#7 bh student guide, fall 2016 by EL Civics, SDCCD CE

2016-2016

Student Guide El Civics # 7- Reporting a Crime or Emergency Beginning High

Teacherâ&#x20AC;&#x2122;s Name: _________________ Studentâ&#x20AC;&#x2122;s Name: _________________ FALL 2016

EL Civics #7, Beginning High

EL Civics: Report a Crime or Emergency

To the Student: You are going to study some lessons that can help you and your family be safer in the community. You will learn how to call the police and report a crime or emergency. You will also learn how to fill out a DMV accident report form. After you complete the lessons, you will take a test. There are two parts: 1. Speaking test: Look at pictures of an emergency or crime. Dial 911 or the nonemergency police number. Report the problem to the operator. Answer questions the operator asks about the problem. 2. Writing test: Read about a car accident and look at driving documents. Use the information to complete a DMV Traffic Accident Report. You are helping your family and the school! Thank you!

Use your smartphone to scan the QR code above for video demonstration of speaking test

ÂŠ Continuing Education, San Diego Community College District, EL Civics Program, 2016 8/22/2016 2:21 PM

# 7 Beginning High

Calling the Police: Reporting a Robbery Ring! Ring! Operator:

911 emergency operator.

Caller:

There’s a robbery at the 7-11.

Operator:

Could you give me your first and last name, please?

Caller:

My name is Linda Lee.

Operator:

Could you spell your last name, please?

Caller:

L-E-E.

Operator:

What’s the address of the robbery?

Caller:

213 Landis Street.

Operator:

Does the robber have a gun?

Caller:

Yes, he has a gun!

Operator:

Is anyone hurt?

Caller:

No, not yet.

Operator:

What is the robber wearing?

Caller:

He’s wearing black pants, a red shirt and a blue hat.

Operator:

Can you describe the suspect? What does he look like?

Caller:

He’s tall. He has a beard. He has a big tattoo on his arm.

Operator:

What is happening right now?

Caller:

The man is pointing the gun. The cashier is giving him money.

Operator:

The police are on the way. Thank you for calling.

213 Landis

Use your phone to listen to the reading.

# 7 Beginning High

Calling the Police: Reporting a Robbery Use pictures of a robbery to practice calling the police. Student A is the operator. Student B is the caller. Do not write on the lines. This is speaking practice. Ring! Ring!

Operator:

911 emergency operator.

Caller:

(Explain the problem or emergency) _____________

Operator:

Could you give me your first and last name, please?

Caller:

_______________________________

Operator:

Could you spell your last name, please?

Caller:

_______________________________

Operator:

Whatâ&#x20AC;&#x2122;s the address of the robbery?

Caller:

_______________________________

Operator:

Does the robber have a gun?

Caller:

______________________________

Operator:

Is anyone hurt?

Caller:

______________________________

Operator:

Can you describe the suspect?

Caller:

______________________________

Operator:

What does he look like? Does he have a mustache, beard, or tattoo?

Caller:

_____________________________

Operator:

Are there other people in the store?

Caller:

_____________________________

Operator

What is happening right now?

Caller:

______________________________

Operator:

The police are on the way. Thank you for calling. 213 Landis

ÂŠ Continuing Education, San Diego Community College District, EL Civics Program, 2016 8/22/2016 2:21 PM

# 7 Beginning High

Calling the Police: Reporting a Purse Snatching #1 Ring! Ring!

Operator: Caller:

Police operator. A man took a woman’s purse.

Operator:

Could you give me your first and last name please?

Caller:

Faduma Mahamad

Operator:

Could you spell your last name?

Caller:

M-A-H-A-M-A-D.

Operator:

What’s the address there?

Caller:

1387 University.

Operator:

Is the thief still there?

Caller:

No, he ran away.

Operator:

What was he wearing?

Caller:

He was wearing black pants, a plaid* shirt and a cap.

Operator:

What did the thief look like?

Caller:

He’s tall and has long blond hair. He’s about 30 years old, I think.

Operator:

Where is the victim now?

Caller:

She’s outside her house.

Operator:

What is she doing?

Caller:

She’s just sitting and crying.

Operator:

Is the woman hurt?

Caller:

No, I don’t think so.

Operator

Is anyone with the woman?

Caller:

No, she’s all alone.

Operator:

The police are on the way. Thank you for calling.

1387 University

# 7 Beginning High

Calling the Police: Reporting a Purse Snatching #1 Use pictures of a purse snatching to practice calling the police. Student A is the operator. Student B is the caller. Do not write on the lines. This is speaking practice. Ring! Ring! Operator:

Police operator

Caller:

(Explain the problem or emergency) ______________

Operator:

Give me your first and last name please.

Caller:

______________________________

Operator:

Could you spell your last name?

Caller:

_______________________________

Operator:

Whatâ&#x20AC;&#x2122;s the address of the problem?

Caller:

_______________________________

Operator:

Is the thief still there?

Caller:

_______________________________

Operator:

What was the thief wearing?

Caller:

________________________________

Operator:

What did the thief look like?

Caller:

________________________________

Operator:

Where is the victim now?

Caller:

_________________________________

Operator:

Is she hurt?

Caller:

________________________________

Operator

Is anyone with the woman?

Caller:

________________________________

Operator:

The police are on the way. Thank you for calling.

1387 University

ÂŠ Continuing Education, San Diego Community College District, EL Civics Program, 2016 8/22/2016 2:21 PM

# 7 Beginning High

Calling the Police: Reporting a Purse Snatching #2 Ring! Ring!

Operator:

Police operator.

Caller:

A man just stole a woman’s purse.

Operator:

Could you give me your first and last name, please?

Caller:

Robert Jensen

Operator:

Could you spell your last name, please?

Caller:

J-E-N-S-E-N.

Operator:

What’s the address there?

Caller:

7902 Adams Ave .

Operator:

Is the thief still there?

Caller:

No, he ran away.

Operator:

What was the thief wearing?

Caller:

He was wearing shorts and a black and white striped shirt.

Operator:

What did the thief look like?

Caller:

He’s short and bald. He’s about 45 years old, I think.

Operator:

Where is the victim now?

Caller:

She’s outside her house.

Operator:

What is the woman doing?

Caller:

She’s just sitting and crying.

Operator:

Is she hurt?

Caller:

No, I don’t think so.

Operator

Is anyone with the woman?

Caller:

No, she’s all alone.

Operator:

The police are on the way. Thank you for calling. 7902 Adams Ave

# 7 Beginning High

Calling the Police: Reporting a Purse Snatching # 2 Use pictures of a purse snatching to practice calling the police. Student A is the operator. Student B is the caller. Do not write on the lines. This is speaking practice. Ring! Ring!

Operator:

Police operator.

Caller:

(Explain the problem or emergency) _________________

Operator:

Could you give me your first and last name, please?

Caller:

___________________________________

Operator:

Could you spell your last name, please?

Caller:

___________________________________

Operator:

Whatâ&#x20AC;&#x2122;s the address there?

Caller:

___________________________________

Operator:

Is the thief still there?

Caller:

___________________________________

Operator:

What was the thief wearing?

Caller:

____________________________________

Operator:

What did the thief look like?

Caller:

____________________________________

Operator:

Where is the victim now?

Caller:

____________________________________

Operator:

Is she hurt?

Caller:

___________________________________

Operator

Is anyone with the woman?

Caller:

___________________________________

Operator:

The police are on the way. Thank you for calling. 7902 Adams Ave

ÂŠ Continuing Education, San Diego Community College District, EL Civics Program, 2016 8/22/2016 2:21 PM

# 7 Beginning High

Calling the Police: Reporting an Accident #1 Ring! Ring!

Operator:

911 emergency operator.

Caller:

There was an accident. A car hit a woman.

Operator:

Could you give me your first and last name, please?

Caller:

Binh Vo.

Operator:

Could you spell your last name, please?

Caller:

V-O.

Operator:

Where is the accident?

Caller:

On the corner of University and 51st, in front of Food for Less. The address is 5127 University.

Operator:

Is the woman hurt?

Caller:

Yes, she is. She’s bleeding.

Operator:

Is the woman conscious?

Caller:

No, I don’t think so. I think she’s unconscious.

Operator:

Where is the driver?

Caller:

The driver is outside the car. She is standing next to the woman.

Operator:

What is happening right now?

Caller: Caller:

The woman is lying on the street. The driver is looking at her. A man is putting a jacket over her.

# 7 Beginning High

Calling the Police: Reporting an Accident #2 Ring! Ring! Operator:

911 emergency operator.

Caller:

There was an accident. A car hit a boy on a bicycle.

Operator:

Could you give me your first and last name, please?

Caller:

Martin Gomez.

Operator:

Could you spell your last name, please?

Caller:

G-O-M-E-Z.

Operator:

Where is the accident?

Caller:

On the corner of Home Avenue and 47th, in front of Food for Less.

Operator:

Is anyone hurt?

Caller:

Yes, the boy is hurt. He’s bleeding.

Operator:

Is the victim conscious?

Caller:

No, I don’t think so. I think he is unconscious.

Operator:

Is the driver there? Where is the driver?

Caller:

Yes, the driver is outside the car. She is standing next to the boy.

Operator:

What is happening right now?

Caller: Caller:

The boy is lying on the street. The driver is looking at him.

# 7 Beginning High

Calling the Police: Reporting an Accident: More Practice Use pictures of accidents that your teacher gives you. Practice calling the police. Student A is the operator. Student B is the caller. Do not write on the lines. This is speaking practice.

Ring! Ring!

Operator:

Police operator.

Caller:

(Explain the problem or emergency) ___________________

Operator:

Give me your first and last name please.

Caller:

____________________________________

Operator:

Could you spell your last name?

Caller:

____________________________________

Operator:

Where is the accident?

Caller:

____________________________________

Operator:

Is anyone hurt?

Caller:

___________________________________

Operator:

Is the victim conscious?

Caller:

_______________________________

Operator:

Is the driver there? Where is the driver?

Caller:

__________________________________

Operator:

What is happening right now?

Caller:

__________________________________

ÂŠ Continuing Education, San Diego Community College District, EL Civics Program, 2016 8/22/2016 2:21 PM

# 7 Beginning High

Reporting a Crime or Emergency: Listening Practice Listen to the teacher ask questions. Underline the correct answer. 1.

(a) No

(b) 1387 University

(a) 7902 Adams Ave.

(b) Tom’s Chicken Shop.

(a) At the 7-11

(b) She’s unconscious.

(a)213 Park Street

(b) The woman is sitting and crying.

(a) S-M-I-T-H

(b) John Smith

(a) black pants, a red shirt and a blue hat

(b) There’s a robbery at the 7-11.

(a) He has a gun.

(b) She’s drunk.

(a) Middle aged, tall and heavy.

(b) In front of her house.

(a) Her head is bleeding.

(b) The driver is standing next to the car.

10. (a) He’s tall. He has a tattoo and a beard.

(b) He has a gun.

11. (a) S-M-I-T-H

(b) John Smith

12. (a) Yes, the victim is bleeding.

(b) She’s crying.

13. (a) The cashier is giving him money.

(b) He has glasses.

14. (a) He has a tattoo.

(b) Yes, he does.

15. (a) It’s in front of the 7-11. The address is 3213 Market Street.

(b) A man took her purse.

# 7 Beginning High

Calling the Police Instructions: The caller’s responses are mixed up. Write them correctly. 1. Ring...ring. Police operator. took / purse. / a / man / A / lady’s ___________________________________________ 2. What is the address there? Avenue. / 3792 / Fairmount / It’s ______________________________________________ 3. Is the thief still there? isn’t / No, / he. _____________________________________________________________ 4. What is the thief wearing? a red hat / a black shirt. / and / wearing / He / is ___________________________________________________________________________ 5. What does the thief look like? has / He / long hair / a big nose. / and ___________________________________________________________________________ 6. Does he have a mustache? doesn’t. / No, / he _________________________________________________________ 7. Where is the victim now? sitting / house. / her / She / outside / is ___________________________________________________________________________ 8. Is she hurt? She / No, / isn’t. ___________________________________________________________

9. What is she doing? crying. / is / She ___________________________________________________________

# 7 Beginning High

Calling the Police: Practice Describing People Instructions: Write the words in the correct list. a black hat

a beard

a scar on his cheek

a backpack

a red t-shirt

a black leather jacket

a red and black scarf a shaved head

grey pants

a big stomach

sunglasses a gold tooth

many tattoos

bald

blue eyes

a necklace

What does he look like?

glasses a watch

an earring in his nose

What is he wearing?

a beard

_____________________ _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ _____________________

spiky hair

tennis shoes

a jacket and hood freckles

a chain

a black hat

# 7 Beginning High

Talking to the Police: Reporting a Robbery Fill in the blanks to make complete sentences. Use words from the box below. 1. __There___ is a robbery at the 7-11. 2. My name ________ ____________________ ____________________. 3. The __________________ _______________ 3482 University. 4. Does the robber have a gun? Yes, he __________. 5. Does the robber have a gun? No, he ___________. He _____________ a knife. 6. What is the robber wearing? He ______ ______________ red pants, _______ blue shirt, _________ ___________ green hat. 7. Can you describe the suspect? What does he look like? He ________ short. He _____________ black hair. He __________ ________ beard. He ________ tattoos on his arm. He ___________ medium-weight. 8. What is happening right now? The robber ___________ ________________ the knife ______ ____________ cashier. The cashier ______ ______________ money to the man.

There

does

doesn’t

address

has

wearing

and

has

pointing

has

the

giving

(your first name)

(your last name)

# 7 Beginning High

Call the Police: Partner Dictation Student A 1. Read the sentences to your partner. Speak slowly and carefully. 1. There is a robbery at the 7-11. 2. The man is pointing a gun at the cashier. 3. The cashier is giving money to the man. 4. He is wearing a red hat, a yellow shirt, and black pants. 5. The address is 3213 Home Ave. 6. I want to report a purse snatching. 7. A man took a womanâ&#x20AC;&#x2122;s purse. 2. Listen to your partner. Write the sentences. Ask your partner to repeat when you do not understand. 1. ___________________________________________________ 2. ___________________________________________________ 3. ___________________________________________________ 4. ___________________________________________________ 5. ___________________________________________________ 6. ___________________________________________________ 7. ___________________________________________________ 3. What words were difficult for you to pronounce? Write the words here. Practice them with your teacher. _________________________________________________________ _________________________________________________________

ÂŠ Continuing Education, San Diego Community College District, EL Civics Program, 2016 8/22/2016 2:21 PM

# 7 Beginning High

Call the Police: Partner Dictation Student B 1. Listen to your partner. Write the sentences. Ask your partner to repeat when you do not understand. 1._____________________________________________________ 2. _____________________________________________________ 3. _____________________________________________________ 4. _____________________________________________________ 5. _____________________________________________________ 6. _____________________________________________________ 7. _____________________________________________________ 2. Read the sentences to your partner. Speak slowly and carefully. 1. The thief ran away. 2. She is sitting outside her house and crying. 3. The car hit a woman. 4. The address is 5127 University. 5. She is unconscious. 6. She is bleeding. 7. The man is covering the woman with his jacket. 3. What words were difficult for you to pronounce? Write the words here. Practice them with your teacher. _________________________________________________________ _________________________________________________________

ÂŠ Continuing Education, San Diego Community College District, EL Civics Program, 2016 8/22/2016 2:21 PM

# 7 Beginning High

Reporting an Accident: Vocabulary #1 Jack’s Accident Last summer, Jack Stone had an accident. It happened on July 14, 2016 at 4:38 in the afternoon. Jack needed his driver license, registration and insurance card to fill out an accident report.

This is Jack’s driver license.

first name=Jack

street address = 587 Skyline St.

last name=Stone

city = San Diego state = CA zip code = 92114

Date of Birth DOB (03/03/82).

MATCH the words and information ____1. time of accident

a) San Diego, CA 92114

____ 2. date of birth

b) Stone

____3. first name

c) 4:38 pm

____4. street address

d) Jack

____5. last name

e) 587 Skyline Street

____6. city, state, zip code

f) 7/14/16

____7. date of accident

g) 03/03/82

Write the words. 8. accident

9. driver license

# 7 Beginning High

Reporting an Accident: Vocabulary #2 1. This is Jack’s vehicle. 2. This is Jack’s vehicle license plate.

California 8PIK858

3. This is Jack’s registration. License Number = 8PIK858 Make = Ford Year = 2007 Vehicle Owner = Stone, Jack

4. This is Jack’s Insurance Card:

INSURANCE CARD

Insurance Company Name = GEICO Insurance Policy Number = P5478632 Policy Period = 2/27/16 to 2/27/17 Policy Holder Name = Stone, Jack

Name insured STONE, JACK

Effective Date: 02/27/16

5. MATCHING – write the letter next to the number.

RUANCE CARD

California 8PIK858

___1. insurance company name

____ 2. license plate

b. P5478632

____3. vehicle owner

c. GEICO

____4. insurance policy number

d. Stone, Jack

____5. year and make

f. 2007 Ford

____6. vehicle

____7. policy periodJack’s

Policy Number P5478632 Expiration Date: 02/27/17

Important Documents h. 2/27/16 to 2/27/17

# 7 Beginning High

Write the words:

registration

driver license

insurance card

A.______________ ______________

B.______________

Name insured

C. ____________________ ____________________

STONE, JACK

Effective Date: 02/27/16

ÂŠ Continuing Education, San Diego Community College District, EL Civics Program, 2016 8/22/2016 2:21 PM

Policy Number P5478632 Expiration Date: 02/27/17

# 7 Beginning High

Vocabulary Review 1. Look at Jack’s Important Documents again. Mark the correct answer. 1. Jack’s date of birth is:

5. These are examples of vehicles:

 a) 02/30/71  b) 03/03/82  c) 08/12/11

 a) cars, vans, trucks  b) houses, schools, banks  c) boys, girls, children

2. Jack’s insurance company is:

6. Jack’s insurance policy period is:

 a) California  b) Department of Motor Vehicles  c) GEICO

 a) 03/03/52  b) 2007  c) 2/27/16 - 2/27/17

3. Jack’s driver license number is:

7. Jack’s vehicle make is:

 a) D7412589  b) 8PIK858  c) 03/03/17

 a) Ford  b) 2003  c) California

4. Jack’s street address is:

8. Jack’s insurance policy number is:

 a) Stone, Jack  b) 587 Skyline St.  c) San Diego

 a) P5478632  b) 8PIK858  c) 04/01/17

2. Write the answers. 1. What city does Jack live in? _____________________________________________

2. What is Jack’s policy number? __________________________________________

3. Who is the vehicle owner? ____________________________________________

4. What is Jack’s zip code? _____________________________________________

5. What is Jack’s vehicle license plate number? ______________________________

# 7 Beginning High

Jack Stone’s Accident Report: Reading Practice This is Jack Stone’s REPORT OF TRAFFIC ACCIDENT. After an accident that costs $750 or more for car repairs, a person must make a report to the Department of Motor Vehicles.

1. Read Jack’s accident report. REPORT OF TRAFFIC ACCIDENT # OF VEHICLES

DATE OF ACCIDENT

ACCIDENT LOCATION-CITY/COUNTY (CALIFORNIA ONLY)

ON PRIVATE PROPERTY

San Diego

 YES  NO

07/14/16

REPORTING PARTY’S INFORMATION

TIME OF ACCIDENT AM HOUR 4:38

STOPPED

DRIVING FOR EMPLOYER

 YES NO

PM MOVING IN TRAFFIC PARKED PEDESTRIAN BICYCLIST OTHER

DRIVER’S NAME

DRIVER LICENSE NUMBER

STATE

Jack Stone

D7412589

DRIVER’S STREET ADDRESS

DATE OF BIRTH

587 Skyline Street

03/03/82

CITY

San Diego

STATE

ZIP CODE

TELEPHONE NUMBERS

92114

WK (858)326-9112

VEHICLE ( YEAR AND MAKE)

2007 FORD

VEHICLE LICENSE PLATE

8PIK858

HM(858)234-7219 STATE

DAMAGES OVER $750

 YES  NO

VEHICLE OWNER – PERSON OR COMPANY

DATE OF BIRTH

Jack Stone

03/03/82

ADDRESS

587 Skyline Street

CITY

STATE

ZIP CODE

92114

San Diego

INSURANCE COMPANY NAME (NOT AGENT OR BROKER) AT THE TIME OF THE ACCIDENT

POLICY NUMBER

GEICO

P548632

COMPANY NAIC NUMBER

POLICY PERIOD

POLICY HOLDER NAME

FROM:02/27/2016 TO: 02/27/2017

Jack Stone

I certify under penalty of perjury under the law of the State of California that the information entered on this document is true and correct. DATE PRINTED NAME SIGNATURE

07/15/16 Jack Stone

Jack Stone

2. Circle TRUE or FALSE. 1. Jack’s driver license number is D7412589.

TRUE

FALSE

2. The vehicle make and year is GEICO P5478632.

TRUE

FALSE

3. The home telephone number is (858) 234-7219

TRUE

FALSE

4. The time of the accident is 4:38 PM.

TRUE

FALSE

5. Jack’s date of birth is 7/14/98.

TRUE

FALSE

# 7 Beginning High Page 1 of 3

Mary Nguyen’s Accident Report: Reading Practice, Part One 1. Read about Mary Nguyen’s accident. Mary Nguyen had an accident on August 21, 2016. Her car hit a fire hydrant at 7:15 a.m. on Elm Street in San Diego. Mary was driving her son to school. There was a dog on the street, and Mary turned her car quickly because she didn’t want to hit the dog. She turned her car too much and hit the fire hydrant. Mary paid $800 to repair her car.

2. Read Mary’s accident report. REPORT OF TRAFFIC ACCIDENT # OF VEHICLES

DATE OF ACCIDENT

REPORTING PARTY’S INFORMATION

ACCIDENT LOCATION-CITY/COUNTY (CALIFORNIA ONLY)

ON PRIVATE PROPERTY

San Diego

 YES  NO

08/21/16 TIME OF ACCIDENT AM HOUR 7:15

DRIVING FOR EMPLOYER

STOPPED

 PM MOVING IN TRAFFIC PARKED PEDESTRIAN BICYCLIST OTHER

 YES NO

DRIVER’S NAME

DRIVER LICENSE NUMBER

STATE

Mary Nguyen

D7496582

DRIVER’S STREET ADDRESS

DATE OF BIRTH

4063 Marlborough Street

06/21/77

CITY

STATE

San Diego

ZIP CODE

TELEPHONE NUMBERS

92116

WK (619)231-4002

VEHICLE ( YEAR AND MAKE)

VEHICLE LICENSE PLATE

2010 TOYOTA

7WDF169

HM(619)524-4805 STATE

DAMAGES OVER $750

 YES  NO

VEHICLE OWNER – PERSON OR COMPANY

DATE OF BIRTH

Mary Nguyen ADDRESS

4063 Marlborough Street

06/21/77 CITY

San Diego

STATE

ZIP CODE

92116

INSURANCE COMPANY NAME (NOT AGENT OR BROKER) AT THE TIME OF THE ACCIDENT

POLICY NUMBER

AAA-Automobile Club Southern California

T1894367

COMPANY NAIC NUMBER

POLICY PERIOD

POLICY HOLDER NAME

FROM:7/01/2016 TO: 7/01/2017

Mary Nguyen

I certify under penalty of perjury under the law of the State of California that the information entered on this document is true and correct. DATE PRINTED NAME SIGNATURE

08/22/16

Mary Nguyen

# 7 Beginning High Page 2 of 3

Mary Nguyen’s Accident Report: Reading Practice, Part Two 3. Look at Mary Nguyen’s Important Documents. Write the words: insurance card

driver license

registration

A.___________________

B.___________________

C.___________________

Insurance Card Name insured NGUYEN, MARY Effective Date: 7/01/16

Policy Number T 1894367 Expiration Date: 7/01/17

# 7 Beginning High Page 3 of 3

Mary Nguyen’s Accident Report: Reading Practice, Part Three 4. Answer the questions. Use Mary’s documents and the accident report to find the information. 1. What is the year and make of Mary’s vehicle? ___________________________. 2. Which document has this information? _________________________________ 3. What is Mary’s date of birth? _________________________________________ 4. Which document has this information? _________________________________ 5. What is the date and time of Mary’s accident? ___________________________. 6. What is Mary’s insurance policy period? ________________________________ 7. Which document has this information? _________________________________ 8. What is Mary’s license plate number? ______________________________ 9. Which document has this information? _____________________________.

5. What about you? Talk with a classmate. Ask and answer the questions. 1. Do you have a driver license? 2. Do you own a car? 3. Did you ever have a car accident? Did you have insurance for the accident? Did anyone get hurt?

# 7 Beginning High, Task Two Page 1 of 2

Ann Smith’s Accident: Writing Practice 1. Read about Ann Smith’s accident. Use Ann’s driving documents on page 26 to fill out the accident report. Ann Smith had an accident on September 1, 2016. The accident happened at 5:00 p.m. in Chula Vista (San Diego County) when she arrived at her neighbor’s house for a birthday party. While she was driving into the neighbor’s driveway, she accidentally hit her neighbor’s car. She was very upset! Ann and her neighbor exchanged information on their driver licenses and insurance cards. Then Ann filled out a traffic accident report and sent it to the DMV. It cost $900 to fix her car and $1100 to repair the neighbor’s car. Ann was very happy that she had insurance because it was her responsibility to pay for both cars!

REPORT OF TRAFFIC ACCIDENT # OF VEHICLES

DATE OF ACCIDENT TIME OF ACCIDENT AM HOUR __________ PM

 YES  NO DRIVING FOR EMPLOYER

MOVING

 STOPPED IN TRAFFIC

PARKED

DRIVER’S NAME

REPORTING PARTY’S INFORMATION

ON PRIVATE PROPERTY

ACCIDENT LOCATION-CITY/COUNTY (CALIFORNIA ONLY)

PEDESTRIAN

BICYCLIST

OTHER

DRIVER LICENSE NUMBER

STATE

DRIVER’S STREET ADDRESS CITY

DATE OF BIRTH

STATE

VEHICLE ( YEAR AND MAKE)

 YES  NO

ZIP CODE

TELEPHONE NUMBERS WK

VEHICLE LICENSE PLATE

STATE

VEHICLE OWNER – PERSON OR COMPANY

DAMAGES OVER $750

 YES  NO DATE OF BIRTH

ADDRESS INSURANCE COMPANY NAME (NOT AGENT OR BROKER) AT THE TIME OF THE ACCIDENT

POLICY NUMBER

COMPANY NAIC NUMBER 74156

POLICY HOLDER NAME

POLICY PERIOD

I certify under penalty of perjury under the law of the State of California that the information entered on this document is true and correct.

DATE

PRINTED NAME

SIGNATURE X___________________________________

# 7 Beginning High, Task Two Page 2 of 2

Ann Smith’s Driving Documents

Name insured: ANN SMITH Policy Number: G 3695843 Eff Date: 04/25/16

Exp Date: 04/25/17