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HomeMy WebLinkAbout2024-00066758 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 1111111 DIII III (III (IIIIII II 11111111111111111011111111111III I I DRAG TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X003593:42- u, 1 U21 1 1 1 U1 2 U2 1 U, 1 U2 1 U1 1 U2 1 1 10 U1 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) ElB Injury and JorTow Due To Crash YR 2024I2024-00066758 VENT * ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 m FOOTHILL RD El ❑ Elgin RELATED ®Y ❑N 10 19 2024 07:42 ®AM ❑YES ®NO U1 ,< PRIVATE mo /day I yr ❑PM FLOW CONDITION m F r J MI N E S W BROOKSI D E ) PEDALCYCUST® 0 FREE FLOW # LNS 0 tg DRIVER ❑ PARKED ❑DRIVERLESS ❑ PEE ❑PEDAL ❑EOUES 0 NW ❑Ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 0 FOR DAMAGEDAREA(S) FitO lT TOWED Ut O NAME(LAST,FIRST,M) .A. 0 mo day / a1 y 7 J 1 9 3 3 Toyota Camry 2003 Do-NONE 11 .1© D DUE TO CRASH El yr 13-UNDERCARRIAGE FIRE ❑ SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 10 O DISTRACTED 0 El U2 2 m 2251 TARA DR F SYTM❑Y INS NE ❑UNK VEH. O AT CRASH D 0 99-UNK 15- NOWN 9 16-TOP 3 ,Distraction Value ALGN = THER W. CITY PLATE NO. STATE YEAR POINT OF 8 i. 6 4 COM VEH 0 ® 1 0 F FIRST CONTACT 1 7_ ? • 5 ^Yves,See Sidebar U1 0 Z 4T1BE30K93U252030 AllState ❑Y ®N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER RSUR m a 99 9 Same 012742376 1 o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET.CITY,STATE,ZIP PHONE NUMBER > >. RESPONDER Same VEHU L ❑Y ®N 2 G1 5 ®cRIVER ❑ PARKED 0 DRNERLESS ❑ PED ❑PEDAL ❑EQUES ❑NUM ❑Ncv 0 ov DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) U1 m m / J R i20 IT TOWED Y N s Deln e,Cesar.S. 0 8 2 3 1 9 8 2 Ford Econoline Super Du1�y017 FO00-DAMAGED NONE 1 AREA(S) F 1 DUE TO CRASH ❑ ® 21 —I NAME(LAST,FIRST,M) Angel, mo day yr OI 12 I! s FIRE ID ® U273 v 13-UNDER CARRIAGE , STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) ® DISTRACTED 0 ® SPDR C a` 255 CENTER ST 1 M SYSTEM IN O ENGAGED 0 15-OTHER 9 16-TOP 3 9 0 X ❑Y MIN El UNK VEH. AT CRASH 99-UNKNOWN Distraction Value N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POF FIRST CNT ONTACT 11 7_'1 8 �_S C•IOMeeVSee Sidebar ® U1 to H ELGIN IL 60120 0 AH24308 AZ 2025 I 0 CCn M TELEPHONE DRIVER'S LICENSE NO. STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0 (331)345-2386 D452-1178-2240 IL 0 1 FDXE4FS3H DC08972 No Insurance ❑Y ❑N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST.FIRST,M) POLICY NUMBER 1 I 99 9 U-Haul Co of Arizona No Insurance BAC 3 HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE.ZIP PHONE NUMBER 996 < RESPONDER 2727 N CENTRAL AVE, Phoenix,AZ,85004 (800)468-4285 U1 = (UNIT) (SEAT) (DOBi (SEX) (SAFT) (AIR) (INJ( (EJCT( (EPTH) PASSENGERS 8 WITNESS ONLY (NAME)I(ADDRESS)/;TELEPHONEI (EMS) (HOSPITAL) 0 I I U2 996 r m #OCCS y / /• U1 1 m I I 1 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POUCE NOTIFIED TIME ®AM Did crash occur ❑Y U2 Z N ® 11 1 10/19 /2024 07 42 ❑pM in a Work Zone? ®N DIRP co 1 r PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME It YES check one below: T PROPERTY OWNERS ADDRESS:STREET.CITY,STATE,ZIP ®AM U1 3 2 0 06 99 10,19 /2024 07 42 0 PM 0 Construction * c' 1 3 ❑ ®CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 7 ®AM ❑Maintenance U2 CO 11 1 ARREST NAME Bayler, Lawn,A. 11-902 51510-000010 10/19/2024 07 46 0 PM SLMT o U ®CITATIONS ISSUED 0 PENDING TIME 0 Utility o NSECTION CITATION NO. ROAD CLEARANCE AM 40 2 0 ARREST NAME Del Angel.Cesar,S. 3-707 S1510-000013 1 01 1 9 /2024 09 18 ®PM 0 Unknown work zone type Ut T 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑qM Workers present? ❑Y 40 1540-Allah. Muhammad 702 272-Bajak 11 , 18/2024 01 30 (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 ; _r } A CMV is defined as any motor vehicle used to transport passengers or property and. D 1 Has a weight rating more than 10,000 pounds(example truck or truck/trailer r I I 1 INDICATE NORTH combination) or —I 7:1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C J. J. d i -t ` r r r (example.shuttle or charter bus)-or 3 Is designed to carry 15 or fewer passengers and operated by a contract carrier 0 -- -- 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 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____ ____; ; ; , — i 1 5 Is any vehicle used to transport anyhazardous material(HAZMAT)that requires •�_�, �� placarding(example-placards will be displayed on the vehicle) D ' _ CARRIER NAME ' i�• _ ADDRESS 0 Ds Fae11Y117RG (.1) • CITY/STATE/ZIP 0 r , A. MOTOR CARR ID ❑ Interstate ❑ Intrastate Not To Soele - N 0 Not in Comm./Govt. ❑ Not in Comm./Other Q C USDOT NO. ILCC NO. , Source of above Z . Were HAZMAT placards on vehicle? ❑ Yes ❑ No 1 If Yes, Name on placard 0 4 digit UN NO. 1 digit Hazard class No P3 73 m Did HAZMAT spill from vehicle(do NOT consider FUEL from vehicle's Z own tank)? ❑ Yes ❑ No ❑ Unknowr D Did HAZMAT Regulations violation contnbute to the crash? r ❑ Yes ❑ No ❑ Unknown D Did Carrier Safety Regulations(MCS)violation contribute to the crash ❑ Yes 0 No ❑ Unknown A C 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 73 IDOT PERMIT NO WIDELOAD? ❑Yes ❑No S TRAILER VIN 1 m N LOCAL USE ONLY TRAILER VIN 2 m TRAILER WIDTH(S) 0-96'1 97-102'1 >10; m m TRAILER 1 ❑ ❑ ❑ Z 7 TRAILER 2 ❑ ❑ ❑ 0 U 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft 2 't En Silver White u 1 TOWED - TOTAL VEHICLE LENGTH ft. NO.OF AXLES DUE TO ❑X DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT- 3 TOWED BY/TO Arties/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 ❑ Arties/Impound Lot Garage VEHICLE CONFIG _ CARGO BODY TYPE LOAD TYPE