Date:    January 1, 2009

To:        Joe Adjuster

Re:        Linda Smith RS - 0123456789

Here is the information from the recorded statement with Linda Smith, which was taken by (name) on January 1, 2009.

 Personal Information:  Linda Jones 1311 Smith,  Davis, TX 77777; home # 111-111-1111; cell # 111-111-111; d.o.b. 1/1/01.

 Date of loss:  11/6/08.  Time of accident/weather conditions.  7:00 pm; dry.

Were your headlights on?  Was the other party’s headlights on?  The headlights were on the c/v, the vehicle behind her and ahead of her.  Unk if the other parties had their lights on.

 What type of vehicle were you driving?  Who owns the vehicle? 2007 Dodge (model name) owned by the clmt.

Describe the other vehicle.  1) white car driven by a male 2) tan car driven by a male 3) white car driven by a male 4) a truck driven by a female 5) white p/u driven by a female 6) c/v  7) dark color truck - driver unk.

Were passengers in either vehicle?  No.

Where did the accident occur?  How many lanes of traffic?  IH-01 s/b Davis, TX; 2 lns.

Which lane/direction were you traveling in?  All parties were traveling s/b on IH-01 in the left ln.

 What is the posted speed limit?  How fast were you traveling?  55 mph; The c/v was stopped.

 How did the accident occur? Heavy traffic conditions. The c/v had been traveling on IH-01 in the left ln for 15 mins. prior to the accident occurring.  The clmt does not know how the accident occurred involving vehicles 1-4.  She witnessed the 5th vehicle (white p/u driven by a female) r/e vehicle #4 (a green or blue truck driven by a male).  The c/v slowed down and stopped 4 ft. behind vehicle #5 (white p/u).  The c/v swerved left to avoid striking vehicle #5.  Her front bumper was angled towards the dividing wall (to her left).  She had been stopped 15-20 seconds when she noticed headlights approaching in her side mirror. She also heard squealing tires/brakes before she was struck from the rear.  Unk what happened ahead of vehicle #4.  When vehicle #7 r/e the c/v she was pushed forward into vehicle #5.  The c/v only scraped vehicle #5.  The impact was not severe enough to force vehicle #5 into vehicle #4.  After r/e the c/v, vehicle #7 reverse, changed lns and sped away.  The clmt was not able to obtain the license plate number or description of the driver.

 Did you see the other vehicle prior to the accident occurring? The clmt saw vehicle #5.  She saw vehicle #7 approaching in her side mirror.

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How far away was the other vehicle when you recognized danger? The clmt recognized danger once she saw vehicle #7 approaching in her side mirror.

 Did either party take evasive action?  The clmt heard squealing tires/brakes from vehicle #7.

What parts on the vehicles collided?  C/v - rear dmg and right fender and door; vehicle #5 - scrape on left rear; dmg to vehicle #7 unk (fled the scene).

 What happened afterwards? The clmt was pinned inside her vehicle.  The male driving vehicle #4 assisted the clmt from her vehicle.  The right door was jammed.  The clmt could not open the left door because of the dividing wall.  A semi stopped in the right ln.  All parties crossed the hwy and waited for the police on the right shoulder.  The vehicles remained in the left ln.  All vehicles were towed excluding the 1st vehicle (white car).

 Which police department came to the scene?  APD - unk if any citations were issued.

Were there skid marks on the pavement from either vehicle?  Unk.

Were there witnesses?  No.

 Was anyone injured?  Extent of injuries.  The clmt injured her neck.  She visited her pcp twice and went to massage therapy once.  She has been released and now feels fine.  Her medical bills were paid under umbi covg.  The male driving vehicle #3 complained of neck pain.  Did ems come to the scene?  Yes.  No one was transported.

Is there anything else you could have done to avoid the accident?  No.

Who caused the accident and why?  Vehicle #7 caused the dmg to the c/v.  Vehicle #5 r/e vehicle #4.  Unk what happened ahead of vehicle #4.

 Did either party admit fault?  No.  Did you discuss who was at fault?  No.

Did you and the police discuss who was at fault?  No.

Is there anything else you would like to add?  Rear impact rating - 8; front impact rating - 6 (scrape).

Please let me know if you have any questions regarding this statement.  Thank you.

Gracie Weatherly

P.O. Box 429 Cedar Park, TX  78630 / 512-535-0975 / Fax: 512-535-2347