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HomeMy WebLinkAbout2024-00066424 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets liii Ill DIII III (III III ll II 111111111111111110111111111111011 DRAG TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X0035°3568 u, 1 U21 2 4 1 U11 O U2 1 U, 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 El A No Injury J Drive Away Elgin Police Department ONE PERSON'S ❑$501-$1.500 ®ON SCENE 1 El NOT ON S VEHICLE/PROPERTY inOVER$1.500 0 AMENDEDCENE(DESK REPORT) ❑ B Injury and/or Tow Due To Crash YR 2024I2024-00066424 VENT * ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 'F'I DWIGHT ST Elgin ❑ RELATED ®Y ❑N 10 17 2024 04:08 ❑AM ❑YES ®NO Ut -< PRIVATE mo /day/yr ®PM FLOW CONDITION m FT/MI N E S W S LIBERTY ) Kane HIT&RUN ❑Y CZN PEDALCYCUST®N ® FREE FLOW # LNS 0 tg DRIVER ❑ PARKED ❑DRIVERLESS ❑ FED ❑PEDAL ❑EOUES ❑NW ❑NcV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 0 0 6 / 2 8 J 1 9 9 0 FOR DAMAGEDAREA(S) FRONT TOWED U1 ,Cecil Toyota Avalon 2004 00-NONE ®i 12 , DUE TO CRASH p NAME(LAST,FIRST,M) mo day yr 13-UNDER CARRIAGE ( L 2 FIRE 0 IA 2 < SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DI ® DISTRACTED 0 ISI U2 m 910 BELLEVUE AVE M ❑Y ®SYSNEM❑UNK VEH. O ATCRASH D 0 99-UUTHER NKNOWN B16-TOP 3 "DlslractlonValue ALGN = T. CITY PLATE NO. STATE YEAR POINT OF 6• !1 6 II-4 COM VEH 0 El 1 0 r' ~ 4T1 BF28B64U378097 StateFarm ❑Y ®N U2 m EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER RSUR m a 99 9 Same 2336492-SFP-13 1 r o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET.CITY,STATE,ZIP PHONE NUMBER '' RESPONDER Same VEHU X L ❑Y ®N 2 G) 5 ®DRIVER ❑ PARKED 0 CRNERLESS ❑ PED ❑PEDAL ❑EQUES 0 NUN ❑NCV 0 oN DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Ut m m / / FOR DAMAGED AREA(S) FRC*41 TOWED Y N n NAME(LAST,FIRST,MI Hernandez Villarruel.(]scar Omo oav 1 9 8 3 Chevrolet Colorado Pickup 2006 oo-NONE +[r is DUE TO ❑ ® 2 -I ✓ 13-UNDER CARRIAGE 10 j Z FIRE ❑ ® U2 C c STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) O DISTRACTED 0 ® SPCA (1 SYSTEM IN O ENGAGED 0 15-OTHER 916-TOP® X 122 DEL RIO RD M ❑Y ® N 0 UNK VEH. AT CRASH 99-UNKNOWN FI Distraction Value 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR I CONTACTO 2 7_it 6 5 CIOMVEH ❑ ® U1 al 1— 60110 FIRST POINT 0 3065087B IL 2024 { • 6 See Sideba 0 C n TELEPHONE DRIVER'S LICENSE NO. STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0 (224)772-0968 H655-6408-3131 IL D 0 1 GCCS148668229483 Country Financial ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST.FIRST,M) POLICY NUMBER 1 I 99 9 Same PO1055411 BAC 3 HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE.ZIP PHONE NUMBER 996 < 0 M N Same Ut = (UNIT' I SEAT) (DOB) (SEX) (SAFT) (AIR) (INJ) (EJCT( (EPTH) PASSENGERS&WITNESS ONLY (NAME)/(ADDRESS),(TELEPHONE) (EMSi (HOSPITAL) 2 3 07 /25/1986 M 2 4 0 1 Santiago Garcia Lopez/116 GRANADA RD,60110 - 996 1- (312)286-0342 , U2 m / / #OCCS D / / UI 1 m / / 2 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME El AM Did crash occur 0 Y U2 Z N 1 ® 11 4 10/17 /2024 04 08 ®pm in a Work Zone? ®N DIRP D 1 r PROPERTY OWNERS ADDRESS:STREET.CITY,STATE,ZIP PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME ❑AM It YES check one below: U1 rJ C) T 2 0 03 99 ! , 0 PM El Construction * N 3 0 ®CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 5 Ei AM El Maintenance U2 ® 11 4 ARREST NAME Thomas,Cecil 11-601 (w)455-393 / / ❑PM SLMT o uCITATIONS ISSUEDPENDING ROAD CLEARANCE• TIME • ❑Utility o N 0 0 SECTION CITATION NO. AM 25 2 0 ARREST NAME 10/17 /2024 04 08 ®PM 0 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 25 455 Hallas.Gabriel 401 246-Kite , 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. , 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. Z r-"--r--- 4 , 4 r r r r r , , , 1 . r 0 1 Has a weight rating more than 10,000 pounds(example truck or truck/trailer -< ' r i ; i i i- r r i r INDICATE NORTH combination) or —I XI BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C ' L I ', ! i- L ' ' '. ', ' I. ` r r r (example'.shuttle or charter bus)-or X ; I I ; 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier 0 i------t-----• + + • : - 1 - 1 i } - i• transporting employees in the course of their employment(example.employee M transporter-usually a van type vehicle or passenger car).or w J. r i 4 Is used or desi nated to trans rt between 9 and 15 assen ers including the driver, 9 Po P 9 N for direct compensation(example:large van used for specific purpose).or O i 1 5 Is any vehicle used to transport any hazardous material(HAZMAT)that requires placarding(example placards will be displayed on the vehicle) 11 T. . ` CARRIER NAME Z ' .. ADDRESS 0 N • CITY/STATE/ZIP , , MOTOR CARR ID ❑ Interstate ElIntrastate ❑ Not in Comm./Govt. ElNot in Comm./Other Q m r-----.-----, r r r r r•---, r - DO ILCC NO. m U N XI , 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 Form Number 0 M X1 IDOT PERMIT NO WIDELOAD? ❑Yes ❑No S TRAILER VIN 1 m N LOCAL USE ONLY TRAILER VIN 2 m CJ TRAILER WIDTH(S) 0-96'1 97-102'1 >10; m m TRAILER 1 ❑ ❑ ❑ Z TRAILER 2 ❑ ❑ ❑ 0 U 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft 2 't Z White RedEn - 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- 2 TOWED BY/TO: DUE TO © VEHICLE CONFIG CARGO BODY TYPE LOAD TYPE