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HomeMy WebLinkAbout2025-00019008 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 I01101100 Hill 111 1111111111 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X003765401 u, 1 U21 1 1 1 U, 2 U2 1 U, 1 U2 1 U, 1 U2 1 1 11 U1 1 U2 1 *P 0 1 1 9* INVESTIGATING AGENCY DAMAGE TO ANY ❑$500 OR LESS TYPE OF REPORT 0 A No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 3 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash 0 AMENDED YR 2025I 2025-00019008 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n ® ❑ RELATED ❑Y ®N 03 26 2025 IMAM ❑YES ®NO U1 RT20 WB Elgin mo /day/yr 08'51 ❑PM FLOW CONDITION m _ PRIVATE 1 COUN PROPERTY ❑TY Y ® N DOORING ❑y #OF MOTOR 0 SLOW 15 ® FT/® NOS W Illinois Ave WITH VEHICLES INVLD 0 STOPPED U2 —I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) Kane HIT&RUN ❑Y ® N PEDALCYCLIST®N ® FREE FLOW # LNS 0 g DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EWES ❑Nuv ❑ncv ❑Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 0 7 / yr 13-UNDER CARRIAGE ©I 2 FIRE ❑ ® < STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) O DISTRACTED 0 ]$I U2 m M 2 4 ❑Y SYSTEM IN ENGAGED 15-OTHER O9 16.70P 3 _ ❑N ❑UNK VEH. AT CRASH 99-UNKNOWN `Distraction Value ALGN r POINT OF 0 CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR i� a 4 COM VEH 0 Ea 1 0 ~ ELGIN N I L 60123 0 1 FIRST CONTACT 12 O7 _; _-5 *If Yes.See Sidebar U1 0 Z EK82347 IL 2026 REAO TELEPHONE IL A 1 FAH P33N 18W260171 American Alliance ❑Y ®N U2 19 . m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Same I LAA 0992470 00 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y ❑ N 2 c g DRIVER ❑ PARKED ❑DRIVERLESS 0 FED ❑PEDAL 0 EWES ❑ ivy 0 Ncv ❑Dv /1 9 9 0 Chevrolet Traverse 2016 00-NONE ,�_"i 12'-_, DUE TO CRASH ❑ (� 2 0 13-UNDER CARRIAGE to l E FIRE ❑ ® U2 C c F 2 4 SYSTEM IN ENGAGED 15-OTHER 9 16.70P 3 4 X ❑Y ❑N DUNK VEH. AT CRASH 99-UNKNOWN *Oistrac on Value N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s II 4- all' COM VEH D ® U1 CO FIRST CONTACT 6 Y :j_O ._5 •If Yes.See Sidebar C 4 ELGIN IL 60123 C 1 EJ78001 IL 2025 aR4 CI) IL D 1 G N KVG KDOGJ298788 Farmers ❑Y ®N RDEF71 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER 1 = Elgin Fire Same 193058171 BAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPOND 0 N u1 = (UNIT) (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 03,26 /2025 08 51 0 AM in a Work Zone? ❑N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 7 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 C) 0 2 ❑ 28 99 / / ❑PM• ®Construction >F R 3 0 $I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 7 ❑AM ❑Maintenance U2 -a, ARREST NAME Arteaga-Mieres•Jethser, R. 11-601 414-1022 / / ❑PM SLMT o N 1 ® 11 1 igi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • 0 Utility AM 30 t 2 0 ARREST NAME Arteaga-Mieres,Jethser, R. 6-101-A 414-1023 / / 0 pM 0 Unknown work zone type U1 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 30 414-Lara. Saul 401 04 ,21 ,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 truckrtrailer -< ` ` --I -" r INDICATE NORTH combination):or .Z-1 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 to carry15 or fewer passengers and operated I a contract carrier O I- I- -A----i - } } } transporting employee � �In the course of their employment(example:employee X S transporter-usually a van type vehicle or passenger car):or w L L.___a____. gym - 4. Is used ordesinatedtotrans rtbetween9and15passengers,includingthedriver. C } } } for direct compensation(examp large van used for speific purose):or O L L-. ..i.. --. - � I Y 5. Is any vehicle used to transport an hazardous material(HAZMAT)that requires m placarding(example:placards will be displayed on the vehicle). °n1111- ®®- CARRIER NAME Z __ ADDRESS 0 w C) CITY/STATE/ZIP g MOTOR CARR.ID 0 Interstate 0 Intrastate 0 1 I r 1 ❑ Not in Comm./Govt. 0 Not in Comm./Other -"--Y-----• - USDOT NO. ILCC NO. m XI Source of above z . ❑ 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 Blue 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 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY/TO: DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE