HomeMy WebLinkAbout2025-00039520 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 10110110000011ll 10100 0
DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X003662020
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INVESTIGATING AGENCY DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away
AGENCY CRASH REPORT NO. TRFW '
Elgin Police Department ONE PERSON'S ❑$501-$1.500 ®ON SCENE 14
VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and f or Tow Due To Crash
El AMENDED
YR 2025I 2025-00039520 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 7
® ❑ RELATED ®Y 0 N 06 20 2025 ❑AM ❑YES ®NO U1 -<
N STATE ST Elgin09:07
_ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION m
FT!MI N E S W W H I G H LAN D AVE COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 1 (n
❑ Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD DO
U2 —I
lgi AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N 51 FREE FLOW # LNS 0
Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NIA/ 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 C)
T TOWED U1 O
FROM
Trice, Rasheed, D. Buick Lacrosse 2013 00-NONE 0Q2 i 0 DUE TO CRASH ® ❑ E
NAME(LAST,FIRST,M) mo yr 13-UNDER CARRIAGE 1U 1 2 FIRE ❑
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ® 0 U2 0 m
M 2 SYTM IN ENGAGE4 ❑Y ®SNEDUNK VEH. 0 ATCRASHD 0 99-UNKNOWN 9 16•TOP 3 `Distraction Value 9 ALGN 2
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR
F• POINT OF & i�6 �i COM VEH 0 j$J 1 0
FIRST CONTACT 11 7_:—__;__5 *llsees.See Sidebar U1
Z CH I CAG O IL 60620 0 1 0 EA57401 IL 2025 REAR
7 TELEPHONE
IL D 0 1 G4GC5E38DF329341 Progressive ❑v IlN U2 I'
13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
Sanders. Myseshia, N. 994061796 1 r
`o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE.ZIP PHONE NUMBER
RESPONDER
2 7]
p; DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 Nuv 0 KCV 0 DV
!2 0 0 1 Toyota Corolla 2016 00-NONE 0.. Q!'-O DUE TO CRASH p 2 x
0 13-UNDER CARRIAGE 10( I 2 FIRE ID El U2 C
M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9,16-TOP 3
❑Y i N ❑UNK VEH. AT CRASH 99-UNKNOWN *Distract on Value 9 4
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8-it 6 11:, COM VEH D ® U1 CO
FIRST CONTACT 11 7�� _,__9 •If Yes.See Sidebar
SOUTH ELGIN IL 60177 0 1 0 AT80828 IL 2025 I 4 ((I)
IL D 0 4T1 BF1 FK8GU999665 State Farm ❑Y ®N RDEF M
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X
Same 0934857-SFP-13 BAG $
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 <
Refused RESPONDER
u1 =
KNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)1(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL)
1 0
EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2Z
N 1 CD 11 4 06,20 /2025 09 14 ®AM in a Work Zone? ®N DIRP
D
1 I PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME ❑AM If YES check one below: U, 8 C)
O T
2 ❑ 2 28 , / ❑PM• ❑Construction X
Z 3 ❑ 0 CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 5
❑AM ❑Maintenance U2
o 1 ® 11 4 ARREST NAME Trice, Rasheed, D. 3-414 W1525000627 / ! ❑PM SLMT
ljg CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME NAM• El Utility
t 2 El ARREST NAME Trice, Rasheed, D. 11-601-Ax 1525000626 06/20 ,2025 09 45 ®PM El Unknown work zone type U1 30
2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 30
1525-NavE,Oscar 601 391-Jacobucci 07 ,28/2025 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••--, , . 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 -<
___ ___
` ` ' ' Not To Scale I
r INDICATE NORTH combination):or —I
BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C
\\\ \ } (example:shuttle or charter bus):or
L A / / ` 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I O
\ / } } } transporting employees In the course of their employment(example:employee
/ transporter-usually a van type vehicle or passenger car):or COL }-----}----; ` �2 / } } } •4. Is used or designated to transport between 9 and 15 passengers,including the driver, C
J�� / for direct compensation(example:large van used for specific purpose):or
O
L L___-a____. * i i t 5. Is any vehicle used to transport anyhazardous material(HAZMAT)that requires m
/ epir placarding(example:placards will be displayed on the vehicle). XI
\ CARRIER NAME Z
/ ADDRESS 'n
\ Il101i)li,
CITY/STATE/ZIP �
/ / \\ \ O
C)
\ \ - i. i. i. i. MOTOR CARR.ID 0 Interstate 0 Intrastate
-
0I I T I \ ❑ Not in Comm./Govt. ❑ Not in Comm./Other
--- --1 USDOT NO. ILCC NO. m
XI
Source of above 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
Gold Black
u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_
DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT 3 TOWED BY/TO.
_Redmons/Impound Lot Garage 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