Loading...
HomeMy WebLinkAbout2024-00062228 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 1111111 DIII III Ifi IIIIIII II 1111111111111111111� I 1110101111II DRAG TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X0035/2224 u, 1 U21 2 4 1 U1 3 U2 1 U, 1 U2 1 Ut 1 U2 1 4 10 Ut 3 U2 1 *P 0119* INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW DAMAGE TO ANY El$500 OR LESS TYPE OF REPORT El A No Injury J Drive Away Elgin Police Department ONE PERSON'S ❑$501-$1.500 ®ON SCENE 1 El NOT ON SVEHICLE/PROPERTY in OVER$1.500 El AMENDEDCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash YR 2024I2024-00062228 VENT * ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 'IT HOPPS RD ® ❑ 09 gin RELATED ®Y ❑N 09 28 2024 :19 ❑AM ❑YES ®NO U1 ,•< PRIVATE mo /day I yr ®PM FLOW CONDITION m FT J MI N E S W WALNUT ) Kane HIT&RUN ❑Y CZN PEDALCYCUST®N ® FREE FLOW # LNS 0 tg ORR/ER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EOUES ❑say ❑Ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 n FOR DAMAGED AREA(S) FRONT TOWED Ut O 1 2 / 2 1 J 1 9 9 5 Chevrolet Cruze 2013 00-NONE /�DIJETOCRASH NAME(LAST,FIRST,M) . Laura mo day yr 0 Q O ® ❑ 13-UNDERCARRIAGE FIRE ❑ IA SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 10 z DISTRACTED 0 El U2 O rll 6033 W NORTH AVE F ❑Y El NSYSTEM DUNK VEH. O ATCRASH D 0 99-UUTHER NKNOWN 9 16-TOP 3 Distraction Value ALGN = T. CITY PLATE NO. STATE YEAR POINT OF 6 j 6 4 COM VEH 0 ® 1 0 1 G1 PH5SB7D7106499 First Chicago Insurance ❑Y ®N U2 m EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER RSUR m 99 9 Same I Ls 1030946-00 1 o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET.CITY,STATE,ZIP PHONE NUMBER r •'' RESPONDER Same VEHU 73 i L ❑Y ®N 2 t7 ®DRIVER ❑ PARKED 0 DRNERLESS ❑ PED ❑PEGS. ❑EOUES 0 WV ❑NCV 0 DV DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N U1 m m / J FOR DAMAGED AREA(S) FRONT TOWED NAME(LAST,FIRST,M) Reyes. Patricia 0 9 mo a 0 1 9 v 5 Ford F150 2012 oo-NONE 1ti 12 DUE EOCRASH O 0 U2 2 —I v 13-UNDER CARRIAGE 0 I:_ZC : STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) ® DISTRACTED 0 ® SPDR n a` 1819 MAPLE AVE F SYSTEM IN O ENGAGED 0 15-OTHER O9 16-TOP 3 0 X ❑Y ® N DUNK VEH. AT CRASH 99-UNKNOWN •Distraction Value - N CITY STATE ZIP INJ EJCT EPTH PLATE Na STATE YEAR POINT OF ©III 6 li 4 COM VEH ❑ ® U1 to I— FIRST CONTACT 10 7___1 • 5 •It Yes,See Sidebar Hanover Park IL 60133 0 2984348B IL 2024 I 0 M TELEPHONE DRIVER'S LICENSE NO. STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0 (630)254-3346 R200698075868 IL D 0 1 FTFW1 CF4CKD89328 State Farm ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST.FIRST,M) POLICY NUMBER 1 I 99 9 Same 0969761-sfp-13 BAC 3 HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE.ZIP PHONE NUMBER 996 < 0 RESPONDER Same U1 = (UNIT) (SEAT) (DOBi (SEX) (SAFT) (AIR) (INJI (EJCTI (EPTH) PASSENGERS 8 WITNESS ONLY (NAME'/-(ADDRESS)/(TELEPHONEI (EMS) (HOSPITAL) 2 3 03 /1 1 /2013 M 2 3 0 1 0 Johnathan A. Reyes/1819 MAPLE AVE,Hanover Park,IL,60133 Refused 996 m (630)254-3346 U2 m / / #OCCS D / /• U1• 1 m / / 2 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 09/28 /2024 09 19 ®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 a 2 ❑ 2 99 / / 0 PM ❑Construction * N 3 0 ®CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME AM ❑Maintenance uz 7 Q 1 CO 11 4 ARREST NAME Calderon. Laura 11-901-A 1528-000147 / / El PM SLMT o u ® 'CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ❑Utility o N AM I 2 0 ARREST NAME Calderon. Laura 6-101 1528-000148 09/28 /2024 09 45 RI RA0 Unknown work zone type Ut 45 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑qM Workers present? ❑Y 45 1528-Rivera. Kevin 702 334-Fries 10 /28/2024 01 30 0 PM IZI 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 l0 ADDITIONAL UNITS FORMS } A CMV is defined as any motor vehicle used to transport passengers or property and. D N 1 Has a weight rating more than 10,000 pounds(example truck or truck/trailer r '. 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 d i -` ` r r r (example.shuttle or charter bus)-or 0 hopps7rm Linn fez t•-----i_----� i_ t )- t designed employeeslin the courseaof theiremployment(example�emapbYeerier O�3. I s } trans transporter-usually a van type vehicle or passenger car).or w i_____A____: : i , la, : i r i 4 Is used or designated to transport between 9 and 15 passengers,including the driver, C Unit i for direct compensation(example.large van used for specific purpose).or O L____-:_____1 1 ; , -: i i 5 Is any vehicle used to transport anyhazardous material(HAZMAT)that requires rn m placarding(example placards will be displayed on the vehicle) M L CARRIER NAME Z YYWnut7Creek7Dr ADDRESS 17 cn . To . I C) CITY/STATE/ZIP ' - MOTOR CARR ID ❑ Interstate ❑ Intrastate ❑ Not in Comm./Govt. ❑ Not in Comm./Other Not To Scale I I : - USDOT NO. ILCC NO. m XI , Source of above Z . MCS ❑Yes ❑ No ❑Unknown Out of Service ❑Yes ❑No C 2 Form Number 0 _ m — X IDOT PERMIT NO WIDELOAD? ❑Yes ❑No 2 ' TRAILER VIN 1 m CA 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 Red Red u 1 TOWED - TOTAL VEHICLE LENGTH ft. NO.OF AXLES DUE TO ❑,r DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT- 2 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