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HomeMy WebLinkAbout2025-00079565 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 I0110 1111 I 100011fl 1010000 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X004071073 u, 1 u21 3 4 1 u, 1 U299 U, 1 1_12 1 U, 1 U2 1 1 10 u1 4 U2 11 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY El$500 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 3 VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) El AMENDED ❑ B Injury and for Tow Due To Crash YR 2025I 2025-00079565 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 2 m ® ❑ RELATED PRIVATE ❑Y ®N 12 15 2025 ❑AM ❑YES ®NO U1 -< BIG TIMBER RD Elgin mo /day/yr 04:34 ®PM FLOW CONDITION Ill I O ®!MI N E S © North State St COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 1 (n Kane HIT&RUN ❑Y ® N WITH VEHICLESOT, 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 ❑NW ❑ncv ❑Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 n FOR DAMAGEDAREA(S) FRO'1T TOWED U1 Q Anselmo Arro o Joa uin 0 8 / yr 13-UNDER CARRIAGE ©,I '. Z FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ❑ 0 U2 4 <<n M 2 SY 15-OTHER 4 ❑Y ®SNE❑UNK VEH. 0 AT CRASH M IN D 0 99-UNKNOWN 9 16•TOP 3 *Distraction Value ALGN = r S ii, COM VEH 0 0 1 CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s it 4 H 1 ELGIN IL 60120 0 1 0 FIRST CONTACT 11 7_; __5 *II Yes.See Sidebar U1 0 Z 4135069B IL 2026 REAR TELEPHONE IL D 0 STBBT48121S146556 State Farm ❑v igiJ N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR . 1 99 9 Same 3664282-SFP-13 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y El 2 0 x DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uv 0 Ncv ❑Dv CIRCLE NUMBER(S) U1 /1 9$0 Toyota Prius 2010 00-NONE 'o,� t2 (,-2 FIRE DUE o CRASH ® U2 2 C o 13-UNDER CARRIAGE ID c M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9.1,6•TOP 3 X ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN `Oistrac on Value 0 POINT OF 8 1 it 4 COM VEH ❑ ® U1 CO N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR �J 5 FIRST CONTACT 5 7 -OS •If Yes.See Sidebar Z Algonquin IL 60102 0 1 0 E897686 IL 2026 REAR 0 N Z IL D 0 JTDKN3DUXA0008567 State Farm ❑Y 123 N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X 99 9 Same 1567781-SFP-13 BAG $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPONDER U1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)1(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 12,15 /2025 04 34 ®pm in a Work Zone? ®N DIRP co 1 F PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 4 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 0 2 20 28 1 1 ❑PM ❑Construction * 4 R 3 0 $ 3 I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME ❑AM ❑Maintenance U2 oD ® 11 1 ARREST NAME Anselmo Arroyo.Joaquin 11-709-A S1527-000380 / r El PM SLMT o N • ❑CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME El Utility 45 F 2 ARREST NAME AM 7 1 1 ❑❑PM ❑Unknown work zone type U1 % El 2 2 3 ❑ OFFICER ID SIGNATURE BEAT!DIST. SUPERVISOR ID. COURT DATE TIME ❑AM Workers present? ❑Y 45 1527-Juarez.Jorge 502 391-Jacobucci 01 ,27/2025 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••--, , ; A CMV is defined as any motor vehicle used to transport passengers or property and: Z - ratingmore than pound (example:truck or truck trailer -< 1. Has a weight 10,000 5 } }---_r__--; ® } INDICATE NORTH combination):or p1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C 1 _ (example:shuttle or charter bus):or 0 ; BIe7rlmOKIBtd._- 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I O -- - } } } transporting employees In the course of their employment(example:employee X c,„r transporter-usually a van type vehicle or passenger car):or w L L.___a____J t 4. Is used ordesi natedtotrans rtbetween9and15 ge ng N I. } } } g po passen rs,includi [he driver, l l l , egalrnteOBhd %' 1 for direct compensation(example:large van used for specific purpose):or L i.____a____.I ° t i. i t 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires 11 CEO DIU placarding(example:placards will be displayed on the vehicle). ;p —1 CARRIER NAME Z ADDRESS 0 C) z CITY/STATE/ZIP g _ MOTOR CARR.ID 0 Interstate 0 Intrastate 5 __Nor*spoo•_. O l I r l ❑ Not in Comm./Govt. Not in Comm./Other ❑ 0 � "Y""1 USDOT NO. ILCC NO. m XI Source of above z ' . 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 Z TRAILER 2 ❑ 0 0 o u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w Gray Blue 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 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/TO. DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE