Loading...
HomeMy WebLinkAbout2024-00061682 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets liii Ill 010 III )III III ll II 11111111111 1101110111111 III III I I DRAG TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X003566432- u, 9 uz 1 1 1 1 U199 uz 1 U1 99 u2 1 U1 99 U2 1 1 12 u1 1 U213 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY ®$500 OR LESS TYPE OF REPORT ® q No Injury J Drive Away AGENCY CRASH REPORT NO. TRFW Elgin Police Department ONE PERSON'S ❑$501-$1.500 El ON SCENE[23 NOT ON • 1 VEHICLE/PROPERTY El OVER$1.500 ❑AMENDEDCENE(DESK REPORT) ❑ B Injury and JorTow Due To Crash YR 2024I2024-00061682 VENT * ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH gg 'r1 DUNDEE AVE ❑Elgin RELATED ❑Y coN 09 26 2024 08:40 ®AM El ®No u1 -< PRIVATE mo /day I yr ❑PM FLOW CONDITION m 0 I MI N E COUNTY PROPERTY El M N DOORING ❑Y #OF MOTOR ❑SLOW 15 N/2:16 ® O W Cooper AveAVe 'WITH VEHICLES INVLD El STOPPED U2 —I ❑ AT INTERSECTION WITH NAME OF ) Kane HIT&RUN ®Y ElN PEDALCYCUST®N ® FREE FLOW # LNS 0 tg DRNER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EOUES ❑NIN ❑NCV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 0 / / FOR DAMAGEDAREA(S) FRONT TOWED U1 .0. Unknown Unknown DO-NONE 11 12 i' , DUE TO CRASH 0 NAME(LAST,FIRST,M) mo day yr ,3-UNDER CARRIAGE ��) 2 FIRE ❑ IA SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 I� U2 4 < I UNKNOWN UNKNOWN ❑Y ❑SM NE El UNK VEH. 9 AT CRASH IN ENGAGED9 ®-U15-UNKNOWN THER 8 16-TOP .Distraction Value ALGN - CITY PLATE NO. STATE YEAR POINT OF l COM VEH 0 ® 1 0 rA UNKNOWN Unknown ❑Y ❑N U2 m EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER RSUR Y Same Unknown 1 m o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET.CITY,STATE,ZIP PHONE NUMBER '' RESPONDER Same VEHU X L ❑Y ®N 99 0 5 ®DRIVER ❑ PARKED 0 DRNERLESS ❑ PED ❑PEDAL ❑EOUES 0 WV ❑NCV 0 DV DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) U1 m m / / FOR DAMAGED AREA(S) FRONT TOWED Y N , NAME(LAST,FIRST,M) Arreola. Lizette 0mo lday 2 0 0 5 Toyota RAV4 2014 00-NONE 11:; 1$ . s FIREETo cRasH ❑❑ ® U2 2 C c yr 13-UNDER CARRIAGE c STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 10 DISTRACTED 0 ® SPDR 1 SYSTEM IN O ENGAGED 0 15-OTHER 9 16-TOP 3 9 X 1140 DENVER DR F ❑Y 0 N 0 UNK VEH. AT CRASH 99-UNKNOWN •Distraction Value N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8 II ll 4 COM VEH ❑ ® U1 Ca F„ FIRST CONTACT 7 Q� 6 -5 •If Yes,See Sidebar 60110 0 BP84090 IL 2025 REAR O cn M TELEPHONE DRIVER'S LICENSE NO. STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0 (847)912-0430 A640-5200-5739 IL D 0 JTMDFREV9ED073120 State Farm ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST.FIRST,M) POLICY NUMBER 1 I ARREOLA- BERARDO 1113742SFP13 BAG 3 HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE.ZIP PHONE NUMBER 996 < RESPONDER 1 140 DENVER DR.60110 (847)668-5629 U1 = (UNIT) (SEAT) ;DOB) (SEX) (SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME){{ADDRESS){{TELEPHONE) {EMS) (HOSPITAL) I I - uz 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 0 Y U2 Z N i ® 11 1 09/26 /2024 02 45 ®PM in a Work Zone? ®N DIRP D 1 1 PROPERTY OWNERS ADDRESS:STREET.CITY,STATE,ZIP PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME El AM It YES check one below: U1 5 C) T 2 ❑ 18 18 ! 1 0 PM ❑Construction * N 3 0 0 CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME ❑AM ❑Maintenance uz 5 Q 1 ® 11 1 ARREST NAME / / ID PM ❑Utility SLMT p U CI CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME o N B AM 30 2 0 ARREST NAME { / ptil ❑Unknown work zone type Ut T OFFICER ID SIGNATURE BEAT/DIST. • SUPERVISOR ID. COURT DATE TIME 2 2 3 0 ❑AM Workers present? ❑Y 30 537-Sanders, Richard 102 334-Fries / / ❑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 ' ; , Mot Tb&We j ' D r_.._r____ ; ; .; } A CMV is defined as any motor vehicle used to transport passengers or property and. Z 01 Has a weight rating more than 10,000 pounds(example.truck or truckrtrailer -< r I I i combination) or INDICATE NORTH XI BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C i ', ', i -` ` r r r (example.shuttle or charter bus)-or C) I X 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier 0 i------;-----� i -t } - t transporting employees in the course of their employment(example.employee XI w transporter-usually a van type vehicle or passenger car).or i_. ...... ...:. i , I [ ' ' ' I I. . 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 11 L_____:____-1 i i 5 Is any vehicle used to transport any hazardous material(HAZMAT)that requires placarding(example placards will be displayed on the vehicle) Zml ` I CARRIER NAME Z ' i. t ADDRESS 0I N ' CITY/STATE/ZIP ' ITT - MOTOR CARR ID ❑ Interstate ❑ Intrastate 0 Not in Comm./Govt. ElNot in Comm./Other Q 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? O ❑ 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 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 ❑ ❑ ❑ o U 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft 2 ft. Z White - u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT- 9 TOWED BY/TO 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