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HomeMy WebLinkAbout2024-00065705 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 1111111 DIII III HI IIII lull II 1111111111111111111111111111011 III U21 11 DRAG TRFD TRFC WEAT DRVA VIS VEND LGHT COLL 'MANY X003602249 u, U1 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 El$500 OR LESS TYPE OF REPORT 0 A No Injury J Drive Away Elgin Police Department ONE PERSON'S ❑$501-$1.500 ®ON SCENE 2 0 NOT ON S VEHICLE/PROPERTY inOVER$1.500 0 AMENDEDCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash YR 2024I2024-00065705 VEHT * ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 '1'1 RANDALL RD ❑Elgin RELATED ❑Y coN 1 O 14 2024 02:57 ❑AM ❑YES ®NO U1 ,< PRIVATE mo /day I yr ®PM FLOW CONDITION m 0 /MI N E W Ho S Rd COUNTY PROPERTY El ®N DOORING ❑y #OF MOTOR ❑SLOW 1 N ICJ O PP WITH VEHICLES INVLD ❑ STOPPED U2 —10 AT INTERSECTION WITH (NAME OF ) Kane HIT&RUN ❑Y CZN PEDALCYCUST®N ® FREE FLOW # LNS 0 tg DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EOUES ❑NIN ❑Ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 C) Honda CRV 2020 00-NONE FOR DAMAGED AREA(S) R20Nr TOWED Ut O /� NAME(LAST,FIRST,M) ,J. mo / day 1 J yr " 1z O DIJETOCRASH El 3 13-UNDERCARRIAGE FIRE ❑ ICI SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 10 z DISTRACTED 0 M U2 4 m 330 WEST RIVER RD F SYM ❑Y ®SNE❑UNK VINEH. O AT CRASHD 0 15-OTHER 99-UNKNOWN 9 16-TOP 3 Distraction Value 9 ALGN = T. CITY PLATE NO. STATE YEAR POINT OF 6 j 4 COM VEH 0 El 0 jL FIRST CONTACT 12 7 .; :_.6- 5_ •Yves,See Sidebar U1 Z 7FARW2H86LE021635 Progressive ❑Y ®N U2 m V. EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER RSUR m a Same 960020311 1 m o HOSPITAL(TAKEN TO) INCIDENT • IF'Y' OWNER STREET.CITY,STATE,ZIP PHONE NUMBER '' RESPONDER Same VEHU L ❑Y ®N 2 G� ®DRIVER El PARKED 0 DRNERLESS El PED ❑PEDAL ❑EQUES 0 NUM ❑NOV 0 DV DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N U1 m m FOR DAMAGED AREA(S) TOWED NAME(LAST,FIRST,MI s Haider,Saman 0 5 / 2 5 /1 9 9 6 Mercedes-Ber12300 2018 00-NONE t3-UNDERCARRIAGE 1t'fi20IT 1' DUE TO CRASH ❑ ® , 2 ©II FIRE ❑ El U2 ✓ mo day yr , 10 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 2 C DISTRACTED 0 IN SPDR C) SYSTEM IN 0 ENGAGED 0 15-OTHER 9 1,6-TOP 3 9 0 a` 1461 WOODLAND DR F ❑Y ® N ❑UNK VEH. AT CRASH 99-UNKNOWN Distraction Value - N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6 1 f 4 COM VEH 0 ® U1 to FIRST CONTACT 6 4) 0 •&Yee.See Sidebar Z SOUTH ELGIN IL 60177 0 CS47271 IL 2025 r-riAR M TELEPHONE DRIVER'S LICENSE NO. STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0 (847)347-4926 H360-7809-6749 IL D 0 55SWF4KBOJU261449 Progressive ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST.FIRST,M) POLICY NUMBER 1 I Same 978327465 BAC 3 HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE.ZIP PHONE NUMBER 995 < 0 M N Same U1 = (UNITE I SEAT) (DOB) fSE)0 ISAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME!/(ADDRESS)/(TELEPHONE) (EIdSI (HOSPITAL) 1 3 10 /27/1987 M 2 3 0 1 0 Jorge C. Sanchez/4317 PRAIRIE AVE.Mchenry.IL.60050 - 996 r (815)836-6833 , U2 m / / #OCCS D / / u1 2 m / I 1 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME ❑AM Did crash occur ElY U2 Z N 1 ® 11 1 10/14 ,2024 02 57 ®pm in a Work Zone? El DIRP al 1 r PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME It YES check one below: T PROPERTY OWNERS ADDRESS:STREET.CITY,STATE,ZIP ❑AM U1 1 2 0 28 19 10,14 /2024 02 57 ®PM 0 Construction * N 3 ❑ ®CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 1 ❑AM 0 Maintenance U2 Q • ARREST NAME Gatlin. Megan,J. 11-601-Ax 752373 / / ❑PM SLMT ® 11 1 0 Utility p U ®CITATIONS ISSUED 0 PENDING ROAD CLEARANCE TIME o NSECTION CITATION NO. AM 45 T 2 1 1 ARREST NAME Gatlin- Megan,J. 11-501-A-2 752372 10/1 4 /2024 03 45 RI 0 Unknown work zone type Ut ❑ 1 • OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 El AM Workers present? ❑Y 45 1526-Walsh.Jacob 702 - 11 , 13/2024 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 . 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 I ; i combination).or —I INDICATE NORTH XI BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C ', ', i t -` ` r r r (example.shuttle or charter bus)-or 0i 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier 0 i_----......---% + i I -i } - i transporting employees in the course of their employment(example.employee M ,,,p,.. transporter-usually a van type vehicle or passenger car).or CO --—— 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 O L____--___-; i . 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 vw CARRIER NAME .. ADDRESS0 To 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 . own tank)? ❑ Yes ❑ No ❑ Unknowr D Did HAZMAT Regulations violation contnbute to the crash? r ❑ 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 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. y White White - u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT- 2 TOWED BY/TO Redmons SELECT CODES FROM THE BACK OF CRASH BOOKLET u 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT. 2 TOWED BY/TO: DUE TO © VEHICLE CONFIG CARGO BODY TYPE LOAD TYPE