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HomeMy WebLinkAbout2024-00060183 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 1111111 010 III )III )IIIIII II 1111111111111111111011111111110 I I DRAG TRFD TRFC WEAT DRVA VIS VEND LGHT COLL •MANY X003560958* u, 1 U2 1 1 1 1 U1 4 U2 1 U, 1 U2 1 Ut 1 U2 1 1 11 Ut 1 U211 *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 2 0 NOT ON SVEHICLE/PROPERTY 0 OVER$1.500 0 AMENDEDCENE(DESK REPORT) ® B Injury and JorTow Due To Crash YR 2O24I2O24-00060183 VENT * ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 '1 RT20 ®gin El ❑Y CON 09 19 2024 05:57 ❑AM ❑YES ®No u1 • ,< PRIVATE mo /day I yr ®PM FLOW CONDITION m 0 'COUNTY PROPERTY El ®N DOORING ❑y #OF MOTOR ❑SLOW 1 U) ICJI MI N E s® Shannon ) Kane HIT&RUN ❑Y CZN PEDALCYCUST®N ❑ FREE FLOW # LNS ' 0 tg ORNER ❑ PARKED ❑DRIVERLESS ❑ PEE ❑PEDAL ❑EOUES ❑NNv ❑Ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 n 0 9 / 0 1 /2 0 0 4 FOR DAMAGED AREA(S) HioNf TOWED U1 .V. Toyota Camry 2011 00-NONE 11 ] 1 DUETOCRASH ® ❑ NAME(LAST,FIRST,M) mo day yr Q 13-UNDERCARRIAGE bpi I 2 FIRE ❑ SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 ISI U2 2 m 278 STRATHMORE LN F ❑Y El NSYSTEM❑LINK VEH. O ATCRASH D 0 99-UUTHER NKNOWN 9 16-TOP 3 Distraction Value 9 ALGN = CITY PLATE NO. STATE YEAR POINT OF 8 it 4 COM VEH 0 ® 1 0 4T1BF3EK8BU210792 Alteza Insurance ❑Y ®N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER RSUR Same 12AU001572981 1 m o HOSPITAL(TAKEN TO) INCIDENT • IF'Y' OWNER STREET.CITY,STATE,ZIP PHONE NUMBER '' RESPONDER Same VEHU L • ❑Y ❑N 2 G1 ®DRIVER ❑ PARKED 0 ORNERLESS ❑ PEE ❑PEDAL ❑EQUES 0 WV ❑Ncv 0 DV DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N U1 m m / / FOR DAMAGED AREA(S) FRONT TOWED NAME(LAST,FIRST,MI Hoving, Kathryn,A. mo day yr 1 0 0 6 1 9 8 2 Honda Accord 2014 00-NONE 'o) 12 s DUE TO CRASH 0 ® U2 2 C v 13-UNDER CARRIAGE I c STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) • DISTRACTED 0 IN SPDR n SYSTEM IN O ENGAGED 0 15-OTHER 9 16-TOP 3 9 3 X a 1721 REI DG EGREST DR F ❑Y ® N DUNK VEH. AT CRASH 99-UNKNOWN •Distraction Value N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8 j ! 4 COM VEH ❑ ® U1 to 1— FIRST CONTACT 6 7__•- ;_6 •Ifyes,See Sidebar Hampshire IL 60140 0 GUVNOR IL 2025 km O C TELEPHONE DRIVER'S LICENSE NO. STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0 (847)804-8308 H152-5018-2885 IL D 1HGCR3F89DA031993 USAA ❑y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST.FIRST,M) POLICY NUMBER 1 I Same 006791499C71014 Bnc ' 3 HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE.ZIP PHONE NUMBER 996 < RESPONDER N El Same U1 _ (UNIT (SEAT) (DOB( (SEX) (SAFT) (AIR) {INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)U(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 ❑Y U2 Z N ® 11 1 co 91 ,91 /024 05 57 ®pm in a Work Zone? ®N DIRP D 1 i PROPERTY OWNERS ADDRESS:STREET.CITY,STATE,ZIP PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME El AM It YES check one below: U1 3 C) T 2 ❑ 28 03 ! I 0 PM El Construction * N 3 0 izi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME AM ❑Maintenance U2 3 Q CO 11 1 ARREST NAME Sorino.Sandi.V. 11-601-Ax 1534000065 / / ❑PM SLMT o U 0 CITATIONS ISSUED 0 PENDING 'SECTION CITATION NO. ROAD CLEARANCE TIME ' ❑Utility o N 8 ApM 45 1 T 2 0 ARREST NAME 1 / til ❑Unknown work zone type Ut 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑qM Workers present? ❑Y 45 1534-SantIago.Jorge 801 334-Fries 10 ( 15/2024 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. 0 IF MORE THAN ONE CMV IS INVOLVED,USE SR 1050A ADDITIONAL UNITS FORMS D , _ _ _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 truck/trailer r ; fe.,/ INDICATE NORTH combination) or Not To Scale 4 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C } J. J. d i -` r r r (example.shuttle or charter bus)-or n 1.0193 0 ; 3. Is designed to carry 15 or fewer passengers and operated a contract carrier O } } } transporting employees in the course of their employment(example employee transporter-usually a van type vehicle or passenger car).or w i_____A____: : i , : i r i 4 Is used or designated to transport between 9 and 15 passengers,including the driver, N for direct compensation(example:large van used for specific purpose).or O L____--____; i . i } 1 5 Is any vehicle used to transport any hazardous material(HAZMAT)that requires m placarding(example placards will be displayed on the vehicle) 71 CARRIER NAME Z ' ADDRESS 0 N . O //�� CITY/STATE/ZIP , ^ MOTOR CARR ID ❑ Interstate ❑ Intrastate , ❑ Not in Comm./Govt. ElNot in Comm./Other Q ^ USDOT NO. ILCC NO. m , Source of above Z . If Yes, Name on placard O 4 digit UN NO. 1 digit Hazard class No M 7) 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 A 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 Form Number 0 m X1 IDOT PERMIT NO WIDELOAD? ❑Yes ❑No S TRAILER VIN 1 m N LOCAL USE ONLY TRAILER VIN 2 m C1 TRAILER WIDTH(S) 0-96'1 97-102'1 >10; m m TRAILER 1 ❑ ❑ ❑ Z 7 TRAILER 2 ❑ ❑ ❑ 0 U 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft 2 't N Silver Black - 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 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