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WINTER 2013



                               Your Rights To Recovery and
                               Compensation Following a Motor
                               Vehicle Accident
                               When injured in a tort accident (motor vehicle accident), the injured party is entitled to damages from the
                               at fault party or tort feasor. Some people never fully recover from a motor vehicle accident and live with
                               permanent injuries. The law says that an injured party can be made “whole” by the tort feasor, but obviously
                               they will never be the same in some cases. Damages are how injured people are made “whole” in an auto
                               accident. You are fully entitled to be put back into the position you were in prior to your injury, to the extent
                               that can be done with money. The following are some different damages that are allowed:
  In this issue
                                    •	   Property Damage
                                         You are entitled to the full repair or replacement cost of your vehicle, as well as diminished value if
                                         applicable.

                                    •	   Medical Expenses
Page 2                                   When your case settles, you are entitled to have your medical bills to date paid in full if they are
	 » Teen Driving Tips                    related to the auto accident.

	 » Client testimonies              •	   Future Medical Expenses
                                         You are entitled to a sum of money which will be sufficient to pay future medical bills, if any. This is
                                         part of the evaluation stage in your injury case.
Page 3                              •	   Lost Wages To Date
	 » Upcoming Local                       This is just a matter of data collection and relatively easy to prove.
    Events
                                    •	   Lost Future Earning Capacity
	 » Helping Hands                        If you are temporarily or permanently, partially or completely unable to work, you are entitled to
                                         a lump sum settlement representing the difference between the amount you could have earned
                                         before the injury and the amount you can earn presently. This is simple if you have a long term,
Page 4                                   full time job that you can no longer do; however, if you are self-employed, a fisherman, or a realtor,
                                         it is more difficult. It is also more difficult if you suffer only a partial loss.
	 » Pocket reference for
                                         When handling your claim, we will take your medical records to experts in physical capacity evalu-
    auto accidents, tear
                                         ation and vocational rehabilitation, quantify the impact of the injury on employment, and then
    out put it into your                 obtain a written opinion from an expert in economic loss.
    glovebox
                                         To recap, you are entitled to a lump sum of money representing the difference between the
                                         amount you could have had the capacity to earn prior to the injury and the amount you can cur-
                                         rently make.

                                    •	   General Damages For Pain, Suffering, Disability, and Disfigurement
                                         This is often the most difficult damage to evaluate, but you are entitled to be compensated for the
                                         injury you have sustained. At Jacobs & Jacobs, we use our expertise as well as past jury verdicts
                                         and arbitration awards to evaluate the general damages portion of your bodily injury claim.



                                                                                                                                       Page 1 |
                         Jacobs & Jacobs | (253) 845-0577 | (253) 845-9060 fax | www.jacobsandjacobs.net
Driving Tips                                                                                          “I highly recommend Jacobs &


for Teens:                                                                                            Jacobs who recently handled

                                                                                                      my accident case. They kept
Not many people enjoy being told what to
do, especially teen drivers; however, you                                                             the stress off me, treated me
shouldn’t disregard the advice you receive
from more experienced drivers. They’ve                                                                with kindness and respect, and
been in your shoes before, and they know
what they’re talking about.                                                                           allowed me to treat and heal
Take these tips into consideration when
                                                                                                      from my accident.”
practicing to become a responsible, safe
driver:
                                                                                                      A. Miller
•	   Pay attention to safety belt laws. Most
     often you can’t have more passengers
     than your vehicle has safety belts. Make                                                         You all know the saying,
     sure you and your passengers always                                                              “referrals are the best form of
     wear safety belts.
                                                                                                      flattery.” Well, we really mean
•	   Inspect your vehicle before you get into                                                         it when we say that. Without
     the car, and adjust your seat and mirror     •	   Pay attention to weather and road
     before you take off. Always remember              conditions. Don’t be ashamed to pull           your referrals, we would not
                                                       over if it’s raining too hard for you to
     to check your gas gauge, too.                                                                    have the opportunity to help
                                                       properly see the road.
•	   Follow the rules. This includes speed                                                            those deserving individuals
     limits, traffic lights, traffic signs, and   •	   Keep your vehicle up-to-date with
                                                                                                      get fair and honest legal
     signaling to the vehicle behind you               regular maintenance. If you can’t do
     when you plan to make a turn. This also           this by yourself, enlist the help of your      representation. We sincerely
     includes never drinking and driving,              dad, your older brother, your sister,          thank you for continuing to
     and never riding with anyone who                  your neighbor, or the local garage.
                                                                                                      trust our family firm to serve as
     has been drinking or using any kind of
                                                  •	   Remember, when the car is in motion
     drugs.                                                                                           your legal advocates.
                                                       it’s time to concentrate. It’s not time
•	   Expect the unexpected. Always have                to put on makeup, fix your hair, talk on
     some way to contact your parents in               the phone, eat, or pretend you’re in the
     the event of an emergency, i.e., carry a          middle of an American Idol audition.
     cell phone, calling card, or extra money          Put everything away and turn the music
     for payphones. Keep extra money for               down.                                        You are entitled by law to
     gas, and make sure you have directions
                                                  Driving is a privilege, and like all privileges
                                                                                                    compensation if you have suffered
     to your destination.                                                                           an injury that was not your fault
                                                  it can be taken away if you abuse it. If you
•	   Pay attention to others. This includes       drive responsibly and safely, you can hang        within the last three years.
     the vehicles behind, beside, and in          on to your driving privilege—and your life.
     front of you, as well as motorcyclists,      (courtesy of the Department of Motor              Whether the injury was whiplash,
     bicyclists,     and       pedestrians.       Vehicles)
                                                                                                    bruising, minor cuts or burns
                                                                                                    or more serious long term
                                                                                                    injuries, we will help you claim
                                                                                                    compensation.

 | Page 2
Local Upcoming Events                                                                               March 9th	 8:00am – 10:30am
                                                                                                    Northwest Trek Wildlife Park
                                                                                                    Photo Tour
With times being as tough as they are and         Location:
jobs are scarce, the City of Puyallup will be        South Meeting Room                             Northwest Trek Wildlife Park
hosting a 3 (three) part “Expert Interview”          Puyallup Public Library                        11610 Trek Dr. E., Eatonville WA, 98328
                                                     324 S Meridian                                 (360) 832-6117
workshop. The first one will be taking place
                                                     Puyallup, Washington 98371                     Enjoy the perfect opportunity for photographers
on March 19th from 10:30 a.m. to 12:30 p.m.
                                                                                                    of all levels, on an amazing tour that allows you
The second workshop will be held in April         Space is limited! To reserve your seat call or    to go where others cannot. This tour will provide
and the third will be held in May.                visit the Library’s 2nd floor Reference desk at   optimal conditions for you to take action shots
                                                  253.841.5454.                                     of the animals in the freeroaming area. From the
                                                                                                    tram you may see moose, mountain goats, bison,
                                                                                                    bighorn sheep and more in their natural habitats.

Helping Hands                                                                                       Finish with a continental breakfast at the Hellyer
                                                                                                    Natural History Center. Ages 18 and up, so go
                                                                                                    to ww.nwtrek.org or call Northwest Trek Wildlife
The team at Jacobs & Jacobs loves to give back to the community and this year we chose to           Park, (360) 832-6117 to reserve your spot today.
volunteer with a local organization called the Helping Hands House.  We had the wonderful
privilege of working together to do yard clean-up for one of the Helping Hands homes.  The
programs at Helping Hand House enable families living in poverty in Pierce County to
                                                                                                    March 16th	 9:00am – 12:00pm
overcome challenges and obstacles that have kept them financially vulnerable. To be                 Point Defiance Marina Beach
eligible for their programs, families must reside in Pierce County, have one child (age 17 or       Clean Up
under) living with them and be homeless or nearly homeless. Each of their programs is tai-
lored to the specific needs, barriers, culture, and location of the families.                       Point Defiance Marina
                                                                                                    5912 N. Waterfront Dr., Tacoma WA, 98402
•	    Diversion/Rapid Re-housing provides housing relocation and stabilization services and         (253) 591-5325
      short-term and medium-term rental assistance from 3-12 months to assist families with         Free
      children who are homeless or at imminent risk of homelessness to quickly regain stability
                                                                                                    Get hooked on helping! Join the Point Defiance
      in permanent housing after experiencing a housing crisis or homelessness.
                                                                                                    Marina and help with the beach clean up event.
•	    Emergency/Interim Housing stabilizes families with children under the age of 18 who           Keep our beaches beautiful.
      are homeless or at imminent risk of homelessness, and help them obtain permanent
      housing as quickly as possible.
                                                                                                    March 23rd	 10:00am – 4:00pm
•	    Transition-In-Place provides single-family housing and intensive, individualized case
      management for up to with a strong emphasis on financial literacy (budgeting and sav-         Celtic Faire Downtown Puyallup
      ing money), life-skills, and workforce training. Leases are in the client family’s name, to
                                                                                                    Downtown Puyallup
      support continuity in that location. Program locations throughout eastern Pierce County.
                                                                                                    107 N. Meridian, Puyallup WA 98371
•	    Permanent Supportive Housing provides single-family housing support, life-skills              (253) 840-2631
      training, and intensive case management that decreases gradually as financial resources       Free
      and skills improve to enable independence. Strong emphasis on workforce training and
                                                                                                    Come to downtown Puyallup and share your
      financial literacy. Program locations in Sumner.
                                                                                                    Celtic heritage. The faire will have a new twist
•	    The Employment Program benefits families in their Rapid Re-Housing and Emergency,             on the tradition of wearing green. The Celtic
      Transitional, and Permanent Supportive Housing programs. Employment, wage progres-            tradition is celebrated by music, good food and
      sion and financial literacy are key elements of their mission to end family homelessness.     community... all of our favorite things. Featured
      Helping Hand House has a full time Employment Specialist who works with adult family          events: clan uprising, pet parade, musical
      members who are unemployed and underemployed.                                                 performances, “Great Kilt” demonstration and
                                                                                                    plenty of great Irish and Scottish dishes.
•	    The Women In Nature (WIN) Program benefits women in the Transition in Place, and
      Permanent Supportive Housing programs by providing monthly opportunities for out-
      door experiences in nature, including hikes, beach clean-ups, and snowshoeing. Studies        April 13th	   10:15am
      have demonstrated the positive effects of such programs in addressing PTSD and other          80th Annual Daffodil Festival
      traumatic experiences experienced by many of the clients in their programs. 
                                                                                                    Grand Floral Street Parade
This is a great organization that provides wonderful opportunities for homeless families in our
community.  Consider donating your time or resources to help their cause!                           Downtown Tacoma
Helping Hands House:                                                                                1516 Pacific Ave., Tacoma WA, 98402
                                                                                                    (253) 840-4194
     Mailing Address:                                                                               Free
     PO Box 710
                                                                                                    The Annual Grand Floral Street Parade is the
     Puyallup, WA 98371                                                                             highlight of the Daffodil Festival Week. The
     Physical Address:                                                                              parade travels through the four cities of Tacoma,
     4321 2nd St SW                                                                                 Puyallup, Sumner and Orting. It consists of
                                                                                                    approximately 40 float entries and more than
     Puyallup, WA 98373
                                                                                                    80 other entries, including bands, marching and
     Phone: (253) 848-6096                                                                          mounted units. The floats are decorated with
                                                                                                    thousands of freshcut daffodils.
                                                                                                                                     Page 3 |
P.O. Box 513
                                    114 East Meeker
                                                                              Pocket Guide for Auto
                                    Puyallup, WA 98372                        Accidents
                                    Phone: 253-845-0577
                                    Toll free 1-866-289-HELP
                                                                              The Three Most Important Steps
                                    Fax: 253-845-9060                         to Follow After an Accident
                                    E-mail: lkroupa@seanet.com
                                                                              1.	   Contact your insurance company to report the accident. If you don’t report the
                                    Free Consultation                               accident to the company in a timely manner, it may try to deny you coverage.
                                    No Recovery- No Fee
                                                                              2.	   Call 9-1-1 and file a police report. You should file a police report if you are
                                                                                    injured or if damages to either your vehicle or the other party’s exceed $200.

Refer a friend or family member and                                           3.	   Get follow-up medical care. Be sure you continue to be treated for all your
you will receive a FREE simple will.                                                injuries and all medical conditions.

Value at $1200!                                                               After the accident it is also a good idea to consult with a personal injury
(limitations Apply: One per family and coupon is not transferable into        attorney who can advise you on your possible claims, analyze your coverages
another person’s name. Your appointment may be set after your friend/family
                                                                              and guide you through the next steps. The highly qualified personal
member has hired Jacobs & Jacobs to handle their claim. Your WILL must be
                                                                              injury attorneys at Jacobs & Jacobs Law Firm will provide you with a FREE
scheduled and complete
prior to the referred person’s
                                                                              consultation, at no obligation to you. Simply contact us about your injury or
case settling).                                                               call toll free at 1-866-289-HELP.




      Put this reference sheet in your glovebox
      Get These Facts                                                         Diagram the Accident
      Other Driver’s Name & DL#: ________________________________________the direction your vehicle was travelling and the direction
                                                                  Indicate
      Address: _______________________________________________________ driver was travelling before the incident. Identify what
                                                                  the other
                                                                  cross street you were on or near, and write a description of what
      Phone Number: __________________________________________________
                                                                  happened.
      Other Driver’s Insurance Name & Number: _____________________________
      Policy Number: __________________________________________________
      Other Car Owner’s Name: _________________________________________
      Address: _______________________________________________________
      Phone Number: __________________________________________________
                                                                                                                                 Street or highway name




      Other Car’s Make/Model/Year/License Number: ________________________ NORTH BY
                                                                     INDICATE
                                                                            ARROW
      Diagram The Accident:
      Date and Time of Accident: ________________________________________
      Weather Conditions: ______________________________________________
      Road Conditions: _________________________________________________
      Location: _____________________________________________


      Notes:
                                                                                                                                    Street or highway name




       | Page 4

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Injury Attorney Puyallup Newsletter Winter 2013

  • 1. WINTER 2013 Your Rights To Recovery and Compensation Following a Motor Vehicle Accident When injured in a tort accident (motor vehicle accident), the injured party is entitled to damages from the at fault party or tort feasor. Some people never fully recover from a motor vehicle accident and live with permanent injuries. The law says that an injured party can be made “whole” by the tort feasor, but obviously they will never be the same in some cases. Damages are how injured people are made “whole” in an auto accident. You are fully entitled to be put back into the position you were in prior to your injury, to the extent that can be done with money. The following are some different damages that are allowed: In this issue • Property Damage You are entitled to the full repair or replacement cost of your vehicle, as well as diminished value if applicable. • Medical Expenses Page 2 When your case settles, you are entitled to have your medical bills to date paid in full if they are » Teen Driving Tips related to the auto accident. » Client testimonies • Future Medical Expenses You are entitled to a sum of money which will be sufficient to pay future medical bills, if any. This is part of the evaluation stage in your injury case. Page 3 • Lost Wages To Date » Upcoming Local This is just a matter of data collection and relatively easy to prove. Events • Lost Future Earning Capacity » Helping Hands If you are temporarily or permanently, partially or completely unable to work, you are entitled to a lump sum settlement representing the difference between the amount you could have earned before the injury and the amount you can earn presently. This is simple if you have a long term, Page 4 full time job that you can no longer do; however, if you are self-employed, a fisherman, or a realtor, it is more difficult. It is also more difficult if you suffer only a partial loss. » Pocket reference for When handling your claim, we will take your medical records to experts in physical capacity evalu- auto accidents, tear ation and vocational rehabilitation, quantify the impact of the injury on employment, and then out put it into your obtain a written opinion from an expert in economic loss. glovebox To recap, you are entitled to a lump sum of money representing the difference between the amount you could have had the capacity to earn prior to the injury and the amount you can cur- rently make. • General Damages For Pain, Suffering, Disability, and Disfigurement This is often the most difficult damage to evaluate, but you are entitled to be compensated for the injury you have sustained. At Jacobs & Jacobs, we use our expertise as well as past jury verdicts and arbitration awards to evaluate the general damages portion of your bodily injury claim. Page 1 | Jacobs & Jacobs | (253) 845-0577 | (253) 845-9060 fax | www.jacobsandjacobs.net
  • 2. Driving Tips “I highly recommend Jacobs & for Teens: Jacobs who recently handled my accident case. They kept Not many people enjoy being told what to do, especially teen drivers; however, you the stress off me, treated me shouldn’t disregard the advice you receive from more experienced drivers. They’ve with kindness and respect, and been in your shoes before, and they know what they’re talking about. allowed me to treat and heal Take these tips into consideration when from my accident.” practicing to become a responsible, safe driver: A. Miller • Pay attention to safety belt laws. Most often you can’t have more passengers than your vehicle has safety belts. Make You all know the saying, sure you and your passengers always “referrals are the best form of wear safety belts. flattery.” Well, we really mean • Inspect your vehicle before you get into it when we say that. Without the car, and adjust your seat and mirror • Pay attention to weather and road before you take off. Always remember conditions. Don’t be ashamed to pull your referrals, we would not over if it’s raining too hard for you to to check your gas gauge, too. have the opportunity to help properly see the road. • Follow the rules. This includes speed those deserving individuals limits, traffic lights, traffic signs, and • Keep your vehicle up-to-date with get fair and honest legal signaling to the vehicle behind you regular maintenance. If you can’t do when you plan to make a turn. This also this by yourself, enlist the help of your representation. We sincerely includes never drinking and driving, dad, your older brother, your sister, thank you for continuing to and never riding with anyone who your neighbor, or the local garage. trust our family firm to serve as has been drinking or using any kind of • Remember, when the car is in motion drugs. your legal advocates. it’s time to concentrate. It’s not time • Expect the unexpected. Always have to put on makeup, fix your hair, talk on some way to contact your parents in the phone, eat, or pretend you’re in the the event of an emergency, i.e., carry a middle of an American Idol audition. cell phone, calling card, or extra money Put everything away and turn the music for payphones. Keep extra money for down. You are entitled by law to gas, and make sure you have directions Driving is a privilege, and like all privileges compensation if you have suffered to your destination. an injury that was not your fault it can be taken away if you abuse it. If you • Pay attention to others. This includes drive responsibly and safely, you can hang within the last three years. the vehicles behind, beside, and in on to your driving privilege—and your life. front of you, as well as motorcyclists, (courtesy of the Department of Motor Whether the injury was whiplash, bicyclists, and pedestrians. Vehicles) bruising, minor cuts or burns or more serious long term injuries, we will help you claim compensation. | Page 2
  • 3. Local Upcoming Events March 9th 8:00am – 10:30am Northwest Trek Wildlife Park Photo Tour With times being as tough as they are and Location: jobs are scarce, the City of Puyallup will be South Meeting Room  Northwest Trek Wildlife Park hosting a 3 (three) part “Expert Interview” Puyallup Public Library  11610 Trek Dr. E., Eatonville WA, 98328 324 S Meridian  (360) 832-6117 workshop. The first one will be taking place Puyallup, Washington 98371 Enjoy the perfect opportunity for photographers on March 19th from 10:30 a.m. to 12:30 p.m. of all levels, on an amazing tour that allows you The second workshop will be held in April Space is limited! To reserve your seat call or to go where others cannot. This tour will provide and the third will be held in May. visit the Library’s 2nd floor Reference desk at optimal conditions for you to take action shots 253.841.5454. of the animals in the freeroaming area. From the tram you may see moose, mountain goats, bison, bighorn sheep and more in their natural habitats. Helping Hands Finish with a continental breakfast at the Hellyer Natural History Center. Ages 18 and up, so go to ww.nwtrek.org or call Northwest Trek Wildlife The team at Jacobs & Jacobs loves to give back to the community and this year we chose to Park, (360) 832-6117 to reserve your spot today. volunteer with a local organization called the Helping Hands House.  We had the wonderful privilege of working together to do yard clean-up for one of the Helping Hands homes.  The programs at Helping Hand House enable families living in poverty in Pierce County to March 16th 9:00am – 12:00pm overcome challenges and obstacles that have kept them financially vulnerable. To be Point Defiance Marina Beach eligible for their programs, families must reside in Pierce County, have one child (age 17 or Clean Up under) living with them and be homeless or nearly homeless. Each of their programs is tai- lored to the specific needs, barriers, culture, and location of the families. Point Defiance Marina 5912 N. Waterfront Dr., Tacoma WA, 98402 • Diversion/Rapid Re-housing provides housing relocation and stabilization services and (253) 591-5325 short-term and medium-term rental assistance from 3-12 months to assist families with Free children who are homeless or at imminent risk of homelessness to quickly regain stability Get hooked on helping! Join the Point Defiance in permanent housing after experiencing a housing crisis or homelessness. Marina and help with the beach clean up event. • Emergency/Interim Housing stabilizes families with children under the age of 18 who Keep our beaches beautiful. are homeless or at imminent risk of homelessness, and help them obtain permanent housing as quickly as possible. March 23rd 10:00am – 4:00pm • Transition-In-Place provides single-family housing and intensive, individualized case management for up to with a strong emphasis on financial literacy (budgeting and sav- Celtic Faire Downtown Puyallup ing money), life-skills, and workforce training. Leases are in the client family’s name, to Downtown Puyallup support continuity in that location. Program locations throughout eastern Pierce County. 107 N. Meridian, Puyallup WA 98371 • Permanent Supportive Housing provides single-family housing support, life-skills (253) 840-2631 training, and intensive case management that decreases gradually as financial resources Free and skills improve to enable independence. Strong emphasis on workforce training and Come to downtown Puyallup and share your financial literacy. Program locations in Sumner. Celtic heritage. The faire will have a new twist • The Employment Program benefits families in their Rapid Re-Housing and Emergency, on the tradition of wearing green. The Celtic Transitional, and Permanent Supportive Housing programs. Employment, wage progres- tradition is celebrated by music, good food and sion and financial literacy are key elements of their mission to end family homelessness. community... all of our favorite things. Featured Helping Hand House has a full time Employment Specialist who works with adult family events: clan uprising, pet parade, musical members who are unemployed and underemployed. performances, “Great Kilt” demonstration and plenty of great Irish and Scottish dishes. • The Women In Nature (WIN) Program benefits women in the Transition in Place, and Permanent Supportive Housing programs by providing monthly opportunities for out- door experiences in nature, including hikes, beach clean-ups, and snowshoeing. Studies April 13th 10:15am have demonstrated the positive effects of such programs in addressing PTSD and other 80th Annual Daffodil Festival traumatic experiences experienced by many of the clients in their programs.  Grand Floral Street Parade This is a great organization that provides wonderful opportunities for homeless families in our community.  Consider donating your time or resources to help their cause!   Downtown Tacoma Helping Hands House:  1516 Pacific Ave., Tacoma WA, 98402 (253) 840-4194 Mailing Address: Free PO Box 710 The Annual Grand Floral Street Parade is the Puyallup, WA 98371 highlight of the Daffodil Festival Week. The Physical Address: parade travels through the four cities of Tacoma, 4321 2nd St SW Puyallup, Sumner and Orting. It consists of approximately 40 float entries and more than Puyallup, WA 98373 80 other entries, including bands, marching and Phone: (253) 848-6096 mounted units. The floats are decorated with thousands of freshcut daffodils. Page 3 |
  • 4. P.O. Box 513 114 East Meeker Pocket Guide for Auto Puyallup, WA 98372 Accidents Phone: 253-845-0577 Toll free 1-866-289-HELP The Three Most Important Steps Fax: 253-845-9060 to Follow After an Accident E-mail: lkroupa@seanet.com 1. Contact your insurance company to report the accident. If you don’t report the Free Consultation accident to the company in a timely manner, it may try to deny you coverage. No Recovery- No Fee 2. Call 9-1-1 and file a police report. You should file a police report if you are injured or if damages to either your vehicle or the other party’s exceed $200. Refer a friend or family member and 3. Get follow-up medical care. Be sure you continue to be treated for all your you will receive a FREE simple will. injuries and all medical conditions. Value at $1200! After the accident it is also a good idea to consult with a personal injury (limitations Apply: One per family and coupon is not transferable into attorney who can advise you on your possible claims, analyze your coverages another person’s name. Your appointment may be set after your friend/family and guide you through the next steps. The highly qualified personal member has hired Jacobs & Jacobs to handle their claim. Your WILL must be injury attorneys at Jacobs & Jacobs Law Firm will provide you with a FREE scheduled and complete prior to the referred person’s consultation, at no obligation to you. Simply contact us about your injury or case settling). call toll free at 1-866-289-HELP. Put this reference sheet in your glovebox Get These Facts Diagram the Accident Other Driver’s Name & DL#: ________________________________________the direction your vehicle was travelling and the direction Indicate Address: _______________________________________________________ driver was travelling before the incident. Identify what the other cross street you were on or near, and write a description of what Phone Number: __________________________________________________ happened. Other Driver’s Insurance Name & Number: _____________________________ Policy Number: __________________________________________________ Other Car Owner’s Name: _________________________________________ Address: _______________________________________________________ Phone Number: __________________________________________________ Street or highway name Other Car’s Make/Model/Year/License Number: ________________________ NORTH BY INDICATE ARROW Diagram The Accident: Date and Time of Accident: ________________________________________ Weather Conditions: ______________________________________________ Road Conditions: _________________________________________________ Location: _____________________________________________ Notes: Street or highway name | Page 4