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HomeMy WebLinkAbout2025-00071176 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 0110 1111 III 110111 1111111 I DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X004015339' u, 1 U2 2 4 1 U1 3 U2 1 U, 1 1_12 1 U, 1 U2 1 1 9 U1 1 U221 *P 0119* INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW ' DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away Elgin Police Department ONE PERSON'S El5501-51.500 ®ON SCENE I VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash El AMENDED YR 202512025-00071176 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 rn ® ❑ RELATED 181 Y 0 N 11 01 2025 ❑AM ❑YES ®NO U1 N LYLE AVE Elgin 02:12 _ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION m FT!MI N E S W W H I G H LAN D AVE COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 3 Cl) ❑ Kane HIT&RUN ❑V ® N WITH VEHICLES INVLD ❑ STOPPED U2 -I lgi AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N 51 FREE FLOW # LNS 0 g DRIVER I] PARKED l]DRIVERLESS 0 PED CI PEDAL 0 EWES 0 NW 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 n 0 8 / yr Vidmar. David.A. Honda Accord 2003 00-NONE ©1 O �OUE TO CRASH ® ❑ 13-UNDER CARRIAGE 10.I 2 FIRE ❑ al STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 m M 2 SY4 ❑Y ®SNE❑UNK VEH. O AT CRASM IN H O 99-UNKNOWN 916•TOP 3 `Distraction Value ALGN 2 T. CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s,;il a 4 COM VEH 0 j$J 1 0 ~ ELGIN IL 60123 0 1 0 FIRST CONTACT 12 7 ; __5 *IIYes.SeeSidebar U1 Z R241846 IL 2025 E TELEPHONE IL D 0 1 HGCM56333A132878 Geico Insurance ❑Y Il N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 Same 4042315442 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Sherman ❑Y El 2 c (3 DRIVER I} PARKED 0 DRIVERLESS 0 FED 0 PEDAL 0 EWES 0 Nuy 0 i v 0 Dv yr 12 ,_ C o 13-UNDER CARRIAGE 10;1 2 FIRE ❑ ® U2 C 'e SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED a SYSTEM IN 0 ENGAGED 0 15-OTHER 9.16-TOPO3 * ❑ ® SPDR ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN O Oistractlon Value U1 0 POINT OF s-.;, a N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR . 6 j' COM VEH ❑ ® CO 11.* FIRST CONTACT 3 7• _,i.OS *((Yes,See Sidebar ASR2244 WI 2025 I 0Si) M . STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0 SFNRL6H95PB024391 Progressive ❑Y ®N RDEF73 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER I X 99 9 RICHTER. ERIK. P. 964543749 BAC $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP U1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJI (EJCTI (EPTH) PASSENGERS&WITNESS ONLY (NAME(!(ADDRESS)/)TELEPHONE) (EMS) (HOSPITAL) LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 El 18 3 Mackey.Olga. M. Damaged Fence/Tree 11 ,01 /2025 02 12 ®AM in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 1 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 ;, 2 ❑ 39 3 307 N LYLE AVE ELGIN IL 60123 23 99 , , PM ❑ ❑Construction >E 1 G Z3 ❑ 0 CITATIONS ISSUED ❑PENDING SECTION CITATION NO. EMS ARRIVED TIME ❑AM ❑Maintenance U2 5 -, 1 ER 11 1 ARREST NAME Vidmar. David.A. 11-904-B 1528-0090316 / / ElPM SLMT o N 0 CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ' 0 Utility 0 AM T 2 ❑ ARREST NAME 1 1/01 /2025 02 20 0 PM ❑Unknown work zone type U1 30 2 2 3 D OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑AM Workers present? ❑Y 00 1528-Rivera. Kevin 602 11 , 17/2025 01 30 ®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••--, , I R A CMV is defined as any motor vehicle used to transport passengers or property and: Z I1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer -< i- -----------' I I. INDICATE NORTH comb rtatbn)or BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C unwtyz (example:shuttle or charter bus):or 0 i i II mer�,tryatwe 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I O I- --I-- ' i-- ---I t xrwd I - I.-} transporting employees In the course of their employment(example:employee X w transporter-usually a van type vehicle or passenger car):or i_ L--------- I r r r:c r r I. } 1.} 4. Is used or designated to transport between 9 and 15 passengers,including the dryer, C for direct compensation(example:large van used for specific purpose):or O L L-_ __i_. --- urtwr aotmtLybaaa - t I. I. t 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires •u placarding(example:placards will be displayed on the vehicle). ,Zmt CARRIER NAME Z t 1 Ct _ __ ADDRESS J ` w — — — C) u*ni CITY/STATE/ZIP g 11 "mbh1indtAu° - MOTOR CARR.ID 0 Interstate 0 Intrastate 1 I r 1 I ❑ Not in Comm./Govt. Not in Comm./Other ❑ o --- --; i. : USDOT NO. ILCC NO. m __mot'Tb Scale_ i 73 Source of above z MCS ❑Yes 0 No 0 Unknown Out of Service ❑Yes ❑No 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 Gray Black 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