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HomeMy WebLinkAbout2024-00068144 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 1111111 OIl III HI IIII lull 111111111111111111111111111111 TIII DRAG TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X0036022 6 u, 1 U21 2 4 1 Ut 2 u2 1 U113 U2 1 U1 1 U2 1 1 15 Ut 1 U2 1 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY El$500 OR LESS TYPE OF REPORT El A No Injury J Drive Away AGENCY CRASH REPORT NO. TRFW Elgin Police Department ONE PERSON'S ❑$501-$1.500 ®ON SCENE 2 El NOT ON SVEHICLE/PROPERTY in OVER$1.500 El AMENDEDCENE(DESK REPORT) 0 B Injury and/or Tow Due To Crash YR 2024I2024-00068144 VENT * ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 '11 HOPPS RD El ❑ RELATED ®Y ❑N 10 25 2024 04:11 DAM 11 YES 0 NO U1 Elgin PRIVATE mo /day I yr ®PM FLOW CONDITION m FT/MI N E S W U M ) Kane HIT&RUN ❑Y ® N PEDALCYCUST®N ® FREE FLOW # LNS 0 tg DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EOUES ❑NIN ❑NCV 0 ov DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 C) 0 9 / 2 2 /2 0 0 0 FOR DAMAGEDAREA(S) FROM TOWED U1 _ NAME(LAST,FIRST,M) ,Austin,J. mo day yr Kia Motors Co tima 2013 00-NONE DUE TO CRASH 11- 12 -1 NI ❑ 13-UNDERCARRIAGE io1 2 FIRE ❑ IA SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 I U2 0 m 2373 COTTONWOOD DR M ❑Y ESYlM❑UNK VEH. O AT CRASH D 0 15-OTHER 99-UNKNOWN 9 76-TOP 3O,Distraction Value 9 ALGN .. Ti' CITY PLATE NO. STATE YEAR POINT OF 6 {I 6 if O COM VEH 0 El 1 0 a ~ 5XXG R4A65 DG 144758 StateFarm ❑Y ®N U2 m V. EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER RSUR Same 1703752SFP13 1 m o HOSPITAL(TAKEN TO) INCIDENT • IF'Y' OWNER STREET.CITY,STATE,ZIP PHONE NUMBER '' RESPONDER Same VEHU X L ❑Y ®N 2 05 ®DRIVER ElPARKED 0 CRNERLESS ElPED ❑PEDAL ElEQUES 0 WV ❑NCV 0 ov DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N U1 m m / J FOR DAMAGED AREA(S) FRONT TOWED s Thakkar. Nishita- M. 0 1 20 1 9 9 2 Honda Accord 2011 00-NONE 1t. �'_1 DUE TO CRASH (ffi 0 2 , NAME(LAST,FIRST,M) mo day yr ©, a 13-UNDER CARRIAGE 10 I, s FIRE ❑ ® U2 C , STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 ® SPDR C) SYSTEM IN O ENGAGED 0 15-OTHER 9 16-TOP 3 9 0 X E. 1471 WALNUT CREEK DR F ❑Y ® N DUNK VEH. AT CRASH 99-UNKNOWN II •Distraction Value 07 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR F FIRST CNT ONTACT 12 7_'1 6 1_5 GIOMesVSee Sidebar ® U1 C H ELGIN IL 60123 0 N534605 IL 2025 I 0 ((1 D TELEPHONE DRIVER'S LICENSE NO. STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0 (847)532-3391 T260-6338-2620 IL D 0 1 HGCP2F41 BA055523 StateFarm ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST.FIRST,M) POLICY NUMBER 1 I Same 4766805B0713D BAC 3 HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE.ZIP PHONE NUMBER 996 < 0 RESPONDER Same U1 = (UNIT) I SEAT) i DOB (SEX) i)SAFT) (AIR) (INJI (EJCTI (EPTH) PASSENGERS&WITNESS ONLY (NAMEI H ADDRESS)((TELEPHONE) (EMS) (HOSPITAL) - 2 3 08 /1 7/2009 F 2 8 0� 1 0 Shreyaa Thakkar/1471 WALNUT CREEK DR,ELGIN.IL-60123 Refused(847)532-3391 _ U2 996 m m 2 6 02 /27/2012 F 2 8 0 1 0 Astha Thakkar/1471 WALNUT CREEK DR-ELGIN.IL.60123 Refused #occs y (847)532-3391 _ X 3 3 06 /02/1988 M 2 3 C 1 0 Erik Rico/2340 NANTUCKET LN,Elgin,IL,60123 • Refused U1 1 m (224)545-2438 D / / 3 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 10,25 /2024 04 11 ®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 Ut 5 2 0 11 1 2 14 ! I 0 PM ❑Construction * N T 3 0 ®CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 3 ❑AM ❑Maintenance U2 • Q ® 11 1 ARREST NAME Garbacz,Austin,J. 11-901 1530000125 / / ❑PM SLMT o U CITATIONS •ISSUED PENDING ROAD CLEARANCE TIME 0 Utility o N SECTION CITATION NO. AM 30 2 0 ARREST NAME 10/25 /2024 05 00 ®PM 0 Unknown work zone type U1 T • OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME Y 2 2 3 0 ®AM Workers present? 0 45 1530-Soto,Oscar 801 - 11 , 12,2024 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. r 0 IF MORE THAN ONE CMV IS INVOLVED,USE SR 1050A ADDITIONAL UNITS FORMS ' } Z A CMV is defined as any motor vehicle used to transport passengers or property and. r- -r- --, , 1 r r r r , , , 1 . r 1 Has a weight rating more than 10,000 pounds(example truck or truck/trailer ' r 1 ; i ; i- r r , , 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 ', ! ' ' 1 ', ' 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 I • : ' ' 1 1 1 i } - i• transporting employees in the course of their employment(example.employee M . I transporter-usually a van type vehicle or passenger car).or w 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 ' 1 i i 1 5 Is any vehicle used to transport any hazardous material(HAZMAT)that requires placarding(example placards will be displayed on the vehicle) 71 M CARRIER NAME Z ' .. ADDRESS 0 N • CITY/STATE/ZIP 2 MOTOR CARR ID ❑ Interstate ❑ Intrastate ❑ Not in Comm./Govt. ❑ Not in Comm./Other Q r-----.-----, r r r r - -, r • - UDO N ILCC NO. m XI , Source of above Z • . Form Number 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 White Blue 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 zr DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT- 3 TOWED BY/TO. DUE TO ❑ Arties/Impound Lot Garage VEHICLE CONFIG _ CARGO BODY TYPE LOAD TYPE