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HomeMy WebLinkAbout2024-00068302 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets liii Ill III )III 111111 II 111111111111111111 01 III 11110111111 DRAG TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X003602266 u, 1 U2 1 1 1 1 U116 U2 2 U, 1 U2 1 Ut 1 U2 1 1 15 Ut 1 U2 1 *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-$1.500EI NOT ON S®ON SCENE • 7 VEHICLE/PROPERTY 0 OVER$1.500 ❑AMENDEDCENE(DESK REPORT) ❑ B Injury and JorTow Due To Crash YR 2024I2024-00068302 VENT * ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 71 SYMPHONY WAY El ❑gin RELATED ❑Y co" 10 26 2024 10:14 ®AM ❑YES ®NO U1 • .< PRIVATE mo /day I yr ❑PM FLOW CONDITION m 'COUNTY PROPERTY ®Y ❑N DOORING ❑y #OF MOTOR ®SLOW 1 N ❑ FT/MI N E S W 'WITH VEHICLES INVLD ❑ STOPPED U2 —I Ej AT INTERSECTION WITH (NAME OF ) Kane HIT&RUN ❑Y ® " PEDALCYCUST®N ❑ FREE FLOW # LNS ' 0 tg oRNER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EOUES ❑NIN ❑Ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N O 0 O . REKHA BMW X3 2022 00-NONE ®j © 1 DUE TO CRASH ❑ ® 3 NAME(LAST,FIRST,M) mo day yr 13-UNDER CARRIAGE 10 2 FIRE ❑ 0 SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 m 1110 E ALGDNQUIN RD 2L F SYSTEM IN ENGAGED 15-OTHER 9 >I6-TOP 3 _ PLATE NO. STATE YEAR POINT OF !1 6 it_ COM VEH 0 0 1 0 5UX53DP04N9M24552 Geico ❑Y ®N U2 m V. EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER RSUR m a 99 SOMA.SANTOSH 6173471241 1 o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET CITY,STATE,ZIP PHONE NUMBER r o RESPONDER Y Ei N 1856 MARBELLA DR, Elgin. IL.60124 VEHU 0 ®DRIVER ❑ PARKED 0 DRNERLESS ❑ 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) FRONT TOWED Y N n NAME(LAST,FIRST,M) Pena, Diana mo day yr 0 8 0 8 2 0 0 0 Hyundai Genesis 2020 Do-NONE ;o) 12 s Re o CRASH ❑❑ ® Uz 2 C c 13-UNDER CARRIAGE , STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) • DISTRACTED 0 ® SPDR C) SYSTEM IN ENGAGED 15-OTHER O9 16-TOP 3 0 a` 74 S ALDINE ST F ❑Y ❑N ❑UNK VEH. AT CRASH 99-UNKNOWN 'Oistrachon Value N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POFIRSNT T COF ONTACT 9 T_II 6 I_5 C•OM e6VEH SeeSideba❑ ® U1 al H ELGIN IL 60123 0 ER76723 IL 2025 TEARf 0 CCn M TELEPHONE DRIVER'S LICENSE NO. STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0 (331)980-6544 P500-1600-0825 _IL D KMTG34LA4LU061948 State Farm ❑y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST.FIRST,M) POLICY NUMBER 1 I 99 Pena-Martinez. Leobardo 1735240SFP13 BAC , 3 HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE.ZIP PHONE NUMBER 996 < RESPONDER ON 74 S ALDINE ST. ELGIN . IL.60123 (224)388-0394 Ut = (UNIT) i SEAT) (DOB) ISEXI (SAFT) (AIR) IINJI (EJCT) (EPTH) PASSENGERS 8 WITNESS ONLY (NAME)I(ADDRESS)U(TELEPHONEI (EMS) (HOSPITAL) 2 6 06 /08/2016 M 2 3 0 1 0 Finnegan P. Stozek/729 MORGAN ST.ELGIN,IL,60123 Refused 996 m uz m / / #OCCS ' y / / Ut 1 m / / 2 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME ®AM Did crash occur 0 Y U2 Z N ® 11 1 10,26 ,2024 10 17 ❑pM in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME It YES check one below: T PROPERTY OWNERS ADDRESS:STREET.CITY,STATE,ZIP ❑AM U1 3 2 ❑ 2 18 ! / 0 PM ❑Construction * N 3 ❑ 0 CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME ❑AM ❑Maintenance uz 1 Q ® 11 1 ARREST NAME / / ❑PM ID Utility SLMT p U 0 CITATIONS ISSUED ❑ TIME PENDING SECTION CITATION NO. ROAD CLEARANCE "'p N8AM 15 T 2 0 ARREST NAME 1 / ptit Unknown work zone type Ut OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME Y 15 402-Free, Richard 101 272-Bajak , / ❑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. IF MORE THAN ONE CMV IS INVOLVED,USE SR 1050A ADDITIONAL UNITS FORMS 0 ' } 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 Z i- 1 ; i ; i- r r , , i r r 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 I • t ' ' 1 1 1 i 't } - i• transporting employees in the course of their employment(example.employee XI transporter-usually a van type vehicle or passenger car).or w 't r 't 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 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 o • CITY/STATE/ZIP . - MOTOR CARR ID ❑ Interstate ❑ Intrastate ❑ Not in Comm./Govt. ElNot in Comm./Other Q r---- ----, r r r •r • UDO N ILCC NO. Cm 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 m TRAILER 1 ❑ ❑ ❑ Z -74 TRAILER 2 ❑ ❑ ❑ o U 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft 2 ft. Z Gray White - u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT- 1 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