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HomeMy WebLinkAbout2024-00061449 ILLINOIS TRAFFIC CRASH REPORT sheet 1 of 4 Sheets 1111111 010 III Ifi IIII lull 11111111111 11011101111101111011 DRAG TRFD TRFC WEAT DRVA VIS VEND LGHT COLL 'MANY X003566416 u, 1 U21 3 4 1 U1 2 U2 1 U, 1 U2 2 Ut 1 U2 1 1 11 Ut 1 U2 1 *P 0119* INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW DAMAGE TO ANY El$500 OR LESS TYPE OF REPORT El A No Injury J Drive Away Elgin Police Department ONE PERSON'S ❑$501-$1.500 ®ON SCENE 2 El NOT ON SVEHICLE/PROPERTY in OVER$1.500 El AMENDEDCENE(DESK REPORT) 0 B Injury and/or Tow Due To Crash YR 2024I 2024-00061449 VENT * ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 'IT N RANDALL RD El ❑ RELATED ®Y ❑N 09 25 2024 03:21 DAM '� YES 0 NO U1 • ,•< Elgin PRIVATE mo /day I yr ®PM FLOW CONDITION m 0 S W West Hi ) Kane HIT&RUN ❑Y ® N PEDALCYCUST®N ® FREE FLOW # LNS ' 0 tg oRNER 0 PARKED 0 DRIVERLESS ❑ PED ❑PEDAL ❑ECUES 0 NW ❑NCV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 5 C) FOR DAMAGED AREA(S) Fi20 1T TOWED Ut O NAME(LAST,FIRST,M) 0 6 / day1 4 /1 9 9 8 Hyundai Accent 2019 Do-NONE 11 ©i 1 DUE TO CRASH El ❑ 13-UNDER CARRIAGE 10 I I• 2 FIRE ❑ Ill SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 ® U2 5 m 266 PARK RIDGE CT F ❑Y ESYlM❑UNK VEH. O AT CRASH D 0 99-UUTHER NKNOWN 9 16-TOP 3 ,Distraction Value ALGN = CITY PLATE NO. STATE YEAR POINT OF 8 1� 6 1 4 COM VEH ❑ ® 3 O a ~ 3KPC24A39KE075443 State Farm ❑Y ®N U2 m V. EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER RSUR m a 99 9 Same 0255226 SFP 13 1 r o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET.CITY,STATE,ZIP PHONE NUMBER '' RESPONDER Same VEHU X L ❑Y ®N 2 05 ®DRIVER ❑ PARKED ❑DRNERLESS ❑ PED ❑PEDAL ❑EQUES 0 WV ❑NOV 0 DV DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) U1 m m / J FOR DAMAGED AREA(S) FRONT TOWED Y N s Yang.Gongyu 0 6 0 8 1 9 6 3 Toyota Corolla 2012 00-NONE 1t i'_1 DUE TO CRASH ❑ DA 2 —I , NAME(LAST,FIRST,M) gY mo day yr ©, C a 13-UNDERCARRIAGE 101 fj 2 FIRE ❑ ® U2 C c STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 IN SPOR C) SYSTEM IN O ENGAGED 0 15-OTHER 9 16-TOP 3 0 X a` 23 WESCOTT LN M ❑Y ® N ❑UNK 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 al FIRST CONTACT 6 7__•- -;_S •bYes,See Sidebar Z SOUTH BARRINGTON IL 60010 0 EC87171 IL 2023 I 0 cn M TELEPHONE DRIVER'S LICENSE NO. STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0 (847)312-3494 Y520-2806-3163 IL D 0 JTDEAMDE5MJ029610 All State ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST.FIRST,M) POLICY NUMBER 1 I 99 9 Same 922 593 283 Bnc ' 3 HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE.ZIP PHONE NUMBER 996 < 0 RESPONDER Same Ut 2 (UNITE i SEAT) (DOBi ISEX) ;SAFT) (AIR) (INJI (EJCTI (EPTH) PASSENGERS&WITNESS ONLY (NAME'/tADDRESS)/ITELEPHONE) (EMS) (HOSPITAL) - 3 3 01 /21 /2014 M 2 3 0 1 0 Sajjan Wu/4200 N STURBRIDGE DR,Hoffman Estates,IL,60192 Refused 996 ,- (847)910-8440 , U2 m / / #OCCS D / / u1• 1 m / I 1 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME El AM Did crash occur 0 Y U2 Z N ® 11 1 co 9/ /5/ /024 03 21 ®PM in a Work Zone? ElN DIRP D 1 r PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME 0 AM If YES check one below: U1 1 T 2 0 28 03 ! I 0 PM El Construction * N 3 0 ®CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 1 ❑AM ❑Maintenance U2 Q • ARREST NAME Arroyo,Guadalupe 11-601 451-1553 / / ❑PM SLMT ® 11 1 0 Utility p U CITATIONS ISSUED PENDING ROAD CLEARANCE TIME SECTION CITATION NO. N AM 50 I 2 ID1 1 1 ARREST NAME 9/ 151 /024 03 35 ®PM 0 Unknown work zone type U1 T 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑qM Workers present? ❑Y 50 451-Nisivaco, Russell 602 334-Fries 11 / 12/2024 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. _ F MORE THAN ONE CMV IS INVOLVED,USE SR 1050A ADDITIONAL UNITS FORMS _ , A CMV is defined as any motor vehicle used to transport passengers or property a+ and. Z I j 01 Has a weight rating more than 10,000 pounds(example truck or truck/trailer Z combination)or —I , +, \ 1 I I ® r INDICATE NORTH XI \ r I BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver n ' .- J. J. ', i \ I 1 Not 7b Sc.,. I ` ` r r r (example shuttle or charter bus)-or \ I 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier 0 i_-----;-----% J - l' i transporting employees in the course of their employment(example.employee M W4Highland7Ave \ V transporter-usually a van type vehicle or passenger car).or w -____A____: : , \ . r 4 Is used or designated to transport between 9 and 15 passengers,including the driver, C \..T.'.:,', i for direct compensation(example:large van used for specific purpose).or O L____"-____; i. i i 5 Is any vehicle used to transport anyhazardous material(HAZMAT)that requires -13 rn 4.. placarding placarding(example placards will be displayed on the vehicle) 71 1 Unit 3 I\ N. _ X. 1 \N CARRIER NAME ' 10 .. ADDRESS '� N (n '• CITY/STATE/ZIP 0 N?Randalt Unit 1 MOTOR CARR ID ❑ Interstate ❑ Intrastate • T F ❑ Not in Comm./Govt. Not in Comm./Other � I ❑ O 'r , USDOT NO. ILCC NO. m , • Source of above Z • . 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 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 7a IDOT PERMIT NO WIDELOAD? ❑Yes ❑No S TRAILER VIN 1 m N LOCAL USE ONLY TRAILER VIN 2 m 0 TRAILER WIDTH(S) 0-96'1 97-102'1 >102 m T TRAILER 1 ❑ ❑ ❑ Z -74 TRAILER 2 ❑ ❑ ❑ 0 U 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft 2 ft. Z White Blue u 1 TOWED - TOTAL VEHICLE LENGTH ft. NO.OF AXLES DUE TO ❑X DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT- 3 TOWED BY/TO Adieu/Impound Lot Garage SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT. 1 TOWED BY/TO: DUE TO © VEHICLE CONFIG CARGO BODY TYPE LOAD TYPE