Report of Traffic Accident Occurring in California: Read Important Information On Back
Report of Traffic Accident Occurring in California: Read Important Information On Back
Report of Traffic Accident Occurring in California: Read Important Information On Back
Yes
TIME OF ACCIDENT
No No
Hour
AM PM
Moving
Stopped in Traffic
Parked
Pedestrian
Bicyclist
Yes
STATE
DATE OF BIRTH
CITY
STATE
ZIP CODE
TELEPHONE NUMBERS
Wk (
VEHICLE (YEAR AND MAKE) VEHICLE LICENSE PLATE OR VEHICLE IDENTIFICATION NUMBER
)
STATE
Hm (
)
DAMAGES OVER $750
Yes
VEHICLE OWNERPERSON OR COMPANY DATE OF BIRTH
No
ADDRESS
CITY
STATE
ZIP CODE
INSURANCE COMPANY NAME (NOT AGENT OR BROKER) AT THE TIME OF THE ACCIDENT
POLICY NUMBER
POLICY PERIOD
To:________________
DRIVING FOR EMPLOYER
Pedestrian
Bicyclist
Yes
STATE
No
DATE OF BIRTH
CITY
STATE
ZIP CODE
TELEPHONE NUMBERS
Wk (
VEHICLE (YEAR AND MAKE) VEHICLE LICENSE PLATE OR VEHICLE IDENTIFICATION NUMBER
)
STATE
Hm (
)
DAMAGES OVER $750
Yes
VEHICLE OWNERPERSON OR COMPANY DATE OF BIRTH
No
ADDRESS
CITY
STATE
ZIP CODE
INSURANCE COMPANY NAME (NOT AGENT OR BROKER) AT THE TIME OF THE ACCIDENT
POLICY NUMBER
POLICY PERIOD
From:________________
NAME AND ADDRESS OF INDIVIDUAL INJURED OR DECEASED
Deceased
NAME AND ADDRESS OF INDIVIDUAL INJURED OR DECEASED
Injured Deceased
OTHER PROPERTY DAMAGED (TELEPHONE POLES, FENCE, LIVESTOCK, ETC.)
Driver Bicyclist
DAMAGES OVER $750
Passenger Pedestrian
Yes
PROPERTY OWNERS NAME AND ADDRESS
No
I certify (or declare) under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
DATE PRINTED NAME SIGNATURE
X
SR 1 (REV. 9/2008) WWW
A
I N S U R A N C E
YOUR VEHICLE
The Department may send this part to the insurance company indicated. If not fully completed, it will be assumed you were not insured for the accident and your license will be suspended.
DO NOT DETACH
NAME OF INSURANCE COMPANY (NOT AGENCY OR BROKERAGE) THAT ISSUED THE LIABILITY POLICY COVERING THE OPERATION OF YOUR VEHICLE POLICY NUMBER POLICY PERIOD
From:
DATE OF ACCIDENT IN OR NEAR (CITY OR TOWN) (CALIFORNIA ONLY)
To:
DRIVER
ADDRESS
OWNER
ADDRESS
ADDRESS
If the policy was not in effect, this form must be completed and returned to the Department within 20 days.
The undersigned company advises that with respect to the reported accident, the policy reported on the reverse side: WAS NOT IN EFFECT Was not a liability policy Policy Number Signature Title Date Did not cover the vehicle/driver Number is not a company policy number Policy Period from to
MAIL TO: Department of Motor Vehicles Financial Responsibility P. O. Box 942884 Sacramento, CA 94284-0884
SR 1A (REV. 9/2008) WWW
IMPORTANT INFORMATION
California law requires traffic accidents on a California street/highway or private property to be reported to the Department of Motor Vehicles (DMV) within 10 days if there was an injury, death or property damage in excess of $750. Untimely reporting could result in DMV suspending a driver license. Accidents involving vehicles not required to be registered such as an off-road vehicle (OHV), implement of husbandry, or snowmobile or occurring on a military base or occurring on the drivers own property involving only the personal property of the driver and there was no injury or death are not reportable. The law requires the driver to file this SR-1 form with DMV regardless of fault. This report must be made in addition to any other report filed with a law enforcement agency, insurance company, or the California Highway Patrol (CHP) as their reports do not satisfy the filing requirement. An insurance agent, attorney, or other designated representative may file the report for the driver. The law requires every driver and every owner of a motor vehicle to be financially responsible for any injury or damage resulting from operating or owning a motor vehicle. The minimum insurance level for financial responsibility is public liability and property damage coverage of $15,000 for injury or death of one person, $30,000 for injury or death of two or more persons and $5,000 property damage per accident. Comprehensive and collision insurance does not meet the legal requirement. 1806 of the California Vehicle Code (CVC) requires the DMV to record accident information regardless of fault when individuals report accidents under the Financial Responsibility Law or if law enforcement agencies or CHP investigate and make a report.
ADVISORY STATeMeNT
The accident information on the SR-1 is required under the authority of Divisions 6 and 7 of the California Vehicle Code. Failure to provide the information will result in suspension of the driving privilege. Except as made confidential by law (e.g., medical information) or exempted under the Public Records Act, the information is a public record, is regularly used by law enforcement agencies and insurance companies, and is open to public inspection. 16005 CVC limits the public record for SR-1 reports to accident involvement, but does allow persons with a proper interest (involved drivers, their employers, etc.) to receive specified information. Individuals may inspect or obtain copies of information contained in their records during regular office hours. The Financial Responsibility Section Manager, 2570 24th Street, Sacramento, CA 95818 (telephone number: 916-657-6677) is responsible for maintaining this information.