HomeMy WebLinkAbout2025-00060515 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 Df 4 Sheets 01111101111
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DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X003966625
u, 1 U21 1 1 1 U1 7 U216 U, 1 1_12 1 U, 1 U2 1 1 9 U1 1 U221 *P 0119*
INVESTIGATING AGENCY DAMAGE TO ANY El$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 El NOT ON SCENE(DESK REPORT) ® B Injury and for Tow Due To Crash
El AMENDED
YR 2025I 2025-00060515 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 �l
® ❑ RELATED ❑Y ®N 09 14 2025 ❑AM ❑YES ®NO U1 -<
RAYMOND ST Elgin04:51
_ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION ITl
1 0 /MI N E S VY MaySt COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 6 (n
® ® 0 Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD DO
U2 --I
❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0
DRIVER t] PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uuv 0!Cy 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 n
FOR DAMAGEDAREA(S) FROM TOWED U1 O
Unruh.Andrew Curtis 0 1 /
yr 13-UNDER CARRIAGE 10.I • 2 FIRE 0
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14--TOTAL(ALL) DISTRACTED 0 0U2 2 I'Tl
M 2 OTHER
5 ❑Y ®SYSNEM IN❑UNK VEH. O AT CRASH O 9:UNKNOWN 9 76.70P 3 ,Distraction Value 9 ALGN =
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6 it 6 4 COM VEH 0 El 1 0
~ SOUTH ELGIN IL 60177 0 1 0 FIRST CONTACT 12 7_;1 __5 *IIYes.See Sidebar U1
ZFH86584 IL 2025 E
TELEPHONE
IL D 7 2FM H K6DT8DBD00065 99108282 El ®N U2 r 1 R
in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
Same Progressive 1 r
`o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER
RESPONDER D
Refused 0 Y El 2 eu
0 DRIVER X. PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0!My 0 Ncv 0 CIRCLE NUMBER(S) U1
DV
!1 9 9 3 Ford Ranger 1992 00-NONE +i_"' 12'-_, DUE TO CRASH ❑ (� 2
0 13-UNDER CARRIAGE 101 y FIRE ❑ ® U2 C
c
M 2 4 SYSTEM IN 0 ENGAGED 0 ®-OTHER 9 16.TOP 3 9 0 X
❑Y i N DUNK VEH. AT CRASH 99-UNKNOWN *Oistraellon Value
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR PFIRST CONTACT 6 NT OF Y�!ifi'li-__5 CIOf Ms geeSH ideear❑ ® U1 CO
C
= ELGIN IL 60120 0 1 0 4130224B IL 2025PEAR 0
IL D 1 FTCR14U8NPB05311 Uninsured ®Y ❑N RDEF71
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 =
99 9 Same Uninsured BAc $
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP 996 <
Refused RESPONDER U1 =
(UNIT) (SEAT) (DOB' (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)+(ADDRESS)+(TELEPHONE) (EMS) (HOSPITAL)
0 O
EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur El U2 Z
u 1 ® 18 1 09,14 /2025 04 54 0 AM in a Work Zone? ®N DIRP co
I I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 5
T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 C)
v 2 0 28 24 09,14 ,2025 04 53 ®PM ❑Construction G >F
R 3 0 xi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 5
❑AM ❑Maintenance U2
a ® 11 1 ARREST NAME Unruh.Andrew Curtis 11-601 1564000061 09,14/2025 04 57 Igi pM• ❑Utility SLMT
j$!CITATIONS ISSUED 0 PENDING SECTION CITATION NO. ROAD CLEARANCE TIME AM
r 2 El ARREST NAME Leon Villagomez. Diego Armando L P1564-000005 09+14 ,2025 06 01 ®PM El 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
1564-Rea. Desiree 401 223-Hughes 10 ,21 ,2025 09 00 ❑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
.-., I .1 ,A ADDITIONAL UNITS FORMS.
-_ Not To Scale I A CMV is defined as any motor vehicle used to transport passengers or property and: z
N z
�____r____; I _ 1. Hasa or more than pounds(example:truck ortruckrtrarler
c1. Hasa weight rating10 000
INDICATE NORTH tan)
BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C
♦_L.. 0
_ } (example:shuttle or charter bus):or
3. Is designed to} A i } carry15 or fewer passengers and operated a contract carrier O
- -
. - ---•
} } transporting employee �In the course of their employment(example:employee
transporter-usually a van type vehicle or passenger car):or w
i. �.___a__-_� _� c - I. } } 1. •4. Is used or designated to transport between 9 and 15 pa ssengers,ssen rs,includingthedriver. y I
for direct compensation(example:large van used fors specific purpose):or
---; Unit ill
i i t 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires
I. '1 placarding(example:placards will be displayed on the vehicle). XI
l 1 ff.MN D
CARRIER NAME z
IIII Z
ADDRESS 'n
lij �
G. CITY/STATE/ZIP 0
Unft#2
MOTOR CARR.ID 0 Interstate 0 Intrastate
0
1 I r 1 ❑ Not in Comm./Govt. 0 Not in Comm./Other
i- --- --1 - USDOT NO. ILCC NO. 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
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
Tan Gray
u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_
DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT- 3 TOWED BY/TO.
_Redmons/Impound Lot Garage . SELECT CODES FROM THE BACK OF CRASH BOOKLET
U 2 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/TO:
DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE