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HomeMy WebLinkAbout2024-00065081 (3) ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets II II OIH III 1001101111 NH HIHI IHIlNI IHI INIHIl II DRAG TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X003535652- u, 1 U21 2 1 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 q No Injury J Drive Away Elgin Police Department ONE PERSON'S ❑$501-$1.500 ®ON SCENE • 8 El NOT ON S VEHICLE/PROPERTY in OVER$1.500 El AMENDEDCENE(DESK REPORT) 0 B Injury and/or Tow Due To Crash YR 2024I2024-00065081 VENT * ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 10 71 MOSELEY ST ® ❑ Elgin RELATED ®Y ❑N 10 11 2024 06:06 ❑AM ❑YES ®NO U1 _< PRIVATE mo /day/yr ®PM FLOW CONDITION m FT/MI N E S W OAK ST COUNTY PROPERTY El ®N DOORING ❑Y #OF MOTOR ❑SLOW 1 N ❑ 'WITH VEHICLES INVLD El STOPPED U2 —1 ® AT INTERSECTION WITH (NAME OF ) Kane HIT&RUN ❑Y CZN PEDALCYCUST®N ® FREE FLOW # LNS 0 tg DRIVER ❑ PARKED ❑ERNERLESS ❑ PEE ❑PEDAL ❑EOUES ❑NIN ❑Ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 n 0 2 / 2 0 J 2 0 0 1 FOR DAMAGED AREA(S) FRCNr TOWED U1 NAME(LAST,FIRST,M) Meza.Yony. M. mo day yr Other Other 2008 00-NONE 11 O1 , DUE TO CRASH ® ❑ 13-UNDERCARRIAGE I, FIRE ❑ SEX SAFT AIR AUTOMATION LEVEL LEVEL (�-TOTAL(ALL) 10 2 DISTRACTED 0 ® U2 0 m 1 HOMELESS ST M ❑Y ®SYSNEM❑UNK VEH. 0 AT CRASHD 0 OTHER 99-UNKNOWN 9 76-TOP 3 ,Distraction Value 9 ALGN 2 CITY PLATE NO. STATE YEAR POINT OF 8 {I� -4 COM VEH 0 ® 1 0 FIRST CONTACT 12 7_ �_6 Yves,See Sidebar U1 Z L8XTBK50990001663 None ®Y ❑N U2 m V. EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER RSUR m a Terrones Andre, Reyna None 1 m o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET CITY,STATE,ZIP PHONE NUMBER •o RESPONDER 371 GRISWOLD ST. ELGIN . IL.60123 VEHU 73 ❑Y ®N 2 0 ®cRIVER ❑ PARKED 0 DRNERLESS ❑ PED ❑PEDAL ❑EQUES 0 WV ❑Ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) U1 m m 7 / J FOR DAMAGED AREA(S) FRONT TOWED Y N NAME(LAST,FIRST,M) Baza Escobar, Patricia 0 mo lday 1 9 y8r 7 Toyota Cressida 2010 00-NONE ;o) 12 s FIREETo CRASH ❑❑ ® U2 2 C v 13-UNDER CARRIAGE c STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 IN SPUR n SYSTEM IN 9 ENGAGED 9 15-OTHER 9 16-TOP 3 9 0 X E 509 ADAMS ST F ❑Y 0 N ®UNK VEH. AT CRASH 99-UNKNOWN FI •Distraction Value to NH CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR F RIST CNT ONTACT 8 rl If a 1=5 C•;O�gee Sidebar C ® U1 ELGIN IL 60123 0 EJ32463 IL 2024 I 9 Sn Z M TELEPHONE DRIVER'S LICENSE NO. STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0 (678)414-8478 0 JTDBT4K34A1 354064 Direct Auto 0 Y ®N RDEF73 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST.FIRST,M) POLICY NUMBER 1 I Same 2019332140 BAG 3 HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE.ZIP PHONE NUMBER 996 < 0 RESPONDER Same Ut i (UNITE I SEAT) IDOB) ISEX) ISAFT) (AIR) IINJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAMEI 7-I ADDRESS i 7 tTELEPHONEI (EMS) (HOSPITAL) 1 8 1 0 /1 1 /1992 M 5 3 B 1 0 Noel E. Santamaria Zuniga/3324 CLOGSTON WAY,Modesto,CA.95354 Elgin Fire Refused 996 (408)750 7620 _ g U2 m / / #OCCS > / / Ut2 m / I 1 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME ❑AM Did crash occur ❑Y U2 Z N 1 ® 11 4 10/1 1 /2024 06 06 ®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 0 23 50 10/11 /2024 06 07 ®PM El Construction * N 3 ❑ ❑CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 5 ❑AM ❑Maintenance U2 CO 11 4 ARREST NAME Rodriguez Meza.Yony. M. 6-101 1537-000007 10/11 /2024 06 20 ®PM SLMT o u Lu CITATIONS ISSUED ❑PENDING 'SECTION CITATION NO. ROAD CLEARANCE TIME 0 Utility rn AM 30 I 2 0 ARREST NAME Rodriguez Meza,Yony- M_ 11-601-Ax 1537-000008 10/11 /2024 09 14 El RA0 Unknown work zone type Ut T OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 ❑ ®AM Workers present? ❑Y 30 1537-Mapp,Teddron 701 - 11 / 12/2024 09 00 p 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. r 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 r- -r--- 4 , 4 r r r r r , , , , . r 1 Has a weight rating more than 10,000 pounds(example truck or truck/trailer ' r • ; i 'r i- r r , , i r r INDICATE NORTH combination) or 'I XI BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C ' •_ I ', ! ( ._ ., ' '. ', ' f ` r r r (example'.shuttle or charter bus)-or X ; I • I ; 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier 0 i------'-----• + + • : - 1 1 1 i } - i• transporting employees in the course of their employment(example.employee M transporter-usually a van type vehicle or passenger car).or w ' i r i 4 Is used or desi nated to trans rt between 9 and 15 assen ers including the driver, 9 Po P 9 N for direct compensation(example.large van used for specific purpose).or O i 1 5 Is any vehicle used to transport any hazardous material(HAZMAT)that requires placarding(example placards will be displayed on the vehicle) 11 . ` CARRIER NAME Z ' .. ADDRESS 0 N • CITY/STATE/ZIP O , , . - MOTOR CARR ID ❑ Interstate El Intrastate ❑ Not in Comm./Govt. ElNot in Comm./Other Q m r-----.-----, r r r r r•---, r - DO ILCC NO. m U N XI , Source of above Z • . If Yes, Name on placard O 4 digit UN NO. 1 digit Hazard class No 73 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 g Did Carrier Safety Regulations(MCS)violation contribute to the crash? ID Yes No ❑ Unknown 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 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 ❑ ❑ ❑ o U 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft 2 ft. Z Yellow Silver u 1 TOWED - TOTAL VEHICLE LENGTH ft. NO.OF AXLES DUE TO ❑X DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT- 3 TOWED BY/TO Redmons/Impound Lot Garage SELECT CODES FROM THE BACK OF CRASH BOOKLET u 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT_ 1 TOWED BYJTO. DUE TO © VEHICLE CONFIG CARGO BODY TYPE LOAD TYPE