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HomeMy WebLinkAbout2025-00033398 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 01111101111 1011011000 hlfl III 11100111000 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X0O3833916 u, 1 u21 3 4 1 u,16 U2 1 u, 1 u2 1 u, 1 U2 1 1 11 u, 13 U2 1 *P 0119 INVESTIGATING AGENCY DAMAGE TO ANY ❑$500 OR LESS TYPE OF REPORT ® q No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 2 VEHICLE/PROPERTY ®OVER 51,500 ❑NOT ON SCENE(DESK REPORT) 0 AMENDED ❑ B Injury and/or Tow Due To Crash YR 202512025-00033398 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 I ® ❑ RELATED PRIVATE ❑Y ®N 05 25 2025 ❑AM ❑YES El NO U1 -< W HIGHLAND AVE Elgin mo /day/yr 07:56 ®PM FLOW CONDITION M 01 O(�/MI N E S © North State St COUNTY PROPERTY ❑Y ® N DOORING ❑Y #OF MOTOR IR SLOW 15 u) Kane HIT&RUN ®Y ❑ N WITH VEHICLES INVLD 0 STOPPED U2 —I 0 AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST IR N ❑ FREE FLOW # LNS O (g:DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NIAV 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 0 _ 1 0 / yr © Q - 13-UNDER CARRIAGE 10 1 , 2 FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 ]$I U2 4 rn F 2 4 15-OTHER ❑Y ®N SYSTEM ❑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 6 �i 4 COM VEH 0 Ea 1 0 ELGIN IL 60123 0 1 0 FIRST CONTACT 11 7_; -__5 *IIYes.See Sidebar U1 Z EY36494 IL 2025 REAR TELEPHONE IL D 0 ZACCJBBB3HPF88972 First Chicago Insurance ❑Y IlN U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 Same ILCS 1091161-00 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused 0 Y ® N 2 XI �{ DRIVER ❑ PARKED 0 DRIVERLESS ❑ PED 0 PEDAL ❑EWES ❑Nov 0 NCv 0 DV /1 9 yf 4 Toyota RAV4 2002 00-NONE +i_"i 12..-_, DUETO CRASH ❑ 2 o 13-UNDERCARRIAGE ta;l 2 FIRE 0 ® U2 C Ti F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16-TOP 3 X ❑Y ®N 0 UNK VEH. AT CRASH 99-UNKNOWN *Distraction Value 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8 i all,,,,....4 COM VEH ❑ ® u1 CO F,,, FIRST CONTACT 5 7 - - 5 •If Yes,See Sidebar C ELGIN IL 60120 0 1 0 6590565 IL 2026 REAR Si)0 IL D 0 JTEGH20V920048092 GEICO ❑Y ®N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = 99 9 Same 6145-98-30-91 BAC $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP 996 < Refused RESPONDER u1 = (UNIT) (SEAT) (005i (SEX) (SAFT) (AIR) (INJI i(EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)((ADDRESS)((TELEPHONE) (EMS) (HOSPITAL) 2 6 01 / / / 4 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z N 1 ® 11 1 05/25 /2025 07 56 ®AM in a Work Zone? ®N DIRP co 1 F PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 7 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 C) v 2 28 99 05,25 /2025 07 56 ®PM El Construction 3 0 ]$I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 7 z J ❑AM ❑Maintenance U2 o 1 ® 11 1 ARREST NAME Richardson.Apnea.A. 11-601-Ax S1527-000315 / / El PM SLMT j$!CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME El AM• ❑Utility F 2 El ARREST NAME Richardson.Apnea.A. 11-407-A S1527-000314 05/25 /2025 08 10 0 PM El Unknown work zone type U1 30 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑qM Workers present? ❑Y 30 1527-Juarez.Jorge 601 223-Hughes 06 /24/2025 01 30 ®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 a; 1. Has a weight rating more than 10,000 pounds(example:truck or truckrtrailer -< INDICATE NORTH combination):orp1 z BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C _ } (example:shuttle or charter bus):or X L A 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I O d }} } transporting employees In the course of their employment(example:employee X ' transporter-usually a van type vehicle or passenger car):or CD L L.___a____.I W' p f07 w.vr�pnbndme 4. Is used ordesi natedtotrans rtbetween9and15 ssen rs,includingthedriver. C a I r'-, r. _ ' • tI. } } } for direct compensation(example:large van used for specific purpose):or O OD ffiti 0 L L.._-a____. �� L L 1 L 5. Is anyvehicle used to transport anyhazardous material(HAZMAT)thatrequires m �, placarding(example:placards will be displayed on the vehicle). s s s D y XI �"' W4169Nad?A' -_ —I W.714phland9Avo • , I • • • CARRIER NAME Z ADDRESS 0 D ;1 rn C) `. CITY/STATE/ZIP g E. aS y 1 MOTOR CARR.ID 0 Interstate 0 Intrastate O +yxmscw ' , I I T I ❑ Not in Comm./Govt. Not in Comm./Other ❑ 0 �" --- --1 - USDOT NO. ILCC NO. m Xl Source of above z . IDOT PERMIT NO. WIDELOAD'; ❑Yes 0 No 2 TRAILER VIM 1 m to LOCAL USE ONLY TRAILER VIN 2 m a 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 White Silver 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 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/TO. DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE