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HomeMy WebLinkAbout2024-00066578 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets liii Ill III Ifi IIIIIII II 1111111111111111 1111111101111111I DRAG TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY XQO3599O16 u, 9 u210 1 1 1 Ui 2 U2 1 U199 U2 1 U1 99 U2 99 1 6 U199 U299 *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 ❑$501-$1.500 ®ON SCENE 2 El NOT ON VEHICLE/PROPERTY inOVER$1.500 0 AMENDEDCENE(DESK REPORT) ❑ B Injury and JorTow Due To Crash YR 2024I2024-00066578 VENT * ADDRESS NO. HIGHWAY or STREET NAME El El CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH gg 7l SUMMIT ST RELATED ❑Y coN 10 18 2024 10:40 ®AM Li YES El U1 .< Elgin PRIVATE mo /day I yr El PM FLOW CONDITION m (� ®I MI N E O W Southeast ) PEDALCYCUST® ® FREE FLOW # LNS ' 0 D4 DRIVER 0 PARKED 0 DRIVERLESS ❑ PED 0 PEDAL 0 ECUES 0 aav 0 Ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 n / / FOR DAMAGEDAREA(S) FRONT TOWED U1 O .0. Unknown Unknown DO-NONE ®i 12 y,DUE TO CRASH ❑ NAME(LAST,FIRST,M) mo day yr 13-UNDER CARRIAGE ,9 li 2 FIRE 0 SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ® 0 U2 m SY❑Y ❑SNEM IN®UNK VEH. 9 AT CRASH ENGAGED 9 99-UUTHER NKNOWN 9 16-TOP 3 .Distraction Value2 9 ALGN r CITY PLATE NO. STATE YEAR POINT OF 6 1� 6 II COM VEH ❑ ® 1 O F ID VIN INSURANCE CO. EXPIRED 1 -13 O. UNKNOWN El ❑N U2 r m o, EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER RSUR m Ya Unknown UNKNOWN 1 o HOSPITAL(TAKEN TO) r INCIDENT IF'Y' OWNER STREET.CITY,STATE,ZIP PHONE NUMBER r RESPONDER VEHU X Lo ❑Y ❑N 99 O 0 DRIVER ❑ PARKED 0 ORNERLESS ❑ PED ❑PEDAL ❑EQUES N WV ❑NCV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N U1 • m m / / FOR DAMAGED AREA(S) FRONT TOWED NAME(LAST,FIRST,M) City of Elgin,City,O. mo day yr Unknown Unknown 00-NONE 1G 1 12 ._Y RE o CRASH O ® U2 99 C-2 13-UNDER CARRIAGE STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 ® SPCA n SYSTEM IN ENGAGED ®-OTHER 9 16-TOP 3 X E. 150 DEXTER CT ❑Y ❑N ❑UNK VEH. AT CRASH 99-UNKNOWN 'Distraction Value 9 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POF FIRST CNT ONTACT 00 7_'1 a �_5 C•IOMesVSee Sidebar ® U1 C ZELGIN IL 60120 0 !QUA Cl) M TELEPHONE DRIVER'S LICENSE NO. STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0 (847)289-2700 Alliant ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 I City of Elgin,City 8109160P901 BAC ' E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE.ZIP PHONE NUMBER 996 < RESPONDERy El 2 150 DEXTER ST. Elgin. IL.60120 (847)289-2700 U1 = (UNIT) (SEAT) (DOB) ISEXI (SAFT) (AIR) (INJI (EJCTI (EPTH) PASSENGERS BWITNESS ONLY (NAME)I(ADDRESS)I(TELEPHONEI (EMS) (HOSPITAL) n I I U2 996 r m /• - #OCCS D / /• U1 1 73 / / NA O EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME ®AM Did crash occur ❑Y U2 Z N 1 ❑ 1 3 City of Elgin electrical pole damaged 10/18 ,2024 10 40 ❑pM in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME It YES Check One below: T PROPERTY OWNERS ADDRESS:STREET.CITY,STATE,ZIP ❑AM U1 5 2 ® 31 2 150 DEXTER CT ELGIN IL 60120 20 18 ! / 0 PM ❑Construction * N 3 0 0 CITATIONS ISSUED MI PENDING SECTION CITATION NO. EMS ARRIVED TIME 99 ❑AM ❑Maintenance U2 Q •1 0 1 3 ARREST NAME Unknown,0. 11-401-B 1514000150 / / El PM SLMT o u 0 CITATIONS ISSUED •❑PENDING 'SECTION CITATION NO. ROAD CLEARANCE TIME 0 Utility o N 8 AM 50 I 2 31 3 ARREST NAME I / ptil El work zone type U1 ® D T OFFICER ID SIGNATURE BEAT I DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 0 0 AM Workers present? ❑ 1514-Pratt.Tamera 201 272-Bajak I / ❑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. _ 0IF MORE THAN ONE CMV IS INVOLVED,USE SR 1050A , ADDITIONAL UNITS FORMS , D r_.._r____ ; ; _� } A CMV is defined as any motor vehicle used to transport passengers or property and. 1 Has a weight rating more than 10,000 pounds(example.truck or truckrtrailer -< r 'I 1 - 1 combination) or INDICATE NORTH 7:1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver n 1 I I -! ` r r r (example.shuttle or charter bus)-or I3. Is designed to carry 15 or fewer passengers and operated by a contract carrier 0 i-----:----- 4 i -i r - t transporting employees in the course of their employment(example.employee M -usually a van vehicle or passenger - mo i transporter n r-_ _ A____: : , I j 1: ° i Ca d fo ect van i i 5 r Is anyvehiclecompensation nused to t ansportla nehazardous for material(HAZMAT)specific (HAZMAT))that requires 11 O :-• t- --". i ' I T oitt . • . placarding(example placards will be any on the vehicle) 71 1 I CARRIER NAME Z ' I ADDRESS 0 To m CITY/STATE/ZIP • MOTOR CARR ID ❑ Interstate ❑ Intrastate 0 Not in Comm./Govt. El Not in Comm./Other USDOT NO. ILCC NO. , Source of above z . Form Number m 7a 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 >102 m T TRAILER 1 ❑ ❑ ❑ z -74 TRAILER 2 ❑ ❑ ❑ o U 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft 2 ft. y - u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT- 9 TOWED BY/TO SELECT CODES FROM THE BACK OF CRASH BOOKLET u 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT. 3 TOWED BY/TO: DUE TO © VEHICLE CONFIG CARGO BODY TYPE LOAD TYPE