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HomeMy WebLinkAbout2025-00002606 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets — 01111101111 I01101100 I 11111111111E1111 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X00a69367 u, 8 U21 1 1 1 U1 6 U2 1 U, 1 u2 1 U, 1 U2 1 1 14 U1 12 U214 *P 0119* INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW ' DAMAGE TO ANY El$500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 1 VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash ❑AMENDED YR 2025I 2025-00002606 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 —n ® ❑ RELATED PRIVATE ❑Y ®N 01 12 2025 12,— ❑YES ®NO U1 —< DUNDEE AVE Elgin mo /day/yr 02:54 ®PM FLOW CONDITION m 0100 /MI N E O W Riverbluff Rd COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR 0 SLOW 1 (n Kane HIT&RUN ❑V ® N WITH VEHICLES INVLD 0 STOPPED U2 --I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 (g:DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL 0 EWES ❑uuv ❑!Cy ❑Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 0 FOR DAMAGED AREA(S) FROr T TOWED U1 O Rickett. Rodney. L. 0 5 / yr 13-UNDER CARRIAGE ©i O-O FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) O O DISTRACTED ® 0 U2 2 m M 2 5 SY❑Y ®SNE❑UNK VEH. O AT CRASM IN H O 99-UNKNOWN 9 76•TOP 3 `Distraction Value 7 ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF $ i1 6 4 COM VEH 0 El 1 0 ~ ELGIN N I L 60120 0 1 0 FIRST CONTACT 12 7 ;{ _5 *II Yes.See Sidebar U1 Z EW45555 IL 2025 REAR TELEPHONE IL C 1N4AL2AP8AN459158 Safeway Ins ❑v ®N U2 m .5 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR co Elgin Fire 99 9 Iverson. Bryanna. M. 3622699-IL-PP-006 2 m o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY.STATE.ZIP PHONE NUMBER RESPONDER 2 m g DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EWES ❑row 0 NCV ❑DV /1 9 9 9 Honda Accord 2018 00-NONE O' Q!'O DUE TO CRASH rg ❑ 2 xl o 13-UNDER CARRIAGE 10( I. 2 FIRE ❑ ® U2 C M 2 8 SYSTEM IN 0 ENGAGED 0 15-OTHER 9,16-TOP 3 X ❑Y NJ N DUNK VEH. AT CRASH 99-UNKNOWN *Oistracton Value 9 U1 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8-iI�1:,-4 COMVEH ❑ ® CO FIRST CONTACT 12 7 _, -5 •It Yes.See Sidebar F= 60110 0 1 0 AZ76624 I L 2025 I 0 Si) IL D 1 HGCV1 F13JA216023 State Farm ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Elgin Fire 99 9 Same 1733393-SFP-13 BAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPONDER U1 = (UNIT) (SEAT) (DOB' (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)/(ADDRESS))(TELEPHONE) (EMS) (HOSPITAL) 2 3 02 / LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z N 1 ❑ 11 1 01 /12 /2025 02 54 ®AM in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 5 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 2 ® 11 1 20 05 01,12 /2025 02 54 pM , ® • ❑Construction �F R O ❑ El CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 1 3 ❑AM ❑Maintenance U2 a ® 11 1 ARREST NAME Rickett. Rodney. L. 11-708 S475000605 01/12/2025 02 57 Igi pM SLMT o N ❑CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • ❑Utility t 2 El ARREST NAME 01/12 /2025 03 45 ®PM El Unknown work zone type U1 DAM 3O 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? D Y 30 475-Williarhs. Brianna 201 334-Fries 02 / 11 /2025 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,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 truckrtrailer -< ` ` ' ' " r INDICATE NORTH combination):or -I A BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C N _ } (example:shuttle or charter bus):or n X . r r i 5 3. Is desgned 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 - yip- Ile transporter-usually a van type vehicle or passenger car):or CD L }-----}----; - } } 1. 4. Is used or designated to transport between 9 and 15 passengers,including the driver. C , for direct compensation(example:large van used fors specific purose):or i 1 r 5. Is any vehicle used to transport anyhazardous material(HAZMAT)that requires , placarding(example:placards will be displayed on the vehicle). XI m ureaa � CARRIER NAME _ Z Not To Scale i - ADDRESS D rn CITY/STATE/ZIP n I. I - i. i. i. MOTOR CARR.ID ❑ Interstate ❑ Intrastate I I T I ❑ Not in Comm./Govt. 0 Not in Comm./Other ;------ --1 USDOT NO. ILCC NO. m XI Source of above z . IDOT PERMIT NO. WIDELOAD'; ❑Yes 0 No = TRAILER VIN 1 m to LOCAL USE ONLY TRAILER VIN 2 m a 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 Gray u 1 TOWED • TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ® DISABLING DAMAGE ElNOT DISABLING DAMAGE DAMAGE EXTENT 3 TOWED BY/TO. Arties/Impound Lot Garage SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® Arties/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE