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' B. 'Other Party Information: (Complete this section for the damaged party who is not a county <br />employee. Complete the items that are applicable to the situation that you are reporting. E.6. <br />vehicle information need not be reported in the event you are reporting a fall on County property.) <br />Flame of other party: ** <br />Address: ** <br />Phone # ** <br />Dote of birth: Driver License Number: <br />If damaged property is a vehicle, provide the following information: <br />Year/Make/Model <br />V.I.N. <br />Plate # <br />If damaged property is not a vehicle, provide description below: <br />(attach additional sheets if needed.) <br />C. Describe, in detoi/, what happened. Use additional sheets ns necessary. <br />.Injuries? Cite medical facility to which injured party was transported, if any: <br />.Law enforcement is to be culled anytime a County vehicle is damaged or causes damage. <br />.What law enforcement agency responded? <br />.Officer's Name? <br />Employee signature: <br />Supervisor Signature: <br />(date) <br />(date) <br />9-2000 <br />