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HomeMy WebLinkAbout2025-00000784 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 01111101111 01101100 00 I Ill 0 IOU DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY XO0 682765 u, 1 U2 U1 3 4 1 U1 3 U2 1 U, 1 1_12 1 U, 1 U2 1 1 10 u1 1 U2 3 *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 El5501-51.500 ®ON SCENE 1 VEHICLE/PROPERTY ®OVER 51,500 El NOT ON SCENE(DESK REPORT) El B Injury and/or Tow Due To Crash 0 AMENDED YR 2025I 2025-00000784 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 —n ® ❑ RELATED ®Y 0 N 01 04 2025 ❑AM ❑YES ®No u1 SHALES PKWY Elgin12:08 _ g PRIVATE mo /day/yr NPM FLOW CONDITION III FT!MI N E S W RT20 COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 15 u) ❑ Cook HIT&RUN ❑V ® N WITH VEHICLESOT, INVLD ® STOPPED U2 —I igl AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ❑ FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EDUCE ❑uuv ❑!CV ❑Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 6 0 0 5 FOR DAMAGEDAREA(S) FROM TOWED U1 O Kia Motors CO ul 2016 00-NONE Q• �I 0 DUE TOCRASH ® ❑ / yr 13-UNDER CARRIAGE 1U 2 FIRE 0 IE STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 6 I'T1 F 2 SYST5 ❑Y ONEM DUNK VEH. 0 AT CRASH 0 99-UUTHER NKNOWN 9 16•TOP 3 *Distraction Value 9 ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8, it a �i 4 COM VEH 0 j$J 1 0 ~ ELGIN I L 60123 A 1 0 FIRST CONTACT 1 7 .- -_5 *IrYes.See Sidebar U1 Z EE23377 IL 2024 E Z. 7 TELEPHONE IL KN DJ P3A53G7262771 State Farm ❑Y Igl N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Elgin Fire 1 99 9 Same 0550339-SFP-13 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Provena St.Joseph ❑Y ❑ N 2 C)) m E{ DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EWES ❑row 0 NCv ❑Dv 1 9 yr 6 Lexus RX330 2014 00-NONE al z j--_, DUE TO CRASH rg ❑ 2 x 0 13-UNDER CARRIAGE U I ©Ic 2 FIRE 0 ® U2 C c F 2 5 SYSTEM IN 0 ENGAGED 0 15-OTHER 9.16•TOP 3 X ❑Y NJ N ❑UNK VEH. AT CRASH 99-UNKNOWN *Distraction Value 9 g N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8 TA—'-'1. 4 COM VEH ❑ N U1 CO FIRST CONTACT 11 7 _5 •• •IfYes.See Sidebar H ELGIN IL 60120 C 1 0 2706911 IL 2025 I g Sn IL D 2T2HA31 UX4C033985 State Farm ❑Y N N RDEF71 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Elgin Fire 1 99 9 Blakeman.Sharon 2050114-SFP-13 BAG E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP U1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJI 1(EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)((ADDRESS)((TELEPHONE) (EMS) (HOSPITAL) 2 3 06 / :A / / UI 1 D / / 2 O EV MOST EVNT LOG DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z N 1 ® 11 4 01 ,04 r2025 12 15 ®PM in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 7 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 v 2 0 25 18 01/04 ,2025 12 09 El Pm ❑Construction A R4 O 0 ]$I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 3 ❑AM 0 Maintenance U2 o1 ® 11 4 ARREST NAME Montes. Isabel 11-306 435000697 01,04 r2025 12 13 Igi pM SLMT o N 0 CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • El Utility 0 AM t 2 0 ARREST NAME 01 r 04 r2025 12 56 ®PM 0 Unknown work zone type U1 35 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 0 AM Workers present? ❑Y 35 435-Mahan. David 302 275-Engelke 02 ,03,2025 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 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer -< c ` -- -' r INDICATE NORTH combination):or —I BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C (example:shuttle or charter bus):or n • I I I I (! 3. Is designed to carry15 or fewer passengers and operated a contract carrier O I- ------, - JM1 I I I ( . . } } } transporting employee in the course of their employment(example:employee X 1 1 1 transporter-usually a van type vehicle or passenger car):or CO L L.___a____.I < 4. Is used ordesi natedtotrans transport passengers,including N } } } g po specific purpose): rs,includi the driver, for direct compensation(example:large van used fors cific p or 0 i i t 5. Is anyvehicle used to transport anyhazardous material(HAZthatMAT)ZMA ) requires< `----�`----; unit - XI ,, placarding(example:placards will be displayed on the vehicle). t j —I CARRIER NAME Z ADDRESS 0 w 1 1.,1 10 1 CITY/STATE/ZIP 0 Not m scare ; 1 I 1 1 - 1 MOTOR CARR.ID 0 Interstate 0 Intrastate 1 I r 1 ❑ Not in Comm./Govt. 0 Not in Comm./Other -----—: - USDOT NO. ILCC NO. rn XI Source of above z IDOT PERMIT NO. WIDELOAD"; ❑Yes 0 No = TRAILER VIN 1 m co LOCAL USE ONLY TRAILER VIN 2 m 0 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 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 DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® DISABLING DAMAGE Redmons/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE