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HomeMy WebLinkAbout2025-00000657 ILLINOIS TRAFFIC CRASH REPORT sheet 1 Df 2 Sheets II III H II II IIIIII 01100 HO 0 H10111111 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X00363151/ u, 9 U21 1 1 1 U1 2 U2 1 U, 1 u2 1 U, 1 u216 4 14 u1 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 ❑5501-51.500 ®ON SCENE 2 VEHICLE/PROPERTY ®OVER 51,500 ❑NOT ON SCENE(DESK REPORT) (83B Injury and/or Tow Due To Crash ❑AMENDED YR 202512025-00000657 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 :l ® ❑ RELATED PRIVATE ❑Y ®N 01 03 2025 ❑AM YES ®NO U1 SHALES PKWY Elgin mo /day/yr 07"08 ®PM FLOW CONDITION m _ 1 J2UNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 3 Cl) ® FT/� ClON E S W Route 20 WITH VEHICLESOT, INVLD ❑ STOPPED U2 —I 0 AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) Cook HIT&RUN ❑V ® N PEDALCYCLIST®N ® FREE FLOW # LNS 0 DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EWES ❑NW ❑!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 0 FOR DAMAGEDAREA(S) FROM TOWED U1 Q Tortorice. K le 1 0 / yr 13-UNDER CARRIAGE ©' -O FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) O 2 DISTRACTED 0 Ej U2 4 <<Tl M 2 8 El ® n is-OTHER SYSTEM ❑UNK VEH. ATCRASHD 99-UNKNOWN 9 76•TOP 3 `Distraction Value 9 ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8 ;iI S 4 COM VEH 0 Ea 4 0 F. FIRST CONTACT 12 7_; _-5 *IfYes.See Sidebar U1 Z Streamwood IL 60103 A 4 0 CM57420 IL 2025 � , TELEPHONE IL D 0 1 N4BL4BV2LC252969 American Alliance ❑Y Il N U2 MI— Si 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Elgin Fire 99 9 Same ILAA-0986891-00 1 r o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Provena St.Joseph ❑Y ® N 2 C)) p; DRIVER ❑ PARKED 0 DRIVERLESS 0 FED 0 PEDAL 0 EWES 0 row 0 KCV 0 DV /1 9 8 2 Kia Motors Co►pedona 2017 00-NONE 0. Q1.-_, DUE TO CRASH rg ❑ 2 x 0 13-UNDER CARRIAGE 10( I 2 FIRE 0 El U2 C c M 2 8 SYSTEM IN 0 ENGAGED 0 15-OTHER 9,16-TOP 3 X ❑Y Ni N DUNK VEH. AT CRASH 99-UNKNOWN *Oistrac on Value 9 U1 9 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8-iI�1:, 4 COM VEH 0 ® CO FIRST CONTACT 11 7�_,•_5 •If Yes.See Sidebar Z SOUTH ELG I N IL 60177 A 1 0 CK30980 IL 2025 I 0 C M IL D 7 KNDMC5C12H6256692 Country Financial ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X Elgin Fire 99 9 Same P010165099 BAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Sherman RESPONDER U1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (IN)) (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 1 01 /03 /2025 07 11 ®AM in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 1 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 C) v 2 0 20 99 01/03 /2025 07 09 ®PM ❑Construction * R 3 0 ]$I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 5 z J ❑AM ❑Maintenance U2 a ® 11 1 ARREST NAME Tortorice. Kyle 11-708 154000060 01/03/2025 07 13 Igi pM SLMT o N ❑CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • El Utility 0 AM t 2 ElARREST NAME 01/03 /2025 08 14 ®PM ElUnknown work zone type U1 30 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 30 1544-Solis,Yulissa 302 223-Hughes 01 /28/2025 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 r combination): r more than pound (example:truck or truck/trailer 1. Hasa weight rating10 000 5 � -< INDICATE NORTH o p3 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver 1 1 - - } (example:shuttle or charter bus):or L A \ \ 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 transporter-usually a van type vehicle or passenger car):or w L }-----}----; \\ - } } •4. Is used or designated to transport between 9 and 15 passengers,including the driver. C for direct compensation(example:large van used for specific purpose):or O I .I. \ t i i , 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m w, .—. _ \ placarding(example:placards will be displayed on the vehicle). XI CARRIER NAME Z ADDRESS C C) CITY/STATE/ZIP g ' °I MOTOR CARR.ID 0 Interstate 0 Intrastate 5 Not To Scale ( - i. I I T I ❑ Not in Comm./Govt. ❑ Not in Comm./Other 0 --- --1 - USDOT NO. ILCC NO. m XI Source of above z . Were HAZMAT placards on vehicle? 0 Yes 0 No = If Yes,Name on placard O 4 digit UN NO. 1 digit Hazard class No. Xl Xl 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 Black 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