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HomeMy WebLinkAbout2025-00001449 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 I01101100 I 110II II � ilfi 1 /1011 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X00a690766 u, 1 U21 2 1 1 U1 2 U2 1 U, 1 1_12 1 U1 1 U2 1 1 15 U1 1 U2 1 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY El$500 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$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash 0 AMENDED YR 2025I 2025-00001449 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 r7 N SPRING ST El In 02:34 ® ❑ RELATED ®Y 0 N 01 07 2025 ❑AM YES ®NO U1 '< _ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION M FT!MI N E S W CHERRY ST COUNTY PROPERTY ❑Y ® N DOORING Ely #OF MOTOR 0 SLOW 1 (/)❑ Kane HIT&RUN ❑V ® N WITH VEHICLES INVLD ❑ STOPPED U2 --I ® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 I83 DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EWES ❑uuv ❑!CV ❑Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 0 0 6 / yr 13-UNDER CARRIAGE al 1t. I•�. 2 FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL O4-TOTAL(ALL) OP 2 DISTRACTED 0 ]$I U2 0 (T1 M 2 8 ❑Y ®SYSNEM DUNK VEH. O ATCRASHD 0 99-UUTHER NKNOWN O9 tS-7 7% `DistractionValue ALGN = r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 0 i 6 ' COM VEH 0 Zgl 1 n H Z WEST DUNDEE IL 60118 0 1 0 FIRST CONTACT 9 Q,.Q:-O 'If Tea.See Sidebar U1 0 BA50162 IL 2023 REAR TELEPHONE IL D 0 3LNHM26T89R621080 None ❑Y ❑N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Elgin Fire Mc Grane.Colin None 1 r "o HOSPITAL(TAKEN TO) INCIDENT IF IC OWNER STREET,CITY.STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y ® N 2 eu p; DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EWES ❑iiuv 0 NCv ❑DV /1 9 9 6 Honda Civic 2024 00-NONE O" z "O DUE TO CRASH ❑ 2 0 yr 13-UNDER CARRIAGE ©f? z FIRE ❑ ® U2 C : M 2 8 SYSTEM IN 0 ENGAGED 0 15-OTHER 9,16-TOPO3 X ❑Y NJ N ❑UNK VEH. AT CRASH 99-UNKNOWN O 0istracti n Value 2 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF S- 1. 6 I f 4 COM VEH D ® U1 W FIRST CONTACT 5 7��'—_,LDS •IrYes,See Sidebar Z South Elgin IL 60177 B 1 0 EP45681 IL 2025 I 0 D 0 19XFL2H88RE023263 State Farm ❑Y ®N RDEF71 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Elgin Fire Same 0558766-SFP-13 BAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP 996 < Sherman RESPONDER u1 = (UNIT) (SEAT) IDOBI (SEX) {SAFT) (AIR) (INJI (EJCTI (EPTH) PASSENGERS&WITNESS ONLY (NAME)((ADDRESS)((TELEPHONE) (EMS) (HOSPITAL) 1 3 06 / / / UI 3 D / / 1 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z N 1 ❑ 11 4 11 /12 /25 02 35 ®AM in a Work Zone? ®N DIRP co 1 t PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 3 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 O 2 ® 31 2 23 28 11 (12 /25 02 35 PM ® , ❑Construction >F " 3 ❑ 0 CITATIONS ISSUED ❑PENDING SECTION CITATION NO. EMS ARRIVED TIME 5 ❑AM ❑Maintenance U2 - ®a, ARREST NAME 11 /12 /25 02 38 ®PM o ' u 1 11 1 0 CITATIONS ISSUED ❑PENDING o N SECTION CITATION NO. ROAD CLEARANCE TIME El Utility SLMT t 2 ❑ 31 3 ARREST NAME 11 (12 /25 03 54 ®PM El Unknown work zone type U1 30 0 AM n 7 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 ❑ ❑AM Workers present? ❑Y 30 476-Ramos.Clarissa 102 334-Fries / / 0 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 -< ` ` - ' ® INDICATE NORTH combination):or .Z�1 itl r BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C } - } r r r (example:shuttle or charter bus):or 0 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 X transporter-usually a van type vehicle or passenger car):or CO 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 o _ 5. Is any vehicle used to transport anyhazardous material(HAZMAT)that requires m a J placarding(example:placards will be displayed on the vehicle). XI Chwrrtar oy CARRIER NAME Z _a ADDRESS O C) CITY/STATE/ZIP g Not To Scale ' - MOTOR CARR.ID 0 Interstate 0 Intrastate I I T I ❑ Not in Comm./Govt. 0 Not in Comm./Other ‘I. - --1 - USDOT NO. ILCC NO. m XI Source of above z . 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 Blue 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