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Accident Report
Accident Report
Accident Report
R A
04 1 1 1 1 8 3 2 02 1 01
00:00
Longitude:
ACCIDENT SEVERITY Fatal Injury X PDO # VEHICLES INVOLVED PAGE #
0 1 1 7 1 3 1 7 5 6
TOWN OR CITY NAME
1 of 4
(Street Name or Route #)
A 1300000856
(Street Name or Route #)
East Haven
IF NOT AT INTERSECTION 1. MEASURE DISTANCE (Check Appropriate Boxes)
0 4 4
Feet Tenths Meters Kilometers Pedestrian 2. DIRECTION North South East of West
Sargent Drive
02 1 01
H 1 S 1 T 1
Parking Lot
H 2 S 2 T 2
X Vehicle
Non-Contact Vehicle (Last, First, Middle Initial) PROPER LICENSE CLASS Yes
X Vehicle
or PEDESTRIAN NAME
OPERATOR # 2
or PEDESTRIAN NAME
Cash, Dominique
ADDRESS (Street Number and Name)
Bissette, Kershen
ADDRESS (Street Number and Name)
J 11 J 12
X No
SEX M
Day
X Yes
ZIP CODE
No SEX
J 21
ZIP CODE
New Haven
OPERATOR LICENSE #
CT
STATE
06511 CT
Month
X F
Year
East Haven
OPERATOR LICENSE #
CT
06512
STATE
X M
Day
F
Year
J 22
DATE OF BIRTH
237814796
U 1 K 11 K 12
1 1 2 8 8 4
CT
Month
DATE OF BIRTH
0 2 1 3 8 8
U 2 K 21
Deming, Jennifer
ADDRESS (Street Number and Name)
84 Jackson Ln
CITY OR TOWN STATE ZIP CODE BODY TYPE
250 Main St CT
STATE VEHICLE YEAR AND MAKE
New Haven
REGISTRATION #
4d Sed Nissan 3 C 2 1 5 2 2 5
CITY OR TOWN
STATE
ZIP CODE
BODY TYPE
K 22 V
CT CT 2012
06512 Ford 1
4-DR 1 26
W
REGISTRATION #
556ZRM 1 N 4 A L
CT
2003
1 1 D 7
A B P 7 B V X B X 1 8
0 5 7
CARRIER NAME CARRIER ADDRESS (#, Street, City or Town, State, Zip Code) SOURCE OF CARRIER NAME USDOT # Shipping Papers/Trip Manifest ICCMC # Driver Side of Vehicle GROSS VEHICLE WEIGHT HAZARDOUS MATERIAL PLACARD No 4 Digit # REQUIRED? Yes RATING # No 1 Digit # DISPLAYED? Yes
CARRIER NAME CARRIER ADDRESS (#, Street, City or Town, State, Zip Code) SOURCE OF CARRIER NAME USDOT # Shipping Papers/Trip Manifest ICCMC # Driver Side of Vehicle GROSS VEHICLE WEIGHT HAZARDOUS MATERIAL PLACARD No 4 Digit # REQUIRED? Yes RATING # No 1 Digit # DISPLAYED? Yes
X 1 Y 1 Z 1
X 2 Y 2
None ENFORCEMENT ACTION TAKEN No X Arrest Verbal Warning Written Warning SUBJECT X Operator OF Owner ACTION Carrier Pedestrian
None Z HAZARDOUS CARGO ENFORCEMENT ACTION TAKEN 2 RELEASED? Yes No Arrest Verbal Warning Written Warning STATUTE OR ORDINANCE #'S SUBJECT OF ACTION Operator Owner Carrier Pedestrian
AA 21 AA 22 AA 23
14-213b, 14-36(a)
AA 11 AA 12 AA 13 AA 14
None NONE
PARTS OF VEHICLE DAMAGED
Left Front
VEHICLE TOWED TO: TOWED DUE TO DAMAGE
N/A NAME AND ADDRESS OF EACH INVOLVED PERSON TRAFFIC UNIT # 1 OPERATOR OR PEDESTRIAN # TRAFFIC UNIT # 2 OPERATOR OR PEDESTRIAN # 471 North High St East Haven, CT 06512
Month Month Month Month Month Month Day Day Day Day Day Day Year Year Year Year Year Year
AA 24
Date of Birth
O. P. Q. 9 2 1 1 2 3 4 5 6 7 8
9 2 1
0 9 2 5 7 9 9 2 1
FORM PR-1
Page # 2 of 4
1300000856
INDICATE NORTH
ACCIDENT DIAGRAM
1
On
TRAVELING
TRAFFIC UNIT #
East
Sargent Drive
East
2
On
TRAVELING
Sargent Drive
On 1/17/13, at about 1730 hrs, information was given to me regarding a motor vehicle accident on Sargent Dr, New Haven involving a police vehicle. The accident was a result of an on going investigation, case number 13-846 (theft of purse), from the town of East Haven. Officer Bissette, (Driver) and Officer Michalowski, (passenger) of vehicle #2, both stated that as they were attempting to stop vehicle #1 for questioning related to the investigation. Officer Michalowski stated that as they were traveling eastbound on Sargent Dr, New Haven, Detective Ranfone (non-contact vehicle) was traveling directly behind vehicle #1 and they were behind Detective Ranfone's unmarked detective vehicle. He stated that he and Detective Ranfone had activated their emergency lights in order to make the motor vehicle stop. After a short distance of traveling east on Sargent Dr, it appeared that vehicle #1 was not pulling over so he instructed Officer Bissette to pull into the left lane and get alongside of vehicle #1 so he can hand motion her to pull over. Officer Michalowski stated that once alongside vehicle #1 he had made eye contact with the female operator of vehicle #1 who indicated to him that she was pulling over. He stated that as vehicle #1 was pulling curbside they had moved ahead of vehicle #1 in an attempted to pull curbside, at which time vehicle #1 struck their vehicle. I spoke to operator of vehicle #1 via telephone conversation, who stated that as she was traveling on Sargent Dr she had noticed a vehicle behind her with it's emergency lights on and a police vehicle on the left side of her. She stated that the officer in the passenger seat of the vehicle alongside of her was motioning for her to pull over. She stated that as she was pulling over and coming to a stop the police vehicle had pulled
DAMAGE TO PROPERTY OTHER THAN INVOLVED VEHICLES
1. DESCRIBE THE NATURE AND EXTENT OF PROPERTY DAMAGE NAME AND ADDRESS OF PROPERTY OWNER 2. DESCRIBE THE NATURE AND EXTENT OF PROPERTY DAMAGE NAME AND ADDRESS OF PROPERTY OWNER
REPORT DATE CASE STATUS SUPERVISOR
Closed
R A
00:00
Longitude:
ACCIDENT SEVERITY Fatal Injury X PDO # VEHICLES INVOLVED PAGE #
0 1 1 7 1 3 1 7 5 6
TOWN OR CITY NAME
3 of 4
(Street Name or Route #)
A 1300000856
(Street Name or Route #)
East Haven
IF NOT AT INTERSECTION 1. MEASURE DISTANCE (Check Appropriate Boxes)
H 1 S 1 T 1
0 4 4
Feet Tenths Meters Kilometers Pedestrian 2. DIRECTION North South East of West
Sargent Drive
Parking Lot
H 2 S 2 T 2
Vehicle
Non-Contact Vehicle (Last, First, Middle Initial) PROPER LICENSE CLASS Yes No SEX M F
Year
Non-Contact Vehicle (Last, First, Middle Initial) PROPER LICENSE CLASS Yes No SEX M F
Year
or PEDESTRIAN NAME
or PEDESTRIAN NAME
J 21 J 22
CITY OR TOWN
STATE
CITY OR TOWN
STATE
OPERATOR LICENSE #
Month
DATE OF BIRTH
Day
OPERATOR LICENSE #
Month
DATE OF BIRTH
Day
U 1 K 11 K 12
OWNER'S NAME (Enter SAME if Owner is Operator) ADDRESS (Street Number and Name)
OWNER'S NAME (Enter SAME if Owner is Operator) ADDRESS (Street Number and Name)
U 2 K 21
STATE
ZIP CODE
BODY TYPE
STATE
ZIP CODE
BODY TYPE
K 22 V
CARRIER NAME CARRIER ADDRESS (#, Street, City or Town, State, Zip Code) SOURCE OF CARRIER NAME USDOT # Shipping Papers/Trip Manifest ICCMC # Driver Side of Vehicle GROSS VEHICLE WEIGHT HAZARDOUS MATERIAL PLACARD No 4 Digit # REQUIRED? Yes RATING # No 1 Digit # DISPLAYED? Yes
CARRIER NAME CARRIER ADDRESS (#, Street, City or Town, State, Zip Code) SOURCE OF CARRIER NAME USDOT # Shipping Papers/Trip Manifest ICCMC # Driver Side of Vehicle GROSS VEHICLE WEIGHT HAZARDOUS MATERIAL PLACARD No 4 Digit # REQUIRED? Yes RATING # No 1 Digit # DISPLAYED? Yes
X 1 Y 1 Z 1
X 2 Y 2
None Z HAZARDOUS CARGO ENFORCEMENT ACTION TAKEN 2 RELEASED? Yes No Arrest Verbal Warning Written Warning STATUTE OR ORDINANCE #'S SUBJECT OF ACTION Operator Owner Carrier Pedestrian
AA 21 AA 22 AA 23
Operator Owner
AA 24
L. M. N. 1 2 3 4 5 6 7 8
NAME AND ADDRESS OF EACH INVOLVED PERSON TRAFFIC UNIT # TRAFFIC UNIT # OPERATOR OR PEDESTRIAN # OPERATOR OR PEDESTRIAN #
Date of Birth
O. P. Q. 1 2
3 4 5 6 7 8
FORM PR-1
Page # 4 of 4
1300000856
TRAFFIC UNIT #
TRAVELING
TRAFFIC UNIT #
TRAVELING
On
On
ahead of her and was coming to a stop, at which time her vehicle rolled into the side of the police vehicle. Officer's Michalowski and Bissette were operating police vehicle #20, registration 103-EHA. Vehicle sustained minor damage to the right side front and rear door's. Damage was photographed and logged into evidence. There was no report of any injuries.
1. DESCRIBE THE NATURE AND EXTENT OF PROPERTY DAMAGE NAME AND ADDRESS OF PROPERTY OWNER 2. DESCRIBE THE NATURE AND EXTENT OF PROPERTY DAMAGE NAME AND ADDRESS OF PROPERTY OWNER
REPORT DATE CASE STATUS SUPERVISOR
Closed