Van Kampen �rz����c�EO���� �a� ��[�€�c� �o�ice a� �fair�� �a �E�y o�€ �a� :
- ����o .
�
ll�innesota State Statcite 466.D5 NOTICE OF CLAIM.,.(EJver am�n�f/.�t
y person...who claims damages f�q�t��n Or
municipality...shall cause to be presented to the governing body of ihe municipality within 18� day��z,��/�
alleged loss or rnjury is discovered a notice stating the time, place, and ci�cumstances ther� and the arr]'d�nt of
compensation or other relief demanded. `
�O�p
Piease complete tiiis forn� in its entiret b t in or r►ntin �
Y Y YP 9 p ' g your answer to each question in
tf�e space provided. If additional space is needed, pfease attach additional sheets.
. ���, � y�� ?,r.�
— PLEA�E RETURfV THIS Office of City Cierk �3. i�� ,3��
COMPLETED FO � �
RM TO:
170 Cit Hall
Y
15 W lCellogg Blvd
St Paui MIV 55102 R�C�Il��,�
Your Name: C��z L • �Q h �a:v-� � ��0�� �� Z���.
street P,ddress:. - 6$� 1- 3—��`�` S� . . N . CITY CL��K
c�ty: O �I,e-�1��.� M ►�
State: Zip Code: �'S ��
Daytime Tele�hone: (b��) a �v � 3 S� � Evening Telephone: {65 t ) �-7 0 � Gz�'g
Date of Accident or Incident: 5 Zzl�3 �Day of Weei<: ���s�,�� Time: (2. 3c�
am i' pm {circle one) ,
Please state, in detail, wliat occurred and the circumstances surrounding the event. indicate how the ,
City of Saini Paul is involved, and why you feel the City is responsible.
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Piease indicate your reason for completing this form:
�--1 Veliicle accident C-1 Other property damage (please provide specifics below) ``�
� Vehicle was towed '.��
� Vef�icle ciamaged ❑ ��I
Other injury to person (piease provide specifics below) ;�
� Slipped an� fell on City property '���I
�� �
Please provide tfie names and telephone numbers of any City employees involved in ihis .1
� :
incident/accident and how tliey were involved: ' '
�ti �.�.� \ o .�.L � ���,c�� r� �lit.vv��c C' � `� ;
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(over)
. ' �'
if your vehicie �n�as involvec�, please compiete tf�e follo�n�ing:
;'Ear, mal:a, and mociel: Iqaq 5wharw Le���i t� License Plate I�lumber: �Kt DTD .
Exteni and araa damaged: �0.�_ � � � ke -E-�-�� bQ+�-f 5� ,�- �o�`f c s.e
�-o��\ �ri(>c../h1•� le�r c�w��c�
Was a City vehicle involved in this accident/incide�t? Yes No (circie one) � ���
�:.� '��G� �-+�5 \nvo��Se.s��t�n C6-ti.s� J
If yes, please complete tf�e foilowing: Type of vehicie
Year, make, and model
Color of vehicle License Plate Number: -
Description of vel�icle
Location of accident/incident (please provide specifics sucl� as street address, intersection, cross streets,
park name, facility name; etc.): ,
v�k��\.z c�.�a s ��rke�� +n� o� t�o.rkw�ra lc�� � �3 h�.,cr5��-v a.�Z� Le�v�a-�-c� w�
�j� ��.t�.Q �,(nG�o U��v�e.J 5 i��, �r��.w.�a,� L�,..�� �A�--�s-� o c c�.rr� ��
S e�n.�c.\.c., v�cz-� A ro o n�s�, r�' a�'i �_ i w.,c�c.�.c� lo� o-r.�. P�+����nv..c� fT.c�. �
P.lease draw or attach a diagram if a�plicabie:
Please specify the nature and extent of tl�e compensation or other relief you are requesting. Please
attach copies of any bills, receipts, ticl<ets, or other documents to support your claim. If you are
ciaiming damage to a vel�icle, please submit i�vo estimates.
S � reg�����3�'iG(-Z-`E i�n Go�o�sc��c.�x , u��ic.`.'cs"� aLcS��a�q,� o'�- '�.rz �-w a �t1�r�msc��
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t�i�S'1't vl� C�r��l.c��w� "'s 1�4� t^o r c�s�- c'r o'E'(.-�r dlC�,vwe�� . }
��Vere tl�ere witnesses to this accident/incident? Ye No (circle one) .
���- � -i�.9- �4tv,���.�a�� ��.�- � � �.�'3 •-1-c`.� +� ���t,�
If yes, please give the names, addresses, and telephone numbers of the witnesses: `�`i"s ��"�''"&�a"J�`�`p`�k�.�"`�
C V�Gv� — �.n�o�,at �� �w.au wti�. �O� vS�� ���Se_c� `l w2 il��t.�.c.
Cw:���n �a�v* �.w�ne� Iry'�v s. ��! S��s�sf��pls , Ma �S�ISN 612 -�06 -�o� (c\4�w.,��� Ls��ct>
(�.�--'F �e�e�c.� - ��C� S �S�"SF�'Lr��-, M� 5 S�k s� b t z -Fsl�6 -�Q 6 �� cQ edl �.&..�.�
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\Nere the police called? Yes No (circle one) If yes, what department or agency? �
Police report number: -
Piease print the name of the
person compfeting this form: �'�0.�� �-- �`�-� K0.-�>-e�
.
Please sign your name: �w...��\ V�--. �'e�� �
I
Date form signed: ��► . `E � 2oi3 I
�isk f�Agmt Division - Revis�d 1-30-01 .�;��;�
.t� „:
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_ ' HEPPNER'S AUTO BODY (Commons) Workfile ID: da14754f
. � �'�,
Caring since 1956
624 COMMONS DR, WOODBURY, MN 55125
Phone: (651) 714-1471
FAX: (651) 578-1287
Preliminary Estimate
Customer: VAN KAMPEN, CRAIG 7ob Number:
Written By: Bill Wilmes
Insured: VAN KAMPEN,CRAIG Policy#: Claim #:
Type of Loss: Date of Loss: Days to Repair: 0
Point of Impact: 06 Rear
Owner: Inspedion Location: Insurance Company:
VAN KAMPEN,CRAIG HEPPNER'S AUTO BODY(Commons) STATE FARM INSURANCE COMPANIES
6881 37TH ST N 624 COMMONS DR SELECT SERVICE*
OAKDALE, MN 55128 WOODBURY,MN 55125 P.O.BOX 52272
(651)210-3541 Cell Repair Facility PHOENIX,AZ 85072-2272
(651)714-1471 Day (866)207-6046 Business
VEHICLE
Year: 1999 Body Style: 4D SED VIN: 4536D6751X6264031 Mileage In:
Make: SUBA Engine: 4-2.5L-FI License: 741DJD Mileage Out:
Model: LEGACY GT Production Date: 4/1999 State: Vehicle Out:
Color: GREEN Int: GREY Condition: ]ob#:
TRANSMISSION Anti-Lock Brakes(4) Cassette Dual Mirrors
5 Speed Transmission ROOF Power Antenna Body Side Moldings
Overdrive Electric Glass Sunroof INTERIOR Ground Effects
SEATS GLASS Power Locks Spoiler �
Bucket Seats Rear Defogger Air Conditioning Fog Lamps I
Cloth Seats Power Windows Cruise Control Keyless Entry
STEERING WHEELS Driver Air Bag PAINT
Power Steering Aluminum/Alloy Wheels Passenger Air Bag Woodgrain
Tilt Wheel RADIO Digital Clock Clear Coat Paint
BRAKES AM Radio Intermittent Wipers �
Power Brakes FM Radio EXTERIOR
4 Wheel Disc Brakes Stereo Power Mirrors
10/30/2013 3:13:27 PM 060167 Page 1
' Preliminary Estimate
Customer: VAN KAMPEN, CRAIG Job Number:
Vehicle: 1999 SUBA LEGACY GT 4D SED 4-2.5L-FI GREEN
Line Oper Description Part Number Qty E�ctended Labor Paint
Price$
1 TRUNK LID
2 * Repl LKQ lift gate+25% 57501AC100 1 500.00 2.0 2.0
3 Add for Clear Coat �8
4 Refn lift gate underside 1.0
5 Repl Nameplate"Legacy"chrome 93022ACO20 1 28.20 0.3
6 R&I Spoiler 0.5
�_.___ ._..__.�._ __..���_ ... �_..._...,�..___,.�_.�.__._ �.____.�....�..._.._....�...�� �__._._ ,......._� ........_.__ _._.. ,.�. __...�._ .. . ._._.
REAR LAMPS
___.. ,,._. .. _.._.�.
open * Repl LKQ Combo lamp assy 84251AC080 1 r�, g�
9 * Repl LKQ RT Tail lamp assy 84201ACO20 1 125.00 �
10 * Repl LKQ LT Tail lamp assy 84201AC030 1 125.00 Q g
.�.-- _�.___,...�____.���.. _.,.,_._._ _.___.....__._...,�_..._. .,._.._... .�.__...___.___.�_.,,. ,,,,,,,�. .__.,,,,......�..,�,,,.... _.__....._.... ....._... ......_.�.._�..._.�.. .. ,.
11 EXHAUST SYSTEM °`
12 Repl Muffler&pipe sedan GT&LSI SOA8376900 1 179.95 m 0.6
.__ __. .... _ ...__..__ _...� _. _.__ ____.... _ _._.
� _. _....._._ � . .__ _.. _ _._ _ ..._. ... _ .___ — . _�..
13 REAR BODY&FLOOR
14 Repl Panel below lid 52410AC040 1 180.15 5.5 1.5
15 Overlap Major Adj. Panel _�4
16 Add for Clear Coat �2
17 Add for Inside ��
__ _, ...__.. __ _ _._�._ _ _.__ _ ___. _._ _. _.._.. ....__--_ .___.._._ _. .. ____
__ _ .—_ _______. ___.._. � .__ �._ __�__._
18 PILLARS,ROCKER&FLOOR
19 R&I RT Rocker molding 0.3
2� R&I LT Rocker molding 0.3
21 # Rpr Set-up&Measure 1 Q �
22 # Rpr Pull&Square 3� F ,
23 # HAZARDOUS WASTE 1 5.00 X li
24 # CORROSION PROTECTION 1 0.3
25 # FLEX ADD 1 3.00
26 # CAR COVER 1 �2 '
SUBTOTALS 1,146.30 14.8 6.3
�
(
10/30/2013 3:13:27 PM 060167 Page 2
' Preliminary Estimate
Customer: VAN KAMPEN, CRAIG )ob Number:
Vehicle: 1999 SUBA LEGACY GT 4D SED 4-2.5L-FI GREEN
ESTIMATE TOTALS
Category Basis Rate Cost$
Pa� 1,141.30
Body Labor 11.8 hrs @ $52.00/hr 613.60
Paint Labor 6.3 hrs @ $52.00/hr 327.60
Frame Labor 3.0 hrs @ $65.00/hr 195.00
Paint Supplies 6.3 hrs @ $32.00/hr 201.60
Miscellaneous 5.00
Subtotal 2,484.10
Sales Tax $ 1,141.30 @ 7.1250% 81.32
Grand Total 2,565.42
Deductible 0.00
CUSTOMER PAY 0.00
INSURANCE PAY 2,565.42
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.
10/30/2013 3:13:27 PM 060167 Page 3
�• Preliminary Estimate
Customer: VAN KAMPEN, CRAIG 7ob Number:
Vehicle: 1999 SUBA LEGACY GT 4D SED 4-2.5L-FI GREEN
Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from the Guide
AEL7521, CCC Data Date 10/17/2013, 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 symbots 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=6lend. BOR=6oron 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. O/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: I
BAR=6ureau of Automotive Repair. EPA=Environmental Protection Agency. NHTSA= National Highway
Transportation and Safety Administration. PDR=Paintless Dent Repair. VIN=Vehicle Identification Number. ;
il
10/30/2013 3:13:27 PM 060167 Page 4
- � LaMettry's Collision, Glass and More Workfile ID: 911d140a
FederalID: 411393089
, �, Maplewood
�� "Every Customer Leaves With A Smile"
2951 Maplewood Drive, Maplewood, MN 55109
Phone: (651) 766-9770
FAX: (651) 766-8660
Preliminary Estimate
Customer: VAN KAMPEN,CRAIG
Written By: MW Team 1 ANDY TIHANYI
Insured: VAN KAMPEN,CRAIG Policy#: Claim #:
Type of Loss: Date of Loss: Days to Repair. 0
Point of Impact:
Owner: Inspection Location: Insurance Company:
VAN KAMPEN,CRAIG LaMettry's Collision,Glass and More
Maplewood
6881 37TH ST N 2951 Maplewood Drive
OAKDALE, MN 55128 Maplewood, MN 55109
(651)210-3541 Business Repair Facility I
(651)766-9770 Bu$iness
WEHICLE
Year: 1999 Body Style: 4D SED VIN: 4S36D6751X6264031 Mileage In: 174000
Make: SUBA Engine: 4-2.5L-FI License: 741DJD Mileage Out:
Model: LEGACY GT Production Date: State: MN Vehicle Out:
Color: GREEN Int: Condition: Job#:
TRANSMISSION Body Side Moldings FM Radio Cloth Seats
Overdrive Woodgrain Stereo Bucket Seats
5 Speed Transmission CONVENIENCE Cassette WHEELS
POWER Air Conditioning I! SAFETIf Aluminum/Alloy Wheels ,
Power Steering Intermittent Wipers Drivers Side Air Bag PAINT
Power Brakes Tilt Wheel Passenger Air Bag Clear Coat Paint
Power Windows Cruise Control Anti-Lock Brakes(4) OTHER
Power Locks Rear Defogger 4 Wheel Disc Brakes Fog Lamps
Power Mirrors Keyless Entry ROOF Rear Spoiler !
DECOR RADIO Electric Glass Sunroof �I
Dual Mirrors AM Radio SEATS �I
li/4/2013 1:02:24 PM 053108 Page 1
. . ' Preliminary Estimate
Customer: VAN KAMPEN, CRAIG
Vehicle: 1999 SUBA LEGACY GT 4D SED 4-2.5L-FI GREEN
Line Oper Description Part Number Qty Extended Labor Paint
Price$
1 # Rpr SHEETMETAL PULL 2.0
. _ � - _. .. .......__.. . __.. _ _..�___.� _. _...__ - -_ ___ _._._ ...._..._ _. .�..�...._ ...
2 REARBUMPER --- _ _ _._. ____ _ _._______
3 0/H rear bumper 2.0
4 R&I R&I bumper assy Incl.
5 * Rpr Bumper cover 2.Q 2.4
6 Add for Clear Coat 1.0
7 * R&I Reinf beam lower IpcL
8 # Flex Additive 1 6.00
__ __ _. ...__�._ __�__ .. .....�,_._.. � �_.�_.._,.___�
_..____�.�_.� ._..___�- _��_._.. ._�__ _� .�.�_�_____
9 REAR LAMPS
open Repl Combo lamp assy 84251AC080 1 329.35 Incl.
il ** Repl RECOND RTTaiI lamp assy 84201ACO20 1 212.00 0.4
12 ** Repl RECOND LT Tail lamp assy 84201AC030 1 212.00 0.4
13 � TRUNK LID _.m___�_ ___ _______-e_ ____ _._.� _._______ __m. .___------
14 Repl Trunk lid w/spoiler 57501AC100 1 819.44 1.4 2.0
15 Add for Clear Coat �•8
16 Add for Underside(Complete) 1.0
17 Add for Clear Coat �•Z
18 Repl Nameplate"Legacy"gold 93022AC620 1 28.20 0.3
19 R&I Spoiler 0.5
20 Repl Nameplate"2.5 GT' 93022AC570 1 23.05 0.2
21 Repl Nameplate"AWD" 93022AC040 1 28.20 0.2
___ ___ ___.. . ___ ._ �__. _ _. _ _._._.. __..
22 REAR BODY&FLOOR
23 Repl Panel below lid 52410AC040 1 180.15 5.5 1.5
24 Overlap Major Adj. Panel -0.4
25 Add for Clear Coat �•Z
26 Add for Inside �•�
27 Add for Clear Coat 0.1
28 ** Repl A/M Seam Sealer-Per Wetded on 1 10.00
Panel
_ _ __ __ _ _
29 QUARTER PANEL
30 * Rpr RT Quarter panel right side �,St 2•4
31 Overlap Major Adj.Panel -0.4
32 Add for Clear Coat 0.4
33 * Rpr LT Quarter panel left side w/o � �•4
SUS w/o power antenna
34 Overlap Major Adj. Panel -0.4
35 Add for Clear Coat 0.4
w_,__ . _��_ �__ ---,,,�-�- __._� � _---- -__�
36 EXHAUST SYSTEM
37 Repl Muffler&pipe sedan GT&LSI SOA8376900 1 179.95 m 0 6 M
_ _ _
_._ _ __ _._ _
_ _ _____ __ . _. __._.. _.._ .. __...._. _ ___.._.__�____...
38 BACK GLASS
39 * Rpr Glass Subaru green �
NOTE: ROPE
40 # Refn Car Cover 0'2
il/4/2013 1:02:24 PM 053108 Page 2
, ' Preliminary Estimate
Customer: VAN KAMPEN, CRAIG
Vehicle: 1999 SUBA LEGACY GT 4D SED 4-2.5L-FI GREEN
41 # Refn Corrosion Protedion 0.3
42 # Subl Hazardous Waste Disposal Fee 1 5.00 X
SUBTOTALS 2,033.34 23.8 14.8
ESTIMATE TOTALS
Category Basis Rate Cost$
Parts 2,028.34
Body labor 23.2 hrs @ $56.00/hr 1,299.20
Paint Labor 14.8 hrs @ $56.00/hr 828.80
Mechanical Labor 0.6 hrs @ $98.00/hr 58.80
Paint Supplies 14.8 hrs @ $38.00/hr 562.40
Body Supplies 23.3 hrs @ $2.00/hr 46.60
Miscellaneous 5.00
Subtotal 4,829.14
Sales Tax $2,637.34 @ 7.1250% 187.91
Grand Total 5,017.05
Deductible 0.00
CUSTOMER PAY 0.00
INSURANCE PAY 5,017.05
THIS REPORT IS AND ESTIMATE ONLY, BASED ON OUR INITIAL INSPECTION AND DOES NOT COVER ADDITIONAL
PARTS OR LABOR WHICH MAY BE REQUIRED AFfER THE WORK IS OPENED UP. PART PRICES SUBJECT TO '
CHANGE PER THE MANUFACTURER AND AVAILABILITY.
WARRANTY: LIFETIME AGAINST DEFECTS IN WORKMANSHIP. WARRANTY REPAIRS DONE BY LAMETTRY'S
COLLISION ONLY. NO WARRANTY ON RUST, CORROSION RESISTANCE OR REPLACEMENT RENTAL CARS.
OUR ESTiMATED COMPLEfION TIME DOES NOT INCLUDE INSURANCE OR PARTS DELAYS THAT WE MAY
EXPERIENCE.
I
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.
i
�
�
11/4/2013 1:02:24 PM 053108 Page 3
, ' Preliminary Estimate
Customer: VAN KAMPEN, CRAIG
Vehicle: 1999 SUBA LEGACY GT 4D SED 4-2.5L-FI GREEN
Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from the Guide
AEL7521, CCC Data Date 11/1/2013, 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 (N) 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 ar� 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. Par�s 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=Di�connect and Reconnect. HSS=High Strength Steel.
HYD=Hydroformed Steel. Inc1.=Included. LKQ=Like Kihd and Quality. LT=Left. MAG=Magnesium. Non-Adj.=Non
Adjacent. NSF=NSF International Certified Part. O/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.
11/4/2013 1:02:24 PM 053108 Page 4
• � Preliminary Estimate
Customer: VAN KAMPEN, CRAIG
Vehicle: 1999 SUBA LEGACY GT 4D SED 4-2.5L-FI GREEN
ALTERNATE PARTS SUPPLIERS
Supplier: Keystone-Complete-Minneapolis
Location(s): 2400 KERPER BLVD, DUBUQUE IA 52001 (800)747-2500 (563)556-5030
3017 A HOOVER AVENUE,STEVENS POINT WI 54481 (800)218-4848 (715)342-0772
2700 29TH AVENUE N, ESCANABA MI 49829 (800)833-2030 (906)789-2200
9532 W.CARMEN AVENUE, MILWAUKEE WI 53225 (800)924-8230 (414)463-1019
822 CENTRAL AVENUE, LINTHICUM MD 21090 (800)390-4600 (410)636-4600
3615 MARSHALL STREET NE, MINNEAPOLIS MN 55418 (800)328-1845 (612)789-1919
2021 WEST DIVISION STREET,ST.CLOUD MN 56301 (800)247-0861 (320)251-8494
5969 HAASE ROAD, DEFOREST WI 53532 (800)356-7252 (608)249-4775
5085 WREN DRIVE,APPLETON WI 54913 (800)422-1995 (920)731-3030
Line Description Item# Price
il RECOND RT Tail lamp assy SU2801104R $212.00
12 RECOND LT Tail lamp assy SU2800104R $212.00
11/4/2013 1:02:24 PM 053108 Page 5
14 East Acker Street • St. Paul, MN 55117 •651-665-0022 • Fax 651-665-0594
/ 4360 N. Lyndale Ave. • Minneapolis, MN 55412 •612-343-0022
� � � Unauthorized Vehicles Removed for Free •Flatbed •Wheel Lifts •Jump Start •Lockouts
' . , . Tire Changes •Miscellaneous Hauling •Nationally Certified Drivers
MPL -ST, PAUL 24 HOUR SERVICE-7 DAYS A WEEK
�� ��� �� �~=µ �� SPPD Impound# � � �'� �
Account � Date � C/N ��' "'�`' � ` �'�"�-''
. 6 .E� F� � t.::,_.
Call# + � �
Driver �� Truck L- `-��' ' ` �t~ �
t _
� Location [ �f>y � f �e'�``'- d�-� ° p�.
.... --a . ; :,r- -, i !
Dispatch Time -`"'"'`� ~� Arrival Time � � Towed To �- Type of Tow:�_
Customer Information Billing Information
Name � V��^ Phone Co�Z-�N3-(fl'S15 Name
Address ! ' s`' �' a� .� AZ �s �'�ntJ Phone
� ; � V�hicle Information Address
� fi, ,<. s':s�.r` f , ,�j,
License# - � State r' Year � ! — Vehicle Condition
,, � �
Make �'�-`'~'��`� Model �-> = •- Color �+=�=��� .
�'�-�a v�k 4��e.�
Odometer �m � O �
r �.��w
�/Ifl�' �.,.� r _ � �� � ,'� �. � "� � _ � - �
q Tow � Jump Start ❑ Locicout__ ❑ Tire_Change: _ _ Y ` -"�`� `
❑ Other Keys �� Y ❑ N
Hook up: `� �`� r r �
Service CaIL• � O
Mileage: miles@: Vehicle Contents
Storage: days@: '
Misc. Charges: Payment Method �
P.O.# Subtotal: ❑ Cash ❑Check ❑ Visa ❑ Mastercard
Mem# Tax: Credit Card Number �,
Total: � �-f . �`_'� ���� �
%
� ; Exp Date: �
Comments: .�� "�� r � V-Code: � Auth.#
received By:
EOE AS an bQua1 oYW�MH�Y�r tltis comP�YS D�wY.as weN a5 Federal and Stm taw.DrohiMls disaiminatian in empbyment based on race,cdor.refqion.sat national oripin.Dh�ical IwdicaP.a ape wrth respect to Ind'aiduak who are M leazt 18 years of e9e.
Saint Paul Police fmpound Lot, 830 Barge Channel Road, Vehicle Release Form
Make: 99 SUBARU License#: 741 DJD CN: 13101300 Invoice#: 144434
Date/Time Released: 05/22/2013 10:00 Tow Charge: $ 54.50
Released to: TOTO Storage Charge: $ 0.00
Paid : CREDIT CA Admin Charge: $ 80.00
y: CHERI Tax: (7.625%) $ 10.26
I,the undersigned,have recovered the vehicle described above. Subtotal: $ 144.76
I will check the vehicle for damage or any other problems that
may have occurred while this vehicle was in the custody of the Service Charge: $ 0_00
Saint Paul Police Department. I acknowledge 1 will report
damage and/or any other problems to the Impound Lot staff Total Charges: $ 144.76
on this form prior to leaving the impound lot.
Damage and/or other problem: �z�..�����\L� 5�+�`����� F ��y�.l�. ��•ti��F�� �u�l .
'M.�,1,z'1��,t�r �$Ci,+��1x���
Police Report made: Yes_No_IF Yes, CN , If NO, Why?
TO PROTECT YOUR RIGHTS, REPORT ANY PROBLEMS/DAMAGE BEFORE LEAVING THE LOT
Signature � 5rz000
. R' �
I