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HomeMy WebLinkAbout2024-00067865 , l Ill ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets Il ii Ill OIl III 1In ll 1111111111111111111111111111111 DRAG TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X0036O2247' u, 1 U21 1 1 1 U199 U2 1 U, 1 U2 1 U1 1 U2 1 1 17 U123 U223 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY El$500 OR LESS TYPE OF REPORT ® q No Injury J Drive Away AGENCY CRASH REPORT NO. TRFW Elgin Police Department ONE PERSON'S ®$501-$1.500 ®ON SCENE 1 El NOT ON S VEHICLE/PROPERTY ElOVER$1.500 ❑AMENDEDCENE(DESK REPORT) ❑ B Injury and JorTow Due To Crash YR 2024I2024-00067865 VENT * ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 '17 KATHLEEN DR ® ❑ Elgin RELATED ❑Y co" 10 24 2024 11.36 ®AM ® ❑YES NO u1 ,•< PRIVATE mo /day I yr ❑PM FLOW CONDITION m COUNTY PROPERTY ❑Y 21 N DOORING ❑Y #OF MOTOR ❑SLOW 1 U) ❑ FT/MI N E S W 'WITH VEHICLES INVLD ❑ STOPPED U2 —1 ❑ AT INTERSECTION WITH (NAME OF ) Kane HIT&RUN ❑Y CZN PEDALCYCUST®N ® FREE FLOW # LNS 0 tg ORNER 0 PARKED 0 DRIVERLESS ❑ FED ❑PEDAL ❑EOUES 0 NIN ❑Ncv 0 ov DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 n FOR DAMAGEDAREA(S) FRONT TOWED Ut NAME(LAST,FIRST,M) mo day yr O GUTIERREZ,YULIBETH 1 1 / 0 5 J 1 9 8 5 Toyota Corolla 2006 00-NONE 11 12 i' , DUE TO CRASH p ® - E 13-UNDERCARRIAGE 1 Y FIRE ❑ ICI SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 10 U2 2 19 m 314 KATHLEEN DR 1 F ❑Y ®SYSNE❑UNK VEH. nM IN AT CRASH ENGAGED O 99-UNKNOWN 9 16-TOP 3 ,Distraction Value ALGN 2 CITY PLATE NO. STATE YEAR POINT OF 6 11 6 i' 4 COM VEH El ® 1 O 1NXBR32E26Z581720 KEMPER ❑Y ®N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER RSUR m RODRIGUEZ,JOSE,A. 12AU001519712 1 I— o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET.CITY,STATE,ZIP PHONE NUMBER > RESPONDER 314 KATHLEEN DR 1. ELGIN , IL,60123 VEHU 73 ❑Y ❑" 2 G) s ®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) FRONT TOWED Y N , NAME(LAST,FIRST,M) DARIS PADRON, EUDO,J. mo 0 8 1d d9ay 1 9 8 6 Nissan Rogue 2017 oo-NONE ;0 12 s FIREETocRasH ❑❑ ® U2 2 C v 13-UNDER CARRIAGE STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 IN SPCA n SYSTEM IN O ENGAGED 0 15-OTHER 9 16-TOP 3 0 X E 1489 MEYER ST 3 M ❑Y ® N ❑UNK VEH. AT CRASH 99-UNKNOWN •Distraction Value N CITY STATE ZIP IN) EJCT EPTH PLATE NO. STATE YEAR POINT OF 8 j , 4 COM VEH ❑ ® U1 to H FIRST CONTACT 6 7__•-_1-;_5 •If yes,See Sidebar ELGIN IL 60123 0 202AC407 IL 2025 I 0 CCn D TELEPHONE DRIVER'S LICENSE NO. STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0 (224)508-3364 D621-2108-6236 IL D 0 JN8AT2MV2HW265755 NONE ❑Y ❑N RDEF73 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 I DARIS, EUDO,J. NONE BAG E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE.ZIP PHONE NUMBER 996 < RESPONDER POO NR 1482 MEYER ST, ELGIN , I L.60123 (224)508-3364 U1 = (UNIT( ;SEAT) ;DOB) (SEX) ISAFT) (AIR) (INJI (EJCTI (EPTH) PASSENGERS&WITNESS ONLY (NAME),(ADDRESS),(TELEPHONE) (EMS) (HOSPITAL) 2 3 12 /05/1988 F 9 3 0 1 0 ANGDY NATERA/309 KATHLEEN 5.ELGIN,IL,60123 996 r (224)468-8356 U2 m W 07 /02/1970 F ODILIA OCHOA/ 308 KATHLEEN 6-ELGIN-IL60123/ #OCCS D (224)456-7414 _ X / / Ut 1 m / / 2 0 EV MOST EVNT LOG DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME ®AM Did crash occur ❑Y U2 Z N ® 11 1 10,24 ,2024 11 36 ❑pM in a Work Zone? El DIRP co 1 r PROPERTY OWNERS ADDRESS:STREET.CITY,STATE,ZIP PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME ID AM It YES check one below: U1 3 C) T 2 ❑ 30 99 ! / ❑PM ❑Construction a c' 3 El ®CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 7 ❑AM El Maintenance U2 CO 11 1 ARREST NAME DARIS PADRON, EUDO,J. 3-707 244-1786 / / ❑PM SLMT o U ❑CITATIONS ISSUED 0 PENDING 'SECTION CITATION NO. ROAD CLEARANCE TIME ' 0 Utility o N B AM 30 2 0 ARREST NAME r / pp1 ❑Unknown work zone type Ut 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑qM Workers present? ❑Y 30 244-Blomberg, Michael 602 272-Bajak 11 ,26/2024 01 30 ®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. r 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. Z 1 Has a weight rating more than 10,000 pounds(example truck or truck/trailer ' r i ; i 'r i- r r , , i INDICATE NORTH combination) or 'I 7:1 I ; BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C ' L I ', ! i. L ' ' '. ', ' f ` r r r (example'.shuttle or charter bus)-or X 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier 0 i------'-----• + + • : - 1 - 1 i } - i• transporting employees in the course of their employment(example.employee M transporter-usually a van type vehicle or passenger car).or CO r i• 4 Is used or designated to transport between 9 and 15 passengers,including the driver, 9 Po P 9 N for direct compensation(example:large van used for specific purpose).or O i i 5 Is any vehicle used to transport any hazardous material(HAZMAT)that requires placarding(example placards will be displayed on the vehicle) 11 2. . ` CARRIER NAME 2 ' t ADDRESS 0 N CITY/STATE/ZIP MOTOR CARR ID ❑ Interstate ❑ Intrastate ❑ Not in Comm./Govt. ❑ Not in Comm./Other Q m r-----.-----, r r r r r•---, r - DO ILCC NO. m U N XI , Source of above z . 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 Red u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT- 2 TOWED BY/TO 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