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Glasnapp RECEIV�D �. _ , � FEB 2 6 2�14 I NOTICE OF CLAIlI�I FORM to the City of Saint Paul, Mi�.��LERK Minnesota State Statute 466.45 states that"...every person._.who claims damages from mry municipality...shall cause to be presented to the gwerning body of the municipaliry within 180 days after the alleged loss or irgury is discovered a notice stating the time,place,and circunrstances thereof,mrd the amount of compensation or other relief deMCmded" Please complete this form in its entiretq by clearty typing or printing yoar answer to each qaestion. If more space is j needed,attach additionaI sheets. Please note that yon wiil not be contacted by telephone to clarify answers,so provide as ' much information as necessary to eaplain yonr claim,and the amount of compensation being reqnested. You will receive a ; written acl�owledgement once your form is received. The process can take np to ten weeks or longer depending on the i natare of yonr ciaim. This form mast be signed,and both pages completed. If something does not apply,write`N/A'. , SEND COMPLETED FORM AND OTSER DOCUMENTS TO: CITY CLERK, I� 15 WEST KELLOGG BLVD,310 �I1'Y HALL, SAINT PAUL,MN 55102 First Name V�..•r�' Middle Initial �" Last Name �i--f1`SN f! f�`' Company or Business Name JV r J3 Are You an rnsurance Company? Yes� If Yes,Claim Nwmber? Street Address ,��G �?>�'�''+�ic�i� ,�"U� ` �� Stat� �� Zip Code��') ' City J� 3�"i�'t�`- Daytime Phone L(-�J i)��Cell Phone(_)�- Evening Telephone(_} - � ' Date of Accidenb Injury or Date Discovered � - 3 - ��/� Time ��• �pm Please state,in detaiT,what occurred(happened),and v�+nY you are�ab�it�.ag a claim.Please int3icate why or how yeu feel the City of Saint Paul or its employees are involved and/or responsible for your damages. � r.vFl 5 -�a-t= ��S i Cf�.." ��t��c`,� '�'.`'>/L �771'F�D .C/,��?,i i�C+ �. �14-f-Ii Z�C� t � c� =� � ' v, :�,— a--T ;z1-� �v°z�2.�`�Tt�nJ ccJ rr�+ �'�' � ur�i-Ti�lt v Tu«. -r-RA-F�� .G'-" � �JJ �k f' �i � ,1ls�/V oN tit� G�v�ofL t�riJ/'La: j/�.C�-Ni�Cyr �rCaiFT "%rtz'- 514+VRC. i�v+e -iAt� se� S:� "T�+e�v�a C�vnJ .�V O � Nc+�t.c:cv €�F.�CarE+v c'.L v/�'rrt�=z-� 1.�D�C-A'T�►:__u4�"i' Gf✓�- � �';Z-�2�.:c.T6.-� �,u A� �N �r£'-�4D�f� /`711z'�� NE.�f�-P �i2�-�f�S A N+� 5�� °�'It'-INC: !�i C'..�}75 iA3 wnc�R ✓lL�s•C! �'1 f�C1^!�.__/ M.�.•.% ��/ �t.i.t iNU"� e� �EfC �4'lIT' \� ,�y !' G 1�D? Tc'J �}1-,t-D'.� i`dIL AwQ�E/�GN' �+i2 'YFiF�F�lti , �Vf�l�jJ ►"��1l� rILLC-Q ``%�l� �LC+�'�C �`3'CE AT'1'� Please check the bo�es)that most closely represent the reason for complet�.ng this form: �(,My vehicle was damaged in an accident ❑My vehicle was damaged during a tow ❑My vehicle vvas damaged 1?;�a nothoie or co�edition of th�str°�t C]l�!£y vehicle was damaged by a plow 17 My vehicle was wrongfiilly towed and/or ticketed ❑ I was injured on City properly ❑Other type of property damage-please specify ❑Other type of injury-please specify In order to process your claim van need to include coaies of all aaulicable docnments. For the ciaims types listed below,please be sure to include the documents indicated or it will delay the handliag of your clai.m. Documents WILL NOT be returned and become the property of the City. You are encoura.ged to keep a copy for youiself before submitting your claim form. O Properly 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 i.mpound lot receipt p pther properry da.mage claims:two regair 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:med.ical 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 retarn both pages of Claim Form Failnre to complete and retnrn both pages will resalt in delay in the handling of yonr claim. All Claims-nlease comDlete this section Were there witnesses to the incident? Yes No � (circle) Provide their names,addresses and telephone numbers: Were the police or law enforcement called? �jse No Unlmown (circle If yes,what department or agency? � r�c,+-.. Case#or report#_[� - D�I)-u�� Where did the accident or injury take place? Provide s�treet address,cross street, intersection,name of park or facility, closest landmark,etc. Please be as detailed as possible. If necessary,attach a diagram. � �iC;�t� Z t:�� "f}-,✓� c;- �,T��u�.�� 5r ,�-r G�' �; Please indicate the amount you are seeking in compensa.tion or what you would like the City to do to resolve this claim to your satisfaction. ;� F',�i ��Q�=-p,��,e.� a� '7�f�- ��=h�iG-�.� ��i �`1�-� T �� (�c �'Z�'C.� -F�� _ VehicIe Claims-ulease complete this section ❑check box if this section does not annlv Your Vehicle: Year�nr,� Make 'To�o-rA Model U)C� License Plate Number SzLS {.I CI w State�_Color �,-,r,�Q Registered Owner ��f��.v L� C��i;,�P ✓f�Lv 1-4 �zA-�:�H/',�� Driver of Vehicle �/��R 4,�;Rp� Area Damaged�Y �s.�; F�uB�c-R�. h�-f►0 Z l C�t�-t �' �u.�1�2+2 City Vehicle: Year_�;6�� Make P,��z i Model License Plate Number �f/� �State��Color cv ' Driver of Vehicle(City Employee's Name) sc�,c��•-'� r7�� v�vZ�AR o r Area.Damaged ,��,"�, Injnrv Claims-please complete this section ��heck 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) I When did you receive treaxment? (provide date(s)) I, Name of Medical Provider(s): ; Address Telephone 'i Did you miss work as a result of your injury? Yes No +� When did yo�miss work? _ (provide date(s)) Name of your Employer: Address Telephone ❑Check here if you are attaching more pages to this claim form. Nnmber 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 knowledg� Unsigned forms will not be processed Submitt�ing a false claim can result in prosecution. Date form was completed :�t3 .2�� 1'� i I Print the Name of the Person who Completed t ' Fo L -`I.,f}�N i° Signatnre of Person Malang the Claim: Revised February 2011 I i . l�f Y � � �' � ' . 'I �,�,} '� , ,�4•. t; � � ln f - . � ,-� t�C_�, `r. ? `` . � ' � K � � . , � 'L.� .. . ., ` J j l`� � � � J � � , � -+Y 1.i `�J � � i � i � I � �i��t �;��.;L f /9��' �� x�t�,4 ¢1'��► l�tiG L� �v /�� jr�•�J fi- ��=T+�� t� ,��3tti5 �y �'� ��-�� .5�� 1.��N ./,��v cv.TH�ti' /2'�- /f� �� F'�5wt /►�.`� l�r%iC L � i�i1>O �-TI'�'�4'j&.Z7 �%L ��.'/t-�' •Q/4y�T `'�c-'� i,� C � �': � � �?Pl��2 /�C'i��'!`� ''7��/t1�Y�� // !/LrG'c�(�� Lu v�L� �� -�,Fi��-L�� 7� ,�rG, l/�i`��.C.c', �v�'aV T v�f L,�--y �i�l.�- l�v� /Li�' ��7� ��d ,E'�}-,�'� ctJh-��s' .c�9�1�9li/L'� ��f1� �l�.t�� .E�T �F�IJ.t�� r4-•v17 ��t:�Q �J�t/T C�.�utr' 'i�r�.y - T�f� CZ��'-z� l-l�-�� y��QU �iV o .L:�"i/.�'.�L t, . J�'il�,�i �1=� �"�-ti --- �j ��'��,! t�/L/�',�2: % //� ��ti`T v F ��'•/�c94 �7'�� .c-�'-�' �v�,� �c�� .C,�a��= `T o ' �v Pr''�� rI�� s , o o,�/�c y fu��-,=z��i/�rx -�z= 7��- . � � I I� i . A�Pnt Report Page 1 of 1 LIX'lLClilNO. �YfIQEp � � 14021805 N MrtANUAUN PtBMOP yp�K{�S r4yEp iKW1ED �YN MbrM WTE TNIVI�t � N Y �2 00 '00 Y 2 3 2014 �On 0930 m ROUIF 8Y Y MiNEP OR pplyyYYDI � O N [ �fJlifCilfY1 tl1 ~ / W Of I � 10 Jackson �S� . w � � — y COIMTY NO C ry INT E191 NEFEpFNCf►dNT ROUfE M ROUTf I.B�RFFI.C01P�YR,p1 FfATUqE 62 8„� St. Paul +_. 10 6th St c n, rosrtiar� aa�cauce1trurxn.� ar�re a.w o�er�*us roerron on�aucoueMae[�.t nnc u.ae nn.TUe aa, va O1 D269051736512 MN B O1 O1 A281040838411 MN D O1 r�cron� NNlffMbT.W00LE.1�6T1 arearram wuECmn.uno�[.w*1 o�r[awn� rncron: JEEFREY SCOTT EBERHARDT 06 16 58 VERN HARRISON GLASNAPP 12 10 46 wu�En �DOREss mvin nc �ct �mME4t on�nn wmiC1 nuVEn 05 2823 LEYLAND TRAIL N; 99 1056 GOODRICH AVE N , 99 21 ,r.,ya .s,�ie.aP em:nat:� wren O1 WOODBURY 55125 651-298-5320 SAINT PAUL 55105 O1 NCOMID AOG�El�9 fE% COMf WEEOVT uRMG EEGi WJ4V 88 9Elt F EOPT LiEEOIT �iNBAO �,J��T MN6lV NCOMVo O1 `�E` M g "" 99 98 05 N �� M �9 "`�04 06 05 N O1 KCNI T9E onW T'IE iOMOSn �Rwr6�p�t .wBULwNCEBEAViGE ftlMIMIMpER Kpl MF ORUO rvpE TONWV 1MNlfPORT WWWCl2EMME RIMIMl1�BFA �ear hsr p wa ,rE�r rEtr _ O�vn � � Q OTNER � ' 0 OTNER OCCUP ONNERM�MF MIE ONMERMAYE � OCCUC 02 St. Paul Fire Dept N GI.ASNAPP KATHRYN ANNE N- O1 � ��rn rawso rav¢o veMrvv 90 St. Paul N. 1056 GOODRICH AVE N O1 YENU9E C�rv.6T�TF.TV Py�(ry(t DqlCT OTY.ST�TE.ZM PLL1M6 DIECf "FnUBE O1 MN, 55101 "Id` 05 ST PAUL MN 55105 °'i9 05 O1 ��a � �. .�+ ��+ � �� ,� � ��a 90 pier 100 000 red TOYT UXS 00 SIL 08 pu6�EV f{wiE� DTREO �FM NEO �E�Kt a�[�e y0ti WJW plA1E I M nE6 vFM PEO i M �i wwu OMi6lEv O1 N/A MN 4 02 � 02 595HWU MN 19 O1 � � � O1 � rrstwwrCE Pa�cvwusEn weulWlcElw�t� va,crMwFN City of St.Paul NA Metro Caualty 0528361610 aaco�o w,zwr vu� r�necnw� wave�ooE� ww[o w�[wa �. rn� n,�t IF ACCIOENT INVOLV�D A COMMERCUL MOTOR VEHICIE,SCHOOL BUS,OR HEAO START BU6 x� .m � � REM618ER TO NO11FY THE STATE PATROL(rpWMA uMO Mi t�Y.7N�nd 1N.IN1). � � LOMIEflCL1L VE WCLE MlMBE0.f-MDTdi GpPoER NIJE OOT NWBER COYYO1C4l KWCIf NUI�EN]-110TOR fMRIfM�MMF OOT NM,fEp fASBF�RtIWIfMEi�1E! INf 1M WTEOFtlNi 9Ea TYPE WE MM6 EIECT W�lEV TOH irY.MSPaMT - Oy�� 1MlfNMCE N11MMU119EN � Q O�Mp � QIM� 1A�9EMVKE � MWMUMOEN � p�Ew O� auaa[tlna AwruraE4 � QO+Me� ��/� NvrEROfOMEIiDNMQOMOPERnu1pOElpIWIIp10iDUUGEDVROPEPTVMIDq0.vELLOWGO'/J1lEIIl5) OW�OEDMIO'E�IY�YE1tOWi�GMYiEX V 1 ACCTYP '�U, IW1MTrvF: OfVICE �2 s �. �1 2 . . .. .. . . .. BCK W9 � F`. SPF Ladder 8 was southbound Jackson turnir.g west 03 �' � ` on 6th St. ��TM :, xow�wn O1 I � �p � Yehicle 2 was parked southbound.Jackson on West O1 .,,� � OG � side of street. aea�or,� • I i As Ladder 8 made right turn, the baekwheel �� N ' clipped the bumper of vehicle 2. � ,.aorw��'• eu, �" No injuries reported. 04 98 SPF took photograph's of vehicles. � �,'r `' �C.Mf�i1m �` � � . . . . ... -uun�[e� � � �i �1 �� Fi � . . . wFl1TMER 1 2' i'".a FaESGN :, I . . . O C ;�. . . . . . UGHf R09uK 2i� 01 OL ` rv��..�a: ( , . . . - OXOT(X h ..- .__..__ "'__"_ ` pItEN �;, :F, Y �:; an a.n �'S " . . oucaw , . ..::� '�:! • �2 �1 ��: ... -�.^ .. . ,. ._. ...... . .. . . . . . ...... .. .. .. . . . orr¢eaw+eww[aoe.00e. .00+c. MTR0.�TA�IOM �su*e.�ma �OUa � Officer Eric Meyers 326 �j.Z�J St Paul PD C p.��.. po,�a https://dvslesupport.org/dvsinfo/accidentrecords_2008/Includes_LE/PrintReportIndiv_LE.as... 2/3/2014 ��"��s�� BONFE'S COLLISION CENTER Workfile ID: f900635f '��''�'"�� Federal ID: 410986303 . , _, CAR CARE BY PEOPLE WHO CARE �7 ,.,,, i 380 7TH ST W, SAINT PAUL, MN 55102 � � �� A S Phone: (651) 222-4458 FAX: (651) 224-8640 � �{ � � � S Preliminary Estimate Customer: GLASNAPP,VERN Written By: MATTHEW BEBEL Insured: GLASNAPP,VERN Policy#: Claim#: Type of Loss: Date of Loss: Days to Repair: � � -�- Point of Impact: 11 Left Front Owner: Inspection Location: Insurance Company: GLASNAPP,VERN BONFE'S COLLISION CENTER 380 7TH ST W SAINT PAUL, MN 55102 Repair Faciliry (651)222-4458 Business VEHICLE Year: 2005 Body Sryle: 4D SED VIN: 4T1BE32K95U016090 Mileage In: 92080 Make: TOYO Engine: 4-2.4L-FI License: 595HWU Mileage Out: Model: CAMRY Production Date: State: MN Vehicle Out: Color: GREY Int: Condition: Excellent Job#: TRANSMISSION Body Side Moldings RADIO SEATS Overdrive Tinted Glass AM Radio Cloth Seats 5 Speed Transmission Console/Storage FM Radio Bucket Seats POWER Overhead Console Stereo Reclining/Lounge Seats Power Steering CONVENIENCE , Search/Seek WHEELS Power Brakes Air Conditioning CD Player Wheel Covers Power Windows Intermittent Wipers SAFETY PAINT Power Locks Tilt Wheel Drivers Side Air Bag Clear Coat Paint Power Mirrors Cruise Control Passenger Air Bag OTHER DECOR Rear Defogger Anti-Lock Brakes(4) Power Trunk/Gate Release Dual Mirrors Steering Wheel Touch Cdntrols 4 Wheel Disc Brakes I 2/3/2014 5:05:17 PM 013793 Page 1 Preliminary Estimate Customer: GLASNAPP,VERN Vehicle: 2005 TOYO CAMRY 4D SED 4-2.4L-FI GREY Line Oper Description Part Number Qty Extended Labor Paint Price; 1 FRONT BUMPER 2 0/H bumper assy 1•9 3 Repl Bumper cover w/o fog lamp 5211906909 1 266.57 Incl. 2.6 4 Add for Clear Coat 1.0 5 Repl LT Support 52116AA020 1 19.85 6 Repl RT Support 52115AA020 1 19.85 7 Repl RT Support pin 9024106020 1 1.12 8 Repl LT Support pin 9024106020 1 1.12 9 Repl Energy absorber 52611AA040 1 63.58 Incl. 10 * Repl LT Hole cover silver 5212806907 1 47.70 Incl. S�Q 11 * Repl RT Hole cover silver 5212706907 1 47.70 Incl. 9_Q 12 Repl License bracket 7510106010 1 12.93 0.2 13 Repl Prep unprimed bumper 1 0.7 14 FRONT LAMPS 15 Repl LT Headlamp assy US built SE 8115006190 1 281.00 Incl. 16 Aim headlamps 0.5 17 FENDER 18 Repl LT Fender 53802AA020 1 264.29 2.2 1.8 19 Add for Clear Coat �•� 2p Add for Edging 0.5 21 Dedud for Overlap -0.4 22 FRONT DOOR z3 Blnd LT Outer panel 1.0 24 R&I LT Belt molding 0.3 25 * R&I LT Body side mldg LE&SE silver � 2( R&I LT Mirror assy power w/o heater 0.4 silver 27 R&I LT Handle,outside silver 0.3 Zg R&I LT R&I trim panel 0.4 29 # Repl FLEX ADDITIVE 1 7.00 T 30 # Repl COVER CAR COMPLETE(2 1 14.00 T 0.2 TIMES) 31 # Rpr 2 WHEEL ALIGNMENT 1.0 M 32 # Repl HAZARDOUS WASTE REMOVAL 1 7.00 T 33 # **** POSSIBLE HIDDEN DAMAGE ! 1 ***** 34 # PART PRICES SUB]ECT TO 1 INVOICE SUBTOTALS 1,053.71 7.3 8.3 2/3/2014 5:05:17 PM 013793 Page 2 Preliminary Estimate Customer: GLASNAPP,VERN Vehicle: 2005 TOYO CAMRY 4D SED 4-2.4L-FI GREY ESTIMATE TOTALS Category Basis Rate Cost� pa� 1,025.71 Body Labor 6.3 hrs @ $56.00/hr 352.80 Paint Labor 8.3 hrs @ $56.00/hr 464.80 MechanicalLabor 1.0 hrs @ $ 109.95/hr 109.95 Paint Supplies 8.3 hrs @ $35.00/hr 290.50 Body Supplies 3.6 hrs @ $3.00/hr 10.80 Miscellaneous 28.00 Subtotal 2,282.56 Sales Tax $ 1,355.01 @ 7.6250% 103.32 Grand Total 2,385.88 Deductible 0.00 CUSTOMER PAY 0.00 INSURANCE PAY 2,385.88 ****************************************************************************** THIS IS A VISUAL ESTlMATE ONLY. ADDITIONAL DAMAGE MAY BE FOUND AFfER 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 guilty 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. 2/3/2014 5:05:17 PM 013793 Page 3 Preliminary Estimate Customer: GLASNAPP,VERN Vehicle: 2005 TOYO CAMRY 4D SED 4-2.4L-FI GREY Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from the Guide ARM8521, CCC Data Date 1/17/2014, 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=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=6ureau of Automotive Repair. EPA=Environmental Protection Agency. NHTSA= National Highway Transportation and Safety Administration. PDR=Paintless Dent Repair. VIN=Vehicle Identification Number. 2/3/2014 5:05:17 PM 013793 Page 4 LaMettry's Collision, Glass and More Workfile ID: 42136119 FederalID: 411393089 � � Maplewood �.�� "Every Customer Leaves With A Smile" 2951 Maplewood Drive, Maplewood, MN 55109 Phone: (651) 766-9770 FAX: (651) 766-8660 Preliminary Estimate Customer: GLASNAPP,VERN Insured: GLASNAPP,VERN Policy#: Claim #: Type of Loss: Date of Loss: Days to Repair: 0 Point of Impact: 12 Front Owner: Inspection Location: Insurance Company: GLASNAPP,VERN LaMettry's Collision,Glass and More SELF PAY Maplewood 1056 GOODRICKS AVE 2951 Maplewood Drive ST. PAUL, MN 55105 Maplewood, MN 55109 (651)227-6892 Day Repair Facility (651)766-9770 Business VEHICLE Year: 2005 Body Style: 4D SED VIN: 4T16E32K95U016090 Mileage In: 92103 Make: TOYO Engine: 4-2.4L-FI License: 595HWU Mileage Out: Model: CAMRY LE Production Date: 11/2004 State: MN Vehicle Out: Color: SILVER Int: GREY Condition: Job#: TRANSMISSION Body Side Moldings RADIO Cloth Seats Overdrive Tinted Glass AM Radio Bucket Seats 5 Speed Transmission Console/Storage FM Radio Reclining/Lounge Seats POWER Overhead Console Stereo WHEELS Power Steering CONVENIENCE Search/Seek Wheel Covers Power Brakes Air Conditioning CD Player PAINT Power Windows Intermittent Wipers SAFETY Clear Coat Paint Power Locks Tilt Wheel Drivers Side Air Bag OTHER Power Mirrors Cruise Control Passenger Air Bag Power Trunk/Gate Release Power Driver Seat Rear Defogger Anti-Lock Brakes(4) DECOR Keyless Entry 4 Wheel Disc Brakes Dual Mirrors Steering Wheel Touch Controls SEATS 2/4/2014 3:23:43 PM 053108 Page 1 Preliminary Estimate Customer: GLASNAPP,VERN Vehicle: 2005 TOYO CAMRY LE 4D SED 4-2.4L-FI SILVER Line Oper Description Part Number Qty E�ctended Labor Paint Price$ 1 FRONT BUMPER 2 0/H front bumper 1.9 3 Repl Bumper cover w/o fog lamp 5211906909 1 266.57 Incl. 2.6 4 Add for Clear Coat 1.0 5 Repl License bracket 7510106010 1 12.93 0.2 6 * Repl RT Hole cover black 5212706907 1 47.70 Incl. Q,Q 7 * Repl LT Hole cover black 5212806907 1 47.70 Incl. Q,Q 8 Repl LT Outer reinf 52126AA020 1 31.58 0.1 0.3 9 Add for Clear Coat 0.1 10 * Repl Upper reinf 52029AA030 1 31.42 0.1 Q.Q 11 Repl Energy absorber 52611AA040 1 63.58 Incl. 12 Repl Reinf beam 52021AA040 1 185.75 Incl. �13 FENDER '_. ...__. _.__�___�._. ,___.__ __ _�. ..._._v ____�__ 14 Repl LT Fender 53802AA020 1 264.29 2.2 1.8 15 Add for Clear Coat 0•� 16 Add for Edging 0.5 17 Deduct for Overlap -0.4 �18 FRONT DOOR � �� - 19 Blnd LT Outer panel 1.0 20 R&I LT Belt molding 0.3 21 * R&I LT Body side mldg LE&SE silver 9� 22 # Repl Molding Clean and Retape 1 2.00 0.2 23 R&I LT Mirror assy power w/o heater 0.4 silver 24 R&I LT Handle,outside silver 0.3 25 R&I LT R&I trim panel 0.4 26 # Refn Car Cover �•Z 27 # Flex Additive 1 6.00 28 # Subl Hazardous Waste Disposal Fee 1 5.00 X SUBTOTALS 964.52 6.0 8.2 2/4/2014 3:23:43 PM 053108 Page 2 Preliminary Estimate Customer: GLASNAPP,VERN Vehicle: 2005 TOYO CAMRY LE 4D SED 4-2.4L-FI SILVER ESTIMATE TOTALS Category Basis Rate Cost� Parts 959.52 Body Labor 6.0 hrs @ $56.00/hr 336.00 Paint Labor 8.2 hrs @ $56.00/hr 459.20 Paint Supplies 8.2 hrs @ $38.00/hr 311.60 Body Supplies 4.3 hrs @ $2.00/hr 8.60 Miscellaneous 5.00 Subtotal 2,079.92 Sales Tax $ 1,279.72 @ 7.1250% 91.18 Grand Total 2,171.10 THIS REPORT IS AND ESTIMATE ONLY, BASED ON OUR INITIAL INSPECTION AND DOES NOT COVER ADDITIONAL PARTS OR LABOR WHICH MAY BE REQUIRED AFfER THE WORK IS OPENED UP. PART PRICES SUBJECT TO CHANGE PER THE MANUFACTURER AND AVAILABILITY. WARRANTY: LIFETIME AGAINST DEFECTS IN WORKMANSHIP. WARRANTY REPAIRS DONE BY LAMETTRY'S COLLISION ONLY. NO WARRANTY ON RUST, CORROSION RESISTANCE OR REPLACEMENT RENTAL CARS. OUR ESTIMATED COMPLEfION TIME DOES NOT INCLUDE INSURANCE OR PARTS DELAYS THAT WE MAY EXPERIENCE. 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. 2/4/2014 3:23:43 PM 053108 Page 3 Preliminary Estimate Customer: GLASNAPP,VERN Vehicle: 2005 TOYO CAMRY LE 4D SED 4-2.4L-FI SILVER Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from the Guide ARM8521, CCC Data Date 2/3/2014, and the parts selected are OEM-parts manufactured by the vehicles Original Equipment Manufacturer. OEM parts are available at OE/Vehicle dealerships. OPT OEM (Optional OEM) or ALT OEM (Alternative OEM) parts are OEM parts that may be provided by or through alternate sources other than the OEM vehicle dealerships. OPT OEM or ALT OEM parts may reflect some specific, special, or unique pricing or discount. OPT OEM or ALT OEM parts may include "Blemished" parts provided by OEM's through OEM vehicle dealerships. Asterisk (*) or pouble Asterisk (**) indicates that the parts and/or labor information provided by MOTOR may have been modified or may have come from an alternate data source. Tilde sign (�) items indicate MOTOR Not-Included Labor operations. The symbol (<>) indicates the refinish operation WILL NOT be performed as a separate procedure from the other panels in the estimate. Non-Original Equipment Manufacturer aftermarket parts are described as Non OEM or A/M. Used parts are described as LKQ, RCY, or USED. Reconditioned parts are described as Recond. Recored parts are described as Recore. NAGS Part Numbers and Benchmark Prices are provided by National Auto Glass Specifications. Labor operation times listed on the line with the NAGS information are MOTOR suggested labor operation times. NAGS labor operation times are not included. Pound sign (#) items indicate manual entries. Some 2014 vehicles contain minor changes from the previous year. For those vehicles, prior to receiving updated data from the vehicle manufacturer, labor and parts data from the previous year may be used. The CCC ONE estimator has a complete list of applicable vehicles. Parts numbers and prices should be confirmed with the local dealership. The following is a list of additional abbreviations or symbols that may be used to describe work to be done or parts to be repaired or replaced: SYMBOLS FOLLOWING PART PRICE: m=MOTOR Mechanical component. s=MOTOR Structural component. T=Miscellaneous Taxed charge category. X=Miscellaneous Non-Taxed charge category. SYMBOLS FOLLOWING LABOR: D=Diagnostic labor category. E=Electrical labor category. F=Frame labor category. G=Glass labor category. M=Mechanical labor category. S=Structural labor category. (numbers) 1 through 4=User Defined Labor Categories. OTHER SYMBOLS AND ABBREVIATIONS: Adj.=Adjacent. Algn.=Align. ALU=Aluminum. A/M=Aftermarket part. BInd=6lend. BOR=6oron steel. CAPA=Certified Automotive Parts Association. D&R=Disconnect and Reconnect. HSS=High Strength Steel. HYD=Hydroformed Steel. Inc1.=Included. LKQ=Like Kind and Quality. LT=Left. MAG=Magnesium. Non-Adj.=Non Adjacent. NSF=NSF International Certified Part. 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. 2/4/2014 3:23:43 PM 053108 Page 4