HomeMy WebLinkAboutAGENDA - 05141991 - 1.21 CLAIM ,
�
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA �
Claim Against the County, or District governed by) BOARD ACTION
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT MAY 14, 1991
and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of
California Government Codes. ) the action taken on your claim by the Board of Supervisors
(Paragraph IV below), given pursuant to Government Code
Amount: $5,713.74 Section 913 and 915.4. Please note all "Warnings".
CLAIMANT: CALIF. STATE AUTOMOBILE ASSOC. ,EIV�D
ATTN: Sandy Yia, Claim Representative
ATTORNEY: 2055 Meridian Park Blvd. APR 17 1991
Concord, CA 94520-5767 Date received
ADDRESS: BY DELIVERY TO CLERK ON April 16CF=, Risk Mgmt)
BY MAIL POSTMARKED:
I. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim. pH
g&,,,,,,_
DATED: April 17, ,1991 BYIL BATCHELOR, Clerk
puty
II. FROM: County Counsel TO: Clerk of the Board of isors
� ) This claim complies substantially with Sections 910 and 910.2.
( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying
claimant. The Board cannot act for 15 days (Section 910.8).
( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send
warning of claimant's right to apply for leave to present a late claim (Section 911.3).
( ) Other:
Dated: ( BY: � Deputy County Counsel
III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2)
( ) Claim was returned as untimely with notice to claimant (Section 911.3).
IV. BOARD ORDER: By unanimous vote of the Supervisors present
( This Claim is rejected in full .
( ) Other:
I certify that this is a true and correct copy of the Board's Order entered in its minutes for
this date.
Dated: MAY 14 1991 PHIL BATCHELOR, Clerk, By Deputy Clerk
WARNING (Gov. code sects 13)
Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or
deposited in the mail to file a court action on this claim. See Government Code Section 945.6.
You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult
an attorney, you should do so immediately.
AFFIDAVIT OF MAILING
I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the
United States, over age 18; and that today I deposited in the United States Postal Service in Martinez,
California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to
the claimant as shown above.
Dated:— IWAY 1. 7 1991 BY: PHIL BATCHELOR by Deputy Clerk
CC: County Counsel County Administrator
Cy i
Claim to: BOARD OF SUPER RS OF CONTRA COST
INSTRUCTIONS TO CLAIMANT
A. Claims relating to causes of action for death or for injury to per"1son or to per-
sonal..property_..or., growing.cr.-ops and which accrue ori or--before-December 31-,-1987,.
must be presented not._later;than the 100th.day after._ the-accrual_.of the cause of
action. Claims relating to,causes of action .for death' or:.for._in,jury.. to'.person
or to personal property or growing crops and which accrue on or after January 1,
1988, must be presented not later than six.months after the accrual of the cause
of.action.-.. Claims relating. to. any. other-- cause of action must-be presented not
later than one:-year after..the accrual of the. cause of action. (Govt. Code §911.2.)
B. Claims must be filed with the Clerk of the Board of Supervisors at its office in
Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553.
C.,.:,If..claim .is against a. district governed by, the Board-of -Supervisors;-rather than
the County, the name of the District should be filled-in: .
D. If.the claim is against more than one public entity, separate claims must be
filed against each public entity.
E.. Fraud.._ See penal ty-for_...fraudulent claims,_ Penal. Code. Sec.- 72 at the--end of this
-
RE: Claim By Reserved. for Clerk's filing stamp
California State Automobile )
Association
>
ECEIVE
Against ,the _County ,of. ,Contra-Costa . ) NR ` 1991
Costa-
or:.. _ )
DiStrlCt)'` �pKgQARD:OF SUPERVISORS y
Fill in name ) CONTRA COSTA CO.
The undersigned claimant hereby makes claim against the County of Contra Costa or
the above-named District in the sum of 5,713.74
and in support of
this claim represents as:foll.6wss$4-83�-1-5' o ision repairs o Khanna vehicle
--------------------------- ------------
1. When did the damage or injury 'occur? (Give exact date and hour)
December. 23 . 1990, -,:_at.-0030 a.:m Y
-------- ---------------
2. Where did the damage or injury occur? (Include city and county)
Treat Blvd/North Main St. Walnut Creek, Contra Costa County, Ca.
3. How did the damage or injury occur? (Give full details; use extra paper if
required) C.S.A.A. insured Roma .Khanna lost ..control. of vehicle due..,to .ice, formation
on the road,. causing _herr-to -collide ,with,William Greens..vehicle.
----------------------------- -- —
4. '. What particular act or .omission._on. the .part of county or. district officers,
servants or employees:.caused,the injury .or damage?,. C.S,.A.A. al-leges, that :the
county was negligent in leaving the water spinklers -on-;causing ice to ,-formZ-in the
road during that partiular winter night freeze.
(over)
��'. ��
� ��
�,�
�.�,� :• 0 �u
° _ --:^'.
15: •WCrat;;are the names of county or aistrict of'f'icers, servants -or employees causing
the damage or.`;injury? . =: Z
City Engineers Office" "`_" -
;�' ' ...'i _ ::' ." _,., - .. _,.: .._ _. ... - ...,.. ... .__.tit... _. • - __.,.. . . _
5.. What damage or _injuries do you claim resulted? -':'(Give -full-extent of injuries or
damages.:claimed:_ Attach two:estimates for--auto damage.
-•Damage to C.S�A A:,=insureds:veiAc— le'and adverse vehicle.v
_ How was..the amount claimed.-above computed? (Include the-:estimated amount of any
prospective injury or damage.)
copy--of .estimates attached. :
8. Names and addresses of:witnesses,, doctors and hospitals:
copy of poli report--attached
9. List the expenditures you made on account of. this accident or injury:'
DATE ITEM AMOUNT
12-24-90• insured repairs - 483. 15
01-29-91 adverse repairs & rental 5;230.50
Gov. Code✓Sec.,,1910:2--provides:
"The claim must be signed by the claimant
SEND NOTICES TO: (Attorney) or some posono his behalf."
Name and Address of Attorney /
SANDY Y
aimant I s gnat -
P..O.;=Bax- 4G. Coneord Ca:�.-94524 -
.... Address ..___.. _. . . ... . . ...
Telephone No. Telephone. No. 415/ 671-2708 ext. 366
NOTICE
Section 72 of--the Penal, Code provides:
"Every person who, with intent to defraud, .presents for allowance or for
payment to any state board or officer, or to any county, city or district board or
officer, authorized to allow or pay the same if genuine, any false or fraudulent f�
claim, bill, account, voucher, or writing, is punishable either by imprisonment in
the county--jail- for.-a -period of not more than one year;-by-a -fine of -not exceeding
one thousand ($1,000), or by both such imprisonment 'and -fine, `or •by -imprisonment in
the state prison, by a fine of not exceeding ten thousand"dollars"($10,000, or by
both such imprisonment and fine.
sxr r—t+'` h-c•[,r of p�•., - � l r✓ <'. -4 r x ti_ -
� 3�-551:99$
Ga fo I] rl a#e o e s Dela ion me nsu ance Bu ;r �'Y
�� z43 L 55f 998 2--R
e qt y �r -f_
_ 5.. �•, r�i 7�.5 `:r4;+t:,=-'.Y.�'+•,.S:-e' -�-:S.' ,.a::-..' _ ..:3:...>.....+ �.5:..
it-DATE OF LOSS''S ,:?„ *z CLAIM = ?s A` '-� NSUREdS - r-� ^vc,zr ::r
a_-�•� -Y- d,�, 1. s• - DATE - r x
12 '23:;90 4:9' 9- tI �} Nf_ Ii I i �S u f '' ;,?' �, -�.1` U 1 ,29 91
'.r%mW:T'_$'i..v..:, ,' �'', x"�'. c, r -eY -ra. .�.•_.- Y'`5.•.r- �,1�3,'Y 4S�:.y'''! y'3?5 'l, *ti' r"'..r'3' h tL -L-
�POLICY-TYPE�;KINO OF LOSS +1i-� "SUFFIX 3'i,3 t r e MANTSNA4E'?S •�a1�^•+. -.t,4t-1� PAY?• -i L Z
AUTO M D' i�'g„'j�Li •t?3 r WLR XP�M � �` s+yam ; rr5, 230. 59
M� r�-..- 3• �c,+.s¢" f..t r"S.r 'r m r ._ >I 'X- 11? P.-'-. s. -�, h t _.C
DO-'•� 3 .. ADJUSTEA NO l - `•-i•Ci IN PAYMEN70F ".G f"rx-i: kms'!`:;. -`_..._'•,�.�, •kR h - 's- r '�',s- Through r .< '.'.
CSI 3 90/1619 3 `z`'U-H,-�t�'I'�IRS' AtVD $ENlTAL � � l ��, ' -SsourYfyPadlteNattonal9ank � 11"a
,�. _ Z Ste' }';ro-. � r!s .t'c` c �. .e.• .� .a.. 4 : O
,,. `. J-. 'b'" ,: t 'ti<«.__� ^ r -•,!Y- - San Francixo Main Office Y05I2 •'.,1210': Z
- .r -tm ti v y a a• sT c S - "` { r ret,eco CAo 94177( -
PAY -_ �� fN=1e,-`I' . T'�t1SANn T W UNC�EiED }1 f Y rJ l C7 !e s
�:%"� -y4 aS- r.r;'.'. .2 .Y �.. .fit-+l 3. �. •.:�' - r
6 '- C •�+l 1z``J.+ ai3-i.•`I-« '.C- . 4 '•3.k'"i'�-T.., TJ'r t ,s G
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dr -.e +' a' i y,.'tN•�'r .� '�' `°' . .a z fav-'-{k ;.T..z" 3 r >
. WILL.l' z0REEN1�,< `' 1Sx 5 " te n #� t
,1 h28 `�#EI,INALLf PKY43 3z R' r' � r �� ,� -- '".l, ✓`
ds AUTHORIZE SIGNATURE
SHE CONC0 ;` ' �CA, 9*4D21 f . ��4� ��f � � , JOEY D RYANANli.":
ORDER': k�. .� <� a 0 "-.a ..._�-c ry't a, -�"-,`r; r �_ .�� PEG®TiA��
4 .,+tT �,1�; 3'r"',r� 7- s'ti"'Z•' �`. Z t a i .
..,.-.,� :!- ::s � � x x.:.`ri� fa:ei Ix`ry .F� ir15... r lam '). �,Y''..'.,.:< , a_ �,2 4.
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RE ASE OF ALL CLAIMS
To be executed by William Green
The undersigned do(es) hereby acknowledge receipt of Draft No. **L551998-2—R** for
FIVE THOUSAND TWO HUNDRED _THIRTY 59/100-----------------------Dollars ($ 5,230.59 )
Payable to William Green
which draft is accepted in full compromise settlement and satisfaction of and as sole consideration for the final
release and discharge of all actions, claims and demands whatsoever, that now exist, or may hereafter accrue
against Khanna, Tejbirs and any other person,
corporation,association or partnership responsible in any manner or degree for injuries to the person and propertyof
the undersigned, and the treatment thereof, and the consequences flowing therefrom, as a result of an accident,
casualty or event which occurred on or about the 23rd day of December 19 90 at or
near Treat Boulevard / North Main Street Pleasant Hill, Contra Costa County, Ca.
and for which the undersigned claims the above named persons or parties are legally liable in damages which legal
liability and damages are disputed and denied, and;
The undersigned warrants that no promise or inducement has been offered except as herein set forth;that this
release is executed without reliance upon any statement or representation by the person or parties released,or their
representatives, or physicians, concerning the nature and extent of the injuries and consequential damages, if any,
and of legal liability therefor,if any;that the undersigned is of legal age,legally competent to execute this release and
accepts full responsibility therefor, and;
The undersigned agrees, as a further consideration and inducement for this compromise settlement, that it
shall apply to all unknown and unanticipated injuries and damages resulting from said accident,casualty or event,as
well as to those now disclosed.
It is understood and agreed that this release and settlement (and dismissal with prejudice, if appropriate)are
not to prejudice the rights,claims,and causes of action accruing to any and all parties herein released and discharged
arising out of the subject accident or incident.
The undersigned hereby expressly waives the provisions of Section 1542 of the Civil Code of the State of
California which reads as follows:
"A general release does not extend to claims which the creditor does not know or suspect to exist in his favor at
the time of execut g the release,which if known byiim must have rr1�terially aff d hi settle ent with.the dA�®r.And do declare that � a r '
®�
Signed at � �`� this day of19 1L_
CITY STATE
1• IMPORTANT— READ BOTH SIDES— BEFORE SIGNING
WITNESS TO SIGNATURE 1 �
ADDRESS SIGNATURE
WITNESS TO SIGNATURE
ADDRESS ' S ATURE
F14808 IS".3.90) SIGNATURES MUST BE NOTORIZED -
7545c
Automobile Damage Evaluation
California State Automobile Association Intef-Insurance Bureau ,
Insured RESIDENCE PHONE:
❑ Claimant INSURED:
REGISTERED OWNER: BUSINESS PHONE: �—
� le ,r
ITEM NO: CLAIM/POLICY NO!:
LEGAL OWNER: G I C
DATE OF LOSS:
MAKE AND YEAR I.D. NO.: 12 --2 3 V
COLOR: MODEL: LICENSE:
W zs 1 tZo op,A k {
CONDITION OF BRAKES: MILEAGE: INSPECTED AT: NO. PHOTOS: INSPECTED BY DATE I SPECT,ED:
� ►4 �� ��.,� -�. �Z 2-14190
NO. REPL REPR DETAILS:REPLACE/REPAIR LABOR UNITS PAINT UNITS PARTS SUBLET
1 J e•r ,n c, Q4�T 0
2 -2l z
3 <
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
IRS N
Labor Units 33 #@ 4* =$
COMMENTS: Paint Units 3-IS #@ _2_ =$ k•OD
Paint Material =$ `-1.2 7
Parts 2.1 . SS Less% =$ •.SS
Tax @ 0 %on$ g =$ .0c)
This is not an authorization by C.S.A.A for repair.Present this estimate to the repair Sublet $--,g3r �
shop before you authorize the repairs.The labor rate is adjustable to the shops Other $ 4V
hourly rate. All supplements or changes must be approved by C.S.A.A. before
repairs are started. Notes: Total
D.O.STAMP-ADDRESS Betterment$ r
Deductible$
STAT[
TRAFF:';c C(SLLISION REP
ORT ,
i1[gAl CplDlTl01q .- NIA/AER MRA RUN CTTV2!Of
Of
-^
• NJl((ILD FELONY JUDICIAL DIST LOCAL AEPOATh{RAS[A
_.
49
,eAd X' POLLED WN'R"" R[►OA7Yq ortTwGT
OLLMO"OCCURRED ON
---------------- ----____________ _ 12-0 Po
IIILEPOITNPoRMATON ______________________
0 l
f DAT OI W[[K TOW AWAT PHOTOGRAPHS my:
uor
SOT 0 _.. l
J �AT M(TEREECTIp[WR11 • - 11 __ `` {n/ RAT[MWT R[l
®OA: 2.Sv IF ET/fAYWt Of LJ�A�1L Gj- '\�.
PARTY owv[R-s LICENSE NWtER ❑v- � ❑�E
STAT[ CLAEA tAf LTv T[M YAK[l YOOEL/COLOR ENS[ STATE
1 /,-1 _ / /T 0- [ _
DRIVER NAM[(RAST,YDDIt,LAST) - - , ,
►EDEt• TAE[T ADDRESS -
TRIAN OVME"NAAA[ -m'AA41 AS QMJR
❑ !tlt�1
/MK[O CITY JtTATKI;bP - .... -
V[NCL[ .. - .- 1 - .-- OW►�[R1 AD0ItI
❑ v�c -)4w.. ._.C 4'�21
CQ wuoxYO• s TT)DA � at Of Y1[1i�l5[DA7 ON�.. Oc.J ❑OfR-
C[R 01aV ER c-�0",tr. 8] Evil QmT
OTHER Iqy[►MON[ R�
(/ �'/^� .:,tUSIHEtt►NO�/N/E'�/r� _ � .,
Of
•� ❑ �'-'t I ) - `�3�i/3 - �.••E/T l �+V '�C _ PRIOR Y(CMAMCAL DIFEM: NON[ANMD[TT;;k-' A[fiR TO NMMTW E a
xJ l -Jl-
CHP USE OhLT LLLJJJ___ [ELIDE W DAJIAG ED M[A•
{ NtURANC[CARRI[R -.. - . . poucymmaEpt V[MKlt h►� 0[SCRItE V[NCL[DAYAG[
71ST L7-
Il F!"'?:.-[ ( O NON[ IANOR .
I
aR,01 ON STREET OR HIGHWAY i ®[t00. QYAJOR 0fOTAL
_ SPEED PCP ICC
f UMT
PARTY CHP
r
OMV[R'S UC[Ns[NW SCR
JKLn5
SAFETY Y[ [M
2 /yx� �� /. •' YAK[l YOD[Ll COLOR ENS[NWStR STATE
DRIVER HAL(t(FIRST.WOOL[,LST) ) �!W (v11-'.: r�/� r. 6A
IEOEL 7RE[T ADDRiSt
T7tAN { _ OWNER?NAY[ [AS DRIVER
PARKED CRY/STAT[/J]► '
Hj
SIX R
- - I
MA{
EYES
-NacHr wa -
D+TT
tIRTMDATi RAC[ at rQWTHM OfV!
YO• A [MCL[ON ORDERS Of; OfFIC[R
DAY � YEAR LAVER OM[A
1 ! !ifs �2iv1 ❑
OTHER N'W,tA[IRON[ EUHNE38 PHONE
❑ ((SIS SJ.� _ "�•! ^� n MOIL Y[CNAHC►10[fICT7: ., NON[A"AREM A[f[R TO tUUMT1Y[ ,-;
w[a+17 D[ NS&Y[NCLI DJWAO[ .5 NAME W DAYAO[O MEA- V
IN RANC[C [V[R UC7NWS[A V[MClt h/[
3q-8" ❑ o oR
aR Of ON STREET OR HIGHWAY
TAA
',` SPEED KI
WELD ..�L r•:.. �r .✓a ss'•o?.'".�" ►ItC❑EIWT
p -
PAR K DwvtR'l U
cNP p
TY ctrscNLt/sEA
1 "yy ITA TY CLASS SAfCfY VETL
3 tOUV, YAKtIYOD[L/CO1011 ENS[NWttltSTATE
NAME(RAST WOOLS LAt7) -o
TR
TRIAN OW
❑ .�., h -{F Wit.. -
El
PARKED
DRIVER -
.:.-
►ARKtO CTT7l CTAT[/D► -
VEHICLE OWNEWS ADOREtt aSAY[N ONY[R
MCT• IE[ [WR [YES hWHT wUOM MRTnOAi[ - -
CIITT NO. DAY r 7[AA [ Dll►ONTION Of Y[HAICLj ON ORDERS OF: QOPFICtR l3oaoV[R• ❑OTMEA
OTHER HOME►MOH! - -- ..EVMN[tt►HONE= - - -.
❑ I s- '', _� ` _ - .-_•MOR Y[CNANCAI O[fiCT7: NON[A"AAM[] "E[ItRTo1W1AAT%Vt❑
` J - cM/w[ONLY { �.E1M0[M DAYAO LD
NtcRwc[cARR[R = VtMltt[h►t D[seltttv[NCLtoAYAOE
►DUCT Nw[[A
awof 0[[tTACETORNONWAYSPt[D `.• L•~. 4,�t',. t►00. EIYAJOA TOTAL '
TMV[L rtt ICE p '•`�
KC Llwr
iyu +
►Al►1AIAi NAM a, .. CNS 1 dW.:AP* .-$"% 'i. h E:'.i. -
` �`{ `r
DISPATCH NOTIFIED AEL+E-.utNwc % Y sDATCAL. co z
NO I�w1 .-ICA
- rHIP SSS PACE I (A. /2J) OM 042 - .a''f''`_-# -•�.`3`�• F rr•v
Y tTATt OR CAUFORMARAF IC Cn LLt IIOON CODING =
CALIF OF cocusl oar L r[an �1 O rr[4scool t•uc nwsc- �nc[A c o
OwN[11 s NAMtl ADDntas _ ,varlT
. ._
PROPERTY �rss[ata.
DAMAGE O[LUUmON OF OAMAGA
SEATING POSITION SAFETY EQUIPMENT EJECTED FROM VEHICLE
OCCUPAHM L-AIR SAO DEPLOYED Y[G RICYCI F.tIFLMPT
A•NONE IN VEHICLE M•AIR BAG NOT DEPLOYED 0•NOT EJECTED
8-UNKNOWN M-OTHER - DRIVER 1•FULLYEJECTED
C-LAP BELS USED P•NOT REQUIRED Y•NO 2•PARTIALLY EJECTED
t-DRIVER D-LAP BELT NOT USED
_-..w'YES 1-UNKNOWN
1 2 3 2TO6-PASSENGERS E-SHOULDER HARNESS USED --.-PASSENGER
a 5 6 7-STATION WAGON REAR F-SHOULDER HARNESS NOT USED CHLORESTR/UHi z•No
••REAR OCC.TRK OR VAN 0•LAP/SHOULDER HARNESS USED O-)N VEHICLE USED Y-YES -
i•POSITION UNKNOWN H-LAP/SHOULDER HARNESS NOT USED R-IN VEHICLE NOT USED
7 0-OTHER -PASSIVE RESTRAINT USED E-IN VEHICLE USE UNKNOWN
K-PASSIVE RESTRAINT NOT USED T-IN VEHICLE IMPROPER USE
U•NONE IN VEHICLE
ITEMS MARKED BELOW FOLLOWED BY AN ASTERISK(')SHOULD BE EXPLAINED IN THE NARRATIVE
PRIMARY COLLISION FACTOR TRAFFIC CONTROL DEVICES - •Z 3 TYPE OF VEHICLE 2 3 MOVEMENT PRECEDING
UST NUMBER (s) OF PARTY AT FAULT COLLISION
+ AYC SECTION VIOLATED: 1118°[s ACONTROLS FUNCTIONING APASSENGER CAR I STATION WAGO ASTOPPED
to 13 CONTROLS NOT FUNCTIONING• JB PASSENGER CAR W I TRAILER BPROCEEDING STRAIGHT
B OTHER IMPROPER DRIVING•: CONTROLS OBSCURED C MOTORCYCLE/SCOOTER RAN OFF ROAD
D NO CONTROLS PRESENT/FACTOR- D PICKUP on PANEL TRUCK D UAYJ14G RIGHT TURN
y C OTHER THAN DRIVER• TYPE OF COW S40H E PICKUP/PANEL TRUCK /TRAILER E BAKING LEFT TURN
D UNKNOWN• HEAD•ON F TRUCK OR TRUCK TA TOA F HATING U TURN
t E L SIDESWIPE
GTRUCK/TRUCK T TORWITRLR. BACKING
IC REAR END . SCHOOLBUS SLOWING/STOPPtHG
WEATHER( MARK t TO 21TEMS) D BROADSIDE I OTHER BUS I PASSING OTHER VEHICLE
ACLEAR B NT OBJECT J EMERGE _Y VEHICLE J CHANGING LANES
BCLOUDY F ;ERTURNED, . KHIC YCONST.EQUIPMENT �' KPARKINGMANEUVER
C RAINING VEHICLE/PEDESTRIAN L CLE L ENTERING TRAFFIC
-
D SNOWING OTHER': OTHER VEHICLE OTHER UNSAFE TURNING
E FOG/VISIBILITY FT. MOTOR VEHICLE INVOLVED WITH N PEDESTRIAN XING INTO OPPOSING LANE
F OTHER ANON-COLLISION MOPED PARKED
G WIND PEDESTRIAN - - - - - - P MERGING
LIGHTING OTHER MOTOR VEHICLE - - - TRAVELING WRONG WAY
AOAYLIGHT D MOTOR VEHICLE ON OTHER ROADWAY OTHER ASSOCIATED FACTOR(S) OTHER•:
B DUSK-DAWN E PARKED MOTOR VEIIICLE 1 2 3 (MARK 1 TO2ITEMS)
CDARK-STREETLIGHTS - FTRAIN AvcaccTIONyIOLATION -.ar[o
DDARK-NO STREET LIGHTS BICYCLE - - �T�
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)
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C smewy-)CY J D
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A HOLES,DEEP RUT• B CROSSING IN CROSSWALK IMPAIRMENT NOT KNOWN
BLOOSE MATERIAL ONROADWAY• ATINTERSECTION -- UNFAMILIAR WITH ROAD NOT APPLICABLE
K DEFECTIVE VEIL EQUIP.: emp
C OBSTRUCTION ON ROADWAY• CROSSING IN CROSSWALK•NOT SLEEPY/FATIGUED
D CONSTRUCTION-REPAIR ZONE AT IKTERSECTION UNO SPECIAL INFORMATION
E REDUCED ROADWAY WIDTH D CROSSING-NOT IN CROSSWALK L UNINVOLVED VEHICLE AWIZARDOUS MATERIAL
FLOODED• IN ROAD-INCLUDES SHOULDER OTHER
OTHER•: NOT IN ROAD NONE APPARENT
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