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HomeMy WebLinkAbout2025-00061879 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 01111101111 011011001 011 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X00396:588� u, 1 U21 2 4 2 U1 4 U2 1 U1 1 U2 1 U1 1 U2 1 1 15 U1 15 U2 1 *P 0119 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 14 VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and for Tow Due To Crash El AMENDED YR 2025I 2025-00061879 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 rn ® ❑ RELATED ®Y ❑N 09 20 2025 DAM ❑YES ®NO U1 S LIBERTY ST Elgin04:17 _ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION m FT!MI N E S W BENT ST COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 3 (A ❑ Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD ❑ STOPPED U2 —I ® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N 51 FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EouES 0 NW 0 Ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 FOR DAMAGEDAREA(S) FROM Solis-Garcia.Guadalu e 0 6 / yr 13-UNDER CARRIAGE ©, :: FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 gi U2 0 m M 2 SYTM IN ENGAGE15-OTHER 4 ❑Y ®S NE❑UNK VEH. O AT CRASHD O 99-UNKNOWN 9 16•TOP 3 `Distraction Value 9 ALGN 2 T. CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF & i�6 4 COM VEH El Ea 2 O F. FIRST CONTACT 12 7_:-__,__5 *Irves.See Sidebar U1 c Z Carpentersville IL 60110 0 1 0 REAR TELEPHONE IL Other 0 None ®Y ❑N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR Elgin Fire 99 9 Alvarez Martinez. Rey. E. None 2 m `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER 2 X p; DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 My 0 KCV 0 Dv !2 0 0 5 Honda Odyssey 2012 00-NONE ,�_' 12..-_, DUE TO CRASH gi ❑ 2 73 0 13-UNDER CARRIAGE o I 2 FIRE ID El U2 C c M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 016•TOP 3 X ❑Y Ni N ❑UNK VEH. AT CRASH 99-UNKNOWN *Oistracton Value 9 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF O 1 6 i'_ COM VEH 0 ® ut CO F,,, FIRST CONTACT 9 O7 _, _5 •If Yes.See Sidebar C ELGIN Z IL 60120 B 1 0 DR16915 IL 2026 I Si)0 M IL D 0 SFNRL5H61 CB093105 State Farm ❑Y J N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X Elgin Fire 99 9 Jaramillo.Aleida. M. 0505641-SFP-13 BAG E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP U1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)!{ADDRESS)((TELEPHONE) (EMS) (HOSPITAL) U2 996 r m ##occs y / ,, U1 1 D 1 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 11 4 09,20 ,2025 04 17 0 AM in a Work Zone? ®N DIRP co 1 t PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 3 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 C) v 2 0 2 28 09,20 ,2025 04 28 ®PM 0 Construction >F R 3 0 gi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 1 z J ❑AM ❑Maintenance U2 -a, ARREST NAME Solis-Garcia.Guadalupe 11-601 S1542-000467 09,20,2025 04 32 ®pM SLMT os. u 1 ® 11 4 CITATIONS ISSUED 0 PENDING Utility o N SECTION CITATION NO. ROAD CLEARANCE TIME AM• Ely T 2 El ARREST NAME Solis-Garcia.Guadalupe 6-101 S1542-000464 09/20 ,2025 05 00 0 PM 0 Unknown work zone type U1 30 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 30 1 542 Chafe. Ethan 401 269-Mendiola 10 ,20,2025 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 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 -< } }____r__--; } combination):or —I INDICATE NORTH p1 IN BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C II _ (example:shuttle or charter bus):or co 3. Is tlesgnetl to car 15 or fewer ssen ers and o rated a contract career O Not To Scale I } } } transporting employees In the courses of their employment(example:employee L L.___a__ 4 i �I« :or trans�sedordrter �llnatedtotrans a van y typeehrtbetweeicle or n9and15pa ger) ssen rs,induding[hedrNer, l• I- • for direct compensation(example:large van used for specific purpose):or N L `t p, .111 i t 5. Is any vehicle used to transport anyhazardous material(HAZMAT)that requires m placarding(example:placards will be displayed on the vehicle). ;p —1 ® CARRIER NAME Z i. i. .i. .:, r r :- :- :-- --:- ADDRESS 'n V) CICITY/STATE/ZIPgC) MOTOR CARR.ID ❑ Interstate ❑ Intrastate 1 I r 1 ❑ Not in Comm./Govt. 0 Not in Comm./Other --- --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?El❑ Yes II No 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 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 DISABLING DAMAGE DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® Arties/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE