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Ntact Risk Management at 701-328-7584 or State Fleet at 701-3281472. Agency Name AGENCY TIME District/Division Address Telephone Number Date of Accident Day of Week Hour A.M. P.M. Location Description (i.e. Highway Number, Posted Speed Limit, Location from Nearest City, City, Street, and Intersection) LOCATION TYPE Backing Turned Over Fixed Object VEHICLE Year Make Model Driver's Name Rear End You Hit Right Angle Head On Other(Describe) Snowplowing/Sanding Animal Sideswipe Yo.

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