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HomeMy WebLinkAbout2025-00007854 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 101101100 IN 11111 fll 110 DRAG TRFD TRFC WEAT DRVA VIS VEHD LGHT COLL MANY X003720493 u, 1 U21 3 4 10 U1 5 U2 1 U, 1 1_12 1 U, 1 U2 1 5 10 u1 4 U2 4 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT ® q No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW ' Elgin Police Department ONE PERSON'S ❑$501-$1.500 ®ON SCENE 14 VEHICLE/PROPERTY ®OVER 51,500 ❑NOT ON SCENE(DESK REPORT) El AMENDED ElB Injury and for Tow Due To Crash YR 2025I 2025-00007854 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 7 m ® ❑ RELATED ®Y 0 N 02 05 2025 ❑AM ❑YES ®NO U1 -< N RANDALL RD Elgin08:40 _ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION m FT!MI N E S W 190 EB EXPY COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 1 (n ❑ Kane HIT&RUN ❑V ® N WITH VEHICLESOT, INVLD ❑ STOPPED U2 --I El AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EOUES 0 Nuv 0 ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 0 FOR DAMAGEDAREA(S) FROPtf TOWED U1 Q Lo vinenko.Yevgeniy.V. 0 3 / yr 13-UNDER CARRIAGE © IE ,I !�. 2 FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 0 m M 2 SYTM IN ENGAGE4 ❑Y ®SNE El LINK VEH. 0 AT CRASHD 0 99-UNKNOWN 9 16•TOP 3 *Distraction Value 9 ALGN = r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR F. POINT OF & i�s �i COM VEH 0 0 1 0 FIRST CONTACT 11 7_:—__;__5 *Ilsees.See Sidebar U1 Z Sedalia MO 65301 0 1 0 YP36364 CA 2025 REAR TELEPHONE MO A 7 4V4NC9EH8JN995698 Third Coast ❑v Igl N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR 99 9 USKO Express Inc FNCAP00018300 2 m `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER RESPONDER 21 (,0j p; DRIVER 0 PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0!My 0 Ncv 0 DV /1 9 6 3 Volkswagen Passat 2014 00-NONE ,,_' t2 DUE TO CRASH ❑ 2 73 o 13-UNDER CARRIAGE I FIRE ❑ ® U2 c M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9I1,6.TOP 3 X ❑Y (gi N DUNK VEH. AT CRASH 99-UNKNOWN *Oistractlon Value 9 0 POINT OF s i1 4 COM VEH ❑ ® U1 CO N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR 1 5 �f_ FIRST CONTACT 1 Y _,__5 •(ryes.See SidebarC Z ST CHARLES IL 60175-6159 0 1 0 V554687 IL 2025 I 0 D IL D 0 1 VWBN7A39EC121432 State Farm ❑Y ®N RDEF X EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = 99 9 Same 1486330-SFP-13 BAG $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < RESPONDER❑Y u1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)1(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL) 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 02,05 l2025 08 40 ®AM in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 4 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 C) 0 2 0 06 18 ) / 0 PM ❑Construction * R 3 0 $I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 4 ❑AM ❑Maintenance U2 a ® 11 4 ARREST NAME Logvinenko.Yevgeniy.V. 11-709-A S1542-000095 / ! El PM SLMT o N ❑CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • El Utility 0 AM t 2 El ARREST NAME 02l 05 l2025 09 45 ®PM El Unknown work zone type U1 45 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 45 1 542 Chafe. Ethan 901 03 + 18,2025 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 truck trailer -< ` ` -' -' I. INDICATE NORTH combination):or .Z-1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C r (example:shuttle or charter bus):or L L.___A.._.� I ® 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier 0 ee 73 Not To Scale : I. } r } transppoorterg-usually employees type vehicle orhpasS peir assenger car):(orxample:empfoY CO L -----}----; i. I I - } } } 4. Is used or designated to transport between 9 and 1 passen rs,including the driver, C ill ✓ for direct compensation(example:large van used fors specific purpose):or O �� _ t i I L 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m L L \� t �� 4, placarding(example:placards will be displayed on the vehicle). ;p . . . . i;:f ill° mamma - ~ —' CARRIER NAME Z I I ADDRESS 'n T. I I C) CITY/STATE/ZIP g MOTOR CARR.ID 0 Interstate 0 Intrastate r ; ❑ Not in Comm./Govt. 0 Not in Comm./Other ;____Y_._.; - USDOT NO. ILCC NO. m XI Source of above z . xi 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 ❑ 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 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 Red Black u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT: 1 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