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HomeMy WebLinkAbout2024-00075557 ILLINOIS TRAFFIC CRASH REPORT sheet 1 Of 4 Sheets MI1111111111111 Mil 0110110 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X003648103 u, 9 U21 3 4 1 u, 2 U2 1 U1 99 1_12 1 u,99 U2 1 5 10 U1 99 U2 -3-1 *P 0119 INVESTIGATING AGENCY DAMAGE TO ANY ❑5500 OR LESS TYPE OF REPORT ® A 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 ❑NOT ON SCENE(DESK REPORT) 0 AMENDED ❑ B Injury and/or Tow Due To Crash YR 202412024-00075557 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 99 71 HIGGINS RD El In11:43 ® ❑ RELATED ®Y 0 N 11 30 2024 ❑AM ❑YES ®NO U1 -< g PRIVATE mo !day/yr ®PM FLOW CONDITION Ill FT!MI N E S W N RANDALL RD COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR 0 SLOW 2 fA ❑ Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD 0 STOPPED U2 --I ® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N 51 FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NIAV 0!CV 0 DV DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 / / T FOR DAMAGEDAREA(S) FROM�TOWED U1 0 Unknown. Unknown Unknown Unknown 00-NONE ©, >2 �/DUE TOCRASH ❑ EN NAME(LAST,FIRST,M) mo yr 13-UNDER CARRIAGE 10.I 2 FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 3 R<1 9 SY9 ❑Y El CO LINK VEH. 9 AT CRASH M IN D 9 99-UNKNOWN 9 16•TOP 3 *Distraction Value 9 ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s i�6 4 COM VEH ❑ Ea 1 0 F. Unknown 0 9 9 FIRST CONTACT 12 7_: __5 *IIYes.SeeSidebar U1 Z UNKNOWN Unknown REAR TELEPHONE 9 UNKNOWN Unknown ❑Y ❑N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Same Unknown 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER t D Y°N0 N N DRIVER 0 PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 MAv 0 I v 0 Dv Yr!1 9 5 7 FR Chevrolet 4500 2015' 00-NONE 1i_-I 12--_, DUETO CRASH ❑ 2 73 o 113-UNDER CARRIAGE 10 1 2 FIREC 0 ® U2 C II M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16•TOP 3 X ❑Y ❑N ❑UNK VEH. AT CRASH 99-UNKNOWN *Oistrac)on Value 9 POINT OF 8 II 4 COM VEH ❑ ® ut CO N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR .I all,.;_:',,, FIRST CONTACT 5 7-' S •If Yes.See Sidebar C Huntley IL 60142 0 1 0 HOFF-NV IL 2025 aR 0 N IL Other 0 1GCVKREH8FZ323347 Allstate ❑y ®N RDEF X EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Same 811610859 BAG $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP 996 < Refused RESPOND 0 N u1 = (UNIT) (SEAT) (D081 (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)((ADDRESS)/(TELEPHONE) (EMS) (HOSPITAL) DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 11 9 12,01 l2024 11 24 ®PM AM in a Work Zone? ®N DIRP D co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 5 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 2 ❑ 25 99 N 3 ❑ 0 CITATIONS ISSUED CI PENDING + ! ❑PM• ❑Construction SECTION CITATION NO. EMS ARRIVED TIME 1 ❑AM ❑Maintenance U2 z -a, ARREST NAME / / ❑PM ' o N ® 11 1 0 CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • ❑Utility SLMT 50 t 2 ❑ ARREST NAME AM 7 1 r ❑❑PM ❑Unknown work zone type U1 n OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 ❑ - ❑AM Workers present? ❑Y 50 1514-Pratt.Tamara sot , ! ❑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 truck trailer -< c ` -' -' r INDICATE NORTH combination):or .Z-1 I I I 11 I BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C R""'�?R' rt I v I _ (example:shuttle or charter bus):or n I I I 3. Is designed to carry15 or fewer0 L L.___A.._.� I I 5e passengers and operated by a contract: carner I O t t I- transporting employees in the course of their employment(example:employee X i t transporter-usually a van type vehicle or passenger car):or CO L }-----}----; b 4 — - } } 1 •4. Is used or designated to transport between 9 and 15 passengers,including the driver. C 9 ,, c for direct compensation(example:large van used fors specific purose):or f. L — L i i 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m a — placarding(example:placards will be displayed on the vehicle). ;p 1 D � � CARRIER NAME Z ADDRESS ...a w ® > Not To Scale CITY/STATE/ nZIP g 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 . Form Number m Xl IDOT PERMIT NO. WIDELOAD' 0 Yes 0 No 2 TRAILER VIN 1 m to LOCAL USE ONLY TRAILER VIN 2 m v TRAILER WIDTH(S) 0-96" 97-102" >102' m TRAILER 1 ❑ ❑ 0 Z TRAILER 2 ❑ 0 ❑ O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w Black u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT 9 TOWED BY/TO: _ . SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY/T6 DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE