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INQUIRIES? (916) 960-0900

HOME
ABOUT
About

NonProfits' United is a member-owned nonprofit insurer since 1988.

About

Board of Directors

Become A Member

Enjoy all the risk management and additional member benefits with NPU.

Apply for Membership
PROGRAMS
Programs

Enroll in our Vehicle Insurance Pool or Workers' Compensation Group, designed specifically to insure nonprofit organizations.

vehicle insurance pool (vip)

workers compensation group (WCG)

Become A Member

Enjoy all the risk management and additional member benefits with NPU.

Apply for Membership
RISK MANAGEMENT
MEMBER RESOURCES
Member Resources

Learn more about health and safety, and access course materials and risk management resources.

MEMBER AUTO ACCIDENT REPORT

Become A Member

Enjoy all the risk management and additional member benefits with NPU.

Apply for Membership
CONTACT
INQUIRIES? (800) 442-4742

Member
Auto Accident Reporting

Members can use the form below to submit an auto accident report.

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Member Information
Member Name*
Today's Date*
MM slash DD slash YYYY
Contact Name*
Policy or Member #
Phone*
Email*
Driver Name*
DOB*
CDL #
Vehicle Make/Model*
Year*
VIN # (Last 5 Digits)*
Describe damage to your vehicle*
Defective Equipment?
- Brakes
- Steps
- WC Lift
- Tie Downs
- Door
- Seats
- Floor
- Other

Other (Adverse) Driver/Vehicle Info
Driver Name
License #
Phone
Address
Vehicle Make/Model
Year
License #
Insurance Carrier
Policy #
Describe damage to other vehicle

Occurrence Information
Date of Occurrence*
MM slash DD slash YYYY
Time

: Hours

Minutes

AM/PM
Location/Intersection
City/County/State
Area
- Residential
- Commercial
- Rural
Pavement
- Paved
- Gravel/Dirt
- Wet
- Dry
Weather
- Clear
- Rainy
- Cloudly
- Snow
- Fog
- Dust
Visibility
- Daylight
- Dark
- Good
- Fair
- Poor

Your Vehicle
Number of occupants
Seatbelts used by driver?
- Yes
- No
Seatbelts used by passengers?
- Yes
- No
Airbags deployed?
- Yes
- No
Number of wheelchairs
W/C tie-downs in use?
- Yes
- No
Other Vehicle
Number of occupants
Seatbelts used by driver?
- Yes
- No
Seatbelts used by passengers?
- Yes
- No
Airbags deployed?
- Yes
- No
Posted Speed Limit
Yours
Other's
Speed of Travel
Yours
Other's
Direction of Travel
Yours
Other's
Intersection Traffic Controls (if applicable)
Choose
- 1 way stop
- 2 way stop
- 3 way stop
- 4 way stop
- Traffic light
- Yield
- RR Crossing
- None

Police Report
Reporting Officer
Badge #
Report #
Depth (CHP, police, etc)
Citation issued?
- Your driver
- Other driver
Witnesses
Name
Phone
Check if applicable
- Your's
- Other's
Name
Phone
Check if applicable
- Your's
- Other's
Name
Phone
Check if applicable
- Your's
- Other's
Name
Phone
Check if applicable
- Your's
- Other's

Member Passenger Injuries
Name
Phone
Injury
Action Taken
Check if applicable
- Wheelchair
- Boarding
- Fell
- Disembarking
Name
Phone
Injury
Action Taken
Check if applicable
- Wheelchair
- Boarding
- Fell
- Disembarking
Other Driver / Passenger Injuries
Name
Phone
Injury
Action Taken
Comments or Additional Information
Comments or Additional Information
(witnesses, injuries, etc.)
Occurence Description
Briefly tell exactly what happened. Remember to include, Who, What, When, Where, How, Why. Indicate movement of involved vehicles when hazard was first seen. Indicate warnings or evasive actions taken. Describe length and position of any skid marks.
Phone
This field is for validation purposes and should be left unchanged.

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Become A Member!

Enjoy comprehensive workers’ comp and vehicle insurance coverage, with the reliable support and exclusive benefits that only NonProfits’ United can provide.

APPLY FOR MEMBERSHIP

Request Online Training

First Name**
Last Name**
Email*
Phone*
Course of Interest*
Email
This field is for validation purposes and should be left unchanged.

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PROGRAMS

Vehicle Insurance Pool

Workers' Compensation Group

INFORMATION

Board of Directors

Risk Management

Member Resources

CONTACT US

610 Fulton Avenue
Suite 200
Sacramento, CA 95825

© Copyright NonProfits United. All Rights Reserved 2024 |

Home
About
- About
- Board of Directors
Programs
- Workers Compensation
- Vehicle Insurance Pool
Risk Management
Member Resources
- Member Auto Accident Reporting
Board Of Directors
Contact Us