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HomeMy WebLinkAbout2025-00036356 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 01111101111 011011000 011011110111I II DRAG TRFD TRFC WEAT DRVA VIS VEHD LGHT COLL MANY X0038:45921 u, 9 U2 1 1 1 U199 u2 U199 1_12 U,99 U2 1 6 U1 99 U2 *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 1215501-$1.500 ®ON SCENE 4 VEHICLE/PROPERTY ❑OVER$1,500 El NOT ON SCENE(DESK REPORT) El AMENDED ❑ B Injury and for Tow Due To Crash YR 2025I 2025-00036356 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 99 m1 BOWES RD Elgin ® ❑ RELATED 0 Y ®N 06 07 2025 DAM ❑YES IX]PRIVATE NO U1 mo /day/yr 02:06 ®PM FLOW CONDITION m • I 0 ®!MI N E S © 1300 Bowes Rd COUNTY PROPERTY ❑Y M N DOORING ICI #OF MOTOR 0 SLOW Cl) Kane HIT&RUN ®Y ❑ N WITH VEHICLES INVLD 0 STOPPED U2 --I ID AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 18:DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uuv 0!CV 0 ov DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 3 C) / / FOR DAMAGEDAREA(S) FROM TOWED U1 0 Unknown.0. Unknown Unknown OD-NONE „ 12 , DUE TO CRASH ❑ ® E NAME(LAST,FIRST,M) mo yr 13-UNDER CARRIAGE IE t�l !�. 2 FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 m SYSTEM IN ENGAGED 15-OTHER 9 16.TOP 3 9 9 ❑Y ID N ID UNK VEH. AT CRASH ®-UNKNOWN `Distraction Value ALGN = s 4 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF _,IL s li,_ 4 I- O 9 0 FIRST CONTACT 99 7=; COM VEH 0 ZgJ mai -5 *II Yes.See Sidebar U1 0 2 Z ' E TELEPHONE . STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED Unknown ❑Y ❑N U2 r in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Same Unknown 1 rn `o HOSPITAL(TAKEN TO) INCIDENT IF IC OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y ® N 99 0 DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NMV 0 KCV 0 DV yr 12 _ X o 13-UNDER CARRIAGE 1U I 2 FIRE 0 0 U2 C c SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED a SYSTEM IN ENGAGED 15-OTHER 9,16-TOP 3 0 0 SPDR O 0 Y ❑N ❑UNK VEH. AT CRASH 99-UNKNOWN *Oistraellon Value U1 4 - POINT OF s-.;, -4 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR FIRST CONTACT YA='+:=5 C•IO e1sYEH See •Sidebar❑ 0 C CO F` pEAR` C M . STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 O ❑Y ❑N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = BAC HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < RESP❑YONDER❑N U1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)!(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL) n / / U2 r m 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z N 1 0 36 1 Elgin Tree 06/07 /2025 02 06 ®AM in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 7 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 � 2 ® 41 3 150 DEXTER CT ELGIN IL 60120 20 18 ! ! ❑PM• ❑Construction * N 3 0 41 3 0 CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME ❑AM 0 Maintenance U2 -a, ARREST NAME ! / ID PM ' ou 0 CITATIONS ISSUED ❑PENDING •SECTION CITATION NO. ROAD CLEARANCE TIME ❑Utility 30 SLMT t 2 ARREST NAME AM ! 1 ❑❑PM ❑Unknown work zone type U1 El 7 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME Y 2 3 0 - ID Am Workers present? ❑ 1545 VanEycke. Brier 701 ! / ❑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 N 9Has a weight rating more than 10,000 pounds(example:truck or truckrtrailer 1. ' }---.;-----; — - combination):or INDICATE NORTH 77 — Not To Scale I BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C — 4. _.-- i. e. (example:shuttle or charter bus):or n 3. Is designed to carry15 or fewer passengers and operated a contract carrier 0 - <_---------i — — } } } transporting employee in the course of their employment� (example:employee � _ y _ transporter-usually a van Type vehicle or passenger car):or C L -----}----; — — - } } } •4. Is used or designated to transport between 9 and 15 passengers,including the driver. to •1 for direct compensation(example:large van used for specific purpose):or O 1 — _ } } t 5. Is any vehicle used to transport an hazardous material(HAZMAT)that requires . placarding(example:placards will be displayed on the vehicle). XI m I.- _ CARRIER NAME Z } — _ __ ADDRESS D ' / — ut — — I - CITY/STATE/ZIP n _ MOTOR CARR.ID 0 Interstate 0 Intrastate T ; III ❑ Not in Comm./Govt. 0 Not in Comm./Other --'---- --1 - USDOT NO. ILCC NO. rn PCI Source of above z . 0 Yes 0 No ❑ Unknown 0 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' m TRAILER 1 ❑ ❑ 0 z ri TRAILER 2 ❑ 0 0 O u 1 COLOR U—COLOR TRAILER LENGTH(S)1 ft. 2 ft. Z 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_TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: TOWED BY/TO.DUE TO VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE