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Home My WebLink About20122463.tiff August 31, 2012 RECEIVED VIA CERTIFIED MAIL/RETURN RECEIPT REQUESTED SEP ` 7 2012 Sean Conway, Chair WELD COMMISSIONERSTY Board of County Commissioners County of Weld 1150 O Street Greeley, Colorado 80632 NOTICE OF CLAIM Notice is hereby given of the following claim: A. The name and address of the Claimant is: Monica Black 4121 Saltgrass Lane Evans, Colorado 80620 B. The name and address of the Claimant's attorney is: Franklin D. Azar & Associates, P.C. 14426 East Evans Avenue Aurora, Colorado 80014 (303) 757-3300 C. The basis of the claim is: On or about July 22, 2012, at approximately 8:40 a.m., the claimant was operating a motor vehicle northbound on SH 257 stopped in the median of the two yellow striped lanes with flashing overhead yellow caution lights activated and flags as a pilot motor vehicle for an approaching over-sized load at or near a construction zone, at or near SH 257 and Poudre Trails Drive, County of Weld, State of Colorado. A motor vehicle operated by Shawn Holmes was traveling southbound on SH 257. A motor vehicle operated by James Briegel was traveling southbound on SH 257. The Holmes motor vehicle was flagged to stop for the approaching over-sized load by claimant. The Briegel motor vehicle failed to stop and struck the Holmes motor vehicle and the claimant's motor vehicle. The County of Weld ("Weld") had a responsibility to warn motorists of the construction zone with signs or otherwise. Weld inadequately warned motorists of the construction zone, which caused or contributed to the occurrence of the collision. One or more employees of Weld failed to warn motorists of the construction zone in the course and scope of his\her\their employment. As a result of the said incident, the claimant sustained personal injuries and property damage. A copy of the State of Colorado Traffic Accident Report dated July 22, 2012 is attached for your review. CtierYNYTAAiiv ll � t�vi nixCC (* ' '\ Cup2012 2463 c-1-I0-l(3- D. The name of the public employee(s) involved is: Unknown E. Claimant has suffered injuries to her arm, neck, back, leg and other and further related injuries. F. The Claimant will seek damages to compensate her for the cost of medical treatment, prescriptions, and therapy for the severe pain and suffering resulting from the subject accident, loss of enjoyment of life, loss of earnings, and loss of property. G. The approximate amount of Claimant's injuries are anticipated to be in excess of$250,000.00. Dated this 364-- day of August, 2012. Very truly yours, F I LIN D. AZAR & ASSOCIATES, P.C. Fr lin D. Azar, #13131 Robert E. Markel, #12401 14426 East Evans Avenue Aurora, Colorado 80014 (303) 757-3300 ATTORNEYS FOR CLAIMANT FDA/djb CERTIFICATE OF MAILING I hereby certify that on the 7In-day of 2012, I deposited in the United States Mail, postage prepaid, certified mail/return receipt requested, a true and correct copy of the foregoing to: Sean Conway, Chair Board of County Commissioners County of Weld 1150 O Street Greeley, Colorado 80632 Event No. 127229 - Incident Report Page 1 of 4 I Incident Report #127229 t N 0 S p l �9orusn,RR 189 Windsor Police Department •_ - 200 N. 11th Street Windsor, Colorado 80550 POLICE Office(970)686-7433 UPI I Fax(970) 686-7478 I � J Event Info Date Reported Time Reported Time Dispatched Time Arrived Time Completed 07/22/2012 00:00 08:43 08:45 10:18 Addr. Of Occ. City District Grid How Reported SH 257 N. OF POUDRE WINDSOR W 4 DISPATCH TRAILS DR Dispatch Disposition RPT Synopsis Dispatched to traffic accident with vehicle damage and multiple minor injuries Agency 1 Event Status/Dispo Event Status/Disp Initial Investigator WINDSOR CLEARED 07/22/2012 COOK,RICHARD I Classification Classification Info COMPLETED Class Subclass TRAFFIC ACCIDENT TRAFFIC ACCIDENT, INJURY Event MO Auto Weapon Indicator N (Suspects r' • Suspect Information Name Type Name SUSPECT BRIEGEL,JAMES COLE Address City State Zip DL No 47414 COUNTY ROAD Z BURLINGTON CO 80807 08-142-0414 DL State DOB SEX RACE EO HT CO 05/20/1993 M WHITE NON-HISPANIC 600 WT HAIR EYES Res Phone 180 BRN GRY (719)342-1447 Victims — — — — Victim Information Name Type Name VICTIM HOLMES,SHAWN MILES Address City State Zip DL No 1980 CATALUNA DR WINDSOR CO 80550 95-093-3406 DOB SEX RACE EO Res Phone Busn/School 04103/1974 M WHITE NON-HISPANIC (970)301-2598 EVANS POLICE Victim Information '7/1A 11/11'1 Event No. U7229 - Incident Repo Page 2 of 4 Name Type Name VICTIM BLACK,MONICA LEE Address City State Zip DL No 4121 SALTGRASS LANE EVANS CO 80520 1D-257-0267 DL State DDB SEX RACE EO Res Phone CO 04/26/1964 F WHITE NON-HISPANIC (970)381-6420 • Witness WITNESS Information Name Type Name WITNESS CULBERT,MICHELLE Address City State Zip DOB 922 VICKIE ST FORT MORGAN CO 80701 11/09/1988 SEX RACE EO Res Phone F WHITE NON-HISPANIC (970)768-1683 Vehicle Record Type-DAMAGED Date Reported Status LIC Plate No State Year 07/22/2012 VICTIM VEHICLE 4B9JNV CO 2011 Make Style Color Vehicle Value Vehicle Owner DODG PICKUP TRUCK GRN/GRN 5000 HOLMES,SHAWN Comments INSURANCE'USAA,POLICY#009080596C Comments INSURANCE:USAA,POLICY#009080595C Record Type-DAMAGED Date Reported Status LIC Plate No State Year 07/222012 VICTIM VEHICLE 966641J CO 2002 Make Style Color Vehicle Value Vehicle Owner DODG PICKUP TRUCK GRY/ 3000 BLACK,MONICA • Comments INSURANCE:PROGRESSIVE,POLICY#07644370-1 Record Type-DAMAGED Date Reported Status LIC Plate No State Year 07/22/2012 SUSPECT VEHICLE 228TRO CO 1994 Make Style Color Vehicle Value Vehicle Owner FORD AUTO-REGULAR RED/RED 5000 BRIEGEL,JAMES Comments INSURANCE:STATE FARM,POLICY#1677680-E26-06A REGISTERED TO HARLEY JAY BRIEGEL,SAME ADDRESS Narrative , Written By: COOK,RICHARD On the above date and time I was dispatched to a traffic accident. I did hear an Evans Police Officer use the County radio to report that he needed WPD as his vehicle was rear-ended. The officer reported there were no injuries. The incident was reported to be on SH257 south of Eastman Park Dr. inn!7M') Event No.. 127229 - Incident Repo' Page 3 of 4 On arrival, I located the accident on SH257 just north of Poudre Trail Dr. I did observe a red Ford Mustang with heavy front-end damage (CO plate 228TRO), stopped in the flat median between the double yellow striped lines, facing south; also observed a gray Dodge pickup (CO temp tag 966641J) with driver side damage, stopped in the median of the two double yellow striped lines, facing north, with flashing hazard lights and flashing overhead yellow caution lights, orange and yellow flags and a roof mounted "oversized load" sign—actively being used as a pilot car; also observing a dark green Dodge pickup truck (CO plate 489-JNV) with heavy driver side rear end damage , stopped in the southbound lane of SH257, facing south,nearly even and parallel with the gray "pilot car". The two trucks were located north of the red Mustang.The driver, and sole occupant, of the green Dodge is identified as Shawn Holmes, whom I know to be the RP and Evans Police Officer. The driver, and sole occupant, of the gray Dodge is identified as Monica Black. The driver, and sole occupant, of the Mustang is identified as (James) Cole Briegel. All drivers advise that they have minor injuries, no signs of bleeding or deformity. All of the drivers were present when they explained the incident. Shawn explained that he was headed home; south on SH257, to Crossroads Blvd. Shawn said that he was flagged to a stop by the driver of the pilot vehicle, for an oversized load. Shawn said that he stopped next to the pilot vehicle and the worker explained the reason for stopping traffic. Shawn said that a few seconds later he was struck from behind. Shawn explained that his truck and the pilot vehicle were struck by the red Mustang. The driver of the pilot vehicle, Monica, confirmed that she was stopping traffic due to the drilling rig being transported through this area of the highway. Monica said that she was speaking with [Shawn] and the Mustang came up quickly, striking [Shawn's] truck,and her truck. Monica said that her truck was slightly displaced by the Mustang, but her truck is still facing the direction it was, in the similar location,prior to impact. Monica said that she is shaken up and has some aches,but no obvious injury at this time. Shawn confirmed that his vehicle was also slightly displaced, possibly 4 to 5 feet from where he had stopped,prior to impact. The driver of the Mustang(preferred to be called Cole) agreed that he did run into the two pickups. Cole discussed the incident with me; Cole recalls that he was traveling approximately 60 MPH and not wearing a seatbelt. Cole explained that he did not see the truck in front of him until he recovered from "yawning". Cole said that he tried to stop and locked up his brakes. Cole said that his vehicle went between the two vehicles and continued to slide to a stop. Cole recalls seeing the flashing yellow lights in a distance, but does not recall seeing the other truck, stopped in the southbound lane. Cole said that he did not wish for medical treatment, but does have some minor pains. Cole expressed that he is angry with himself because others were injured and cars were damaged. Cole said that he was on his way to UNC in Greeley for a presentation. During the investigation, the following information was discovered: Monica was actively displaying caution lights and flags for an oversized load. The load was traveling north on SH257 and would soon be approaching the bridge, located just south of the accident. Monica was one of the pilot vehicles and she found a wide area of the roadway to stop traffic before the bridge. Shawn was traveling south on SH257, and was flagged to stop by Monica. Shawn would later explain he was calm and spoke to his wife via phone, as well as spoke to Monica. Shawn did not see the Mustang coming, nor did Monica while she explained to Shawn the reason for stopping traffic. Monica was stopped in the median area; Shawn was stopped in the southbound lane. Cole was approaching this location and had yawned,taking his eyes off the road momentarily. Cole saw the stopped traffic, hit his brakes and left a skid of approximately 57.5 feet, impacted the driver side rear end of Shawn's truck, and also made minor contact with Monica's truck, driver side front tire area. Cole's car ricocheted away from Shawn's truck and struck the driver side rear of Monica's truck. Cole's vehicle did then slide, with the passenger front tire and rim destroyed,to a stop,approximately 140 feet after the point of impact. All vehicles were damaged enough to no longer be operable. Three tow trucks responded to tow each vehicle. While waiting for two trucks. T continued to ask each driver to tell me their status. Shawn and Monica hnth Event No.. 127229 -Incident Repo' Page 4 of 4 reported that they are experiencing an increase in pain and agreed to be assessed by paramedics/firefighters. I explained the incident to medical workers and they did visit with each driver. No one was transported to emergency facilities at this time. Cole was issued summons#C251O3 for Careless Driving. Insurance information and tow information will be added to the vehicle section of this report. Photos were taken of the vehicles and general area. A second pilot vehicle showed on scene, driven by Michelle Culbert. Michelle stated that she was ahead of the oversized load, but behind Monica. Michelle stated that she saw Monica and the other truck stopped, and watched the Mustang approach southbound and run into both trucks, striking the green Dodge first,then Monica's truck.Michelle provided a written statement. I did later take measurements for the diagram. I did attempt to see how it was that Cole did not see the stopped truck in the southbound lane. I called Shawn on 07/23/12. Shawn could not recall for certain if he had his foot on his brake pedal,but believes he did have his vehicle transmission in park. It is possible that Cole may not have observed brake lights from the stopped truck, but should still have had time enough to observe the pilot vehicle's flags and lights. Nothing further to report at this time. Lase Management Initial Investigator Event StatuslDispo Event Status/Dispo Date Report Status COOK,RICHARD CLEARED 07/22/2012 APPROVED Approved By Solvability Percentage SHAINLINE,ROBERT 0.00% 7/2d/71119 pR 2a47{o3;a3i06J MAIL TO: STATE OF COLORADO COLORADO DEPARTMENT OF REVENUE MOTOR VEHICLE TRAFFIC RECORDS STATE OF COLORAG _. TRAFFIC ACCIDENT RL.,0RT DENVER,CO 80261-0216 ❑AMENDED/SUPPL. O UNDER $1,000 O COUNTER REPORT 0 PRIVATE PROPERTY PAGE./ OF .3_PAGES C DOT Code I— LIMN NUMBER Inn?.r•...4.,, t KI Li INTERSTATE HWY m © 0i i I f OS - A Casekl /2 — 22 ❑CTYSTICNTYRD ill Ill ❑ IIIIII IIIIIIIIIIIIIIIIIIIIIIII n7K Dale of Accident City envy County r County x e e9 Time(24 Hr.) Officer N r ithAin-04 Officer Na. ! i e Simon t S� DetailL cPcn A i :e s s -Number.tilled Number Irgrred Location Route,Street,Road Miles 375- Feet NO S❑ E❑ W❑ OF: /r/J �L yr.) - 4fP& 7742/j Der• ❑At: _5//;ZS— 7 0 s Date d Report 7- Latitude Longitude B(2 G ,2 - i� 9. /7 Agency Code Investigated Total Vehides District Number Public Property/ Photos Taken Railroad Crossing'Const.Zone Highway Bridge M Scene g) 3 Ernplo)ee O Related 0 I Related❑ I nterchg.O Related O 7 a 'flank UM I 0 Volt. ❑Pecked ❑Bicycle O Pedestrian O Non-Vehicle 0 Non-Contact Veh Z a Trare f yrilt 1.,.7 lo, _ ❑Veh. 0 Park ed ❑a vi ❑P�esirian O Non-Vehicle ❑Non'oNed Veh M 03 Last Name First Mf 185'Name Firs MI l r ,, L � ref _C neei s, 4 4//'�c:/1r fri StreetAddress + Personal Phone Street Address •- Personal Phone -�f7cl/r{ �-cuAr /` (7,' ) 3v2./S'S'T /9/c� L;�,' ir,vel /. (9rG),1G!2};,S- City, State ZIP Bus.Phone City Slate ZIP Bus.Phone N !3r�4il:cihri ti Ci= rsrl" 7 ( ) t4(l.oefrA" fe .:1J i ( 65- Drivel Liwnse Number CDL S ite Sex 006 Driver License Number CDL Stale Sex 1X16 o —/4�?_ p5�/Y C'c� ,/,fsic 9 3 9 5 n 1.3 c CL' ,. dy-e. .7ci 6..:• ':' %� Primary Violation A Primary Violation c0o ❑DUI (.' i .jI,1 fl ii./JF; O DUI Vwlatien Code,,// 'Citation Number Common Code Violation Code Citation Number I Common Code of Y—/Cf02. C,2 570,3 /v/ JC P Ye Make 'Model BoCY T Year 'Make Model aooy Type 0 Ci -6ZI' C' 2 j/7 freef7L _ 0 fib —/. license Plate Number State or country CoI� License Plate Number Slate or Country Colg _ .2.^ .S' 7C'/i (0' Z/0 Vj 72r/tit/ (1G I`t/C'.s. y .Vehicle Identification Number Vehicle Identification Number l/NL(y'G'rr K At e).3a, /o7pv i Cr VL?5t(,(1;.;ePq Vehicle Owopr Last Name 9 Same First MI Vehicle Owner Last Name fii3 Same First Mt , /.'/f6R_ /4Qr/ `I T r(: \Address p Same Ciry " State ZIP Address❑Srune City State ZIP o Towed Due to Damage g By: N0S.L %'7 't' Towed Due to Damage ISkSY: 14� 'rie/e F incY•✓() l70 To: iii'%L's 4r To. fiee,e7 Aer;f Y ie7- [1{, ; C; Trailer VIN# Trailer VINS - i _i I -- "-- I-JH I----r LI.._ 1-Slight _.. r__��• �-_!L 12. _ i• : L---' 1-Slight t. ; ,:. I , , , , 2-Moderate , i . '-3'3 2-Moderate c _Undercarriage Undercarriage 3-Severe _ Undercarriage Undercarriage 3-Severe P y 0 None ❑No Proof Dale R �( insurance Company ❑Nore ❑No Proof Ex p,pate, InsuranceC. .. -c-,7;4 rrjte,/;'r //-; 6./2 R$ �c/-O-/3 (.. Policy Number Policy Number ry i _ fi t !. t H H /677(-C %�:v 6, :P !- , 7t a Owner Damaged Prop. Last Name First MI Address City State ZIP _-Owner DarnagedProp Last Name First MI Address City Stale ZIP J CO T.U. POS. 9EST.ENDO SAFETY SUSPECTED AIR BAG FJECTSUSPE D INJ. AGE SEX NAME/ADDRESS S e _ EQUIP. ALCO DRUG SEV. 4/1/". /42 1? ..3 I oo 1/� 0�1 F ;)r~ �e Al , t. ill / ( � c /_ !,'l l7 .' r`I{rb.i: G'c'f11 4,4 s z / rat L,0 i3 I-0/ 1 A o! 1 r ar'a c..�. (7/ 3k Al ,;,):'/), . h N3 1 lti• C.i r3 `C, 1 A 0 i f ft r=e ,..y o r Y',� C /.',:1 :4 lira 3 I I { T _� ! Ce �u T lig H1 . • Approved By ID.# Date L ' J un cwr tuJIWVOJ MAIL IU: a IAILUP .,ULURMVU 1 COLORADO DEPARTMENT OF REVENUE MOTOR VEHICLE 1 TRAFFIC RECORDS STATE OF COLORAL ) TRAFFIC ACCIDENT Ri. _'ORT DENVER,008028111-0016 ❑AMENDED/SUPPL. ❑UNDER $1,000 0 COUNTER REPORT O PRIVATE PROPERTY PAGE _OF J _PAGES CDOT Code ❑ INTERSTATE HWY HWY NUMBER El © Z DOR Code K K II ('/A p STATE HWY MILEPOINT11 lliI I I _-'J_Case s I X. — 799 i ❑CITY ST/CNTY RD 111 0 .0 El I Date of Accident Clly Agency ,, {County County d mrtnree t97 r 2-/2_ (��:1.etiz': `NNW/2�• r L/r;4;k.110,1 vY 1 /l'2 C/V TPe'V11 . 0ffeerJjlarrt�� /j d ISig4Dtt;r Decal _._._.� -Number Killed Number Injured 1 Location Route,Street, oad Miles .375- Feet _ N E3 S❑ E❑ W❑ OF: _ r L 8 3 — L C'7 Date?Report �•'t•,'4"J i-i�.'//.( ❑At: J(/A S 7 - /2 Latitude Longitude /.2 Agency Code I Investigated Total Vehicles PrD ! Photos Taken Railroad Crossing'Const.Zone H hwa Bridge M I @ Scene fgi I 3 I District Number'Public Employee 0 I Related 0 Related 0�In erchg.0 i Related 0 'l'3 Traffic r�l t Trek Unit N µ 6 .LI� a 0 veh. ❑Parked 0 Bicycle 0 Pedestrian 0 Non-Vehicle 0 Non-Contact van.2 e 0 Yen- 0 Parked O Bicycle 0 Peliesvian 0 Non-Vehicle ❑Non-Contecl Veh. Last Name 1First MI, Last Name First MT I ljLllit _1 .1..e.'-,12_,0 L Street Address Personal Phone Street Address Personal Phone (/'/:.,'' ,riri j tLrS.i //'.�rc (Z77r•) _?gi-E's,r,'': ( ) City fSlate ZIP Bus.Phone City Stale ZIP Bus.Phone // N 4J%24'1 /ti" 8G'c6.'(J I( ) ( ) N•� Driver License Number CDL Stale Sex DOB Driver License Number CDL State Sex DOB N Primary Violation Primary Violation C 0 Dui ID DUI _ Violation Code Citation Number Common Code Violation Code Citation Number Gammon Coda P /, Model Year Make Body Type Year Make Model Body Type 4,06:, /K P License Plate Number State or Country Color License Plate Number T ^Stale or Country Color 0 9,,6 cli r (7a 7/V U~ Vehicle identification Number Vehicle Identification Number ' r37//L32-it,22S6. 9.3 r2 _ Vehicle Owner Last Name Same First IMI Vehicle Owner Last Name 0 Same First I MI — E1`; Address 0:Same —�� City 'State 'ZIP Address 0 Same City State 1ZIP a l i06 Towed Due to Damage AI By: (,',.6 /(,,/aet%l 7t ='�.i towed Due to Damage 0 By: O To:/3/6 /444=4'r1 19 7 To: L' L. Trailer VIN# - Trailer VIN# "� I 1 - 11 t U... I I I I �_-_1 �'' I -,---II'l l -._ �! 1-Slight ----t i T ' --- ' 1-Slight l` f ' ! : 2 131 2-Moderate 2-Moderate G Undercarriage Undercarriage 3-Severe Undercarriage Undercarriage 3 Severe L O ( Insurance Company 0 None 0 No Proof Exp.Dale Insurance Company 0 None O No Proof Exp Dale ^ P Number Policy Number R y N L'/ Owner Damaged Prop. Last Name First MI Address City Slate ZIP Owner Damaged Prop. Last Name First MI Address City State ZIP lC'•7 T.U. SAFETY SUSPECTED 1N1. POS REST.ENDO EQUIP AIR BAG EEO,SUSPECTED DRUG SEV AGE SEX NAME 1 ADDRESS 1. ,S ;�r I s 1 1 _ I — T T 1 I - Approved By I.D.# Date L 1 1 PAGE__..., ,_OF_a—PAGES Case# DOA CODE Accident Date Agency HH Describe Accident �1 HH AA v ..,4!�l1�' �h!•ZS 1.S 4 t�iL[rr_ r'44. V. .2 70.).S—Sg_ 77c1X7l Fa '. ,;L-=S[ii e' :c'.4/,�- V2—.;ZY�'� t>fr_Z.Z._ AS `671_07-, . 4f'nt/�I-52 -3/42ST.. lr `. '%_ .I.'s:i'll!',T/'.4.,,4,C/c __4,../..7.-0...... 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I I , ' NN �cc; Carrier Name US DOT (] ICC � State DOT - Address Carrier Identification# NN IGG , Carrier Name US DOT [3 ICC D State DOT D NN IGGk — IV 3 Address Cagier Identfication# L WINDSOR POLICE DEPARTMENT 200 N. 11th St.Windsor, CO 80550 Phone: (970) 686-7433 Fax: (970) 686.7478 coCo> -' www.ci.windsor.co.us WITNESS STATEMENT Case Number: /2 -7229 Name: 27/V'i/,c?,,,e r.G/ / 6-?/' V DOB: //- 9- c — Address: r 2 -C / V (74', -P b (- City, State, Zip: =f 2/c��lolGf) acs `6O76 7 Phone: c' 7O - 7/ 7-- /6 SiJJ /gam 99 i 0- /r am:6G (1-,/ / u;f4e ±u i f G C( PO'/ 22 `-iri 6( Y2t// - -7/ 7-77;..q. wa S /A/4yr7A / f cd)I c,'/f cl ' 7"t i c g'-/ �A 6 /Oa d /..0 8 c ct tic /2 c lc) ti-/L P 6-4,;:yye (t y c 7/'-ice) et/A(3,i y-A a2 /lec fkt 4 i/ Amp C.-Z:7 e 0/ .ci 'S' 7r, J il �il.eif? ,. pie 111i_s. xp�,7�2-, Ft/ rS Y"� A17/- fil -0 ol(9'?, e jaic7f-CIF f !I ' '47 /e ra(''e 4ia as 60./.;) v, 6d 7c is a ped1 % -e6) a cii r r - l ds n.112 e G`4v-Ergy at C (J m i-Clef') ,� Y. O i , v 7 / ;1 ';7 '14`' % /1 ° f- Oen lJ; /7 art A( Cad (2fl/ {9 bac e �� - Witness Signature: ��t��7�� Z c c2 ? Date: Received By: ----'" __ ,cS Date: G07--22-/, (Revised 1112010) Page of WINDSOR POLICE DEPARTMENT UNIFORM SUMMONS & COMPLAINT TOOR PENALTY ASSESSMENT THE PEOPLE OF THE STATE OF COLORADOVS CASE NO. /C - / 22 9 No. c 25103 Defendant (Last Nam 1 (First) (Middle) Date el Bind' I A Violation Date: .) - z cf— / / Traffic 2 Penal - 2 - / Defendant s Address /2 • ,. City Slate Zip Approa T ahon L Slate Race Sex H1 W 1 T6/✓ e 7 Q '7�C Sa sAu%5/ T , / J/'/! 6 Dr vets t b 5 �. Hair E Telephone , X clz 0 /y � /, !u Ar (00 / iO ' .�si'a Eyes 71_91 --3C/ 2 - / c/ V7 vehicle ucense # Slate VIN 22 -7-/c)(-) 110 liALFS/ G9AfiI2d3S2g- m Approximate Locale n of Violation, State of Colorado. weld County I1 ••:^+^• root)/ l he Tow noVlids0 Vehicle C//IoIl(or Vehicle YearC (� Make/n Type (/� i A X' T N X' AO / Y7. I lY'CG� _�1 __PI. TY '1N ,S/ix .-7 �t �'i!2 T/(L / Y.. Registered Owner (Name and Address)X'SA YOU ARE SUMMONED AND ORDERED TO APPEAR TO ANSWER CHARGES AS STATED BELOW IN: mro, eooe amphve WINDSOR MUNICIPAL COURT '"' WELD CO COURT LAflIMER UNTY C RT x .110, y at 301 Walnut 51 In Windsor, Colorado om,o a , al Dente ! Bldg., 975101h St in Greet , Colorado at 201 LaP a in Fad ins, Colorado on S< A' /3 __207 2 . at . .5-: 3CC,o/( on 201 al on 201 at CHARGE Ssnon / M.iCT FINE + SURCHARGE TOiAI. ROIr.MS CPA CODE CRS wM.e 7 sea Descrp'on oI Donee cn -I w = ❑ - fU7 N 2 CHARGE Secion MIL 1 FINE . SURCHARGE TOTAL FOUNTS COIN CODE D O ,43 CRS wL , Sect r CO Des ,Pon SI Olense f7 o n w I cc r o H O C) Z C W JMTC 1211 J CRS 42.4 1211 CC. PTS MTC 1402 J CRS 42-4-1402 C .C. PTS JMTC 1008 J CRS 42-4-10Da111 C :C. PTS RELESS GRIVING 141 4 FOLLOWING TOO CLOSE 142 4 Z UNSAFE BACKING 153 2 FINE SURCHARGE ,___ U FINE SURCHARGE FINE . SURCHARGE vs - - - —1 TOTAL _ r a TOTAL _.-_.-_ TOTAL (.u�. - 21 J JMTC 1101 (7) J CRS 42-01101 J CRS 42-4-140913) m < SPEEDING _ MPH IN A NO PROOF OF INSURANCE C.C. P13 ] WMC SEC 7-G-20 D G7 MPH ZONE C.C. PTS' 957 4 DOG IDENTIFIGATIDN REQUIRED O FINE SURCHARGE03 W FINE _ SURCHARGE _._ FINE ..-,_ --__ SURCHARGE _ J TOTAL ____ Q TOTAL TOTAL _ -H in J MIL 703 (3) JCRS42-4-703(3) J CRS 42-4-1409(2) JWMC SEC 7-6-60 Cl) U) FAILED TO STOP FOR STOP SIGN C.C. PTS NO LIABILITY INSURANCE iannR IRAN °CREP.I C. C. PTS DOG AT LARGE 5 = FINE SURCHARGE 319 4 FINE , SURCHARGE 956 4 . FINE __ _ SURCHARGE _ rn t- TOTAL TOTAL TOTAL J MIT 236 JCH542-l237 (2) JCRS 42-4-1409(1 ) JWMC SEC 7-6-30 SEAT BELT REQUIREMENTS C.C. PTS NO LIABILITY INSURANCE IOw1=SROP(EA1we VETO C.C. - PTS RABIES VACCINATION REQUIRED FINE __ SURCHARGE 575 0 FINE SURCHARGE _ 954 4 FINE SURCHARGE TOTAL _ TOTAL TOTAL _ J CRS 4?-3-114 (1 ) (a) J CRS 42 2. 101 (1 ) JWMC SEC 7-6-70 EXPIRED LICENSE PLATES DROVE VEHICLE WITHOUT VALID C.C PTS DISTURBING THE PEACE - BARKING DOG FINE SURCHARGE C.C. PTS DRIVERS LICENSE 060 3 FINE _ SURCHARGE __ TOTAL 038 0 FINE SURCHARGE _ TOTAL TOTAL SUMMONS: 7:TRAFFIC INFRACTION OFFENSE PENALTY ASSESSMENT: 1 T AFFIC INFRACTION - J OFFE t - WITHOUT ADMITTING IT, I HEREBY PRO E TO UPON PAYMENT OF THIS PENALTY A ESSMENT I ACKNOWLEDGE GUILT OF jo APPEAR AT THE TI AND PLACE INDICA ABOVE. ALL CHARGES CONTAINED HEREO AND UNDERSTAND THAT THE POINTS TOTAL FINE: INDICATED ABOVE WILL BE AS SED AGAINST MY DRI FRS LICENSE U DEFENDANT DEFENDANT NOTICE: SEE I S R I I NS ON R D NOTICE.' SEE INSTRUCT! SON CE,RSE SIDE ' WITHOUT ADMITTING GUILT I HEREBY PROMISE TO APPEAR AT THE MANDATORY COURT APPEARANCE NOTICED PLACE INOIC;D VE`2 TIME ? TOTAL FINE : DEFENDANT _ SEE UCiiON5 ESIDE - /f CITIZEN COMPLAINT THE UNDERSIGNED HAS PROBABLE CAUSE TO BELIEVE THAT THE DEFENDANT COMMITTED OFFENSE(S) AGAINST THE PEACE AND DIGNITY OF THE PEOPLE OF THE STATE OF COLORADO AND AFFIRMS THAT A COPY OF THIS;SUMMONS 8 COMPLAINT P7 OR PENALTY T WAS DULY SERVED UPON THE DEFENDANT. DATED THIS 2 2 DAY OF.J 71( E Y 201_C OFFICER x �� RR,' no,, ion urr ^ nu emir .Ire a rasa nernin A an rum, ' WM Tn A Amorol : r nnl n n Hello