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TACTICAL RESPONSE REPORT/Chicago Police Department 1. DATE OF INCIDENT TIME 2. ADDRESS OF OCCURRENCE 3. LOCATION CODE4. BEAT/OCCUR 4a, VIDEO RECORDED INCIDENT 21-JUL-2016 20:13:00 1801 S CALUMET AVE CHICAGO, IL 60616 269 0132 01 BW 02 IN-CAR CAMER 03 OTHER REPT VIDEO D 5. POSITION 6. LAST NAME 7. FIRST NAME 8. STAR NO. 9. SEX 10. RACE CODE11. AGE 12. HT. 13. WT. RE EV 9161 RIVERA JUAN R 17308 01 M 02 F S 508 185 BL MO 14. DATE OF APPT. 15. EMPLOYEE NO. 16. UNIT & BEAT OF ASSIGNMENT 17. DUTY STATUS 18. MEMBER INJURED? 19. MEMBER IN UNIFORM? MENV 05-DEC-2005 001 0186G 01 On 02 Off 01 Yes 02 No 01 Yes 02 No I 20. LAST NAME 21. FIRST NAME 22. M.I. 23. SEX 24. RACE 25. D.O.B. 26. HT. 27. WT. LOVE DEREK 01 M 02 F BLK 26-AUG-1965 510 185 DNA 28. ADDRESS 3331 S GILES AVE CHICAGO, IL 29. TELEPHONE NO. 30. WAS SUBJECT ARMED? FIREARM - SEMI-AUTOMATIC 31. SUBJECT INJURED? 32. SUBJECT ALLEGED INJURY? ON 60616 01 Yes 02 No 01 Yes 02 No 01 Yes 02 No ECTRMATI 3IINN2JJaUU, RR IFEY DS,U DBEJESCCTRIBE 0013 FNaotna-lFatal - Minor Injury 0024 NNoonn--FAaptpaal r-e Mnta/Njoor nInejury 3N3.O WRHETREH WWASE MSETDIECARL NTR EMATEMMENOT ROBITAAILN EHD?OSPITAL UBJFO 34. BY WHOM? 35. CONDITION 01 Apparently Normal 02 Under Influence 03 Hospitalized SN DR. SWAROOP I 04 Not Hospitalized 05 Refused Medical Aid 36. CHARGES PLACED DNA 37. CB NO. IR NO. DNA 00000000 PASSIVE RESISTER ACTIVE RESISTER ASSAILANT:ASSAULT ASSAILANT:BATTERY ASSAILANT:DEADLY FORCE DID NOT FOLLOW IMMINENT THREAT ATTACK WITH WEAPON USES FORCE LIKELY TO RCEDNA BJECT'SCTIONS VS(DETEIRFABFDAE WLN EDEDIIRG EHCTT)ION FPLUELDLED AWAY OOFT HBEART T E R Y AWOTTETHAAEPCROK N W I T H O U T CGOWARTEUHEASAEPETRO DB N O E AD T I L H Y O H R A R M O UA F F S OTHER OTHER PERCEIVED AS PERCEIVED AS Oy) E pl MEMBER PRESENCE OPEN HAND STRIKE Sp REASON FOR UCheck all that a MEMBER'SRESPONSE VEWAESRRRCIMSBOBTARALLTOR CHC OOKML DM SA N DS THOCTAAAAC0KSNN 1CEEDINH RCDEE UO(MPFWrIFoCN0IbAN2 e/LG ED WMisEcEAhRaPG0rOgE3eNN)CY ECSLTLBOROISKWEED /SP HTUARNNICKDHE KKNICEKES STRIKE FIREARM ( TASER (Contact Stun) PRESSURE SENSITIVE AREAS IMPACT WEAPON IMPACT MUNITION 01 02 03 (Describe in Box 40) (Describe in Box 40) OTHER CONTROL INSTRUMENT TASER (ARC Cycle) OTHER 01 02 03 OC/CHEMICAL WEAPON W/AUTHORIZATION TASER (Spark Displayed) LRAD WITH AUTHORIZATION 01 02 03 OTHER OTHER * OC/CHEMICAL WEAPON AUTHORIZED BY (NAME) RANK STAR NO. UNIT NO. 40. DID THE INVOLVED MEMBER DISCHARGE A WEAPON ONLY TO DESTROY OR DETER AN ANIMAL? 01 Yes 02 No DNA 40a. WAS THIS AN ACCIDENTAL DISCHARGE IN THE 40b. DID THIS WEAON CONTRIBUTE TO A SUBJECT INJURY 40c. DID THE DISCHARGE RESULT IN A SELF -INFLICTED INJURY? CONTEXT OF A NON-CRIMINAL INCIDENT? T 01 Yes 02 No 01 Yes 02 No 01 No 02 Yes - Subject 03 Yes - Member N DE 41. WEAPON TYPE 04 SEMI-AUTO PISTOL 42. INCIDENT OCCURRED 43. LIGHTING CONDITIONS 01 Daylight 44. WEATHER CONDITIONS CI 01 REVOLVER 05 CHEMICAL WEAPON Indoors Outdoors 02 Night 03 Dawn 04 Dusk CLEAR N 05 Poor Artificial 06 Good Artificial E I 02 RIFLE 06 TASER (Probe Discharge) G 45. MAKE/MANUFACTURER 46. MODEL 47. BARREL LENGTH 48. CALIBER/GAUGE R 03 SHOTGUN 07 OTHER SIG/S. I. G./SWISS INDUSTRIAL GESELLSCHAFT -- P226 4.4 9 MM A SZ-- H C 49. TASER DART ID NO. 50. WEAPON SERIAL No. (Include Letters) 51. CHICAGO GUN REG. NO. 52. IL FIREARM OWNER ID. NO. 53. HANDGUN CERTIFICATE NO. S U722655 635989 54383024 DI PON 54. SPECIAL WEAPON CERTIFICATE NO. 55. PROPERTY INVENTORY NO. 5D6.e TpYPaEr OtmF AeMnMtU NIsITsIOuN eUdSED 5 T7H.NISO M. OEFM WBEERA.P ONS DISC1HARGED BY 5M8E. MTOBETRAL F NIROE.D OF SHOT9S 162 70. EVE A 0 N WE 59. WHO FIRED FIRST SHOT 03 OTHER (SPECIFY) 6D0U. RWINAGS IFNIRCEIDAERNMT RELOADED 6S1H.O NTO S OHFE LCLASRTRIDGES/ 62. HOW WAS MEMBER'S HANDGUN WORN 03 OTHER (Specify) 31 T NO 01 MEMBER 02 OFFENDER 01 YES 02 NO RELOADED 01 RT. SIDE (WAIST) 02 LT. SIDE (WAIST) 5 . 63. HOW WAS MEMBER'S HANDGUN DRAWN 03 OTHER (Specify) 64. SPECIFY METHOD/EQUIPMENT USED TO RELOAD 65. DID MEMBER USE SIGHTS 04 01 STRONG SIDE DRAW 02 CROSS DRAW 01 YES 02 NO 8 66. DESCRIBE PROTECTIVE COVER USED (LIGHT POLES, DOORWAYS, CAR, FURNITURE, ETC) 67. DISTANCE BETWEEN INVOLVED MEMBER & OFFENDER WHEN FIRST SHOT WAS FIRED H 6N8. OPENR01SE OSUNB/OJBEJCETCT STRU0C3K A ANSIM RAELSULT OF 0T5H SEU DBIJSECCHTA &R GOET HOEFR M CEAMTBEEGRO'SR WYEAPON07 NONE 69. P0O013S 0SIT I-ITO 0TN5IN FOGTF. MEM0B4E K0RN2 D E0IE5S LC-I N1H0GA FRTG.ING05 W OETAHP0EO3R N1 (0S P- 1E5C 0FI1FT YS.)T ANDIN0G4 OVER0 125 L FYTIN.G DOWN Z3588 71. R.D. NO. 70. ADDITIONAL INFORMATION 5 02 OTHER PERSON 04 OBJECT 06 UNKNOWN 08 ANY OTHER COMBINATION 6 CPD-11.377 (REV. 3/16) Page 1 of 3 NOTIFICATIONS (ALL INCIDENTS): IMMEDIATE SUPERVISOR DSS OF DISTRICT OF OCCURRENCE 16 70. E ON NOTIFICATIONS (TASER, OC SPRAY, OTHER CHEMICAL WEAPONS INCIDENT): OEMC CPIC 20 VENT ASEMATI NMOeTmIFbIeCrAsT wIOilNl eSn (sUuSrEe OthFa Dt aElAl DreLqYu FirOeRd CnEo,t iFfiIcRaEtiAoRnMs ,a InMdP AaCll Tw MitnUeNsIsTeIOsN toS ,t LhRisA uDs, eC oAfN fIoNrEc eIN aCrIeD EdNocTu):mented in OthEeM aCppropiate case report. 315 NO. CR 0 O 4 F 40. ADDITIONAL INFORMATION 8 N I S R73I.V REEPRORAT,IN JGU MAEMNBE RR (Print Name) 1ST7A3R0/E8MPLOYEE NO. SIGNATURE HZ 71. R URE 22-JUL-2016 02:26:25 35 .D. NO T Reviewing supervisor will ensure the legibility and completeness of this report and attest by entering the required information below. 8 . A 8 GN 74. REVIEWING SUPERVISOR (Print Name) STAR NO. SIGNATURE DATE REVIEWED TIME 5 SI BRESNAHAN, LAUREL A 46 22-JUL-2016 02:27:14 6 Additional discharged weapons: CPD-11.377 (REV. 3/16) Page 2 of 3 LIEUTENANT OR ABOVE/INCIDENT COMMANDER REVIEW FOR REPORTABLE USE OF FORCE INCIDENTS, THE FOLLOWING RANKED SUPERVISOR WILL BE RESPONSIBLE FOR REVIEWING AND APPROVAL OF ALL TRR'S FROM THE SAME INCIDENT: 1. THE EXEMPT_LEVEL INCIDENT COMMANDER WILL REVIEW AND APPROVE THE FOLLOWING TYPES OF INCIDENTS: (A) THE DISCHARGE OF IMPACT MUNITIONS OR A FIREARM BY A DEPARTMENT MEMBER, EXCLUDING UNINTENTIONAL DISCHARGES WITH NO INJURY AND DISCHARGES TO DESTROY AN ANIMAL. (B) A MEMBER'S USE OF FORCE, BY WHATEVER MEANS, THAT RESULTS IN THE DEATH OR INJURIES LIKELY TO CAUSE OF DEATH OF ANY INDIVIDUAL. (C) ANY LESSER USE OF FORCE BY A DEPARTMENT MEMBER WHEN THAT USE OF FORCE STEMS FROM THE SAME INCIDENT IN WHICH ANOTHER MEMBER USED FORCE AS STATED ABOVE. 2. THE ASSIGNED DISTRICT OF OCCURRENCE MEMBER THE RANK OF CAPTAIN OR ABOVE WILL REVIEW AND APPROVE TRR'S FOR THE FOLLOWING INCIDENTS: (A) THE DESTRUCTION OF AN ANIMAL WITH NO HUMAN INJURY. (B) AN ACCIDENTAL WEAPONS DISCHARGE WITH NO INJURY. (C) ANY INCIDENT NORMALLY INVESTIGATED BY A LIEUTENANT WHERE A LIEUTENANT IN THE DISTRICT OF OCCURRENCE IS NOT AVAILABLE. 3. THE ASSIGNED DISTRICT OF OCCURRENCE MEMBER THE RANK OF LIEUTENANT WILL INVESTIGATE ALL OTHER INCIDENTS. 75. SUBJECT'S STATEMENT REGARDING THE USE OF FORCE DNA REFUSED INTERVIEW NOT CONDUCTED (Specify Reason) Unable to interview subject/Offender deceased. 76. LIEUTENANT OR ABOVE/INCIDENT COMMANDER: COMMENTS Based upon the facts available at this time, it is the preliminary determination of the undersign that P.O. Rivera, Juan #17308 acted in compliance with department policy in that P.O. Rivera fired his weapon in fear of his life. This action was taken after offender Love, Derek IR#785158 pointed a weapon and fired same striking Officer Benitez, David #12678 and thus placing Officer Rivera in fear of his life and fearing for the lives of Officers Benitez #12678 and Officer Herrera, Alfonso #14777.(cid:10) Log#1081543 U# 16-012 77. LIEUTENANT OR ABOVE/INCIDENT COMMANDER USE ONLY 78. LIEUTENANT OR ABOVE/INCIDENT COMMANDER DETERMINATION BASED ON THE INFORMATION THAT I HAVE REVIEWED, I I HAVE REVIEWED THIS TRR AND COMPLIED WITH THE I HAVE CONCLUDED THIS INVESTIGATION FALLS UNDER HAVE CONCLUDED THAT THE MEMBER'S USE OF FORCE RES DUTIES OUTLINED IN G03-02-05. THE INVESTIGATION AUTHORITY OF THE INDEPENDENT POLICE REVIEW AUTHORITI (IPRA). IN COMPLIANCE WITH DEPARTMENT POLICY AND DIRECTIVES. LOG NO. 1081543 OBTAINED NOT IN COMPLIANCE WITH DEPARTMENT POLICY AND DIRECTIVES. 79. LIEUTENANT OR ABOVE/INCIDENT COMMANDER (Print Name) 80. ALEXANDER, DANA TRR __________________________ OF _________________________TRR(S) 81. TOTAL TRR's THIS EVENT No. 3 SIGNATURE DATE COMPLETED TIME 22-JUL-2016 03:01:28 CPD-11.377 (REV. 3/16) Page 3 of 3