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HomeMy WebLinkAbout2024-00066313 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 1111111 OIl III (III (IIIIII II 111111111111111111111110101111111 II DRAG TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X003590624 u, 1 U21 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 1 0 NOT ON SVEHICLE/PROPERTY in OVER$1.500 0 AMENDEDCENE(DESK REPORT) [Z] B Injury and JorTow Due To Crash YR 2024I2024-00066313 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 '1 HOPPS RD Elgin ❑ RELATED ®Y ❑N 10 17 2024 06:58 ®AM ❑YES ®NO U1 -< PRIVATE mo /day/yr ❑PM FLOW CONDITION m FT/MI N E S W RANDALL R ) Kane HIT&RUN ❑Y CZN PEDALCYCUST®N ® FREE FLOW # LNS 0 tg DRNER 0 PARKED 0 DRIVERLESS ❑ PEE ❑PEDAL ❑EOUES 0 NW 0 Ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 0 0 3 / 2 4 /1 9 8 2 FOR DAMAGED AREA(S) FROM TOWED U1 , GABRIEL Chevrolet Malibu 2010 00-NONE ©' ..0.,D1 DUE TO CRASH ® ❑ NAME(LAST,FIRST,M) mo day yr 13-UNDER CARRIAGE FIRE ❑ SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 10 221 DISTRACTED 0 El U2 0 m 1220 KINGS CT 103 M ❑Y ❑SNEM®UNK EINH. 9 AT CRASHD 9 99-UNKNOWN 9 16-TOP 3 ,Distraction Value 9 ALGN 2 T. CITY PLATE NO. STATE YEAR POINT OF 8 . 4 COM VEH 0 ® 1 0 F FIRST CONTACT 12 7_ ? 6 :_.6 ^Yves,See Sidebar U1 Z 1G1ZB5EBXAF162055 KEMPER ❑Y ®N U2 m EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER RSUR m 99 9 Same 12RA000020463 1 r o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET.CITY,STATE,ZIP PHONE NUMBER '' RESPONDER Same VEHU X L ❑Y ❑N 2 05 ®DRIVER ❑ PARKED 0 ORNERLESS ❑ PED ❑PEDAL ❑EQUES 0 WV ❑Ncv 0 DV DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) U1 m /m FOR DAMAGED AREA(S) FROM TOWED Y N s NAME(LAST,FIRST,M) GUTIERREZ-DIAZ- MARIA,A. 0 6 2 /day 1 9 8 9 yr Toyota Corolla 2021 00-NONE O 12 OUETOCRASH 0 2 v 13-UNDER CARRIAGE 101 ! 2 FIRE El ® U2 C 2 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 ® SPCA C) SYSTEM VIN 9 ENGAGED 9 15-OTHER 9 16-TOP 3 9 9 a` 324 GLENWOOD DR 204 F ❑Y ❑ N ®UNK VEH. AT CRASH 99-UNKNOWN II •DistractionValue N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POF FIRST CNT ONTACT 11 7_'1 6 1_S G•IOMesVSee Sidebar ® U1 to H BLOOMINGDALE IL 60108 0 CQ27112 IL 2025 REAR 0 CC/1 M TELEPHONE DRIVER'S LICENSE NO. STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0 (224)385-6673 G362-5418-9776 IL D 0 JTDEAMDEOMJ030454 UNIQUE ❑y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST.FIRST,M) POLICY NUMBER 1 I 99 9 Same I LP2823441 BAC 3 HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE.ZIP PHONE NUMBER 996 < RESPONDER ❑ Same U1 = (UNIT) (SEAT) ;DOB) (SEX) )SAFT) (AIR) IINJI (EJCT( (EPTH) PASSENGERS&WITNESS ONLY (NAME'((ADDRESS)((TELEPHONE) (EMS) (HOSPITAL) 1 3 1 0 /07/2002 M 9 4 0 1 0 JESUS LAZORO/1220 KINGS CROSS,WEST CHICAGO.IL.60185 U2 996 r (630)956-0090 - m W 1 0 /1 2/1962 F DIANE L BERG/701 9N PUEBLO PEAK -ELGIN-IL60124/ #OCCS D • (847)340-2261 X / / U1 2 m / 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 1 4 10/17 /2024 06 59 ❑pM in a Work Zone? ®N DIRP CO 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: T PROPERTY OWNERS ADDRESS:STREET.CITY,STATE,ZIP ❑AMU1 8 a 2 0 2 28 ! / PM 0 Construction * r�^A 3 0 ®CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 5 ❑AM ❑Maintenance U2 El 11 1 ARREST NAME ABAD-LAZARO.GABRIEL 11-901 326000067 / / El PM SLMT o U CI CITATIONS ISSUED El PENDING 'SECTION CITATION NO. ROAD CLEARANCE TIME ' 0 Utility "'p N II AM 45 2 0 ARREST NAME 1 / PM ❑Unknown work zone type Ut T OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 0 0 AM Workers present? ❑Y 45 326-Hornsby. Marc 702 272-Bajak I / 0 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 2 1 Has a weight rating more than 10,000 pounds(example truck or truck/trailer r 'I 1 i 1 INDICATE NORTH combination) or 711 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C I 1 ', i //////// ! ` r r r (example shuttle or charter bus)-or 0 ------;-----% I + J i } } t transporting employeeed to sl5 or fewer in the courseaof theirempayrs and ment(example�emact ployeerier O�vehicle or -____ ____1 , $ i r i 4a Is usedror designated to trra-usually a van nsport between 9 andgr 15rpassengers,including the driver, N for direct compensation(example:large van used for specific purpose).or I : O 11 L____-L____ 1 . , -t i 1 5 Is any vehicle used to transport any hazardous material(HAZMAT)that requires t placarding(example placards will be displayed on the vehicle) 71 T. .7' '' 4 4 1 )1° CARRIER NAME Z ' i / `r' t t i. t ADDRESS 0 N ' 0 CITY/STATE/ZIP MOTOR CARR ID ❑ Interstate ❑ Intrastate ❑ Not in Comm./Govt. Not in Comm./Other USDOT NO. ILCC NO. , Source of above Z . Form Number 0 — X IDOT PERMIT NO WIDELOAD? ❑Yes ❑No 2 ' TRAILER VIN 1 m to LOCAL USE ONLY TRAILER VIN 2 m D 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 Blue.Dark 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