HomeMy WebLinkAbout2025-00078346 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111
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DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X�065608
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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 0$501-51.500 ®ON SCENE 2
VEHICLE/PROPERTY ®OVER 91,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash
El AMENDED
YR 2025I 2025-00078346 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n
® ❑ RELATED ®Y 0 N 12 09 2025 ®AM ❑YES ®NO U1
SHALES PKWY Elgin 08:51
_ _ g PRIVATE mo /day/yr ❑PM FLOW CONDITION IT1
FT l MI N E S W BODE RD COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 15 cn
❑ Cook HIT ❑V ® N WITH VEHICLES INVLD El STOPPED U2 —I
El AT RUN AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0
Qg3 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 wuv 0 ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 3 0
FOR DAMAGED AREA(S) FRO T TOWED U1 0NAME(LAST,FIRST,M) M I RAN DA FLORES.AMANDA.J. m0 01 / /1 9 8 1 Toyota Camry 2007 00-NONE „ Oi_, DUE TO CRASH ® ❑
13-UNDER CARRIAGE 1a i , 2 FIRE 0 IE
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED THER ❑ 0 U2 3 M
F 2 SYTM 8 ❑Y ®SNE DUNK VEH. 0 AT CRASH 99-UNKNOWN 9 16•TOP 3 *Distraction Value 9 ALGN
-
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 7 :il a 4 COM VEH 0 j$J 1 0
I .
ELGIN I L 60120 B 1 0 FIRST CONTACT 12 7_; _5 *II Yes.See Sidebar U1
Z AY12515 IL 2026 REAR
TELEPHONE
IL D 0 4T1BE46K67U698395 PROGRESSIVE ❑Y ®N U2 m
13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
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Elgin Fire 99 9 Same 924296278 2 r
o HOSPITAL(TAKEN TO) INCIDENT IF'' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER
RESPONDER D
Sherman ❑Y El 2 c
N DRIVER 0 PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NMV 0 Ixv 0 DV
/1 9 9 8 Volkswagen Tiguan 2020' 00-NONE 1("j 12..-_, DUE TO CRASH rg ❑ 2 x
.. Yr 13-UNDER CARRIAGE 10'i !., 2 FIRE 0 N U2 C
c
F 2 8 SYSTEM IN 0 ENGAGED 0 15-OTHER 9,1,6-TOPO3 * X
❑Y i N DUNK VEH. AT CRASH 99-UNKNOWN O 0istraglon Value 9 0
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8-.il�_.,_4 COM VEH ❑ N U1 CO
FIRST CONTACT 3 7 _,'_5 •• •IfYes.See Sidebar
= ELGIN IL 60120 B 1 0 FM46009 IL 2026 I 0
IL D 0 3VV4B7AX6LM138306 STATE FARM ❑Y N N RDEF
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER 1 X
Elgin Fire 99 9 CARDENAS.JAMIE 1761034SFP13 BAC
E
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP
U1 =
(UNIT) (SEAT) (008) (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)((ADDRESS)((TELEPHONE) (EMS) (HOSPITAL)
2 6 10 /
D
/ / 4 0
EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z
N 1 ® 11 4 co
12,9/ /025 08 51 ®❑PM AM in a Work Zone? ®N DIRP D
1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 3
T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ®AM U1
v 2 ❑ 2 26 12/9/ /025 08 51 ❑PM El Construction
R O ❑ ]$I CITATIONS ISSUED PENDING SECTION CITATION NO. EMS ARRIVED TIME 5
3 ®AM ❑Maintenance U2
- uSECTION CITATION NO. ROAD CLEARANCE TIME
a, ARREST NAME MIRANDA FLORES.AMANDA.J. 11-901 374001357 12/9/ /025 08 58 ❑PM SLMT
1 ® ElUtilit 11 4 0 CITATIONS ISSUED PENDING
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AM 25
r 2 ElARREST NAME 12/9/ /025 09 24 M PM ElUnknown work zone type U1
2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑qM Workers present? Y 25
374-Rizzu-o. Michael 202 1/ / /2 /26 01 30 ®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•---, 9HALE871+ARKUYAY ® - . 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 ` -' -' I. INDICATE NORTH combination):or �
' BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C
- } (example:shuttle or charter bus):or
JNot To Scale X
y 1 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier 0
} -A- -•i `
} } } transporting employees in the course of their employment(example:employee
transporter-usually a van type vehicle or passenger car):or CO
I. L.___a____.I eO°E'RD 4. Is used ordesi natedtotrans rtbetween9and15 passengers,including C
} } for direct com nation exam I lar a van used for s cifi ur o ):or the driver,
Pe ( P 9 Pe P pose):or o
I. L____a..... r r t i. i. t 5 Is any vehicle used to transport any hazardous material(HAZMAT)that requires -D
um I placarding(example:placards will be displayed on the vehicle). XI
r- CARRIER NAME Z
ADDRESS 0
C
Qok CITY/STATE/ZIP n
MOTOR CARR.ID 0 Interstate 0 Intrastate
0
1 I r 1 ❑ Not in Comm./Govt. 0 Not in Comm./Other
---"-• - USDOT NO. ILCC NO. m
XI
Source of above z
. 0 Yes 0 No ❑ Unknown A
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
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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
Gold 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 DAMAGE EXTENT: 3 TOWED BY/TO:
DUE TO ® DISABLING DAMAGE Redmons/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE