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HomeMy WebLinkAbout2024-00064309 , I Ill ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets Il ii III OII III 1III1011 IIIN HO 10 101110111111 DRAG TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY >003519Pr9a- u, 1 U21 2 4 1 Ut 2 U2 1 Ut 1 U2 1 Ut 1 U2 1 1 10 Ut 3 U2 1 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY El$500 OR LESS TYPE OF REPORT ® A No Injury J Drive Away AGENCY CRASH REPORT NO. TRFW Elgin Police Department ONE PERSON'S ❑$501-$1.500 ®ON SCENE 14 El NOT ON S VEHICLE/PROPERTY inOVER$1.500 El AMENDEDCENE(DESK REPORT) ❑ B Injury and JorTow Due To Crash YR 2024I2024-00064309 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 'IT LINCOLN AVE ® ❑ Elgin RELATED ®Y ❑N 10 08 2024 05:31 ❑AM ® ❑YES NO ut ,•< PRIVATE mo /day I yr ®PM FLOW CONDITION m FT/MI N E S W HILL AVE 'COUNTY PROPERTY El ®N DOORING ❑Y #OF MOTOR 0 SLOW 1 U) El 'WITH VEHICLES INVLD 0 STOPPED U2 —I El AT INTERSECTION WITH (NAME OF ) Kane HIT&RUN ❑Y CZN PEDALCYCUST®N ® FREE FLOW # LNS 0 tg DRNER ❑ PARKED ❑DRIVERLESS ❑ PEE ❑PEDAL ❑EOUES ❑SIN ❑Ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 n 0 4 / l D /2 0 0 2 FOR DAMAGED AREA(S) FRovr TOWED U, .AUSTIN. M. Hyundai Kona 2024 00-NONE 11 DUE TO CRASH 0 NAME(LAST,FIRST,M) mo day yr 121 D 13-UNDER CARRIAGE 10) , 2 FIRE 0 IA SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 ® U2 0 m 3160 PEARL ST M THER ❑Y El NSYSTE❑UNK VEH. nM IN AT CRASH ENGAGED 0 99-UNKNOWN 9 16-TOP 3 ,Distraction Value 9 ALGN 2 CITY PLATE NO. STATE YEAR POINT OF 6 )1 6 1 4 COM VEH 0 ® 1 0 a KM8HC3AB8RU167364 STATE FARM ❑Y ®N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER RSUR m a 99 9 Same 2878199-SFP-13 1 r o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET.CITY,STATE,ZIP PHONE NUMBER '' RESPONDER Same VEHU L ❑Y ®N 2 G) 5 ®cRIVER ❑ PARKED 0 ERNERLESS ❑ ED ❑P PEDAL ❑EDU cv ❑CE ❑NUM ❑N ov DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) U1 m m 5 / /19 FOR DAMAGED AREA(S) Fi20 IT TOWED Y N , NAME(LAST,FIRST,M) AGUINAGA-LOPEZ.JJESUS 0 mo day yr Nissan Altima 2009 DO-NONE 1tr 1$I _� DUE TOCRASH 0 ® 2 xi I: t3-UNDER CARRIAGE 10 j : 2 FIRE ❑ ® U2 C STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ❑ ® SPDR 0 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16-TOP 3 X E 901 KRAMER AVE M ❑Y El El UNK VEH. AT CRASH 99-UNKNOWN O 'OistractIon Value 9 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6 C U1 1— FIRST CONTACT 8 O7 tt -.. .5 •It Yee See Sidebar❑ ® C ELGIN IL 60120 0 AT52976 IL 2025 REAR 0 (I D TELEPHONE DRIVER'S LICENSE NO. STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0 (331)588-8341 A252-4305-7146 IL D 0 1 N4AL21 E09N503826 FARMERS INSURANCE ❑Y ®N RDEF73 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST.FIRST,M) POLICY NUMBER 1 I 99 9 Same 549260568 BAC 3 HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE.ZIP PHONE NUMBER 996 < ElRE Y NR Same U1 = (UNIT) (SEAT) (DOB( (SEX) (SAFT( (AIR) IINJI (EJCT( (EPTH) PASSENGERS&WITNESS ONLY (NAME)I(ADDRESS)/(TELEPHONE) (EMS) (HOSPITAL) 1 3 05 /26/2302 M 2 4 0 1 0 DAVID E. SMITH/3160 PEARL ST-ELGIN.IL.60124 996 r (331)551-0768 , U2 m 1 4 06 /23/2001 M 2 4 0 1 0 NICHOLAS M. HINES/820 S PROSPECT AVE-Bartlett-IL-60103 #OCCS D (630)624-8394 _ 2 3 02 /1 8/1958 F 2 4 0 1 0 ESPERANZA AGUINAGA/901 KRAMER AVE,ELGIN.IL,,60120 Ut 3 m (224)402-5501 W 1 2 /28/1971 M CARLOS J VILLAO SAMANIEGO/498 LINCOLN AVE -ELGIN-IL,60120/ 0 (224)817-3481 U2 2 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Z ❑AM Did crash occur ❑Y N 1 ® 1 1 4 10,8/ /024 05 31 I81 pM in a Work Zone? ®N DIRP co 1 r PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME It YES check one below: T PROPERTY OWNERS ADDRESS:STREET.CITY,STATE,ZIP ❑AM U1 2 a 2 ❑ 2 18 ! / ❑PM ❑Construction * N 1 3 0 ®CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 1 ❑AM ❑Maintenance U2 Q CO 11 4 ARREST NAME WALKER.AUSTIN. M. 11-601 1542000003 / / ❑PM SLMT o uI CITATIONS ISSUED PENDING ROAD CLEARANCE• TIME ❑Utility o N ❑ ❑ SECTION CITATION NO. AM 30 2 0 ARREST NAME 10/81 /024 05 31 ®PM 0 Unknown work zone type U1 T OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 0 1542 Chase. Ethan 201 334-Fries 11 19,2024 09 00 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. _ F MORE THAN ONE CMV IS INVOLVED,USE SR 1050A ADDITIONAL UNITS FORMS . I , r_.._r_ __; ; ; _� } A CMV is defined as any motor vehxae used to transport passengers or property and. 01 Has a weight rating more than 10,000 pounds(example truck or truck/trailer ✓ } combination) or Not To Scale • r INDICATE NORTH XI BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C ▪ } i I d i I -` ` r r r (example'.shuttle or charter bus)-or n S r designedcarryorpassengersand operated0 i------'-----, , , } } their .ZI ' 3 Is to 15fewer by a contract Carrie } transporting employees in the course of employment(example.employee J `~ transporter-usually a van type vehicle or passenger car).or w i____A____: : , ,� : i r i 4 Is used or designated to transport between 9 and 15 passengers,including the driver, N 4,4. — _ _ for direct compensation(example:large van used for specific purpose).or O t L____- ____; . , -: i } i 5 Is any vehicle used to transport anyhazardous material(HAZMAT)that requires m placarding(example placards will be displayed on the vehicle) m — 1 I l incsi a ` 1, CARRIER NAME Z ' I — ADDRESS En . O If • CITY/STATE/ZIP MOTOR CARR ID ❑ Interstate ❑ Intrastate ❑ Not in Comm./Govt. ❑ Not in Comm./Other Q r- 4 i i I • USDOT NO. ILCC NO. m XI , Source of above Z . IDOT PERMIT NO WIDELOAD? ❑Yes ❑No 2 ' TRAILER VIN 1 m to LOCAL USE ONLY TRAILER VIN 2 m (7 TRAILER WIDTH(S) 0-96'1 97-102'1 >102 m T TRAILER 1 ❑ ❑ ❑ Z TRAILER 2 ❑ ❑ ❑ o u 1 COLOR u 2 COLOR TRAILER LENGTH(S)1 ft 2 ft Z rn Gray Black - u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT- 1 TOWED BY/TO SELECT CODES FROM THE BACK OF CRASH BOOKLET u 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT- 2 TOWED BY/TO: DUE TO © VEHICLE CONFIG CARGO BODY TYPE LOAD TYPE