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HomeMy WebLinkAbout2025-00080916 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 6 Sheets 01111101111 I0110 1111 10111 II I11111111 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X08.002' u, 1 U21 2 3 1 U1 2 U2 1 U1 1 U2 1 U1 1 U2 1 4 15 U, 1 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$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash 0 AMENDED YR 2025I 2025-00080916 VERY ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n ® ❑ RELATED ®Y 0 N 12 23 2025 ❑AM ❑YES ®NO U1 -< ST CHARLES ST Elgin08:07 _ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION m FT!MI N E S W WATCH ST COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 15 ❑ Kane HIT&RUN ❑V ® N WITH VEHICLESOT, INVLD DO U2 --I lgi AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N 51 FREE FLOW # LNS 0 g DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uuv 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 0 FOR DAMAGEDAREA(S) FRO r TOWED U1 Q Rodriguez. Brayan.A. 0 1 / yr 13-UNDER CARRIAGE ©i FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) O " 2 DISTRACTED 0 0 U2 O m M 2 SYTM IN ENGAGE15-OTHER 4 ❑Y ®SNE❑UNK VEH. O AT CRASHD O 99-UNKNOWN 016•TOP 3 *Distraction Value ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8,_iL S 4 COM VEH 0 ZgJ 1 0 ~ ELGIN I L 60120 0 1 0 FIRST CONTACT 1 O 7 ; _5 *II Yes.See Sidebar U1 Z FN85531 IL 2026 REAR TELEPHONE IL D 0 1ZVFT80N755166700 none ®Y ❑N U2 I— in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Elgin Fire 99 9 Same none 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused 0 Y El 2 0 g DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NW 0 Nev 0 Dv !2 0 0 5 Chevrolet Tahoe 2011 00-NONE 11_"I Qj O DUE TO CRASH rg ❑ 2 x 13-UNDER CARRIAGE I I! FIRE ❑ El U2 M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 1,6-TOP 3 X ❑Y ON ❑UNK VEH. AT CRASH 99-UNKNOWN *Distraction Value 9 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF FIRST CONTACT 12 8 7. i1 I 4 COM VEH 0 ® U1 co 6 IL5 •If Yes.See Sidebar H Belvidere IL 61008 C 1 0 FD14058 IL 2026 I 0 IL D 0 1 GNSKBEO3BR237501 State Farm ❑Y ®N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER 1 = Elgin Fire 99 9 Padilla Esparza. Luis.A. 3394475-SFP-13 BAG E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP U1 I (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 0 Y U2 Z N 1 ® 11 4 12,23 ,2025 08 07 ®AM in a Work Zone? ®N DIRP co 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 C) 2 0 18 1 2 08 12,24 ,2025 08 07 PM , ® • ❑Construction �F R 3 0 CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 5 J ❑AM ❑Maintenance U2 o1 ® 11 4 ARREST NAME Rodriguez. Brayan.A. 6-20-E 747959 12,24,2025 08 08 ®pM• • ❑Utility SLMT ljg CITATIONS ISSUED 0 PENDING SECTION CITATION NO. ROAD CLEARANCE TIME AM o r 2 0 ARREST NAME Rodriguez. Brayan.A. 11-601 747956 12,24 ,2025 09 02 ®PM El Unknown work zone type U1 30 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 30 1560-Jones. Bennett 401 269-Mendiola 01 ,30,2026 09 00 ❑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. ' 3t7 3L I I 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- i•--_.r-_--; N _ I combination):or INDICATE NORTH p2 I I BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C } - } r . ,. (example:shuttle or charter bus):or C Not To Scale Dnit#3 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I^' I II O watch2st - } }} transporting employees In the course of their employment(example:employee X i. }. transporter-usually a van type vehicle or passenger car):or w } } } 4. Is used or designated to transport between 9 and 15 passengers,including the driver. N "" ""i l— 1 = t for direct compensation(example:large van used for specific purpose):or o < <____a. t 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires w . _1'. ; . . . placarding(example:placards will be displayed on the vehicle). .Zm1 WIN - Z CARRIER NAME Z { ( ADDRESS 0 n. f D I I n N.Unit . CITY/STATE/ZIP MOTOR CARR.ID 0 Interstate 0 Intrastate I I . I I I ❑ Not in Comm./Govt. Not in Comm./Other --- --1 - USDOT NO. ILCC NO. m XI Source of above z . • m 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 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 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: DUE TO ® DISABLING DAMAGE Arties/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE