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HomeMy WebLinkAbout2024-00063818 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 1111111 010 III IIII IIIIIII II II 11111111111111111011010111110 II DRAG TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X003579929' u, 1 U29 3 4 1 u, 2 U299 u1 1 U2 99 U1 1 U2 99 1 10 Ut 4 U2 1 *P 0119* INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW DAMAGE TO ANY El$500 OR LESS TYPE OF REPORT ❑ A No Injury J Drive Away Elgin Police Department ONE PERSON'S ❑$501-$1.500 ®ON SCENEEl NOT ON 1 VEHICLE/PROPERTY ill OVER$1.500 0 AMENDED [Z] (DESK REPORT) [Z] B Injury and JorTow Due To Crash YR 2024I2024-00063818 VENT * ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 10 '1 S MCLEAN BLVD ❑Elgin RELATED ®Y ❑N 10 06 2024 03:44 ❑AM ❑YES ®NO U1 -< PRIVATE mo /day I yr ®PM FLOW CONDITION m 12 'COUNTY PROPERTY ❑Y M N DOORING ❑Y #OF MOTOR ❑SLOW 99 Cl) 12Sr25 0/MI MI N E S W Fleetwood Dr 'WITH VEHICLES INVLD 0 STOPPED U2 —I ❑ AT INTERSECTION WITH (NAME OF ) Kane HIT&RUN ®Y ❑ N PEDALCYCUST®N ® FREE FLOW # LNS 0 tg oRNER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EO.ES 0 NW ❑Ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 n FOR DAMAGEDAREA(S) FRONT TOWED Ut 0 0 6 / 2 6 /1 9 5 1 Suzuki Motorc t orcycle 1977 00-NONE , , DUEFIRE TO CRASH p21 NAME(LAST,FIRST,M) mo day yr © 72 13-UNDERCARRIAGE 2 0 IA 2 < SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) ® DISTRACTED 0 153 U2 m 1251 SOUTH ST M PLATE NO. STATE YEAR POINT OF Ij _ COM VEH ❑ ® 1 (7 r' ~ JS1 VS52A3V2102949 Progressive Universal ❑Y ®N U2 m EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER RSUR m 99 9 Same 947984550 1 r o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET.CITY,STATE,ZIP PHONE NUMBER '' RESPONDER Same VEHU X L ❑Y ®N 2 G) 5 ®DRIVER ❑ PARKED 0 DRNERLESS ❑ PED ❑PEDAL ❑EQUES 0 KW ❑NCV 0 DV DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N U1 m m / / FOR DAMAGED AREA(S) FROM TOWED —I , NAME(LAST,FIRST,M) Unknown,0_ mo day yr Unknown Unknown 00-NONE ;o) 12 I. 2 FIREo CRASH 0 ® U2 99 C c 13-UNDER CARRIAGE c STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED a SYSTEM IN ENGAGED 15-OTHER 9 16-TOP 3 0 El SPDR 0 ❑Y ❑N ❑UNK VEH. AT CRASH 99-UNKNOWN 8 4 •Distraction Value UI N CITY STATE ZIP POINT OF 0 X INJ EJCT EPTH PLATE NO. STATE YEAR FIRST CONTACT 99 T_'1 6 1_S •CIOf MeeVSee Sidebar ❑ ® C 03 1- 0 REAR O fn M TELEPHONE DRIVER'S LICENSE NO. -STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0 99 ❑Y ❑N RDEF X EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST.FIRST,M) POLICY NUMBER 1 I 99 9 Same 99 BAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE.ZIP PHONE NUMBER 996 < RESPONDER ElYSame U1 = (UNIT) (SEAT) ;DOB) (SEX) (SAFT) (AIR) (INJI (EJCTI (EPTH) PASSENGERS B WITNESS ONLY (NAME)/(ADDRESS)/(TELEPHONE) {EMS) (HOSPITAL) / I - U2 996 1- m #OCCS y / / U1 1 m I I 1 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME El AM Did crash occur 0 Y U2 Z N i ® 11 1 10/06 /2024 05 03 ®PM in a Work Zone? ®N DIRP D 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME It YES check one below: T PROPERTY OWNERS ADDRESS:STREET.CITY,STATE,ZIP ❑AM Ut 5 ai 2 ❑ 2 99 ! / 0 PM ❑Construction * N 3 ❑ ❑CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIMEEl AM El Maintenance U2 5 • Q ® 11 9 0 CITATIONS ISSUED 0 PENDING SECTION CITATION NO.ARREST NAME / / El PM SLMT o UROAD CLEARANCE TIME ' 0 Utility o N AM 30 2 ❑ ARREST NAME 10/06 /2024 03 50 ®PM 0 Unknown work zone type U1 T • OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 ❑ 1528-Rivera. Kevin 701 - I / 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. 0 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. D 1 Has a weight rating more than 10,000 pounds(example truck or truck/trailer r combination) or 'I 1r INDICATE NORTH -1 48073 �% 1 I BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C M n H -! . r r r (example.shuttle or charter bus)-or -:1 / / .^Ar'.ro etrawuri 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier 0 -----;-----. 4 i / -i } - t transporting employees in the course of their employment(example employee transporter-usually a van type vehicle or passenger car).or w i_____A____: : , / Q ii r i 4 Is used or designated to transport between 9 and 15 passengers,including the driver, N for direct compensation(example:large van used for specific purpose).or O L____"-____; i i Y 5 Is any vehicle used to transport an hazardous material(HAZMAT)that requires ( placarding(example placards will be displayed on the vehicle) 13 rn V / / ® CARRIER NAME Z / , .. ADDRESS '� To CITY/STATE/ZIP / / MOTOR CARR ID ❑ Interstate ElIntrastate / ❑ Not in Comm./Govt. El Not m Comm./Other OO ' USDOT NO. ILCC NO. , Source of above Z 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 2 ft. y Black - 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. 9 TOWED BY/TO: DUE TO © VEHICLE CONFIG CARGO BODY TYPE LOAD TYPE