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HomeMy WebLinkAbout2025-00053191 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 01111101111 011011001 01111000100 III DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X003926413 u, 1 U21 2 4 1 U, 2 U2 1 U, 1 1_12 1 U, 1 U2 1 1 15 U1 1 U2 1 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY El$500 OR LESS TYPE OF REPORT ❑ 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) ® B Injury and/or Tow Due To Crash El AMENDED YR 2025I 2025-00053191 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 r1 ® ❑ RELATED ®Y 0 N 08 15 2025 ❑AM ❑YES ®NO U1 S LIBERTY ST Elgin 03:19 _ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION III FT!MI N E S W LAUREL ST COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 21 cn ❑ Kane HIT&RUN ❑V ® N WITH VEHICLES INVLD ❑ STOPPED U2 —1 lgi AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 g DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EWES ❑uuv ❑!CV ❑Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 n FOR DAMAGED AREA(S) FROr4T TOWED U1 0Sn der.Ste hanie. N. 0 7 / yr 13-UNDER CARRIAGE ©,I ©:: FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14--TOTAL(ALL) DISTRACTED 0 0U2 2 m F 2 OTHER $ ❑Y ®N SYSTEM ❑UNK VEH. AT CRASHD 99-UNKNOWN 9 76.70P 3 ,Distraction Value 9 ALGN = r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s . a j 4 COM VEH 0 j$J 1 n t. Z Streamwood IL 60107 B 1 0 FIRST CONTACT 15 7 s.4RO *If Yes.See Sidebar U1 0 ET64881 IL 2011 E TELEPHONE IL D 7 3N 1 BC1 AP1 BL447060 Uninsured ®Y ❑N U2 m 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Elgin Fire 99 9 Gresens.Judith. M. Uninsured 1 r o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER RESPONDER /1 9 yf 4 Ford F350 2001 00-NONE 0, 0i'(. DUE TO CRASH rg ❑ 20 xj _ 13-UNDER CARRIAGE I FIRE ❑ El U2 c M 2 4 SYSTEM IN 0 ENGAGED 0 ®-OTHER 9,1,6-TOP 3 9 9 X ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN `Oistracuon Value POINT OF S i1 C 4 COM VEH 0 ® U1 CO N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR FIRST CONTACT 12 Y A �I�.S C. IfYes,See Sidebar — North Aurora IL 60542 B 1 0 452417D IL 2025 I 0 C IL D 7 1 FDWW37F31 EB38667 Keystone ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Elgin Fire 99 9 Midwest Building&L 04044100 SAC E 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),(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 4 COM ED Comed Pole damaged 81 ,51 /025 03 19 ®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 C) 2 0 5100 S ILLINOIS RT 31 Crystal Like 60014 28 2 81 ,51 ,025 03 20 mi pM • ❑Construction * R 3 0 El CITATIONS ISSUED El PENDING SECTION CITATION NO. EMS ARRIVED TIME 5 z J ❑AM ❑Maintenance U2 a 1 0 11 4 ARREST NAME Snyder.Stephanie. N. 11-502.15- 1564000041 81 /51 /025 03 20 Igi pM SLMT at. CITATIONS ISSUED 0 PENDING SECTION CITATION NO. ROAD CLEARANCE TIME AM• ❑Utility Ti 2 El 31 3 ARREST NAME Snyder.Stephanie. N. 11-601 1564000039 $1 /51 /025 06 18 ®PM 0 Unknown work zone type U1 30 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 30 1564-Rea. Desiree 302 91 , 61 /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. 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- }__-_r-_--; INDICATE NORTH combination):or Not To Scale A —I BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver n N - (example:shuttle or charter bus):or X L I- --I-•--; 111 I transporting employened to es Inthe course passengers5 or fewer thir emplod yment example:employee transporter} } } 6ransportet-usually a van type vehicle or passenger car):or CO L L.__-a__-_.I "'4.1. 1 4. Is used ordesi natedtotrans transport passengers,including y} } } g Po passen rs,includi the driver, -4 MN* for direct compensation(example:large van used for specific purpose):or O L___ ...---+ — — — #2 unit#1 - - - - I. } } t 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m I I placarding(example:placards will be displayed on the vehicle). XI r r -:- ''. —•,, :. : :• :--r --:- - CARRIER NAME Z ADDRESS 'n D I C) O CITY/STATE/ZIP � MOTOR CARR.ID 0 Interstate 0 Intrastate I r ❑ Not in Comm./Govt. 0 Not in Comm./Other --- --1 - USDOT NO. ILCC NO. m XI Source of above z . MCS ❑Yes 0 No ❑Unknown Out of Service ❑Yes ❑No 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 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 White White 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