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HomeMy WebLinkAbout2024-00063744 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets liii III OII III III 10 101 lIOfl 111100III 11111101111 DRAG TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X003579642' u, 9 uz9 1 1 1 U, 2 U2 8 U199 U299 u1 99 U2 99 1 12 U1 16 U214 *PO 1 1 9* INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW DAMAGE TO ANY 0$500 OR LESS TYPE OF REPORT ® q No Injury J Drive Away Elgin Police Department ONE PERSON'S ®$501-$1.500 (83ON SCENE 1 0 NOT ON SVEHICLE/PROPERTY 0 OVER$1.500 ❑AMENDEDCENE(DESK REPORT) ❑ B Injury and JorTow Due To Crash YR 2024I2024-00063744 VENT * ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 '1'1 DUNDEE AVE ❑Elgin RELATED ❑Y co" 10 06 2024 08:51 ®AM ❑YES ®NO U1 .< PRIVATE mo /day I yr ❑PM FLOW CONDITION m 0 ®/MI N OE S W Cooper Ave 'COUNTY PROPERTY El ®" DOORING ❑y #OF MOTOR ❑SLOW 1 N WITH VEHICLES INVLD ❑ STOPPED U2 —1 ❑ AT INTERSECTION WITH (NAME OF ) Kane HIT&RUN ®Y 0 N PEDALCYCUST®N ® FREE FLOW # LNS 0 ❑DRNER ❑ PARKED 0 DRIVERLESS ❑ PED 0 PEDAL ❑EOUES 0 MIN tg ncv ❑ov DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 3 0 / / FOR DAMAGEDAREA(S) FRONT TOWED U1 TCN 2019 -NONE 11 12 1 DUE TO CRASH ❑ 21 — E NAME(LAST,FIRST,M) .0. mo day yr 13-UNDER CARRIAGE 10 1 , 2 FIRE 0 IA SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) SYSTEM IN ENGAGED 15-OTHER 9 16-TOP 3DISTRACTED 0 El U2 3 m ❑Y ❑N ❑UNK VEH. AT CRASH POINT OF OO UNKNOWN S - i 4 VI Value ALGN ® ALGN CITY PLATE NO. STATE YEAR 1 6 i COM EH 1 F ID VIN INSURANCE CO. EXPIRED 1 none ❑Y p N U2 m EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER RSUR m Y Same none 1 rI— t" HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET.CITY,STATE,ZIP PHONE NUMBER '' RESPONDER Same VEHU X L ❑Y ❑" 99 GI ®DRIVER ❑ PARKED ❑DRNERLESS ❑ PED ❑PEDAL ❑EOUES ❑RWV ❑Rcv ❑Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N Ut m m / / F R DAMAGED AREA(S) FRONT TOWED NAME(LAST,FIRST,M) Unknown mo day yr Unknown Unknown -NONE 11: 12 '_s Re o CRASH ❑❑ ® U2 99 C c 13-UNDER CARRIAGE I I c STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 IN SPDR 9 C) E F SYSTEM IN ENGAGED 15-OTHER 9 16-TOP 3 El ❑N ❑UNK VEH. AT CRASH 99-UNKNOWN 8 4 •OistracllonValue U1 N CITY STATE ZIP POINT OFco INJ EJCT EPTH PLATE NO. STATE YEAR FIRST CONTACT 00 7_'I a 115 •CIOMe6VSee Sidebar ❑ ® C 1— 0 FEAR 9 .91 M TELEPHONE DRIVER'S LICENSE NO. STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0 none 0 Y 0 N RDEF X EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST.FIRST,M) POLICY NUMBER 1 I Same none BAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE.ZIP PHONE NUMBER 996 < RESPONDER ❑ Same Ut = (UNIT) i SEAT) (DOBi ISEXI ;SAFT) (AIR) (INJI IEJCTI (EPTH) PASSENGERS&WITNESS ONLY (NAME'/(ADDRESS)/(TELEPHONE) (EMS) (HOSPITAL) 3 4 1 2 /1 5/1974 M 2 4 0] 1 0 Brett M. Mahan/507 PARK AVE.Hartford City.NA.47348 Refused 996 r (765)499-2548 , U2 m 3 3 05 /1 0/2005 F 2 4 0 1 0 Emma D. Daugherty/11 CLAMME CT.Hartford City-NA.47348 Refused #OCCS y (765)499-5190 _ X / / lit 1 m / I 1 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME ®AM Did crash occur 0 Y U2 Z N i ® 9 9 10/06 /2024 08 51 ❑pM in a Work Zone? ®N DIRP CO 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: T PROPERTY OWNERS ADDRESS:STREET.CITY,STATE,ZIP 0 AMUt 5 2 ❑ 2 04 ! / 0 PM ❑Construction * c' 3 ❑ 0 CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME ❑AM ❑Maintenance U2 5 Q CO 11 1• ARREST NAME / / ❑PM 0 Utility SLMT p U 0 CITATIONS ISSUED 0 PENDING SECTION CITATION NO. ROAD CLEARANCE TIME "'p NII AM 35 2 ❑ ARREST NAME / / ptil ❑Unknown work zone type U1 T • OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 ❑ ❑AM Workers present? ❑Y 35 483-Lynch, Miriam 200 272-Bajak / / El 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. 0 IF 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. Z D PI___I § 1 1 Hasa weight rating more than 10,000 pounds(example.truck or truck/trailer , r 1 . ; I combination) or —I NDICATE NORTHM °"U""" BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C ', ', i , r •I ,,,bp,o,,..,,,,., - I. ` r r r (example'.shuttle or charter bus)-or 3 Is designed tocarry15 or fewer passengers andoperated contractcar r i_-----.-----• + + i o,:s -f - i- transporting employee in the course of thir employent(exampleemployeerie M f witi_____A____: : ., — i r i 4tra Is usedror designated to trra-usually a van nsport between 9 andvehicle or gr 15rpassengers,including the driver, N t@ for direct compensation(example:large van used for specific purpose).or L_____:_____4 ; ; + t i i 5 Is any vehicle used totransport anyhazardous material(HAZMAT)that requires i~, placarding(example placards will be isplayed on the vehicle) XI11 _. 6 CARRIER NAME z . . .. " . , , , ,. t ADDRESS '� N tt • CITY/STATE/ZIP . . -111:11' 0 i : : ' MOTOR CARR ID ❑ Interstate ❑ Intrastate I ❑ Not in Comm./Govt. ❑ Not m Comm./Other Q ,. ...... , iNOt TO Scale l USDOT NO. ILCC NO. m m , Source of above Z . IDOT PERMIT NO WIDELOAD? ❑Yes ❑No S ' TRAILER VIN 1 m N LOCAL USE ONLY TRAILER VIN 2 m D TRAILER WIDTH(S) 0-96'1 97-102'1 >10; m m TRAILER 1 ❑ ❑ ❑ Z 7 TRAILER 2 ❑ ❑ ❑ o U 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft 2 't N Gray - u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT- 0 TOWED BY/TO: SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT- 0 TOWED BY/TO: DUE TO © VEHICLE CONFIG CARGO BODY TYPE LOAD TYPE