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HomeMy WebLinkAbout2024-00076088 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 01111101111 I01101100 0100 1111111111 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X00364,1r / u, 1 U21 3 4 1 U1 7 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 ❑ 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 ❑NOT ON SCENE(DESK REPORT) ® B Injury and for Tow Due To Crash 0 AMENDED YR 2024I 2024-00076088 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n ® ❑ RELATED PRIVATE ❑Y ®N 12 03 2024 ❑AM ❑YES ®NO U1 -< N RANDALL RD 1190 Elgin mo /day/yr 03:34 ®PM FLOW CONDITION III 1 O Ln COUNTY PROPERTY ❑Y ® N DOORING toy #OF MOTOR IR SLOW 1 (n ® ®!MI N OE S W Alft WITH VEHICLES INVLD ❑ STOPPED U2 --I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) Kane HIT&RUN I2J Y ElN PEDALCYCLIST IR N ❑ FREE FLOW # LNS 0 183 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEON. 0 EOUES 0 NW 0 ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 n T�TOWED U1 0mo Sotelo Hernandez.Juan. P. Hyundai Elantra 2013 00-NONE ©, >2 �/OUETOCRASH ® ❑ NAME(LAST,FIRST,M) yr 13-UNDER CARRIAGE 10. 2 FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ❑ 0 U2 4 rn M 2 4 ❑Y ®N SYSTEM ❑UNK VEH. O AT CRASHD O 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, ii_6 1,.4 COM VEH ❑ Ea 1 O ~ ELGIN IL 60120 0 1 0 FIRST CONTACT 12 7 ; _-5 *II Yes.See Sidebar U1 ZEV25254 IL 2025 E TELEPHONE IL D 0 5NPDH4AE5DH387925 First Chicago ❑Y J N U2 m 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Same I LS-1036796-00 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y ® N 2 c g DRIVER ❑ PARKED 0 DRIVERLESS ❑ PED 0 PEDAL ❑EWES 0 2 0 0 0 Mazda CX5 2018 00-NONE 'o,1 t2 c,�2 FIRE DUE O CRASH 0 ® U2 2 C o Yr 13-UNDER CARRIAGE Ti F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9.1,6•TOP 3 X ❑Y i N ❑UNK VEH. AT CRASH 99-UNKNOWN *0istrac on Value 9 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8 1 6 .t. 4 COM VEH ❑ ® Ut CO FIRST CONTACT 5 O7 a_Q-)OS •(ryes.See Sidebar C Z Cary IL 60013 0 1 0 DW99358 IL 2024 'aR 0 D IL D 0 JM3KFBCM3J0444161 State Farm ❑Y ®N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Same 0846790-SFP-13 BAG $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPONDER 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 0 Y U2 Z N 1 ® 11 1 12,03 (2024 03 34 ®pm in a Work Zone? ®N DIRP co 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 o" 2 0 28 99 ( ( ❑PM• ❑Construction >E R 3 0 $I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 1 ❑AM ❑Maintenance U2 -a, ARREST NAME Sotelo Hernandez.Juan. P. 11-601 1532-000368 ( r El PM SLMT 1 El 11 1 CITATIONS ISSUED 0 PENDING Utility o NSECTION CITATION NO. ROAD CLEARANCE TIME AM• ❑ t 2 El ARREST NAME Sotelo Hernandez.Juan. P. 6-101-A 1532-000367 12(03 (2024 03 45 ®PM ❑Unknown work zone type U1 45 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID.- COURT DATE TIME CI Workers present? ❑Y 45 1532-Hernandez. Daniel 502 334-Fries 01 , 14(2025 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 p 1 ; r r• -, , d N 01. Has a weight rating more than 10,000 pounds(example:truck or truck trailer -< } }----i-----; I I Not To Seale f - } I combination):or NDICATE NORTH BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C 1 I I } (example:shuttle or charter bus):or 0 a 1 I } } 1. 3. Is designed to carry 15 or fewer passengers and operated a contract carrier O transporting employees in the course of their employment(example:employee transporter-usually a van type vehicle or passenger car):or w L L-___a__ 4. Is used ordesi natedtotrans rtbetween9and15 passengers,including C} } for direct compensation(example:large van used for specificpurpose):or [he driver, Pe ( P 9 Pe or O L i t i 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m placarding(example:placards will be displayed on the vehicle). XI .--.--;- CARRIER NAME —1Z I ADDRESS 0 I I I CITY/STATE/ZIP g - MOTOR CARR.ID 0 Interstate 0 Intrastate . . . . I II ❑ Not in Comm./Govt. Not in Comm./Other ❑ o ‘I. - --• - USDOT NO. ILCC NO. m XI Source of above z . ❑ 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 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 Black u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE El NOT DISABLING DAMAGE DAMAGE EXTENT 2 TOWED BY/TO. _Redmons/Impound Lot Garage . SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY/TO: DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE