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HomeMy WebLinkAbout2025-00051332 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 I011011001 I ill 11111111 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X4039ir270 u, 1 U2 1 1 1 U116 U2 U, 1 1_12 U, 1 U2 1 1 9 U1 1 U221 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY El$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 1 VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash 0 AMENDED YR 2025I 2025-00051332 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 �I ® ❑ RELATED ❑Y ®N 08 08 2025 ®AM ❑YES ®NO U1 -< MCCLURE AVE Elgin07:56 _ _ g PRIVATE mo /day/yr ❑PM FLOW CONDITION m FT/MI N E S W MILL ST COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 15 u) ❑ Kane HIT&RUN ❑V ® N WITH VEHICLES INVLD ❑ STOPPED U2 --I lgi AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 Q83 DRIVER t] PARKED O DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NW 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 C) T TOWED U1 0En elmann.Grace. E. Acura RDX 2018 00-NONE • z OUETOCRASH ® ❑ NAME(LAST,FIRST,M) g mo yr 13-UNDER CARRIAGE ©1 O;!m FIRE STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL O4-TOTAL(ALL) O O ❑DISTRACTED 0 0 U2 al 2 M F 2 8 ❑Y ®SNEM❑UNK VEH. 0 AT CRASH IN ENGAGE0 99-UUNKNOWN OE>TOR® `Distraction Value 5 ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF D i s 'I COM VEH 0 j$J 1 C) Z SOUTH ELGIN IL 60177 0 1 0 FIRST CONTACT 1 O7 _Li _OS *If Yes.See Sidebar U1 0 AQ21187 IL 2026 REAR TELEPHONE IL D 5J8TB4H52JL022355 Allmerica ❑Y ®N U2 M 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Elgin Fire Same AWCD707713-06 1 r o HOSPITAL(TAKEN TO) INCIDENT IF IC OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y ® N 2 0 rg- p DRIVER X. PARKED 0 DRIVERLESS 0 FED 0 PEDAL 0 EWES 0 NMV 0 NCv 0 Dv yr o 13-UNDER CARRIAGE 10;I c. 2 FIRE 0 El U2 C SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 ® SPDR C) a SYSTEM IN 0 ENGAGED 0 15-OTHER 9..16-TOP 3 X 0 Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN `Oistractlon Value 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF O I �.. 4 COM VEH ❑ ® U1 CO F,,, FIRST CONTACT 7 O7 �� 4a�1�.5 •(ryes,See Sidebar DL76T IL 2026 i 0 M . STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0 3G N FK16T81 G257052 Kemper ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X Briseno Martinez.Christian. E. 12RA000021081 BAc $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP U1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)!(ADDRESS)/(TELEPHONEI (EMS) (HOSPITAL) 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z N 1 ® 18 1 08/08 /2025 07 56 ®❑PM in a Work Zone? ®N DIRP co I I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 1 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ®AM U1 C) v 2 0 41 20 08/08 /2025 07 56 ❑PM 0 Construction * R 3 0 ]$I CITATIONS ISSUED ElPENDING SECTION CITATION NO. EMS ARRIVED TIME 1 z J ®AM 0 Maintenance U2 o1 ® 11 1 ARREST NAME Engelmann.Grace. E. 11-708 340000146 08/08/2025 08 01 ❑PM ❑Utility SLMT o N 0 CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME AM U, 30 r 2 El ARREST NAME 08/08 /2025 08 35 I PM ❑Unknown work zone type 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 30 340-Phillips. Kathryn 600 226-Roscher 09 ,09/2025 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. Hasa weight rating more than 10,000 pounds(example:truck or truck/trailer -< ---------- Not To Scale I - INDICATE NORTH comb nation)or BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C i_ sf - } (example:shuttle or charter bus):or f jj ® 3. Is designed to carry 15 or fewer passengers and operated a contract carrier O Y I- }.___A--- LL-p - } } } } transportingemployees in the course of their employment(example:employee X s. '�� transporte -usually a van type vehicle or passenger car): r co i. ,;-,I C }--- ----; -' } } } 4. Is used or designated to transport between 9 and 1 passen rs,including the driver, -" I� for direct compensation(example:large van used fors specific purpose):or NO __ _ t i i 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires 'D placarding(example:placards will be displayed on the vehicle). XI -I CARRIER NAME Z ADDRESS 0 CITY/STATE/ZIP g MOTOR CARR.ID 0 Interstate 0 Intrastate I 1 r ,�,. ❑ Not in Comm./Govt. Not in Comm./Other ---------, I I - 0 o USDOT NO. ILCC NO. < 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 to LOCAL USE ONLY TRAILER VIN 2 m v TRAILER WIDTH(S) 0-96" 97-102" >102' m TRAILER 1 ❑ ❑ 0 Z TRAILER 2 ❑ 0 0 O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. Z 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. 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 Mies/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE