Form STD270 "Vehicle Accident Report" - California

What Is Form STD270?

This is a legal form that was released by the California Department of General Services - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on October 1, 2019;
  • The latest edition provided by the California Department of General Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form STD270 by clicking the link below or browse more documents and templates provided by the California Department of General Services.

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Download Form STD270 "Vehicle Accident Report" - California

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STATE OF CALIFORNIA
DEPARTMENT OF GENERAL SERVICES
VEHICLE ACCIDENT REPORT
OFFICE OF RISK AND INSURANCE MANAGEMENT
916.376.5300
**CONFIDENTIAL INFORMATION**
STD 270 (Rev. 10/2019)
claims@dgs.ca.gov
DO NOT RELEASE TO OTHER PARTIES WITHOUT CONSENT OF
THE OFFICE OF RISK AND INSURANCE MANAGEMENT.
This report must be received by ORIM within 2 business days after accident.
STATE DRIVER
EMPLOYING DEPARTMENT
NAME
DRIVER'S LICENSE NUMBER
DATE OF BIRTH
PHONE
JOB TITLE
STATE DRIVER'S EMAIL
OFFICE ADDRESS (Street, City, State, Zip Code)
WAS VEHICLE BEING USED ON OFFICIAL STATE BUSINESS?
SUPERVISOR NAME
YES
NO
(If NO, attach explanation)
DATE LAST STATE DEFENSIVE
SUPERVISOR EMAIL
SUPERVISOR PHONE
NOT TAKEN
DRIVER TRAINING COMPLETED:
STATE VEHICLE
VEHICLE LICENSE NUMBER VEHICLE YEAR MAKE
MODEL
VEHICLE EQUIPMENT NUMBER
* If Dept. Owned or Rental, Enter Owner's Name
VEHICLE OWNER: Indicate Dept. Owned*, Rental*, DGS Pool, or Employee Owned
DESCRIBE DAMAGES TO STATE VEHICLE
ACCIDENT DETAILS
ACCIDENT LOCATION (Address/Area)
ACCIDENT DATE
ACCIDENT TIME
HOW FAST WERE
EST. SPEED OF
YOU DRIVING?
OTHER VEHICLE
ROAD CONDITIONS
POLICE REPORT MADE?
YES:
NO:
WEATHER CONDITIONS
CITY
STATE ZIP CODE
INVESTIGATING AGENCY NAME AND ADDRESS
COUNTY
TRAFFIC CONDITIONS
FULLY STATE HOW THE ACCIDENT OCCURRED
OTHER VEHICLE
DRIVER'S NAME
VEHICLE LICENSE NO. VEHICLE YEAR
MAKE
MODEL
DRIVER'S LICENSE NUMBER
DATE OF BIRTH
PHONE
REGISTERED OWNER
OWNER PHONE
NO. OF PASSENGERS
DRIVER'S ADDRESS
OWNER ADDRESS (Street, City, State, Zip Code)
CITY
STATE ZIP
NAME AND POLICY NUMBER OTHER PARTY'S INSURANCE
BRIEFLY DESCRIBE DAMAGE TO OTHER VEHICLE/PROPERTY
Submit by Email
Reset Form
STATE OF CALIFORNIA
DEPARTMENT OF GENERAL SERVICES
VEHICLE ACCIDENT REPORT
OFFICE OF RISK AND INSURANCE MANAGEMENT
916.376.5300
**CONFIDENTIAL INFORMATION**
STD 270 (Rev. 10/2019)
claims@dgs.ca.gov
DO NOT RELEASE TO OTHER PARTIES WITHOUT CONSENT OF
THE OFFICE OF RISK AND INSURANCE MANAGEMENT.
This report must be received by ORIM within 2 business days after accident.
STATE DRIVER
EMPLOYING DEPARTMENT
NAME
DRIVER'S LICENSE NUMBER
DATE OF BIRTH
PHONE
JOB TITLE
STATE DRIVER'S EMAIL
OFFICE ADDRESS (Street, City, State, Zip Code)
WAS VEHICLE BEING USED ON OFFICIAL STATE BUSINESS?
SUPERVISOR NAME
YES
NO
(If NO, attach explanation)
DATE LAST STATE DEFENSIVE
SUPERVISOR EMAIL
SUPERVISOR PHONE
NOT TAKEN
DRIVER TRAINING COMPLETED:
STATE VEHICLE
VEHICLE LICENSE NUMBER VEHICLE YEAR MAKE
MODEL
VEHICLE EQUIPMENT NUMBER
* If Dept. Owned or Rental, Enter Owner's Name
VEHICLE OWNER: Indicate Dept. Owned*, Rental*, DGS Pool, or Employee Owned
DESCRIBE DAMAGES TO STATE VEHICLE
ACCIDENT DETAILS
ACCIDENT LOCATION (Address/Area)
ACCIDENT DATE
ACCIDENT TIME
HOW FAST WERE
EST. SPEED OF
YOU DRIVING?
OTHER VEHICLE
ROAD CONDITIONS
POLICE REPORT MADE?
YES:
NO:
WEATHER CONDITIONS
CITY
STATE ZIP CODE
INVESTIGATING AGENCY NAME AND ADDRESS
COUNTY
TRAFFIC CONDITIONS
FULLY STATE HOW THE ACCIDENT OCCURRED
OTHER VEHICLE
DRIVER'S NAME
VEHICLE LICENSE NO. VEHICLE YEAR
MAKE
MODEL
DRIVER'S LICENSE NUMBER
DATE OF BIRTH
PHONE
REGISTERED OWNER
OWNER PHONE
NO. OF PASSENGERS
DRIVER'S ADDRESS
OWNER ADDRESS (Street, City, State, Zip Code)
CITY
STATE ZIP
NAME AND POLICY NUMBER OTHER PARTY'S INSURANCE
BRIEFLY DESCRIBE DAMAGE TO OTHER VEHICLE/PROPERTY
Submit by Email
Reset Form
STATE OF CALIFORNIA
DEPARTMENT OF GENERAL SERVICES
VEHICLE ACCIDENT REPORT
OFFICE OF RISK AND INSURANCE MANAGEMENT
916.376.5300
**CONFIDENTIAL INFORMATION**
STD 270 (Rev. 10/2019)
claims@dgs.ca.gov
DO NOT RELEASE TO OTHER PARTIES WITHOUT CONSENT OF
THE OFFICE OF RISK AND INSURANCE MANAGEMENT.
This report must be received by ORIM within 2 business days after accident.
INJURED
NAME
DATE OF BIRTH
ADDRESS (Street, City, State, Zip Code)
NAME
DATE OF BIRTH
ADDRESS (Street, City, State, Zip Code)
WITNESS
NAME
PHONE
ADDRESS (Street, City, State, Zip Code)
NAME
PHONE
ADDRESS (Street, City, State, Zip Code)
ADDITIONAL VEHICLE
DRIVER'S NAME
VEHICLE LICENSE NO. VEHICLE YEAR
MAKE
MODEL
DRIVER'S LICENSE NUMBER
DATE OF BIRTH
PHONE
REGISTERED OWNER
OWNER PHONE
DRIVER'S ADDRESS (Street, City, State, Zip Code)
OWNER ADDRESS (Street, City, State, Zip Code)
NAME AND POLICY NUMBER OTHER PARTY'S INSURANCE
DESCRIBE DAMAGE TO OTHER VEHICLE/PROPERTY
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