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HomeMy WebLinkAbout2025-00069339 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 01111101111 I0110 II II 10 01111 11111III100 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X003292 u, 1 U21 2 4 1 U1 2 U2 8 U1 1 U2 1 U1 1 U2 1 1 10 U, 1 U2 3 *P0119* INVESTIGATING AGENCY DAMAGE TO ANY El$500 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 2 VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) (83B Injury and/or Tow Due To Crash El AMENDED YR 2025I 2025-00069339 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 mN ALDINE ST Elgin03:17 ® ❑ RELATED ®Y 0 N 10 23 2025 ❑AM ❑YES ®NO U1 _ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION III FT!MI N E S W LARKIN AVE COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR Ell SLOW 15 0) ❑ Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD 0 STOPPED U2 -I ® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ❑ FREE FLOW # LNS 0 /83 DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EWES ❑uuv ❑!CV ❑Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 0 0 2 / yr 13-UNDER CARRIAGE ©,I :: FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 0 rn F 2 SY 15-OTHER 4 ❑Y ®SNE DUNK VEH. 0 AT CRASH M IN D 0 99-UNKNOWN 9 16•TOP 3 *Distraction Value ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s, i�6 4 COM VEH 0 j$J 1 0 ~ ELGIN I L 60123 0 1 0 FIRST CONTACT 12 7 ; _5 *Yves.See Sidebar U1 Z CE84066 IL 2026 REAR TELEPHONE IL D 0 1 G N KVFKDXHJ238903 Progressive ❑Y Il N U2 I' in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 Same 967467924 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused 0 Y El 2 0 N DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EWES ❑r uv 0 NCv ❑DV CIRCLE NUMBER(S) U1 0 0 8 Dodge Durango 2019 00-NONE 11 12'-_, DUE TO CRASH ❑ 2 0 13-UNDER CARRIAGE FIRE 0 ® U2C c M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16-TOP( ❑Y EQ N ❑UNK VEH. AT CRASH 99-UNKNOWN O Oistraetlon Value 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6 1 6 l.- 4 COM VEH ❑ ® tit CO FIRST CONTACT 3 Y��_,-`-�C. (ryes,See Sidebar C Z SOUTH ELGIN I L 60177 0 1 0 CE77392 I L 2026 I 0 N D IL D 0 1 C4SDJCT6KC575990 American Freedom ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X 99 9 Baker. Maria.G. 12247656200 BAc $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP U1 = (UNIT) (SEAT) (DOBi (SEX) {SAFT) (AIR) (INJ) 1(EJCTI (EPTH) PASSENGERS&WITNESS ONLY (NAME)!{ADDRESS)(TELEPHONE) (EMS) (HOSPITAL) 1 6 12 / LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur El N 1 ® 11 4 10,23 l2025 03 17 ®AM in a Work Zone? ®N DIRP co 1 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME ❑AM If YES check one below: U1 1 n T v 1 2 ❑ 2 20 1 1 0 PM ❑Construction * Z 3 0 0 CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 3 ❑AM ❑Maintenance U2 -a, ARREST NAME / / El PM ' o N1 ® 11 `1 0 CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ,...,Utility SLMT 30 T 2 ARREST NAME AM T 1 / ❑❑PM 0 Unknown work zone type U1 El OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 0 - ❑AM Workers present? ❑Y 30 1515-BellEck.Stacy sot , / ❑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 r ÷ combination):. Haor more than pound (example:truck or truckrtratler 1. Has a weight rating10 000 5 � -< N I INDICATE NORTH p0 _ BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C i_ } � Not To Scale I - } (example:shuttle or charter bus):or 0 I3. Is designed to carry15 or fewer passengers and operated a contract carrier O }. -A- --i ` } } } transporting employee in the course of their employment(example:employee transporter-usually a van type vehicle or passenger car):or w i. }-----}----+ - I. } } } •4. Is used or designated to transport between 9 and 15 passengers,including the driver. C J. r r J for direct compensation(example:large van used for specific purpose):or N L L____a..... ( / L L L I t 5. Is any vehicle used to transport anyhazardous material(HAZMAT)that requires m J 1 placarding(example:placards will be displayed on the vehicle). XI M l I I CARRIER NAME Z ADDRESS 0 D CITY/STATE/ZIP g _ i. i. i. i. MOTOR CARR.ID 0 Interstate 0 Intrastate 5 l I r l ❑ Not in Comm./Govt. 0 Not in Comm./Other � "Y""1 USDOT NO. ILCC NO. m XI Source of above z . 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 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 Blue White 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