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HomeMy WebLinkAbout2024-00071185 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 1111111111111111 11111111 011011011110 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X003628924 u, 2 U21 2 1 1 U, 4 U2 1 U, 1 1_12 1 U, 1 U2 1 1 11 U1 1 U2 1 *P 0 1 1 9* INVESTIGATING AGENCY DAMAGE TO ANY ❑$500 OR LESS TYPE OF REPORT El A No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW ' Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 1 VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) El Injury and/or Tow Due To Crash 0 AMENDED YR 202412024-00071185 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 3 -n PRESTON AVE El In 04:54 ® ❑ RELATED ®Y 0 N 11 08 2024 DAM ❑YES ®NO U1 -< g PRIVATE mo /day/yr ®PM FLOW CONDITION m FT N E S W CONGDON AVE COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR 0 SLOW 2 to ❑ Kane HIT&RUN ®Y ❑ N WITH VEHICLES INVLD 0 STOPPED U2 --I ® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST IZI N ® FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EOUES 0 wuv 0 ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 0 NAME(LAST,FIRST,M) mo /1 9 8 2 Dodge Caravan(inc Grand)2005 00-NONE ,©. t2 - , DUE TOCRASH ® ❑ 13-UNDER CARRIAGE FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) O " 2 DISTRACTED 0 0U2 2 m M 2 4 SYTM❑Y ®SNEDUNK VEH. 0 ATCRASHD 99-UUNKNOWN THER 9 6 TOP 3 `Distraction Value 9 ALGN X. r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8 iI a 4 COM VEH 0 Ea 1 H 1 ELGIN IL 60120 0 1 0 ET78026 IL FIRST CONTACT 12 T ;Ismi _s Yeg.See sidebar u1 0 Z E TELEPHONE IL 2D4GP44L05R462144 Ramos Insurance ❑v ®N U2 19 , m 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m ro 99 9 Same ILS1024522 1 r o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y El 2 c rg- p; DRIVER ❑ PARKED 0 DRIVERLESS ❑ PED ❑PEDAL ❑EWES ❑l uv 0 NOV ❑Dv /1 9 yf 4 Chevrolet Silverado 2016 00-NONE i1_"j t2'-_, DUE TO CRASH ❑ 2 x .. 13-UNDER CARRIAGE 1U'I :., 2 FIRE ❑ ® U2 C M 2 3 SYSTEM IN 0 ENGAGED 0 15-OTHER 9..16-TOP 3 X ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN `Oistraetlon Value 9 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF �'i al l;, 4 COM VEH D ® ut CO FIRST CONTACT 6 O7 �_ == -2_5 •If Yes.See Sidebar ELGIN IL 60120 0 1 0 2015553B IL kAR 0 fp 3GCUKREC2GG151463 All State ❑Y ®N RDEF71 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER 1 = Elgin Fire 99 9 Same 911407221 SAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP 996 < ElY RESPONDER U1 = ;UNIT) (SEAT) (DO81 (SEX) {SAFT) (AIR) (INJ) (EJCTI (EPTH) PASSENGERS&WITNESS ONLY (NAME)/(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL) 2 4 1 2 / :A / / U1 1 D / / 3 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z N 1 ® 11 1 11 ,08 /2024 04 54 ®AM in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 7 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 o" 2 ❑ 28 19 / / ❑PM ❑Construction * r' 3 ❑ Dyg CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 7 ❑AM ❑Maintenance U2 -a, ARREST NAME Ambriz Sandoval.Juan 11-601 752417 / / El PM SLMT o u 1 ® 11 1 CITATIONS ISSUED 0 PENDINGTIME ' ❑Utility o NSECTION CITATION NO. ROADCLEARANCE 0 AM 35 o' n T r 2 ❑ ARREST NAME Ambriz Sandoval.Juan 11-501-A-2 752416 / / pM ❑Unknown work zone type U1 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 ❑ - ❑AM Workers present? ❑Y 35 475-Williarhs. Brianna 201 / / ❑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 1. Has a weight rating more than 10,000 pounds(example:truck or truckrtrailer -< c ` ''- ' r INDICATE NORTH combination):or —I JBY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C A _ (example:shuttle or charter bus):or r r r X I 3. is desgned to car 15 or feweripassengers and o rated a contract carrier O N r } } } transporting employees In the course of their employment(example:employee X i_ �.___a.___I. - 1 4alsuosedordesgnatedtotransportbetween9a d15rprssen passengers,} } } g Po pa ge rCjt I for direct compensation(example:large van used for specific purpose):or O L L--_-a-___.: — — —a:+a ,ia„, — — — l. i. < i. L 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires placarding(example:placards will be displayed on the vehicle). XI ,,, lV/ - -- '1 I r - CARRIER NAME Z ADDRESS 0J I D Not To Scale CITY/STATE/ZIP MOTOR CARR.ID 0 Interstate ❑ Intrastate I I T I ❑ Not in Comm./Govt. 0 Not in Comm./Other -----------1 - USDOT NO. ILCC NO. rn XI Source of above Z . IDOT PERMIT NO. WIDELOAD-; ❑Yes 0 No = 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 Blue Blue u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT: 2 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