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HomeMy WebLinkAbout2024-00066105 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets liii Ill OIl III I III ll II 111111111111111111H1 111110111 Ill I I DRAG TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X003590642- u, 1 U21 1 1 1 U1 4 U2 1 U, 1 U2 1 U1 1 U2 1 1 10 Ut 2 U2 3 *P 0119* INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW DAMAGE TO ANY El$500 OR LESS TYPE OF REPORT ® A No Injury J Drive Away Elgin Police Department ONE PERSON'S ❑$501-$1.500 ®ON SCENE 1 El NOT ON SVEHICLE/PROPERTY El OVER$1.500 0 AMENDEDCENE(DESK REPORT) ❑ B Injury and JorTow Due To Crash YR 2024I2O24-000661 O5 VENT * ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 'I'I BLUFF CITY BLVD ❑Elgin RELATED ❑Y coN 10 16 2024 12:04 ❑AM ❑YES ®NO U1 ,‹ PRIVATE mo /day I yr ®PM FLOW CONDITION m COUNTY PROPERTY ❑Y ®N DOORING ❑y #OF MOTOR ❑SLOW 1 U) ❑ FT/MI N E S W Cook HIT&RUN ❑Y ® N WITH N VEHICLES INVLD ❑ STOPPED U2 —I ❑ AT INTERSECTION WITH (NAME OF ) PEDALCYCUST® ® FREE FLOW # LNS 0 tg ORNER ❑ PARKED ❑DRNERLESS ❑ PED ❑PEDAL ❑EOUES ❑ARV ❑Ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 0 0 4 / 2 7 /2 0 0 7 FOR DAMAGEDAREA(S) FRONT TOWED U1 .Angela,J. Ford Explorer 2016 00-NONE „ I 12 D1 DUE TO CRASH p NAME(LAST,FIRST,M) g mo day yr 13-UNDER CARRIAGE 1 FIRE 0 IA SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 10 O DISTRACTED 0 ll U2 2 m 2345 BUTTERCUP CT F ❑Y ISYNM❑UNK VEH. O AT CRASH D 0 15-OTHER 99-UNKNOWN 9 16-TOP.3 ,Distraction Value 9 ALGN .. r CITY PLATE NO. STATE YEAR POINT OF 8 {I 6 ii_ COM VEH 0 ® 3 (7 1— FIRST CONTACT 1 7__, _�,6 •If Yes,See Sidebar U1 O Z 1 FM5K8GT1GGA61434 Bristol West ❑Y ®N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER RSUR m a Furlong.Jeffrey P. G01509023100 1 m o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET.CITY,STATE,ZIP PHONE NUMBER o RESPONDER y°®EN 2345 BUTTERCUP CT.Auroral. IL.60506 (630)877-1270 VEHU 0 5 ®DRIVER ❑ PARKED 0 DRNERLESS ❑ PED ❑PEDAL ❑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 Hernandez-Fuentes, Edwin 1 2 3 1 2 0 0 6 Nissan Sentra 2012 00-NONE O' 1 0 DUE TO CRASH ❑ ® 2 -I NAME(LAST,FIRST,MI mo day yr 'Z, ✓ t3-UNDERCARRIAGE 10 fj 2 FIRE ❑ ® U2 C c STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 IN SPDR C) SYSTEM IN O ENGAGED 0 15-OTHER 9 16-TOP 3 9 3 X E 7401 BRIAR LN G N M ❑Y ® N DUNK VEH. AT CRASH 99-UNKNOWN II •Distraction Value N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POF FIRST CONTACTNT O 11 7_'1 6 1_S G•I°MesVSee Sidebar ® U1 07 H Hanover Park I D 60133 0 EW81860 IL 2025 1 0 C M TELEPHONE DRIVER'S LICENSE NO. STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0 (847)708-5386 H655200006372 _IL D 3N1AB6APXCL692291 Direct Auto ❑y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST.FIRST,M) POLICY NUMBER 1 I Same PAI L001 100282 BAC 3 HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE.ZIP PHONE NUMBER 996 < RESPONDER yO®N Same U1 = (UNIT) I SEAT) (DOB) (SEX) ISAFT) (AIR) (INJI (EJCTI (EPTH) PASSENGERS 8 WITNESS ONLY (NAME)I(ADDRESS),ITELEPHONEI (EMS) (HOSPITAL) 1 3 11 /03/2007 F 2 3 0 1 O Alize Gutierrez/866 COOKANE AVE.ELGIN.IL.60120 996 1— (224)762-3006 , U2 m / / #OCCS D / / U1 2 m / I 1 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME El AM Did crash occur El U2 Z N ® 11 1 10/16 ,2024 12 04 ®pm in a Work Zone? ®N DIRP D 1 r PROPERTY OWNERS ADDRESS:STREET.CITY,STATE,ZIP PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME ID AM It YES check one below: U1 3 C) T 2 0 04 03 ! , 0 PM El Construction * N 3 0 ®CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 3 ❑AM ❑Maintenance U2 Q ® 11 1 'ARREST NAME Furlong.Angela,J. 11-601 1529-000139 / / El PM SLMT o U 0 CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ❑Utility o N BAM 30 2 0 ARREST NAME , / ptil ❑Unknown work zone type Ut 2 2 3 0 • OFFICER ID SIGNATURE BEAT I DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 30 1529-Audi red.Jonathan 401 272-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. _ 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. D Z 1 Has a weight rating more than 10,000 pounds(example truck or truck/trailer r I I i combination) or INDICATE NORTH XI BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C i I ', i t070}OL �' '�D -I' ` r r r (example.shuttle or charter bus)-or n 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier 0 t.-----;-----� / -f } - t transporting employees in the course of their employment(example.employee ,3 �J transporter-usually a van type vehicle or passenger car).or 03 �____A____: : i , : 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).or O L____"-____; 4 C [ ; i. i i 5 Is any vehicle used to transport anyhazardous material(HAZMAT)that requires placarding(example placards will be displayed on the vehicle) 71 T. aw�� ' CARRIER NAME Z ' :4-: ADDRESS 0 ewrfmrrvavv° D [n Not Ibis% I 0 • CITY/STATE/ZIP 0 r , MOTOR CARR ID ❑ Interstate ❑ Intrastate I 0 Not in Comm./Govt. El Not in Comm./Other USDOT NO. ILCC NO. m XI , Source of above Z . Form Number _ m IDOT PERMIT NO WIDELOAD? ❑Yes ❑No 2 ' TRAILER VIN 1 m CA 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 Black Gray - u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT- 2 TOWED BY/TO SELECT CODES FROM THE BACK OF CRASH BOOKLET u 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT. 3 TOWED BY/TO: DUE TO © VEHICLE CONFIG CARGO BODY TYPE LOAD TYPE