Loading...
HomeMy WebLinkAbout2024-00066982 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 1111111 010 III Ifi IIII lull 111111111111111 111011 0111 1111 DRAG TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X003602313 u, 1 U2 1 1 1 1 U1 5 U2 1 U, 1 U2 1 U1 1 U2 1 5 9 Ut 1 U221 *P 0119* INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW DAMAGE TO ANY El$500 OR LESS TYPE OF REPORT ❑ A No Injury J Drive Away Elgin Police Department ONE PERSON'S ®$501-$1.500 ®ON SCENE 1 EI NOT ON S VEHICLE/PROPERTY ElOVER$1.500 ❑AMENDEDCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash YR 2024I2024-00066982 VENT * ADDRESS NO. HIGHWAY or STREET NAME ® ❑CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 '11 SPRING ST RELATED ❑Y coN 10 20 2024 01'48 ®AM �� YES 0 NO u1 ,•< Elgin PRIVATE mo /day I yr ❑PM FLOW CONDITION m 1 'COUNTY PROPERTY El ®N DOORING ❑Y #OF MOTOR ID SLOW 15 co ® ®/MI N E OS W River Bluff ) Kane HIT&RUN El CZN PEDALCYCUST®N 0 FREE FLOW # LNS 0 tg DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EOUES ❑NIA/ ❑Ncv ❑DV DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) y N 0 0 4 / 0 4 /2 0 0 1 FOR DAMAGED AREA(S) FRONT TOWED U1 0 Rodriguez.Vanessa Buick Enclave 2000 00-NONE �' ..'�..D DUE TO CRASH ® ❑ - E NAME(LAST,FIRST,M) g mo day yr 13-UNDERCARRIAGE 1 2 FIRE ❑ ® < SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) ® DISTRACTED 0 El U2 m 10N835 S MAPLE ST F ❑Y ®SYSNEM❑UNK VEH. O ATCRASH D 0 99-UUTHER NKNOWN O9 16-TOP 3 Distraction Value ALGN = r CITY PLATE NO. STATE YEAR POINT OF 8 iI 6 it_• 4 COM VEH 0 El 1 0 FIRST CONTACT 10 7_:}_�5 ^Yves,See Sidebar U1 0 Z 1G4HP54K6Y4108355 None ❑Y ❑N U2 m EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER RSUR m a Same None 1 o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET.CITY,STATE,ZIP PHONE NUMBER r •>. RESPONDER Same VEHU L El ®N 2 G) ❑DRIVER ta PARKED ❑CRNERLESS ❑ PED ❑PED L ❑EOUES 0 Nuv ❑NCv ❑Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) U1 m m / / FOR DAMAGED AREA(S) FRONT TOWED Y N 5 NAME(LAST,FIRST,M) mo day yr Toyota RAV4 2012 00-NONE 11 .. s 1 DUETO CRASH ❑ ® 2 c 13-UNDER CARRIAGE 10 O FIRE ❑ ® U2 C c STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) O DISTRACTED 0 ® SPDR 0 a SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16-TOP 3O X ❑Y ® N ❑UNK VEH. AT CRASH 99-UNKNOWN 8 O•Detraction Value U1 9 EH to H CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR p RI ST CONTACT F 5 7_:{_ -OS C)OYe6MVSee Sideba❑ ® C BL20518 IL 2024 REAR O cn M TELEPHONE DRIVER'S LICENSE NO. STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0 2T3BF4❑V1 CW215066 State Farm ❑Y 0 N RDEF73 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST.FIRST,M) POLICY NUMBER 1 I Bidelman. Maria-J. 3385694-sfp-13 BAC 3 HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE.ZIP PHONE NUMBER 996 < RESPONDER❑ 1 731 N SPRING ST. ELGIN . 11_60120 (224)482-1328 U1 = (UNIT) (SEAT) (DOB) ISEXI (SAFT) (AIR) (INJI (EJCTI (EPTH) PASSENGERS 8 WITNESS ONLY (NAME)I(ADDRESS),(TELEPHONE) (EMS) (HOSPITAL) n I I - U2 996 r m / / '#OCCS > / / U1 1 m / I 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME ®AM Did crash occur ❑Y U2 Z N ® 18 1 10,20 ,2024 01 49 ❑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 3 2 ❑ 08 06 10,20 ,2024 0 PM El Construction * c' 1 3 ❑ ®CITATIONS ISSUED ❑PENDING SECTION CITATION NO. EMS ARRIVED TIME 1 ❑AM ❑Maintenance U2 Q ARREST NAME De La Torre Rodriguez.Vanessa 11-601 751631 10/20/2024 ❑PM SLMT CO 11 1 ❑Utility p UCITATIONS ISSUEDPENDING ROAD CLEARANCE TIME n 0 0 SECTION CITATION NO. 8 AM30 o N 2 0 ARREST NAME , / ptil El Unknown work zone type U1 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 30 1517-Le Cates. Brittany 100 360-Yucaitis 11 , 15,2024 09 00 ❑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 _� } A CMV is defined as any motor vehicle used to transport passengers or property and. Tx 1 Has a weight rating more than 10,000 pounds(example truck or truck/trailer i- I I I _; INDICATE NORTH combination)or —I 7:1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C i ', d i .3 ,'+ -` ` 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------;-----% -i } - i transporting employees in the course of their employment(example.employee 7, transporter-usually a van type vehicle or passenger car).or w i____A____: : i , : : i 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____1 i; . , 15 _t i ) i 5 Is any vehicle used to transport any hazardous material(HAZMAT)that requires m a,wnawmw0.+aPn I . placarding(example placards will be displayed on the vehicle) 71 UNIT. . . . -• r ____.— wt'+�.. CARRIER NAME farri_ a t ADDRESS 'n nrar ro s. r� T D to _ O CITY/STATE/ZIP r , MOTOR CARR ID ❑ Interstate ❑ Intrastate 0 Not in Comm./Govt. Not in Comm./Other r , USDOT NO. ILCC NO. Xl , Source of above Z . Form Number m XI 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. Z Gold Red u 1 TOWED - TOTAL VEHICLE LENGTH ft. NO.OF AXLES DUE TO ❑X DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT- 3 TOWED BY/TO Redmons/Impound Lot Garage SELECT CODES FROM THE BACK OF CRASH BOOKLET u 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT- 3 TOWED BYJTO. DUE TO © VEHICLE CONFIG CARGO BODY TYPE LOAD TYPE