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HomeMy WebLinkAbout2025-00072639 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets II III HH II11II UHI U� I� II IUI HHI1D 10010000 DRAG TRFD TRFC WEAT DRVA VIS VEHD LGHT COLL MANY X�024616 u, 1 U21 3 4 3 U1 4 U2 1 U, 2 1_12 1 U, 1 U2 1 5 11 u1 1 U211 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY ❑$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 3 VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash El AMENDED YR 2025I 2025-00072639 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIPINTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 m N RANDALL RD Elgin 10:14 0 0 RELATED ®Y ❑N 11 09 2025 ❑AM ❑YES ®NO U1 -< _ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION MFT!MI N E S W ALFT LN COUNTY PROPERTY ❑Y ® N DOORING Ely #OF MOTOR 0 SLOW 15 u) ❑ Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD 0 STOPPED U2 --I ® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N 51 FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EOUES ❑NW ❑Icy ❑Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 n 0 8 / yr 13-UNDER CARRIAGE ©I O; FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 1U O THERDISTRACTED 0 0 U2 2 M M 2 5 SYTM❑Y ®SNE❑UNK VEH. O AT CRASH 0 15-99-UUNKNOWN 9 16•TOP 3 `Distraction Value ALGN X. r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s, ii_6 I,.4 COM VEH ElEi 1 0 F. FIRST CONTACT 12 7 ;—, _5 *Irves.See Sidebar U1 Z Chicago IL 60659 C 1 0 FH43839 IL 2026 REAR TELEPHONE IL D 7M UCAABG 1 SV134466 State Farm ❑Y ®N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER RSUR m Elgin Fire Calco Pallets 3356587sfp13 3 r o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER RESPONDER 2 eu Eg DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EWES ❑NMv 0 Ncv ❑DV !1 9 9 6 Nissan Rogue 2017 00-NONE a i Q!'-O DUE TO CRASH rg D 2 x o 13-UNDER CARRIAGE 16 I f: 2 FIRE ❑ ® U2 C c M 2 4 SYSTEM IN ENGAGED 15-OTHER 9.16•TOP 3 0 X ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN •Oistraglon Value N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF oa©-',O COM VEH ❑ ® tit CO FIRST CONTACT 6 7 __Li. 5 •If Yes,See Sidebar — Rockford IL 61108 0 1 0 AE77218 IL 2025 i&-AR 0 C Z IL D JN8AT2MV2HW252892 State Farm ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Dehoyos.Jose. I. 0434092sfp13 BAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP U1 = (UNIT) (SEAT) (D081 (SEX) {SAFT) (AIR) (WI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)!(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL) 3 3 07 / U1 1 D / / 1 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 El 11 4 11 ,91 ,025 10 14 ®AM in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 5 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 O 2 0 11 28 11,9/ ,025 10 18 ®PM ❑Construction F <ov 3 0 El CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 5 z J ❑AM ❑Maintenance U2 - ® • 0Utility a, ARREST NAME Riyazuddin. Mohammed 11-601 1545-443 1 1,9/ /025 10 24 Igi PM oSLMT U 1 11 4 Iffi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. ROAD CLEARANCE TIME AM Ti 2 0 11 4 ARREST NAME Riyazuddin. Mohammed 11-1427-H- 1545-442 1 1,9/ ,025 10 57 ®PM 0 Unknown work zone type U1 45 2 2 3 IDOFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 45 1545-VanEycke. Brier 901 331-Ziegler 12 ,23,2025 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 ADDITIONAL UNITS FORMS. r e---•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 -< c ` --I -' r INDICATE NORTH combination):or .Z-1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C _ } (example:shuttle or charter bus):or X guar To arils. .1 I I 3. Is designed to carry15 or fewer passengers and operated a contract carrier 0 I- }-----I----. l I Li I I - } } . transportingemployees in the course of their employment JJJ �J \\\ g pbyntent(example:employee transporter-usually a van type vehicle or passenger car):or w L L.___a__ - - - 1 4. Is used ordesi natedtotrans rtbetween9and 15 passengers,including C. . . for direct compensation(example:large van used for specificpurpose):or [he driver, Pe ( P 9 Pe or L t 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires . placarding(example:placards will be displayed on the vehiclele).). m 0 CARRIER NAME Z ADDRESS 0 i I I '�" I I- i. i. i. i. 4. CITY/STATE/ZIP 0 MOTOR CARR.ID 0 Interstate 0 Intrastate I . ❑ Not in Comm./Govt. 0 Not in Comm./Other ‘I. -- - - USDOT NO. ILCC NO. m XI Source of above z . Form Number m Xl IDOT PERMIT NO. WIDELOAD'; ❑Yes 0 No 2 TRAILER VIN 1 m co LOCAL USE ONLY TRAILER VIN 2 m a 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 Red 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: 2 TOWED BY/TO: DUE TO ® DISABLING DAMAGE Redmons/Owners Residence VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE