Hilmas � M �TICE OF CLAIM FORM to the City of Sainf Paul, Mi.nnesota
i�f'�rsotc St�r Stcaae d66.05 states that"._.every person...who claims damages from arry municipality.._shall cause to be presented to the
" gova�I+ody o�the municipaliry within 180 days after the alleged loss or injray is discovered a notice stating the time,place,arul
circumstances thereof,and the amount of compensation or other relief demanded"
ptirsse co;piete t�form in its entirefy by clearly typing or printing yonr answer to each question. If more space is
�d,atcec�sdditional sheets. Please note that you wili not be contacted by telephone to clarify answers,so provide as
��ci Qlorsatioa�n�xsary to egplain yonr claim,and the amount of compensation being requested. You will receive a
written ac�owledgement once your form is received. The process can take np to ten weeks or longer depending on the
natnre of yonr ciaim: This form mnst be signed,and both pages completed if something does not apply,write`N/A'.
SEND COMPLE'I`ED FORM AND OTHER DOCUlV�NTS TO: CITY CLERK,
15 WEST KELLOGG SLVD,310 CTTY HALL, SAINT PAUL, MN 55102� -
First Name Middle Initial L-. Last Name �C�
Company or Business Name FC j /�� +
� d�� �
Are You an Insurance Company? Yes/� Tf Yes,Cra.im Nwmber? nC ��
Street Address �(�i(��p GU'/4�'1 �f� � � -- ���
City fi ��Q State�/V Zip Code �-//3
Daytime Phone(_) - Cell Phone 66'�_Z 2 O Eveni.ng Telephone�) - ' i
Date of Accident/Injury or Date Discovered. ,���� Time �f`O O am. pm �
Please staxe, in de�ail,w�at occurred(happened),and why you are submitting a claim.Please indicate why or how you
feel the City of SaiIIt Paul or its em Ioyees are involved and/or responsble for your da.mages.
�
�r- 'rt t l �' • � �
� �
r .
�lease check the box(es)that most closely represent the reason for completing this form: �
_�GIy veIucle was damaged in an accident �My vehicle was da.maged during a tow
u '�1�-�-eiucle was damaged by a pothoie or condition of the street ❑i�iy vehicle was damaged by a p1o�
O My vehicte was wrongfully towed and/or ticketed ❑I was injured on City proper�y
❑Other type of property damage—please specify
❑Other type of injury—please specify
In order to process your claim.vou need to include coAies of all anplicable doeuments.
For the cla.ims types Iisted below,please be sure to include the documents indicated or it will delay the handling of
your cIaim. Documents WILL NOT be retumed and become the property of the City. You are encouraged to keep a
copy for yourself before submitting your claim form. �
�Properly damage claims to a vehicle:fwo estimates for the repairs to your v�icle if the damage exceeds
$500.00;or the actual bills and/or receipts for the repairs
O Towing claims: legible copies of any ficket issued and a copy of the impound lot receipt
O Other properiy damage claims:two repa.ir estimates if the da.mage exceeds$500.00;or fihe acfual bills
andlor receipts for fihe repairs;detailed Iist of damaged items
O Tnjury claims:medical bills,receipts
O Photographs are always welcome to document and support your claim but will not be retunaed.
Page 1 of 2—Please complete and return both pages of Claim Form
(
Failnre to complete and return both pages will resnit in delay in the handling of your claim.
All Claims—blease comulete this section
Wer�there witaesses to the incident? Yes No Unknown (circle)
Provide their names,addresses and telephon bers: �t� {��tij���Nok Aq���ss p�-t �'rriYt�,
. �
n
Were the police or law enforcement called? Ye No Unlaiown (circle)
If yes,what department or agency?�?�7� Case#or report# /32��2p?
Where ciid the accidenf or injury talce place? Provide street address,cross stxeet,intersection,name of park or facility,
closest landmark,etc. Please be as detailed as possible. If necessary,attach a diagram. ����b�-- 7�''� Sf-
�.f �•t. 1 s�" /�i�,.- r�k.- �n �'rvn� o� /1!j�.�,�.n�.�.�.s ����� ,�,c��S�w'�
Please indicate the amount you are seeking in compensation or what you would like the City to do to resolve this claim
to your satisfaction. �a ' � �p {� ,'
` /ilC� i`f �o �lon,t a.�- a. .�/ir.�� o� .
wt�y (Lk�%u • T wo'Klo( a,f�a !�<<G o� lo�..tic.- C�.u- �/h.: ,'r�' h�t�n� r�C ol
Vehic�e Claims—nlease complete this section ❑check box if this section does not applv
Your Vehicle: Year 200 Make Model-�-��,1��
License Plate Number �$ State�_Color �/h;}-�
Registered Owner k,S
Driver of Vehicle ��
Area Damaged pr`�u�trS 'Yr r I�Z�.r o� e�,It.B -- ' i G�U�vr �
City Vehicle: Year �Cr' Make x vZ � Model �aµG� °�'�
License Plate Number State 1 r t.�'ti/`� ���-
Driver of Vehicle(C' Em loyee's Name) v� c�cy''
Area.Damaged •��� . C
Injnry Claims—please complete this section ef,�check box if this section does not applv
How were you injured?
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 da.te(s))
Name of Medical Provider(s):
Address Telephone �
Did�-ou miss a�ork as a result of your iniury? Ves No
Rbcu did�-ou miss n�ork? (provide date(s))
h'ame of your Employer:
Address Telephone
R Check here if you are attaching more pages to this claim form. Nnmber of additional pages�.
By signing this foYm,you are stating that all information you have provided is true and corr�ect to the best
of your knowledge. Unsigned forms will not be processed
,Submitting a false claim can�esult in prosecution. Date form was completed .•_/��/��,C�
Print the Name of the Person who Complete is F � �
Signature of Person Making the Claim: -
Revised February 2011
i: t
• MASTER COLLISION ROSEVILLE Workfile ID: 31e240f9
FederalID: 411916060 �
� Quality Auto Body Repair
2325 N0. PRIOR AVENUE, ROSEVILLE, MN 55113
Phone: (651) 604-2929
� ' FAX: (651) 604-2932
Preliminary Estimate
Cusbomer: HILMAS, RACHEL 7ob Number:
Written By:Jeremy Scanlon
Insured: HILMAS, RACHEL Policy#: Claim#:
Type of Loss: Date of Loss: Days to Repair: 0
Point of Impact:
Owner: Inspection Location: Insurance Company:
HILMAS, RACHEL MASTER COLLISION ROSEVILLE I
2666 MARION STREEf 2325 N0. PRIOR AVENUE
ROSEVILLE, MN 55113 ROSEVILLE, MN 55113
(651)357-5250 Cell Repair Faciliry
(651)357-5250 Day (651)604-2929 Business
VEHICLE ,
Year: 2008 Body Sryle: 4D SED VIN: 2G1WT58K481367285 Mileage In: 1
Make: CHEV Engine: 6-3.5L-FI License: 649-HAJ Mileage Out:
Model: IMPALA LT Production Date: State: MN Vehide Out:
Color: WHITE Int: Condition: Job#:
TRANSMISSION Wood Interior Trim AM Radio Communications System I
Automatic Transmission CONVENIENCE FM Radio SEATS �
Overdnve Air Conditioning Stereo Cloth Seats
POWER Intermittent Wipers Search/Seek Bucket Seats !
Power Steering Tilt Wheel CD Player WHEELS
Power Brakes Cruise Control Auxiliary Audio Connection Aluminum/Alloy Wheels ii
Power Windows Rear Defogger Satellite Radio PAINT �,
Power Locks Keyless Entry SAFETY Clear Coat Paint ,
Power Mirrors Alarm Drivers Side Air Bag OTHER ',
Power Driver Seat Message Center Passenger Air Bag Power Trunk/Gate Release
DECOR Remote Starter 4 Wheel Disc Brakes �
Dual Mirrors RADIO Head/Curtain Air Bags i
I
�
I
t
4
I
I
�
12/17/2013 12:52:48 PM 071463 Page 1 �I
i
� � �
�
Preliminary Estimate
Customer: HILMAS, RACHEL )ob Number:
Vehicle: 2008 CHEV IMPALA LT 4D SED 6-3.5L-FI WHITE
Line Oper Description Part Number Qty Extended Labor Paint
Price�
1 FRONT BUMPER&GRILLE
Z R&I R&I bumper cover 1.4
3 FRONT LAMPS
4 R&I LT Headlamp assy 0.3
5 FENDER
6 Blnd LT Fender 1.1
7 Repl LT Emblem GM 15223484 1 8.28 0.2
8 PILLARS,ROCKER&FLOOR
9 Sect LT Uniside assy quarter panel 89025203 1 759.70 s 16.5 3.0
10 Add for Clear Coat l,Z
11 # Add to repair W/S pillar 1 1.0 1.0
12 R&I LT Rocker molding p,g
13 * Rpr LT Rocker molding � 2,1
14 Add for Clear Coat p,q
15 * Refn LT Roof rail �
16 FRONT DOOR
17 Repl LT Door shell 19178063 1 68333 4.8 3.0
18 Overlap Major Adj. Panel -0.4
19 Add for Clear Coat 0.5
20 Add for mirror 0.3
21 R&I LT Belt w'strip Incl.
22 * R&I LT Body side mldg Q,�
23 # clean and retape mldg 1 0.3
24 Repl LT Mirrorassy w/defogger 25947197 1 180.95 Incl. 0.6
grained
25 Overlap Minor Panel -p,2
26 Add for Clear Coat 0.1
27 R&I LT Door glass GM Incl.
28 * R&I LT Run channel �
29 R&I LT Inner w'strip Incl.
30 * R&I LT Rearchannel �
31 R&I LT Window regulator Incl.
32 R&I LT Handle,outside w/o chrome Incl.
33 R&I LT R&I trim panel Incl.
34 REAR DOOR
35 * Rpr LT Door shell � 2.0
36 Overlap Major Adj. Panel -0.4
37 Add for Clear Coat 0.3
38 Add for Inside 0.5
39 * Rpr LT Outer panel �Q Incl.
40 R&I LT Belt w'strip 0.3
41 * R8cI LT Body side midg Q,2
42 * Rpr LT Body side mldg Q.,� 0.4
12/17/2013 12:52:48 PM 071463 Page 2
� •
Preliminary Estimate
Customer: HILMAS, RACHEL 7ob Number:
Vehicle: 2008 CHEV IMPALA LT 4D SED 6-3.5L-FI WHITE
43 Overlap Minor Panel -�•2
44 * Add for Clear Coat 0.1
45 # clean and retape mldg 1 0.3
46 * R&I LT Run channel 9�
47 R&I LT Handle,outside w/o chrome 0.3
48 R&I LT R&I trim panel 0.4
49 BACK GLASS _ _
50 R&I Back glass GM Incl.
_._
_ _ _ ..
51 QUARTER PANEL
52 Repl Fuelpocket 10337267 1 5.58 0.3
53 Repl Fuel door 10337264 1 77.43 Incl. 0.3
54 * Add for Clear Coat 0.1
55 R&I LT Wheelhouse liner 0.3
56 Repl LT Emblem flying impala 10424491 1 43.55 0.2
57 R&I LT Qtr glass GM Incl.
58 REAR LAMPS
59 R&I LT Tail lamp assy IncL
_ _
60 REAR BUMPER
61 R&I R&I bumper cover Incl.
6Z * Rpr Bumper cover w/o dual exh 4 Q 3.0
63 Add for Clear Coat l.Z
64 MISCELLANEOUS OPERATIONS
65 # Subl GLASS KIT(QTR) 1 19.95 X
66 # Subl GLASS KIT(BACK GLASS) 1 19.95 X
67 Repl Cover car/bag 1 0.2
6g s Refn CORROSION PROTECTION 0.3
59 _ FLIX ADDITIVE 1 6.00 X
_ s Repl SEAM SEALER 1 30.00 X 0.3
�; t Repl PANEL BOND 1 30.00
�1 s Repl SPOT WELD BIT 1 30.00
'3 s HAZARDOUS WASTE REMOVAL 1 3.00 X
SUBTOTALS 1,897.72 42.9 20.3
:2. :7 20:3 12:52:a8 PM 071463 Page 3
.
Preliminary Estimate
Customer: HILMAS, RACHEL 7ob Number:
Vehicle: 2008 CHEV IMPALA LT 4D SED 6-3.5L-FI WHITE
ESTIMATE TOTALS
Category Basis Rate Cost�
Parts 1,818.82
Body Labor 42.9 hrs @ $55.00/hr 2,359.50
Paint Labor 20.3 hrs @ $55.00/hr 1,116.50
Paint Supplies 20.3 hrs @ $35.00/hr 710.50
Body Supplies 36.5 hrs @ $5.00/hr 182.50
Miscellaneous 78•9�
Subtotal 6,266.72
Sales Tax $2,711.82 @ 7.1250% 193.22
Grand Total 6,459.94
Deductible 0.00
CUSTOMER PAY 0.00
INSURANCE PAY 6,459.94
***NO GUARANTEE ON RUST REPAIRS***
WARRANTY ONLY VALID WITH ORIGINAL PAPER WORK AND WARRANTY CERTIFICATE
PART PRICES SUB]ECT TO INVOICE FROM DEALER
REPAIR TIMES ARE ESTIMATED AND DO NOT NECESSARILY DICTATE ACTUAL REPAIR TIMES NEEDED
MASTER COLLISION GROUP DOES NOT ACCEPT PERSONAL CHECKS OVER $1000.00
A PERSON WHO SUBMITS AN APPLICATION OR FILES A CLAIM WITH INTENT TO DEFRAUD OR HELPS COMMIT A
FRAUD AGAINST AN INSURER IS GUILTY OF A CRIME
Please Present A Copy Of This Estimate To A Repair Facility Of Your Choice
*USAA Subsidiaries include: United Services Automobile Association(USAA), USAA Casualty Insurance Company(CIC),
USAA General Indemnity Company(GIC) USAA County Mutual Insurance(CMI) and Garrison Property Casualty
Insurance Company. Garrison Property and Casualty Insurance Company, a subsidiary of USAA Casualty Insurance
Company, is authorized to use the USAA logo, a registered trademark of United Services Automobile Association.
This is not an authorization to repair. Failing to present this estimate to the repairing garage before repair may result
in additional expenses to you. A USAA appraiser must authorize any supplement to this estimate. Repairs to this
vehicle may require specific welding equipment as recommended by the manufacturer.
If alternative quality replacement parts have been included in this appraisal, the source for these parts has also been
disclosed. If alternative quality replacement parts as listed on the appraisal are ultimately used in the repair of your
vehicle, the warranty on such parts will be equal to, or greater than, the parts being replaced, as stated in USAA's
limited parts warranty. USAA warrants that the parts used on your vehicle will be of like kind and quality, function, fit,
safety and corrosion protection as the part or parts they replace. USAA identifies certified and validated parts for
sheet metal replacement parts.
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.
;2;17;2013 12:52:48 PM 071463 Page 4
, <
Preliminary Estimate
Customer: HILMAS, RACHEL 7ob Number:
Vehicle: 2008 CHEV IMPALA LT 4D SED 6-3.5L-FI WHITE
Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from the Guide
DR10606, CCC Data Date 12/16/2013, 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=Mistellaneous Non-Taxed charge category.
SYMBOLS FOLLOWING LABOR:
D=p�agnostic labor category. E=Electrical labor category. F=Frame labor category. G=Glass labor category.
M=Mecftianical labor category. S=Structural labor category. (numbers) 1 through 4=User Defined Labor Categories.
OTHER SYMBOLS AND ABBREVIATIONS:
Ad�.=Adyacent. A1gn.=Align. ALU=Aluminum. A/M=Aftermarket part. BInd=Blend. BOR=6oron steel.
CAPA=CerUfied 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
Ad�acent. 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.
12/17/2013 12:52:48 PM 071463 Page 5
. �
�� ��'� BONFE'S COLLISION CENTER Workfile ID: 078e3271
�g£��� Federal ID: 410986303
b p$�'qCY�AtY�
'�W�""`� ° CAR CARE BY PEOPLE WMO CARE
��� � �,, � 380 7TH ST W, SAINT PAUL, MN 55102
Phone: (651) 222-4458
FAX: (651) 224-8640
Preliminary Estimate
Customer: Hilmas, Rachel
Written By: DAN DREELAN
Insured: Hilmas, Rachel Policy#: Claim#:
Type of Loss: Date of Loss: Days to Repair: 0
Point of Impact: 09 Left T-Bone(Left Side)
Owner: Inspection Location: Insurance Company:
Hilmas, Rachel BONFE'S COLLISION CENTER
2666 Marion St. 380 7TH ST W
Roseville,MN 55113 SAINT PAUL, MN 55102
(651)357-5250 Cell Repair Facility
(651)222-4458 Business
VEHICLE
Year: 2008 Body Style: 4D SED VIN: 2GiWT58K481367285 Mileage In: 53000
Make: CHEV Engine: 6-3.5L-FI License: 647AAJ Mileage Out:
Model: IMPALA LT Produdion Date: 7/2008 State: MN Vehicle Out:
Coior: white Int: Condition: Job#:
TRANSMISSION Wood Interior Trim AM Radio Communications System
Automatic Transmission CONVENIENCE FM Radio SEATS
Overdrive Air Conditioning Stereo Cloth Seats
POWER Intermittent Wipers Search/Seek Bucket Seats
Power Steering Tilt Wheel CD Player WHEELS
Power Brakes Cruise Control Auxiliary Audio Connection Aluminum/Alloy Wheels
Power Windows Rear Defogger Satellite Radio PAINT
Power Locks Keyless Entry SAFETY Clear Coat Paint
Power Mirrors Alarm Drivers Side Air Bag OTHER
Power Driver Seat Message Center Passenger Air Bag Power Trunk/Gate Release
DECOR Remote Starter 4 Wheel Disc Brakes
Dual Mirrors RADIO Head/Curtain Air Bags
12/17/2013 8:11:09 AM 013793 Page 1
PDF created with pdfFactory trial version www pdffactorv.com
Preliminary Estimate
Customer: Hilmas, Rachel
Vehicle: 2008 CHEV IMPALA LT 4D SED 6-3.5L-FI white
Line Oper Description Part Number Qty Extended Labor Paint
Prite$
1 FRONT DOOR
z * Rpr LT Outer panel � Z•�
3 Add for Clear Coat �•$
4 R&I LT Belt w'strip 03
5 * R&I LT Body side mldg �
6 Repl LT Mirror assy w/o defogger 20759191 1 130,83 0.3 0.6
smooth
7 Overlap Minor Panel ��'Z
g Add for Clear Coat 0.1
9 # Clean and retape molding 1 5.00 T 0.3
10 R&I LT Handle,outside w/o chrome ��3
11 R&I LT R&I trim panel 0.4
12 REAR DOOR
13 * Rpr LT Door shell 1_0 2.0
14 Overlap Major Adj. Panel -0.4
15 Add for Clear Coat 03
16 * Rpr LT Outer panel � Incl.
17 R&I LT Belt w'strip 0.3
lg R&I LT Applique front 0.3
19 R&I LT Applique rear 0.3
Zp * R&I LT Body side mldg �
21 * Rpr LT Body side mldg � ��4
ZZ Overlap Minor Panel ��Z
0.1
23 Add for Clear Coat
24 R&I LT Handle,outside w/o chrome 0.3
25 # Clean and retape molding 1 5.00 T 0.3
26 R&I LT R&I trim panei 0.4 _
27 BACK GLA55
Z5
R&I Back glass GM Incl.
- c Glass Kit 1 20.00 T
30 PILLARS,ROCKER&FLOOR
31 Sect LT Uniside assy quarter panel 89025203 1 759.70 s 16,5 3.0
-0.4
3Z Overlap Major Adj.Panel
0.5
33 Add for Clear Coat
0.8
34 R&I LT Rocker molding
Incl.
35 R&I LT Weatherstrip
0.5
36 # Bind LT Upper Sail Panel
37 QUARTER PANEL
38 Repl Fuel pocket 10337267 1 5•58 �•3
39 Repi Fuel door 10337264 1 77.43 Incl. 0.3
0.1
40 Add for Clear Coat
0.3
41 R&I LT Wheelhouse liner
Incl.
4z R&I LT Qtr glass GM
12/17/2013 8:11:09 AM
013793 Page 2
PDF created with pdfFactory trial version www pdffactorv.com
,
Preliminary Estimate
Customer: Hilmas, Rachel
Vehicle: 2008 CHEV IMPALA LT 4D SED 6-3.5L-FI white
43 R&I LT Upper trim panel ebony, Incl.
titanium
44 # Glass Kit 1 20.00 T
45 REAR BODY&FLOOR
46 R&I LT Side trim 0.z
47 * Refn Rear body panel p,g
48 Overlap Major Adj. Panel -0.4
49 Add for Clear Coat 0.1
50 ROOF _
51 R&I LT Molding 0.4
52 TRUNK LID
53 R&I R&I trunk lid p,7
54 R&I Weatherstrip 0.4
55 REAR LAMPS
56 R&I LT Tail lamp assy Incl.
57 REAR BUMPER
58 R&I R&I bumper cover Incl.
59 * <> Rpr Bumper cover w/o dual exh 4�. 3.0
60 Overlap Major Non-Adj. Panel -p,2
61 * Add for Clear Coat 0.6
62 # Repl COVER CAR COMPLETE(2 1 14.00 T 0.2
TIMES)
63 » Repl FLEX ADDITNE : 7.00 T
64 # Repl CORROSION PROTECTION 1 15.00 T 0.5
65 # Repl HAZARDOUS WASTE REMOVAL 1 7.00 T
66 # Refn MASK&TAPE JAMBS 0.3
67 # Repi PANEL BOND KIT 1 25.00 T
68 # PART PRICES SUBJECT TO 1
INVOICE
69 # ****POSSIBLE HIDDEN DAMAGE 1
.****
SUBTOTAIS 1,091.54 36.8 13.7
12/17/2013 8:11:09 AM 013793 Page 3
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. ,
Preliminary Estimate
Customer: Hilmas, Rachel
Vehicle: 2008 CHEV IMPALA LT 4D SED 6-3.5L-FI white
ESTIMATE TOTALS
Category Basis Rate Cost;
Parts 973.54
Body Labor 36.8 hrs @ $56.00/hr 2,060.80
Paint Labor 13.7 hrs @ $56.00/hr 767.20
Paint Supplies 13.7 hrs @ $35.00/hr 479.50
Body Supplies 30.3 hrs @ $3.00/hr 90.90
Miscellaneous 118.00
Subtotal 4,489.94
Sa�es Tax $ 1,661.94 @ 7.6250% 126.72
Grand Total 4,616.66
******************************************************************************
THIS IS A VISUAL ESTIMATE ONLY.
ADDITIONAL DAMAGE MAY BE FOUND AFTER TEAR DOWN OF VEHICLE.
NO GUARANTEE ON RUST WORK.
******************************************************************************
MINNESOTA FRAUD WARNING
A person who submits an application or files a claim with intent to defraud or helps commit a fraud against an
insurer is guilry of a crime.
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.
12/17/2013 8:11:09 AM 013793 Page 4
PDF created with pdfFactory trial version www.pdffactory.com
Preliminary Estimate
CustAmer: Hilmas, Rachel
Vehicle: 2008 CHEV IMPALA LT 4D SED 6-3.5L-FI white
Es�mate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from the Guide
DR10606, CCC Data Date 12/16/2013, 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=6lend. BOR=6oron steel.
CAPA=Certified Automotive Parts Association. D&R=Disconnect and Reconnect. H55=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 Safery Administration. PDR=Paintless Dent Repair. VIN=Vehicle Identification Number.
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