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HomeMy WebLinkAbout2024-00066065 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 1111111 OIl III (III (IIIIII II 111111111111111111H1 111110111111 I DRAG TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X003590645 u, 1 U21 2 4 1 U, 2 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 14 El NOT ON SVEHICLE/PROPERTY Ill OVER$1.500 El AMENDEDCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash YR 2024I2024-00066065 VENT * ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION ' DATE OF CRASH TIME SECONDARY CRASH 15 't'I N LIBERTY ST ❑Elgin RELATED ®Y ❑N 10 16 2024 08:46 ®AM ❑YES ®No u1 ,< PRIVATE mo /day I yr ❑PM FLOW CONDITION m FT/MI N E 5 W SLADE AVE 'COUNTY PROPERTY El ®N DOORING ❑y #OF MOTOR 0 SLOW 15 N ❑ 'WITH VEHICLES INVLD El STOPPED U2 —1 ® AT INTERSECTION WITH (NAME OF ) Kane HIT&RUN ❑Y CZN PEDALCYCUST IN N ® FREE FLOW # LNS 0 tg DRIVER 0 PARKED 0 DRNERLESS ❑ PED 0 PEDAL 0 EOUES 0 NW 0 Ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 C) FOR DAMAGEDAREA(S) FRONT TOWED Ut 0 .Yoselin 1 1 / 0 3 /2 0 0 3 Nissan Rogue 2020 00-NONE „ 12 , DUE TO CRASH El ❑ NAME(LAST,FIRST,M) mo day yr 13-UNDER CARRIAGE �0 2 FIRE ❑ IA SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 l U2 4 m 628 SLADE AVE F SYSTEM IN ENGAGED '1' 15-OTHER 9 76-TOP®3 = ❑Y ®N ❑UNK VEH. AT CRASH99-UNKNOWN Distraction Value 9 ALGN CITY PLATE NO. STATE YEAR POINT OF 8 {I 6 ii 4 COM VEH 0 ® 1 0 5N1AT2MV9LC736141 State Farm ❑Y ®N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER RSUR m a 1 99 9 Garcia, Daniel 0613843sfp13 1 Ei HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET.CITY,STATE,ZIP PHONE NUMBER r o RESPONDER y°®EN 3 628 SLADE AVE. ELGIN . IL.60120 (224)508-0598 VEHU 0 ®DRIVER ❑ PARKED 0 DRNERLESS ❑ PED ❑PEDALL ❑EQUES 0 WV ❑NCv 0 DV DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) U1 2 m m / / FOR DAMAGED AREA(S) FRONT TOWED �Y N s Gonzalez Martinez,Zoyla 0 7 0 4 1 9 8 8 Honda Pilot 2008 00-NONE ,t. j'_, DUE TO CRASH Id 0 2 —I , NAME(LAST,FIRST,M) y mo day yr ©, C -1?, 13-UNDER CARRIAGE ��I Ij z FIRE ❑ ® U2 C STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 IN SPDR C) a 2134 MORNINGSIDE LN E F SYSTEM IN O ENGAGED 0 15-OTHER 9 16-TOP 3 9 0 X ❑Y ® N DUNK VEH. AT CRASH 99-UNKNOWN Distraction Value N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POF FIRST CONTACTNT O 12 7_'1 a 1_5 CIOMe6VSee Sidebar❑ ® U1 to PEAR C Z Carpentersville IL 60110 B DB58844 IL 2024 0 fp D TELEPHONE DRIVER'S LICENSE NO. STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0 (224)388-5247 G524-9808-8790 IL D 0 5FNYF18288B057332 State Farm ❑Y 0 N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST.FIRST,M) POLICY NUMBER 1 I 1 99 9 Same 1106614-sfp-13 BAC 3 HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE.ZIP PHONE NUMBER 996 < RESPONDER y°®N 3 Same U1 = (UNITE i SEAT) (DOBi (SEX) (SAFT) (AIR) IINJI (EJCT( (EPTH) PASSENGERS&WITNESS ONLY (NAME)/(ADDRESS)/ITELEPHONE) EMS) (HOSPITAL) 1 3 07 /25/2012 M 2 8 B 1 Diego Garcia/628 SLADE AVE,ELGIN.IL.60120 U2 996 m 2 5 10 /1 0/2021 F 12 4 0 1 0 Luccana Hernandez/2134 MORNINGSIDE LN E.Carpentersville-IL-60110 #OCCS > 2 4 11 /1 6/2023 M 12 4 0 1 0 Emmanuel Soto/2134 MORNINGSIDE LN E.Carpentersville.IL.60110 Ut 2 m D / I 3 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 1 4 10/16 /2024 08 46 ❑pM in a Work Zone? ®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 7 — 2 0 2 18 ! / PM ❑Construction * N 3 0 ®CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 5 ❑AM ❑Maintenance U2 ARREST NAME Garcia-Garcia.Yoselin 11-901-A 324-1419 / / ❑PM SLMT 1 CO 4 0 Utility p u ❑CITATIONS ISSUED ❑PENDING •SECTION CITATION NO. ROAD CLEARANCE TIME "'p N IIAM 35 2 0 ARREST NAME / / ptil ❑Unknown work zone type Ut 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? 0 Y 35 324-Phillos.James 201 272-Bajak 11 / 12/2024 09 00 ❑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. _ IF MORE THAN ONE CMV IS INVOLVED,USE SR 1050A ADDITIONAL UNITS FORMS r_.._r_ __ 1 , _� } A CMV is defined as any motor vehicle used to transport passengers or property and. 0D 1 Has a weight rating more than 10,000 pounds(example truck or truck/trailer Z { combination) or —I ', 4, r INDICATE NORTH XI Leey Le.ryy N BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver I i n I' ` r r r (example shuttle or charter bus) or n S designed to carryoperateda c r 3 Is sl tl 15fewer passengers i_-----'-----' , , i _: t inof h gor and by contractcarrier } } transporting employees the course their employment(example.employee � Bade ' i „ till— Baas transporter-usually a van type vehicle or passenger car).or w �____A____: : , ` i : } r i- 4 Is used or designated to transport between 9 and 15 passengers,including the driver, fn li—- .for direct compensation(example:large van used for specific purpose) or i I : : o unit < 1 5 Is any vehicle used to transport any hazardous material(HAZMAT)that requires m placarding(example placards will be displayed on the vehicle) 71 sae. CARRIER NAME Z t ADDRESS 0 N ' L°'ro I ..o..y • • CITY/STATE/ZIP MOTOR CARR ID ❑ Interstate ❑ Intrastate 0 Not in Comm./Govt. El Not in Comm./Other USDOT NO. ILCC NO. , Source of above Z . ❑ Yes 0 No ❑ Unknown A 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 5 z Form Number 0 _ m — X IDOT PERMIT NO WIDELOAD? ❑Yes ❑No 2 TRAILER VIN 1 m to LOCAL USE ONLY TRAILER VIN 2 m 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 Black Black 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 I Impound Lot Garage SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED X 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