2. Note:

   To request a report involving a traffic crash please click HERE.

   This form is for Non-Traffic Crash reports only.

   
   

4. REQUESTOR DETAILS
6. Requestor's Name*
8. Requestor's Relationship to Incident*
   -- Select One --Involved PartyAttorney for Involved PartyInsurance Agency for Involved PartyMediaOther
10. Media Outlet

    If you are requesting this information as a member of the media please indicate which organization you are representing.

12. Client's Name
    If you are representing a person involved in the incident please list their name.
13. Claim Number

    If you have an insurance claim number related to this incident please list it here.

15. Other Relationship
17. Do you have the Incident Number(s)?*

    1. Yes

    1. No
19. Incident Number 1
20. Incident Number 2
21. Incident Number 3
22. Incident Number 4
24. Incident Street Address
    Please include street address if known
26. Date of Incident
    Date of Incident
    If known
27. Time of Incident
    Time of Incident
    If known
31. DELIVERY & BILLING ADDRESS

    Please let us know where you would like the requested information sent to if approved by the City Attorney. 

    This is also the address that will be billed for the associated costs. Please click here for additional information concerning related costs.

33. Address*
35. City*
36. State*
37. Zip Code*
39. Phone Number
41. Email Address
45. Instructions
    Please describe below the information you are requesting with as much detail as possible to ensure we provide you the correct information. If there is additional information not captured in the choices above (multiple dates, times, etc) please indicate that here.
47. Requested Information*
    Please be as specific as possible
51. // For Internal RPD Use Only //
    Please enter your PO# (4 digits only)
Leave This Blank:


53. 1. Receive an email copy of this form.
54. Email address

    This field is not part of the form submission.

55. Submit

* indicates a required field