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HomeMy WebLinkAbout2024-00062409 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets liii Ill DIII III I IIIIIII II 1111111111111101111HI 11111110 II DRAG TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X0035;4359* u, 1 U21 2 4 1 U1 5 U2 1 U, 1 U2 1 U1 1 U2 1 1 10 U1 4 U2 4 *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 [23 NOT ON SVEHICLE/PROPERTY in OVER$1.500 0 AMENDEDCENE(DESK REPORT) ❑ B Injury and JorTow Due To Crash YR 2024I2024-00062409 VENT * ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 71 S MCLEAN BLVD ® ❑ Elgin RELATED ®Y ❑N 09 29 2024 05:00 DAM YES ®No u1 ,< PRIVATE mo l day I yr ®PM FLOW CONDITION m COUNTY PROPERTY ®Y 0 N DOORING ❑Y #OF MOTOR ❑SLOW 15 N ❑ FT/MI N E S W 'WITH VEHICLES INVLD ® STOPPED U2 —I ❑ AT INTERSECTION WITH (NAME OF ) Kane HIT&RUN ❑Y ® N PEDALCYCUST®N ❑ FREE FLOW # LNS 0 tg DRIVER 0 PARKED 0 DRIVERLESS ❑ PED 0 PEDAL 0 EOUES 0 NIN ❑Ncv 0 ov DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 3 n 0 3 / 2 4 /1 9 7 9 FOR DAMAGEDAREA(S) FRONT TOWED U1 .GABRIELLE Chevrolet Equinox 2016 00-NONE 11 .i 72 , DUE TO CRASH p ® - E NAME(LAST,FIRST,M) mo day yr 13-UNDER CARRIAGE FIRE 0 IBI SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 10 O DISTRACTED 0 53 U2 3 m 526 WILCOX AVE F PLATE NO. STATE YEAR POINT OF {I 6 p O COM VEH 0 El 1 O a ~ 2GNFLFEK5G6190773 State Farm ❑Y ®N U2 m EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER RSUR m a Gonzalez, Felix,A. 1208968SFP13 1 m o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET.CITY,STATE,ZIP PHONE NUMBER L RESPONDER 526 WILCOX AVE. ELGIN - IL, 60123 (847)529-2779 VEHU G1 ®DRIVER ❑ PARKED 0 DRNERLESS ❑ PED ❑PEDAL ❑EQUES 0 Nov ❑NCV 0 DV DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) U1 2 m m / / FOR DAMAGED AREA(S) FRONT TOWED Y N 5 NAME(LAST,FIRST,M) Garcia,Griselda 0 6 0 $ 1 9 9 0 mo day yr Nissan Rogue 2011 00-NONE O' 12 y DUE TO CRASH ❑ ® 2Xi v 13-UNDER CARRIAGE 101 ! z FIRE ❑ ElU2 C : STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 IN SPDR n SYSTEM IN O ENGAGED 0 15-OTHER 9 16-TOP 3 0 X E 1264 AMAN DA Cl R F ❑Y ® N ❑UNK 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_5 G•I°MeeVSee Sidebar ® U1 to H ELGIN IL 60123 0 ER228442 IL 2025 1 0 CC11 M TELEPHONE DRIVER'S LICENSE NO. STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0 (224)558-7039 G620-2809-0763 IL D JN8AS5MV3BW687190 Kemper ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST.FIRST,M) POLICY NUMBER 1 I Same 12RA000005604 BAC 3 HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER 996 < 0 RESPONDERY Same U1 = {UNIT) I SEAT) (DOBi ISEX) (SAFT) (AIR) (INJI (EJCTI (EPTH) PASSENGERS&WITNESS ONLY (NAME)/(ADDRESS)/(TELEPHONE) {EMS) (HOSPITAL) 996 1 3 03 /1 7/2014 M 2 4 0 1 Felix G. Gonzalez/526 WILCOX AVE.ELGIN,IL,60123 U2 m m 2 4 09 /1 6/2018 11 4 0 1 Genesis E. Garcia/1264 AMANDA CIR-ELGIN.IL.60123 #OCCS D 2 3 12 /1 1 /1989 M 2 4 0 1 Cornellius A. Ames/7N056 SMITH ST,SOUTH ELGIN.IL.60177 Ut 2 m (224)523-0215 D / / 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 5 09,29 ,2024 07 15 ®pm in a Work Zone? ®N DIRP co 1 I 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 06 ! 1 ❑PM ❑Construction * N 3 0 0 CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 7 ❑AM ❑Maintenance uz Q ® 11 5 ARREST NAME / / ❑PM ❑Utility SLMT 0 U 0 CITATIONS ISSUED El PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ',3N 8AM 10 2 ❑ ARREST NAME , I ptil ❑Unknown work zone type Ut T • OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 0 0 AM Workers present? ❑Y 10 537-Sanders, Richard 602 334-Fries , / ❑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. _ IF MORE THAN ONE CMV IS INVOLVED,USE SR 1050A ADDITIONAL UNITS FORMS r_.._r_ __ ; , _� } A CMV is defined as any motor vehicle used to transport passengers or property and. 0D 1 Has a weight rating more than 10,000 pounds(example truck or truck/trailer r ; ( -; ; combination).or —I INDICATE NORTH 7:1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver n 1 i -! ` r r r (example.shuttle or charter bus)-or X 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier 0 i------:-----% i -i } } i transporting employees in the course of their employment(example.employee M transporter-usually a van type vehicle or passenger car).or 0 J i i 4 Is used or designated to transport between 9 and 15 passengers,including the driver, N 4., —" for direct compensation(example:large van used for specific purpose).or O L____-L____1 i; J I e i ) . 5 Is any vehicle used to transport any hazardous material(HAZMAT)that requires placarding(example placards will be displayed on the vehicle) 11 1 1 t Nat To scare CARRIER NAME Z ' Ii. , ADDRESS 0 N — • - CITY/STATE/ZIP r , , MOTOR CARR ID ❑ Interstate ❑ Intrastate • 0 Not in Comm./Govt. El Not in Comm./Other •r , ' 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 Form Number 0 m 7a IDOT PERMIT NO WIDELOAD? ❑Yes ❑No S TRAILER VIN 1 m N LOCAL USE ONLY TRAILER VIN 2 m 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 Blue Gray - 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