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HomeMy WebLinkAbout2024-00062004 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets liii Ill III III 0 lu II 1111111111111111111111011111111 �DRAG TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X0035;2226 ut 9 U2 1 1 1 Ut 9 U2 1 ut 99 U2 U1 99 U2 1 4 9 U123 U221 *P 0119* INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW DAMAGE TO ANY 0$500 OR LESS TYPE OF REPORT ® q No Injury J Drive Away Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE • 7 0 NOT ON SVEHICLE/PROPERTY 0 OVER$1.500 ❑AMENDEDCENE(DESK REPORT) ❑ B Injury and/or Tow Due To Crash YR 2024I2024-00062004 VENT * ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 3 -n LARKIN AVE ❑Elgin RELATED ❑Y coN 09 27 2024 09:33 ❑AM ❑YES ®NO U1 ,< PRIVATE mo /day/yr ®PM FLOW CONDITION m 'COUNTY PROPERTY ®Y ❑N DOORING ❑Y #OF MOTOR ❑SLOW 1 U) ElFT/MI N E S W 'WITH VEHICLES INVLD ® STOPPED U2 —I ❑ AT INTERSECTION WITH (NAME OF ) Kane HIT&RUN ®Y 0 N PEDALCYCUST®N 0 FREE FLOW # LNS ' 0 D4 ORNER ❑ PARKED ❑ORNERLESS ❑ PEO ❑PEDAL ❑EOUES 0 NW 0 Ncv 0 DV DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 00 n / / FOR DAMAGED AREA(S) FRONT TOWED U1 .0. Chrysler Town&Country 2016 00-NONE 11 12 i' , DUE TO CRASH p21 NAME(LAST,FIRST,M) mo day yr t3-UNDER CARRIAGE 1 FIRE 0 1l 10 2 00 m SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED U2 M SYSTEM IN O ENGAGED 0 15-OTHER 9 16-TOP 3 = ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN 'Distraction Value 9 ALGN r CITY PLATE NO. STATE YEAR POINT OF 6 {I�jl 4 COMVEH 0 ® 1 0 F 2C4RC1 BGXGR157372 UNKNOWN ❑Y ❑N U2 m m EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER RSUR m a Coc-Choc, Ricardo UNKNOWN 1 r o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET.CITY,STATE,ZIP PHONE NUMBER V. RESPONDER 25 ALAMEDA DR.60110 VEHU X L ❑Y ®N 2 0m 0 DRIVER ® PARKED 0 DRNERLESS ❑ PED ❑PEDAL ❑EQUES 0 NMV ❑Ncv 0 os DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) U1 • m m / / FOR DAMAGEDAREA(S) R2C IT TOWED Y N s Hyundai Sonata 2019 00-NONE tt' i'_t DUE TO CRASH ❑ ® 2 —I NAME(LAST,FIRST,M) mo day yr ©, XI 13-UNDER CARRIAGE 10) f 1 2 FIRE ❑ IN U2 C c STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 ® SPCA C) a SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16-TOP 3 X ❑Y ® N 0 UNK VEH. AT CRASH 99-UNKNOWN 8 4 •Distraction Value 9 Ut 9 POINT OF N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR II COM VEH ❑ ® C H FIRST CONTACT 12 7__.1 a_5 •(ryes,See Sidebar BR42062 IL 2025 1 0 (p M TELEPHONE DRIVER'S LICENSE NO. STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0 5NPE24AF4KH781525 Progressive ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 I Aguilera Nava. Maria. F. 947556602 BAC ' 3 HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET.CITY.STATE.ZIP PHONE NUMBER 996 < 0 Y RESPONDER 41 WOOLAND AVE. Elgin. IL.60123 (224)833-2489 Ut 2 (UNIT( I SEAT) i DOB) (SEX) (SAFT) (AIR) IINJI (EJCTI (EPTH) PASSENGERS&WITNESS ONLY (NAME!!(ADDRESS)/(TELEPHONE) (EMS) (HOSPITAL) 2 4 08 /26/2024 F 13 4 0 1 0 Camila Escobar/41 WOODLAND AVE,ELGIN.IL.60123 996 1— (224)281-2871 , U2 m 2 5 07 /2 3/2022 F 12 4 0 1 0 Bianca E. Escobar/41 WOODLAND AVE.ELGIN-IL-60123 #OCCS D (224)281-2871 _ X 2 6 07 /2 0/2022 F 12 4 0 1 0 Fernanda Escobar/41 WOODLAND AVE.ELGIN.IL.60123 lit1 m (224)281-2871 , D / / 3 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME co DAMAGED PROPERTY POLICE NOTIFIED TIME El AM Did crash occur 0 Y U2 Z N 1 ® 18 5 09/27 /2024 10 30 0 pm in a Work Zone? El DIRP D 1 I PROPERTY OWNERS ADDRESS:STREET.CITY,STATE,ZIP PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME ❑AM It YES check one below: U1 7 C) T 2 0 30 28 ! 1 0 PM ElConstruction * N 3 0 0 CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME AM ❑Maintenance uz 3 Q 1 ® 11 9 ARREST NAME / / ❑PM 0 Utility SLMT p U ❑CITATIONS ISSUED 0 PENDING SECTION CITATION NO. ROAD CLEARANCE TIME o N B AM OO T 2 0 ARREST NAME 1 / ppl Ut ❑Unknown work zone type OFFICER ID SIGNATURE BEAT/DIST. • SUPERVISOR ID. COURT DATE TIME present? El Y OO 1508-Salgado. Leandro 602 - 1 / p 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 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 and. n 1 Has a weight rating more than 10,000 pounds(example truck or truck/trailer r ; ; ; ; combination) or INDICATE NORTH Z�1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C 1 ', ' 1660?Larkin?Ave?(Jewel?Osco) u -I. ` r 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_. ..... _. 4 t i t - i transporting employees in the course of their employment(example.employee ,3 Not To Scale ? transporter-usually a van type vehicle or passenger car) or w i I t : .1- r 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 L____--____; i t t y 1 5 Is any vehicle used to transport any hazardous material(HAZMAT)that requires m placarding(example placards will be displayed on the vehicle) M CARRIER NAME Z ' t ADDRESS 0 'IL r To , J �:- CITY/STATE/ZIP r , MOTOR CARR ID ❑ Interstate ❑ Intrastate 0 Not in Comm./Govt. El Not in Comm./Other r , ^ USDOT NO. ILCC NO. XI , 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 l 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 — X IDOT PERMIT NO WIDELOAD? ❑Yes ❑No 2 TRAILER VIN 1 m to LOCAL USE ONLY TRAILER VIN 2 m 0 TRAILER WIDTH(S) 0-96'1 97-102'1 >102 m m TRAILER 1 ❑ ❑ ❑ Z -74 TRAILER 2 ❑ ❑ ❑ o u 1 COLOR u 2 COLOR TRAILER LENGTH(S)1 ft 2 ft. Z Silver Black - u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT 1 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