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Coicou RECElV�� J�N 17 2Q14 NOTICE OF CLAIM FOR1�oT�i��Saint Paul, Minnesota Minnesnta State Staa�te 466.05 states that"...every persnn...who claims damages frnm any municipality...shall cause to be pre,sented tn the governing body nf the municipaliry within 180 days after the alleged Ins.r or injury is discavered a nntice.stating the time,place,and circum,stance,s thereof,and the amount of compensatinn or other relief demanded." Please complete this form in its entirety by clearly typing or printing your answer to each question. If more space is needed,attach additional sheets. Please note that you will not be contacted by telephone to clarify answers,so provide as much information as necessary to explain your claim,and the amount of compensation being requested. You will receive a written acknowledgement once your form is received. The process can take up to ten weeks or longer depending on the nature of your claim. This form must be signed,and both pages completed. If something does not apply,write`N/A'. SEND COMPLETED FORM AND OTHER DOCUMENTS TO: CITY CLERK, 15 WEST KELLOGG BLVD,310 CITY HALL, SAINT PAUL, MN 55102 First Name 1 �� \ � ��= Middle Initial •�Last Name �e��� C Z�-�- Company or Business Name .'✓�,f� Are You an Insurance Company? Yes No If Yes,Claim Number? i C� �u�nt cY-rr/� S�t/z�c.c?T /1�� � Street Address -� � City����� / '.I i � / State M �V Zip Code � S^�`�� � �'l� 91�f'j `7�`f3 �r.t `�E•t�•- 7f3`j-3 Zz-v ;7c��� � Daytime Phone( ) - Cell Phone( ) - Evening Telephone(��) - t � ( 1 � r Date of Accidend Injury or Date Discovered r �17"4Y ���'�K�?�'�,'��`3 Time /�'R�'�v am� ! i Please state,in detail,what occurred(happened),and why you are submitting a claim.Please indicate why or how you � feel the Gity of Saint Paul or its employees are invdlved and/or responsible for your,damages. �/Z : �l w4,� ��� wt\ K� c'��, T�(.r �..Sr-✓,.�z-r T.2::,y, �►�r l,�� c� W 5 ��s�j =CT1� � ti�i�+H :� .i3�t e f 1�1�i�i �.:;h e ni G1 i F i C r/� �i 2��, 'i�(.c'i Q c c-'7i-�'.-✓..s_ ,h�y I iN�tic- �rv ���'Q .���! , � v F .��''>.rn ,,llc :�' ';.�V,�s �SS ; C'�n��.� I G �+s� � l3— a��v�� � Please check the box(es)that most closely represent the reason for completing this form: ❑My vehicle was damaged in an accident ❑My vehicle was damaged during a tow ❑ My vehicle was damaged by a pothole or condition of the street ❑My vehicle was damaged by a plow ❑ My vehicle was wrongfully towed and/or ticketed ❑ I was injured on City property �Other type of property damage—please specify ri'1 y 1�Z(�;� �• �� �%�n�.�L�� h,� 1 ��3�•i/�'f /54�1��� �R+��K` 1� ❑ Other t e of in' lease s ecif w�N�� YP J�'—P P Y ,.::��s�e�r��� ��,y,,��}l1 In order to process your claim vou need to include coqies of all apnlicable documents. For the claims types listed below,please be sure to include the documents indicated or it will delay the handling of your claim. Documents WILL NOT be returned and become the property of the City. You are encouraged to keep a copy fo yourself before submitting your claim form. � �Property damage claims to a vehicle: two estimates for the repairs to your vehicle if the damage exceeds $500.00;or the actual bills and/or receipts for the repairs O Towing claims: legible copies of any ticket issued and a copy of the impound lot receipt O O[her property damage claims:two repair estimates if the damage exceeds$500.00;or the actual bills and/or receipts for the repairs;detailed list of damaged items O Injury claims: medical bills,receipts O Photographs are always welcome to document and support your claim but will not be returned. Page 1 of 2—Please complete and return both pages of Claim Form Failure to complete and return both pages will result in delay in the handling of your claim. All Claims—nlease comnlete this section Were there witnesses to the incident? Ye No Unknown (circle) Provide their names,addresses and telephone numbers: ��,'✓!t��R�L!S�.R�% �� �FF�c��.- �+r � �E�/��'- G=n� Si. pku�. �vr<��s'; c � ���iq r►�1 Were the police or law enforcement called? Yes No Unknown (circle) If yes,what deparcment or agency? Case or report Where did the accident or injury take place? Provide street address,cross street,intersection,name of park or facility, closest landmark,etc. Please be as detailed as possible. If necessary,attach a dia am. ' •�✓ � �u..e� ��rt�rLY rk:R�Ss r'k'c,� mY f��/�s v��N�,��� s:f✓�.� 5� �� ,Mnl <' /C�S� � 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. . � '�Er �; � t�i ir� j�S �— : ' � ��'�SS �f�1 G�i���� � �? �� ;;� � YZr �.?3�'� a-; � T Vehicle Claims—nlease comqlete this section ❑check box if this section does not apnlv Your Vehicle: Year j�i �i� Make_'�r,rJ:�h Model �c=�2 D �C - �t�����2 License Plate Number �. 7 f� �i.(_C� State Lvt v�Color GRt�'�=� Registered Owner �_� 1,n.�L E�v� �a,:e.€;v` Driver of Vehicle n`� Area Damaged �Afs {�FEv�, �ritz.n/;' �'u n�� ,�.vs� f� C R,�LIl r��� �nN �1i� •�� ��'1``� City Vehicle: Year ,��,�_Make ��/{ Model 2�"��'i2�'x'�' � License Plate Number�i if State�Color , Driver of Vehicle(City Employee's Name) �✓'/'/f Area Damaged �/A Iniurv Claims—alease comnlete this section check box if this section does not applv � How were you injured? What part(s)of your body were injured? �I Have you sought medical treatment? Yes No Planning to Seek Treatment(circle) When did you receive treatment? (provide date(s)) I Name of Medical Provider(s): i Address Telephone Did you miss work as a result of your injury? Yes No When did you miss work? (provide date(s)) Name of your Employer: Address Telephone Check here if you are attaching more pages to this claim form. Number of additional pages ,/ . By signing this form,you are stating that all information you have provided is true and correct to the best of your knowledge. Unsigned forms will not be processed. Submitting a false claim can result in prosecution. Date Form was completed�`J��'t1.tL+� 3 ��l`f � �T— Print the Name of the Person who Completed this F,,� ��' �'` � ��v Y ��'�C� �✓ � �� Signature of Person Making the Claim: Revised Februazy 2011 DEPARTMENT OF POLICE Thomas E.Smith,Chief of Police CITY OF SAINT PAUL 367GroveStreet Telephone:651-291-1111 Christopher B.Coleman,Mayor St.Paul,Minnesota 55/01 Facsimile:65/-266-5711 December 9, 2013 Philipe Guy Coicou �10 St. Albans St.N. Apt. 6 St. Paul, Minnesota 55104 Case# 13-260475 On December 6, 2013 at about 21:06 hours, St. Paul Police were in foot pursuit of a violent offender in the area of 110 St. Albans. The culprit threatened an officer with a firearm. The officer then fired his , service weapon at the suspect. ' Your vehicle: (LIC/678EUC. LIY/13. LIT/PC. ' NAM/COICOU,PHILIPE GUY.*RECORD DISSEMINATION RESTRICTED* � SNM/110 ST ALBANS ST N APT. CTY/ST PAUL. STA/MN. ZIP/55104. VIN/1HGCD553XVA038968. VYR/97. VMA/HOND. VCO/GRN/GRN. VMO/ACCORD LX-EX,4DR SEDAN, was parked legally on St. Albans opposite the addressl 10 St. Albans facing south. It was subsequently damaged by gunfire. I responded to the scene of the shooting and discovered the damage to your vehicle. I could see that it was struck by what appeared to be a bullet on the hood area closest to the windshield, driver side and in the front bumper area, driver side. Your vehicle and its damage was photographed and documented by police and members of The St. Paul Police Forensic Services Unit. No fragments or elements of the bullets were recovered. Should you discover any fragments or what you believe to be elements of the bullets, after moving the vehicle, please notify me right away. Please notify The City of St. Paul Risk Mana�ement Division at 651-266-8887 for instructions on ' how to begin the claim process. Sergeant Bryant Gaden— `S� ��G -��0,�6 St. Paul Police/Homicide Unit 651-266- AA-ADA-EEO Employer i n�y h�� k,����... � .!�. D E L T A ��3 ` CARGO L�C��'�f,'t-F�✓/�I•C�'i+f'/ � � � �. � 17�c,<,k-- C��vrl�_'1'.. Philipe G.Coicou Delta Air�ines,Inc. Customer Service Agent Department 807 Employee Diversity Network 7200 34th Ave South � DL Cargo MSP Minneapolis,MN 55111-3032 T. +1 612 266 4244 F. +1 612 266 4250 M.+1 612 968 7843 ' philipe.coicou@delta.com i i . i ROERING AUTOBODY Workfile ID: Ofe5cf4e FederalID: 411827490 90 N. DALE ST., SAINT PAUL, MN 55102 Phone: (651) 221-0919 FAX: (651) 221-1946 Preliminary Estimate Customer: COICOUS, PHILIPE ]ob Number: Written By: Chad Mear Insured: COICOUS, PHILIPE Policy#: Claim #: Type of Loss: Date of Loss: Days to Repair: 0 Point of Impact: Owner: Inspection Location: Insurance Company: COICOUS, PHIIIPE ROERING AUTOBODY 110 ST ALBANS 90 N. DALE ST. ST PAUL, MN 55102 SAINT PAUL, MN 55102 , (651)228-1708 Cell Repair Facility ' (651)221-0919 Day ; VEHICLE Year: 1997 Body Style: 4D SED VIN: 1HGCD553XVA038968 Mileage In: � Make: HOND Engine: 4-2.2L-FI License: Mileage Out: Model: ACCORD LX Production Date: State: Vehicle Out: Color: green Int: Condition: Job #: TRANSMISSION DECOR Rear Defogger Passenger Air Bag Overdrive Dual Mirrors RADIO SEATS 5 Speed Transmission Body Side Moldings AM Radio Cloth Seats POWER Console/Storage FM Radio Bucket Seats Power Steering CONVENIENCE Stereo Reciining/Lounge Seats Power Brakes Air Conditioning Search/Seek WHEELS Power Windows Intermittent Wipers Cassette Wheel Covers Power Locks Tilt Wheel SAFETY PAINT Power Mirrors Cruise Control Drivers Side Air Bag Clear Coat Paint f 12/19/2013 2:30:03 PM G76657 Page 1 � Preliminary Estimate Customer: COICOUS, PHILIPE Job Number: Vehicle: 1997 HOND ACCORD LX 4D SED 4-2.2L-FI green Line Oper Description Part Number Qty E�ctended Labor Paint Price$ 1 FRONT BUMPER 2 * Rpr Bumper cover � 2.3 3 Add for Clear Coat 0.9 4 0/H front bumper 2.3 5 FRONT LAMPS 6 R&I RT H'lamp&marker 0.5 7 R&I LT H'lamp&marker 0.5 8 HOOD 9 Repl Hood 60100SV4508ZZ 1 546.42 1.3 3.0 10 Add for Clear Coat 1.2 11 Add for Underside(Complete) 1.5 12 FENDER 13 Blnd RT Fender 1.0 14 * Rpr LT Fender 3.Q 2.0 15 Overlap Major Adj. Panel -0.4 16 Add for Clear Coat 0.3 17 R&I RT Fender liner 0.5 18 R&I LT Fender liner 0.5 19 # Subl Hazardous waste removal 1 5.00 X 20 # Repl Car Cover 1 5.00 21 # Repl Corrosion protection primer 1 0.2 SUBTOTALS 556.42 11.6 12.0 ESTIMATE TOTALS Category Basis Rate Cost; � Parts 551.42 Body Labor 11.6 hrs @ $52.00/hr 603.20 Paint Labor 12.0 hrs @ $52.00/hr 624.00 Paint Supplies 12.0 hrs C $32.00/hr 384.00 Miscellaneous 5.00 � Subtotal 2,167.62 Sates Tax $935.42 @ 7.6250% 71.33 I Grand Total 2,z38•g5 ' Deductible Q.00 CUSTOMER PAY 0.00 INSURANCE PAY 2,238.95 12/19/2013 2:30:03 PM 076657 Pa9e 2 � Pretiminary Estimate Customer: COICOUS, PHILIPE 7ob Number: Vehicle: 1997 HOND ACCORD LX 4D SED 4-2.2L-F?green Roering Auto Body, takes great care to ensure that every repair meets your satisfaction. The labor performed by Roering Auto Body is guararteed against any defect in workmanship for as long as you own your car. Roering Auto Body guarantees that for as long as you own your vehicle, t2oering will, at its expense, correct or repair all defects which are attributable to defective or faulty workmanship in thz repairs stated on the repair invoice, unless caused by or damaged resulting from unreasonable use, impro�er maintenance or care of vehicle, and rust and/or corrision. This guarantee covers labor only and does not apply to parts, materals or equipment which may be covered by manfacturer's warranty. MN ST 60A.955 - A PERSON WHO FILES A CLAIM WITH INTENT TO DEFRAUD OR HELPS COMMIT A FRAUD AGAINST AN INSURER IS GUILTY OF A CRIME. � �I I I , i i ; i 12/19/2013 2:30:03 PM 076657 Page 3 � Preliminary Estimate Customer: COICOUS, PHILIPE ]ob Number: Vehicle: 1997 HOND ACCORD LX 4D SED 4-2.2L-FI green Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from the Guide AEG4424, 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 andJor 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=Blend. BOR=Boron 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. I 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. i The following is a list of abbreviations that may be used in CCC ONE Estimating that are not part of the MOTOR CRASH ESTlMATING GUIDE: BAR=6ureau of Automotive Repair. EPA=Environmental Protection Agency. NNTSA= National Highway , Transportation and Safety Administration. PDR=Paintless Dent Repair. VIN=Vehicle Identification Number. 12/19/2013 2:30:03 PM 0?6657 Page 4 HEPPNERS AUTO BODY (MldWay) Workfile ID: b2558bcf ����� 400 SYNDICATE ST. N., SAINT PAUL, MN 55104 Phone: (651) 646-8615 FAX: (651) 645-3230 Preliminary Estimate Customer: Philipe, Coicous )ob Number: Written By:Jason Wengler Insured: Philipe,Coicous Policy#: Claim#: Type of Loss: Date of Loss: Days to Repair: 0 Point of Impact: 10 Left Front Pillar(Left Side) Owner: Inspection Location: Insurance Company: Philipe,Coicous HEPPNERS AUTO BODY(Midway) 110 St.Albans St. 400 SYNDICATE ST. N. St. Paul,MN 55102 SAINT PAUL, MN 55104 (651)228-1708 Cell Repair Facility (651)646-8615 Day VEHICLE i Year. 1997 Body Style: 4D SED VIN: 1HGCD553XVA038968 Mileage In: � Make: HOND Engine: 4-2.2L-FI License: Mileage Out: � Model: ACCORD LX Production Date: State: Vehicle Out: Color. Green Int: Condition: Job#; I � TRANSMISSION DECOR I Rear Defogger Passenger Air Bag Overdrive Dual Mirrors RADIO SEATS 5 Speed Transmission Body Side Moldings AM Radio Cloth Seats POWER Console/Storage FM Radio Bucket Seats Power Steering CONVENIENCE Stereo Reclining/Lounge Seats Power Brakes Air Conditioning Search/Seek WHEELS Power Windows Intermittent Wipers Cassette Wheel Covers Power Locks Tilt Wheel SAFETY PAINT Power Mirrors Cruise Control Drivers Side Air Bag Clear Coat Paint 1/2/2014 3:23:22 PM 050503 Page 1 Preliminary Estimate Customer: Philipe, Coicous 7ob Number: Vehicle: 1997 HOND ACCORD LX 4D SED 4-2.2L-FI Green Line Oper Description Part Number Qty Extended Labor Paint Price$ 1 FRONT BUMPER Z 0/H front bumper Z 3 3 * <> Rpr Bumper cover � 2 3 4 Add for Clear Coat �g _.� .._. .. . . _..._ ,__.. __� _ . ...� _ �_._�_ ��_W _.._ . . � _ _ ..___ _-_ � ___ __ _.._ . . 5 HOOD 6 ** Repl A/M CAPA Hood 60100SV4508ZZ 1 285.00 1.3 3.0 � Overlap Major Non-Adj. Panel _�Z $ Add for Clear Coat 0.6 9 Add for Underside(Complete) 1.5 10 Repl Emblem 75700SV4000 1 20.15 0.2 ..... _...�.__.. ,,,,,._.._�.._ .,,.. ...__. ._. .,... _..,,,,. ._. . .....,,. . . _ _. ,..... ,,,,, _.,,_,.. _ il FRONT LAMPS -- _. 12 R&I RT H'lamp&marker 0.5 13 R&I LT H'lam &marker 0.5 P - __ �.. ,__. _ ... �._.. _�_ ��.. .,_ . � �_.____ _. . .. � ._� ...�. � .,_. _ .__ _ _� . _..... 14 FENDER 15 Blnd RT Fender 1.0 16 R&I RT Fender liner 0.5 17 * Rpr LT Fender � Z� 18 Overlap Major Adj. Panel -0.4 19 Add for Clear Coat 0.3 20 R&I LT Fender liner 0.5 Z1 * R&I RT Body side mldg DX&LX � 22 * R&I LT Bod side mld DX&LX � _ _. .__.�_�� . __..�._ __..._� Y 9 , _ . _.__ ��__e ... � _..� ._. __. _. ._ ___ _.� __. ._ __ _____ ., .. 3 MISCELLANEOUS OPERATIONS 24 Repl Cover car/bag 1 0.2 , 25 # RESTORE CORROSION 1 �2 I PROTECTION 26 # Repl FLEX ADDITIVE 1 5.00 T 2� # Subl HAZARDOUS WASTE REMOVAL 1 5.00 X I i SUBTOTALS 315.15 12.2 11.2 I � 1/2/2014 3:23:22 PM 050503 Page 2 Preliminary Estimate Customer: Philipe, Coicous 7ob Number: Vehicle: 1997 HOND ACCORD LX 4D SED 4-2.2L-FI Green ESTIMATE TOTALS Category Basis Rate Cost$ Parts 305.15 Body Labor 12.2 hrs @ $54.00/hr 658.80 Paint Labor 11.2 hrs @ $54.00/hr 604.80 Paint Supplies 11.2 hrs @ $34.00/hr 380.80 Body Supplies 7.7 hrs @ $3.00/hr 23.10 Miscellaneous 10.00 Subtotal 1,982.65 Sales Tax $690.95 @ 7.6250% 52.68 Grand Total 2,035.33 Deductible 0.00 CUSTOMER PAY 0.00 INSURANCE PAY 2,035.33 THIS IS A VISUAL ESTiMATE ONLY. ADDITIONAL PARTS AND LABOR MAY BE EXTRA UPON TEARDOWN. PART PRICES SUBJECT TO INVOICE. ' NO GUARANTEE ON RUST REPAIR! ' I i 1/2/2014 3:23:22 PM 050503 Page 3 Preliminary Estimate Customer: Philipe, Coicous 7ob Number: Vehicle: 1997 HOND ACCORD LX 4D SED 4-2.2L-FI Green QUALITY REPLACEMENT PARTS WARRANTY OUR REPAIR ESTIMATE MAY SPECIFY THE USE OF QUALITY REPLACEMENT PARTS. QUALITY REPLACEMENT PARTS ARE PARTS NOT MANUFACTURED BY OR FOR THE ORIGINAL EQUIPMENT MANUFACTURER. WE WILL STAND BEHIND THE QUALITY REPLACEMENT PARTS THAT ARE SPECIFIED ON THIS ESTIMATE AND USED IN THE REPAIR OF YOUR VEHICLE, FOR AS LONG AS YOU OWN/LEASE THE VEHICLE. WE WARRANT THESE PARTS ARE OF LIKE KIND, QUALITY, SAFETY, FIT AND PERFORMANCE TO PARTS MANUFACTURED BY OR FOR THE ORIGINAL EQUIPMENT MANUFACTURER. THIS WARRANTY EXCLUSIVELY COVERS LOSS OR DAMAGE THAT IS RELATED TO DEFECTS IN THE QUALITY REPLACEMENT PART. THIS WARRANTY DOES NOT COVER DAMAGE OR PART FAILURE DUE TO IMPROPER INSTALLATION, MISUSE, NEGLECT, ABUSE, IMPROPER MAINTENANCE, ABNORMAL OPERATION, OR NORMAL WEAR &TEAR. SHOULD A SUPPLIER OF A PART SPECIFIED IN OUR REPAIR ESTIMATE, OR THE REPAIR FACILI�TY THAT PERFORMS THE REPAIR ON YOUR VEHICLE, BE UNABLE TO RESOLVE A LEGITIMATE COMPLAINT ABOUT THE QUALITY REPLACEMENT PART USED IN THE REPAIR, WE WILL MAKE EVERY EFFORT TO SEE THAT THE PROBLEM IS CORRECTED. THIS WARRANTY AND ANY REPRESENTATIONS MADE HEREIN ARE NON-TRANSFERABLE AND EXTEND ONLY TO THE PARTY OWNING/LEASING THE VEHICLE AT THE TIME OF THE REPAIR. FOR ASSISTANCE, PLEASE CONTACT THE NEAREST CLAIM DEPARTMENT OFFICE. DISCLAIMER: ANY PERSON WHO KNOWINGLY PRESENTS A FALSE OR FRAUDULENT INSURANCE CLAIM FOR THE PAYMENT OF A LOSS MAY BE GUILTY OF A CRIME AND MAY BE SUBJECT TO FINES AND CONFINEMENT IN STATE PRISON. THE LABOR AND TAX RATES USED WERE DETERMINED BY THE VEHICLE INSPECTION LOCATION UNLESS THE ' REPAIR FACILITY WAS KNOWN AT THE TIME OF THE INSPECTION OR ANOTHER LOCATION WAS SPECIFIED BEFORE THE ESTIMATE WAS PREPARED i THIS IS NOT AN AUTHORIZATION TO REPAIR. ' TO ENSURE REPAIRS WILL BE COMPLETED BASED ON THIS ESTIMATE; PLEASE PROVIDE A COPY TO THE REPAIR FACILITY PRIOR TO AUTHORIZING REPAIRS. FAILURE TO DO SO MAY RESULT IN YOU BECOMING RESPONSIBLE � FOR PAYING UNAPPROVED EXPENSES. � NO PAYMENT FOR A SUPPLEMENT WILL BE APPROVED OR ISSUED UNLESS THE REPAIRS WERE AUTHORIZED I PRIOR TO COMPLEfING THE SUPPLEMENTAL REPAIRS. TO EXPEDITE THE HANDLING OF ANY SUPPLEMENTAL , DAMAGES, PLEASE ACCESS HTTP://WWW.THESHOPOFCHOICE.COM/FARMERS. IF YOU NEED TECHNICAL ASSISTANCE REGISTERING OR UPLOADING ATTACHMENTS, CONTACT NUGEN IT CUSTOMER SUPPORT AT (855)-684-3648 BEl1NEEN 7 AM AND 7 PM CENTRAL TIME. POTENTIALLY, A REINSPECTION MAY BE NECESSARY. CIRCLE OF DEPENDABILITY SUPPLEMENTS: CIRCLE OF DEPENDABILITY PROGRAM SHOPS WILL CONTINUE TO ' PROCESS SUPPLEMENTS THROUGH THE NORMAL SUPPLEMENT PROCESS. PLEASE CONTACT YOUR FIELD OR OFFICE CONSULTANT IF YOU HAVE ANY QUESTIONS. THIS PROCESS DOES NOT APPLY TO BRISTOL WEST. 1/2/2014 3:23:22 PM 050503 Page 4 . . Preliminary Estimate Customer: Philipe, Coicous 7ob Number: Vehicle: 1997 HOND ACCORD LX 4D SED 4-2.2L-FI Green 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. Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from the Guide AEG4424, 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 pertormed 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 Structur�l component. T=Miscellaneous Taxed charge category. ' X=Miscellaneous Non-Taxed charge category. I SYMBOLS FOLLOWING LABOR: I 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: i Adj.=Adjacent. Algn.=Align. ALU=Aluminum. A/M=Aftermarket part. BInd=Blend. BOR=Boron 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. 1/2/2014 3:23:22 PM 050503 Page 5 Preliminary Estimate Customer: Philipe,Coicous 7ob Number: Vehicle: 1997 HOND ACCORD LX 4D SED 4-2.2L-FI Green ALTERNATE PARTS SUPPLIERS Supplier: Keystone-Complete-Minneapolis Location(s): 3615 MARSHALL STREEf NE, MINNEAPOLIS MN 55418 (800)328-1845 (612)789-1919 Line Description Item # Price 6 A/M CAPA Hood H01230126C $285.00 i 1/2/2014 3:23:22 PM 050503 Page 6 ' � �� : , �., , . , �' la'� e•� c:,�..t.. �4�1 �+�� r �- . ..., . ,. �� � �� .� � _ ,; � , � .. . .,.. - � �. , � � '' . .,-: , .- ' ` :,_. _ :_� , � � � � '��, � .e' • . .-.., _ a,,._ . ��"�: ,.:,:� 11 � ;y �i i�il A��w�� �� 4����i+,��� l l ,: a.. _ �� �� � � �'. 3 i �� � �� ��� ��, ,. 3 f � .l �$ t4�µ ��` 1 �k �.� ,`���� � j �, � '�,��{+11I�� k ',,�:I ; ' � ° z �' � �� � a� � �. � �_ � � �' N � � : �� �: � `ro:° � ° - � � ��"�� � ,t � . � a � ���� r � ��� ; �� s , �; � �� esTF,ti �t � �w � ��}, ��. �� ' � � � � � �.`, � _ �� m . � , , ,__ �,' t° y , � �,r .�� � � � , � ,,�_ �; , �, .�- � ��` . ����� � � . �,� � _- V� a,ri}z i� �+"T� _ , „�� � � . �, ,� n P���.�� z y � f x a� 'r ��. . w � # yJVi u �., f� &_ . - . �,L� y �, 'f w� � �,F r. �, � , _' : _� . � , ,� .�... � pk, %�°'#', " _, '��r � ,� Ir�� k„_' " "� '.. . � ,c ' ��'ry��_ u > ._ . , .°�z.. �,v�` "dt`' ,+ [ r �s �",��.�'� �kzi :k ._ � '¢ui. `��� �'� . i = ; �-.�Cx" '. — - ,..�; �w.� � } �_.. `��� ..,fa�. �� � y� T� ��_. � v� �E. 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