Loading...
HomeMy WebLinkAbout2024-00060013 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 1111111 010 III I IIIIIII II 111111111111111111101 111111101111 I I DRAG TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X003560944 u, 1 U2 1 2 4 1 U1 2 U2 1 U, 1 U2 1 U1 1 U2 1 1 10 Ut 3 U2 1 *P 0119* INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW DAMAGE TO ANY El$500 OR LESS TYPE OF REPORT 0 A No Injury J Drive Away Elgin Police Department ONE PERSON'S ❑$501-$1.500 ®ON SCENE • 1 0 NOT ON SVEHICLE/PROPERTY in OVER$1.500 ❑AMENDEDCENE(DESK REPORT) ElB Injury and JorTow Due To Crash YR 2024I2024-00060013 VENT * ADDRESS NO. 'HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 'IT SHALES PKWY ®gin ID ®Y ❑N 09 19 2024 07:42 ®AM ❑YES ®NO U1 ,< PRIVATE mo /day I yr ❑PM FLOW CONDITION m FT/MI N E S W MAROON DR COUNTY PROPERTY El ®N DOORING ❑y #OF MOTOR ❑SLOW 15 CO ❑ Cook HIT&RUN ❑Y ® N WITH N VEHICLES INVLD ❑ STOPPED U2 —I ® AT INTERSECTION WITH (NAME OF ) PEDALCYCUST® ® FREE FLOW # LNS 0 tg DRNER ❑ PARKED ❑DRIVERLESS ❑ PEE ❑PEDAL ❑EOUES 0 AIN ❑Ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 n Ford Focus 2013 00-NONE FOR DAMAGEDAREA(S) FRONT TOWED Ut 0 NAME(LAST,FIRST,M) , Crystal mo day yr ®i © -1 DUE TO CRASH ® ❑ 13-UNDERCARRIAGE 101 L 2 FIRE ❑ IA SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 El U2 4 m 1273 THORNDALE CT F ❑Y ®SYSNEM❑UNK VEH. O ATCRASH D 0 99-UUTHER NKNOWN 9 16-TOP 3 ,DistractlonValue ALGN = T. CITY PLATE NO. STATE YEAR POINT OF 8 1{ 6 II COM VEH 0 El 3 0 a ~ 1 FADP3E26DL142873 Kemper Ins ❑Y ®N U2 m EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER RSUR m a 99 9 Same 12AU000704383 1 r o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET.CITY,STATE,ZIP PHONE NUMBER •'' RESPONDER Same VEHU 73 L ❑Y ®N 2 an ®DRIVER ❑ PARKED 0 DRNERLESS ❑ PED ❑PEDAL ❑EDUCE 0 WV ❑Ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) U1 m m / J FOR DAMAGED AREA(S) FRONT TOWED Y N s Jimenez Guillermo.Ximena 0 7 2 0 2 0 0 5 Chevrolet Equinox 2018 00-NONE 1t i'_1 DUE TO CRASH (g ❑ 2 —I mo day yr NAME(LAST,FIRST,M) ©, XI 13-UNDERCARRIAGE 10 fj 2 FIRE El ® U2 C c STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ❑ ® SPDR 0 SYSTEM IN O ENGAGED 0 15-OTHER 9 16-TOP 3 X a` 389 CHAPARRAL GIR F ❑Y ® N DUNK VEH. AT CRASH 99-UNKNOWN Distraction Value 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR PO P RI8T NT COONTACT F 12 7_'1 a 1_5 C•IOMe6VSee ❑ ® U1 to H ELGIN IL 60120 C DA60737 IL 2024 REAR Sidebar 0 Sn M TELEPHONE DRIVER'S LICENSE NO. STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0 (224)580-4562 J552-9400-5806 IL D 0 2GNAXSEV6J6331245 Kemper Ins ❑Y ®N RDEF73 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST.FIRST,M) POLICY NUMBER 1 I 99 9 Jimenez-Juan.A. 12AU001201282 BAC 3 HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET.CITY.STATE.ZIP PHONE NUMBER 996 < RESPONDE0Y NEl R 389 CHAPARRAL CIR. ELGIN , IL.60120 U1 = (UNIT) (SEAT) ;DOB) ISEX) SSAFT) (AIR) (INJ( (EJCTI (EPTH) PASSENGERS&WITNESS ONLY (NAME)I{ADDRESS)IITELEPHONEI (EMS) (HOSPITAL) I I U2 996 1- m - '#OCCS > / /• U1 1 73 I I 1 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME ®AM Did crash occur ❑Y U2 Z N 1 ® 11 4 91 /91 /024 07 42 ❑pM in a Work Zone? ®N DIRP D 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME It YES check one below: T PROPERTY OWNERS ADDRESS:STREET.CITY,STATE,ZIP ®AM U1 1 2 0 2 12 91 /91 /024 07 44 D PM ❑Construction * '61 3 ❑ ®CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 5 ®AM ❑Maintenance U2 CO 11 4 ARREST NAME Armenta.Crystal 11-902 319001060 91 /91 /024 07 48 El pm SLMT o u 0 CITATIONS ISSUED ❑ •PENDING 'SECTION CITATION NO. ROAD CLEARANCE TIME 0 Utility NAM 30 2 0 ARREST NAME 91 /91 /024 08 32 El PM 0 Unknown work zone type Ut 2 2 3 0 • OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME fC ®AM Workers present? ❑Y 30 319-Ross..Adam 302 275-Engelke 11 / 12/2024 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_ __1 1 , _� } ACMVisdefinedas any motor vehicle used to transport passengers or property and. 1 Has a 0D weight rating more than 10,000 pounds(example truck or truck/trailer r ; ; II I _; ; INDICATE NORTH combination).or -I r"0 """ BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C 1 i 0 4 IU I _. . r r r (example'.shuttle or charter bus)-or 0 0 Not 7b Scale I I -t 'r i transporting employeeed to slin the cours5 or fewer e their employrs and ment(example�emaployeect rier fXI l transporter-usually a van type vehicle or passenger car).or pt i____A____4 : ' ti i i r i- 4 Is used or designated to transport between 9 and 15 passengers,including the driver, N w�. for direct compensation(example:large van used for specific purpose).or O L____L____; , i ) i 5 Is any vehicle used to transport hazardous material(HAZMAT)that requires any placarding(example placards will be displayed on the vehicle) Zml CARRIER NAME 1 I - rZ.� i. t 2 l RIAR00470R _• • .- y' 1 ADDRESS 1 I I a I . . CITY/STATE/ZIP r , um2 MOTOR CARR ID ❑ Interstate El Intrastate 0 Not in Comm./Govt. El Not in Comm./Other r , USDOT NO. ILCC NO. , Source of above z IDOT PERMIT NO WIDELOAD? ❑Yes ❑No i ' TRAILER VIN 1 m N LOCAL USE ONLY TRAILER VIN 2 m TRAILER WIDTH(S) 0-96'1 97-102'1 >10:' m m TRAILER 1 ❑ ❑ ❑ Z TRAILER 2 ❑ ❑ ❑ o U 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft 2 ft N Black Gold u 1 TOWED - TOTAL VEHICLE LENGTH ft. NO.OF AXLES DUE TO ❑X 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 X DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT- 3 TOWED BY/TO: DUE TO ❑ Redmons/Impound Lot Garage VEHICLE CONFIG _ CARGO BODY TYPE LOAD TYPE