Loading...
HomeMy WebLinkAbout2025-00074342 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 Of 2 Sheets 01111101111 10110 ll 1111 101001 �1110E111 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X0D4045441 u, 1 U21 3 4 2 u, 2 U2 1 u, 1 1_12 1 u, 1 U2 1 4 10 u1 3 U2 1 *P 0119 INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW ' DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 1 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash 0 AMENDED YR 202512025-00074342 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 r1 SUMMIT ST Elgin 05:42 ® ❑ RELATED ®Y 0 N 11 18 2025 ❑AM ❑YES N NO U1 g PRIVATE mo !day!yr ®PM FLOW CONDITION Ill FT!MI N E S W SHADY OAKS DR COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR El SLOW 1 cn ❑ Cook HIT&RUN ❑Y ® N WITH VEHICLES INVLD ❑ STOPPED U2 —I O AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N 51 FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 eaves 0 NIIv 0 I Cv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) y N O 0 FOR DAMAGEDAREA(S) FRONT TOWED U1 O Sandoval Morales. Miguel.A. 1 1 / yr 13-UNDER CARRIAGE ©I O; FIRE 0 IE STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 10 0 DISTRACTED 0 0U2 0 171 M 2 4 SYTM❑Y NSNE❑UNK VEH. 0 AT CRASH 0 15-99-UUNKNOWN THER9 16•TOP 3 `Distraction Value 9 ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s ii_s I, 4 COM VEH 0 0 1 0 H 1- BARTLETT I L 60103 0 1 0 FIRST CONTACT 1 7._.: __5 *IIYes.See Sidebar U1 ZAL96256 IL 2026 REAR TELEPHONE IL D 7 1 H G CG 16571 A050263 Statefarm ❑Y ®N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Same 3746646SFP13 2 r "o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y ® N 2 X p; DRIVER 0 PARKED 0 DRIVERLESS ❑ FED 0 PEDAL 0 touts 0 iiuiv 0 v ❑ov !2 0 0 7 Chevrolet Volt 2014 00-NONE n. Qj O DUE TO CRASH rg ❑ 2 73 ... 13-UNDER CARRIAGE I f. FIRE 0 N U2 C il F 2 5 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16-TOP 3 X ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN *0istrac on Value 9 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF S .i�.._ 4 COM VEH 0 N U1 CO FIRST CONTACT 11 7 �_-5 •If Yes.See Sidebar C ELGIN IL 60120 0 1 0 DG97922 IL 2026 REAR Si)0 Z IL D 0 1 G 1 RD6E45EU 150317 American Alliance ❑Y N N RDEF Xl EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Ontiveros.Aylin I LAA076313304 BAG $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP u1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)((A.DDRESS)((TELEPHONE) (EMS) (HOSPITAL) 2 3 02 / F 2 5 0 1 0 m / / #OCCS D 71 / / U1 1 D / / 2 0 EV MOST EVNT LOG DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z N 1 N 11 4 11 ,18 /2025 05 42 ®pm in a Work Zone? NCI 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 C1 T o" 2 ❑ 2 99 / / ❑PM• ❑Construction R 3 ❑ ]yg CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 7 ❑AM ❑Maintenance U2 o1 ® 11 4 ARREST NAME Sandoval Morales. Miguel.A. 11-901-A W1500000397 / / El PM SLMT o N ❑CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ❑El AM Utility t 2 ElARREST NAME 1 1/18 /2025 06 20 0 PM ❑Unknown work zone type U1 35 n T OFFICER ID SIGNATURE BEAT!DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 0 ❑AM Workers present? ❑Y 35 1500-Chew. Marie 201 391-Jacobucci / ❑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••--, , ; 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 -< ` ` -' -' I. INDICATE NORTH combination):or —I j I 0 1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C (example:shuttle or charter bus):or n , 3. Is designed tocarry 15 or fewer passengers and operated a contract carrier O `----------i 1 L Not To Scale i - 7 } } . transportinggemployees in the course of their employment p ypbyment(example:employee � eunmrra transporter-usually a van type vehicle or passenger car):or C -- -- .,. _ I i - I. } } 1 •4. Is used or designated to transport between 9 and 15 passengers,including the driver, (I)40' _ for direct compensation(example:large van used for specific purpose):or O 40, L i_____a____.i €Ni\, _ t 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 -I CARRIER NAME Z r I ADDRESS O T. r . . . . ... rn CITY/STATE/ZIP n I - MOTOR CARR.ID 0 Interstate El Intrastate I r ❑ Not in Comm./Govt. 0 Not in Comm./Other ----- ----4 - USDOT NO. ILCC NO. rn XI Source of above Z . 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 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 v TRAILER WIDTH(S) 0-96" 97-102" >102' T TRAILER 1 ❑ ❑ 0 Z TRAILER 2 ❑ 0 ❑ o u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w Silver Black u 1 TOWED • TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT 3 TOWED BY/TO. Arties/Impound Lot Garage . SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DAMAGE EXTENT: 3 TOWED BY/TO:TO ® DISABLING DAMAGE Arties VEHICLE CONFIG._CARGO BODY TYPE LOAD TYPE