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HomeMy WebLinkAbout2025-00037235 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 011011000 I0 10000100 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X003855115 u, 9 U2 1 1 1 u199 U2 U199 1_12 U,99 U2 1 1 9 U1 99 U221 *P 0119* INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW ' DAMAGE TO ANY El$500 OR LESS TYPE OF REPORT ® A No Injury 1 Drive Away Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 7 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) 0 AMENDED ❑ B Injury and/or Tow Due To Crash YR 2025I 2025-00037235 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 99 m 1425 N RANDALL RD Elgin02:45 ® ❑ RELATED ❑Y ®N 06 11 2025 ❑AM ❑YES ®NO U1 _ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION m COUNTY PROPERTY ''Y ❑N DOORING ❑y #OF MOTOR ❑SLOW 15 u) ❑ FT/MI NESW Kane HIT ®Y ❑ N WITH VEHICLES INVLD ❑ STOPPED U2 --I &RUN 0 AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 Q83 DRIVER 0 PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES p NW p!CV 0 DV DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 / ! FOR DAMAGEDAREA(S) FRO NA TOWED U1 0 Unknown.O. Unknown Unknown 00-NONE it.. 12 , OUETOCRASH ❑ VI NAME{LAST,FIRST,M) mo yr 13-UNDER CARRIAGE 10 ! 2 FIRE ElIE < STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) U2 9 9 SYSTEM IN 9 ENGAGED 9 15-OTHER 9 is-Top 3 DISTRACTED ❑ 0 _ ❑Y ❑N ®UNK VEH. AT CRASH ®-UNKNOWN `Distraction Vatuc 9 ALGN 6 4 COM VEH 0 j$J r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF _,I[6 !i,_ 1 00 I- 0 9 9 FIRST CONTACT 99 7_; _5 *II Yes.See Sidebar U1 REAR 2 Z ' E TELEPHONE . STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED 1 Unk ❑Y ❑N U2 I— .9 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Same Unk 1 I- `o HOSPITAL(TAKEN TO) INCIDENT IF`Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y ❑ N 9 99 G0) 0 DRIVER X. PARKED 0 DRIVERLESS 0 FED 0 PEDAL 0 EWES 0!My 0 Ncv 0 DV yr 13-UNDER CARRIAGE 11--I 12 1.J FIRE 0 ® U2 Ti SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 10 f O DISTRACTED 0 ® SPDR 0 0 0 SYSTEM IN ENGAGED 15-OTHER 9.1,6-TOP 3 9 a ❑Y ❑N D UNK VEH. AT CRASH 99-UNKNOWN *Distraction Value POINT OF 6 ) ut N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR FIRST CONTACT 99 7 ,r-b CIO VEH sidebar❑ ® CO H DL24699 IL 2023 I:EaR 9 N M . STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0 JA4AD3A38GZ046260 State Farm ❑Y ®N RDEF X EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X Moller.Stephanie 1982353SFP13 BAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP U1 = {UNIT) (SEAT) (008) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)!{ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL) U2 0 996 / / m ##occs > 71 / / U1 1 D / / 0 0 E/ MOST EVNT DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 18 9 06,11 /2025 02 45 ®AM in a Work Zone? Igi N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 30 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 2 0 18 18 N 3 0 0 CITATIONS ISSUED 0 PENDING / 0 PM- ❑Construction SECTION CITATION NO. EMS ARRIVED TIME ❑AM ❑Maintenance U2 3 z —a, ARREST NAME / / ❑PM ' o u ® 11 5 0 CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • El Utility SLMT 15 t 2 0 ARREST NAME AM T 1 r ❑❑PM ❑Unknown work zone type U1 n OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 0 — ❑AM Workers present? ❑Y 15 1519-Bae2 a.Guadalupe 502 / / ❑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 II I I ' 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 c ` ''- ' - r INDICATE NORTH combination):or A UNIT BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C — ® - (example:shuttle or charter bus):or X . Nysaer.: 3. is designed to carry 15 or fewer passengers and operated by a contract Garner 0 _.; — - . . . transporting employees In the course of their employment(example:employee transporter-usually a van type vehicle or passenger car):or w L L.___a.___. 4. Is used ordesi natedtotrans rtbetween9and15 passengers,including N — - } } } • for direct compensation(example:large van used for specificpurpose):or [he driver, Pe ( P 9 Pe or O __ _a_ 1 t i i i. ._ 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires M placarding(example:placards will be displayed on the vehicle). CARRIER NAME Z '''-----__Ell-TD ©-------- I' I' I' I-- --I- ADDRESS 'n 0 CITY/STATE/ZIP g MOTOR CARR.ID 0 Interstate 0 Intrastate 5 . I iMn.nXpW a1l(1umt rtmMYnrm) 0 Not in Comm./Govt. 0 Not in Comm./Other 00 ;I. -- _ ._; USDOT NO. ILCC NO. rn 73 Source of above z . GVWR/GCWR m ❑ <10,0oo 0 10,000-26,000 0 >26,000 z Were HAZMAT placards on vehicle? 0 Yes 0 No = If Yes,Name on placard O 4 digit UN NO. 1 digit Hazard class No. 71 73 Did HAZMAT spill from vehicle(do NOT consider FUEL from vehicle's Z own tank)? 0 Yes 0 No 0 Unknown D Did HAZMAT Regulations violation contribute to the crash? r ❑ Yes 0 No 0 Unknown g Did Carrier Safety Regulations MCS)violation contribute to the crash?❑ Yes IQNo El Unknown 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 cn LOCAL USE ONLY TRAILER VIN 2 m O TRAILER WIDTH(S) 0-96" 97-102" >102' m TRAILER 1 ❑ ❑ 0 z ri TRAILER 2 ❑ 0 0 O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. Z Gray Bronze u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT 9 TOWED BY/TO: _ . SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/TO. DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE