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HomeMy WebLinkAbout2025-00020307 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 101101100 ! III InDRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X003 3480/ u, 9 u21 3 4 1 U1 8 U2 1 u,99 U2 1 U1 99 U2 99 1 12 U, 13 U2 1 �K P 0119�K INVESTIGATING AGENCY DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT ® A No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW Elgin Police Department ONE PERSON'S ❑$501-$1.500 El ON SCENE 2 VEHICLE/PROPERTY ®OVER$1,500 ®NOT ON SCENE(DESK REPORT) El AMENDED ElB Injury and/or Tow Due To Crash YR 202512025-00020307 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 mE HIGHLAND AVE El In 03:00 ® ❑ RELATED ❑Y ®N 03 02 2025 ❑AM ❑YES IX]NO U1 -< g PRIVATE mo !day!yr ®PM FLOW CONDITION ITl 0 !MI N E S North Spring St COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 1 (n �' ® © P g Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD ❑ STOPPED U2 --I 0 AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 (gl DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EOUES 0 NW 0 ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 n 0 6 ! yr General Motors 2013 00-NONE 13-UNDER CARRIAGE 10 1 2 VI E FIRE 0 IE STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0U2 2 M M I 9 SY9 ❑Y ONM❑UNK VEH. 0 AT CRASH IN 0 15-OTHER 99-UNKNOWN 9 16•TOP 3 `Distraction Value 9 ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s i�S 1i 4 COM VEH 0 j$J 1 O .`,2 F. 60110 0 9 EL14138 IL FIRST CONTACT 11 7_: __5 *Il sees.See Sidebar U1 0 REAR 2 Z TELEPHONE . STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED 1 1) ( 2GKFLREKOD6422366 First Chicago ❑v Il N U2 10 . m 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 Same I LS 1077200-00 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER XI Refused ❑Y ❑ N 2 0 p; DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NAV 0 I v 0 DV '1 9 9 1 Honda Civic 2018 00-NONE till 12 (,-2 DUE FIREO CRASH 0 ® U2 2 C o mo 13-UNDER CARRIAGE III ll M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9.1,6•TOP 3 X ❑Y ®N DUNK VEH. AT CRASH 99-UNKNOWN O `Distraction Value 9 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF S- 1 6 j1:, 4 COM VEH ❑ ® U1 CO FIRST CONTACT 4 7- L_5 *(ryes.See Sidebar H ELGIN IL 60120 0 1 CS76840 IL I C 0 cn M IL D 19XFC1 F39JE003111 Geico ❑Y (EN RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = 99 9 Same 6094475446 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) OHM (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)!(ADDRESS)/(TELEPHONE) (EMS) (HOSPITAL) 1 3 / / F 9 4 0 1 m / / #OCCS D 71 / / UI 2 D / / 1 0 EV MOST EVNT DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z N 1 ® 11 9 03,31 /2025 05 23 ®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 ❑ 18 18 ! / ❑PM• ❑Construction * N 3 ❑ Jgi CITATIONS ISSUED PENDING SECTION CITATION NO. EMS ARRIVED TIME 7 ❑AM ❑Maintenance U2 o1 ® 11 1 ARREST NAME Angulo Martinez. Francisco.J. 6-101 465000440 / ! El PM SLMT o Nu 0 CITATIONS ISSUED PENDING - SECTION CITATION NO. ROAD CLEARANCE TIME • 0 Utility 30 t 2 ARREST NAME AM 7 ! ! ❑❑PM ❑Unknown work zone type U1 El 2 2 3 D OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 30 547-Hometer.William 05 ,20,2025 01 30 ElPM ®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 truck trailer -< i- }--__r-_--; I I. combination):or -I INDICATE NORTH 51 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver Not To Scale (example:shuttle or charter bus):or n 3. Is designed to carry15 or fewer passengers and operated a contract carrier O ` --I— . rtwl r.eavAw } } } transportingemployees In the courses of their employment(example:employee73 transportr-usually a van type vehicle or passenger car): r w L 4. Is used or designated to transport between 9 and 15 passengers,including N }--- ----; - - } } } g po passen rs,indudi the driver, for direct compensation(example:large van used for specific purpose):or L L____a..... T l. i. i 5. Is any vehicle used to transport anyhazardous material(HAZMAT)that requires m g i i placarding(example:placards will be displayed on the vehicle). ;p f 1 Wham CARRIER NAME Z J ` __ ADDRESS 0 V) C) CITY/STATE/ZIP g —` - i. MOTOR CARR.ID 0 Interstate 0 Intrastate . I . . ❑ Not in Comm./Govt. 0 Not in Comm./Other --- --1 - USDOT NO. ILCC NO. m XI Source of above z . MCS ❑Yes 0 No 0 Unknown Out of Service ❑Yes ❑No Z Form Number 0 m Xl IDOT PERMIT NO. WIDELOAD'; ❑Yes 0 No 2 TRAILER VIM 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 Silver 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 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/TO. DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE