HomeMy WebLinkAbout2025-00005006 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111
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INVESTIGATING AGENCY DAMAGE TO ANY ❑5500 OR LESS TYPE OF REPORT ® q No Injury 1 Drive Away
AGENCY CRASH REPORT NO. TRFW '
Elgin Police Department ONE PERSON'S El5501-51.500 ®ON SCENE 1
VEHICLE/PROPERTY ®OVER 51,500 El NOT ON SCENE(DESK REPORT)
0 AMENDED ❑ B Injury and for Tow Due To Crash YR 2025I 2025-00005006 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 71
® ❑ RELATED ❑Y ®N 01 23 2025 DAM ❑YES ®NO U1 -<
N STATE ST Elgin05:38
_ g PRIVATE mo /day/yr ®PM FLOW CONDITION ITI
1 0 !MI N E S W WingSt COUNTY PROPERTY ❑Y Igl N DOORING ❑y #OF MOTOR ®SLOW 15 u)
® Kane HIT&RUN ❑V ® 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 ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EWES 0 uuv 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 n
1 2 /
yr Jeep(after 19>3aJriot 2012 oo-NONE „_ Oi_, ODE TO CRASH ❑ VIE
13-UNDER CARRIAGE 1a , 2 FIRE 0 IE
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 4 I<n
M I 2 4 15-OTHER
❑Y ®N
SYSTEM
❑UNK VEH. 0 AT CRASHD 0 99-UNKNOWN 9 76•TIDP 3 `Distraction Value ALGN =
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 7_iL S 4 COM VEH 0 j$J 3 O
~ ELGIN IL 60123 0 1 0 FIRST CONTACT 12 7_; _-5 *IIYes.SeeSidebar Ut
Z DK43208 IL 2025 E
TELEPHONE
IL D 0 1 C4NJ PBBXCD538647 Allstate ❑Y ®N U2 m
B EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
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Same 932595066 1 r
`o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER
RESPONDER en
Refused ❑Y ® N 2 0
m g DRIVER ❑ PARKED 0 DRIVERLESS ❑ FED ❑PEDAL 0 EWES ❑iiMv 0 NCv ❑DV
/1 9 9 3 Chevrolet Trax 2025 00-NONE ,�_"' t2 -_, DUE TO CRASH ❑ (� 2
0 13-UNDER CARRIAGE 10 1 y FIRE ❑ ® U2 C
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F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16.TOP 3 X
❑Y ON ❑UNK VEH. AT CRASH 99-UNKNOWN *Oistraellon Value U1 0
POINT OF s iI 4 COM VEH ❑ ® CO N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR - MI'
FIRST CONTACT 6 Y__{_ -5 •If sees.See Sidebar
— Wheaton IL 60189 0 1 0 EW15495 IL 2025 REAR 0 C
IL D 0 KL77LKEP8SC112549 Farmers Insurance ❑Y ®N RDEF71
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 8 x
Same 532912823 BAG $
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 <
Refused RESPOND 0 N U1 =
(UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)1(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL)
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 1 01 ,23 �2025 05 38 ®AM 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 C)
0 2 03 28 I ) ❑PM ❑Construction *
1
Z3 0 I!!I CITATIONS ISSUED ElPENDING SECTION CITATION NO. EMS ARRIVED TIME ❑AM ❑Maintenance U2 5
oD ® 11 1 ARREST NAME Aranda. Raul.O. 11-601-Ax S1529-000268 / r El PM SLMT
o N ❑CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • 0 Utility
35
r 2 0 ARREST NAME AM
7 1 r ❑❑PM 0 Unknown work zone type U1
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2 2 3 IDOFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 35
1529-Audi red.Jonathan 501 03 +04/2025 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 Z
• N 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer
i- i•---.r----; r combination):or -I
\\ INDICATE NORTH p1
\ BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C
i_ \ - i. • • t- (example:shuttle or charter bus):or 0
1 r \\ 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier O
I- <.__-A-.-.� \ \ - y } } } transportingemployees In the course of their employment
\ transportr-usually a van vehicle or (example:employee co
type passenger car):or �
C
L L.___a.. - 4. Is used or designated to transport between 9 and 15 passengers,including the driver,
a 1\ , Xi \\1 } } } •
for direct compensation(example:large van used for specific purpose):or
L ..i.. . / l \\ i i L 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires III
G� _ placarding(example:placards will be displayed on the vehicle). XI
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�~ — 1 CARRIER NAME Z
\ ADDRESS D
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Not To Stele i \
\ \\ CITY/STATE/ZIP �
\ MOTOR CARR.ID 0 Interstate ❑ Intrastate
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tt ❑ Not in Comm./Govt. Not in Comm./Other
1 1 ❑ 0
USDOT NO. ILCC NO. m
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Source of above z
. MCS ❑Yes 0 No 0 Unknown Out of Service ❑Yes ❑No Z
Form Number 0
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IDOT PERMIT NO. WIDELOAD'; ❑Yes 0 No 2
TRAILER VIN 1 m
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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
Gray Green
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: 2 TOWED BY/T6
DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE