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HomeMy WebLinkAbout2025-00055685 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 01111101111 I011011001 I1111 0111 01000 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X00393.1S0 u, 1 U21 1 1 1 U1 8 U2 1 U, 1 1_12 1 U, 1 U2 1 1 10 u1 3 U2 3 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY El 5500 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$1,500 ❑NOT ON SCENE(DESK REPORT) (83 B Injury and/or Tow Due To Crash El AMENDED YR 2025I 2025-00055685 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n ® ❑ RELATED PRIVATE ®Y 0 N 08 25 2025 ❑AM ❑YES ®NO U1 RT20 EB I LARKIN AVE Elgin mo /day/yr 04:40 ®PM FLOW CONDITION M ^2 COUNTY PROPERTY ❑Y 21N DOORING Ely #OF MOTOR 0 SLOW 1 (n 020 ® O/MI N S W Rt.20 WITH VEHICLES INVLD 0 STOPPED U2 --I El AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) Kane HIT&RUN ❑V ® N PEDALCYCLIST®N 51 FREE FLOW # LNS 0 18:DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uuv 0 icy ❑Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) y N 4 n 12 FOR DAMAGEDAREA(S) FRONT TOWED U1 Q NAME(LAST,FIRST,M) Hammond.Arlene. K. mo / /1 9 6 0 Toyota Corolla 2020 00-NONE Q. O 17T DUE TO CRASH ® ❑ 13-UNDER CARRIAGE } �:/ FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) O O �O DISTRACTED 0 ]$I U2 4 (<Tl F 2 4 ❑Y ESYlM❑UNK VEH. 0 AT CRASH 0 99-UUTHER NKNOWN O9 1a-7 `Distraction Value ALGN = r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 7 i 6 Li,4 COM VEH 0 0 1 0 " �- SOUTH ELGIN I L 60177 0 1 0 FIRST CONTACT 11 7 : --5 *IIves.See Sidebar u1 ZCE79822 IL 2025 REAR TELEPHONE IL D 0 4T1 F31AKXLU523350 State Farm ❑v IlN U2 I' IL'in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 PENA. PATRICIO 1844672SFP13 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER RESPONDER 2 eu x DRIVER 0 PARKED 0 DRIVERLESS ❑ FED 0 PEDAL 0 EWES 0 uv 0 NOV ❑DV /2 0 0 2 Dodge Charger 2015 00-NONE Q j ©Loa)DUE TO CRASH ❑ 2 0 13-UNDER CARRIAGE ©I, E FIRE 0 ® U2 C P: M 2 4SYSTEM IN 0 ENGAGED 0 15-OTHER 9,,16-TOPO3 * X 0 Y ®N 0 UNK VEH. AT CRASH 99-UNKNOWN O Distraction Value 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s-.;, 6 1( 4 COM VEH ❑ ® u1 CO FIRST CONTACT 1 7 -5 *It Yes.See Sidebar z ELGIN IL 60120 0 1 0 EG39462 IL 2025 REAR 0 N IL D 0 2C3CDXBG5FH776671 State Farm ❑Y 123 N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = 99 9 ERASMO.AYALA 0149447SFP13 BAG $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP U1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)((ADDRESS)((TELEPHONE) (EMS) (HOSPITAL) 2 3 02 / M 2 8 C 1 0 m / / #OCCS D P3 / / U1 1 D / / 2 0 EV MOST EVNT LOC, DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 11 1 08/25 /2025 04 40 0 pm in a Work Zone? ICJ 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 0 2 0 04 99 / / 0 PM ❑Construction >F 4 R 3 0 $I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 3 ❑AM 0 Maintenance U2 a 1 ® 11 1 ARREST NAME Hammond.Arlene. K. 11-601-Ax 1528-000300 / / El PM SLMT I$!CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME AM• • ❑Utility Ti 2 0 21 1 ARREST NAME Hammond.Arlene. K. 11-709-A 1528-000299 08/25 /2025 05 30 0 PM El Unknown work zone type U1 55 2 2 3 ElOFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑AM Workers present? ❑Y 55 1528-Rivera. Kevin 702 269-Mendiola 09 /22/2025 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 c ` Z 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer -< -' -' r INDICATE NORTH combination):or ARROW 2 Is used or designed to transport more than 15 passengers including the driver C (example:shuttle or charter bus):or ''''''—!--------.°1/ r ;BY • 3. Is desgned to carry 15 or fewer passengersandoperated by acontractcarrier I O} } transporting employees In the course of their empbyment(example:employee X transporter-usually a van type vehicle or passenger car):or w L L.__-a-_ ———— — 4. Is used or designated to transport between 9 and 15 passengers,including the driver, C } } for direct compensation(example:large van used for specific purpose):or r <--_-a-___. t i } t 5. Is any vehicle used to transport anyhazardous material(HAZMAT)that requires rn placarding(example:placards will be displayed on the vehicle). ;p CARRIER NAME Z ADDRESS 0 V) C) *.>§�J CITY/STATE/ZIP MOTOR CARR.ID 0 Interstate 0 Intrastate l I r l ❑ Not in Comm./Govt. 0 Not in Comm./Other � --- --1 - USDOT NO. ILCC NO. m XI Source of above z IDOT PERMIT NO. WIDELOAD-; ❑Yes 0 No = 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 Silver Blue u 1 TOWED • TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT- 3 TOWED BY/TO. Arties/Impound Lot Garage 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