HomeMy WebLinkAbout2025-00065464 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 1111111111111111
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DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X003989..82
u, 1 U21 2 4 1 U1 2 U2 1 U, 1 1_12 1 U, 1 U2 1 1 15 U1 1 U2 1 *P 0119*
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 ❑$501-$1.500 ®ON SCENE 14
VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash
El AMENDED
YR 2025I 2025-00065464 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n
DWIGHT ST Elgin07:46
® ❑ RELATED ®Y 0 N 10 06 2025 ®AM ❑YES ®NO U1 -<
_ _ g PRIVATE mo !day/yr ❑PM FLOW CONDITION MFT!MI N E S W ST CHARLES ST COUNTY PROPERTY ❑Y ® N DOORING Ely #OF MOTOR El SLOW 7 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
Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EDUES 0 NIA/ 0 NCV 0 DV DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 n
0 3 !
yr g 1t. 12
_ E
13-UNDER CARRIAGE 10l FIRE 0
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U22 2 M
SYSTEM IN ENGAGED15-OTHER 9 16.T 3
F 2 4 ❑Y ®N ❑UNK VEH. O ATCRASH 0 99-UNKNOWN O `DistractionVatue 9 ALGN
-
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6 iII 6 11 4 COM VEH 0 0 2 C)
~ ELGIN I L 60123 0 1 0 FIRST CONTACT 4 7_;LQ_OS =II Yes.See Sidebar U1 0
Z FE21455 IL 2026 E
TELEPHONE
IL D 0 3VW2K7AJ6BM336705 Kemper ❑Y ®N U2 m
13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
99 9 VILLEGAS.YINYERLIS 12RA000083206 1 r
`o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER
RESPONDER D
Refused ❑Y ® N 2
m E{ DRIVER ❑ PARKED 0 DRIVERLESS ❑ PED ❑PEDAL ❑EWES ❑NMV 0 Ncv ❑DV
yr Mack Trucks. !Unknown 2001 00-NONE Qf O DUE TO CRASH ❑ ® 20
o 13-UNDERCARRIAGE 10,i I.. 2 FIRE ❑ ® U2 C
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M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16.TOP 3 X
❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN `Oistraellon Value 9 0
POINT OF 6 i 4 C.OM VEH ® ❑ U1 W N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR 6 �S_. C
I— FIRST CONTACT 1 , _,-_6 •If Yes.See Sidebar
BARTLETT IL 60103 0 1 0 31443V IL 2026 I 0 N
IL A 7 1 M2AA18Y11 W141851 Artisan and Trucker Casua ❑Y ®N RDEF 7)
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 =
99 9 KG K Development 957182481 SAC E
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP
U1 =
(UNIT) (SEAT) (DOE) (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)!(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL)
1 3 11 / F 2 4 0 1 0
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/ / #OCCS D
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/ / 1 0
E/ MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z
N 1 El 11 4 10/61 l025 07 46 ®❑pM in a Work Zone? ®N DIRP co
1 I PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME ❑AM If YES check one below: U1 7 C)
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2 ❑ 2 99 I ! ❑PM ❑Construction
1
N 3 ❑ Igi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 5
❑AM ElMaintenance U2
-a, ARREST NAME Belandria Amaya. Dayana.Y. 6-101* 1557000124 ! ! ❑PM SLMT
o N 1 ® 11 4 igiCITATIONS ISSUED 0 PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ❑Utility
AM 30
t 2 El ARREST NAME Belandria Amaya. Dayana.Y. 11-904-B 1557000123 r , 0 pM ElUnknown work zone type U1
2 2 3 0 -
OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 30
1557-Wieske. Nathan 401 11 , 41 ,025 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.
.- .. , I A CMV is defined as any motor vehicle used to transport passengers or property and: Z
r r 1. Has a weight rating more than 10,000 pounds(example:truck or truck/trailer -<
i- _ _r_ - combination):or —I
ID 0
INDICATE NORTH p1
BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C
tcrwd�vst Not To Scale _ } (example:shuttle or charter bus):or
C
}
L L.___A.._.� I 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I O
} } transporting employees In the course of their employment(example:employee X
transporter-usually a van type vehicle or passenger car):or w
a C
L L.___a..-..l A - } } } •4. Is used or designated to transport between 9 and 15 passengers,including the driver, (I)
for direct compensation(example:large van used for specific purpose):or O
L t i. i L 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires 'U
placarding(example:placards will be displayed on the vehicle). XI
• ` - - Z CARRIER NAME KG K Development Inc.
-u � R1 - Z
ADDRESS 1249 BOA TRL
T.
UNyM75t
CITY/STATE/ZIP Carol Stream I I L/60188 n
MOTOR CARR.ID Interstate Intrastate
I I T I Not in Comm./Govt. Not in Comm./Other0
i- --- --1 % % % USDOT NO. 2062403 ILCC NO. 131801
m
x
Source of above z
. m
Did HAZMAT spill from vehicle(do NOT consider FUEL from vehicle's z
own tank)? 0 Yes ® No 0 Unknown
Did HAZMAT Regulations violation contribute to the crash? r
❑ Yes ❑ No 0 Unknown g
D
Did Carrier Safety Regulations(MCS)violation contribute to the crash? A
❑ 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'7 ❑Yes ®No 2
TRAILER VIN 1 4M9DS232XR1O1728O m
co
LOCAL USE ONLY TRAILER VIN 2 m
0
TRAILER WIDTH(S) 0-96" 97-102" >102' -n
TRAILER 1 ® 0 0 Z
TRAILER 2 0 0 0 o
u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 25 ft. 2 ft. w
Gray Blue
u 1 TOWED TOTAL VEHICLE LENGTH 40 f ft. NO.OF AXLES 2
DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT 3 TOWED BY/TO.
_Redmons/Owners Residence . 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. 4 CARGO BODY TYPE 5 LOAD TYPE 9