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HomeMy WebLinkAbout2024-00060380 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 1111111 OIl III I IIIIIII II 11111111111 lIHIUflI 111111 DRAG TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY XQO3565187 u, 1 U21 1 1 1 U1 8 U2 1 U, 1 U2 1 Ut 1 U2 1 1 10 Ut 1 U2 3 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY El$500 OR LESS TYPE OF REPORT ❑ A No Injury J Drive Away AGENCY CRASH REPORT NO. TRFW Elgin Police Department ONE PERSON'S ❑$501-$1.500El NOT ON®ON SCENE 2 VEHICLE/PROPERTY ®OVER$1.500 ❑AMENDEDCENE(DESK REPORT) 0 B Injury and/or Tow Due To Crash YR 2O24I2O24-00060380 VEHT * ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 't'I POPLAR CREEK DR Elgin ❑ RELATED ®Y ❑N 09 20 2024 03:08 ❑AM El YES ®NO U1 ,•< PRIVATE mo /day I yr ®PM FLOW CONDITION m ®/MI N E S W Spruce Ln 'COUNTY PROPERTY ❑Y M N DOORING ❑y #OF MOTOR ❑SLOW 1 Cl) O p Cook HIT&RUN ®Y ❑ N WITH N VEHICLES INVLD 0 STOPPED U2 —I ❑ AT INTERSECTION WITH (NAME OF ) PEDALCYCUST® ® FREE FLOW # LNS 0 tg ORNER 0 PARKED ❑DRIVERLESS ❑ PEO ❑PEDAL ❑EOUES 0 NIN ❑Ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 0 0 3 / 1 6 /2 0 0 7 FOR DAMAGED AREA(S) FRONT TOWED U, , David.0. Jeep(after 19S�goneer 2022 00-NONE 11 .I,z D DUETOCRASH 0 ® - E NAME(LAST,FIRST,M) mo day yr 13-UNDER CARRIAGE 1 FIRE ❑ 21 SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 1D O DISTRACTED 0 1l U2 2 m 44 HIGHBURY DR M / ❑Y ESYlM❑UNK VEH. O AT CRASH D 0 99-UUTHER 9 NKNOWN 8 16 TOP® 'Distraction Value ALGN = r CITY PLATE NO. STATE YEAR POINT OF {I 6 it_ COM VEH 0 El 1 O FIRST CONTACT 2 7__, _�,6 •If Yes,See Sidebar U1 O Z 1C4SJVBT2NS136426 State Farm ❑Y ®N U2 m V. EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER RSUR m 11, 99 9 Mayen,Cindy G53 4507-Al2-13A 1 o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET.CITY,STATE,ZIP PHONE NUMBER r L 0 YONDE J N 44 HIGHBURY DR. ELGIN • IL.60120 (224)789-6029 VEHU GI ® GI DRIVER ❑ PARKED 0 DRNERLESS ❑ PED ❑PEDAL ❑EQUES 0 WV ❑NCV 0 DV DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) U1 2 m m / / FOR DAMAGED AREA(S) FRONT TOWED NAME(LAST,FIRST,M) Joy. Y N s Farmer. A. 0 8 2 6 1 9 7 9 Dodge Charger 2017 00-NONE 13-UNDER CARRIAGE O' DUEFIRE TO CRASH ❑ ® 2 C 9 i 12 ! 2 ❑ ® U2 mo day yr c STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) ® DISTRACTED 0 IN SPOR 1) SYSTEM IN O ENGAGED 0 15-OTHER 9 16-TOP 3 0 X E. 1175 SPRUCE LN F ❑Y ® N DUNK VEH. AT CRASH 99-UNKNOWN II •Distraction Value N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POF FIRST CNT ONTACT 11 7_'1 6 1_S G•I°MeeVSee Sidebar ® U1 to H ELGIN IL 60120 B W-326597 IL 2025 I 0 Sn M TELEPHONE DRIVER'S LICENSE NO. STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0 (773)569-5729 F656-4217-9843 IL D 0 2C3CDXHG7HH623798 State Farm ❑y ®N RDEF73 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST.FIRST,M) POLICY NUMBER 1 I 99 9 Same 1185721-SFP-13 BAG 3 HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER 996 < RESPONDER yO®N Same U1 = (UNITE i SEAT) ;DOB) (SEX) ISAFT) (AIR) iINJI (EJCTI (EPTH) PASSENGERS&WITNESS ONLY (NAMEi/(ADDRESS)/1TELEPHONEI (EMS) (HOSPITAL) 1 3 04 /29/2010 F 1 4 0 1 0 Camila 0. Castaneda/44 HIGHBURY DR•ELGIN.IL.60120 Refused 996 ,- (224)789-6029 , 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 ® 11 1 09/20 /2024 03 08 ®pm in a Work Zone? ®N DIRP D 1 r PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME ❑AM It YES check one below: U1 1 C) T 2 ❑ 20 28 / I 0 PM El Construction * N 3 0 ®CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 7 ❑AM ❑Maintenance U2 • Q El 11 1 ARREST NAME Castaneda, David.0. 11-701 1527000205 / / El PM SLMT oN ®CITATIONS ISSUED ❑PENDING 'SECTION CITATION NO. ROAD CLEARANCE TIME AM' 0 Utility 30 2 0 ARREST NAME Castaneda. David.0. 11-601 1527000206 09/20 /2024 04 00 ®PM 0 Unknown work zone type U1 T OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 0 1527-Juarez.Jorge 302 334-Fries 09 /22/2024 01 30 0 PM workers present? ®N U2 30 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 ; _� } A CMV is defined as any motor vehicle used to transport passengers or property and. D Z 1 Has a weight rating more than 10,000 pounds(example truck or truck/trailer ✓ } I I i INDICATE NORTH combination) or XI BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C ▪ } i I d i -` ` r r r (example.shuttle or charter bus)-or n S 3 Is designed to carry 15 or fewer passengers and operated a contract carrier O - ', ' � by 9 P _ } } } transporting employees in the course of their employment(example.employee 0 0 T"J transporter-usually a van type vehicle or passenger car).or 03 C i____A____: : i , t i } r } 4 Is used or designated to transport between 9 and 15 passengers,including the driver, rn El for direct compensation(example:large van used for specific purpose).or ! I O i____ -____; . , ___ .- ——— -: i } i 5 Is any vehicle used to transport any hazardous material(HAZMAT)that requires m Q placarding(example placards will be displayed on the vehicle) 71 .P.... .= 3,671570 O '1 - CARRIER NAME Z 0 _ To Mi- i t ADDRESS 0 CITY/STATE/ZIP r , MOTOR CARR ID ❑ Interstate ❑ Intrastate tial*� 0 Not in Comm./Govt. El in Comm./Other Q USDOT NO. ILCC NO. m , Source of above Z . IDOT PERMIT NO WIDELOAD? ❑Yes ❑No 2 ' TRAILER VIN 1 m to LOCAL USE ONLY TRAILER VIN 2 m l7 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 Red Red - 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- 3 TOWED BY/TO: DUE TO ❑ © Other/Impound Lot Garage VEHICLE CONFIG _ CARGO BODY TYPE LOAD TYPE