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HomeMy WebLinkAbout2024-00064758 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets II II I Ill OIH SIN 1001IN liii NH HIHI HI NIHHIIIHIIII II DRAG TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY n0353260/ u, 1 U2 1 2 4 1 U1 3 U2 1 U, 1 U2 1 Ut 1 U2 1 1 15 Ut 1 U2 1 *P 0119* INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW DAMAGE TO ANY El$500 OR LESS TYPE OF REPORT El A No Injury J Drive Away Elgin Police Department ONE PERSON'S ❑$501-$1.500 ®ON SCENE 2 El NOT ON SVEHICLE/PROPERTY ill OVER$1.500 El AMENDEDCENE(DESK REPORT) Ill B Injury and JorTow Due To Crash YR 2024I2024-00064758 VENT * ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 6 'T'I DWIGHT ST Elgin ❑ RELATED ®Y ❑N 10 10 2024 0223 ❑AM ❑YES ®No u1 ..< PRIVATE mo /day I yr ®PM FLOW CONDITION m FT/MI N E S W ST ) Kane HIT&RUN ❑Y CZN PEDALCYCUST®N ® FREE FLOW # LNS 0 tg DRIVER 0 PARKED 0 DRIVERLESS ❑ PED 0 PEDAL 0 EOUES 0 NNV 0 Ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 0 John.J. 04 / 2 1 J 1 9 6 1 Chevrolet 4500 2017 00-NONE © O Z , DUE TO CRASH p ® - E 13-UNDERCARRIAGE FIRE 0 IA SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 10 z DISTRACTED 0 10U2 2 m 480 E MONTROSE AVE M SYTM❑Y ®SNE❑UNK VEH. O ATCRASH 0D 99-U 15-UNKNOWN 916-TOP 3 Distraction Value ALGN = THER W. CITY PLATE NO. STATE YEAR POINT OF 8 . :_.5 ^ FIRST CONTACT 12 7_.; 6- 4 COM VEH 0 El1 0 Y Yes,See Sidebar U1 Z 54DCDW1B9HS800232 Zurich American Ins ❑Y ®N U2 m V. EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER RSUR m West Jeff Auto Sales ADP862753500 1 r Ei HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET.CITY,STATE,ZIP PHONE NUMBER o RESPONDERN 2001 W J EFFERSON ST.Joliet. I L.60435 (224)717-1387 VEHU ®DRIVER ❑ PARKED 0 DRNERLESS ❑ PED ❑PEDAL ❑EQUES 0 WV ❑NCV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) U1 98 m m / J FOR DAMAGED AREA(S) FRONT TOWED Y N s Ortiz Castilla, Elo 0 8 0 9 1 9 6 9 Nissan Sentra 2017 00-NONE O' DUE TO CRASH VI ❑ 2 NAME(LAST,FIRST,M) y mo day yr i 12 ! s FIRE ID ® U2 C v 13-UNDER CARRIAGE c STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) ® DISTRACTED 0 ® SPDR 17 64 GOLFVIEW LN M SYSTEM IN O ENGAGED 0 15-OTHER p9 16-TOP 3 0 X ❑Y ® N DUNK VEH. AT CRASH 99-UNKNOWN •Distraction Value N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POFIRSNT T tOONTACT 9 F all a 1_5 C•IOMe6 Bee SidebarH ❑ Igl UI to 60110 0 AL74645 IL 2025 REAR0 CC/� n TELEPHONE DRIVER'S LICENSE NO. STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0 (224)363-8167 0632-2006-9226 IL D 0 3N1AB7AP2HY307063 State Farm Ins ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST.FIRST,M) POLICY NUMBER 1 I Same 1352575SFP13 BAG 3 HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE.ZIP PHONE NUMBER 996 < RESPONDER E Same Ut = (UNIT) (SEAT) ;DOB) (SEX) ISAFT) (AIR) (INJI (EJCTI (EPTH) PASSENGERS&WITNESS ONLY (NAME),(ADDRESS)((TELEPHONE) (EMS) (HOSPITAL) I 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 ® 1 1 4 10/10 /2024 03 00 0 pm in a Work Zone? ®N DIRP co 1 I PROPERTY OWNERS ADDRESS:STREET.CITY,STATE,ZIP PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME ❑AM It YES check one below: U1 7 C) T 2 ❑ 23 28 ! / 0 PM El Construction * N ' 3 ❑ ®CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 5 ❑AM ❑Maintenance U2 Q • ARREST NAME Murphy,John,J. 11-1204-B 465-375 / / ❑PM SLMT 1 ® 11 4 0 Utility p U 0 CITATIONS ISSUED 0 PENDING 'SECTION CITATION NO. ROAD CLEARANCE TIME o N BAM 30 2 0 ARREST NAME / / ppl ❑Unknown work zone type Ut 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑AAA Workers present? ❑Y 30 465-Dorado,Ariana 401 - 11 , 19/2024 01 30 0 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. D 1 Has a weight rating more than 10,000 pounds(example truck or truck/trailer r } I I 1 INDICATE NORTH combination) or —I XI 1 : BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C i_ I ', i I N -! ` r r r (example.shuttle or charter bus)-or X o I 3. Isdesigned to carry 15fewer passengers andoperated r ----------+ + + 4 -� } } transportingemployees inof theirm in n x a or rig a by a contract Carrie 0 } e poyees the course a pby e t(example employee ov�mrm I transporter-usually a van type vehicle or passenger car).or 03 ____A____: : iL i . . r i 4 Is used or designated to transport between 9 and 15 passengers,including the driver, N iSilli for direct compensation(example:large van used for specific purpose).or O L____ ____; ; ; 1 ur+— i } 1 5 Is any vehicle used to transport any hazardous material(HAZMAT)that requires placarding(example placards will be displayed on the vehicle) XI 1 CARRIER NAME Z ADDRESS N ' I Not To Scale CITY/STATE/ZIP MOTOR CARR ID ❑ Interstate El r , ❑ Not in Comm./Govt. El Not in Comm./Other USDOT NO. ILCC NO. , Source of above Z . —I Were HAZMAT placards on vehicle? ❑ Yes ❑ No If Yes, Name on placard O 4 digit UN NO. 1 digit Hazard class No PJ 7) m Did HAZMAT spill from vehicle(do NOT consider FUEL from vehicle's Z own tank)? ❑ Yes ❑ No ❑ Unknowr D Did HAZMAT Regulations violation contnbute to the crash? r ❑ Yes ❑ No ❑ Unknown D Did Carrier Safety Regulations(MCS)violation contribute to the crash ❑ Yes 0 No ❑ Unknown A C 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 Form Number 0 m X1 IDOT PERMIT NO WIDELOAD? ❑Yes ❑No S TRAILER VIN 1 m N LOCAL USE ONLY TRAILER VIN 2 m CJ TRAILER WIDTH(S) 0-96'1 97-102'1 >10; m m TRAILER 1 ❑ ❑ ❑ Z 7 TRAILER 2 ❑ ❑ ❑ 0 U 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft 2 't Z White BlueEn - 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 i. .1 DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT. 3 TOWED BY/TO: DUE TO Arties VEHICLE CONFIG _ CARGO BODY TYPE LOAD TYPE