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HomeMy WebLinkAbout2025-00072459 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 1111111111111111 11111111 II 1111 !III II100 11 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X�02464$ u1 2 U21 3 4 2 U1 4 U2 1 U1 1 U2 1 U1 1 U2 1 4 11 U1 1 U2 1 *P 0 1 1 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 ❑$501-$1.500 ®ON SCENE 1 VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) El AMENDED ElB Injury and/or Tow Due To Crash YR 202512025-00072459 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 7 ® ❑ RELATED PRIVATE 13I Y 0 N 11 08 2025 DAM YES ®NO U1 S LIBERTY ST Elgin mo /day/yr 06"29 ®PM FLOW CONDITION M 50 ® COUNTY PROPERTY ❑Y ® N DOORING Ely #OF MOTOR NI SLOW 1 (n !MI N E S W Villa St WITH VEHICLES INVLD El STOPPED U2 --I El AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) Kane HIT&RUN ❑Y ® N PEDALCYCLIST®N ❑ FREE FLOW # LNS 0 18: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 2 n FOR DAMAGEDAREA(S) FROM TOWED U1 O Rubio-Aguilar.Guadalu e 1 1 yr 13-UNDER CARRIAGE ©,I �:: FIRE 0 NI STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ❑ 0 U2 2 1'11 M 2 4 ❑Y ®SYSNEM❑LINK VEH. O ATCRASHD 0 99-UUTHER NKNOWN 9 16•TOP 3 `Distraction Value ALGN = r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF iL 6 I,.4 COM VEH 0 Ei 1 O ~ SOUTH ELGIN IL 60177 0 1 0 FIRST CONTACT 12 7 . _5 *If Yes.See Sidebar U1 ZCC30116 IL 2026 TELEPHONE IL D 1J8GN58K29W541766 Nla 0Y ® 4 U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER RSUR m Ramos.Aguilar N/a 2 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER RESPONDER 2 eu g DRIVER ❑ PARKED 0 DRIVERLESS 0 FED 0 PEDAL 0 EWES 0 NPAy 0 NOV 0 Dv 1 9 yr 9 Volkswagen Jetta 2020 00-NONE 'o,� t2 (,-2 FIRE DUE o CRASH ® U2 2 C o 13-UNDER CARRIAGE c M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9.1,6•TOP 3 X ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN `0istraglon Value U1 0 POINT OF 8 i —4 COM VEH D MI CO N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR 6 FIRST CONTACT 6 O7 ,�=QIOS •It Yes.See Sidebar C Naperville IL 60563 0 1 0 DN46871 IL 2026 i:EaR0 Si) IL D 3VWEB7BU2LM024727 Progressive ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X Same 12669293 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),(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL) 2 3 08 / M 2 3 0 1 0 m / / #OCCS > / / U1 1 D / / 2 O EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur El U2 Z N 1 ® 11 1 11 ,8/ ,025 06 29 ®PM in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 5 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 2 28 99 , , ❑PM• ❑Construction * 5 R5 3 ❑ ]�CITATIONS ISSUED 0PENDING SECTION CITATION NO. EMS ARRIVED TIME ❑AM ❑Maintenance U2 —a, ARREST NAME Rubio-Aguilar.Guadalupe 11-601 C7476700 , r ID PM SLMT ® 11 1 igiCITATIONS ISSUED 0 PENDING Utility o N 1 SECTION CITATION NO. ROAD CLEARANCE TIME El AM• ❑ t 2 ❑ ARREST NAME Rubio-Aguilar.Guadalupe 6-101 C748275 1 1+8/ ,025 11 42 ®PM El Unknown work zone type U1 30 2 2 3 ID ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 35 1552-Thompson.Ahmad Rashad 401 12 , 1/ ,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 i A CMV is defined as any motor vehicle used to transport passengers or property and: Z } r• -, r� f 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer -< i- ____r____1 T } combination):or —I INDICATE NORTH p1 87Liharly7at I 0 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C ��� } r i f r r (example:shuttle or charter bus):or X L A 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier 0 I - } } } transporting employees In the course of their employment(example:employee X transporter-usually a van type vehicle or passenger car):or L L.___a__ } 4. Is used ordesi nated to trans rt between 9 and 15passengers,includingthedriver. C IScale 1 ! • } for direct compensation(example:large van used for speific purose):or N` _a ..o Not To t ` ` ` , 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m I 1 placarding(example:placards will be displayed on the vehicle). ;p CARRIER NAME Z I ADDRESS C l—// "' tn11e7st r CITY/STATE/ZIP g - MOTOR CARR.ID 0 Interstate 0 Intrastate I I T I I ❑ Not in Comm./Govt. Not in Comm./Other � --- --1 USDOT NO. ILCC NO. m XI Source of above z . —I Were HAZMAT placards on vehicle? 0 Yes 0 No = If Yes,Name on placard O 4 digit UN NO. 1 digit Hazard class No. Xl Xl 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 Beige Silver u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT 3 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/TO. DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE