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HomeMy WebLinkAbout2025-00018412 ILLINOIS TRAFFIC CRASH REPORT sheet 1 Of 2 Sheets 01111101111 I01101100011! IV I IIIIII II DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X003764583 u, 1 U21 3 4 1 u, 2 U2 1 u, 1 1_12 1 u, 1 U2 1 5 10 u1 3 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 ❑$501-$1.500 ®ON SCENE 2 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) El B Injury and/or Tow Due To Crash 0 AMENDED YR 2025I 2025-00018412 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 r7 N MCLEAN BLVD El In 08:37 ® ❑ RELATED ®Y 0 N 03 23 2025 ❑AM ❑YES ®No U1 -< _ _ g PRIVATE mo !day/yr ®PM FLOW CONDITION ITT FT!MI N E S W LARKIN AVE COUNTY PROPERTY ❑Y ® N DOORING Ely #OF MOTOR 0 SLOW 15 u) ❑ Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD 0 STOPPED U2 —I ® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 MUSS 0 uuv 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 0 0 1 / yr 13-UNDER CARRIAGE ©I O; FIRE 0 NI STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 10 O DISTRACTED 0 0 U2 4 <<Tl M 2 8 SYTM❑Y ®S NE DUNK VEH. 0 AT CRASH 0 99-U 15-UNKNOWN THER9 16•TOP 3 `Distraction Value 9 ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s it �i 4 COM VEH 0 0 1 C) I� _FIRST CONTACT 1 7_ ,__-a_;__5 *II Yes.See Sidebar U1 0 Z Schaumburg IL 60194 0 1 0 FC71889 IL 2026 REAR TELEPHONE IL D 0 1 N4AL21 E87C218414 MERCURY INSURANCE ❑Y ®N U2 I''I in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Same ILAP0000046730 2 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y El 2 eu m x DRIVER ❑ PARKED ❑DRIVERLESS ❑ PEO ❑PEDAL 0 EWES 0 iiuv 0 !1 9 7 y 8 Audi Q5 2015 00-NONE �1' �i.0 DUE TO CRASH ❑ 2 0 13-UNDER CARRIAGE FIRE ❑ ® U2 C c M 2 8 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16-TOP 3 X ❑Y NJ N ❑UNK VEH. AT CRASH 99-UNKNOWN *0i$trac on Value 9 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s .i�..__4 COM VEH ❑ ® U1 W FIRST CONTACT 11 7 _,r_5 C. If Yes.See Sidebar C ELGIN IL 60123 0 1 0 EH15810 IL 2025 I Si)0 IL 0 WA1 LFAFP5FA021459 FIRST CHICAGO INSURANCE C ❑Y ®N RDEF71 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Same PAL1068178-00 BAG $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP 996 < Refused RESPONDER u1 = (UNIT) (SEAT) (D091 (SEX! {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)1(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL) 2 3 02 / F 2 8 0 1 0 m / / #OCCS D X1 / / 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 1 03,23 ,2025 08 37 ®pm in a Work Zone? ®N DIRP co 1 I PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME ❑AM If YES check one below: U1 7 C) T o" 2 ❑ 2 06 , , ❑PM ❑Construction Z3 ❑ xi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME ❑AM ❑Maintenance U2 o ® 11 1 ARREST NAME Hayes.Avante. D. 11-901-A S1526000 r / El PM SLMT 'S N ❑CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME 0 Utility El AM t 2 El ARREST NAME 03 r 23 i2025 09 30 0 PM El Unknown work zone type U1 30 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑qM Workers present? ❑Y 30 1526-Walsh.Jacob 601 391-Jacobucci 04 ,22,2025 01 30 ®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-- --' I - I. INDICATE NORTH comb natbn)or p3 CBY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C i II I - r r (example:shuttle or charter bus):or 0 !II I I 3. Is designed to car 15 or fewer ssen ers and o rated a contract carrier O I- <----A---.� I. } } } transporting employees In the course�of their employment(example:employee I � wamnve I transporter-usually a van type vehicle or passenger car):or w L L.___a____� _= _ 4. Is used ordesi natedtotrans rtbetween9and 15 passengers,including N } } for direct compensation(example:large van used for specificpurpose):or [he driver, : Pe ( P 9 Pe or L L-. ..i.. - f i - t i. I L 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires ® 0 placarding(example:placards will be displayed on the vehicle). m —— — —�D _ D - 2 CARRIER NAME Z i ADDRESS O V) .I 1 0 CITY/STATE/ZIP g 1 1MrleeMBh'd - i. 1i. MOTOR CARR.ID 0 Interstate 0 Intrastate r : ❑ Not in Comm./Govt. 0 Not in Comm./Other ----'Y----- - USDOT NO. ILCC NO. rn XI Source of above Z . own tank)? 0 Yes 0 No 0 Unknown Did HAZMAT Regulations violation contribute to the crash? r ❑ Yes 0 No 0 Unknown g D Did Carrier Safety Regulations MCS)violation contribute to the crash? ❑ Yes II No ElUnknown 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 VIM 1 m LOCAL USE ONLY TRAILER VIN 2 m v TRAILER WIDTH(S) 0-96" 97-102" >102' T TRAILER 1 0 0 0 Z ill TRAILER 2 ❑ 0 0 O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w Silver Black u 1 TOWED • TOTAL VEHICLE LENGTH ft. NO.OF AXLES DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT- 3 TOWED BY/TO. Redmons/Impound Lot Garage SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE DISABLING DAMAGE NOT DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® Redmons/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE