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HomeMy WebLinkAbout2025-00005592 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 01111101111 01101100 ill II IIIIIIII Oil DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X00370678S u, 1 U21 3 4 1 u, 2 U2 1 u, 1 1_12 1 u, 1 U2 1 1 10 u, 3 U2 1 *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 51,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash 0 AMENDED YR 202512025-00005592 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 rn DOUGLAS AVE Elgin 02:24 ® ❑ RELATED ®Y 0 N 01 26 2025 12— ❑YES El NO U1 -< _ _ PRIVATE mo !day!yr ®PM FLOW CONDITION MFT!MI N E S W KIMBALL BALL ST COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR 0 SLOW 1 (n ❑ Cook HIT ❑V ® N WITH VEHICLES INVLD El STOPPED U2 --I El AT RUN AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 Qg3 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EDUES 0 RIAv 0 ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 0 FOR DAMAGED AREA(S) FROM TOWED U1 NAME(LAST,FIRST,M) Martinez-Castillo. Ludivina moo ! /1 9 y7 0 Chrysler 300 2005 00-NONE ©,: Q i 0 DUE TO CRASH ® ❑ 13-UNDER CARRIAGE } FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) O O DISTRACTED 0 0U2 2 171 F 2 SYSTM IN ENGAGE 4 ❑Y IN NE DUNK VEH. 0 AT CRASH 0 99-UUNKNOWN 9 16-TOP 3 ,Distraction Value 9 ALGN = 1• CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6 :i1 6 • 4 COM VEH ❑ El 1 0 ~ ELGIN IL 60120 C 1 0 FIRST CONTACT 12 7_; _5 *Irves.See Sidebar U1 Z EM55050 IL 2024 REAR TELEPHONE IL D 2C3AA63H45H660183 Falcon Insurance ❑Y ®N U2 13 . m 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Elgin Fire 99 9 Same 0100133649-2 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused 0 Y ® N 2 XI m g DRIVER ❑ PARKED 0 DRIVERLESS 0 FED 0 PEDAL 0 EWES 0!My 0 IKv 0 DV !1 9 9 5 Toyota Camry 2005 00-NONE 0 Qj O DUE CRASH ❑ 2 13-UNDER CARRIAGE FIRE 0 ® U2 C II F 10 8 SYSTEM IN 9 ENGAGED 9 15-OTHER 9 16-TOP 3 X ❑Y ❑N ®UNK VEH. AT CRASH 99-UNKNOWN *Distracton value 9 0 POINT OF 6 i1 C 4 COM VEH 0 ® U1 CO N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR FIRST CONTACT 12 Y �Ii s COM See Sidebar — Palatine IL 60173 B 1 0 EV20671 IL 2025 I 0 N IL D 4T1BF30K95U616723 Insure Now Inc ❑Y J N RDEF 2I EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Elgin Fire 99 9 GUTLYYEVA. MAYSA I LP3379722 BAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP u1 = (UNIT) (SEAT) (DOBi (SEX) {SAFT) (AIR) (INJ) 1(EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME))(ADDRESS))(TELEPHONE) (EMS) (HOSPITAL) 3 3 08 / / / 1 0 EV MOST EVNT LOG DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z N 1 ® 11 1 01 ,26 /2025 02 24 ®AM in a Work Zone? ®N DIRP co 1 t PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 7 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 2 0 11 1 28 2 ! , 0 PM. ❑Construction >E N 3 0 $I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 3 ❑AM 0 Maintenance U2 o1 ® 11 1 ARREST NAME Martinez-Castillo. Ludivina 11-801-B SO475000624 , ! ❑PM SLMT o N 0 CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ' 0 Utility ❑ 35 t 2 El ARREST NAME AM T 1 ! ❑PM 0 Unknown work zone type U1 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 35 475-Williarhs. Brianna 101 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 1. Has a weight rating more than 10,000 pounds(example:truck or truckrtrailer -< c ` -' -' r INDICATE NORTH combination):or .Z-1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C i I - (example:shuttle or charter bus):or i i i i I 3. Is designed to carry15 or fewer passengers and operated a contract carrier O ` } } 1-I A N - transporting employee � �In the course of their employment(example:employee � 73 transporter-usually a van type vehicle or passenger car):or w L L.___a__ 4. Is used ordesi natedtotrans transport passengers,including C} } } g po passen rs,includi the driver, s e.nw for direct compensation(example:large van used for specific purpose):or _ . OAtYz i. i i. t 5. Is anyvehicle used to transport anyhazardous material(HAZMAT)that requires 9a� �'e wi m placarding(example:placards will be displayed on the vehicle). ;p ~4< ,3 —I CARRIER NAME Z sir _ ADDRESS 0Not To Scale . m'°""' 7��, rA l CITY/STATE/ZIP 0 MOTOR CARR.ID 0 Interstate 0 Intrastate 1 I r 1 ❑ Not in Comm./Govt. 0 Not in Comm./Other i. --- '-4 - USDOT NO. ILCC NO. m XI Source of above z . Form Number m Xl IDOT PERMIT NO. WIDELOAD'; ❑Yes 0 No 2 TRAILER VIN 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 Silver Silver 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 2 TOWED DISABLING DAMAGE NOT DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® DISABLING DAMAGE Redmons/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE