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HomeMy WebLinkAbout2025-00066559 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 01111101111 011011001 0011 flI 00 0 DRAG TRFD TRFC WEAT DRVA VIS VEHD LGHT COLL MANY XO0398992O U1 1 U21 10 4 1 U144 U2 1 U, 1 1_12 1 U, 1 U2 1 5 11 u, 1 U211 *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 El$501-$1.500 ®ON SCENE 3 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and f or Tow Due To Crash 0 AMENDED YR 202512025-00066559 VEHT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 71 N RANDALL RD Elgin07:32 ® ❑ RELATED ❑Y ®N 10 10 2025 ❑AM ❑YES ®NO U1 -< _ g PRIVATE mo !day/yr ®PM FLOW CONDITION m FT l MI N E S W BIG TIMBER RD COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR IR SLOW 15 u) ❑ Kane HIT&RUN ❑V ® N WITH VEHICLES INVLD ❑ STOPPED U2 --I ® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST IR N ❑ FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uuv 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 5 n FOR DAMAGEDAREA(S) FROf tf�OUETOCRASH TOWED U1 Q Reed. Bret. R. 0 5 / yr 13-UNDER CARRIAGE 1U 2 FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 5 M M 2 4 ❑Y ®SNE❑ n 15-OTHER UNK VEH. ATCRASHIN n ENGAGED 99-UNKNOWN 9 16•TOP 3 `Distraction Value ALGN = r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF S,;il S �i COM VEH 0 Ea 1 0 F. FIRST CONTACT 3 7 ;—--_;__5 *If Yes.See Sidebar U1 Z Geneva IL 60134 0 1 0 EK11768 IL 2026 is TELEPHONE IL D 0 1FMSK8DH8LGC37246 Starr Indemnity ❑Y ®N U2 m B EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER RSUR m 99 9 Shaw Industries Inc 1000692544251 1 r "o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER RESPONDER 2 XI N DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NW 0 KCV 0 DV '1 9 5 8 Mitsubishi Outlander 2016 00-NONE 'o,1 t2 c,�2 FIRE DUE O CRASH 0 ® U2 2 C o mo Yr 13-UNDER CARRIAGE c M 2 4SYSTEM IN 0 ENGAGED 0 15-OTHER 9.1,6•TOP 3 X 0 Y ®N 0 UNK VEH. AT CRASH 99-UNKNOWN *Oistracton Value 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF & 1 S "t. 4 C.OM VEH ❑ ® Ut CO FIRST CONTACT 6 O7 ,�=Q-)OS •If Yes,See Sidebar C ELGIN IL 60124 0 1 0 AP94748 IL 2026 FIRST 0 Si) Z IL D 0 JA4AZ3A31GZ021783 Country Financial ❑Y ®N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = 99 9 Patel. Mrugesh. N. PO10268689 SAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP U1 = KNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)!{ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL) U2 996 r m ##occs y 71 / ,, U1 1 D 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 10,10 l2025 07 32 ®AM in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 5 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 C) .6 2 ❑ 08 28 1 1 ❑PM ❑Construction * Z3 0 CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME ❑AM ❑Maintenance U2 5 —a, ARREST NAME Reed. Bret. R. 11-601-Ax 747928 ! ! El PM " o u 1 El1 1 1 CITATIONS ISSUED 0 PENDING SLMT o N SECTION CITATION NO. ROAD CLEARANCE TIME AM• 0 Utility t 2 El ARREST NAME Reed. Bret. R. 11-709-A 747929 1 O1 10 12025 09 50 0 PM 0 Unknown work zone type U1 45 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 45 1527-Juarez.Jorge 901 391-Jacobucci 11 ,03,2025 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••--, , jLi' ; A CMV is defined as any motor vehicle used to transport passengers or property and: Z 11 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer -< - }__-_r_-__; } combination):or 6 © INDICATE NORTH p1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C 01 ,, _ } (example:shuttle or charter bus):or 0 ,. r r en °°A 3. Is desgned to carry 15 or fewer passengers and operated by a contract carrier O }____A____J. I - y } } } transportingemployeesemploymentinthecourseoftheir = ; transporter- a van vehicle or (example:employee CO Po usually type passenger car):or CO L _ .,..... I I i r_ 4. Is used or designated to transport between 9 and 15 passengers,including (I) }--- - - } } } g po passen rs,includi the driver, '-------- o for direct compensation(example:large van used for specific purpose):or a O __ ti L L____a____� „ - ,Y�,�, _ 5 Isanyvehcleusedtotransportanyhazardousmateral(HAZMAT)thatrequires , j placartling(example:placards will be displayed on the vehicle). _.. r' ' CARRIER NAME Z __ ADDRESS D I CITY/STATE/ZIP g - MOTOR CARR.ID ❑ Interstate ❑ Intrastate i T I ❑ NotinComm./Govt. ❑ NotinComm/Other 0 . Y , USDOTNO. ILCCNO. m I m Source of above z . MCS 0 Yes 0 No 0 Unknown Out of Service 0 Yes ❑No Z Form Number 0 m 71 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 Blue u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT 2 TOWED BY/TO. _Redmons/Impound Lot Garage . 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