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HomeMy WebLinkAbout2025-00039799 ILLINOIS TRAFFIC CRASH REPORT sheet 1 Of 4 Sheets 01111101111 I01101100111101 !III IIIIIIIIII DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV XO03862OOS u, 1 U21 3 4 1 U1 3 U2 1 U1 1 U2 1 U1 1 U2 1 5 10 U, 1 U2 -3-1 .P0119* 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 ❑$501-$1.500 ®ON SCENE 2 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) El Injury and/or Tow Due To Crash 0 AMENDED YR 2025I 2025-00039799 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 rl ® ❑ RELATED ®Y 0 N 06 21 2025 ❑AM ❑YES ®NO U1 -< N MCLEAN BLVD Elgin 11:19 _ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION M FT!MI N E S W LARK!N AVE COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 15 u) ❑ Kane HIT&RUN ❑Y ® N WITH VEHICLESOT, INVLD ❑ STOPPED U2 —I El AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uuv 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 3 n 0 6 / yr 13-UNDER CARRIAGE ©, !'0 FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 10 O DISTRACTED 0 0 U2 3 <<T1 M 2 SY5 ❑Y ONM❑UNK VEH. 0 AT CRASH IN 0 15-OTHER 99-UNKNOWN 9 16•TOP 3 `Distraction Value 9 ALGN = r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s, i�a �i 4 COM VEH 0 j$J 1 0 ~ ELGIN N I L 60123 C 1 0 FIRST CONTACT 1 7_: __5 *IIYes.See Sidebar U1 Z ZU86693 IL 2025 REAR TELEPHONE IL D 0 2C3CCAGG8EH337262 AllState El IglN U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 Same 975194950 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER en Refused ❑Y ❑ N 2 0 m Ei{ DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 m,lv 0 NCv 0 DV yr Q 12 ..� C 11', 13-UNDER CARRIAGE I E FIRE 0 ® U2 C M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16-TOP 3 X ❑Y NJ N ❑UNK VEH. AT CRASH 99-UNKNOWN *Oistraellon Value 4 POINT OF s i1 COM VEH D ® U1 W N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR FIRST CONTACT 14 7.A J-5 C. (ryes.See Sidebar — Hinsdale IL 60521 0 1 0 P264664 IL 2026 RE 0 N D IL D 0 3GYFNDE39CS533672 AllState ❑Y ®N RDEF71 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Elgin Fire Same 932955802 BAG $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP 996 < Sherman RESPOND 0 N U1 = (UNIT) (SEAT) (DOE) (SEX) {SAFT) (AIR) (INJ) (EJCTI (EPTH) PASSENGERS&WITNESS ONLY (NAME)((ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL) W 06 / M m / / #OCCS D 71 / / U1 1 D / / 1 0 EV MOST EVNT LOG DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z N 1 ® 11 4 06/21 /2025 11 19 ®PM AM in a Work Zone? ®N DIRP D 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 ❑ 25 28 ( ( ❑PM ❑Construction * R 3 ❑ 0 CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 7 -a, ARREST NAME Munoz.Alejandro 11-601 001346 / / ❑❑PM ❑Maintenance U2 o u 1 ® 11 4 CITATIONS ISSUED 0PENDING TIME • 0 Utility SLMT o N SECTION CITATION NO. ROAD CLEARANCE 0 AM 35 r 2 ❑ ARREST NAME Munoz.Alejandro 11-306 001347 ( / PM ❑Unknown work zone type U1 n 7 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 D ❑AM Workers present? ❑Y 35 1514-Pratt.Tamers 601 367-Stein / / ❑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. .. .. A CMV is defined as any motor vehicle used to transport passengers or property and: Z r r• -, , I b 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer -< } }-----I-----; I combination):or rrorm Sarre INDICATE NORTH -I BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C i i I - (example:shuttle or charter bus):or L q _ 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier 0 I. } } transporting employees In the course of their employment(example:employee X transporter-usually a van type vehicle or passenger car):or w L L.___a____-: 4. Is used ordesi natedtotrans rtbetween9and15 passengers,including N I. for direct com nation exam I lar a van used for s cifi ur o ):or the driver, Pe ( P 9 Pe P Pose):or -u L L---_-----_. , i i t 5. Is any vehicle used to transport anyhazardous material(HAZMAT)that requires M ., placarding(example:placards will be isplayed on the vehicle). Larkin Ave. CARRIER NAME Z ADDRESS 0 V) N.Mclean Blvd. CITY/STATE/ZIP n .' _ MOTOR CARR.ID Interstate Intrastate I I T I I I Not in Comm./Govt. ❑ Not in Comm./Other 00 I C - • USDOT NO. ILCC NO. m XI Source of above z . Form Number m Xl IDOT PERMIT NO. WIDELOAD'; ❑Yes 0 No 2 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 Black Silver 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