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HomeMy WebLinkAbout2025-00073308 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 0110 11111010110100 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X004028905 u, 1 U21 2 4 1 U1 2 U2 1 U, 9 U2 1 U, 1 U2 1 1 10 u1 3 U2 11 *P 0119 INVESTIGATING AGENCY DAMAGE TO ANY ❑5500 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 2025I 2025-00073308 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 rn SHALES PKWY El In 12:05 ® ❑ RELATED ®Y 0 N 11 13 2025 ❑AM YES ®NO U1 _ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION III FT!MI N E S W MAROON DR COUNTY PROPERTY ❑Y ® N DOORING Ely #OF MOTOR El SLOW 1 0)❑ Cook HIT&RUN ❑Y ® N WITH VEHICLES INVLD ❑ STOPPED U2 --I ® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N 51 FREE FLOW # LNS 0 Qg3 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EOUES 0 Nuv 0 icy ❑ov DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 n 1 1 Chevrolet Einox 2023 00-NONE DUE TO CRASH ® ❑ FOR DAMAGEDAREA(S) FROM Q u NAME(LAST,FIRST,M) Garcia Moreno. Maria. D. mo / / T TOWED U1 yr q 13-UNDER CARRIAGE ©.• 12 FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) O 2 DISTRACTED 0 0U2 4 <<Tl F 2 4 SYTM❑Y ®S NE El UNK VEH. 0 AT CRASH 0 15-99-UUNKNOWN THER O9 16-TOP 3 ,Distraction Value ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 0 if 6 I'.4 COM VEH 0 )g! 1 n ELGIN I L 60120 B 1 0 FIRST CONTACT 9 O_; __5 •If Yes.See Sidebar U1 0 Z EU21860 IL 2026 REAR TELEPHONE IL D 0 3GNAXUEG5PL185180 Progressive ❑Y ®N U2 m .9 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 Garcia.Shiela.S. 998714586 1 rn `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y ® N 25 c g DRIVER 0 PARKED 0 DRIVERLESS ❑ FED 0 PEDAL 0 EWES 0 NMV 0 Ncv 0 DV yr 12 0 13-UNDER CARRIAGE 10• ) f) E FIRE 0 ® U2 C c F 2 5SYSTEM IN 0 ENGAGED 0 15-OTHER 9,16-TOPO3 0 Y ®N 0 UNK VEH. AT CRASH 99-UNKNOWN Distraction Value 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8-il�( 4 COM VEH ❑ ® U1 CO FIRST CONTACT 12 Y A _=5 •If Yes.See Sidebar Z SOUTH ELGIN IL 60177 0 1 0 EM94105 IL 2026 I 0 M IL D 0 5N PE34AF4FH 197080 State Farm ❑Y 123 N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X Elgin Fire 99 9 Shindhe. Rajesh. D. 1699023-SFP-13 SAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP 996 < Refused RESPONDER U1 = ;UNIT) (SEAT) (DOBI (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)/(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL) 1 4 08 / M 2 6 A 1 0 m / / #OCCS > / / UI 2 D / / 1 0 EV MOST EVNT LOG DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z N 1 ® 11 4 11 /13 /2025 12 05 ®AM 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 3 n T 2 2 rn 2 0 / / ❑PM- ❑Construction 1 R 3 0 $I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 5 ❑AM ❑Maintenance U2 o1 ® 11 4 ARREST NAME Garcia Moreno. Maria. D. 11-901 S3480001358 / / ID PM SLMT o N ❑CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ' El Utility El AM t 2 El ARREST NAME 11/13 /2025 12 32 ®PM El Unknown work zone type U1 3O 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑AM Workers present? D Y 30 348-Rapacz.Jordan 12 / 16/2025 01 30 ®PM I 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 } i ; u�rta 1. Has a weight rating more than 10,000 pounds(example:truck or truck/trailer -< l —I c I INDICATE NORTH comb nation):or p0 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C I I (example:shuttle or charter bus):or , 3. Is designed to car 15 or fewer passengers and operated a contract carrier O }-----I—•-• I I - I. } } } transportingemployees In the course of their employment Maroon?Dr. pbymar):or ample:employee • I I transporter-usually a van type vehicle or passenger car):or C _ Shales?Pkwy - } } } •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 I- `-----`-----I I MO 111 i i t 5. Is anyvehicle used to transport anyhazardous material(HAZMAT)that requires u,kr Uik( placarding(example:placards will be displayed on the vehicle). X/ D CARRIER NAME ~ ADDRESS w n T Not To Scale J MOTOR CARR.ID5 CITY/STATE/ZIP ----__-- ._ 0 Interstate 0 Intrastate I r ❑ Not in Comm./Govt. 0 Not in Comm./Other I----- ----4. - USDOT NO. ILCC NO. m XI Source of above z . If Yes,Name on placard 0 4 digit UN NO. 1 digit Hazard class No. XI 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 M 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 0 0 Z TRAILER 2 ❑ 0 0 O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w Blue Black u 1 TOWED • TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT- 3 TOWED BY/TO. Redmons/Impound Lot Garage . SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® Redmons/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE