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HomeMy WebLinkAbout2025-00050538 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 01111101111 I011011001 110 liii 0 00 0 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X00391O260 u, 1 U21 1 1 1 U116 U2 1 U, 1 1_12 1 U, 1 U2 1 1 10 u, 2 U2 4 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT 0 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 ❑NOT ON SCENE(DESK REPORT) ® B Injury and f or Tow Due To Crash 0 AMENDED YR 2025I 2025-00050538 VENT ADDRESS NO. HIGHWAY or STREET NAME ® ❑ ❑Y ®N CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 r1 ❑AM U1 RELATED 08 04 2025 825 S RANDALL RD Elgin PRIVATE mo /day/yr 06:44 ❑YES ®NO®PM FLOW CONDITION m • 0O 1C.'J!MI O E S W BOWES Rd COUNTY PROPERTY ❑Y ® N DOORING El #OF MOTOR 0 SLOW 1 (n 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 gi DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 Peoa. 0 EouES 0 uuv 0 ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) 4 n Y N 0 4 / yr Toyota00-NONE Corolla 2014 ©1 12 - 1 DUE TO CRASH ® ❑ 13-UNDER CARRIAGE 10 1 2 FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 4 rn M 2 4 SY❑Y ®SNE❑UNK VEH. 0 ATCRASHD 0 99-UNKNOWN 9 16•TOP 3 `DlstractionValue 9 ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO STATE YEAR POINT OF s it �i 4 COM VEH 0 01 O . f. FIRST CONTACT 11 7. : a --5 *If Yes.See Sidebar U1 Z CARPENTERSVILLE IL 60110 0 1 0 FA96092 IL 2026 ,ui TELEPHONE IL D 0 4T1 BF1 FK9EU735237 AMERICAN FAMILY INSURANCE ❑Y ®N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 Same 1732559908 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y El 2 eu g DRIVER ❑ PARKED 0 DRIVERLESS 0 FED 0 PEDAL 0 EWES 0 lily 0 i v 0 Dv yr 1 9 9 5 Honda Civic 2008 00-NONE 'o.r t2 (,-2 FIRE DUE o CRASH ® U2 2 C o 13-UNDER CARRIAGE c M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9.1,6•TOP 3 ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN O *0istractlon Value 9 0 POINT OF s-.;, It 4 COM VEH ❑ ® U1 CO N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR 6 FIRST CONTACT 5 7 —_,SOS •IfYes,See Sidebar Z West Dundee IL 60118 0 1 0 FC71279 IL 2026 REAR 0 C Z IL C 0 2HGFG12698H574117 BRISTOL WEST ❑Y ®N RDEF71 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = 99 9 Same G01585913700 BAc $ 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)1(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL) 1 0 E/ MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 11 1 08,04 ,2025 06 44 ®AM in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 1 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 C) o" 2 ❑ 28 20 1 1 0 PM ❑Construction >E R 3 0 $I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 1 ❑AM ❑Maintenance U2 -a, ARREST NAME Manrique Zendejas. Miguel.A. 11-601 1551000168 t r El PM SLMT 1 ® 11 1 CITATIONS ISSUED 0 PENDING Utility o NSECTION CITATION NO. ROAD CLEARANCE TIME AM• 0 r 2 0 ARREST NAME Manrique Zendejas. Miguel.A. 11-709-A 1551000169 08/04 i2025 06 44 ®PM El Unknown work zone type U1 45 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 45 1551-Dede.Joseph 702 09 ,09,2025 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 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 -< ` ` --I -' r INDICATE NORTH combination):or .Z-1 p BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C - } (example:shuttle or charter bus):or L A 0 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I O - }} } transporting employees in the course of their employment(example:employee X transporter-usually a van type vehicle or passenger car):or w • i_ i..__4._._� I-.,.._�-;. - - nrotrn— ' I. } } 1 •4. Is used or designated to transport between 9 and 15 passengers,including the driver. N . for direct compensation(example:large van used for specific purpose):or L L i i _ m 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires v placarding(example:placards will be displayed on the vehicle). XI -- -I CARRIER NAME Z 71 I n iL ADDRESS 0 C) CITY/STATE/ZIP g MOTOR CARR.ID 0 Interstate 0 Intrastate 0 I I T I ❑ Not in Comm./Govt. 0 Not in Comm./Other �" --- --1 - USDOT NO. ILCC NO. m XI Source of above z MCS ❑Yes 0 No 0 Unknown Out of Service ❑Yes ❑No z Form Number 0 m Xl IDOT PERMIT NO. WIDELOAD'; 0 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 Green 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 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/T6 DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE