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HomeMy WebLinkAbout2025-00020309 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 I01101100 IVIII II fl 0111100 DRAG TRFD TRFC WEAT DRVA VIS VEHD LGHT COLL MANY X003772O19 u1 1 U2 1 1 1 U1 1 U2 U1 1 U2 U1 1 U2 1 4 U1 1 U2 *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-$1.500 ®ON SCENE 3 VEHICLE/PROPERTY ®OVER 51,500 ❑NOT ON SCENE(DESK REPORT) 0 AMENDED ❑ B Injury and for Tow Due To Crash YR 202512025-00020309 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 �I ® ❑ RELATED PRIVATE ❑V ®N 03 31 2025 ❑AM ❑YES IX]NO U1 -< BIG TIMBER RD Elgin mo /day/yr 05:23 ®PM FLOW CONDITION M • 00 1C.'J/MI NOS W North RANDALL Rd COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR 0 SLOW Cl) Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD 0 STOPPED U2 --I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 (g)DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uuv 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 0 0 5 / yr 13-UNDER CARRIAGE ©,I '._Z FIRE 0 NIC STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 ]$I U2 rr1 M 2 4 ❑Y ®SYSNEM DUNK VINEH. 0 AT CRASHD 0 99--UUNKNOWN THER 9 t6.TOP 3 ,Distraction Value 9 ALGN = r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6 it 6 �i 4 COIN VEH 0 0 1 00 ELGIN IL 60123 0 1 0 FIRST CONTACT 11 7_; __5 *II Yes.See Sidebar U1 Z AQ19186 IL 2025 REAR TELEPHONE IL D 0 1C4SDHCT8EC501516 AMERICAN FAMILY ❑Y ®N U2 nr'I 5 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER RSUR m co 99 9 Medrano.Yasmin.Y. 41115-78897-99 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER RESPONDER 2 ou 0 DRIVER 0 PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NMv 0 KCv 0 Dv yr 12 _ C1 o 13-UNDER CARRIAGE 10 1 c. 2 FIRE 0 ❑ U2 C c SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED a SYSTEM IN ENGAGED 15-OTHER 9,16-TOP3 ❑ ❑ SPDR 0 ❑Y ❑N ❑UNK VEH. AT CRASH 99-UNKNOWN *Distraction Value U1 0 - POINT OF s-.;, 4 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR FIRSTO CONTACT Y 6 I._ CIO Ms See SidebarEH 0 C CO I� REAR` co M . STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 O ❑Y ❑N RDEF73 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = BAC HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < RESP❑YD❑N NDER U1 = (UNIT) (SEAT) (D00) (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)!(ADDRESS)/(TELEPHONE) (EMS) (HOSPITAL) 0 1 3 03 / M 2 4 0 1 0 I71 / / #OCCS > / / UI 2 D / / 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z N 1 ® 15 1 DNR Deer 31 , 11 /025 05 23 ®AM in a work zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 3 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 ;, t 2 0 1 NATURAL RESOURCE WAYSpringfieldL 62702 21 99 r , ❑PM ❑Construction * ZJ 3 ❑ ❑CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED - TIME ❑AM 0 Maintenance U2 a ARREST NAME / / ❑PM ' o u 1 ❑ ❑CITATIONS ISSUED ❑PENDING UtilitySLMT o N El AM SECTION CITATION NO. ROAD CLEARANCE TIME ❑ t 2 El, T ARREST NAME 31 1 11 /025 05 40 0 PM 0 Unknown work zone type U1 45 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME Y 2 3 ❑ - El Am Workers present? 0 1551 Dede.Joseph 502 , / ❑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 -< ®u INDICATE NORTH combination):or p3 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C Not To SceAq (example:shuttle or charter bus):or 0 A I I 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I O } } } transporting employees in the course of their employment(example:employee X 1 ,... I transporter-usually a van type vehicle or passenger car):or w L L.___a__ j 4. Is used ordesi natedtotrans rtbetween9and15 passengers,including C- - - - - - } } } • for direct compensation(example:large van used for specificpurpose):or [he driver, —— — — — Pe ( P 9 Pe or O L L.._-a____. r - l. i i ._ 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m 3 placarding(example:placards will be displayed on the vehicle). I ` edCARRIER NAME Z ADDRESS 0 n T. I I CITY/STATE/ZIP n. . . , 0 111 C ®� i. 4. MOTOR CARR.ID 0 Interstate 0 Intrastate O I I . I ❑ Not in Comm./Govt. 0 Not in Comm./Other ;_...Y. ._.; USDOT NO. ILCC NO. m 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? A ❑ Yes II El Unknown C 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—COLOR TRAILER LENGTH(S)1 ft. 2 ft. w Black 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_DUE ETOO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: TOWED BY/TO.DUE T VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE