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HomeMy WebLinkAbout2025-00046675 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 01111101111 I0110110011 0111111111I DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X403894909 u, 1 u21 1 1 1 U, 1 U216 U, 1 U2 1 U1 1 U2 1 1 11 U1 1 U211 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY ❑$500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 3 VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash El AMENDED YR 202512025-00046675 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n ® ❑ RELATED PRIVATE ❑Y ®N 07 19 2025 12,— ❑YES ®NO U1 -< S RANDALL RD Elgin mo /day/yr 01.49 ®PM FLOW CONDITION M I Q ®!MI N E OS VY Randall Rd/Rt 20 COUNTY PROPERTY ❑Y ® N DOORING Ely #OF MOTOR IR SLOW 15 Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD ❑ STOPPED U2 —I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST IR N ❑ FREE FLOW # LNS 0 18:DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EOUES 0 NW 0 ICU 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 0 FOR DAMAGEDAREA(S) FRONT TOWED U1 O Ramirez-Patino.Jor ue. L. 0 3 / yr 13-UNDER CARRIAGE ©,I !�. 2 FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 ]$I U2 4 <<n M 2 SY4 ❑Y ®SNE❑UNK VEH. O AT CRAS IN H O 15-OTHER 99-UNKNOWN 9 16•TOR 3 `Distraction Value ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s i 6 COM VEH ❑ j$J 2 C) Lake in the Hills IL 60156 0 1 0 FIRST CONTACT 11 O7 _:,.0:_0 •If Yes.See Sidebar U1 0 ZEQ51875 IL 2026 REAR TELEPHONE IL D 0 WVWGD71 K39W127508 Magnum Insurance Agency ❑Y Il N U2 Ill , m 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m co Same 990568454 2 r o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused 0 Y ® N 2 X p; DRIVER ❑ PARKED 0 DRIVERLESS 0 PEO 0 PEOAL 0 EWES 0 /1 9 6 9 Ford Escape 2011 00-NONE 11 12 i t2'-_, DUE TO CRASH ❑ (� 2 0 13-UNDER CARRIAGE to l 2 FIRE 0 ® U2 C c M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16-TOP 3 X ❑Y ON ❑UNK VEH. AT CRASH 99-UNKNOWN `0istraellon Value 0 POINT OF s i4 COM VEH ❑ ® U1 CO N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR all,,,,, FIRST CONTACT 5 7 - S •If Yes.See Sidebar C Algonquin IL 60102 0 1 0 DF70406 IL 2026 REAR 0 Si) IL D 0 Cincinatti Insurance Comp ❑Y ®N RDEF71 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Same eba0048814 BAc $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP 996 < Refused RESPONDER U1 = (UNIT) (SEAT) (DOBI (SEX) (SAFT) (AIR) (INJ) 1(EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)/(ADDRESS)/(TELEPHONE) (EMS) (HOSPITAL) 2 3 11 / U2 2 Z EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur IDY N 1 ® 11 1 07/19 /2025 01 49 ®AM in a Work Zone? ®N DIRP co 1 T PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 5 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 2 0 11 1 28 99 ! / 0 PM• ❑Construction >F R 3 0 $I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 5 ❑AM 0 Maintenance U2 o ® 11 1 ARREST NAME Ramirez-Patino.Jorgue. L. 11-601-Ax W1545-347 / / El PM SLMT o N ❑CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • 0 Utility r 2 ❑ ARREST NAME AM 7 / / pM El Unknown work zone type 45 U1 n OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 ❑ ❑AM Workers present? ❑N 45 1545-VanEycke. Brier 801 / / ❑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 -< c ` '' -' r INDICATE NORTH combination):or .Z-1 r I BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C i_ I i i. e. ,. (example:shuttle or charter bus):or 0 �, 3. Is designed to carry 15 or fewer passengers and operated a contract carrier 0 I- <.__-A-.-.J �,t I I. } } } transportingemployees in the course of their employment pbgeyment(example:employee transporter-usually a van type vehicle or passenger car):or w < -----------i rmwrmaeJe76a irnzamaza •4. Is used or desi sated to trans rt between 9 and 15 ge ng rCjt } } } for direct com nation exam I lar a van used for s �cifice ur o ):or [he driver,. Pe ( P 9 Pe P pos�):orz t i i t 5. Is any vehicle used to transport an hazardous material(HAZMA that requires a ' Iplacarding(example:placards will be displayed on the vehicle). ,ZmtI ZCARRIER NAME Z IADDRESSO Io Scale J w 1 c)I CITY/STATE/ZIP 0 MOTOR CARR.ID ❑ Interstate ❑ Intrastate 5R9Ra ud - 6) . . r . I ❑ Not in Comm./Govt. 0 Not in Comm./Other ____ _ _ 1 USDOT NO. ILCC NO. m XI Source of above z IDOT PERMIT NO. WIDELOAD"; ❑Yes 0 No = TRAILER VIN 1 m co LOCAL USE ONLY TRAILER VIN 2 m 0 TRAILER WIDTH(S) 0-96" 97-102" >102' -n TRAILER 1 0 0 0 Z TRAILER 2 ❑ 0 0 O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w Gray 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 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY/TO: DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE