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HomeMy WebLinkAbout2025-00012982 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 01101100 111 Iill 11 11111111111 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X003741227' u, 9 U21 1 1 1 u1 2 U2 1 U199 U2 1 u1 99 U2 1 1 11 u, 1 U2 1 *P 0119 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 3 VEHICLE/PROPERTY El OVER$1,500 ❑NOT ON SCENE(DESK REPORT) 0 AMENDED ❑ B Injury and for Tow Due To Crash YR 202512025-00012982 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 99 m ® ❑ RELATED PRIVATE ❑Y ®N 02 27 2025 ❑AM ❑YES ®NO U1 RT20 WB Elgin mo /day/yr 05:44 ®PM FLOW CONDITION m 0100 /MI N O S W South State St COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR 0 SLOW 1 cn Kane HIT&RUN ®Y ❑ N WITH VEHICLES INVLD 0 STOPPED U2 --I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 18:DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL 0 EWES ❑uuv ❑!Cy ❑ov DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 3 n 1 yr 13-UNDER CARRIAGE 1U 1 2• FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTR EN ACTED 0 ga U2 3 <<T1 M 9 SY9 ❑Y ®SNE❑UNK VEH. 0 AT CRASH M IN D 0 99-UNKNOWN 9 16•TOP 3 ,Distraction Value ALGN = r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s i�6 �i COM VEH 0 Ea 1 0 m ~ FIRST CONTACT 1 T_; __s =IIYes.seesidabar Ut Unknown Unknown 0 9 BC96797 IL REAR c Z E TELEPHONE UNK. 9 1 NXBU4EE9AZ169030 Unknown ❑Y ❑N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER RSUR m 99 9 Patel.Chandrakan. L. Unknown 1 rn `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER RESPONDER 99 GC) N DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL 0 EWES ❑NMV 0 NCv ❑DV 9 6 0 Honda Civic 2020' 00-NONE i1_"j t2"-_, DUE TO CRASH ❑ 2 73 0 Yr 13-UNDER CARRIAGE 16'I 2 FIRE ID El U2 C Ti F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9,16-TOP 3 X ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN `Oistracl Dn Value 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6 1:, COM VEH D ® U1 CO FIRST CONTACT 6 7�_, _6 •(ryes.See Sidebar n ELGIN IL 60123 0 1 0 DN80083 IL 2025 REAR0 C M IL D 0 2HGFB6E5XDH701403 Nationwide ❑Y ®N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X 99 9 Same 9112J069860 BAG $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPONDER U1 = KNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)((ADDRESS)((TELEPHONE) (EMS) (HOSPITAL) DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 11 9 02,27 ,2025 05 34 ®AM in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 7 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 C) v 2 28 99 02,27 ,2025 05 44 ®PM ❑Construction * R 3 ❑ 0 CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 7 ❑AM ❑Maintenance U2 -a, ARREST NAME / / - ❑PM ' 1 ® 1 1 1UtilitySLMT o N SECTION CITATION NO. ROAD CLEARANCE TIME ❑ ❑CITATIONS ISSUED PENDING t 2 ❑ 0 AM ARREST NAME 02(27 12025 05 44 ®PM El Unknown work zone type U1 55 n 7 OFFICER ID SIGNATURE BEAT!DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 ❑ ❑AM Workers present? ❑Y 55 1527-Juarez.Jorge 701 397-Jones , , ❑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 -< c ` --I -' r INDICATE NORTH combination):or .Z-1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C Y © - (example:shuttle or charter bus):or I- I- --I--•--; transporting employeeslin 5 the courses r passengers their emaployment nd operated xample:employee transporter n10Int073.7sretent , } } } < <.___a____. � �� I. 1 I �sedor �lltoy a van type ehbetweeicle or n9andr15r):or co } } } designatedtransportpassengers,including the driver, ram\ -t—X— m o ! for direct compensation(example:large van used fors specific purpose):or O L .'''r°etaxml/R01 <' I \4' i. < i. ,_ 5. Is any vehicle used to transport anyhazardous material(HAZMAT)that requires m ` ` C, < wa.mouno7ROVI ao placarding(example:placards will be displayed on the vehicle). ;p I I I D eeemo,>.d7rmem720 ,-> - i. -- . 1 EeoWouMNtoute720,5 > , , , , , CARRIER NAME Z Ir ADDRESS i D evmaow ' I , ' () CITY/STATE/ZIP g MOTOR CARR.ID 0 Interstate El Intrastate 0 I r ❑ Not in Comm./Govt. 0 Not in Comm./Other --- --1 - USDOT NO. ILCC NO. m 73 Source of above z . 0 Yes II No ❑ Unknown A 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 Black Black u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT: 9 TOWED BY/TO: _ SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 0 TOWED BY/TO. DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE