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HomeMy WebLinkAbout2025-00031113 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets _ 01111101111 I01101100001 Ol 1101 Oil DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X0038236 3 u, 9 U21 3 4 1 U,10 U2 1 U199 1_12 1 U,99 U2 1 1 12 u, 2 U2 1 *P 0119* INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW ' DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT ® q No Injury 1 Drive Away Elgin Police Department ONE PERSON'S 1215501-51.500 ®ON SCENE 1 VEHICLE/PROPERTY ❑OVER$1,500 El NOT ON SCENE(DESK REPORT) El AMENDED ❑ B Injury and/or Tow Due To Crash YR 2025512025-00031113 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 99 m® ❑ RELATED PRIVATE ❑Y ®N 05 16 2025 12,—AM ❑YES El NO U1 -< N LYLE AVE Elgin mo /day/yr 01.37 ®PM FLOW CONDITION m I0 ® O COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 1 (n !MI N E S W Larkin Ave WITH VEHICLESOT, INVLD ❑ STOPPED U2 --I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) Kane HIT&RUN ®V ❑ N PEDALCYCLIST®N ® FREE FLOW # LNS 0 18:DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EWES ❑uuv ❑!CV ❑Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 n FOR DAMAGEDAREA(S) FRONT TOWED U1 O Unknown.0. Unknown Unknown 00-NONE ©, 12 , DUE TOCRASH ❑ EN NAME(LAST,FIRST,M) mo yr 13-UNDER CARRIAGE I ! FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) OO. 2 SYSTEM IN ENGAGED 15-OTHER 9 16.TOP 3 DISTRACTED 0 ]$I U2 2 m 9 9 ❑Y ❑N ❑UNK VEH. AT CRASH 99-UNKNOWN `Distraction Value ALGN = s 4 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF ,Ii_6 Ii,_ 1 ~ 0 9 0 FIRST CONTACT 11 7_: COM VEH 0 Ea_5 *II Yes.See Sidebar U1 0 REAR 2 Z ' E TELEPHONE . STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED 1 11/ ° none El ❑N U2 m 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m co 99 9 Same none 1 rn `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused 0 Y El 99 0 m x DRIVER ❑ PARKED ❑DRIVERLESS 0 FED ❑PEDAL 0 EWES ❑iiuv 0 NOV ❑DV CIRCLE NUMBER(S) U1 1 9 4 5 Toyota Prius 2015 00-NONE ,�_"i Qj O DUE TO CRASH ❑ (� 2 13-UNDER CARRIAGE I FIRE ❑ El U2 c F 2 4SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16.TOP 3 X 0 Y ®N 0 UNK VEH. AT CRASH 99-UNKNOWN *0istraellon Value 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8-iI 6 i_i, COM VEH ❑ ® U1 W FIRST CONTACT 1 Y _, _5 •(ryes,See SidebarC = ELGIN IL 60120 0 1 0 AV18123 IL 2025 REAR 0 IL D 0 JTDKN3DU2F1895289 State Farm ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = 99 9 Same 0600534-SFP-13 BAc $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPONDER U1 = KNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)1(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL) 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 05,16 i2025 01 37 ®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 O 2 04 99 ) ) 0 PM ❑Construction * Z 3 0 0 CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 1 ❑AM 0 Maintenance U2 -a, ARREST NAME / / El PM ' 1 El 11 1 ❑CITATIONS ISSUED ❑PENDING • Utilit SLMT o N SECTION CITATION NO. ROAD CLEARANCE TIME ❑ y 0 AM t 2 0 ARREST NAME 051 16 r2025 01 40 0 PM ElUnknown work zone type U1 30 n OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 ❑ ID AM Workers present? ❑Y 30 1528 Rivera. Kevin 602 , ❑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••--, , I - A CMV is defined as any motor vehicle used to transport passengers or property and: z N 1. Has a weight rating more than 10,000 pounds(example:truck or truckrtrailer -< i- }-----I-----' Ifli`;I .. - INDICATE NORTH combination):or -I r ' BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C I m.IL - } (example:shuttle or charter bus):or 0 MI- 3. Is designed to carry15 or fewer passengers and operated a contract carrier O I- }-----I----I I Un-. - } } } transportingemployees in the course of their employment pbyment(example:employee X transporter-usually a van type vehicle or passenger car):or CO L 4. Is used or designated to transport between 9 and 15 passengers,including C}--- ----; - } } } g po passen rs,includi the driver, for direct compensation(example:large van used for specific purpose):or O L — t i i _ 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m i placarding(example:placards will be displayed on the vehicle). m 0 Larkin?ave aI\ I - -- CARRIER NAME Z ADDRESS 'n w • CITY/STATE/ZIP 0 MOTOR CARR.ID Interstate Intrastate I r . I ° Not in Comm./Govt. 0 Not in Comm./Other I - Not TO Scale I USDOT NO. ILCC NO. m 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-; 0 Yes 0 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 0 0 Z TRAILER 2 ❑ 0 0 O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w Silver u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT' 1 TOWED BY/TO: _ . SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/TO. DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE