HomeMy WebLinkAbout2025-00052135 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets II I 111 II II DIII 01100101111111
III 1111
DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X003921902
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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 El$501-$1.500 ®ON SCENE 1
VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash
0 AMENDED YR 2025I 2025-00052135 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 7
168 RT20 EB El 05
® ❑ RELATED ❑Y ®N 08 11 2025 ❑AM ❑YES El NO U1 -<
:11
_ _ g PRIVATE mo !day!yr ®PM FLOW CONDITION Ill
PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR 0 SLOW 1 cn
❑ FT/MI NESW Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD 0 STOPPED U2 --I
❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0
Qg3 DRIVER 0 PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EouES 0 NOV ❑ncv 0 DJ DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 n
T�TOWED U1 0NAME(LAST,FIRST,M) mo yr
Lemus-Medrano. Rodlofo. D. Toyota Camry 2002 00-NONE 0• >2 �/DUE TOCRASH ® 0
13-UNDER CARRIAGE 10.I 2 FIRE ❑
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL)THERDISTRACTED ® 0 U2 2 I'll
M 2 SYTM 4 ❑Y ®$NE DUNK VEH. O AT CRASH 0 99-U15-UNKNOWN 9 15•TDP 3 ,Distraction Value 9 ALGN X.
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CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POISTNTOONTACT 12 O!l®`__COir Ms SeeSideDar VEH ❑ 0 U1 1 0
Z ELGIN IL 60120 0 1 0 Y776037 IL 2025 REAR
M TELEPHONE
IL D 0 4T1 BE32K32U105276 unknown ®Y 0 N U2 m
in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
Medrano. Daniela unknown 1 r
`o HOSPITAL(TAKEN TO) INCIDENT IF IC OWNER STREET,CITY.STATE,ZIP PHONE NUMBER
RESPONDER
2 7]
m N DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL 0 EWES ❑NM CIRCLE NUMBER(S) U1
V ❑NcV ❑DV
!1 9$7 Ford Escape 2017 00-NONE 10' t2 c,�2 FIRE DUE El
CRASH 0 ® U2 2 C
o — 13-UNDER CARRIAGE
M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9.1,6•TOP 3
❑Y i N ❑UNK VEH. AT CRASH 99-UNKNOWN `0istracton Value 9 4
POINT OF 8 i 4 COM VEH D ® U1 CO
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR 5
BARTLETT I L 60103 0 1 0 Q656185 I L 2025 FIRST CONTACT 6 O,fiEAR
ITN •If See Sidecar 4C
Sn
IL D 0 1 FMCU9J95HUA89812 Country Financial ❑Y J N RDEF M
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X
Same PO10657533 BAG $
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)
3 4 11 / M 2 4 0 1 O
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/ / #OCCS D
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EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur El U2 Z
N 1 ® 11 1 08,11 /2025 05 11 ®AM in a Work Zone? ❑N DIRP D
1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 3
T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1
2 ❑ 28 03 , , 0 PM ®Construction >F
04
" 3 ❑ $I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 3
❑AM ❑Maintenance U2
o ® 11 1 ARREST NAME Lemus-Medrano. Rodlofo. D. 11-601-Ax 1525000709 , ! ID PM SLMT
o N 0 CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • 0 Utility
0 AM
t 2 ❑ ARREST NAME 08)11 12025 05 47 ®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
1525-NavE.Oscar 701 09 ,23,2025 09 00 0 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
44 ADDITIONAL UNITS FORMS.
r ----r••--, , A CMV is defined as any motor vehicle used to transport passengers or property and: Z
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` r -I Not To Scale 1 f INDICATE NORTH combing r more than pounds(example:truck or truck/trailer
1. Has a weight rating10 000
--
tan)o
BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver
_ } (example:shuttle or charter bus):or
L A 3. Is desgned tol carry 15 or fewer passengers and operated by a contract carrier I O
} } } transporting employees In the course of their employment(example:employee
transporter-usually a van type vehicle or passenger car):or w
L L.___a__. 4. Is used ordesi natedtotrans rtbetween9and15 passengers,including y} } for direct compensation(example:large van used for specific purpose):or
the driver,
L L____a____. I l. i i i _ 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires r
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placarding(example:placards will be displayed on the vehicle). m
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Unit a�nit 1iiitaillIM - ........... —D{
r CARRIER NAME Z
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ADDRESS 0
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CITY/STATE/ZIP g
p MOTOR CARR.ID 0 Interstate ❑ Intrastate �
1 I r 1 ❑ Not in Comm./Govt.; Not inComm./Other
_"."Y. "_ USDOT NO. ILCC NO. rn
Source of above z
. 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
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LOCAL USE ONLY TRAILER VIN 2 m
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TRAILER WIDTH(S) 0-96" 97-102" >102' T
TRAILER 1 ❑ ❑ 0 Z
ill
TRAILER 2 ❑ 0 0 o
u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. Z
Gold Gray
u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_
DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT 3 TOWED BY/TO.
_Redmons/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