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HomeMy WebLinkAbout2024-00072434 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 01111101111 01101100 110 II 1I V U I VI 1110 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X00362523 u, 1 U21 1 1 1 U1 7 U2 1 U, 1 1_12 1 U, 1 U2 1 1 11 U1 1 U211 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY ❑5500 OR LESS TYPE OF REPORT 0 A No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 3 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and f or Tow Due To Crash 0 AMENDED YR 202412024-00072434 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 m® ❑ RELATED PRIVATE ❑Y ®N 11 15 2024 ®AM ❑YES ®NO U1 -< S RANDALL RD Elgin mo /day/yr 07 38 ❑PM FLOW CONDITION m 2350 qC7!MI N E O W Bowes Rd COUNTY PROPERTY ❑Y ® N DOORING 0 Y #OF MOTOR IR SLOW 3 Cl) Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD 0 STOPPED U2 --I 0 AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST IR N ❑ FREE FLOW # LNS 0 18:DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uuv 0 ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 3 FROP,r TOWED U1 0 mo SIMMONS. MADELINE.O. Volvo XC90 2005 00-NONE ©1 O , DUE TO CRASH ® 0 O NAME{LAST,FIRST,M) yr 13-UNDER CARRIAGE I FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 2 DISTRACTED ❑ 0 U2 3 M F 2 4 ❑Y IN NE M IN ENGAGED ❑UNK VEH. O AT CRASH 99-OTHER WN 9 76•TOP 3 ,Distraction Value ALGN = r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s, i�a �i COM VEH 0 Ea 1 0 F. Nourth aurora IN 60542 0 1 0 FIRST CONTACT 11 7_: __5 *Ilsees.SeeSidebar U1 Z BZ61825 IL 2025 REAR TELEPHONE IL D 0 YV1 CZ852651209704 AAA ❑y ®N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Elgin Fire 99 9 Same AUT005950824 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y ® N 2 0 x DRIVER ❑ PARKED 0 DRIVERLESS ❑ PED 0 PEDAL ❑EWES ❑NMV 0 KKv 0 DV 1 9 yf 0 Dodge Caravan(inc Grand)2012 00-NONE ,._I Q�,-_, DUE TO CRASH p (� 2 x 0 13-UNDER CARRIAGE 1a) I 2 FIRE 0 ® U2 C M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16.TOP 3 X ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN *Oistracton Value U1 0 POINT OF 8 i . 4 COM VEH ❑ ® CO N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR 5 FIRST CONTACT 5 7 -�IOS •(ryes,See Sidebar C LAKE IN THE HILLSZ IL 60156 0 1 0 9005519 IL 2025 I Si)0 IL D 0 2C4RDGCG5R247361 USAA ❑Y ®N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Elgin Fire 99 9 Same GIC0326231457101 BAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPONDER U1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)((ADDRESS)((TELEPHONE) (EMS) (HOSPITAL) DAMco AGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 11 1 11 ,15 (2024 07 38 ®❑PM AM in a Work Zone? ®N DIRP > 1 t PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 1 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 � 0 2 ❑ 03 28 ( / ❑PM ❑Construction >E R 3 ❑ 0 CITATIONS ISSUED El PENDING SECTION CITATION NO. EMS ARRIVED TIME 1 ❑AM ❑Maintenance U2 -a, ARREST NAME SIMMONS. MADELINE.O. 11-601-Ax 1541000022 / ! El PM SLMT o u 1 ® 11 1 • 0 Utility 0 CITATIONS ISSUED PENDING o N SECTION CITATION NO. ROAD CLEARANCE TIME AM r 2 ❑ 11 1 ARREST NAME 11,15 (2024 10 18 [M PM El Unknown work zone type U1 45 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑AM Workers present? ❑Y 45 1541-Wilkerson.Tondeo 700 404-Duffy 12 , 17(2024 01 30 ®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 I I I I I II I I ADDITIONAL UNITS FORMS. r ------••--, , I I`BOWea?Rd. . 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 -< ` ` ' ' r INDICATE NORTH combination):or .Z-1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C - } (example:shuttle or charter bus):or X — ——— . A 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I O . - . transporting employees in the course of their employment(example:employee X transporter-usually a van type vehicle or passenger car):or w L L.___a__._. - t 4. Is used ordesi natedtotrans rtbetween9and15passengers,includingthedriver, I N } } • for direct compensation(example:large van used for speific purose):or 0 L L--_-a-___. - t i. i I 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires _Not Togcsre I placarding(example:placards will be displayed on the vehicle). ,Zmt S.?Randall? -I CARRIER NAME Z ADDRESS 0 0. CITY/STATE/ZIP 00 '�' - i. i. i. i. MOTORCARR.ID ❑ Interstate ❑ Intrastate I I . I ❑ Not in Comm./Govt. 0 Not in Comm./Other �""Y""1 USDOT NO. ILCC NO. m f I Source of above z . If Yes,Name on placard 0 4 digit UN NO. 1 digit Hazard class No. Xl Xl Did HAZMAT spill from vehicle(do NOT consider FUEL from vehicle's Z own tank)? 0 Yes 0 No 0 Unknown Did HAZMAT Regulations violation contribute to the crash? r ❑ Yes 0 No 0 Unknown g D Did Carrier Safety Regulations MCS)violation contribute to the crash? A ❑ Yes II El Unknown C Was a driver/vehicle Examination Report Form completed? r HAZMAT ❑Yes 0 No ❑Unknown Out of Service ❑Yes ❑No 7 MCS ❑Yes 0 No 0 Unknown Out of Service ❑Yes ❑No C Z Form Number 0 m Xl IDOT PERMIT NO. WIDELOAD'; ❑Yes 0 No 2 TRAILER VIN 1 m co LOCAL USE ONLY TRAILER VIN 2 m v TRAILER WIDTH(S) 0-96" 97-102" >102' T TRAILER 1 ❑ ❑ 0 Z TRAILER 2 ❑ 0 0 O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. Z Silver White 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 DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/TO: DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE