Loading...
HomeMy WebLinkAbout2024-00074533 ILLINOIS TRAFFIC CRASH REPORT sheet 1 a Sheets Mill III H IIIl mil 011001111000011111 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV X003,a45189' u, 1 U21 2 4 1 U1 3 U2 1 U1 1 U2 1 U1 1 U2 1 5 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 1215501-$1.500 ®ON SCENE 14 VEHICLE/PROPERTY ❑OVER$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and f or Tow Due To Crash 0 AMENDED YR 202412024-00074533 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n 308 S MCLEAN BLVD El 05:36 ® ❑ RELATED ®Y 0 N 11 25 2024 ❑AM ❑YES ®NO U1 _ g PRIVATE mo !day!yr ®PM FLOW CONDITION m COUNTY PROPERTY ®Y ❑ N DOORING ❑y #OF MOTOR ®SLOW 1 cn ❑ FT!MI N E S W Kane HIT&RUN ❑Y ® N WITH VEHICLESOT, INVLD ❑ STOPPED U2 —I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ❑ FREE FLOW # LNS 0 /83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EOUES 0 uuv 0!Cu 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 n 0 6 ! yr 13-UNDER CARRIAGE ©,I 0,,:O FIRE 2 ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ❑ Ea U2 2 m F 2 SYTHER 4 ❑Y ®SNE DUNK VEH. 0 AT CRASH M IN ENGAGED 0 99-UNKNOWN 9 16-TOP 3 ,Distraction Value 9 ALGN = r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 6 i�6 4 COM VEH 0 Ea 1 0 F. FIRST CONTACT 12 7_:---_-_{-___S *IrYes.See Sidebar U1 Z SOUTH ELGIN IL 60177 B 1 0 FA11670 IL 2025 REAR TELEPHONE IL D 0 JTDZN3EU8C3176657 Magnum ❑Y ®N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Same 12-2439783-00 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y El 2 c N DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0!My 0 Ixv 0 DV CIRCLE NUMBER(S) U1 !2 0 0 5 Honda Accord 2008 00-NONE ,o11 12 ._y DUE FIREO CRASH 0 ® U2 2 C o Yr 13-UNDER CARRIAGE III 6' F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9,1,6-TOPO7 * X ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN O Distraction Value 9 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s-.;,• 6 1.,( 4 COM VEH D ® U1 CO FIRST CONTACT 3 7-'_, _S •(ryes.See SidebarC I- ELGIN I L 60120 0 1 0 E F94018 I L 2025 REAR 0 IL D J H MCP26858C055991 State Farm ❑Y ®N RDEF M EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X Gutierrez.Olivia J500413-A20-13A BAG $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE;ZIP U1 = KNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJI (EJCT) (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 ❑Y U2 Z N 1 El 11 4 11 ,25 /2024 05 36 ®pm in a Work Zone? NJ o1RP co 1 I PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME ❑AM If YES check one below: U1 3 n .31 T 2 ❑ 23 2 ? / _ ❑PM ❑Construction * Z 3 ❑ 0 CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 6 ❑AM ❑Maintenance U2 —a, ARREST NAME / / ❑PM ' o N 1 El 11 4 0 CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • El Utility SLMT r 2 ❑ 25 ARREST NAMEAM c- T / / ❑❑PM ❑Unknown work zone type U1 n OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 ° 1532-Hernandez. Daniel 602 334-Fries ? / ❑❑PnMn Workers present? ®N U2 25 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 -< i- ;--__r-_--; ( INDICATE NORTH combination):or —I a p1 N BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C - } (example:shuttle or charter bus):or 0 Not To Scale_; 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__ 4. Is used ordesi natedtotrans rtbetween9and15 passengers,including y I } } for direct compensation(example:large van used for specificpurpose):or [he driver, Pe ( P 9 Pe or 0 t l. I I t 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m placarding(example:placards will be displayed on the vehicle). i 1,— > 1 ".."'�° i CARRIER NAME Z --• 1-11 - ADDRESS '0 w CITY/STATE/ZIP 00 MOTOR CARR.ID 0 Interstate 0 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 . MCS ❑Yes 0 No 0 Unknown Out of Service ❑Yes ❑No 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 0 TRAILER WIDTH(S) 0-96" 97-102" >102' T TRAILER 1 ❑ ❑ 0 Z TRAILER 2 ❑ 0 ❑ O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w Blue Black u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/TO. _Mies/Impound Lot Garage . SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/T6 DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE