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HomeMy WebLinkAbout2025-00048603 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 I011011001 0 11001001011 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X003901525 u, 1 U21 3 4 1 U1 3 U2 1 U, 1 1_12 1 U, 1 U2 1 1 10 u1 1 U2 3 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY ❑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 51,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash ❑AMENDED YR 2025I 2025-00048603 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n ® ❑ RELATED ®Y 0 N 07 27 2025 ❑AM ❑YES ®NO U1 -< N LYLE AVE Elgin 02:22 _ g PRIVATE mo /day/yr ®PM FLOW CONDITION m FT l MI N E S W BIG TIMBER RD COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR 0 SLOW 1 (n ❑ Kane HIT&RUN ❑V ® N WITH VEHICLES INVLD 0 STOPPED U2 --I ® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EOUES 0 uuv 0 ucv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 n T�TOWED U1 O NAME(LAST,FIRST,M) WOZNIAK.ARLENE.A. mo Chevrolet Impala 2010 00-NONE Q. OI�, OUETOCRASH ® El -UNDER CARRIAGE } O FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) O THERDISTRACTED ® 0 U2 4 M F 2 8 SYTM❑Y ®SNE DUNK VEH. 0 AT CRASH 0 15-99-UNKNOWN 9 76•TOP 3 `Distraction Value 9 ALGN X. r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF $,_iL 6 �i 4 COM VEH 0 j$J 1 0 H 1- HUNTLEY NTLEY I L 60142 B 1 0 FIRST CONTACT 1 7 : __5 *I1 Yes.See Sidebar u1 ZTK4319 IL 2025 REAR TELEPHONE IL D 0 2G1WB5EN6A1263937 State Farm ❑v IlN U2 1— Illin EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Elgin Fire 99 9 Same 2503279-SFP-13 1 r o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Sherman 0 Y ❑ N 2 0 p; DRIVER 0 PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0!My 0 Ncv 0 Dv /1 9 8 2 Subaru Outback 2025 00-NONE „ _.©i,O DUE TO CRASH rg ❑ 2 x o 13-UNDER CARRIAGE I, FIRE ❑ ® U2 c M 2 8 SYSTEM IN 0 ENGAGED 0 15-OTHER 016-TOPO3 * X ❑Y ®N DUNK VEH. AT CRASH 99-UNKNOWN Distraction value 9 g N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 0'i 6 �Y 4 COM VEH 0 ® U1 CO F„ FIRST CONTACT 11 7 _, _5 •• •)ryes.See Sidebar C ELGIN IL 60123 B 1 0 P3W085 KY 2026 I 0 Si) M IL D 0 4S4BTALCOS3230047 Self Insured ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Elgin Fire 99 9 Avis Budget Group S1024 DOI#604045 BAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE;ZIP U1 = (UNIT) (SEAT) (D08) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)1(ADDRESS)+(TELEPHONE) (EMS) (HOSPITAL) 1 3 10 / / / UI 2 :A m / / 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 City of Elgin. Elgin Traffic Light Damaged 07,27 ,2025 02 22 ®AM in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 7 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 2 0 151 DOUG LAS AVE ELGIN IL 60120 25 28 07/27 ,2025 02 24 PM ® • ❑Construction >E N 3 o jg CITATIONS ISSUED ❑PENDING SECTION CITATION NO. EMS ARRIVED TIME 5 ❑AM ❑Maintenance U2 -a, ARREST NAME WOZNIAK.ARLENE.A. 11-306 1543000217 07/27/2025 02 28 ®PM SLMT ® 11 4 0Utility o u 1 SECTION CITATION NO. ROAD CLEARANCE TIME 0 CITATIONS ISSUED PENDING t 2 El ARREST NAME 07/27 /2025 03 20 0 PM 0 Unknown work zone type 0 AM U1 45 2 2 3 ID OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 0 AM Workers present? ❑Y 45 1543-Sturgeon. Kyle 500 08 /26/2025 01 30 0 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- }-- -'-- --; I I I. INDICATEcombination):or —I NORTH BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver i_ r� I o�_ } (example:shuttle or charter bus):or Q e. r Ellg7mmbermi. II',' `� , 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I O I- }____A____J. _ I. } } } transportingemployees in the course of their employment(example:employee X NogCAD transporte -usually a van type vehicle or passenger car): r unit 1 — — 4. Is used or designated to transport between 9 and 15 9e including (C/) .. I. } for direct compensation(example:large van used for specificpurpose):or [he driver, Pe ( P 9 Pe or 0 L____a____. _ i iany t 5. Is any vehicle used to transport hazardous material(HAZMAT)that requires placarding(example:placards will be displayed on the vehicle). J jm ;p 2# CARRIER NAME Z ADDRESS 0 I I I CITY/STATE/ZIP n ' ill _ Not To Scale j _ i. i. i. i. MOTOR CARR.ID Interstate Intrastate I I . I I I I Not in Comm./Govt. ❑ Not in Comm./Other 0 I""Y""4 USDOT NO. ILCC NO. C m XI Source of above z . own tank)? 0 Yes 0 No 0 Unknown —I D 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?El❑ Yes II No Unknown C 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 Gray Silver 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