Loading...
HomeMy WebLinkAbout2025-00028626 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 0110110000011110111111 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X003614189' u, 9 U21 3 4 1 U,16 U2 1 U199 u2 1 U,99 U2 1 1 10 U1 1 U2 3 *P 0119 INVESTIGATING AGENCY DAMAGE TO ANY El$500 OR LESS TYPE OF REPORT ® A No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW Elgin Police Department ONE PERSON'S ®5501-$1.500 ®ON SCENE 2 VEHICLE/PROPERTY ❑OVER$1,500 ❑NOT ON SCENE(DESK REPORT) El AMENDED ElB Injury and/or Tow Due To Crash YR 202512025-00028626 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 99 m ® ❑ RELATED ®Y ❑N 05 06 2025 ®AM ❑YES ®NO U1 -< W CHICAGO ST Elgin08:16 _ _ g PRIVATE mo /day/yr ❑PM FLOW CONDITION ITl FT!MI N E S W N STATE ST COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 5 (A ❑ Kane HIT&RUN ®Y ❑ N WITH VEHICLESOT, INVLD ❑ STOPPED U2 --I lgi AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N 51 FREE FLOW # LNS 0 Q83 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 C) 0 8 ! yr RIOS.JUAN. M. Unknown Unknown 00-NONE ©, 12 i DUE TOCRASH ❑ VI E 13-UNDER CARRIAGE 10.I !�. 2 FIRE ❑ IE STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ❑ 0 U2 4 rn M I 9 SYTM IN ENGAGE9 ❑Y ®S NE❑UNK VEH. 0 AT CRASHD 0 99-UNKNOWN 9 16•TOP 3 `Distraction Value 9 ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s i�B �i 4 COM VEH 0 0 1 0 H F. FIRST CONTACT 11 T_: __5 *lives.See Sidebar U1 ROCKDALE I L 60436 0 9 0 Z E TELEPHONE IL D 0 UNKNOWN ❑Y 0 N U2 I— in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 Bradley.Anthony. M. UNKNOWN 1 rn `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER RESPONDER 99 0 x DRIVER ❑ PARKED 0 DRIVERLESS ❑ FED ❑PEDAL 0 EWES ❑iiuv 0 Ncv ❑DV e� !1 9 9 9 El Dorado MfgEZlrtder 2008 00-NONE 0t2..-_, DUE TO CRASH ❑ ® 32 0Yr 13-UNDER CARRIAGE 10 I 2 FIRE ID ® U2 C c F 2 3 SYSTEM IN 0 ENGAGED 0 15-OTHER 9,16-TOP 3 X ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN •Distraction value 9 U1 0 POINT OF 8 i1 1i COM VEH El ❑ CO N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR 6 FIRST CONTACT 11 7 __5 •If Yes.See Sidebar = ELK GROVE VILLAGEZ IL 60007 0 1 0 M182725 IL 2007 REAR 0 IL B 7 1N9MNAC648C084066 SELF INSURED ❑Y ®N RDEF X EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = 99 9 PACE SUBURBAN BUS DI NA BAG $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE:ZIP U1 = (UNIT) (SEAT) (DOBI (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)!{ADDRESS)(TELEPHONE) (EMS) (HOSPITAL) W 10 / M m S/ / #OCC D 71 / / U1 1 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 05,06 /2025 08 16 ®❑PM 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) 2 ❑ 20 99 N 3 ❑ 0 CITATIONS ISSUED 0 PENDING + ❑PM, El Construction SECTION CITATION NO. EMS ARRIVED TIME ❑AM ❑Maintenance U2 5 -a, ARREST NAME / / ID PM ' 1 ® 1 1 1 0CITATIONS ISSUED PENDINGUtilitySLMT NSECTION CITATION NO. ROAD CLEARANCE TIME o 0 AM U, 30 t 2 El ARREST NAME 05 r 06 /2025 08 16 [0 PM El Unknown work zone type n OFFICER ID SIGNATURE BEAT!DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 ❑ - ❑AM Workers present? ❑Y 30 1551 Dede.Joseph sot , ❑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 vittltzal 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer -< ` ` ' ' GI H INDICATE NORTHcomWrtatlon)or p0BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver(example:shuttle or charter bus):or 0 <____ �____� Ilk I Not To Scale 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I O } I- I- transporting employees in the course of their employment(example:employee X transporter-usually a van type vehicle or passenger car):or wI C L L.___a_ 4. Is used ordesi natedtotrans rtbetween9and15 passengers,including y} } for direct compensation(example:large van used for specificpurpose):or [he driver, • Pe ( P 9 Pe or 0 L i — — — — — — — t i 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m •---• placarding(example:placards will be displayed on the vehicle). ;p • • -- CARRIER NAME PACE SUBURBAN BUS DIVISION Z I I _ ADDRESS 550 ALGONQUIN RD w II I lw• l CITY/STATE/ZIP Arlington Heights I IL 160005 o II - MOTOR CARR.ID 0 Interstate ❑ Intrastate I I T I ❑ Not in Comm./Govt. 0 Not in Comm./Other ; --- --1 - USDOT NO. ILCC NO. m XI • Source of above z . 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 ®No 2 TRAILER VIN 1 m to 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 Blue u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT: 9 TOWED BY/TO: _ SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY/TO. DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE