Loading...
HomeMy WebLinkAbout2025-00032246 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 1111 III 11 III1II IIIIII U lUDU III II UDIHI 1 U DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X003626733 u, 1 U21 2 4 2 U1 6 U2 1 U, 1 1_12 1 U, 1 U2 1 1 10 U1 3 U2 4 *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 2 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash 0 AMENDED YR 2025I 2025-00032246 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 �I WALNUT AVE Elgin11:02 ® ❑ RELATED ®Y 0 N 05 21 2025 ®AM ❑YES ®NO U1 -< _ _ g PRIVATE mo /day/yr ❑PM FLOW CONDITION ITT FT!MI N E S W ELM ST COUNTY PROPERTY ❑Y 21N DOORING ❑y #OF MOTOR 0 SLOW 15 u) ❑ Kane HIT&RUN ❑Y ® 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 0 EWES 0 uuv 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 02 o F tf 0 7 / yr 13-UNDER CARRIAGE 1 FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) O 2 THERDISTRACTED ® 0 U2 02 i n M 2 8 SYTM❑Y ®SNE DUNK VEH. 0 AT CRASH 0 15-99-UNKNOWN 9 76•TOP 3 `Distraction Value 2 ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s, ii_6 I, 4 COM VEH 0 g! 1 0 ELGIN I L 60123 C 1 0 FIRST CONTACT 11 7_: __5 *II Yes.See Sidebar U1 Z DJ77850 IL 2025 REAR TELEPHONE AL D 0 3G NCJ PSB6KL178851 Unknown ®v ❑N U2 m 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 Martinez, David Unknown 2 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER 2 eu x DRIVER ❑ PARKED 0 DRIVERLESS 0 FED ❑PEDAL 0 EWES 0 NMV 0 NOV 0 DV '1 9 yr 2 Jeep(after 19681�rokee 2026 00-NONE O z -_, DUE TO CRASH ❑ 2 0 13-UNDER CARRIAGE 9 I ©1. 2 FIRE 0 ® U2 C c F 2 8 SYSTEM IN 0 ENGAGED 0 15-OTHER 9.16-TOP 3 X ❑Y NJ N ❑UNK VEH. AT CRASH 99-UNKNOWN *Distraction Value 9 g N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8-iI�1:, 4 COM VEH ❑ ® U1 CO FIRST CONTACT 11 7�—�_-5 •If Yes.See Sidebar = ELGIN IL 60120 0 1 0 FD11662 IL 2018 I 0 IL D 0 3C4NJDABXJT320991 State Farm ❑Y ®N RDEF71 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X 99 9 Toledo, Lizett 2066778-SFP-13 BAc $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP U1 = (UNIT) (SEAT) (DOE) (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)!(ADDRESS)/(TELEPHONEI (EMS) (HOSPITAL) 2 4 09 / F 12 8 0 1 0 m / / #OCCS D / / U1 1 D / / 2 O EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 11 4 05/21 /2025 11 02 ®❑PM AM in a Work Zone? ®N DIRP D co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 7 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 O 2 0 05 06 / / ❑PM 0 Construction >E Z 3 0 I!!I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 3 ❑AM 0 Maintenance U2 a 1 ® 11 4 ARREST NAME Martinez.Jose. R. 6-101 1543000181 / / El PM SLMT I$!CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME o ®AM 30 • ❑Utility t 2 El ARREST NAME Martinez.Jose. R. 3-707 1543000182 05121 /2025 11 40 ❑PM 0 Unknown work zone type U1 2 2 3 ID ID SIGNATURE BEAT!DIST. SUPERVISOR ID. COURT DATE TIME ❑AM Workers present? ❑Y 30 1543-Sturgeon. Kyle 700 275-Engelke 06 /23,2025 01 30 ®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 A. } }----�'----' N Not To Scale i - ) combination):or more thanpounds(example:truck or truckrtrarler 1. Hasaweight rating10,000 -< INDICATE NORTH p0 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C i - } (example:shuttle or charter bus):or X VINIMICIAVO 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I O I- 1- --1-- --; u z 1 - transporting employees in the course of their employment(example:employee X rter- y a van type L L____a____J. _ III.-.: [ trans�sedord�llnatedtotransehicle or rtbetween9andr15r) ssen rs,indudirg[hedriver, to } } } I _ � } } } for direct compensation(examp large van used for specific purpose):or O , , i 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires .O placarding(example:placards will be displayed on the vehicle). XI m —1 - CARRIER NAME Z ADDRESS In CITY/STATE/ZIP 0 MOTOR CARR.ID ❑ Interstate ❑ Intrastate I I T I I ❑ Not in Comm./Govt. Not in Comm./Other ❑ 0 -- - --1 USDOT NO. ILCC NO. m XI Source of above z . If Yes,Name on placard 0 4 digit UN NO. 1 digit Hazard class No. Xl Xl 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' -n TRAILER 1 ❑ ❑ 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. Redmons/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 Redmons/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE