HomeMy WebLinkAbout2025-00058275 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 01111101111
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DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X003950308
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INVESTIGATING AGENCY DAMAGE TO ANY ❑$500 OR LESS TYPE OF REPORT 0 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$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash
®AMENDED YR 2025I 2025-00058275 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 mDUNDEE AVE Elgin
® ❑ RELATED ❑Y ®N 09 04 2025 DAM ❑YES IX]PRIVATE NO U1
mo /day/yr 07.01 ®PM FLOW CONDITION m
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glue,MI N E O W LU DA St COUNTY PROPERTY ❑Y ® N DOORING Ely #OF MOTOR ElSLOW 2 Cl)
Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD ® STOPPED U2 —I
❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ❑ FREE FLOW # LNS 0
18:DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EDUES 0 uuv 0 ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 n
FOR DAMAGED AREA(S) FRONT TOWED U1 0
NAME(LAST,FIRST,M) REYES CORTEZ.YESENIA mo / /1 9 9 2 Ford Escape 2009 00-NONE „ Oi"_, DUE TOCRASH ® ❑
13-UNDER CARRIAGE 10 i , 2 FIRE ❑
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0THER ]$I U2 4 <<Tl
F 2 SYTM 5 ❑Y ®$NE DUNK VEH. O AT CRASH 0 99-UNK15- NOWN 9 76•TOP 3 *Distraction Value ALGN 2
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR 7 POINT OF :il a 4 COM VEH El j$J 1 0
F. FIRST CONTACT 12 _;,_, _5 *IIYes.SeeSidebar U1
Z Carpentersville IL 60110 0 1 0 BK19696 IL 2025 REAR
TELEPHONE
IL D 0 1 FMCUO3G79KB00989 NONE ®Y ❑N U2 m
in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
99 9 Same NONE 1 r
`o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER
RESPONDER D
Refused ❑Y 0 N 2 XI
x DRIVER ❑ PARKED 0 DRIVERLESS 0 FED ❑PEDAL 0 EWES 0 iiuv 0 Ixv 0 Dv
/2 0 0 6 General MotorSiQoq 2022 00-NONE ,�"j t2 -_, DUE TO CRASH 0 (� 2
0 13-UNDER CARRIAGE to l E FIRE ❑ ® U2 C
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M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16.TOP 3 X
❑Y gi N ❑UNK VEH. AT CRASH 99-UNKNOWN *Oistracton Value 9 0
POINT OF s 4 COM VEH D ® U1 CO N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR 6 l'
FIRST CONTACT 6 Y��"Q,__5 •If Yes.See Sidebar
H CARPENTERSVILLE IL 60110 B 1 0 4174070B IL 2026 0
IL D 0 3GTUUDEDXNG601105 State Farm ❑Y ®N RDEF
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 =
Elgin Fire 99 9 Same 3623091-SFP-13 BAC
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HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 <
Provena St.Joseph RESPONDER
U1 =
(UNIT) (SEAT) (DOE) (SEX) {SAFT) (AIR) (INJI 1(EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)/(A.DDRESS))(TELEPHONE) (EMS) (HOSPITAL)
1 6 09 /
D
/ / 2 0
EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z
N 1 El 11 1 09/04 /2025 07 02 ®PM in a Work Zone? ®N DIRP co
1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 5
T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1
o"
2 0 28 99 / / ❑PM• ❑Construction >F
Z 3 0 1!>I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 5
❑AM 0 Maintenance U2
a REYES CORTEZ.YESENIA 11-601 1559000055 / / PM '
-' 1 ® 1 1 1 ARREST NAME ❑
o U �!CITATIONS ISSUED 0 PENDING UtilitySLMT
o N SECTION CITATION NO. ROAD CLEARANCE TIME AM• ❑
2 0 11 1 ARREST NAME REYES CORTEZ.YESENIA 3-707 1559000056 09/05 /2025 07 30 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
1559-DavE los.Yoana 201 269-Mendiola 10 ,21 /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.
. 0
r ----r•---, , I Dundw?Ave.j / I - 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-----' / / } NORTHcombination):or —I
INDICATE p1
Scats I / BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C
/ } (example:shuttle or charter bus):or 0
L ® // / tarde7Street i 3. Is designed to carry 15 or fewer passengers and operated a contract carrier O
-- / / } } } transporting employees In the course of their employment(example:employee
�. _a. --
transporter-usually a van type vehicle or passenger car):or w
L 4. Is used or designated to transport between 9 and 15 passengers,includingC---- ----; / - } } } g po the driver,
/ for direct compensation(example:large van used for specific purpose):or
/ O
__ 1 - i. < L 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m
/ / placarding(example:placards will be displayed on the vehicle). XI
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rv^n? 1/ CARRIER NAME
11 / ADDRESS 'n
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/ CITY/STATE/ZIP g
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_ MOTOR CARR.ID 0 Interstate 0 Intrastate
1 I r 1 /1 1! ❑ Not in Comm./Govt. Not in Comm./Other
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Source of above z
. IDOT PERMIT NO. WIDELOAD-; ❑Yes 0 No =
TRAILER VIN 1 m
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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.
_Adieu/Impound Lot Garage SELECT CODES FROM THE BACK OF CRASH BOOKLET
U 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY1T6
DUE TO VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE