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HomeMy WebLinkAbout2025-00040422 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 01111101111 I0110110011 011 111II DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X003&64;4r u, 1 U21 3 4 1 U1 7 U2 1 U, 1 U2 1 U, 1 U2 1 1 11 U1 1 U211 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY ❑$500 OR LESS TYPE OF REPORT ® q No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW ' Elgin Police Department ONE PERSON'S ®5501-$1.500 ®ON SCENE 14 VEHICLE/PROPERTY ❑OVER$1,500 ❑NOT ON SCENE(DESK REPORT) 0 AMENDED ❑ B Injury and/or Tow Due To Crash YR 2025I 2025-00040422 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 rl ® ❑ RELATED PRIVATE ❑Y ®N 06 24 2025 DI Am ❑YES ®NO U1 -< N RANDALL RD Elgin mo /day/yr 02:40 ®PM FLOW CONDITION m 00 ® O COUNTY PROPERTY El ® N DOORING ❑y #OF MOTOR IR SLOW 1 Cl) !MI N E S W 1-90 WITH VEHICLES INVLD 0 STOPPED U2 --I 0 AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) Kane HIT&RUN I2J Y ElN PEDALCYCLIST IR N ❑ FREE FLOW # LNS 0 (g)DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EOUES 0 NW 0 ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 04 n 0 7 / yr 13-UNDER CARRIAGE ©,I �:: FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 04 r<rl M 2 4 ❑Y ®N SYSTEM ❑UNK VEH. 0 AT CRASHD 0 99-UNKNOWN 9 16•TOP 3 *Distraction Value 9 ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s iL 6 1,.4 COM VEH 0 0 1 C) ~ ELGIN I N 1 L 60123 0 1 FIRST CONTACT 12 7 . _5 *II Yes.See Sidebar U1 Z EF69672 IL 2025 TELEPHONE IL D 3LN6L5FC9HR618232 NO INSURANCE ❑Y ❑N U2 I' in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 REYES. HECTOR NO INSURANCE 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y ® N 2 eu x DRIVER ❑ PARKED 0 DRIVERLESS 0 KO 0 PEDAL 0 EWES 0 IU/v 0 Ncv 0 Dv 1 9$5 BMW X6 2026' 00-NONE ,._j 12..-_, DUETOCRASH 0 2 x o 13-UNDERCARRIAGE 10;1 2 FIRE 0 ® U2 C c F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16.TOP 3 X ❑Y El N ❑UNK VEH. AT CRASH 99-UNKNOWN *Distract on Value 9 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 5 iI 6 I',_4 COM VEH ❑ ® Ut CO FIRST CONTACT 6 ._,!1 MI •IfYes,SeeSidebar Z ST CHARLES IL 60175 0 1 RMF PIF IL 2025 REAR 0 N M IL D 5UX43EMOOT9022627 ILLINOIS INSURANCE ❑Y ®N RDEF71 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = 99 9 Same 55-593-426-00 BAc $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPONDER U1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)!(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL) 1 0 EV MOST EVNT LOC, DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 11 1 61 r 41 r025 02 40 0 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) 0 2 ❑ 03 28 ) r 0 PM ❑Construction * Z 3 0 xi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 5 ❑AM ❑Maintenance U2 -a, ARREST NAME Reyes Salazar. Hector 3-707 1506-408 r r El PM SLMT o U 1 ® 11 1 CITATIONS ISSUED 0 PENDINGTIME • 0 Utility o NSECTION CITATION NO. ROADCLEARANCE 0 AM 45 r 2 El ARREST NAME Reyes Salazar. Hector 6-303-A 1506-407 r r pM 0 Unknown work zone type U1 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 45 1506-Nunez. Maria 901 81 r 21 r025 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 T INDICATE NORTH 1 Has a weight rating more than 10,000 pounds(example:truck or truck trailer combination):or p1 IL.. Not To Scale I BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver } - } r r (example:shuttle or charter bus):or I 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier O I. } } transporting employees in the course of their employment(example:employee X I transporter-usually a van type vehicle or passenger car):or w L L.___a____J 4B0 4. Is used ordesi natedtotrans rtbetween9and15 passengers,including N } } for direct compensation(example:large van used for specificpurpose):or [he driver, Pe ( P 9 Pe or O L i t i i 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires 'D placarding- - - - - - (example:placards will be displayed on the vehicle). � -I CARRIER NAME Z a I ADDRESS D w n I CITY/STATE/ZIP g MOTOR CARR.ID 0 Interstate 0 Intrastate I I T I ❑ Not in Comm./Govt. 0 Not in Comm./Other ----- ----1 - USDOT NO. ILCC NO. rn XI Source of above Z . own tank)? 0 Yes 0 No 0 Unknown 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 to LOCAL USE ONLY TRAILER VIN 2 m v TRAILER WIDTH(S) 0-96" 97-102" >102' m TRAILER 1 ❑ ❑ 0 Z TRAILER 2 ❑ 0 0 O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. Z Black Green u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/TO: _ . SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY/T6 DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE