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HomeMy WebLinkAbout2024-00068023 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 1111111 OIl III )III IIII lull 11111111111111111111 01 IIIIIIIIIIIU21 III DRAG TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X003602259 u, Ut 2 U2 1 Ut 1 U2 1 Ut 1 U2 1 5 15 U120 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 JorTow Due To Crash YR 2024I2024-00068023 VENT * ADDRESS NO. HIGHWAY or STREET NAME • CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 71 E CHICAGO ST ® ❑ Elgin RELATED ❑Y coN 10 25 2024 06:21 ®AM ❑YES ®No ut ,< PRIVATE mo /day/yr ❑PM FLOW CONDITION m E 'COUNTY PROPERTY El ®N DOORING 0 y #OF MOTOR ❑SLOW 1 Cl) ®/MI N O S W Chapel St 'WITH VEHICLES INVLD El STOPPED U2 —I AT INTERSECTION WITH (NAME OF ) Kane HIT&RUN ❑Y CZN PEDALCYCUST®N ® FREE FLOW # LNS O tg ORNER 0 PARKED 0 DRIVERLESS ❑ PEo ❑PEDAL ❑EDDES ❑NMV ❑Ncv 0 ov DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 0 0 1 / 1 2 /1 9 7 0 FOR DAMAGEDAREA(S) FBCM TOWED Ut .Ja ueline Kia Motors Colfportage 2024 00-NONE 11_ 12 , DUE TO CRASH Ego ❑ NAME(LAST,FIRST,M) t1 mo day yr 13-UNDER CARRIAGE ( _. 2 FIRE ® 2 < SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) ® DISTRACTED 0 10 U2 m 356 E CH ICAGO ST 2 F ❑Y ESYlM❑UNK VEH. O AT CRASH D 0 99-UUTHER NKNOWN 9 16-TOP 3 ,Distraction Value ALGN = T. CITY PLATE NO. STATE YEAR POINT OF 8 I{ 6 II_ COM VEH 0 El 1 0 a 5XYK6CDF3RG225656 Progressive ❑Y ®N U2 m EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER RSUR rn a Same 982160998 2 m o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET.CITY,STATE,ZIP PHONE NUMBER LR❑ESPON❑DEnR 3 Same VEHU ®DRIVER ❑ PARKED 0 CRNERLESS ❑ PED ❑PEDAL ❑EQUES 0 WV ❑NCv 0 DV DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) U1 2 m m FOR DAMAGED AREA(S) Fi20 IT TOWED NAME(LAST,FIRST,M) Y N s Salinas-Hernandez,Javier 0 5 / 2 5 /1 9 6 0 Toyota Corolla 2013 00-NONE Xi t3-UNDER CARRIAGE ,t �' , DUE TO CRASH 0 2 ©, ✓ mo day yr c 10 I l FIRE El [2] U2 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 2 Xi DISTRACTED 0 IN SPDR C) E. 175 LINCOLNSHIRE CT (1 SYSTEM IN O ENGAGED 0 15-OTHER 9 16-TOP 3 0 X ❑Y MI N ❑LINK VEH. AT CRASH 99-UNKNOWN •Distraction Value N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POF FIRST CNT ONTACT 12 7_'1 a 1_5 CIOMe6VSee Sideba❑ ® U1 to H ELGIN IL 60120 0 V995202 IL 2025 I 0 (C/j, M TELEPHONE DRIVER'S LICENSE NO. STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0 (224)454-0091 S452-4206-0149 IL Other 2T1 BU4EE2DC966693 State Farm ❑y ®N RDEF73 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST.FIRST,M) POLICY NUMBER 1 I Salinas. Maria 2630338SFP13 BAC 3 HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE.ZIP PHONE NUMBER 996 < ElESPON RESPONDER 3 326 DWIGHT ST. ELGIN . IL.60120 U1 i (UNIT( (SEAT) (DOB) (SEX) )SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)/{ADDRESS)/(TELEPHONE) (EMS/ (HOSPITAL) 2 4 02 /04/1958 F 2 3 A 1 0 Bertha Salinas/175 LINCOLNSHIRE CT,ELGIN.IL.60120 Elgin Fire Provena St.Joseph U2 996 1 (221)276-0147 _ m / / #OCCS D • / / U1 1 m / / 2 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME ®AM Did crash occur ❑Y U2 Z N 1 ® 1 1 1 10/25 /2024 06 21 ❑pM in a Work Zone? ®N DIRP D 1 r PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME It YES check one below: T PROPERTY OWNERS ADDRESS:STREET.CITY,STATE,ZIP ®AM U1 5 N0 2 0 2 28 10/25 /2024 06 42 I�PM ❑Construction * N 3 0 izi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 7 ®AM ❑Maintenance U2 • ARREST NAME Sosa-Guerrero.Jaqueline 11-1205 298001140 10/25/2024 06 46 ❑PM SLMT oN , CO 11 1 ®CITATIONS ISSUED El PENDING 'SECTION CITATION NO. ROAD CLEARANCE TIME AM' 0 Utility 30 2 0 ARREST NAME Salinas-Hernandez-Javier 6-101-A 298001141 10/25 /2024 07 24 ®PM 0 Unknown work zone type Ut r,f Co T OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 0 298-Lopez. Mirko 301 272-Bajak 11 / 18/2024 01 30 0 PM Am Workers present? ®N U2 30 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 1 Has a weight rating more than 10,000 pounds(example truck or truck/trailer r 1 i 1 INDICATE NORTH combination) or -I m BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C ', ', i 0 -t t r r r (e xample.shuttle or charter bus)-or 0 • 3 Is designed to carry 15 or fewer passengers and operated by a contract carrier 0 -----;-----� -t t r r r transporting employees in the course of their employment(example.employee M Not To Scale 1 transporter-usually a van type vehicle or passenger car).or w su.E..ryneere. C , . : i r i 4 Is used or designated to transport between 9 and 15 passengers,including the driver, rn for direct compensation(example.large van used for specific purpose).or O L____L____; ; ; ` ; ` 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 a unnz ` ! arriw�,e' L CARRIER NAME Z ADDRESS 0 , , • CITY/STATE/ZIP r , MOTOR CARR ID ❑ Interstate ❑ Intrastate 0 Not in Comm./Govt. Not in Comm./Other USDOT NO. ILCC NO. , Source of above Z . 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 X1 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" 97-102" >102 m T TRAILER 1 ❑ ❑ ❑ Z TRAILER 2 ❑ ❑ ❑ 0 U 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft 2 ft. Z White Gray u 1 TOWED - TOTAL VEHICLE LENGTH ft. NO.OF AXLES DUE TO ❑X 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- 2 TOWED BY/TO. DUE TO ❑ Arties/Impound Lot Garage VEHICLE CONFIG _ CARGO BODY TYPE LOAD TYPE