HomeMy WebLinkAbout2025-00052417 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets _ II
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DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X003925568
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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 ®5501-$1.500 ®ON SCENE 2
VEHICLE/PROPERTY ❑OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash
0 AMENDED YR 2025I 2025-OOO5Z417 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 rn
S MCLEAN BLVD Elgin 05:23
® ❑ RELATED ®Y 0 N 08 12 2025 12,— ❑YES ®NO U1
_ _ PRIVATE mo !day!yr ®PM FLOW CONDITION MFT/MI N E S W LI LLIAN ST COUNTY PROPERTY ❑Y ® N DOORING Ely #OF MOTOR 0 SLOW 3 Cl)
❑ Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD 0 STOPPED U2 —I
® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N 51 FREE FLOW # LNS 0
g DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EOUES 0 WV 0 NCV 0 DJ DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 3 0
0 7 /
yr 13-UNDER CARRIAGE lE
101 ! 2 FIRE ❑
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 3 M
F 2 4 ❑Y ®SYSNEM❑UNK VINEH. O AT CRASHD 0 99--UUNKNOWN THER 9 76.70P 3 ,Distraction Value 9 ALGN =
T. CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF S_iL 6 I, 4 COM VEH 0 El 1 0
I .
ELGIN IL 60123 0 1 0 FIRST CONTACT 1 7. •, *IrYes.See Sidebar Ut
Z FM24460 IL 2025 REAR
TELEPHONE
IL D 7 1 FAFP34N57W317282 Uninsured ®Y ❑N U2 m
in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
99 9 Same Uninsured 1 r
`o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER
RESPONDER D
Refused ❑Y ® N 2 XI
g DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 New 0 Ncv ❑Dv
!1 9 yf 5 Chrysler Town&Country 2001 13-NONE 1 t2 (,�2 FIRE DUE O CRASH 0 ® U2 2 C
oil 13-UNDER CARRIAGE
M 2 4 SYSTEM IN 0 ENGAGED 0 ®-OTHER 9:1,6•TOP 3 X
❑Y MN DUNK VEH. AT CRASH 99-UNKNOWN POINT OF
t *Oistractlon Value
9 0
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR 64 COM VEH 0 ® U1 CO
.5 FIRST CONTACT QS , _5 •If Yes.See Sidebar
Bartlett IL 60103 B 1 0 EY27691 IL 2024 I 0
IL D 7 2C8GP54L01 R109706 Kemper ❑Y ®N RDEF Xl
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 =
99 9 Same 12AU001572760 BAc $
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP 996 <
Refused RESPONDER U1 =
(UNIT) (SEAT) (DOE) (SEX) {SAFT) (AIR) (INJI 1(EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)!(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL)
2 6 03 /
:A
/ / UI 1 D
/ / 3 0
EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z
N 1 ® 11 1 08,12 /2025 05 23 ®pm 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
0 2 ❑ 03 04 ! ! 0 PM ❑Construction >E
N 3 0 $I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 1
❑AM ❑Maintenance U2
—a, ARREST NAME Mazariegos Mazariegos. Estefany Yolanda 11-601-Ax 1564000037 / / 0 PM SLMT
o N 1 ® 11 1 igi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ' ❑Utility
AM 30
t 2 El ARREST NAME Mazariegos Mazariegos. Estefany Yolanda 3-707 1564000036 ! / 0 pM ❑Unknown work zone type U1
2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 30
1564-Rea. Desiree 702 09 , 16,2025 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
1../ 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 -<
} }---_r__--; I } combination):or —I
4. INDICATE NORTH p1
1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C
lJe1t02 N (example:shuttle or charter bus):or
I A 3. Is designed to carry15 or fewer passengers and operated a contract carrier 0
I'. Not To Scale II } } } transporting employee in the course of their employment(example:employee X
I l transporter-usually a van type vehicle or passenger car):or w
L ----------- j• ° - I. } } •4. Is used or designated to transport between 9 and 15 passengers,including the driver. N
1 for direct compensation(example:large van used for specific purpose):or
L L____a____. _ L L Li. L 5. Is any vehicle used to transport anyhazardous material(HAZMAT)that requires m
in
placarding(example:placards will be displayed on the vehicle). XI
CARRIER NAME Z
I ADDRESS 'O
IICITY/STATE/ZIP g
I _ i. i. i. MOTOR CARR.ID 0 Interstate 0 Intrastate
I I T I ❑ Not in Comm./Govt. 0 Not in Comm./Other
; _Y_ __1 I I - i. USDOT NO. ILCC NO.
m
.M x
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 ❑ 0 z
TRAILER 2 ❑ 0 0 o
u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w
Gold White
u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_
DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT' 2 TOWED BY/TO:
_ SELECT CODES FROM THE BACK OF CRASH BOOKLET
U 2 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/TO.
DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE