HomeMy WebLinkAbout2024-00061807 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 1111111 DIII III HI I III
III II 11111111111111011111011110111111
DRAG TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X003574360*
u, 1 U21 1 4 1 U1 2 U2 1 U, 1 U2 1 Ut 1 U2 1 5 15 Ut 1 U2 1 *P 0119*
INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW
DAMAGE TO ANY 0$500 OR LESS TYPE OF REPORT 0 A No Injury J Drive Away
Elgin Police Department ONE PERSON'S ❑$501-$1.500 ®ON SCENE •
2
ID NOT ON S
VEHICLE/PROPERTY inOVER$1.500 0 AMENDEDCENE(DESK REPORT) ® B Injury and JorTow Due To Crash YR 2024I2024-00061807 VENT *
ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 'tI
ST CHARLES ST Elgin ❑ RELATED ❑Y coN 09 27 2024 03:30 ®AM ❑YES ®No U1 ,<
PRIVATE mo /day/yr ❑PM FLOW CONDITION m
F r/MI N E S W BENT ST COUNTY PROPERTY El ®N DOORING ❑Y #OF MOTOR ❑SLOW 1 U1
❑ 'WITH VEHICLES INVLD ❑ STOPPED U2 —I
® AT INTERSECTION WITH (NAME OF ) Kane HIT&RUN ❑Y CZN PEDALCYCUST®N ® FREE FLOW # LNS O
I&ORNER 0 PARKED 0 DRIVERLESS ❑ PEO ❑PEDAL ❑EOUES ❑NW ❑Rey 0 ov DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 C)
FOR DAMAGEDAREA(S) FRONT TOWED Ut O
NAME(LAST,FIRST,M) Torres, Francisco.A. mo 1 2 / day
y 7 J 1 9 9 8 Acura TL 2005 00-NONE 11 . 72 , DUE TO CRASH ® ❑
yr 13-UNDER CARRIAGE FIRE
SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 10 O DISTRACTED 0 ® U2 2 m
819 JEFFERSON AVE 3 M / ❑Y El NSYSTEM❑UNK VEH. O ATCRASH D 0 99-UUTHER 9 NKNOWN 8 16 TOPO Distraction Value ALGN =
r CITY PLATE NO. STATE YEAR POINT OF {I 6 i(O COM VEH 0 ® 1 O
~
19UUA66205A022061 NONE ❑Y ❑N U2 m
V. EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER RSUR m
a
99 9 Same NONE 1
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 ❑NOV 0 DV DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) U1 m
m / / FOR DAMAGED AREA(S) .4T TOWED
Y N
s Ale o- Ricardo 0 3 1 31 9 9 7 Nissan Altima 2008 00-NONE 0 1 O 0 2 XI
NAME(LAST,FIRST,M) mo day yr 10' Ojl 2 FIRE ❑ ® U2 XI
v 13-UNDER CARRIAGE
, STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 IN SPDR C)
a 443 VILLA ST M
SYSTEM IN O ENGAGED 0 15-OTHER 9 16-TOP 3 0 X
❑Y El N ❑UNK VEH. AT CRASH 99-UNKNOWN •Distraction Value
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POF
FIRST CNT ONTACT 12 7,:1-6-7 .5 Clrveeal
M See Sideba❑ ® U1C
I— ELGIN IL 60120 0 EM69651 IL 2025 REAR. O f/j
M TELEPHONE DRIVER'S LICENSE NO. STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0
(224)805-6400 A420-7209-7075 IL A 7 1 N4BL21 EX8C257768 American Alliance ❑Y ®N RDEF
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST.FIRST,M) POLICY NUMBER 1 I
99 9 Same ILAA097746400 BAG 3
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE.ZIP PHONE NUMBER 996 <
0 RESPONDER Same U1 =
(UNITE (SEAT) iDOBI (SEX) ISAFT) (AIR) IINJI (EJCT) (EPTH) PASSENGERSB WITNESS ONLY (NAME)I(ADDRESS)((TELEPHONE) EMS) (HOSPITAL)
1 3 11 /03/2000 F 2 8 B 1 0 Evelyn J. Compean/317 BENT ST-ELGIN,IL,60120 Elgin Fire Provena St.Joseph U2 996
(720)365 1397 _ 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 ❑Y U2 Z
N 1 ® 11 1 91 /71 /024 03 37 ❑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 ❑ 2 99 91 171 /024 03 37 ❑PM ElConstruction *
N 11- 1 3 ❑ ®CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 5
®AM ❑Maintenance U2
Q • ARREST NAME Sanchez Torres. Francisco.A. 11-1204-B 1512405 91 /71 /024 03 42 ❑PM SLMT
oN 1 ® 11 1 ®CITATIONS ISSUED 0 PENDING SECTION CITATION NO. ' ROAD CLEARANCE TIME AM' 0 Utility 35
2 0 ARREST NAME Sanchez Torres. Francisco-A. 6-101 1512404 91 171 /024 04 45 El pm0 Unknown work zone type Ut
T
2 2 3 0 • OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑qM Workers present? D Y 30
1512-Juarez-Huichapan.Juan 400 - 11 112/2024 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
. , . " 0
ADDITIONAL UNITS FORMS
4.
r_.._r_ __; ; ; \ _� } A CMV is defined as any motor vehicle used to transport passengers or property and.
1 Has a Z
N I weight rating more than 10,000 pounds(example truck or truck/trailer
{ ' combination) or
0
` INDICATE NORTH 7:1
BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C
' I J Not To Scale 1 r - r (example shuttle or charter bus)-or 0
? \ 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier 0
-- ` } } i transporting employees in the course of their employment(example.employee
transporter-usually a van type vehicle or passenger car).or C
i-____A____i i , i i 4 Is used or designated to transport between 9 and 15 passengers,including the driver,) ` for direct compensation(example.large van used for specific purpose).or O
L____ ____; ; ; , r g � i i 5 Is any vehicle used to transport any hazardous material(HAZMAT)that requII
ires
. placarding(example placards will be displayed on the vehicle) Zml
.a 2#
CARRIER NAME Z
' Unit 1 i. ADDRESS D
N
' \ CITY/STATE/ZIP
:- -.- .; \ \ i. '.. ... .
MOTOR CARR ID ❑ Interstate ❑ Intrastate
❑ Not m Comm./Govt. ❑ Not m Comm./Other OO
. USDOT NO. ILCC NO.
•
, Source of above Z
). ❑ Yes 0 No ❑ Unknown A
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
73
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
Red Silver
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