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Risk Management

Services - Automobile Incident Report

Services - Automobile Incident Report

ATBE Automobile Fund Incident Report

Instructions: An authorized representative of an ATBE Covered Party is to use this form to report to ATBE, within 7 days of the Incident, an Incident involving a Member board owned or Covered Party operated Covered Automobile, as defined in the Coverage Agreement. Transmit with this form or immediately upon receipt, if after submission of this form, a copy of the official police accident report and all supporting documentation as instructed below.

Note that a Claim or Loss should be submitted separate from the Incident Report and pursuant to the Notice of AL Claim Procedure or Notice of APD Loss Procedure. Reporting an Incident is separate from and does not constitute an ATBE AL Claim nor an ATBE APD Loss.

Submit this form and all documents/photos/videos to ATBE, via E-Mail: lhs@hestersellers.com

Complete the form below OR
download and print the form and return it and all documents to ATBE:

Board of Education Employee Involved in Incident

1. Does the driver have a valid Alabama driver's license and commercial driver's license, if required for the type of Automobile to be driven? *

If no, why not?

2. Does the driver have appropriate certification from the Alabama State Department of Education, if required, including but not limited to Alabama Department of Education School Bus Driver Certificate and documentation maintained by the Board evidencing the driver's compliance with Ala. Code Section 16-27-4.1 and applicable Alabama Administrative Code provisions (Physicals for School Bus Drivers)? *

If no, why not?

3. Is the driver an Employee of the Board (a person duly elected as a superintendent of the Board, employed by the Board as a superintendent, employed by the Board as a chief school financial officer, or whose employment was recommended in writing by the superintendent and approval, thereof, by the Board recorded in its minutes; and a person who meets the Internal Revenue Service definition of employee – a copy of the Board minutes may be subsequently required)?

Board of Education Vehicle Involved in Incident

Claimant(s) or Potential Claimant(s)

Provide name, address, and telephone number for each; if claimant is a minor provide the age of the minor and the name of a parent or legal guardian. (Field will expand if needed)*

Witness(es) to the incident

Provide name, address, and telephone number for each. *

Description of Incident, including statement by board employee driver involved in the Incident

Include (i) a description of the facts surrounding the Incident (separate from any information on police report); and (ii) a description of any property belonging to the claimant or potential claimant that may have been damaged

Upload the Following Supporting Documentation Below

Photographs, Video, and/or Illustrations: Attach and provide (i) photographs of any damaged property AND (ii) photographs, video, and/or illustrations of the Incident location to illustrate location of vehicle(s).

Official Police Accident Report: Separate from the description, statements, and information above, attach and provide a copy of the official police accident report.

Additional Information or Supporting Documentation: Attach and provide any additional information or supporting documentation as available and appropriate.

(Upload Supporting Documentation Below.)

Board of Education Contact Regarding this Incident

Upload Supporting Documentation for Incident Report

Attach File(s). Total upload cannot exceed 250MB.

Do NOT attach an AL Claim nor an APD Loss. AL Claims to be submitted pursuant to the Notice of AL Claim Procedure and APD Losses to be submitted pursuant to the Notice of APD Loss Procedure.

Add more...

Note: Additional supporting documentation and/or photographs may be emailed directly to lhs@hestersellers.com.

Updated 2024/2025

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