Eckman, t -.
. NOTICE OF CLAIM FORM to� the City of Saint Paul, Minnesota
Minnesota State Statute 466.05 states that "...every person...who claims damages from any municipality...shall cause to be presented to the
governing body of the municipality within 180 days after the alleged loss or injury is discovered a notice stating the time,place,and
circumstances thereof,and the amount of compensation or other relief demanded." .
Please complete this form in its entirety by clearly typing or printing your answer to each question. If more space is
needed,attach additional sheets. Please note that you will not be contacted by telephone to clarify answers,so provide as
much information as necessary to explain your claim,and the amount of compensation being requested. You will receive a
written acknowledgement once your form is received. The process can take up to ten weeks or longer depending on the
nature of your claim. This form must be signed,and both pages completed. If something does not apply,write`N/A'.
SEND COMPLETED FORM AND OTHER DOCUMENTS TO: CITY CLERK, '
15 WEST KELLOGG BLVD, 310 CITY HALL, SAINT PAUL, MN 55102
First Name�[��-.C�_ Middle Initial�Last Name� �vL/�, � R F(��I e/�D ,
� Company er Busine��Name � Q �� �T��S�_�V.��.�,�_ f1(`T 1 n '�013 I'
Are You an Insurance Company? Yes/ o ff Yes, Claim Number? �
RK
Street Address�������"��� �v � ' �'
City j I {�/�-(�� State m� Zip Code . ,_ !�y ,
�
Daytime Phone(� - Cell Phone(�)�- (�,5�6 NEvening Telephone(_� - ,
! Date of Accident/Injury or Date Discovered �c / Time am/� !
;
Please state,in detail,what occurred(happened),and why you are submitting a claim.Please indicate why or how you {
feel the City of S 'nt P/�u�l or its emplo��e/�s are involved d/or responsible for your da ages� r I �"� I r�' � �C i
�!'✓� �t�7.�� �V l 2 '�J i � �' ' ;
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f7� ' � '�e^
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Pl ase check the box(es)that most closely represent the reason for completing this form:
�My vehicle was damaged in an accident ❑ My vehicle was damaged during a tow
� �VIy vehicle was damaged by a pothole or condition of the street ❑ My vehicle was damaged by a plow
❑ My vehicle was wrongfully towed and/or ticketed ❑ I was injured on City p:opErty �
❑ Other type of property damage—please specify
❑ Other type of injury—please specify
In order to process your claim vou need to include copies of all applicable documents.
For the claims types listed below,please be sure to include the documents indicated or it will delay the handling of
your claim. Documents WII..L NOT be returned and become the property of the City. You are encouraged to keep a
copy for yourself before submitting your claim form.
O Properiy damage claims to a vehicle:two estimates for the repairs to your vehicle if the damage exceeds
$500.00; or the actual bills and/or receipts for the repairs
O Towing claims: legible copies of any ticket issued and a copy of the impound lot receipt ,
O Other properiy damage claims:two repair estimates if the damage exceeds$500.00;or the actual bills
and/or receipts for the repairs; detailed list of damaged items ,
O Injury claims: medical bills,receipts
O Photographs are always welcome to document and support your claim but will not be returned.
Page 1 of 2—Please complete and return both pages of Claim Form
. ,� _
Failure to complete and return both pages wilt result in delay in the handling of your claim.
All Claims—ulease comulete this section
Were there witnesses to the incident? Ye No Unknown (circle)
Provide their names, addresses and telephone n b s: e.� i` /�h � h � �
r�� � �' 'Q��� , �Co-�'�,�� ^ L�P �7
Were the police or law enforcement called? es No Unknown (circle
If yes,what department or agency? (�i� � Case#or report# l 3 —��S �`.�6 9 '
Where did the accident or injury take place? Provide street address,cross street, intersection,name of park or facili ,
closest landmark, etc. Please be as detailed as possible. If necessary, attach a diagram. �7� �/a�� ��/2
Please indicate the amount you are seeking in com ensation or what you would like the City to do to resolve this claim
to your satisfaction. � /-`
Vehicle Claims—please complete this section ❑ check bax if this section does not annlv
Your Vehicle: Year Make � e v,�o e Model �a h�/f.
License Plate Number , \� � �State Color �
Registered Owner IL 1— o -� � �
Driver of Vehicle � ' �� C A-S c�� C�
Area Damaged 2� J Lr� � ,
City Vehicle: Year Make � Model --° � �'J
License late Number State Color
Driver of Vehicle(City Emplo e 's Name) �� W�(�t-�
Area Damaged Cf' I
In'u Claims— lease com lete this section check box if this section does not a 1 �
How were you injured? ;
I
What part(s)of your body were injured? '
�
Have you sought medical treatment? Yes No Planning to Seek Treatment(circle) ��,
When did you receive treatment? (provide date(s)) ;
Name of Medical Provider(s): i
Address Telephone
Did you miss work as a result of your injury? Yes No !
VVhen di�veu miss work? (provide date(s)) �
Name of your Employer: j
Address Telephone
�
❑ Check here if you are attaching more pages to this claim form. Number of additional pages i
B si nin this orm ou are statin that all in ormation ou have rovided is true and correct to the best �
Y g g .f �Y g .f Y P �
of your knowledge. Unsigned forms will not be processec� �
Submitting a false claim can result in prosecution. Date form was completed
,
Print the Name of the Person who Completed this Form: i
li
Signature of Person Making the Claim: �
Revised February 2011
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� � COMNII�SIONER OF COMM�RCE , �
for t}ae State of Mi.nnesota hereby
certifies that .
CITY OF SAINT PAUL
has made application,paid the fees required and in aIl other respects complied with the laws of the State af ;
Mmnesota and is hereby authorized to transact the business of a No-Fault Reparation Obligor authorized to
seif-insure p� �a t to Minnesota Statutes, Section 65B.48. �
ar 300 City Hall Annex,25 W.4th Street, St Paul,MN 55102
" Unless this authority be suspended,revoked, or otherwise legally terminated,this certificate shall be in effect until
� May 31,2012. .
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IN'I`ESTIlVIONY WHEREOF, I have hereunto set my hand at
�q`�� � my office in the City of St.Paul,Minnesota,
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� � May 31,2009
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�'Qbxe a�d Procedure f�r Repo�-4�ng and Docum�nting 14'iotor Vehicle Accide�ts involvigag City af Saant I
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Paul and Saint Paul Region�i �'ater Serv�ces Vehicles
P���cv: A State of Minnesota Mator Vehicle Accident Report form must be completed, in its entirety, for
every accident involving property damage, vehicle darriage, or personal injury- Every accident that involves
a private vehicle, private property or personal injury of a non-City employee must be reported to the Poiice
Deparhnent of the municipality where the accident occurred.
A1I damage, including dents or scrapes to the City of Saint Paul or Saint Pau1 Reg�anal Water Services
vehicle(s), dar�age to City property or damage to ott��er property, must also be reparted to the dri�er's
su�ervisor.
F�s�rance Inforrai�tio�a: `ihe City oi Sai4# Paul and the Saint Paul Regional Water Services are self insured
per Minnesota Statute_ A copy af the self-insured notice should be 1n the gIove compartment of each vehicte
ovmed and operated by the City and SPRWS. If the self-insured certificate rs not present, contact Risk
Ma��agement for a copy.
�river's Responsibiliiies: When an accident occurs, the driver must complete the State of Minnesata Motor
Vehicle Accident report form and immediately notify his/her supervisor_ If the accident involves damage to
pnvatety owned vehicles or property or personal injury to a non-City empIoyee, the Police must be called to
the scene to compfete a report. The Police report numbe ao d�n�°�poeh aDepartmentP's�Sa ety pea on or
submitted to the supervisor, who in turn, should tum the
Division ivlanager. The fleet manager for the Department should also be notified of the extent of damage to
the City or SPRWS vehicle_
Safetv Person / Division 1V4ana�er Responsibilities: The SaFetv person for the Departrr�ent, the Fleet
titana�er or the Division 11�1anager who recelves the forms should rev�ew the accident report for corripleteness
�nd �ccuracv. If there is an Accident Review Board in place for the Depavment, copfes of the Forms shouId
be forwarded to the Board for considerahon and review at the next meetm�_
Copies of all �orms shouId be sent to the Claims Mana�er in Risk �'lanbe keec bv thetD partment for their
reviewed for accuracy. A summary of rnotor vehicle accidents shouJd p .
rec�rds, and for possible inclusion in the City's and SPRWS's annuaI report to t�'�e Stace cf Minneseta fer
self-insured status_ �
:�ceident Reviel� Board's Res onsibilities: A �epar�nent's Accident R�e���O�ion sho�ld b p�aken °Tl�- -
review of the circumstances of each accident an a rcgular basis to deterrn
prevent future accidents. Recognition of hazards, and recomm�de o�°�nat�e ecmeetings ia ae��e�ded
to the appropnate indivlduals_ Risk Management staff�s avail _ _
����c: pac�cets includin� the State af Minneso�'��a�dttshoPJd he in the Ioav�e campartrr�ent of each
Ivlanagement — CIaims Manager—6S 1-266-888 P
Citv and SPRWS vehfcle that is on the road. �
Last updated on 8/23/0�
. HEPPNERS AUTO BODY (Midway) Workfile ID: e2873b21
1 ������� 400 SYNDICATE ST. N., SAINT PAUL, MN 55104
�t�F�a�?��'�
Phone: (651) 646-8615
FAX: (651) 645-3230
Preliminary Estimate
Customer: ECKMAN, BRAD 7ob Number:
Written By:Tony Demma
Insured: ECKMAN, BRAD Policy#: Claim #:
Type of Loss: Date of Loss: Days to Repair: 0
Point of Impact:,
Owner: Inspection Location: Insurance Company:
ECKMAN, BRAD HEPPNERS AUTO BODY(Midway)
873 MARSHALL AVE 400 SYNDICATE ST. N.
ST PAUI, MN 55104 SAINT PAUL, MN 55104
(651)216-0564 Business Repair Facility
(651)646-8615 Day
VEHICLE
Year: 2007 Body Style: 4D SED VIN: 1G1AL55F877233284 Mileage In: 89577
Make: CHEV Engine: 4-2.2L-FI License: 271HWU Mileage Out:
Model: COBALT LT Produdion Date: 12/2006 State: MN Vehicle Out:
Color: tan Int: Condition: Job#:
TRANSMISSION Tinted Glass AM Radio Cloth Seats
5 Speed Transmission Console/Storage FM Radio Bucket Seats
POWER CONVENIENCE Stereo Reclining/Lounge Seats
Power Steering Air Conditioning Search/Seek WHEELS
Power Brakes Intermittent Wipers CD Player Wheel Covers
Power Windows Tilt Wheel Auxiliary Audio Connection PAINT
Power Locks Rear Defogger SAFETY Clear Coat Paint
Power Micrors Keyless Entry Drivers Side Air Bag OTHER
DECOR Message Center Passenger Air Bag Power Trunk/Gate Release
Dual Mirrors RADIO SEATS
9/27/2013 11:10:56 AM 050503 Page 1
Preliminary Estimate
� Customer: ECKMAN, BRAD 7ob Number:
Vehicle: 2007 CHEV COBALT LT 4D SED 4-2.2L-FI tan
Line Oper Description Part Number Qty Extended Labor Paint
Price$
1 FRONT BUMPER
'2 ** <> Repl A/M CAPA Bumper cover 19120183 1 280.00 2.2 2.6
3 FRONT LAMPS _ _
4 R8cI LT Headlamp assy w/o SS Incl.
5 ELECTRICAL _
6 Repl Horn 22758313 1 26.32 0.2
_
_ __ __ __ _ _
7 WINDSHIELD _ _
8 Repl Washer reservoir 2.2L&2.4L 22695010 1 56.65 03
_ __ __ __ _
9 FENDER
10 ** Repl A/M CAPA LT Fender 15793419 1 122.00 2.0 1.8
11 Overlap Major Non-Adj. Panel -0.2
i2 Add for Edging 0.5
13 Deduct for Overlap -0.3
14 Repl LT Fender liner 2.2L 15845961 1 34.25 Incl.
15 Repl LT Emblem GM MARK OF 15223484 1 8.28 0.2
EXCELLENC
16 WHEELS _ _ _. _
17 Repl Wheel,steel 15" 9595086 1 99.58 m 03
18 PILLARS,ROCKER&FLOOR _ _ _ _ _
19 R&I LT Rocker molding 0.6
_
20 FRONT DOOR
, 21 * Rpr LT Outer panel � 2•0
22 Overlap Major Adj. Panel -0.4
23 * Repl LKQ LT Mirror assy w/power 25831896 1 81.25 0_3 Qs.S
+25%
24 Overlap Minor Panel -0•2
25 Repl LT Body side mldg w/body color 15234550 1 52.50 03 0.5
cashmere
26 Overlap Minor Panel -0•2
27 R&I LT Belt w'strip 0.3
28 R&I LT Handle,outside primed 0.4
29 R&I LT R&I trim panel 0.5
30 REAR DOOR
31 * Rpr LT Outer panel 5_0 2.0
32 Overlap Major Adj. Panel -0.4
33 R8cI LT Belt w'strip 0•2
34 * R&I LT Body side mldg w/body color 0_3
cashmere
35 # Rpr clean and retape 0.3
36 R&I LT Handle,outside primed 0.4
37 R8cI LT R&I trim panel 0.5
38 QUARTER PANEL _
39 * Rpr LT Quarter panel � 2•4
9/27/2013 11:10:56 AM 050503 Page 2
Preliminary Estimate
� Customer: ECKMAN, BRAD ]ob Number:
. Vehicle: 2007 CHEV COBALT LT 4D SED 4-2.2L-FI tan
40 Overlap Major Adj. Panel -0.4
41 R&I LT Wheelhouse liner base, LS, LT, 0.3
LTZ
42 # Refn rope back glass 0.3
' 43 # Refn blend upper rail 0.5
44 REAR LAMPS _ _ _ _ _ _
45 R&I LT Tail lamp assy 0.2
• 46 REAR BUMPER . . .,
47 0/H bumper assy 1.0
48 # WHEEL REPLACED AND 1 20.00 X 0.1
BALANCED
49 * <> Rpr Bumper cover base, LS, LT � 3.0
50 Overlap Major Non-Adj. Panel -0.2
' S1 * Clear Coat �
52 # Refn BAG/CAR COVER 0.2
53 # Repl FLEX ADDITIVE 1 5.00 T
" . 54 # Subl HAZARDOUS WASTE REMOVAL 1 5.00 X
55 # RESTORE CORROSION 1 0.2
PROTECTION
56 # Repl TAPE STRIPE 1 16.00 T 03
" 57 # Subl TIRE DISPOSAL 1 2.00
58 # Repl TIRE 1 75.00
SUBTOTALS 883.83 22.4 17.5
: ESTIMATE TOTALS
Category Basis Rate Cost;
Parts 837.83
Body Labor 22.4 hrs @ $54.00/hr 1,209.60
Paint Labor 17.5 hrs @ $54.00/hr 945.00
Paint Supplies 17.5 hrs @ $34.00/hr 595.00
Body Supplies 17.9 hrs @ $2.00/hr 35.80
Miscellaneous 46.00
Subtotal 3,669.23
Sales Tax $ 1,453.83 @ 7.6250% 110.85
� Grand Total 3,780.08
Deductible 0.00
CUSTOMER PAY 0.00
INSURANCE PAY 3,780.08
THIS IS A VISUAL ESTIMATE ONLY. ADDITIONAL PARTS AND LABOR MAY BE EXTRA UPON TEARDOWN. PART
PRICES SUBJECT TO INVOICE.
NO GUARANTEE ON RUST REPAIR!
9/27/2013 11:10:56 AM 050503 Page 3
Preliminary Estimate
' , Customer: ECKMAN, BRAD lob Number:
Vehicle: 2007 CHEV COBALT LT 4D SED 4-2.2L-FI tan
MN ST 60A.955 - A PERSON WHO FILES A CLAIM WITH INTENT TO DEFRAUD OR HELPS COMMIT A FRAUD
AGAINST AN INSURER IS GUILTY OF A CRIME.
Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from the Guide
DR1CL05, CCC Data Date 9/16/2013, and the parts selected are OEM-parts manufactured by the vehicles Original
Equipment Manufacturer. OEM parts are available at OE/Vehicle dealerships. OPT OEM (Optional OEM) or ALT OEM
(Alternative OEM) parts are OEM parts that may be provided by or through alternate sources other than the OEM
vehicle dealerships. OPT OEM or ALT OEM parts may reflect some specific, special, or unique pricing or discount.
OPT OEM or ALT OEM parts may include "Blemished" parts provided by OEM's through OEM vehicle dealerships.
Asterisk (*) or pouble Asterisk (**) indicates that the parts and/or labor information provided by MOTOR may have
been modified or may have come from an alternate data source. Tilde sign (�) items indicate MOTOR Not-Included
Labor operations. The symbol (<>) indicates the refinish operation WILL NOT be performed as a separate procedure
from the other panels in the estimate. Non-Original Equipment Manufacturer aftermarket parts are described as Non
OEM or A/M. Used parts are described as LKQ, RCY, or USED. Reconditioned parts are described as Recond.
Recored parts are described as Recore. NAGS Part Numbers and Benchmark Prices are provided by National Auto
Glass Specifications. Labor operation times listed on the line with the NAGS information are MOTOR suggested labor
operation times. NAGS labor operation times are not included. Pound sign (#) items indicate manual entries.
Some 2014 vehicles contain minor changes from the previous year. For those vehicles, prior to receiving updated
data from the vehicle manufacturer, labor and parts data from the previous year may be used. The CCC ONE
estimator has a complete list of applicable vehicles. Parts numbers and prices should be confirmed with the local
.dealership.
The following is a list of additional abbreviations or symbols that may be used to describe work to be done or parts to
be repaired or replaced:
•SYMBOLS FOLLOWING PART PRICE:
m=MOTOR Mechanical component. s=MOTOR Structural component. T=Miscellaneous Taxed charge category.
X=Miscellaneous Non-Taxed charge category.
SYMBOLS FOLLOWING LABOR:
�D=Diagnostic labor category. E=Electrical labor category. F=Frame labor category. G=Glass labor category.
M=Mechanical labor category. S=Structural labor category. (numbers) 1 through 4=User Defined Labor Categories.
OTHER SYMBOLS AND ABBREVIATIONS:
Adj.=Adjacent. Algn.=Align. ALU=Aluminum. A/M=Aftermarket part. BInd=Blend. BOR=Boron steel.
CAPA=Certified Automotive Parts Association. D&R=Disconnect and Reconnect. HSS=High Strength Steel.
HYD=Hydroformed Steel. Inc1.=Included. LKQ=Like Kind and Quality. LT=Left. MAG=Magnesium. Non-Adj.=Non
Adjacent. NSF=NSF International Certified Part. 0/H=Overhaul. Qty=Quantity. Refn=Refinish. Repl=Replace.
R&I=Remove and Install. R&R=Remove and Replace. Rpr=Repair. RT=Right. SAS=Sandwiched Steel.
Sect=Section. Subl=Sublet. UHS=UItra High Strength Steel. N=Note(s) associated with the estimate line.
CCC ONE Estimating - A product of CCC Information Services Inc.
The following is a list of abbreviations that may be used in CCC ONE Estimating that are not part of the MOTOR
CRASH ESTIMATING GUIDE:
BAR=6ureau of Automotive Repair. EPA=Environmental Protection Agency. NHTSA= National Highway
Transportation and Safety Administration. PDR=Paintless Dent Repair. VIN=Vehicle Identification Number.
• 9/27/2013 11:10:56 AM 050503 Page 4
� Preliminary Estimate
` Customer: ECKMAN, BRAD 7ob Number:
Vehicle: z007 CHEV COBALT LT 4D SED 4-2.2L-FI tan
� ALTERNATE PARTS SUPPLIERS
Supplier: Keystone-Complete-Minneapolis
Location(s): 3615 MARSHALL STREEf NE, MINNEAPOLIS MN 55418 (800)328-1845 (612)789-1919
Line Description Item# Price
2 A/M CAPA Bumper cover GM1000733PP $280.00
10 A/M CAPA LT Fender GM1240324C $ 122.00
9/27/2013 11:10:56 AM 050503 Page 5
LATUFF BROS., INC.
880 UNIVERSITY AVENUE
ST. PAUL,MINNESOTA 55104
(651)224-2828 FAX:(651)291-0677
FEDERAL ID#41-0777034
***PRELIMINA Y ESTIMATE"""
I 09/27/2013 10:27 AM
Owner I
Owner: BRAD ECKMAN
Address: 873 MARSHALL AVE Work/Day:
Cell: (651)216-0564
City State Zip: Saint Paul, MN 55104 FAX:
Inspection
inspection Date: 09/27/2013 10:26 AM Inspection Type: Drive In
Inspection Location: Latuff Brothers Inc Contact:
Address: 880 University Ave Work/Day: (651)224-2828x
FAX: (651)291-0677x
City State Zip: Saint Paul, MN 55104 Work/Day:
Email: general@latuffbrothers.com
Primary Impact: Left Side Secondary Impact:
Driveable: Yes Rental Assisted:
Appraiser Name: ROBERT LATUFF Appraiser License#:
Repairer
Repairer: Latuff Brothers Inc Contact:
Address: 880 University Ave Work/Day: (651)224-2828
FAX: (651)291-0677
City State Zip: Saint Paul, MN 55104 Work/Day:
Email: general@latuffbrothers.com
Target Complete Date/Time: Days To Repair: 12
Remarks
12 DAY REPAIR
*****"""*�*PRELIMINARY ESTIMATE*""""'"`""""""`""'
POSSIBLE ADDITIONAL DAMAGE MAY BE FOUND AFTER TEAR DOWN
Vehicle
2007 Chevrolet Cobalt LT 4 DR Sedan
4cyl Gasoline 2.2
4 Speed Automatic
Lic.Plate: 271 HWU Lic State: MN
Lic Expire: VIN: 1G1AL55F877233284
Prod Date: 12/2006 Mileage: 89,575
Veh Insp#: Mileage Type: Actual
Condition: Code: U2363B
Ext.Color: GOLD Int.Color:
Ext.Refinish: Two-Stage Int.Refinish: Two-Stage
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2007 Chevrolet Cobalt LT 4 DR Sedan
Claim#: 09/27/2013 10:27 AM
Options
AM/FM CD Player Air Conditioning Alarm System
Automatic Trans Center Console Dual Airbags
Floor Mats Intermittent Wipers Keyless Entry System
Lighted Entry System MP3 Player Mud/Splash Guards
Power Brakes Power poor Locks Power Mirrors
Power Steering Power Windows Rear Window Defroster
Rem Trunk-L/Gate Release Tachometer Theft Deterrent System
Tilt Steering Wheel Tinted Glass Trip Computer
Velour/Cloth Seats
Damages
Line Op Guide MC Description MFR.Part No. Price ADJ% B% Hours R
Strines And Mouldinas
1 E 227 01 MIdg,Front Door Side LT 15234554 GM Part $60.65 0.2 SM
2 RI 299 MIdg,Rear poor Side LT R&I Assembly 0.2 SM
Front Bumoer
3 E 6 01 Cover,Front Bumper 19120182 GM Part $353.42 3.5 SM
4 L 6 13 Cover,Front Bumper Refinish 3.7 RF
2.6 Surface
0.6 Two-stage setup
0.5 Two-stage
5 E 63 Reinf,Frt Bmpr Cover LT 15232754 GM Part $13.62 0.4 SM
6 RI 12 Emblem,Frt Bmpr Cover R&I Assembly 0.2 SM
7 RI 19 Brkt,Front Lic Plate R&I Assembly 0.2 SM
Radiator S�u�nort
8 RI 890 Horn R&I Assembly 0.1 SM
Coolina And Air Conditionina
9 RI 153 Reservoir,W/S Washer R&i Assembly 0.3 SM
Front Bodv And Windshield
10 E 103 Fender,Front LT 15793419 GM Part $143.85 1.0 SM
11 L 103 Fender,Front LT Refinish 3.0 RF
2.0 Surface
0.5 Edge
0.5 Two-stage
12 E 241 Emblem,Front Fender LT 15223484 GM Part $8.28 0.2 SM
Front Bodv Interior Sheetmetal
13 E 155 Skirt,lnner Fender LT 15845961 GM Part $34.25 INC SM
Front Doors
14 I 209 Pnl,Front Door Outer LT Repair 9.0' SM
15 L 209 Pnl,Front Door Outer LT Refinish 2.4 RF
2.0 Surface
0.4 Two-stage
16 RI 407 W/Strip,Belt Outer LT R&I Assembly 0.1 SM
17 E 245 Mirror,0uter R/C LT 25831896 GM Part $186.03 0.7 SM
18 L 245 Mirror,0uter R/C LT Refinish 0.6 RF
0.5 Surface
0.1 Two-stage
19 RI 447 Channel,Front Glass Ru LT R&I Assembly 0.2 SM
20 RI 470 Handle,Front Door Otr LT R&I Assembly 0.2 SM
09/27/2013 1035 AM Page 2 of 4
2007 Chevrolet Cobalt LT 4 DR Sedan
Claim#: 09/27/2013 1027 AM
Rear poors
21 I 289 Pnl,Rear poor Outer LT Repair 7.0' SM
22 L 289 Pnl,Rear poor Outer LT Refinish 2.3 RF
1.9 Surface
0.4 Two-stage
23 RI 252 W/Strip,Belt Outer LT R&I A�ssembly 02 SM
24 RI 39 Rear Vent Glass R&I LT R&I A�ssembly 1.2 SM
25 RI 330 Handle,RR Door Outer LT R&I Alssembly 0.2 SM
Quarter And Rocker Panel
26 BR 256 Panel,Bodyside Otr Upr LT Blend Refinish 0.7 RF
0.5 Blend
0.2 Two-stage
27 IT 430 07 Panel,Rocker Front LT Partial Repair 3.0' SM
28 L 430 Panel,Rocker Front LT Refinish 12 RF
1.2 SurFace
INC Two-stage
29 IT 444 07 Panel,Rocker Rear LT Partial Repair 1.0* SM
30 L 444 Panel,Rocker Rear LT Refinish �NC RF
INC Two-stage
31 I 420 Panel,Quarter LT Repair 1.0' SM
32 L 420 Panel,Quarter LT Refinish 2.5 RF
2.1 Surface
0.4 Two-stage
Rear Bumoer
33 RI 569 Rear Bumper Cover R&I R&i Assembly 1.8 SM
34 I 569 Cover,Rear Bumper Repair 2.0* SM
35 L 569 Cover,Rear Bumper Refinish 3.1 RF
2.6 Surface
0.5 Two-stage
Manual Entries
36 L M14 Corrosion Protection Refinish 0.3' RF
37 EC M17 Cover Car Exterior Replace Economy $7.00" RF
38 SB M60 Hazardous Waste Removal Sublet Repair $5.00' SM
39 EC CLEAN AND REBACK SD MLDG Replace Economy $3.00' 0.3` SM'
40 EC RESTRIPE TAPE 4 PNLS Replace Economy $15.00" 1.0; SM*
41 I ROPE BACKGLASS Repair 0.3* SM'
42 I ROPE WINDSHIELD Repair 0.3* SM"
43 EC FENDER LOUVER, LT Replace Economy $15.00* 0.2* SM*
43 Items
MC Message
01 CALL DEALER FOR EXACT PART#/PRICE
07 STRUCTURAL PART AS IDENTIFIED BY I-CAR
13 INCLUDES 0.6 HOURS FIRST PANEL TWO-STAGE ALLOWANCE
Estimate Total&Entries
Gross Parts $800.10
Other Parts $40.00
Paint Materials $633.60
Parts&Material Total $1,473.70
Tax on Parts&Material @ 7.625% $112.37
Labor Rate Replace Repair Hrs Total Hrs
Hrs
Sheet Metal(SM) $52.00 12.4 23.6 36.0 $1,872.00
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. � r
2007 Chevrolet Cobalt LT 4 DR Sedan
Claim#: 09/27/2013 1027 AM
Mech/Elec(ME) $85.00
Frame(FR) $75.00
Refinish(RF) $52.00 19.8 19.8 $1,029.60
Paint Materials $32.00
Labor Total 55.8 Hours $2,901.60
Sublet Repairs $5.00
Gross Total E4,492.67
Net Total $4,492.67
Alternate Parts No
SPPL Yes Zip Code:55104 Default
Audatex Estimating 7.0.019 ES 09/27/2013 10:35 AM REL 7.0.019 DT 08/01/2013 DB 09/15/2013
Copyright(C)2013 Audatex North America, Inc.
3.6 HRS WERE ADDED TO THIS ESTIMATE BASED ON AUDATEX'S TWO-STAGE REFINISH FORMULA.
ESTIMATE CALCULATED USING THE 2.5 HOUR MAXIMUM ALLOWANCE FOR TWO-STAGE REFINISH OF NON-FLEX,EXTERIOR
SURFACES.
THIS ESTIMATE HAS BEEN PREPARED BASED ON THE USE OF ONE OR MORE CRASH PARTS
SUPPLIED BY A SOURCE OTHER THAN THE MANUFACTURER OF YOUR MOTOR VEHICLE.
WARRIINTIES APPLICABLE TO THESE REPLACEMENT PARTS ARE PROVIDED BY THE PARTS
MANUFACTURER OR DISTRIBUTOR RATHER THAN BY THE MANUFACTURER OF YOUR VEHICLE.
A PERSON WHO FILES A CLAIM WITH INTENT TO DEFRAUD OR HELPS COMMIT A FRAUD
AGAINST AN INSURER IS GUILTY OF A CRIME.
Op Codes
* = User-Entered Value E = Replace OEM NG= Replace NAGS
EC= Replace Economy OE= Replace PXN OE Srpls UE= Replace OE Surplus
ET= Partial Replace Labor EP= Replace PXN EU= Replace Recycled
TE = Partial Replace Price PM= Replace PXN Reman/Reblt UM= Replace Reman/Rebuilt
L = Refinish PC= Replace PXN Reconditioned UC= Replace Reconditioned
TT = Two-Tone SB= Sublet Repair N = Additional Labor
BR= Blend Refinish I = Repair IT = Partial Repair
CG= Chipguard RI = R&I Assembly P = Check
AA= Appearance Allowance RP= Related Prior Damage
This report contains proprietary information of Audatex and may not be disclosed to any third party(other than
the insured, claimant and others on a need to know basis in order to effectuate the claims process)without
�����`t�� Audatex's priorwritten consent.
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a Suae+a eu�;a,u�r��
- Copyright(C)2013 Audatex North America,Inc.
Audatex Estimating is a trademark of Audatex North America, Inc.
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