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HomeMy WebLinkAbout2024-00080556 ILLINOIS TRAFFIC CRASH REPORT sheet 1 Of 4 Sheets 01111101111 01101100 01111 111011/0 DRAC TRFD TRFC WEAT DRVA VIS VEHD LGHT COLL MANY X0O367692O u, 1 U21 1 1 4 U1 4 U2 1 U, 1 1_12 1 u1 6 U2 1 2 14 u1 2 u2 1 *P 0119* INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW ' DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 1 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) (83B Injury and/or Tow Due To Crash 0 AMENDED YR 202412024-00080556 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 2 mSHALES PKWY Elgin ® ❑ RELATED ❑Y ®N 12 26 2024 ®AM ❑YES ElPRIVATE NO U1 mo /day/yr 08'18 ❑PM FLOW CONDITION m 02040,MI N E O W Walden Dr COUNTY PROPERTY ❑Y 21 N DOORING Ely #OF MOTOR 0 SLOW 6 Cl) Cook 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 (g DRIVER ❑ PARKED ❑DRIVERLESS 0 PED ❑PEDAL ❑EWES ❑NIAV ❑!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 0 FOR DAMAGEDAREA(S) FROM TOWED U1 O Calderone.Anthony. . 1 1 / yr 13-UNDER CARRIAGE ©, :: FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 4 rn M 2 SYTHER 4 ❑Y ®SNE❑UNK VEH. O AT CRASH M IN ENGAGED O 99-UNKNOWN 9 16-TOP 3 ,Distraction Value ALGN = r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF D i 6 )r COM VEH 0 E! 6 C) H Z SOUTH ELGIN IL 60177 0 1 0 FIRST CONTACT 4 ®-' -® •If Yee.See Sidebar U1 0 3829325B IL 2025 REAR TELEPHONE IL D 0 2GCEC19V231303145 Allstate El ®N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Same 962997508 2 r "o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER RESPONDER D Refused ❑Y ElN 2 0 x DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 MAV 0 KV 0 DV yr/1 9 6 8 Volvo VN L 2020' 00-NONE 11_O' 12 "_, DUE TO CRASH p ® 98 xi 0 13-UNDER CARRIAGE ( 2 FIRE ❑ El U2 C Ti M 2 4 ❑Y ❑N DUNK VEH. AT CRASH 99-UNKNOWN `Distraction Value N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF FIRST CONTACT 1 O 8 i1 1i 4 COM VEH 14 ❑ U1 W 7- B '_.5 •If Yes.See Sidebar — Lisle IL 60532 0 1 0 P1063552 IL 2025 I 0Si) IL A 7 4V4NC9EH9LN224136 Acord ❑Y ®N RDEF XI EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER 1 X Best Way Logistics WMC1 963737-02 SAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP U1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)((ADDRESS)(TELEPHONE) (EMS) (HOSPITAL) U2 m ##OCCS y / / U1 1 D / / 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 co 12/26 /2024 08 18 ®❑pM AM in a Work Zone? ®N DIRP D 1 I PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME If YES check one below: 1 T PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP ❑AM U1 � o" 2 0 28 11 / / 0 PM- ❑Construction * N 3 ❑ $I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 5 ❑AM 0 Maintenance U2 o1 ® 11 1 ARREST NAME Calderone.Anthony.J. 11-601-Ax 1529-000232 / / El PM SLMT o N ❑CITATIONS ISSUED PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ' ❑Utility 35 t 2 0 ARREST NAME AM T / / ❑❑PM 0 Unknown work zone type U1 2 2 3 ❑ OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? ❑y 35 1529-Audi red.Jonathan 302 404-Duffy 02 (04/2025 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 Shales?Pkwy ADDITIONAL UNITS FORMS. r ----r•"--, , I 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 Z INDICATE NORTH combination):or 51 BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C I - (example:shuttle or charter bus):or h r r 3. Is designed tocarry 15 or fewer passengers and operated a contract carrier 0 w }----A----' esg pa g pe } } } transporting employees In the course of their employment(example:employee ,,F.4 transporter-usually a van type vehicle or passenger car):or C L ...l. ilI. } } } •4. Is used or designated to transport between 9 and 15 passengers,including the driver, N i for direct compensation(example:large van used for specific purpose):or O i. i t 5. Is any vehicle used to transport anyhazardous material(HAZMAT)that requires 71 a placarding(example:placards will be displayed on the vehicle). m z li CARRIER NAME Best Way Logistics Z ADDRESS 1520 SHELDON DR O <' '\ D to CITY/STATE/ZIP ELGIN I IL/60120 n g i _ i. i. i. 4. MOTOR CARR.ID 0 Interstate El Intrastate Not TO Scale ❑ Not in Comm./Govt. ❑ Not in Comm./Other 0 ; _Y_ __ USDOT NO. 1916638 ILCC NO. m XI Source of above z . Form Number m Xl IDOT PERMIT NO. 1916638 WIDELOAD� El Yes ®No = TRAILER VIN 1 1 UYVS2539H7175141 m to LOCAL USE ONLY TRAILER VIN 2 m a TRAILER WIDTH(S) 0-96" 97-102" >102' -n TRAILER 1 ® ❑ 0 Z TRAILER 2 0 0 0 o u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 53 ft. 2 ft. w Blue White u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT- 3 TOWED BY/TO. _Mies/Impound Lot Garage SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TODUE TO DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 2 TOWED BY/TO. DUE TO ® VEHICLE CONFIG. 2 CARGO BODY TYPE 2 LOAD TYPE 5