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HomeMy WebLinkAbout2025-00003965 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 01101100 11101 11111011 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X003698606 u, 1 u21 2 4 1 u1 2 U2 1 u, 1 u2 1 u, 1 u2 1 4 10 u1 3 u2 1 *P 0119 INVESTIGATING AGENCY DAMAGE TO ANY El 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 14 VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash El AMENDED YR 2025I 2025-00003965 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 1.171 W HIGHLAND AVE EIIn ® ❑ RELATED ®Y 0 N 01 18 2025 05:43 12,— ❑YES ®NO U1 -< g PRIVATE mo /day/yr ®PM FLOW CONDITION III FT!MI N E S W MOUNTAIN ST COUNTY PROPERTY ❑Y ® N DOORING Ely #OF MOTOR El SLOW 1 0)0 Kane HIT&RUN ❑Y ® 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 EOUES 0 NW 0!CV 0 DV DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 00 n 0 3 FOR DAMAGEDAREA(S) FROM NAME(LAST,FIRST.M) Silva Fernandez. Lady.J. mo / / T TOWED U1 Q Nissan Sentra 2012 00-NONE yr ©1 12 - DUE TO CRASH ® ❑ 13-UNDER CARRIAGE FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) O 2 DISTRACTED 0 0U2 00 I<T1 F 2 8 SY IN ENGAGED 15-OTHER ❑Y ®SNE❑UNK VEH. 0 AT CRASH 0 99-UNKNOWN 016-TOP 3 `Distraction Value 9 ALGN x r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF ,it a I 4 COM VEH 0 E! 1 n ~ SOUTH ELGIN I L 60177 B 1 0 FIRST CONTACT 9 t _; __5 •II Yes.see Sidebar U1 0 ZAT56856 IL 2025 REAR TELEPHONE IL D 3N 1 AB6AP8CL729094 State Farm ❑Y Il N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Elgin Fire 99 9 Compian. Richard. D. G56-5638-B28-13C 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER RESPONDER 2711 m x DRIVER ❑ PARKED ❑DRIVERLESS ❑ PEO ❑PEOAL ❑EWES 0 iiuv 0 i v 0 Dv /1 9 2 8 Chevrolet Traverse 2016 00-NONE O"i Z -O DUE TO CRASH ❑ 2 0 13-UNDER CARRIAGE ©f? z FIRE 0 ® U2 C : M 2 6 SYSTEM IN 0 ENGAGED 0 15-OTHER 9.16-TOPO3 X ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN i coDistraction value 9 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s- j 6 iC 4 COM VEH 0 ® U1 CO FIRST CONTACT 12 7-' ,�=5 •If Yes.See Sidebar 4 ELGIN IL 60124 0 1 0 YANNI14 IL 2018 I 0 C IL D 1 G N KVJ KDXGJ239115 Farmers ❑Y ®N RDEF71 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Elgin Fire 99 9 Same 190681683 BAG $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPONDER u1 = (UNIT) (SEAT) (DO01 (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)((ADDRESS)/(TELEPHONE) (EMS) (HOSPITAL) 1 5 12 / / / UI 3 D:A / / 1 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 11 4 01 /18 /2025 05 43 ®AM in a Work Zone? ®N DIRP co 1 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME ❑AM If YES check one below: U1 5 n T o" 2 ❑ 2 99 / / ❑PM. ❑Construction 1 Z3 0 I!!I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME ❑AM El Maintenance U2 a ® 11 4 ARREST NAME Silva Fernandez. Lady.J. 11-902 1506-344 / / ❑PM SLMT o N ❑CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ' ❑Utility 30 t 2 ARREST NAME AM T El / ❑❑PM El Unknown work zone type U1 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME COAM Workers present? ❑Y 30 1506-Nunez. Maria 602 334-Fries 02 / 11 /2025 09 00 ❑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 _N p -< 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer i- }-- -'-- --; IJ 1 Not To Scale I - } combination):or —I INDICATE NORTH p1 1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C (example:shuttle or charter bus):or n ' r r 0 ` A t 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I 0 } } } transporting employees in the course of their employment(example:employee 73 utdrr • i i i transporter-usually a van type vehicle or passenger car):or w L L.___a____J �_' : 1 P� o.i. 4. Is used ordesi natedtotrans rtbetween9and15 passengers,including y— _ } } for direct com nation exam I lar a van used for s cific ur o ):or the driver, Pe ( P 9 Pe P Pose):or L L____a____. _ l. I I _ 5. Is any vehicle used to transport anyhazardous material(HAZMAT)thatrequires dm I i placarding(example:placards will be displayed on the vehicle). ;p �� MOUNTAN98T _ __ _{ CARRIER NAME Z W ADDRESS O D ICITY/STATE/ZIP n I _ i. 4. MOTOR CARR.ID Interstate Intrastate I I T 0 Not in Comm./Govt. o Not in Comm./Other 0 ; _Y_ __1 USDOT NO. ILCC NO. m XI Source of above z . 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 co LOCAL USE ONLY TRAILER VIN 2 m 0 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 Silver Maroon u 1 TOWED • TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ti DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT 3 TOWED BY/TO. Arties/Impound Lot Garage SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® Arties/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE