HomeMy WebLinkAbout2025-00011334 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets _ 01111101111
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DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X003733046-
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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 ®5501-$1.500 ®ON SCENE 7
VEHICLE/PROPERTY ❑OVER$1,500 El NOT ON SCENE(DESK REPORT)
0 AMENDED ❑ B Injury and/or Tow Due To Crash YR 202512025-00011334 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 99 m
600 VILLA ST Elgin08:08
® ❑ RELATED 0 Y ®N 02 20 2025 ❑AM ❑YES El NO U1
PRIVATE mo /day/yr ®PM FLOW CONDITION m
_
COUNTY PROPERTY ®Y ❑N DOORING ❑y #OF MOTOR ®SLOW 1 (n
❑ FT l MI N E S W Kane HIT&RUN ®Y ❑ N WITH VEHICLESOT,
INVLD ❑ STOPPED U2 --I
❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ❑ FREE FLOW # LNS 0
Q83 DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EWES ❑uuv ❑!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 n
FOR DAMAGEDAREA(S) FROPtf TOWED U1 O
NAME(LAST,FIRST,M)
Suarez. Kevin. I. mo !2 0 0 7 Dodge Avenger 2008 00-NONE Q 12 DUE TO CRASH 0 13-UNDER CARRIAGE } FIRE ❑
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) O 2 DISTRACTED 0 U2 0
!$I m
M 9 4 SYSTEM IN O ENGAGED O 9 OTHER 9 16•TOP 3 _
❑Y (Z) ElUNK VEH. AT CRASH -UNKNOWN `Distraction Value 9 ALGN
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF lay i_4 COM VEH 0 )gI 1 n
~ ELGIN I L 60120 0 9 0 FIRST CONTACT 6 k7 ::L _OS =if Yes.See Sidebar U1 0
Z DS87384 IL 2024 REAR
TELEPHONE
IL D 0 1B3LC46K38N278038 State Farm ❑Y ®N U2 m
13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
99 9 Suarez Suarez. Luis.A. 0360117-SFP-13 1 r
o HOSPITAL(TAKEN TO) INCIDENT IF`Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER
t RESPONDER ( G0)
m N DRIVER 0 PARKED ❑DRIVERLESS ❑ PED ❑PEDAL 0 EWES ❑NMy 0 Ncv ❑Dv CIRCLE NUMBER(S) U1
yr 12 _ x
o 13-UNDER CARRIAGE 101 2 FIRE 0 ® U2 C
c
M 2 4 SYSTEM IN 0 ENGAGED 0 ®-OTHER 016.70P 3 X
❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN `OistraclIon Value 9 0
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 1 6 l!- COM VEH ❑ ® Ut CO
FIRST CONTACT 9 7 _, _6 •)ryes.See Sidebar C
ELGIN IL 60123 0 1 0 DA60729 IL 2018 I 0 N
IL D 0 1G1ZD5ST9JF291170 None ❑Y 123J N RDEF
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 =
99 9 Same None BAG $
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 <
Refused RESPONDER U1 =
(UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)1(A.DDRESS)1(TELEPHONEI (EMS) (HOSPITAL)
LOG DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z
N 1 ❑ 11 5 02,20 l2025 08 08 ®AM in a Work Zone? ®N DIRP co
1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 1
OT T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 .,
1
2 ® 18 5 30 28
1 , 0 PM. ❑Construction *
Z 3 0 'xi CITATIONS ISSUED ❑PENDING SECTION CITATION NO. EMS ARRIVED TIME 7
❑AM 0 Maintenance U2
au ® 11 9 ARREST NAME Suarez. Kevin. I. 11-402-A SO485-000351 / ! ❑PM SLMT
o N ❑CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ' El Utility
10
t 2 ARREST NAME AM
7 1 ! ❑❑PM 0 Unknown work zone type U1
% El
2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 10
485-Quintana.Josue 302 04 ,01 ,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 truck trailer -<
i- }---.r----; I. INDICATE NORTH combination):or
p3
1 Not 7b Se j BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C
} ' - } r r r (example:shuttle or charter bus):or
X
rBerra 3. Is desgned to carry15 or fewer passengers and operated a contract carrier 0
`----------i a ?�fiIla?St - } } } transportingemployees in the course of their employment
pbyment(example:employee
w, transporter-usually a van type vehicle or passenger car):or w
L L.___a_ .w I } } } •4. Is used or designated to transport between 9 and 15 passengers,including the driver, c
C7 for direct compensation(example:large van used for specific purpose):or
ffi -D
< a ,' ,_I I < < t 5. Is any vehicle used to transport anyhazardous material(HAZMAT)that requires m
m
placarding(example:placards will be displayed on the vehicle). XI
CARRIER NAME Z
n
ADDRESS
� ir7i&it11 I I
r
CITY/STATE/ZIP
MOTOR CARR.ID 0 Interstate 0 Intrastate
I r ❑ Not in Comm./Govt. 0 Not in Comm./Other
-"-------1 - USDOT NO. ILCC NO. m
XI
Source of above z
). Form Number
m
Xl
IDOT PERMIT NO. WIDELOAD'; ❑Yes 0 No 2
TRAILER VIM 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
Blue Red
u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_
DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/TO:
_ SELECT CODES FROM THE BACK OF CRASH BOOKLET
U 2 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY/TO.
DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE