HomeMy WebLinkAbout2024-00067972 ILLI NOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 1111111 Dlii
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DRAG TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X0Q3559111-
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INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW
DAMAGE TO ANY El$500 OR LESS TYPE OF REPORT ❑ q No Injury J Drive Away
Elgin Police Department ONE PERSON'S ❑Emit-$1.500 ®ON SCENE 2
0 NOT ON S
VEHICLE/PROPERTY inOVER$1.500 0 AMENDEDCENE(DESK REPORT) ® B Injury and JorTow Due To Crash YR 2024I2024-00067972 VENT
ADDRESS NO. 'HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 m
S RANDALL RD ® ❑
Elgin RELATED ❑Y coN 10 24 2024 07:14 ❑AM ❑YES ®No u1 • -<
PRIVATE mo /day I yr ®PM FLOW CONDITION m
0 'COUNTY PROPERTY ❑Y ®N DOORING ❑y #OF MOTOR ❑SLOW 1 U)
I ®/MI ON E S W South St 'WITH VEHICLES INVLD ❑ STOPPED U2 —I
❑ AT INTERSECTION WITH (NAME OF ) Kane HIT&RUN ❑Y CZN PEDALCYCUST®N ® FREE FLOW # LNS ' 0
DA DRIVER ❑ PARKED ❑DRIVERLESS ❑ PEE ❑PEDAL ❑EOUES ❑NIN ❑Ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 C)
FOR DAMAGED AREA(S) FRONT TOWED Ut
NAME(LAST,FIRST,M) , Pamela. E. Ford Focus 00-NONE
O
mo / day J yr 0 Q D DUE TO CRASH El ❑
13-UNDERCARRIAGE FIRE ❑ IA
SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) �� z DISTRACTED 0 I U2 2 m
128 KI M BALL ST F ❑Y ESYlM❑UNK VEH. 0 AT CRASH 99-UUTHER NKNOWN 9 16-TOP 3 ,Distraction Value ALGN =
CITY PLATE NO. STATE YEAR POINT OF 6 j 6 4 COM VEH 0 ® 1 0
a
1FADP3F27EL217869 State Farm ❑Y ®N U2 m
in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m
a KREGGER. Douglas,J. 0302192-SFP-13 1
o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET.CITY,STATE,ZIP PHONE NUMBER r
L 0 YONDE J N 1303 WH ITFI ELD DR.G EN EVA. I L.60134 (224)392-6622 VEHU 0
®DRIVER ❑ PARKED 0 DRNERLESS ❑ PED ❑PEDAL ❑EDUCE 0 WV ❑Ncv 0 DV DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) U1 2 m
m / J FOR DAMAGED AREA(S) FRONT TOWED Y N
s Tecuanapa Enriquez. Felipe 0 8 0 3 1 9 7 1 Hyundai Accent 2015 00-NONE O' O DUE TOCRASH 0 2
NAME(LAST,FIRST,M) P 9 P mo day yr Q, XI
v t3-UNDER CARRIAGE 10 Ij 2 FIRE ❑ ® U2 C
c STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 IN SPDR C)
E 1425 EAGLE RD M
SYSTEM IN 0 ENGAGED Q 15-OTHER 9 16-TOP 3 0 X
❑Y ® N DUNK VEH. AT CRASH 99-UNKNOWN •Distraction Value
N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6 1 ii COM VEH ❑ ® U1 to
F- FIRST CONTACT 6 a •bYes See Sidebar C
ELGIN IL 60123 B CY59934 IL 2025 _ 0 '
M TELEPHONE DRIVER'S LICENSE NO. STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0
(224)276-9948 T251-2407-1220 IL D 0 KMHCT4AEOFU886078 None ❑y ®N RDEF
EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST.FIRST,M) POLICY NUMBER 1 I
Same None Bnc ' 3
HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE.ZIP PHONE NUMBER 996 <
0 Y RESPONDER Same U1 2
iUNITi i SEAT) ;DOB' (SEX) )SAFT) (AIR) (INJI (EJCTI (EPTH) PASSENGERS&WITNESS ONLY (NAME'/-(ADDRESSI I(TELEPHONEI (EMS) (HOSPITAL)
3 3 09 /06/1941 F 2 4 0 1 0 Geraldine L. Meyer!745 HILLCREST DR.Sleepy Hollow.IL.60118 Elgin Fire Refused 996
(847)710 1364_ g Uz m
/ / #occs y
/ / u1 1 m
/ I 1 0
EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME ❑AM Did crash occur ❑Y U2 Z
N 1 ® 11 1 10/24 /2024 07 14 ®pm in a Work Zone? ®N DIRP D
1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME It YES check one below:
T PROPERTY OWNERS ADDRESS:STREET.CITY,STATE,ZIP ❑AM Ut 1
2 0 28 03 10,24 /2024 07 15 ®PM ❑Construction *
N 3 0 ®CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 1
❑AM ❑Maintenance U2
® 11 • 1 ARREST NAME KREGGER, Pamela. E. 11-601 476000301 10/24/2024 07 19 ®PM SLMT
o U ®CITATIONS ISSUED ❑PENDING ROAD CLEARANCE TIME 0 Utility
o N SECTION CITATION NO. AM 45
I 2 0 11 1 ARREST NAME KREGGER. Pamela. E_ 6-303-A 476000300 10/24 /2024 08 23 El pm0 Unknown work zone type U1
D T
2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? D Y 45
476-Ramos.Clarissa 702 334-Fries 11 , 19/2024 09 00 p 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.
_ 0 IF MORE THAN ONE CMV IS INVOLVED,USE SR 1050A
ADDITIONAL UNITS FORMS
_r } A CMV is defined as any motor vehicle used to transport passengers or property and.
D
Z
1 Has a weight rating more than 10,000 pounds(example truck or truck/trailer
r } I I i combination) or
INDICATE NORTH 711
BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C
} J. J. d i co 0 -t ` r r r (example.shuttle or charter bus)-or 0
e
3. Is designed to carry 15 or fewer passengers and operated by a contract carrier 0
.<_ f
___a____. � �� , o_ _ } } transporting employees in the course of their employment(example.employee ,3
transporter-usually a van type vehicle or passenger car).or w
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 0
L____-L____1 i; , 3 -t i } 1 5 Is any vehicle used to transport any hazardous material(HAZMAT)that requires m
placarding(example placards will be displayed on the vehicle) 71
/I CARRIER NAME Z
ADDRESS 0
N
' Sou h73t - C)
IYGI TO Scale • CITY/STATE/ZIP
MOTOR CARR ID ❑ Interstate ❑ Intrastate -
.
0 Not in Comm./Govt. Not in Comm./Other
O
USDOT NO. ILCC NO. <
XI
, Source of above Z
. own tank)? ❑ Yes ❑ No ❑ Unknowr D
Did HAZMAT Regulations violation contnbute to the crash? r
❑ Yes ❑ No ❑ Unknown E
Did Carrier Safety Regulations MCS)violation contribute to the crash? ID
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 C
z
Form Number 0
_ m
xi
IDOT PERMIT NO WIDELOAD? ❑Yes ❑No 2
TRAILER VIN 1 m
to
LOCAL USE ONLY TRAILER VIN 2 m
TRAILER WIDTH(S) 0-96'1 97-102'1 >102 m
T
TRAILER 1 ❑ ❑ ❑ Z
TRAILER 2 ❑ ❑ ❑ o
U 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft 2 ft. Z
Black Silver
u 1 TOWED - TOTAL VEHICLE LENGTH ft. NO.OF AXLES
DUE TO ❑X DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT- 2 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. 2 TOWED BY/TO.
DUE TO ❑ Arties/Impound Lot Garage VEHICLE CONFIG _ CARGO BODY TYPE LOAD TYPE