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HomeMy WebLinkAbout2024-00068186 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 1111111 OIl III (III IIII lull 111111111111111 111011111111111 DRAG TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X0036O2305 u, 1 U21 1 1 1 Ut 8 U2 1 Ut 1 U2 1 Ut 1 U2 1 4 12 Ut 13 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 ❑$5oi-$1,500 ®ON SCENE 3 0 NOT ON S VEHICLE/PROPERTY inOVER$1.500 0 AMENDEDCENE(DESK REPORT) ® B Injury and JorTow Due To Crash YR 2024I2O24-00068186 VENT * ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 3 'T1 S RANDALL RD El ❑ Elgin RELATED ❑Y coN 10 25 2024 06:23 ❑AM ❑YES ®No u1 ,< PRIVATE mo /day I yr ®PM FLOW CONDITION m Q COUNTY PROPERTY ❑Y ®N DOORING ❑y #OF MOTOR ❑SLOW 2 co ®/MI ON E S W 190 WITH VEHICLES INVLD El STOPPED U2 —I ❑ AT INTERSECTION WITH (NAME OF ) Kane HIT&RUN ❑Y CZN PEDALCYCUST®N ® FREE FLOW # LNS ' 0 18)DRIVER 0 PARKED 0 DRIVERLESS ❑ PED 0 PEDAL 0 EOUES 0 WV 0 Ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 5 C) FOR DAMAGEDAREA(S) FRONT TOWED Ut O ,Taqhiuddin 0 6 / a0 J1 9 y 7 Honda Odyssey 2021 00-NONE tt . 72 , DUE TO CRASH 0 ® E NAME(LAST,FIRST,M) q 13-UNDER CARRIAGE FIRE ❑ IA SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) t9 • O DISTRACTED 0 El U2 5 m 906 SUNRISE DR M ❑Y ®SYSNEM IN❑UNK VEH. O AT CRASH ENGAGED O 99-UNKNOWN 9 16-TOPO3 ,Distraction Value 9 ALGN 2 CITY PLATE NO. STATE YEAR POINT OF 8 1 6 1i 4 COM VEH ❑ ® 1 0 a 5FNRL6H57MB033800 Allstate ❑Y ®N U2 m EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER RSUR a Same 802-305-017 1 m o HOSPITAL(TAKEN TO) INCIDENT • IF'Y' OWNER STREET.CITY,STATE,ZIP PHONE NUMBER '' RESPONDER Same VEHU 73 L ❑Y ®N 2 0 5 ®DRIVER ❑ PARKED 0 CRNERLESS ❑ PED ❑PEDAL ❑EQUES 0 WV ❑NCV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N U1 m m / 21 J FOR DAMAGED AREA(S) FRONT TOWEDTLiE , Q NAME(LAST,FIRST,M) Turkman, Melissa,A. mo day 1 9 yr General General MotorSiOnp 2004 oo-NONE Q 12 CRASH 0 ® 2 xi ✓ 13-UNDER CARRIAGE t�) Ij 2 FIRE ❑ ® U2 C c STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ❑ IN SPOR C) E. 415 G EDRG E ST F SYSTEM IN O ENGAGED 0 15-OTHER 9 16-TOP 3 9 0 X ❑Y El DUNK VEH. AT CRASH 99-UNKNOWN 'Oistractlon Value N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR p PORIST COF ONTACT 11 7.'1-6" .5 CUOVesVSee Sidebar❑ 21 U1 C H ELGIN IL 60120 B 3739456B IL 2024 l 0 (/j, M TELEPHONE DRIVER'S LICENSE NO. STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0 (224)416-5390 44435590 TX D 0 2GTEK19T641300882 Bristol West Ins Co. ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 I Plazola, Daniel,A. G01 4877694 00 Bnc ' 3 HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE.ZIP PHONE NUMBER 996 < RESPONDER pO®N 415 GEORGE ST, ELGIN . 11_,60120 (224)219-2369 U1 = (UNIT) ISEATI (DOB) (SEX) i)SAFT) (AIR) IINJI (EJCT( (EPTH( PASSENGERS&WITNESS ONLY (NAME'/1ADDRESS,1ITELEPHONEI (EMS) (HOSPITAL) - 1 10 07 /27/1988 F 2 3 0] 1 0 Asra Taqhiuddin/906 SUNRISE DR,SOUTH ELGIN,IL,60177 996 r (703)663-0701 U2 m 1 12 09 /06/2020 M 12 3 0 1 0 Madtha Taqhiuddin/906 SUNRISE DR,SOUTH ELGIN,IL,60177 #OCCS D (703)597-9240 _ X 1 6 01 /21 /2020 F 12 3 0 1 0 Zarah Taqhiuddin/906 SUNRISE DR,SOUTH ELGIN,IL.60177 Ut 5 m (703)597-9240_ D 1 4 05 /09/2018 F 13 3 0 1 0 Adeebah Taqhiuddin/906 SUNRISE DR,SOUTH ELGIN,IL,60177 (703)597-9240 U2 2 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY 1 POLICE NOTIFIED TIME ❑AM Did crash occur ❑Y Z N ® 11 1 10,25 /2024 06 23 ®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 ❑AM Ut 5 2 0 20 99 10,25 /2024 06 23 ®PM El Construction * N 1 3 0 ®CITATIONS ISSUED El PENDING SECTION CITATION NO. EMS ARRIVED TIME 5 z ❑AM ❑Maintenance U2 CO 11 1 ARREST NAME Mohammed,Taqhiuddin 11-709-A 1538000010 10/25/2024 06 26 ®PM SLMT o U CITATIONS ISSUEDPENDING • ROAD CLEARANCE TIME 0 Utility o N ❑ 0 SECTION CITATION NO. AM 50 T 2 0 ARREST NAME 10/25 /2024 07 47 ®PM 0 Unknown work zone type U1 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 0 1538-Estrada, Leticia 900 - 11 , 12/2024 01 30 0 pM Am Workers present? ®N U2 50 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. D 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 w 00elli 1 Has a weight rating more than 10,000 pounds(example truck or truck/trailer r } ; 4 combination) or NDICATE NORTH C BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver } J. +. ', i _ I Net 7b Scala 1 -` ` r r r (example'.shuttle or charter bus)-or 0 I3. Is designed to carry 15 or fewer passengers and operated by a contract carrier 0 ----+ f-----+ + + � -� � } } transporting employees in the course of their employment(example.employee M Itransporter-usually a van type vehicle or passenger car).or w C i_____A____: : I : : i r i 4 Is used or designated to transport between 9 and 15 passengers,including the driver, for direct compensation(example:large van used for specific purpose).or O L____L____I ; ; 1 I t i } i 5 Is any vehicle used to transport any hazardous material(HAZMAT)that requires -13placarding(example placards will be displayed on the vehicle) m Z1 190 1` CARRIER NAME ' 1 1 t ADDRESS 0. . I 11 ~ ` cn • CITY/STATE/ZIP MOTOR CARR ID ❑ Interstate ❑ Intrastate F ❑ Not m Camm./Gwt. ❑ Not m Comm!Other OO h . . C r , USDOT NO. ILCC NO. , Source of above Z . ❑ Yes 0 No ❑ Unknown 0 Was a driver/vehicle Examination Report Form completed? D HAZMAT ❑Yes ❑ No ❑Unknown Out of Service ❑Yes ❑ - MCS ❑Yes ❑ No ❑Unknown Out of Service ❑Yes ❑Nc C Z Form Number D m 7a IDOT PERMIT NO WIDELOAD? ❑Yes ❑No S TRAILER VIN 1 m N LOCAL USE ONLY TRAILER VIN 2 m D TRAILER WIDTH(S) 0-96'1 97-102'1 >10:' m m TRAILER 1 ❑ ❑ ❑ Z TRAILER 2 ❑ ❑ ❑ o U 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft 2 ft Z ip Blue Blue - u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES DUE ED ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT 1 TOWED BY/TO 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