Reporting Incidents

Incident Reporting Form

Has your vehicle sustained minor damage while on the E-470 roadway, and would you like to report that damage to us? The E-470 Public Highway Authority encourages our customers to report minor, non-injury incidents as soon as possible. E-470 highly recommends that you contact your own insurance provider as well as submitting the incident reporting form below. In most cases, your insurance provider is best equipped to advise you regarding vehicle damage and they will need you to report your claim in a timely manner. Once this form is received, E-470 will review the details provided and contact you within one week from submission.

Incident Reporting Form

Name*
First Last
Company Name
Email*
Enter Email Confirm Email
Phone*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Did you receive Roadside Assistance?*
- Yes
- No
Police Report Number
Date of Incident*
MM slash DD slash YYYY
Time of Incident*

Hours :

Minutes

AM/PM
Please tell us as much as you can about the location of the incident.*
In which direction were you traveling?*
- Northbound
- Southbound
Mile Marker
Please describe the incident in as much detail as possible.*
Vehicle Make*
Vehicle Model*
Vehicle Color*
License Plate*
Please describe any damage to your vehicle or other property in as much detail as possible.*
Certification*
By completing and submitting this form I certify that my answers are true and correct to the best of my knowledge and that if I am completing this form on behalf of a corporation I have the authority to release this information on behalf of the corporation. I acknowledge that my submitting this form does not mean E-470 Public Highway Authority has or will accepted liability. This form merely allows investigation and analysis of the facts and circumstances relating to the incident. I further understand and agree that I am providing the requested information voluntarily to assist in investigation of the incident, and that, by completing this form, I hereby grant my permission to the E-470 Public Highway Authority to use and share the information contained herein, including sharing this form and all related information with E-470 Public Highway Authority’s insurer, law enforcement, or others investigating the incident. Further, I understand that E-470 Public Highway Authority is subject to the Colorado Open Records Act, Sections 24-72-200.1 et seq. C.R.S., and the Colorado Governmental Immunity Act, Sections 24-10-101, et seq., C.R.S. and that all claims will be reviewed in accordance with applicable statutes. Finally, E-470 Public Highway Authority does not in providing this form intend to waive immunity provided to governmental entities in Colorado.
- I certify the following:
CAPTCHA
Email
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