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HomeMy WebLinkAbout2025-00030372 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 01111101111 I011011000011111 ilU 11111011 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X003823709* u, 1 U212 3 4 1 U1 3 uz 1 U, 1 u2 1 U, 1 U2 1 1 10 U1 1 U2 3 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY El 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 15 VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash ❑AMENDED YR 2025I 2025-00030372 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 mROYAL BLVD Elgin03: ® ❑ RELATED ®Y 0 N 05 13 2025 ❑AM ®YES 0 NO U1 -< 10 _ _ PRIVATE mo /day/yr ®PM FLOW CONDITION m FT l MI N E S W N MCLEAN BLVD COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR 0 SLOW 1 (/)❑ 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 ❑PEDAL ❑EWES ❑NOV ❑!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 0 / T TOWED U1 Q FOR DAMAGED AREA(S) FROM NAME(LAST,FIRST,M) Hernandez.Arnold mo !2 0 0 4 Toyota RAV4 2011 00-NONE ©,: Q i 0 DUE TO CRASH ® ❑ 13-UNDER CARRIAGE } FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) O 2 THERDISTRACTED 0 0 U2 0 m M 2 8 SYTM❑Y ®SNE❑UNK VEH. 0 AT CRASH 9 15-99-UNKNOWN 9 i6•TOP 3 *Distraction Value 9 ALGN 2 T CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6_iL 6 I,.4 COM VEH 0 E! 1 0 ~ ELGIN N I L 60120 0 1 0 FIRST CONTACT 12 7_; _5 *IIYes.See Sidebar U1 Z DL222S IL 2025 E TELEPHONE IL D 0 2T3DF4DVXBW153626 VALLEY INSURANCE ❑Y ®N U2 I' in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Elgin Fire 99 9 Biggers Imports AYA763321830 1 r o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER RESPONDER 98 0 m x DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 Nov 0 NCv 0 DV !1 9 5 4 Toyota Corolla 1999 00-NONE 11"1 Qj O DUE TO CRASH ❑ 2 x .. y Yr 13-UNDER CARRIAGE 10 I I:. z FIRE l� ❑ U2 C c F 2 8 SYSTEM IN 9 ENGAGED 9 15-OTHER 9,16•TOPO3 * X ❑Y ❑N El VEH. AT CRASH 99-UNKNOWN Distraction value 9 4 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s-it 6 I( 4 COM VEH 0 ® U1 CO FIRST CONTACT 2 7 . -5 •If Yes.See Sidebar = ELGIN IL 60123 C 1 0 EE53537 IL 2024 I 0 IL D 1 NXBR12E6XZ258115 Direct Auto ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Elgin Fire 99 9 Same PAI L1235063 BAG $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Sherman RESPONDER u1 = (UNIT) (SEAT) (DOBi (SEX) {SAFT) (AIR) (INJI 1(EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)((A.DDRESS))(TELEPHONE) (EMS) (HOSPITAL) 3 3 02 / / / 1 0 EV MOST EVNT LOG DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 11 1 05,13 /2025 03 10 ®AM in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 5 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 C) 2 ® 11 1 2 25 05,13 ,2025 03 11 pM ® • ❑Construction �F R 3 0 gi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 7 z J ❑AM ❑Maintenance U2 a ® 11 1 ARREST NAME Hernandez.Arnold 11-306 1553-000052 05,13,2025 03 16 Igi pM• ❑Utility SLMT I$[CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME AM o t 2 El ARREST NAME Hernandez.Arnold 11-601-Ax 1553-000053 05 r 13 ,2025 05 32 ®PM 0 Unknown work zone type U1 20 2 2 3 El ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME COAM Workers present? ❑Y 35 1553-Jentsch.Clarissa 501 06 ,24,2025 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••--, , I I - ; A CMV is defined as any motor vehicle used to transport passengers or property and. N 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer -< } }---_r__--; *1-11 dtIt u I. combination):or -I INDICATE NORTH p1 Not To SCCJs i BY ARROW C oa - 2 Is used or designed to transport more than 15 passengers including the driver _ } (example:shuttle or charter bus):or X 4-- ;e; 3. Is designed to carry 15 or fewer passengers and operated a contract carrier 0 r" r } } } transporting employees in the course of their employment(example:employee X !! transporter-usually a van type vehicle or passenger car):or w C L L.---a.--.. 4. Is used or designated to transport between 9 and 15 passengers,including the driver, Roya��� /�*:' } } for direct compensation(example:large van used for specific purpose):or O L L_._-a..... / i i t 5. Is any vehicle used to transport anyhazardous material(HAZMAT)that requires 'D placarding(example:placards will be displayed on the vehicle). XI CARRIER NAME Z ADDRESS 4, 14 .%I t l t+ °— . . . rn CITY/STATE/ZIP II I - MOTOR CARR.ID 0 Interstate El Intrastate r ; ❑ Not in Comm./Govt. 0 Not in Comm./Other I USDOT NO. ILCC NO. XI Source of above z ' . MCS ❑Yes 0 No 0 Unknown Out of Service ❑Yes ❑No 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 Silver White 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