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HomeMy WebLinkAbout2025-00018647 ILLINOIS TRAFFIC CRASH REPORT sheet 1 of 2 Sheets 01111101111 I01101100 00 III 11000 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X003764570 u, 1 U21 2 4 1 U1 8 U2 1 U1 1 U2 1 U1 1 U2 1 5 10 U, 4 U2 1 *P 0119 INVESTIGATING AGENCY DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT El A No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW Elgin Police Department ONE PERSON'S ❑5501-51.500 ®ON SCENE 2 VEHICLE/PROPERTY ®OVER 51,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash ❑AMENDED YR 2025I 2025-00018647 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -11 ® ❑ RELATED PRIVATE ❑Y ®N 03 24 2025 ❑AM ❑YES ®NO U1 -< S RANDALL RD Elgin mo /day/yr 07:55 NPM FLOW CONDITION M • ONC7!MI N E O W BOWES Rd COUNTY PROPERTY ❑Y ® N DOORING Ely #OF MOTOR 0 SLOW 15 u) Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD 0 STOPPED U2 --I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST IZI N ® FREE FLOW # LNS 0 Ig:DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EWES ❑uuv ❑!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 6 n T TOWED U1 O FOR DAMAGED AREA(S) FROM Rodriguez. Lilliana. L. 1 1 / yr 13-UNDER CARRIAGE ©,I 0,,:O 2FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ❑ 0 U2 IE 6 r11 F 2 3 ❑Y NSYSNEM❑UNK VEH. O ATCRASHD 0 99-UUTHER NKNOWN 9 16•TOP 3 `DistractionVaiue 9 ALGN = r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s it 6 �i 4 COM VEH ❑ j$J 1 0 H 1- BARTLETT IL 60103 B 1 0 FIRST CONTACT 11 T_: __s *If Yes.See Sidebar U1 ZV276784 IL 2021 TELEPHONE IL D 0 2C3CDXHG2EH202244 STATE FARM ❑Y ®N U2 1—Ill - 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Elgin Fire 99 9 RODRIGUEZ. ULISES 1181392-SFP-13 1 r o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER RESPONDER 2 ou p; DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 /1 9 8 5 Dodge Durango 2024 00-NONE ,i_. 12 DUE TO CRASH rg ❑ 2 x o 13-UNDER CARRIAGE I FIRE ❑ N U2 c F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 1,6-TOP 3 X ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN `Oistracuon Value 9 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s-iI 6 i_i, COM VEH 0 N U1 CO FIRST CONTACT 1 Y _, _s •Iryes.See Sidebar = ELGINREAR C Mz IL 60123 B 1 0 SPIKE4 IL 2025 IL D 0 1 C4RDJDG6RC175261 STATE FARM ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Elgin Fire 99 9 Same 2384477-SFP-13 BAG E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPONDER U1 = (UNIT) (SEAT) (DOBi (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)/(ADDRESS)/(TELEPHONE) (EMS) (HOSPITAL) 1 3 01 / :A / / UI 2 D / / 1 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z u 1 ® 11 1 03,24 /2025 07 55 ®AM in a Work Zone? NCI N DIRP co 1 1 PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 5 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 C) v 2 0 20 99 03/24 /2025 08 03 ®pM ❑Construction >F R O 0 ]$I CITATIONS ISSUED El PENDING SECTION CITATION NO. EMS ARRIVED TIME 5 3 ❑AM ❑Maintenance U2 o ® 11 1 ARREST NAME Rodriguez. Lilliana. L. 11-708 S1551-000022 03/24/2025 08 10 Igi pM SLMT o N ❑CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • El Utility t 2 0 ARREST NAME 03/24 /2025 08 54 ®PM El Unknown work zone type U 0 AM 1 50 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 50 1551-Dede.Joseph 801 391-Jacobucci 05 / 13/2025 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. I r ----r••--, , ; A CMV is defined as any motor vehicle used to transport passengers or property and:I I I Z 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer - (-- -Y- --; I I I I I. INDICATE NORTH combination):or p1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C II I I - r r r (example:shuttle or charter bus):or 0 J a ` 3. Is designed to car 15 or fewer` A g carry passengers and operated by a contract career i O } } } transporting employees In the course of their employment(example:employee X — — transporter-usually a van type vehicle or passenger car):or w C L L.___a._._' I al } } 1 •4. Is used or designated to transport between 9 and 15passen rs,includingthedriver, } ill 1 I I for direct compensation(example:large van used for specific purpose):or O i. i _ 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires II 0 placarding(example:placards will be displayed on the vehicle). D I- 1 .. CARRIER NAME —I Z J I I Not To Scale l - ADDRESS D rn - CITY/STATE/ZIP 0 MOTOR CARRi. .ID ❑ Interstate ❑ Intrastate I I T I 0 Not in Comm./Govt. 0 Not in Comm./Other Y USDOT NO. ILCC NO. m XI Source of above z . • m Did HAZMAT spill from vehicle(do NOT consider FUEL from vehicle's z own tank)? 0 Yes 0 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 II 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. 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. 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