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HomeMy WebLinkAbout2024-00058704 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 01111101111 0110110001111110 11011 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X0035529 1 u, 1 U21 3 4 1 U1 1 U2 1 u, 1 1_12 1 1.11 1 U2 1 1 10 u, 1 U2 3 *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 El$501-$1.500 ®ON SCENE 2 VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and for Tow Due To Crash El AMENDED YR 202412024-00058704 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 rn ® ❑ RELATED ®Y 0 N 09 13 2024 ❑AM ❑YES ®NO U1 LAMBERT LN Elgin02:55 _ g PRIVATE mo /day/yr ®PM FLOW CONDITION III FT!MI N E S W RT20 COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 1 cn ❑ Cook HIT&RUN ❑Y ® N WITH VEHICLESOT, INVLD ❑ STOPPED U2 —I O AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NW 0!Cy 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 5 C) 0 8 ! yr 13-UNDER CARRIAGE ©,I :: FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 5 M M 2 SY4 ❑Y ®SNEM DUNK VEH. 0 AT CRASH IN 0 99-UNKNOWN 9 16•TOP 3 *Distraction Value ALGN = r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF S, it 6 4-5 *IIYes.See Sidebar U1 COM VEH 0 0 1 0 F. FIRST CONTACT 12 7 ,_ Z G E N OA IL 60135 0 1 0 CS72591 IL 2025 is TELEPHONE IL D 0 KL8CB6SA4MC712749 Progressive ❑Y Il N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 Same 961423310 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused El El 2 0 N DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 row 0 NCv 0 DV !1 9 6 8 Toyota Camry 2017 00-NONE ,011 12 ._1 DUE O CRASH 0 D U2 2 C o 13-UNDER CARRIAGE III il M 2 6SYSTEM IN 0 ENGAGED 0 15-OTHER 9,1,6•TOPO3 * X 0 Y NJ El UNK VEH. AT CRASH 99-UNKNOWN Oistracl n Value 0 -' N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8-.;, 6 I.,( 4 COM VEH ❑ ® U1 CO FIRST CONTACT 2 7 _, _5 •(ryes.See Sidebar n ELGIN IL 60120 0 1 0 DT31329 IL 2024 REAR C D IL D 0 4T1 BF1 FKOHU740038 Geico ❑Y ®N RDEF Xl EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X 99 9 Same 4253255816 BAG E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPONDER u1 = (UNIT) (SEAT) (DORM (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)((ADDRESS)((TELEPHONE) (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 09,13 l2024 02 55 ®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) v 2 0 28 99 09,13 ,2024 02 55 ®PM El Construction >E Z 3 0 0 CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 3 ❑AM Maintenance U2 ❑ 1 ® 11 4 ARREST NAME Evinger.Zachary.T. 11-601-Ax 1527000203 , ! 0 PM SLMT o N ❑CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ' ❑El AM Utility r 2 0 ARREST NAME 09(13 l2024 02 55 ®PM 0 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 1527-Juarez.Jorge 401 334-Fries 10 ,22,2024 01 30 0 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-__ _r_ __1 III } INDICATE NORTHcomb nation)or IP. BYARROW 2 Isusedordesignedtotransportmorethan 15 passengersincludingthedriver C I I I N - (example:shuttle or charter bus):or 0esfMvaeoubYmoumrlo1 1 I I } 3. Is tl geed to carry 15 or fewer passengers and operated by a contract careertovmmoeaY+Reureazo transporting employees In the course of their employment(example:employee___II 4 I 1 1' ®I t aew transporter-usually a van type vehicle or passenger car):or w L ___-: « « } } } •4. Is used or designated to transport between 9 and 15passengers,including the dryer, C PE. for direct compensation(example:large van used fors cific purpose):or O I I I -———— � 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m ____ pWcartling(example:placards will be displayed on the vehicle). XI -• -. D '► -, CARRIER NAME Z Z _ ADDRESS O twereeunalarrare®� 1 I 1�I 1 1 1 (weeeaarmr route m T. 1 1 1 1 I I I I CITY/STATE/ZIP g Not fiScat* i I I I I - MOTOR CARR.ID 0 Interstate 0 Intrastate 0 I I T I ❑ Not in Comm./Govt. 0 Not in Comm./Other r ;'___Y____1 - USDOT NO. ILCC NO. m XI Source of above z : 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 Black Red u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT 3 TOWED BY/TO. _Other/Impound Lot Garage SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® Other/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE