HomeMy WebLinkAbout2025-00019368 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 01111101111 I fl IOU11100
DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X003769021
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INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW '
DAMAGE TO ANY El$500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away
Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 14
VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash
El AMENDED
YR 2025I 2025-00019368 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n
ST CHARLES ST Elgin 03:11
® ❑ RELATED ®Y 0 N 03 27 2025 ❑AM ❑YES ®NO U1 —<
_ _ g PRIVATE mo !day!yr ®PM FLOW CONDITION MFT!MI N E S W DWIGHT ST 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®N 51 FREE FLOW # LNS 0
Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uuv 0 icy ❑Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) y N 2 C)
T TOWED U1 0
NAME(LAST,FIRST,M) Benitez. Briana. L. mo yr
Kia Motors Cott5 2024 00-NONE Q �I 7T OUETOCRASH ❑
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13-UNDER CARRIAGE 10 1 EN
2 FIRE ❑
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 2 rn
F 2 4 SYTM❑Y ®SNEDUNK VEH. O ATCRASHD 0 99-U 15-UNKNOWN THER9 16•TOP 3 `Distraction Value ALGN
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r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s, ii_6 1,.4 COM VEH 0 g! 2 O
~ ELGIN N I L 60123 0 1 FIRST CONTACT 12 7 ; _5 *IIYes.See Sidebar U1
Z ED18942 IL 2025 REAR
TELEPHONE
IL D 0 5XXG64J23RG233872 State Farm ❑Y Il N U2 13 , m
13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
Same 2354650SFP13 1 r
`o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER
RESPONDER >
Refused ❑Y ® N 2 XI
m g DRIVER 0 PARKED 0 DRIVERLESS ❑ PED 0 PEDAL 0 EWES 0 IIIAV 0 Ncv 0 DV
!2 0 0 2 Acura RDX 2008 00-NONE 0.. QI'-O DUE TO CRASH rg ❑ 2 x
o y Yr 13-UNDER CARRIAGE 16 I ). 2 FIRE 0 ® U2 C
F 2 5 SYSTEM IN 0 ENGAGED 0 15-OTHER 9..16-TOP 3 X
❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN *Oistrac)on Value 0
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR PFIRST CONTACT 1NT OF 2 O S �i�-5 C•IOMs gee SidebarH ® U1 CO
C
n ELGIN IL 60124 0 1 0 EX55592 IL 2025
Z
IL D 0 5J8TB18588A011994 Horace Mann ❑Y ®N RDEF XI
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 =
Same 65000009080101 BAc E
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP 996 <
Refused RESPONDER u1 =
(UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJI (EJCTI (EPTH) PASSENGERS&WITNESS ONLY (NAME)!(ADDRESS)((TELEPHONE) (EMS) (HOSPITAL)
1 3 05 / F 2 4 0 1 0
m
/ / #OCCS >
/ / UI 2 D
/ / 1 0
EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z
N 1 ® 11 1 31 /71 l025 03 11 ®PM 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 �
0 2 23 99 I / 0 PM ❑Construction >E
Z 3 0 lyg CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 5
❑AM ❑Maintenance U2
o 1 ® 11 1 ARREST NAME Benitez. Briana. L. 11-1204-B 482000505 r ! El PM SLMT
I$[CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ' 0 Utility
8 N ❑AM 30
Ti 2 0 1 1 1 ARREST NAME Onate.Adrian 6-507-B-1 482000506 r r 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
482-Flentye.Jeremy 401 51 r 12 r25 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.
...III
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 -<
} --
i- --_--I--- ; i•::;; [1.— i. AT combination):or —I
../ INDICE NORTH p1
BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C
"'O"= .'. • - } (example:shuttle or charter bus):or n
LW
3. Is designed to carry15 or fewer passengers and operated I a contract carrier O
} } } transporting employee � �In the course of their employment(example:employee X
—♦ --! transporter-usually a van type vehicle or passenger car):or
L ----------+ \ 0 - 1* } } } •4. Is used or designated to transport between 9 and 15 passengers,including the driver, N
waa +:11 for direct compensation(example:large van used for specific purpose):or O
`-•-•-`-----I Not To Scale j r.l'_f,, - } t 5. Is any vehicle used to transport hazardous material(HAZMAT)that requires m
s placarding(example:placards will be anyisplayed on the vehicle). X/
CARRIER NAME LIS Trucking Inc Z
' - ADDRESS 2300 GRAHAM ST O
CITY/STATE/ZIP BARTLETT 1 IL 160103 n
M
MOTOR CARR.ID 0 Interstate ® Intrastate
0
1 I r 1 ❑ Not in Comm./Govt. ❑
Not in Comm./Other
------r-- - % % % % usDOT NO. 1475964 ILCC NO. 557118
xi
Source of above z
. Form Number m
m
IDOT PERMIT NO. WIDELOAD? ❑Yes ®No 2
TRAILER VIN 1 m
co
LOCAL USE ONLY TRAILER VIN 2 m
v
TRAILER WIDTH(S) 0-96" 97-102" >102' -n
TRAILER 1 ❑ ❑ 0 Z
TRAILER 2 ❑ 0 ❑ O
u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w
Gray Gray
u 1 TOWED •
TOTAL VEHICLE LENGTH ft. NO.OF AXLES_
DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT' 2 TOWED BY/TO.
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