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

Student Guide El Civics # 7- Reporting a Crime or Emergency Intermediate High Teacherâ&#x20AC;&#x2122;s Name: _________________ Studentâ&#x20AC;&#x2122;s Name: _________________ FALL 2016

#7 Intermediate High, Task One

EL Civics: Reporting 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’ll practice reporting problems to 911 or a non-emergency police number, and you’ll also learn how to fill out the DMV Traffic Accident Report. 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. Look at a driver license, registration form, and insurance card. 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 © Continuing Education, San Diego Community College District, EL Civics Program, 2016

8/22/2016 1:27 PM

#7 Intermediate High, Task One

Reporting a Robbery Ring! Ring! 213 Landis

Operator:

911 emergency operator.

Caller:

There’s a robbery at the 7-11!

Operator:

Give me your first and last name, please.

Caller:

Rueben Gomez.

Operator:

Could you spell your last name, please?

Caller:

Sure. G-O-M-E-Z.

Operator:

What’s the location of the robbery?

Caller:

Um. The address is 213 Landis Street.

Operator:

Does the suspect have a weapon?

Caller:

Yes, he’s got a gun.

Operator:

Has anyone been injured?

Caller:

No, not yet.

Operator:

What is the suspect wearing?

Caller:

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

Operator:

Can you describe the robber’s appearance?

Caller:

He’s tall and dark, with a beard and a mustache.

Operator:

Does he have any distinguishing marks?

Caller:

He has a big tattoo on his left arm.

Operator:

Is the robber working alone or does he have an accomplice?

Caller:

I think he’s alone. I don’t see anyone with him.

Operator:

Are there other people in the store?

Caller:

I don’t think so. I don’t see anyone.

Operator:

What is happening at the scene right now?

Caller:

He’s pointing the gun at the cashier, and the cashier is giving him some money.

Operator:

What is happening outside the store? Can you describe the scene outside?

Caller:

I’m the only one in the parking lot. There’s a bicycle next to the store.

Operator:

Could you describe any other details?

Caller:

Not really. I just drove into the parking lot and I saw the guy with the gun inside the store.

Operator:

The police are on the way. Thank you for calling. Use your phone to listen to the reading.

8/22/2016 1:27 PM

#7 Intermediate High, Task One

Calling the Police: Reporting a Robbery Student A is the police operator. Student B is the caller. Do not write on the lines; this is speaking practice. If the picture does not show the answer to a question or if you are not sure of the answer, you can say, “I don’t know” or “I’m not sure.”

Ring! Ring! Operator:

911 emergency operator.

Caller:

(Explain the problem or emergency) ___________________________________

Operator:

Give me your first and last name please.

Caller:

________________________________________

Operator:

Could you spell your last name, please?

Caller:

________________________________________

Operator:

What’s the location of the robbery?

Caller:

_________________________________________

Operator:

Does the suspect have a weapon?

Caller:

___________________________________

Operator:

Has anyone been injured?

Caller:

___________________________________

Operator:

What is the suspect wearing?

Caller:

_______________________________________________

Operator:

Could you describe the robber’s appearance?

Caller:

_________________________________________________

Operator:

Does he have any distinguishing marks?

Caller:

_____________________________________

Operator:

Is the robber working alone or does he have an accomplice?

Caller:

_____________________________________

Operator:

What is happening in the store right now?

Caller:

___________________________________________________

Operator:

What is happening outside the store? Can you describe the scene outside?

Caller:

___________________________________________________

Operator:

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

8/22/2016 1:27 PM

213 Landis

#7 Intermediate High, Task One

Calling the Police: Reporting a Purse Snatching Ring! Ring! Operator:

Police operator.

Caller:

A man just stole a woman’s purse.

Operator:

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:

Where did the incident happen?

Caller:

7902 Adams Ave.

Operator:

Is the thief still there?

Caller:

No, he ran away.

Operator:

What was he wearing?

Caller:

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

Operator:

Could you describe the suspect’s appearance?

Caller:

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

Operator:

What was the victim doing when the incident happened?

Caller:

She was walking on the sidewalk.

Operator:

Where is the woman right now?

Caller:

She’s outside her house.

Operator:

What is she doing?

Caller:

She’s just sitting and crying.

Operator:

Was the woman injured?

Caller:

No, I don’t think so.

Operator

How did it happen? What did you see?

Caller:

The woman was walking on the sidewalk. A man walked up next to her, grabbed her purse, and he ran away.

Operator:

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

7902 Adams Ave.

8/22/2016 1:27 PM

#7 Intermediate High, Task One

Calling the Police: Reporting a Purse Snatching Partner Practice Student A is the police operator. Student B is the caller. Do not write on the lines, this is speaking practice. If the picture does not show the answer to a question or if you are not sure of the answer, you can say “I don’t know.” 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?

Caller:

____________________________________________________

Operator:

Do you know the address there?

Caller:

___________________________________________________

Operator:

Is the thief still at the scene?

Caller:

____________________________________________________

Operator:

What was he wearing?

Caller:

_____________________________________________________

Operator:

Could you describe the suspect’s appearance?

Caller:

_____________________________________________________

Operator:

Where is the woman right now?

Caller:

______________________________________________________

Operator:

What is she doing?

Caller:

______________________________________________________

Operator:

Is the victim injured?

Caller:

______________________________________________________

Operator:

Could you describe the details of the incident* ?

Caller:

_____________________________________________________

Operator:

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

* incident = something that happened 7902 Adams Ave.

8/22/2016 1:27 PM

#7 Intermediate High, Task One

Calling the Police: Reporting an Accident Ring! Ring!

Caller:

Operator:

911 emergency operator.

Caller:

There was an accident. A car hit a pedestrian.

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:

What is the location of the accident?

Caller:

On the corner of 51st and University, in front of Food for Less. The address is 5128 University.

Operator:

Is the pedestrian hurt?

Caller:

Yes, she is. She’s bleeding

Operator:

Is the victim conscious?

Caller:

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

Operator:

Is the driver at the scene? Can you describe the driver?

Caller:

The driver is standing outside her car. She is wearing pants and a jacket. She is medium height and medium weight.

Operator:

What is happening at the scene now?

Caller:

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

Operator:

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

5128 University

8/22/2016 1:27 PM

#7 Intermediate High, Task One

Calling the Police: Reporting an Accident Student A is the operator. Student B is the caller. Do not write on the lines, this is speaking practice. If the picture does not show the answer to a question or if you are not sure of the answer, you can say “I don’t know.” Ring! Ring! Operator:

911 emergency operator.

Caller:

_______________________________________________________

Operator:

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

Caller:

_______________________________________________________

Operator:

Could you spell your last name, please?

Caller:

_______________________________________________________

Operator:

What is the location of the accident?

Caller:

______________________________________________________

Operator:

Is the pedestrian hurt?

Caller:

______________________________________________________

Operator:

Is the victim conscious?

Caller:

______________________________________________________

Operator:

Is the driver at the scene? Can you describe the driver?

Caller: Operator:

______________________________________________________________ How did the accident happen? Can you describe what you saw?

Caller: Caller: ________________________________________________________ Operator:

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

5128 University

8/22/2016 1:27 PM

# 7 Intermediate High, Task Two

Traffic Accidents 1. Discuss these questions in small groups. A.) Do you drive? If yes, How long have you been driving? What kind of car do you drive? B.) How is driving in the United States different from driving in your native country? C.) Have you ever been in a traffic accident? If so, How many cars were involved? How many people were involved? What happened? Did the police come? Was anybody hurt? What was the damage to the cars? Did anybody report the accident to the Department of Motor Vehicles (DMV)?

2. Discuss these words with your teacher. What do they mean? How do you pronounce them?

vehicle

scene involve

damage witness

party require

3. Listen to your teacher read these sentences. Repeat. a. There were two vehicles in the accident. b. The police quickly arrived at the scene of the accident c. Some damage happened to both vehicles. d. All the parties involved gave information for the police report. e. There were no witnesses. f. They are required to fill out a DMV report.

ÂŠ Continuing Education, San Diego Community College District, EL Civics Program, 2016

8/22/2016 1:27 PM

# 7 Intermediate High, Task Two

4. Read the paragraph about traffic accidents. What Should You Do When You Are Involved in a Traffic Accident? Sooner or later, most people, drivers or passengers, will be involved in a motor vehicle accident. It’s important to know that the law requires several steps if you have an accident. First, you must always stop. Never leave the scene of an accident, but move your car out of the traffic lanes if you can. If anyone is hurt, call 911 for help. Do not move the person from the vehicle. Wait for the police or ambulance to arrive. You must also report the accident to the police if there is damage to the cars, even if no one is hurt. All drivers should be present when the police arrive to give information for the police report. While you are waiting for the police, the parties involved should exchange driver licenses, car registrations, and insurance card information. Also write down names and telephone numbers of witnesses. Be very careful about making an agreement with the other driver without reporting the accident. The other driver may promise to pay for the damage, but later decide not to. The law also requires that you make a written report to the Department of Motor Vehicles (DMV) within ten days if there is over $750 of damage or anyone is hurt or killed. The DMV has a traffic accident form to fill out. You can pick up a copy at any DMV office or get it from the Internet. 5. True or False? Write ‘T’ for true or ‘F’ for false. ______ 1. Wait for the police before you move your car. ______ 2. If there is damage to the cars, you do not need a police report. ______ 3. Always stop if your car is in an accident. ______ 4. If someone is hurt, take him or her out of the car. ______ 5. Wait for the police to arrive and give them information to make a report. ______ 6. Try to make an agreement with the other party without calling the police. ______ 7. Exchange names, driver license numbers, registration information and insurance Information with the other parties involved in the accident. ______ 8. If there is damage over $750 or if someone is hurt or killed, you must report the accident to the DMV.

6. Write any four of the sentences above with “should” or “shouldn’t”. Example: You should always stop if your car is in an accident. __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________

7. Read your sentences to a classmate. © Continuing Education, San Diego Community College District, EL Civics Program, 2016

8/22/2016 1:27 PM

# 7 Intermediate High, Task Two

Filling Out a DMV Traffic Accident Form: Vocabulary 1. Look at a blank DMV traffic accident form with a partner on the last page of this booklet. Look for the words below. Check off  each word as you find it.

 occur

 party

 vehicle

 injured

 pedestrian

 deceased

 make

 perjury

 damage

 policy

2. Read the definitions below. Write the word from the lists above that best matches the definition. Work with a partner and use a dictionary to help you make the matches. 1. a certificate of insurance ______________________ 2. to happen ______________________ 3. something for transporting people or things ______________________ 4. the name of the manufacturer of a vehicle ______________________ 5. destruction of property ______________________ 6. to lie to a court or law official ______________________ 7. hurt ______________________ 8. dead ______________________ 9. a person ______________________ 10. a person traveling on foot ______________________

# 7 Intermediate High, Task Two

Filling Out a Traffic Accident Report Form: Vocabulary Practice Complete the sentences below with a word from the box.

deceased

damage

injured

make

occurred

party

pedestrians

perjury

policy

vehicles

1. It wasn’t a serious accident. Fortunately they didn’t need to call 9-1-1. No one was ____________________ and there was very little ___________________ to the cars.

2. _______________________ must look carefully before crossing the street. Sometimes drivers don’t pay attention to people in the crosswalk.

3. I need to fill in the vehicle year and ____________________. It’s a Toyota.

4. Not many people were involved in the accident. It was just me and one other _________________________.

5. You have to tell the truth when you report an accident to the DMV. If you don’t, you could get a penalty for ____________________________.

6. I always keep documentation of my insurance ____________________ in the glove compartment of my car.

7. The accident happened in front of my house. It ____________________ at 8:00 last night.

8. Please park your car in the parking lot. No ________________are allowed on the street overnight.

9. The emergency workers discovered three __________________ victims. All of them had died at the scene of the accident.

# 7 Intermediate High, Task Two

Traffic Accident Report – Reading Practice REPORT OF TRAFFIC ACCIDENT # OF VEHICLES

DAMAGE

INJURY/DEATH PROPERTY

OTHER PARTY’S INFORMATION REPORTING PARTY’S INFORMATION

DATE OF ACCIDENT

ON PRIVATE PROPERTY

ACCIDENT LOCATION-CITY/COUNTY (CALIFORNIA ONLY)

San Diego / San Diego  YES  NO 09/12/16 DRIVING FOR EMPLOYER TIME OF ACCIDENT AM STOPPED HOUR 10:00 PM MOVING IN TRAFFIC PARKED PEDESTRIAN BICYCLIST OTHER  YES NO DRIVER’S NAME

DRIVER LICENSE NUMBER

STATE

Wu Chen

A8503146

DRIVER’S STREET ADDRESS

DATE OF BIRTH

3809 North St. #202

12/07/64

CITY

STATE

ZIP CODE

92116

San Diego

TELEPHONE NUMBERS WK (619)581-2600 HM(619)282-4520 STATE DAMAGES OVER $750

VEHICLE ( YEAR AND MAKE) VEHICLE LICENSE PLATE

5LYR118

2003 TOYOTA

 YES  NO

VEHICLE OWNER – PERSON OR COMPANY

DATE OF BIRTH

Wu Chen

12/07/64

ADDRESS

CITY

3809 North St. #202

STATE

San Diego

ZIP CODE

92116

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

21st Century

4856272

COMPANY NAIC NUMBER

POLICY HOLDER NAME

POLICY PERIOD FROM:05/30/2016 TO: 05/30/2017

16923

Wu Chen

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

DRIVING FOR EMPLOYER

 YES NO

DRIVER’S NAME

DRIVER LICENSE NUMBER

STATE

Deborah Rivers

A9029347

DRIVER’S STREET ADDRESS

DATE OF BIRTH

3910 Madison Ave CITY

06/05/71

STATE

San Diego

ZIP CODE

TELEPHONE NUMBERS WK (858)720-7898 HM(619)285-7271 STATE DAMAGES OVER $750

92116

VEHICLE ( YEAR AND MAKE) VEHICLE LICENSE PLATE

2005 JEEP

4UWX220

 YES  NO

VEHICLE OWNER – PERSON OR COMPANY

DATE OF BIRTH

Deborah Rivers ADDRESS

3910 Madison Ave

06/05/71 CITY

San Diego

STATE

ZIP CODE

92116

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

State Farm

T1894367

POLICY HOLDER NAME POLICY PERIOD Deborah Rivers unknown FROM:08/30/2016 TO: 08/30/2017 NAME AND ADDRESS OF INDIVIDUAL INJURED OR DECEASED  Injured Driver  Passenger Wu Chen  Deceased  Bicyclist  Pedestrian 3809 North St. #202 San Diego, CA 92116 NAME AND ADDRESS OF INDIVIDUAL INJURED OR DECEASED  Injured  Driver  Passenger  Deceased  Bicyclist  Pedestrian

COMPANY NAIC NUMBER

OTHER PROPERTY DAMAGED (TELEPHONE POLES, FENCE, LIVESTOCK, ETC.)

None PROPERTY OWNER’S NAME AND ADDRESS

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

09/12/16 Wu Chen

SIGNATURE

Wu Chen

. 12

# 7 Intermediate High, Task Two

Reading a DMV Traffic Accident Form Work with a partner. Ask and answer the questions about the DMV Traffic Accident Report on page 12. Write short answers. General Information 1. How many vehicles were involved? 2. What was the date of the accident? 3. Where did the accident occur? 4. Was it on private property? 5. What time was the accident? Reporting Party’s Information 1. What was he/she doing when the accident occurred? (moving, stopped, parked, etc.) 2. What is the driver’s name? 3. What is the driver license number? 4. What kind of car does he/she drive? 5. What is the vehicle license plate number? 6. Were there damages over $750? 7. Who is the vehicle owner? 8. What is the name of the insurance company? 9. What is the policy period? Other Party’s Information 1. What was he/she doing when the accident occurred? (moving, stopped, parked, etc.) 2. What is the driver’s name? 3. What is the driver license number? 4. What kind of car does he/she drive? 5. What is the vehicle license plate number? 6. Were there damages over $750? 7. Who is the vehicle owner? 8. What is the name of the insurance company? 9. What is the policy period?

*Note to Teacher: For added dictation practice, refer to page 7 Teacher Guide Part 2.

# 7 Intermediate High, Task Two

1 of 3

Written Assessment: Filling out an Accident Report Practice #1 Directions: Read the information about Judy Chang’s accident. Then fill out a DMV Traffic Accident Report (page 20 or 21) with information about Judy and the other party involved in the accident. For the date on the form, use a date one to ten days after the accident.

Judy Chang was involved in an accident on September 11, 2016. She was driving to the supermarket at around 10:00 a.m. in her 2003 Ford when the collision occurred in El Cajon (in San Diego County). She was turning right at a four way intersection when another driver hit the side of her car. Luckily no one was seriously hurt, but both of their cars were damaged badly. Judy’s car needed $1,500 worth of repairs. The other party, Felori Panaligan, was driving a 2002 Mazda. It needed $1,000 worth of repairs. Ms. Panaligan was especially upset because she was driving her brother’s car. The women exchanged names, addresses and phone numbers. They also showed each other their insurance information and car registrations.

Reporting Party Driver: Judy Chang 344 Division St., National City, CA 91950 Home phone: 619-587-2345 Work phone: 619-271-8422 Birth date: August 14, 1972

Vehicle Owner: Judy Chang 344 Division St., National City, CA 91950 Home phone: 619-587-2345 Work phone: 619-271-8422 Birth date: August 14, 1972

Other Party Driver: Felori Panaligan 245 D Street, National City, CA 91950 Home phone: 619-586-4554 Work phone: 858-711-8411 Birth date: February 24, 1981

Vehicle Owner: Lewis Panaligan 245 D Street, National City CA 91950 Home phone: 619-586-4554 Work phone: 858-711-8411 Birth date: September 6, 1975

# 7 Intermediate High Task Two

2 of 3

Practice # 1: Reporting Party’s Information REGISTRATION VALID FROM

AUTO

07/15/2016 TO 07/15/2017

TYPE

LICENSE NUMBER

8HDT152

VEHICLE IDENTIFICATION NUMBER

MAKE

5KRFH85U37K872634

FORD

BODY TYPE

MODEL

CYLS.

4D DATE ISSUED

TYPE VEH.

120

DATE FIRST SOLD

CLASS

05/26/2003

UNLADEN/G/CGW

YEAR

2003

TOTAL FEES PAID

06/11/2016

CHANG, JUDY 344 DIVISION ST NATIONAL CITY CA 91950

3700

$98

Z0684529

STATE OF CALIFORNIA DEPARTMENT OF MOTOR VEHICLES

VALIDATED REGISTRATION CARD READ REVERSE SIDE – IMPORTANT INSTRUCTIONS

INSURANCE CARD

Name Insured CHANG, JUDY Effective Date: 07/15/2016

Policy Number G 6951284

Expiration Date: 07/15/2017

NAIC # 58469

# 7 Intermediate High Task Two 3 of 3

Practice # 1: Other Party’s Information REGISTRATION VALID FROM

AUTO 08/25/2016 TO 08/25/2017

TYPE

LICENSE NUMBER

8UTG846

VEHICLE IDENTIFICATION NUMBER

MAKE

8OTGN28D84J551394

MAZDA

BODY TYPE

MODEL

CYLS.

DATE FIRST SOLD

CLASS

04/28/2002

DATE ISSUED

TYPE VEH.

07/30/2016 120

UNLADEN/G/CGW

3700

PANALIGAN, LEWIS 245 D STREET NATIONAL CITY CA 91950

YEAR

2002

TOTAL FEES PAID

$87

P 0268458

STATE OF CALIFORNIA DEPARTMENT OF MOTOR VEHICLES

VALIDATED REGISTRATION CARD READ REVERSE SIDE – IMPORTANT INSTRUCTIONS

INSURANCE CARD Name Insured

Policy Number K 1584692

PANALIGAN, LEWIS Effective Date: 06/30/2016

Expiration Date: 06/30/2017

NAIC # 84796

# 7 Intermediate High Task Two 1 of 3

Written Assessment: Filling out an Accident Report Practice #2 Directions: Read the information about Ricardo Zuniga’s accident. Then fill out a DMV Traffic Accident Report (page 20 or 21) with information about Ricardo and the other party involved in the accident. For the date on the form, use a date one to ten days after the accident. Ricardo Zuniga was involved in an accident on August 09, 2016. He was driving his truck, a 2004 Nissan, after work at around 4:00 p.m. He was on the 805 freeway in Chula Vista (in San Diego County) in rush hour traffic. The car in front of him, a 2009 Dodge Caravan, stopped suddenly and Ricardo hit it from behind. Ricardo’s truck had $750 in damages and the Dodge had $1,200 in damages. The other driver, Sergio Cervantes, and Mr. Zuniga exchanged names, addresses and phone numbers. They also showed each other their insurance information and car registrations.

Reporting Party Driver: Ricardo Zuniga 953 Maria Way Chula Vista, CA 91910 Home Phone: 619-657-8432 Work Phone: 619-864-8605 Birth Date: January 5, 1965

Vehicle Owner: Ricardo Zuniga 953 Maria Way Chula Vista, CA 91910 Home Phone: 619-657-8432 Work Phone: 619-864-8605 Birth Date: January 5, 1965

Other Party Driver: Sergio, Cervantes 445 Orange Ave. Chula Vista, CA 91910 Home Phone: 619-507-8432 Work Phone: 619-357-8753 Birth Date: March 3, 1952

Vehicle Owner: Sergio, Cervantes 445 Orange Ave. Chula Vista, CA 91910 Home Phone: 619-507-8432 Work Phone: 619-357-8753 Birth Date: March 3, 1952

# 7 Intermediate High, Task Two 2 of 3

Practice # 2 Reporting Party’s Information REGISTRATION VALID FROM

AUTO

04/15/2016 TO 04/15/2017

TYPE

LICENSE NUMBER

8JYR851

VEHICLE IDENTIFICATION NUMBER

MAKE

4MGEY87G37K426951

NISSAN

BODY TYPE

MODEL

CYLS.

4D DATE ISSUED

TYPE VEH.

03/30/2016

120

DATE FIRST SOLD

CLASS

09/17/2004

UNLADEN/G/CGW

ZUNIGA, RICARDO 953 MARIA WAY CHULA VISTA CA 91910

YEAR

2004

TOTAL FEES PAID

3700

$84

F0458763

STATE OF CALIFORNIA DEPARTMENT OF MOTOR VEHICLES

VALIDATED REGISTRATION CARD READ REVERSE SIDE – IMPORTANT INSTRUCTIONS

INSURANCE CARD Name insured

Policy Number G 8795426

ZUNIGA, RICARDO Effective Date: 02/01/2016

Expiration Date: 02/01/2017

NAIC # 58481

# 7 Intermediate High, Task Two 3 of 3

Practice # 2 Other Party’s Information REGISTRATION VALID FROM

AUTO

05/30/2016 TO 05/30/2017

TYPE

LICENSE NUMBER

8PIK858

VEHICLE IDENTIFICATION NUMBER

MAKE

8TRFH28D75P161394

DODGE

BODY TYPE

MODEL

CYLS.

4D DATE ISSUED

TYPE VEH.

04/01/2016

120

DATE FIRST SOLD

CLASS

12/22/2009

UNLADEN/G/CGW

CERVANTES, SERGIO 445 ORANGE AVE CHULA VISTA CA 91910

YEAR

2009

TOTAL FEES PAID

$169

P 0154789

STATE OF CALIFORNIA DEPARTMENT OF MOTOR VEHICLES

VALIDATED REGISTRATION CARD READ REVERSE SIDE – IMPORTANT INSTRUCTIONS

INSURANCE CARD Name insured CERVANTES, SERGIO Effective Date: 03/30/2016

Policy Number: P5478632

Expiration Date: 03/30/2017

NAIC # 84512

# 7 Intermediate High, Task Two

DMV Traffic Accident Report REPORT OF TRAFFIC ACCIDENT Occurring in California # OF VEHICLES

ON PRIVATE PROPERTY

ACCIDENT LOCATION-CITY/COUNTY (CALIFORNIA ONLY)

 YES  NO

REPORTING PARTY’S INFORMATION

TIME OF ACCIDENT AM STOPPED HOUR _ PM MOVING IN TRAFFIC PARKED PEDESTRIAN BICYCLIST OTHER

DRIVER’S NAME

DRIVER LICENSE NUMBER

DRIVING FOR EMPLOYER

 YES NO STATE

DRIVER’S STREET ADDRESS

DATE OF BIRTH

/ CITY

STATE

ZIP CODE

 YES  NO

VEHICLE OWNER – PERSON OR COMPANY

DATE OF BIRTH

/ ADDRESS

TELEPHONE NUMBERS WK ( ) HM( ) STATE DAMAGES OVER $750

VEHICLE ( YEAR AND MAKE) VEHICLE LICENSE PLATE

CITY

STATE

ZIP CODE

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

POLICY HOLDER NAME

POLICY PERIOD FROM: / /

.TO:

OTHER PARTY’S INFORMATION

STOPPED MOVING IN TRAFFIC PARKED PEDESTRIAN BICYCLIST OTHER

DRIVER’S NAME

DRIVING FOR EMPLOYER

 YES NO

DRIVER LICENSE NUMBER

DRIVER’S STREET ADDRESS

STATE DATE OF BIRTH

/ CITY

STATE

ZIP CODE

 YES  NO

VEHICLE OWNER – PERSON OR COMPANY

DATE OF BIRTH

/ ADDRESS

TELEPHONE NUMBERS WK ( ) HM( ) STATE DAMAGES OVER $750

VEHICLE ( YEAR AND MAKE) VEHICLE LICENSE PLATE

CITY

STATE

ZIP CODE

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

PROPERTY DAMAGE

INJURY/DEATH

DATE OF ACCIDENT

POLICY PERIOD FROM: / /

NAME AND ADDRESS OF INDIVIDUAL INJURED OR DECEASED NAME AND ADDRESS OF INDIVIDUAL INJURED OR DECEASED

POLICY HOLDER NAME

.TO: /  Injured  Deceased  Injured  Deceased

/ .  Driver  Bicyclist  Driver  Bicyclist

 Passenger  Pedestrian  Passenger  Pedestrian

OTHER PROPERTY DAMAGED (TELEPHONE POLES, FENCE, LIVESTOCK, ETC.) PROPERTY OWNER’S NAME AND ADDRESS

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

ÂŠ Continuing Education, San Diego Community College District, EL Civics Program, 2016 8/22/2016 1:27 PM

# 7 Intermediate High, Task Two

DMV Traffic Accident Report REPORT OF TRAFFIC ACCIDENT Occurring in California # OF VEHICLES

ON PRIVATE PROPERTY

ACCIDENT LOCATION-CITY/COUNTY (CALIFORNIA ONLY)

 YES  NO

REPORTING PARTY’S INFORMATION

TIME OF ACCIDENT AM STOPPED HOUR _ PM MOVING IN TRAFFIC PARKED PEDESTRIAN BICYCLIST OTHER

DRIVER’S NAME

DRIVER LICENSE NUMBER

DRIVING FOR EMPLOYER

 YES NO STATE

DRIVER’S STREET ADDRESS

DATE OF BIRTH

/ CITY

STATE

ZIP CODE

 YES  NO

VEHICLE OWNER – PERSON OR COMPANY

DATE OF BIRTH

/ ADDRESS

TELEPHONE NUMBERS WK ( ) HM( ) STATE DAMAGES OVER $750

VEHICLE ( YEAR AND MAKE) VEHICLE LICENSE PLATE

CITY

STATE

ZIP CODE

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

POLICY HOLDER NAME

POLICY PERIOD FROM: / /

.TO:

OTHER PARTY’S INFORMATION

STOPPED MOVING IN TRAFFIC PARKED PEDESTRIAN BICYCLIST OTHER

DRIVER’S NAME

DRIVING FOR EMPLOYER

 YES NO

DRIVER LICENSE NUMBER

DRIVER’S STREET ADDRESS

STATE DATE OF BIRTH

/ CITY

STATE

ZIP CODE

 YES  NO

VEHICLE OWNER – PERSON OR COMPANY

DATE OF BIRTH

/ ADDRESS

TELEPHONE NUMBERS WK ( ) HM( ) STATE DAMAGES OVER $750

VEHICLE ( YEAR AND MAKE) VEHICLE LICENSE PLATE

CITY

STATE

ZIP CODE

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

PROPERTY DAMAGE

INJURY/DEATH

DATE OF ACCIDENT

POLICY PERIOD FROM: / /

NAME AND ADDRESS OF INDIVIDUAL INJURED OR DECEASED NAME AND ADDRESS OF INDIVIDUAL INJURED OR DECEASED

POLICY HOLDER NAME

.TO: /  Injured  Deceased  Injured  Deceased

/ .  Driver  Bicyclist  Driver  Bicyclist

 Passenger  Pedestrian  Passenger  Pedestrian

OTHER PROPERTY DAMAGED (TELEPHONE POLES, FENCE, LIVESTOCK, ETC.) PROPERTY OWNER’S NAME AND ADDRESS

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