Loading...
HomeMy WebLinkAbout2025-00024058 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 0110110 III 1100 IVI � III III11111011 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV XO03790095 u, 1 U21 1 1 1 U1 5 U2 1 U, 1 1_12 1 U, 1 U2 1 1 10 u1 6 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 El5501-51.500 ®ON SCENE 1 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash 0 AMENDED YR 2025I 2025-00024058 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 71 LAUREL ST El In03:58 0 ❑ RELATED ®Y ❑N 04 16 2025 DAM ❑YES ®NO U1 -< _ _ g PRIVATE mo !day/yr ®PM FLOW CONDITION m FT!MI N E S W LAUREL CT COUNTY PROPERTY ❑Y ® N DOORING ICIy #OF MOTOR 0 SLOW 2 to ❑ Kane HIT&RUN ❑V ® 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!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 n FOR DAMAGED AREA(S) FROM TOWED U1 O NAME(LAST,FIRST,M) Diaz.Yolanda m0 D ! !1 9 y7 8 Chrysler Town&Country 2005 00-NONE ©,: Q i DUE TO CRASH ® ❑ 13-UNDER CARRIAGE } O FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) O DISTRACTED 0 0 U2 2 m F 2 4 SY❑Y ❑SNEM®UNK VEH. 9 AT CRASH IN 9 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_iL 6 4 COM VEH 0 Ea 1 C) m H ELGIN N I L 601 20 0 1 0 FIRST CONTACT 12 7_• __5 *If Yes.See Sidebar U1 Z Q551794 IL 2020 E TELEPHONE IL D 2C4GP44R85R155354 KEMPER ❑Y ®N U2 1- in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 Same 12RA000010374 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y El 2 c m x DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL 0 EWES 0 uv 0 /1 9 Yr 5 Ford F150 2000' 00-NONE ,�_"j t2 -_, DUE TO CRASH ❑ 2 xr 0 13-UNDER CARRIAGE 10 1 E FIRE 0 ® U2 C c M 2 4 SYSTEM IN 9 ENGAGED 9 15-OTHER 916-TOPO3 ❑Y ❑N ®UNK VEH. AT CRASH 99-UNKNOWN O Oistramon value 9 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8 iII 6 i 4 COM VEH ❑ ® U1 W FIRST CONTACT 5 Y rj= 1 •Iryes,See Sidebar C 60110 0 1 0 538329D IL 2025 aR 0 Si) IL D 1 FTWW32F7YEE27184 Country Financial ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = 99 9 Same PO10222540 BAc E 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)!(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL) 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 1 04,16 /2025 03 58 0 AM in a Work Zone? ®N DIRP co 1 t PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME ❑AM oIf YES check one below: U1 " 7 n T 2 ❑ 2 06 , r 0 PM ❑Construction R 3 0 $I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 7 ❑AM ❑Maintenance U2 o 1 ® 11 1 ARREST NAME Diaz.Yolanda 11-802 SO475000660 r r El PM SLMT ljg CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • 0 Utility 8 N ❑AM 30 t 2 0 ARREST NAME Diaz.Yolanda 6-101-A SO475000661 r r ❑pM ElUnknown work zone type U1 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 30 475-Williarhs. Brianna 301 05 , 13/2025 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 truck trailer -< i- }-- -'-- --' I - r INDICATE NORTH combination):or -I BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C - (example:shuttle or charter bus):or X . r r i "i 3. Is designed tocar15 fewerpassengers andoperated carrier esg ry or by a contractO - } } } transporting employees In the course of their employment(example:employee transporter-usually a van type vehicle or passenger car):or w C L L.__-a-_- I 4. Is used ordesi natedtotrans rtbetween9and15passengers,induding[hedrrver, • I. } } for direct compensation(example:large van used for speific purose):or L--_-a-___J ups - t i i 5. Is any vehicle used to transport anyhazardous material(HAZMAT)that requires -u placarding(example:placards will be displayed on the vehicle). ,Zmt MafiaCARRIER NAME Z ADDRESS 'n I th Not To Scale J I CITY/STATE/ZIP g MOTOR CARR.ID 0 Interstate El Intrastate 1 I r 1 ❑ Not in Comm./Govt. 0 Not in Comm./Other --- --1 - USDOT NO. ILCC NO. m 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' -n TRAILER 1 ❑ ❑ 0 Z TRAILER 2 ❑ 0 0 o u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w Maroon White u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT 3 TOWED BY/TO. _Adieu/Impound Lot Garage . SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY1T6 DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE