Loading...
HomeMy WebLinkAbout2025-00051612 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 1011011001 I lIOI 0 110 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY x003.917351* u, 9 u21 1 1 1 U, 5 U2 1 U,99 1_12 1 U,99 U2 1 1 10 u, 3 U2 1 *P 0119* INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW ' DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away Elgin Police Department ONE PERSON'S El5501-51.500 ®ON SCENE 1 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) (83B Injury and for Tow Due To Crash 0 AMENDED YR 202512025-00051612 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 99 -n S STATE ST Elgin12:15 ® ❑ RELATED 181 Y 0 N 08 09 2025 ❑AM ❑YES El NO U1 _ _ PRIVATE mo /day/yr ®PM FLOW CONDITION MFTlMI N E S W STANDISH ST COUNTY PROPERTY El ® N DOORING ❑y #OF MOTOR El SLOW 3 Cl) ❑ Kane HIT&RUN ®Y ❑ N WITH VEHICLES INVLD ❑ STOPPED U2 —I ® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST IZI N 51 FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uuv 0!CV 0 ov DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 0 / ! T FOR DAMAGEDAREA(S) FROM�TOWED U1 O Unknown.0. Ford Taurus 2013 00-NONE ©, >2 �/DUE TOCRASH ❑ NAME(LAST,FIRST,M) mo yr 13-UNDER CARRIAGE 1U 1 2• FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTR EN ACTED 0 0 U2 0 171 SYSTEM IN ENGAGED 15-OTHER 916.70P 3 9 9 ❑Y El N ❑UNK VEH. AT CRASH 99-UNKNOWN `Distraction Value ALGN = r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s i�6 4 COM VEH 0 Ea 1 0 ~ 0 9 0 FIRST CONTACT 12 7_: __5 *lIVes.See Sidebar U1 ZFC60332 IL 2026 REAR TELEPHONE . STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED 1 1 FAHP2D80DG106574 Unknown ❑v ❑N U2 m 5 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m co Brower. Leticia.A. Unknown 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER r RESPONDER 0 m N DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL 0 EWES 0 !1 yr 9 9 4 Chrysler Pacifica 2017 00-NONE 'o,�l t2 ;,-2 FIRE DUE o CRASH ® U2 2 C o 13-UNDER CARRIAGE Po M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9.16-TOP 3 X ❑Y ®N DUNK VEH. AT CRASH 99-UNKNOWN O *Distraction Value 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8- 1. 6 1i 4 COM VEH ❑ ® U1 CO FIRST CONTACT 5 7�'—_,SOS •byes,See SidebarC ELGIN IL 60120 0 1 0 ES71457 IL 2025 I 0 IL D 2C4RC1 BGXH R526801 Kemper ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X Same 12RA000007355 BAc E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPONDER U1 = (UNIT) (SEAT) (DO81 (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)1(ADDRESS)/(TELEPHONE) (EMS) (HOSPITAL) U1 1 D / / 1 0 EV MOST EVNT LOG DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z N 1 ® 11 4 08/09 l2025 12 15 ®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 Eri 2 0 06 99 N 3 ❑ 0 CITATIONS ISSUED 0 PENDING + ! ❑PM• 0 Construction >F SECTION CITATION NO. EMS ARRIVED TIME 5 ❑AM 0 Maintenance U2 -a, ARREST NAME / / El PM ' o N1 ® 11 `1 0 CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ,_,Utility SLMT 30 T 2 ❑ ARREST NAME AM 7 1 r ❑❑PM El Unknown work zone type U1 n OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 ❑ - ❑AM Workers present? ❑Y 30 1547-Steele.Justin 701 , ! ❑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 truck/trailer -< A. I. ATE NORTH combination):or531 N BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C L L ; i. r r (example:shuttle or charter bus):or 0 i Not To Scale I I 3. Is desi gned to carry 15 or fewer passengers and operated by a contract carrier 10 } } } transporting employees in the course of their employment(example:employee X _ transporter-usually a van type vehicle or passenger car):or co leranertent L i. __}----+ J J } 1- 1 } 4. Is used or designated to transport between 9 and 1 ssen rs,including the driver, y I for direct compensation(example:large van used fors specific purpose):or L L____a____. 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). fa7 I D CARRIER NAME Z urinal titem 1 ADDRESS 0 rn CITY/STATE/ZIP 0 I - MOTOR CARR.ID ElInterstate ElIntrastate I I . I ❑ Not in Comm./Govt. 0 Not in Comm./Other ----------1 - USDOT NO. ILCC NO. m XI Source of above z . • m Did HAZMAT spit from vehicle(do NOT consider FUEL from vehicle's z own tank)? 0 Yes 0 No 0 Unknown T. 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 Silver Black u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/TO: _ SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/TO: DUE TO ® Redmons/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE DUE