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HomeMy WebLinkAbout2025-00025806 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 I01101100 VI DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X003797829 u, 1 U21 1 1 1 U1 7 U2 1 u, 1 1_12 1 1.11 1 U2 1 1 11 u1 1 U2 1 *P 0 1 1 9* INVESTIGATING AGENCY DAMAGE TO ANY El$500 OR LESS TYPE OF REPORT El A No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW Elgin Police Department ONE PERSON'S ®5501-$1.500 ®ON SCENE 3 VEHICLE/PROPERTY ❑OVER$1,500 El NOT ON SCENE(DESK REPORT) 0 B Injury and/or Tow Due To Crash 0 AMENDED YR 2025I 2025-00025806 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 mN RANDALL RD El08:03 ® ❑ RELATED ❑Y ®N 04 24 2025 EIAM ❑YES ®NO U1 _ _ g PRIVATE mo !day/yr ❑PM FLOW CONDITION Ill FT!MI N E S W 190 WB EXPY COUNTY PROPERTY ❑Y ® N DOORING Ely #OF MOTOR El SLOW 15 u) ❑ Kane HIT&RUN ❑V ® N WITH VEHICLES INVLD ❑ STOPPED U2 --I CO AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST IZI N ® FREE FLOW # LNS 0 g DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EDUCE 0 uuv 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 n T TOWED U1 O FROM Di Prima.Vincent. R. Toyota RAV4 2018 00-NONE ©, 12 OUE TO CRASH ❑ VI NAME(LAST,FIRST,M) mo yr 13-UNDER CARRIAGE 10 i ! 2 FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL)THERDISTRACTED ❑ 0U2 2 i n M 2 4 SYTM❑Y OS NEDUNK VEH. 0 ATCRASHD 99-UUNKNOWN 9 76•TOP 3 `Distraction Value ALGN • r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF S, il_6 I, 4 COM VEH ❑ Ea F. 3 O FIRST CONTACT 11 7-. *IIYes.SeeSidebar U1 Z ALGONQUIN IL 60102 0 1 0 DQ19103 IL 2025 TELEPHONE IL D 2T3BFREV7JW735250 Garrison Prop&Cas. ❑Y J N U2 M in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Same 0423267667101 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y Ell 2 c p; DElVER ❑ PARKED ❑DRIVERLESS 0 FED 0 PEDA. 0 EWES 0 !1 9 6 9 Buick Enclave 2018 00-NONE 'o,I 12 (,-2 FIRE DUE ID CRASH 0 ® U2 2 C o 13-UNDER CARRIAGE c M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9.1,6•TOP 3 X ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN *Oistraelion Value U1 0 POINT OF 8 i1�I" 4 COM VEH D ® CO N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR 6 FIRST CONTACT 5 71 1 —_,SOS •If Yes.See Sidebar Z WEST DUNDEE IL 60118-3325 0 1 0 EZ96980 IL 20250 IL D SGAEVBKW2JJ235517 Progressive ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X Elgin Fire Same 985690368 BAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPONDER u1 = (UNIT) (SEAT) (DOB' (SEX) {SAFT) (AIR) (INJI 1(EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)!(ADDRESS)((TELEPHONE) (EMS) (HOSPITAL) 2 6 03 / P3 / / UI 1 D / / 3 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 11 1 41 /41 /025 08 04 ®❑PM in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 5 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 ci, 2 ❑ 36 1 03 28 ! / ❑PM, ❑Construction R 3 ❑ $I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 5 ❑AM ❑Maintenance U2 o1 ® 11 1 ARREST NAME Di Prima.Vincent. R. 11-710-A 327003144 / / El PM SLMT o N ❑CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ❑Utility 45 r 2 ARREST NAME AM / / ❑❑PM ❑Unknown work zone type U1 El 7 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑Y 45 327-Hromadka.Scott 901 / / ❑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 I I ADDITIONAL UNITS FORMS. 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-- --; 0 I I combination):or INDICATE NORTH tion) p0 `11 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C } +'r, r- I r r r (example:shuttle or charter bus):or 0 "_' f 3. Is designed to carry15 or fewer_ gpassengers and operated a contract carrier O - }____A____- - } } } transporting employee in the course of their employment(example:employee X transporter-usually a van type vehicle or passenger car):or co L }-----}----; - I. } } 1. •4. Is used or designated to transport between 9 and 15 passengers,including the driver. N j for direct compensation(example:large van used for specific purpose):or O } } } t 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m placarding(example:placards will be displayed on the vehicle). ;p 1 I CARRIER NAME —I _ ADDRESS 0 0 CITY/STATE/ZIP g INot To Scale , i. i. i. i. MOTOR CARR.ID 0 Interstate 0 Intrastate I I T I I ❑ Not in Comm./Govt. Not in Comm./Other I ‘I. I _ ' , _Y____ I USDOT NO. ILCC NO. rn XI Source of above z . If Yes,Name on placard O 4 digit UN NO. 1 digit Hazard class No. Xl Xl Did HAZMAT spill from vehicle(do NOT consider FUEL from vehicle's 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 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. y Maroon 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 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/TO. DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE