HomeMy WebLinkAbout2025-00000844 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111
I01101100
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DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY XoOa6a5554
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INVESTIGATING AGENCY DAMAGE TO ANY ❑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-$1.500 ®ON SCENE 2
VEHICLE/PROPERTY ®OVER 91,500 El NOT ON SCENE(DESK REPORT) ® B Injury and f or Tow Due To Crash
0 AMENDED YR 2025I 2025-00000844 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n
® ❑ RELATED PRIVATE ❑Y ®N 01 04 2025 DAM ❑YES ®NO U1 -<
RAN DALL RD Elgin mo /day/yr 05:40 ®PM FLOW CONDITION Ill
112 FT 1 vt N E S VY HO S Rd COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 1 (n
® ® pp Kane HIT&RUN ❑Y , WITH VEHICLESOT,
INVLD ® STOPPED U2 —I
O AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ❑ FREE FLOW # LNS 0
DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EWES ❑uuv ❑!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 n
T TOWED U1 Q
Wadford.T ler, R. Scion TC 2009 00-NONE „ , DUE TO CRASH ® ❑
NAME(LAST,FIRST,M) y mo yr 13-UNDER CARRIAGE �a) 2 , 2 FIRE ❑
4 (<
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ® 0 U2 Tl
M 2 SY is-OTHER
4 ❑Y ®SNE❑UNK VEH. O AT CRASH M IN D O 99-UNKNOWN 9 76•TOP 3 *Distraction Value 5 ALGN 2
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 7 :il a 4 COM VEH ❑ j$J 1 0
~ ELGIN I L 60124 0 1 0 FIRST CONTACT 12 7_. __5 *If Yes.See Sidebar U1
Z EB23084 IL 2025 E
TELEPHONE
IL D 0 JTKDE167590288066 STATE FARM ❑Y ®N U2 Rr'I
13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
99 9 Wadford,Sharon, M. 12636100-SFP-13 1 r
o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER
RESPONDER
2 ou
p;rg• DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 i My 0 KCV 0 DV
1 9 9 1 Nissan Sentra 2024 00-NONE +i_"i 12-- DUE TO CRASH ❑ C 2
o is-UNDER CARRIAGE ta;I 2 FIRE ❑ ® U2 C
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M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16.TOP 3 X
❑Y i N ❑UNK VEH. AT CRASH 99-UNKNOWN *Oistraellon Value 9 0
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF S iI S l;,_4 COM VEH D ® Ut CO
FIRST CONTACT 6 Y__{_O ._5 •(ryes,See Sidebar
H ELGIN IL 60123 C 1 0 DS24502 IL 2025 AR
M
IL D 0 3N1AB8CVXRY282450 STATE FARM ❑Y ®N RDEF
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER 1 =
99 9 Cardenas Diaz, Kassadnra 2059712-SFP-13 BAC
$
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP 996 <
Provena St.Joseph RESPONDER
u1 =
(UNIT) (SEAT) (DOS) (SEX) {SAFT) (AIR) (INJ) (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 ❑Y U2 Z
N 1 ® 11 1 11 ,12 ,25 05 40 0 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 .,
ai 2 ❑ 41 99 11 ,12 ,25 06 30 ®PM ❑Construction
*
R O ❑ ]$l CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 1
3 ❑AM ❑Maintenance U2
-a, ARREST NAME Wadford,Tyler. R. 11-601-Ax 1544000062 11 ,12 r25 06 35 Igi pM SLMT
1 ® ElUtilit 11 1 ❑CITATIONS ISSUED PENDING
o u SECTION CITATION NO. ROAD CLEARANCE TIME y
r 2 El ARREST NAME 11 r 12 125 05 40 0 PM ❑Unknown work zone type 0 AM U1 45
2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 45
1544-Solis,Yulissa 702 11 , 81 ,025 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 -<
` ' // / i
.. INDICATE NORTHcomWrtation)or
0
BYARROW 2 Is used or designed to transport more than 15 passengers including the driver C
- (example:shuttle or charter bus):or Xr r 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier 0
I- 1.---------i .r7,
} } } transporting employees in the course of their employment(example:employee
transporter-usually a van type vehicle or passenger car):or tl
II R
L 4. Is used or designated to transport between 9 and 15 passengers,including c
}-----;----; .� - } } } g po passen rs,indudi the driver,
j for direct compensation(example:large van used for specific purpose):or
41.211.1131.0 O
__ / / _ l. I 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m
/ placarding(example:placards will be displayed on the vehicle). XI
CARRIER NAME Z
ADDRESS0
iii w
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// CITY/STATE/ZIP
/ / - i. i. i. i. MOTOR CARR.ID 0 Interstate 0 Intrastate
/ / ❑ Not in Comm./Gout. ❑ Not in Comm./Other 00
� --- --1 / USDOT NO. ILCC NO. C
m
XI
Source of above z
. —I
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
White Blue
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 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY/TO:
DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE