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HomeMy WebLinkAbout2025-00047311 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 011011000 010 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X0038585r7 u, 1 U21 1 1 1 U1 2 U2 1 U, 1 u2 1 U, 1 u2 1 1 12 u1 1 u2 1 *P 0119* INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW ' DAMAGE TO ANY El 5500 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 f or Tow Due To Crash YR 2025512025-00047311 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n DAVIS RD El In08:09 ® ❑ RELATED ❑Y ®N 07 22 2025 ®AM ❑YES ®NO U1 —< _ _ g PRIVATE mo /day/yr ❑PM FLOW CONDITION m FT l MI N E S W N MCLEAN BLVD COUNTY PROPERTY ❑Y 21N DOORING ❑y #OF MOTOR IR SLOW 7 Cl) ❑ Kane HIT&RUN ❑V ® N WITH VEHICLES INVLD ❑ STOPPED U2 —I ® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST IR N ❑ FREE FLOW # LNS 0 g DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EWES ❑NW ❑ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 n FOR DAMAGEDAREA(S) FRONT TOWED U1 Q Del ado-Castillo. Daniels. I. 0 1 / yr 13-UNDER CARRIAGE ©i ! FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 2 DISTRACTED 0 0 U2 2 m F 2 SY4 ❑Y ONM DUNK VEH. 0 AT CRASH IN D 0 99-UNKNOWN 9 16•TOP 3 *Distraction Value 9 ALGN = r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF S, ii_6 1, 4 COM VEH 0 0 1 0 ELGIN N I L 60120 0 1 0 FIRST CONTACT 11 7_: __5 *rives.See Sidebar U1 ZBV88778 IL 2025 REAR TELEPHONE IL D 19U U B2F51 FA018604 Country Finacial ❑Y ®N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Same PO10319471 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER > Refused ❑Y ® N 2 73 g DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL 0 EWES ❑ uv 0 Ncv ❑Dv 9 9 5 Volvo VNM 2013 00-NONE "- 12 c,_2 DUE TO CRASH 0 ® U2 21 C o yr 13-UNDER CARRIAGE c M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 91,6•TtOPO3 * X ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN 0istraetlon Value 9 U1 0 POINT OF 8 it jl 4 COM VEH ® 0 CO N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR �J 6 FIRST CONTACT 3 7_ _,__5 •• •If Yes.See Sidebar Z Chicago IL 60631 0 1 0 P1043915 IL 2026 I 0 C Z IL A 4V4MC9EHXDN132384 Acord ❑Y ®N RDEF 7) EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER 1 = PYH Express 302401-9143876Y SAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP 996 < Refused RESPONDER 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 occAur ❑Y U2 Z N 1 CD 11 1 71 ,21 ,025 08 09 ®❑PM in a Work Zone? NJ DIRP co 1 t PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME ❑AM 0If YES check one below: U1 7 n T 2 ❑ 2 28 , , 0 PM, 0 Construction R 3 0 $I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 7 ❑AM ❑Maintenance U2 o1 ® 11 1 ARREST NAME Delgado-Castillo. Daniela. I. 11-703-B 1561-000036 , r ID Pm SLMT o N - ❑CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ❑Utility r 2 ❑ ARREST NAMEAM i T 1 / ❑❑PM 0 Unknown work zone type U1 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 30 1561-Sarovic• Mirko 501 91 , 12 ,25 09 00 ❑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. A CMV is defined asmotor vehicle used to transportand: r ----,5-•---, ; any passengers or property Z 1. Has a weight rating more than 10,000 pounds(example:truck or truckrtrailer -< } i.-- -i-- --; ; } } } i- -, , ; ; , ; ( INDICATE NORTH combination):or —I p1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C } ' , } (example:shuttle or charter bus):or X 3. Is L L----A.-- 1 i. ... . .. .itransporting edmployeeslIn5 hecourseeo theire rsmployment example:employeener } } - transporter-usually a van type vehicle or passenger car):or 1:0 I- <.__-a-_-_-I , I' I' I- <--_-a__--- , , , , 4. Is used ordesi nated to trans rt between 9 and 15 passengers,including C} for direct compensation(example:large van used for specificpurpose):or [he driver, Pe ( P 9 Pe or O L L----a____.: L L L ...._-.�_ ; l. i i t 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires placarding(example:placards will be displayed on the vehicle). XI i. -D7 CARRIER NAME PYH Express Z ADDRESS 1024 MONTEGO BAY CT O T. , CITY/STATE/ZIP Elgin)IL 160446 MOTOR CARR.ID 0 Interstate ❑ Intrastate O ❑ Not in Comm./Govt. ❑ Not in Comm./Other 0 :----Y----4 ; I- I- Y- ; ; , ; 54262 USDOT NO. 21 ILCC NO. m XI Source of above z . IDOT PERMIT NO. 2154262 WIDELOAD'� 0 Yes ®No II TRAILER VIN 1 527SR5321 FL005491 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 White White 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 DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY/T6 DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE 2 LOAD TYPE 9