Loading...
HomeMy WebLinkAbout2024-00080395 ILLINOIS TRAFFIC CRASH REPORT sheet 1 of 2 Sheets lUI III II IIIl DIII 01100111 0011 IlIHIlID DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV XO03671951 u, 1 U21 3 4 1 U1 3 U2 1 U1 1 U2 1 U1 1 U2 1 5 10 U, 3 U2 1 *P 0119 INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW ' DAMAGE TO ANY ❑5500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away Elgin Police Department ONE PERSON'S ❑$501-$1.500 ®ON SCENE 1 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash 0 AMENDED YR 202412024-00080395 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME BOWES RD El In 07:12 SECONDARY CRASH 1 �1 ® ❑ RELATED ®Y 0 N 12 24 2024 ❑AM ❑YES El NO U1 —< _ _ g PRIVATE mo !day!yr ®PM FLOW CONDITION m FT N E S W S MCLEAN BLVD COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR 0 SLOW 1 (n ❑ 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 ❑EWES ❑uuv ❑!CV ❑Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 C) FOR DAMAGEDAREA(S) FROM TOWED U1 Q NAME(LAST,FIRST,M) Luken. Eric.J. m0 0 / T !1 9 8 8 Ford Fiesta 2015 00-NONE „_' ©'O DUE TO CRASH ® ❑ 13-UNDER CARRIAGE ) FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 10 O DISTRACTED 0 0 U2 0 m M 2 SY4 ❑Y ❑SNEM®UNK VEH. 9 AT CRASH IN 9 99-UNKNOWN 9 16•TIDP 3 *Distraction Value ALGN = T. CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8,_;—1 a �i-- 4 COM VEH 0 Ea 1 0 F. FIRST CONTACT 2 7 _;__5 *elves.See Sidebar U1 Z SCHAUMBURG IL 60173 0 1 0 EY64249 IL 2025 Is TELEPHONE IL D 0 3FADP4BJ1 FM219944 State Farm ❑Y Il N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Same 3398785-SFP-13 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER > Refused 0 Y El 2 0 x DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EWES ❑NMV 0 NCv ❑DV /1 9 7 Buick LeSabre 2002 00-NONE al z j--O DUE TO CRASH rg ❑ 2 x 0 Yr O 13-UNDER CARRIAGE 9 I ©). 2 FIRE ID El U2 C ll M 2 4 SYSTEM IN 9 ENGAGED 9 15-OTHER 9.16_TOP 3 X ❑Y ❑N ®UNK VEH. AT CRASH 99-UNKNOWN *Distraclj n Value 0 POINT OF 8 i1�i-4 COM VEH ❑ ® U1 CO N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR FIRST CONTACT 1 O 7 B .5 •If Yes.See Sidebar 1= ELGINZ IL 60123 0 1 0 CD32408 IL 2025 I C 0 Si) IL Other 0 1G4HP54K12U250765 Allstate ❑Y ®N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Same 902213720 BAG $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPONDER u1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ) (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 12,24 ,2024 07 12 ®AM in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 2 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 C) v 2 0 25 28 12,24 ,2024 07 12 ®pm El Construction >F R 3 0 ]$I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 7 z J ❑AM ❑Maintenance U2 a1 ® 11 1 ARREST NAME Luken. Eric.J. 11-306 494000365 12,24 l2024 07 12 ICI pM SLMT o N ❑CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • 0 Utility t 2 ❑ ARREST NAME AM! ! ❑❑PM 0 Unknown work zone type U1 35 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 35 494 Kirsh. Katherine 701 246-Kite 11 , 41 ,024 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. 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 -< -__-_r-_--; _ INDICATE NORTH combination):or BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C jt _ } (example:shuttle or charter bus):or X L 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 -----}----; p 4.. - s„drad } } 1 •4. Is used or designated to transport between 9 and 15 passengers,including the driver. C o for direct compensation(example:large van used for specific purpose):or O L i i t m 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires Ut2 1": placarding(example:placards will be displayed on the vehicle). ;p CARRIER NAME —1Z D ADDRESS 'n Not To Scale C) CITY/STATE/ZIP MOTOR CARR.ID ❑ Interstate ❑ Intrastate I I T I ❑ Not in Comm./Govt. 0 Not in Comm./Other ‘I. - --1 USDOT NO. ILCC NO. m XI Source of above z . own tank)? 0 Yes 0 No 0 Unknown Did HAZMAT Regulations violation contribute to the crash? r ❑ Yes 0 No 0 Unknown M 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 to LOCAL USE ONLY TRAILER VIN 2 m 0 TRAILER WIDTH(S) 0-96" 97-102" >102' -n TRAILER 1 0 0 0 Z ill TRAILER 2 ❑ 0 0 O u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w Black Blue u 1 TOWED • TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT 3 TOWED BY/TO. Arties/Impound Lot Garage . SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE DISABLING DAMAGE NOT DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® Arties/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE