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HomeMy WebLinkAbout2025-00079742 ILLINOIS TRAFFIC CRASH REPORT sheet 1 Df 2 Sheets 01111101111 IIIIII II 1111 III 1110 I fl III 1111 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X004071060 u, 1 U21 1 1 1 u, 1 U299 u, 1 u2 1 u, 1 U2 1 2 10 u1 1 u2 3 .P0119* INVESTIGATING AGENCY DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT ® q 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$1,500 ❑NOT ON SCENE(DESK REPORT) 0 AMENDED ❑ B Injury and/or Tow Due To Crash YR 202512025-00079742 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n BIG TIMBER RD El In03:49 ® ❑ RELATED ®Y 0 N 12 16 2025 ❑AM ❑YES El NO U1 -< g PRIVATE mo !day/yr ®PM FLOW CONDITION m FT N E S W JANSEN FARM DR COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR 0 SLOW 1 (n ❑ Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD 0 STOPPED U2 —I ® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EDUCE 0 uuv 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 8 0 4 ! yr 13-UNDER CARRIAGE ©,I :: FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 4 rn M 2 SY4 ❑Y IN ❑UNK VEH. O AT CRASH M IN D 0 99-UNKNOWN 9 16•TOP 3 *Distraction Value ALGN = r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF T. it S �i COM VEH 0 0 1 0 F. FIRST CONTACT 6 7 ;—--_;__5 *elves.See Sidebar U1 Z GILBERTS IL 60136 0 1 0 BV41850 IL 2026 is TELEPHONE IL D 0 3VWPZ7AJ9BM632965 State Farm ❑v Igl N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 Same 3662897-SFP-13 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER 73 > Refused ❑Y ElN 2 0 x DRIVER ❑ PARKED 0 DRIVERLESS ❑ PED ❑PEDAL 0 EWES ❑row 0 NCv ❑Dv !2 0 0 4 Infiniti G37X 2021 00-NONE 'o,1 t2 c,�2 FIRE DUE O CRASH 0 ® U2 2 C ... — 13-UNDER CARRIAGE c F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9..16-TOP 3 X ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN *Oistraelion Value 0 POINT OF S iITN4 COM VEH ❑ ® U1 W N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR I— FIRST CONTACT 6 O7 ,�= 05 •If Yes,See Sidebar C Batavia IL 60510 0 1 0 5981945 IL 2026aR0 fp Z IL D 0 J N 1 CV6APOCM622370 Auto Club Insurance ❑Y ®N RDEF 7) EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = 99 9 Same AUT700846020 BAc $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPONDER u1 = (UNIT) (SEAT) (DOS) (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 0 Y U2 Z N 1 CD 11 1 12,16 l2025 03 49 ®pm in a Work Zone? ®N DIRP co 1 t PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 7 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 � 0 2 28 99 ( ( ❑PM• ❑Construction * Z 3 0 I!!I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 6 ❑AM Maintenance U2 ❑ o1 ® 11 1 ARREST NAME Hopfner. Ryan. M. 11-601-Ax S1527-000381 ( ! El PM SLMT o N ❑CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • ❑Utility r 2 ❑ ARREST NAMEAM x- 7 ( / ❑❑PM ❑Unknown work zone type 45 U1 n OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 0 ❑AM Workers present? ❑Y 40 1527-Juarez.Jorge 502 302-Snow 1 ( ❑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----r----, , MI_ ® : 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 -< ` ` --I -' .f� r INDICATE NORTH combination):or —I '°'^iO"JiI BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C F7 - ; err (example:shuttle or charter bus):or 0 1 r G'ACND 3. Is desgned to carry15 or fewer passengers and operated I a contract carrier O I- I- -------i b - }} } transporting employee � �In the course of their employment(example:employee X C:› transporter-usually a van type vehicle or passenger car):or CO C L L.__-a__ w . 4. Is used or designated to transport between 9 and 15 passengers,including the driver, 1 �T m�. } } } for direct compensation(example:large van used for specific purpose):or L ..i.. . E - i. . < �_ 5. Is any vehicle used to transport anyhazardous material(HAZMAT)that requires -u 1 1 1 1 placarding(example:placards will be displayed on the vehicle). XI —1 CARRIER NAME Z ADDRESS 0 Nod To 8ceb I , • , • (D/) 1 CITY/STATE/ZIPg ' Q - i. i. i. i. 4. MOTOR CARR.ID 0 Interstate El Intrastate 0 1 I r 1 ❑ Not in Comm./Govt. 0 Not in Comm./Other -"-------1 - USDOT NO. ILCC NO. m XI Source of above z . 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'; 0 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 Black Black u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT' 2 TOWED BY/TO: _ SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/TO. DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE