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HomeMy WebLinkAbout2025-00068881 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 01111101111 0110 111110 fl 111fl11110000 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X004002085 u, 1 U21 3 4 2 U, 3 U2 1 U, 1 1_12 1 U, 1 U2 1 1 10 U1 1 U2 3 *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 ❑$501-51,500 ®ON SCENE 1 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash El AMENDED YR 2025I 2025-00068881 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 2 �I BOWES RD El In06:12 ® ❑ RELATED ®Y 0 N 10 21 2025 ❑AM ❑YES ®NO U1 -< g PRIVATE mo !day/yr ®PM FLOW CONDITION ITl FT N E S W LONGCOMMON PKWY COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR 0 SLOW 3 Cl) ❑ Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD 0 STOPPED U2 --I CO AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST IZI N 51 FREE FLOW # LNS 0 Qg3 DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EWES ❑uuv ❑!CV ❑DV DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) 0 0Y N 0 3 / yr Lancaster.Tucker.S. Ford F250 2001 00-NONE ©, 12 , DUE TO CRASH ❑ EN 13-UNDER CARRIAGE 10.I !�. 2 FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ❑ ]$I U2 0 rr1 M 2 4 SYTM IN ENGAGE15-OTHER ❑Y ®SNE❑UNK VEH. 0 ATCRASHD 0 99-UNKNOWN 9 16•TOP 3 `DlstractionValue ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s, i1_6 1, 4 COM VEH 0 Ea 0 F. FIRST CONTACT 1 7 ;—_;__5 *IIYes.See Sidebar U1 Z ST CHARLES IL 60175 0 1 0 4009768E IL 2026 REAR TELEPHONE IL D 0 1 FTNX21 L21 EB36415 Elephant Insurance ❑v ®N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Same 214-000-223-50 2 r o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER X* Refused ❑Y ® N 2 X N DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EWES ❑ ivy 0 Ncv ❑Dv !1 9 9 2 Dodge Caravan(inc Grand)2012 00-NONE 11_"I Qr O DUETOCRASH ❑ 2 0 13-UNDER CARRIAGE 10( I 2 FIRE 0 ® U2 cXj F 2 8 SYSTEM IN 0 ENGAGED 0 15-OTHER 9,1,6-TOP 3 X ❑Y i N DUNK VEH. AT CRASH 99-UNKNOWN *Oistraglon Value 3 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8 -il _ Il,-4 COM VEH D ® U1 CO FIRST CONTACT 1 7��—O__{-_5 •• •IfYes.See Sidebar = ELGIN IL 60123 0 1 0 ES81892 IL 2025 I 0 z IL D 0 2C4RDGCGXCR378219 Unknown ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Same Unknown BAc $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPONDER U1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ) (EJCT( (EPTH) PASSENGERS&WITNESS ONLY (NAME)((ADDRESS)((TELEPHONE) (EMS) (HOSPITAL) 1 3 07 / D / / 3 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 11 4 10/21 /2025 06 12 ®AM in a Work Zone? ®N DIRP co 1 t PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 7 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 v 2 25 28 10/21 /2025 06 14 RI ❑Construction R O ❑ gi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 3 3 ❑AM ❑Maintenance U2 o ® 11 4 ARREST NAME Lancaster.Tucker.S. 11-306 S1529-000529 10/21 /2025 06 15 izi pM' ❑Utility SLMT MI CITATIONS ISSUED 0 PENDING SECTION CITATION NO. ROAD CLEARANCE TIME AM r 2 ❑ ARREST NAME Vargas. Natalia.J. 3-707 S1529-000530 10/21 /2025 07 03 ®PM ❑Unknown work zone type U1 45 2 2 3 El OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 45 1529-Audi red.Jonathan 801 12 ,02/2025 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 4 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer -< i- }____r____1 Longcommon?Pkwy. N _ combination):or —I INDICATE NORTH .....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 3. Is designed to carry 15 or fewer passengers and operated by a contract career O } } } transporting employees In the course of their employment(example:employee X ' transporter-usually a van type vehicle or passenger car):or w ------}----; - } } } •4. Is used or designated to transport between 9 and 15 passengers,including the driver, C �� L. for direct compensation(example:large van used for specific purpose):or L L____a____.I A. _ l. i. i t 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m 47 I. placarding(example:placards will be displayed on the vehicle). m A a_8; iriur' ;� CARRIER NAME ADDRESS U owes?Rd. CITY/STATE/ZIP n g _ MOTOR CARR.ID 0 Interstate 0 Intrastate Not To Scale 1 0 Not in Comm./Govt. 0 Not in Comm./Other 00 ----------1 - USDOT NO. ILCC NO. C m XI Source of above z . Form Number m Xl IDOT PERMIT NO. WIDELOAD'; ❑Yes 0 No 2 TRAILER VIN 1 m co LOCAL USE ONLY TRAILER VIN 2 m v 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 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