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HomeMy WebLinkAbout2025-00048744 ILLINOIS TRAFFIC CRASH REPORT sheet 1 Df 2 Sheets 01111101111 I011011001 0 III Ol IIIIII DO DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X003902323 u, 1 U21 3 4 1 U1 2 U2 1 u, 1 u2 1 u1 1 u2 1 2 11 u1 1 u2 1 *P 0 1 1 9* INVESTIGATING AGENCY DAMAGE TO ANY ❑$500 OR LESS TYPE OF REPORT 0 A No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 2 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) 0 B Injury and f or Tow Due To Crash 0 AMENDED YR 202512025-00048744 VENT ADDRESS NO. HIGHWAY or STREET NAME El ❑CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 "n RT20 RELATED ❑Y ®N 07 28 2025 05:13 ®AM ❑YES ®NO U1 —< Elgin PRIVATE mo /day/yr ❑PM FLOW CONDITION m 0 !MI N E S Shales Pk COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ®SLOW 15 Cn © Cook HIT&RUN ❑V ® N WITH VEHICLESOT, INVLD ❑ STOPPED U2 --I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ❑ FREE FLOW # LNS 0 18:DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EDUCE ❑uuv ❑!CV ❑Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 8 0 0 5 / yr 13-UNDER CARRIAGE IE fat !. 2 FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 8 m M 2 SY n 15-OTHER 4 ❑Y ®SNE❑UNK VEH. AT CRASIN n H 99-UNKNOWN 9 76•TOP 3 `Distraction Value 9 ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF $ iI a �i 4 COM VEH 0 j$J 1 0 ~ Rockford I L 61107 0 1 0 FIRST CONTACT 1 7 ; -_5 *II Yes.See Sidebar U1 Z ED21463 IL 2025 E TELEPHONE IL D 0 1 FMCUOG93HUD89366 State Farm ❑Y ®N U2 m 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Same 1462431-SFP-13 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER > Refused ❑Y ❑ N 2 c m x DRIVER ❑ PARKED ❑DRIVERLESS 0 FED ❑PEDAL 0 EWES ❑NMV 0 NOV ❑DV CIRCLE NUMBER(S) U1 1 9 8 3 Ford Explorer 2015 00-NONE 11_1 t2..-_, DUE TO CRASH p 2 x ... 13-UNDER CARRIAGE 10'( 2 FIRE ❑ ® U2 C c F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9,16-TOP 3 X ❑Y NJ N ❑UNK VEH. AT CRASH 99-UNKNOWN *Distraction Value 9 0 POINT OF S i 4 COM VEH D ® U1 CO N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR 6 FIRST CONTACT 7 O7 ,�=QI:._5 •If Yes.See Sidebar ELGIN IL 60123 0 1 0 FE59324 IL 2026 REAR 0 IL D 1 FM5K8AR3FGB83871 State Farm ❑Y ®N RDEF 73 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER I = Same 3578710-SFP-13 BAG $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPOND O N 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 U2 Z N 1 ® 11 1 71 ,8/ )025 05 13 ®❑PM in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 3 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 � 0 2 0 03 28 I ) ❑PM 0 Construction * Z 3 0 1!>I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 3 ❑AM 0 Maintenance U2 o1 ® 11 1 ARREST NAME Fanelli.John.A. 11-601-Ax W1534000301 / r El PM SLMT o N ❑CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • 0 Utility t 2 El 45 NAMEAM x- 7 1 / ❑❑PM 0 Unknown work zone type U1 n OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 0 ❑AM Workers present? ❑Y 45 1534-Santiago.Jorge 401 331-Ziegler , ( ❑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 I----I- I , i ; A CMV is defined as any motor vehicle used to transport passengers or property and: Z i 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer -< ` ` --I -' / ", • INDICATE NORTH combination):or .Z-1 1 , a BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C ))J -- _ } (example:shuttle or charter bus):or 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I O I- <.__-A-.---: Neskik _ ` } } } } transporting employees In the course of their employment(example:employee X E transporter-usually a van type vehicle or passenger car):or 03 L -a.-_.i -_ �'+x.., } } •4. Is used or designated to transport between 9 and 15 passengers,including the driver, C _ ,� = __ ° for direct compensation(example:large van used fors specific purose):or O L L--_-a-....I _ t 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). D / ` CARRIER NAME Z ---.� / ADDRESS 0 AA• / D / rn d`� // CITY/STATE/ZIP g / i. i. i. i. MOTOR CARR.ID 0 Interstate 0 Intrastate / ❑ Not in Comm./Govt. Not in Comm./Other USDOT NO. ILCC NO. m XI Source of above z . If Yes,Name on placard O 4 digit UN NO. 1 digit Hazard class No. Xl Xl Did HAZMAT spill from vehicle(do NOT consider FUEL from vehicle's 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 Gray White u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT 3 TOWED BY/TO. _Adieu/Impound Lot Garage SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY1T6 DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE