Loading...
HomeMy WebLinkAbout2024-00067196 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 1111111 010 III (III (IIIIII II 11111111111111111011111011111011 DRAG TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X00355E419' u, 1 U21 1 1 1 UI 7 U2 1 U, 1 U2 1 Ut 1 U2 1 1 11 U1 13 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 • 3 El NOT ON SVEHICLE/PROPERTY in OVER$1.500 El AMENDEDCENE(DESK REPORT) ® B Injury and JorTow Due To Crash YR 2024I2 024-0 0 0 671 96 VENT * ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 'T'I N STATE ST ®gin El ❑Y coN 10 21 2024 0727 ®AM ❑YES ®NO U1 -< PRIVATE mo /day/yr El PM FLOW CONDITION m 1 COUNTY PROPERTY El 21N DOORING ElY #OF MOTOR El SLOW 1 N ® �/MI O E S W Judson Dr WITH VEHICLES INVLD ❑ STOPPED U2 —I El AT INTERSECTION WITH (NAME OF ) Kane HIT&RUN ❑Y CZN PEDALCYCUST®N ❑ FREE FLOW # LNS O tg oRNER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EOUES ❑NIN ❑Ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 n 0 1 / 1 3 J2 0 0 2 FOR DAMAGED AREA(S) FRONT TOWED U1 Chevrolet Malibu 2013 00-NONE DUE TO CRASH NAME(LAST,FIRST,M) . M. mo day yr 11- Q lJ ® ❑ 13-UNDERCARRIAGE FIRE ❑ IA SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) �� z DISTRACTED 0 El U2 2 m 1426 ROYAL CT M ❑Y ISYNM❑UNK VEH. 0 AT CRASH 99-UUTHER NKNOWN 9 16-TOP 3 ,Distraction Value ALGN = r CITY PLATE NO. STATE YEAR POINT OF & j 6 4 COM VEH 0 ® 3 0 A ~ 1 G 11 E5SA6DU 134463 State Farm ❑Y ®N U2 m EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER RSUR Same 1309727-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 ❑PEDAL ❑EQUES 0 NUM ❑NOV 0 DV DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) U1 m m / J FOR DAMAGED AREA(S) FROM TOWED Y N n NAME(LAST,FIRST,M) Fahrenwald- Kirk, H. 0 8 0 6 1 9 7 mo day 2 r Hyundai Sonata 2019 00-NONE 11 12I. s ReocRasH O ® Uz 2 C v 13-UNDER CARRIAGE c STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 IN SPDR n a 133 AUGUSTA DR M SYSTEM IN Q ENGAGED Q 15-OTHER 9 16-TOP 3 0 X ❑Y ® El UNK VEH. AT CRASH 99-UNKNOWN •Distraction Value - N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF ©j 4 COM VEH ❑ ® U1 to I— FIRST CONTACT 7 4_1-;=5 •IfYes,See SidebarC Z Gilberts IL 60136 0 C413279 IL 2025 REAR Q 99) 2 TELEPHONE DRIVER'S LICENSE NO. STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0 (847)652-5578 F654-5087-2223 IL D 5NPE34AF3KH773400 Allstate ❑y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST.FIRST,M) POLICY NUMBER 1 I Same 102242911 BAC 3 HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE.ZIP PHONE NUMBER 996 < ElRE Y NR Same Ut = (UNIT) (SEAT) (DOB) (SEX) (SAFT) (AIR) (INJ( (EJCT( (EPTH) PASSENGERS&WITNESS ONLY (NAME)/(ADDRESS)/(TELEPHONE) (EMS) (HOSPITAL) I I U2 996 1- m - #OCCS y / / U1 1 m I I 1 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME ®AM Did crash occur El U2 Z N ® 11 1 10/21 /2024 07 27 ❑pM in a Work Zone? El DIRP co 1 I PROPERTY OWNERS ADDRESS:STREET.CITY,STATE,ZIP PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME ID AM It YES check one below: U1 1 C) T 2 ❑ 28 03 ! I 0 PM El Construction * N 3 ❑ ®CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 1 ❑AM ❑Maintenance U2 Q CO 11 1 ARREST NAME Beck, Dylan, M. 11-601-Ax 1529-000157 / / El PM SLMT o U ❑CITATIONS ISSUED 0 PENDING 'SECTION CITATION NO. ROAD CLEARANCE TIME ' 0 Utility p N AM 35 2 ❑ ARREST NAME 10/21 /2024 08 12 El pmElUnknown work zone type Ut T OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 ❑ 1529-Audi red.Jonathan 501 272-Bajak 11 / 12/2024 09 00 Ej PM Workers present? ®N U2 35 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 ; _� } 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 N7State?St. combination)or ; ', ', , r INDICATE NORTH XI IA BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver A ', ', i I -! ` r r r (example'.shuttle or charter bus)-or C N 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier 0 - i } } i transporting employees in the course of their employment(example.employee M transporter-usually a van type vehicle or passenger car).or w ff I i_____A____: : i . i r i 4 Is used or designated to transport between 9 and 15 passengers including the driver, N ect van used i i 5 r Is anyvehiicompensation c enused tot ansportla nehazardous for material(HAZMAT)specific (HAZMAT))that requires O placarding(example placards will be any on the vehicle) 71 3 rn •\ Judson?Dr. i i i D CARRIER NAME .. ADDRESS 0 O CITY/STATE/ZIP MOTOR CARR ID ❑ Interstate ❑ Intrastate _Nor To Scale J " 0 Not in Comm./Govt. ElNot in Comm./Other Q C USDOT NO. ILCC NO. XI • , Source of above Z . MCS ❑Yes ❑ No ❑Unknown Out of Service ❑Yes ❑No z Form Number 0 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 97-102'1 >102 m -n TRAILER 1 ❑ ❑ ❑ Z -74 TRAILER 2 ❑ ❑ ❑ 0 U 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft 2 ft. Z Blue Silver 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