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HomeMy WebLinkAbout2024-00066310 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 1111111 010 III )III )IIIIII II 111111111111111110111111111111011 DRAG TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X00355E408 u, 1 U21 3 4 1 U1 4 U2 1 Ut 1 U2 1 Ut 1 U2 1 1 12 Ut 2 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 • 3 El NOT ON SVEHICLE/PROPERTY 0 OVER$1.500 ❑AMENDEDCENE(DESK REPORT) ElB Injury and JorTow Due To Crash YR 2024I2O24-0006631 O VENT * ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 'F'I RANDALL RD ®gin El ®Y ❑N 10 17 2024 06'25 ®AM ❑YES ®No u1 • ,< PRIVATE mo /day/yr ❑PM FLOW CONDITION m EP0 ® O COUNTY PROPERTY Ely ®N DOORING ❑y #OF MOTOR 0 SLOW 1 N /MI N S W 1-90 WITH VEHICLES INVLD ElSTOPPED U2 CD ❑ AT INTERSECTION WITH (NAME OF ) Kane HIT&RUN ❑Y CZN PEDALCYCUST®N ® FREE FLOW # LNS ' 0 tg oRNER 0 PARKED 0 DRIVERLESS ❑ FED 0 PEDAL 0 EOUES 0 NW 0 Ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 FOR DAMAGEDAREA(S) FRONT TOWED U1 0 NAME(LAST,FIRST,M) mo / 0 8 J 1 9 4 Tesla Y 2021 00-NONE DUE TO CRASH .Geannaay ++_ 1$ D ❑ ® 3 yr13-UNDERCARRIAGE ) Y FIRE 0 IA +o O < SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 1l U2 m 9005 BUNKER LN F ❑Y ESYlM❑UNK VEH. O AT CRASH D 0 99-UUTHER NKNOWN 9 16-TOP 3 ,Distraction Value ALGN = CITY PLATE NO. STATE YEAR POINT OF 8 {I 6 ii 4 COM VEH 0 El 1 0 ~ SYJYGDEE5MF109894 State Farm ❑Y ®N U2 m EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER RSUR Same 3135017 SFP 13 1 m o HOSPITAL(TAKEN TO) INCIDENT • IF'Y' OWNER STREET.CITY,STATE,ZIP PHONE NUMBER '' RESPONDER Same VEHU L El Y ®N 2 G1 ' ®DRIVER ❑ PARKED 0 DRNERLESS ❑ PED 0 PEDAL ❑EQUES 0 NUN ❑NCV 0 ON DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) U1 m m 7 / J FOR DAMAGED AREA(S) F0 rIT TOWED Y N NAME(LAST,FIRST,M) Pritchett. Karen 0 mo day 1 9 yr 7 5 Buick Enclave 2017 00-NONE 11, 12 '_s RE o CRASH O 0 U2 2 C v 13-UNDER CARRIAGEI 11 c STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 0 DISTRACTED 0 ® SPUR 0 a 1231 LEXINGTON DR F SYSTEM IN O ENGAGED 0 15-OTHER 9 16-TOP 3 0 X ❑Y El DUNK VEH. AT CRASH 99-UNKNOWN •Distraction Value N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF ©1 all! 4 COM VEH 0 ® U1 to C FIRST CONTACT 7 4_••-1d,1_5 ••*Yes,See Sidebar Z Algonqion IL 60102 0 EL31730 IL 2025 O rn D TELEPHONE DRIVER'S LICENSE NO. STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0 (847)340-5279 P632-5127-5810 IL D SGAKVCKD4HJ146999 Erie ❑y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 I Pritchette. Daniel Q050177304 Bnc ' 3 HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE.ZIP PHONE NUMBER 996 < RESPONDER 1231 LEXINGTON DR•Algonquin• I L.60102 (847)980-5072 U1 = (UNIT) (SEAT) ;DOB) (SEX) (SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)//ADDRESS(1ITELEPHONEI (EMS) (HOSPITAL) 0 / I U2 996 r m / #OCCS ' D / /• 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 ® 11 1 10/17 /2024 06 25 ❑pM in a Work Zone? ®N DIRP co 1 r PROPERTY OWNERS ADDRESS:STREET.CITY,STATE,ZIP PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME ❑AM It YES check one below: U1 5 0 T 2 0 28 99 , / 0 PM ❑Construction * c' 3 0 ®CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME ❑AM ❑Maintenance uz 5 CO 11 1 ARREST NAME Boswell.Geanna 11-601 S1517-000351 / / 0 PM SLMT o U 0 CITATIONS ISSUED 0 PENDING •SECTION CITATION NO. ROAD CLEARANCE TIME ' 0 Utility N 8 ApM 45 T 2 0 ARREST NAME / / pl El Unknown work zone type Ut 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 45 1517-Le Cates. Brittany 502 272-Bajak 11 ,21 /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. IF MORE THAN ONE CMV IS INVOLVED,USE SR 1050A ADDITIONAL UNITS FORMS r_.._r____.; ; ; A CMV is defined as any motor vehicle used to transport passengers or property and. 0Tx 1 Has a weight rating more than 10,000 pounds(example truck or truck/trailer ; ; INDICATE NORTH combination)or —I d + ' BY ARROW 2 Is used or designed to transport more than 15 passengers Including the driver C +, , i I j I ` r r r (example'.shuttle or charter bus)-or ew 3. Is designed to carry 15 or fewer passengers and operated a contract carrier 0 9 P by I -----'-----+ + + I I -i i- - i- transporting employees in the course of their employment(example.employee xi tr -usually a van vehicle or �____A____I : , ei I~II i r i 4a Is usedror designated to trransport between 9 andgr 15rpassengers,including the driver, N r I I �/ ; ; for direct compensation(example:large van used for specific purpose) or O 11 L_____ ____;1 i , �' i i 5 Is any vehicle used to transport anyhazardous material(HAZMAT)that requires \o placarding(example placards will be displayed on the vehicle) Zml : I • CARRIER NAME Z I r ADDRESS0 To 1 � cn O It CITY/STATE/ZIP • r , Not To Scale 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 . Form Number m 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" >102 m m TRAILER 1 ❑ ❑ ❑ Z -74 TRAILER 2 ❑ ❑ ❑ 0 U 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft 2 ft. Z Gray White - 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 X DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT- 2 TOWED BY/TO: DUE TO ❑ Redmons I Impound Lot Garage VEHICLE CONFIG _ CARGO BODY TYPE LOAD TYPE