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HomeMy WebLinkAbout2025-00013217 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 101101100 111111111111111011 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X003741„8,7 u, 1 U21 1 1 1 U, 2 U2 1 U, 1 1_12 1 U, 1 U2 1 1 12 U1 7 U2 1 *P 0119* INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW ' DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT 0 A No Injury 1 Drive Away Elgin Police Department ONE PERSON'S ❑$501-51.500 ®ON SCENE 1 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and for Tow Due To Crash 0 AMENDED YR 202512025-00013217 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 r1 454 ASHLAND AVE Elgin04:14 ® ❑ RELATED ❑Y ®N 02 28 2025 DAM ❑YES ®NO U1 _ PRIVATE mo /day/yr ®PM FLOW CONDITION m COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 1 cn ❑ FT/MI NESW Kane HIT&RUN ❑Y ® N WITH VEHICLESOT, INVLD ❑ STOPPED U2 --I O AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST IZI N ® FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS ❑ PEO ❑PEOAL ❑EWES ❑MAU ❑!CV ❑Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 0 FOR DAMAGEDAREA(S) FRONT TOWED U1 Silva Pinzon.Jorge.A. 0 7 / yr 13-UNDER CARRIAGE ©i O - FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 2 DISTRACTED 0 0 U2 2 m M 2 SY4 ❑Y ONM DUNK VEH. O AT CRASH IN O 99-UNKNOWN 9 16•TOP 3 *Distraction Value ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s, i�6 �i COM VEH 0 j$J 1 0 1 . ELGIN I L 60123 0 1 0 FIRST CONTACT 11 7_: __5 *Ilsees.See Sidebar U1 Z CZ16107 IL 2025 REAR TELEPHONE IL D 0 2T1BU4EE7BC547297 Magnum Insruance ❑v ®N U2 13 . m 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m co 99 9 Same PAIL001007064 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER Ai Refused 0 Y ❑ N 2 0 p; DRIVER ❑ PARKED ❑DRIVERLESS ❑ FED ❑PEDAL 0 EWES ❑iiuv 0 i v ❑DV yr �� 12 ( E FIRE 0 ® U2 C o 13-UNDER CARRIAGE c M 2 4SYSTEM IN 0 ENGAGED 0 15-OTHER 9,16-TOPO3 * X 0 Y ®N 0 UNK VEH. AT CRASH 99-UNKNOWN O Distraction Value 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8-.;,• 6 1( 4 COM VEH ❑ ® U1 CO FIRST CONTACT 2 7-'_, _5 •(ryes,See Sidebar = ELGIN IL 60123 0 1 EY28155 IL 2025REAR C IL D 0 1 FMCUOF71 DUD34330 Kemper ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER 1 X Same 12RA000002465 BAc E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPOND O N U1 = KNIT) (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 02,28 ,2025 04 14 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 2 99 02,28 ,2025 04 14 mi PM 0 Construction * <w O 0 0 CITATIONS ISSUED PENDING SECTION CITATION NO. EMS ARRIVED TIME 5 3 ❑AM 0 Maintenance U2 a 1 ® 11 1 ARREST NAME Silva Pinzon.Jorge.A. 11-905 1527000288 / i El PM SLMT igi CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME AM• 0 Utility t 2 El ARREST NAME Silva Pinzon.Jorge.A. 6-101-A 1527000287 02,28 ,2025 05 00 0 PM El Unknown work zone type U1 30 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑AM Workers present? ❑Y 30 1527-Juarez.Jorge 701 386-Lynch 03 ,25,2025 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 N , 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 -< ' }-----I-----; H..alny+ee♦J I I I 1,20-wwin4 - } INDICATE NORTH combination):or —I p1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C —— —— — - } (example:shuttle or charter bus):or X 3. Is designed tocarry15 fewer passengers and operated a contract carrier O I- <----A----i II es or } } } transporting employees in the course of their employment(example:employee co transporter-usually a van type vehicle or passenger car):or w L L.___a__ Ij? - } } } •4. Is used or designated to transport between 9 and 15 passengers,including the driver. C I for direct compensation(example:large van used for specific purpose):or O ® L t 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires placarding(example:placards will be displayed on the vehicle). m A I CARRIER NAME Z - ADDRESS D I rn �amee--ta '014 `�— C) _Not ToSoab_J CITY/STATE/ZIP ___ __ __ i. MOTOR CARR.ID 0 Interstate 0 Intrastate 1 I r 1 ❑ Not in Comm./Govt. ❑ Not in Comm./Other 00 ;_...Y. I USDOT NO. ILCC NO. I I ~Wrd7'8R , , , m m XI Source of above z . 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 Z TRAILER 2 ❑ 0 0 o u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w Silver 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 DUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/TO: DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE