HomeMy WebLinkAbout2025-00016062 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 01101100 lfl UI I lI 1110
DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X003755627*
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INVESTIGATING AGENCY DAMAGE TO ANY El 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-$1.500 ®ON SCENE 2
VEHICLE/PROPERTY ®OVER 51,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash
0 AMENDED YR 2025I 2025-00016062 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n
® ❑ RELATED ®Y 0 N 03 12 2025 ❑AM ❑YES ®NO U1
N MCLEAN BLVD Elgin03:53
_ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION ITl
FTlMI N E S W MILDRED AVE COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 1 cn
❑ Kane HIT&RUN ❑V ® N WITH VEHICLES INVLD ❑ STOPPED U2 —I
® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST IZI N ® FREE FLOW # LNS 0
Qg3 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uuv 0!Cy 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 0
FOR DAMAGEDAREA(S) FROM T TOWED U1 Q
NAME(LAST,FIRST,M) Walker. Nayla. B. 1 2 /
yr 13-UNDERCARRIAGE i FIRE 0
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) O 2 THERDISTRACTED 0 0 U2 4 M
F 2 SYTM 4 ❑Y ®$NE DUNK VEH. 0 AT CRASH 99-UNKNOWN 9 76•TOP 3 *Distraction Value 9 ALGN 2
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s ;i�S 4 COM VEH 0 j$J 1 O
~ ELGIN I L 60123 C 1 0 FIRST CONTACT 1 U 7 ; •_-5 *If Yes.See Sidebar U1
Z EZ51648 IL 2026
TELEPHONE
IL D 0 4T1 BE32K44U919701 Progressive ❑Y IlN U2 m
in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
Same 992153589 1 r
`o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER
RESPONDER XI
Sherman ❑Y El 2 0
p; DRIVER ❑ PARKED 0 DRIVERLESS ❑ PED 0 PEDAL 0 EWES 0 NMV 0 NCv 0 DV
!1 9 9 1 Kia Motors Col ,orento 2014 00-NONE i1_"j Q�,-_, DUE TO CRASH rg ❑ 2 x
0 13-UNDER CARRIAGE 10( I E FIRE ❑ ® U2 C
F 2 5 SYSTEM IN 0 ENGAGED 0 15-OTHER 9,16-TOP 3 X
❑Y i N DUNK VEH. AT CRASH 99-UNKNOWN *Distracion Value 9 0
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s-iI�1:,-4 COMVEH ❑ ® U1 co
FIRST CONTACT 12 7 _, -5 •If Yes.See Sidebar
n ELGIN IL 60123 0 1 0 CQ74143 IL 2025 I9 Sn
Z
IL D 0 5XYKT3A68EG453756 StateFarm ❑Y ®N RDEF XI
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 =
Owen. Rachel 0599740SFP13 BAG $
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP
u1 =
(UNIT) (SEAT) (DO01 (SEX) {SAFT) (AIR) (INJI 1(EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)!{ADDRESS)((TELEPHONE) (EMS) (HOSPITAL)
2 6 08 /
' D
/ / 4 0
EV MOST EVNT LOG DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z
N 1 ® 11 4 03,12 l2025 03 53 ®AM in a Work Zone? ®N DIRP co
1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 3CI
T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1
v 2 ❑ 2 99 03,12 ,2025 03 54 El PM ❑Construction
R O ❑ xi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 5
3 ❑AM ❑Maintenance U2
-a, ARREST NAME Walker. Nayla. B. 11-901-A 1530000310 03,12/2025 03 59 Igi pM CITATIONS ISSUED PENDING SLMT
1 ® 11 4 ❑ Utility o u SECTION CITATION NO. ROAD CLEARANCE TIME Ely
r 2 El ARREST NAME 03 r 12 ,2025 04 44 ®PM ❑Unknown work zone type U1 0 AM
30
2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 30
1530-Soto.Oscar 601 04 ,01 ,2025 09 00 0 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
N?Mclean?Blvd 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer -<
` ` ''- -' �11— r INDICATE NORTH combination):or p0
1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver 0
} Abott?Dr - } '' ` (example:shuttle or charter bus):or
< <---- -•-•; I I ) transporting mployeened to slIn the course passengers5 or fewer thir emplod yment example:employeener X
Not To Scale transporter-usually a van type vehicle or passenger car):or co
I I.
4. Is used or designated to transport between 9 and 15 passengers,including y
}-----;----; - } } g po passen rs,includi the driver,
for direct compensation(example:large van used for specific purpose):or
Unit 2o
L L____a____. I _ _ 5 Is an vehicle used to transport an hazardous material(HAZMAT)that requires
i I f ( placarding(example:placards will be displayed on the vehicle). XI....1I I * D
6) CARRIER NAME Z
Mildred?Ave i° z
`\, ADDRESS 0
k V)
r.
' I I CITY/STATE/ZIP n
MOTOR CARR.ID ❑ Interstate ❑ Intrastate
I I ❑ Not in Comm./Govt. ❑ Not in Comm./Other 0
--- --1 - USDOT NO. ILCC NO. C
m
XI
Source of above z
. 0 Yes J 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
Silver Red
u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_
DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT' 2 TOWED BY/TO:
_ SELECT CODES FROM THE BACK OF CRASH BOOKLET
U 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 3 TOWED BY/T6
DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE