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HomeMy WebLinkAbout2025-00081997 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 10110 ll 1111 100 10011 Dl III00 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X08/35/ u, 1 U21 1 1 3 U1 8 U2 1 U1 1 U2 1 U1 1 U2 1 4 12 U, 13 U2 1 *P 0119 INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW ' DAMAGE TO ANY 0 5500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away Elgin Police Department ONE PERSON'S ❑$501-$1.500 ®ON SCENE 1 VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash El AMENDED YR 2025I 2025-00081997 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 rn ® ❑ RELATED ®Y 0 N 12 30 2025 DAM ❑YES ®NO U1 -< N LIBERTY ST Elgin07:18 _ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION m FT/MI N E S W COOPER AVE COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 15 ❑ Cook HIT&RUN ❑V ® N WITH VEHICLESOT, INVLD ❑ STOPPED U2 --I Igi AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N 51 FREE FLOW # LNS 0 Qg3 DRIVER O PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EDUCE 0 uuv 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 n 0 3 / yr 13-UNDER CARRIAGE ©i 4!- FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) O 2 DISTRACTED 0 ]$I U2 2 m F 2 SYTM IN ENGAGETHER 4 ❑Y ®SNE❑UNK VEH. O AT CRASH O 99-U15-UNKNOWN 016-TOP 3 ,Distraction Value 9 ALGN = V. CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6 iI 6 4 COM VEH 0 0 1 F. Hoffman Estates IL 60169 B 1 0 FIRST CONTACT 10 7_;1ksmi _-5 *II Yes.See Sidebar U1 0 Z EQ81168 IL 2026 TELEPHONE IL D 5YFB4MDE9PP024730 State Farm ❑Y Il N U2 19 , m B EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR co Elgin Fire 99 9 Same 1779132-SFP-13 3 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER XI St.Alexius Medical Center ❑Y ® N 2 0 g DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NMV 0 KCV 0 Dv yr Q 2 -1 o 13-UNDERCARRIAGE 10;j ©�( 2 FIRE ❑ ® U2 C c M 2 8 SYSTEM IN 9 ENGAGED 9 15-OTHER 9©TQP®* 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 6 ),I 6 i�!, 4 COM VEH ❑ ® U1 CO F,,, FIRST CONTACT 1 O 7 :.{ _:5 •(ryes,See Sidebar ELGIN IL 60120 0 1 0 CR78964 IL 2026 I 0 C IL D 2CN FLEECXB6464467 Kemper ❑Y ®N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Elgin Fire 99 9 Same 12RA000086243 BAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP 996 < Refused RESPONDER U1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJI (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 City of Elgin Cooper Ave sign 12,30 /2025 07 18 ®AM in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 1 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 C) 2 0 150 DEXTER CT ELGIN IL 60120 20 06 12,30 ,2025 07 18 PM , ® , 0 Construction >E R 3 ❑ ❑CITATIONS ISSUED (g!PENDING SECTION CITATION NO. EMS ARRIVED TIME 1 z J ❑AM ❑Maintenance U2 o1 0 11 1 ARREST NAME Vega.Viviana 11-708 SO475-000691 12,30/2025 07 22 Igi pM SLMT o N ❑CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ' El Utility 0 AM r 2 ® 20 2 ARREST NAME 12/30 /2025 07 26 ®PM ❑Unknown work zone type U1 35 - 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 35 475-Williarhs. Brianna 201 02 , 10,2025 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 r r----T-•--, , A ; A CMV is defined as any motor vehicle used to transport passengers or property and: Z i- i•-- --I-- --1 i L Non): more than pounds(example:truck or truck trailercombinat or -< 1. Has a weight rating10,000 INDICATE NORTH p1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C - } r r r (example:shuttle or charter bus):or X 0 -'I Cooper?Ave 3. Is designed to15 or fewer carry passengers and operated by a contract carrier 1 g } } } transporting employees in the course of their employment(example:employee 73 transporter-usually a van type vehicle or passenger car):or w L , .. 4. Is used or designated to transport between 9 and 15 passengers,including y-- -- - } } } g po passen rs,includi the driver, for direct compensation(example:large van used for specific purpose):or O L L____a____. i i 5. Is any vehicle used to transport anyhazardous material(HAZMAT)thatrequires rn placarding(example:placards will be displayed on the vehicle). XI �O`• I i "' CARRIER NAME Z Unk.2l - ADDRESS D w CITY/STATE/ZIP n 0 Not To Scale 1 N?U I rtyttlt MOTOR CARR.ID 0 Interstate 0 Intrastate I I I ❑ Not in Comm./Govt. 0 Not in Comm./Other I I -_-4 , USDOT NO. ILCC NO. < 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'; ❑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' m TRAILER 1 ❑ ❑ 0 Z TRAILER 2 ❑ 0 0 O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. Z Black Gray 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 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 3 TOWED BY/T6 DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE