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HomeMy WebLinkAbout2025-00077497 ILLINOIS TRAFFIC CRASH REPORT sheet 1 of 2 Sheets II III H IIII UHI II II II lUll IIII IIII IIIIII DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X004068837 u, 1 U21 3 4 1 u1 2 U2 1 u, 1 u2 1 u, 1 U2 1 5 10 u1 3 U2 1 *P 0119 INVESTIGATING AGENCY DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW ' Elgin Police Department ONE PERSON'S ❑$501-$1.500 ®ON SCENE 14 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and for Tow Due To Crash El AMENDED YR 2025I 2025-00077497 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 r1 ® ❑ RELATED ®Y 0 N 12 04 2025 ❑AM ❑YES ®NO U1 -< S RANDALL RD Elgin06:15 _ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION m FTlMI N E S W COLLEGE GREEN DR COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 1 (n ❑ Kane HIT&RUN ❑V ® N WITH VEHICLES INVLD ❑ STOPPED U2 —I lgi AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N 51 FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EWES ❑uuv ❑!CV ❑Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 C) FOR DAMAGEDAREA(S) FROM Neumann. Richard.J. 0 7 yr 13-UNDER CARRIAGE 1 FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 0 m 10 M 2 SYTM IN ENGAGE15-OTHER 9 ❑Y ®SNE❑UNK VEH. 0 ATCRASHD 0 99-UNKNOWN 9 76•TOP 3 `Distraction Value ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8,_i L a �i 4 COM VEH El Ea 1 0 F. FIRST CONTACT 1 7 ;—_;__5 *Irves.See Sidebar U1 Z Gilberts IL 60136 0 1 0 Z772954 IL 2027 "E TELEPHONE IL D 0 1 FAHP2KT5EG174135 American Family ❑Y IlN U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 Same 410964262589 1 I— t HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER en Refused 0 Y ® N 2 0 p; DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEOAL 0 EWES ❑ uv 0 K V ❑Dv /1 9 8 1 Honda Pilot 2014 00-NONE O z -_, DUE TO CRASH ❑ 2 0 13-UNDER CARRIAGE 9 I ©Ic 2 FIRE 0 ® U2 C c F 2 9 SYSTEM IN 0 ENGAGED 0 15-OTHER 9.16-TOP 3 X ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN *Oistracl n Value 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8-iI�1:, 4 COM VEH ❑ ® U1 W FIRST CONTACT 11 7 _5 •If Yes.See Sidebar 4 ELGIN IL 60123 C 1 0 BD12581 IL 2026 I 0 C IL D 0 5FNYF4H55EB023999 Statefarm ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Elgin Fire 99 9 Same 0715313-SFP-13 BAG 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) 1 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z N 1 ® 11 4 12,04 ,2025 06 15 ®AM in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 6 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 v 2 0 2 20 12,04 ,2025 06 26 ®PM ❑Construction * R O 0 ]$I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 3 3 ❑AM ❑Maintenance U2 ou 1 ® 11 4 ARREST NAME Neumann. Richard.J. 11-901-A 1560000208 12,04 i2025 06 30 ®pM SLMT o N 0 CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • El Utility 0 AM t 2 ElARREST NAME 12 r 04 ,2025 06 58 ®PM ElUnknown work zone type U1 35 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 35 1560-Jones. Bennett 801 01 ,06/2026 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 ----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 -< °''AY OV°A0' r INDICATE NORTH combination):or -I J l r i 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 ea.v.w...�nor. . 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier O } } } transporting employees In the course of their empbyment(example:employee C transporter-usually a van type vehicle or passenger car):or CO L }-----}----; - I. I I 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 ill L L____a____. �11 �'�1 t 5 Isanyvehcleusedtotransporthazardous material(HAZMAT)that requires _Jany 1 placarding(example:placards will be displayed on the vehicle). XI ♦ • CARRIER NAME Z un ax I I I A ADDRESS D to N CITY/STATE/ZIP g I Not To Scale _ i. i. i. MOTOR CARR.ID ❑ Interstate El i. Intrastate 0 1 I r 1 ❑ Not in Comm./Govt. 0 Not in Comm./Other --- -'4 - USDOT NO. ILCC NO. m XI Source of above z . own tank)? 0 Yes 0 No 0 Unknown Did HAZMAT Regulations violation contribute to the crash? r ❑ Yes 0 No 0 Unknown g D Did Carrier Safety Regulations MCS)violation contribute to the crash? A ❑ Yes II El Unknown C 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 Z TRAILER 2 ❑ 0 0 o u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w White 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 DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® DISABLING DAMAGE Redmons/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE