Loading...
HomeMy WebLinkAbout2024-00060180 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 1111111 DIII III I IIIIIII II 11111111111111111110110111111 IIIIIII DRAG TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X0035�60965 u, 1 U21 3 4 1 U1 3 U2 1 U, 1 U2 1 U1 1 U2 1 1 15 Ut 1 U2 1 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY El$500 OR LESS TYPE OF REPORT 0 A No Injury J Drive Away AGENCY CRASH REPORT NO. TRFW Elgin Police Department ONE PERSON'S ❑$501-$1.500 ®ON SCENE 2 0 NOT ON S VEHICLE/PROPERTY inOVER$1.500 ❑AMENDEDCENE(DESK REPORT) 0 B Injury and JorTow Due To Crash YR 2024I2024-00060180 VENT * ADDRESS NO. •HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 'F'I S EDISON AVE ®gin ❑ RELATED ®Y ❑N 09 19 2024 05-40 ❑AM ❑YES ®No u1 ,< PRIVATE mo /day I yr ®PM FLOW CONDITION m FT/MI N E S W W CH ICAGO ) Kane HIT&RUN 0 Y CZN PEDALCYCUST®N ® FREE FLOW # LNS 0 tg DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EOUES ❑rmv ❑Ncv 0 ov DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N O n 0 7 / 1 4 /2 0 0 5 FOR DAMAGED AREA(S) HtONr TOWED U1 NAME(LAST,FIRST,M) Guerrero, Daysy mo day yr Honda Civic 2024 co-NONE �' .i 72..D DUE TO CRASH ® ❑ 13-UNDERCARRIAGE ,� FIRE ❑ SEX SAFT AIR AUTOMATION LEVEL LEVEL (ICI-TOTAL(ALL) ® O DISTRACTED 0 ® U2 0 m 235 S EDISON AVE F ❑Y ®SYSNEM❑UNK VEH. O AT CRASHD 0 OTHER 99-UNKNOWN 9O16-TOP3 'Distraction Value ALGN 2 r CITY PLATE NO. STATE YEAR POINT OF 8 Il 6 li_4 COM VEH 0 El 1 n FIRST CONTACT 12 7 _, �5 ^Yves,See Sidebar U1 0 Z 2HGFE2F53RH534372 Progressive Ins ❑Y ®N U2 m EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Rodriguez,Oscar,A. 934340509 1 o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET.CITY,STATE,ZIP PHONE NUMBER r RESPONDER 235 S EDISON AVE. ELGIN , IL,60123 VEHU L ❑Y ®N 2 G1 ®DRIVER ❑ PARKED 0 DRNERLESS ❑ PED ❑PEDAL ❑EQUES 0 WV ❑NCV 0 DV DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) U1 m m / / FOR DAMAGED AREA(S) FRC IT TOWED Y N n NAME(LAST,FIRST,M) Aranda Vlllegas,Ana,G. 0 mo6 0 7 1 9 8 7 Subaru Tribeca 2008 00-NONE '0 12 Y REocRasH O ® U2 2 C c yr 13-UNDER CARRIAGE c STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 ® SPOR n a 4 TIMES SQUARE 309 F SYSTEM IN O ENGAGED 0 15-OTHER O9 16-TOP 3 0 X ❑Y MI N ❑LINK VEH. AT CRASH 99-UNKNOWN •Distraction Value N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF ©I i 4 COM VEH ❑ ® U1to FIRST CONTACT 1 O a - - •(rYes,See Sidebar ELGIN IL 60120 B CF24073 IL 2025 -MAR 0 Cl)C D TELEPHONE DRIVER'S LICENSE NO. STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0 (224)268-4013 A653-0078-7762 IL 0 4S4WX93D684416109 Kemper ❑Y ®N RDEF73 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST.FIRST,M) POLICY NUMBER 1 I Rodriguez,Oscar.A. 12A0001453437 BAG 3 HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET.CITY.STATE.ZIP PHONE NUMBER 996 < O Y RESPONDER 235 S EDISON AVE, ELGIN , IL,60123 U1 = (UNIT( (SEAT) IDOBI (SEX) (SAFT) (AIR) (INJI (EJCTI (EPTH) PASSENGERS&WITNESS ONLY (NAME)r(ADDRESS)/ITELEPHONEI (EMS) (HOSPITAL) W 03 /21 /1981 M javier leon garcia/413 S EDISON AVE ,Elgin,IL60123/ 996 1— (331)588-1206 - U2 m / / #OCCS y /• / • U1 1 m / 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 /9/ /024 05 40 0 pm in a Work Zone? ®N DIRP co 1 r PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME It YES check one below: T PROPERTY OWNERS ADDRESS:STREET.CITY,STATE,ZIP ❑AM U1 5 — 2 ❑ 2 28 ! J 0 PM ❑Construction * N ' 3 ❑ ®CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 3 ❑AM ❑Maintenance U2 Q • ARREST NAME Rodrigue Guerrero. Daysy 11-601 W465-369 / / El PM SLMT o u ® 11 4 Lu CITATIONS ISSUED ❑PENDING 'SECTION CITATION NO. ROAD CLEARANCE TIME ❑Utility p N AM 35 2 0 ARREST NAME Rodrigue Guerrero, Daysy 11-1204-B 465-368 r / 8 ptil ❑Unknown work zone type Ut 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 0 qM Workers present? ElY 35 465-Dorado,Ariana 601 334-Fries 10 r 15/2024 01 30 (0 PM IZI 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. 0 IF MORE THAN ONE CMV IS INVOLVED,USE SR 1050A ADDITIONAL UNITS FORMS r ; _� } A CMV is defined as any motor vehicle used to transport passengers or property and. D 1 Has a weight rating more than 10,000 pounds(example truck or truck/trailer r 1 i ; i combination) or —I Li. NDICATE NORTH XI BY ARROW2 Is used or designed to transport more than 15 passengers including the driverC } ', ', iI -( ` r r r (example.shuttle or charter bus)-or 40i 0 • 3 Is designed tocarry15 or fewer passengers andoperated contract car r l------'-----• + + I f } } } transporting employee in the couBe Of thir empayrent(example�emapbyeerie O� transporter-usually a van type vehicle or passenger car) or CO A W7Chilce®o7St ; 't r i 4 Is used or designated to transport between 9 and 15 passengers,including the driver, C is I I for direct compensation(example:large van used for specific purpose).or O i i + + c transportany (HAZMAT) requires11 ✓.• } } } 5 Is any vehicle used to hazardous material HAZMAT that { --_i placarding(example placards will be displayed on the vehicle) M T. UM .:ip CARRIER NAME Z 0 ' pAip I ADDRESS cn Not To Scale CITY/STATE/ZIP , MOTOR CARR ID ❑ Interstate ❑ Intrastate r 0 0 Not in Comm./Govt. Not in Comm./Other r , USDOT NO. ILCC NO. , Source of above Z . Were HAZMAT placards on vehicle? ❑ Yes ❑ No If Yes, Name on placard 0 4 digit UN NO. 1 digit Hazard class No M 71 m Did HAZMAT spill from vehicle(do NOT consider FUEL from vehicle's Z own tank)? ❑ Yes ❑ No ❑ Unknowr D Did HAZMAT Regulations violation contnbute to the crash? r ❑ Yes ❑ No ❑ Unknown D Did Carrier Safety Regulations(MCS)violation contribute to the crash ❑ Yes 0 No ❑ Unknown 0 C Was a driver/vehicle Examination Report Form completed? D HAZMAT ❑Yes ❑ No ❑Unknown Out of Service ❑Yes ❑ No - MCS ❑Yes ❑ No ❑Unknown Out of Service ❑Yes ❑No C Z Form Number D m XI IDOT PERMIT NO WIDELOAD? ❑Yes ❑No S TRAILER VIN 1 m N LOCAL USE ONLY TRAILER VIN 2 m D TRAILER WIDTH(S) 0-96'1 97-102'1 >10; m m TRAILER 1 ❑ ❑ ❑ Z 7 TRAILER 2 ❑ ❑ ❑ o U 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft 2 't Z En Gray Gray 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 I 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 I Impound Lot Garage VEHICLE CONFIG _ CARGO BODY TYPE LOAD TYPE