HomeMy WebLinkAbout2025-00034865 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 01111101111 0110110011 01000011E111111
DRAG TRFD TRFC WEAT DRVA VIS VEHD LGHT COLL MANY X4038475
u, 1 U21 1 1 1 U1 2 U2 1 U, 1 1_12 1 U, 1 U2 1 5 11 u1 1 U211 *P 0119*
INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW '
DAMAGE TO ANY El$500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away
Elgin Police Department ONE PERSON'S 1215501-$1.500 ®ON SCENE 1
VEHICLE/PROPERTY ❑OVER$1,500 El NOT ON SCENE(DESK REPORT) El B Injury and/or Tow Due To Crash
0 AMENDED YR 202512025-00034865 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIPINTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n
DUNDEE AVE Elgin® 0 RELATED ®Y ❑N 05 31 2025 ❑AM ❑YES ®NO U1
10:34
_ _ PRIVATE mo /day/yr ®PM FLOW CONDITION MFT!MI N E S W PARK ST COUNTY PROPERTY ❑Y ® N DOORING Ely #OF MOTOR El SLOW 1 cn
❑ Kane HIT&RUN ❑V ® N WITH VEHICLES INVLD ❑ STOPPED U2 --I
® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0
Qg3 DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EWES ❑uuv ❑!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 n
FOR DAMAGEDAREA(S) FROf T�TOWED U1 O
Menchaca. Erik 0 5 /
yr 13-UNDER CARRIAGE 16 1 • 2 FIRE ❑
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 4 <<Tl
M 2 SY is-OTHER
5 ❑Y ®SNE❑UNK VEH. O AT CRASH M IN O O 99-UNKNOWN 9 16•TOP 3 *Distraction Value ALGN 2
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s iL 6 I,.4 COM VEH 0 E! 1 0
~ ELGIN I L 60123 0 1 0 FIRST CONTACT 12 7_: __5 *lI Ves.See Sidebar U1
ZZ313884 IL 2026 REAR
TELEPHONE
IL D 3N1AB61E78L621541 Kemper ®Y ❑N U2 13 . m
13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
REYES FLORES.GLENDY. M. 12AU001573839 1 1-
15 HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER
RESPONDER
2 XI
g DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0
/1 9 8 7 Honda Accord 2013 00-NONE 'o,1 t2 (,-2 DUE TO CRASH 0 ® U2 2 C
o 13-UNDER CARRIAGE
c
M 2 4SYSTEM IN 0 ENGAGED 0 15-OTHER 9.1,6•TOP3 X
0 Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN `Oistrac on Value 0
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF S 1 6 t. 4 C.OM VEH ❑ ® Ut W
FIRST CONTACT 6 O7 ,�=Q)OS •(ryes.See Sidebar C
ELGIN IL 60120 0 1 0 R900911 IL 2026 IAR Si)0
Z
IL D 1 HGCR2F79DA043515 State Farm ❑Y ®N RDEF M
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 =
Same 1470108-sfp-13 SAC E
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 <
Refused RESPONDER U1 =
(UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME))(ADDRESS)((TELEPHONE) (EMS) (HOSPITAL)
2 3 10 /
U1 1 D
/ / 2 0
EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z
u 1 ® 11 1 5/ , 1/ ,025 10 34 ®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 0 28 19 5/ ,1/ ,025 11 09 ®PM ❑Construction
F
R O 0 ]$I CITATIONS ISSUED PENDING SECTION CITATION NO. EMS ARRIVED TIME 5
3 ❑AM ❑Maintenance U2
o1 ® 11 1 ARREST NAME Menchaca. Erik 11-601 752135 5/ /1/ l025 11 14 Igi PM• • El Utility SLMT
I$!CITATIONS ISSUED 0 PENDING SECTION CITATION NO. ROAD CLEARANCE TIME
8 N ❑AM 30
t 2 0 ARREST NAME Menchaca. Erik 3-707 752136 , , ❑pM ElUnknown work zone type U1
2 2 3 ID El ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 30
1517-Le Cates. Brittany 1o1 331-Ziegler 6/ , 5/ ,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
i•____r_ __; / i _ 1. Hasa weight
ign):ht rating more than 10,000 pounds(example:truck or truckrtrailer -<
INDICATE NORTH
4— IOntrH81.7Eltaln / / N —I
BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C
} } — / i.i. e. r r (example:shuttle or charter bus):or C)
,
; - - N 3. Is designed to carry15 or fewer passengers and operated a contract carrier O
I- <.__-A-.-.� wmalwetMalain ." / } } } } transportingemployees in the course of their employment(example:employee X
-- - - - vuneee7aro,aElgln transporte -usually a van type vehicle or passenger car): r
' 1 / . 4. Is used or desi nated to trans rt between 9 and 15 ww/t
i. i. __}----; — — —1 8 } } } g po passengers,including[he driver,
1 / for direct compensation(example:large van used for specific purpose):or
L L--_-a-.... / t i i i L 5. Is anyvehicle used to transport any hazardous material(HAZMAT)that requires m
rn
if placarding(example:placards will be displayed on the vehicle). ;p CARRIER NAME/ y,
ADDRESS (/)
units.—. — n`'�.7 CITY/STATE/ZIP g
l�fo!To Scale J / i. i. MOTOR CARR.ID 0 Interstate 0 Intrastate
r ; ❑ Not in Comm./Govt. 0 Not in Comm./Other
; _Y_ _..; - USDOT NO. ILCC NO. m
XI
Source of above z
IDOT PERMIT NO. WIDELOAD-; ❑Yes 0 No =
TRAILER VIN 1 m
co
LOCAL USE ONLY TRAILER VIN 2 m
a
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
Red Black
u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_
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/T6
DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE