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HomeMy WebLinkAbout2024-00079492 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets II� III HH II11I1 1UHI U 110111�00111111111 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X4036/1909 u, 1 U21 2 4 1 u, 4 U2 1 u, 1 u2 1 u, 6 U2 1 1 11 u, 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$1,500 El NOT ON SCENE(DESK REPORT) El B Injury and/or Tow Due To Crash 0 AMENDED YR 2024I 2024-00079492 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 �l ® ❑ RELATED ®Y 0 N 12 20 2024 ®AM ❑YES ®NO U1 -< ILLINOIS AVE Elgin 07:27 g PRIVATE mo /day/yr ❑PM FLOW CONDITION ITl • FT l MI N E S W SHERMAN AVE COUNTY PROPERTY ❑Y ® N DOORING El #OF MOTOR El SLOW 15 u) ❑ Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD 0 STOPPED U2 --I ® AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N 0 FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uuv 0!CV 0 De DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 0 0 A uilar-Aldeco.Jose Nissan Pathfinder 2006 00-NONE , s , DUE TOCRASH ® ❑ NAME(LAST,FIRST,M) g mo yr 13-UNDER CARRIAGE ©,I �:. 2 FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 2 rrl M I 2 4 ❑Y ®Nn 15-OTHER SYSTEM ❑UNK VEH. AT CRASHD 99-UNKNOWN 9 16•TOP 3 ,Distraction Value ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s.;il a 4 COM VEH ❑ Ea 2 O Z ELGIN IL 60120 0 1 0 EW85840 IL FIRST CONTACT 12 7 ;Ismi _s ves.See sidebar Ut TELEPHONE IL 5N 1 AR18W86C647046 American Alliance ❑Y I$I N U2 m .5 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m co Same I LAA-1006427-00 3 r o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y ® N 2 XI m g DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 New 0 NCV 0 DV 1 9 yf 7 Honda CRV 2008 00-NONE O, 0i.O DUE TO CRASH 0 D 2 x 0 13-UNDER CARRIAGE 10 i I. 2 FIRE 0 ® U2 C c M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16.TOP 3 X ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN `Distraction Value 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF S iI S I',_4 COM VEH ❑ ® Ut CO FIRST CONTACT 6 Y__{_O -_5 •IfYes,SeeSidebar = ELGIN IL 60123 0 1 0 EW53808 IL 2025 REAR IL D J H LRE48728C042328 American Alliance ❑Y ®N RDEF71 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X Santiago. Edward.S. I LAA-0725408-04 BAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP u1 = (UNIT) (SEAT) (DOBi (SEX) {SAFT) (AIR) (INJI 1(EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)/(ADDRESS)((TELEPHONE) (EMS) (HOSPITAL) 2 3 12 / / / 2 0 EV MOST EVNT LOG DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z N 1 El 11 1 12/20 /2024 07 27 ®❑AM in a Work Zone? ®N DIRP 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 0 2 ❑ 28 03 / / ❑PM ❑Construction Z3 0 I!!I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME ❑AM ❑Maintenance U2 5 o 1 ® 11 1 ARREST NAME Aguilar-Aldeco.Jose 6-101 1529-000227 / / El PM SLMT I$!CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME 0 Utility o N ❑AM 25 t 2 ElARREST NAME Aguilar-Aldeco.Jose 11-601-Ax 1529-000228 / / ❑pM ElUnknown work zone type U1 n 7 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 D 1529 Audi red.Jonathan 401 391-Jacobucci 02 (03,2025 09 00 0 pM 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 Illinois?Ave. A I 1. Has a weight rating more than 10,000 pounds(example:truck or truck/trailer - i- `-- --I-- --' N - I. INDICATE NORTH combination):or -I BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver UUnit1I - (example:shuttle or charter bus):or n A t 3. Is designed to carry 15 or fewer passengers and operated a contract carrier O } I• . transporting employees in the course of their employment(example:employee X transporter-usually a van type vehicle or passenger car):or w C L }-----}----; - t t t •4. Is used or designated to transport between 9 and 15 passengers,including the driver. N for direct compensation(example:large van used for specific purpose):or 0 _ i i. , 5. Is anyvehicle used to transport anyhazardous material(HAZMAT)that requires 1 placarding(example:placards will be displayed on the vehicle). XI 2:.— — — — J `, CARRIER NAME Z ADDRESS 'n T. ISh@rman7AVe. CITY/STATE/ZIP n _ MOTOR CARR.ID Interstate Intrastate I I I 0 Not in Comm./Govt. Not in Comm./Other Not To Scale ( � � 00 �I. ------1 USDOT NO. ILCC NO. m m XI Source of above z . IDOT PERMIT NO. WIDELOAD' ❑Yes 0 No = TRAILER VIN 1 m to 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 Silver u 1 TOWED • TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT' 2 TOWED BY/TO. Arties/Impound Lot Garage . SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® DISABLING DAMAGE Arties/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE