Creeron RECEIVED
F�B 06 2�14
NOTICE OF CLAIM FORM to the City of Saint Paul, Mi�i�sYit�LERK
Minnesota State Statute 466.05 states that"...every person...who claims damages from any municipality...shall cause to be presented to the
governing body of the municipaliry within 180 days after the alleged loss or injury is discovered a notice stakng the time,place,and
circumstances thereof,and the amount of compensation or other relief demanded.°
Please compiete 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 weel�s or longer depending on the
nature of your claim. This form must be signed,and both pages completed. ff 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 Middle Initial� Last Name���� (��i(�
Company or Business Name
Are You an Insurance Company Yes/ o If Yes,Claim Number? V`��q�L JT� „�5 rn j o�5
Street Address � �
City �1�L(�� State � Zip Code 3��
Daytime Phone���-���Cell Phone( ) - Evening Telephone(_) -
Date of Accidenb Injury or Date Discovered bl� �`C�(�/ � Time ���am/(pm)
v
Please state,in detail,what occurred(happened),and why you are submitting a claim. Please indicate why or how you I
f�el th r ity of Saint Pa�o�r its e 1 ees are involved a�n�r responsible f r your damage�
�
�
;
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Please check the box(es)that most closely represent the reason for completing this form: i
❑ 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
❑ Other type of injury—please specify
In order to process your claim youu need to include copies of all applicable 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 WII.L NOT be retumed and become the property of the City. You are encouraged to keep a
copy for yourself before submitting your claim form.
CC�roperty damage claims to a vehicle: two estiinates 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 Other 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
C�hotographs 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 complete this section
Were there witnesses to the incident? Yes o� Unknown (circle)
Provide their names,addresses and telephone numbers:
Were the police or law enforcement c d? es No Unknown (circle)
If yes,what department or agency? Case#or report#,1�-�, C al`b�
Where did the accident ar injury take place? Provide street address,cross street,intersect n,name of park or facility,
closest landmark,etc. Please be as detailed as possible. If necessary,attach a diagram. �,�� 1�ao j F- �
�� �� ���� �n
Please indicate the am unt ou are seeking in compensation r what y,,,Qu�f ould like the City to do to resolve this claim
to your satisfaction.��.����(�.Qr�+ �1 q E�j�j���Q_-'
�C'C��^��— � Cd �� "�-� ,
Vehicle Claims— 1 e com lete this section ❑ check box if this section does not a 1
Your Vehicle: Year Make C) Model �
License Plate Number iC State�Color
Registered Owner �
Driver of Vehicle
Area Damaged
City Vehicle: Yearo J�'�Make fiC Model
License Plate Number State�_ olor
Driver of Vehicle(City Employee's Name) �Q : � ° �
Area Damaged
Injurv Claims—please complete this section �� J� ❑check box if this section does not apply
How were you injured?
What part(s)of yaur body were injured?
Have you sought medical treatment? Yes No Planning to Seek Treatment(circle)
When did you receive treatment? (provide date(s))
Name of Medical Provider(s):
Address Telephone
Did you miss wark as a result of your injury? Yes No
When did you miss work? (provide date(s))
Name of your Employer:
Address Telephone
�k here if you are attaching more pages to this claim form. Number of additional pag�
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 prosecutiort. Date form was completed�1 — �—�1��1,�_
Print the Name of the Person who Completed this Form: ���n�.A �C �1�0. � �Q� C(�,
Signature of Person Making the Claim:�A��y�• �c9'�1��,_��(a.Y..,s� �,D�'L� �-�
Revised February 2011
(Page 3 of 8)
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A UTHp1t17ATION AND BBQUISIT70N R,SCORD/NAOR6lATION ,
I hereby authorize Metropolkan Reporling Bureau,PO Box 926 Wiltiem Pann Mnex, " �
Phlladelphia,PA 191 OS to recaive lrom the Rec:ord aepartment eny i�ormatio� •
allawed by Isw ragarding the{nddent nOted bebw. :
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Accident Report � Page 2 of6
Case�:1926��8
Report Date:12/9►2013
Accfdent Narradve,contlnued: .
traffic.
All vehicles were legelly parked and unoccvpied.
Business cards with the case number were telt wiTh a[I vehiGes Involved,no owners could be reeched.
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(Page 8 of 8)
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(Page 1 of 9)
GEICO
geico.com
EMAIL SUPPLEMENTS TO
R3MOMNSUPP@GQCO.COM
FAX SUPPLEMENTS TO 305-328-4105
P.O. BOX 130608
1 F1/�JVffLLI'ILIY IJ 1 V JVJ JLV��IVJ
P.O. BOX 130608
ROSEVILLE, MN 55113
Phone: (612)369-5645 Claim#�: �+49441960101025-01
FdX: (855)783-1613 Workfile ID: 47b834c5
Estimate of Record
Written By:Steve Williams,12/17/2013 12:39:33 PM
Adjuster:A994
Insured: KERRY CREERON Policy#: 4272845142 Claim#: 0949441960101025-01
Type of Loss: Collision Date of Loss: 12/09/2013 12:00 PM Days to Repair: 13
Point of Impact: OS Left Qtr Post Deducdble: 500.00
(Left Side)
Owner. Inspection Location: Appraiser Information: Repair Facility:
KERRY CREERON COOKS ONE STOP BODY stevwilliams@geico.com COOKS ONE STOP
238 DALE ST N SHOP (612)369-5645
SAI�ff PAUL,MN 55102-1738 1790 GERVAIS CT
(608)345-4935 Evening MAPLEWOOD,MN 55109-0000
Drive-in
(651)777-5555 x0000 Day
VEHICLE
Year: 2010 Color: WHITE Int: License: 483KAD Production Date:
Make: TOYO Body Style: 4D UTV State: MN Odometer: 41704
Model: VENZA AWD Engine: 6-3.SL-FI VIN: 413BK3BB9AU034065 Condition:
TRANSMISSION Overhead Console AM Radio SEATS
Automadc Transmission CONVENIENCE FM Radio Cloth Seats
4 Wheel Drive Air Conditloning Stereo Bucket Seats
POWER Intertnittent Wipers Search/Seek WHEELS
Power Steering Tilt Wheel CD Player 20"Or Larger Wheels
Power Brakes Cruise Control Au�liary Audio Connection PAINT
Power Windows Rear Defogger SAFETY Three Stage Paint
Power Locks Keyless Entry Drivers Side Air Bag OTHER
Power Mirrors Message Center Passenger Air Bag Fog Lamps
Power Driver Seat Steering Wheel Touch Controls Anti-Lock Brakes(4) Rear Spoiler
Power Passenger Seat Rear Window Wiper 4 Wheel Disc Brekes TRUCK
DECOR Telescopic Wheel Traction Control PowerTrunk/Gate Release
Dual Mirrors Climate Control Stability Control
Privacy Glass Home Link Front Side Impact Air Bags
Console/Storage RADIO Head/Curtain Air Bags
12/17/2013 12:39:33 PM 094900 Page 1
(Page 2 of 9)
Claim#: 0449441960101025-01
Workfile ID: 47b834c5
Estimate of Record
2010 TOYO VENZA AWD 4D UTV 6-3.5L-FI WHITE
L'ne Oper Description Qty Extended Labor Paint
Price�
1 �ENDER
2 Repl LT Fender 1 302.06 1.7 2.0
3 Add for Three Stage 1.4
4 Add for Edging 0.5
5 R&I LT Frt rocker mldg Incl.
6 ROBF
7 R&I LT Roof molding 0.4
8 # Blnd lT Upper rail clear only 0.6
9 # Rpr Rope w/shield for paint 0_3
_. . .. .._..._..._ _ _ . _ _ .
10 FRONT DOOR
il Repl Lfi Outer panel 1 353.15 f.f 2.1
12 Overlap Major Adj.Panel -0.4
13 Add for Three Stage 0•7
14 Add for mirror 0.4
15 Add for Edging 0.5
16 * Repl LT Mirror assy wJo heated white pearl 1 212.4b Incl. �6
17 * Repl LT Handle,outside w/Smart Key white pearl 1 201.96 Incl. 0_0
18 Repl LT Cover w/Smart Key white peari 1 15.80 IncL
19 * Rpr LT Door shell 1 0 icl.
20 R&I LT Lower moiding 0.3
2i R&I LT U��e�molding 0.4
22 Repl LT Black out tape front 1 8.19 0.2 '�
23 Repl LT Black out tape upper 1 41.17 03
24 Repl LT Black out tape rear 1 23.24 0•2 I
25 REAR DOOR '
26 Repl LT Outer panel 1 319.93 6.4 2.0 �
27 Overiap Major Adj.Pand -0.4 ,
z8 Add for Three Stage 0.6
29 Add for Edging 0.5
30 Repl LT Stone guard 1 13.99 Incl.
31 R&I LT Lower molding 0.3
32 R&I LT Rear molding 03
33 R&I LT Upper molding 0.3
34 R&I LT Belt molding Incl.
35 Repl LT Stripe front 1 23.24 0.2
36 Repl LT Stripe upper 1 32.41 0.z
37 Repl LT Stripe rear 1 11.64 0.2
38 QUARTER PANEL
39 * Rpr LT Quarter panel ¢� 2.6
40 Overlap Major Adj.Panel -0.4
41 Add for Three Stage 0•9 I
12/17R013 12:39:33 PM 094900 Pa9e Z
(Page 3 of 9)
Claim#: 0449441960101025-01
Workfile ID: 47b834c5
Estimate of Record
2010 TOYO VENZA AWD 4D UTV 6-3.SL-FI WHiTE
42 Repl LT Quarter panel protector 1 12.30 0.2
42 Repl LT Quarter paneJ protector 1 12.30 0.2
43 Repl FueJ door 1 57.23 0.4 03
44 Add for Three Stage 0.1
45 * Rpr LT Quarter glass Toyota tinted 0_5
NOTE: Rope for paint
46 REAR LAMPS
47 R&I LT Tail lamp assy 0.3
---- _
- _ _ _
48 REAR BUMPER
49 # Repl Restore Corrosion Protection 1 30.00 X 0.2
50 * R&I R&I bumper cover 0.5
51 OTHER CHARGES
52 # E.P.C. 1 4.00
SUBTOTALS 1,642.77 28.3 13.6
N07E5
Prior Damage Notes:
Prior Unrelated Damage Notes:
Front Bumper:
LT Fender:
Hood:
L[Front Door:
Lt Rear poor:
Roof:
Lt Quarter Panel:
Decklid�Tailgate:
Rear Bumper. ,
Interior:
Front Lamps:
Rt Fender:
C�ass:
Rt Front Door:
Rt Rear poor.
Sunroof:
Rt Quarter Panel:
Rear Lamps. '
eack Glass: �
�
Tires:
�
i
12/17/2013 12:39:33 PM 094900 Page 3
(Page 4 of 9)
Claim#: 0449441960101025-01
Workfile ID: 47b834c5
Estimate of Record
2010 TOYO VENZA AWD 4D UTV 6-3.SL-Fi WHITE
ESTTMATE TOTl1LS
ESTIMATE TOTALS
Category Basis Rate Cost�
Parts 1,628.77
Body Labor 28.3 hrs � $52.00/hr 1,471.60
Paint Labor 13.6 hrs @ $52.00/hr 707.20
Paint Supplies 13.6 hrs @ $32.00/hr 435.20
Miscelianeous 10.00
Other Charges 4.00
S�btotal 4,256.77
Sales Tax $2,063.97 @ 7.1250°,6 147.06
ToW I Cost of Repai-s 4,403.83
Deductible 500.00
Total Adjustinents 500.00
Net Cost of Repairs 3,903.83
This is not an authorization to repair.
All GEICO customers have the right to have their vehicle repaired in the shop of their choice.
No Supplement will be honored unless authorized by GEICO.
NOTICE: Vehicles constructed of special metals may require the use of specialized welding and bonding equipment.
Proper measuring and structural repair systems are requirement on today's vehicle to accurately accomplish vehicle
repairs. Make sure your shop has the proper equipment to repair your vehicle.
ALTERNATE PARTS DISCLAIMER:
IF A QUALITY REPLACEMENT PART(Af M, LKQ RECOND OR OPT OEM)APPEARS ON THIS ESTIMATE,IT INDICATES
THAT THIS ESTIMATE HaS BEEN PREPARED BASED ON THE USE OF ONE OR MORE CRASH PARTS SUPPLiED BY A
SOURC€OThI�R TI°IAN TNI�MANUFACTURER OF YOUR MOTOR VEHICLE. WARRANTIES, I�ANY, APPLICA�LE TO
THESE REPLACEMENT CRASH PARTS ARE PROVIDED BY TNE PART MANUFACTURER OR DISTRIBUTOR RATNER
THAN BY THE MANUFACTURER OF YOUR VEHICLE.
*** IN ADDITION TO ANY SUCH WARRANTIES, GEICO PROVIDES THE FOLLOWING:
**** OWNER LIMITED WARRANTY****WE WARRANT THAT ALL QUALITI(REPIACEMENT BODY PARTS(PARTS
NOT MANUFACTURED BY THE MANUFACTURER)IDENTIFIED ON YOUR ESTIMATE,ARE FREE OF DEFECTS IN
MATERIAL AND WORKMANSHIP AND MEEf GENERALLY ACCEPTED INDUSTRY STANDARDS. THLS PARTS AND
IABOR WARRANTY WILL BE IN EI�ECT�R AS LONG AS YOU OWN THE VEHICLE DESCRIBED IN THE ESTIMATE.
THIS WARRANTY COVERS THE COST OF T}iE PART, LABOR TO INSTALL, AND INCIDENTALS SUCH AS PAINT AND
MATERIALS AND IS SPECIFICALLY LIMITED TO THOSE ITEMS. THIS WARRANTY DOES NOT COVER LOSS OR
DAMAGE THAT LS UNRELATED TO DEFECTS IN THE QUAL1lY REPLACEMENT PARTS. THIS IS NOT TRANSFERABLE.
IF ANY QUALITY REPLACEMENT PARTS ARE DEFECTNE IN EITHER MATERIAL OR WORKMANSHIP, CONTACT YOUR
LOCAL GEICO REPRESENTATNE.
MN ST 60A.955-A PERSON WHO FILES A CLAIM WITN INTENT TO DEFRAUD OR HELPS COMMIT A FRAUD
AGAINST AN INSURER IS GUILT(OF A CRIME.
12/17/2013 12:39:33 PM 094900 Page 4
(Page 5 of 9)
Claim#: 0449441960101025-01
WorkfileID: 47b834c5
Estimate of Record
2010 TOYO VENZA AWD 4D UTV 6-3.SL-FI WHITE
Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from the Guide
Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from the Guide
ARM8445, CCC Data Date 12/09/2013, 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 parks data from the previous year may be used. The CCC ONE
estimator has a complete list of applicable vehicles. Parts numbers and prices should 6e confirmed with the local
c1�al�rship,
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=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. O/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.
12/17/2013 12:39:33 PM 094900 Page 5
(Page 6 of 9)
Claim#: 0949941960101025-01
Worlcfile ID: 47b834c5
Estimate of Record
2010 TOYO VENZA AWD 4D UTV 6-3.5L-F!WH1TE
THIS IS NOT AN AUTHORIZATION TO REPAIR.
THIS IS NOT AN AUTHORIZATION TO REPAIR.
BY SIGNING THIS ESTIMATE THE SHOP AGREES TO HAVE REVIEWED AND DLSCUSSED THE ESTIMATE OF DAMAGE
1NITH A GQCO �I€LD AD]UST�R AND TO MAV€AGR€€D TO ALL VISIBL� (NON-�1IDD€N)DAMAG�R€PAIR,
REFINISH OR REPLACEMENT TIMES. THE SHOP ALSO AGREES TO THE LABOR AND MATERIAL RATES LISTED IN
THE ESTIMATE AND ACKNOWLEDGES THE SUPPLEMENT REQUEST PROCEDURE LISTED BELOW.
SHOP REPRESENTATIVE DATE
NO SUPPLEMENTAL RAYMENT REQUEST WILL BE HONORED BY GQCO UNLESS IT HAS BEEN INSRECTED AND
AUTHORIZED IN WRITING BY A GQCO REPRESENTATIVE BEFORE TNE SUPPLEMENTAL REPAIRS ARE STARTED
AND THE PROPER INVOICES HAVE BEEN SUPPLIED. SHOP PHOTOS OF ANY PART OR LABOR IS NOT A SUBSTITUTE
FOR A GQCO PHYSICAL INSPECTION AND CANNOT BE CONSIDERED. REPAIR SHOPS MUST ALSO PRESEP(T A COPY
OF THE ORIGINAL GEICO ESTIMATE BEFORE ANY SUPPLFMENTAL CHARGES WILL BE CONSIDERED.
12/17/2013 12:39:33 PM 094900 Page 6
(Page 7 of 9)
Claim#: 0949441960101025-OS
Workfile ID: 47b834c5
Estimate of Record
2010 TOYO VENZA AWD 4D UTV 6-3.5L-FI WH1TE
ALTERNATE PARTS USAGE
ALTERNATE PARTS USAGE
Year: 2010 Color: WHITE Int: License: 483KAD Producdon Date:
Make: TOYO Body Style: 4D UN State: MN Odometer: 41704
Model: VENZA AWD Engine: 6-3.SL-FI VIN: 4T36K36B9AU034065 CondiBon:
Alternate Part Type #Of Available Parts #Of Parts Selected
ARermarket 4 0
Opdonal OEM 0 0
Reconditioned 0 0
Recycled 2 0
�,
12/17/2013 12:39:33 PM 094900 Page 7
(Page 8 of 9)
Claim#: 0449941960101025-OS
Woricfile ID: 47b834c5
Estirn�te of Record
2010 TOYO VENZA AWD 4D UTV 6-3.5L-FI WHITE
RECALL INFO
RECALL INFO
Year: 2Q10 Color: WHITE Int: �cense: 483KAD Producdon Date:
Make: TOYO Body Style: 4D UTV State: MN Odometer: 41704
Model: VENZA AWD Engine: 6-3.SL-FI VIN: 4T36K36B9AU034065 Condition:
The National Highway Transportation and Safety Administration(NHTSA)has issued 4 safety-related recall nodce(s)that may apply to the selected
vehicle.
NHTSA ID: 13ViZ3000 Issued: Number of Vehicies: 00007389
Equipment:Other:Labels Southeast toyota is recalling certain model year 2008 and 2010-2013 toyota Tundra,2010-2012 RAV4,2012 toyota
Sequoia,2010-2011 toyo[a Corolla,2010-2011 toyota Camry and Camry hybrid,2010-2013 toyota Highlander and Highlander hybrid,2010-2013
toyota F]Cruiser,2411 toyota Land Cruiser,2410-2413 toyota venza,2410-2Q11 toyota 4Runner,2014-2013 toyota Tacoma,2011-2012 toyota
Sienna,2012 toyota Prius,2013 scion fr-S,2011 scion XD,2011 scion XB,and 2012 scion TC Vehicles.These V�icles were sold with labels that
were outside the allowable one percent of accuracy of actual weight added.Thus,these Vehicles faii to comply with the requirements of Federal
motor Vehicle safety standard(FMVSS)number 110,"tire selection and rims."an inaccurate labd could lead to owners overloading their Vehicles
and bres.An overloaded Vehicle can result in a tlre failure which may result in a Vehicle crash,personal injury,or property damage.Southeast
toyota will notify owners and provide a corrected label with instructions conceming its installation.A small Group of the affected Vehicles will need
additonai remedies which are still being developed.The recall is pl�ned to begin on,or about,may 7,2013.Owners may contact Southeast
toyota at 1-800-301-6859.
NHTSA ID: 13V014000 Issued: Number of Vehicles: 00003235
Seats Souti�east toyota distributors,Ilc(set)is recalling certain models interspersed tlirough modei years 2009 through 2013 as follows:Model year
2009-2012 Tacoma,4Runner,Camry,Camry hybrid,Prius,and RAV4;model year 2009-2010 Avalon,FJ Cruiser,and Highlander hybrid;model
year 2010-2013 model year Corolla,Sienna and Tundra;model year 2009-2013 Highlander and venza;model year 2012 Prius V;and model year '
2010-2012 Sequoia. During modificadon by set to include accessories such as Leather seat covers,seat heaters or headrest dvd systems,these
Vehicles may not have had the passenger seat occupant sensing system calibration tested.Without passing the calibra6on test,the occupant '
s�sing systan may not operate as designed.If the front passenger seat occupant sensing systeln is out of calibration,the front passenger airbags ,
may not deploy or they may deploy inappropriately for the passenger's size and posidon.This could increase the risk of personal injury dunng the ,
event of a Vehicle crash necessitating airbag deployment.Southeast toyota wili notify owners,and Dealers will test tfie sensitivity of the occupant i
detectian sensars,and recalibrate them as necessary.The recall is acpected ta begin during]anuary 2013.Owners may contact Sautheast toyota
at 1-800-301-6859. �
NHTSA ID: 12V091000 Issued: Number of Vehicles: 00186798 i
Exterior Iighting:Brake Iights:Switch toyota is recalling certain mod�year 2009 Camry Vehicles manufactured from July 1,2008,through February �
28,20d9,an�mod�l y�r 2009-2011 v�i5za Vel`iicl�s mai5ufactu��d itbm Ottober 20,2008,througli J�nuaiy 4,2011.du�i�ig�ssembly of tl5e I
contact-type stop lamp switch,silicone grease may have come in contact with the surface of the switch which could cause contact resistance.If
this occurs,waming lamps could illuminate,a no start condition could result,the shift lever may not shift from the?Park?postion,or the Vehicle?S
brake lights could become inoperative.Inoperetive brake lights would not wam other Drivers that the Vehicle is slowing or stopping,increasing the
risk of a crash.Toyota will notify owners,and Dealers will replace the stop lamp switch,free of charge.The safery recall is expected to begin in
early April 2012.Owners may contact toyota at 1-800-331�331. �
I
NHTSA ID: 1OV023000 Issued: Number of Vehicles: 03093000
Vehicle speed control:Accelerator pedal toyota is recalling certain model year 2008-2010 Highlander,model year 2009-2010 Coroila,venza and
matnx passenger Vehicles.The accelerator pedal can get stuck in the wide open position due to its being trapped by an unsecured or incompatible I
Driver's floor mat.This recall is an e�ansion of a campaign of 3.8 million other toyota Vehicles announced in 2009 for tfie same issue(see
09V-388).A stuck open accelerator pedal may result in very high Vehicle speeds and make it difficult to stop the Vehicle,which could cause a
crash,serious injury or death.Toyota will modify or replace the accderator pedals on the subject Vehicles.Floor surface modifications are also
12/17/2013 12:39:33 PM 094900 Page 8
(Page 9 of 9)
Claim#: 0449941960101025-01
Worlcfile ID: 47b834c5
Estimate of Record
2010 TOYO VENZA AWD 4D UTV 6-3.SL-F!WHITE
being considered and will be included for any model for which it is deemed appropriate.Initially,Dealers will be instructed on how to reshape the
being considered and will be included for any model for which it is deemed appropriate.Initially,Dealers will be instructed on how to reshape the
accelerator pedal for the repair.As replacement parts with the same shape as tl-�e modified pedal become available,they will be made available to
the Dealers for the repair.Customers who have had the pedal reshape remedy compieted will have the opportunity to receve a new pedal if they
desire,after replac�nent pedals become available.In addition,toyota will replace any toyota all-weather floor mat in a subject Vehicle with a
newly designed mat,free of charge.For those Customers who have the previous design all-weather floor mat but do not need or want the newly
designed all-weather floor mat,toyota will recover the previous design ail-weather floor mat and reimburse its price.Toyota has not ye[provided
an owner nodfication schedule.Owners may contact toyota at 1-800-331-4331.
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12/17/2013 12:39:33 PM 094900 Page 9
Rer�lal Comparry: ENTERPRISE RENT-A-CAR
-�'' _ GEICO InvoiCe�: D293554-1901
BIII To: GEI55MW RENTAL DETAIL:
GEICO Rental Period: 12/18/13 to 12/31/13(14 days)
ATTN:STEVEN CAZC-WILLIAMS gNled Period: 12M8N3 bo 1?131N3(14 days)
1 GEICO CENTER
MACON,GA 31296 - Rate � Amowrt
14 DAYS @ 24.72 j $346.08'
RENTER INFORMATION: !
Renter. CREERON,KERRY 1 DAYS DW @ 15.60' ' $15.601
�
REt+['CAL INFORMATION: 1 MNRENTL 9.20%� $31.84
Rer�l Branch Locatlon: II 1 MNREGFEE 5.00%I $17.30�
ENTERPRISE RENT-A-CAR(1901) 1 SALES TAX 7.12%� $24.66'',,
1567 COUNN ROAD E E
WHITE BEAR LAKE,MN 551105261 ' Total Char+ges: $435.48 I
Less Maunt Recelved: $15.60 i
(651)484-2911 Total Amount Due: s419.88!,
ADdITIONAL CLAIM tNFQRMATION:
Claim Number 044944196010102501
Claim Type:Insured
Vehicle Condition:Driveable
Date Of Loss:12/9/13
Insured Name:
Owner's Vehicle:2013 NISSAN ROGUE
Additional Driver.
Repalr Facility:
COOK'S ONE STOP SHOP
LEXINGTON,MN 55014
(651)777-5555
VEHICLES RENTED:
Ef(ective Date and Time I Year I Yake I Modsl I VIN I Rate Charged
12/18/13 2013 CHEV IMPA $Zq,72 �
Rental Invoice
Please Retum This Portion with Remittance i
Make PaymeM To: Total Charges: $435.48 I�
ENTERPRISE RENT-A-CAR Less Amount ReCehred: $15.60
P.O.BOX 840086 Total Amourrt Due.................... 5419.88 �
KANSAS CITY,MO 64184-0086 Please indude on your check: '
Federal ID:43-0724835 Invoice#:D293554-1901
(Page 1 of 20)
Claim Number:044944196070102501 Yeer 2010
Version:Edi Make:Toyota
Image FileName:PHOT01 Model:VENZA
Image Label:IMGP9762 VIN:4T3BK3B89AU034065
Image Label:IMGP9762 VIN:4T3BK3BB9AU034065
Insured:CREERON,KERRY Loss Date:12/092013
Policy Number:4272845142 Appraiser:
Clalmant:CREERON,KERRY Photo Added Date:12/17/2013
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Payment Details Page 1 of 1
Claim Number 0449441960101025
Pay To The Order Of ERAC
Financials
Gross Amount $419.88
Net Amount $419.88
Backup Withholding g0.00
Payment Identification
Issued Date 01/22/2014
Mail To Name ERAC
Mail To Address nullnullnull
Memo PROGERTY COVERAGE
Payment Type Electronic funds transfer
Check Number E00450406
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��Kerry Thomas Creeron-Rental �',.Rental Reimbursement '��Loss �.$419.88 .
(2010 TOYOTA) '� . i � '��..
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Payment Details Page 1 of 1
Claim Number 0449441960101025
Pay To The Order Of COOKS ONE STOP
KERRY THOMAS CREERON
Financials
Gross Amount $3,903.83
Net Amount $3,903.83
eackup Withholding $0.00
Payment Identification
Iss�ed Da[e 12/17/2013
Mail To Name KERRY THOMAS CREERON
Mail To Address KERRY THOMAS CREERON,238 DALE ST N,
SAINT PAUL,MN,55102-1738
Memo COLLiSION COVERAGE
ORIGINAL PAYMENT
Payment Type Manual Check
Check Number 613446564
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�'..Kerry Thomas Creeron-Collision =Collision �Loss _$3,903.83 �
'(2010 TOYOTA) � . .__. .._. . .
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