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HomeMy WebLinkAbout2025-00027872 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 6 Sheets 01111101111 0110110011 0 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY XO03604645 u, 2 U2 2 4 1 U1 3 U2 U, 1 1_12 1 U, 1 U2 1 5 9 U1 1 U221 *P 0119* INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW ' DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT El A No Injury 1 Drive Away Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 1 VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and for Tow Due To Crash El AMENDED YR 202512025-00027872 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 2 m152 JEWETT ST El In00:59 ® ❑ RELATED ®Y 0 N 05 03 2025 ®AM ❑YES El NO U1 _ g PRIVATE mo /day/yr ❑PM FLOW CONDITION m _ COUNTY PROPERTY ®Y ❑ N DOORING ❑y #OF MOTOR ❑SLOW 1 cn ❑ FT!MI N E S W Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD DO U2 —I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST IZI N ® FREE FLOW # LNS 0 Q83 DRIVER O PARKED O DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NW 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 n _ f4T TOWED U1 0P NAME(LAST,FIRST,M) Espinoza.Carlos. F. mo yr Dodge Dakota 2004 00-NONE ©, 0 0DUE TO CRASH ® ❑ O3-UNDER CARRIAGE I 2 FIRE ❑ 10 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 O m M 2 SY4 ❑Y ®SNEM❑UNK VEH. O AT CRASH IN O 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 iL 6 I, 4 COM VEH 0 0 1 0 ELGIN I L 60123 0 1 0 FIRST CONTACT 11 7_: __5 *Ilsees.See Sidebar U1 Z2798403B IL 2025 REAR TELEPHONE IL D 0 1 D7GL32KX4S649228 None ❑Y ❑N U2 m 5 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR co Davile.Javier None 2 m `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER 2 X 0 DRIVER X. PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 Nuv 0 NCv 0 Dv yr Nissan X-Terra 2007' 00-NONE till 12 ._ FIRE o CRASH ® U2 1 C 13-UNDERCARRIAGE IIIID Ti AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) O DISTRACTED 0 ® SPDR n SEX SAFT AIR O 0 9!1,6•TOPO3 * 0 SYSTEM IN ENGAGED15-OTHER a ❑Y i N DUNK VEH. AT CRASH 99-UNKNOWN ® 0istracti n Value 4 POINT OF 8 4 Ut N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR 6 i',_ COM VEH D ® CO FIRST CONTACT 3 7_. _,�_5 •Iryes.See Sidebar ~ BN32452 IL 2025 REAR 0 Si) M . STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0 5N1AN08W27C545068 Falcon Insurance Co ❑Y ®N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X Flores Rodriguez. Francisco 0100123003-6 BAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE:ZIP U1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)!(ADDRESS)/(TELEPHONE) (EMS) (HOSPITAL) 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 18 3 Flores Rodriguez. Francisco 3 ft brick wall destroyed 05,03 l2025 00 45 ®❑pM AM in a Work Zone? ®N DIRP co 1 t PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 7 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 v 2 ❑ 152 J EW ETT ST ELGIN IL 60123 19 15 , , 0 PM ❑Construction >F Z3 ❑ 0 CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME ❑AM ❑Maintenance U2 -, 1 ER 11 5 ARREST NAME Espinoza.Carlos. F. 11-601 752854 ! ! ❑PM SLMT I$[CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME AM ❑Utility t 2 El ARREST NAME Espinoza.Carlos. F. 11-1204-B 752852 05/03 l2025 01 00 0 PM ❑Unknown work zone type U1 30 n 7 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 0 - ❑AM Workers present? ❑Y 00 469-Taylor,Jonathan 701 r ! 0 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 truckrtrailer -< ` ` -' -' r INDICATE NORTH combination):or —I 22 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C N - (example:shuttle or charter bus):or 0 L L.__-A-. - } } } transportinggemployeeo sl5 or fewer in hecourseeo their rs employ nt example:employee a contract ner X 1527Jevreti transporte -usually a van type vehicle or passenger car):or w L 4. Is used or designated to transport between 9 and 15 passengers,including C Street -- -- r - } } g po passen rs,includi [he driver,for direct compensation(example:large van used for specific purpose):or O L L___-a..... ro �� t l. I 1 t 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m *� �P placarding(example:placards will be displayed on the vehicle). X/ . 1 CARRIER NAME Z —Untt2 Entire Incident __ ADDRESSO V)C)I CITY/STATE/ZIP E MOTOR CARR.ID 0 Interstate 0 Intrastate 0 I I T I ❑ Not in Comm./Govt. 0 Not in Comm./Other ; _Y_ _-1 USDOT NO. ILCC NO. m XI Source of above Z . • m 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 M 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 0 0 Z TRAILER 2 ❑ 0 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 3 TOWED BY/TO. Arties/Impound Lot Garage SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 3 TOWED BY/T6 DUE TO ® Other VEHICLE CONFIG._CARGO BODY TYPE LOAD TYPE