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HomeMy WebLinkAbout2024-00081399 ILLINOIS TRAFFIC CRASH REPORT sheet 1 of 2 Sheets 01111101111 01101100 110111111111 0 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X00a676402' u, 1 u21 1 1 1 u, 8 U2 1 u, 1 1_12 1 u, 1 U2 1 5 12 u, 13 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 51,500 ❑NOT ON SCENE(DESK REPORT) 0 AMENDED ❑ B Injury and/or Tow Due To Crash YR 202412024-00081399 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 15 71 BOWES RD Elgin ® ❑ RELATED ❑Y ®N 12 30 202412,—AM ❑YES ®NO U1 -< PRIVATE mo /day/yr 05:19 ®PM FLOW CONDITION M 01 O(�/MI N E S © South Randall Rd COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ®SLOW 15 u) Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD ❑ STOPPED U2 -I ❑ AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ❑ FREE FLOW # LNS 0 18:DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 uuv 0 Ncv 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 06 n FOR DAMAGED AREA(S) FROPtf TOWED U1 Q Laad. Parisha 0 1 / yr 13-UNDER CARRIAGE I ! FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTHER TAL(ALL) 2 DISTRACTED 0 !a U2 06 M3045 F 2 4 ❑Y IN SYSTEM❑UNK VEH. 0 AT CRASH 0 99-UUNKNOWN 9 16•TOP 3 `Distraction Value 9 ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s, i�6 �i 4 COM VEH 0 Ea 1 0 F. ELGIN I L 60123 0 1 0 FIRST CONTACT 11 7_: __5 *II Yes.See Sidebar U1 ZAZ90236 IL 2025 REAR TELEPHONE IL D 0 SFNYG 1 H81 SB039618 Allstate ❑Y ®N U2 m 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m ID 99 9 Laad.Suved 802787327 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF'V' OWNER STREET,CITY.STATE,ZIP PHONE NUMBER RESPONDER 2 XI N DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 Nlw '1 9 9 0 Nissan Pathfinder 2022 00-NONE ,i_' 12 DUE TO CRASH ❑ (� 2 x Ti 13-UNDER CARRIAGE I FIRE ❑ ® U2 F 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9I1,6.TOP 3 x ❑Y NJ 0 UNK VEH. AT CRASH 99-UNKNOWN *Distraction Value 9 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8-iI 6 i_i, COM VEH ❑ ® U1 CO FIRST CONTACT I Y _,__5 •Iryes.See Sidebar = ELGINREAR C D IL 60120 0 1 0 DX18682 IL 2025 IL 0 5N1 DR3CC6NC200025 Progressive ❑Y J N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Elgin Fire 99 9 Same 989913370 BAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP 996 < Sherman RESPONDER u1 = (UNIT) ISEATI (DOB) (SEX) {SAFT) (AIR) (INJI (EJCTI (EPTH) PASSENGERS&WITNESS ONLY (NAME)/(ADDRESS)/(TELEPHONE) (EMS) (HOSPITAL) 1 4 12 / ' D / / 1 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z N 1 ® 11 1 12/30 /2024 05 19 ®AM in a Work Zone? ®N DIRP co 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 3 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 v 2 0 20 50 12,30 /2024 05 19 ®pM ❑ConstructionR O 0 ]$I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 3 3 ❑AM ❑Maintenance U2 o ® 11 1 ARREST NAME Laad. Parisha 11-708 S1537-000068 12/30/2024 05 25 Igi pM SLMT Iffi CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME o N AM• ❑Utility t 2 El ARREST NAME Olivares Canada. Elizabeth 3-708 S1537-000069 12/30 /2024 05 41 ®PM 0 Unknown work zone type U1 45 2 23 0 OFFICER ID SIGNATURE BEAT!DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑Y 45 1537-Mapp.Teddron 800 334-Fries 02 ,04/2024 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 -< ` ` --I -' r INDICATE NORTH combination):or .Z-1 } I r I r I I r I r BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C I % - } (example:shuttle or charter bus):or 1 1 i i 1 i 3. Is designed to carry 15 or fewer I- --I-- 1passengers and operated �rated a contract carrier O - ---- } } } transporting employees in the course of their employment(example:employee � � rr�..yrra I I I I I transporter-usually a van type vehicle or passenger car):or co L L.___a__ - 4. Is used ordesi natedtotrans rtbetween9and15 passengers,including C- - } } for direct compensation(example:large van used for specificpurpose):or [he driver, 1 Pe ( P 9 Pe or L L____a..... UAW* 0 - i 5. Is any vehicle used to transport anyhazardous material(HAZMA that requires m placarding(example:placards will be isplayed on the vehicle). ;p c 11 11 CARRIER NAME Z 1 1 1 1 1 ADDRESS D I I I I I avwnarrraa w MI To Seale CITY/STATE/ZIP 0 g MOTOR CARR.ID 0 Interstate 0 Intrastate 0 1 I r 1 ❑ Not in Comm./Govt. 0 Not in Comm./Other ; _Y_ _-1 - USDOT NO. ILCC NO. m XI Source of above z . If Yes,Name on placard 0 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 White Blue.Dark 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 DUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/T6 DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE