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HomeMy WebLinkAbout2025-00009208 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 01111101111 I01101100 VI 1010100100 1III DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X003721/23 u, 1 U21 1 1 1 U1 8 U2 1 U, 1 1_12 1 U, 1 U2 1 1 11 U1 18 u2 1 *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 El$501-$1.500 ®ON SCENE 2 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) El Injury and/or Tow Due To Crash ❑AMENDED YR 202512025-00009208 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 I ® ❑ RELATED PRIVATE ®Y 0 N 02 11 2025 ❑AM ❑YES ®NO U1 —< RT20 WB Elgin mo /day/yr 02:39 ®PM FLOW CONDITION m �� ® © COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ®SLOW 15 u) !MI N E S Grace St WITH VEHICLES INVLD ❑ STOPPED U2 —I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) Kane HIT&RUN ❑Y ® N PEDALCYCLIST®N ❑ FREE FLOW # LNS 0 18:DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EDUES 0 Nuv 0 ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 C) FOR DAMAGEDAREA(S) FROM TOWED U1 O Parada Zelaya.Juan.J. 1 0 / yr 13-UNDER CARRIAGE ©,I :: FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14--TOTAL(ALL) DISTRACTED 0 0 U2 2 m M 2 OTHER 8 ❑Y ®SYSNEM IN❑UNK VEH. O AT CRASH D O 99-UNKNOWN 9 76.70P 3 ,Distraction Value 9 ALGN = r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s iI 6 ji COM VEH 0 E! 1 C) ~ ELGIN IL 60123 0 1 0 FIRST CONTACT 6 O_:LQ_O •II Yes,See Sidebar U1 0 Z EK91607 IL 2024 REAR TELEPHONE IL D 0 2HNYD2H6OBH512510 Magnum Insurnace ❑Y I$I N U2 m 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m co 99 9 Same PAIL001124834 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER en Refused 0 Y El 2 0 x DRIVER 0 PARKED 0 DRIVERLESS 0 FED 0 PEDAL 0 EWES 0 NAV 0 KCv 0 Dv yf 3 Toyota RAV4 2023 00-NONE 0. Q!'-O, DUE TO CRASH rg ❑ 2 x 0 13-UNDER CARRIAGE 10( I 2 FIRE 0 ® U2 C c M 2 4 SYSTEM IN 0 ENGAGED 0 ®-OTHER 9,16-TOP 3 9 0 X ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN `Oistracton Value N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6 11:, 4 COM VEH 0 ® U1 CO FIRST CONTACT 12 7� -.5 •If Yes.See Sidebar = ELGINREAR D IL 60124 0 1 0 DY45465 IL 2024 IL D 0 JTMB6RFV8PD082318 Allstate ❑Y ®N RDEF71 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = 99 9 Same 811280725 BAC $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP 996 < Refused RESPONDER U1 = (UNIT) (SEAT) (DOBi (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)!(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL) U2 m ##OCCS y 71 / / U1 1 D / / 1 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z N 1 ® 11 1 02/11 /2025 02 39 ®PM 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 Eri 2 ® 11 1 03 28 ! / ❑PM• ❑Construction * Z 3 0 'xi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 7 ❑AM ❑Maintenance U2 o1 ® 11 1 ARREST NAME Parada Zelaya.Juan.J. 11-601 485349 / / El PM SLMT o N ❑CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ' ❑Utility t 2 ❑ ARREST NAMEEl AM 7 / / PM 0 Unknown work zone type 45 U1 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 45 485-Quintana.Josue 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••--, , ; 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 _ } (example:shuttle or charter bus):or d Not To Scats I 3. Is designed to carry 15 or fewer passengers and operated a contract carrier O l- <.__-A-.-.� A - fr, _ y } } } transportingemployees In the course of their employment // (example:employee transporter-usually a van type vehicle or passenger car):or Jf C 1El ltl I. 4. Is used or designated to transport between 9 and 15 passengers,including w-- -- - } } } g Po passen rs,includi the driver, for direct compensation(example:large van used for specific purpose):or O 1 1 1 ��. � L ;----�;----; —Urdt a UnttNt'Unit#2— —unit unn#2 _ L I. I. L 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires Unit#1 �' placarding(example:placards will be displayed on the vehicle). XI CARRIER NAME —1Z .► __ ADDRESS D Lir—i w CITY/STATE/ZIP 00 MOTOR CARR.ID 0 Interstate 0 Intrastate 0 . I . . ❑ Not in Comm./Govt. 0 Not in Comm./Other ----------1 - USDOT NO. ILCC NO. m XI Source of above z . MCS ❑Yes 0 No 0 Unknown Out of Service ❑Yes ❑No 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 Black White u 1 TOWED • TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ® 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 DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® DISABLING DAMAGE Arties/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE