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HomeMy WebLinkAbout2025-00046668 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets II III HH II11II UHI UU II11111011111Iii�1HHUUIDUU DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY XO03694a35 u, 1 U21 1 1 1 u, 2 U2 1 U113 u2 1 U1 1 U2 1 1 12 U1 18 u2 7 *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 ❑5501-51.500 ®ON SCENE 1 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) 0 AMENDED ❑ B Injury and/or Tow Due To Crash YR 202512025-00046668 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n ® ❑ RELATED PRIVATE ❑Y ®N 07 19 202512,— ❑YES ®NO U1 -< ST CHARLES ST Elgin mo /day/yr 12:59 ®PM FLOW CONDITION M I O ®/MI ON E S W Russell St COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ®SLOW 1 Cl) 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 gi 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 2 n FOR DAMAGEDAREA(S) FRONT TOWED U1 Q Porras.Jor e 0 4 / yr 13-UNDER CARRIAGE ©i ! FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 2 DISTRACTED 0 Ea U2 2 rn M 2 4 SYTM❑Y ®SNEDUNK VEH. 0 ATCRASHD 0 99-U 15-UNKNOWN THER9 16•TOP 3 `Distraction Value 9 ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s, it S �i 4 COM VEH 0 Ea 1 0 ELGIN I N I L 60123 0 1 0 FIRST CONTACT 11 7_:, __5 *II Yes.See Sidebar U1 ZDB42693 IL 2026 REAR TELEPHONE IL D 0 3N1AB8DV3NY209641 State Farm ❑Y Il N U2 I' 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 Same 0803491-SFP-13 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER Ai Refused 0 Y El 2 0 g DRIVER ❑ PARKED 0 DRIVERLESS ❑ PED 0 PEDAL ❑EWES ❑ /1 9 5 2 Honda Civic 2013 oo-NONE 13-UNDER CARRIAGE 11 ' 12 DUE TO CRASH ❑ (� ❑ ® U2 2 0 FIRE c M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9I 19•TOP 3 X ❑Y i N ❑UNK VEH. AT CRASH 99-UNKNOWN *OiSIrSetlon Value 9 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s i1 4 5 Lf,_ COM VEH ❑ ® U1 CO FIRST CONTACT 1 7�. -5 *If Yes,See Sidebar C— Algonquin IL 60102 0 1 0 S758581 IL 2025 REAR 0 Si) IL D 0 19XFB2F84DE024747 Erie Insurance ❑Y ®N RDEF71 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X 99 9 Same Q060915274 BAc E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPONDER U1 = (UNIT) (SEAT) (D08) (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME(/(A.DDRESS)/(TELEPHONE) (EMS) (HOSPITAL) 2 3 11 / UI 1 D / / 2 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 07/19 /2025 01 10 ®❑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 1 C) T 0 2 0 2 14 / / ❑PM ❑Construction Z3 0 $I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME ❑AM 0 Maintenance U2 1 a ® 11 1 ARREST NAME Porras.Jorge 11-906 1540-280 / / ID PM PM ' S' Nu ❑CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME 0 Utility AM U, 30 r 2 ❑ ARREST NAME 07/19 /2025 01 45 M PM ❑Unknown work zone type 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 30 1540-Allah. Muhammad 401 08 / 12/2025 01 30 ElPM ®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••--, , JSt.?ClLIes?St : A CMV is defined as any motor vehicle used to transport passengers or property and: Z } - - ' I r INDICATE NORTH 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer combination):or -< p0 1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C (example:shuttle or charter bus):or C r r X I- ._.� Rusw07st 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I O } } } transporting employees in the course of their employment(example:employee X — — — transporter-usually a van type vehicle or passenger car):or CO L L.__.a__ 4. Is used ordesi natedtotrans transport passengers,including C} } } g po passen rs,includi the driver, j _•� 1 for direct compensation(example:large van used for specific purpose):or O __ I 1 i. < 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m placarding(example:placards will be displayed on the vehicle). XI CARRIER NAME Z I tom.10.* ADDRESS '0 Ei t<. , A D lit,". r CITY/STATE/ZIP./ N I 0 n Not To Scale j MOTOR CARR.ID 0 Interstate 0 Intrastate :le I I . I ❑ Not in Comm./Govt. Not in Comm./Other 0 Y § i. : CC NO Om USDOT NO. IL m XI Source of above z . If Yes,Name on placard O 4 digit UN NO. 1 digit Hazard class No. XI XI Did HAZMAT spill from vehicle(do NOT consider FUEL from vehicle's 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 LOCAL USE ONLY TRAILER VIN 2 m 0 TRAILER WIDTH(S) 0-96" 97-102" >102' -n TRAILER 1 ❑ ❑ 0 Z ill TRAILER 2 ❑ 0 0 o u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w Silver Silver u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT 1 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