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HomeMy WebLinkAbout2025-00027116 ILLINOIS TRAFFIC CRASH REPORT sheet 1 Df 2 Sheets 01111101111 I0110110011 0 fl Ifl III IflIIIIIII DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X0036003,9' u, 1 U21 1 1 1 U1 2 U2 1 U1 1 U2 1 U1 1 U2 1 3 10 U, 3 U2 1 *P 0119 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 ❑$501-$1.500 ®ON SCENE 15 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash 0 AMENDED YR 2025I 2025-00027116 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 r1 BOWES RD Elgin 07:26 ® ❑ RELATED ®Y 0 N 04 29 2025 ❑AM ❑YES ®NO U1 '< _ g PRIVATE mo /day/yr NPM FLOW CONDITION M FT N E S W CORRON RD COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR 0 SLOW 1 0)0 Kane HIT&RUN ❑V ® N WITH VEHICLES INVLD 0 STOPPED U2 --I ® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N 51 FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑ORNERLESS 0 PED 0 PEDAL 0 EWES 0 NAV 0!CV 0 DJ DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 1 n 1 2 / yr 13-UNDER CARRIAGE ©,I �:: FIRE 0 IE STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14--TOTAL(ALL) DISTRACTED 0 ]$I U2 1 r<r1 F 2 OTHER 4 ❑Y OSYNM IN❑UNK VEH. 0 AT CRASH 0 99-UNKNOWN 9 76.70P 3 ,Distraction Value 9 ALGN = r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s, it 6 4 COM VEH 0 j$J 1 0 ~ St Charles I L 60174 0 1 0 FIRST CONTACT 12 7 ;1 __5 *It Yes,See Sidebar U1 Z EZ46229 IL 2025 E TELEPHONE IL D 0 3FAHPOHA2BR266673 State Farm ❑Y ICI N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Elgin Fire 99 9 Cardoza.zuleika 1233664-sfp-13 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER RESPONDER 2 eu t, N DRIVER ❑ PARKED 0 DRIVERLESS 0 PED ❑PEDAL 0 EWES 0 N,Iv 0 NO! 0 DV yr 13-UNDER CARRIAGE 10( I 2 FIRE ❑ ® U2 C c M 2 4 SYSTEM IN 0 ENGAGED 0 ®-OTHER 9,16-TOP 3 9 0 X ❑Y i N ❑UNK VEH. AT CRASH 99-UNKNOWN *Oistracton Value N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8-it 6 11:,-4 COM VEH 0 N U1 CO FIRST CONTACT 12 7� .5 •(ryes.See Sidebar H ELGIN IL 60120 0 1 0 Z282906 IL 2025 REAR-5 0 M IL M 0 5NPEB4AC3BH2O9643 American Family ❑Y ®N RDEF71 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Elgin Fire 99 9 Same 41107-46947-85 BAG E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Sherman RESPONDER U1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (NJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)((A.DDRESS)(TELEPHONE) (EMS) (HOSPITAL) D / / 1 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 04,29 /2025 07 26 ®AM 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 0 2 06 , , ❑PM ❑Construction X Z 3 0 N CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 3 ❑AM 0 Maintenance U2 a ® 11 1 ARREST NAME Campos.Camila 11-801 1531000048 / / El PM SLMT o Nu ❑CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • ❑Utility 0 AM t 2 0 ARREST NAME 04/29 /2025 08 10 0 PM ElUnknown work zone type U1 50 n T OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 ❑ 1531—Sch'c mbach.Jack 801 391-Jacobucci 06 / 10,2025 01 30 ®PM Workers present? ®N U2 50 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 -< ` ` ' ' r INDICATE NORTH combination):or —I ',rMt BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C i - } (example:shuttle or charter bus):or tot L A 3. Is designed to carry 15 or fewer passengers and operated a contract carrier O - } } } transporting employees In the course of their employment(example:employee X L ----------' . } • transporter sf used or d usually nated to transpoicle or rt between 9 and 15 passengers,including the driver. 0 C } } for direct compensation(example:large van used for speific purose):or N caronvnu ' I L t 5. Is anyvehicle used to transport anyhazardous material(HAZMAT)that requires _Not To Scale placarding(example:placards will be displayed on the vehicle). m XI - CARRIER NAME Z ADDRESS 0 w O CITY/STATE/ZIP g _ i. MOTOR CARR.ID 0 Interstate 0 Intrastate ' ❑ Not in Comm./Govt. ❑ Not in Comm./Other 00 i- "Y" ""1 USDOT NO. ILCC NO. C 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 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 Red 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 NOT DISABLING DAMAGE DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® Redmons/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE