Johnson, Amanda \
i � �
NOTI�E OF CLAIlVI FaRM to the City of Saint Faui, Minnesota
7Ni�ueesow Sta�e Statute 4b6.05 states that"_..ei�ery persai...►vho clai�ns da►nages fro�n m�y mw�icipQlfly...shall cause to be presented!o th�
guvernittg budy uf thr municipulity x-ithin 18U duys uftrr thr ullrgrd uiss or injttrt�i.s tliscovrred a ruitice stuting thr timK pluce,uruf
circumstances ihereof,and the mnount of compensanon or other relief demand�d."
Plesse c.�nu�lete Wis forin in its entiretp by dearlp typing or printlug your answer to each question. If more sp�ce is
needed,attach additional sheets. Please note that Son wiil not be contaMed bq tdephone to dariPy auswers,so provide as
much information u necessary to e�ain your claim,and t�e amount of compensation being requested. You will receive a
written aclrnewledgement�ce your form is received. Tt►t process can take up to ten wee�s or longer depending on the
natnre of yoar clairn. This form must be signed,and bot�pages completed. If something das not apply,write`N/A'.
SEND COMPLETED FORM AND► OTHER DOCUMENTS TO: CITY CLERK,
, AINT FAUL,MN 55102
First Name(11�1Q!~1(,IG�� Middie Tnitial t" Last Name ��,"��n
D
Company or Business Name 1� ��
Are You an Insurance Company? Yes/� If Yes,Claim Number?�f� NOV �8 2��3
SueetAddress ��� 1��-( 1v � �i�T� �ITY CLERK
City J�� S�"� �1 State_�(� Zip Code �Sr�� �
Daytime Phone(�)�-�1l,L Cell Phone(.�)�t-���Evening Telephone( ) -
Date of AccidenU injury-or Date Discovered{���i"�� Time am/pm
Please state,in detail,what occurred(happened),and why you are submitting a claim.Please indicate why or how you
feel the City of.Saint Paul or its empioyees are invo ved and/or r sponsible for your damages_
- ,
«
� ` �
__ , � � t�
y
Please check the box(es)[hat most closely represent the reason for completing this form:
�My vehiele was dainaged in an accident ❑My vehicle was damaged during a tow
❑My vehicle was damaged by a pothole or condiaon of the street ❑My vehicle was dainaged by a plow
❑My vehicle was wrongfully towed and/or ticketed ❑I was injured on Ciry property
❑Ot6er rype of property damage—please specify
❑ Other type of injury—please specify
In order to process your claim von need to inctnde copies of all apalicable documents.
For the claims rypes lis[ed below,please be sure to include the documents indicated or it will delay the han�ing 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 Property damage claims to a��ehicle:two es �timates for the repairs to your vehicle if the damage exceeds
$500.00;or the actual bills and/or receipts for[h�repairs
O To�ving claims:legible copies of any ticket issued and a eopy of ihe impound lot receipt
O Other property damage claims: two repair estimates if the damage exceeds$SOO.tlO;or the actual bills
and/or receipts for the repairs;detailed list Qf damaged items
O Injury cl�:medicat bills,receipts
O Photographs are always weleome to document and support your claim bt�t will not be retumed.
I
Page 1 of 2-Please complete and return both pages of Claim Fot�t
� �
. � " __�_. .. -. . �.r. ...,a ` �
��
I ���.__ _. .�.
�—�
i
Failure to complete and return both pages wlli res�t in delay in the handltng of yonr claim.
%�II Claims-ulease candlete this section
Were there wrimesses to the incident? Y� No Unknown (circle)
Provide their names>addresses and telephone numbers:D_Q-'nl(.,� jZ o�l�� (�(� cl� --��_j� �
Were the police or law enforcement cali ? � Ye No Unknov�m (circ e
Tf yes,what department or agency,k PD 1 �P Case#or report# i 3 "O� ���p
Where did the accident or injury take place? Provide street address,cross street, intersectio � me of k or facility,
closest landmark,etc. Ple e be as detailed as possible. If necessary,attach a diagram.
Please indicate the amount you aze seeking in compensati n or wh�at y ��,aid�e the City to do to resolv this claim
to y ur satisfacoion. �J
�
Vehicle Claims- lease com lete this section ❑check box if this section does not a 1
Yow Vehicle: Year_�_i�,�ake Model S3 tS�.F�
License Plate Number Statel'1�_Color_ �n��l C
Registered Owner ti1
Driver of Vehicle
Area Damaged r �
City Vehicle: Year Make. � Y' Model
License Plate Number�$°I -y� State t11o.� Color ►�i�
Driver of Vehicle(City Employee's Name)T��'�C'V �. ed. .� ✓1
Area Damaged __ _____
_ -- - -' �.
Ininrv Qaims-ulease comulete this section �'check box if this section dces not aoniv
How weie you in�ured?
What part(s)of your body were injured?
Have you sought medical h-eatment? Yes No Planning to Seek Treaunent(circle)
When did you receive treatment? (provide date(s))
Name of Medical Provider(s):
Address Telephone
Did you miss work as a result of your injury? Yes No
When did you miss worl:? (provide date(s))
Name of your Employer:
Address Telephone
❑ Check here if you are attaching more pages to this claim[orm. Number of additlonal pages
By signing this form,you are stating thart all info►mation you havt provided is true and correct to the best
of your knowledge. Unsigned forms will not be proctssed.
Submitting a false claim can result in prosecution. Date form was completed ��_�� �
Print the Name of the Person veho Comp this Fo
Sigaature of Petson Making the Gaim:
Revised February•?0 t I
I
' � �,tt,__ �.� .�..._.:
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Yride, Professionalism & Partnership
DANIELLE LEW(S
Polrre Qf/icer
'� POLICE DEPARTMENT
�����N'�� CITY OF SAINT NAUL
, �������
'u ' ' ;67 Grore.Snec! l'orre M11uil�6S/-'(6-9000 e.rt 71�5;1
�TP^���,ad-,,T,��-pO���// S<rinr Pnul.61N SS/0/ danictic)Icivis(i�c{stpaid.mri.u.c
�'✓
CN#� � i'?� "L�_—�_�—_
lf�ou ive yueshons re�arding your rcport,cxll:
Saint Paul Police Recurds Unit (G51)26fi-5700
O
/"1 r�C�`^C��i ���C�S G 1 �.Ci.��
CASTRO'S COLLISION CENTER INC. Workfile ID: 3e5ed371
_ FederalID: 41-1720033
' 786 ROBERT ST S, SAINT PAUL, MN 55107 State ID: 16132285
Phone: (651) 291-2965 State EPA: MND98 0683429
FAX: (651) 224-0112 License Number: 75348
Preliminary Estimate
Customer: 7ohnson,Amanda 7ob Number:
Written By:Tony Castro
Insured: Johnson,Amanda Policy#: Claim#:
Type of Loss: Date of Loss: Days to Repair: 0
Point of Impact:
Owner: Inspection Location: Insurance Company:
Johnson,Amanda CASTRO'S COLIISION CENTER INC.
707 12th st 786 ROBERT ST S
SO ST Paul,MN 55075 SAINT PAUL,MN 55107
(651)276-7482 Business Repair Facility
(651)291-2965 Day
VEHICLE
Year: 2001 Body Style: 4D LONG VIN: 2GCEK19TX11103080 Mileage In:
Make: CHEV Engine: 8-5.3L-FI License: Mileage Out:
Model: K1500 4X4 SILVERADO Producaon Date: State: Vehicle Out:
IXf
Color: Int: Condition: ]ob#:
TRANSMISSION Dual Mirrors Stereo Styled Steel Wheels
Automatic Transmission CONVENIENCE Search/Seek PAINT
Overdrive Intermittent Wipers SAFETY Clear Coat Paint
4 Wheel Drive Tilt Wheel Drivers Side Air Bag TRUCK
POWER Message Center Passenger Air Bag Rear Step Bumper
Power Steering RADIO Anti-Lock Brakes(4)
Power&akes AM Radio 4 Wheel Disc Brakes
DECOR FM Radio WHEELS
11/14/2013 1:32:47 PM 011444 Page 1
Preliminary Estimate
�Customer: )ohnson,Amanda 7ob Number:
Vehicle: 2001 CHEV K1500 4X4 SILVERADO EXT 4D LONG 8-5.3L-FI
Line Oper Description Part Number Qty Extended Labor Paint
Price#
1 FRONT BUMPER
2 0/H front bumper 1.9
3 * Repl LKQ bumper assy;chrome+25% 15759060 1 625.00 Incl.
4 FRONT LAMPS
5 * Repl LKQ LT Headiamp assy+25% 16526133 1 106.25 �.4
6 Aim headlamps 0.5
7 * Repl LKQ LT Park/tum/side+25% 15199558 1 56.25 S?�
8 R&I RT Park/tum/side 0.3
9 R&I RT Headlamp assy 0.4
10 GRILLE
11 * Repl LKQ Grille chrome w/o heavy 15764313 1 250.00 Incl•
duty+25%
12 Repl Grille retainer 15764320 6 10.02
13 FENDER
14 Repl LT Fender liner 4WD 15186612 1 35.02 0.4
15 * Rpr LT Fender Chevrolet 1 4 Z•2
16 Add for Clear Coat 0•9
17 * Rpr LT Flare painted � �•$
1g Overlap Minor Panel '0•2
19 Add for Clear Coat 0.1
20 # HAZARDOUS WASTE 1 2.00 X
21 # CAR COVER 1 5.00 X
SUBTOTALS 1,089.54 7.2 3.8
ESTIMATE TOTALS
Category Basis Rate Cost;
pa� 1,082.54
g�y��r 7.2 hrs @ $54.00/hr 388.80
Paint Labor 3.8 hrs @ $54.00/hr 205.20
Paint Supplies 3.8 hrs @ $32.00/hr 121.60
Miscellaneous 7.00
Subtotal 1,805.14
Shces Tax $1,082.54 @ 7.6250% 82.54
Grand Total 1���•�
Deductible 0.00
CUSTOMER PAY 0.00
INSURANCE PAY 1+��'�
il/14/2013 1:32:47 PM 011444 Page 2
Preliminary Estimate
� Customer: 7ohnson,Amanda 7ob Number:
Vehicle: 2001 CHEV K1500 4X4 SILVERADO DCf 4D LONG 8-5.3L-FI
AUTO CLUB INSURANCE ASSOCIATION, MEMBERSELECT INSURANCE COMPANY OR AUTO CLUB GROUP INSURANCE
COMPANY (HEREIN INDIVIDUALLY AND COLLECTIVELY REFERRED TO AS ACIA) GUARANTEES THAT IT WILL
REPLACE THE QUALITY REPLACEMENT PARTS (PARTS NOT MANUFACfURED BY THE ORIGINAL EQUIPMENT
MANUFACTURER) IDENTIFIED ON THE VEHICLE ESTIMATE ASSOCIATED WITH THIS GUARANTEE IF A DEFECT IS
DISCOVERED.
ACIA FURTHER GUARANTEES THAT THE QUALITY REPLACEMENT PARTS, DCCLUDING GLASS AND MECHANICAL
PARTS, ARE CERTIFIED OR VALIDATED TO BE OF OEM QUALITY IN ALL INSTANCES WHEN THIS CERTIFICATION
OR VALIDATION IS AVAILABLE FOR THE PART. THIS GUARANTEE IS IN EFFECT FOR AS LONG AS YOU OWN THE
REPAIR VEHICLE AND IS NOT TRANSFERABLE TO ANOTHER PARTY AT ANY TIME. THIS GUARANTEE COVERS THE
COST OF THE PART, LABOR TO INSTALL, PAINT AND MATERIALS IF REQUIRED, AND REASONABLE RENTAL COST
OF A SIMILAR TEMPORARY REPLACEMENT VEHICLE DURING THE REPAIRS. THIS GUARANTEE DOES NOT COVER
CLAIMS FOR DIMINUTION IN VALUE OR CONSEQUENTIAL DAMAGES.
IF A DEFECT IN A QUALITI' REPLACEMENT PART IS DISCOVERED, CONTACT YOUR LOCAL ACIA CLAIMS
DEPARTMENT IMMEDIATELY AND ACIA WILL REPLACE TNE PART WITH A NEW ORIGINAL EQUIPMENT
MANUFACTURER PART. IF AN ORIGINAL EQUIPMENT MANUFACTURER PART IS NOT REASONABLY COMMERQALLY
AVAILABLE, ACIA WILL REPLACE THE DEFECTIVE PART WITH ANOTHER QUALIT�Y REPLACEMENT PART.
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.
11/14/2013 1:32:47 PM 011444 Page 3
Preliminary Estimate
Customer:7ohnson,Amanda 7ob Number:
Vehicle: 2001 CHEV K1500 4X4 SILVERADO IXT 4D LONG 8-5.3L-FI
Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted ali items are derived from the Guide
DRiGH99, CCC Data Date 11/13/2013, 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=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. 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 ESfIMATING GUIDE:
BAR=Bureau of Automotive Repair. EPA=Environmental Protection Agency. NHTSA= National Highway
Transportation and Safety Administration. PDR=Paintless Dent Repair. VIN=Vehicle Identification Number.
11/14/2013 1:32:47 PM 011444 Page 4
� M~V�o.com Wst si P u�SMN 55118
�� �.7��(� Fox:651.552.8176 '
E'na��:cscheffler@ �,
l.�.USA.ABRA °braaufo.com
� �to Body & Glass - West St �Norkfile ID: 89873f3e
FederalID: 41-1942823
Paul
Right the First Time...On Time
130 THOMPSON AVE E, West Saint Paul, MN
55118
Phone: (651) 552-7744 ,
FAX: (651) 552-8176
Preliminary Estimate
Customer: 70HNSON,AMANDA Job Number:
Written By: Craig Scheffler
Insured: JOHNSON,AMANDA Policy#: Claim #:
Type of Loss: Date of Loss: Days to Repair: 4
Point of Impact: 12 Front
Owner: Inspection Location: Insurance Company:
JOHNSON,AMANDA ABRA Auto Body&Glass-West St Paul CUSTOMER PAY
707 12TH AVE N 130 THOMPSON AVE E
SOUTH ST PAUL, MN 55075 West Saint Paul, MN 55118
(651)276-7482 Business Repair Facility
(651)552-7744 Business
EHICLE
Year: 2001 Body Style: 4D SHORT VIN: 2GCEK19TX11103080 Mileage In: 238569
Make: CHEV Engine: 8-5.3L-FI License: NA Mileage Out:
Model: K1500 4X4 SILVERADO Produdion Date: 6/2000 State: Vehicle Out:
EXT I
Color: PEWTER Int: Condition: Job#:
TRANSMISSION Dual Mirrors Stereo Styled Steel Wheels ��
Automatic Transmission CONVENIENCE Search/Seek PAINT '
Overdrive Intermittent Wipers SAFETY Clear Coat Paint I
4 Wheel Drive Tilt Wheel Drivers Side Air Bag TRUCK
POWER Message Center Passenger Air Bag Rear Step Bumper
Power Steering RADIO Anti-Lock Brakes(4)
Power Brakes AM Radio 4 Wheel Disc Brakes
DECOR FM Radio WHEELS
11/13/2013 4:02:22 PM 029893 Page 1
•Providing a safe wo�'��`"`" for aus�UF� ,�
,.,-h�PVing excellent financial pe�formance
� w Pl A
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Preliminary Estimate
Customer: JOHNSON,.AMANDA Job Number:
Vehicle: 2001 CHEV K1500 4X4 SILVERADO EXT 4D SHORT 8-5.3L-FI PEWTER
Line Oper Description Part Number Qty Extended Labor Paint
Price$
1 FRONT BUMPER
2 0/H front bumper 1.9
3 ** Repl A/M Bumper chrome 12336026 1 360.00 Incl.
4 ** Repl A/M CAPA Cap w/o heavy duty 15050703 1 103.00 Incl. Q,Q
black
5 ** Repl A/M CAPA Air defledor 4WD 15005294 1 90.00 Incl.
_ _ _ __ . _ _
6 GRILLE
7 Repl Grille chrome w/o heavy duty 15764313 1 371.70 Incl.
_ __ _ _
__ _ _ _ _ _ __
8 FRONT LAMPS
9 ** Repl A/M CAPA LT Park/turn/side 15199558 1 72.00 0.3
10 _FENDER _ _. _ _ .. _
11 * Rpr LT Fender Chevrolet � 2•2
12 Add for Clear Coat �•9
13 R&I LT Fender liner 4WD 0.4
14 R&I LT Flare painted 0.4
15 * Rpr LT Flare painted �.4 0•$
16 Overlap Minor Panel -�•2
17 Add for Clear Coat 0.1
SUgTOTALS 996.70 8.0 3.8
ESTIMATE TOTALS
Category Basis Rate Cost$
Parts 996.70
Body Labor 8.0 hrs @ $54.00/hr 432.00
Paint Labor 3.8 hrs @ $54.00/hr 205.20
Paint Supplies 3.8 hrs @ $34.00/hr 129.20
Subtotal 1,763.10
Sales Tax $ 1,125.90 @ 7.1250% 80.22
Grand Total 1,843.32
Deductible 0.00
CUSTOMER PAY 0.00
INSURANCE PAY 1,843.32
THIS IS A VISUAL INSPECTION ONLY. THERE MAY BE ADDITIONAL DAMAGE AFTER DISASSEMBLY. PARTS ARE
SUBJECT TO INVOICE. THERE ARE NO GUARANTEES ON RUST REPAIRS.
"Minnesota law gives you the right to choose any rental vehicle company, and prohibits me from requiring you to
choose a particular vendor."
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.
li/13/2013 4:02:22 PM 029893 Page 2
Preliminary Estimate
Customer: 70HNSON,AMANDA Job Number:
Vehicle: 2001 CHEV K1500 4X4 SILVERADO EXT 4D SHORT 8-5.3L-FI PEWTER
Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from the Guide
DR1GH99, CCC Data Date 11/7/2013, 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=P•1iscellaneous 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. 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=Bureau of Automotive Repair. EPA=Environmental Protection Agency. NHTSA= National Highway
Transportation and Safety Administration. PDR=Paintless Dent Repair. VIN=Vehicle Identification Number.
11/13/2013 4:02:22 PM 029893 Page 3
1
� � � Preliminary Estimate
Customer: 70HNSON, AMANDA Job Number:
Vehicle: 2001 CHEV K1500 4X4 SILVERADO EXT 4D SHORT 8-5.3L-FI PEWTER
ALTERNATE PARTS SUPPLIERS
Supplier: Keystone-Complete-Minneapolis
Location(s): 3615 MARSHALL STREET NE, MINNEAPOLIS MN 55418 (800)328-1845 (612)789-1919
Line Description Item# Price
3 A/M Bumper chrome GM1002376DSN $360.00
4 A/M CAPA Cap w/o heavy duty black GM1051103PP $ 103.00
5 A/M CAPA Air deflector 4WD GM1092167PP $90.00
Supplier: Keystone-P+A-Minneapolis
Location(s): 3615 MARSHALL STREET NE, MINNEAPOLIS MN 55418 (800)328-1845 (612)789-1919
Line Description Item# Price
9 A/M CAPA LT Park/turn/side GM2520173C $72.00
11/13/2013 4:02:22 PM 029893 Page 4