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HomeMy WebLinkAbout2025-00018741 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 01111101111 01101100 00 IV 0 1110 DRAC TRFD TRFC WEAT DRVA VIS VEHD LGHT COLL MANY X003764564 u, 1 U21 1 1 1 U1 7 U2 1 u, 1 1_12 1 u, 2 u2 1 1 11 u, 1 U2 1 *P 0 1 1 9* INVESTIGATING AGENCY DAMAGE TO ANY ❑$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 2 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and f or Tow Due To Crash 0 AMENDED YR 2025I 2025-00018741 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 21 ® ❑ RELATED ❑Y ®N 03 25 2025 ®AM 100 NATIONAL ST Elgin 08:01 g ❑YES ®NO U1 _ PRIVATE mo !day!yr ❑PM FLOW CONDITION m COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR 0 SLOW 1 (n ❑ FT/MI NESW Kane HIT ❑Y ® N WITH VEHICLES INVLD 0 STOPPED U2 --I ID AT RUN AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS O g DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EDUCE 0 NIAV 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 3 n FOR DAMAGEOAREA(S) FRO �TOWED U1 NAME(LAST,FIRST,M) mo 1 9 7 5 Chevrolet Silverado 1998 00-NONE ©, • 0 �/OUETOCRASH ® ❑ 13-UNDER CARRIAGE ��I 2 FIRE El STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 3 M M 2 SYTM IN ENGAGE4 ❑Y ®SNE❑UNK VEH. O ATCRASHD O 99-UNKNOWN 9 16•TOP 3 `Distraction Value 9 ALGN = r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s, i�a 4 COM VEH ® ❑ 1 O ~ ELGIN I L 60123 0 1 0 FIRST CONTACT 12 7 ; _-5 *II Yes.See Sidebar U1 Z 1GBJC34R IL 2025 TELEPHONE IL D 0 1 GBJC34ROWF069383 State Farm ❑Y ®N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 STAR LANDSCAPING J338831-D08-13 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER RESPONDER 24 (,0j g DRIVER 0 PARKED 0 DRIVERLESS 0 FED 0 PEDAL 0 EWES 0 MAV 0 NCv 0 DV y Yr 2 0 0 1 Hyundai Sonata 2019 00-NONE 0. Qi•-_, DUE TO CRASH ❑ (� 2 73 0 13-UNDER CARRIAGE 10( I 2 FIRE ❑ ® U2 C M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9,16-TOP 3 X ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN *0istracton Value 9 0 POINT OF 8 i 4 COM VEH ❑ ® U1 CO N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR 6 FIRST CONTACT 6 O7 ,�=QI OS •IfYes See Sidebar C ELGINZ IL 60120 0 1 0 EH44267 IL 2024 AR Si)0 IL 0 5N PE34AF1 KH767384 Bristol West ❑Y ®N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = 99 9 Same G01-3877048-02 BAc $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPONDER u1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)1(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 03,25 ,2025 08 01 ®❑PM in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 2 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 C) 0 2 0 10 03 , , ❑PM ❑Construction >F R 3 0 $I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 2 ❑AM ❑Maintenance U2 o ® 11 1 ARREST NAME Maciel Maciel.Alfredo 11-601 1540-165 r r El PM SLMT I$!CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME NAM• 0 Utility t 2 El ARREST NAME Maciel Maciel.Alfredo 12-101 1540-166 03125 i2025 09 36 f PM El Unknown work zone type U1 35 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑qM Workers present? ❑Y 35 1540-Allah. Muhammad 401 310-Zierk 05 , 13,2025 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 .:: 0 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 - 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 0 / : 3. Is designed to carry 15 or fewer passengers and operated a contract carrier O -- / c - . } . transporting employees in the course of their employment(example:employee73 transporter-usually a van Type vehicle or passenger car):or w-- -- - } } } 4. Is used or designated to transport between 9 and 15 passengers,including the driver. N I y / \ \ for direct compensation(example:large van used for specific purpose):or 'OD ' L____a..... rt, n _ � � � t 5. Is any vehicle used to transport anyhazardous material(HAZMAT)that requires rn >� / ,,;� placarding(example:placards will be displayed on the vehicle). XI f -/�* CARRIER NAME a 1 ADDRESS D ,g,;r '+,�.r rA _Not To Scab 0 _, CITY/STATE/ZIP I g ,c" ./....:-.. ,,,:....-.. ;�. - MOTOR CARR.ID 0 Interstate 0 Intrastate nO I :k 0 Not in Comm./Govt. 0 Not in Comm./Other ' i USDOT NO. ILCC N 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 73 IDOT PERMIT NO. WIDELOAD-; 0 Yes ®No 2 TRAILER VIM 1 m co LOCAL USE ONLY TRAILER VIN 2 m v TRAILER WIDTH(S) 0-96" 97-102" >102' T TRAILER 1 ® 0 0 z 11 TRAILER 2 0 0 0 O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. Z White White u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT 2 TOWED BY/TO. _Redmons/Owners Residence SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY/TO: DUE TO ® VEHICLE CONFIG. 4 CARGO BODY TYPE 9 LOAD TYPE 5