HomeMy WebLinkAbout2025-00029886 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 1111111111111111
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DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X003623653
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INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW '
DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away
Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 1
VEHICLE/PROPERTY ®OVER 51,500 El NOT ON SCENE(DESK REPORT) (83B Injury and/or Tow Due To Crash
❑AMENDED YR 2025I 2025-00029886 VENT
ADDRESS NO. HIGHWAY or STREET NAME ® ❑CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n
RT20 RELATED ❑Y ®N 05 11 2025 02:25 ❑AM ❑YES ®NO U1 -<
Elgin PRIVATE mo /day/yr ®PM FLOW CONDITION m
FT!MI N E S W REI N KI NG RD COUNTY PROPERTY ❑Y 21N DOORING ❑y #OF MOTOR 0 SLOW 16 u)
❑ Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD 0 STOPPED U2 --I
® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0
Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uuv 0!CV 0 ov DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 C)
1 FOR DAMAGEDAREA(S) FRONT TOWED U1 Q
NAME(LAST,FIRST,M) Bonilla. Ela.X. mo0 / 1 9 9 2 Ford Fusion 2013 00-NONE „ OI_1 DUE TOCRASH ® ❑
13-UNDER CARRIAGE 10 , 2 FIRE 0
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 Ea U2 2 m
F 2 6 SYTM❑Y ®SNE❑UNK VEH. O AT CRASH 0 15-99-UNKNOWN THER9 76•TOP 3 *Distraction Value 9 ALGN X.
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF $ iI a 4 COM VEH 0 Ea 1 0
~ ELGIN N I L 60123 B 1 0 FIRST CONTACT 12 7 ;1 _5 *IIYes.See Sidebar U1
Z DN81024 IL 2025 Isui
TELEPHONE
IL D 0 3FA6P0H70DR190921 Progressive ❑Y ®N U2 53 , m
in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
99 9 Same 992698453 1 r
o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER
RESPONDER on
Other ❑Y El 2 0
m N DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 lily 0
of 5 Volvo VNL 2002 00-NONE ,1_"j Q�,-_, DUE TO CRASH ❑ (g► 21
0 13-UNDER CARRIAGE 10( I FIRE ❑ 21 U2 C
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M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9,16-TOP 3 X
❑Y ®N D UNK VEH. AT CRASH 99-UNKNOWN `0istraction Value 9 0
POINT OF 8 i1�i 4 COM VEH ® ❑ U1 CO
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR FIRST CONTACT 12 7� B .5 •(ryes,See Sidebar
— Arlington Heights IL 60005 0 1 0 P798997 IL 2026 I O N
IL D 0 4V4NC9GH02N328154 Progressive ❑Y ®N RDEF
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 =
99 9 Same 968544274 BAG $
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 <
Refused RESPONDER u1 =
(UNIT) (SEAT) (DOBi (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME(((A.DDRESS)!(TELEPHONE! (EMS) (HOSPITAL)
1 3 1 2 / M 2 5 B 1 0
m
/ / #OCCS >
/ / UI 2 D
/ / 1 0
EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z
u 1 ® 11 1 05,11 /2025 02 26 ®PM in a Work Zone? ®N DIRP co
1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 3
T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1
0 2 0 23 99 1 1 0 PM ❑Construction >F
Z 3 ❑ xi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 7
❑AM 0 Maintenance U2
a1 ® 11 1 ARREST NAME Bonilla. Ela.X. 11-1204-B S1924-00038 / / El PM SLMT
o N -
❑CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • ❑Utility
AM
r 2 El ARREST NAME 1 / ❑❑PM 0 Unknown work zone type U1 45
2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑y 45
1524-Silva,Jose 901 07 1 16,2025 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 -<
` ` ' ' r —I
INDICATE NORTH combination)or P3
\avuyaa.
BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver n
\ (example:shuttle or charter bus):or
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\ 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I O
} --I -•i
} r } transppoorterr-employees
ploya van vehicleor
the cours of e
usually typepassenger car):or CO
1 4. Is used ordesi natedtotrans rtbetween9and15 ge ng C
} } } g po passen rs,includi [he driver,
1 \ for direct compensation(example:large van used for specific purpose):or O
L L--_-a-....I I \ - l. i I L 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires
placarding(example:placards will be displayed on the vehicle). XI
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_ _ _
1Jnmt CARRIER NAME ALEKS 75 INC
ADDRESS 1126 S NEW WILKE RD 407 0
Iran D
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CITY/STATE/ZIP Arlington Heights/IL/60005 C
Not To Scale i Ro1b920 MOTOR CARR.ID 0 Interstate El Intrastate
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I I T I ❑ Not in Comm./Govt. ❑ Not in Comm./Other
- i. i. i. = USDOT NO. 1735832 ILCC NO. 635834
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Source of above z
. Form Number
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IDOT PERMIT NO. 1735832 WIDELOAD'7 El Yes ®No =
TRAILER VIN 1 1 UYVS2533FP248209 m
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LOCAL USE ONLY TRAILER VIN 2 m
v
TRAILER WIDTH(S) 0-96" 97-102" >102' -n
TRAILER 1 0 ® 0 Z
TRAILER 2 ❑ 0 ❑ O
u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 53 ft. 2 ft. w
Gray Gray
u 1 TOWED TOTAL VEHICLE LENGTH 73 f ft. NO.OF AXLES 3
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 BY/TO:
DUE TO ® VEHICLE CONFIG. 4 CARGO BODY TYPE 9 LOAD TYPE 5