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HomeMy WebLinkAbout2025-00022974 ILLINOIS TRAFFIC CRASH REPORT sheet 1 of 4 Sheets 01111101111 01101100 00111111111 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X003784209 u1 2 U21 3 4 1 U1 2 U2 1 U1 1 U2 1 U1 1 U2 1 5 10 U, 3 U2 1 *P 0119 INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW ' DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT 0 A No Injury 1 Drive Away Elgin Police Department ONE PERSON'S ❑5501-S1,500 ®ON SCENE 14 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) El B Injury and/or Tow Due To Crash 0 AMENDED YR 202512025-00022974 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 71 LILLIAN ST El 00:45 ® ❑ RELATED ®Y ❑N 04 12 2025 ®AM ❑YES ®NO U1 _ _ g PRIVATE mo !day,yr ❑PM FLOW CONDITION MFTlMI N E S W S MCLEAN BLVD COUNTY PROPERTY ElY ® N DOORING ❑y #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 ® FREE FLOW # LNS 0 Qg3 DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EOUES ❑NW ❑ncv ❑Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 0 FOR DAMAGEDAREA(S) FRONT TOWED U1 Q NAME(LAST,FIRST,M) mo 1 9 9 1 Ford Escape 2013 00-NONE © 12 - , DUE TOCRASH ® ❑ _ 13-UNDER CARRIAGE FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) O ' 2 DISTRACTED 0 0 U2 0 171 M 2 SYTM 4 ❑Y ®SNE DUNK VEH. 0 AT CRASH 0 99-U15-UNKNOWN THER9 76•TOP 3 `Distraction Value 9 ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s, ii_6 I, 4 COM VEH 0 0 1 Z ELGIN IL 60123 0 1 0 CN82265 IL FIRST CONTACT 11 T_;REAR __s ves.See sidabar Ut 0 TELEPHONE IL 0 1 FMCUOF78DUC72618 Direct Auto ❑Y Igl N U2 63 . m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Same PAIL001059238 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y El 2 eu g DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EWES ❑NMV 0 Ncv ❑DV /1 9 yr 4 Toyota Corolla 2024 00-NONE 11_ 12 _, DUE TO CRASH ❑ 2 0 13-UNDER CARRIAGE 161 z FIRE ❑ ® U2 C Po M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER O9 16.70P 3 X ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN `Oistractlon Value g g N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 0 1 ,_4 COM VEH ❑ ® U1 W F,,, FIRST CONTACT 8 kL _, _s •If Yes.See Sidebar C ELGIN IL 60120 0 1 ER88821 IL 2025 REAR Si) M IL D 7M U DAABG9RV099027 American Freedom ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER 1 X Same 12244117501 BAG $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 997 < Refused RESPONDER u1 = (UNIT) (SEAT) (DOB! (SEX) {SAFT) (AIR) (WI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)((A.DDRESS),(TELEPHONE) (EMS) (HOSPITAL) 1 3 06 / :A / / 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 El 11 4 04,12 ,2025 00 44 ®❑pM in a Work Zone? ®N DIRP co 1 r PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME ❑AM If YES check one below: U1 5 n T 0 2 ❑ 2 19 , , ❑PM ❑Construction R 3 ❑ $I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 1 ❑AM ❑Maintenance U2 —a ARREST NAME Jimenez Morales. Ismael 11-901 752029 , r ❑PM SLMT o U 1 ® 11 0 CITATIONS ISSUED I]PENDING SECTION CITATION NO. ROAD CLEARANCE TIME AM ❑Utility r 2 El ARREST NAME Jimenez Morales. Ismael 11-402-A 752028 04 r 12 r2025 00 43 [M PM El Unknown work zone type U1 35 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM ❑Y 35 1513-Mann. Nathaniel 701 331-Ziegler 05 , 19,2025 09 00 ❑P Workers present?M ®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••--, , 9.714denn7eMd - ; A CMV is defined as any motor vehicle used to transport passengers or property and: Z I I I 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer -< ' ;.--__r-_--; I I I ® ( combination):or p0 INDICATE NORTH -1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C r r r (example:shuttle or charter bus):or 0 I- I- --I.----; I I I 1 - . - . transporting employeesned to inthe course passengers or fewer thir emplod yment example:employee transporter 4 transporter-usually a van type vehicle or passenger car):or w < i... 4----; Lrllran?3t - I. } } 1 •4. Is used or designated to transport between 9 and 15 passengers,including the driver. N � , for direct compensation(example:large van used for specific purpose):or I. I____a_____I yii'A' _ l. i i _ 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m ie _ _ _ placarding(example:placards will be displayed on the vehicle). XI j -I CARRIER NAME Z , I ' ADDRESS D I � I Not To Scale J CITY/STATE/ZIPI - MOTOR CARR.ID 0 Interstate 0 Intrastate I. I. i. r I I ❑ Not in Comm./Govt. Not in Comm./Other ------------ - USDOT NO. ILCC NO. rn XI Source of above Z . 0 Yes 0 No ❑ Unknown A 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' m TRAILER 1 ❑ ❑ 0 Z TRAILER 2 ❑ 0 0 O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. Z White Blue u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT 3 TOWED BY/TO. _Mies/Impound Lot Garage . SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 3 TOWED BY/TO. DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE