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Vehicle Accident Report TC-3 - Nevada

Vehicle Accident Report Form. This is a Nevada form and can be used in Office Of Attorney General Statewide .
 Fillable pdf Last Modified 4/12/2016
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VEHICLE ACCIDENT REPORT INSTRUCTIONS: COMPLETE as much information as possible at the scene. REPORT all accidents involving third parties, whether or not there is damage or injury. COOPERATE with investigating officer(s) and the State's adjuster(s). WITHIN 48 HOURS: Send copy to AG's Office Claims Manager, DMV Legal/Tort Claims, 555 Wright Way, Carson City, NV 89711 Send copy to Risk Management Claims Manager, 201 S. Roop St., Suite 201 Carson City NV 89701 Date of Accident Time OUR INFORMATION: Driver's Name Office Address Driver's Lic. No. Contact Person State Title Vehicle ID No. (VIN) Year Make Model Agency Bus. Phone Expiration Date Phone Is this a MOTOR POOL Vehicle? Plate No. Location of vehicle Location of Accident Describe Damage to State Vehicle: Windshield Damage only? If NO describe damage Accident Reported to (NHP, Metro, Reno P.D., etc.) If Yes, explain: Report # Citations Issued? American LegalNet, Inc. www.FormsWorkFlow.com THEIR INFORMATION: Self-Insurance card provided to driver/owner? D Yes D No Owner's Name Address Insurance Company Insurance Agent Plate No. Driver's name Address Driver's Lic. No. State State Year Policy No Phone No. Make Daytime phone City/State/Zip Expiration Date Model Daytime Phone City/State/Zip City/State Describe damage to other vehicle and any injuries reported: EXPLAIN WHAT HAPPENED: WITNESSES (Please include NAME, ADDRESS and PHONE NUMBER) PERSONS INJURED (If injured person is a State Employee, complete a Worker's Compensation Claim Form) Agency Information: Damage estimates attached Estimates will follow Date Date Date State Driver's Signature Reviewed by Safety Coordinator Reviewed by Department Head RSK-001 (webversion) rev. 11/15 American LegalNet, Inc. www.FormsWorkFlow.com
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