HomeMy WebLinkAbout2025-00003084 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111
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DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X003699351
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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-$1.500 ®ON SCENE 14
VEHICLE/PROPERTY ®OVER 51,500 El NOT ON SCENE(DESK REPORT) ® B Injury and f or Tow Due To Crash
0 AMENDED YR 202512025-00003084 VENT
ADDRESS NO. HIGHWAY or STREET NAME ® ❑CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 21 �I
RT20 RELATED ®Y 0 N 01 14 2025 03:00 ❑AM YES ®No u1
Elgin PRIVATE mo /day/yr ®PM FLOW CONDITION IT7
FT!MI N E S W SHALES PKWY COUNTY PROPERTY ❑Y ® N DOORING Ely #OF MOTOR 0 SLOW Cl)❑ Cook HIT&RUN ❑Y ® N WITH VEHICLES INVLD 0 STOPPED U2 —I
® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N 51 FREE FLOW # LNS 0
Qg3 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEON. 0 EWES 0 uuv 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 5 C)
1 1 FOR DAMAGEDAREA(S) FROM TOWED U1 0
NAME(LAST,FIRST,M) Schmidt.James. M. mo / /2 0 0 0 Mack Trucks. !Unknown2012 00-NONE 11 • >z T,0
DUE TO CRASH ® ❑
13-UNDER CARRIAGE 10 FIRE El
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 0 DISTRACTED 0 ]$I U2 M
M 2 SYTM IN ENGAGEDTHER
3 ❑Y ®SNE❑UNK VEH. 0 AT CRASH 0 99-Uis-UNKNOWN 9 16-TOPO `Distraction Value 9 ALGN =
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6 i! 6 �1 COM VEH ® El 3 0~ Mchenry IL 60050 A 1 0 P1142718 IL 2025 FIRST CONTACT 5 7 ; _O =IlYes.See Sidebar U1
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TELEPHONE
IL A 7 1 M 1 AW02Y3CM024473 Cincinnati Insurance ❑Y ICI N U2 r 1 R
13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER RSUR m
Elgin Fire Sunset Cartage Inc EBA0550613 1 rn
o HOSPITAL(TAKEN TO) INCIDENT IF IC OWNER STREET,CITY.STATE,ZIP PHONE NUMBER
RESPONDER
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c SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED
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EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X
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(UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)((A.DDRESS)!TELEPHONE) (EMS) (HOSPITAL) n
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EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z
u Ni ® 2 1 01 ,14 ,2025 03 00 ®PM in a Work Zone? ®N DIRP co
1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 3
T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 ,,
2 ❑ 28 12
! , ❑PM- ❑Construction *
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R 3 ❑ $I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME
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-a, ARREST NAME Schmidt.James. M. 11-601-Ax S1529-000253 / ! El PM SLMT
o u 1 ❑ CITATIONS ISSUED PENDING Utility
o N SECTION CITATION NO. ROAD CLEARANCE TIME 0
0 AM
t 2 ❑ ARREST NAME 01!14 ,2025 05 17 ®PM ❑Unknown work zone type U1 35
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OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y
1529-Audi red.Jonathan 401 02 !04,2025 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.
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r 1----1--•--, , ; 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 -<
i- ;.__-_r-_--; ( combination):or —I
INDICATE NORTH p1
°o BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C
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_ (example:shuttle or charter bus):or 0` 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier IO
-,` 't/,+k z. t t t transporting employees In the course of their employment(example:employee X
r r transporter-usually a van type vehicle or passenger car):or C
L ------}----; - I. t t t •4. Is used or designated to transport between 9 and 15 passengers,including the driver, (I)for direct compensation(example:large van used for specific purpose):or O
L L____a____� ` , �� �-. _ t l. I I L 5. Is any vehicle used to transport anyhazardous material(HAZMAT)thatrequires
�' _ placarding(example:placards will be isplayed on the vehicle). XI
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/ CARRIER NAME Z
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MOTOR CARR.ID 0 Interstate 0 Intrastate
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--- --1 USDOT NO. ILCC NO. m
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Source of above z
. Form Number
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IDOT PERMIT NO. WIDELOAEP 0 Yes ®No 2
TRAILER VIN 1 2K9TP1 L274G035056 m
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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_COLOR TRAILER LENGTH(S)1 ft. 2 ft. w
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_TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: TOWED BY/TO:
DUE TO VEHICLE CONFIG. CARGO BODY TYPE 8 LOAD TYPE 5