HomeMy WebLinkAbout2025-00068887 ILLINOIS TRAFFIC CRASH REPORT sheet 1 of 4 Sheets 01111101111
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DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X 00208&
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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 ❑5501-51,500 ®ON SCENE 14
VEHICLE/PROPERTY ®OVER 51,500 ❑NOT ON SCENE(DESK REPORT)
0 AMENDED ❑ B Injury and/or Tow Due To Crash YR 2025I 2025-00068887 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 2 �I
N MCLEAN BLVD Elgin06:48
® ❑ RELATED ' V 0 N 10 21 2025 ❑AM ❑YES El NO U1 -<
_ _ g PRIVATE mo !day/yr ®PM FLOW CONDITION Ill
FT!MI N E S W WING ST COUN NTY PROPERTY ❑Y ® DOORING Ely #OF MOTOR 0 SLOW 15 u)
❑ Kane HIT ❑Y ® N WITH VEHICLES INVLD 0 STOPPED U2 --I
El AT RUN AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0
Qg3 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EWES 0 uuv 0!CV 0 ov DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 0
FROr4r TOWED U1 Q
NAME(LAST,FIRST,M) mo yr
Flores. Felix. F. Chevrolet Silverado 2018 00-NONE VI
13-UNDER CARRIAGE ®
12 DUE TO CRASH ❑
10.I !�. 2 FIRE 0 NI
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 0 rr1
M 2 4 15-OTHER
❑Y ®N
SYSTEM
❑UNK VEH. 0 AT CRASHD 0 99-UNKNOWN 9 16•TOP 3 *Distraction Value 9 ALGN 2
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s i�6 �i 4 COM VEH 0 j$J 1 O
ELGIN I L 60123 0 1 0 FIRST CONTACT 11 7_: __5 *If Yes.See Sidebar U1
Z3873868B IL 2026
TELEPHONE
IL D 0 3GCUKSEC2JG271861 Progressive ❑Y ISI N U2 m
in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
99 9 De Leon.Yuliana. N. 993441420 2 r
o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER
RESPONDER
2 XI
m g DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL ❑EWES ❑ uv 0 N v ❑DV
!1 9 9 2 Mitsubishi Outlander 2017 oo-NONE i1_"j t2..-_, DUE TO CRASH ❑ 2 x
oYr 13-UNDER CARRIAGE 10'I c., 2 FIRE ❑ ® U2 C
c
F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9,1,,6.TOPO3 * X
❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN O 0istraglon value 9 0
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF S-iI 6 i_,,_4 COM VEH D ® U1 CO
FIRST CONTACT 4 7 _5 •(ryes,See Sidebar
= ELGIN IL 60123 0 1 0 EU93132 IL 2025 RFJ 0
IL D 0 JA4AZ3A37HZ039951 Geico ❑Y ®N RDEF
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 =
99 9 Same 6197784918 BAG E
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP 996 <
Refused RESPONDER
U1 =
(UNIT) (SEAT) (DOBi (SEX) {SAFT) (AIR) (INJ) 1(EJCT( (EPTH) PASSENGERS&WITNESS ONLY (NAME)/(ADDRESS)((TELEPHONE) (EMS) (HOSPITAL)
1 6 02 /
U2 5 Z
EV MOST EVNT LOG DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ID
N 1 ® 11 4 10/21 l2025 06 48 ®PM in a Work Zone? ®N DIRP co
1 r PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME ❑AM If YES check one below: U1 4 n
T
o 2 ❑ 28 2 / / ❑PNI ❑Construction
Z3 ❑ ❑CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME ❑AM ❑Maintenance U2 6
a ARREST NAME / / ID PM '
1 1 1 4 0 CITATIONS ISSUED ❑PENDING SLMT
o- N ® El Utility
SECTION CITATION NO. ROAD CLEARANCE TIME El AM
r 2 El ARREST NAME 10/21 /2025 06 50 ®PM ❑Unknown work zone type U1 3O
n T OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME
2 2 3 ❑ 1542-Chase. Ethan 501 - / r ❑❑PM Workers present? ®N U2 30
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
N 1. Hasaa weighht t rating more than 10,000 pounds(example:truck or truckrtrailer on):
` ` ' ' � � I. INDICATE NORTH 1.
p1
BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C
r '► _ } r r r (example:shuttle or charter bus):or 0
I ~ _ ` _ a 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I 0
I- -A- -
I. } I.- } transporting employees In the course of their employment(example:employee X
transporter-usually a van type vehicle or passenger car):or w
L -----------; ` ` - I. } } } •4. Is used or designated to transport between 9 and 15 passengers,including the driver, N
/ _ for direct compensation(example:large van used for specific purpose):or O
L .i. .. . - � i. L 5. Is an vehicle used to transport an hazardous material(HAZMAT)that requires m
` placarding(example:placards will be displayed on the vehicle). ;p
�.� — D
r wlI � _+ CARRIER NAME Z
ii ADDRESS O
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CITY/STATE/ZIP g
MOTOR CARR.ID 0 Interstate 0 Intrastate
I ❑ Not in Comm./Govt. ❑ Not in Comm./Other 00
I-'--- -"'-• - USDOT NO. ILCC NO. m
m
XI
Source of above z
. Form Number m
Xl
IDOT PERMIT NO. WIDELOAD' ❑Yes 0 No 2
TRAILER VIN 1 m
to
LOCAL USE ONLY TRAILER VIN 2 m
v
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
Black Silver
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 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/T6
DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE