HomeMy WebLinkAbout2025-00008253 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 01111101111
101101100 VI 10 0 1110
DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X00372856r
u, 2 U21 1 1 1 U1 2 U2 1 U, 1 1_12 1 U, 1 U2 1 1 10 U1 3 U2 1 *P 0119*
INVESTIGATING AGENCY DAMAGE TO ANY El$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 15
VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and f or Tow Due To Crash
El AMENDED
YR 202512025-00008253 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n
® ❑ RELATED ®Y 0 N 02 07 2025 ❑AM ❑YES ®NO U1
N MCLEAN BLVD Elgin02:47
_ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION m
FT!MI N E S W ABBOTT DR COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 1 (n
❑ Kane HIT&RUN ❑V ® N WITH VEHICLESOT,
INVLD ❑ STOPPED U2 --I
Igl AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0
Qg3 DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EDUCE ❑uuv ❑ncv ❑Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 0
FOR DAMAGEDAREA(S) 660hrr TOWED U1 Q
NAME(LAST,FIRST,M) Palma Cerrato. Daniz.A. mo yr Nissan Altima 2013 00-NONE
OUETOCRASH ® ❑1t, 1z
13-UNDER CARRIAGE 101 1: 2 FIRE ❑
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) O DISTRACTED 0 0 U2 4 <<Tl
M 2 6 ❑Y ®SNE❑UNK VEH. 0 AT CRASH IN ENGAGED0 99-UUNKNOWN 9 16-TOPO `Distraction Value ALGN =
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6, it 6 jl COM VEH 0 Ea 1 C)
I� FIRST CONTACT 2 7__c—:)-_5 *II Yes.See Sidebar U1 0
Z ELGIN IL 60123 B 1 0 FB72946 IL 2026 REAR
TELEPHONE
IL D 0 1 N4AL3AP4DC182885 American Freedom ❑Y I$I N U2 m
S3 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
co
Elgin Fire Same 12-2423068-01 1 r
`o HOSPITAL(TAKEN TO) INCIDENT IF IC OWNER STREET,CITY,STATE,ZIP PHONE NUMBER
RESPONDER D
Provena St.Joseph ❑Y El 2 0
E{ DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EWES ❑row 0 KCV ❑Dv
1 9 9 4 Subaru Impreza 2012 00-NONE 0.,. QI'-O DUE TO CRASH 0 ❑ 2 x
o Yr 113-UNDER CARRIAGE 10( I 2 FIRE 0 ® U2 C
M 2 4SYSTEM IN 0 ENGAGED 0 15-OTHER 9,16-TOP 3 X
0 Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN *Distraction Value 0
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8
-iI�1:, 4 COM VEH ❑ ® U1 W
FIRST CONTACT 11 7 _5 •
I.. ELGIN IL 60123 B 1 0 BP93666 IL 2025 REAR If Yes.See Sidebar 0 C
M
IL D 0 J F1 G PAB61 CH245032 Travelers ❑Y ®N RDEF
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 =
Elgin Fire Same 9967495182031 BAG $
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 <
Sherman RESPONDER
El N U1 =
(UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME),(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL)
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 02,07 ,2025 02 47 ®AM in a Work Zone? ®N DIRP co
1 r 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 2 19 02,07 ,2025 02 49 ®PM 0 Construction
*
1
R 3 ❑ ]$I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 1
z J ❑AM ❑Maintenance U2
-a, ARREST NAME Palma Cerrato. Daniz.A. 11-901-A 751906 02,07 r2025 02 52 Igi pM SLMT
o U1 ® 11 1 El CITATIONS ISSUED 0 PENDINGTIME ' 0 Utility
o N SECTION CITATION NO. ROADCLEARANCE AM
r 2 0 ARREST NAME Palma Cerrato. Daniz.A. 11-501-A-2 751905 , , 0 PM El Unknown work zone type U1 35
2 2 3 IDOFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? El 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
1. as a weight rating more than 10,000 pounds(example:truck or truck trailer -<
.-- _r- A _ combination):or —I
r N?McLean?Blvd. 0 INDICATE NORTH
BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C
r r (example:shuttle or charter bus):or 0
. A II 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I
} I• I. transporting employees In the course of their employment(example:employee
transporter-usually a van type vehicle or passenger car):or w
i. <_ a I I _ 4. Is used or desi nated to trans rt between 9 and 15 ssen rs,including the driver. C
T AbbotY?Dr. } } } for direct compensation(examp large van used for specific purpose):or N
L L____a____.I r A t l. I 1 t 5. Is any vehicle used to transport any hazardous material(HAZMAT)thatrequires m
I 1 placarding(example:placards will be displayed on the vehicle).
CARRIER NAME Z
I Ions ADDRESS
Not To Scale i I I rn
CITY/STATE/ZIP 00
- i. i. i. i. MOTOR CARR.ID 0 Interstate ❑ Intrastate
I I . I ❑ Not in Comm./Govt. 0 Not in Comm./Other
---"'4 USDOT NO. ILCC NO. m
XI
Source of above z
. 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
Bronze Black
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