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HomeMy WebLinkAbout2025-00061104 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 I011011001 01111 lU 100 000 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X003966728 u, 1 U2 U2 3 4 1 U116 U2 1 U1 1 U2 1 1.11 1 U2 1 1 11 U1 11 U2 11 *P 9* INVESTIGATING AGENCY DAMAGE TO ANY ❑$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$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash 0 AMENDED YR 202512025-00061104 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 I ® ❑ RELATED ❑Y ®N 09 17 2025 ❑AM ❑YES ®NO U1 -< S RANDALL RD Elgin02:54 _ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION m 1 O !MI N E S W HO S Rd COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ®SLOW 1 (n ® pp Kane HIT&RUN ❑Y ® N WITH VEHICLESOT, INVLD ❑ STOPPED U2 --I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ❑ FREE FLOW # LNS 0 18:DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EOUES ❑NW ❑Ncv ❑Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 6 n FOR DAMAGEDAREA(S) FROM TOWED U1 O NAME(LAST,FIRST,M) Argumedo Garcia.Saul.O. mo 0 6 / !1 9 yr7 T 3 Jeep(after 196 i0nd Cherokee 2011 00-NONE ©, Off, 0DUE TO CRASH ® ❑ 13-UNDER CARRIAGE 10 2 FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 6 m M 2 SY 15-OTHER 4 ❑Y ®SNE❑UNK VEH. O AT CRASH M IN D O 99-UNKNOWN 9 16•TOP 3 *Distraction Value ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF S,;i�S 4 COM VEH 0 j$J 1 0 ~ ELGIN N I L 60123 0 1 0 FIRST CONTACT 12 7 ; _5 *Irves.See Sidebar U1 ZDD73094 IL 2025 REAR TELEPHONE IL D 0 1J4RR5GT2BC71342 Magnum Insurance ❑Y Il N U2 13 . m 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 Same ILS119680200 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER 73 D Refused 0 Y ® N 2 0 m x DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL 0 EWES ❑ uv 0 Ncv ❑Dv CIRCLE NUMBER(S) U1 !2 0 0 2 Saturn ION 2003 00-NONE 'o,1 t2 (,-2 FIRE DUE O CRASH 0 ® U2 2 C o Yr 13-UNDER CARRIAGE c M 2 4SYSTEM IN 0 ENGAGED 0 15-OTHER 9.1,6•TOP 3 0 Y ®N 0 UNK VEH. AT CRASH 99-UNKNOWN *Oistraglon Value 9 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8 1 S .t. 4 C.OM VEH ❑ ® Ut CO F,,, FIRST CONTACT 6 O7 ,�_QOS •If Yes.See Sidebar C ELGIN IL 60123 0 1 0 KRT2702 IL 2025 REAR 0 fp M IL D 0 1G8AF52F53Z190275 Geico ❑Y ®N RDEF 7) EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X 99 9 Same 6144509889 BAC E 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) 1 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z N 1 ® 11 1 09 r 17 l2025 02 54 ®AM in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 1 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM u1 o" 2 ❑ 28 99 1 ! ❑PM• 0 Construction * R 3 ❑ $I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 1 ❑AM 0 Maintenance U2 oEl 11 1 ARREST NAME Argumedo Garcia.Saul.O. 11-601-Ax 1515-000734 r r ❑PM SLMT o N iffi CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • 0 Utility AM 45 r 2 0 ARREST NAME Argumedo Garcia.Saul.O. 6-303-A 1515-000733 r r DI PM 0 Unknown work zone type U1 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑AM Workers present? ❑Y 45 1515-BellEck.Stacy 702 10 ,07 r2025 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 A ADDITIONAL UNITS FORMS. r ----r••--, , N - A CMV is defined as any motor vehicle used to transport passengers or property and: Z @x n3x.!.- 1. Has than pounds(example:truck or truck/trailer -< } }____r____; I I _ } combination): rating more10, O INDICATE NORTH -1 y i BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver _ } (example:shuttle or charter bus):or r r r X 3. Is designed to carry15 or fewer passengers and operated a contract carrier O } } transporting employee in the course of their employment(example:employee 1 1 1 1 } transporter-usually a van type vehicle or passenger car):or X -- f - } } 1. •4. Is used or designated to transport between 9 and 15 passengers,including the driver, N ♦ / III for direct compensation(example:large van used for specific purpose):or O } } } '- 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m _r1 placarding(example:placards will be displayed on the vehicle). XI 1 -- f^, I - CARRIER NAME Z I ADDRESS 0 T. I iii 0 0 CITY/STATE/ZIPg - i. i. i. i. MOTOR CARR.ID 0 Interstate El Intrastate ' I I ❑ Not in Comm./Govt. 0 Not in Comm./Other0 1 ‘I. -- - -- , .Y_ _. I I USDOT NO. ILCC NO. 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 White Maroon u 1 TOWED • TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT' 1 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: 1 TOWED BY/TO: DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE