HomeMy WebLinkAbout2025-00043447 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 01111101111
I011011000 000
DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X6636BB573
u, 1 U21 2 4 1 U1 2 U2 1 u, 1 U2 4 u, 1 U2 2 1 2 u, 4 U2 1 *P 0 1 1 9
INVESTIGATING AGENCY DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT ® q No Injury 1 Drive Away
AGENCY CRASH REPORT NO. TRFW
Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 2
VEHICLE/PROPERTY ®OVER 51,500 ❑NOT ON SCENE(DESK REPORT)
El AMENDED ElB Injury and f or Tow Due To Crash YR 2025I 2O255-00043447 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 m
® ❑ RELATED ®Y 0 N 07 05 2025 ❑AM ❑YES ®NO U1 -<
N LIBERTY ST Elgin05:18
_ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION m
FT/MI N E S W PAGE AVE COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 16 '
❑ Kane HIT&RUN ❑Y ® N WITH VEHICLESOT,
INVLD ❑ STOPPED U2 —I
Egl AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N 51 FREE FLOW # LNS 0
Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uuv 0!Cy 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 FRO r TOWED U1 0
NAME(LAST,FIRST,M) Carranza. Lucero mo General Motor-tterrain 2023 00-NONE 11;. O I_, ODE TO CRASH ❑
EN
13-UNDER CARRIAGE 10 ' 2 FIRE 0
0
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 m
F 2 SYTM IN ENGAGE15-OTHER
4 ❑Y ®SNE El UNK VEH. 0 AT CRASHD 0 99-UNKNOWN 9 16•TOP 3 *Distraction Value ALGN 2
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6_iL 6 4 COM VEH 0 j$J 1 0
H 1- BARTLETT I L 60103 0 1 0 FIRST CONTACT 12 r: _5 *II Yes.See Sidebar Ul
ZSKY94-WS IL 2025 REAR
TELEPHONE
IL D 0 3GKALYEG8PL136877 GEICO ❑Y ®N U2 I—
in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
99 9 Same 6132-11-65-31 1 r
`o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER
RESPONDER D
Refused ❑Y ® N 2 c
❑ DRIVER ❑ PARKED 0 DRIVERLESS 0 PED N PEDAL 0 EWES 0 uv 0 NCv 0 DV
!2 0 0 7 Other Other oo-NONE 1("j 12..- , DUE TO CRASH ❑ 2 x
0 13-UNDER CARRIAGE 10 i z FIRE 0 ® U2 C
c
M 5 3 SYSTEM IN 0 ENGAGED 0 15-OTHER 9,16-TOP 3 X
❑Y NJ El UNK VEH. AT CRASH 99-UNKNOWN *Oistraellon Value 0
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8-it 6 Il, COM VEH ❑ ® U1 W
FIRST CONTACT 9 Y _, _6 •(ryes,See Sidebar
H ELGIN IL 60120 0 1 0 NIA Unknown 202 I C0
IL D 0 NIA ❑Y ❑N RDEF71
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 =
1 47 2 NIA BAC
$
HOSPITAL(TAKEN TO) INCIDENT RESPONDER IF'Y' OWNER STREET,CITY STATE,ZIP 996 ARefused ❑Y ®N 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 ❑Y U2 Z
N 1 ® 13 1 Munoz,Giovany 36V Adult Electric Bike 07,05 l2025 05 18 ®AM in a Work Zone? ®N DIRP co
I I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 1
T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 C)
Eri 2 1130 IROQUOIS DR ELGIN IL 60120 2 28 07,05 ,2025 05 18 PM
® • ❑Construction *
Z 3 0 'xi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 5
❑AM ❑Maintenance U2
a1 ® 13 1 ARREST NAME Carranza, Lucero 11-901 S1527-000329 / ! El PM SLMT
o N 0 CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • El Utility
0 AM
r 2 ❑ ARREST NAME 07 t 06 ,2025 05 28 ®PM ElUnknown work zone type U1 30
2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 0 AM Workers present? ❑Y
1527-Juarez,Jorge 201 388-Nelis 08 ,26,2025 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
1. Has a weight rating more than 10,000 pounds(example:truck or truckrtrailer -<
r r -- -' r INDICATE NORTH combination):or .Z-1
BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C
} - i. e. r r (example:shuttle or charter bus):or 0
0 .
L L____A____J. - ii } } } transportinggemployeeo slin hecourse 5 or fewer o their emplrs oy nt example:employee a contract ner X
1 jet transporte -usually a van type vehicle or passenger car):or w
L i.-----}----; /? a - } } } •4. Is used or designated to transport between 9 and 15 passengers,including the driver,
/ s... for direct compensation(example:large van used for specific purpose):or to
Pe ( P 9 Pe P P� O
' L____a_ _ l. I I t 5. Is any vehicle used to transport anyhazardous material(HAZMAT)thatrequires
•D
-marl' " m
I I I I I I I I I I ! placarding(example:placards will be displayed on the vehicle). XI
`'` 1 ; CARRIER NAME Z
-.� I 1i. i. ADDRESS O
1
CITY/STATE/ZIP 00
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. rTl
XI
Source of above Z
IDOT PERMIT NO. WIDELOAD-; ❑Yes 0 No =
TRAILER VIN 1 m
co
LOCAL USE ONLY TRAILER VIN 2 m
v
TRAILER WIDTH(S) 0-96" 97-102" >102' T
TRAILER 1 ❑ ❑ 0 Z
TRAILER 2 ❑ 0 ❑ O
u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w
Black Black
u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_
DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT: 0 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