HomeMy WebLinkAbout2025-00000601 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets _ 01111101111
I01101100 II 000100000
DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY XO03631528
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INVESTIGATING AGENCY DAMAGE TO ANY ❑$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 14
VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash
0 AMENDED YR 202512025-00000601 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n
N MCLEAN BLVD Elgin 03:51
® ❑ RELATED ®Y 0 N 01 03 2025 ❑AM ❑YES ®No u1 —<
_ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION MFT!MI N E S W TIMBER DR COUNTY PROPERTY ❑Y ® N DOORING Ely #OF MOTOR 0 SLOW 99 Cl)
❑ Kane HIT&RUN ®Y ❑ N WITH VEHICLES INVLD 0 STOPPED U2 —I
® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0
Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uuv 0!CV 0 ov DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 n
FOR DAMAGEDAREA(S) FROM TOWED U1 0Chen. Danfeng1 2 /
yr 13-UNDER CARRIAGE (4.)
:. 2 FIRE 0
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0U2 04 M
F 2 SYTM 4 ❑Y ®SNE DUNK VEH. O AT CRASH 0 99-UNK 15- NOWN THER9 16•TOP 3 *Distraction Value 9 ALGN X.
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s, ii_6 1,.4 COM VEH 0 0 1 0
~ ELGIN I N I L 60124 0 1 0 FIRST CONTACT 12 7 ; _5 *Yves.See Sidebar Ut
Z DV81257 IL 2025 REAR
TELEPHONE
IL D 0 3VV2B7AX5PM034483 State Farm ❑Y Il N U2 13 . m
in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
99 9 Same 2894272sfp13 1 r
"o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER
RESPONDER D
Refused ❑Y ® N 3 eu
p; DRIVER ❑ PARKED 0 DRIVERLESS ❑ PED 0 PEDAL 0 EWES 0 m,lv 0 i v 0 DV
yr 10 12 c, 2 FIRE 0 ® U2 C
o 13-UNDER CARRIAGE .1c SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED
a SYSTEM IN 9 ENGAGED 9 15-OTHER 9:1,6•TtOP 3 ❑ ® SPDR n
9 9 ❑Y ❑N ®UNK VEH. AT CRASH 99-UNKNOWN *Distraction Value 9 0
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8- 1. 6 j1:, 4 COM VEH D ® U1
COF,, 57. �_5 •If Yes.See Sidebar C
0 9 0 REAR 9 (p
M . STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0
Unkown ®V 0 N RDEF71
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 =
99 9 Same Unkown BAC
$
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 <
RESPONDER❑Y Ui =
iUNIT) (SEATI (DOBi (SEX) {SAFT) (AIR) (WI 1(EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)!(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL)
1 4 10 /
:A
/ / u1 03 D
/ / 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 1 01 ,03 /2025 03 51 ®pm in a Work Zone? ®N DIRP co
1 r PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 1
T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1
2 ❑ 11 1 04 20
! / ❑PM• ❑Construction >E
" 3 ❑ I!!I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 1
❑AM ❑Maintenance U2
o ® 11 9 ARREST NAME Chen. Danfeng 11-708 S1537-000078 / / El PM SLMT
o N •
❑CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME El Utility
0 AM
r 2 ❑ ARREST NAME 01/03 /2025 04 20 0 PM El Unknown work zone type U1 3O
2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 30
1537-Mapp.Teddron 501 334-Fries 02 ,04,2025 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.
r ----r••--, , ; A CMV is defined as any motor vehicle used to transport passengers or property and: Z
II A 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer -<
} }--_.;-----; e - combination):or
INDICATE NORTH P3
3ILIl. n I I L _ro_ -,a eb•,r-E_1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C
} - i. e. r r (example:shuttle or charter bus):or
- L.___a.._.� I I - - } } } . 3. Is gemned tolcaees15 or in the coer rsee passengers
their employment
operated by a contract carrier I
transporting employees ployment(example:employee X
transporter-usually a van type vehicle or passenger car):or co
— — — — — — — — — —
L 4. Is used or designated to transport between 9 and 15 passengers,including N
}--- ----; fT 8 - } } } g po passen rs,includi the driver,
. for direct compensation(example:large van used for specific purpose):or O
L L___-a..... - t i i 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires
D
I placarding(example:placards will be displayed on the vehicle). XI
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LiiiiiiIIiHMi11i1iiii11ii1i1ii CARRIER NAME Z
nmoonar ADDRESS 0
! I :` ..N.... V)
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; CITY/STATE/ZIP o
,Ayo' at I 'or i.- i. i. i. MOTOR CARR.ID ❑ Interstate ❑ Intrastate
❑ Not in Comm./Govt. ❑ Not in Comm./Other 0
----- ----1 - USDOT NO. ILCC NO. C
m
XI
Source of above z
. Form Number
m
Xl
IDOT PERMIT NO. WIDELOAD'; 0 Yes 0 No 2
TRAILER VIN 1 m
co
LOCAL USE ONLY TRAILER VIN 2 m
v
TRAILER WIDTH(S) 0-96" 97-102" >102' m
TRAILER 1 ❑ ❑ 0 Z
TRAILER 2 ❑ 0 0 O
u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. Z
White
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 DISABLING DAMAGE DAMAGE EXTENT: 9 TOWED BY/TO:
DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE