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HomeMy WebLinkAbout2024-00063623 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets liii III OII III (III IIIIIII II lIOfl II III IHO III IlUIHUIIIII DRAG TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X0Q35;936r u, 1 U21 3 4 1 U1 8 U2 1 Ut 1 u2 1 U1 1 U2 1 1 10 Ut 4 U2 1 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY El$500 OR LESS TYPE OF REPORT ® q No Injury J Drive Away AGENCY CRASH REPORT NO. TRFW Elgin Police Department ONE PERSON'S ®$501-$1.500 ®ON SCENE 1 El NOT ON S VEHICLE/PROPERTY 0 OVER$1.500 El AMENDEDCENE(DESK REPORT) ❑ B Injury and JorTow Due To Crash YR 2024I2024-00063623 VENT * ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 '1'1 KIMBALL ST ® ❑ Elgin RELATED ❑Y coN 10 05 2024 05:56 ❑AM ❑YES ®No ut ,< PRIVATE mo /day I yr ®PM FLOW CONDITION m ®20 ®I MI NOS S W North Grove ) PEDALCYCUST® ® FREE FLOW # LNS O tg DRNER ❑ PARKED ❑DRIVERLESS ❑ PEE ❑PEDAL ❑EOUES 0 NIN ❑Ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 3 C) 0 4 / 2 9 /2 0 0 1 FOR DAMAGEDAREA(S) HtCNT TOWED UI NAME(LAST,FIRST,M) mo day yr -Jose.J. Jeep(after 198�)nmander 2008 00-NONE 11 7 DUE TO CRASH p 13-UNDERCARRIAGE 172 FIRE 0 IA SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 21 t9 • O DISTRACTED 0 ® U2 3 m 55 S E N ECA ST M THER ❑Y ®SNE❑UNK VEH. n AT CRASH O 99-UUNKNOWN 9 76-TOP®,Distraction Value 9 ALGN = CITY PLATE NO. STATE YEAR POINT OF 6 {I 6 ii 4 COM VEH 0 ® 1 O a ~ 1J8HG68278C116760 State Farm ❑Y ®N U2 m EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER RSUR m 99 9 Same 3105080SFP13 1 r o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET.CITY,STATE,ZIP PHONE NUMBER '' RESPONDER Same VEHU L ❑Y ®N 2 05 ®DRIVER ❑ PARKED 0 DRNERLESS ❑ PED ❑PEDAL ❑EDUCE 0 WV ❑Ncv 0 DV DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N U1 m m / / FOR DAMAGED AREA(S) 667a7T TOWED CRasH s Espinoza. Lisette 0 8 2 0 1 9 9 2 Dodge Durango 2022 00-NONE Q' 7 ❑ ® 2 xi NAME(LAST,FIRST,M) P mo day yr 72 - C v 13-UNDER CARRIAGE t9) 2 FIRE ❑ ® U2 C 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 76-TOP 3 9 0 X E. 403 N PORTER ST F ❑Y ® N DUNK VEH. AT CRASH 99-UNKNOWN I Distraction Value N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POFIRSNT T COF ONTACT 11 7.'{ 6 ,5 G•IOMee VEH See Sidebar❑ ® U1 to F- C ELGIN IL 60120 0 EJ39034 IL 2025 • • 0 (n D TELEPHONE DRIVER'S LICENSE NO. STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0 (224)465-6191 E215-5209-2837 IL D 0 1C4RDJDG8NC132129 Country Financial ❑y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST.FIRST,M) POLICY NUMBER 1 I 99 9 Same P010219469 BAG 3 HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE.ZIP PHONE NUMBER 996 < 0 POND El N Same Ut = (UNIT) I SEAT) (DOS) (SEX, i)SAFT) (AIR) (INJ( (EJCT( (EPTH) PASSENGERS&WITNESS ONLY (NAME)I(ADDRESS)/(TELEPHONE) (EMS) (HOSPITAL) 1 3 1 2 /06/2005 M 2 3 0 1 0 Javier Chairez/55 SENECA ST,ELGIN.IL.60120 U2 996 r (224)634-8247 , m 1 4 04 /01 /2004 M 2 3 0 1 0 Lazaro Chairez/55 SENECA ST-ELGIN.IL.60120 #OCCS D (224)634-8247 _ u 1 6 07 /28/1965 F 2 3 0 1 0 Martha Chairez/55 SENECA ST.ELGIN,IL,60120 Ut 4 m (224)634-8247 D 2 4 08 /1 8/2023 M 13 3 0 1 0 Aiden Ochoa/403 N PORTER ST-ELGIN-IL-60120 (224)465-6191 U2 2 2 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME ❑AM Did crash occur ❑Y N ® 11 1 10,05 /2024 05 57 ®pM in a Work Zone? ®N DIRP co 1 r PROPERTY OWNERS ADDRESS:STREET.CITY,STATE,ZIP PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME 0 AM It YES check one below: U1 7 T 2 ❑ 20 99 / I 0 PM ❑Construction * N 3 ❑ ®CITATIONS ISSUED El PENDING SECTION CITATION NO. EMS ARRIVED TIME 7 AM El Maintenance U2 Q CO 11 1 ARREST NAME Chairez.Jose.J. 11-708 W1924-000216 / / ❑PM SLMT o U CITATIONS ISSUED PENDING • ROAD CLEARANCE TIME ' ❑Utility o N ❑ ❑ SECTION CITATION NO. AM 30 2 0 ARREST NAME 10/05 /2024 06 02 ®PM 0 Unknown work zone type Ut T OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 ❑ 1524-Silva.Jose 102 - / / ❑Q PM workers present) °N U2 30 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 A CMV is defined as any motor vehicle used to transport passengers or property and. Z : l : l : 01 Has a weight rating more than 10,000 pounds(example truck or truck/trailer Z ' r • ; i ; i- r r , , i INDICATE NORTH combination).or —I • XI BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C ' •_ I ', ! i ._ ' ' '. ', ' f ` r r r (example'.shuttle or charter bus)-or n S ; I I ; 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier 0 i------.-----• + + • : - -, 1 - 1 i } - i• transporting employees in the course of their employment(example.employee ,3 transporter-usually a van type vehicle or passenger car).or w ' r i 4 Is used or desi nated to trans rt between 9 and 15 assen ers including the driver, 9 Po P 9 N for direct compensation(example:large van used for specific purpose).or O i 1 5 Is any vehicle used to transport any hazardous material(HAZMAT)that requires placarding(example placards will be displayed on the vehicle) 11 T. . ` CARRIER NAME Z ' ADDRESS 0 N • CITY/STATE/ZIP O • . - MOTOR CARR ID ❑ Interstate ❑ Intrastate ❑ Not in Comm./Govt. El Not in Comm./Other Q C r-----.-----, r r r r ,-•---, ir '- DO ILCC NO. m U N XI , Source of above Z . 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 T TRAILER 1 ❑ ❑ ❑ z -74 TRAILER 2 ❑ ❑ ❑ o U 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft 2 ft. Z Gray Gray - u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT- 2 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