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HomeMy WebLinkAbout2025-00047490 ILLINOIS TRAFFIC CRASH REPORT sheet 1 of 2 Sheets 01111101111 0110110000 liii 1l11UU111100 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X003696401 u, 1 U21 1 1 1 U11 O U2 1 U, 1 1_12 1 U, 1 U2 1 5 12 u1 2 u2 1 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY 0 5500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW ' Elgin Police Department ONE PERSON'S ®5501-$1.500 ®ON SCENE 1 VEHICLE/PROPERTY ❑OVER 51,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash 0 AMENDED YR 2025I 2025-00047490 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 2 ® ❑ RELATED PRIVATE ❑Y ®N 07 22 2025 ❑AM ❑YES ®NO U1 -< RT20 EB HWY Elgin mo /day/yr 11.10 ®PM FLOW CONDITION M l O(� COUNTY PROPERTY ❑Y ® N DOORING Ely #OF MOTOR 0 SLOW 15 u) ® ,C.7/MI N E S © Larkin Ave WITH VEHICLES INVLD 0 STOPPED U2 --I El AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) Kane HIT&RUN ❑Y ® N PEDALCYCLIST®N ® FREE FLOW # LNS 0 18:DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL ❑EOUES ❑NW ❑ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 n O 4 / yr Chevrolet Silverado 2015 00-NONE 1 DUE TO CRASH El11-_ +2 - EN E 13-UNDER CARRIAGE 1 2 FIRE ❑ IE 10 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL)THERDISTRACTED 0 ]$I U2 �Tl F 2 4 SYTM❑Y ®SNE❑UNK VEH. O AT CRASH 0 15-99-UUNKNOWN 9 76•TOP 3 ,Distraction Value 9 ALGN - r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF i, 6 I,.4 COM VEH 0 El 1 C) ~ ELGIN I L 60120 0 1 0 FIRST CONTACT 8 O7 _; __5 *II Yes.See Sidebar U1 0 Z 4074917B IL 2025 REAR TELEPHONE IL D 0 1 GCHC33J3YF428573 State Farm ❑Y Igl N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR --1 Randazzo. Michael,A. 3088900-SFP-13 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER RESPONDER 2 N DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 iiuv 0 Ncv 0 Dv /1 9 7r 2 Ford Explorer 2015' 00-NONE ,�_ t2 DUE TO CRASH ❑ 2 0 13-UNDER CARRIAGE FIRE ❑ ® U2 c F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9,1,6.TOP 3 X ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN `0istracton Value 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8 iI 6 I_i, COM VEH D ® U1 CO FIRST CONTACT 2 7�. —�_-5 •If Yes,See Sidebar = SOUTH ELGIN IL 60177 0 1 0 E345873 IL 2025 REAR IL D 0 V1 FM5K7D86FGA183 State Farm ®Y ❑N RDEF71 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Same 210000-SFP13 BAC $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP 996 < Refused RESPONDER U1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJI 1(EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)((ADDRESS)((TELEPHONE) (EMS) (HOSPITAL) 1 3 01 / / / UI 2 D:A / / 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 07,22 /2025 11 10 0 PM in a Work Zone? ®N DIRP co 1 t PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 3 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 O 2 ❑ 04 24 , / 0 PM ❑Construction >F 14 R 3 ❑ $I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 3 ❑AM ❑Maintenance U2 o1 ® 11 1 ARREST NAME Ramirez Sanchez, Karen, E. 11-601 447000838 / / El PM SLMT o N ❑CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ' 0 Utility t 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 0 447-Collins, Dominique 702 331-Ziegler 08 , 12,2025 01 30 ®PM Am Workers present? ®N U2 45 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 -< ` ` --I -' r INDICATE NORTH combination):or .Z-1 8 i BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C } I I I I la - } (example:shuttle or charter bus):or X I I I 1 1 1 I I I 4 "^ 3. Is designed to carry15 or fewer passengers and operated a contract carrier O (� �) }} } transporting employee � �In the course of their employment(exam �(example:employee � _ transporter-usually a van type vehicle or passenger car):or a r,,, ►o` - } } } •4. Is used or designated to transport between 9 and 15 passengers,including the driver. N 1 for direct compensation(example:large van used for specific purpose):or L L--_-a-....I •> Aink 2_90.'' - i. I 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m :.* placarding(example:placards will be displayed on the vehicle). ;p (scar— o� - - 2# CARRIER NAME Z . . . . ( /�r r -1- -: 17. I _ ADDRESS 0D rn 1 n / �'� 4. CITY/STATE/ZIP 0 MOTOR CARR.ID 0 Interstate 0 Intrastate 1 I r 1 ❑ Not in Comm./Govt. 0 Not in Comm./Other ‘I. - --• - USDOT NO. ILCC NO. m XI Source of above z . 0 Yes 0 No ❑ Unknown A 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 co 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 Black Black 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 TOWED DISABLING DAMAGE NOT DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® DISABLING DAMAGE Redmons/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE