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HomeMy WebLinkAbout2024-00066059 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 1111111 OIl III I IIII lull II 11111111111111111 101111 lUll Ill II DRAG TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X003539552' u, 1 U2 1 3 4 1 U1 2 U2 1 U, 1 U2 1 Ut 1 U2 1 1 10 Ut 3 U2 1 *P 0119* INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW DAMAGE TO ANY El$500 OR LESS TYPE OF REPORT 0 A No Injury J Drive Away Elgin Police Department ONE PERSON'S ❑$501-$1.500 ®ON SCENE 14 0 NOT ON SVEHICLE/PROPERTY El OVER$1.500 El AMENDEDCENE(DESK REPORT) ElB Injury and JorTow Due To Crash YR 2024I2024-00066059 VENT * ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 '11 SPARTAN DR ® ❑ Elgin RELATED ®Y ❑N 10 16 2024 08:01 ®AM ❑YES ®NO U1 ,< PRIVATE mo /day I yr ❑PM FLOW CONDITION m FT/MI N E S W S MCLEAN ) Kane HIT&RUN ❑Y CZN PEDALCYCUST®N ® FREE FLOW # LNS 0 tg DRNER 0 PARKED 0 DRIVERLESS ❑ PEE ❑PEDAL ❑ECUES 0 NIN ❑Ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 0 FOR DAMAGED AREA(S) FRONT TOWED Ut 0 mo day yr 13-UNDER CARRIAGE FIRE ❑ IA SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 10 z DISTRACTED 0 EI U2 0 m 2808 TURNBERRY RD M ❑Y IN NSYSTEM❑LINK VEH. O ATCRASH D 0 99-UUTHER NKNOWN 9 16-TOP 3 Distraction Value 9 ALGN = r CITY PLATE NO. STATE YEAR POINT OF & j 6 4 COM VEH 0 ® 1 0 2T1 BURHE2JC037740 AAA ❑Y ®N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER RSUR m Y 99 9 Same AUT700887230 1 r o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET.CITY,STATE,ZIP PHONE NUMBER L ❑Y ®N 2 '' RESPONDER Same VEHU 5 ®DRIVER ❑ PARKED ❑DRNERLESS ❑ PED ❑PEDAL ❑EQUES 0 WV ❑Nov 0 ov DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N U1 m m / J FOR DAMAGED AREA(S) FROM TOWED s Estrella_ El n_ N. 1 1 0 3 1 9 9 9 Ford Fusion 2006 00-NONE 1t' 1'_1 DUE TO CRASH (g 0 2 —I , NAME(LAST,FIRST,M) y © C v mo day yr 13-UNDERCARRIAGE 10 fj FIRE ❑ ® U2 C , STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 IN SPDR n SYSTEM IN O ENGAGED 0 15-OTHER 9 16-TOP 3 9 0 X a` 319 N MELROSE AVE F ❑Y ® N DUNK VEH. AT CRASH 99-UNKNOWN II •Distraction Value N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POF FIRST CNT ONTACT 12 7_'1 6 1_S CIOf MeeVSee Sidebar ® U1 to H ELGIN IL 60123 B DH59157 IL 2025 REAR 9 Z M TELEPHONE DRIVER'S LICENSE NO. STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0 (224)629-7734 E236-2149-9913 IL D 0 3FAFP07Z86R130939 Direct Auto ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST.FIRST,M) POLICY NUMBER 1 I 99 9 Same PAIL001013174 BAC 3 HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE.ZIP PHONE NUMBER 996 < RElE Y NR Same U1 = (UNITE (SEAT) ;DOB) (SEX) (SAFT) (AIR) (INJ) (EJCTI (EPTH) PASSENGERS&WITNESS ONLY (NAME)I(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 ®AM Did crash occur 0 Y U2 Z N ® 1 1 4 10/16 /2024 08 02 �pM in a Work Zone? El N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME It YES check one below: T PROPERTY OWNERS ADDRESS:STREET.CITY,STATE,ZIP ❑AM U1 1 - 2 0 2 18 ! / PM ❑Construction * N T 3 0 ®CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 5 ❑AM ❑Maintenance U2 ® 11 4 ARREST NAME Schiopu, Daniel, R. 11-901 499000720 / / El PM SLMT o u 0 CITATIONS ISSUED ❑PENDING •'SECTION CITATION NO. ROAD CLEARANCE TIME ❑Utility 'd NII AM 45 2 0 ARREST NAME / / ptil ❑Unknown work zone type Ut 2 2 3 El • OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 45 499-Dirck Cameron 702 272-Bajak 11 ,26/2024 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. 0 IF MORE THAN ONE CMV IS INVOLVED,USE SR 1050A I ADDITIONAL UNITS FORMS ' _ } A CMV is defined as any motor vehicle used to transport passengers or property and. 1 Has a weight rating more than 10,000 pounds(example truck or truck/trailer r 1 i i Nor-rb scarej ; ; combination) or —I INDICATE NORTH XI BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C J. J. d iI. ` r r r (example.shuttle or charter bus)-or n X 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier 0 t.-----;------t 4 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 A ; .1SPARTAN?DR N l' r i 4 Is used or designated to transport between 9 and 15 passengers,including the driver, C J ` for direct compensation(example:large van used for specific purpose).or O _--; ; , , i i 5 Is any vehicle used to transport anyhazardous material(HAZMAT)that requires N. ! placarding(example placards will be displayed on the vehicle) 13 rn CARRIER NAME Z ' t ADDRESS 0 v N • CITY/STATE/ZIP O i . MOTOR CARR ID ❑ Interstate ❑ Intrastate 0 Not in Comm./Govt. ElNot in Comm./Other Q USDOT NO. ILCC NO. C • , Source of above 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 rn 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. Z Gray Gray u 1 TOWED - TOTAL VEHICLE LENGTH ft. NO.OF AXLES DUE TO ❑,r 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 ,r DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT. 3 TOWED BY/TO: DUE TO ❑ Redmons I Impound Lot Garage VEHICLE CONFIG _ CARGO BODY TYPE LOAD TYPE