HomeMy WebLinkAbout2025-00034993 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets II 111 I M IIIIII 01111111
II
DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X003839522'
u, 1 U21 1 1 1 U1 2 U2 1 U, 1 1_12 1 U, 1 U2 1 1 15 U1 20 U2 1 *P 0119*
INVESTIGATING AGENCY DAMAGE TO ANY El$500 OR LESS TYPE OF REPORT 0 A 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$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash
0 AMENDED YR 202512025-00034993 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n
® ❑ RELATED PRIVATE ❑Y ®N 06 01 2025 ❑AM ❑YES ®NO U1 -<
WING ST Elgin mo /day/yr 02:33 NPM FLOW CONDITION m
I 0 ®/MI O E S W McLean Blvd COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 1 (n
Kane HIT&RUN ❑V ® N WITH VEHICLESOT,
INVLD ❑ STOPPED U2 --I
0 AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0
Ig:DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EWES ❑uuv ❑!CV ❑Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 0
FOR DAMAGEDAREA(S) FRONT TOWED U1 Q
NAME(LAST,FIRST,M) Cooks. Breon. K. mo 0 6 / /1 9 9 4 Dodge Charger 2021 00-NONE �, O _, DUE TO CRASH ® ❑
O 13-UNDER CARRIAGE I FIRE ❑ N
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 2 DISTRACTED 0 Ea U2 4 <<Tl
M 2 SY is-OTHER
4 ❑Y ®SNE❑UNK VEH. O AT CRASH M IN D O 99-UNKNOWN 9 76•TOP 3 *Distraction Value 9 ALGN 2
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s, it 6 1i COM VEH 0 Ea 1 C)
f. FIRST CONTACT 11 7__ --_;__S *II Yes.See Sidebar U1 0
Z ELGIN IL 60123 0 1 0 T256099 IL 2025 REAR
TELEPHONE
IL A 7 2C3CDXL99MH583324 Geico Indemnity Company ❑Y ISI N U2 m
13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
Same 6193167118 1 r
o HOSPITAL(TAKEN TO) INCIDENT IF IC OWNER STREET,CITY,STATE,ZIP PHONE NUMBER
RESPONDER D
Refused 0 Y El 2 0
p; DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EWES 0 lily 0 KCV 0 DV CIRCLE NUMBER(S) U1
2 0 0 4 Honda Civic 1998 00-NONE O1 Q�'O DUE TO CRASH ❑ 2
0 Yr 13-UNDER CARRIAGE 10( I 2 FIRE ❑ ® U2 C
c
M 2 5 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 19-TOP 3 X
❑Y NJ N ❑UNK VEH. AT CRASH 99-UNKNOWN *Oistracton Value 9 0
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8-iI 6 1:, COM VEH 0 N U1 CO
FIRST CONTACT 1 Y _, _S •IfYes.See SidebarC
H ELGIN IL 60123 A 1 0 FG32389 IL 2026 I 0 M
IL D 0 1 HGEJ8244WL096788 NA ❑Y 0 N RDEF
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 =
Elgin Fire Same NA BAG $
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 <
Sherman RESPONDER U1 =
(UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME),(ADDRESS)/(TELEPHONE) (EMS) (HOSPITAL)
1 0
EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z
N 1 ® 11 1 06,O1 /2025 02 33 ®AM in a Work Zone? NCI 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 C)
v 2 0 2 99 06,01 ,2025 02 33 ®PM ❑Construction >E
R 3 0 ]$I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 3
z J ❑AM ❑Maintenance U2
- ® • El a, ARREST NAME Cooks. Breon. K. 11-901-A 1549000106 06/01 /2025 02 35 Igi pM
o1 SLMT
U 11 N CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME AM
o r 2 0 ARREST NAME Hernandez.Aaron.V. 3-707 1549000107 06/01 /2025 02 53 ®PM 0 Unknown work zone type U1 30co
2 2 3 ID El ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM workers present? ❑Y 30
1549-Brown. Bryan 275-Engelke 07 ,08,2025 09 00 ❑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••--, , t . 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 -
i- ------:-----; N?Mclean?Blvd - !' INDICATE NORTH combination):or -I
BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C
i_ - } • (example:shuttle or charter bus):or 0
Q N 3. Is designed to car 15 or fewer ssen ers and o rated a contract carrier O
< <_---------i
i. } } } transporting employees In the courses of their employment(example:employee I X
d I ( transporter-usually a van type vehicle or passenger car):or co
} } 1. •4. Is used or designated to transport Po between 9 and 15 passengers,including the driver, to
Um I
t i i 5. Is any vehicle for direct compensation(example:large van used for specific purpose):or o
L L____a____ _-�_ 1� _ hicle used to transport any hazardous material(HAZMAT) m
. placarding(example:placards will be displayed on the vehicle). XI
1i Driveway?of7595
Le?Salle?PI _{
= I CARRIER NAME Z
ADDRESS 'n
I it D
l 0
n
CITY/STATE/ZIP g
MOTOR CARR.ID El Interstate El Intrastate
I I T I ❑ Not in Comm./Govt. Not in Comm./Other
Not To Scale
,____Y____, USDOT NO. ILCC NO. rn
XI
Source of above z
. If Yes,Name on placard 0
4 digit UN NO. 1 digit Hazard class No. Xl
Xl
Did HAZMAT spill from vehicle(do NOT consider FUEL from vehicle's z
own tank)? 0 Yes 0 No 0 Unknown
Did HAZMAT Regulations violation contribute to the crash? r
❑ Yes 0 No 0 Unknown g
D
Did Carrier Safety Regulations MCS)violation contribute to the crash? A
❑ Yes II El Unknown C
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 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
Blue White
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