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

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

Intermediate Low Teacher’s Name: ____________________ Student’s Name: ____________________ FALL 2016

# 7 Intermediate Low, 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

# 7 Intermediate Low, Task One

Reporting a Robbery Read the conversation. Practice the conversation with a partner. Ring! Ring! 213 Landis St.

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 is the location of the robbery? What’s the address there?

Caller:

Um. The address is 213 Landis Street.

Operator:

Does the suspect have a weapon?

Caller:

Yes, he’s got a gun.*

Operator:

Is anyone hurt?

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? What does the robber look like?

Caller:

He’s tall, with a beard, and he has a big tattoo on his left arm. Oh, and he has a mustache, too.

Operator:

Is the robber working alone or is someone helping him?

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

Operator:

* He’s got = He has © Continuing Education, San Diego Community College District, EL Civics Program, 2016 8/22/2016

# 7 Intermediate Low, Task One

Calling the Police: Reporting a Robbery Practice calling the police. 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:

(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 robbery happening? What’s the address there?

Caller:

________________________________________________________

Operator:

Does the suspect have a weapon?

Caller:

________________________________________________________

Operator:

Is anyone hurt?

Caller:

_______________________________________________________

Operator:

What is the suspect wearing?

Caller:

_______________________________________________________

Operator:

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

Caller:

_______________________________________________________

Operator:

Is the robber working alone or does he have a helper?

Caller:

_______________________________________________________

Operator:

Are there other people in the store?

Caller:

_______________________________________________________

Operator:

What is happening at the scene right now?

Caller:

_______________________________________________________

Operator:

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

# 7 Intermediate Low, Task One

Calling the Police: Reporting a Purse Snatching Read the conversation. Practice the conversation with a partner. 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 at the scene?

Caller:

No, he ran away.

Operator:

What was he wearing?

Caller:

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

Operator:

What did the thief look like? Can you describe the suspect?

Caller:

He’s tall and he has a mustache. He’s about 45 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 victim injured?

Caller:

No, I don’t think so.

Operator

Is anyone with the victim?

Caller:

No, she’s all alone.

Operator:

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

# 7 Intermediate Low, Task One

Calling the Police: Reporting a Purse Snatching Practice calling the police. 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:

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 did the crime happen? What’s the address there?

Caller:

________________________________________________________

Operator:

Is the thief still at the scene?

Caller:

________________________________________________________

Operator:

What was the suspect wearing?

Caller:

_______________________________________________________

Operator:

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

Caller:

_______________________________________________________

Operator:

Did the suspect have a weapon?

Caller:

_______________________________________________________

Operator:

Is the victim injured?

Caller:

_______________________________________________________

Operator:

Where is the victim now?

Caller:

_______________________________________________________

Operator:

Is anyone with the victim?

Caller:

_______________________________________________________

Operator:

What is the victim doing right now?”

Caller:

_______________________________________________________

Operator:

The police are on the way. Thank you for calling. 7902 Home Avenue

# 7 Intermediate Low, Task One

Calling the Police: Reporting an Accident Read the conversation. Practice the conversation with a partner. Ring! Ring! 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:

Where did the accident happen?

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? 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 in 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

# 7 Intermediate Low, Task One

Calling the Police: Reporting an Accident Practice calling the police. 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:

Police operator.

Caller:

___________________________________________________

Operator:

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

Caller:

___________________________________________________

Operator:

Could you spell your last name, please?

Caller:

___________________________________________________

Operator:

Where did the accident happen?

Caller:

___________________________________________________

Operator:

Is the pedestrian hurt?

Caller:

___________________________________________________

Operator:

Is the victim conscious?

Caller:

___________________________________________________

Operator:

Is the driver at the scene? Where is the driver?

Caller:

___________________________________________________

Operator:

What is happening right now? ___________________________________________________

Caller: Caller: Operator:

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

5128

# 7 Intermediate Low, Task One

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 Home Avenue

(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 Adams Ave.

(b) A man took her purse.

Extra Practice: Work with a partner. Ask questions for each number. Your partner will answer. Then answer your partner’s questions.

*Questions are in Teacher Guide Part 2, page 3 © Continuing Education, San Diego Community College District, EL Civics Program, 2016 8/22/2016

# 7 Intermediate Low, 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 yes, 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 you 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

# 7 Intermediate Low, 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.

# 7 Intermediate Low, 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 Low, 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 Low, Task Two

DMV Traffic Accident Report – Reading Practice REPORT OF TRAFFIC ACCIDENT DATE OF ACCIDENT

09/12/16

OTHER PARTY’S INFORMATION REPORTING PARTY’S INFORMATION

# OF VEHICLES

ON PRIVATE PROPERTY

ACCIDENT LOCATION-CITY/COUNTY (CALIFORNIA ONLY)

 YES  NO

San Diego / San Diego

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 CITY

12/07/64

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

DRIVING FOR EMPLOYER

 YES NO

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

06/05/71

ADDRESS

3910 Madison Ave

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 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

INJURY/DEATH PROPERTY DAMAGE

unknown

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

09/12/16

PRINTED NAME

Wu Chen

SIGNATURE

Wu Chen

# 7 Intermediate Low, Task Two

Reading a DMV Traffic Accident Form Work with a partner. Ask and answer the questions about the DMV accident report on the previous page. 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?

# 7 Intermediate Low, Task Two

Page 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 21 or 22) 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 2012 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 92116 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 92116 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 Low, Task Two Page 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.

DATE FIRST SOLD

CLASS

YEAR

12/08/2003

2003

4D DATE ISSUED

TYPE VEH. MP

06/11/2016

120

UNLADEN/G/CGW TOTAL FEES PAID

CHANG, JUDY 344 DIVISION ST NATIONAL CITY CA 92116

3700

$118

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 Low, Task Two

Page 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

01/25/2012

DATE ISSUED

TYPE VEH.

07/30/2016

120

CLASS

YEAR

2012

WC UNLADEN/G/CGW TOTAL FEES PAID

3700

PANALIGAN, LEWIS 245 D STREET NATIONAL CITY CA 91950

$230

P 0268458

STATE OF CALIFORNIA DEPARTMENT OF MOTOR VEHICLES

VALIDATED REGISTRATION CARD READ REVERSE SIDE – IMPORTANT INSTRUCTIONS

INSURANCE CARD Name Insured PANALIGAN, LEWIS

Policy Number K 1584692

Effective Date: 06/30/2016

Expiration Date: 06/30/2017

NAIC # 84796

# 7 Intermediate Low, Task Two

Page 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 21 or 22) 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 Low Task Two Page 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.

DATE FIRST SOLD

CLASS

YEAR

08/21/2004

2004

4D DATE ISSUED

TYPE VEH. MP

03/30/2016

120

UNLADEN/G/CGW TOTAL FEES PAID

ZUNIGA, RICARDO 953 MARIA WAY CHULA VISTA CA 91910

3700

$84

F0458763

STATE OF CALIFORNIA DEPARTMENT OF MOTOR VEHICLES

VALIDATED REGISTRATION CARD READ REVERSE SIDE – IMPORTANT INSTRUCTIONS

INSURANCE CARD Name insured ZUNIGA, RICARDO

Policy Number G 8795426

Effective Date: 02/01/2016

Expiration Date: 02/01/2017

NAIC # 58481

# 7 Intermediate Low, Task Two Page 3 of 3

Practice # 2 Other Party’s Information REGISTRATION VALID FROM

AUTO

TYPE

LICENSE NUMBER

8PIK858

05/30/2016 TO 05/30/2017

VEHICLE IDENTIFICATION NUMBER

MAKE

8TRFH28D75P161394

DODGE

BODY TYPE

MODEL

CYLS.

DATE FIRST SOLD

CLASS

YEAR

07/06/2009

2009

4D DATE ISSUED

TYPE VEH. MP

04/01/2016

120

UNLADEN/G/CGW TOTAL FEES PAID

CERVANTES, SERGIO 445 ORANGE AVE CHULA VISTA CA 91910

$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 Low, 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 DRIVING FOR EMPLOYER HOUR PM MOVING IN TRAFFIC PARKED PEDESTRIAN BICYCLIST OTHER  YES NO

DRIVER’S NAME

DRIVER LICENSE NUMBER

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

# 7 Intermediate Low, Task Two

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

# 7 Intermediate Low, 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 DRIVING FOR EMPLOYER HOUR PM MOVING IN TRAFFIC PARKED PEDESTRIAN BICYCLIST OTHER  YES NO

DRIVER’S NAME

DRIVER LICENSE NUMBER

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