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HomeMy WebLinkAbout2025-00072458 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 I0110 1111 10111 10 11100 DRAG TRFD TRFC WEAT DRVA VIS VEHD LGHT COLL MANY X004024649 u, 1 U21 3 4 2 U116 U2 1 U, 1 u2 1 U, 1 U2 1 5 11 U1 1 U211 *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 El$501-$1.500 ®ON SCENE 3 VEHICLE/PROPERTY ®OVER 01,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash 0 AMENDED YR 2O25I 2025-00072458 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 r1 BOWES RD El In06:22 ® ❑ RELATED ®Y 0 N 11 08 2025 ❑AM ❑YES ®NO U1 -< g PRIVATE mo /day/yr ®PM FLOW CONDITION ITl •FT!MI N E S W S RANDALL RD COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ID SLOW 1 (/)❑ Kane HIT&RUN ❑V ® N WITH VEHICLES INVLD ® STOPPED U2 —I lgi AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ❑ FREE FLOW # LNS 0 Qg3 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 5 n NT FOR DAMAGEDAREA(S) FRO TOWED U1 Q NAME(LAST,FIRST,M) Kepes. Matthew.J. 9 7 / yr 13-UNDER CARRIAGE © Q10 2 FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 5 M M 2 5 ❑Y ®SY M IN ENGAGE N SE DUNK VEH. 0 AT CRASH 0 199-UUNKNOWN 9 16-TOP 3 ,Distraction Value 9 ALGN = r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s, it 6 4 COM VEH 0 Ea 1 0 F. FIRST CONTACT 12 7_:, , _5 *II Yes.See Sidebar U1 Z SOUTH ELGIN IL 60177 0 1 0 DK75620 IL 2026 REAR TELEPHONE IL D 0 5XYP3DHC8NG280344 State Farm ❑ IlN Y U2 1- 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m co Same 2327850-SFP-13 2 r o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y ® N 2 XI Eg DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED 0 PEOAL ❑EWES 0 iiuv 0 i v 0 Dv 1 9$3 Ford Flex 2016 00-NONE 11_"j t2 -_, DUE TO CRASH ❑ 2 0 13-UNDER CARRIAGE 10'( 2 FIRE ❑ EI u2 C F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9,16-TOP 3 X ❑Y i N DUNK VEH. AT CRASH 99-UNKNOWN *Oistractlon value 9 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 5 1 6 l:; COM VEH 0 ® Ut CO FIRST CONTACT 7 v.,�==Qom..-5 •ItYes,SeeSidebar SOUTH ELGIN IL 60177 0 1 0 48602US IL 2026 I AR 0 Z M IL D 0 2FM H K6DT8G BA00286 State Farm ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER 1 = Same 0526499-SFP-13 BAC $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPONDER U1 = (UNIT) (SEAT) (DOBi (SEX) {SAFT) (AIR) (INJI 1(EJCT( (EPTH) PASSENGERS&WITNESS ONLY (NAME),(A.DDRESS)/(TELEPHONE) (EMS) (HOSPITAL) 1 6 01 / t / / 3 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z N 1 ® 11 1 11 ,81 r025 06 22 ®AM in a Work Zone? ®N DIRP co 1 t PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 5 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 C) v 2 0 28 17 11,81 ,025 O6 22 ®PM ❑Construction R 3 0 igi CITATIONS ISSUED ElPENDING SECTION CITATION NO. EMS ARRIVED TIME 5 z J ❑AM ❑Maintenance U2 o ® 11 1 ARREST NAME Kepes. Matthew.J. 11-601 1549000238 1 1,81 r025 06 30 0 pM SLMT o N 0 CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ' El Utility t 2 0 ARREST NAME 1 1 i 81 ,025 07 04 ®PM ❑Unknown work zone type U1 0 AM 50 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? D Y 50 1549-Brown. Bryan 801 12 , 91 ,025 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 I N ADDITIONAL UNITS FORMS. r -- r••--, , 1 ; A CMV is defined as any motor vehicle used to transport passengers or property and: z v 1 11 ti ti I Not To Soots I ; 1. Has a weight rating more than 10,000 pounds(example:truck or truckrtrailer -< ` ` ' ' J r INDICATE NORTH combination):or A t BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C i - (example:shuttle or charter bus):or 0 j 3. Is designed to carry15 or fewer passengers and operated a contract carrier 0 I- I-- -A----i < - }} } transporting employee � �In the course of their employment(example:employee P3 transporter-usually a van type vehicle or passenger car):or P L L.___a____.l t 4. Is used ordesi natedtotrans rtbetween9and15passengers,induding[hedriver, C r I I. } } for direct compensation(examp large van used for speific purose):or 0 L L____a____. =�, t A 1 Boma } } t 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m 51- placarding(example:placards will be displayed on the vehicle).iRood j;i' • • • CARRIER NAME - , ADDRESS 0 ( CITY/STATE/ZIP 0 0 MOTOR CARR.ID 0 Interstate El Intrastate 5 r ; I ❑ Not in Comm./Govt. 0 Not in Comm./Other 00 ‘I. - --4. I USDOT NO. ILCC NO. C 73 Source of above z . If Yes,Name on placard O 4 digit UN NO. 1 digit Hazard class No. Xl 71 m Did HAZMAT spill from vehicle(do NOT consider FUEL from vehicle's Z own tank)? 0 Yes 0 No 0 Unknown D Did HAZMAT Regulations violation contribute to the crash? r ❑ Yes 0 No 0 Unknown M Did Carrier Safety Regulations I/ICS)violation contribute to the crash?❑ Yes IQNo El Unknown Unknown 0 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' T TRAILER 1 0 0 0 Z 4 TRAILER 2 ❑ 0 0 O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w White Red u 1 TOWED • TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ti 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 DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/TO: DUE TO ® Redmons/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE