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HomeMy WebLinkAbout2025-00061414 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 011011001011 11101011110 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X003969742* u, 1 U21 1 1 1 U110 U2 1 U, 1 1_12 1 U, 1 U2 1 1 12 u, 2 U2 1 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY 0 5500 OR LESS TYPE OF REPORT ® q No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW Elgin Police Department ONE PERSON'S ❑$501-$1.500 ®ON SCENE 3 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) 0 AMENDED ❑ B Injury and/or Tow Due To Crash YR 202512025-00061414 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n ® ❑ RELATED PRIVATE 0 Y ®N 09 18 2025 ❑AM ❑YES ®NO U1 -< RT20 EB Elgin mo /day/yr 05:46 ®PM FLOW CONDITION m ®15((1 ,MI N E S © East S State St COUNTY PROPERTY ❑Y ® N DOORING El #OF MOTOR 0 SLOW 1 (n Kane HIT&RUN ❑V ® N WITH VEHICLES INVLD 0 STOPPED U2 --I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 18:DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EWES 0 uuv 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 n FOR DAMAGEDAREA(S) FRONT TOWED U1 Q Casarez.Omar 0 6 / yr 13-UNDER CARRIAGE I FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) O 2 DISTRACTED 0 0U2 2 m M 2 4 SYTM❑Y ®S NE❑UNK VEH. 0 AT CRASH 0 15-99-UUNKNOWN THER O9 16-TOP 3 ,Distraction Value 9 ALGN X. r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF ,iI 6 I,.4 COM VEH 0 )g! 1 n Z Saint Charles I L 60174 0 1 0 FIRST CONTACT 9 O7 _; __5 *lives.See Sidebar U1 0 CJ77067 IL 2026 REAR TELEPHONE IL A 7 7FARS6H84SE000655 Travelers Insurance ❑Y ISI N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR M Same 6166376992031 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF IC OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER > Refused 0 Y ® N 2 XI x DRIVER ❑ PARKED 0 DRIVERLESS ❑ PED ❑PEDAL ❑EWES ❑ 1 9 9 8 Honda Pilot 2003 00-NONE 1(-I t2..-_, DUETO CRASH ❑ cg 2 x o 13-UNDER CARRIAGE 1 FIRE 0 ® U2 II F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16-TOP® X ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN O Distraction value 9 0 POINT OF 8 i1 4 COM VEH ❑ ® U1 CO N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR A 6 FIRST CONTACT 3 7�� —_,A •ITYes,See Sidebar Hanover Park IL 60133 0 1 0 EF78523 IL 2024 REAR 0 C IL D 0 2HKYF18593H574398 American Alliance ❑Y ®N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Same I LAA-1039529-00 BAC $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPONDER U1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (WI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)r(A.DDRESS)!(TELEPHONE) (EMS) (HOSPITAL) 1 3 07 / F 2 4 0 1 0 m / / ##OCCS y / / UI 2 m / / 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 91 ,81 ,025 05 46 ®AM in a Work Zone? ❑N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 3 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 C) 0 2 ❑ 04 99 , r 0 PM ®Construction * Z 3 0 xi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 3 ❑AM ❑Maintenance U2 o 1 ® 11 1 ARREST NAME Casarez,Omar 11-703-B W1500000387 r r El PM SLMT ISI CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME p N El AM 0 Utility 45 T 2 ❑ ARREST NAME Chavez.Crystal 3-414 W1500000386 91 r 81 r025 05 46 ®PM 0 Unknown work zone type U1 n 7 OFFICER ID SIGNATURE BEAT!DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 0 ❑AM Workers present? ❑Y 45 1500-Chew. Marie 701 391-Jacobucci r ❑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 truckrtrailer -< - }----'-- --' r h INDICATE NORTH combination):or -I n ; BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver N _ (example:shuttle or charter bus):or X 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I O A u }} } transporting employees in the course of their employment(example:employee X transporter-usually a van type vehicle or passenger car):or w ` plot To Scale } 4. Is used or designated to transport between 9 and 15 passengers,including y }-----;----+ - } } } g po passen rs,includi the driver, J • • for direct compensation(example:large van used for specific purpose):or I. i i _ 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires 'D placarding(example:placards will be displayed on the vehicle). XI RO1ts720 Unit 2 Bile CARRIER NAME Z li�l�� - ADDRESS O Unit 1 D '\ 0 CITY/STATE/ZIP g Ednmpke?Sme?3a MOTOR CARR.ID 0 Interstate El Intrastate rCt; ❑ Not in Comm./Govt. 0 Not in Comm./Other r ----'Y----1 - USDOT NO. ILCC NO. rn XI Source of above Z . ❑ 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' m TRAILER 1 ❑ ❑ 0 Z TRAILER 2 ❑ 0 0 O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. Z White Blue u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/TO: _ . SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/T6 DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE