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HomeMy WebLinkAbout2024-00078431 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 6 Sheets Mil l III H IIIl DIII 0110011101111 1101 I II 111100 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X0036/2684t u, 1 U21 1 1 1 U1 4 U2 1 U, 1 u2 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 0$501-$1.500 ®ON SCENE 1 VEHICLE/PROPERTY ®OVER$1,500 El NOT ON SCENE(DESK REPORT) ® B Injury and/or Tow Due To Crash El AMENDED YR 2024I 2024-00078431 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n 599 S MCLEAN BLVD EIin 02:27 ® ❑ RELATED ❑Y ®N 12 14 2024 DAM ❑YES N NO U1 -< _ g PRIVATE mo /day/yr ®PM FLOW CONDITION m COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR 0 SLOW 1 (n ❑ FT/MI NESW Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD 0 STOPPED U2 --I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 Qg3 DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EWES ❑uuv ❑!CV ❑Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 04 n Brown.Aaliyah. DAMAGED AREA(S) FROM TOWED U1 v L. 0 7 / yr 13-UNDER CARRIAGE ©,I ©:. FIRE 0 IE STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 04 M F 2 4 ❑Y ®N SYSTEM ❑UNK VEH. O AT CRASHD O 99-UNKNOWN 9 16•TOP 3 *Distraction Value 9 ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s i�S 4 COM VEH 0 j$J 1 O ~ ELGIN I L 60120 0 1 0 FIRST CONTACT 12 7_•; _-5 *If Yes.See Sidebar Ut Z CT35774 IL 2024 TELEPHONE IL D 0 3A4FY48B36T272029 N/A ❑Y 0 N U2 m 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER RSUR m Elgin Fire 99 9 VICICONDI. PETER N/A 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y ® N 2 m g DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL 0 EWES O yr /1 9$7 Nissan Sentra 2021 00-NONE 'o,I t2 (,-2 FIRE DUE OCRASH 0 ® U2 2 C o 13-UNDER CARRIAGE M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9.1,6•TOP 3 X ❑Y i N ❑UNK VEH. AT CRASH 99-UNKNOWN *Distraction Value 9 0 POINT OF 8 i 4 COM VEH 0 N U1 CO N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR 5 FIRST CONTACT 6 �,�_Q �S •IfYes See Sidebar C Z Schaumburg IL 60194 0 1 0 EP56249 IL 2025 IAR0 D IL D 0 1 N4AL4CV3MN302830 Progressive ❑Y ®N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Elgin Fire 99 9 Same 963707243 BAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPONDER U1 = (UNIT? (SEAT) (DOB1 (SEX) {SAFT) (AIR) (INJI j(EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)1(A.DDRESS)!(TELEPHONE) (EMS) (HOSPITAL) 1 4 07 / LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ID N 1 ® 11 1 Z 12,14 /2024 02 27 ®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 v 2 0 03 28 12/14 /2024 02 27 ®PM ❑Construction >F R 3 0 $I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 5 ❑AM ❑Maintenance U2 o ® 11 1 ARREST NAME Brown.Aaliyah. L. 3-414 S1537-000057 12/14/2024 02 27 ®• PM• El Utility SLMT MI CITATIONS ISSUED 0 PENDING SECTION CITATION NO. ROAD CLEARANCE TIME NAM t 2 El ARREST NAME Brown.Aaliyah. L. 11-601-Ax S1537-000058 12/14 /2024 03 11 ®PM 0 Unknown work zone type U1 35 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 35 1537-Mapp.Teddron 701 01 /02/2025 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. 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 truckrtrailer -< i- }--__r-_--; } INDICATE NORTH combination):or -I p1 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C i.vo 0_ } (example:shuttle or charter bus):or 0 3. Is designed to carry 15 or fewer passengers and operated �rated a contract carrier O I- I- -A----i ` }- } } transporting employees in the course of their employment(example:employee � X .I, N. p .. transporter-usually a van type vehicle or passenger car):or CO L L.___a____.I I 4. Isusedordesinatedtotrans rtbetween9and15 passengers,including C } } for direct com nation exam I lar a van used for s �cifice ur rs'mdudi the driver, Pe ( P 9 Pe P Pose):or o L L____a..... iZ '�_. - t i 1 iany t 5. Is any vehicle used to transport hazardous material(HAZMAT)that requires placarding(example:placards will be displayed on the vehicle). XIS -{ -r.l CARRIER NAME Z �� I '; ADDRESS D rn I I I oNatlb&Mr; .. . ,, SI i CITY/STATE/ZIP g II C MOTOR CARR.ID 0 Interstate 0 Intrastate . ; ❑ Not in Comm./Govt. 0 Not in Comm./Other ; _Y_ _..; - USDOT NO. ILCC NO. m XI Source of above z . Were HAZMAT placards on vehicle? 0 Yes 0 No = If Yes,Name on placard O 4 digit UN NO. 1 digit Hazard class No. Xl Xl Did HAZMAT spill from vehicle(do NOT consider FUEL from vehicle's z own tank)? 0 Yes 0 No 0 Unknown Did HAZMAT Regulations violation contribute to the crash? r ❑ 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 Blue Orange 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 NOT DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® DISABLING DAMAGE Arties/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE