Loading...
HomeMy WebLinkAbout2024-00067838 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 1111111 OIl III I III lull 1111111111111111 IUIIIIHIIIII 1111 DRAG TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X003599343 u, 1 U21 1 1 1 UI 7 U2 1 U, 1 U2 1 Ut 1 U2 1 1 11 Ut 1 U2 1 *P 0119* INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW DAMAGE TO ANY 0$500 OR LESS TYPE OF REPORT 0 A No Injury J Drive Away Elgin Police Department ONE PERSON'S ❑$501-$1.500 ❑ON SCENE 3 [23 NOT ON S VEHICLE/PROPERTY in OVER$1,500 ❑AMENDEDCENE(DESK REPORT) ® B Injury and JorTow Due To Crash YR 2024I2024-00067838 VENT * ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 '11 ROUTE 20 WEST BOUND ❑Elgin RELATED ❑Y coN 10 24 2024 09:09 ®AM ❑YES ®No u1 .< PRIVATE mo /day I yr ❑PM FLOW CONDITION m �0Q3 ® COUNTY PROPERTY El Y ®N DOORING ❑y #OF MOTOR ®SLOW 1 U) I MI N E s Villa St 'WITH VEHICLES INVLD ❑ STOPPED U2 —I AT INTERSECTION WITH (NAME OF ) Cook HIT&RUN El Y ® N PEDALCYCUST®N ❑ FREE FLOW # LNS ' 0 tg ORIVER ❑ PARKED 0 DRIVERLESS ❑ PEo ❑PEDAL ❑EDDES ❑ WV ❑Ncv ❑on DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 C) 0 6 / 0 6 /2 0 0 6 FOR DAMAGED AREA(S) FRONT TOWED U1 -Trathen,Austin, L. Chevrolet Traverse 2014 00-NONE ©' ..0..D1 DUE TO CRASH ® ❑ NAME(LAST,FIRST,M) mo day yr 13-UNDER CARRIAGE FIRE ❑ I$1 SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) �� 2 DISTRACTED 0 El U2 2 m 133 BORRIS CIR M SYTM❑Y ®SNE❑UNK VEH. O ATCRASH D 0 15-99-UUNKNOWN THER9 16-TOP 3 Distraction Value 7_ ? 6 • ALGN I T' CITY PLATE NO. STATE YEAR POINT OF 8 i. 4 COM VEH 0 ® 1 0 FIRST CONTACT 00 :_.6 ^Y Yes,See Sidebar U1 Z 1GNKRFKDOEJ305072 State Farm ❑Y ®N U2 m V. EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER RSUR m 99 9 Heckman, Dianna LOO 339-C28-13M 1 r o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET.CITY,STATE,ZIP PHONE NUMBER RESPONDER 133 BORRIS CIR.Streamwood. IL,60107 VEHU L ❑Y ®N 2 17 5 ®DRIVER ❑ PARKED 0 DRNERLESS ❑ PED ❑PEDAL ❑EQUES 0 WV ❑NCV 0 DV DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) U1 m m / J FOR DAMAGED AREA(S) FROM TOWED Y N s Mercado.Sandra, D. 0 2 1 1 1 9 9 4 Hyundai Santa Cruz 2022 00-NONE O' j D1 DUE TOCRASH ❑ ® 2 , NAME(LAST,FIRST,M) mo day yr Q, ✓ 13-UNDER CARRIAGE 10 f j 2 FIRE ❑ ® u2 C c STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 IN SPDR C) SYSTEM IN O ENGAGED 0 15-OTHER 9 16-TOP 3 0 X a 332 PEN NSYLVAN IA AVE 11 F ❑Y ® N ❑UNK VEH. AT CRASH P® UNKFNOWN ••Distraction Value 01 CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR FIRST CONTACT 6 O�_© S COM VEH ❑ ® U1 •*Yes,See Sidebar Z Glen Ellyn IL 60137 0 1321EG IL 2025 REeR 0 fp M TELEPHONE DRIVER'S LICENSE NO. STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0 (331)230-3622 M623-7849-4642 IL D 0 SNTJBDAE9NH028343 State Farm ❑y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 I 99 9 MICHAEL. BYTNER 2535965-SFP-13 Bnc ' 3 HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE.ZIP PHONE NUMBER 996 < RESPONDER 1502 CENTER AVE,Wheaton, IL.60189 (630)445-9379 U1 = (UNITE (SEAT) IDOBi (SEX) (SAFT) (AIR) (INJI (EJCTI (EPTH) PASSENGERS 8 WITNESS ONLY (NAME)1)ADDRESSi!(TELEPHONE I IEMSt (HOSPITAL) n I I U2 996 r m _ '#OCCS D / / U1 1 m I I 1 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME ®AM Did crash occur ❑Y U2 Z N ® 11 1 10,24 ,2024 09 09 ❑pM in a Work Zone? ®N 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 7 C) T 2 0 03 99 ! / 0 PM ❑Construction * c' ' 3 0 ®CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 7 ❑AM 0 Maintenance U2 CO 11 1 ARREST NAME Heckman-Trathen,Austin, L. 11-601 51540-000014 / / El PM SLMT o U ❑CITATIONS ISSUED ❑PENDING 'SECTION CITATION NO. ROAD CLEARANCE TIME ' ❑Utility o N IIAM 55 l 2 0 ARREST NAME r / ppt Ut ❑Unknown work zone type T ' OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 0 1540-Allah. Muhammad 401 272-Bajak 11 , 18/2024 01 30 o PM Workers present? ®N U2 55 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 . D passengers or property; _r } A CMV is defined as any motor vehicle used to transport and. 1 Has a weight rating more than 10,000 pounds(example truck or truck/trailer r 'I 1 - 1 combination) or 'I INDICATE NORTH XI BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C i I d i -` ` r r r (example.shuttle or charter bus)-or n X 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier 0 i------:-----% 4 . -i } - i transporting employees in the course of their employment(example.employee M transporter-usually a van type vehicle or passenger car).or CO i-____A____: : 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 L____- ____; i 1 1 . '/ -t i i 5 Is any vehicle used to transport any hazardous material(HAZMAT)that requires m = placarding(example placards will be displayed on the vehicle) 71 //, CARRIER NAME ' ADDRESS • N O CITY/STATE/ZIP r , , MOTOR CARR ID ❑ Interstate ❑ Intrastate 0 Not in Comm./Govt. El Not in Comm./Other r , USDOT NO. ILCC NO. , Source of above Z . ❑ Yes ❑ No ❑ Unknown g Did Carrier Safety Regulations(MCS)violation contribute to the crash? O ❑ Yes No ❑ Unknown 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 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 Silver White u 1 TOWED - - TOTAL VEHICLE LENGTH ft. NO.OF AXLES DUE TO ❑zr 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