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HomeMy WebLinkAbout2025-00029286 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 011011000 l III*11111000 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X003&14138 u, 1 U21 2 4 1 U1 2 U2 1 U, 1 u2 1 U1 1 u2 1 1 15 U1 1 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 El$501-$1.500 ®ON SCENE 1 VEHICLE/PROPERTY ®OVER 31,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash El AMENDED YR 2025I 2025-00029286 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 r1 W CHICAGO ST Elgin 05:55 ® ❑ RELATED ®Y 0 N 05 08 2025 ❑AM ❑YES ®NO U1 -< _ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION m FT N E S W N EDISON AVE COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR El SLOW 1 (/)❑ Kane HIT ❑V ® N WITH VEHICLES INVLD El STOPPED U2 --I El AT RUN AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST IR N ❑ FREE FLOW # LNS 0 Qg3 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 Non 0(Cy 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 00an.Falk. Dylan. E. Volvo 850 1994 00-NONE 1 I 1 DUE TO CRASH ® ❑ NAME{LAST,FIRST,M) y mo yr 13-UNDER CARRIAGE ©,I ©:. FIRE ❑ al STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ❑ ]$I U2 0 m M I 2 4 SYTM IN ENGAGE❑Y ®S NE❑UNK VEH. 0 AT CRASHD 0 99-UNKNOWN 9 16•TOP 3 *Distraction Value ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s it a ii,4 COM VEH 0 El 1 0 ~ Hoffman Estates IL 60192 0 1 0 FIRST CONTACT 1 7_: -__5 *u Yes.See Sidebar Ut ZX314068 IL 2025 REAR TELEPHONE IL D 0 YV1 LS5529R2145418 Geico ❑Y ®N U2 m 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Same 4525-63-44-18 1 r o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER 73 73 Refused D Y ElN 2 0 p; DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEOAL 0 EWES 0 Nov 0 Ncv 0 CIRCLE NUMBER(S) U1 Dv yr/1 9 9 8 Kia Motors Coilptima 2012 00-NONE O QI-O DUE TO CRASH ❑ 2 0 13-UNDER CARRIAGE 10( I 2 FIRE 0 ® U2 C F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9,16-TOP 3 X ❑Y NJ ❑UNK VEH. AT CRASH 99-UNKNOWN *Distraction Value 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8-iI�1:, 4 COM VEH ❑ ® U1 CO FIRST CONTACT 12 7 _, -S •If Yes.See Sidebar = ELGIN IL 60120 0 1 0 FE45106 IL 2026 IL D 0 SXXGN4A7OCG052413 Progressive ❑Y ®N RDEF73 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Same 993752533 BAc $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP 996 < Refused RESPOND D N U1 = (UNIT) (SEAT) (DOBi (SEX! {SAFT) (AIR) (INJI 1(EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)/(ADDRESS)+(TELEPHONE) (EMS) (HOSPITAL) 1 3 06 / LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 11 4 05/08 /2025 05 55 ®AM in a Work Zone? ®N DIRP co 1 t PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 1 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 v 2 ❑ 2 28 05,08 /2025 03 57 RI ❑Construction R O ❑ ]$l CITATIONS ISSUED El PENDING SECTION CITATION NO. EMS ARRIVED TIME 7 3 ❑AM ❑Maintenance U2 -a, ARREST NAME Falk. Dylan. E. 11-901-A 1529-000382 05/08/2025 06 00 Igi pM SLMT oi. u ® 11 4 0 CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ' 0 Utility AM t 2 ElARREST NAME / / ❑❑pM ❑Unknown work zone type U1 30 n 7 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 ° 1529 Audi red.Jonathan 601 391-Jacobucci 06 ,03,2025 09 00 0 pM Workers present? ®N U2 35 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 A1. Has a weight rating more than 10,000 pounds(example:truck or truckrtrailer -< c ` --I-- -' r INDICATE NORTH combination)or S,�.Edison.,?Ave. BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C N - (example:shuttle or charter bus):or 0 L A '`! 3. Is designed to carry 15 or fewer passengers and operated a contract carrier 0 } } } transporting employees in the course of their employment(example:employee X transporter-usually a van type vehicle or passenger car):or w L L.___a____.i Ti__I 4. Is used ordesi natedtotrans rtbetween9and15 ssen rs,includingthedriver, } } } for direct compensation(examp large van used for specific purpose):or N Lw?Chicaqo?st. 0 L L____a..... t 5 Is any vehicle used to transport anyhazardous material(HAZMAT)that requires m rn {,-,:1 placarding(example:placards will be displayed on the vehicle). XI � CARRIER NAME Z ' iT -_ ADDRESS 0Not To Scale rn 1 CITY/STATE/ZIP o _ i. i. i. i. MOTOR CARR.ID 0 Interstate 0 Intrastate I I . I ❑ Not in Comm./Govt. 0 Not in Comm./Other -"-------1 - USDOT NO. ILCC NO. m Xl Source of above z . MCS 0 Yes 0 No 0 Unknown Out of Service 0 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 Blue u 1 TOWED • TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT- 3 TOWED BY/TO. Arties/Impound Lot Garage . SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® DISABLING DAMAGE Arties/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE