HomeMy WebLinkAbout2025-00071894 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets III III 11 IIII
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DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X004026974
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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 2
VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash
El AMENDED
YR 202512025-00071894 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 m
SHALES PKWY Elgin12:21
® ❑ RELATED ®Y 0 N 11 05 2025 ❑AM ❑YES ®NO U1
_ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION Ill
FT!MI N E S W MAROON DR COUNTY PROPERTY ❑Y 21N DOORING ❑y #OF MOTOR NI SLOW 1 cn
❑ Cook HIT&RUN ❑V ® N WITH VEHICLES INVLD ❑ STOPPED U2 --I
® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ❑ FREE FLOW # LNS 0
Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uuv 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 n
0 9 !
Chevrolet Tahoe 2007 00-NONE it_ O i_, DUE TO CRASH 0
13-UNDER CARRIAGE 10 EN
i ' 2 FIRE ❑
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 0 m
M 2 4 ❑Y ®N SYSTEM
❑UNK VEH. AT CRASH 99-UNKNOWN 9 76•TOP 3 *Detraction Value 9 ALGN 2
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s,_iL 6 4 COM VEH 0 j$J 1 0
~ ELGIN N I L 60123 0 1 0 FIRST CONTACT 12 7 ; _5 *Irves.See Sidebar U1
Z BD46467 IL 2026 REAR
TELEPHONE
IL D 1 G N FC13J27R288533 State Farm ❑Y ®N U2 11 , m
13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
99 9 Elvir. Luz 3095865SFP13 1 r
`o HOSPITAL(TAKEN TO) INCIDENT IF'' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER
RESPONDER
2 73
m x DRIVER 0 PARKED 0 DRIVERLESS ❑ PED 0 PEDAL 0 EWES 0 r My 0 NCv 0 DV CIRCLE NUMBER(S) U1
Yr!1 9 9 8 FRNT Toyota Corolla 2024 00-NONE ,�_-1 t2..-_, DUE TO CRASH rg ❑ 2
o _ 13-UNDERCARRIAGE 10;i t• 2 FIRE El ElU2 C
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M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16-TOPO3
❑Y Ni N ❑UNK VEH. AT CRASH 99-UNKNOWN Oistraglon Value 9 0
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6 1 & i�; COM VEH 0 ® Ut W
FIRST CONTACT 3 Y� _, _5 •IfYes.See Sidebar C
F= ELGIN IL 60124 0 1 0 KBN2562 OH 2026 " 0 fn
IL D 5YFB4MDE4RP168656 EAN Holdings LLC ❑Y ®N RDEF 7I
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 =
99 9 EAN HOLDINGS 39S208536 BAG $
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP
U1 =
KNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)((ADDRESS)((TELEPHONE) (EMS) (HOSPITAL)
1 0
EV MOST EVNT LOG DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z
N 1 El 11 4 11 r 51 l025 12 21 ®PM AM in a Work Zone? NJ DIRP >
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1 tT PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME ❑AM If YES check one below: U1 3 n
F.; I 2 ❑ 2 18 1 r 0 PM 0 Construction
Z3 0 ❑CITATIONS ISSUED Iffi PENDING SECTION CITATION NO. EMS ARRIVED TIME ❑AM ❑Maintenance U2 5
o ® 11 4 ARREST NAME Perez.Carlos 11-901 W486000252 / ! El PM SLMT
o Nu ❑CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • El Utility
30
ARREST NAME AM
Ti 2 ❑ ❑❑PM 0 Unknown work zone type U1
r r
n OFFICER ID SIGNATURE BEAT!DIST. SUPERVISOR D. COURT DATE TIME
2 2 3 0 ❑AM Workers present? ❑Y 30
486-Munoz.Jasmine 300 275-Engelke r i ❑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••--, , ;i 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 -
c ` -' -' r INDICATE NORTH combination):or —I
I BY ARROW 2 Is used or designed to transport more than 15 C
g sp passengers including the driver 0
} r r r (example:shuttle or charter bus):or
<____ �____� Men�on7Drlve 3. Is designed to carry 15 or fewer passengers and operated by a contract career I 0
® - . . . transporting employees in the course of their employment(example:employee73
transporter-usually a van type vehicle or passenger car):or CO
L L.__.a....� — 1 I T1. . 4. Is used or designated to transport between 9 and 15 passengers,including the driver. C
( • ,1 m } } for direct compensation(example:large van used for specific purpose):or O
L i.....a..... — �•_ A a i. < i. 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m
placarding(example:placards will be displayed on the vehicle). ;p
—1
CARRIER NAME Z
ADDRESS
I D
rn
N I CITY/STATE/ZIP n
MOTOR CARR.ID 0 Interstate El Intrastate
- -- 0r .
I Not To Scale I ❑ Not in Comm./Govt. ❑ Not in Comm./Other 0
�____Y____1i. USDOT NO. ILCC NO. C
m
XI
Source of above Z
. MCS 0 Yes 0 No 0 Unknown Out of Service 0 Yes ❑No 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 0 0 Z
TRAILER 2 ❑ 0 0 o
u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w
White Gray
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 DISABLING DAMAGE NOT DAMAGE EXTENT: 3 TOWED BY/TO.DUE TO ® Redmons VEHICLE CONFIG._CARGO BODY TYPE LOAD TYPE