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HomeMy WebLinkAbout465 and 485 Graham Road i 1� RECEW A CONDITION REPORT NOV 8 1993 Graham Road from House #415 to #450 P�UBUCMI p November 3, 1993 by Mel Stead �;e Dp,T The information about motor vehicle accidents provided by Police Department, plotted on the 40 scale sewer map, shows that five accidents occured between December 11 , 1992 and February 20, 1993 in an area in front of #432 to #445 Graham Road. I have researched the physical factors that may have contributed to them: * The vehicles were all traveling in a north bound direction. * All of the accidents occurred when it was darn, except one on December 11 , 1992. One of the accidents happened during a storm event (Heavy rain/slush) December 11 , 1992. Ice is mentioned in four of the accident reports. Alcohol is mentioned in one report - march 4, 1993 - arrest made. * We were called in to sand with two to four truck call out after the incident in three of the cases. We were already out on December 11 , 1992 and Larch 9, 1993. * Pictures taken after a rain October 21 , 1993 show no puddles in this area. First puddle shows up beyond the area where the vehicles end up. Pictures taken October 25, 1993 show what looks like excessive crown in the north bound lane in this area. Pictures show the area is shaded. Observation shows a line of 35 f t to 440 f t of tall evergreens running east to west along the south property line of #432 Graham Road. Low trajectory of sun during these winter months combined with the trees keep this area in constant shade. Conclusion: This area is subject to freezing before the area south of the evergreen tree line. The sunlight in the straight approach area gives operators a feeling of being within safe traveling parameters. Operators are therefore traveling too fast for the unanticipated potential icy condition ahead of them. Condition Report November 3, 1993 Page 2 There is also greater crown in the road as one crosses over the slight knoll in front of house number 427. A complete solution to this problem would be: 1. Post a warning sign to warn motorists of potential icing condition. 2. Remove the privately owned evergreen trees. 3. Regrade about 200 feet of road to lessen crown. I recommend that we post a sign and approach the land owner about tree removal . This may be enough to not have to do regrading of roadway. 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WANTS TO SEE {y "_ � e � a rtamher � WILL CALL AGAIN r.' ti CAME To SEE=YOU 'rl� N RETURNED YOUR CALL:` 11VA1 M> 8 �0II AETIRNED YOyi Messa9e . a s R z A ;�' _ e �IVANTS TSEEx tvtx 1Qlll.i��A?CYOU UIiGq17s FM itr31 s 7.. f Zk; - x * Operator �, CIs1tR r t �` - �g> vxas� s �`.. or b Fore �! 5 ate Time Date Time WHILE, YOU WERE OUT, WHILE YOU WERE;OUT. nn nn Fromq w► J�J From Phone No. Phone.No. 14 Area Code _ Number Extension. Area Code Number- tension - TELEPHONED URGENT TELEPHONED URGENT: PLEASE CALL WANTS TO SEE YOU PLEASE CALL WANTS TO SEE OU WILL CALL AGAIN. CAME TO SEE YOU r WILL CALL-AGAIN:.': 1 CAME TO SEE YOU', D-YOUR CALL RETURNED YOUR CAS L Message - x ' „a:; Message q Grp .,:_._ Ca tc k ►s.1�v S �'��/e-�re�v� f 4 ,tt r �' CJ�. YYTJ/ Iit-� r a ¢ e The botserd =that Gigs Lu 5t �ii �� �• r, y, L Operator y ` 3 Operator nrDataCom qlq, v, x_ .,.. ..:.........r�.N..s.k:-m `:•#'ay^.a.,..wuw�:-.�..ch+asre:.aJ.y.�;.=tr„ .Akhu,G.b - *�:r,6F,. A ��".'"'..t... .v�_ai.cs v�._ .-_�._r �.. ,_- ..,. ; ii161 � r s f 11 tr ,116, F TRAFFIC ACCIDENT Date Time Case Number Location Officer Y 910703 0759 4 GRAHAM ROAD Y 910109 1813 91-00263V GRAHAM ROAD 121 Y 910915 1735 .9-1 GRAHAM ROAD 120 Y 911008 0932 4 AYERS ROAD AND GRAHAM ROAD 131 Y 911010 1739 A1z093 GRAHAM ROAD 121 Y 911105 1711 P-09ff6— GRAHAM ROAD 121 Y 911230 0815 91—HIJ7 GRAHAM ROAD 120 Y 920104 1618 9L0�9 GRAHAM ROAD 120 Y 920329 0159 .94-t-2TTi8 GRAHAM ROAD 131 Y 920521 1012 38` GRAHAM ROAD AND SULLIVAN AVENUE 102 Y 920716 2032 9, - 540-2'�` GRAHAM ROAD 121 Y 910218 2335 OLD FARM ROAD AT GRAHAM ROAD 135 Y 920902 0608 J� 0�63.95 GRAHAM ROAD 138 Y 920926 0905 9z.=07243 SULLIVAN AVENUE AND GRAHAM ROAD 105 Y 921016 1448 0 GRAHAM ROAD AND NEVERS ROAD 111 Y 921024 1916 $2-01J7r'" SULLIVAN AVENUE AT GRAHAM ROAD 137 Y 910320 2320 9;—+�M SULLIVAN AVENUE AT GRAHAM ROAD 122 Y 921031 2103 914M-i GRAHAM ROAD 121 Y 921211 0706 324M 6 GRAHAM ROAD 129 Y 921216 0742 9�0 GRAHAM ROAD AND NEVERS ROAD 129 Count: 20 Date Location Case Number ------------------------------ 930125 GRAHAM ROAD - 930206 GRAHAM ROAD X SULLIVAN AVENUE . 930217 GRAHAM ROAD 930223 GRAHAM ROAD _@ 930224 GRAHAM ROAD `g 930304 GRAHAM ROAD } 930305 GRAHAM ROAD g3= 930309 GRAHAM ROAD .3 g 930310 GRAHAM ROAD 930320 GRAHAM ROAD 930328 607 GRAHAM ROAD 93-02092 930403 SULLIVAN AVENUE AND GRAHAM ROAD 93-02251 Count: 12 April 1 , 1993 Director of Public Works D� f Town of South WindsorTown 1540 Hall 1540 Sullivan Avenue l�rLG1 South Windsor, CT 06074 � �'t�• ,TAM.114 t Dear Sir: a.,c t hG= c Gl a e, , PU- -,v I reside at 835 Foster Street Extension in South Windsor. I have encountered a problem with the location of a speed control sign ] located about 15 feet north of my driveway. It has become an 'attractive target' for passing vandals who drink beverages while in their automobiles. More frequently these vandals have taken to throwing drink containers at the reflective sign, usually late at night. When the containers hit the sign, broken glass and/or spilled liquids are sprayed over my lawn and driveway, most times also hitting my parked vehicles. The Town Police Department will confirm that I reported an incident where a window on a vehicle parked in my driveway was shattered by a thrown beer bottle. Please review the placement of the speed control sign, before it was placed in its present location, I had no problems with thrown drink containers. If the speed control sign can't be eliminated, please relocate it at least 175 feet further south. That would eliminate the problem of broken glass in my lawn as well as move the target zone away from my vehicles and driveway. I am well aware that our Police Department is doing its job well , but is powerless to stop these acts of random vandalism. I also don't have any suggestions on how on how to stop this vandalism. Thank you for your assistance in this matter. Frank W. Felletter 835 Foster Street South Windsor, CT 06074 (203) 644-0710 cc:Police Department, Town of South Windsor, CT file G ZPR Tres�+So.�;',Y�sc► IIVDUSE I CHECKED By I LOW LETTERONLY I oil 3 POLICE�ICCIDENT REPORT please send to DEPARTMENT OF MOTOR VEHICLES PR-1 Rev.8-85 Accident Security Unit 60 St to Street 1.6 MVD CASE NUMBER t 1 ) Wethersfield.Connecticut 06109-1896 A Al2 DATE OF ACCIDENT DAY OF WEEK 3 is TIME(maaary) +KILLED +INJURED +OF VEHICLES POLICE CASE NUMBER INVOLVED 1 Imonthl Itlayl r �r f i.19 CITY OR TOWN(name) (City,Town Code) ACCIDENT NT OCCURRED ON!sneer name or route a)AT ITS INTERSECTION WITH(sneer name or route+1 _ H IF NOT AT INTERSECTION C L� 1. Give distance and✓either 2. Check(✓)direction. 3. Give nearest intersecting street(name or route#) 2 O "Feet"or "Tenths"of a mile. underpass, overpass, bridge, river or town line. o ❑�Feet LC North s E w DO NOT USE house III,utility pole#,or business name. - i 1�J1! /)V I Tenthe W ❑ ❑ ❑ of-�Se'r rJ!,. i 6 � OPERATOR AND VEHICLE #1 OPERATOR AND VEHICLE #2 (or pedestrian) S .OPERATOR at NAME!last.first.middle initial) OPERATOR x2 OR PEDESTRIAN NAME tlasr.first middle imtiali WOW lhar wE �'L.os IG Nl tr✓t �c FS ADDRESS(street number and name) ADDRESS(street number and name) V 1 V� - 0•ti CITY OR TOWN STATE ZIP CODE 20 SEX CITY OR TOWN STATE ZIP CODE 21 SEX c 1 �-4 inns OT' otvo r i 4e State I 24-49 OPERATOR LICENSE NUMBER 49-54 Date of Birth DOT L,c State 9.33 OPERATOR LICENSE NUMBER 34.39 Date of Birth 1213 Code ONLY Code 61 I z am I `54 639 ZG,& a a s' :9 Zi VEHICLE a1 OWNER NAME(d same as operator+I.enter 'same') VEHICLE+2 OWNER NAME(if same as operator a2.enter-same I 14�i w l G il:.l 4r1 t1 �^�� l OSUis' G rAJK 1415 - �`ADDRESS(street number and name/ ADDRESS(street number and name) 16 17 CITYORTOWN STATE ZIPCODE CITY OR TOWN STATE ZIP CODE n2 40-41 PLATE#AND STATE CODE VEHICLE YEAR AND MAKE 42-43 PLATE+AND STATE CODE VEHICLE YEAR AND MAKE 1 P 3ej24 I S v L 1913 `/ A VEHICLE MODEL NAME BODY TYPE(e g 4-door sedan,truck.ell I VEHICLE MODEL NAME BODY TYPE le g 4-door sedart truck.etc I 1 1 i tv1 u j L Z�C1v_ S @CY�e� 7 o L.LA Z 1�C/ac.L'. S E�?eJ El 44-61 VEHICLE IDENTIFICATION NUMBER(not engine number) - DOT7.24 VEHICLE IDENTIFICATION NUMBER snot engine numbery ONLY ��^i4(3� Z�7J �f 1'�S 2 3 �Z�X D �IG5FCo 24 H2 Did operator carry current Connecticut No-Fault Insurance Did o erafor carry a current Connecticut No-Fault Insurance V/ I.D.Card in vehicle as required under CGS,Section 14-12b CKES El NO I.D.f and in vehicle as required under CGS,Section 14-12b SKES 13 NO NA E OF AUTOMOBILE INSURANCE CO. AUTOMOBILE INSURANCE POLICY NO. NA E OF AUTOMOBILE INSURANCE CO. AUTOMOBILE INSURANCE POLICY NO. 101I. kr; CO Q' 146 1249 /,v) 4" 0 bL{•qA&&Zl PARTS OF�fEHICLE DAMAGED(40.left front fender,etc.) PARTS OF VEHICLE DAMAGED(i.e.left front tender etc.) ffDAMAGE TOWED TO(if not towed,indicate"none") VEHICLE#2 TOWED TO(if not towed,indicate"none") firI. Doscrtbe the property and extent of damage(e.g.50 feet of fence knocked down)ON2.Give name and address of property owner rA AGE SEX NAME AND ADDRESS OF WITNESS yW H1 W AGE SEX NAME AND ADDRESS OF WITNESS I J I K L NAME AND ADDRESS for operator aI.operator a2.etc I - NIOJP Q I 25 26 27-28 - 29 30 1 r OPERATOR at 1 Z31 32 33-34 _ 2 a PERA TOR OA PEDESTRIAN(circle the one which applies) Z[ t+1 L 3 •�-+ 2 p 37 38 39.40 41 42 3 3 d 43 44 45.46 47 4a O 4 4 49 50 51.52 - 53 54 ..a 5 5 Z 6 55 56- 57-58 - 59 60 _ 8 7 61fl62 +61..6485 66 7 677t 7? s PLEASE DRAW A DIAGRAM OF WHAT HAPPENED The sure to include all vehicle pedestrian and bfCyclul,maneuvers both prior and alter the colbsronj a Draw an arrow P`�E1 t7 tJoT Tv S�q i pointing north in this circle. (��L i o � u W ' o Q �1 A �-r Del II&LAil 01*5a- GioqWri 4 :DIRECTION OF TRAVEL OF EACH VEHICLE.PEDESTRIAN,ETC N �8 E W VEHICLE at EW/N ❑ (J❑ ❑ on VENICLE.e2 yNnO L„Jy ❑ ❑ ❑ an f3rAA4AI PLEASE GIVE-AA COMPLETE DESCRIPTION OF WHAT HAPPENED the sure to explain any prior response marked with an astensay NO s IIIJ 6v^qql A. .JlAe 4T30. nT' •+ S'7T2 a 7 R . A- AJ P�. 9C-17-1 Ua i W 4 U .+Y rnl VJ T1vt Arm r r ,•,7 s Z 0 C,,j Ae�r' kjf:tt .l of- T-1 v C7,eA'M., I- V t/WI Y hC.LR "�I•t/ra :Ja t.0 G UY �1t12%f'7.( .. Ua7 L'�'1fE GF G'7QA-ld+9s'H r4ly- k4,l.'; Oweiv- 04c Alva < Ur'1'�'�faT(1= ±ivD Wj��'E S'tz;JD:rYG rV 2 G?7VE v4,LE S. S _ {ta¢jUt£ i�/L. ! CJN '97otrN T74G9' b+4.�+raGl. 7'La .erCsrX' Sr S: A U r fc- A&U47C Y�!• Taw. ktC�£ c ,.t-r Frewvr u;.z F 57tZtler•✓e yl u.F Qr1 E. �"x►[5M. rs: Ow-r rve 0-4t .SvJ S ;krti 7U4i att s ✓-,+,6a P ©eJ tW4 After' l4Wd yes No If•. �'7 7'hs ffT�l�l tu:Lt�,► 7T Wog s `LJ'/c{ ✓�Fh wu j WERE MEASUREMENTS TAKEN? ❑ ,PHOTOS? ❑ 4 Cont Road x JAL Du NIR Ramp TA x CI SI Cum MOO IRd'Ty I SF Local Road Location 22 25 26 21 28 30 3t 3a 35 J6 J7 38 J9 as a5 a6 U a8 a9 50 53 54 57 56 61. 62 65 • DOT CF Cot Card Card Alpha Description - USE 66 -67 68 69. 7 11 ONLY 4 5 CV Du Man Obl at L Obi a2 L P'C Dn Man CV Dn Man 60-62 Obl al i Obl a2 L P'C Dn Man Card 1. 5 ZO NAME OF PERSON ACTION WAS TAKEN AGAINST TYPE OF ENFORCEMENT ACTION(,r one) COURT DATE AND TOWN CODE IJI. e.t �' ❑ Aired C7 W'rnlip ❑ Note ❑ Other — — — < CHARGE f STATUTE OR ORDINANCE NUMBER UNIFORM SUMMONS/COMPLAINT NUMBER 12 I IrJfY 17�rSS ct>•JL11 T9 uN 5 NAME OF PERSON ACTION WAS TAKEN AGAINST TYPE OF ENFORCEMENT ACTION �l/one) COURT DATE AND TOWN COD ❑ re E Arst ❑ WarnlnE L7-None ❑ Olh•r 2 CHARGE STATUTE OR ORDINANCE NUMBER UNIFORM SUMMONS/COMPLAINT NUMBER W .RANK AND SIGNATURE OF INVESTIGATING OFFICER BADGE NUMBER DEPARTMENT NAME - REPORT DATE CASE STATUS SUPERVISOR Open Closed PR-1 Re11.6-85 BACK) i SOUT14 WINDSOR POLICE DEPARTMENT LSUP!LEMWVOR STATEMENT DATE/TIME OF INCIDENT INCIDENT/COMPLAINT DATE OF THIS REPORT CASE N 69 q1 AM )0-J-,of lql-60,ZG� - IF STATEMENT TAKEN BY: WHERE T^AJ DATEITIME TAKEN GIVEN BY yyIVARNING: THE CONSTITUTION REQUIRES THAT I INFORM YOU OF YOUR RIGHTS: YOU HAVE THE RIGHT TO REMAIN SILENT. IF YOU TALK TO ANY POLICE OFFICER ANYTHING YOU SAY CAN AND WILL BE USED AGAINST YOU IN COURT. YOU HAVE A RIGHT TO CONSULT WITH A RD A LAWYER ONE WILL BE APPO NTEO FOYOU AhER YOU IFYOU WISH.NED MAY BEFORE ANY QUESTIO HAVE HIM WITH NING IF YO DURINGQUESTIONING. W SH TONANSWER QUESTIONS VpU If YOU CANNOT HA E THE R QHt TO STOP ANSWERING AT ANY TIMIL. YOU MAY STOP ANSWERING QUESTIONS AT ANY TIME IF YOU WISH TO TALK TO A LAWYER,AND MAY HAVE HIM WITH YOU DURING ANY FURTHER QUESTIONING. WITNESS: _ WARNING UNDERSTOOD SIGNED Grj (T;C -I9+Y A wilW Ols trFA cam, -its t /#jn3s C.:o,i-,CyL `3y•r t4E CAYkA ijc —, bo so A&,:4uiF_ n,or- rxtt s[-DPP / s. �r�ntiJwslu,� �7.vh,1 17 E3QFA� oc >NT;14lle,F -fb J C•-e,& ST?Fq t;, Ayr— of G onm 7zit, ;iL\,V 5"11G 1 A-S vY E.L.I. A`s 71.1.1; C<W Q I Tl UNS - Cl— r-E 0060 S'Vef-Ac r 7- t t 7W7s 40AA(*t 1 UY,r!1wJi r 6rJ 3A,W OCL '72.sr 71►o 'rt.V suW LrG( I At AJ 1 IUQ 700 Jxy r AZ Z146 C,0qj,,r76,vS i9r✓sI 43 A &.S C.i I,USr' C.cxJ-IYZ L uF P"s s%ia SUASLouzAj&Li r5'-mizIG Ori 1'rJs7nr-en-yOfJA A40.3 fief 1 G%VF f -7Z -I-)4L Si...tPf v P--a-4J> cwnl n uns t5u- KLos-,wslct 5/ftuL0 I4,w F CC..rey!6 -ntost \L cp,j^I rlu ry s, rw-ra r1-Ia TuSti7rw Ito sfoA ACGCp-b.y✓cu V(S{P051'nod cyrrl'1�772 !-wo V-WSCynfSIC( vJ1S ISSutn A Plel "- 1 W&ee )rML f2e 7ZZ, AA30 fYL i I' I HAVE READ THE ABOVE STATEMENT AND 1T IS TRUE TO THE BEST OF MY KNOWLEDGE. I FULLY UNDERSTAND THAT IF I MAKE A STATE- MENT THAT IS UNTRUE AND WHICH IS INTENDED TO MISLEAD A LAW ENFORCEMENT OFFICER IN THE PERFORMANCE OF HIS OFFICIAL FUNCTION I WILL BE IN VIOLATION OF SECTION 53a-157. CONNECTICUT GENERAL STATUTES. A FALSE STATEMENT IS A CLASS A MISOE- iMEANOR,UP TO I YEAR IN JAIL AND/OR $1000.00 FINE AND NOT MORE THAN 3 YEARS PROBATION. I have read this statement consisting of ... . ... . ..... ... page(s), and I affirm to the truth and accuracy of the facts contained therein. ii This statement was completed at . . . . . . . M, on the . . , , , day of . . . . . , . . , 19 , , . . . WITNESS U Signature of person giving statement SUBSCRIBED AND SWOON BEFORE ME THIS DAY OF 19 SIGNED: White- File Copy Yellow-Detective Pink- Officer P LICE ACCIDENT REPORT Please send to STATE OF CONNECTICUT o P 1` v.vs1 .11 DEPARTMENT OF TRANSPORTATION 3 ACCIDENT RECORDS SECTION 2175 BERLIN TURNPIKE Q NEWINGTON,CT 06111 1-sbOT CASE NUMBER E I .. ..J F'm17-12 DATE OFACCIDENT AY OF WEEK 13-16 TIME(military) #KILLED #INJURED #OF VEHICLES POLICE CASE NUMBER n onth) (day) (y INVOLVED i I 17-19 CITY OR TOW me) (City Town Code) ACCIDENT OCCURRED ON(street name or route#)AT ITS INTERSECTION WITH(street name or route#1) 13 Z IF NOT AT INTERSECTION 3. Give nearest intersecting street(name or route#) 1 1 underpass,overpass,bridge,river or town line. c 1. Give distance and ✓either 2. Check(✓)direction. 7 � DO NOT USE house#,utility pole#,or business name. Feet"or'T nths"of a male. o 4 �Q� Feet North El ❑ ,1 r El Tenths of OPERATOR AND VEHICLE#1 OPERATOR AND VEHICLE#2 (or pedestrian) E 6 OPERATOR#1 NAME(last,first,middle initial) PERATOR#2 OR PEDESTRIAN NAME(last,first,middle initial) 11v� V-1 F 9 ADDRESS(street number and name) Q ADDR S(street number and name) CITY OR TOWN STATE ZIP CODE 20 SEX CITY OR TO STATE ZIP CODE 21 SEX 1011 Gi d1,L c tate 24-48 OPERATOR LICE SE NUMBER 49-54 DATE OF BIRTH OT Lic State 9.33 O RATOR LICENSE NUMBER 39 DATE OF BIRTH Cade ONLY Code 12 13 O ® V i 1 2 1 G7 VEHICLE If 1 OWNER NAME(ff same as operator#1,enter"same) VEHICLE If 2 OWNER NAMeSQY same as operator#2,enter"s e) M 1415 ADDRESS(streetnumber dnd name) ADDRESS(street number andname Gz CITY OR TOWN STATE ZIP CODE CITY OR TOWN STATE ZIP CODE 1627 G✓ 40-Al PLATE#AND STATE CODE VEHICLE YEAR AND MAKE 42-43 PLATE#AND STATE CODE V ICLE Y KD MAKE C� ,C>, m 4CLE MODEL NAME BODY TYPE(e.g.4-door sedan,truck,etc.) VEHICLE MODEL NAME BODY TYPE(e.g. oor sedan,truck,etc.) is i9 44-61 VEHICLE IDENTIFICATION NUMBER(not engine number) ODO Y 7-24 VEHICLE(DENT (CATION NUMBER(not engine numbIL �\ '� •�- �' 2 3 2021 Did operator carry a current Connecticut No-Fault Insurance Did operator carry current Connecticut No-Fault Insurance r2—] I.D.Card in vehicle as required under CGS,Section 14-12b YES ❑ NO I.D.Card in veh' a as required under CGS,Section 14-12b ❑Y ❑ NO NAME OF AUTOMOBILE INSURANCE CO. AUTOMOBILE INSURANCE POLICY NO. NAME OF A OMOBILE INSURANCE CO. AUTOMOBILE INSURANC OLICY NO. PARTS OF VEHICLE DAMAGED(i.e.left front fender,etc.) PART F VEHICLE DAMAGED(i.e.left front render,etc.) `� ���i Qom. SQ •1r Q1 Q� VEHICLE#1 TOWED TO(ffnot towed,Indicate"none) ICLE#2 TOWED TO towed,indicate none)V DAMAGE TO 1.Describe the property and extent of damage(e.g.50 feet of fence knocked down) CC PROPERTY W OTHER THAN OINVOLVED 2.Give name and address of property owner Cr VEHICLES Ql) y AGE SEX NAME AND ADDRESS OF WITNESS W rn H Z AGE SEX NAME AND ADDRESS OF WITNESS F- 3 J I K L NAME AND ADDRESS(or operator#1,operator#2,etc.) M N �pO P O _L 1 5 2s 27-2� OPERATOR If 1y 2 Z 31 132 33-34 �+ �_35 38 OPERATOR#2 OR PEDESTRIAN(circle the one which applies) 2 N 3 37 38 39-40 41 42 3 IL a 4 43 44 45-46 47 48 4 0 > 49 50 51-52 53 54 5 O' Z6 55 56 57-58 59 60 6 J 61 62 63-64 65 66 _j 7 7 'Q 8 67- 66 69-70 - 71 72 -..8 Cs PLEASE DRAY/A DIAGRAM OF WHAT HAPPENED(be sure to include all vehicle pedestrian and bicyclist maneuvers both prior and a/ter the collision) Draw an arrow pointing north in Q kU5 UVW� i this circle. j . 0 &IL W IM a 0 a `o DIRECTION OF TRAVEL OF EACH VEHICLE,PEDESTRIAN,ETC. VEHICLE#1 going LJ [In 0 on �Q� VEHICLE#2 going on PLEASE GIVE A COMPLETE DESCRIPTION OF WHAT HAPPENED(be sure to explain any prior response marked with an asterisk*) o r U W N W p a Yes N Yes WERE MEASUREMENTS TAKEN? PHOTOS? 4 Cont Road# RL Oir NIR Ramp TR# CL St Cum Mile Rd Ty 1, SF Local Road Location 22 25 26 27 28 30 31 34 35 36 37 38 39 44 45 46 47 48 49 50 53 54 57 58 61 62 65 DOT CF Col Card Card Alpha Description USE 66 67 68 69 7 - ONLY 4 1 5 41 CV Dir Man Obj#1 1 L Obj#21 L I P C Dir Man I CVJ Dir I Man 60-62 jObj#1 I L jObj#2 L P C I Dir Man Card 5 'ZO NAME OF PERSON ACTION WAS TAKEN AGAINST TYPE OF ENF RCEM ENT ACTION(/one) COURT DATE AND TOWN CODE Written\ _ U � �Arrest �Warning [:]None Other a CHARGE STATUTE OR ORDINANCE NUMBER UNIFORM SUMMONS/COMPLAINT NUMBER W �� �\ Z NAME OF PERSON ACTION WAS TAKEN AGAINST TYPE OF ENFORCEMENT ACTION(✓one) COURT DATE AND TOWN CODE LU Written IX Q Arrest Warning ®\ None Other — — 2 CHARGE STATUTE OR ORDINANCE NUMBER UNIFORM SUMMONS/COMPLAINT NUMBER Z W RANK AND SIGNATURE OF INVESTIGATING OFFICER BADGE NUMBER DEPARTMENT NAME REPORT DATE CASE STATUS SUPERVISOR Open Cloged PP-1 Rev.1/91(BACK) Ohl r • • ' '�Al 4 Narrative: See manual for • •ual report Instructions. ` " WNa 0 go M i 10 knpl _ " ` • Owill ♦ �� , ire 11 _1� !, -N `,I ON=NNO , 01 ,'% / % 1 PQRCE ACCIDENT REPORT Please send to STATE OF CONNECTICUT DOT DEPARTMENT OF TRANSPORTATION ONLY PR• Re 1791 3 ACCIDENT RECORDS SECTION 2175 BERLIN TURNPIKE NEWINGTON,CT 06111' 1-6 DOT CASE NUMBER 4❑ u 7-12 DATE OF ACCIDENT DAY OF WEEK 13-16 TIME(military) #KILLED #INJURED #OF VEHICLES POLICE CASE NUMBER A {month) .(day) ( INVOLVED 17-19 CITY OR TOWN e) (City Town Code) ACCIDENT OCCURRED ON(street name or route#)AT ITS INTERSECTION WITH(street name or route#1) 1 e 1 � of Soft 2 Z IF NOT AT INTERSECTION _O 3. Give nearest Intersecting street(name or route#) t 1. Give distance and✓either 2. Check(✓)direction. underpass,overpass,bridge,river or town line. c , Q 'Feet"or"Tenths"of a mile. North S E W DO NOT USE house#,utility pole#,or business name. ❑ Feet y 1/10 ff Tenths ❑ lrl ❑ ❑ of _ LtlFa2MAn/ w4y a OPERATOR AND VEHICLE#1 OPERATOR AND VEHICLE#2 (or pedestrian) r OPERATOR#1 NAME(last,first,middle initial) OPERATOR#2 OR PEDESTRIAN NAME(last first,middle initial) A - QPIL4#4 M 9 ADDRESS(street number and name) ADDRESS(street number and name) [i] 4 6W,4 Ate+ 90,4 CITY OR TOWN STATE ZIP CODE 20 SEX CITY OR TOWN STATE ZIP CODE 21 SEX 1011 ra sour�,1 A11441sot CT oLic State 24.48 OPERATOR LICENSE NUMBER 49-54 DATEOF BIRTH DOT Lic State 9-33 OPERATOR LICENSE NUMBER 34-39 DATE OF BI Code ONLY Code ,11 213 C� ce toy (oq t / 1 2 I O, VEHICLE#1 OWNER NAME(ffsame as operator ,enter same) VEHICLE#2 OWNER NAME(if same as operator#2,enter same) /s ADDRESS(street number and n me) 14 15 ,AN.3Rn/R-1 fif"G — ADDRESS(street number and name) G2 CITY OR TOWN STATE ZIP CODE CITY OR TOWN STATE ZIP CODE 1827 1 40-41 PLATE#AND STATE CODE VEHICLE YEAR AND MAKE 42-43 PLATE#AND STATE CODE VEHICLE YEAR AND MAKE ❑ (. 9 13U14lc EHICLE MODEL NAME BODY TYPE(e.g.4-door sedan,truck,etc.) VEHICLE MODEL NAME BODY TYPE(e.g.4-door sedan,truck,etc.) tots EGA L2 3)0az fbDA�d 11, 44.61 VEHICLE IDENTIFICATION NUMBER(not engine number) ODOT NLY 7.24 VEHICLE IDENTIFICATION NUMBER(not engine number) d t 10r A 43661 23 12 3 2021 Did operator carry a current Connecticut No-Fault Insurance �(ES ❑ NO Did operator carry a current Connecticut No-Fault Insurance Ft2... I.D.Card in vehicle as required under CGS,Section 14-12b I.D.Card in vehicle as required ❑YES under CGS,Section 14-12b ❑ No E OF AUTOMOBILE INSURANCE CO. AUTOMO NA BILE INSURANCE POLICY NO, NAME OF AUTOMOBILE INSURANCE E POLICY NO. CO. AUTOMOBILE INSURANC &L.6 -m °L INS Co. 0 d PARTS OFYEHICLE MAGED(i.e.left front fender,etc.) PARTS OF VEHICLE DAMAGED(l.e.left front lender,etc.) , VEHICLE#1 TOWED TO(if not towed,indicate none) VEHICLE#2 TOWED TO(ifnot towed,Indicate"none") o W iirOSui M/1'IJ7—o DAMAGE TO 1.Describe the property and extent of damag (e.g.50 feet offence knocked down) PROPERTY Uj OTHER T' -b4mle o4 RoobtvbtoN) do" AC 06 THAN cD INVOLVED 2•Give name and address ofproperty owner a. VEHICLES —10044 47:0rr,s 32 QV444m Ago SbtrrwLjjW0.re4r000� CaAGE SEX NAME AND ADDRESS OF WITNESS co 31 F pt✓�+ QoSA 1107 b.U'VC �,t R Sovsat , 4 Ste4-. `0:7 H AGE SEX NAME AND ADDRESS OF WITNESS 3 ' J I K L NAMEAND ADDRESS(or operator#1,operator#2,etc.) M N O P 0 25 26 27.26 1 C. O,, OPERATOR#1 �t 29 30 1 to 2 31 32 33-34 35 36 U) OPERATOR#2 OR PEDESTRIAN(circle the one which applies) 2 (n 3 37 38 39.40 - 41 42 U.1 3 IL 4 43 44 45-46 47 48 W 4 49 50 51-52 j 53 54 L. 5 55 56 57-58 _Z 6 59 60 6 J 61 62 63.64 —I 7 65 66 a 7 8 67 68 69.70 71 72 S PLEASE DhAW A DIAGRAM OF WHAT HAPPENED(be sure to include all vehicle pedestrian and bicyclist maneuvers both prior and after the collision), Draw an arrow pointing north in 4-40wae this circle. 0 z o , U W IM DIRECTION OF TRAVEL OF EACH VEHICLE,PEDESTRIAN,ETC. N S E W /+I N S E W VEHICLE#1 going [Vf 0 Q on G 4Qt�, M VEHICLE#2 going 0 0 El on PLEASE GIVE A COMPLETE DESCRIPTION OF WHAT HAPPENED(be sure to explain any prior response marked with an asterisk bo rfvr<Qs. N I s 3 SrFf4tss �/ u t ✓ z O W w ta-r Fn cz• �i2!T �S��c. G-r rac �U4�9N -n�2f�c.-t-�u., 2Et'..�o� ✓ �c a z act t UNE, s spa 4,v Ars A !qU L-n F A OH- nP "4q� .L T w49 s A414 Div. �M47- ©AYZgM QIk Gf i La r [ 4 ,4 s Sqt S "4 ✓ dG ��£ .Nv� Yes No Yes No - �'"t� WERE MEASUREMENTS TAKEN? E] &K PHOTOS? 4 Cont/eRoad# RL Dir NIR Ramp TR# CL St Cum Mile Rd Ty I SF Local Road Location 22 25 26 27 28 30 31 34 35 36 37 38 39 44 45 46 47 48 49 54 57. 58 50 63 61 62- 65 DOT CF Cot Card Card Alpha Description USE 66 67 66 69 7 ;ONLY 4 5 4t i I CV Dir Man Obj#1 L Obj#2 L P C Dir Man CV Dir Man 60-62 Obj#1 L Obj#2 L P C Dir Man Card 5 O NAME OF PERSON ACTION WAS TAKEN AGAINST TYPE OF ENFORCEMENT ACTION(I one)Written COURT DATE AND TOWN CODE /� 4v'r/ 0&414 ❑Arrest ❑ Warning ❑ None IyOther Q CHARGE STATUTE OR ORDINANCE NUMBER UNIFORM SUMMONS/COMPLAINT NUMBER H /� t` W f i /71Z 1 770✓ / T Zl SG V (� GJ le. W NAME OF PERSON ACTION WAS TAKEN AGAINST TYPE OF ENFORCEMENT ACTION(/one) COURT DATE AND TOWN CODE (� Written ❑Arrest ❑ Warning lone ❑Other O CHARGE STATUTE OR ORDINANCE NUMBER UNIFORM SUMMONS/COMPLAINT NUMBER z W RANK AND SIGNATURE OF INVESTIGATING OFFICER - BADGE NUMBER DEPARTMENT NAME [RJORT DATE CASE STATUS SUPERVISOR Open Clossedd �/ 9 ❑ LM to PR-1 Rev.1/ ACK) w Town of - South POLICE SERVICES Vindsor CONTINUATION PAGE FVICLL rrative: See manual for individual report instructions. E.vT ss 0 sz9 4 E Fiatsr o- ,r D 1 1 q M GL V2 C& 2 U 1.o 4 Aa owy cw&,r, c*mwm. o/- a ✓E #4tA o4 3 gr c a!rAa A Pvj>vu6 uF �31�4e44 /cCr 3.4 Q. 4 0 5 � 6 7 uT Lo Z ' M0'*4 tc i Co L G� V/ o s 8 P TL c r n.s -r 9 00 *- LON> 400 10 i 00- rig& A2 12 2 T1s "TK1>, vH�cIJLS ,Zt Oqk G,VVS 49 13 Y M -7Vq F-AS'T" (VZ T14C ICy Co^Ad sr7 14 fS 1. ST C9N"1Yiv Y/G ht l IY 7'I i ti i y1-,0 15 'T'>tt� GO a ion l- i iwG 16 S+ oN: T12 t 7 e AM S oNR 1 S 17 ✓ELW 6 7U 0 .!T /�R "" f- dt-0540 18 19 20 21 22 23 24 25 26 27 28 29 30 31 ;r 32 33 34 2.Elf 13.Page 4.Case Number SLAPS-80(7.90) �a� a 01 d' 93-0113s' POLICE ACCIDENT REPORT Please send to STATE OF CONNECTICUT o v PR-1 l91 DEPARTMENT OF TRANSPORTATION 3 ACCIDENT RECORDS SECTION 2175 BERLIN TURNPIKE NEWINGTON,CT 06111 1-6 DOT CASE NUMBER ,00aS 7-12 DATE OF ACCIDENT DAY OF WEEK 13 16 TIME(military) #KILLED #INJURED 10OF VEHICLES POLICE CASE NUMBER A (month) (day) (year) 1 INVOLVED 0 3 0 9 3 TNU o o ! 0 1 1 93 -0 /Y,6 pp3S 17-19 CITY OR TOWN(name) (City Town Code) ACCIDENT OCCURRED ON(street name or route#)AT ITS INTERSECTION WITH(street name or route#1) 8 S 0 UT SNO oi? I i"Z,�- yI'1 20� ZO IF NOT AT INTERSECTION 3. Give nearest intersecting strebt(name or route#) L 0 1. Give distance and✓either 2. Check(✓)direction. underpass,overpass,bridge,river or town line. c Q DO NOT USE house#,utility pole#,or business name. o UO r 'Feet"or"Tenths"of a mile. ❑ Feet North S E W (� Tenths ❑ ® El ❑ of `' r 6 OPERATOR AND VEHICLE#1 </— a OPERATOR AND VEHICLE#2 (or pedestrian) OPERATOR#1 NAME(last,first,middle initial) OPERATOR#2 OR PEDESTRIAN NAME(last,first middle initial) c.VA7-01?E o515PH 9 a ADDRESS(street number and name) ADDRESS(street number and name) �•+ 6 tzEE/�It�1�Gl+� DiZ. S CITY OR TOWN STATE ZIP CODE 20 SEX CITY OR TOWN STATE ZIP CODE 21 SEX 1011 ro 001 ,J0iC 0607 M � Lic State .48 OPERATOR LICENSE NUMBER 49.54 DATE OF BIRTH DOT LicState g-33 OPERATOR LICENSE NUMBER 34.39 DATE OF BIRTHCode ONLY Code - t213 6124 y� 8`do oa 01 o 6 8 1 2 , G, VEHICLE#1 OWNER�NAAME(if same as operator 0,enter Same) . VEHICLE#2 OWNER NAME(if same as operator#2,enter°same) I Z 1415 ADDRESS(street number and name) ADDRESS(street number and name) G2r CITY OR,TOWN STATE ZIP CODE CITY OR TOWN STATE ZIP CODE 1627 r2 I 40-41 PLATE It AND STAT€CODE VEHICLE YEAR AND MAKE 42-43 PLATE#AND STATE CODE VEHICLE YEAR AND MAKE P—' I o I v '70 CttEil 'EHICLr=MODEL NAME BODY TYPE(e.g.4-door sedan,truck,etc.) VEHICLE MODEL NAME BODY TYPE(q.g.4-doorsedan,truck,etc.) 1819 el&6 SS H H, 44-61 VEHICLE IDENTIFICATION NUMBER(not engine number) ODO Y 7.24 VEHICLE IDENTIFICATION NUMBER(not engine number) Q 1 /36 3 70!3 12 FY,3 V2 3 2021 Did operator carry a current Connecticut No-Fault Insurance 1 Did operator carry a current Connecticut No-Fault Insurance H2 I.D.Card in vehicle as required under CGS,Section 14-12b ®.YES ❑ NO ID.Card in vehicle as required under CGS,Section 14-12b ❑YES ❑ NO NAME OF AUTOMOBILE INSURANCE CO. AUTOMOBILE INSURANCE POLICY NO. NAME OF AUTOMOBILE INSURANCE CO. AUTOMOBILE INSURANCE POLICY NO. r nawwxz>6 MoP, 5' iJ 665" PARTS OF VEHICLE DAMAGED(i.e.left front lender,etc.) PARTS OF VEHICLE DAMAGED(i.e.left front fender,etc.) MT F, oN i 0-1 , AZ-. VEHICLE It 1 TOWED TO(if not towed,indicate"none') VEHICLE#2 TOWED TO(lint towed,indicate'none) REENFI�LD t7Z i3y .Sc.J2r/D G'Af?. DAMAGE TO 1 the Ox and��extent (e.g.of damage5 en knocked �) PROPERTY � s� r w / 1u. OTHER THAN �/ "/ cJ UJ�»V/v cp INVOLVED 2•Give name and ad ess of,4 Cproperty owner a VEHICLES '""' 'v /' -1— v3�GiZatt7'�7�'t 52�.� Z,J/V y AGE SEX NAME AND ADDRE S O I NESS co co � Fn d Z AGE SEX NAME AND ADDRESS OF WITNESS H ,3 J 1 K L NAME AND ADDRESS(or operator#1,operator#2,etc.) M N O P O 25 26 27-28 29 30 1 OPERATOR#1 0 07 1 31 32 33-34 35 36 CO 2 OPERATOR#2 OR PEDESTRIAN(circle the one which applies) 2 3 37 38 39-40 - 41 42 - 3 W ' a 43 44 45-46 - 47 48 4 G 4 tL 49 50 51-52 53 64 5 5 Z 6 55 56 57-58 59 60 6 J 61 62 63-64 65 66 Q 7 7 8 67 68 69-70 71 72 1 PLEASE DRAW A DIAGRAM OF WHAT HAPPENED(be sure to include all vehicle pedestrian and bicyclist maneuvers both prior and alter the collision) Draw an arrow /� A='A 130O —75 FT" S P<Mr39 A KKS F_M AXLZox - pointing north in L✓ _ ) 13=MAiLf30)c1NEi.j5e"1-APE(Z 30X this circle. C c R1xK G— FXNAL. VZS:sT 0= TREfFs E= TIZAF M t-J W a mouT GS F P,/f I AG �lys 91-711H?"Y7 XL> o o ^/o To SCAt-F— DIRECTION OF TRAVEL OF EACH VEHICLE,PEDESTRIAN,ETC. (.�.�,{,�� �_ S E W 8Xr4If� 'w,4� N 3 E W VEHICLE#1 going Q � � on - VEHICLE#2 going El 11 0 El on i PLEASE GIVE A COMPLETE DESCRIPTION OF WHAT HAPPENED(be sure to explain any prior response marked with an asterisk*) ON TNU O M.4lZ 93 67- /4-6dtJ7- 0667 1-t77,S :r WA;S ofr /4- A40TZ i-C AiPaX pEtJ T o N (3,rw n7 ryr i 2a. N EAI Z.. �r- iZA'Ft7t-YYt .yNf ' 'a-S. U Z.;.v e4b Psi f o v 1 o c)S-y SAOD E i LjKAAJ W J Gcm��1 /JAWe AW D t�rzR�"oi� E. �vsEr�tt s���►�1Z-r Z�a:zY . p �Zt+ %Z Cr y F NE . Titer MYA -rNVO"VfS� Couc.� r GFNZC./rnWERE MEASUREMENTS TAKEN? Yes No Yes No PHOTOS? 4 ContVRoad ILL Dir NIRR# CL St Cum Mile Rd Ty I SF Local Road Location it 25 26 27 28 3039 44 45 46 47 48 49 50 5354 5758 61 62 65 I'bOT Cot Card Card Alpha Description USE 68 69 7 ONLY 4 5 41 CV Dir Man Obj#1 L Obj#2 L P C 1!±CV Dir Man 60-62 Obi#1 L Obj#2 L P C-1 T Man Card 5 O NAME OF PERSON ACTION WAS TAKEN AGAINST`, �7 TYPE OF ENFORCEMENT ACTION TV one) COURT DATE AND TOWN CODE ri �5 epif a�Y AT`7'� Arrest wartning None Other O3 19 0 CHARGE STATUTE OR ORDINANCE NU BER UNIFORM SUMMONS/COMPLAINT NUMBER w ,�v• Too � Dr-1 NS — 1 C o`t 111-5 NAME OF PERSON ACTION WAS TAKEN AGAINST TYPE OF ENFORCEMENT ACTION(✓one) COURT DATE AND TOWN CODE U Written IY Arrest Warning None Other ZCHARGE STATUTE OR ORDINANCE NUMBER FUNIFORMONS/COMPLAINT NUMBER LU p. RANK AANNDSIGNATURE OF INVESTIGATIN FICER BADGE NUMBER DEP�A�RTTMENT NAME REPORT DATE SUPERVISORV1pen (J 'R-1 Rev.1l91(BACK) J - Town of POLICE SERVICES South -� i u Y WindsorCONTINUATION PAGE FNarrative: See manual for individual report instructions. q-oiz T a2 EAtZ of I+s� NO—SE. .i , m o�vE►] - , �Q�JZ.R,N`C� /�-N D G t YF -Y -A�. 2 3 MAN D� D A z,-HCaYQG v r"Iv M Y 1"Z`Z2YA-L . 4 IZA"ttIt'Yl JZD .%5 '1 WO LA-"E WL,J Y L�J F 4- 5 o N E i7- N—f3 d(JAI D A V i D or1 f 7 vbZ —raoL w D -fTzRf-F-� 6 EN��,� C3+YV ZFsT,a�V(, E4 s Y i Z N s4ki z. 71TV- 10 AZ0P6Vz i y/� /KNor,JtJ qL49 - 611ZMMY1'1 2 D . VEH UNE 11 G'�4 Y I.iy����1�`Al,soul 12 5PF F & .!. E--� —p Z i .L C Al 'lam t,+J psi 13 14 i; 15 yevy ffY�7�ZC/ 16 fk QD EW k,OX i � F'i 3� 17 ,p,tYtt7c `Z17t� �ls �1� E2� 16 '! �►1"r�i �� 19 izoo? Dr --1ZEE<S 3 TZE S l-}yZ' 20 22 d C,,JN 5 4-DeV b 12L��G.1J4 f 24 25 �- E K.L !��Z���S� yJ,,F-Z E 26 (ill},--� 1JY MIS 27 7nT N c> LfN-N E o u i l-• Of— 28 FIN t'rZ, —68 ► v Z Qom!�+ 1~ L� 2s 30 7- �/` 3� Cj ( Z�, 31 C�I'E2//P���i vZ E GN-7�E �SAr�D �1i Ifi1P�73� ( 32 ICcJ.`j W c^\S r vC- 7C t,�5T M�1 E 33 � {,,J A-S V CD G d (�N 34 2.EIN 3.Page / 4.Case Number SLAPS-80(7-90) `a 3 of 4 Town of South POLICE SERVICES �� VindsorCONTINUATION PAGE Narrative: See manual for individual report instructions. cf= , V 1-4 O-N a , PE A� SZ oN r s t� niv 111-1 2 `3 c)XNG /��.300T ZSS' OI PI-> oPWA-iaSZ 3 SAC 4 5 C ��J• 6 c0 ItA-D o -1 iZ-�.I,�cl/�E 1� Cam 1_ fi5 7 uN P A7 ^t�VM zXz-E L�un�E i� j�T�. s c E: '��N e c�cr�,z a A- S 1U ePOW NY A MW 11 SC7 -rF— SC t=. 12 13 - 14 �[t�c���1�7 15 Q-SOU 1�i CF F— v�" m-z 1�. L=. / 16 0i?0z > j iT A a l- dam - �S / 17 j bG��lr°'T�i7 /�L-� Zi�Z` . �3E� z ES 18 13ASED vi 1 r� J�1'�'ti�N 1���N �0. 1���lYli� 1g -,.- IN f"3, '"--"F-V E D Vim.W O N S- 20 VICE v E� E S K-DVED (C0-tZacSS jjrF S ?�CS(1N> 23 61w1�j T-Fj,'> T Li 5-:15 T 24 01V2t 6vk C/Y%i E< S-,7Z(xK 1 VTF- 612- 0 25 ' 60S7AP'CIG C 130)(EiS 1 1 qtb AWJ�> 26 TMW 27 _ C--vri C* _T O(-.�;�4 1y S Me Q Ts 28 GGn1 Y n 29 C��V ./ M S(� fteVZO cSS 30 �;^�A- tJ ^-� C 31 G ZU l�1- 6� \l M„F7 �.NG 32 -mgi-r5 vs tA- tw a 33 34 2.EIN 3.Page 4.Case Number SLAPS-80 c7-g01 i I Town of South =� POLICE SERVICES Vindsor CONTINUATION PAGE Narrative: 'See manual for individual report instructions. LJ HZt-=- C0mr1NG FZv A-L, SiTZ Q C K v / �Z A-F " C._ /v . 2 4 5 6 7 8 i 9 10 11 12 13 14 15 16 17 18 19 20 is 21 22 23 24 25 26 is 27 I j 28 i I 29 30 i 31 32 33 34 2.EIN 3.Page 4.Case Number SW PS-80(7.90) //l v-)— M S 3-o/YS6 P LICE ACCIDENT REPORT Please send to STATE OF CONNECTICUT ED.OT DEPARTMENT OF TRANSPORTATION Y 1 ftev.1f9t 3 ACCIDENT RECORDS SECTION 2175 BERLIN TURNPIKE NEWINGTON,CT 06111 1-6 DOT CASE NUMBER 4❑ I �531 '-12 DATE OF ACCIDENT DAY OF WEEK 113-16 TIME(military) *KILLED #INJURED #OF VEHICLES POLICE CASE NUMBER n (month) (day) (year) INVOLVED 17-19 CITY OR TOWN(name) (City Town Code) ACCIDENT OCCURRED ON(street name or route#)AT ITS INTERSECTION WIT (street name or route#1) B Z IF NOT AT INTERSECTION 3. Give nearest intersecting street(name or route#) O underpass,overpass,bridge,river or town line. c t— 1. Give distance and ✓either 2. Check(✓)direction. 7 Q DO NOT USE house#,utility pole#,or business name. UO "Feet"or"Tenths"of a mile. North S E W—+ Feet J ® ❑ El ❑ of 4c xln q o Gf//� Y ILI Ca O Tenths❑ 8 OPERATOR AND VEHICLE#1_ OPERATOR AND VEHICLE#2 (or pedestrian) E7 OPERATOR#1 NAME(last,first,middle initial) �G OPERATOR#2 OR PEDESTRIAN NAME(last,first,middle initial) . r n/7 ADDRESS(street number and n me) ADDRESS(street number and name) CITY OR TOWN STATE ZIP CODE 20 SEX CITY OR TOWN STATE ZIP CO 21 SEX 1011 G1 Lic State 24-48 OPERATOR LICENSE NUMBER 49.54 DATE OF BIRTH DOT Lic State 9-33 OPERATOR LICENSE NUMBER 34-39 DATE OF BIRTH Code ONLY Code 1213 1 2 G! VEHICLE#1 OWNER NAME(if same as operator#1,enter"same') VEHICLE#2 OWNER NAME(if same as operator#2,ent "same') r� 1415 ADDRESS(street number and n me) ADDRESS(street number and name) G2 CITY OR TOWN STATE ZIP CODE CITY OR TOWN STATE ZIP CODE 1627 G2 . 40.41 PLATE#AND STATE CODE VEHICLE YEAR AND MAKE 42-43 PLATE#AND STATE C E VEHICLE YEAR AND MAKE 356 HC'Z/0 6 9 E" VEHICLE MODEL NAME BODY TYPE(e.g.4-door sedan,truck,etc.) VEHICLE MODEL N BODY TYPE(e.g.4-door sedan,truck,etc.) 1819 H7 44-61 VEHICLE IDENTIFICATION NUMBER(Loot engine,/lumber) ONLY 7-24 V CLE IDENTIFICATION NUMBER(not engine number) /✓/� 9 9 6/ / 2 3 2021 Did operator carry a current Connecticut No-Fault Insurance II�1 Did operator carry a current Connecticut No-Fault Insurance H2 [I I.D.Card in vehicle as required under CGS,Section 14-12b YES ❑ NO LD.Cardin vehicle as required under CGS,Section 14-12b ❑YES ❑ NO .� NAA OF AUTOMOBILE INSURANCE CO. AUTOMOBILE INSURANCE POLICY NO. NAME OF AUTOMOBILE INSURANCE CO. AUTOMOBILE INSURANCE O. s r a-�' PARTS OF VEHICLE DAMAGED(i.e.left front fender,etc.) PARTS OF VEHICLE DAMAGED(i.e.left front c.) VE}QCLE#1 TOWED TO(if not towed,indicate"none) VEHICLE#2 T (if not towed,indicate'none') DAMAGE TO 1.Describe the property and extent of damage(e.g.50 feet of fence knocked down) tY PROPERTY sT� 7 33 — U — S Lu OTHER THAN O INVOLVED 2.Give name and address of property owner L VEHICLES N / /�_Z ca AGE SEX NAME AND ADDRESS OF WITNESS W N LU Z AGE SEX NAME AND ADDRESS OF WITNESS 3 J I K L NAME AND ADDRESS(or operator#1,operator#2,etc.) M N O 3PP O 25 zs 27-zfi a .> A 1 OPERATOR#1 l? 1 31 32 33-34 35 36 Z OPERATOR#2 OR PEDESTRIAN(circle the one which applies) — 2 N 37 38 39-40 41 42 3 W n, 43 44 45-46 47 48 4 49 50 51-52 J65 54 5 Z 55 56 57-58 60 6 J 61 62 63.64 66 7 69-70 72 8 PLEASE DRAW A DIAGRAM OF WHAT HAPPENED(be sure to include all vehicle pedestrian and bicyclist maneuvers both prior and after the collision) Draw an arrow14 pointing north in O this circle. rIN �tiiky O .{- 1 1 z O U 'i W cn IX IX 1 l3!_J ED a a 'c DIRECTION OF TRAVEL OF EACH VEHICLE,PEDESTRIAN,ETC. N VEHICLE#1 going Ig ❑ ❑ ❑ on Q A u A m Rd VEHICLE#2 going p.Q.,�- on �— PLEASE GIVE A COMPLETE DESCRIPTION OF WHAT HAPPENED(be sure to explain any prior response marked with an asterisk) c -L 1 - 4-7 % /"O r # z H �P / Pl ! N ESS U W W icl�: -z Zv s - 1 , JF a z Yes No Yes No WERE MEASUREMENTS TAKEN? ❑ ,® PHOTOS? ❑ 4 Cont Road# RL Dir NIR Ramp TR# CL St Cum Mile Rd Ty I SF Local Road Location 22 25 26 27 28 30 31 34 35 36 37 38 39 44 45 46 47 48 49 50 531541 57 58 61 62 65 j I I j DOT CF Col Card Card Alpha Description USE 66 67 68 69 7 41 ONLY 14 5 i I i I 1 1 1i CV DI, Man Obj#1 L Obj#2 L IP C Dir Man I CV Dir Man 60.62 Obj If 1 L I Obj#2 IL I P C Dir Man I Card i I I I i I I i I I I L I I I I i 1 15 O NAME OF PERSON ACTION WAS TAKEN AGAINST TYPE OF ENFORCEMENT ACTION(✓one) COURT DATE AND TOWN CODE ritten U ❑Arrest Lj Warning a CHARGE STATUTE OR ORDINANCE NUMBER UNIFORM SUMMONS/COMPLAINT NUMBER F z W a NAME OF PERSON ACTION WAS TAKEN AGAINST TYPE OF ENFORCEMENT ACTION(✓one) COURT DATE AND TOWN CODE W W' UU ❑Arrest arnin-g o r O CHARGE STATUTE OR ORDINANCE NUMBER UNIFORM SUMMONS/COMPLAINT NUMBER I.L. z W RANK AND SIGNATURE OF INVESTIGATING OFFICER BADGE NUMB12XER DEPARTMENT NAME REPORT DATE CASE STATUS SUPERVISOR Open Closed PR-1 Rev.1/91(BACK) ICE ACCIDENT REPORT Please send to STATE OF CONNECTICUT DOT DEPARTMENT OF TRANSPORTATION ONLY P -1 ev.1/91 3 ACCIDENT RECORDS SECTION 2175 BERLIN TURNPIKE NEWINGTON,CT 06111 1 -6 DOT CASE NUMBER 4❑ I I 7-12 DATE OF ACCIDENT DAY OF WEEK 113-16 TIME(military) #KILLED #INJURED #OF VEHICLES POLICE CASE NUMBER A �,Mont (day /,4yea6 INVO ED 17-19 CITY OR TOWN(name) (City Town Code)I ACCIDENT OCCURRED ON(street name or route#)AT ITS INTERSECTION WITH(street name or route#1) s Z IF NOT AT INTERSECTION 3. Give nearest intersecting street(name or route#) O underpass,overpass,bridge,river or town line. a 1. Give distance and ✓either 2.Check(✓)direction. DO NOT USE house#,utility pole#,or business name. 7 UO "Feet"or"Tenths"of a mile. North S E W 1 ❑ Feet ❑ X ❑ ❑ ® Tenths of 4 F r1 1Z y O i 8 OPERATOR AND VEHICLE#1 OPERATOR AND VEHICLE#2 (or pedestrian) OPERATOR#1 NAME(last,first,middle initial) ERATOR#2 OR PEDESTRIAN NAME(last,first,middle initial) L_ U c ZAz Ann nm • 9 ADDRESSLtreet number and name9 ADDR S(street number and name) l S-5 MOODY Z ,� ^� CITY OR TOWN STATE ZIP CODE 20 SEX CITY OR TO STATE ZIP CODE 21 SEX 1011 FzC- Lp C 1 D 60 FAD G, �Lic�)oSt/aet�_e 124-48 OPERATOR LICENSE NUMBER 49-54(,D�ATE OF BIRTH DOT Lic State 9-33 0 RATOR LICENSE NUMBER 34-39 DATE OF BIRTH I `' dtL: T 1 a H 0 ( ONLY 2 Code 7 z t 3 Gt VEHICLE It 1 OWNER NAME(if same as operator.#1,enter same') VEHICLE#2 OWNER NAM if same as operator#2,enter"same") rn C 1415 ADDRESS(street number and name) ADDRESS(street number and name G2 1 CITY OR TOWN STATE ZIP CODE CITY OR TOWN STATE ZIP CODE 1627 G= 40-41 PLATE#AND STATE CODE VEHICLE YEAR AND MAKE 42.43 PLATE#AND STATE CODE VEHICLE Y R AND MAKE m C. I S 0 6 U G H 12YSLE(Z EHICL VODEL NAME BODY TYPE(e.g.4-door sedan,truck,etc.) VEHICLE MODEL NAME BODY TYPE(e.g. oorsedan,truck,etc.) 1819 AU E DO 0(? 545P fl n H, 44-61 VEHICLE(IDENTIFICATION N BER(not engin`eI number) DOT 7-24 VEHICLE IDENTIFICATION NUMBER(not engine num rJ , C ✓ �I.�J P :7W ± Q %J ONLY 2 3 2021 Did operator carry a current Connecticut No-Fault Insurance Did operator carry a current Connecticut No-Fault Insurance H2 I.D.Card in vehicle as required under CGS,Section 14-12b DYES ❑ NO 1.0.Card in vehicle as required under CGS,Section 14-12b ❑ S ❑ NO NAME-0 1 L UTQM�BIV INSURANCE CO. ATOMOOBILE�NS'l`�I C Q4IC}�N0. NAME OF AUTOMOBILE INSURANCE CO. AUTOMOBILE INSURA POLICY NO. PARTS OF VEHICLE DAMAG D(' l�:�front fender,etc.)7 J '1 �J (', PARTS OF VEHICLE DAMAGED(i.e.left front fender,etc.) VEHICLE#1 TOWED TO(ffnot to, d,ipdi-caatte'none') VEHICLE#2 TOWED TO(ifnot towed,indicate none') Y DAMAGE TO 1.Describe the property••and extent of damage(e.g.50 fleet of fence knocked down) PROPERTY 5 9 Uc P_0r L E S O tI m A 6 t 0 W OTHER THAN o INVOLVED 2.Give name and address of property owl ^� / /� (� CC VEHICLES J(� ,J©� S t c>L C3 f 1�1 I S(3 lS�T lJ" 1.i1 O.5 0� W AGE SEX NAME AND ADDRESS OF WITNESS LU coo Z AGE SEX NAME AND ADDRESS OF WITNESS 3 J I K L NAME AND ADDRESS(or operator#1,operator#2,etc.) M N 0 P O 1 2 26 2 28' OPERATOR#9 O 2 1 31 32 33-34 35 36 Z 2 OPERATOR#2 OR PEDESTRIAN(circle the one which applies) — — 2 38 39-40 41 f1 43 44 45-46 47 48 c 4 �- (� 1..E L 4 — _uj 5 49 50 L63-64 ` 53 5= 5 55 56 .— 59 60 6 z 6 _ _ — J 61 62 .. + 7 Q 7 8 67 r6j69j1. — - 71 72 8 s� PLEASE DRAW A DIAGRAM OF WHAT HAPPENED As sure to include all ve lcle pedestrian and bicyclist man uvers both prior anc after the collisio Draw an arrow pointing north in this circle. SHQubS �t z O Cn W \ Q O G f = L �_ J DIRECTION OF TRAVEL OF EACH VEHICLE,PEDESTRIAN,ETC.p /� N S E W L �HA � �.(1Pr� 9 g ❑IN ❑ ❑ ❑VEHICLE#1 going 11❑ ❑ ❑ on _ VEHICLE#2 oin on PLEASE GIVE A COMPLETE DESCRIPTION OF WHAT HAPPENED(be sure to explain any prior response marked with an asterisk') C._ 6 o-- -T0 C A L E. v LC- tr Un A 0P- ST C007POL OF CL FTEi3 U HZ MA F S o 0 U ") 746 ' 1'Zo Ps ib W j2 S So(Y1 C W Q z Yes No - Yes No WERE MEASUREMENTS TAKEN? ❑ PHOTOS? ❑ 4 Cont Road# RL Dir NIR lRamp jTR# ICLI St ICum Mile 111d Tyl 1 ISF I Local Road Location 22 25 26 1 27 28 30 31 34.35 361371 38139 44 1 45 46 47 48 49 50 53 54 57158 61 62 65 ' I ' I DOT CF' Col Card Card Alpha Description USE 66 67 68 69 7 - 41 ONLY q 5 ! CV Dir Man Obj#1 L Obi If 21 L IP C 1 Dir Man I CV Dir I Man 60-62 jObj#1 1 L 10bi#2 1 L IP C I Dir Man Card j 5 O NAME OF PERSON ACTION WAS TAKEN AGAINST TYPE OF ENFORCEMENT ACTION(✓one) COURT DATE AND TOWN CODE Written U ` ❑Arrest ❑ Warning I<None ❑ Other Q CHARGE STATUTE OR ORDINANCE NUMBER UNIFORM SUMMONS/COMPLAINT NUMBER z W 2 NAME OF PERSON ACTION WAS TAKEN AGAINST TYPE OF ENFORCEMENT ACTION(✓one) COURT DATE TOWN CODE W Written 0 �" Arrest ❑ Warning RNone ❑ Other IM O CHARGE STATUTE OR ORDINANCE NUMBER UNIFORM SUMMONS/COMPLAINT NUMBER U. z W RANK AND SIGNATURE OF INVESTIGATING OFFICER BADGE NUMBER �DEPARTMENTNAME REPORT DATE CAGE STATUS SUPERVISOR— Open Closed �vTt+' znDsa2 g�rnARg3El PR-1 Rev.1/91(BACK)