Loading...
HomeMy WebLinkAbout2024-00061700 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 1111111 OIl III (III IIIIIII II 11111111111 1101111111111111111111I DRAG TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X003569034 u, 1 U21 1 1 1 U1 2 U2 1 U, 1 U2 1 Ut 1 U2 1 1 13 Ut 1 U2 1 *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 • 3 0 NOT ON SVEHICLE/PROPERTY in OVER$1.500 0 AMENDEDCENE(DESK REPORT) 0 B Injury and JorTow Due To Crash YR 2024I2024-00061700 VENT * ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 '11 TECHNOLOGY DR El ❑ Elgin RELATED ®Y 0 N 09 26 2024 04:09 ❑AM ❑YES ®NO U1 ,< PRIVATE mo l day I yr ®PM FLOW CONDITION m FT/MI N E S W BUSHWOOD ) Kane HIT&RUN ❑Y CZN PEDALCYCUST®N ® FREE FLOW # LNS O I&DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EOUES ❑Nuv ❑Ncv 0 ov DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N O 0 0 2 / 0 4 /1 9 9 6 FOR DAMAGEDAREA(S) FRONT TOWED U1 . E. Kia Motors Co11io 2012 00-NONE 11 12 , DUE TO CRASH ® ❑ NAME(LAST,FIRST,M) mo day yr 13-UNDER CARRIAGE ( 2 FIRE ❑ IA O E SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) ® DISTRACTED 0 ® U2 m 3526 SONOMA CIR F ❑Y ESYlM❑UNK VEH. O AT CRASH D 0 99-UUTHER NKNOWN 9 16-TOP 3 ,Distraction Value ALGN = T. CITY PLATE NO. STATE YEAR POINT OF 8 I{ 6 II COM VEH 0 El 1 0 3KPA24AD4NE496362 Farmers ❑Y ®N U2 m EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER RSUR m 99 9 Same A7997637050 1 o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET.CITY,STATE,ZIP PHONE NUMBER r •'' RESPONDER Same VEHU 73 L ❑Y ®N 2 0 ®DRIVER ❑ PARKED ❑DRNERLESS ❑ PED ❑PEDALL ❑EDUCE ❑NUM ❑Ncv ❑DV DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N U1 m m / / FOR DAMAGED AREA(S) fi20 IT TOWED s Torres Romo. Miguel,A. 0 8 1 7 1 9 9 5 Honda Accord 2008 00-NONE 1tr I' fffi 0 2 —I , NAME(LAST,FIRST,M) g mo day yr 10 ©i. Y FIRE ❑ ® U2 C c 13-UNDER CARRIAGE : STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 ® SPDR C0 SYSTEM IN O ENGAGED 0 15-OTHER 9 16-TOP 3 0 X E 214 CHANNING CT M ❑Y El N ❑UNK VEH. AT CRASH 99-UNKNOWN F II •Distraction Value N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POFIRSNT T OONTACT 12 7.'1 6 5 C•IOf gee SidebarH ❑ ® U1 to H ELGIN IL 60120 0 EK41220 IL 2023 0 CCn M TELEPHONE DRIVER'S LICENSE NO. STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0 (331)276-7362 T626-5419-5234 IL D 0 1HGCP36878A020633 Unique Insurance ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST.FIRST,M) POLICY NUMBER 1 I 99 9 Same ILP2817397 BAC 3 HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE.ZIP PHONE NUMBER 996 < 0 YRESPO®N Same U1 = (UNIT) I SEAT) (OOEI (SEX) (SAFT) (AIR) (INJ( (EJCT( (EPTH) PASSENGERS 8 WITNESS ONLY (NAME'/(ADDRESS)/(TELEPHONE) (EMS) (HOSPITAL) 2 4 09 /25/2001 M 2 8 B 1 0 Juan E. Torres Romo/214 CHANNING CT.ELGIN.IL.60120 (773)239 0849 U2 Rutland Dundee FirRefused 996 m 2 3 10 /0 9/1999 F 2 8 0 1 0 Fatima Torres Romo/214 CHANNING CT,ELGIN.IL.60120 Rutland Dundee FirRefused #occs y (773)434-8293 _- X , I � U1 1 m / / 3 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME ❑AM Did crash occur ❑Y U2 Z N 1 ® 1 1 4 09/26 ,2024 04 08 ®pM in a Work Zone? ®N DIRP D 1 r PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME It YES check one below: T PROPERTY OWNERS ADDRESS:STREET.CITY,STATE,ZIP ❑AM U1 7 2 0 2 28 09/26 /2024 04 09 ®PM ❑Construction * N 3 0 ®CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 3 ❑AM ❑Maintenance U2 ® 11 4 ARREST NAME Baez,Samantha, E. 11-801-B (YII)451-1554 09/26/2024 04 11 ®PM SLMT o u CITATIONS ISSUED PENDING ROAD CLEARANCE TIME 0 Utility o N SECTION CITATION NO. AM 30 2 0 ARREST NAME 09/26 /2024 05 00 El RA0 Unknown work zone type Ut rY T OFFICER ID SIGNATURE BEAT I DIST. SUPERVISOR ID. COURT DATE TIME ❑Y 30 451-Nisivaco. Russell 901 334-Fries / / 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 ; _� } A CMV is defined as any motor vehicle used to transport passengers or property and. D ( ( 1 Has a weight rating more than 10,000 pounds(example truck or truck/trailer , r 1 1 1 I combination) or —I INDICATE NORTH � BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C , L i_ I I _i i (example.shuttle or charter bus)-or f Not To 5rr�18 r r r i 3 Is designed to carry 15 or fewer passengers and operated by a contract carrier O ----......--- + + I r } } ttransporting employeesmploym nt(example employee in the vehicle of or passenger e e a XI transporter-usually a van type car) or w i_____A____: : i 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____L____; ; . + —thit2 1 5 Is any vehicle used to transport an hazardous material(HAZMAT)that requires Y 11 placarding(example placards will be displayed on the vehicle) 71 ilellnoiopyfflr CARRIER NAME . . . 1 r ' t ADDRESS '� O CITY/STATE/ZIP MOTOR CARR ID ❑ Interstate ❑ Intrastate 0 Not in Comm./Govt. ElNot in Comm./Other Q USDOT NO. ILCC NO. C • , 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 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 0 TRAILER WIDTH(S) 0-96'1 97-102'1 >10; m m TRAILER 1 ❑ ❑ ❑ Z TRAILER 2 ❑ ❑ ❑ 0 U 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft 2 't Z Silver SilverEn u 1 TOWED - TOTAL VEHICLE LENGTH ft. NO.OF AXLES DUE TO ❑X DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT- 3 TOWED BY/TO Arties/Impound Lot Garage SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED X DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT- 3 TOWED BY/TO. DUE TO ❑ Arties/Impound Lot Garage VEHICLE CONFIG _ CARGO BODY TYPE LOAD TYPE