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HomeMy WebLinkAbout2024-00066869 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets liii Ill 010 III )III IIIIIII II 11111111111111111011111011111111 DRAG TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X00355E416 u, 1 U2 1 1 1 1 U116 U2 1 U, 1 U2 1 U1 1 U2 1 5 15 U1 23 U2 1 *P 0119* INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW DAMAGE TO ANY El$500 OR LESS TYPE OF REPORT ® A No Injury J Drive Away Elgin Police Department ONE PERSON'S ®$501-$1.500 ®ON SCENE • 1 El NOT ON S VEHICLE/PROPERTY ElOVER$1.500 El AMENDEDCENE(DESK REPORT) ❑ B Injury and JorTow Due To Crash YR 2024I2024-00066869 VENT * ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 'F'I N CRYSTAL AVE ®gin El ❑Y co" 10 19 2024 06'33 DAM El ®No u1 ,< PRIVATE mo /day I yr ®PM FLOW CONDITION m 050 ,MI O E S W Lawerence ) PEDALCYCUST® [] FREE FLOW # LNS 0 DA ORNER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑ECUES ❑NIN ❑Nee 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 0 FOR DAMAGEDAREA(S) FRONT TOWED Ut O 1 2 / 1 3 J 1 9 6 0 Honda Accord 2010 00-NONE „ 21 12 i' , DUE TO CRASH 0 NAME(LAST,FIRST,M) mo day yr 13-UNDER CARRIAGE �0( 2 FIRE ❑ SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 ® U2 2 m 268 S ALFRED AVE M ❑Y ®SYSNEM❑UNK VEH. O ATCRASH D 0 99-UUTHER NKNOWN 9 76-TOP 3 Distraction Value 9 ALGN = CITY PLATE NO. STATE YEAR POINT OF 6 {I®ji 4 COMVEH 0 ® 1 0 A ~ 1HGCP2F47AA138033 NIA ❑Y ❑N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER RSUR m a Same NIA 1 o HOSPITAL(TAKEN TO) INCIDENT • IF'Y' OWNER STREET.CITY,STATE,ZIP PHONE NUMBER r >. 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) Ut m m / J FOR DAMAGED AREA(S) FRONT TOWED Y N , NAME(LAST,FIRST,M) Jaramillo-Jenny mo day yr 0 8 0 9 1 9 9 2 Nissan Rogue 2019 00-NONE +c 112 s REETocRasH ❑❑ ® Uz 2 C c 13-UNDER CARRIAGE c STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 ® SPDR C) E 77 LOCKMAN CIR F SYSTEM IN O ENGAGED 0 15-OTHER 9 16-TOP 3 9 0 X ❑Y El N ❑LINK VEH. AT CRASH 99-UNKNOWN •Distraction Value 8 1II j� 4 COM VEH ❑ ® U1 to N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR p RIST CONTACT 3 7__d 6 ® •Itves.See Sidebar H ELGIN IL 60123 0 DN27381 IL 2025 1 0 C. M TELEPHONE DRIVER'S LICENSE NO. STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0 (224)800-8834 J654-4209-2504 IL D 5N1AT2MV7KC796370 Progressive ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST.FIRST,M) POLICY NUMBER 1 I Calderon,Arturo 975541905 BAC 3 HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET.CITY.STATE.ZIP PHONE NUMBER 996 < RESPONDER N El 77 LOCKMAN CIR. ELGIN . IL.60123 (224)322-1084 U1 = (UNIT( (SEAT) (DOBi (SEX) (SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS B WITNESS ONLY (NAME)1fADDRESSI rITELEPHONEI (EMS) (HOSPITAL) n I I - U2 996 1— m - #OCCS y / /• U1 1 73 la I I 1 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME El AM Did crash occur ❑Y U2 Z N ® 11 1 10/19 /2024 06 33 0 pm in a Work Zone? El 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 3 C) T 2 0 30 99 ! / 0 PM El Construction * N 3 ❑ ®CITATIONS ISSUED ❑PENDING SECTION CITATION NO. EMS ARRIVED TIME 5 ❑AM ❑Maintenance uz Q • ARREST NAME Garcia. Rene 11-1102 1532-000307 / / ❑PM SLMT c U , CO 11 1 ®CITATIONS ISSUED ❑PENDING 'SECTION CITATION NO. ROAD CLEARANCE TIME ' ❑Utility N AM 30 2 0 ARREST NAME Garcia, Rene 3-707 1532-000308 r / 8 ptil El Unknown work zone type Ut 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑qM Workers present? ❑Y 30 1532-Hernandez. Daniel 601 334-Fries 11 / 12/2024 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. r 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. Z r-"--r--- 4 , 1 r r r r r , , , 1 . r 1 Has a weight rating more than 10,000 pounds(example truck or truck/trailer ' r • ; i ; i- r r , , i INDICATE NORTH combination).or —I • XI BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C ' ._ I ', ! i ._ ' ' '. ', ' 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------i-----• + + • : - -, 1 - 1 i } - i• transporting employees in the course of their employment(example.employee ,3 transporter-usually a van type vehicle or passenger car).or w ' i 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 O , , . - MOTOR CARR ID ❑ Interstate ❑ Intrastate ❑ Not in Comm./Govt. ElNot in Comm./Other Q C r-----.-----, r r r r r•---, ir '- DO ILCC NO. m U N XI , Source of above Z . MCS ❑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 to 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. Z Silver Gray - 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