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HomeMy WebLinkAbout2025-00046302 ILLINOIS TRAFFIC CRASH REPORT sheet 1 of 4 Sheets 01111101111 I011011001 0 II I )III 10110 0 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X003902324 u, 1 U21 2 4 1 u, 2 U2 1 u, 1 1_12 1 u, 1 U2 1 3 15 u, 1 U2 1 *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 ❑$501-51.500 ®ON SCENE 1 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) El Injury and/or Tow Due To Crash 0 AMENDED YR 202512025-00046302 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n RAYMOND ST El In 08:08 ® ❑ RELATED ®Y 0 N 07 17 2025 DAM ❑YES ®NO U1 -< _ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION M FT!MI N E S W BENT ST COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR 0 SLOW 1 0)0 Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD 0 STOPPED U2 —I ® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST IZI N ® FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NW 0!CV 0 DV DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 0 .FRO NI TOWED U1 Johnson. Lauryn.O. 1 0 / yr 13-UNDER CARRIAGE ©,I �._Z FIRE ❑ al < STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 ]$I U2 M F 2 SYTM 4 ❑Y ®$NE❑UNK VEH. 0 ATCRASHD 99-UUNKNOWN THER9 16•TOP 3 `Distraction Value ALGN X. r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s ii_6 I, 4 COM VEH 0 ga 1 0 ~ ELGIN N I L 60120 B 1 0 FIRST CONTACT 1 7_: __5 *II Yes.See Sidebar U1 Z DW88940 I L 2025 REAR TELEPHONE IL D 0 JN8AS58V58W130011 None ❑Y ❑N U2 13 , m 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m co 99 9 Streater.Carol.C. None 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER RESPONDER 2 eu N DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 row 0 i v 0 Dv /1 9 9 9 Nissan Sentra 2023 00-NONE ,�_"j Q�-_, DUE TO CRASH ❑ 2 0 13-UNDER CARRIAGE 10( I 2 FIRE 0 ® U2 C M 2 4SYSTEM IN 0 ENGAGED 0 15-OTHER 9,16-TOP 3 X 0 Y ®N 0 UNK VEH. AT CRASH 99-UNKNOWN `Oistraellon 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 ZSAINT CHARLES IL 60174 0 1 0 FF21376 IL 2025 I 0 N M IL D 0 3N 1 AB8CV7PY280443 Allstate ❑Y ®N RDEF71 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = 99 9 Same 802321404 BAc $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP 996 < Refused RESPONDER u1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJI 1(EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)!(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL) 1 6 04 / / / UI 3 D:A / / 1 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z N 1 ® 11 4 71 171 /025 08 08 ®PM in a Work Zone? ®N DIRP co 1 F PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME ❑AM If YES check one below: U1 7 C) T 0 2 0 2 99 ! / ❑PM- ❑Construction Z 3 0 I!!I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 1 ❑AM 0 Maintenance U2 -a, ARREST NAME Johnson. Lauryn.O. 11-901-A 455-431 ! / ID PM SLMT ,S u 1 ® 9 4 m!CITATIONS ISSUED 0 PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • 0 Utility S' N 0 AM 30 F 2 ❑ ARREST NAME Johnson. Lauryn.O. 3-707 455-432 7/ !7/ /025 08 08 ®PM ❑Unknown work zone type U1 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 30 455-HallaE.Gabriel 401 81 ! 91 ,025 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. . 0 r ----r••--, , ; A CMV is defined as any motor vehicle used to transport passengers or property and: Z �____r____; I _ combination):. Has or more than pounds(example:truck or truck/trailer 1. Has a weight rating10 000 � � INDICATE NORTH p0 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver - r r r (example:shuttle or charter bus):or I- A 3. Is desgned to carry 15 or fewer passengers and operated by a contract career I O •- } } } transporting employees In the course of their employment(example:employee X transporter-usually a van type vehicle or passenger car):or w L L____a____� 4. Is used ordesi nated to trans rt between 9 and 15passengers,includingthedriver, C I_- ' 1 H for direct compensation(examp:large van used for speific purose):or0 •t7_ i t 5. Is any vehicle used to transport an hazardous material(HAZMAT)that requires 17♦i placarding(example:placards will be displayed on the vehicle). xi t -I N CARRIER NAME Z uoeaz O f ADDRESS T.:;�` rn r —.- C) T L �I I r 1 MOTOR CARR.ID Interstate Intrastate - w Not To Scale CITY/STATE ❑ Not in Comm./Govt. ❑ Not in Comm./Other 00 ---------'4 USDOT NO. ILCC NO. C m XI Source of above z 0 Yes 0 No ❑ Unknown A Was a driver/vehicle Examination Report Form completed? r HAZMAT ❑Yes 0 No ❑Unknown Out of Service ❑Yes ❑No - 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 Red Blue 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 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® Redmons/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE