HomeMy WebLinkAbout2025-00014921 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111
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DRAG TRFD TRFC WEAT DRVA VIS VEHD LGHT COLL MANY X003747365
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INVESTIGATING AGENCY DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT ® A No Injury 1 Drive Away
AGENCY CRASH REPORT NO. TRFW '
Elgin Police Department ONE PERSON'S ❑5501-51,500 ®ON SCENE 15
VEHICLE/PROPERTY ®OVER 51,500 ❑NOT ON SCENE(DESK REPORT)
El AMENDED ❑ B Injury and/or Tow Due To Crash YR 202512025-00014921 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 71
BIG TIMBER RD Elgin® ❑ RELATED ' ' 0 N 03 07 2025 ❑AM ❑YES ®NO U1 -<
10:25
_ _ PRIVATE mo /day/yr ®PM FLOW CONDITION M
FT!MI N E S W GATEWAY DR COUNTY PROPERTY :IN Y ® DOORING Ely #OF MOTOR El SLOW 7 rA
❑ Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD IN STOPPED U2 --I
lgi AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST IR N ❑ FREE FLOW # LNS 0
Qg3 DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EouES ❑NOV ❑ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 03 n
0 FOR DAMAGEDAREA(S) FROM
NAME(LAST,FIRST,M) Rondon Garate. Rayfer.S. mo8 / /1 9 9 2 NT TOWED U1 Q
� 2023 yr Jeep(after 19 nd Cherokee 00-NONE 11_ - 1 DUE TO CRASH El13-UNDER CARRIAGE ( t2 I FIRE ❑ EN
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTHER TAL(ALL) O 2 DISTRACTED 0 0U2 03 M1678 M 2 4 ❑Y IN NEDUNK VEH. 0 ATCRASHD 0 99-UUNKNOWN O9 1t •70P 3 `Distraction Value ALGN
-
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s iI S 4 COM VEH 0 Ea 1 0
~ ELGIN N I L 60123 0 1 0 FIRST CONTACT 10 7 ;1 _5 *II Yes.See Sidebar Ut
Z EZ52448 IL 2026 Ismi
TELEPHONE
IL D 0 1C4RJKAG7P8782451 Geico ❑Y ®N U2 m
in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
99 Same 6191794590 2 r
o HOSPITAL(TAKEN TO) INCIDENT IF IC OWNER STREET,CITY,STATE,ZIP PHONE NUMBER
RESPONDER D
Refused ❑Y ® N 2 c
m g DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL 0 EWES 0
/1 9 9 0 Volvo VN L 2024 00-NONE 'o,1 t2 c,�2 FIRE DUE O CRASH 0 ® U2 18 C o yr 13-UNDER CARRIAGE
c
M 2 4 ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN `Oistraelion Value
POINT OF S 1 iI COM VEH ® ❑ U1 CO
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR A 5
FIRST CONTACT 5 7. —_,SOS •If Yes.See Sidebar
Los Angeles CA 90046 0 1 0 P976516 IL 2025 I0 C
D
CA A 7 4V4NC9EH6RN625748 Acord Insurance ❑Y ®N RDEF
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 =
99 All Trucks Leasing C CPS7972096 BAC
E
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP
u1 =
)UPIIT) (SEAT) (D081 (SEX) {SAFT) (AIR) (WI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)/(A.DDRESS)!(TELEPHONE) (EMS) (HOSPITAL)
2 5 02 /
2 0
EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z
u 1 ® 11 1 03,07 /2025 10 25 ®pm in a Work Zone? ®N DIRP co
1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 1
T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1
o"
2 28 99 / / ❑PM• ❑Construction *
1
R 3 ❑ xi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 1
❑AM ❑Maintenance U2
a ® 11 1 ARREST NAME Rondon Garate. Rayfer, S. 11-601-Ax W1521000481 / / El PM SLMT
o N ❑CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME El Utility
El AM
t 2 El ARREST NAME 03/07 /2025 10 45 ®PM El Unknown work zone type U1 30
n 7 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME
❑Y 30
1521-Vega.Wendy 901 - / / ❑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 -<
c ` --I -' r INDICATE NORTH combination):or -I
BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C
i_ - } (example:shuttle or charter bus):or OC
I- I- --I--•--I - 1 transporting mployeened to slin the course passengers5 or fewer thir employmentd example:employeener X
/ ♦ } } }
i. ...I. 1 i► ""°`"' 1 1 transporter sedord�llnatedtotransy a van type ehrtbetween9andr15r) ssen rs,including[hedriver, to
n } } } for direct compensation(examp large van used for specific purpose):or O
< .I. 4 ,yam - l I 1 5. Is any vehicle used to transport any hazardous material III placarding(example:placards will be displayed on the vehicle). XI
4
IE CARRIER NAME All Trucks Leasing Corp Z
r ADDRESS 863 BITTERSWEET DR
rn
CITY/STATE/ZIP Northbrook 1 IL 160062 D
n
MOTOR CARR.ID El Interstate ❑ Intrastate
I r ❑ Not in Comm./Govt. ❑ Not in Comm./Other
--- --1 - USDOT NO. 1346895 ILCC NO. m
XI
Source of above z
. -I
Were HAZMAT placards on vehicle? 0 Yes ® No =
If Yes,Name on placard O
4 digit UN NO. 1 digit Hazard class No. Xl
Xl
Did HAZMAT spill from vehicle(do NOT consider FUEL from vehicle's z
own tank)? 0 Yes ® No 0 Unknown
Did HAZMAT Regulations violation contribute to the crash? r
❑ Yes 0 No 0 Unknown g
D
Did Carrier Safety Regulations(MCS)violation contribute to the crash? A
❑ Yes I 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. NIA WIDELOAD? ❑Yes ®No 2
TRAILER VIN 1 1 UYVS2535HU849576 m
co
LOCAL USE ONLY TRAILER VIN 2 m
0
TRAILER WIDTH(S) 0-96" 97-102" >102' -n
TRAILER 1 0 ® 0 Z
TRAILER 2 ❑ 0 ❑ O
u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 53 ft. 2 ft. w
White White
u 1 TOWED TOTAL VEHICLE LENGTH 73 f ft. NO.OF AXLES 6
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. 6 CARGO BODY TYPE 2 LOAD TYPE 5