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HomeMy WebLinkAbout2025-00028367 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 10110110011011111000100 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY XOG3O9/45 u, 1 U21 1 1 1 U1 2 U2 1 u, 1 1_12 1 1.11 1 U2 1 1 11 u1 1 U211 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY ❑5500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 2 VEHICLE/PROPERTY ®OVER 31,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash 0 AMENDED YR 2O25I 2025-00028367 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 mHIGGINS RD Elgin ® ❑ RELATED ❑Y ®N 05 05 2025 ®AM ❑YES ®NO U1 -< PRIVATE mo /day/yr 08:52 ❑PM FLOW CONDITION M �10(�!MI N E S © Weseman Dr COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ®SLOW 15 co Kane HIT&RUN ❑Y ® N WITH VEHICLESOT, INVLD El U2 —1 ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ❑ FREE FLOW # LNS 0 gi 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 20160 2 / yr 13-UNDER CARRIAGE 1a./ 2 2 FIRE ❑ al STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ® 0 U2 2 m M 2 4 ❑Y ❑SNEM® 15-OTHER UNK VEH. 9 AT CRASHD 9 99-UNKNOWN 9 76•TOP 3 *Distraction Value 4 ALGN = r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR F. POINT OF $ 1 S 4 COM VEH 0 El 1 0 FIRST CONTACT 12 7 _-5 *I(Yea.See Sidebar Ut Z Gilberts IL 60136 0 1 0 Q992045 IL 2025 I , TELEPHONE IL D 0 JA4AR3AU7GZ027998 State Farm ❑Y ®N U2 m 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Rodriguez.Claudia 1726125-SFP-13 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER RESPONDER 1 9 9 9 Honda CRV 2024 00-NONE 'o,1 t2 (,�2 FIRE DUE OCRASH 0 ® U2 2 C o Yr 13-UNDER CARRIAGE M 2 4 SYSTEM IN 9 ENGAGED 9 15-OTHER 911,6•TOP 3 X ❑Y ❑N ®UNK VEH. AT CRASH 99-UNKNOWN *Oistracton Value 0 POINT OF S i 4 COM VEH ❑ ® u1 IN N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR 5 FIRST CONTACT 6 O7 ,�_QOS •IfYes See Sidebar C Aurora IL 60542 C 1 0 EK54333 IL 2025 I AR0 Si) IL D 0 7FARS6H58RE051625 Progressive ❑Y ®N RDEF X1 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Elgin Fire Same 975668220 BAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Sherman RESPONDER u1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)/(ADDRESS)/(TELEPHONE) (EMS) (HOSPITAL) 1 0 uco EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME ®AM Did crash occur ❑Y U2 Z N 1 ® 11 1 5/ //2 /25 08 52 ❑PM in a Work Zone? ®N DIRP D 1 t PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 3 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ®AM U1 C) 2 0 28 41 5/ //2 /25 08 52 ❑PM ❑Construction * 4 R 3 0 ]$I CITATIONS ISSUED ElPENDING SECTION CITATION NO. EMS ARRIVED TIME 3 z J ®AM ❑Maintenance U2 o1 ® 11 1 ARREST NAME Rodriguez.Alexander 11-601 1539000178 5/ //2 /25 09 07 ❑PM SLMT o N 0 CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME- • ❑Utility AM u, 55 r 2 ❑ ARREST NAME 5/ //2 /25 09 34 [�PM 0 Unknown work zone type 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 55 1539-Vargas. Miguel 901 6/ / 0/ /025 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 -< c ` -' -' r INDICATE NORTH combination):or .Z-1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C - } (example:shuttle or charter bus):or • X 3. Is designed to carry15 or fewer passengers and operated a contract carrier O _A-'--J. N Not To Scale 1 — I - } } } transporting employee in the course of their employment(example:employee X ----- --- transporter-usually a van type vehicle or passenger car):or w 9 I. } C 4. Is used ordesi natedtotrans rtbetween9and15passengers,includingthedriver, I I I } } for direct compensation(examp large van used for speific purose):or I-..__a____-I -I I - t i i iany _ 5. Is any vehicle used to transport hazardous material(HAZMAT)that requires m placarding(example:placards will be displayed on the vehicle). XI —I —al will) ) ' ' ' ' CARRIER NAME Z ADDRESS 0 D I morons 1 C) CITY/STATE/ZIP 00 MOTOR CARR.ID 0 Interstate 0 Intrastate I I T I ❑ Not in Comm./Govt. 0 Not in Comm./Other --"-'Y----1 - USDOT NO. ILCC NO. rn 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 T. 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' m TRAILER 1 ❑ ❑ 0 Z TRAILER 2 ❑ 0 0 O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. Z 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 DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® DISABLING DAMAGE Arties/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE