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HomeMy WebLinkAbout2025-00001991 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 101101100 Oh I I DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X0036896S2 u, 1 U21 1 1 1 u1 2 U2 1 U1 1 U2 1 1.11 1 U2 1 4 12 u, 18 U2 1 *P 0119 INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW ' DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT ® q No Injury 1 Drive Away Elgin Police Department ONE PERSON'S ❑$501-51.500 ®ON SCENE 1 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ❑AMENDED ❑ B Injury and for Tow Due To Crash YR 202512025-00001991 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 m N MCLEAN BLVD El In 05:04 ® ❑ RELATED ❑Y ®N 01 09 2025 DAM ❑YES ®NO U1 —< g PRIVATE mo !day!yr ®PM FLOW CONDITION m 0 !MI N E S W BigTimber Rd COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 15 u) E05 ® Kane HIT&RUN ❑Y ® N WITH VEHICLESOT, INVLD ❑ STOPPED U2 --I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 18:DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EWES ❑uuv ❑!CV ❑Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 04 0 0 6 ! yr 13-UNDER CARRIAGE © IE 10,I !�. 2 FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 04 r<n M 2 SY4 ❑Y ®SNE❑UNK VEH. 0 AT CRAS IN H 0 15-OTHER 99-UNKNOWN 9 16•TOP 3 `Distraction Value 9 ALGN 2 • r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF & i�S �i 4 COM VEH ❑ j$J 1 0 Des Plaines I L 60018 0 1 0 FIRST CONTACT 11 7_: __5 *Ilsees.See Sidebar U1 ZDA94247 IL 2025 REAR TELEPHONE IL D 0 JTM B6RFV3N D524726 National General ❑v Il N U2 10 . m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Same 2018550205 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER en Refused ❑Y ® N 2 0 x DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EWES O New 0 KDV ❑DV � !1 9 9 2 Yr Toyota RAV4 2021 00-NONE ,1__' t2...0 DUE TO CRASH ❑ 2 x 0 13-UNDER CARRIAGE 10 z FIRE ❑ ® U2 C c M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16-TOP 3 X ❑Y NJ N ❑UNK VEH. AT CRASH 99-UNKNOWN *Oistracton Value 9 0 POINT OF 8 i1�i 4 COM VEH D ® U1 CO N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR 6 FIRST CONTACT 1 Y __5 •• •If Yes.See Sidebar — Mundelein IL 60060 0 1 0 EG34891 IL 2025 REAR 0 C IL 0 2T3W1 RFV9MC122423 Kemper ❑Y ®N RDEF71 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Same 12A0001554784 BAC $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPONDER U1 = (UNIT) (SEAT( (DOS) (SEX) {SAFT) (AIR) (INJI (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 co N 1 El 11 1 11 ,12 !25 05 04 ®AM in a Work Zone? NJ DIRP D 1 I PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME ID AM If YES check one below: U1 o" T 3 n 2 ❑ 2 99 + / ❑PM• ❑Construction * 4 Z 3 ❑ Igi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME ❑AM ❑Maintenance U2 3 —a, ARREST NAME Patel. Rajesh 11-905 1508000626 / / El PM 1 ® 1 1 1 ❑CITATIONS ISSUED PENDING SLMT o N SECTION CITATION NO. ROAD CLEARANCE TIME ElUtilit y 0 AM t 2 ❑ ARREST NAME 11 112 125 05 04 ®PM ❑Unknown work zone type U1 45 2 2 3 ID10 ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 45 1508-Salgiado. Leandro 501 334-Fries 21 r 81 ,025 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,U:nil:R 1050A ADDITIONAL UNITS FORMS. r ----r••--, A CMV is defined as any motor vehicle used to transport pasers or property and: Z 0 01. Has a weight rating more than 10,000 pounds{example: or truck trailer - ` ` ' ' I. INDICATE NORTH combination)or .Z�1 BY ARROW 2 Is used or designed to transport more than 15 C passengers including the driver IL (example:shuttle or charter to s):orLJ3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I O i. } } } transporting employees in the course of their employment(example:employee X transporter-usually a van type vehicle or passenger car):or w L L.___a._ - - - - - - 4. Is used ordesi natedtotrans rtbetween9and15 passengers,including C} } for direct compensation(example:large van used for specificpurpose):or [he driver, Pe ( P 9 Pe or 0 L L--_-a-___J f' € &1 ntd - t l. I. I ._ 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m .—UNt2—. . , , . placarding(example:placards will be displayed on the vehicle). :t1 t- 1 CARRIER NAME —I ;kJ_ o '1 , I ADDRESST. CITY/STATE/ZIP 0 - MOTOR CARR.ID 0 Interstate ❑ Intrastate 0 I I I I MMCLean7BNe ❑ Not in Comm./Govt. ° Not in Comm./Other 0‘I. - --1 - <USDOT NO. ILCC NO. XI Source of above z . If Yes,Name on placard 0 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 to 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 Red Silver u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT' 2 TOWED BY/TO: _ SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/TO. DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE