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HomeMy WebLinkAbout2025-00006960 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 I01101100 I 1111111I1 III111111111 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X003713� u, 1 U2 1 1 1 u1 4 U2 u, 1 1_12 1 u, 1 U2 1 4 9 U1 1 U221 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY ❑$500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW ' Elgin Police Department ONE PERSON'S ❑5501-$1.500 ®ON SCENE 1 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash 0 AMENDED YR 2025I 2025-00006960 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 m430 G EORG E ST Elgin07:20 ® ❑ RELATED ❑Y ®N 02 01 2025 ❑AM ❑YES ®NO U1 -< PRIVATE mo /day/yr ®PM FLOW CONDITION m _ COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR 0 SLOW 1 (n ❑ FT/MI NESW Kane HIT ❑Y ® N WITH VEHICLES INVLD 0 STOPPED U2 --I &RUN ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 Qg3 DRIVER t] PARKED O DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NW 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 n f�rr_ TOWED U1 Q Sanchez.Sall A. Chevrolet Equinox 2018 00-NONE 1 2 DUE TO CRASH ® ❑ NAME(LAST,FIRST,M) y mo yr 13-UNDER CARRIAGE ©' -0 FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) O 2 THERDISTRACTED 0 0 U2 2 �T1 F 2 4 SYTM❑Y EIS NE El UNK VEH. 0 AT CRASH 99-UNKNOWN 9 16•TOP 3 •Distraction Value ALGN X. r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s, i�a �i 4 COM VEH 0 Ea 1 0 ELGIN I L 60123 0 1 0 FIRST CONTACT 11 7_: __5 *II Yes.See Sidebar U1 Z DA25674 IL 2025 REAR TELEPHONE IL D 0 2GNAXSEV8J6205050 STATE FARM ❑Y ®N U2 Rr'I in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m MARTI N EZ.ANA. L. 1101702SFP13 1 r o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET.CITY.STATE.ZIP PHONE NUMBER RESPONDER 2 ou 0 DRIVER X. PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 row 0 Ncv 0 DV yr Honda Accord 2002 00-NONE O z -O DUE TO CRASH ❑ 1 73 Ti 13-UNDER CARRIAGE 9 I ©Ic, 2 FIRE 0 ® U2 C SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) O DISTRACTED 0 ® SPDR n SYSTEM IN 0 ENGAGED 0 15-OTHER 9.16-TOP 3 0 a ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN *Oistraglon Value POINT OF 8 '4 ut N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR ��', COM VEH ❑ ® CO FIRST CONTACT 11 7 __5 •If Yes.See Sidebar H AU75017 IL 2025 I 0 Si) M . STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0 1 HGCG56722A058877 STATE FARM ❑Y J N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = PELLOT BONILLA. KIDANY 1579044SFP13 BAc $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE:ZIP U1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)((ADDRESS)((TELEPHONE) (EMS) (HOSPITAL) 1 3 05 / F 2 3 0 1 0 m / / #OCCS D / / u1 2 D / / 0 EV MOST EVNT LOG DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 18 1 02/01 /2025 07 20 0 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) v 2 0 50 15 02/01 /2025 07 20 ®PM 0 Construction R O 0 ]$I CITATIONS ISSUED El PENDING SECTION CITATION NO. EMS ARRIVED TIME 5 3 ❑AM 0 Maintenance U2 -a, ARREST NAME Sanchez.Sally.A. 11-601 S1519-000275 02/01 /2025 ❑PM SLMT N 1 ® 11 1 0 Utility o SECTION CITATION NO. ROAD CLEARANCE TIME ❑CITATIONS ISSUED PENDING 0 AM t 2 ElARREST NAME 02/01 /2025 08 00 0 PM 0 Unknown work zone type U1 25 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 25 1519-Bae2 a.Guadalupe 401 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----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 -< i- }--__r-_--; INDICATE NORTH combination):or P3 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C J L. - (example:shuttle or charter bus):or X ._.; ehomn4Aw r r r 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 X transporter-usually a van type vehicle or passenger car):or w s+ } } } 4. Is used or designated to transport between 9 and 15 passengers,including the driver. C .1 i for direct compensation(example:large van used for specific purpose):or O I I rae»so.uJ ' _ t l. I 1 t 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m g placarding(example:placards will be displayed on the vehicle). X/ g CARRIER NAME Z 3 Genies _ ADDRESS 0 C) CITY/STATE/ZIP g MOTOR CARR.ID 0 Interstate 0 Intrastate 0 I I T I ❑ Not in Comm./Govt. 0 Not in Comm./Other --- --4. - USDOT NO. ILCC NO. m XI Source of above z . -I Were HAZMAT placards on vehicle? 0 Yes 0 No = If Yes,Name on placard O 4 digit UN NO. 1 digit Hazard class No. XI Did HAZMAT spill from vehicle(do NOT consider FUEL from vehicle's z own tank)? 0 Yes 0 No 0 Unknown Did HAZMAT Regulations violation contribute to the crash? r ❑ Yes 0 No 0 Unknown M D Did Carrier Safety Regulations MCS)violation contribute to the crash? A ❑ Yes II El Unknown C 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 0 0 Z TRAILER 2 ❑ 0 0 O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w White 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 DISABLING DAMAGE DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® Redmons/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE