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HomeMy WebLinkAbout2024-00063165 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 1111111 DIII III I IIIIIII II 1111111111111101111111111111111 I I DRAG TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X00357:292- u, 1 U21 1 1 1 U, 4 u2 1 U, 1 U2 1 Ut 1 U2 1 1 11 U1 14 U211 *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 0 OVER$1.500 ❑AMENDEDCENE(DESK REPORT) ® B Injury and JorTow Due To Crash YR 2024I2024-00063165 VENT ADDRESS NO. 'HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 'F'I S RANDALL RD ®gin El ❑Y coN 10 03 2024 02:17 ❑AM ❑YES ®No u1 ,< PRIVATE mo /day I yr ®PM FLOW CONDITION m FT/MI N E S W BOWES RD 'COUNTY PROPERTY El ®N DOORING ❑Y #OF MOTOR ®SLOW 1 U) ❑ 'WITH VEHICLES INVLD ❑ STOPPED U2 —I El AT INTERSECTION WITH (NAME OF ) Kane HIT&RUN 0 Y CZN PEDALCYCUST®N ❑ FREE FLOW # LNS 0 tg DRNER ❑ PARKED ❑ERNERLESS ❑ PEE ❑PEDAL ❑EOUES 0 NIN ❑Rcv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 6 0 1 2 FOR DAMAGED AREA(S) FRONT TOWED Ut O NAME(LAST,FIRST,M) ,Aurianna.J. mo / day yr 9 J 2 0 0 4 Toyota COROLLA 2007 Do-NONE 11 O� , DUE TO CRASH ® ❑ 13-UNDERCARRIAGE 101 I FIRE IDIIASTREET SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ❑ ® U2 6 2 m 1954 ASBURY BLVD F ❑Y ®SYSNEM❑UNK VEH. 0 ATCRASH 99-UUTHER NKNOWN 9 76-TOP 3 Distraction Value 9 ALGN I CITY PLATE NO. STATE YEAR POINT OF 6 1� 6 1 4 •COM VEH ❑ ® 1 O 1NXBR32E77Z825086 Geico ❑Y ®N U2 m B EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER RSUR m a 99 9 Same 6174-39-83-44 1 o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET.CITY,STATE,ZIP PHONE NUMBER > '' RESPONDER Same VEHU L ❑Y ®N 2 0 5 ®DRIVER ❑ PARKED 0 DRNERLESS ❑ PED ❑PEDAL ❑EQUES 0 WV ❑ncv 0 ov DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) U1 m m / J FOR DAMAGED AREA(S) FRONT TOWED Y N s Phillips,Thomas- M. 0 8 1 8 1 9 3 7 Honda Insight 2019 00-NONE ,t' �' , DUE TO CRASH ❑ ® 2 Xi , NAME(LAST,FIRST,M) p mo day yr ©, I', t3-UNDER CARRIAGE 10 Ij 2 FIRE ❑ IN U2 C STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 ® SPUR C0 E. 1845 SHEFFIELD DR M SYSTEM IN Q ENGAGED Q 15-OTHER 9 16-TOP 3 9 9 X ❑Y El DUNK VEN. AT CRASH 99-UNKNOWN •Distraction Value N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8 i all! 4 COM VEH ❑ ® U1 to H FIRST CONTACT 6 7__ 5 •If Yes,See Sidebar ELGIN IL 60123 0 AZ27012 IL 2024 1 0 (Cn M TELEPHONE DRIVER'S LICENSE NO. STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0 (630)217-2240 P412-8333-7235 IL D 0 19XZE4F59KE015786 State Farm ❑Y ®N RDEF73 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST.FIRST,M) POLICY NUMBER 1 I 99 9 Same 3406761-SFP-13 BAC 3 HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE.ZIP PHONE NUMBER 996 < 0 POND El N Same U1 = (UNIT) /SEAT) ;DOB/ (SEX) (SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)I(ADDRESS)H(TELEPHONE) (EMS( (HOSPITAL) 2 3 05 /20/1939 F 2 4 0 1 0 Rita Z. Phillips/1845 SHEFFIELD DR,ELGIN-IL.60123 996 1— (847)697-0153 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 0 Y U2 Z N ® 11 1 10/3/ /024 02 23 0 pm in a Work Zone? ®N DIRP co 1 r PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME ❑AM It YES check one below: U1 5 0 T 2 0 28 06 / I 0 PM ❑Construction * N 3 0 ®CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME ❑AM ❑Maintenance uz 5 Q ® 11 1• ARREST NAME Miranda.Aurianna,J. 11-601-Ax 499000709 / / ❑PM SLMT o U 0CITATIONS ISSUED 0PENDING 'SECTION CITATION NO. ROAD CLEARANCE TIME ' ❑Utility rnII AM 45 I 2 0 1 1 1 ARREST NAME r / ptit El Unknown work zone type Ut 2 2 3 El OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 45 499-Dirck Cameron 801 404-Duffy 10 /22/2024 09 00 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 ADDITIONAL UNITS FORMS ; _� } A CMV is defined as any motor vehicle used to transport passengers or property and. D I i i 01 Has a weight rating more than 10,000 pounds(example.truck or truck/trailer Z , r 1 i ; I I I . _. l. combination) or Not To Solo INDICATE NORTH X1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C } i J. d i I I I -t ` r r r (example'.shuttle or charter bus)-or y p X IN�I I ) 3. Is designed to carry 15 or fewer passengers operatedby a and contract carrier sso act n0 e ---- ----� f } } } transporting employees in the course of their employment(example employee 0 i I I I transporter-usually a van type vehicle or passenger car).or CO i_____A__...: : , I ~ : i r i 4 Is used or designated to transport between 9 and 15 passengers,including the driver, N I ) for direct compensation(example:large van used for specific purpose).or O L____L____4 4 ; I Ni i } i 5 Is any vehicle used to transport any hazardous material(HAZMAT)that requires m �°" I I I I placarding(example placards will be displayed on the vehicle) 11 CARRIER NAME Z ' t ADDRESS 0 To 1 I I I I ri to • I I I I • CITY/STATE/ZIP , MOTOR CARR ID ❑ Interstate ❑ Intrastate . l I I I I 0 Not in Comm./Govt. El Not mComm/Other ' USDOT NO. ILCC NO. m , Source of above 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 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 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 m TRAILER 1 ❑ ❑ ❑ Z -74 TRAILER 2 ❑ ❑ ❑ o U 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft 2 ft. Z Gray Silver u 1 TOWED - TOTAL VEHICLE LENGTH ft. NO.OF AXLES DUE TO ❑,r 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 DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT. 2 TOWED BY/TO: DUE TO © VEHICLE CONFIG CARGO BODY TYPE LOAD TYPE