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HomeMy WebLinkAbout2025-00071692 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 10110 11 II fl Ill fl 101111111 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X00401604.7' u, 1 U21 1 1 1 U1 4 U2 1 U, 1 1_12 1 U, 1 U2 1 1 11 U1 1 U2 1 *P 0 1 1 9* INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW ' DAMAGE TO ANY ❑$500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 1 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) 0 B Injury and f or Tow Due To Crash 0 AMENDED YR 202512025-00071692 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n CORRON RD Elgin ® ❑ RELATED ❑Y ®N 11 04 2025 El AM El YES ®NO U1 —< PRIVATE mo /day/yr 09"29 ID PM FLOW CONDITION m ®70co!MI N E O W McDonald Rd COUNTY PROPERTY ❑Y 21 N DOORING Ely #OF MOTOR 0 SLOW 2 Cl) Kane HIT&RUN ❑V ® N WITH VEHICLES INVLD 0 STOPPED U2 —I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS O 18:DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uuv 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 1 n 0 1 / yr Q Gonyea. Maxwell.J. Chevrolet Impala 2005 00-NONE �3-UNDER CARRIAGE 11' 0 DUE TOCRASH ® ❑ 16 O Z FIRE 0IE 1 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 ]$I U2 r<r1 M 2 4 ❑Y ®SNEM❑UNK VEH. 0 AT CRASH IN ENGAGE0 99-UUNKNOWN 9 16-TOPO ,Distraction Value 9 ALGN = r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF $ ;iI 6 jl COM VEH 0 j$J 1 0 ~ St Charles I L 60175 0 1 0 FIRST CONTACT 1 7 . -_5 *II Yes.See Sidebar Ut Z FR51381 IL 2025 E TELEPHONE IL D 0 2G 1 WH52K259315676 State Farm ❑Y ®N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Same 0592237-sfp-13 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y ® N 2 0 x DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 r uv 0 txv 0 DV CIRCLE NUMBER(S) U1 1 9 6 0 Dodge Ram 1500(pickup) 2023 00-NONE 11 12 _1 DUE TO CRASH rg ❑ 2 x Ti ©-UNDER CARRIAGE FIRE El El U2 M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 016-TOP 3 X ❑Y EQ N ❑UNK VEH. AT CRASH 99-UNKNOWN *Oistracton Value 9 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 241�,.4 COM VEH 0 ® Ut to FIRST CONTACT 7 l:!__ _s •IfYes.SeeSidebar C ST Charles IL 60175 0 1 0 3646860B IL 2026 REAR 0 Si) Z D IL D 0 1 C6SRFRT6PN636439 Acuity ❑Y ®N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Same VK6917 BAc $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPONDER U1 = KNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME),(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL) DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 11 1 Fend. Kelly Wood fence 11 ,41 ,025 09 29 ®❑PM 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 C) o" 2 ❑ 28 28 , , ❑PM, ❑Construction * 1 R 3 0 $I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 1 ❑AM 0 Maintenance U2 o1 ® 11 1 ARREST NAME Gonyea. Maxwell.J. 11-601 1531000191 / ! El PM SLMT o N ❑CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ❑Utility 50 t 2 0 ARREST NAME AM T 1 r ❑❑PM 0 Unknown work zone type U1 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑AM Workers present? ❑Y 50 1531-SchEmbach.Jack 801 12 , 91 ,025 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••--, , ; A CMV is defined as any motor vehicle used to transport passengers or property and: Z r 1 S ight rating more than 10 000 pounds(example:truck or truckrtrailer -< - }-_- -----; ice{ combination):or i�t I INDICATE NORTH BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C ..r - } (example:shuttle or charter bus):or 4 , 3. Is d ned t carry 15 or fewer passengers and operated a contract carrieror I O L ------I-----: I iv - } } } transportingemployees In the course of employment 5 type their car):((example:employee w U transporter-usuallya van vehicle or L L.___a____.l I - I. } 4. Is used ordesi natedtotrans rtbetween9and15passengers,includingthedriver, } for direct compensation(example:large van used for speific purose):or 0 L____a____. l. L I L 5. Is any vehicle used to transport anyhazardous material(HAZMAT)thatrequires •p m I placarding(example:placards will be displayed on the vehicle). ;p I. D rl ff' CARRIER NAME ADDRESS 0* D t% (ft �, . CITY/STATE/ZIP g MOTOR CARR.ID El Interstate El Intrastate 5 ' Not To Scale j 0 I I ❑ Not in Comm./Govt. 0 Not in Comm./Other 0 -----------1 - USDOT NO. ILCC NO. C m XI Source of above z . ❑ Yes 0 No 0 Unknown g D Did Carrier Safety Regulations MCS)violation contribute to the crash? A ❑ Yes No ❑ 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'; 0 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' m TRAILER 1 ❑ ❑ 0 Z TRAILER 2 ❑ 0 0 o u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. Z Gold Silver u 1 TOWED • TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT 3 TOWED BY/TO. Redmons/Impound Lot Garage . SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® DISABLING DAMAGE Chads/unknown VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE