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HomeMy WebLinkAbout2025-00044815 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 011011000 0011 fll 1100 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X463886196 u, 1 U21 1 1 1 U1 2 U2 1 U, 1 u2 1 U, 1 U2 1 1 10 u1 3 U2 1 *P 0119* 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 El5501-S1,500 ®ON SCENE 2 VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash ❑AMENDED YR 2025I 2025-0004d815 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 rn 995 N MCLEAN BLVD Elgin 10:13 ® ❑ RELATED ❑Y ®N 07 11 2025 ®AM ❑YES ®NO U1 -< _ _ g PRIVATE mo /day/yr ❑PM FLOW CONDITION m COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR 0 SLOW 15 u) ❑ FT/MI N E S W Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD 0 STOPPED U2 —I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 Qg3 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uuv 0!Cy 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 n r T TOWED U1 0O ukwe. Favour. I. Hyundai Accent 2010 00-NONEDUE TO CRASH ® ❑ NAME(LAST,FIRST,M) gmo yr 13-UNDER CARRIAGE ©, 0,:0 2FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL)THERDISTRACTED 0 0 U2 4 rn F 2 6 SYTM❑Y ®SNE❑UNK VEH. 0 ATCRASHD 0 15-99-UUNKNOWN 9 16•TOP 3 `Distraction Value ALGN X. r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s it �i 4 COM VEH El El 1 n H FIRST CONTACT 11 7__ a--_;__5 *IIYes.See Sidebar U1 0 Z ELGIN IL 60123 0 1 0 EX87220 IL 2025 REAR TELEPHONE IL D KM HCN4ACXAU428534 American Alliance Casualt ❑Y ®N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Elgin Fire Ogukwe.Augustina.C. ilaa-0939984-01 1 r o HOSPITAL(TAKEN TO) INCIDENT IF IC OWNER STREET,CITY.STATE,ZIP PHONE NUMBER RESPONDER 2 ou m �{ DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0!My 0 Ncv 0 Dv /1 9 5 2 Hyundai PALISADE 2024 00-NONE ,._"1 0 O DUE TO CRASH 0 ❑ 2 x 13-UNDER CARRIAGE I FIRE 0 ® U2 M 2 5 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16.TOP 3 X ❑Y ®N D UNK VEH. AT CRASH 99-UNKNOWN *Oistracti n Value 0 POINT OF s i 4 COM VEH ❑ ® U1 CO N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR e �S:_ C FIRST CONTACT 1 / _,-_5 C. If Yes,See Sidebar ADDISON IL 60101 C 1 0 W-322532 IL 2026 I0 Si) IL D KM8R5DGE2RU806585 Safeco Insurance ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Elgin Fire Same z5220794 BAG $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP 996 < Other RESPONDER U1 = (UNIT) (SEAT) (DOB' (SEX) {SAFT) (AIR) (INJI 1(EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)!(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL) 2 3 01 / :A / / UI 1 D / / 2 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 11 4 07/11 /2025 10 13 ®❑PM in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 6 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ®AM U1 v 2 0 2 99 07/11 /2025 10 14 ❑pM El Construction >F R O ❑ zi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 1 3 ®AM ❑Maintenance U2 o ® 11 4 ARREST NAME Ogukwe. Favour. I. 11-901-A 1545-339 07/11 /2025 10 15 ❑pM El Utility SLMT igi CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ®AM 30 t 2 El ARREST NAME Ogukwe. Favour. I. 6-101-A 1545-338 07/11 /2025 10 50 ❑PM El Unknown work zone type U1 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 30 1545-VanEycke. Brier 501 08 /26/2025 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 truckrtrailer -< ` ` --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 n r r X 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I O ` `----------1 Not To Scale I - } } } transportingemployees in the course of their employment , Ipbyment(example:employee � transporter-usually a van type vehicle or passenger car):or w L }-----}----; - } } } •4. Is used or designated to transport between 9 and 15 passengers,including the driver. N I `_ for direct compensation(example:large van used for specific purpose):or O i. i _ 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires ;kw placarding(example:placards will be displayed on the vehicle). XI,l D CARRIER NAME —I ADDRESS 0D N7MdenAIW n I i. i. i. 0 4. CITY/STATE/ZIP g MOTOR CARR.ID 0 Interstate 0 Intrastate I r ❑ Not in Comm./Govt. 0 Not in Comm./Other -"--------1 - USDOT NO. ILCC NO. rn XI Source of above z . 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'; 0 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' T TRAILER 1 ❑ ❑ 0 Z TRAILER 2 ❑ 0 0 O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. Z Gray Blue 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