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HomeMy WebLinkAbout2024-00080841 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets Mill III H IIIl DIII 01100111 110 DII 1111111111 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X00a676876 u, 9 u21 3 4 2 U,16 U2 1 U199 u2 1 U,99 U2 1 5 11 U1 1 U211 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY El$500 OR LESS TYPE OF REPORT ® q No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW Elgin Police Department ONE PERSON'S 1215501-$1.500 ®ON SCENE 2 VEHICLE/PROPERTY ❑OVER$1,500 ❑NOT ON SCENE(DESK REPORT) 0 AMENDED ❑ B Injury and for Tow Due To Crash YR 202412024-00080841 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 99 11 ® ❑ RELATED PRIVATE ❑Y ®N 12 27 2024 ❑AM ❑YES ®NO U1 -< HIGGINS RD Elgin mo /day/yr 06:53 ®PM FLOW CONDITION M_ ®25 ® © COUNTY PROPERTY ❑Y ® N DOORING Ely #OF MOTOR 0 SLOW 1 0)!MI N E s Galvin Dr WITH VEHICLES INVLD 0 STOPPED U2 --I El AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) Kane HIT&RUN I2J V ElN PEDALCYCLIST®N ® FREE FLOW # LNS 0 18:DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EDUCE 0 uuv 0!CV 0 ov DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 4 0 yr 13-UNDER CARRIAGE 10 IE 1 ! 2 FIRE 0 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED U2 4 < 9 9 SYSTEM IN O ENGAGED 0 15-OTHER 9 16.TOP 3 ❑ _ ❑Y ®N ❑UNK VEH. AT CRASH ®-UNKNOWN `Distraction Value 9 ALGN s 4 COM VEH 0 j$J r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF _,'[a !i,_ 1 0 ~ 0 9 0 FIRST CONTACT 12 7_; _5 *IIYes.See Sidebar Ut REAR c Z ' E TELEPHONE . STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED 1 11/ Unknown ❑Y ®N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m Same Unknown 2 r `o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP PHONE NUMBER r RESPONDER 0 m N DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NMV 0 NOV ❑Dv CIRCLE NUMBER(S) U1 1 9 9 4 Infiniti Q50 2016 00-NONE 1("j 12..-_, DUE TO CRASH ❑ 2 x 0 yr 13-UNDER CARRIAGE 10'( 2 FIRE ❑ ® U2 C c M 2 4 SYSTEM IN 0 ENGAGED 0 15-OTHER 9,16-TOP 3 X ❑Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN *Oistracton Value 9 0 POINT OF s i 4 COM VEH D ® U1 CO N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR 6 FIRST CONTACT 6 O7 ,�_QI._5 •Iryes.See Sidebar PINGREE GROVE IL 60140 0 1 0 BY80035 IL 2025 IL D 0 J N 1 EV7ARXG M341473 StateFarm ❑Y ®N RDEF71 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 = Same 3450680SFP13 BAc $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY,STATE,ZIP 996 < Refused RESPONDER u1 = (UNIT) (SEAT) (DOB' (SEX) {SAFT) (AIR) (WI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)!(ADDRESS)!(TELEPHONE) (EMS) (HOSPITAL) 1 3 10 / DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur 0 Y U2 Z N 1 ® 11 9 12!27 l2024 06 53 ®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 2 ❑ 28 99 N 3 0 0 CITATIONS ISSUED 0 PENDING ! 1 0 PM• El Construction SECTION CITATION NO. EMS ARRIVED TIME ❑AM 0 Maintenance U2 3 z -a, ARREST NAME / / ID PM o N ® 11 1 0 •CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME ❑Utility SLMT 45 t 2 ARREST NAME AM ! r ❑❑PM 0 Unknown work zone type U1 El 7 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 ❑ ❑AM Workers present? 0 Y 45 1530 Soto.Oscar 981 246-Kite ! ❑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 �____r____; M I y I combination):or thanpound (example:truck or truck/trailer II. 1. Hasa rating more10,000 5 � -< INDICATE NORTH -I p3 t BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C _ } (example:shuttle or charter bus):or Higgins?Rd 3. Is designed to carry15 or fewer passengers and operated a contract carrier O L I- -A- -•i } } } transporting employee In the course of thir employent(example:employee 1 1 transporter-usually a van type vehicle or passenger car):or_UnitC ..i =1-Unit 2. } } } •4. Is used or designated to transport between 9 and 15 passengers,including the driver, N for direct compensation(example:large van used for specific purpose):or O ' .4, t i 5. Is any vehicle used to transport an hazardous material(HAZMAT)that requires m `? placarding(example:placards will be displayed on the vehicle). 0 CARRIER NAME Z Not To Scale I - i. ADDRESS O w C) CITY/STATE/ZIP g • MOTOR CARR.ID 0 Interstate El Intrastate Galvin?Dr O I I . I ❑ Not in Comm./Govt. 0 Not in Comm./Other ----------.; - USDOT NO. ILCC NO. m XI Source of above z . Form Number m m IDOT PERMIT NO. WIDELOAD-; ❑Yes 0 No 2 TRAILER VIN 1 m to LOCAL USE ONLY TRAILER VIN 2 m v TRAILER WIDTH(S) 0-96" 97-102" >102' -n TRAILER 1 ❑ ❑ 0 Z TRAILER 2 ❑ 0 ❑ o u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w White Black u 1 TOWED TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT: 9 TOWED BY/TO: _ SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT: 1 TOWED BY/T6 DUE TO ® VEHICLE CONFIG. CARGO BODY TYPE LOAD TYPE