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HomeMy WebLinkAbout2024-00071362 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 I01101100 00 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X003619250 u, 1 U21 3 4 1 U1 3 U2 1 U, 1 1_12 1 U, 1 U2 1 1 10 u1 1 U2 3 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW ' Elgin Police Department ONE PERSON'S ❑$501-51.500 ®ON SCENE 1 VEHICLE/PROPERTY ®OVER 51,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash El AMENDED YR 2024I 2024-00071362 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 m789 SUMMIT ST EIIn01:22 ® ❑ RELATED 181 Y 0 N 11 09 2024 ❑AM ❑YES ®NO U1 -< _ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION m COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 15 u) ❑ FT/MI NESW Cook HIT ❑Y ® N WITH VEHICLES INVLD 0 STOPPED U2 --I &RUN ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EWES ❑uuv ❑!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 n T TOWED U1 0 FOR DAMAGEDAREA(S) FROM Za alak.William. M. 1 2 / yr 13-UNDER CARRIAGE ©,I 0,,:0 FIRE 2 0 NI STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL)THERDISTRACTED 0 0 U2 5 M M 2 8 SYTM❑Y ®SNE❑UNK VEH. 0 ATCRASHD 99-UUNKNOWN 9 16•TOP 3 `Distraction Value 9 ALGN X. r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s i�6 �i 4 COM VEH 0 j$J 1 0 ELGIN I L 60124 B 1 0 FIRST CONTACT 11 7_: __5 *II Yes.See Sidebar U1 Z QM5097 IL 2025 REAR TELEPHONE IL JF2SKAXC4LH424894 AARP-The Hartford ❑v IlN U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR • m Elgin Fire Same 55PHB834757 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF IC OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Sherman ❑Y ® N 2 0 Eg DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 yr 10) 12 ` 2 FIRE ❑ ® U2 C o 13-UNDER CARRIAGE c F 2 8 SYSTEM IN 0 ENGAGED 0 15-OTHER 9,1,6•TOPQ * X 0 Y ®N 0 UNK VEH. AT CRASH 99-UNKNOWN O 0istraglon Value 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s-.;,• 6 1,:,_ COM VEH ❑ ® U1 CO FIRST CONTACT 2 7-'_, _5 •(ryes.See SidebarC H ELGIN IL 60120 B 1 0 EV61695 IL 2025 REAR 0 M IL D 5N1AT2MV5GC886446 Insure on the Spot ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Elgin Fire Same I Lt6046163 SAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPONDER u1 = (UNIT) (SEAT) (DORM (SEX) {SAFT) (AIR) (INJI 1(EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME),(ADDRESS)1ITELEPHONEI (EMS) (HOSPITAL) 1 3 07 / :A / / UI 2 m / / 1 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 11 1 11 ,09 /2024 01 22 ®AM in a Work Zone? ®N DIRP co 1 t PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 3 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 C) v 2 0 25 28 11,09 ,2024 01 23 ®PM ❑Construction R 3 0 xi CITATIONS ISSUED ElPENDING SECTION CITATION NO. EMS ARRIVED TIME 5 z J 0 AM ❑Maintenance U2 o ® 11 1 ARREST NAME Zagalak.William. M. 11-306 1529-000185 11,09/2024 01 26 ®pM SLMT o N ❑CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • El Utility 35 t 2ARRESTNAMEAM 7 El / ! ❑❑PM 0 Unknown work zone type U1 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 35 1529-Audi red.Jonathan 202 275-Engelke 12 ,03,2024 09 00 ❑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. r ----r••--, , ; A CMV is defined as any motor vehicle used to transport passengers or property and: Z Hiawatha?Dr. 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer -< i- }--__r-_--; I ° INDICATE NORTH combination):or p0 • BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C - (example:shuttle or charter bus):or C) ' I r Summit?St. 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier 0 I- I-----A--_.1 J 1, - i• } } } transport) employees in the course of their employment ngpbyment(example:employee transporter-usually a van type vehicle or passenger car):or w L L.___a____.I 4. Isusedordesinatedtotrans rtbetween9and15 passengers,including C } } for direct com nation exam I lar a van used for s �cific ur o ):or the driver, Pe ( P 9 Pe P Pose):or L____a____. r —Unit 1 - t } } t 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires D — — placarding(example:placards will be displayed on the vehicle). 0 CARRIER NAME Z , I � Z ADDRESS0 D I Mobil?Gas?Station 0 I not To scare I CITY/STATE/ZIP g _ i. i. i. MOTOR CARR.ID 0 Interstate ❑ Intrastate ❑ Not in Comm./Govt. ❑ Not in Comm./Other 00 --- --4. - USDOT NO. ILCC NO. m m XI Source of above z . IDOT PERMIT NO. WIDELOAD'; ❑Yes 0 No = TRAILER VIN 1 m co LOCAL USE ONLY TRAILER VIN 2 m 0 TRAILER WIDTH(S) 0-96" 97-102" >102' -n TRAILER 1 0 0 0 Z 1-1 TRAILER 2 ❑ 0 ❑ O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w Bronze Gray u 1 TOWED • TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT 3 TOWED BY/TO. Redmons/Impound Lot Garage . SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® DISABLING DAMAGE Redmons/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE