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HomeMy WebLinkAbout2024-00068113 , l Ill ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets Il ii Ill OIl III 1001lu ll 11111111111111111111111111111 DRAG TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X0036O22 5 u, 1 U2 1 2 4 1 U1 2 U2 1 U, 1 U2 1 U1 1 U2 1 1 15 U1 1 U2 1 *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 0 NOT ON S VEHICLE/PROPERTY inOVER$1.500 ❑AMENDEDCENE(DESK REPORT) ❑ B Injury and JorTow Due To Crash YR 2024I2O24-00068113 VENT * ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 7'1 N EDISON AVE ❑ Elgin RELATED ®Y ❑N 10 25 2024 03:01 ❑AM ❑YES ®NO U1 PRIVATE mo /day I yr ®PM FLOW CONDITION m FT/MI N E S W W CHICAGO ) Kane HIT&RUN ❑Y CZN PEDALCYCUST®N 0 FREE FLOW # LNS 0 tg DRIVER 0 PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑Eoues ❑NIN ❑Ncv ❑ov DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 n 0 6 / 2 4 /1 9 6 9 FOR DAMAGEDAREA(S) FRONT TOWED U1 ,Juan, D. Nissan Rogue 2017 00-NONE ©' . O..D DUETOCRASH p 21 NAME(LAST,FIRST,M) mo day yr z 13-UNDERCARRIAGE FIRE 0 SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) ® O DISTRACTED 0 Il U2 2 m 1315 CONCORD DR M SYTM❑Y ®SNE❑UNK VEH. O ATCRASH 0D 99-U 15-UNKNOWN 9 16-TOP 3 Distraction Value ALGN = CITY PLATE NO. STATE YEAR POINT OF 8 i1 6 ii_• 4 COM VEH 0 El 1 O F FIRST CONTACT 1 7_ _{_�5 •Yves,See Sidebar U1 0 Z KN MAT2MTXH P569162 Founders ❑Y ®N U2 m V. EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER RSUR m 99 9 Same ITIL209645 1 o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET.CITY,STATE,ZIP PHONE NUMBER > '' RESPONDER Same VEHU L ❑Y ®N 2 G) ®DRIVER ❑ PARKED ❑CRNERLESS ❑ PED ❑PEDAL ❑EQUES ❑WV ❑NCV ❑DV DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N U1 m m FOR DAMAGED AREA(S) FRONT TOWED , NAME(LAST,FIRST,M) Rodriguez,Alan.J. 0 5 / 0 9 /2 0 0 7 Honda VT1100C 2004 DO-NONE mo day yr 13-UNDER CARRIAGE 12 _y RE ❑ocRASH p ® U2 2 Xi v 6 2 C c STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) ® DISTRACTED 0 IN SPDR 0 E 101 S UNION ST M SYSTEM IN O ENGAGED 0 15-OTHER I©9 16-TOP 3 0 X ❑Y MIN DUNK VEH. AT CRASH 99-UNKNOWN •Distraction Value N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF ©j 4 COM VEH 0 ® U1 to I— FIRST CONTACT 11 0 6 5 •ItYes,See Sidebar ELGIN IL 60123 0 AL2489 IL 2025 R,:AR 0 ((1) M TELEPHONE DRIVER'S LICENSE NO. STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0 (224)629-1761 3620-1007-133R IL Other 0 1HFSC43074A403210 Geico ❑Y ®N RDEF EMS AGENCY PEDV PPA ' PPL VEHICLE OWNER(LAST.FIRST,M) POLICY NUMBER 1 I 99 9 Lechel_ Kurt 4296084918 BAG 3 HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE.ZIP PHONE NUMBER 996 < RESPONDER Y IXI N 101 S UNION ST, ELGIN . 11_60123 (847)401-8039 U1 = (UNITE (SEAT) (DOBi (SEX) (SAFT) (AIR) (INJI (EJCTI (EPTH) PASSENGERS 8 WITNESS ONLY (NAME)I(ADDRESS)I;TELEPHONEI (EMS) (HOSPITAL) n / I U2 996 r m - #OCCS y / /• U1 1 m I I 1 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME ❑AM Did crash occur ❑Y U2 Z N ® 11 1 10,25 /2024 03 01 ®pM in a Work Zone? ®N DIRP co 1 r PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME It YES check one below: T PROPERTY OWNERS ADDRESS:STREET.CITY,STATE,ZIP 0 AM U, 5 a 2 ❑ 2 99 ! / 0 PM ❑Construction * N 3 0 ®CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME ❑ ❑AM Maintenance U2 3 •Q ® 11 1 ARREST NAME Morales,Juan, D. 11-904-B 1528-000159 / / ❑PM SLMT o UCITATIONS ISSUED PENDING ROAD CLEARANCE TIME ❑Utility o N 0 ❑ SECTION CITATION NO. AM 30 2 0 ARREST NAME l 0/25 /2024 03 15 ®PM 0 Unknown work zone type U1 r,f Co T OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 0 ❑AM Workers present? El Y 30 1528-Rivera, Kevin 601 - 11 /26/2024 01 30 0 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 0IF 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 truckrtrailer -< r i• ; i r r , , i r r INDICATE NORTH combination) or 'I ."0 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C '. ' t ` ` ' ' 1 ` ` r r r (example'.shuttle or charter bus)-or X ; I I ; 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier 0 i------i-----• + + • : - -, 1 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 w ' i r i 4 Is used or desi nated to trans rt between 9 and 15 assen ers including the driver, 9 Po P 9 N for direct compensation(example:large van used for specific purpose).or O i 1 5 Is any vehicle used to transport any hazardous material(HAZMAT)that requires placarding(example placards will be displayed on the vehicle) 11 • CARRIER NAME Z ' .. ADDRESS 0 N • CITY/STATE/ZIP , , . - MOTOR CARR ID ❑ Interstate El Intrastate ❑ Not in Comm./Govt. ElNot in Comm./Other Q C 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 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 m TRAILER 1 ❑ ❑ ❑ z -74 TRAILER 2 ❑ ❑ ❑ o U 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft 2 ft. y Silver Black - 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_ 1 TOWED BY/TO: DUE TO © VEHICLE CONFIG CARGO BODY TYPE LOAD TYPE