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HomeMy WebLinkAbout2024-00057471 , l Ill ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets Il ii Ill OIl III 1In ll 11111111111111H11 1011 101100 III II DRAG TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X003553?61 u, 1 U21 2 4 1 U1 3 U2 1 U, 1 U2 1 U1 1 U2 1 1 15 Ut 1 U2 1 *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 SCENE 1 0 NOT ON VEHICLE/PROPERTY inOVER$1.500 ❑AMENDEDCENE(DESK REPORT) ❑ B Injury and JorTow Due To Crash YR 2024I2024-00057471 VENT * ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 11 CAPITAL ST El ❑ Elgin RELATED ❑Y coN 09 09 2024 02:58 ❑AM ❑YES ®No u1 ,•< PRIVATE mo /day I yr ®PM FLOW CONDITION m ^,D � 'COUNTY PROPERTY El ®N DOORING ❑Y #OF MOTOR ❑SLOW 2 fJ1 02 (]CJ I /MI N E C1 W Westfield Dr 'WITH VEHICLES INVLD El STOPPED U2 —1 ❑ AT INTERSECTION WITH (NAME OF ) Kane HIT&RUN ❑Y CZN PEDALCYCUST®N ® FREE FLOW # LNS O tg ORNER ❑ PARKED ❑DRIVERLESS ❑ FED ❑PEDAL ❑EOUES ❑NIa ❑Ncv 0 DV DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 0 1 1 / J Honda Accord 2008 00 FOR DAMAGEDAREA(S) FRONT TOWED U1-NONE NAME(LAST,FIRST,M) , Michael,G. mo day yr ®, © 1 D,IETOCRASH ❑ 21 13-UNDERCARRIAGE 10t �; 2 FIRE 0 SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 M U2 2 m 39W376 HOGAN HILL M ❑Y ®SNEM❑UNK EH. 0 AT CRASHD 99-UUNKNOWN THER 9 16-TOP 3 ,Distraction Value ALGN = 1.' VIN PLATE NO. STATE YEAR POINT OF 8 it 6 Il-4 COM VEH El ® 4 C) jL FIRST CONTACT 11 7. 71_�5 •If Yes,See Sidebar U1 0 Z 1 HGCP26718A078299 Safeco Insurance Coompany ❑Y ®N U2 m II EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER RSUR m Same Z45542116 1 m o HOSPITAL(TAKEN TO) INCIDENT • IF'Y' OWNER STREET.CITY,STATE,ZIP PHONE NUMBER '' RESPONDER Same VEHU L ❑Y ®N 2 0®DRIVER ❑ PARKED 0 DRNERLESS ❑ PED ❑PEDAL ❑EQUES 0 NOV ❑NCv 0 DV DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) U1 m m FOR DAMAGED AREA(S) FRONT TOWED Y N 5 NAME(LAST,FIRST,M) Smith, Cameron,A. 0 0 / 2 Jd day 1 9 9 1 Dodge Ram 2500 2022 00-NONE 1t. ©l'D DUE TO CRASH ❑ ® 24xi v 13-UNDER CARRIAGE 10 I, z FIRE ❑ ® U2 C c STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 ® SPDR C) SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16-TOP 3 0 X ° 166W37 ST M ❑Y MI N ❑UNK VEH. AT CRASH 99-UNKNOWN •Distraction Value N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8 it 6 �p_4 COM VEH ❑ ® U1 FIRST CONTACT 1 7 . 5 •It Yes,See Sidebar C to ZSteger IL 60475 0 GBY721 GA 2025 0 (p D TELEPHONE DRIVER'S LICENSE NO. STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0 (815)573-7000 S530-1019-1113 IL D 3C6UR5HJ7NG390218 Old Republic Insurance Co ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST.FIRST,M) POLICY NUMBER 1 I Osmose Utilities Ser MWTB315620-24 BAC 3 HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET.CITY.STATE.ZIP PHONE NUMBER 996 < RESPONDER pO®N 635 HIGHWAY 74 S. Peachtree City.GA,30269 U1 = IUNITI I SEAT) (DOS) (SEX) i ISAFT) (AIR) IINJI (EJCT( (EPTH) PASSENGERS&WITNESS ONLY (NAME'/I ADDRESS)l(TELEPHONEI i EMS) (HOSPITAL) 2 6 04 /1 7/2000 M 2 3 0 1 Fermin Sanchez-Marquez/1780 CAPITAL ST,ELGIN,IL,60124 Refused(331)213-5861 _ U2 996 m m 2 4 1 0 /1 0/1992 M 2 3 0 1 Joaquin Sanchez-Marquez/1780 CAPITAL ST,ELGIN,IL,60124 Refused #occs y (779)939-7141 _ XI 2 3 1 2 /2 6/1981 M 2 3 0 1 0 Onofre Sanchez-Marquez/1780 CAPITAL ST,ELGIN,IL,60124 Refused U1 1 m (5011418-7121 D / / 4 O EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME ❑AM Did crash occur ❑Y U2 Z N 1 ® 11 1 09/09 /2024 02 58 ®pm in a Work Zone? ®N DIRP co 1 I PROPERTY OWNERS ADDRESS:STREET.CITY,STATE,ZIP PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME ❑AM If YES check one below: U1 7 C) T 2 ❑ 23 2 ! I 0 PM El Construction * N ' 3 ❑ ®CITATIONS ISSUED ❑PENDING SECTION CITATION NO. EMS ARRIVED TIME 1 ❑AM ❑Maintenance U2 Q ® 11 1 ARREST NAME Rusniak, Michael,G. 11-1204-B 51529-000079 / / ❑PM SLMT o U CITATIONS ISSUEDPENDING • ROAD CLEARANCE TIME ❑Utility o N ❑ 0 SECTION CITATION NO. AM 30 2 0 ARREST NAME 09/09 /2024 04 24 ®PM 0 Unknown work zone type U1 T OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 ❑ 1 529-Audi red,Jonathan 901 - 10 /01 /2024 09 00 0 PM Workers present? ®N U2 30 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 I I 0 ADDITIONAL UNITS FORMS . ' } 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 r r INDICATE NORTH combination) or —I • XI BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C ' L I ', ! i. L ' ' '. ', ' f ` r r r (example'.shuttle or charter bus)-or X ; I • I ; 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier 0 i------i-----• + + • : - -, 1 - 1 i } - i• transporting employees in the course of their employment(example.employee M transporter-usually a van type vehicle or passenger car).or w ' r i 4 Is used or desi nated to trans rt between 9 and 15 assen ers 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 T. . ` CARRIER NAME Z ' .. ADDRESS 0 N . O • CITY/STATE/ZIP 0 , , . - MOTOR CARR ID ❑ Interstate ❑ Intrastate ❑ Not in Comm./Govt. ElNot in Comm./Other Q m r-----.-----, r r r r r----, r - DO ILCC NO. m U N XI , Source of above z . MCS El Yes ❑ No ❑Unknown Out of Service ❑Yes ❑No Form Number 0 M X1 IDOT PERMIT NO WIDELOAD? ❑Yes ❑No S ' TRAILER VIN 1 m N LOCAL USE ONLY TRAILER VIN 2 m CJ TRAILER WIDTH(S) 0-96'1 97-102'1 >10; m m TRAILER 1 ❑ ❑ ❑ z TRAILER 2 ❑ ❑ ❑ 0 U 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft 2 't N Blue White - 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- 2 TOWED BY/TO: DUE TO © VEHICLE CONFIG CARGO BODY TYPE LOAD TYPE