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HomeMy WebLinkAbout2025-00058138 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 I011011001 I0H 1111I110110011 DRAG TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X003950318 u111 U2 U1 2 4 1 U1 3 U2 1 U1 1 U2 1 U1 1 U2 1 1 15 U1 1 U2 1 .P0119* INVESTIGATING AGENCY DAMAGE TO ANY El$500 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$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash 0 AMENDED YR 2025I 2025-00058138 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 7 ® ❑ RELATED ®Y 0 N 09 04 2025 ®AM ❑YES ®No U1 -< ANN ST Elgin 08:08 _ _ g PRIVATE mo /day/yr ❑PM FLOW CONDITION m FT l MI N E S W DUNDEE DEE AVE COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 1 (n ❑ Kane HIT&RUN ❑V ® N WITH VEHICLES INVLD ❑ STOPPED U2 --I ® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N 51 FREE FLOW # LNS 0 Qg3 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uuv 0 wcv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 n FOR DAMAGED AREA(S) FROr4T TOWED U1 Q Soto.Abigail 0 5 / yr 13-UNDERCARRIAGE I! FIRE ❑ al STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 10 O DISTRACTED 0 0 U2 4 M F 2 8 SYIN ENGAGED 15- ❑Y ®SNE❑UNK VEH. 0 AT CRASH 0 99-UUNKNOWN 9 16•TOPO `Distraction Value ALGN = r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6 iI 6 it COM VEH El Ea 1 n F. FIRST CONTACT 3 7 _,--_;_OS •IIYes.See&debar U1 0 Z ELGIN IL 60120 B 1 0 AZ29190 IL 2025 REAR TELEPHONE IL D 4A4AP4AU3FE015959 Progressive ❑Y ❑N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Elgin Fire Aponte. Martha. I. Unknown 1 o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER r RESPONDER D Sherman El ® N 2 ou p; DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NMV 0 NOV 0 DV /1 9 9 5 Volkswagen Atlas 2024 00-NONE of 2 j p DUE TO CRASH 0 ❑ 2 x o 13-UNDER CARRIAGE 19 i ©1l 2 FIRE ❑ ® U2 C c F 2 8 SYSTEM IN 0 ENGAGED 0 15-OTHER 9,16•TOP 3 X ❑Y NJ N ❑UNK VEH. AT CRASH 99-UNKNOWN `Distraglon Value 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6-it 6 1, COM VEH D ® U1 CO FIRST CONTACT 1 Y• _, _6 •)ryes.See Sidebar = ELGINREAR IL D 3VVUX7B27RM057005 Geico ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Elgin Fire Same 4434868313 BAG $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Sherman RESPONDER u1 = (UNIT) (SEAT) (DOBi (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME),(ADDRESS)+(TELEPHONE) (EMS) (HOSPITAL) 1 6 06 / 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 Ramirez.Gustavo Tree in front yard 91 ,12 /25 08 08 ®❑pM AM in a Work Zone? ®N DIRP co 1 t PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 7 I PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ®AM U1 2 0 41 6 322 DUNDEE AVE ELGIN IL 60120 23 99 91 ,12 /25 08 08 PM 1 ❑ 0 Construction * R O ❑ CITATIONS ISSUED ❑PENDING SECTION CITATION NO. EMS ARRIVED TIME 5 3 ®AM 0 Maintenance U2 -, ER 11 1 ARREST NAME Soto.Abigail 11-1204-B S350643 91 ,12 /25 08 08 0 PMSLMT 1$4 CITATIONS ISSUED 0 PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ❑Utility o N 0 AM 30 t 2 El ARREST NAME Soto.Abigail 3-707 S350644 , / pM 0 Unknown work zone type U1 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 30 350-Farrell. Heather 102 10 , 14,2025 09 00 0 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••--, , I I - . A CMV is defined as any motor vehicle used to transport passengers or property and: Z ` ` ' ' °ndL° r INDICATE NORTH 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer combination):or -< I p0 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C _'I IL — _ (example:shuttle or charter bus):or C ID 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I O _-- } F } transporter-usuluyavans in typ course of vehicle or employment or(example:employee �-- Po Y type passenger car):or � L }-----}----+ v"�` - } } 1 •4. Is used or designated to transport between 9 and 15 passengers,including the driver. C mos, for direct compensation(example:large van used for specific purpose):or L L--_-a-.... _. t 5 Is any vehicle used to transport any hazardous material(HAZMAT)that requires placarding(example:placards will be displayed on the vehicle). m;p I I Not To Scale . CARRIER NAME z ADDRESS 0 CITY/STATE/ZIP n g - MOTOR CARR.ID 0 Interstate El Intrastate I r ❑ Not in Comm./Govt. Not in Comm./Other0 ;__._Y. __ I USDOT NO. ILCC NO. rn 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 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 Gray Silver 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