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HomeMy WebLinkAbout2025-00023994 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 I01101100 00 1101 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X003 2;6230 u, 1 U21 2 4 1 U1 5 U2 1 U113 1_12 1 U, 1 U2 1 1 10 u1 3 U2 11 *P 0119* INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW ' DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT ® q 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) El AMENDED ElB Injury and for Tow Due To Crash YR 202512025-00023994 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n ® ❑ RELATED ®Y 0 N 04 16 2025 ®AM ❑YES 0 NO U1 -< ST CHARLES ST Elgin 10:52 _ _ g PRIVATE mo !day!yr ❑PM FLOW CONDITION m FT!MI N E S W DWIG HT ST COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR IR SLOW 1 (n ❑ Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD ❑ STOPPED U2 —I ® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST IR N ❑ FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 UUV 0!CV 0 DV DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 0 FOR DAMAGEDAREA(S) FROM TOWED U1 Allende. Daniel 1 2 / yr 13-UNDER CARRIAGE } FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) O 2 DISTRACTED 0 0U2 2 m M 2 4 El ®SNE❑UNK VEH. 0 AT CRASH IN ENGAGED0 99-UUNKNOWN 016 `Distraction Value 9 ALGN = r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6 1 6 �i 4 COM VEH 0 0 1 0 ALGONQUIN IL 60102 0 1 0 FIRST CONTACT 11 7-. -_5 *IIYes.SeeSidebar U1 Z FF96869 IL 2026 E TELEPHONE IL D 7 1 N4BL4BV1 NN354951 Geico ❑Y ®N U2 m 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 Same 6170724188 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER > Refused ❑Y ® N 2 c m x DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NMV 0 Ncv 0 Dv CIRCLE NUMBER(S) U1 !2 0 0 6 Nissan Sentra 2015 00-NONE 0.,. z j--O DUE TO CRASH ❑ 2 x ... 13-UNDER CARRIAGE 9 I ©(. 2 FIRE ❑ ® U2 C c F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9.16-TOP 3 X ❑Y lYi N ❑UNK VEH. AT CRASH 99-UNKNOWN *Distraction Value 9 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6-it 6 11:, COM VEH D ® U1 CO FIRST CONTACT 11 7�� _,__5 •If Yes.See Sidebar F= ELGIN IL 60120 0 1 0 FA40125 IL 2025 RE 0 C IL D 0 3N1AB7APXFY230858 State Farm ❑Y ®N RDEF .73 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER 1 = 99 9 DIAZ. MARGARITA 2396321-SFP-13 BAG $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE;ZIP 996 < Refused RESPONDER U1 = KNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ) (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 CD 11 1 41 ,61 ,025 10 52 ®❑AM in a Work Zone? NJ DIRP co 1 I PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME ❑AM If YES check one below: U1 3 C) Si T 2 ❑ 2 14 / / El PM ❑Construction * R 3 0 $I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 5 -a ARREST NAME Allende. Daniel 11-801 1540-W212 ! ! ❑❑AM ❑Maintenance U2 1 ® 1 1 1 ❑CITATIONS ISSUED PENDING UtilitySLMT • , o N SECTION CITATION NO. ROAD CLEARANCE TIME El AM U1 25 t 2 ❑ ARREST NAME 41 1 61 /025 11 20 [M PM ElUnknown work zone type n T OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 0 - ❑AM Workers present? ❑Y 25 1540-Allah. Muhammad 401 , , ❑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 at?charrea?ar I 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer i- }---.r----; } INDICATE NORTH combination):or -1 , i_ ®J. BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C ? _ } (example:shuttle or charter bus):or � A I l TT } 3. Is designed to carry15 or fewer passengers and operated a contract carrier 0 . - - ---: {I I } } transporting employee �In the course of their employment(example:employee transporter-usually a van type vehicle or passenger car):or w C L L.___a__._I. I _ 4. Is used ordesi natedtotrans rtbetween9and15passengers,includingthedriver, f p, Lo-- } } } • for direct compensation(example:large van used for speific purose):or 0 Il�� • , Dwlphl?81 -a •D t l. I I _ 5. Is any vehicle used to transport anyhazardous material(HAZMAT)that requires ® placarding(example:placards will be displayed on the vehicle). m A —as , "' , CARRIER NAME Z I ADDRESS D w CITY/STATE/ZIP 00 MOTOR CARR.ID ❑ Interstate ❑ Intrastate 1 I r 1 I ❑ Not in Comm./Govt. ❑ Not in Comm./Other 00 � "Y""1 USDOT NO. ILCC NO. C m XI Source of above z . If Yes,Name on placard O 4 digit UN NO. 1 digit Hazard class No. Xl Xl Did HAZMAT spill from vehicle(do NOT consider FUEL from vehicle's z own tank)? 0 Yes 0 No 0 Unknown Did HAZMAT Regulations violation contribute to the crash? r ❑ 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 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: 1 TOWED BY/TO. DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE