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HomeMy WebLinkAbout2024-00061435 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 1111111 DIII III HI IIIIIII II 11111111111 1101110111111011111111 I DRAG TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X003566429- u, 1 U21 3 4 1 U1 3 U2 1 U, 1 U2 1 Ut 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-$1.5000 NOT ON S®ON SCENE 14 VEHICLE/PROPERTY in OVER$1.500 0 AMENDEDCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash YR 2024I2024-00061435 VENT ADDRESS NO. HIGHWAY or STREET NAME • CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 '11 N MCLEAN BLVD ® ❑ Elgin RELATED ®Y ❑N 09 25 2024 0227 DAM ❑YES ®NO U1 ,< PRIVATE mo l day I yr ®PM FLOW CONDITION m F r/MI N E S W W ) Kane HIT&RUN ❑Y CZN PEDALCYCUST®N ® FREE FLOW # LNS 0 DI DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EOUES ❑say ❑Ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 n 1 1 FOR DAMAGEDAREA(S) FRONT TOWED Ut NAME(LAST,FIRST,M) GOMEZ. MARTINA Chevrolet Malibu 2018 00-NONE 13-UNDERCARRIAGE O mo / day J yr ©' Q 0 DUE TO CRASH ❑ ® 3 FIRE ❑ SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 10 z DISTRACTED 0 ® U2 0 m 921 GARFIELD DR F ❑Y El NSYSTEM DUNK VEH. 0 ATCRASH 99-UUTHER NKNOWN 9 16-TOP 3 Distraction Value 7 ALGN = r CITY PLATE NO. STATE YEAR POINT OF 8 I I. 6 • 4 COM VEH ❑ ® 1 0 I— 1 G 1 ZD5ST8J F248732 State Farm ❑Y ®N U2 m B EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER RSUR a Same 026644 SFP 13 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 WV ❑NCV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) U1 m m / / FOR DAMAGED AREA(S) F9 4T TOWED Y N s Rodriguez. Rosa.A. 1 0 1 2 1 9 7 6 BMW X3 2011 00-NONE O' i DUE TO CRASH ❑ DA 2 —I , NAME(LAST,FIRST,M) i g mo day yr i 12 I. 2 FIRE ❑ ® U2 C v 13-UNDER CARRIAGE ® c STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 IN SPDR n SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16-TOP 3 0 X a` 14N168 CO DY CT F ❑Y ® N DUNK VEH. AT CRASH 99-UNKNOWN II •Distraction Value to N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR F FIRST CNT ONTACT 11 7_'1 6 1_S G•IOMeeVSee Sidebar ® U1 C H ELGIN IL 60123 0 BX64458 IL 2024 1 9 D TELEPHONE DRIVER'S LICENSE NO. STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0 (847)989-1591 R362-7217-6891 IL D SUXWX5C59BL700819 State Farm ❑Y ®N RDEF73 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST.FIRST,M) POLICY NUMBER 1 I Same 0468415-SFP-13 BAC 3 HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE.ZIP PHONE NUMBER 996 < ElRE Y 0NR Same U1 = (UNIT) (SEAT) iDOBi (SEX) ISAFT) (AIR) IINJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)/(ADDRESS)/(TELEPHONE) (EMS) (HOSPITAL) 1 3 01 /1 8/2008 F 2 4 C 1 Jasmine A. Hipolito/921 GARFIELD DR.60110 996 r (224)689-4405_ U2 m / / #OCCS D / / u1 2 m / 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 ® 1 1 4 09/25 /2024 02 27 ®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 1 2 ❑ 23 28 09,25 /2024 02 34 ®PM ❑Construction * 'KJ 3 0 ®CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME ❑AM ❑Maintenance U2 Q 1 ® 11 4 ARREST NAME ALVAREZ-GOMEZ, MARTINA 11-601-Ax 4870004856 09/25/2024 02 39 ®PM SLUT o u Lu CITATIONS ISSUED 0 PENDING 'SECTION CITATION NO. ROAD CLEARANCE TIME ` ❑Utility o N AM 35 2 0 1 3 ARREST NAME ALVAREZ-GO M EZ. MARTINA 11-904-B 487000485 09/25 /2024 03 25 El pm0 Unknown work zone type U1 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑qM Workers present? ❑Y 35 487-Heal. Kayla 601 334-Fries 11 / 12/2024 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. ZD 1 Has a weight rating more than 10,000 pounds(example.truck or truc r 'I ; krtrailer -< $ � Blvd I 'ue7N?r+aeefaewa INDICATE NORTH combination)or 71 BYARRO 2 Is used or designed to transport more than 15 passengers including the driver (example.shuttle or charter bus)-or C , , t ; ( t� ) I I I rlit 2t3r7P►pMrl'°"7BI"d W0 ir r r II - , ; 3. Is designed tocarry15 or fewer passengers o era ed by a dand contract carrier0 -----1-----• + + ♦ -t ) } } transporting employees in the course of thir employment(example�emaployeerie ,3 I } y goy .. transporter-usually a van type vehicle or passenger car) or pt 1 1 1 ?ott C i-____A____+ + + , --` i } r } 4 Is used or designated to transport between 9 and 15 passengers,including the driver, u) for direct compensation(example:large van used for specific purpose).or O L_____ ____1 i; 1 + i } 1 5 Is any vehicle used to transport any hazardous material(HAZMAT)that requires ,x placarding(example placards will be displayed on the vehicle) 71 m — CARRIER NAME Z ' l I ^ I ADDRESS D N II CITY/STATE/ZIP 0 Not ToSacks I MOTOR CARR ID ❑ Interstate ElIntrastate ❑ Not in Comm./Govt. Not in Comm./Other USDOT NO. ILCC NO. m Source of above Z . own tank)? ❑ Yes ❑ No ❑ Unknowr D Did HAZMAT Regulations violation contnbute to the crash? r ❑ Yes ❑ No ❑ Unknown g Did Carrier Safety Regulations MCS)violation contribute to the crash? ID Yes No ❑ Unknown 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 0 _ m — X IDOT PERMIT NO WIDELOAD? ❑Yes ❑No 2 TRAILER VIN 1 m to LOCAL USE ONLY TRAILER VIN 2 m D TRAILER WIDTH(S) 0-96'1 97-102'1 >102 m T TRAILER 1 ❑ ❑ ❑ Z TRAILER 2 ❑ ❑ ❑ o U 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft 2 ft. Z White Grayrn - 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