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HomeMy WebLinkAbout2024-00073546 ILLINOIS TRAFFIC CRASH REPORT sheet 1 of 2 Sheets 01111101111 01101100 1111111 �EEll lID TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV XO0a638464 u, 1 U21 1 1 10 u, 2 U2 1 u, 1 u2 1 u, 1 U2 1 5 12 u, 13 U2 1 *P 0119 INVESTIGATING AGENCY DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT ® q No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW Elgin Police Department ONE PERSON'S ❑$501-$1.500 ®ON SCENE 3 VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) El AMENDED ❑ B Injury and for Tow Due To Crash YR 202412024-00073546 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 2 m® ❑ RELATED ❑Y ®N 11 20 2024 ❑AM ❑YES E)PRIVATE NO U1 N RANDALL RD Elgin mo /day/yr 05:11 ®PM FLOW CONDITION m IO ®!MI N E s © Westfield Dr COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 1 fA Kane HIT&RUN ❑V ® N WITH VEHICLES INVLD ❑ STOPPED U2 --I 0 AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 g DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEOAL 0 EWES 0 NW 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 6 0 0 5 / yr 13-UNDER CARRIAGE 10l �. 2 FIRE 0 •STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 6 m M 2 4 El ®SNE❑UNK VEH. 0 AT CRASH IN ENGAGED0 99-UUNKNOWN 9 76-TOP® `Distraction Value 9 ALGN = r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6 ;i� 6 �I COM VEH 0 j$J 1 n ~ ELGIN I N I L 60123 0 1 0 FIRST CONTACT 3 7 ; _O •II Yes.See Sidecar U1 0 Z917RS-B IL 2025 REAR TELEPHONE IL D 0 3GCUKSECXJG644256 State Farm ❑Y Igl N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR 99 9 Same 2476373-SFP-13 2 m `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER > Refused ❑Y ElN 2 0 g DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 row 0 NCv 0 DV 1 9$8 Hyundai Elantra 2013 00-NONE O I t2 c 2 DUE O CRASH 0 ® U2 2 73 C o 13-UNDER CARRIAGE c M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9.16-TOP 3 X ❑Y i N ❑UNK VEH. AT CRASH 99-UNKNOWN `Oistracton Value 9 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF FIRST CONTACT 10 6 i1 1i 4 COM VEH ❑ ® U1 CO 7 B .6 •If Yes.See Sidebar — West Dundee AB 60118 0 1 S195271 IL 2025 REAR0 Si) IL D 0 SNPDH4AE6DH319116 Progressive ❑Y ®N RDEF X EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Same 963933639 BAC $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPONDER u1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ) (EJCTI (EPTH) PASSENGERS&WITNESS ONLY (NAME)((ADDRESS)((TELEPHONE) (EMS) (HOSPITAL) 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 ,20 ,2024 05 11 ®AM in a Work Zone? ®N DIRP co 1 t PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 5 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 C) 2 ❑ 03 2 11,20 ,2024 05 11 ®PM ❑Construction * Z 3 ❑ igi CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 5 ❑AM ❑Maintenance U2 o ® 11 1 ARREST NAME Hanley. Bruce. M. 11-709-A 1527000242 / ! ❑PM SLMT o N ❑CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ' 0 Utility 0 AM t 2 El ARREST NAME 1 1(20 12024 05 19 ®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 1527-Juarez.Jorge 502 334-Fries 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 ADDITIONAL UNITS FORMS. A CMV is defined as any motor vehicle used to transport passengers or property and: Z r -- ,r••--, _ - 1. Has a weight rating more than 10,000 pounds(example:truck or truck/trailer -< i- combination):or r ' r INDICATE NORTH BY ARROW 2 Is used or designed to transport more than 15 passengers including the driverC - } (example:shuttle or charter bus):or X I I I /Entrence4Ramp7to?I-90 3. Is desgned to carry 15 or fewer passengers and operated a contract carrier O }} } transporting employees In the course of their employment(example:employee X EdnRemparrom?t-eO I — transporter- a van vehicle or -C,, PO usually typepassenger car):or co L L____a____.; ~,� �- _ 4. Is used ordesi nated to trans rt between 9 and 15passengers,includingthedriver, C ii •�+ l ar } } } for direct compensation(example:large van used for speific purose):or O L rr _� _ ._ 5. Is any vehicle used to transport hazardous material(HAZMAT)thatrequires m B any placarding(example:placards will be displayed on the vehicle). ;p $ —D ®s I I - -- CARRIER NAME Z f ®®�b ADDRESS O CITY/STATE/ZIP ��pp�geM - MOTOR CARR.ID 0 Interstate 0 Intrastate g ———— ❑ Not in Comm./Govt. ❑ Not in Comm./Other 00 i- - - - - 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 Z TRAILER 2 ❑ 0 0 o u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w Black Red 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 DUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY/TO. DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE