Loading...
HomeMy WebLinkAbout2024-00065971 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 1111111 OIl III (III IIII lull 11111111111111111 10 1 U21 1 1 1 U116 lllH0lfl IIIII DRAG TRFD TRFC WEAT DRVA VIS VEND LGHT COLL 'MANY X003539547 u, U2 1 U, 1 Uz 1 Ut 1 Uz 1 5 11 Ut 7 U2 7 *P 0119* INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW DAMAGE TO ANY 0$500 OR LESS TYPE OF REPORT 0 A No Injury J Drive Away Elgin Police Department ONE PERSON'S ❑$501-$1.500 ®ON SCENE • 3 0 NOT ON SVEHICLE/PROPERTY in OVER$1.500 ❑AMENDEDCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash YR 2024I2024-00065971 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 7'1 N RANDALL RD ❑Elgin RELATED ❑Y coN 10 15 2024 06:39 DAM ❑YES ®No Ui -< PRIVATE mo /day/yr ®PM FLOW CONDITION m ®10 0/MI N E 0 W POINT Blvd 'COUNTY PROPERTY ❑Y ®N DOORING ❑y #OF MOTOR ®SLOW 15 N Kane HIT&RUN ❑Y ® N WITH N VEHICLES INVLD ❑ STOPPED U2 —I ❑ AT INTERSECTION WITH (NAME OF ) PEDALCYCUST® ❑ FREE FLOW # LNS O tg DRIVER 0 PARKED 0 DRIVERLESS ❑ PEE 0 PEDAL ❑EOUES 0 RUM ❑Ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 6 0 FOR DAMAGED AREA(S) FRONT TOWED Ut O NAME(LAST,FIRST,M) ,ALEXA. M. mo d yr/ 03 J 1 9 8 7 Nissan Rogue 2011 oo-NONE 11 O� , DUETOCRASH ❑ 13-UNDERCARRIAGE 10 DI 1 I 2 FIRE 0 ISI SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 M U2 6 m 579 DARLINGTON LN 8 F ❑Y IN NSYSTEM DUNK VEH. 0 ATCRASH 99-UUTHER NKNOWN 9 16-TOP 3 Distraction Value 9 ALGN I CITY PLATE NO. STATE YEAR POINT OF 6 1� 6 1 4 •COM VEH 0 ® 1 0 JN8AS5MVXBW252635 UNIQUE INSURANCE ❑Y ®N U2 m V. EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER RSUR m 99 9 Same ILP3379179 1 r o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET.CITY,STATE,ZIP PHONE NUMBER '' RESPONDER Same VEHU L ❑Y ®N 2 G) RIVER ❑ PARKED 0 DRNERLESS ❑ PED ❑PEDAL ❑EDUES 0 NUM ❑Ncv 0 o MAKE MODEL YEAR v DATE OF BIRTH CIRCLE NUMBER(S) Ut ®Dm 5 10 / 1 7 /1 9 7 2 FOR DAMAGED AREA(S) FRONT TOWED CRASH Y N NAME(LAST,FIRST,M) REICH.JANET. L. mo day yr BMW X5 2025 00-NONE 11_ 12 1 0 ® 2 73 v 13-UNDER CARRIAGE 10 j I! 2 FIRE ❑ 21 U2 C c STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 IN SPDR 0 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16-TOP 3 9 0 X a 3731 WINTERGREEN TER F ❑Y ® N DUNK VEH. AT CRASH 99-UNKNOWN •Distraction Value N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8 iI 6 4 COM VEH ❑ ® U1 FIRST CONTACT 6 7.-1 Q_S •If Yes,See Sidebar RFAR C to ZAlgonquin IL 60102 B BW75323 IL 2024 0 C 2 TELEPHONE DRIVER'S LICENSE NO. STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0 (708)289-2913 R200-4327-2896 IL D 0 5UX23EU09S9W61448 STATE FARM ❑y ®N RDEF73 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST.FIRST,M) POLICY NUMBER 1 I 99 9 Same 0608005-SFP-13 BAC 3 HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE.ZIP PHONE NUMBER 996 < RESPONDER Same Ut = (UNIT) I SEAT) (DOB' (SEX, (SAFT) (AIR) (INJ( (EJCT( (EPTH) PASSENGERS&WITNESS ONLY (NAME',(ADDRESS i 7 iTELEPHONEI (EMS) (HOSPITAL) 2 3 1 0 /08/2009 M 2 4 0 1 0 NATHAN F. REICH/3731 WINTERGREEN TER.Algonquin.IL.60102 996 1— (708)446-1425 U2 m / / #OCCS D / / U1 1 m / / 2 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME ❑AM Did crash occur 0 Y U2 Z N i ® 11 1 10,15 /2024 06 42 ®pM in a Work Zone? ®N DIRP co 1 r PROPERTY OWNERS ADDRESS:STREET.CITY,STATE,ZIP PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME It YES check one below: U1 1 0 T 2 0 28 18 ❑AM ( I 0 PM ❑Construction a N 3 ❑ ®CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 1 ❑AM ❑Maintenance U2 Q 1 CO 11 1 ARREST NAME BOYER,ALEXA, M. 11-601 1542-000007 / / ❑PM SLMT O UCITATIONS ISSUEDPENDING • ROAD CLEARANCE TIME 0 Utility o N 0 0 SECTION CITATION NO. AM 45 2 0 ARREST NAME 10/15 /2024 06 42 ®PM 0 Unknown work zone type Ut T • OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 45 2 2 3 ❑ 1542-Chase. Ethan 901 334-Fries 11 , 19/2024 09 00 0 PM Workers present? ®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 AD DITIONAL UNITS FORMS _r } A CMV is defined as any motor vehicle used to transport passengers or property and. D Z Not To Scale I I : 1 Has a weight rating more than 10,000 pounds(example truck or truck/trailer r I I I I I ' ' INDICATE NORTH combination) or —I XI BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver n I ', ' I I �� I IMO -f ` r r r (example.shuttle or charter bus)-or 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier 0 i_----.....---% -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_____A____: : , i 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).orMOM O . t i 1 5 Is any vehicle used to transport any hazardous material(HAZMAT)that requires 13 placarding(example placards will be displayed on the vehicle) 71 CARRIER NAME Z ADDRESS 0 • CITY/STATE/ZIP 2 MOTOR CARR ID ❑ Interstate ❑ Intrastate 0 Not in Comm./Govt. El Not in Comm./Other USDOT NO. ILCC NO. XI , Source of above Z . Were HAZMAT placards on vehicle? ❑ Yes ❑ No If Yes, Name on placard O 4 digit UN NO. 1 digit Hazard class No M 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 g Did Carrier Safety Regulations MCS)violation contribute to the crash? O ❑ 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 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 ❑ ❑ ❑ o U 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft 2 ft. y Maroon White - 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_ 1 TOWED BY/TO: DUE TO © VEHICLE CONFIG CARGO BODY TYPE LOAD TYPE