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HomeMy WebLinkAbout2025-00073711 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 01111101111 I0110 II II Ifllfl Ill fl 01100 DRAG TRFD TRFC WEAT DRVA VIS VEHD LGHT COLL MANY X004033016 u, 1 U2 1 1 1 U116 u2 u, 1 u2 U, 1 u2 1 6 u, 1 U2 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT El A No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 2 VEHICLE/PROPERTY ®OVER 51,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash El AMENDED YR 202512025-00073711 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 �I N MCLEAN BLVD El In12:37 ® ❑ RELATED ❑Y ®N 11 15 2025 12,— ❑YES ®NO U1 -< g PRIVATE mo !day/yr ®PM FLOW CONDITION ITl 2`FT/vt N E S tN BigTimber Rd COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW (n ® O Kane HIT&RUN ❑Y ® N WITH VEHICLESOT, INVLD ❑ STOPPED U2 --I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uuv 0 Ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 0 FOR DAMAGEDAREA(S) FROM TOWED U1 0 Talley, Khan.T. 0 8 / yr 13-UNDER CARRIAGE © NI ,I O, 0 FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) O DISTRACTED ❑ ]$I U2 (T1 M 2 8 SYTM❑Y ®SNE❑UNK VEH. 0 ATCRASHD 99-UUNKNOWN THER9 t6•TDP 3 `Distraction Value 9 ALGN = r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6.;il Ii 4 COM VEH ❑ Ea 1 0 I- 60110 0 1 0 FIRST CONTACT 1 7 ;- -_5 *Irves.SeeSidebar U1 Z DY32759 IL 2026 E TELEPHONE IL D 0 2GNALBEK5H1524866 American Alliance ❑Y ®N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Elgin Fire 99 9 Talley,Ashley,S. I LAA-0995797-01 1 r o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER RESPONDER 2 ou 0 DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 Nuy 0 KCv 0 DV yr ,2 - C o 13-UNDER CARRIAGE 10 I c. 2 FIRE ❑ ❑ U2 C c SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED a SYSTEM IN ENGAGED 15-OTHER 9,16-TOP3 ❑ 0 SPDR 0 ❑Y ❑N ❑UNK VEH. AT CRASH 99-UNKNOWN *Distraction value U1 4 - POINT OF s-.;, 4 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR FIRSTO CONTACT Y 6 I,_ CIO Ms See SidebarEH 0 C CO F` REAR` co M . STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 O ❑Y ❑N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = BAC HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < RESP❑YD❑N NDER U1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)!(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL) 0 1 3 05 / F 2 8 0 1 0 m / / #OCCS > / / UI 2 D / / 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z N 1 0 36 3 City of Elgin Fire Hydrant 11 ,15 /2025 12 37 ®PM 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 2 ® 43 3 150 DEXTER CT ELGIN IL 60120 28 17 11,15 /2025 12 45 PM ® • ❑Construction >F N 3 IN 36 2 $I CITATIONS ISSUED ❑PENDING SECTION CITATION NO. EMS ARRIVED TIME ❑AM 0 Maintenance U2 -a, ARREST NAME Talley, Khan,T. 11-601 S1542-000560 11,15/2025 12 49 El pm SLMT o U 1 0 0 CITATIONS ISSUED PENDING Utility o N SECTION CITATION NO. ROAD CLEARANCE TIME Ely t 2 El ARREST NAME 11/15 /2025 12 37 ®PM El Unknown work zone type U1 El AM 30 n 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 1542 Chafe. Ethan 501 12 , 16,2025 09 00 ❑PM ID 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 ISt.!NVOLVED,USE SR 1050A _ ADDITIONAL UNITS FORMS. r ----r••--, , — _ l A CMV is defined as any motor vehicle used transport passengers or property and. D ■ Z -< ■ 01. Hasa weight rating more than 10,000 pounds(example:truck or truck/trailer } I. o�Mne aeetVI ■ combination):or}____r__-_, ..�a a Not To Sado r y ■ f INDICATE NORTH p3 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C is } r (example:shuttle or charter bus):or 0 I I ° ■ 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I O • } } } transporting employees in the course of their employment(example:employee X ■ transporter-usually a van type vehicle or passenger car):or CDC -- l\el ''+ ■ } 1. •4. Is used or designated to transport between 9 and 15 passengers,including the driver. N= \ _ for direct compensation(example:large van used for specific purpose):or O kfaffrow V MI 1:1 L L____a____. ` \ I. _ l. i i. t 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires • placarding(example:placards will be displayed on the vehicle). m A MI CARRIER NAME Z \ 1r ADDRESS D ' o a 'l n CITY/STATE/ZIP g MOTOR CARR.ID 0 Interstate 0 Intrastate I I . I ^--,- ❑ Not in Comm./Govt. 0 Not in Comm./Other I I I I ilik_ _ i- ILCC C l_ USDOT NO. NO. m XI Source of above z ' . MCS 0 Yes 0 No 0 Unknown Out of Service 0 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_COLOR TRAILER LENGTH(S)1 ft. 2 ft. w White u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT 3 TOWED BY/TO. _Adieu/Impound Lot Garage SELECT CODES FROM THE BACK OF CRASH BOOKLET U_DUE ETOO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: TOWED BY/TO DUE T VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE