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HomeMy WebLinkAbout2024-00078034 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 I01101100 II M 11111 0 00 0 DRAG TRFD TRFC WEAT DRVA VIS VEHD LGHT COLL MANY Xcoa657460' u, 1 U21 1 1 1 U116 U2 1 U, 1 u2 1 U, 1 U2 1 5 11 u, 1 U211 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY ❑5500 OR LESS TYPE OF REPORT ® q No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW Elgin Police Department ONE PERSON'S 0$501-$1.500 ®ON SCENE 3 VEHICLE/PROPERTY ®OVER 51,500 ❑NOT ON SCENE(DESK REPORT) El AMENDED ❑ B Injury and/or Tow Due To Crash YR 202412024-00078034 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 —n S STATE ST Elgin 04:35 ® ❑ RELATED ❑Y ®N 12 12 2024 12,— ❑YES ®NO U1 -< _ _ PRIVATE mo /day/yr ®PM FLOW CONDITION m FT!MI N E S W RT20 EB COUNTY PROPERTY El ® N DOORING ❑y #OF MOTOR El SLOW 15 u) ❑ Kane HIT&RUN ❑V ® N WITH VEHICLES INVLD 0 STOPPED U2 --I ® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ❑ FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EOUES ❑NW ❑ncv ❑Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) 2 C)Y N 1 2 / yr 13-UNDER CARRIAGE ©,I ©:. FIRE 0 NI STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL)THERDISTRACTED 0 0 U2 2 m F 2 4 SYTM❑Y ®S NE❑UNK VEH. 0 AT CRASH 0 15-99-UNKNOWN 9 16•TDP 3 *Distraction Value 9 ALGN = r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s, it 6 4 COM VEH 0 j$J 1 0 ~ ELGIN I L 60123 0 1 0 FIRST CONTACT 12 7 ;1 _5 *II Yes.See Sidebar Ut Z DQ36197 IL 2025 Ismi TELEPHONE IL D 0 2HGFG12948H571927 Progressive ❑Y IlN U2 m 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m ro Elgin Fire 99 9 Wooldridge.Cara. M. 971051535 1 r o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER RESPONDER 2 ou m x DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEOAL 0 EWES ❑NW 0 Ncv 0 Dv /1 9 9 9 General Motor's np 2006 00-NONE 1t"i 12..-_1 DUETO CRASH ❑ !g 2 .. 13-UNDERCARRIAGE 10;1 2 FIRE ❑ ® U2 C c F 2 4SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16-TOP 3 X 0 Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN *Distraction Value 9 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s iI 6 _4 COM VEH ❑ ® U1 CO FIRST CONTACT 6 Y :j=aR _5 •(ryes,See Sidebar i C = ELGIN N D IL 60120 0 1 0 EQ38009 IL 2025 IL D 0 1GKEK63U36J158020 Kemper ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Elgin Fire 99 9 Same 12ra000020957 BAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPONDER U1 = (UNIT) (SEAT) (DOB) (SEX) (SAFT) (AIR) (INJ( 1(EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)((ADDRESS)((TELEPHONE) (EMS) (HOSPITAL) 2 6 06 / :A / / UI 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 12/12 ,2024 04 35 ®AM in a Work Zone? 0 N DIRP co 1 t PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 3 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 C) 2 0 28 99 12/12 /2024 04 35 ®PM ®Construction R 1 3 ❑ ]$I CITATIONS ISSUED ElPENDING SECTION CITATION NO. EMS ARRIVED TIME 3 z J ❑AM ❑Maintenance U2 o ® 11 1 ARREST NAME Wooldridge.Sabrina. R. 11-601-Ax 1545000066 12/12,2024 04 40 ®pM SLMT o N ❑CITATIONS ISSUED ElPENDING SECTION CITATION NO. ROAD CLEARANCE TIME ❑Utility t 2 0 ARREST NAME 12/12 /2024 04 35 ®PM 0 Unknown work zone type U1 0 AM 45 2 2 3 El ID SIGNATURE BEAT!DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 45 1545-VanEycke. Brier 400 01 ,28/2025 09 00 ❑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 ID 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer -< c ' r INDICATE NORTH combination):or P3 Not To Scant J BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C j. _ } (example:shuttle or charter bus):or X . A 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 C } } for direct compensation(example:large van used for specificpurpose):or [he driver, ' Pe ( P 9 Pe or O Unit -D L L-___a-___. - i � 5. Is anyvehicle used to transport an hazardous material(HAZMAT)that requires ICI 0 placarding(example:placards will be displayed on the vehicle). m I I D P.o.I. CARRIER NAME Z ADDRESS O unit 0i. i. CITY/STATE/ZIP n Q 0i. i. i. i. MOTOR CARR.ID 0 Interstate ❑ Intrastate O I I . I Q ❑ Not in Comm./Govt. ❑ Not in Comm./Other 0 � --- --1 USDOT NO. ILCC NO. m 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' -n TRAILER 1 ❑ ❑ 0 Z TRAILER 2 ❑ 0 0 o u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w Silver Black u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT 2 TOWED BY/TO: _ . 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