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HomeMy WebLinkAbout2025-00009071 ILLINOIS TRAFFIC CRASH REPORT sheet 1 of 2 Sheets 01111101111 I01101100 VI 1010100000 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X003721/28 u, 1 U21 3 4 3 u, 2 U2 1 u, 1 1_12 1 u, 1 U2 1 5 10 u, 3 U2 1 *P 0119 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 ®5501-51.500 ®ON SCENE 14 VEHICLE/PROPERTY ❑OVER 51,500 ❑NOT ON SCENE(DESK REPORT) 0 AMENDED ❑ B Injury and/or Tow Due To Crash YR 2025I 2025-00009071 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n S RANDALL RD El In 06:34 ® ❑ RELATED ' V 0 N 02 11 2025 ®AM ❑YES ®NO U1 _ g PRIVATE mo /day/yr ❑PM FLOW CONDITION ITI FT!MI N E S W SOUTH ST COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR 0 SLOW 15 u) ❑ Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD 0 STOPPED U2 --I ® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST IZI N 51 FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NIAV 0 Icy ❑Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) y N 0 0 FRO 1 TOWED U1 O Barkoc David. R. Lincoln LS 2002 00-NONE z _.,2 , DUE TO CRASH 0EN NAME(LAST,FIRST,M) y- mo yr 13-UNDER CARRIAGE ©,I '._Z FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ❑ U2 0 r ]$I n M 2 4 ❑Y SYSTEM IN ENGAGED 15-OTHER 9 16•TOP 3 _ ❑N ❑UNK VEH. AT CRASH 99-UNKNOWN `Distraction Value ALGN r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s, ii_6 I,.4 COM VEH ❑ E! 1 0 ~ ELGIN I L 60124 0 1 0 FIRST CONTACT 12 7 ; _5 *II Yes.See Sidebar Ut ZBH81358 IL 2025 REAR TELEPHONE IL D 1 LN H M86S92Y705121 State Farm ❑Y ign4 U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Same 1659944SFP13 3 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y ❑ N 3 2 eu p; DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 MAV 0 NOV ❑Dv /1 9 yr 09 Ford Edge 2022 00-NONE 'o,� t2 (,-2 FIRE DUE o CRASH ® U2 2 C o 13-UNDER CARRIAGE ID c F 2 4 SYSTEM IN ENGAGED 15-OTHER 9:1,6•TOP 3 0 X ❑Y ❑N ❑UNK VEH. AT CRASH 99-UNKNOWN *Distraction Value POINT OF 8 � II,_ COM VEH D ® CO U1 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR 6 FIRST CONTACT 7 Q _,L_5 •If See Sidebar ELGIN IL 60124 0 1 0 R380380 IL 2025aR0 IL D 2FMPK4G97NBA77535 Sate Farm ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER I = Same 0461763SFP13 BAc $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP 996 < Refused RESPOND N 3 u1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)/(ADDRESS)/(TELEPHONE) (EMS) (HOSPITAL) 2 6 04 / M 12 3 0 1 0 U2 996 m / / #OCCS > / / U1 1 D / / 2 O EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 11 4 2/ / 1/ /025 06 37 ®❑PM in a Work Zone? ®N DIRP co 1 F PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME ❑AM If YES check one below: U1 1 n T o", 2 0 2 28 / / ❑PM- ❑Construction R 3 0 $I CITATIONS ISSUED El PENDING SECTION CITATION NO. EMS ARRIVED TIME 7 ❑AM 0 Maintenance U2 a1 ® 11 4 ARREST NAME Barkocy. David. R. 11-902 298001194W / / El PM SLMT o N • 0 CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ❑Utility ❑ 50 F 2 El ARREST NAME AM T / / ❑PM 0 Unknown work zone type U1 n OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 0 ❑AM Workers present? D Y 50 298-Lopez, Mirko 800 - / / ❑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 c ' -'- -' v 0 INDICATE NORTH combination):or rating more than 10,000 pounds(example: truck/trailer1 truck or truck —I N BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver n } I I m I . - } (example:shuttle or charter bus):or v l I Not To Scale f f X r I y I 3. Is designed to carry 15 or fewer passengers and operated a contract carrier 0 I- }____A____J. 1 L.,,,,,. - I. } } } transportingemployeesinthecourseoftheirem ployment(example:employee transporter-usually a van type vehicle or passenger car):or w L Unit 2 i I. •4. Is used or designated to transport between 9 and 15 passengers,including C -- -- - } } } g po passen rs,includi the driver, for direct compensation(example:large van used for specific purpose):or Cr-:;) Point?of?Impact O L____a____. at I • I. i. } } t 5. Is any vehicle used to transport an hazardous material(HAZMAT)that requires .D ufat 1 placarding(example:placards will be displayed on the vehicle). ;p South?St. 4' - ` CARRIER NAME Z i _ ADDRESS 0RIMI D rn CITY/STATE/ZIP g - 1 MOTOR CARR.ID ❑ Interstate ❑ Intrastate I . 144 l'I I ❑ Not in Comm./Govt. 0 Not in Comm./Other ; _Y_ __. USDOT NO. ILCC NO. m Xl Source of above further. 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 0 0 Z 1-1 TRAILER 2 ❑ 0 0 o u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w Blue,Dark Green,Dark u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT- 3 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