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HomeMy WebLinkAbout2025-00054587 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 2 Sheets 01111101111 IIIIII DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANV XO03934.5 5 u, 1 U21 2 4 1 U, 2 U2 1 U, 1 u2 1 U, 1 U2 1 1 10 U1 3 U2 1 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY El 5500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away AGENCY CRASH REPORT NO. TRFW ' Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 15 VEHICLE/PROPERTY ®OVER 51,500 El NOT ON SCENE(DESK REPORT) ® B Injury and for Tow Due To Crash El AMENDED YR 2025I 2025-00054587 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 3 -n ® ❑ RELATED ®Y 0 N 08 21 2025 ®AM ❑YES ®NO U1 TORINO DR Elgin10:28 _ _ g PRIVATE mo /day/yr ❑PM FLOW CONDITION m FT!MI N E S W N AI RLITE ST COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ❑SLOW 1 (n ❑ Kane HIT&RUN ❑Y ® N WITH VEHICLES INVLD DO U2 --I lgi AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ® FREE FLOW # LNS 0 Qg3 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEON. 0 EWES 0 uuv 0!CV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 0 T TOWED EN U1 0Fulbri ht.Aiden. K. Toyota Sienna 2011 00-NONE , 2 0 DUE TO CRASH ❑ NAME(LAST,FIRST,M) g mo yr 13-UNDER CARRIAGE ©,I 0.,: FIRE ❑ STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 0 U2 0 m M 2 SYTM IN ENGAGE15-OTHER 4 ❑Y ❑SNE®UNK VEH. 9 ATCRASHD 9 99-UNKNOWN 916•TOP 3 `Distraction Value 9 ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF & i�B 4 COM VEH 0 j$J 4 0 I . ELGIN I L 60124 0 1 0 FIRST CONTACT 12 7_: __5 *lI Yes.See Sidebar U1 Z7309484 IL 2026 REAR TELEPHONE IL D STDYK3DC7BS147161 Amica ❑Y ®N U2 m 13 EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER RSUR m co Fulbright. Eric.W. 95101220EE 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF IC OWNER STREET,CITY.STATE,ZIP PHONE NUMBER RESPONDER 2 eu p; DRIVER ❑ PARKED 0 DRIVERLESS 0 PED 0 PEDAL 0 EWES 0 NW 0 i v 0 DV yr Hyundai Sonata 2015' oo-NONE O, Qj O DUE TO CRASH rg ❑ 2 x oP. 13-UNDER CARRIAGE 10,i I.. 2 FIRE 0 ® U2 C M 2 5 SYSTEM IN 9 ENGAGED 9 15-OTHER O16.70P 3 X ❑Y ❑N Cgi UNK VEH. AT CRASH 99-UNKNOWN *Oistracton Value 9 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF O) B i!,_ COM VEH 0 ® Ut CO F,,, FIRST CONTACT 9 O7 _, _5 •(ryes,See Sidebar C ELGIN IL 60123 0 1 0 CV78176 IL 2026 REAR 0 Si) M IL D 5NPE24AF5FH021867 Allstate ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER 1 X Hernandez.Adana.J. 911721558 BAG $ HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE:ZIP U1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJI (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)!{ADDRESS)((TELEPHONE) (EMS) (HOSPITAL) U2 996 r 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 4 08,21 l2025 10 28 ®p PM AM in a Work Zone? ®N DIRP D co 1 I PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME ❑AM If YES check one below: U1 2 n T 0 2 ❑ 2 23 I ! ❑PM ❑Construction * R 1 3 0 I!!I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 1 ❑AM ❑Maintenance U2 a1El 11 4 ARREST NAME Fulbright.Aiden. K. 11-904-B 410000746 ! ! ❑PM SLMT o N ❑CITATIONS ISSUED ❑PENDING SECTION CITATION NO. ROAD CLEARANCE TIME • ❑Utility 30 t 2 0 41 2 ARRESTNAME AM T 1 r ❑❑PM 0 Unknown work zone type U1 n OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 0 ❑AM Workers present? ❑Y 30 410-DeLeon.Jessica 602 - r ! ❑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. .. .. , I A CMV is defined as any motor vehicle used to transport passengers or property and: Z r r , N7Lyle Ave 1. Has than pound (example:truck or truck trailer -< c i --I -' G I INDICATE NORTH combination):or rating more10, s BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver 531 , a ; 9 sP Pa n9e 9 i_ 0 '\ - } ,. (example:shuttle or charter bus):or X L -----A--- Not To Scat. 1 ```��� I - } } } } transporti3. Is ng mployeened to slin the course passengers5 or fewer thir emplod yment example:employee a contract 73 — '--'— \ transporter-usually a van type vehicle or passenger car):or � 4. Is used or designated to transport between 9 and 15 passengers,including (I) C -- -- } } } g Po passen rs,includi the driver, Torino9Drlve , .� for direct compensation(example:large van used for specific purpose):or O L i - — Vj •i g t i. i i. L 5. Is any vehicle used to transport any hazardous material(HAZMAT)that requires m` - ''' II'III I I ; placarding(example:placards will be displayed on the vehicle). XI CARRIER NAME Z ADDRESS 0 D rn n CITY/STATE/ZIPg MOTOR CARR.ID 0 Interstate 0 Intrastate ; ; r ; I ❑ Not in Comm./Govt. 0 Not in Comm./Other ;____Y____.; - USDOT NO. ILCC NO. m XI Source of above z . 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 Gray Gray u 1 TOWED • TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ❑ DISABLING DAMAGE ® NOT DISABLING DAMAGE DAMAGE EXTENT 2 TOWED BY/TO. SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® DISABLING DAMAGE Redmons/Impound Lot Garage VEHICLE CONFIG._CARGO BODY TYPE_LOAD TYPE