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HomeMy WebLinkAbout2025-00036599 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 01111101111 I011011000 I0 1 fl II 00 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X003E-54034 u, 1 U21 2 4 1 u, 2 U2 1 u, 1 1_12 1 u1 1 U2 1 1 15 u1 1 U2 1 *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 El$501-$1.500 ®ON SCENE 2 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) (83B Injury and/or Tow Due To Crash 0 AMENDED YR 202512025-00036599 VEHT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 �I ALFT LN Elgin06:20 ® ❑ RELATED ®Y 0 N 06 08 2025 ❑AM ❑YES ®NO U1 g PRIVATE mo /day/yr ®PM FLOW CONDITION ITl _ FT/MI N E S W CAPITAL ST COUNTY PROPERTY ❑Y ® N DOORING Ely #OF MOTOR El SLOW 15 u) ❑ Kane HIT&RUN ❑V ® N WITH VEHICLES INVLD ❑ STOPPED U2 --I CO AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST IZI N ® FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EWES ❑uuv ❑!CV ❑Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 12 FROPtf TOWED U1 Kell Rich.C. Land Rover Discovery 2020 00-NONE 0 12 , OUE TO CRASH ® ❑ NAME(LAST,FIRST,M) y mo yr 13-UNDER CARRIAGE ©i FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) O 2 DISTRACTED 0 0U2 12 in F 2 6 SYTM❑Y ®SNE❑UNK VEH. 0 AT CRASH 99-UUNKNOWN THER O9 16•TOP 3 *Distraction Value ALGN X. r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s,_iL B 4 COM VEH 0 Ea 1 0 I . Matteson IL 60443 0 1 0 FIRST CONTACT 10 7 ; _5 *uves.SeeSidebar U1 Z EE21572 IL 2025 REAR TELEPHONE IL D 0 SALRG2RV9L2430415 Allstate ❑v ®N U2 19 , m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 Same 811 838 205 1 11— "6 HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y El 2 0 Eg DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EWES ❑!My ❑NCv ❑Dv Yr/2 0 0 2 Nissan Armada 2010' 00-NONE O Qi-O DUE TO CRASH ❑ 2 0 13-UNDER CARRIAGE 10( 1. 2 FIRE 0 ® U2 C F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9,16-TOP 3 X ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN *OistractIon Value 0 POINT OF 8 i1�i" 4 COM VEH ❑ ® U1 CO N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR FIRST CONTACT 12 7� B .5 •(ryes,See Sidebar ZSchaumburg IL 60195 0 1 0 ET71607 IL 2025 I 0 C D IL D 0 5N1 BA0ND8AN619866 Progressive ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X 99 9 Same 983335396 BAc $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP 996 < Refused RESPONDER u1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ) 1(EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)/(ADDRESS)/(TELEPHONE) (EMS) (HOSPITAL) 1 3 07 / / / UI 2 D:A / / 2 O EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur El U2 Z N 1 ® 11 4 06/08 /2025 06 20 ®AM in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 5 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 v 2 ❑ 2 28 06,08 ,2025 06 21 ®PM ❑Construction >F Z ❑ igi CITATIONS ISSUED ❑PENDING SECTION CITATION NO. EMS ARRIVED TIME ❑AM El Maintenance U2 7 —<, 3 ARREST NAME Kelly. Rich.C. 11-901-A S1527-00032 / ! ❑PM 1 ® 11 4 0 CITATIONS ISSUED PENDING UtilitySLMT o N SECTION CITATION NO. ROAD CLEARANCE TIME ❑ r 2 El ARREST NAME 06/08 /2025 07 00 ®PM ❑Unknown work zone type El AM U1 30 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑AM Workers present? ❑Y 30 1527-Juarez.Jorge 901 386-Lynch 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 1. Has a weight rating more than 10,000 pounds(example:truck or truckrtrailer -< c ` -' -' r INDICATE NORTH combination):or —I BY ARROW 2 Is used or designed totrann ortmorethan15 C } N ,. ,. ,. (example:shuttle or charter bus):or passengers including the driver 0 CI I 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I O I- :-----------' v i I - } } } transporting employees in the course of their employment(example:employee '.". transporter-usually a van type vehicle or passenger car):or 03 L }-----}----; ..,.---.R j tiI v - I. } } 1. 4. Is used or designated to transport between 9 and 15 passengers,including the driver. N •for direct compensation(example:large van used for specific purpose):or O ___� o r' gall < PB' < < . t 5. Is any vehicle used to transport anyhazardous material(HAZMAT)that requires —BM 'u ` `'_"'J`' f f ' t t t m placarding(example:placards will be displayed on the vehicle). D I'`I T f "'"' CARRIER NAME L'I w lsa ADDRESS D n _NarmnJ i C'iwi.. rn I I CITY/STATE/ZIP n MOTOR CARR.ID 0 Interstate 0 Intrastate 0 1 I r 1 ❑ Not in Comm./Govt. 0 Not in Comm./Other ; _Y_ __1 _ USDOT NO. ILCC NO. m XI Source of above z . IDOT PERMIT NO. WIDELOAD-; ❑Yes 0 No 2 TRAILER VIN 1 m co 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 Blue u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT: 3 TOWED BY/TO. _Other/Owners Residence . SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY/TO: DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE