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HomeMy WebLinkAbout2025-00060671 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 I011011001 01111 11IIIIIIIIII DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X063966638 u, 1 U21 1 1 1 U199 U2 1 U, 1 1_12 1 u,99 U2 1 1 2 U199 u214 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY ❑5500 OR LESS TYPE OF REPORT ® A No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW Elgin Police Department ONE PERSON'S ❑$501-$1.500 ®ON SCENE 2 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) 0 AMENDED ❑ B Injury and for Tow Due To Crash YR 2025I 2025-00060671 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 99 m ® ❑ RELATED PRIVATE ❑Y ®N 09 15 2025 Ilk-AM ❑YES ®NO U1 -< BIG TIMBER RD Elgin mo /day/yr 04:01 ®PM FLOW CONDITION M l O 5 FT/� N E S © North Randall Rd COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ®SLOW 15 fA Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD ❑ STOPPED U2 -I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ❑ FREE FLOW # LNS 0 0 DRIVER ❑ PARKED 0 DRIVERLESS 0 PED g PEDAL 0 EWES 0 uuv 0!Cy 0 DV DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 / , FOR DAMAGEDAREA(S) FRONT TOWED U1 0 NAME(LAST,FIRST,M) UNK. UNK mo yr Unknown Unknown NONE „ , OUE TO CRASH ❑ EN 13-UNDER CARRIAGE 101 12! 2 FIRE 0 IE STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ❑ 0U2 2 fT1 SYSTEM IN ENGAGED 15-OTHER 9 16.TOP 3 5 3 ❑Y El N ❑UNK VEH. AT CRASH 99-UNKNOWN Distraction Value ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF S_iL 6 j�.4 COM VEH 0 El 1 00 ~ 0 2 0 FIRST CONTACT OO 7_;___5 *lIVes.See Sidebar U1 ZUNK ' E TELEPHONE . STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED 1 1) UNK UNK ❑Y ❑N U2 I— in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 1 99 9 Same UNK 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER '‘.3D Y°®N 0 m g DRIVER ❑ PARKED ❑DRIVERLESS 0 FED ❑PEDAL 0 EWES 0 r My 0 NCv 0 DV 9$2 General MotorYtfra ry9 2007 00-NONE 111112 :_y DUE TO CRASH 0 ® U2 2 C73 o 13-UNDER CARRIAGE III Ti M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9;1,6•TOPO3 * X ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN O Oistracton Value 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8-.;,• 6 1.,( 4 COM VEH ❑ ® U1 CO FIRST CONTACT 2 7-'_, _5 •(ryes.See Sidebar H ELGIN Z IL 60123 0 1 0 AS73321 IL 2007 REAR C M IL D 0 1 G KFK16347J356147 State Farm ❑Y ®N RDEF X EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = 99 9 Same 3001868SFP13 BAC $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPONDER ut = (UNIT) (SEAT) (DO81 (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)1(A.DDRESS)!(TELEPHONE) (EMS) (HOSPITAL) U1 1 D / / 1 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z N 1 ® 13 1 CITY OF ELGIN Speed sign was bent 09,15 ,2025 04 01 ®AM in a Work Zone? ®N DIRP co I I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 3 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 0 v 2 150 DEXTER CT ELGIN 60120 32 99 , 1 ❑PM 0 Construction * 4 Z 33 0 0 CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME ❑AM ❑Maintenance U2 1 ARREST NAME / / ❑PM ' ou ® 13 1 ❑CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • ❑Utility SLMT r 2 ❑ 20 3 ARREST NAME ❑AM 7 1 1 ❑PM 0 Unknown work zone type U1 n OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 0 El AM Workers present? ❑Y 45 1515-BellEck.Stacy 901 , / ❑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. 0IF 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: lllo < Z 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer -< i- }____r__--; l i ( combination):or —I Not To Scale INDICATE NORTH BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C/,q. _ } (example:shuttle or charter bus):or 0 0 < :- --:-•--; _ /1,4 - transdrtig em lloyeeslin 5 he course of r passengers er employment(example:employee a contract ner X } r } transppoorterg-usually a van type vehicle or passenger car): r 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 L____a____� - L 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). ,Zmt J \ - CARRIER NAME Z ADDRESS 0 V CITY/STATE/ZIP 00 MOTOR CARR.ID 0 Interstate ElIntrastate - I �"� ❑ Not in Comm./Govt. 0 Not inComm./Other Y USDOT NO. ILCC NO. Cm Source of above z . Were HAZMAT placards on vehicle? 0 Yes 0 No = If Yes,Name on placard O 4 digit UN NO. 1 digit Hazard class No. XI XI 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 iO No 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 VIM 1 m co LOCAL USE ONLY TRAILER VIN 2 m 0 TRAILER WIDTH(S) 0-96" 97-102" >102' -n TRAILER 1 0 0 0 Z ill TRAILER 2 ❑ 0 0 o u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w Beige u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ElNOT DISABLING DAMAGE DAMAGE EXTENT: 0 TOWED BY/TO: _ . SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/TO. DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE