCE 0 uuv 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 5 C) FOR DAMAGEDAREA(S) FRO TOWED U1 I� NAME(LAST,FIRST,M) mo /1 9 7 9 Honda Civic 2005 00-NONE ©1 T©I'0 DUE TO CRASH El VI 13-UNDER CARRIAGE 10.I 2 FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0U2 5 r<rl M 2 4 SYTM❑Y ®SNEDUNK VEH. 0 ATCRASHD 0 99-U 15-UNKNOWN THER9 16•TOP 3 `Distraction Value 9 ALGN X. r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s i1 6 �i,4 COM VEH 0 j$J 1 0 ELGIN IL 60120 0 1 0 FIRST CONTACT 11 7_;{ __5 *II Yes.See Sidebar U1 Z EN50261 IL 2025 REAR TELEPHONE IL D 0 1 HGES267X5L003897 NATIONAL GENERAL ❑Y ®N U2 I-- B EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR co 1 99 9 Same 2026005853 4 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y ® N 9 2 eu m x DRIVER ❑ PARKED 0 DRIVERLESS ❑ FED ❑PEDAL 0 EWES ❑IN.ry 0 KV ❑Dv 1 9 9 4 Kia Motors Col portage 2011 00-NONE 1,1 t2-0 DUETOCRASH rg ❑ 2 x omo 113-UNDER CARRIAGE FIRE ❑ ® U2 c F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9,1,6.TOP 3 X ❑Y NJ N ❑UNK VEH. AT CRASH 99-UNKNOWN *0istracton Value 9 3 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8-iI 6 i_i, COM VEH ❑ ® U1 CO FIRST CONTACT 2 Y _,__5 •(ryes.See Sidebar Im = ELGINREAR IL D 0 KNDPCCA26B7100993 BRISTOL WEST ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER 1 X 1 99 9 ALDANA. EDWIN. F. G01510885300 BAC $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP u1 = (UNIT) (SEAT) (D08) (SEX) {SAFT) (AIR) (INJI 1(EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)1(ADDRESS)1(TELEPHONE) (EMS) (HOSPITAL) 1 3 01 / DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z N 1 El 11 4 Vargas.Javier bush 01 ,06 /2025 06 42 ®❑Pne 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 ✓ 2 ❑ 343 N M I LL RD APT 9 Addison IL 60101 11 28 1 1 ❑AM ❑Construction >F R 3 ❑ j i CITATIONS ISSUED ElPENDING SECTION CITATION NO. EMS ARRIVED TIME 7 -a, ARREST NAME ROMAN.ADOLFO 11-1427-H- 374001288 , , ❑❑PM ❑Maintenance U2 ® 1 1 4 UtilitySLMT SECTION CITATION NO. ROAD CLEARANCE TIME o N 1 ❑ 0CITATIONS ISSUED PENDING AM u, 35 T 2 ❑ ARREST NAME 01(06 12025 07 30 j PM ❑Unknown work zone type 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑AM Workers present? ❑Y 35 374-Rizzu-o. Michael 201 02 ,04,2025 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 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer -< c ` --I -' r INDICATE NORTH combination):or .Z-1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C - } (example:shuttle or charter bus):or X N 3. Is designed tocarry15fewer passengers and operated a contract carrier O ` © or 9 pe by es }.___A.._.J - . I. } } transporting employees In the course of their employment(example:employee � y,,,a" t ,,,,,;, vD Scale I transporter-usually a van type vehicle or passenger car):or CO w14..a,.a. / }--- ----; • } 1. } •4. Is used or designated to transport between 9 and 15 passengers,including the driver, (1)__ i - for direct compensation(example:large van used for specific purpose):or L i. i. t 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires placarding(example:placards will be displayed on the vehicle). m ;0 _ tA D o . . . . . CARRIER NAME Z T \\ ADDRESS D n CITY/STATE/ZIP g MOTOR CARR.ID 0 Interstate El Intrastate . I . . ❑ Not in Comm./Govt. 0 Not in Comm./Other ; _Y_ _- USDOT NO. ILCC NO. rn XI Source of above Z . ❑ Yes 0 No 0 Unknown E D Did Carrier Safety Regulations MCS)violation contribute to the crash? 0 Yes II No ElUnknown A 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 73 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' m TRAILER 1 ❑ ❑ 0 Z TRAILER 2 ❑ 0 0 O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. Z Blue Blue u 1 TOWED • TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/TO. SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® Redmons/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE