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HomeMy WebLinkAbout2025-00053217 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 011011001 01110 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV XO03924849` u1 1 U21 2 4 1 U1 5 U2 1 U1 1 U2 1 U1 1 U2 1 1 10 U1 3 U2 1 .P0119* INVESTIGATING AGENCY DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT El 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$1,500 El NOT ON SCENE(DESK REPORT) El B Injury and/or Tow Due To Crash El AMENDED YR 2025I 2025-00053217 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n ® ❑ RELATED PRIVATE ❑Y ®N 08 15 2025 ❑AM ❑YES ®NO U1 -< SUMMIT ST Elgin mo /day/yr 05:45 ®PM FLOW CONDITION M 05° /MI NOS W Hiawatha Dr COUNTY PROPERTY ❑Y ® N DOORING El #OF MOTOR ElSLOW 15 u) Cook HIT&RUN ❑Y ® N WITH VEHICLES INVLD ❑ STOPPED U2 --I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ❑ FREE FLOW # LNS 0 tg:DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NIAV 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 n FOR DAMAGEDAREA(S) FROPtf TOWED U1 O Mora Duran. Maria.A. 0 1 / yr 13-UNDER CARRIAGE t FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 2 DISTRACTED 0 0U2 2 rn F 2 4 SYSTM • ❑Y IN NE DUNK VEH. 0 AT CRASH 99-UNKNOWN THER9 16•TOP 3 *Distraction Value 9 ALGN X. r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s, it 6 �i 4 COM VEH 0 j$J 1 0 H 60110 B 1 0 FIRST CONTACT 11 7_;1 __5 *IIYes,SeeSidebar U1 Z FG78421 IL 2026 E TELEPHONE IL D 0 SFNYF18555B057455 American Allience ❑Y ign4 U2 13 , m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 Same I LAA-1067394-00 1 r o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused El ® N 2 0 m �{ DElVER ❑ PARKED ❑DRIVERLESS 0 KO 0 PEDAI 0 EWES 0 Nov 0 i v 0 DV /1 9$3 Ford Escape 2014 oo-NONE 11-i ©Lilo)DUE TO CRASH rg ❑ 2 x 13-UNDER CARRIAGE I FIRE 0 ® U2 M 2 6 SYSTEM IN 0 ENGAGED 0 15-OTHER 9I 1,6.TOP 3 X ❑Y i N ❑UNK VEH. AT CRASH 99-UNKNOWN `Oistractlon Value 9 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s-iI 6 i_i, 4 COM VEH 0 ® U1 CO FIRST CONTACT 1 Y• _, _5 •(ryes,See Sidebar H ELGINREAR C M IL 60120 0 1 0 MB83-BD IL 2014 IL D 0 1 FMCU9JX1 EUD06900 Statefarm ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER 1 = 99 9 Same 0994230-SFP-13 BAC $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPONDER u1 = (UNIT) (SEAT) (000i (SEX) {SAFT) (AIR) (INJI 1(EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)/(ADDRESS)/(TELEPHONE) (EMS) (HOSPITAL) 1 3 12 / / / UI 2 :A D / / 2 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z u 1 ® 11 1 08/15 /2025 05 45 ®AM in a Work Zone? ®N DIRP co 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 C) v 2 0 06 2 08/15 /2025 05 55 ®pM El Construction R 3 ❑ xi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 7 z J ❑AM ❑Maintenance U2 o1 ® 11 1 ARREST NAME Mora Duran, Maria.A. 6-101 S1563-000052 08/15/2025 06 08 Igi pM• • El SLMT j$!CITATIONS ISSUED 0 PENDING SECTION CITATION NO. ROAD CLEARANCE TIME AM r 2 El ARREST NAME Mora Duran, Maria,A. 11-801-A S1563-000051 08/15 /2025 07 10 0 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 1563-Rodriguez,Carlos 201 09 / 16/2025 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 truckrtrailer -< } }--__r-_--; } combination):or —I oz INDICATE NORTH p1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C t- (example:shuttle or charter bus):or 0 L A I 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier 0 [ ; } I.- transporting employees in the course of their employment(example:employee 73 a I } transporter-usually a van type vehicle or passenger car):or I J I. N 4. Is used or desi nated to trans rt between 9 and 15 ge ng rCjt Nor To Scala ' • } } } g po passen rs,includi [he driver, i I for direct compensation(example:large van used for specific purpose):or O L L____a____.l sumnrrneAn. _ t i. i i 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m ' placarding(example:placards will be displayed on the vehicle). X/ >lnuez— - - -- CARRIER NAME Z ADDRESS 0 I C r r T 1 I [ . . . . — CITY/STATE/ZIP 0 g i i. i. i. i. MOTOR CARR.ID 0 Interstate 0 Intrastate ' ❑ Not in Comm./Govt. ❑ Not in Comm./Other 0 ‘I. - "4 USDOT NO. ILCC NO. C m XI Source of above z . • m 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 0 No 0 Unknown M 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 co LOCAL USE ONLY TRAILER VIN 2 m 0 TRAILER WIDTH(S) 0-96" 97-102" >102' -n TRAILER 1 0 0 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 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: 3 TOWED BY/TO: DUE TO ® Redmons/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE