Pettiford NOTICE OF CI.AIM FORM to thc City of Saint Paul, Minnesota
Mi��nc.snln SlcUe Slutuir��tfi6.0�.stcNe.s lhru "...ercr�'pursnn...tirhn c/ciim.s dumu,�e.s/rr�m a�i��muniri��nlih�....sluiN cui�se lu l��•pr��senlc�cl to�he
,�urcrnrng boch�o/thr�municr��alih�wi�hrn lH0 dcn�.c u(1er the uNegecl lo.s.s ur injur��is drscu��er��d a nniicr s�cuin,�i/�e�ime,plac�F.nnd
circum.stuncr�s Ihereo/,unc(�he umaunl n/'rompensnlinn ar u�lier rulic��elentunded..'
Plcase complete this form in its entirety by clearly typing or printing your answer to each yuestion. I1'more space is
necdcd,attach additional shects. I'Icasc notc that you will not be contactcd b�� tcicphonc to clarify answcrs,so providc as
much infonnation as necessary to explain your clxim,and the amount nf compensation bein�;reyuested. You will receive u
written acknowledgemcnt once your S'orm is received. "I'he process can take up to ten weeks or lon�er dependin�;on the
nature oi'your claim. "I'his form must be si�;ned,��nd both paKes completed. li'somethin�;does not apply,��rite`N/A'.
SI:ND COYIPI.I:'1'I;D I�ORM AND O'I'HI;K DOCUMI?N"1'S 1'O: CI1'Y CI,ERK,
15 WI:S'T KF,LLOGG BLVD, 310 CITY HALI., SAIN1' PAUL, MN 55102
First Name____�"�lP��_ ___—_ Middle Initial T _Last Name _ ����_T_��
Company or Busincss Name ��� - `
- - -- _ _ E��I V��
nrc You an Insurancc Company? Ycs Nc� If Ycs, C1aim Numbcr? _ ___ ____ _____�ff��
_ _ - 1 �ZOt�f
Strcct �lddress_c� 1� _ 'Q _�l`T-- ! � V�. _V v -_ � _t;f r �_
- Ss � �ERK
City �� ��}�l_ _ _ Statc ��' Li�� ('odc
Daytimc Phonc 1�51 )�-J}(�`7Cc11 Phonc (�Q`]/ k��Q -��7��� l:vcning'I�cicphonc (���) y�� .����
Date of nccident/ Injury or llate Discovcrecl __.1'�' (_.y _ ___ - I�ime ���_ 'ir /pm
Pl�as� st�ttc. in dctail, what occurrcd (happcned), and why you are submitting a claim. I'icasc indicatc why or how vou
feel the Ciiy oi�Saint Paul or its employees are involved and/or responsibl� for your damages. - -_-- ----_- -- ---_- __
�. dL � G�_1:�7Z_��-�.D /i1L�_ P �>,�' _Qf C>9G�.S�1� -����r3��7� _
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- TD�,tU�__ / v��,!� ,���� L'�l/� ��tJ';T�� - _ -- -___ _ _ _ .
�'D�'�C� o���C:E��'�S �- �"BT��?�a �S_���� ����� •
Plcasc chcck thc hox(cs)that most cl��scly rcpresent thc rcason for complcting this I�orm:
�ivl�� vchicic was damagcd in an accident ❑ My vchicic was aama�cd clw-ii��a tow
❑ ;vly vchicl� was damagcd by a potholc or condition of thc strcet ❑ My vchicic was damagcd by a plo��
❑ My vchicle was wrongfully towe�l and/or ticketed ❑ I was injured on City property
❑ Other type of property damage-pleasc specify _ . ___ _ _ - - -- -- __ _ .__ __ _ _
❑ Other type oC injury-plcase specify ------- -- --- - --- --�-- - -
ln order to pco�css your claim ��u need to include copies of'all applicable documents.
I�or the claims types listed below, please be s�ire to include th� documents indicated or it will delay the handling of
yo�ir cluim. I)ocumcnts WIL1. NO"1� bc rct�n-ncd �nd bccomc the property of th�Ci�y. You arc cncouragccl to k�cp a
copy for yo�n•scl��bcf���re submittin�yuur clain�i form.
O Pr�>pcny damagc claims to a ��chicic: two cstimates �or the rcpa�rs to yow�vchicic if�thc dama��c cxcccds
S�UO.00: ��r tN�c actua] bills and/or rcccipts j�or the rcp�iirs
O �I�owing claims: lc�iblc copics of any tickct issucd and �i copy �>f thc impoun�l lot rcccipt
O Othcr property dumagc claims: tw�>rcpair estimatcs if thc ciamagc cxccccls $�00.00; or thc actual hills
ancUor rcccipts for thc rcpairs, dctxiled list of�d�ul�agcd itcros
O Injury claims: medica] bills, receipts
O Phutographs are always welcome to document and support your claim hut will not be returned.
Pa�;e 1 of 2-Please complete and return both pages of'Claim Form
I�ailure to complete and return both pages will result in dclay in the handling oi'your daim.
All Claims-please comnlete this section
Were there wimesses to the incident? Yes No IJnknown ,, (circle)
Provide tl�cir namcs, addresses and tclephonc numbcrs: _
Were the police or law cnf�oreement called? �vYes - No Unknown (circle)
If yes, what department or agency?_�_��_; ��� ___ _ Case#or rcport# _��Q�1���_
Where did the accident or injury take place? Providc street address, eross street, intcrsection, namc of park or facility,
closest landmark, etc. I'lease be as detailed as possible. If�nccessary, attach a diagram. _ � rn r?�r_i��-�.Sj��r�
Plcase indicate the amount you are seeking in compensation or what you would like the Ciry to do to resolve this claiir�
. ;.
to y��ur sat�tifacUon '��f ����,. _� � __ - - - - - - - - �
__-;'z_�', � �,,', 7��C����,� L��r r�'���-j �����L��,� _ V.� C.e��-={S � t'�f,��r��'s
_ a,-Cl-��6�.��C.
Vchitic Claim� �plca5c complctc thiti 5cction ❑ chcck hox if�this scction docs i�ot applv
Your Vchicic: Ycar _- : ==- i�1ah� � � Modcl _ '
. ,
, , _
- 1_ c . -__ ._' �_\__ _ __ _
r ___ ,
License Plate N�imber - -- _�_ _ St ue, `'.'._Color _�_��_ �..� -- ------ --
Rcgistcrcd Own�r __`i!t = --,-.-��_. _ �-__ _ _ - - -----
Driver of Vehicle.�_�y�; " � ' � = --
-____�-_F -----------
--_ -- _ _ _----- -
Area Damaged_ ----------- --- -
City Vehicle: Ycar___ _Make _ --- Model - ---_- -- --
License Plate Number-- __ __ __ State-_--- Color __---- _ _-- ___ - ____.
Driver of Vehicle (City I:mployee's Name)_ -_ __ __ - _-. _ __ __-
nre�i Damagcd -- __ � - � �
In'ur � Claims- lcasc com Ictc this section ❑ chcek box �f this sccti�m �loes not a 1 �
� Fiow wcrc y�t in��u-c `? -- �"L7�/��/ /--���-�f�-1�7��•.Cii�i Gt��!Lv_ __��1__./��}"Q v�-
!�
What p�art(s) oC your bo�iy wcrc injurccl? � J� `f ��C�� _ _ - - - _
� %�f�/�rv� ,�(-�E� k%� � /�r L_�_yS�.
_ _ _ .__ __ --
_ ___ _ _ ___ _ _ _ __
% ,
Have you s��ught medical trealmcnt? �,Y�s j No Plannmg to S�el. l�reatment(circle) i•tii LL /�'� /IU
Whcn did you r�c,civc trcatmcnl`.'_�����_'�-' S--�-- ��-�- ---- ---(Providc datc(s)) �ilJ�lv
---
-- ,
I�iame of Medical Providcr(s): _ __ - " ' 11���1�
_ —. -- -
- -- -- - - -
Address "I'clephonc - -- -- --- __
__ ____ ------
-- - _ ._ .__._
Did you miss wo�k as a rc�ult of your in�ury? 1'es No
Whcn did yo�i m�tis wo�l.' -- (providc date(s))
Namc of your Employer: � � �-�- ��-
--- -
-- -- - - ._
__ --- --
Address_ ___ _ "l'elephon�, _. _ __ __. _____ _
��Check here if you are attaching more pages to this claim form. l�umber of'additional pages _ ___
By signing this.%nrnz,you are stati�zg thal aIl i�tforfnatinn you have prnvicfed is lrue and cnrrect to lhe hest
��/'your•k�zowledge. U�zsigned fornzs will not he processed.
Submitti�ig a false claim ca�z result in prosecutiore. Date form was completed � " �� ��
Print the Name of the Person who Compl�ted this Form: �-�� __ _ �j _f� � �
�-�1_�° �- _ _ _
Signature of'Person Making the Claim: _�.� � � �---� -� --- ��
:a�r��-- —.
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Revis�d Fchruw'Y 201 1
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r or call 612-726-5237 J
L—._ _ _
RECEIPT J
�_ _
Rental Agreement Number: 313593674
Vehicle Number: 62182492
_ ___ -__. _�
YQUR INFORMATION
L_ __ _ _
PETTIFORD SR,WALTER
BUDGET DISC: AUTO ASSOCIATION
PAYMENT METHOD: MASTER XX7027
YOUR RENTAL J
Picked up: MSP
Date/Time: JAN 08, 2014@11 :41AM
Returned: MSP
Date/Time: JAN 15, 2014@10: 17AM 5T �R�� tnrouno ��T
830 BARGE CHANNEL RD
Veh Group: Compact Sfl1NT PAUL. MN. 55�e7-zase
Veh Charged : Subcompact 651-266 5642
Vehi cl e: FORD FOCUS 5DR Merchant tr,: sees�aeiaa
Term IG: 001739006080063801940£3
Odometer Out : 23918
Odometer In: 24283 Sale
Fuel Reading : Full
_ __. _ -- zzzzzzzzzzzz45Z4
YOUR VEHICLE CHARGES J MRSrERCARD Ertrv Method; Swiped
1 WK@ 109.00 109.00 Total: � 234,76
DISCOUNT 5.0 5.45 �l%14�14 16.5�.28
YOUR TIME AND MILEAGE: 103.55 Inv #: 00000z APPr Code; �6�929
YOUR TAXABLE FEES APPrvd: Online
•*11 . 11� FEE _ 32.49 r,.�.., ° �
LOSS DAMAGE WAIVER: �8S 93 ���;;,�r ,r�,�
CUST FAC CHARGE 3.25/DY 22.75
YOUR SUBTOTAL
TAXABLE SUBTOT 347.72
TAX 7.275� 25.30
YOUR NON TAXABLE ITEMS
14.2� SURCHARGE 49.38
TOTAL CHARGES 422.40
NET CHARGES 422.40
YOUR TOTAL DUE: 0.00
PAID ON MASTER XX7027
..CONC���T..:; � ,. .r�., r_^
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H�MAuto Body �Towing �� �0 2 2
867 N.Dale Street �.
St Paul,A�IN 55103 Date��__L�_� '_'�%_���`� '
1 Tel(651)489-2932 Fax(651)489-04�8 � � �
_.__�__--;-.�` _ 24 Hour Towing(651)248-9657
Diiver's Name � �' ' �' � � Truck#
Picic-np Timc:am pm .�;., ' ,
urop otr'rime:am pm ; `; �% ;�'� Nature of the Call
Invoice Service( ) Lock out( ) Break Down( )
; .�
;
::�:
Customer's Name ' ' '"'� . -� � ,�`= Tel - � � ` -�-�'� ��� ell
Address City State Zip
Pick Up Location:Address �: �. ��"�� ', -� � City - �� <°� r � State Zip
, � _
Destination:Address � '�?� ' '� _�.'.'�_��`=�-~� Ci � � ���'� 't��� � State Zi
Vehicle Inform}tion � ! r ' '
x
Year � Make `~i-'; '�� i. '�L� Model �"+ !� � : Color � �'-r�°,., �
,
Odometer License No L-� ��'�'� -- � � � �' i- Serial No �
Irrsurance Co. olicy No A ent Phone
Descri tion o Cha es Amount
Labor i '_;-�`�?� ,`.,,✓ --r- , , ) � ; -� �-- ,r�.
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Gas&Supplies ` +
Extra Labor r1- ,, %-�, < � , ����' �`'
Mileage Starting Ending Total '
Storage Charge From To Per A Day $
°�;. � � t `°���' Sub-Total - �' r�,
c`�h �� ' ' 1 � %! We Appreciate Your Business. Tax
C/teck
Credit � � Please Pay This Amount! Grand Total �'='
Important Notice: We are not responsible for loss or damages of any kind. Whether it is your vehicle or
Personal property which may be in the vehicle after drop off the vehicle.Eztra Labor charges are for finding or
Moving the vehicle near tow truck in the case of customer giving wrong information about the location of the vehicle.
Received BY:1 understand and certify that 1 am the owner or authorized owner's representative to take possession of
The vehicle in its present condition and agree, that will not bring cmy charges against H&MAuto Body&Towing.
Name Signature Date
White o�ce Canary customer Designed&Piinted by Payless Printing(65/f 283-5745
___�_:._., ..,..:,..._.._.:..�_.__�._�_._,_ _�_____ ---___-----� �. _�____— - _�_..�..��
Accident Report Page 1 of 1
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WINDY'S COLLISION CENTE, INC.
767 BUSH AVENUE
ST. PAUL MN 55106
PHONE: 651)774-4426 FAX: (651)772-0368
***PRELIMINARY ESTIMATE***
01/09/2014 12:14 PM
Owner
Owner: WALTER PETTIFERD
Address: Work/Day: (651�89-3285
Inspection
Inspection Date: 01/09/2014 12:14 PM Inspection Type:
Primary Impact: Left Front Corner Secondary Impact:
Appraiser Name: JON PHILMALEE Appraiser License#:
Address: 767 BUSH AVE Work/Day: (651)774-4426
Cell: (612)237-6526
City State Zip: Saint Paul, MN 55106 FAX: (651)772-0368
Email: THEFUMS@MSN.COM
Repairer
Repairer: WINDY'S COLLISION CENTER Contact: JON PHILMALEE
Address: 767 BUSH AVE Work/Day: (651)774-4426
ST PAUL Home/Evening:
City State Zip: ST PAUL, MN 55106 FAX: (651)772-0368
Email: THEFUMS@MSN.COM
Vehicle
2000 Honda Accord EX V6 4 DR Sedan
6cyl Gasoline 3.0 VTEC
4 Speed Automatic
Lic Expire: VIN: 1HGCG1656YA045923
Veh Insp#: Mileage Type: Actual
Condition: Code: H1263C
Eut.Refinish: Two-Stage Int.Refinish: Two-Stage
Options
AM/FM CD Player Air Conditioning Alarm System
Aluminum/Alloy Wheels Anti-Lock Brakes Bucket Seats
Center Console Climate Control For A/C Cruise Control
Dual Airbags Garage Door Opener Intermittent Wipers
Keyless Entry System Leather Seats Leather Steering Wheel
Lighted Entry System Overhead Console Power Brakes
Power poor Locks Power Drivers Seat Power Mirrors
Power Moonroof Power Steering Power Windows
Rear Window Defroster Rem Trunk-L/Gate Release Side Airbags
Strg Wheel Radio Control Tachometer Theft Deterrent System
Tilt Steering Wheel Tinted Glass
01/10/2014 1030 AM Page 1 of 4
20Q0 Honda Accord EX V6 4 DR Sedan
Claim#: 01/09/2014 12:14 PM
Damages
Line Op Guide MC Description MFR.Part No. Price ADJ% B% Hours R
Strines And Mouldinas
1 L 259 MIdg,Front Door Side LT Refinish 0.6 RF
0.5 Surface
0.1 Two-stage
2 RI 259 MIdg,Front Door Side LT R& I Assembly 1.1* SM
Front Bumoer
3 EC 6 Cover,Front Bumper Replace Economy $217.00' 1.1 SM
4 L 6 13 Cover,Front Bumper Refinish 3.7 RF
2.6 Surface
0.6 Two-stage setup
0.5 Two-stage
Front End Panel And Lam�s
5 EC 41 Headlamp Assy,Halogen LT Replace Economy $110.00' INC SM
6 N 973 Headlamps Aim Additional Labor 0.4 SM
Front Body And Windshield
7 EU 103 Fender,Front LT Replace Recycled $125.00" 1.5 SM
8 L 103 Fender,Front LT Refinish 3.5 RF
2.4 Surface
0.5 Edge
0.6 Two-stage
Front Bodv Interior Sheetmetal
9 EU 107 Skirt,lnner Fender LT Replace Recycled 0.1 SM
»COMES WITH FENDER
Front Doors
10 EU 207 Door Assembly,Front LT Replace Recycled $275.00* +30.00 3.6 SM
11 L 207 Door SheIl,Front LT Refinish 3.5 RF
1.9 Surface
1.0 Edge
0.6 Two-stage
12 RI 233 W/Strip,Front Door LT R& I Assembly INC SM
13 RI 241 MIdg,Front Door Belt LT R& I Assembly INC SM
14 RI 131 Applique,Frt Door Fram LT R& I Assembly 0.2 SM
15 RI 229 Mirror,0uter R/C LT R& I Assembly INC SM
16 RI 253 Channel,Front Glass Ru LT R& I Assembly 0.2 SM
17 RI 243 Rod,Front Door Check LT R& I Assembly 0.2 SM
18 RI 221 Lock,Front Door LT R&I Assembly 0.3 SM
19 RI 227 Handle,Front Door Otr LT R&I Assembly INC SM
Quarter And Rocker Panel
20 I 161 07 Panel,Bodyside Front LT Repair 4.0* SM
21 L 161 10 Panel,Bodyside Front LT Refinish 1.9` SM*
1.2 Surface
0.7 Two-stage
Section Reolacement&Refinish
22 EU 678 Susp Assembly,Front LT Replace Recycled $175.00* +30.00 1.7 ME
Manual Entries
23 SB ALIGN Sublet Repair $89.95" SM*
24 SB tire Sublet Repair $145.00* SM"
01/10/2014 10:30 AM Page 2 of 4
200�J Honda Accord EX V6 4 DR Sedan
Claim#: 01/09/2014 12:14 PM
25 SB mount and balance Sublet Repair $20.00' SM*
25 Items
MC Message
07 STRUCTURAL PART AS IDENTIFIED BY I-CAR
10 INCLUDES AUDATEX TIME TO CLEAR ENTIRE PANEL
13 INCLUDES 0.6 HOURS FIRST PANEL TWO-STAGE ALLOWANCE
Estimate Total&Entries
Other Parts $902.00
Paint Materials $384.20
Line Item Markup $135.00
Parts&Material Total $1,421.20
Tax on Parts 8�Material @ 7.625% $108.37
Labor Rate Replace Repair Hrs Total Hrs
H rs
Sheet Metal(SM) $54.00 10.2 4.4 14.6 $788.40
Mech/Elec(ME) $85.00 1.7 1.7 $144.50
Frame(FR) $75.00
Refinish(RF) $54.00 11.3 11.3 $610.20
Paint Materials $34.00
Labor Total 27.6 Hours $1,543.10
Sublet Repairs $254.95
Gross Total $3,327.62
Net Total $3,327.62
Alternate Parts Y/00/00/00/00/00 CUM 00/00/00/00/00 Zip Code: 55106 Audatex Host
Audatex Estimating 7.0.123 ES 01N0/207410:30 AM REL 7.0.123 DT 12/01/2013 DB 12/15/2013
Copyright(C)2013 Audatex North America, Inc.
3.1 HRS WERE ADDED TO THIS ESTIMATE BASED ON AUDATEX'S TWO-STAGE REFINISH FORMULA.
Op Codes
" = User-Entered Value E = Replace OEM NG= Replace NAGS
EC= Replace Economy OE= Replace PXN OE Srpls UE= Replace OE Surplus
ET = Partial Replace Labor EP= Replace PXN EU = Replace Recycled
TE = Partial Replace Price PM= Replace PXN Reman/Reblt UM= Replace Reman/Rebuilt
L = Refinish PC= Replace PXN Reconditioned UC= Replace Reconditioned
TT = Two-Tone SB= Sublet Repair N = Additional Labor
BR= Blend Refinish I = Repair IT = Partial Repair
CG= Chipguard RI = R&I Assembly P = Check
AA= Appearance Allowance RP= Related Prior Damage
Ot/10/2014 1030 AM Page 3 of 4
2008 Honda Accord EX V6 4 DR Sedan
Claim#: 01/09/2014 12:14 PM
This report contains proprietary information of Audatex and may not be disclosed to any third party(other than
the insured,claimant and others on a need to know basis in order to effectuate the claims process)without
�'Audatex Audatex's prior written consent.
a SaJera com�!anr
Copyright(C)2013 Audatex North America, Inc.
Audatex Estimating is a trademark of Audatex North America, Inc.
01/10/2014 10:30 AM Page 4 of 4
BUNBLE BEE LLC DBA DEERING AUTO BODY
1449 CONCORD ST S
SOUTH SAINT PAUL,MN 55075-5921
(651)455-5089 FAX: (651)455-0841
SCOTT@DEERINGAUTOBODY.COM/WENDY@DEERINGAUTOBODY.COM
***PRELIMINARY ESTIMATE'""`
01/14/2014 08:50 AM
Own�
Owner: Walter Pettiford
Address: Work/Day: (651�t89-3285
City State Zip: South Saint Paul,MN 55075 FAX:
� __
Inspection �, _�....�.�
Inspection Date: 01/14/2014 08:57 AM Inspection Type:
Primary Impact: Left Front Side Secondary Impact:
Appraiser Name: Wendy Kieger Appraiser License#:
Address: 1449 Concord Street S Work/Day: (651�55-5089
City State Zip: South Saint Paul,MN 55075 FAX: (651�55-0841
Email: wendy@deeringautobody.com
Repairer
Repairer: Deering Auto Body&Repair Contact: Wendy Kieger
Address: 1449 Concord Street S WoMdDay: (651�55-5089
City State Zip: South Saint Paul,MN 55075 FAX: (651�55-0841
Email: wendy@deeringautobody.com
��..��____��. �.�m_. �.� e d -.�.�� -.�._.�
Vehicle �� — -���� � � -�---'
2000 Honda Accord EX V6 4 DR Sedan
6cyl Gasoline 3.0 VTEC
4 Speed Automatic
Lic Expire: VIN: 1 HGCG 1656YA045923
Veh Insp#: Mileage Type: Actual
Condition: Code: H1263C
Eut.Refnish: TwaStage Int.Refinish: Two-Stage
Options
AM/FM CD Player Air Conditioning Alarm System
Aluminum/Alloy Wheels Anti-Lock Brakes Bucket Seats
Center Console Climate Control For A/C Cruise Control
Dual Airbags Garage Door Opener Intermittent Wipers
Keyless Entry System Leather Seats Leather Steering Wheei
Lighted Entry System Overhead Console Power Brakes
Power poor Locks Power Drivers Seat Power Mirrors
Power Moonroof Power Steering Power Windows
Rear Window Defroster Rem Trunk-L/Gate Release Side Airbags
Strg Wheel Radio Control Tachometer Theft Deterrent System
Tilt Steering Wheel Tinted Glass
Page 1 of 4
Ot/14I201410:11 AM �
2000 Honda AccoM EX V6 4 DR Sedan
Claim#: 01/14/2014 08:50 AM
Damages�_ � -----__ � ____._�___ _.___._ ___
Line Op Guide MC Description MFR.Part No. Price ADJ% B% Hours R
�ront Bum�er
1 EP 6 Cover,Front Bumper Repiace PXN $213.00 1.1 SM
2 L 6 13 Cover,Front Bumper Refinish 3.7 RF
2.6 Surface
0.6 Two-stage setup
0.5 Two-stage
3 RI 348 Emblem,Frt Bmpr Cover R&I Assembly 0.2 SM
Front End Panel And Lam�s
4 E 41 Headiamp Assy,Halogen LT 33151S84A01 $209.15 INC SM
5 N 973 Headlamps Aim Additional Labor 0.4 SM
Front Body And Windshield
6 EP 103 Fender,Front LT Replace PXN $151.00 1.6 SM
7 L 103 Fender,Front LT Refinish 3.5 RF
2.4 Surface
0.5 Edge
0.6 Two-stage
8 ET 21 Guard,Fender Mud LT Partial Replace Labor INC SM
9 TE 31 Guard,Fender Mud Partial Replace Price $49.25 SM
10 E 113 Brace,Front Fender LT 60212SV4000ZZ $16.70 0.1 SM
11 L 113 Brace,Front Fender LT Refinish 0.1 RF
0.1 Surtace
Front Bodv Interior Sheetmetal
12 I 127 07 Reinf,inner Fender LT Repair 2.0" SM
13 L 127 Reinf,lnner Fender LT Refinish 0.5 RF
0.4 Surface
0.1 Two-stage
14 EP 107 Ski�t,lnner Fender LT Replace PXN $38.00 0.1 SM
Whe15 EU 54 70 Wheel,Front LT Replace Recycled $93.00 +30.00 0.3 SM
Front Susoension
16 N 974 Suspension Align,Frt Additional Labor 1.5 ME
17 E 659 Absorber,Strut UF 51606S87A03 $147.50 1.3 ME
Front Doors
18 EU 207 Door Assembly,Front LT Replace Recycled $650.00` +30.00 3.6 SM
19 L 207 Door SheIl,Front LT Refinish 3.5 RF
1.9 Surface
1.0 Edge
0.6 Two-stage
Manual Entries
20 SB M17 Cover Car Exterior Sublet Repair $7.00* RF
21 SB M60 Hazardous Waste Removal Sublet Repair $7.00` SM
22 EC tire Replace Economy $105.00* SM'
23 N mount&balance tire Additional Labor 0.4` SM"
23 Items
MC Message
07 STRUCTURAL PART AS IDENTIFIED BY I-CAR
Page 2 of 4
01/14/2014 10:11 AM
2000 Honda Axord EX V6 4 DR Sedan
Claim#: 01/14/2014 08:50 AM
13 INCLUDES 0.6 HOURS FIRST PANEL TWO-STAGE ALLOWANCE
70 RECYCLED AUDATEX SPPL
_ _� ��_�__�.�.�._�..��._.�._....__.�......�.._���....�._a_.�.�..___.. ._.�._v�
Estimate Total&Entries � _ _�
Gross Parts $422.60
Other Parts $1,250.00
Paint Materials $395.50
Line Item Markup $222.90
Parts&Material Total $2,291.00
Tax on Parts&Material @ 7.125% $163.23
Labor Rate Replace Repair Hrs Total Hrs
Hrs
Sheet Metal(SM) $54.00 7.0 2.8 9.8 $529.20
Mech/Elec(ME) $75.00 1.3 1.5 2.8 $210.00
Frame(FR) $75.00
Refinish(RF) $54.00 11.3 11.3 $610.20
Paint Materials $35.00
LaborTotal 23.9 Hours $1,349.40
Sublet Repairs $14.00
Gross Total 33,817.63
Net Total E3,817.63
Alternate Pa�ts Y/03/03/00/00/00 CUM 03/03/00/00/00 Zip Code:55075 Default
SPPL Yes Zip Code:55075 Default
Audatex Estimating 7.0.123 ES 01/14/201410:11 AM REL 7.0.123 DT 11/01/2013 DB 12/15/2013
Copyright(C)2013 Audatex North America,Inc.
2.4 HRS WERE ADDED TO THIS ESTIMATE BASED ON AUDATEX'S TWO-STAGE REFINISH FORMULA.
THIS ESTIMATE HAS BEEN PREPARED BASED ON THE USE OF ONE OR MORE CRASH PARTS
SUPPLIED BY A SOURCE OTHER THAN THE MANUFACTURER OF YOUR MOTOR VEHICLE.
WARRANTIES APPLICABLE TO THESE REPLACEMENT PARTS ARE PROVIDED BY THE PARTS
MANUFACTURER OR DISTRIBUTOR RATHER THAN BY THE MANUFACTURER OF YOUR VEHICLE.
A PERSON WHO FILES A CLAIM WITH INTENT TO DEFRAUD OR HELPS COMMIT A FRAUD
AGAINST AN INSURER IS GUILTY OF A CRIME.
Op Codes
" = User-Entered Value E = Replace OEM NG= Replace NAGS
EC= Replace Economy OE= Replace PXN OE Srpls UE= Replace OE Surplus
ET= Partial Replace Labor EP= Replace PXN EU= Replace Recycled
TE= Partial Replace Price PM= Replace PXN Reman/Reblt UM= Replace Reman/Rebuilt
L = Refinish PC= Replace PXN Reconditioned UC= Replace Reconditioned
TT = TwaTone SB= Sublet Repair N = Additional Labor
BR= Biend Refinish I = Repair IT = Partial Repair
CG= Chipguard RI = R 8�I Assembly P = Check
Page 3 of 4
01/14I201410:11 AM
2000 Honda Accord EX V6 4 DR Sedan
Claim#: 01/14/2014 08:50 AM
AA=Appearance Allowance RP= Related Prior Damage
This report contains proprietary information of Audatex and may not be disclosed to any third party(other than
the insured,claimant and others on a need to know basis in order to effectuate the ciaims process)without
��l���°�,�� Audatex's prior written consent.
�i
��,��s��,��,�r
- Copyright(C)2013 Audatex North America,Inc.
Audatex Estimating is a trademark of Audatex North America, Inc.
Page 4 of 4
01114/2014 10:11 AM
BUNBLE BEE LLC DBA DEERING AUTO BODY
1449 CONCORD ST S
SOUTH SAINT PAUL,MN 55075-5921
(651)455-5089 FAX:(651)455-0841
SCOTT DEERINGAUTOBODY.COM/WENDY DEERINGAUTOBODY.COM
Notes
2000 Honda Accord EX V6 4 D Sedan 2 WD Gasoline
Claim#: 01/14/2014 08:50 AM
�riginal Estimate _ 01/14/2014 10.09 AM WendY,Kie er � ��,�
possable hidden damage after tear down
This report contains proprietary information of Audatex and may not be disclosed to any third party(other than the
insured,claimant and others on a need to know basis in order to effectuate the claims process)without Audatex's
�����dV priorwritten consent.
irllr
a SW�r�curn�arrr
Copyright(C)2013 Audatex NoKh America,Inc.
Audatex Estimatin is a trademark of Audatex North America Inc.
Page 1 of 1
01I14/2014 10:11 AM