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HomeMy WebLinkAbout2024-00066831 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets liii Ill DIII III I IIIIIII II 111111111111111110111111111111111 I I DRAG TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X0O3593:29- u, 1 U2 1 2 4 1 U, 2 U2 1 U, 1 U2 1 U1 1 U2 1 1 15 U1 1 U2 1 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY ®$500 OR LESS TYPE OF REPORT ® A No Injury J Drive Away AGENCY CRASH REPORT NO. TRFW Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 1 0 NOT ON SVEHICLE/PROPERTY ❑OVER$1.500 ❑AMENDEDCENE(DESK REPORT) ❑ B Injury and/or Tow Due To Crash YR 2024I2024-00066831 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 '1 N MCLEAN BLVD ®gin ❑ RELATED ®Y ❑" 10 19 2024 03:45 ❑AM ❑YES ®No u1 -< PRIVATE mo /day I yr ®PM FLOW CONDITION m FT/MI N E S W M I LD R E D ) Kane HIT&RUN ❑Y CZN PEDALCYCUST®N 0 FREE FLOW # LNS 0 tg DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EOUES ❑NW ❑Ncv 0 ov DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 n FOR DAMAGEDAREA(S) FRONT TOWED Ut O y mo day yr 13-UNDER CARRIAGE 10 2 FIRE DI E IA SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 M U2 0 m 75 PARKWOOD RD M ❑Y ®SYSNEM DUNK VEH. 0 ATCRASH 99-UUTHER NKNOWN 9 16-TOP 3 "OIStract(onValue 9 ALGN = r CITY PLATE NO. STATE YEAR POINT OF 6• f1 6 ii 4 COM VEH 0 El 1 0 r' )494-4859 4T4BF3EK7BR1 04906 Progressive ❑Y ®N U2 m EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER RSUR a Same 969941758 1I— m o HOSPITAL(TAKEN TO) INCIDENT • IF'Y' OWNER STREET.CITY,STATE,ZIP PHONE NUMBER >. RESPONDER Same VEHU ❑Y ®" 2 G) ®DRIVER ❑ PARKED 0 DRNERLESS ❑ PED ❑PEDAL ❑EQUES 0 WV ❑NCV 0 DV DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) U1 m m / / FOR DAMAGED AREA(S) FRONT TOWED Y N n NAME(LAST,FIRST,M) RODRIGUEZ GOMEZ-ANGEL,O. 0 8 lday 1 9 y 7 Toyota Camry 2018 00-NONE +c 112 s FIREETocRasH ❑❑ ® U2 2 C I', 13-UNDER CARRIAGE STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 IN SPUR n a` 404 SHERWOOD DR M SYSTEM IN 0 (on ENGAGED 0 15-OTHER 9 16-TOP 3 9 0 X ❑Y El DUNK VEH. AT CRASH 99-UNKNOWN Distract Value N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POFIRSNT T COF ONTACT 7 Q,II 6 1,S COM VEH 0 ® U1 to If Yes,See Sidebar Z STREAMWOOD IL 60107 0 Z233032 IL 2025 F 0 I D TELEPHONE DRIVER'S LICENSE NO. STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0 R362-0148-7228 IL 4T1 B61 HK9JU038996 State Farm ❑Y ®N RDEF73 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 I RAMIREZ,ADRIANA. M. 2399102-SFP-13 BAC 3 HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET.CITY.STATE.ZIP PHONE NUMBER 996 < RESPONDER pO®N 404 SHERWOOD DR.,STREAMWOOD- IL-60107 U1 = (UNIT) (SEAT) (DOB) (SEX) (SAFT) (AIR) (INJI (EJCTI (EPTH) PASSENGERS&WITNESS ONLY (NAME 17(ADDRESS)7(TELEPHONE 1 (EMS) (HOSPITAL) 2 3 09 /1 7/1989 F 1 4 0 1 ADRIANA M. RAMIREZ/404 SHERWOOD DR.,STREAMWOOD.IL.60107 U2 996 m m / / #occs y / / u1 1 m / / 2 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 10/19 /2024 03 45 ®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 a 2 0 2 99 / / 0 PM ❑Construction * N 3 ❑ ®CITATIONS ISSUED ❑PENDING SECTION CITATION NO. EMS ARRIVED TIME 5 ❑AM ❑Maintenance U2 ARREST NAME Albright, Raymond,J. 11-901.01 1532-000307 / / ❑PM SLMT 1 ® 11 4 ❑Utility p u 0 CITATIONS ISSUED 0 PENDING 'SECTION CITATION NO. ROAD CLEARANCE TIME o N 8 AM 30 2 0 ARREST NAME / / ppt ❑Unknown work zone type Ut 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑qM Workers present? ❑Y 30 1532-Hernandez, Daniel 501 334-Fries 11 , 12/2024 01 30 0 PM IZI 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. r IF MORE THAN ONE CMV IS INVOLVED,USE SR 1050A ADDITIONAL UNITS FORMS } 0 A CMV is defined as any motor vehicle used to transport passengers or property and. Z F. -r- -'4 4 4 r r r 1 I r"- - . r . 1 Has a weight rating more than 10,000 pounds(example truck or truck/trailer Z r • ; i ; i- r r , i i INDICATE NORTH combination).or —I • XI BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C ', ', ! ' ' 1 ', ' f ` r r r (example'.shuttle or charter bus)-or n S ; I I ; 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier 0 i------'-----• + + • : - 1 1 1 i } - t transporting employees in the course of their employment(example.employee ,3 transporter-usually a van type vehicle or passenger car).or w ' 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 • CARRIER NAME 2 ' ADDRESS 0 N . O • CITY/STATE/ZIP 0 . ^ MOTOR CARR ID ❑ Interstate ❑ Intrastate ❑ Not m Comm./Govt. El Not in Comm./Other O r---- ----, r r r r r----, USDOT NO ILCC NO. m , Source of above z . MCS El Yes ❑ No ❑Unknown Out of Service ❑Yes ❑No C z Form Number 0 _ m — X IDOT PERMIT NO WIDELOAD? ❑Yes ❑No 2 TRAILER VIN 1 m 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. y Silver White - u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT 1 TOWED BY/TO SELECT CODES FROM THE BACK OF CRASH BOOKLET u 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT- 1 TOWED BY/TO: DUE TO © VEHICLE CONFIG CARGO BODY TYPE LOAD TYPE