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Wood
i i I ����������� Payment Address Document Address 24344 Network Place P.O.Box 512929 Chicago, IL 60673-1243 Los Angeles,Ca 90051 Phone:(877)818-0139 Fax:(888)781-6947 10/29/2013 1:11:00 PM Certified Mail 91 7108 2133 3934 2583 7072 Retum Receipt Requested CITY OF ST PAUL ���,��-��A��� CITY CLERK OFFICE �-•°��°'� `d �`� - 310 CITY HALL 15 WEST KELLOGG BLVD ���I G8 ZO73 ST PAUL,MN 55102 C�I � L.���"�� Your Client: CITY OF ST PAUL Your Ciaim Number: N/A Our Insured:WOOD, ELVIN Our Claim Number:l3-2436556 Amount Subject to Reimbursement:6,850.57 Amount of Insured's Deductible: 500.00 Please take this as formal notice of our subrogation rights relative to the above-captioned claim. We have completed our investigation into the facts of the above-captioned loss and find that your insured was the proximate cause of the accident. Location of Loss: ARCADE AND IDAHO STREETS in ST. PAUL Date and Time of Loss:08-11-13 @ 3:00 PM Description of Loss: Our named insured's 2008 Chevrolet Cobalt was traveling on Arcade St when our insured's vehicle struck an unmarked water main cover, which caused damage. We are seeking reimbursement from the City of St Paul for the damages to our insured's vehicle as a result of this loss. Please make your draft payable to Progressive Universal Insurance Co as subrogee of "WOOD, ELVIN", in the amount stated above and mail it to the attention of the undersigned at your earli onvenience. All supporting documentation is enclosed. I have diaried my file ahea ' ee (1 hank you for your anticipated, prompt atterrtion to this matter. , Jason S Su �on Representative P ogressive Universal Insurance Co el. 877-818-0139 Ext 37273 Fax. 888-781-6947 Email: Jason_E_Saba@progressive.com I Claim Payment Detail Page 1 of 1 �f�i�, ������� ������ � �.����3���� � s--Payment Information-----------------------------------------------------------------------------------------------------------------------------------------� ! Disbursement Number: 479232445 Total Amount: �7,411.32 � 's EFT Trace Number: Invoice Number: iPaid To: ELVIN E WOOD 11,ONL � Mailing Address: 631 N WASHINGTON AVE. NEW RICHMOND,WI 54017 USA I In Payment Of: COLL-08 CHEROLET COBALT T/L F&F STLM LESS 500 DED PRS I.•----_.__.__.____.----_.__._._________________________________________----------------------------------•__•_-_--_______-__-------------______-__________---------------' �-•Vendor Information-______._______________________.__________..___.___________.________________.._____.__._____________-------_____----_--__..___________________, ' Name: 1099 Required: � TYPe� � ,.---------------------.____.___-_-__•_----_______________.___________---__--__.______---------------_____.__.___----------------__-_________________.---________._________� i--ReviewedSumma -------------------------------------------------------------------------------------------___�_--__._----------_____. ry------------------ i s Issuing Rep: A090465 Approved By: A081575 j Issue Date: 0&1&13 Review Date: � Last Updated Rep: A090465 Reviewed B : � Y �---------------------------------------------------------------------------------------------------------------------------------------------------------------------------� fi-•Bank Infortnation-_____________.________.__.__.__.___________________________________._____________._____.________.__.__.________.______--.•_-.__.__.________.._____, s Bank Code: AS2 � TYPe: LOSs $ Stop Reason: Cleared: 08-1�13 i � Stop Date: � �____________________________.�________.___----------____.__---•__•- �--Exposure Detail:COLL------------•--•---------------------------------_____----__-------_------------_.----------------------------------__-__-------� j Party Name: WOOD,II ELVIN E Amount Paid: $7,411.32 � Property Description: 08 CHEVROLET COBALT Deductlble Taken: 5500.00 j Payment Type: FINAL PAYMENT Property Damage: �0.00 � Rental: $0.00 http://cla.imspayments/Alpha/ClaimsPaymentsWeb/default.aspx... 10/29/2�13 Ciaim Payment Detail Page 1 of 1 ���i�, �a�m�►�� ���aE� � �.��a��s��� a ;--Paymerrt Informatlon-----------------------------------------------------------------------------------------------------------------------------------------• ! Disbursement Number: 479325093 Total Amount: �241.50 s I EFT Trace Number: Invoice Number: � Paid To: ELVIN E W'OOD II,ONL i Mailing Address: 631 N WASHINGTON AVE. � NEW RICHMOND,WI 54017 USA I In Payment Of: COLL-SALES TAX REMB F8�F STLM ; �•____________________________---..__._______________------__________-------___--------____------______________-__-_..___________--------_________________.__.__._____.__.___! VendorInformation__..__..___---___________---____________________.___---_____.._____________________..__.._______._____-------__._________..__________..__._____. � Name: 1099 Required: ! TYPe� ; .__.__. ---._.--------------_____________________--------._____.---------, �--Reviewed Sum ma -------______.._____..___--.--___..-----..--------------------...--.-----------------------_--------------.___________.._-, -------.___ . = Issufng Rep: A090465 Approved By: jIssue Date: 0&22-13 Review Date: ! Last Updated Rep: A090465 Reviewed By: � , _______________________________________________________________a �__________ - ---------------------------------------------------------------------- - - _________________________ �-•Bank Information-_.__------•----_._____.__�_______-------•-----._______..______--_______________________________----_____..__._____.__..____.___._______..__..__._; ; Type: LOSS Bank Code: AS2 � Stop Reason: Cleared: 08-2&13 ; Stop Date: � �---------------------------------------------------�_______.____---_._---_._-------__.------________---------__------------•------------_-_-•-----.__----------•-------_. �-Exposure Detail:COLL-------------------------------------------_______---______----------------=------------------------------------___-----------, � Party Name: WOOD,II ELVIN E Amount Paid• 5241.50 ` Property Description: OS CHEVROLET COBALT Deductible Taken: $0.00 f Payment Type: SUPPLEMENTAL PAYMENT Property Damage: $0.� � Rental: $0.00 s http://claimspayments/Alpha/ClaimsPaymentsWeb/default.aspx... 10/29/2�]3 Claim Payment Detail Page 1 of 1 ���irg, l�a�r��n�E t��ta€i ( i��a�3s5�� � f--Payment Information---------------------------------------------�-------------------------------------------------------------------------------------------� � Disbursement Number: 787401807 i Total Amount: a150.00 ) EFT Trace Number: Invoice Number: j Paid To: ENTERPRISE RENT-MGAR jMailing Address: ENTERPRISE RENT-ArCAR � 14454 N60TH STREET 1 STILLWATER,MN 55082-8313 � In Payment Of: ENTERPRISE RENT-MCAR RENTAL INVOICE#1918D166167 �_.._____..__..__._____..___________.___________________________________________________________________.________..________._.___----_.._____.______________..___.._______..__._____� -----------------------------------------------------------------------------------------. ;--Vendor Information-------------------------------------------______ ; } Name: ENTERPRISE RENT... 1099 Required: = Type: GIASS SHOP � � ' �________________________________________-------____-----______----______________---------------------------______----___�_________________---_________________-----------� ReviewedSumma ____________________________________________________________________________________________________________________________, �-- ry______________ - ; � Issuing Rep: A090465 Approved By: � Iss�Date: 0&1�13 Review Date: s Last Updated Rep: A090465 Reviewed By: i �Bank Information ! T �B$ Bank Code: CTB I y�� � Stop Reason: Cleared: 08-21-13 � Stop Date: � � .. . ... ......... ._........ ......... . . .. ..... _...............� �. ... .... .. .. . ........ ...... .... ...... .... . ..._... . .. .. .. . _ ....... .. ........ �--Expasure Detail:RENTAL----.___--------___________________________.-----------___.._-------______._____-------•--------___..---------------------------; j Party Name: WOOD, II ELVIN E Amount Paid: $150.00 � Property Description: OS GHEVROLET COBALT Deductible Taken: $0.00 1 PaymentType: FINAL PAYMENT Property Damage: 30.W I � Rental: $150.00 i http://claimspayments/Alpha/ClaimsPaymentsWebldefault.aspx... 10/29/2013 ARMSt9-Automated Rental Management System Page 1 of 1 Rental Company:ENTERPRISE RENT-A-CAR �� PROGRESSIVE �nvoice: D166187-1918 Bill To: PR04401 RENTAL DETAIL: PROGRESSIVE ATTN:ASHLEY SHUSTA Rental Period: 8/12/13 to 8/16/13(5 days} 1700 S 108TH STREET Billed Period: 8N2113 to Bl16113(5 daysj WEST ALLIS, NA 532145898 RENTER iNFOt2MA7'tON: �r��a�����R•a�l�:r,r�ui��s; Ret9 � Amount ; Rerrter: WOOD,ELVIN 5 DAYS� 24.72 ! $123.60 � a RENTAL INFQRMA710N: �����"��� Rental Branch Location: ��a��'�'���� � 3 ENTERPRISE RENT-PrCAR(1918) 1 SURCHARGE% ' 14.20% ; $17.56 � 14454 N 60TH STREET STILLWATER, MN 550828313 1 SALES TAX 7.1296 ; $8.81 � (S51)351-0000 __......._............___....................._..;........._....�;...:......$150.00. ..� TOtal Chp ADDI170NAL CI.,�IM INFC}RMATION. l.ess Amount Received: $0.00 � Claim Number:13-2436556 Total AmouM Due: $180.00 � Claim Type:Insured Vefrode Condition:Non-Drivable Date Of Loss:8/11/13 Insured Name:ELVIN 1MOOD Owner's Vehide:2008 CHEVROLET COBa� Ad�tional Driver. Repair Faciliiy: UNKNOWN SHOP ST.LOUIS, MO 63105 ,(999)99�9999 YEHICLEB RENTED: EffeCtive Date and Year Malae Model VIN M�� �d� Mi�� ��d Tima 8/12/13 2013 DODG AVEN 1C3CDZAB1DN535115 25473 25778 305 324.72 12:11 PM Rental Invoice Please Retum This Portion with Remitlanoe Make Payment To: Totai Charges: $150.00 ENTERPRISE RENT-A-CAR Less/1mp�t Repeived: �0.00 P.O.BOX 840088 Total Arnount Due........_.......... 5750.00 KANSAS CITY,MO 841840086 Federal ID:43-072d835 Please indude on your chedc: Irnoice:D166187-1918 https:/lwww.annsweb.com/armsweb/closedcustomerfile.do 10/29/2U 13 D�b: 8l1SJm1309:36 AM Eatlmate ID: 13-2498556-01 Eatlmate Yxslon: D CommYtsd P►o1Ne1D: Metro AIIParts PRO�RESSIVE Damage Asse�ed By: JENN�ER CROWLEY 'Cl�m Rep: Jenniter Crowley (651)900-1338 'R»ductType Auto 'Date o1 Loss: 8�11/2013 'Deductlble: 500.00 'Clalm Nu�er: 13-2436566-01 Insixed: ELYIN WOOD Ownar: ELVIN WOOD Address: 8S1 N WASHINGTON AVE,PEW RICHMOND,WI 54077 Telephane: Home Phone: (851)BOB-7693 Contact Phone: (B51)808-7693 ANMhNI SstvlM: D10411 Descrlptlon: 2008 Chevrolet Cobalt LS VehlNe Productlon Date: 12A7 Body Slyle: 2D Cpe Drive Train: 22L In�4 G�I14A FWD VIN: 1 G1AK78F4871952B5 Mlleage: 80,848 OEMfALT: A Search Code: ARDENHILL7 Cola: BLUE Optfans: PASSENGER AIRBAG,DRIYB2 AIRBAG,REAR WIN�W DEFOGGER,MANUpI ARt CONOfT10N TILT STEERINO COLUMN,AUXILIARY INPUT,SATELLRE RADIO,AUTOYATIC TRAN9MI3910N FRONT AIR DAM,REAR AIR DMA,TINTED GLASS,TRIP C�PUTHt VARIABLE AS313TED STEFRING,ANTI-THEFT SYSTEM,AUTOYATIC HEADLIGHTS SIDE HEAD CURTANi AIRBAGS,DAYTNYIE RUNNING LIGHT3,AMlFM STEREO CDIMPS PLAYER FRONT BUCKET SEATS,MlTERIOR AN2 FIITER,POWER�F'fGATE�TRUFp( Line Entry Laba Linsltem PartTyps/ Dollar Labor Ram Numbx Typa Oporatlon Dascrlptlon Part Number AmourR Unttc Coolina 1 002372 BDY REMOVEIREPLACE Coding Radiator 42731217 GM PART 198.Y5 3.1 2 002965 BDY REMOVEIREPLACE Coding FanlUAdw 6 3broud Assy 7D824475 GM PART 189.36 0.5 iC FrorK innor Str�xWre 3 000210 MCH REMOVEIREPLACE S1�DFrame aYl UsedlRecycled 150.00 ' 5.7 q Lins Markup 9'�0.00 �m Front Susoension 5 002291 MCH REMOVEIREPLACE L Lwr Fr[Susp CaiVd Arm Aasy aYl ORDER FROM DEALER 218.40 1.3 A Ena�a/Trans 6 001658 MCH F�MOVEANSfALL Engf�re 6 Tnns Assy aYl 9•� 7 003007 MCH IZEMOVElREPLACE Engl�ro ON Pan �il 12607290 GM PART 1�.33 2.7 En�inetfrans Mounb 8 000430 BDY REIIAOVEIREPLACE Frt Eng 3upt Trans Maunt 25973863 GM PART 98.18 M1C Ezhaust 9 000481 BDY REMOVE1REPlACE E�aust ConverDSr�bW �iB62173 GM PART 133.87 0.4� 70 MCH R9iA0YFJINSfALL 6d�austSyatsm �A �C � 11 006059 BDY REMOVE/REPLACE Exhaust MufAer 152B3437 GM PART 542.32 Ob Rsar Susoensian 12 009498 MCH REMOVEIREPLACE Re�r Susp A�de aYl ORDER FROM DEALER 7,106.76 4.2 0 IiiANUAL ENTRIES 13 90050D MCH' ADDt LABOR� FOUR WHEEL ALIGNMENT S�b�e� 8bm � �.�' 14 90D500 MCH' I�MOVEIREPLACE ENGNE OIL AND FlLTER "Non-OEIM 35.OD ' �.0' 15 900500 MCH' F�Ii10VEiREPtACE COOLANT-(GREEN OR RED) "Non-OFJN 75.00 ' OA' 16 900500 MCH' ADDt LABOR� CNANGE ENGINE OI�IFILTER 3ub�st �•� ` �-�` 17 90D30D MCH' I�MOVE/REPLACE Engirw UsadlRecyNad 1,250.OD ' MC' Y8 AAA,851423-2432,Don,(]81932187 19 une Marlo�p%30.OD 575.00 ESTIMATE RECALL NUMBER: 08+Y31201309:3B:39 Y3-24 36 556-01 iAltchell Data Verslon: OEM:JUL_13_V0807 MAPP:JUL_13_V0817 Copyright(C)19D4-7D13 MRche111Mxnatlonal Page 1 of 4 Soltware Version: 7A.488 All RigMs Reserved wa: ansrLO�sa�:�aM Eatlmaro 10: 13-2496556-0Y Eatlmate Y�slon: 0 CommiKsd Pro1Ye ID: Yetro All Parts '-Judgmerrt Rem #-Labor Note Applles Racycler Iniomutlon S�ctlon: MA Auto Salwge-ARAPro as»yeom se.w. Rosemouirt Iu1N 5fi088 BDO-238�866A�51-423-2BOB 3 Z008 Chevrolat Cobalt FRaNNT CR039NIEMBER 1Y6223 YA 150.00 Descrlptlon:22L,ATOD,FNID,FRT,FE1„ Disclaimer:The price Indicatlons on recyNad parts are roal or compasite values,based an the prlcM�g optlon selected wMh QRP. PAces are tl�e latest avaNaWe at time of Inventory download and are sub�ect to change and avail�Rity. To determine actual repairer net or wholesale price,call the automalve recyNx ot your cholce. CerWn puts located tw Mls quote ae hterehangeable but are not an axact match. Call the autamotive recyNe►oi your choice. 1i►11 msnufactur�rs rsquirsmsnts req�rdiaq aaat belt sad suppledental rsatsaint systst raplacemeat sust be adhered to. If additional parts or oparations ara noc�ssary to propariy acaomplish thia, pleasa contact tha astimatinq claias rap. Estimate Totals Add'1 Labor SuWet I. Labor Subtotals UnNs Rate Amount AmourK TWals II. Par[R�placwmaM Summary AmoaM gudy 4.6 5200 0.00 O.OD 239.20 Taxable Parts 4,Y0475 Mechanical 23.6 80.00 O.OD 120.00 P,008.00 Parts Atl�ustme�RS 420.00 Sales Tax � 8.87596 311.OB Non-Taxable Labo► 2,247.20 Totil Replxement PaRa Amount 4,835.83 Laba 3unxnary 28.2 2,247.7A 111. Addltloml Costs AmauM IV. Ad�usdne�RS AmouM To[al Additional Costs 0.00 Insurance DeductlWe 500.00- Customer Respans�llity �.�- I. TMaI Laba: 2,247.20 II. Tofai ReplacemsM Parts: 4,835.88 111. Tofal Additloml Cosb: � Groas Taal: 7,083A3 IY. Tofal AdJusbne�rts: �•�- Net Total: 6,5B3A3 PoIM(s)ollmpact 21 Undercarriage(3) ESTIIAATE RECALL NUMBER: OB/13f201309:36:39 13-2436556-01 Mltchell Dan Verslon: OE111:JUL_Y3_V0807 MAPP:JUL_13_V0811 Copyright(C}1994-7D13 MRchell IMarnatlanal Page 2 of 4 SolMare Yxslon: 7A.488 All Rights Reservad Dah: 8M3/2D13 69:36 AM Estlmam ID: 1 3-24 38 556-0Y Estlmate Verslon: 0 CammYtsd Pro1Ne ID: Metro All Parts Alt.Lmatioo: PROGRE391VE INSURANCE Mspeclion Slte: IM-ST PAUL Address: 1�OJACK90N$rREET St Paul,MN 55117 {651)308$299 TH18 18 A nAl�►GS A$$E88'l�NT O�iLY — NOT llld l�i[TTHORIZ]►TIOTi TQ R3PAIR — Bi1$8D O�N Q�t�S VI$L�..g OR (�RT1►IN 1►4 TFIS TII� IT �Q1$ NRITl'BN. IS SR]N� OR LA�TIHODY RSPAIR I$ INQ.UO�D ON THI$ RBTID�►►TB, '1'H8 1N�UNT BHO�YPN It�liCi.U�EB TII� O�t � H'OR I�TRIIQG BEB+O�i3, DURING 1�laD 11FTBR TA08S IiEPAIRB. TF1� OR�iSR OF TFlt VaHZCIi �1Y SEL=C? '!F� REP]1IR H'AiCILITY OS HIS/FaR CFIOICs. TQ p.Ai$�JRg PRQPgR AND PRQ�'P PAYl�iT E'O�t ]IDDITIOI�UIL D]NQ11t3 DI$CGViR$D DURIN6 TFIt COURBB Os RSPAIIiB. OdNTAL`! PR06RS8$ZVS H+OR 8(TPFLS�NT �IDZnaG �xOC�avRaB. PROGRS88ZVS HONO�iB TFa PR=VAILIII6 7.71BOR D�1R1�T RAT� II1 YOUR ARZ7► H�OR YOUR PROPZRTY. IS YO[J CHOO$S A $HOP THAT CH7IRGS$ IN SXCB$$ OF PREVAII+ING L1i1BOR �4R1�T RATS$, Yd�T ifILL HE R88P�i$IHLS POR TF� DIPTS1aNCB. LIF&TI1� C;W1R71NTBg H'OR BHEgT 1�T11L 11ND PI.ih$TIC HODY PART$ T'ha replacemsnt parts rritten on t.k►e ast3mata ara intsndad to return your v�ahiale to its pre-loss condition with pmper installation. llfter rrpair, if amy sheat metal or plast.ic body psrt includsd ia the estiaata fails to return your vehicle to its pre-loss condition (assuming prCpsr installatiOn) , in taerms of form, fit, finish, durability or £unctioaality, Proqrossiw Nill arranQe and pay for tha replsaement of the par�, to the estent not covared by a manufacturer's or oth•r Marranty. Thia sarvice nill bo perfoaod at no c�st to you (includiaq associatod rop�ir and r�ntal car c�sts) . To abtain eervice under this Guarantee, call Proqressive at 1-800-274-4641. This (ivaranY�o appiirs aa lonq as you o.rn or i�as• the vahicle. 1'liis Guarantae is not transferabla and torminates if you ssil or othar�riss tr�nsfsr your whicis. THI$ t#�JAR1i1NT8B DOB$ NOT CdV�R NOl�►L i1B�11R AND 'i'E�1R OR D�i� C11L1$8D BY D�ROP=R 1�►II�1T�I71N�s 1�fiI.�C'P, AHIT88 � SU888QL7ENT 11L:CID3N'!. TFII$ GfTl�RANTBB I$ I�II�TED TO ARR�INGING B'0[t TFIg $BLECTION OF RBPAIR PARTB THAT iPILL RS7VRN YOUR VSHI(�.B TO I�$ PR$-I.0$8 C�IDITION. ACC�DINGLY, P1tAGR8861VS 1fII.L NiOT BE LIl1HI+8 H"O�t 11NS I1�DIR8CT, INCIDENTAL 0� ppl�i$gQ(J�7TI�►I, DAMI4GS$ TAAT RE$LJLT HF�Omi '1'I� ZN$TALLATION OR U88 OF TF33$E PART$. Part Typo Tams and Abbrsviations I+��P and O�M or part nuaber displaysd - Tt►e� rafer to a aenr, oriqinsl oquipment manufacturar p�rt. N�T-O�d aad A/li aad Qual RBPL ' 7'heae refer to an aftsr-narkat part, Mlaich ia a nanr, non-oriqinal aquipaant maaufacturar part. ESTIMATE RECALL NINVA BER: OBI7 3I207 3 09:36:39 132436556d7 Mitchell Data Verslon: OEM:JUL_Y3_V0807 MAPP:JUL_13_YOB17 Copyright(C)1�D4-7Dt3 MRchell Intarnatlonal Page 3 0l 4 So1[ware Version: 7A.488 All RigMs Reserved Dab: 8!1 SJm13 09:38 AM Estlmwts ID: 13•2436566-01 Eatlmate Vxslon: 0 CommNtsd Pro111e ID: Matro All Parts US=D/RECYCIiD �nd LKQ - Trt�so r�f�r to a usod O=!i part. snd RZCOND, aad RtCORZ - Thos• r�£or to urod/z�c.yclod �M part.s tliat havr b��n r�furbish�d. RSP]►IR SHOP'$ ]►[1TFpRZBSD R8PR�8BNT!►TZVS'$ $IQi�A7VRE INDIC]1TINQ !IL`sR8l1�NT �T C08T TQ RBTULaI THR VSHICI.S TO PR3-I.0$$ OONDI'PION II�ICLUDING Td1f�$TOR� (�►RQi$: BHOP $16NA'1VRZ: B8'!. C�I�TION D111'6: 11NY P=R80N NF10. 1rIT8 Il�l'1'aNT TQ DEFR11L1D OR RTO1fING TH7►T I�IBI� 28 FACII.ITI►TING l� H'R1WD !►(�►ZN$T ]1N IN$�AiBR� $QBMIT$ !1N 1i1PPLIGTION OR D'ILSS A C7+AIDi C�iT11IL�TINi6 A H'AL$S OR D3QPTIVS BTAT�iT I8 6QILTY OF IId$UR11NC8 H'RAL7D. Even[Log Flle Created: 08/13JZ013 09�8:40 AM Estimaze SWted: OB/13/2013 09:12:15 AM F�tlmate Printed: Estlm�e not prlMed Fatimaze Committed: OB/13/�13 09:86:�AM Estlmate Uploaded: OBl13/2013 09:96:45 AM ESTI�IIATE RECALL NUMBER: OB11 31201 3 09:36:39 132436556-07 MI[chell Data Verslon: OE1A:JUL_73_V0807 MAPP:JUL_13_V0811 Copyrlght(C)1994-�D13 MRdwll Intxnatlonal Page 4 0l 4 So1[ware Versio�: 7.0.488 All RIgMs Reserved *�..k� � �` � ����� � � - .�"-`� `' ` 5°�`';`��'� Vehicie Valuation Report Pvv✓er�r�fnrm�t�an tYc�iwark" Prepared for:Progressive Group ot hsurance Companies {B00)321-9843 ' , , „ ;,�, . ....:s��y,,,�,�.��;,�.,�� ...... ....... . ,��.�.:,�,<,�,�..,�,�,�,� �.�,�.�,�,�,�,�,;,�,�, ��,�.,��,�.�,�,yy„�.�,�, �����.. ....... Claim Information Gaim Number: 13-243655&01 Version!t: 1 Policy Number: Coverage Type of Loss: ColliNOn Ovmer: ELVIN WOOD Loss Date: 08/11/2013 Address: 631 N WASFiINGTON AVE. ReporteU Da1e: 08J1112013 NEW RICFIMOND,WI 54017 Valuation Report Date: 0&13l2013 07:19:52 Ovmer Home Phone: (661)808-7�3 Valuation Report ID: 1003882270 Vehicle Information �oss Vehicle: 2008 CHEVROLET COBALT LS 2D CPE LocaSon: WI 54017 2.214 Cyl Ges A 2WD Exterior Cdor: Imperlel Blue Metellic VIN: 1G1AK18F487195�b License Plate: Mdeage: 60,646 milas TiUe History: No Valuation Summary I I ee�v��e: ss,xsa.ss II Loes Vehicla A�uetmeMa Condition Adjustmem: -$342.67 ' Prior Damag�Adjustmern: $0.00 Afler Market Part�Atljusiment: 50.00 Refurbishmerr�Adjustment: $0.00 Title History Adjustment: $0.00 Market Value: 57,911.32 Settlement Adjustments �I Dedudible: -$500.00 Seltlement Value: 57,411.32 � THIe Wstory Commente: � II Mi1ch[;II t#�,�CL°�::t�t�' ', 7bT�1 LON Claim%:13-2�38558-01�CopyrigM(c)2011-Mitchell Memational.All Righta Reeerved.�Page 7 ��, �$���f����� Loss vehicle: 2008 CHEVROLET COBALT LS 2D CPE 2.2L 4 Cyl Ges A 2WD Standard Equipment Exterior ,, : � � : � ,4uhm3�LeFieaarfghts�hli�:�kubor,►a��"Jm s; ...,:, � .;;: Ciayt�rt,e'�tiaum�g:i:�ts Front Air Dam F�nrrt and Rear Body Color Burr�pers _ _ _.... .. .... .._. ......_ _ _ __. _ _ .. _.. _ .. ..... . _...... ........ _ __. .._.._.._ .._.__.._.__ _ ............... .._....._ .. Hato�jen Fieadl�tits ...;:; .....:'_ :::. . ;; . . . :::. . .. ;,; f�tk�r De� :�;' . ,: Steel Wheels.1�In. Inberior �1�i 3�s��a si��t se�����ins�r��ne�t�t�a�s aur��y i�c,►� Y�taiw��'IQ�;:�t�:���ii�,�N�.��3��....:: ........ ..: ....,..,,. ,..,.�........ . :: ........: ...... .:. ........: ........:.....:; Cloth Seats Dual Biadc Menually Adjustsble Exterior Rearview Mirrors .. ;.. . . �a�r.�r�trr�eat-3�v,a :; .:; F'�c,t�al��s�e�ce�Saats qcr�a�sis��+�Y.J�l�ts a�?la�rs. . .. . ..:: . . ::: : . ..:: . .: :'`. . .. ;,: . .. ..'::.... :.�dtai,bYith iS�rJsdjusta6��.�,ea[Hetgtrtand Rdj�fie hlea�sts':. . ': _ __ _ _ _ _._ _ _ . :_ _ :::::.. :: �. : :: , _ __ Front Dual Sunvisors Front Passenger Vanity Mirror _ _ . __ __ _ __ _ _ _ _ _ .. __ _ __ _. _ . __ _ __. . ....... _ _ . .._._.__ .__ __. . In�or f1f�llter:; , _. ........::..#A�raIiJUF-i'N1i��i4�...:; .. �... P�e-Programmed Equalizer Radio Mtenna _.. .. ., . _ __. _ _. __. .._. __........... ..._ .. .. ._. .._ _._._. .._. .__... ..... .._. ............_._. .......... ._ . ..._. __. ..... . _ _ ___ .. _...._ _ _ .. _ _ _ __ __ .. __. __ _... _.... . _ _ .._ .. .... . _ ..._._... ... ._.._._... . .__._.. .. 129G3��F4Q,'��ptit:�ti�fig89r1i,���-�ffli�t�4G1jii8€3t3t�Ft8�W65t6 ::°: -;:� �$Ai`i8i$6tp99�2't5t6�t ;5 ' Rear dtRndow Defroster Solar-Ray(R)Tirrted Glass _ .. .....,...._ .. .. .... .. .. .. . ..... . .... .. .. .. ... ........... .._._.... ...... . . .. . ..... ....... . ........... ...... .......... .. .. .. .. ... 1'F�lerStyle�ir�g ri: ,;; ::; • •.i, c-.;: . .. ..,: �'np,�PWter ;;= ' _' .'. Vehide Speed Sensitive Intermittent Windshield Wipers Mechanical �r+Qni;f,?ower�258=r�ri?t�-0=;r�,'t�er�ted�tise�id fie�'F?vi�eF'�i:�rs� ;:� Pt��rer'8peeif-�eris�ng E�k�t�!F�'triie��l�tif�:�s,s�steEf$te�irtg.;': Tilt Steering Column Safety . , , ��c���e�a�to�s :.;; :r _....' ... .::. ..... .'.': G��c"�s :;;: .....;', ..:; ....,r... .. .. , .,...... Driver Airbag Wrth Dual Stage Deployment Front and Rear&Poirrt Seatbelts L A T+�i^I . ; ;:; •s;: ;; ..; ..; ,;; Passeriper AHbB�[�toft 3e�sot!#eitivated$y l?asseriger iNeipMt .: Passenger Alrbag Witti Dual Stage Deployment Rear 3-Point Cerrter Seatbett _ _ ___ . __ _...._ __. __._ _ _ . _ .._. __ _ _. _ . __ _ _. __ .__.. . ._.__... _ . ._. __. _ _ _ _ . . ___ _.._ _ _ . __ _ _ _ __. _._ _ _. __ _ _ __._. . . . .._ _ . _ _ _ _ :; : : : R�ti�Sic.E��f&�e s:,:;; ;:` ,: , `.:. ; �Ci��d i7c�t,YB�'dtti& `: Slde Head Curtein Airbags Thefllock(R)Radio Mti-Theft Yr�c fis�tti`#r�l�ev�e,;,;;, ,,,,,,,;,`, ,,. ' ,, ,;,,�+ete.i��'#fie�t�a�n�xt I�+$�.tt�t��t I�s�ine inunob�6zer Optional Equipment _.. ,, 4,�t�tt�tk�c.Bt�i. . .. .;i. :: ,�f�r.�AiTE�r�......;::.. ;. 'DIOlPIOc DealerlPort Installed Oplion Mitclx3B�icL°a::t,�Y' Tb�1 LvM Claim 8:13-2438556-01�CopyrigM(c)207 7-AAitchell Intemalional.All Rights Reserved.�Page 2 �s�v`�t`t����'��t!i� ..,;,,;,; .,,,,..., .,,:;.:;, ..:....::...... .. .. . ......� ,;,:;.:: ..,.,..:...:,....: Loss vehicle: 2008 CHEVROLET COBALT LS 2D CPE 2.2L 4 Cyl Gaa A 2WD Comparable Vehicle Information Search Radius used tor this v�uation: 75 mlles trom lossvehide ziplpostal eode. Typical Mileage for this vehide: 71,000 milos Distance From Adjusted # Vehicle Description Mileage Location Loss Vehicle P��� Va1ue �Ft�'RS?l.�G��4l��,S�Sk3�� ���!�}9 �..:,�I�RhhAL.�A�A�VftI .....:. .. _. ' .....$�.�....�4�$b �rlA7e� ��9�$ ... ........ . .... .... ..... .. .: ... ... :. .... :�.�� .....:. 2 20Q8 CHEVROLET COBALT LS 4D SDN 4 85,336 55033 33 miles �7'�'�� $8,280.43 2.2NORMAL GAS A 2WD List Price ���H�i"�I.�'����kL�`�.S�4fl'�t�k� �7�d�5 Ofl 3: . 97,718 �43Z ��'rr�c �8,1�{t9 ..:�.�f1331�,1Y11f+�:it"aAs&:,�i?2�N�1......:::' :::: ........:i :..::... ....:,:.: .... ...:;....... .: .........:... .,;:�.Ia1,P!r�..._:::. ..::,.:: _.._. __ ..._ . _ . ._... __ ........ __... _ ..... _........ _._ .._ .._. ..._... .. .. ___ _ .._ .... 4 20U8 CHEVROLET C08ALT LS 4D SDN 4 63,537 55423 41 mites $�'�'�� 38,453.79 2.2NORMAL GAS A 2111fD List Priw _........ ._._.._._._....... .. . . ._._...._ . _ .. ...... _. ..... ......._... .. ._............ .__. ......... . L�7 GI��R'L�'L��D�DY�?� $g�i8�tJ0 . � '. C�-I�vRO . 58��ri4� ���i3 .. ..:: 4�`rm�s ., ., ...:[:lat��. ,�8�'��d .,2ia�J�3�L;#�lh�+�i�.�3. ..:,,. .:,', . ...,..' ,,, ...... ......................................................................................................................................................................................................................, ..........._....................................................... 6 2008 CHEVROLET COBALT LS 4D SDN 4 51,725 55044 52 miles $8�499.00 $�g�0.61 2.2NORMAL GAS A 2WD List Price _._._.. _.. 7:2D4$t'.��?l�[`i€7�147'I,S 43}Sk�+L . : $�I�I�!�t}0 ...:2;3N�Rt�VSt:�14°wR��?.......;' .......:`. ......... .....�895 . &8587... ..:.. &8 mites. ..... :.......�fSt:�t#....�75 Base Value: 58,233.99 M,�����I��c��i��. .. .. ......; Loss vehicle: 2008 CHEVROLET COBALT LS 2D CPE 2.2L 4 Cyl Gaa A 2WD Condition Adjustments Cor�itlon AdJustment: •5342.67 Ovarall Conditfon: 2.74-Good Typical Vehicle Conditlon: 3.00 Mitchnl3 ti�ae*L°a::'t,�r' Tb�l LAN Claim A:13•2438558-07�CopyrigM(c)2011-Mitchell Mtematlonal.All Rights Reserved.�Page 3 Category Condition Comments ,:. ;-; ttKe+ipr . .. ..,:;. ; .:.' ,;. . ;,.. ,, _, ,, . , . ,, ,, , _ _ _ _ __. HEADLINER 3 Good ::��C`al.lkFii�?,' _,:; ''" ::'". 3.Gp� ; -.;. :: . . . ... . . .. .. . . .. . ... ..... „ ,.,,. .. . .. . .. . . .. .. ..... .. .., . .. .. , . . . .. . . .,... ,,. DOORSlINTERIOR PANELS 3 Good :. ;. ' ...,:,.', .,.....�'. ...,..,: �A�' ..... ,i. ,..�..,'t:�f&�c. ....:.::..... ,�::: �v �b^�.::? ......♦: ,.... ...: . ..:� „ ....;. ..:,, .�xiens�ve Perr�s�ar�a u�seal,s ,, „ . ,, , ,, ,,, ,,,,,,, ,, , ,,,,,, , ,,,, , ,, , ,, , .,,, „ ,.,, ,� . , ,, , _ , .,., „ „ , ,, „ „ ,,, ,., CARPET 3 Good ; , ;;�4SL�(�.SQLE.`:; _'. :' 3'�'ood .. -...: . . ..;;;. . ..... . ; _ ,, , :. , ,:: ,:.: _ _ _. Exterior , ;:;i�lCA�tTr:. . . ::;, . .': � r: , ,�.FaiF.. �. �: . ..,;,, . , :''r ���.�.�.��.��4^!p�,... .: �:'. . ,,,,, ,, ,,,, , , ,,, ,. ,,, „ , ,,,,,, , yP , „ „ ,. , , ,,,, ,.,.,, , , ., , , ,, , „ ,,, „ „ ,, , ., „ . , , ,, , ,,, VINYUCONVERTIBLE TOP T ical _. .._. ....._. .._ ...... ... . .. ........ ..... .._ .. ._._. . . . ...... ..._ .. .. ..... ...... .. . . ...... .. . .__.. . ...::�t11ik..:; .:, ....:; : ..._ ....2.�a�� : . ... .. ,..,;.. :, al��'wt+aQi.r�w�s m�y: ;:. . , ::: BODY 3 Good Mq�ckia�n�sl . . . „ . . . . .... . . .. . .. .. .. . . . ... . . .. . .,.:... . . ..... .. . :. .: . . . . TRANSMISSION 3 Good .,;;i�ndC�l�;:; .. ... ;:. ..:',:. ..:'., ......'�:t3ood �::�. . ...:._. ..:. .. .:-. •:.:.;, ,., . ..::! ,.:::,. :..:..: , . , ,,,.. _, , �: _.: _. Tire 3 Good 7,4,7,2 Typcai t�ndition refl eds a vehicle that is in ready-tor-s�e condilion and rellecls norm al wear and t ear 1or ihai vehide type/age. Comrwnts: ..�"'x�. ... .���.�! .�ir�+�..e:.::.. ..:.:...: :.:.:.:. :.:.;,:.. ...:.:.: ...:.:.:. ....:.::: ....:.:.: ...:...:. .:.:.:.: :.;...:. .:.:.:.......:.:.: Loss vehicle: 2008 CHEVROLET COBALT LS 2D CPE 2.2L 4 G�rl G�s A 2WD Comparable Vehicles Mitch[al1 ti�t:s9�cL�::2�y� 7bTa1 Loss Claim Jt:13-2/38558-01�CopyrigM(c)2011-Mitchell Mtemational.All Rights Reserved.�Page 4 1 2008 CHEVROLET COBALT LS 4D SDN 4 2.2 NORMAL GAS A2WD Sold Price: s7,350.00 VIN: 1G1AK58F487XXX)0(X Adjustmerrts loss VehiGe This Vehide Amount Stodc No: Vehide Configuradon _ �� I 50.00 Listing Date: O6f12l2013 Ad�usUrt2r�t ;, i+�eag .. ..,::: $�,6�d6;:: .....: .g1,d�6�:' �'.�: e..,, .... .:. . .,�.:.. ...... _ 21 P/Postal Code: 54765 _::: ., ,, ., ,. _ ,,,, ,.::: : Equipment Distance trom 40 miles :.`:..�i.�Hl9'�'f.k�1"fd..k��k�:-:'i`..�!��..:.: ...:::....t+l�...:::.... .. .:. ......::�l3t�'f: ...::..:...:::......:::....:::.:..:.:::.:. .: ::....::::...: :......:::.... :::::... .:.....:::: Loss VehiGe: Rear Spoiler Yes No $138.44 Source: FRANCHISE SALE•J.D. POWER AND ASSOCIATES Tohal Adjus2menL�: $979.49 Adjusfad Prico: 58,329.49 2 2008 CF�VROLET COBALT LS 4D SDN 4 2.2 NORMAL GAS A21ND List Price: i7,900.00 VIN: 1G1AK58F887213612 AdJustmertts Loss VehiGe This Vehide Amount SYodc No: 16903A projected Sold Ad�ustment -$710.00 Listing Date: OSl1512013 :�"4'�IS���t�b4F1. . .,;: i; ..;i, ..;;. :;: ;;;.$ETff9 �t+Treiit ; ZIP/Postal Code: 55033 Mileage 60,646 � 85,336 E758 02 Distance from 33 miles �flt;: „ ., .;,; , : : ;_ - ,.. ..: 441R�eeI Mti-LOCk Brakes : „ " , '� . � " ; , � , � �: :i Lass VehiGe: Yes No $196.98 Source: FRANCHISEYYEBLISTING ;:: 1�6�C.Stftl►t�k ; , ,'i,Y� ,`, ' Nb .,,, , . �73�� CARS.COM ._..: ,.....,. .. ..:.. ...:... VALLEY CHEVROLET OF Total Adjustmerns: E380 43 HASTINGS Adjusied Price: 58,280.d3 � 2929 HIGHINAY 316 I HASTINGS MN 55033 � 651-437-4161 il i I� Mitctxall�Ita��C3:a:5t�t• T�L� Claim at:13-2438558-01�Copyright(c)2011-Mitchell Intemational.All Righis Reserved.�Page 5 3 �108 CHEYROLET COBALT LS 4D SDN 4 2.2 NORMAL GAS A2WD List Price: 57,425.00 VIN: 1G1AK58FX87216731 Adjustmerrts Loss Vehide This Vehide Arnount Stodc No: . _ 'P�1]�t�d;S�IQ�fijl,tg�itl�YSf ;� _:'.; ,i `.:. ,. :: "�pp _ .._:.. ..:.. :. _ . _... _... . _ _:_._._. Listing Date: 07/08/2013 Vehide Configuradon $0.00 Adjustntent ZIP/Postal Code: 55432 - f�ge-';: _'::: . ;:- FiQ�£`i4�{r r; ��`��i�i: . :: �';x�<tY�;�i� _ .. . .. . _ Distance from 37 milea Equi�xnent Loss Vehide: . 4�ee[�ih:t�oah�raka�s : 'Yss ; , l�h> ; ;" % $1$512 Souroe: FRANCHISE DEALER 1NEB Rear Spoiler Yes No 5927 27 LISTING•YAST.COM FRIDLEY MOTOR COMPANY Total Adjustments: E69914 7501 MIGHWAY 85 NE Adfusted Price: 58,124.14 FRIDLEY MN 55432 763-788-8100 4 Z008 CHEVROLET C06AtT LS 4D SDN 4 2.2 NORMAL GAS A2WD List Prite: 57,988.00 VIN: 1G1AK58F487331065 Adjustments Loss Vehicle This Vehide Amount Stodc No: 10473A Pro�ected'Sold Atl�ustment ��$0 00 Listing Date: 0810312013 =k�eFnof�C�ontr�[pa�an , ,, ;; ;.�1�1tl ;�it��n� .::;: : :: .: ZI P/Postal Code: 55429 „ . , . ,,. ., , r: . , , ..,. . ,. .�. ,s.,,,;;:^ , „ , , ., ., , .,,.. . . Mileege 60,646 63,537 $98.58 ; ; Distancefrom 41 miles �q�i�; .:.. .....: .. ...:. ... _: .... ...;::; ... ..=: ; __ _. .. :: _ ._._.._._. .. :. .._. .::.. .. . : . ,,..:- Loss Vehicle: 4Wfiee1 Mti-LOCk 8rakes Yes No $218-79 ' Source: FRANCHISE WEB LISTING- I�4�r 5�sff8�" .:i. Y�_.:': NC . :: . `:,: .....$��'� I CARS.COM WTHER BROOKDALE MAZDA Total Adjustmenfs- $46779 MIT5UBISHI ' AdJusted Prlco: 58,453.79 7235 BROOKLYN BOULEVARD BROOKLYN CENTER MN 55429 I I I i � i � il Mitchnll tiu��CL�::2�r' ��L� Claim�t:13-20.38558-01�Copyright(c)2011-Mitchell htemational.All Righta Reeerved.�Page 6 5 2008 CHEVROLET COBALT LS 4D SDN 4 2.2 NORMAL GAS A2YYD List Price: 58,888.00 VIN: 1G1AK58F+8729�079 Adj errts Lass Vehicle This Vehide Amount Stodc No: A340 ;: _ rPr�l�t�d s�sld�usi�rie�Yt ; �;�800. _. _ .. .. _, _ .: . :: __ _ . Listlng Date: �'i10412a13 Vehlde Configuration $0.00 Adjushrfer�t ZIP/Postal Code: 55303 ,�g& ;,; •:; 50,�`r+15;r' ���+t'f#!;. �7;,� Distance from 47 miles Equtpment Loss Vehicle: :� M#�Mee(Actt��iok�talces;` Y�s ; No ;; . $�L'1;8'� Source: FRANCHISE WEB USTING- Rear Spoaer Yes No E152 36 CARS.COM MAIN MOTOR CHEVROLET Total Adjustments: -5502.26 CADILLAC Adjusiod Price: :8,383.74 435 W.MAfN ST. ANOKA NN 55303 763-421-2700 6 200B CHEVROLET COBALT LS 4D SDN 4 2.2 NORMAL GAS A2VYD List Price: 58,499.00 i VIN: 1G1AK58FX8T107248 Adjustrnerrts Loss Vehicle This Vehide Amount ' Siodc No: C340009 B Projected�Sold Ad�ustment ' -$764 00 � Listing Date: 06102l2013 ;17�i0t�{�tn��n �4,�7 ZI PlPostal Code: 55044 '��n� �. , , � ,. . �, �� , �� �' � _. Md48gB 60,646 51,725 -$282.01 i :: _ �. Distancefrom 52miles �q�iki ........:.. .. ..:.: .......;: ...... .:; ...,. ., .....:'. .:::. . :: __ __ _ __ _ __ _ ... Loss Vehicle: 4Wheel AnG-LOGc 8rakes Yes No $211.92 Source: FRANCHISE WEB LISTING ` ; ��r. ..�� ...:: . Y� ..:;.. CAR5.COM � t:: �0 ...i. .,.., ..�1�7#� JEFF BELZER'S CHEVROLET Total Adjustments: -$688.39 21111 CEDAR AVE Adjusted Price: $7,870.67 LAKEVILLE MN 55044 9b2-469-0444 � Mitch�l!i�t���C�`�:s2�r' T��L� Claim#:13-2438558-01�Copyright(c)2011-Milchell Imemational.All Righis Reserved.�Page 7 7 2008 CHEVROLET COBALT LS 4D SDN 4 2.2 NORMAL GAS A2WD List P�ice: 58,495.� VIN: 1G1AK58F187155804 Adjustmerrts Loss VehiGe This Vehide Mwunt Siodc No: 12138B ;p�� '��� ' ....: �51+ ;"�'p�. Listing Date: OS114l2013 Vehide Configurafion $0.00 AdjusVttertt ZIP/Postal Code: 55387 � _ '1�8gas�-i� ,.' - frQ,��:;. .:r ���i �,.: ..;i&�3.5i''�, Distance from 65 miles Equipment Loss Vehicle: ; �.#�h�e�Antwl:odi�rakes � Yss ;. ;;` No ;';=; '! 'S2'#�1�1 . .R88fSp0ilEr... , . . , .:..Y�. . . . ..,:.,,,NO ..............:.........:......:.. Source: FRANCHISE WEB LISTING- g S9a5 62 CARS.COM WACOMA DODGE CHRYSLER Total AdjustmeMS: -�101.25 JEEP RAM AdJusted P�1ca: 58,393.75 905 5TR�1G DR. WACONUI MN 55387 800-632-9784 ,,;: : ; , ;,:.� :. : � � �::� , ,� :� � . . . . .. . . . ..... _ .;.:!..;� _ ..:... � � . � : :� � � ;� Sub-Model Description Configuration Original MSRP __. _. .. . . . _ _. _ _ _. 2�S+k�f��t(7E;�FC€3$:4LTCS 'E ii 2�3{;PE;22E.+f��.Yt°U�S:2yli�? �1�M1�,'�'O�f ;; . :: .::.. . .. ,.. . .., . . , ,.. .., :, . ., . _:, . ., . . ; 2008 CHEVROLET COBALT LS 4D SDN 4 2.2 NORMAL GAS A 2WD $14,6U0.00 � Mitcheli���C�°`�:;tt s" ���� Claim�t:13-2436558-Ot�CopyrigM(c)2017-Mitchell Intemational.All Rights Reserved.�Page 8 Vehicle Valuation Methodology Explanation WorkCenter Total Loss was buiN through a joint partnership belween J.D.Power and Assoaetes vehide valuation divi sion Pow�IrHormation Network (P.I.N.J and Mitchell Irrternational,a leading provider of daims processing solutions to private passenger insurers. WorkCemer Total Loss produces accurate and easy-to-undersiaxl vehide vakrations via tt�s five step process: 9tep 1-Locate Comp�ade Vehlcles Locate vehicles similar to the loss vehide in the same markel area.WorkCerner Total Loss finds these vehides in AuioTracbr.com,Cars.com, V�tcom and directly irom dealerships. Step 2•Ad�ust ComperaWe Vohiclos Make adjustmerrts to the prices oi the comparable vehicles.The comparade vehides are iderrtic�io 1he loss vehicle except where atljustmerrts are itemized.There are several types oi comparable vehicb adNstmems . Projeded Sold Pudjustment-an ad'justment to reflecl consumer purchasing behavror(negotiating a d itterem price ihan the Nsted price). .Vehide Config�aation Adjustment-an adjusUnent for difierences in configuredon between the cornparable vehicle and the loss vehicle(e.g diflerences in trim). . Mileage Adjustment-an adjustment 1or ditterences in mileage between 1he comparade vehide and the loss vehide. . Equipment-adjushnents for differenoes in equipment between tt�e comparable vehicic(e.g.equipment packages and optionsj and the lo vehi de. 9tep 3•CalcWate Base Vehicle Value The base vehicle value is c�culated by av�aging the adjusted prices ot the comparabie vehicles. Step 4-Calculste Loes Vehicle Ad�ustments There are tour types of loss vehide adjustmerns: . Condition Atfjustmem: Adjustrnertls to accour�tor the contlition ot the loss vehide prior to the loss. . Prior Damage AdJuslmerri: Adjustments to accoum 1or any prior damage presem on the loss vehide prior to the loss. . After Market Part Adjustmern: I Adjustmenls to account tor any aHer markel parts present on the loss vehicle prior to the loss. '� . Returbishmern Adjuslmem: Adjustrnenis to accouM iw any returbi shmeM pe�ed on the loss vehide prior to the loss. : Step 5-Calculate the Merket Velue i The Market V81u8 is Calalffied by applying 1he loss vehide adjuslments to the base value. Milch�ll§it�s�L`aast�t•' ���� Claim A:13-2438556-01�Copyright(c)2011-Mitchell Intemational.All Rights Reaerved.�Page 9 Page 1 of 1 Progressive Group of lnsurance Companies Settlement Summary Clalm Informafion Clsim N►mber: 13-2436558-01 CpvM7iga Type oi Lo�s: Coilision Policy Number: Lo�s Debs: 08/11/2013 Owner: V11�OD, ELVIN Reported D�tia: 08/11l2013 V�uuaafion Report ID: 1003882270 Vehicle Information Loss Vehide: 2008 CHEVROLET COBALT LS 2D CPE 2.2L 4 Locatlon: WI 54017 Cyl Gas A 2WD VIN: 1G1AK18F487195285 Exterlor Color: Imperial Blue Metallic Mileag9: 80,848 miles LiCerqa p�ab: Tifle History: No Title History Comments: Loan Infortnation Paymsnt IMom�atlon Lien Holder Payoff: $0.00 Llen Holder Pa�rment(s►: $p.0p LoaNLease Payoff Coverage: �O.OQ Net to Own9r. $7,846.44 Settlement Sta�ad Amount: $0.00 Ach�d Cash Value: $7,911.32 Base Value: �8,253.gg Title History Adjustment: -$Q.QQ Refurbishment Adjustment: 50.00 After Market Parts AdjusUnent: 50.00 ' Condition Adjustment: -$342.87 ' Prior Damage Adjustment: -$0.� ' Market Value: S 7,911.32 Settlement Adju�ment(Pr+o-Tax): �0.00 ' F..s: so.00 Tax�s: $435.12 I Company Obtains: �0.00 Net Sottlemaitt: $8,348.44 ; SettlemeM AdJw�tmerrt(Post Tax): $0.00 Deductlble: �$�7Q.� Othsr AdJustrnants: �0.00 . Total Settlemsnt: $7,848.44 i Adjuster License#: ; Comments: i https://progressive.mymitchell.com/TotalLossiT'LOSettlementWorksheet/T'LASetxlemen�.. 14i29/2013 08/23/2013 07:34 FAg �001/003 � Progressive Claims Branch I700 SouBi 108'�Slneet ��;; � � • West Atiis, �i 53214�023 � Fax: 414-258-1640 T.o: - y s 5G '�rom; � . � � � M� � � � � . 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Progresslve CasueEty lnsuranCe-Corporafe Att�:Settiement Group 6055 Parkland Blvd.Box EN!-3 Two We�k Corporate Center Sulte 500 Attn:Naiions!S�lvage Un(t Westchester, IL 60154 Ma�eld Helghts,OH 44124 Phone (708)492-70Q0 ffi:Saivage Dept Fax: t708)492-7078 E-mail Tata1 �Ivaoe Inf�rmation Accounf nf Sale Activitv %ACV IAA Sbock#; 000-11781934 Sales $1.560.00 18.59 iAA Branch: MinneapollslSt Paul tAA Charges Fed.Tax I.D. 9537941'I'E Consignment Flat Fee $85.00 1.07 Adjuster: Ashley Shusta DMV FrTing Fee $98.00 0.23 Insured: Eivin Wood g��/t,pq�;��{er Fee $2d.75 4.26 Owner: Dvin Wood Claim#: 43-2436566 Po�icy#: Lsss taa char9es t$123.75) (1.5s) Vehicfe: 2008 CNEVROLET COBALT Net IAA Retum $�i,426.25 18.03 Damage: ltndercarriage/Transmission pa mer�t Amour�t ViN: 1G1AK18F487195285 Y S1,4Z6.Z5 98.03°� ACV: $7,911.00 NICB Date: 90J1712013 Buyer fnfamation_ Johnson Aub 3ales&Service 330 W River Dr M�aca.MN 56353 Resale Ce�tificaie#:2922733(MN) Efaqsed Davs Analvsis Date of Event: �� Davs �gg 8/11/2013 — Assigned $/12/2013 2 Released 8/12/2013 1 Pickup 8/12J20'!3 '1 Title Rec'd 9/17/2013 37 ' Saie Doc.Redd 10l8/2093 22 � Auction Date 10116/2013 9 Buyer Payment N/A 0 � Remittance 10/97/2013 2 Elapsed Total Days: 68 IAA�Dec.RP0�2.�pt Received Date: 10/21/2013 09/18/2013 08:32 FA% �001/008 Progre�ive C1ai�ms Branch � 1700 South 108 Street �D�s • �est Allis, Wi 53214-4�23 Fax: 414258•I640 . To: j 3 -�2�13d 55� ��: Fa�c � Re• � . . � / � ��� ° f r , • • ��� . . . . ' ' . or ob�ious irom the r�d Ihe������ied h I; �R��eb�aflderitlal i�fonna�ion htended f�ih�u���e h�id�,�1 a I erd�r If rie r+e�aler d ihis n�e i�rat 1he i�landed r�o��ar 1he � ' apeqt rec�ier�. die�utlon or oopyip d � oQrirnur�isa�on is slri�p,a�M�. ���°f ; this oo�nnuitc�ior�In error a ae ntit sue whetlier it ts prh�iepet�p4eie � ����.and r�e�urn tl�e algir�l rt�eQe�us st 1he aboMe addraes vi��Ug�g�� ' � AUTO ' MOTORCYCLE ` MfJ1TERCRAFf' ' RY ` �� us ariytime 24 ho�rs a day 7 days a w�eek�1-800-PROGRESSlyEp�.��� aRprogr�siu�e•oom 09l18/2013 08:33 FAg 1�002/00B Saint Pau! Police Departmen���s 4 (3_ a y 3�SS(� ORIGINAL OFFENSE 1 iNCfDENT REPORT Corr�pfaint Number Rel�erence CN Date and TFme of Report 13170401 08/11/2413 17:00:00 Prima►y oi�ense: INVESTIGATE-AND ALL OTHER PnEmerY RePo+�n9 olfcer. Steven s, Eric J Neme ot 1a�atioMwslness,• PrimeN s4ued: 331 tacet�on afrnddenr. qRCADE ST&IDAFiO ��aN�P�+'�1�r l8�tlle,Joseph R ST PAllL,M!d 55106 �P�r Kd1, Steven ms��Eastem Dat.8 s►ne ofac+cunance: Qg/�1/2413 16:tO:OQ m . . S�� 08/11/2013 16:01:00 Arreatmaoie: 5ecio►idery oflens�e: Police OfFraerAsssulted or Irtl�' Pofice Off'icer Asslst�d Sufade: Cn'me Scens Processed.• � ' � � - - - '" OFFENSE-DETAILS -. � . _ _ . . _ . INVESTIGA�E�AND�AIL OTHER .. .. . , attem�r oniy: ,a�ro r�ceng�rnred: CHme Scene Ms6hod 6 Polnt ofErrtry tYae� Public domain Force used: r�n��e_ ��a�= Highway/street/road/altey pbrnrorenty.• Mefhod� NAMES Compla(nant Wood, Elvin Earl s�Q��/ .��i . 323 WILLIAMSBURG PL f- NE1N RICHMOND,WI 54017 Fp��Zv��l Nra�►�m.s o.�u� �,�"'� ��3 . N►c!c Narne.� A1ias' � i4KA First Name:. , - . • AKA Lasf N�me: . _ ._.... . - -. ..._. ___. -- . 'DaMils-:. :. - . _ .. sex: �t{� Rsoe: White D09: 14115/1985 .,-Resident Stetus:' . tlispeMc: Age: 27 trom to Phonts . � � �' ��= ��' 651-808-7653 Wfork Fex: pager. . ' ' , SPYEAF85587CiA7 09l18/2013 08:33 FA% �003/006 Saint Paut Po{ice Department P�' 2 °`5 ORfGINAL OFFENSE / (NCIDENT REPORT co�►svra�r rv�m�► �rere�cx �re aoa rme or ReAort 1317�401 08/11/201317:00:00 Pdm�ery offerrse: INVESTIGATE-AND ALL OTHER �� °�"o^. �,,,�.. ���� ssn,: �ens�or►a�� r..rce,�ae s�ra: Suspect UNKNOWN Nklu+ames orAHases Nidc Name� A1fas: AKA FlrstName: AKA Last Neme: Oefa!!s Sex: Race: D08: Resident Status: Hr'spank: �4ge: bam � Phonss Home.� (;eh!• �• Wak.' Fax: pa� EmploYmeret �CC�eUon� Fmp�Yer. /d�enllHcaElo�rt i � SSN: Licenae or fDB:; ���re: � � � �� Pnrsrw o�scr�v, US Mehic: -- keighr to Bu!!d: Ftalrtent,�h: HalrCobr. VIA�ighC to Skln: Fac►a!Hair Ha1r 7j�p9: Teeth: Eye Colbr. g/pod Type: ol�naMrrafo.m.�on Arnested� P�ursult sngaged: Yaleted Restreinfng Order,' DUI: Res/st8noe ernaD�interad.' Condi6on: i Taken to heslth cere/acility.� Medical release obtained: sveeafessn7cw� 09/18/2013 08:33 FA% �0041006 Saint Paul Police Department P°� 3 °�B ORIGINAL OFFENSE ! iNCiDENT REPORT Canpfarnt Number ReAerence CN p8fe and Tirtre pr Report 13�70401 081'I'f/20'I 3 17:Q0:00 ��oa���: INVESTIGATE-AND ALL OTHER SOLVABILITY FACTORS Suspect csn be ldentiNed.• 8y Photos Teken: Stolen PropeKy TiaceabJe: Evidence Fumed In: Property Tumed 1n: Relafed i+nanlanl: 1.�8 Biolog�ca►MelY�� Flnperprir►ts 7aken Naraotic Anatysls: ltems F,i�p�prfnted.• L8b Comments: PROPERTY �rFM�r ����g� Damaged oere ofioss:g/11l2p13 �ocenon Losr.• owner. Wood,Elvin Earl Dete Reonverea. r..ocabon Reco,reied.� Modef!k. Querrtity� Serfa!�' ,a.�derypeit�,n.• Otherproperty / Vehide rotarvm�: ' ���+; Blue 2d08 Chevy Cobalt. Tumed in at: Loaker!D!k. Lab exams: I � I i SP9N1F85587C9A1 09:18/2013 08:33 FA% T�J 005/006 Saint Paul Police Department p� 4 °�$ ORfGfNAL OFFENSE 1 INCIDENT REPORT Compfaint Number ��►„�cN oero e►►a r���orr 13170401 08/11/2013 17:00:00 P�Imary ollense: INVESTIGATE-AND ALL OTHER VEHICLE INFORMATION{Property) srares p��yp� status.� Damaged ucense no.: 446KPU Year. 2008 rowed.• No state: MN � Hard t�p Loek sbt�a veer.• 8/2013 Color Slue DO°�'"'�Oa`�� v��N�� 1G�AK18F4B7195285 �oor�� lgnition unlxked.• Make: Ch@Vf01E� Tianamismion: r►unic ardoclaea: Modeh. COBALT sn�7t Aos�ion ICeys h►vehlc�a:No h4lesge: Maurance 3 owrt�Ir�onnatlo►i ViAld�contants d�'Mar �� ���� Insurance co.: Keys in veAide: NO � Owner allowed someona to ����ny. use vehicle: Amount Ow�sd.•� Stofen R�eihod,• Regfste+edamer. �11/OOd, Elvin Ear{ t�eftcoveraqe: Drivers license no.: Personal property irr vehicle: Vehkle Dam�e DAMAGE TO UNDERSIDE. Partc�pants: ' Person Type: Name: Address: p��e: Complainant Wood,Elvin Ea�i 323 WILLIAMSBURG Pl NEW RICWMOND,W154017 Suspect NARRATIVE No iCC#1936 i On Sunday Q8-11-13 at 1630 hours we, Officers STEVENS and LABATHE{squad#331}, responded to the I area of Arcade arxi idaho on an assist. We were advised that the complainarrt had strudc a manhole cover wifh his vehicle. We arrived and met with the comp who was identified by his WI state drivers license as ELVIN EARL WOOD (10-95-85). WOOD said he was t�aveling s�uth bound in the right�ane of Arcade at rdaho when he drove over a water main co�er which was roning dowrt Arcade. � - -- � -- - spsa�,Fesse�csat 09l18/2013 08:33 FAg �j0061006 Saint Paul PoJice Department P�e 3 of5 ORfGINAL 4FFENSE / 1NCIDENT REPORT Complaint Number Re�israrrce CN Date and 7trqe of Alspwt 13170401 08/11l2013 17:QQ:04 �o���: INVESTIGATE-AND ALL OTHER WOOD said the cover was kicked up by a vehicle which was traveling south bound in front of him. WOOD couid not avoid the cover and drove over it. The cover did damage to the bottom of his blue 2008 Chevrolet Cabalt(W1:406-KPU). WOOD said the cover tore his transmission cover off and punctured his tadiator. Thsre was a large amount of fluid undemeath his vehide. WOOD said the vehicle was not operable and we requested a tow to his location. � � � � PUBLlC NARRATIVE Sunday 08-11-13 a� 7630 sent to motorist assist at Arcade artd Idaho. �! 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