Loading...
HomeMy WebLinkAbout2025-00005363 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 I01101100 111 11111 1 1 'III Oil DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X003 058,3 u, 1 U21 2 4 1 u116 U2 1 u, 1 1_12 1 u, 1 U2 1 1 10 u, 6 u2 1 *P0119* INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW ' DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 14 VEHICLE/PROPERTY ®OVER 51,500 El NOT ON SCENE(DESK REPORT) El Injury and/or Tow Due To Crash 0 AMENDED YR 202512025-00005363 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 mALFT LN El In 08:42 ® ❑ RELATED ®Y 0 N 01 25 2025 ®AM YES ®No u1 -< _ g PRIVATE mo /day/yr ❑PM FLOW CONDITION ITT FT/MI N E S W CAPITAL ST COUNTY PROPERTY ❑Y ® N DOORING Ely #OF MOTOR 0 SLOW 2 rn ❑ Kane HIT&RUN ❑V ® N WITH VEHICLES INVLD 0 STOPPED U2 --I ® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N 51 FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uuv 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 C) FOR DAMAGEDAREA(S) FROM TOWED U1 0NAME(LAST,FIRST,M) mo /1 9 6 7 Chevrolet Trax 2024 00-NONE 13-UNDER CARRIAGE 2 DUE TO CRASH © el 0 ® ❑ ,I FIRE ❑ tz STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 0 171 F 2 4 SYTM❑Y ®S NE❑UNK VEH. 0 AT CRASH 0 15-99-UUNKNOWN THER9 16•TOP 3 `Distraction Value ALGN 2 T CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s iL 6 1, 4 COM VEH 0 El 1 0 ELGIN I L 60120 0 1 0 FIRST CONTACT 11 7_: __5 *II Yes.See Sidebar U1 Z EF14123 IL 2025 REAR TELEPHONE IL D KL77LJE29RC130941 State Farm ❑Y ®N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Same E566117C2713A 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y El 2 c x DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 �1 9 6 8 General Motort500 2016 00-NONE ,i ' t2 O DUE TO CRASH ❑ 2 0 13-UNDER CARRIAGE 10 2 FIRE ❑ ® U2 C M 2 4SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16-TOP 3 X D Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN *Oistraellon Value 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6 Il, COM VEH ❑ ® U1 COFIRST CONTACT 1 7�' —�_-5 •If Yes.See Sidebar ZSOUTH ELGIN IL 60177 0 1 0 2740344B IL 2025 REAR M IL D 1 GTV2N EC4GZ370258 Allstate ❑Y ®N RDEF71 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Same 962343633 BAG $ 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),(A.DDRESS)/(TELEPHONE) (EMS) (HOSPITAL) 1 3 07 / M 2 4 0 1 0 m / / #OCCS D / / UI 2 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 01 ,25 ,2025 08 42 ®❑PM in a Work Zone? ®N DIRP co 1 t PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 6 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 C) o" 2 ❑ 20 99 , , ❑PM ❑Construction >F R 3 ❑ $I CITATIONS ISSUED El PENDING SECTION CITATION NO. EMS ARRIVED TIME 7 ❑AM ❑Maintenance U2 a1 ® 11 4 ARREST NAME Boldwyn.Catherinet.S. 11-709-A 1545-129 , / ❑PM SLMT o N 0 CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ❑Utility AM U, 30 t 2 El ARREST NAME 01 l 25 i2025 08 43 0 PM ❑Unknown work zone type 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 30 1545-VanEycke. Brier 502 275-Engelke 02 ,25,2025 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 r0 f 1. Has r more than pounds(example:truck or truck trailer 1. Has a weight rating10 000 5 INDICATE NORTH combination):o -I BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C UL (example:shuttle or charter bus):orNOf TO SCBIB 3. Is designed to car 15 or fewer ssen ers and o rated a contract career O A i I. } } transporting employees In the coursee of their employment(example:employeey a van type vehicle or 4f`" 1 4alsuorter-sedordesllnatedtotransportbetween9a dr15passengers,includingthedriver, y C } } } • • for direct compensation(examp large van used for speific purose):or L L--_-a-....I - t i I 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires — — — — uMut — — — — placarding(example:placards will be displayed on the vehicle). XI le -I _ CARRIER NAME Z T ADDRESS '.Z V) ICITY/STATE/ZIP - MOTOR CARR.ID ❑ Interstate ❑ Intrastate 8 I I , I ❑ Not in Comm./Gout. Not in Comm./Other i. --- --4 - USDOT NO. ILCC NO. m XI Source of above z . IDOT PERMIT NO. WIDELOAD-; ❑Yes 0 No = 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/Unknown . 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