Loading...
HomeMy WebLinkAbout2024-00063423 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets II II DIII III 1In ll 1111111111111101111111�lll I11II DRAG TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY XO035T;;2135 u1 3 U21 3 1 1 UI 7 U2 1 Ut 1 U2 1 U1 1 U2 1 1 11 Ut 1 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 2 0 NOT ON SVEHICLE/PROPERTY in OVER$1.500 0 AMENDEDCENE(DESK REPORT) Ill B Injury and JorTow Due To Crash YR 2024I2024-00063423 VENT * ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 1T N STATE ST El ❑ Elgin RELATED ®Y ❑" 10 04 2024 03:54 ❑AM ❑YES ®No u1 ,•< PRIVATE mo /day I yr ®PM FLOW CONDITION m FT/MI N E S W W CHICAGO ) Kane HIT&RUN ❑Y CZN PEDALCYCUST®N ® FREE FLOW # LNS 0 I&DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EOUES 0 NW ❑Ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 n 0 1 / 0 5 /2 0 0 6 FOR DAMAGED AREA(S) FRONT TOWED UI ,Andrew Acura CL 1998 00-NONE ©' ..'�..D DUE TO CRASH ® ❑ - E NAME(LAST,FIRST,M) mo day yr 13-UNDER CARRIAGE FIRE ❑ 21 SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 10 2 DISTRACTED ® ❑ U2 4 m 1610 YOSEMITE PKWY M SYTM❑Y INS NE ❑UNK VEH. O AT CRASH 0D 99-U 15-UNKNOWN 9 16-TOP 3 ,Distraction Value 7 ALGN = THER W. CITY PLATE NO. STATE YEAR POINT OF 8 . • 5 • FIRST CONTACT 12 7_.1—'--_::_.4 COM VEH ❑ El1 0 Y Yes,See Sidebar U1 Z 19UYA2250WL009990 State Farm ❑Y ®N U2 m EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER RSUR a Sanchez, Heriberto 1361263-SFP-13 1 m I— o HOSPITAL(TAKEN TO) INCIDENT • IF'Y' OWNER STREET.CITY,STATE,ZIP PHONE NUMBER o RESPONDER Y DEN 1610 YOSEM ITE PKWY,Algonquin, I L.60102 (224)523-0347 VEHU GI ®DRIVER 0 PARKED 0 DRIVERLESS ❑ PED ❑PEDAL ❑EDUCE 0 NUV ❑Ncv 0 oV DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) U1 2 GI m m / / FOR DAMAGED AREA(S) FRONT TOWED Y N NAME(LAST,FIRST,M) Callahan, Sean,J_ D mo8 ld 6 1 9 9 D Ford F150 2023 00-NONE it i 1$ s RE o CRASH ❑❑ ® Uz 2 C v 13-UNDER CARRIAGE I I 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 151 DOUG LAS AVE M ❑Y ® N ❑UNK VEH. AT CRASH 99-UNKNOWN •Distraction Value N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6 j ! 4 COM VEH 0 ® U1 to H FIRST CONTACT 6 7__•- ;_5 •It Yes,See Sidebar ELG I N IL 60120 0 3768049B IL 2025 Rr AR 0 CC/) M TELEPHONE DRIVER'S LICENSE NO. STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0 (847)289-2770 C450-7909-0233 IL D 0 1 FTFW1 E86PKE89032 Allstate ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST.FIRST,M) POLICY NUMBER 1 I Same 962 844 635 BAG 3 HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE.ZIP PHONE NUMBER 997 < RENR El Y El N Same U1 = (UNITE (SEAT) ;DOB) (SEX) (SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)/(ADDRESS)/(TELEPHONE) (EMS) (HOSPITAL) I I - U2 996 i- m - #OCCS y / / U1 1 m I I 1 0 EV MOST EVNT LOT DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME El AM Did crash occur 0 Y U2 Z N ® 11 1 10/04 /2024 03 55 ®pM in a Work Zone? ®N DIRP CO 1 1 PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME It YES check one below: T PROPERTY OWNERS ADDRESS:STREET.CITY,STATE,ZIP 0 AM Ut 3 N• 2 0 17 03 10/04 /2024 03 55 ®PM ❑Construction * N 3 0 0 CITATIONS ISSUED ❑PENDING SECTION CITATION NO. EMS ARRIVED TIME 3 ❑AM ❑Maintenance uz Q • ARREST NAME 10/04/2024 03 58 ®PM SLMT 1 CO 11 1 0 Utility p U CITATIONS ISSUED PENDING ROAD CLEARANCE TIME o N SECTION CITATION NO. AM 30 2 0 ARREST NAME 10/04 /2024 04 35 El pm0 Unknown work zone type Ut 1,1 T OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 0 ❑AM Workers present? ElY 30 476-Ramos,Clarissa 601 334-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 ' / \ -� 0A CMV is defined as any motor vehicle used to transport passengers or property a ° 1 Has a weight rating more than 10,000 pounds(example truck or truck/trailer r 1 i ; 1 ' ' INDICATE NORTH combination) or 'I XI BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C J. J. i i -` ` r r r (example.shuttle or charter bus)-or n X 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier 0 -- -- } - t transporting employees in the course of their employment(example.employee M W70hk• 1. rrr2_ ; transporter-usuallya vanvehicle or passenger car or iNt1�V po type Pa 9e ) 07 _ i r i 4 Is used or designated to transport between 9 and 15 passengers,including the driver, C for direct compensation(example:large van used for specific purpose).or O L----"----1 , i i 5 Is any vehicle used to transport anyhazardous material(HAZMAT)that requires m- placarding(example placards will be displayed on the vehicle) 71 l CARRIER NAME Z ' t ADDRESS 0 N • CITY/STATE/ZIP 0 MOTOR CARR ID ❑ Interstate ❑ Intrastate 0 ❑ Not in Comm./Govt. El Not in Comm./Other Not To Scale USDOT NO. ILCC NO. m , 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 7a 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 Black Black u 1 TOWED - TOTAL VEHICLE LENGTH ft. NO.OF AXLES DUE TO ❑X 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 DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT_ 1 TOWED BY/TO: DUE TO © VEHICLE CONFIG CARGO BODY TYPE LOAD TYPE