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HomeMy WebLinkAbout2025-00056488 ILLINOIS TRAFFIC CRASH REPORT sheet 1 of 2 Sheets 01111101111 I011011001 fl III IIIII I II DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X0039943353 u, 1 U21 3 4 1 U1 2 U2 1 U1 1 U2 1 U1 1 U2 1 3 10 U, 3 U2 1 *P 0119 INVESTIGATING AGENCY DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW Elgin Police Department ONE PERSON'S 1215501-$1.500 ®ON SCENE 2 VEHICLE/PROPERTY ❑OVER 91,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash 0 AMENDED YR 2025I 2025-00056488 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 I N STATE ST Elgin 05:52 ® ❑ RELATED ®Y 0 N 08 28 2025 12,— ❑YES N NO U1 _ _ PRIVATE mo !day!yr ®PM FLOW CONDITION Ill FT!MI N E S W W HIGHLAND G H LAN D AVECOUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR El SLOW 1 cn ❑ Kane HIT&RUN ❑V ® N WITH VEHICLES INVLD ❑ STOPPED U2 —I ® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N 51 FREE FLOW # LNS 0 Qg3 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEON. 0 EWES 0 uuv 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2/ yr Q 0 FOR DAMAGEDAREA(S) FROM TOWED U1 Kia Motors Co Iluride 2022 00-NONE © 2 DUE TO CRASH ❑ EN 13-UNDER CARRIAGE 1U 1 • 2 FIRE 0 IE STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14--TOTHER OTAL(ALL) DISTRACTED 0 0U2 2 M90 F 2 4 ❑Y ON DUNK VEH. O AT CRASH D O 99-UNKNOWN 9 76.70P 3 ,Distraction Value 9 ALGN = r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s, i�6 4 COM VEH 0 j$J 1 0 ~ ELGIN I L 60124 0 1 0 FIRST CONTACT 12 7 ; _5 *IIYes.See Sidebar U1 Z DJ47343 IL 2025 REAR TELEPHONE IL D 0 5XYP34HC9NG276786 Progressive ❑Y Il N U2 13 , m 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 Same 985761673 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER XI Refused 0 Y El 2 0 g DRIVER 0 PARKED 0 DRIVERLESS 0 FED 0 PEDAL 0 EWES 0 row 0 KCv 0 Dv /1 9 8 0 Volkswagen Passat 2010' 00-NONE O,' t2 "_, DUE TO CRASH rg ❑ 2 x 0 13-UNDER CARRIAGE 10 I 2 FIRE 0 ® U2 C Ti F 2 4 ❑Y i SYSTEM IN 0 ENGAGED 0 ®-OTHER 9,16-TOP 3 9 0 X N DUNK VEH. AT CRASH 99-UNKNOWN *Oistrac8Dn Value N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s-it 6 11:, COM VEH ElN U1 CO FIRST CONTACT 11 7 _5 •(ryes.See Sidebar H ELGIN Z IL 60120 0 1 0 FD11024 IL 2025 M IL D 0 3VWRX7AJ8AM132938 geico ❑Y N N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X 99 9 Same 6119832985 BAc E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPONDER u1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ) 1(EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)+(ADDRESS)((TELEPHONE) (EMS) (HOSPITAL) 1 10 08 / ' D / / 2 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z N 1 ® 11 4 08,28 /2025 05 52 ®AM in a Work Zone? lgi N DIRP co 1 I PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME ❑AM If YES check one below: U1 3 C1 T o" 2 0 28 2 / / ❑PM• ❑Construction X 7 Z 3 0 N CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME ❑AM 0 Maintenance U2 -, 1 ® 11 4 ARREST NAME Kadam.Swapnali 11-601 1564000053 / ! El PM SLMT o N ❑CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • El Utility 0 AM t 2 0 ARREST NAME 08/28 /2025 05 54 0 PM 0 Unknown work zone type U1 3O 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 30 1564-Rea. Desiree 601 09 , 16/2025 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. Has a weight rating more than 10,000 pounds(example:truck or truck trailer -< i- }--__r-_--; } combination):or —I r INDICATE NORTH p1 Not To Scale IA BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C I I =IL N } (example:shuttle or charter bus):or n L A 3. Is desgned to carry 15 or fewer passengers and operated by a contract carrier I O } } } transporting employees In the course of their empbyment(example:employee I transporter-usually a van type vehicle or passenger car):or co L }-----}----; - - - .01' umsi2 I. } } } •4. Is used or designated to transport between 9 and 15 assen passengers,including the driver,for direct compensation(example:large van used for specific purpose):or O i i 5. Is any vehicle used to transport anyhazardous material(HAZMAT)that requires a placarding(example:placards will be displayed on the vehicle). m et CARRIER NAME Z i. ADDRESS 0 D 0 II r .:. i. i. i. 4. O CITY/STATE/ZIP MOTOR CARR.ID 0 Interstate ❑ Intrastate 1 I r 1 ❑ Not in Comm./Govt. 0 Not in Comm./Other ; _Y_ __1 - USDOT NO. ILCC NO. m XI Source of above z ' . MCS ❑Yes 0 No 0 Unknown Out of Service ❑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 Black Gray 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 DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® DISABLING DAMAGE Arties/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE