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HomeMy WebLinkAbout2025-00056980 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets Mil l III H IIII 1111111111111110111111�HIIIIOII DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X003943175 u, 1 U21 1 1 1 U1 2 U2 1 U, 1 u2 1 U, 1 U2 1 1 10 u1 3 U2 1 *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 2 VEHICLE/PROPERTY ®OVER 51,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash 0 AMENDED YR 2025I 2025-00056980 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 �l ® ❑ RELATED PRIVATE ❑Y ®N 08 30 2025 ❑AM ❑YES ®No u1 -< N MCLEAN BLVD Elgin mo /day/yr 06:35 ®PM FLOW CONDITION Ill ®50 0/MI N E 0 VY Weatherstone Ln COUNTY PROPERTY ❑Y ® N DOORING Ely #OF MOTOR 0 SLOW 2 rn Kane HIT&RUN ❑V ® N WITH VEHICLES INVLD 0 STOPPED U2 --I El 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 uuv 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 n FRO 0Morales. Miguel Toyota RAV4 2005 00-NONE sf4T TOWED U1 OUETOCRASH ® ❑ NAME(LAST,FIRST,M) g mo yr 13-UNDER CARRIAGE ©,I 0,,:O FIRE 2 0 tz STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ❑ 0 U2 2 rrl M 2 5 ❑Y ON SYSTEM DUNK VEH. 9 AT CRASH 99-OTHER WN 9 16•TOP 3 ,Distraction Value ALGN = r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s i�6 �i 4 COM VEH 0 Ea 1 0 ELGIN I L 60123 0 1 0 FIRST CONTACT 11 7_: __5 *Ilsees.See Sidebar U1 Z FG52425 IL 2025 REAR TELEPHONE IL D 0 JTEG D21 A550109482 American Alliance ❑v ®N U2 1— in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 Morales. Esteban. M. ILAA107631600 1 r o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER RESPONDER 2 ou m g DRIVER 0 PARKED 0 DRIVERLESS ❑ FED 0 PEDAL 0 EWES 0 row 0 NOV 0 Dv yr ��l t2 ( z FIRE ❑ ® U2 C o 13-UNDER CARRIAGE c M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9.16-TOPO3 * X ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN 0istraction Value 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s-.;, 6 1,:,_ COM VEH ❑ ® U1 CO FIRST CONTACT 2 7-'_,__5 •IfYes.See SidebarC = ELGIN IL 60123 0 1 3750099B IL 2025 REAR 0 IL D 0 1 C6RR7GG5JS311087 Bristol West ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = 99 9 Same G01636794400 BAc $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP 996 < Refused RESPONDER U1 = (UNIT) (SEAT) (DOB1 (SEX) {SAFT) (AIR) (INJI (EJCTI (EPTH) PASSENGERS&WITNESS ONLY (NAME)((ADDRESS)((TELEPHONE) (EMS) (HOSPITAL) 2 3 1 0 / 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 08/30 /2025 06 37 ®PM in a Work Zone? ®N DIRP co 1 I PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME ❑AM If YES check one below: U1 7 C) T o" 2 0 2 99 / / ❑PM• ❑Construction Z 3 ❑ xi CITATIONS ISSUED El PENDING SECTION CITATION NO. EMS ARRIVED TIME 1 ❑AM 0 Maintenance U2 aEl 11 1 ARREST NAME Morales. Miguel 11-902 1512580 / / El PM SLMT o N ❑CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • 0 Utility El AM t 2 El ARREST NAME 08/30 /2025 07 00 0 PM El Unknown work zone type U1 35 n T OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 0 1512-Juarez-Huichapan.Juan 600 391-Jacobucci 10 /07/2025 01 30 ®PM Am Workers present? ®N U2 35 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 -< ' 0 r INDICATE NORTH combination):or p3 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C r'MOoam" _ } (example:shuttle or charter bus):or i _ Not To Sca/s_ I 3. Is designed to carry15 or fewer passengers and operated a contract carrier 0 I- I- -A- --i — — } } i- transportingemployee in the course of their employment(example:employee transporter-usually a van type vehicle or passenger car):or w i. i. ..,. ..; 1 - 1. } } 1 •4. Is used or designated to transport between 9 and 15 passengers,including the driver. N for direct compensation(example:large van used for specific purpose):or 0 L ..i.. . - t i. i 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires •u I 7 I I t I placarding(example:placards will be displayed on the vehicle). ,Zmt 9757N?Mctean CARRIER NAME Z - I Blvd O i. i...__ ADDRESS D w ..nwn.... CITY/STATE/ZIP g _ i. i. i. i. 4. MOTOR CARR.ID 0 Interstate ❑ Intrastate I ❑ Not in Comm./Govt. ❑ Not in Comm./Other 00 � "Y""1 USDOT NO. ILCC NO. C m XI Source of above 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 to 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 Black Black 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—