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HomeMy WebLinkAbout2025-00045865 ILLINOIS TRAFFIC CRASH REPORT sheet 1 of 2 Sheets II III H IIII UHI UU l��lUll 11111UUll1UU DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X003694931 u, 9 u21 1 1 1 U, 5 U2 1 U,99 1_12 1 u,99 U2 1 3 10 U, 3 U211 *P 0119* INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW ' DAMAGE TO ANY El$500 OR LESS TYPE OF REPORT ® q No Injury 1 Drive Away Elgin Police Department ONE PERSON'S 1215501-51.500 ®ON SCENE 1 VEHICLE/PROPERTY ❑OVER$1,500 ❑NOT ON SCENE(DESK REPORT) 0 AMENDED ❑ B Injury and f or Tow Due To Crash YR 2025I 2025-000458655 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 99 71 465 DUNDEE AVE Elgin 08:21 ® ❑ RELATED ❑Y ®N 07 15 2025 ❑AM ❑YES ®NO U1 —< _ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION ITI COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR 0 SLOW 1 fu7 ❑ FT/MI N E S W Kane HIT ®Y ❑ N WITH VEHICLES INVLD 0 STOPPED U2 --I &RUN ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 /83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uuv 0!CV 0 ov DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 0 FOR DAMAGEDAREA(S) FROPtf TOWED U1 O Unknown. Unknown / / Chevrolet Equinox 00-NONE ©1 O , DUE TO CRASH 0 NAME(LAST,FIRST,M) mo yr 13-UNDER CARRIAGE 10 EN I , 2 FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 4 I<TI 9 9 SYTM❑Y ®SNE❑UNK VEH. 0 AT CRASH 0 15-99-UUNKNOWN THER9 16•TOP 3 `Distraction Value 9 ALGN 2 a 4 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF ,Ii_6 I,. 1 ~ 0 9 0 FIRST CONTACT 11 7_: COM VEH 0 j$J_5 *IIYes.See Sidebar U1 0 REAR c Z ' E TELEPHONE . STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED 1 11/ UNK ❑Y ❑N U2 M in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 1 99 9 Same UNK 1 rn `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused 0 Y ® N 99 CAi )) m g DRIVER ❑ PARKED 0 DRIVERLESS 0 PEO 0 PEDAL 0 EWES 0 NMV 0 NCV 0 DV /2 0 0 8 Honda CRV 2020' 00-NONE ,� ' t2...�DUE TO CRASH 0 (� 2 0 13-UNDER CARRIAGE 10 2 FIRE 0 ® U2 C F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16-TOP 3 X ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN *Oistracton Value 9 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8-it 6 Il, COM VEH ❑ ® U1 CO FIRST CONTACT 1 Y _, _5 •IfYes.See SidebarC H ELGIN IL 60120 0 1 0 EX47036 IL 2025 I 0 IL D 0 5J6RW2H89LL008624 STATE FARM ❑Y ®N RDEF71 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER 1 = 1 99 9 Villafana-Cuadros.Gloria 3449358FFP13 BAc $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP U1 = (UNIT) (SEAT) (008i (SEX) (SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)1(A.DDRESS)1(TELEPHONE) (EMS) (HOSPITAL) 2 3 09 / F 2 4 0 1 0 m / / #OCCS D X1 / / 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 1 07,15 /2025 08 29 ®pm in a Work Zone? ®N DIRP co 1 I PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME ❑AM If YES check one below: U1 7 C) T 0 2 0 06 2 / / ❑PM ❑Construction Z 3 0 0 CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 1 ❑AM 0 Maintenance U2 —a, ARREST NAME / / ❑PM ' oN ® 11 1 0 CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • ❑Utility SLMT N 2 ❑ ARREST NAME AM T / / PM 0 Unknown work zone type 30 U1 n OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 0 1558-Lundvick.John 301 391-Jacobucci / / ❑❑pM Workers present? ®N U2 30 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 N1 1.Has aweight rating more than 10,000 pounds(example:truck or truck/trailer (/ 1. -1 } } ' ; / } INDICATE NORTH tan)or P3 rur To SCrw.cj // / BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C} / / (example:shuttle or charter bus):or 3. Is designed to carry 15 or fewer passengers and operated �rated a contract carrier O I- I- -A----J. ` }- } } transporting employees in the course of their employment(example:employee � X transporter-usually a van type vehicle or passenger car):or CO L , 4. Is used or designated to transport between 9 and 15 passengers,including C-}-----;----; - } } } g po passen rs,includi the driver, for direct compensation(example:large van used for specific purpose):or -U L____a..... / _ � � m / : t 5. Is any vehicle used to transport anyhazardous material(HAZMAT)that requires / placarding(example:placards will be displayed on the vehicle). XI / / ; _- CARRIER NAME O Q / ADDRESS D r o / rA r r T 1 /) /UnR 1 0 / CITY/STATE/ZIP g O / / - i. MOTOR CARR.ID ❑ Interstate ❑ Intrastate 1 I r 1 ❑ Not in Comm./Govt. 0 Not in Comm./Other ; _Y_ __1 USDOT NO. ILCC NO. m XI Source of above z . ❑ Yes 0 No 0 Unknown g D Did Carrier Safety Regulations MCS)violation contribute to the crash? A 0 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 VIM 1 m to 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 Red Red u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT: 9 TOWED BY/TO: _ SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY/TO DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE