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HomeMy WebLinkAbout2025-00049792 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 01111101111 011011001 0 11111111111 DO DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X003909323 u, 1 U21 2 4 1 U1 2 U2 1 U1 1 U2 1 U1 1 U2 1 1 10 U, 3 U2 1 *P 0119 INVESTIGATING AGENCY DAMAGE TO ANY El 5500 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 2 VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash 0 AMENDED YR 2025I 2025-00049792 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n MCLEAN BLVD Elgin ® ❑ RELATED ®Y 0 N 08 01 2025 ❑AM ❑YES ®NO U1 -< PRIVATE mo /day/yr 07:07 ®PM FLOW CONDITION M I�0 ®!MI N E S © Abbott Dr COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 15 Kane HIT&RUN ❑Y , WITH VEHICLES INVLD ❑ STOPPED U2 —I 0 AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N 51 FREE FLOW # LNS 0 18:DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 UUV 0!Cu 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 n FOR DAMAGEDAREA(S) FRObff TOWED U1 Q NAME(LAST,FIRST,M) g mo /2 0 0 3 Honda Civic 2007 00-NONE „. (2) , DUE TO CRASH ® ❑ 13-UNDER CARRIAGE FIRE ❑ IE STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 1U O DISTRACTED 0 0 U2 4 M M 2 4 ❑Y ®SNEM❑ 15-OTHER UNK VEH. O AT CRASH IN ENGAGEDO 99-UNKNOWN 9 16•TOP 3 *Distraction Value 9 ALGN = r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF T_iL a ii,4 COM VEH 0 Ea 1 0 ~ ELGIN I L 60123 0 1 0 FIRST CONTACT 1 7_; __5 *IIYes.See Sidebar U1 Z FF31005 IL 2026 REAR TELEPHONE IL B 1 HG FA16897L033129 Kemper ❑Y ®N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Vlllegas Cercado. Kathia. D. 12RA000064103 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE.ZIP PHONE NUMBER RESPONDER D Refused ❑Y ❑ N 2 XI x DRIVER ❑ PARKED 0 DRIVERLESS ❑ PED 0 PEDAL 0 EWES 0 row 0 Ixv 0 DV '1 9 9 4 Toyota Prius 2016 00-NONE ,j_' 12.._, DUE TO CRASH ❑ !g► 25 o Yr 13-UNDER CARRIAGE 1U 1 2 FIRE ❑ ® U2 C c M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 016•TOP 3 X ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN *Oistractlon value 9 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF C)1. !,_4 COM VEH ❑ ® U1 CO FIRST CONTACT 9 7 _5 ••If Yes.See Sidebar C Z Sleepy Hollow IL 60118 0 1 EQ23067 IL 2026 I 0 Z IL D JTDKARFU4G3523387 Bristol West ❑Y ®N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Mattoon Corporation GO1 6713911 00 BAG E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE:ZIP U1 = {UNIT) (SEAT) (DOBi (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)!{ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL) 2 6 10 / M 2 4 0 1 m S / / #OCC D 71 / / U1 1 D / / 2 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z N 1 ® 11 1 08/01 /2025 07 07 ®AM 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 5 C) T o� 2 ❑ 2 15 / / 0 PM ❑Construction R 3 ❑ $I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 5 ❑AM ❑Maintenance U2 -a, ARREST NAME Villegas Cercado. Richard.A. 11-601 487000569 / / El PM SLMT 1 ® 11 1 • 0 Utility CITATIONS ISSUED ❑PENDING u SECTION CITATION NO. ROAD CLEARANCE TIME AM t 2 ❑ ARREST NAME Villegas Cercado. Richard.A. 6-101 487000567 08/01 /2025 07 49 ®PM ❑Unknown work zone type U1 30 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑AM Workers present? ❑Y 30 487-Heal. Kayla 501 09 /08/2025 01 30 ®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 truck trailer -< c ` -' -' r INDICATE NORTH combination):or .Z-1 I i' ® 8rB?8'+0.1 ? BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C r r (example:shuttle or charter bus):or Blvd I T, L.— 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier i O `---------•-I I - ` } I- I- transporting employees in the course of their employment(example:employee < <.___a____� '-_` 4alsuorter-sedord�llnatedtotrans vehicle rtbetween9andr15r) C including[hedriver, to 4' . } } } 9 Po passengers, c . ;�. AnbetC/or for direct compensation(example:large van used for specific purpose):or O < <____a____.l ?Q4 t } } I L 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires I I _ Not To Scale placarding(example:placards will be displayed on the vehicle). XI CARRIER NAME Z 7MeLwn9131W1 ADDRESS 0 w CITY/STATE/ZIP 0 g MOTOR CARR.ID 0 Interstate El Intrastate 1 I r 1 ❑ Not in Comm./Govt. 0 Not in Comm./Other �I. ------1 - USDOT NO. ILCC NO. rn XI Source of above z . If Yes,Name on placard 0 4 digit UN NO. 1 digit Hazard class No. Xl Xl 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 ❑ 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 to LOCAL USE ONLY TRAILER VIN 2 m v TRAILER WIDTH(S) 0-96" 97-102" >102' T TRAILER 1 ❑ ❑ 0 Z TRAILER 2 ❑ 0 ❑ O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w Gray Black u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT' 2 TOWED BY/TO. _Artier/Impound Lot Garage . SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY/TO: DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE