Exchange of Information California law requires that anyone involved in a traffic collision exchange information relative to their name, address, phone number, vehicle information and insurance information. If you are involved in a traffic collision, you can use this form to collect information from the other drivers and email the information to yourself for future reference. If someone sustained a minor injury as a result of the traffic collision, you can contact the Placerville Police Department at 530-642-5280. If someone sustained a major injury please dial 911.Date of Collision* MM slash DD slash YYYY Time of Collision* : Hours Minutes AM PM AM/PM Location of Collision* Name of Other Driver First Last Address of Other Driver Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Year of Other Vehicle Make of Other VehicleFord/Chevy/Toyota, etc. Color of Other Vehicle License Plate or VIN of Other VehicleState/License or VIN Insurance Company & Policy Number of Other DriverPicture of Other Driver's LicenseAccepted file types: jpg, jpeg, gif, png, Max. file size: 128 MB.Picture of Other Driver's InsuranceAccepted file types: jpg, jpeg, gif, png, Max. file size: 128 MB.Picture of Other Driver's RegistrationAccepted file types: jpg, jpeg, gif, png, Max. file size: 128 MB.Picture of DamageAccepted file types: jpg, jpeg, gif, png, Max. file size: 128 MB.Your Email Address*
