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HomeMy WebLinkAbout2025-00006951 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 01111101111 01101100IIII II ) IV IIIIII DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X003712454 u, 1 U21 1 1 1 U116 U2 1 U, 1 u2 1 U, 1 U2 1 4 6 U1 14 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 ❑$501-$1.500 ®ON SCENE 3 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash 0 AMENDED YR 2025I 2025-00006951 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 rn RT20 WB El In 06:39 ® ❑ RELATED ❑Y ®N 02 01 2025 ❑AM ❑YES ®NO U1 g PRIVATE mo !day!yr ®PM FLOW CONDITION III FT!MI N E S W ILLINOIS NOIS EXIT RAMP COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR 0 SLOW 1 cn ❑ Cook HIT&RUN ❑V ® N WITH VEHICLES INVLD 0 STOPPED U2 —I ® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 g DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EWES ❑NOV ❑!CV ❑Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 n T TOWED U1 Q ©1 FOR DAMAGEDAREA(S) FROM Aranda. Ruben 0 2 / yr 13-UNDER CARRIAGE I , FIRE ❑ al STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 2 DISTRACTED 0 0 U2 4 M M 2 SYTM IN ENGAGE4 ❑Y ®SNE DUNK VEH. O AT CRASHD O 99-UNKNOWN 9 16•TOP 3 *Distraction Value ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF S, it S �i 4 COM VEH 0 Ea 1 0 I. FIRST CONTACT 11 7_:,__—_;__5 *IIYes.See Sidebar U1 V Z Addison IL 60101 0 1 0 CD70001 IL 2025 REAR TELEPHONE IL D 7 JN1 EV7AR4KM590361 Progressive ❑v ®N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Same 9426211594 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER XI Refused ❑Y ® N 2 0 g DRIVER ❑ PARKED ❑DRIVERLESS 0 FED ❑PEDAL 0 EWES ❑Nov 0 NCv ❑DV !2 0 0 5 Honda Civic 2008 00-NONE 'o,I t2 (,-2 FIRE DUE O CRASH D D U2 2 C o Yr 13-UNDER CARRIAGE c M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9.1,6•TOP 3 X ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN `0istrac on Value U1 4 POINT OF S i 4 COM VEH D ® CO N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR 6 FIRST CONTACT 6 O7 ,�=QIOS •ItYes See Sidebar C Hoffman Estates IL 60169 C 1 CD70001 IL 2025 i AR 0 IL D 0 1 HGCP268X8A047089 Progressive ❑Y ®N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Same 987392070 BAC $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused 0 Y°ND 0 N U1 = (UNIT) (SEAT) (DM (SEX) {SAFT) (AIR) (INJI 1(EJCTI (EPTH) PASSENGERS&WITNESS ONLY (NAME)/(A.DDRESS)/(TELEPHONE! (EMS) (HOSPITAL) 2 6 06 / / / 3 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 24 1 02/01 /2025 06 39 ®AM in a Work Zone? ®N DIRP co 1 I 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 3 28 99 ! / ❑PM• 0 Construction >F R 3 0 1 3 $I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 7 - U2 a, ARREST NAME Aranda. Ruben 11-601 482000469 / / ❑❑PM ❑Maintenance SLMT® 11 3 UtilitySLMT o uSECTION CITATION NO. ROAD CLEARANCE TIME El 0CITATIONS ISSUED PENDING T 2 El ARREST NAME 02/01 /2025 06 39 ®PM 0 Unknown work zone type U1 0 AM 55 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑AM Workers present? D Y 55 482-Flentye.Jeremy 401 03 /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 —I BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C i - } (example:shuttle or charter bus):or X - ------I----; - transporting employened to es inthe course passengers5 or fewer thir emplod yment example:employeener X enger car):or 1:0 L -----}----; - } } } •transporter sed or des gnated to transport betweelly a van type vehicle or n 9 and 15 assen passengers,including the driver, C / 7iz S for direct compensation(example:large van used fors cific purpose):or L i.____a____. l® i _ 5 Isanyvehicleusedtotransportanydhazardousmaterial(HAZ MAT)that requires placartling(example:placards will be displayed on the vehicle). XI CARRIER NAME Z - __ 1 ADDRESS w n CITY/STATE/ZIP g MOTOR CARR.ID 0 Interstate 0 Intrastate I r ❑ Not in Comm./Govt. 0 Not in Comm./Other ------- --1 - USDOT NO. ILCC NO. rn XI Source of above z . Form Number m Xl IDOT PERMIT NO. WIDELOAD'; 0 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' T TRAILER 1 ❑ ❑ 0 Z TRAILER 2 ❑ 0 0 O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. Z Black Gray 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 DISABLING DAMAGE DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® Redmons/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE