HomeMy WebLinkAbout2025-00082234 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 Df 2 Sheets 1111 III 11 III1II IIIIII U
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INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW '
DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away
Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 14
VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) (83B Injury and/or Tow Due To Crash
❑AMENDED YR 202512025-00082234 VENT
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 71
® ❑ RELATED ®Y 0 N 12 31 2025 ❑AM ❑YES ®NO U1 -<
S RANDALL RD Elgin09:57
_ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION Ill
FTlMI N E S W HOPPS RD COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 15 u)
❑ Kane 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
g DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EWES ❑uuv ❑!CV ❑Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 C)
Richard, Ida,V. 01 /
yr 13-UNDER CARRIAGE al
10l •!. 2 FIRE 0
STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 0 M
F 2 8 El ®SNE❑UNK VEH. O AT CRASH IN ENGAGED0 99-UUNKNOWN 9 76-TOP® `Distraction Value ALGN =
r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6 iI 6 �I COM VEH 0 Ea 5 n
~ ELGIN I N I L 60124 B 1 FIRST CONTACT 4 7 : R-O •II Yes.See Sidebar U1 0
Z BE22769 IL 2026
TELEPHONE
IL D 3VV2B7AX6LM134408 Progressive Ely ®N U2 m
in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
Elgin Fire Same 987090929 2 1—
'6 HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER
RESPONDER D
Refused ❑Y El 2 0
g DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EWES ❑INv 0 NCv ❑DV
!1 9 9 7 Volkswagen Atlas 2025 00-NONE 0.. Q!'-O DUE TO CRASH 0 ❑ 2 x
...
Yr 13-UNDER CARRIAGE 10( I 2 FIRE ❑ ® U2 C
c ij
F 2 8 SYSTEM IN 0 ENGAGED 0 15-OTHER 9,16-TOP 3 X
❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN `Oistraglon Value 0
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF
i1I-4 COM VEH ❑ ® U1 CO
6
FIRST CONTACT 11 8 7 -5 •If Yes.See Sidebar
— North Aurora IL 60542 B 1 BX60431 IL 2026 I 0 C
IL D 1 V2CR2CA2SC562971 Nationwide ❑Y ®N RDEF
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 =
South Elgin Fire Same 9112j048429 BAC E
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 <
Refused RESPONDER u1 =
(UNIT) (SEAT) (D081 (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTHI PASSENGERS&WITNESS ONLY (NAME)((A.DDRESS)((TELEPHONEI (EMS) (HOSPITAL)
U1 1 D
/ / 1 0
EV MOST EVNT LOG DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z
N 1 ® 11 4 12,31 /2025 09 57 ®AM in a Work Zone? ®N DIRP co
1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 8
T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 C)
v 2 0 2 99 12,31 ,2025 10 46 ®PM ❑Construction >F
R O 0 ]$I CITATIONS ISSUED El PENDING SECTION CITATION NO. EMS ARRIVED TIME 5
3 ❑AM ❑Maintenance U2
— u a, ARREST NAME Richard, Ida,V. 11-901-A 1545-460 12/31 /2025 10 49 ®PM SLMT
1 ® UtilityEl 11 4 0 CITATIONS ISSUED SECTION CITATION NO. ROAD CLEARANCE TIME
PENDING
o
r 2 El ARREST NAME 12/31 /2025 11 21 ®PM ❑Unknown work zone type U1 45
2 2 3 0 OFFICER ID SIGNATURE BEAT!DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 45
1545-VanEycke, Brier 801 331-Ziegler 01 ,27,2025 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.
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 truck trailer -<
r ' I I I I INDICATE NORTH combination):or p0
[mil BY BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C
} I I - } (example:shuttle or charter bus):or X
Not To Scale 3. Is designed tocarry15 fewer passengers and operated contractcarrier
I �____a_._.J 11" r . 41 I - } } } transportingemployeesinthecoursee thir employment example:employee
he
.o� ` transporter usuall a van type vehicle or passen r car):or CO
L •---..i.. .-l. I_ I - } } 1 •4. Is used or designated to transport between 9 and 15 passengers,including the driver. (I)uyr, for direct compensation(example:large van used for specific purpose):or
____a . ll _ t i i i t 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires
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placarding(example:placards will be displayed on the vehicle). m
l r1►E I �, J I I CARRIER NAME Z
aDOBe78urrr
_ __ ADDRESS 0I T.
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CITY/STATE/ZIP g
aYaAa I - MOTOR CARR.ID 0 Interstate 0 Intrastate
I . ❑ Not in Comm./Govt. 0 Not in Comm./Other
--- --1 USDOT NO. ILCC NO. m
XI
Source of above z
. Form Number
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Xl
IDOT PERMIT NO. WIDELOAD'; ❑Yes 0 No 2
TRAILER VIN 1 m
co
LOCAL USE ONLY TRAILER VIN 2 m
v
TRAILER WIDTH(S) 0-96" 97-102" >102' -n
TRAILER 1 0 0 0 Z
TRAILER 2 ❑ 0 0 O
u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w
Gray White
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 DISABLING DAMAGE NOT DAMAGE EXTENT: 3 TOWED BY/TO:
DUE TO ® Redmons/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE