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HomeMy WebLinkAbout2024-00063850 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets II II 010 III 111111 11 lIOflIIll01101111111111 DRAG TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X0Q35;9368• u, 1 U21 3 4 1 Ut 9 U2 1 Ut 1 U2 1 Ut 1 U2 1 5 11 U1 11 U211 *P 0119* INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW DAMAGE TO ANY ®$500 OR LESS TYPE OF REPORT ❑ A No Injury J Drive Away Elgin Police Department ONE PERSON'S 0$501-$1.500 ®ON SCENE 2 EI NOT ON SVEHICLE/PROPERTY ❑OVER$1.500 ❑AMENDEDCENE(DESK REPORT) ® B Injury and JorTow Due To Crash YR 2024I2024-00063850 VENT * ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 'IT N RANDALL RD ® ❑ Elgin RELATED ❑Y coN 10 06 2024 07:12 EH,'" ❑YES ®NO U1 • ,< PRIVATE mo /day I yr ®PM FLOW CONDITION m 15 I MI N S w Higgins 'COUNTY PROPERTY El ®N DOORING ❑Y #OF MOTOR ID SLOW 1 N ® ® E Rd Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD ❑ STOPPED U2 —I ❑ AT INTERSECTION WITH (NAME OF ) PEDALCYCUST®N ® FREE FLOW # LNS ' 0 tg DRNER 0 PARKED 0 DRIVERLESS ❑ PEo ❑PEDAL ❑EOUES 0 NMV ❑Ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 7 C) FOR DAMAGED AREA(S) FRONT TOWED Ut O NAME(LAST,FIRST,M) , C. �r o day yr/ 0 6 J 1 9 8 7 Kia Motors Col�tinger 2022 ®-NONE 11 12 , DUE TO CRASH ❑ ® - E t3-UNDER CARRIAGE 10 2 FIRE 0 ICI SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 ® U2 7 1027 ROSEWOOD DR M ❑Y ®SYSNEM❑UNK VEH. O ATCRASH D 0 99-UUTHER NKNOWN 9 16-TOP 3 Distraction Value 9 ALGN I CITY PLATE NO. STATE YEAR POINT OF 6 {I 6 ii 4 COM VEH ❑ ® 1 0 KNAE35LDON6104109 GEICO El ®N U2 m EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER RSUR m Same 4312396791 1 o HOSPITAL(TAKEN TO) INCIDENT • IF'Y' OWNER STREET.CITY,STATE,ZIP PHONE NUMBER '' RESPONDER Same VEHU L El Y ®N 2 G1 ®cRIVER ❑ PARKED 0 DRNERLESS ❑ PED ❑PEDAL ❑EQUES 0 WV ❑NOV 0 DV DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N U1 m m / J F R DAMAGEDAREA(S) fi20 IT TOWED NAME(LAST,FIRST,M) Villalobos.Guadalupe mo day yr 0 8 0 6 1 9 9 9 Ford Fusion 2014 -NONE +c' 12 s RE o CRASH ❑❑ ® U2 2 C v t3-UNDER CARRIAGE : STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 ® SPDR C0 a` 3011 ARLINGTON DR M SYSTEM IN O ENGAGED 0 15-OTHER 9 16-TOP 3 9 0 X ❑Y ® N IDUNK VEH. AT CRASH 99-UNKNOWN Distraction Value N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POF FIRST CNT ONTACT 12 T_'1 a 1_5 C•IOMe6VSee Sidebar ® U1 H Princeton IL 61356 C DQ25172 IL 2025 1 0 C M TELEPHONE DRIVER'S LICENSE NO. STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0 (815)915-3445 V441-2809-9823 IL D 0 3FA6POHD4ER218002 Progressive ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST.FIRST,M) POLICY NUMBER 1 I Same 971526922 Bnc ' 3 HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE.ZIP PHONE NUMBER 996 < 0 RESPONDER Same Ut 2 (UNIT) (SEAT) ;DOB' (SEX) (SAFT) (AIR) (INJI (EJCTI (EPTH) PASSENGERS 8 WITNESS ONLY (NAME'HADDRESS),(TELEPHONE) (EMS) (HOSPITAL) 2 6 11 /1 3/2018 F 12 3 0 1 0 Maya R. Lira-Villalobos/3011 ARLINGTON DR.Princeton.IL-61356 - 996 1— (815)915-3445 _ U2 m 2 4 11 /05/2020 F 12 3 0 1 0 Melanie A. Lira-Villalobos/3011 ARLINGTON DR.Princeton-IL.61356 #OCCS D (815)915-3445 _ / / Ut 1 m / / 3 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME ❑AM Did crash occur ❑Y U2 Z N i ® 11 1 co 10,06 /2024 07 12 ®pM in a Work Zone? ®N DIRP D 1 r PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME It YES check one below: T PROPERTY OWNERS ADDRESS:STREET.CITY,STATE,ZIP ❑AM U1 7 2 ❑ 30 99 10,06 ,2024 07 25 ®PM ❑Construction * N 3 0 ®CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 7 ❑AM ❑Maintenance U2 ® 11 1 ARREST NAME Ewert,Justin,C. 11-1402 1530000096 10/06/2024 07 32 ®PM SLMT o UCITATIONS ISSUEDPENDING • ROAD CLEARANCE TIME 0 Utility o N 0 0 SECTION CITATION NO. AM 45 T 2 ❑ ARREST NAME 10/06 /2024 08 01 ®PM ❑Unknown work zone type U1 OFFICER ID SIGNATURE BEAT/DIST. • SUPERVISOR ID. COURT DATE TIME 2 2 3 0 1530-Soto,Oscar 901 - 11 , 12/2024 09 00 0 PM Workers Am present? ®N U2 45 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. 0F MORE THAN ONE CMV IS INVOLVED,USE SR 1050A ADDITIONAL UNITS FORMS .1 _� } A CMV is defined as any motor vehicle used to transport passengers or property and. N?Rardald z : r r Y?n r 1 Has a weight rating more than 10,000 pounds(example truck or truck/trailer ` ; ', ' -I , j I I 11 I 0 r INDICATE NORTH combination) or + C �� a BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver 01 ', /q I I I of TO Scale j -f ` r r r (example.shuttle or charter bus)-or 0 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier 0 . ..... _. 4 J - -t i' } i transporting employees in the course of their employment(example.employee M r ——-Unit 1-Unit 2 i transporter-usually a van type vehicle or passenger car).or Qt i_____A____: aa: , lilnr1Rd g i : i r i 4 Is used or designated to transport between 9 and 15 passengers,including the driver, N s for direct compensation(example:large van used for specific purpose).or O • L____-L____; i ; , 1, - i i 5 Is any vehicle used to transport any hazardous material(HAZMAT)that requires m placarding(example placards will be displayed on the vehicle) 71 CARRIER NAME Z ' w,. ADDRESS D N ' • CITY/STATE/ZIP O MOTOR CARR ID ❑ Interstate ❑ Intrastate 0 0 Not in Comm./Govt. El Not in Comm./Other r , USDOT NO. ILCC NO. , Source of above Z . Form Number 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 Silver Redrn - u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES DUE ED ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT- 0 TOWED BY/TO: 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