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HomeMy WebLinkAbout2024-00080377 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets _ II III H IIII OUI 001100001111DIV 1111100 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY Xooa6 2681 u, 1 U21 3 4 1 U1 8 U2 1 U, 1 1_12 1 U, 1 U2 1 1 12 u, 2 U2 1 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY El$500 OR LESS TYPE OF REPORT ® A No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW Elgin Police Department ONE PERSON'S ❑5501-51.500 ®ON SCENE 2 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ❑AMENDED ElB Injury and for Tow Due To Crash YR 202412024-00080377 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 -n ® ❑ RELATED ®Y ❑N 12 24 2024 ❑AM ❑YES ®NO U+ -< N RANDALL RD Elgin04:53 _ _ g PRIVATE mo /day/yr ®PM FLOW CONDITION m FT!MI N E S W W H I C H LAN D AVE COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 15 u) ❑ Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD ❑ STOPPED U2 —I lgi AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N 51 FREE FLOW # LNS 0 Qg3 DRIVER ❑ PARKED ❑DRIVERLESS ❑ PED ❑PEDAL ❑EOUES ❑uuv ❑ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 n Honda Civic 2010 00-NONE FOR DAMAGEDAREA(S) FRO T TOWED U1 Q + VI NAME(LAST,FIRST,M) Christensen. Patricia. L. mo yr ©+. +2 13-UNDER CARRIAGE } I! 2 OUEFIRETOCRASH ❑❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) O DISTRACTED 0 0U2 4 <<Tl F 2 SY 15-OTHER 4 ❑Y ®SNE DUNK VEH. 0 AT CRASH M IN D 0 99-UNKNOWN 9 +6•TOP 3 *Distraction Value ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 7 :i1 6 �i, COM VEH 0 j$J 1 0 ~ ELGIN IL 60123 0 1 0 FIRST CONTACT 1 7_; __5 *IIYes.SeeSidebar U1 Z L885451 IL 2025 Isui TELEPHONE IL D 0 19XFA1 F36AE013715 Safeco Insurance ❑Y Il N U2 Si . m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m 99 9 Same Z4198446 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused 0 Y ® N 2 0 p; DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uv 0 NOV 0 Dv CIRCLE NUMBER(S) U1 1 9 5 1 Ford Edge 2024 00-NONE 11_' t2 JD DUE TO CRASH ❑ 2 x o yr 13-UNDER CARRIAGE I FIRE ❑ ® U2 c M 2 4SYSTEM IN 0 ENGAGED 0 15-OTHER 9I 1,6-TOP3 X 0 Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN *0istraction Value 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8-iI 6 ii, COM VEH ❑ ® U1 CO HREAR FIRST CONTACT 1 Y _, _5 •(ryes,See Sidebar ELGIN IL 60124 0 1 0 2451025 IL 2025 C M IL D 0 2FMPK4AP2RBA2698 State Farm ❑Y ®N RDEF71 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = 99 9 Same 772 8815-A03-13E BAc E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY STATE,ZIP 996 < Refused RESPONDER U1 = (UNIT) (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 u 1 ® 11 1 12,24 ,2024 04 53 ®AM in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 7 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 C) ai 2 20 2 12,24 ,2024 04 53 mi PM ❑Construction * R 3 0 xi CITATIONS ISSUED ❑PENDING SECTION CITATION NO. EMS ARRIVED TIME 7 ❑AM 0 Maintenance U2 o1 ® 11 1 ARREST NAME Christensen. Patricia. L. 11-709-A 1527-000257 / r El Pm SLMT o N ❑CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • 0 Utility 0 AM t 2 ElARREST NAME 12,24 i2024 05 00 ®PM ElUnknown work zone type U1 35 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ❑qM Workers present? ❑Y 35 1527-Juarez.Jorge 901 334-Fries 01 ,28,2025 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. r ----r•---, , 1 1 1 1 - ; A CMV is defined as any motor vehicle used to transport passengers or property and: Z I I I I /2 ® 1. Has a weight rating more than 10,000 pounds(example:truck or truck trailer -< ;.--- -----; I I I I combination):or IIIIII ® INDICATE NORTH i BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C , i e�a.n taaw. �p I I I I lFnentl9Ave - } (example:shuttle or charter bus):or t .•_, � 0 ,i• ———— —— ,+ —Zr. en_ — } 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier I --I`- --' ai } } transporting employees in the course of their employment(example:employee X -———— —— — transporter-usually a van type vehicle or passenger car):or w -———— C -- -- �� / - I I 1 4. Is used or designated to transport between 9 and 15 passengers,including the driver. N 1 i 7 / for direct compensation(example:large van used for specific purpose):or O ,_ :___ J. r (!/ } } _ 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m '. /� placarding(example:placards will be displayed on the vehicle). ;p I Ii - -- rwmsswJ CARRIER NAME /iv Z i - - ADDRESS 'n T. C) I CITY/STATE/ZIP g - i. i. i. 4. MOTOR CARR.ID 0 Interstate 0 Intrastate I 0 Not in Comm./Govt. 0 Not in Comm./Other 00 - --- --: I - USDOT NO. ILCC NO. C m I x 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 g D Did Carrier Safety Regulations(MCS)violation contribute to the crash? A ❑ Yes I El Unknown C Was a driver/vehicle Examination Report Form completed? r HAZMAT ElYes 0 No ElUnknown Out of Service ❑Yes ❑No -Ti MCS ❑Yes 0 No 0 Unknown Out of Service ❑Yes ❑No C Z Form Number 0 m X) 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 ill TRAILER 2 ❑ 0 0 o u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w Blue Black u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT: 1 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