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HomeMy WebLinkAbout2024-00057333 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets liii Ill III HI III ll II 11111111111111H1111111 111111101111 I I DRAG TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X003553544 u, 1 U2 1 1 1 1 U1 9 U2 1 U, 1 U2 1 Ut 1 U2 1 5 10 U1 23 U2 3 *P 0119* INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW DAMAGE TO ANY El$500 OR LESS TYPE OF REPORT ® A No Injury J Drive Away Elgin Police Department ONE PERSON'S ®$501-$1.500 ®ON SCENE0 NOT ON • 7 VEHICLE/PROPERTY El OVER$1.500 0 AMENDEDCENE(DESK REPORT) ❑ B Injury and JorTow Due To Crash YR 2024I2024-00057333 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 21 '11 DUNDEE AVE El ❑ AM Elgin RELATED ❑Y coN 09 08 2024 11.39 ❑ ❑YES ®NO U1 -< PRIVATE mo /day I yr ®PM FLOW CONDITION m 'COUNTY PROPERTY ICI Y ❑N DOORING ❑Y #OF MOTOR 0 SLOW 1 U) ❑ FT/MI NESW 'WITH VEHICLES INVLD ❑ STOPPED U2 —I ❑ AT INTERSECTION WITH (NAME OF ) Kane HIT&RUN ❑Y IM N PEDALCYCUST®N ® FREE FLOW # LNS ' O DIC DRNER ❑ PARKED ❑ORNERLESS ❑ PEE ❑PEDAL ❑EOUES ❑NIA/ ❑Ncv 0 ov DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 0 , Mayyr FOR DAMAGEDAREA(S) FRONT TOWED Ut 0 NAME(LAST,FIRST,M) p mo / 0 6 J 1 9 8 5 Volvo V N M 2020 NONE 11 12 i 1 DUE TO CRASH ❑ . 13-UNDER CARRIAGE to 21 ) .r 2 FIRE 0 SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 El U2 1 m 5495 N MAIN ST M ❑Y ESYlM❑UNK VEH. 0 AT CRASH 99-UUTHER NKNOWN 9 16-TOP 3 ,Distraction Value 6 ALGN = CITY PLATE NO. STATE YEAR POINT OF 6 II 6 I( COM VEH NJ 0 1 0 ~ 4V4MC9EH2HN975131 Aon Risk Servces ❑Y ®N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER RSUR m a 99 9 The SYGMA Network BAP 234720415 1 r o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET CITY,STATE,ZIP PHONE NUMBER L RESPONDER N 3600 SOUTHGATE DR, Danville, IL,61834 (217)477-7360 VEHU 0 5 ®COWER ❑ PARKED 0 ORNERLESS ❑ PEE ❑PEON. ❑EQUES 0 Nov ❑Ncv 0 ov DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) U1 21 m m 4 / J FOR DAMAGED AREA(S) FRONT TOWED Y N n NAME(LAST,FIRST,M) Green, Kyle,J. O molday 1 9$4 Toyota Camry 2004 oo-NONE 13-UNDER CARRIAGE 11: I E TO 2 E CRASH 12 1 FIR ❑ ® 2 XI v c 111 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) El El U2 C DISTRACTED 0 ® SPDR C) SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16-TOP 3 5 0 X a 404 MONARCH BIRCH LN M ❑Y ® N DUNK VEH. AT CRASH 99-UNKNOWN •Distraction Value N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POto FIRSNT T COF ONTACT 8 7.,I 6 a CUOM VEH Sidebar Igl U1 C BARTLETT IL 60103 0 EG87134 IL 2024 RFAR 0 f/j TELEPHONE DRIVER'S LICENSE NO. STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0 (630)750-8377 G650-5108-4105 IL D 0 4T1 BE32K44U901585 American Select ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST.FIRST,M) POLICY NUMBER 1 I 99 9 Same WNP 325979H Bnc , 3 HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE.ZIP PHONE NUMBER 996 < RESPONDER 0N Same Ut 2 (UNIT( (SEAT) (DOB) (SEX) (SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS 8 WITNESS ONLY (NAME)I(ADDRESS)((TELEPHONE) (EMS) (HOSPITAL) I I U2 996 1- m / - - #OCCS ' D / / U1 1 m I I 1 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME ®AM Did crash occur 0 Y U2 Z N 1 ® 11 1 09,09 ,2024 00 45 ❑pM in a Work Zone? ®N DIRP co 1 I PROPERTY OWNERS ADDRESS:STREET.CITY,STATE,ZIP PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME It YES check one below: U1 5 C) T 2 0 30 99 ❑AM ! / ❑PM El Construction * N 3 0 0 CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 1 AM ❑Maintenance uz Q 21 11 1 ARREST NAME / / ❑PM ❑Utility SLMT p U ❑CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME o N B AM 00 T 2 0 ARREST NAME r / pp1 ❑Unknown work zone type Ut • OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 0 ❑AM workers present? ❑Y 99 468-Barron, Miguel 200 280-Marabillas , I p 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. r IF MORE THAN ONE CMV IS INVOLVED,USE SR 1050A ADDITIONAL UNITS FORMS r-"--r---"1 , 4 . r r r r l l I 1 . r } 0 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 Z ' r • ; i ; i- r r ' i i INDICATE NORTH combination).or —I • XI BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C I ', ! ' ' 1 ', ' f ` r r r (example'.shuttle or charter bus)-or n S ; I I ; 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier 0 i------'-----• + + • : - -, 1 - 1 i } - i• transporting employees in the course of their employment(example.employee ,3 transporter-usually a van type vehicle or passenger car).or w r i- 4 Is used or designated to transport between 9 and 15 passengers,including the driver, 9 Po P 9 N for direct compensation(example:large van used for specific purpose).or O i 1 5 Is any vehicle used to transport any hazardous material(HAZMAT)that requires placarding(example placards will be displayed on the vehicle) 11 CARRIER NAME The SYG MA Network Z .. ADDRESS 3600 SOUTHGATE DR To • CITY/STATE/ZIP Danville 1 I L 161834 o . - MOTOR CARR ID El Interstate ❑ Intrastate ❑ Not in Comm./Govt. ElNot in Comm./Other Q i------ , USDO r r r r r•--• - 014811 ILCC NO. 135541 m T NO xi , Source of above Z . Form Number _ m IDOT PERMIT NO WIDELOAD? ❑Yes ®No 2 ' TRAILER VIN 1 m CA LOCAL USE ONLY TRAILER VIN 2 m 0 TRAILER WIDTH(S) 0-96'1 97-102'1 >102 m T TRAILER 1 ❑ ❑ ❑ z -74 TRAILER 2 ❑ ❑ ❑ o U 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft 2 ft. Z White Gold - u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT- 0 TOWED BY/TO: SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT_ 1 TOWED BY/TO: DUE TO © VEHICLE CONFIG CARGO BODY TYPE LOAD TYPE