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HomeMy WebLinkAbout2024-00065972 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 1111111 DIII III IIII IIII lull 11111111111111111 10 11101111 110 I I DRAG TRFD TRFC WEAT DRVA VIS VEND LGHT COLL 'MANY X0035395�46 u, 1 U21 3 4 1 U1 4 U2 1 U, 1 U2 1 U1 2 U2 1 5 11 U1 1 U2 1 *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 1 0 NOT ON SVEHICLE/PROPERTY in OVER$1.500 0 AMENDEDCENE(DESK REPORT) ® B Injury and JorTow Due To Crash YR 2024I2024-00065972 VENT * ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 '11 N STATE ST ❑ Elgin RELATED ®Y ❑N 10 15 2024 06:47 DAM ® ❑YES NO u1 ,< PRIVATE mo /day/yr ®PM FLOW CONDITION m 75 'COUNTY PROPERTY ❑Y M N DOORING ❑y #OF MOTOR ®SLOW 1 Cl) ® ®/MI ON E S W Wing St 'WITH VEHICLES INVLD ❑ STOPPED U2 —I ❑ AT INTERSECTION WITH (NAME OF ) Kane HIT&RUN ®Y ❑ N PEDALCYCUST®N ❑ FREE FLOW # LNS 0 tg ORNER 0 PARKED 0 DRIVERLESS ❑ FED 0 PEDAL 0 EOUES 0 NW 0 NCV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 C) FOR DAMAGED AREA(S) FRONT TOWED Ut O NAME(LAST,FIRST,M) ,Adan mo 1 2 / day J 2 6 Lincoln Town Car 1997 Do-NONE 11O� , DUE TO CRASH ® o yr 13-UNDERCARRIAGE tOl• I 2 FIRE ❑ SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 10U2 4 m 206 ARROWHEAD ST M ❑Y ESYlM❑UNK VEH. O AT CRASH D 0 99-UUTHER NKNOWN 9 76-TOP 3 ,Distraction Value 9 ALGN = CITY PLATE NO. STATE YEAR POINT OF 8 {I 6 ii 4 COM VEH 0 ® 3 0 A ~ 1 LN LM82W8VY686066 Allstate ❑Y ®N U2 m V. EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER RSUR m Garcia, Martin 962722182 1 m o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET CITY,STATE,ZIP PHONE NUMBER .5 RESPONDER y°DEN 206 E ARROWHEAD ST, North Aurora. I L.60542 (630)486-9116 VEHU G1 ®DRIVER ❑ PARKED 0 CRNERLESS ❑ PED 0 PEDAL ❑EQUES 0 WV ❑NOV 0 DV DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Ut 2 m m / J FOR DAMAGEDAREA(S) FRONT TOWED Y N s Scott, Kennetth,J. 0 1 0 7 2 0 yr0 4 Chrysler 200 2016 00-NONE ,t �' , DUE TO CRASH 0 ® 2 Xi NAME(LAST,FIRST,M) mo day ©, v t3-UNDER CARRIAGE �� I/ z FIRE ❑ ® U2 C c STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 IN SPCA C) E 2203 COLORADO AVE M SYSTEM IN O ENGAGED 0 15-OTHER 9 16-TOP 3 9 9 X ❑Y ® N DUNK VEH. AT CRASH 99-UNKNOWN •Distraction Value N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8 j ! 4 COM VEH ❑ ® U1 to F, FIRST CONTACT 6 7__•-_1 ;_5 •(rYes,See Sidebar ELGIN IL 60123 0 DJ31026 IL 2025 0 C M TELEPHONE DRIVER'S LICENSE NO. STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0 (224)762-9289 S300-5100-4007 IL D 1 C3CCCAB7G N 132275 Allstate ❑y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST.FIRST,M) POLICY NUMBER 1 I Same 932559037 BAC 3 HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE.ZIP PHONE NUMBER 996 < ElRE Y 0NR Same U1 = (UNIT) i SEAT) ;DOB' (SEX' ;SAFT) (AIR) (INJI (EJCTI (EPTH) PASSENGERS&WITNESS ONLY (NAME'/I ADDRESS)/(TELEPHONE) (EMS) (HOSPITAL) 1 6 11 /1 6/2006 M 2 3 0� 1 0 Jose E. Avelar-Armas/407 SPRUCE ST,South Elgin-IL.60177 Refused 996 1— (630)611-5856 _ U2 m 1 3 09 /07/2006 M 2 3 0 1 0 Daniel Gonzalez-Flores/404 LOCUST ST-North Aurora-IL-60542 Refused #occs y (331)301-9541 _ X 3 3 1 2 /09/1989 F 2 3 0 1 0 Sharonda Johnson/888 ATLANTIC AVE A,Hoffman Estates.IL.60169 Refused U1 3 m 18471751-1032 D / / 1 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME 0 AM Did crash occur ❑Y U2 Z N i ® 11 1 10,15 /2024 06 47 ®pM in a Work Zone? ElN DIRP co 1 r PROPERTY OWNERS ADDRESS:STREET.CITY,STATE,ZIP PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME 0 AM It YES check one below: U1 1 T 2 0 28 03 ! I 0 PM ❑Construction * c 3 ❑ ®CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 1 ElAM ❑Maintenance U2 Q 1 ® 11 1 ARREST NAME Salgado,Adan 11-601 51504000415 / / ❑PM SLMT o UCITATIONS ISSUED PENDING ROAD CLEARANCE TIME ' 0 Utility o N 0 SECTION CITATION NO. AM 35 I 2 ID1 1 1 ARREST NAME 10/16 /2024 07 40 ®PM 0 Unknown work zone type Ut T OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 0 1504-Real, Hilario 501 334-Fries 11 ,26/2024 01 30 CO PM Workers present? ®N U2 35 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 l ADDITIONAL UNITS FORMS ; , .f l A CMV is defined as any motor vehicle used to transport passengers or property and. D �` A. \ 0 j 1 Has a weight rating more than 10,000 pounds(example truck or truck/trailer Z r �� combination)or —I ', ', r INDICATE NORTH XI 4 ‘ I BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C i '• ', i , -` ` r r r (example'.shuttle or charter bus)-or • ` 1 i. ---- ----1 1 t ) )- itransporting 15 or fewer the course theiremployment(example�emaployeerier 0 3. I s } transporter-usually a van type vehicle or passenger car).or w ' 1i r i 4 Is used or designated to transport between 9 and 15 passengers,including the driver, C ` \ for direct compensation(example:large van used for specific purpose).or 0 L_____-___-; i i i 5 Is any vehicle used to transport any hazardous material(HAZMAT)that requires placarding(example placards will be displayed on the vehicle) 11 T. r f J� ` , ` 1 CARRIER NAME Z 1 • ® ADDRESS Ij� • En r 1R 1, �I o tr _ • CITY/STATE/ZIP •, • i 1t �1 MOTOR CARR ID ❑ Interstate ❑ Intrastate • ❑ Not m Comm./Govt. El Not m Comm./Other Q 1 C 1 USDOT NO. ILCC NO. , Source of above Z . If Yes, Name on placard 0 4 digit UN NO. 1 digit Hazard class No M 71 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 0 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 C Z Form Number D m XI IDOT PERMIT NO WIDELOAD? ❑Yes ❑No S TRAILER VIN 1 m N LOCAL USE ONLY TRAILER VIN 2 m D TRAILER WIDTH(S) 0-96'1 97-102'1 >10; m m TRAILER 1 ❑ ❑ ❑ Z 7 TRAILER 2 ❑ ❑ ❑ o U 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft 2 't Z Silver BlueEn 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- 2 TOWED BYJTO. DUE TO © VEHICLE CONFIG CARGO BODY TYPE LOAD TYPE