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HomeMy WebLinkAbout2025-00052252 ILLINOIS TRAFFIC CRASH REPORT sheet 1 of 2 Sheets 01111101111 I011011001 01 III DRAC TRFD TRFC WEAT DRVA VIS VEHD LGHT COLL MANV X003928642 u, 1 U21 3 4 8 U1 4 U2 1 U, 1 u2 1 u, 2 u2 1 2 11 U1 11 U211 *P 0119 INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW ' DAMAGE TO ANY ❑$500 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$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash 0 AMENDED YR 202512025-00052252 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 r1 ® ❑ RELATED PRIVATE ®Y ❑N 08 12 2025 ®AM ❑YES IX]NO U1 -< BIG TIMBER RD Elgin mo /day/yr 06.18 ❑PM FLOW CONDITION m • I 0 0/MI N E S © North State St COUNTY PROPERTY ❑Y ® N DOORING ❑Y #OF MOTOR 0 SLOW 1 (n Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD IN STOPPED U2 —I 0 AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ❑ FREE FLOW # LNS 0 18:DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EWES ❑uuv ❑!CV ❑Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 n 0 5 / yr 13-UNDER CARRIAGE ©,I ©:: FIRE ❑ tz STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14--TOTAL(ALL) DISTRACTED El ]$I U2 4 M2026 M 2 5 OTHER ❑Y ®N SYSTEM ❑UNK VEH. AT CRASH D 99-UNKNOWN 9 16.70P 3 ,Distraction Value ALGN = r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s it 6 �i 4 COM VEH 0 j$J 2 O ELGIN IL 60124 0 1 FIRST CONTACT 11 7_; _-5 *IIYes.SeeSidebar U1 Z FH81833 IL 2026 REAR TELEPHONE IL D 7 1 G 11 C5SLXFF163978 NONE ❑Y ❑N U2 I-- 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR cp Elgin Fire Same NONE 2 m `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y ❑ N 3 2 0 m x DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EWES ❑NMv 0 KCV ❑DV /1 9 6 2 Chevrolet Equinox 2024 00-NONE ,�_"j t2..-_, DUE TO CRASH ❑ 2 x o yr 13-UNDER CARRIAGE 10,1 2 FIRE ❑ ® U2 C Ti F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16•TOP 3 X ❑Y ®N 0 UNK VEH. AT CRASH 99-UNKNOWN *0istrac on Value 9 PO NT OF CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR FIRST CONTACT 6 Q_I LOI`O CIO esVSee Sidebar ® ut to ELGIN IL 60123 0 1 ES20912 IL 2026 �aR 0 N IL D 0 3G NAXM EG 1 RL327205 American Family Insur ❑Y ®N RDEF X) EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Elgin Fire Same 41006-01703-44 BAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < RESPONDER❑Y0N3 u1 = Y (UNIT) (SEAT) (008i (SEX) {SAFT) (AIR) (INJI 1(EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)!(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL) 1 6 06 / 7/ / / UI 3 m / / 1 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 11 1 co 08/12 /2025 06 18 ®❑PM AM in a Work Zone? ®N DIRP D 1 T PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 3 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ®AM U1 2 0 36 3 10 28 08,12 /2025 06 18 PM ❑ El Construction * en R O 0 CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 3 3 ®AM ❑Maintenance U2 - ® ❑Utility a, ARREST NAME Faust.Jerry.J. 11-601 S0359-000629 08/12/2025 06 21 ❑PM oSLMT SECTION u 11 1 CITATIONS ISSUED 0 PENDING ®CITATION NO. ROAD CLEARANCE TIME o 45 AM y T 2 El ARREST NAME Faust.Jerry.J. 3-707 S0359-000628 08/12 /2025 07 30 ❑PM 0 Unknown work zone type U1 n T OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 ❑ 359-Williarhson. Linda 501 331-Ziegler 09 ,09,2025 01 30 E PM Workers present? ®N U2 45 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 -< c ` -'- ' r INDICATE NORTH combination):or —I BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C ,�,� _ (example:shuttle or charter bus):or X I . N9RAR98f ` A 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier i O } } } transporting employees In the course of their employment(example:employee X ® transporter-usually a van type vehicle or passenger car):or w L L____a____� 4. Is used ordesi natedtotrans rtbetween9and15 passengers,including C } } for direct compensation(example:large van used for specificpurpose):or [he driver, Pe ( P 9 Pe or O L t ii. t 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m 1 • • • • placarding(example:placards will be displayed on the vehicle). XI 1 CARRIER NAME Z ADDRESS 'n ` C 8® i. CITY/STATE/ZIP 0 MOTOR CARR.ID 0 Interstate ❑ Intrastate I I T I ❑ Not in Comm./Govt. 0 Not in Comm./Other i— --- --1 - USDOT NO. ILCC NO. m XI Source of above z . MCS 0 Yes 0 No 0 Unknown Out of Service 0 Yes ❑No 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 Brown Black 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: 2 TOWED BY/TO: DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE