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HomeMy WebLinkAbout2025-00073867 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 Mil it ll 1111 Ifllfl ll III 1111011 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY XO04033005 u, 1 U21 2 4 1 U1 2 U2 1 U1 1 1_12 1 U, 1 U2 1 1 15 U1 1 U2 1 *P 0119* INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW ' DAMAGE TO ANY El$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) El Injury and/or Tow Due To Crash 0 AMENDED YR 202512025-00073867 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 rn W HIGHLAND AVE El In08:57 ® ❑ RELATED ®Y ❑N 11 16 2025 ®AM ❑YES ®NO U1 -< _ _ g PRIVATE mo !day/yr ❑PM FLOW CONDITION MFT!MI N E S W N LYLE AVE COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR 0 SLOW 1 (n ❑ Kane HIT&RUN ❑V ® N WITH VEHICLES INVLD ❑ STOPPED U2 --I ® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST IZI N ® FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EDUCE 0 NIAV 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 0 0 1 / yr Honda Accord 2016 © 13-UNDER CARRIAGE 10 2 FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 O 171 F 2 4 SY 15-OTHER ❑Y ®SNE❑UNK VEH. O AT CRASM IN H O 99-UNKNOWN 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 H F. PINGREE GROVE IL 60140-5411 0 1 0FIRST CONTACT 12 T ; _s *Irves.seesidabar Ut Z CCBNO1 IL 2025 ' E TELEPHONE IL D 0 1 HGCR2F8XGA245292 State Farm ®Y 0 N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Same p143238f2913m 1 r "o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER > Refused 0 Y ® N 2 XI Eg DRIVER 0 PARKED 0 DRIVERLESS ❑ FED 0 PEDAL 0 EWES 0 MAV 0 NOV ❑DV yr 10' 12 ( 2 FIRE ❑ ® U2 C 0 13-UNDER CARRIAGE M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9.16•TOP 3 X ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN •Distraction Value 9 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8- 1. 6 p,_4 COM VEH D ® U1• CO FIRST CONTACT 3 7�. _,�_s •If Yes.See Sidebar z ELGIN IL 60120 0 1 0 FH40363 IL 2026 RE 0 N IL D 0 1 G 1 YB3D46M5122231 Owners Auto ❑Y ®N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Same 52-0260059-00 BAC $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP 996 < Refused RESPONDER u1 = (UNIT) (SEAT) (DOB1 (SEX) {SAFT) (AIR) (INJ) (EJCTI (EPTH) PASSENGERS&WITNESS ONLY (NAME)((ADDRESS)/(TELEPHONE) (EMS) (HOSPITAL) U1 1 D / / 1 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 r 16 /2025 08 57 ®❑PM AM in a Work Zone? ®N DIRP D co 1 t PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME ❑AM If YES check one below: U1 3 n T 0 2 ❑ 2 99 1 / ❑PM ❑Construction R 3 ❑ ]yg CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 5 ❑AM ❑Maintenance U2 a 1 ® 11 1 ARREST NAME Cwiklinkski.Cheryl.A. 11-901-A w1531000195 r r El PM SLMT igi CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME 0 Utility o N AM 30 t 2 El ARREST NAME Cwiklinkski.Cheryl.A. 3-707 1531000196 r r ❑❑PM ❑Unknown work zone type U1 n T OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 ❑ - ❑AM Workers present? ❑Y 30 1531 SchE mbach.Jack sot , r ❑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 1. Has a weight rating more than 10,000 pounds(example:truck or truckrtrailer -< i- }-----I-----; (-47) combination):or NINDICATE NORTH p0 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C II (example:shuttle or charter bus):or N? ?Ave T, 3. Is designed to carry15 or fewer passengers and operated a contract carrier O } } } transporting employee in the course of their employment(example:employee f-Alot To Scale I transporter-usually a van type vehicle or passenger car):or w L L.___a__ 4. Is used ordesi natedtotrans rtbetween9and15 passengers,including C w!NIpIWrIG?Ave t F } for direct compensation(example:large van used for speific purpoe):or the driver. r -- -wet A — — - } t 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m placarding(example:placards will be displayed on the vehicle). ;p (1 111)ai i D CARRIER NAME —I Z ADDRESS 'n i. I O CITY/STATE/ZIP C) MOTOR CARR.ID ❑ Interstate ❑ Intrastate I I T I ❑ Not in Comm./Govt. 0 Not in Comm./Other ;_...Y. ._.; 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 Gold Black 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 2 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BYlT6 DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE