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Filed for Record 11/01/2018 01:12:36 PM - Kittitas County, WA Auditor - 201811010016 Page 2 of 5 <br />7. Describe in detail the defect which caused the injury: <br />No iniury, must van damage on inside due to being popped out about 1/2" <br />with forklift. Frame upper left side door wouldn't closed a misalig <br />Describe in narrative form and in detail exactly how the incident occurred: <br />Bryan Nass used forklift to place pallet inside van. Upon placing it inside <br />he backed up to pull out and hit van door which popped it out and door <br />wouldn't close. It was hit with forklift on the frame on left side. <br />9. List the names of all persons involved and contact information, if known. <br />—Bryan -Nass and Cesar Vaquera <br />1.0. Was claim investigated by a police officer? No <br />Sheriff State Patrol City Police <br />11. Description of claimant's vehicle: Ford Make 2017 Year <br />Model: Transit T250 License No. C44626M <br />12. Describe what you did after the accident occurred: <br />Bryan Nass and I tried to fix the alignment of the van door so it would close. <br />13. Describe the conversations you had, if any, with County personnel during or after the <br />incident occurred: <br />I contacted mV boss Br an Calamia to see what to do. Bryan Nass and 1 put <br />wire rope from the door to handle to secure it and keep it from opening. <br />2 of 3 <br />Kittitas County Claim for Damages Form <br />Revised 912012 <br />