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HomeMy WebLinkAbout2025-00024605 ILLINOIS TRAFFIC CRASH REPORT sheet 1 of 2 Sheets 01111101111 I01101100 1VVI11fl1*111000000 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X003790178 u, 1 U21 1 1 2 u, 8 U2 1 u, 1 1_12 1 u, 1 U2 1 5 12 u, 13 U2 1 .P0119* INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW ' DAMAGE TO ANY 0 5500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away Elgin Police Department ONE PERSON'S ❑5501-51,500 ®ON SCENE 1 VEHICLE/PROPERTY ®OVER 51,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash 0 AMENDED YR 202512025-00024605 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 r1 N STATE ST EIIn ® ❑ RELATED ❑Y ®N 04 18 2025 10:34 ❑AM ❑YES ®NO U1 -< g PRIVATE mo /day/yr ®PM FLOW CONDITION IT1 10 !MI N E S W North Tollgate Rd COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 15 co ® g Kane HIT&RUN ❑Y ® N WITH VEHICLESOT, INVLD ❑ STOPPED U2 -I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 gi 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 2/ yr FOR DAMAGEDAREA(S) FROM TOWED U1 Kia Motors Co rento 2024 00-NONE s , DUE TO CRASH ❑ � © �.:!UNDER CARRIAGE to,l EN 2 FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ® 0 U2 2 I'T1 M 2 4 SYTM❑Y ®S NE El UNK VEH. 0 AT CRASH 99-UNKNOWN THER9 76•TOP 3 `Distraction Value 7 ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s :it_6 _4 COM VEH 0 gJ 1 0 F. FIRST CONTACT 12 7_ , _, _5 *IIYes.See Sidebar U1 Z Carol Stream IL 60188 0 1 0 EH60390 IL 2025 REAR TELEPHONE IL D 0 KNDRHDLGXR5236056 MIC General Insurance ❑v ®N U2 m 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m co Same 2007721524 2 r o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y ❑ N 2 0 g DRIVER ❑ PARKED 0 DRIVERLESS 0 PEO 0 PEDAL 0 EWES 0 iiuv 0 i v 0 Dv 1 9 y 9 Subaru XV Crosstrek 2.0 2021 00-NONE „ " 12' _, DUE TO CRASH ❑ 2 x .. - ®13-UNDERCARRIAGE FIRE ❑ ® U2 c F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 016-TOP 3 X ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN *Oistracllon Value 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF O I ., 4 COM VEH ❑ ® U1 CO FIRST CONTACT 8 7 _, _5 •• •It Yes,See Sidebar C = WEST DUNDEE IL 60118 0 1 0 FD11781 IL 2025 Si)0 IL D 0 J F2GTDNC8M H330297 StateFarm ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Same 2510426-SFP-13 BAG $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPOND O N u1 = (UNIT) (SEAT) (DO81 (SEX) {SAFT) (AIR) (WI (EJCT( (EPTH) PASSENGERS&WITNESS ONLY (NAME)!(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL) 1 6 03 / F 2 3 C 1 0 m / / #OCCS > / / UI 2 D / / 1 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z u 1 ® 11 1 04/18 r2025 10 34 ®AM in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 1 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 C) v 2 0 20 15 04!18 r2025 10 52 RI ❑Construction R 3 0 ]$I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVE° TIME 1 z J ❑AM ❑Maintenance U2 o1 ® 11 1 ARREST NAME 0 Connor. Paul. P. 11-708 1514000211 04!18 r2025 11 00 Igi pM SLMT o N 13CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • El Utility 40 t 2 ARREST NAME AM 7 ! r ❑❑PM ❑Unknown work zone type U1 El n OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑Y 40 1514-Pratt.Tamera 501 331-Ziegler ! ( ❑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••--, , J , I I ToUgsb?Rd . 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 -< ` ` ' ' — — — — — r INDICATE NORTH combination):or p3 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C - } (example:shuttle or charter bus):or X - ------;----; — —` — — — transportingtlgem lloyeeo slin the course of 5 or fewer rye r emplors andyment(example:employee a contract der '�t] } r } transportr-usually a van type vehicle or passenger car): r w L }-----}----; - } } 1 •4. Is used or designated to transport between 9 and 15 passengers,including the driver, C for direct compensation(example:large van used for specific purpose):or O __ i i 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires 'D I . placarding(example:placards will be displayed on the vehicle). ,Zmt i CARRIER NAME Z U O ADDRESS CITY/STATE/ZIP n I i. MOTOR CARR.ID 0 Interstate 0 Intrastate r I 0 ❑ Not in Comm./Govt. Not in Comm./Other 00 Y ❑ 0 USDOT NO. ILCC NO. m XI Source of above z . MCS ❑Yes 0 No 0 Unknown Out of Service ❑Yes ❑No 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' T TRAILER 1 0 0 0 Z TRAILER 2 ❑ 0 0 O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. Z Gray White u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT 3 TOWED BY/TO: _ . SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY/T6 DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE