Loading...
HomeMy WebLinkAbout2025-00069699 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets IC HHH 11 III1II U li D� 1111ID DDIII� �II111111 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X004006502* u, 9 U21 1 1 1 U1 2 U210 U199 u2 1 u1 99 U2 1 1 12 u, 1 U2 1 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY 0 5500 OR LESS TYPE OF REPORT ® q No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW Elgin Police Department ONE PERSON'S ®5501-$1.500 ®ON SCENE 2 VEHICLE/PROPERTY ❑OVER$1,500 ❑NOT ON SCENE(DESK REPORT) 0 AMENDED ❑ B Injury and/or Tow Due To Crash YR 202512025-00069699 VENT ADDRESS NO. HIGHWAY or STREET NAME ® ❑CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 99 71 RT20 RELATED ❑Y ®N 10 25 2025 09:54 ®AM D YES IX]NO U1 -< Elgin PRIVATE mo /day/yr ❑PM FLOW CONDITION IT1 FT l MI N E S W WELD RD COUNTY PROPERTY El ® N DOORING ❑y #OF MOTOR 0 SLOW 1 0)0 Kane HIT&RUN ®Y ❑ N WITH VEHICLES INVLD 0 STOPPED U2 —I ® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EWES ❑uuv ❑!CV ❑ov DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 n FOR DAMAGEDAREA(S) FRONT TOWED U1 O Unknown.O. Unknown Unknown 00-NONE ©, 12 , DUE TOCRASH ❑ VI NAME(LAST,FIRST,M) mo yr 13-UNDER CARRIAGE 10 1- !�. 2 FIRE ❑ IE STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ❑ 0U2 2 rn SYSTEM IN ENGAGED 15-OTHER 916.70P 3 9 9 ❑Y ❑N ❑UNK VEH. AT CRASH 99-UNKNOWN `Distraction Value ALGN = s 4 COM VEH ❑ j$J r POINT OF CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR I�6 �i,_5 U1 1 0 H FIRST CONTACT 11 7_0 9 _ *lIYes.SeeSidebar 2 Z ' E TELEPHONE . STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED 1 unk ❑Y ❑N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Same unk 1 I- `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y ❑ N 99 0 m g DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEOAL 0 EWES O Nlw 1 9 8 4 Subaru Outback 2017 00-NONE 'o,� t2 (,-2 FIRE DUE D CRASH ❑❑ U2 2 C o Yr 13-UNDER CARRIAGE c F 2 4 ❑Y ❑N ❑UNK VEH. AT CRASH 99-UNKNOWN `Oistracton Value 4 - N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8-it 6 i,,,, COM VEH 0 0 U1 CO FIRST CONTACT 5 7 � —_,SOS •If Yes.See Sidebar ELGIN IL 60124 0 1 ZY16214 IL 2025 I4 Si)C IL D 0 4S4BSADC6H3306381 State Farm ❑Y ®N RDEF71 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Same 1225028-SFP 13 BAc $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPOND 0 N U1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJI 1(EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)r(A.DDRESS)r(TELEPHONE) (EMS) (HOSPITAL) 2 5 09 / / / 3 0 EV MOST EVNT LOG DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 11 1 10,25 �2025 09 54 ®❑pM 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 2 0 04 28 N 3 ❑ ❑CITATIONS ISSUED 0 PENDING + ) ❑PM ❑Construction SECTION CITATION NO. EMS ARRIVED TIME ❑AM 0 Maintenance U2 7 -a, ARREST NAME 1 / ID PM ' o N ® 11 1 0 CITATIONS ISSUED 0 PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ❑Utility SLMT 50 r 2 ARREST NAME AM 7 1 r ❑❑pM 0 Unknown work zone type U1 El OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 ID ❑AM Workers present? ❑Y 45 260-Sheehan.Joseph 801 r r 0 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 INDICATE NORTH combination):or —I BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C _ } (example:shuttle or charter bus):or Not To Scale j0 � 3. is designed to carry 15 or fewer passengers and operated a contract carrier O I- I- -A- -•-I j I t - } } } transporting employees In the course of their employment(example:employee � X L -----}----; } } •transporter. sed or des gnated to transport betweelly a van type vehicle or n 9 and 15 passengers,including the driver, enger car):or co for direct compensation(example:large van used fors specific purose):or O L L--_-a-....I I "• "'� �_ Ne, — _ L L 5 Is any vehicle used to transport any hazardous material(HAZMAT)that requires —unnz— . . . . placarding(example:placards will be displayed on the vehicle). III \ / --II \ - CARRIER NAME Z Iieeii.v2o 0) ADDRESS D C) CITY/STATE/ZIP g MOTOR CARR.ID 0 Interstate 0 Intrastate 0 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 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 II 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 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 White u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY/TO: _ SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY/TO. DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE