Pedicab Accident Report - Nyc Department Of Consumer Affairs
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242 Broadway | New York, NY 10004 | nyc.gov/consumers
PEDICAB ACCIDENT REPORT
PEDICAB DRIVER:
If you are involved in an accident during which someone is killed or is injured and requires medical treatment, you must immediately:
1)
Call 911 to report the accident. AND
2)
Notify the pedicab business owner. AND
3)
Provide your name, address, and information about liability insurance coverage to any person sustaining physical injury or property
damage in the accident.
PEDICAB BUSINESS OWNER:
As soon as you are notified that one of your pedicab drivers has been involved in an accident during which someone was killed or was injured
and requires medical treatment, you must immediately:
1)
Call (212) 487-8768 or e-mail
accidentreports@dca.nyc.gov
to notify the Department of Consumer Affairs (DCA) about the time and
location of the accident and any deaths or injuries requiring medical treatment.
IMPORTANT: Within 24 hours of any accident, BOTH THE PEDICAB DRIVER AND PEDICAB BUSINESS OWNER must jointly sign
and submit this form to DCA by e-mail to accidentreports@dca.nyc.gov. Failure to do so may result in fines and/or license suspension or
revocation.
PEDICAB BUSINESS LICENSEE INFORMATION
Name of Pedicab Business (Licensee):
Address:
DCA Pedicab Business License Number:
Owner, Principal, or Officer Name:
Telephone Number:
Pedicab Registration Plate Number:
Pedicab Identifying Number (PID):
Manufacturer:
PEDICAB DRIVER LICENSEE INFORMATION
Name of Pedicab Driver (Licensee):
DCA Pedicab Driver License Number:
Telephone Number:
ACCIDENT INFORMATION
Date of Accident:
Approximate Time of Accident:
Place Where Accident Occurred:
□
□
1. Was anyone killed in the accident?
Yes
No
If Yes, print the name, telephone number, and address of the person(s) below, if known:
□
□
2. Did anyone sustain an injury requiring medical attention?
Yes
No
If Yes, print the name, telephone number, and address of the injured person(s) below and describe the nature of the injuries:
□
□
3. Was any property damaged, including the pedicab?
Yes
No
If Yes, print the name of the property owner, telephone number, and address below, with a brief description of the damaged property:
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