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HomeMy WebLinkAbout2025-00055093 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 I011011001 I0fl III HIV 1VI111111 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X003934544 u, 1 u210 1 1 1 u116 U2 1 U113 u2 1 u1 1 U2 1 1 9 u1 1 U221 *P 0119* INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW ' DAMAGE TO ANY El$500 OR LESS TYPE OF REPORT El A No Injury 1 Drive Away Elgin Police Department ONE PERSON'S El5501-51.500 ®ON SCENE 1 VEHICLE/PROPERTY N OVER$1,500 El NOT ON SCENE(DESK REPORT) N B Injury and for Tow Due To Crash 0 AMENDED YR 202512025-00055093 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 6 �I 1588 JUNIOR PL Elgin09:24 ® ❑ RELATED ❑Y ®N 08 23 2025 NAM ❑YES N NO U1 -< _ g PRIVATE mo /day/yr ❑PM FLOW CONDITION MCOUNTY PROPERTY ❑Y N N DOORING ❑y #OF MOTOR 0 SLOW 1 (n ❑ FT!MI N E S W 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 Q83 DRIVER O PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EDUCE 0 uuv 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 1 0 FOR DAMAGEDAREA(S) MOM TOWED U1 0Enrique © Nava. 0 5 / yr 13-UNDER CARRIAGE ,I �:. 2 FIRE 0 N < STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ® 0 U2 M M 2 4 ❑Y ®N SYSTEM ❑UNK VEH. 0 AT CRASH O 0 99-UNKNOWN 9 16•TOP 3 *Distraction Value 6 ALGN = r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s it B �i 4 COM VEH 0 N 1 0 ~ ELGIN I L 60123 0 1 0 FIRST CONTACT 1 7_: -__5 *Irves.See Sidebar Ut Z 4108538B IL 2026 REAR TELEPHONE IL D 0 3GTU2NEC9GG294192 Farmers ❑Y ®N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 Same 543023116 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y N N 2 0 ❑ DRIVER X. PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NMv 0 NOV 0 DV CIRCLE NUMBER(S) U1 yr 10' 12 c, 2 FIRE 0 N U2 2 C o 13-UNDER CARRIAGE c SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED a SYSTEM IN 0 ENGAGED 0 15-OTHER 9.1,6•TOP3 0 ® SPDR n ❑Y i N DUNK VEH. AT CRASH 99-UNKNOWN *Oistrac8Dn Value 9 U1 9 '' POINT OF 8 ) -4 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR S COM VEH ❑ N CO F,,, FIRST CONTACT 7 O7 ,�=QI 105 •IfYes See Sidebar C CF32809 IL 2025 0 N M . STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0 3N1AB7AP7HY397343 Allstate ❑Y 123 N RDEF71 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = 99 9 Perez. Melanie 811662664 BAG $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP U1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ) 1(EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)/{ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL) 1 5 03 / 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 18 1 08/23 /2025 09 24 ®❑pm in a Work Zone? ®N DIRP co 1 r PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 3 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 0 2 40 28 / / ❑PM ❑Construction >F Z 3 ❑ N CITATIONS ISSUED ❑PENDING SECTION CITATION NO. EMS ARRIVED TIME 3 ❑AM ❑Maintenance U2 a ® 11 1 ARREST NAME Nava. Enrique 11-601 W1543000228 / / ID PM SLMT o N ❑CITATIONS ISSUED ElPENDING SECTION CITATION NO. ROAD CLEARANCE TIME ❑Utility AM U1 25 r 2 ❑ ARREST NAME 08/23 /2025 10 00 [M PM ❑Unknown work zone type n 7 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑Y 25 1543-Sturgeon. Kyle 600 - / / 0 PM N 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- -----------1 16887,hP1011P1 - } combination):or INDICATE NORTH 531 LT BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C _ } (example:shuttle or charter bus):or X < <---- -•-•; I . 1. :- 1. transporting mployeeslin 5 he courses r o their employmenters d example:employee transporter-usually a van type vehicle or passenger car):or co L 4. Is used or designated to transport between 9 and 15 passengers,including C}--- ----; - } } g Po passen rs,includi the driver, for direct compensation(example:large van used for specific purpose):or ! t i 5. Is anyvehicle used to transport anyhazardous material(HAZMAT)that requires r r--- 71 --r----iii lrnitl XIo� placarding(example:placards will be displayed on the vehicle). iUnit2 CARRIER NAME Z JunflP1 _ __ ADDRESS O N rn CITY/STATE/ZIP n g r I _ MOTOR CARR.ID ❑ Interstate ❑ Intrastate r I ❑ Not in Comm./Govt. Not in Comm./Other o Y_-_-. Not To Scale 1 N _ ; ; ; ; ❑ << USDOT NO. ILCC NO. m XI Source of above z . xi 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 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 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 Red Black u 1 TOWED • TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT' 1 TOWED BY/TO. SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® DISABLING DAMAGE Arties/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE