Loading...
HomeMy WebLinkAbout2025-00049564 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets Mill III H IIII DIII 00110010111111111111111 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X003909154 u, 1 U21 1 1 1 U116 U2 1 U, 1 1_12 1 U, 1 U2 1 4 13 u1 1 u2 1 *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 ❑$501-$1.500 ®ON SCENE 2 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) (83B Injury and/or Tow Due To Crash El AMENDED YR 202512025-00049564 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 71 S STATE ST Elgin 09:18 ® ❑ RELATED ®Y 0 N 07 31 2025 ❑AM YES ®NO U1 _ _ PRIVATE mo /day/yr ®PM FLOW CONDITION MFT!MI N E S W ORANGE ST COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR 0 SLOW 1 0)0 Kane HIT&RUN ❑V ® N WITH VEHICLES INVLD 0 STOPPED U2 --I ® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 Q83 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 DAMAGED AREA(S) FROM TOWED U1 O Olson.Jaedyn.C. 0 5 / /1 9 9 1 Chrysler 200 2015 00-NONE , z , DUE TO CRASH ® ❑ NAME(LAST,FIRST,M) y mo yr 13-UNDER CARRIAGE ©i o 0 FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) O O DISTRACTED 0THER 0 U2 2 r11 F 2 4 SYTM❑Y ®S NE DUNK VEH. O AT CRASH 0 15-99-UNKNOWN 9 16•TOP 3 *Distraction Value ALGN - r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s, ii_6 Ii 4 COM VEH 0 E! 1 0 I� 60110 0 1 0 FIRST CONTACT 11 7_: __5 *II Ves.See Sidebar U1 Z ZY45006 IL 2015 REAR TELEPHONE IL D 0 1 C3CCCAB5FN602835 Geico ❑Y ®N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 Same 6096411597 1 r "o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused 0 Y ® N 2 eu m g DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEOAL 0 EWES 0 /2 O O 0 Hyundai Kona 2023 00-NONE 'o,� t2 (,-2 FIRE DUE D CRASH ® U2 2 C o yr 13-UNDER CARRIAGE c F 2 4SYSTEM IN 0 ENGAGED 0 15-OTHER 9.1,6•TtOP 3 X 0 Y ®N 0 UNK VEH. AT CRASH 99-UNKNOWN `Distraction Value 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 0'i- 6 IC 4 COM VEH ❑ ® U1 CO C FIRST CONTACT 8 Q __,�_5 *If Yes.See Sidebar ELGIN IL 60120 0 1 0 DP42269 IL 2025 I Si)0 IL D 0 KM8K62AB9PU934353 All State ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = 99 9 Espinoza. Rosalva 974301870 BAG $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP U1 = (UNIT) (SEAT) (D08) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)((ADDRESS)((TELEPHONE) (EMS) (HOSPITAL) 2 3 11 / F 2 3 0 1 0 m / / #OCCS D 71 / / U1 1 D / / 2 O EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ®Y U2 Z N 1 El 11 1 07/31 /2025 09 18 ®AM in a Work Zone? ❑N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 5 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 C) o" 2 ❑ 20 99 / / 0 PM ®Construction >E Z 3 ❑ xi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 1 ❑AM ❑Maintenance U2 a 1 ® 11 1 ARREST NAME Olson.Jaedyn.C. 6-101* 1519-000379 / / El PM SLMT I$!CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME AM• 0 Utility o T 2 El ARREST NAME Olson.Jaedyn.c. 11-709-A 1519-000380 07/31 /2025 10 10 0 PM El Unknown work zone type U1 20 2 2 3 ID El ID SIGNATURE BEAT!DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? D Y 20 1528-Rivera. Kevin 701 269-Mendiola 09 /02/2025 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 I I ADDITIONAL UNITS FORMS. r ----r••--, , ; A CMV is defined as any motor vehicle used to transport passengers or property and: Z N 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer -< `----'-----; I - ) INDICATE ARROW NORTH combination):or BY2 Is used or designed to transport more than 15 passengers including the driver —I t- (example:shuttle or charter bus):or 0 / ) }I 3. Is designed to carry 15 or fewer passengers and operated a contract carrier } } transporting employees in the course of their employment (example:--I-- employee X transporter-usually a van type vehicle or passenger car):or CO } } 1 •4. Is used or designated to transport between 9 and 15 passengers,including the driver. C Mwxr for direct compensation(example:large van used for specific purpose):or O L L____a____. �' i i. i. _ 5 Is any vehicle used to transport any hazardous material(HAZMAT)that requires -D . . ir i placarding(example:placards will be displayed on the vehicle). XI _' __ D uvxa CARRIER NAME —I _ __ ADDRESS0 Not To Scale I D C) I II CITY/STATE/ZIP 0 _ MOTOR CARR.ID Interstate Intrastate I I T I I Not in Comm./Govt. Not in Comm./Other o 0 ; _Y_ __1 - USDOT NO. ILCC NO. m XI Source of above z . MCS 0 Yes 0 No 0 Unknown Out of Service 0 Yes ❑No 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' 2 TOWED BY/TO. _Adieu/Impound Lot Garage . SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 DUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY/T6 DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE