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HomeMy WebLinkAbout2025-00014640 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 1111 III 11 III1II DIII 01100011111 lIflIl 111111 III DRAC TRFD TRFC WEAT DRVA VIS VEHD LGHT COLL MANY XO03749402' u, u29 1 1 9 u, 1 U299 u1 U299 U, U2 99 1 1 U1 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 2 VEHICLE/PROPERTY El OVER$1,500 ®NOT ON SCENE(DESK REPORT) ® B Injury and f or Tow Due To Crash El AMENDED YR 202512025-00014640 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH -r1 234 S WESTON AVE Elgin06:00 ® ❑ RELATED ❑Y ®N 03 06 2025 ❑AM ❑YES ®NO U1 _ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION m COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 99 Cl) ❑ FT/MI NESW Kane HIT&RUN ®Y ❑ N WITH VEHICLES INVLD ❑ STOPPED U2 —I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST IZI N ® FREE FLOW # LNS 0 0 DRIVER 0 PARKED 0 DRIVERLESS PED 0 PEDAL 0 EDUCE 0 uuv 0!CV 0 ov DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 0 FOR DAMAGED AREA(S) FRO T TOWED U1 Q Perez.Jane!. I. 0 1 yr 13-UNDER CARRIAGE IE 101 ! 2 FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 2 m F SYSTEM IN ENGAGED 15-OTHER 9 16.TOP 3 _ ❑Y ❑N ❑UNK VEH. AT CRASH ®-UNKNOWN S l 4 `Distraction Value ALGN tr. CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF L 6 1i COM VEH ❑ Ea 1 0 I . E LG I N IL 60123 B FIRST CONTACT 99 7_; __5 *Il yes.See&debar U1 REAR c Z E TELEPHONE . STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED 1 ( ❑Y ❑N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Other 1 47 1 9 I— t HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER > Other RESPONDER Ai G) g DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NMV 0 NCv 0 DV yr ©2,,_ 0 13-UNDER CARRIAGE 19( I FIRE ❑ El U2 U2 C Ti SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ❑ ® SPDR C) SYSTEM IN ENGAGED 15-OTHER 9.16-TOP 3 a` M 9 3 ❑Y ❑N ❑UNK VEH. AT CRASH � UNKNOWN *Distracter(Value N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR �'OINT OF 8-it 6 1l, 4 COM VEH ❑ ® U1 W F,,, FIRST CONTACT 1 7� ---5 •If Yes,See Sidebar C 0 9 0 REAR9 N M NA Other 37396 Unknown ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = 47 1 Same Unknown BAc $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < RESPOND❑YigN u1 = Y (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 ® 12 1 03,06 i2025 06 00 ®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 ,, Ft 2 ❑ 18 99 N 3 ❑ 0 CITATIONS ISSUED 0 PENDING / / ❑PM• ❑Construction SECTION CITATION NO. EMS ARRIVED TIME ❑AM ❑Maintenance U2 1 z -a, ARREST NAME ! r ❑PM o u ® 12 9 0 CITATIONS ISSUED 0 PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • El Utility SLMT 20 r 2ARREST NAME AM 7 1 r ❑❑PM CI Unknown work zone type U1 Eln OFFICER ID SIGNATURE BEAT!DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 CI - ❑AM Workers present? CI Y 20 1530 Soto.Oscar 601 , ❑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 S?Weston?AvE ADDITIONAL UNITS FORMS. r ----r••--, , I 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- i•---_r----; IV - I NDICATE NORTH combination):or -I BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C Co •J _ (example:shuttle or charter bus):or CO , 3. Is designed to carry15 or fewer passengers and operated a contract carrier O 0 - . . . transporting employee in the course of their employment(example:employee X transporter-usually a van type vehicle or passenger car):or w L L.___a__._� Unit?1 0 �4. Isusedordesinatedtotrans rtbetween9and15 ssen rs,includingthedriver, C } } } for direct compensation(example:large van used for specific purpose):or 0 L L____a____� I C t l. I I 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m tD "- placarding(example:placards will be displayed on the vehicle). X1 I- I- -:- '.. 0 Unit 2 CARRIER NAME Z 0Not To Scale ADDRESSL., D 0 J CITY/STATE/ZIP g MOTOR CARR.ID 0 Interstate 0 Intrastate I I T I ❑ Not in Comm./Govt. 0 Not in Comm./Other -« O ‘I. -- --1 Meyer?St USDOT NO. ILCC NO. C XI Source of above z . ❑ 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 v TRAILER WIDTH(S) 0-96" 97-102" >102' m TRAILER 1 ❑ ❑ 0 Z TRAILER 2 ❑ 0 ❑ o u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. Z 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 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 9 TOWED BY/T6 DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE