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HomeMy WebLinkAbout2025-00073176 ILLINOIS TRAFFIC CRASH REPORT sheet 1 Of 4 Sheets 01111101111 I0110 1111 101 IIII IIIIIII IIIIII DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X�028t 64 u, 1 U21 1 1 1 U116 U2 1 U, 1 u2 1 U, 1 u2 1 3 11 U1 1 u2 1 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY ❑5500 OR LESS TYPE OF REPORT 0 A No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 2 VEHICLE/PROPERTY ®OVER 51,500 El NOT ON SCENE(DESK REPORT) ® B Injury and for Tow Due To Crash El AMENDED YR 2025I 2025-00073176 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 r1 BIG TIMBER RD El In 05:37 ® ❑ RELATED ❑Y ®N 11 12 2025 ❑AM ❑YES ®NO U1 -< g PRIVATE mo !day!yr ®PM FLOW CONDITION m 0 !MI N E S ti Morningside Dr COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 1 (n g Kane HIT&RUN ❑Y ® N WITH VEHICLESOT, INVLD ❑ STOPPED U2 —I 0 AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 (i DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EWES ❑uuv ❑!CV ❑Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 n f'rr TOWED U1 0NAME(LAST,FIRST,M) g mo yr Hodges.Connor.J. Hyundai Sonata 2016 00-NONE , s , DUE TO CRASH ® ❑ 13-UNDER CARRIAGE ©,I :: FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ❑ Ea U2 4 rn M 2 5 ❑Y ®Nn is-OTHER SYSTEM❑UNK VEH. ATCRASHD 99-UNKNOWN 9 16•TOP 3 `Distraction Value 9 ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF & it S �i COM VEH 0 Ea 1 0 " �- SOUTH ELGIN IL 60177 0 1 0 FIRST CONTACT 11 T_;1 __s *IIYes.See Sidebar U1 ZFG41936 IL 2026 E TELEPHONE IL D 0 5NPE34AF2GH430701 State Farm ®Y ❑N U2 m 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Same 3628859-SFP-13 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF IC OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER !1 9 8 8 Honda Accord 2005 00-NONE O 2'--O DUE TO CRASH rg ❑ 2 x o 13-UNDER CARRIAGE I ©I„ 2 FIRE 0 ® U2 C c F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9.16-TOP®* X ❑Y i N ❑UNK VEH. AT CRASH 99-UNKNOWN Oistraetlon Value 9 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8 .i S ...(9 C.OM VEH 0 ® U1 W FIRST CONTACT 6 O,�_Q)OS •byes.See Sidebar C ELGIN IL 60123 A 1 0 EP80651 IL 2026aR Si)0 Z IL D 1 HGCM66865A051989 Country Financial ❑Y ®N RDEF M EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER 1 = Elgin Fire Same P010483786 BAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Sherman RESPONDER U1 = (UNIT) (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 ❑Y U2 Z N 1 ® 11 1 DNR Deer 11 ,12 ,2025 05 37 ®AM in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 7 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 C) 2 0 1 NATURAL RESOURCE WAYSpringfieldl 62702 28 99 11,12 ,2025 05 37 PM ® • ❑Construction * R 0 ❑CITATIONS ISSUED �[PENDING SECTION CITATION NO. EMS ARRIVED TIME 7 3 ❑AM ❑Maintenance U2 a0 11 1 ARREST NAME Hodges.Connor.J. 11-601-Ax 1549-000242 1 1,12 l2025 05 37 Igi pM SLMT o N 0 CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • ❑Utility 0 AM ' 2 El11 1 ARREST NAME 11 r 12 ,2025 06 45 ®PM ElUnknown work zone type U1 45 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑y 45 1549-Brown. Bryan 501 269-Mendiola 12 ,09,2025 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. . 0 ..-1-- .. , I I A CMV is defined as any motor vehicle used to transport passengers or property and: Z r r , W than pound (example:truck or truckrtratler -< 1. Has a weight rating more10 000 5 i- ;__-_r-_--; =N* y ( INDICATE NORTH combination):or P3 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C r r (example:shuttle or charter bus):or 0 U�!!a 3. Is designed to carry15 or fewer passengers and operated a contract carrier O i_ }---_J.• -•� U" ' o transporting employees In the course of their employment(example:employee p• transporterpo -usually a van type vehicle or passenger car): r C L L.___a____.I. s } 4. Is used or designated to transport between 9 and 15 passengers,including the driver,{� r � - -'r; z - t } } for direct compensation(example::large van used for specific purpose):or 0 L L____a____� ale2,4Z I l. I 1 t 5. Is any vehicle used to transport anyhazardous material(HAZMAT)thatrequires m ,, L ,. placarding(example:placards will be displayed on the vehicle). ... © I ��� ... ..... _I CARRIER NAME Z Not To Scale I ADDRESS O ef I . . . . . ... rn CITY/STATE/ZIPg 'torntnpslde?DdwY(200?Fll - MOTOR CARR.ID 0 Interstate 0 Intrastate I I T I I I l ❑ Not in Comm./Govt. ❑ Not in Comm./Other 0 Y USDOT NO. ILCC NO. C m XI Source of above z . 0 Yes II No ❑ Unknown A 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 0 0 Z TRAILER 2 ❑ 0 0 O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w Red Blue 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 DISABLING DAMAGE DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® Redmons/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE