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HomeMy WebLinkAbout2025-00076391 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 0110 1111 101111 0011000 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X0D4049905 u, 1 U21 1 1 3 U1 2 U2 1 U, 1 1_12 1 U, 1 U2 1 1 10 u1 3 U2 1 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT ® A No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW ' Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 1 VEHICLE/PROPERTY ®OVER 51,500 ❑NOT ON SCENE(DESK REPORT) El AMENDED ❑ B Injury and/or Tow Due To Crash YR 202512025-00076391 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n ® ❑ RELATED ❑Y ®N 11 29 2025 ❑AM ❑YES ®NO U1 VILLA ST Elgin12:10 _ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION m �r,0 !MI N E S W South Liberty St COUNTY PROPERTY ❑Y ® N DOORING ❑v #OF MOTOR ®SLOW 1 cn El ® O Liberty Kane 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 18:DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EouES ❑Nuv ❑ncv ❑Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 0 1 FOR DAMAGEDAREA(S) FR 4T TOWED U1 0 2008 Buick Enclave 00-NONE , DUE TO CRASH ❑ O ' NAME(LAST,FIRST,M) Gantes Sanchez.Cintia. I. mo / / yr 13-UNDER CARRIAGE ©i O!- FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 2 DISTRACTED ID U2 2 m F 2 4 ❑Y ®N SYSTEM ❑UNK VEH. O 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, it B �i COM VEH ❑ El 1 0 �- ELGIN I L 60120 0 1 0 FIRST CONTACT 11 7_:, __5 *Ir Yes.See Sidebar U1 Z AT48438 IL 2026 REAR TELEPHONE IL D 0 5GAEV23788J265638 Falcon Insurance ❑Y igi N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR 99 9 Gonzalez.Alvan0100096916-15 3 m `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER RESPONDER > Refused ❑Y ® N 2 XI N DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EWES ❑NMV 0 NCV ❑DV CIRCLE NUMBER(S) U1 !1 9 6 1 Honda Accord 2012 00-NONE 0. Q1--_, DUE TO CRASH ❑ (� 2 x 0,.. 13-UNDER CARRIAGE 10( I 2 FIRE ❑ El U2 C c M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9,16•TOP 3 X ❑Y ®N DUNK VEH. AT CRASH 99-UNKNOWN *Distraction Value 9 0 POINT OF 8 i1 1. COM VEH D ® U1 W N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR 6 FIRST CONTACT 11 7 _, _5 •IfYes,See Sidebar n BARTLETT IL 60103 0 1 0 N147646 IL 2026 RE 0 C IL D 0 1 HGCP2F33CA016912 AAA Insurance ❑Y ®N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X 99 9 Same AUT700867088 BAc $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPONDER U1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)((ADDRESS)((TELEPHONE) (EMS) (HOSPITAL) 1 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z N 1 ® 11 1 11 ,29 l2025 12 10 ®PM 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 5 C) T o" 2 0 2 11 ( ( 0 PM• ElConstruction * R 3 0 $I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 7 ❑AM 0 Maintenance U2 o1 ® 11 1 ARREST NAME Gantes Sanchez.Cintia. I. 11-906 W1540-380 ( ! El Pm SLMT o N ❑CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • 0 Utility 0 AM t 2 ElARREST NAME 1 1(29 12025 01 00 0 PM ElUnknown work zone type U1 30 n T OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 0 - ❑AM Workers present? 0 Y 30 1540-Allah. Muhammad 401 ( , ❑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 S'rlm'rpRet 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer -< ` ` -' -' r INDICATE NORTH combination):or .Z-1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C mimeo. } (example:shuttle or charter bus):or C r r r X I- Not To Soule ) 3. Is designed to carry15 or fewer passengers and operated a contract carrier O }. -A- --i I I } } } transporting employee in the course of their employment(example:employee X or CO C i. <.--_a.._.i -1111 4alsuosedordrter- esgnatedto tranlly a van type sport betweeicle or n9a d15enger rprssen rs,includingthedriver, } } • • for direct compensation(example:large van used for specific purpose):or N -I 111111 �' t i i 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m tamplacarding(example:placards will be displayed on the vehicle). ;p _ i �c� Vllle'ISt— �— -' 2 UIYIE - __ _{ �i _ CARRIER NAME Z ADDRESS 0 w CITY/STATE/ZIP g _ i. i. i. MOTOR CARR.ID 0 Interstate 0 Intrastate I I T I I ❑ Not in Comm./Govt. ❑ Not in Comm./Other 00 -""Y""1 USDOT NO. ILCC NO. C m Xi Source of above z . If Yes,Name on placard 0 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? 0 Yes 0 No 2 TRAILER VIN 1 m LOCAL USE ONLY TRAILER VIN 2 m 0 TRAILER WIDTH(S) 0-96" 97-102" >102' -n TRAILER 1 ❑ ❑ 0 Z ill TRAILER 2 ❑ 0 0 o u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w Beige Gray u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY/TO: _ SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: TOWED BY/TO. DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE