Abenth . RECEIVED
MAR 14 2014
� NOTICE OF CLAIM FORM to the City of Saint Paul, lV�i�es�t�ERK
` C
Minnesota Sta�e Statu�e 466.05.rtates that "...everr person...who claims damages from am�municipaliry...shnll cause to be presented to the
governing body of the municipality within 180 days after�he nlleged loss or injury•is drscovered a notice stating the time,place,and
circumstances thereof,and the amount of compensa�ion 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 dces 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 e h zn Middle Initial � Last Name �J ���°�
N�,7Company or Business Name '
Are You an Insurance Company? Yes/IVo If Yes,Claim Number? �``r/�
Street Address -��% ��� �►�n���%-S� / i V� -
,
City '.� �� ���1 v � State ��'��i Zip Code =�-� � � �
Daytime Phone(�:S) ) �/ -��7 C Cell Phone(6.y� ) L/�� G`%�f Evening Telephone(��1��- �`��S+
Date of Accidend Injury or Date Discovered�e� ���ti �C'� ��`
�T / Time � am pm�`;
Please state,in detail, what occurred(happened),and why you are submitting a claim. Please indicate why or how you
feel the City of Saint.1 Paul or}ts employees rej�volved�'and/or resp�nsible for your damages.
� 4:.C 1.5 h� � ���•� G'� ��. 1'�`�a v � '.C i f� �" V�/,-1. L�J�.'h�J (�c�i^ c''�� }���•%? V/' l,
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DLVIi in%'f�, �-���"1 / ��� i✓1t �"/�L, f.,. �: _'r.fic'c�� '� t' � Gti "�;t�
�{-�c."� �JC'. S �:/� C�1 �)t /CC' /1�E'v_r' `f�-� Y_.�7 "��/�i r �-C �-;S-L= fvC" `•
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
❑ Other type of injury-please specify
In order to process your claim vou need to include conies of all anulicable 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 for 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 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
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-please comalete this section
Were there witnesses to the incident? Yes No �_Unkno n: (circle)
Provide their names, addresses and telephone numbers: _T�
Were the police or law enforcement called? Yes� No Unknown (circle)
ff yes, what department or agency? �t ������ }01��2 ����`� Case#or report# 1`�"�'-�`7'��..:J�
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�ietailed as possible. If necessary, attach a dia ra �;,5 �2��,'�lrt'.��/ _,.,
�'-C t�5 ���(.�(� O j� ����Jlf ��fJ� �✓`t' , i -i �S�- �ai v��� �v�f� r���� C�- c�J � f�E tZ'i�� 'L'
Lc� j�,_ . �
Please indicate the amountyou are see�cipg in compens ion or what you would like the City tq do to resolve this clairr�
ta,your tisfaction. � i.-�: ��l�( /,�/�5 z �c �� C i;;�-, 2»,����7�t°c� t�,e c�✓���,c=� �,7-
�'�� �i.�.i� ���-I��r,7�CJ �ic�� 1_ w�_5 �}, VC'r� •- � Gtir �l,Z�r�.lnf Wu-+/� (� 'f� �LL��I..�`._
Vehicle Claims- lease com lete this section ❑check box if this section does not a 1
Your Vehicle: Year ��' Make �-e�>� Model �-���^� �-�,r�+v��n S-�o r� .
License Plate Number �//1-B b`/ State /"11V Color wh% �
Registered Owner �S �' h��n C � : ��-��-�,
Driver of Vehicle S f����� �- �-��'%��i
Area Damaged F-r�.�� Lc%��� t-" ��^�—he�ti� /,'�h t .
City Vehicle: Year ? Make F�c�°•-� Model i'�c ��
License Plate Number ���'7 -���`7 State �''�N Color ��h�f�
Driver of Vehicle(City Employee's Na�ne) �? ��"'' � a�7-53
AreaDamaged �,�� '' (`� 7c�� rfl��.'_;�2�
Iniury Claims-please complete this section �check box if this section does not apply
�How were you injured?
' What part(s)of your body were injured?
�`•J ' 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 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���`�/� r
Print the Name of the Person who Completed ' Form: `�--� � �����' ��'' �b���
Signature of Person Making the Claim: � ,
Revised February 2011 �
- 4
John G. Corcocan
Police Offrcer
POLICE DEPARTMENT
CITY OF SAINT PAUL
367 Gr�ve Sfreet �x
Saiiet Paul,MN 55101
Voice Mail:651-266-9Q00 '
�
Mail Box#:71088
cr,#,�`� �/?3`�
If you have any questiuru regarding your report,call:
Saint Paul Police Records Unit(651)26(r5700
. RAYMOND AUTO BODY, INC. Workfile ID: 577a1891
FederalID: 41-0888257
� 1075 PIERCE BUTLER RTE, SAINT PAUL, MN
55104
Phone: (651) 488-0588
FAX: (651) 488-4794
Preliminary Estimate
Customer: ABENTH, STEVE Job Number:
Written By: STEVE SUNDERLAND
Insured: ABENTH,STEVE Policy#: Claim #:
Type of Loss: Date of Loss: Days to Repair: 0
Point of Impact:
Owner: Inspection Location: Insurance Company:
ABENTH,STEVE RAYMOND AUTO BODY,INC.
2023 PINEHURST AVENUE 1075 PIERCE BUTLER RTE
ST PAUL, MN 55116 SAINT PAUL, MN 55104
(651)251-1425 Cell Repair Facility
(651)488-0588 Business
VEHICLE
Year: 2001 Body Style: 4D VAN VIN: 264GP44331R332170 Mileage In:
Make: DODG Engine: 6-3.3L-FI License: Mileage Out:
Model: GRAND CARAVAN 4X2 Produdion Date: State: Vehicle Out:
SPORT
Color. WHITE Int: GREY Condition: ]ob#:
TRANSMISSION DECOR Rear Defogger Passenger Air Bag
Automatic Transmission Dual Mirrors Rear Window Wiper Anti-Lock Brakes(4)
Overdrive Body Side Moldings RADIO SEATS
POWER Tinted Glass AM Radio Cloth Seats
Power Steering Console/Storage FM Radio Bucket Seats
Power Brakes CONVENIENCE Stereo 3rd Row Seat
Power Windows Air Conditioning Search/Seek WHEELS
Power Locks Intermittent Wipers Cassette Wheel Covers
Power Mirrors Tilt Wheel SAFETY PAINT
Heated Mirrors Cruise Control Drivers Side Air Bag Clear Coat Paint
3/10/2014 1:56:21 PM 019495 Page 1
Preliminary Estimate
Customer: ABENTH, STEVE Job Number:
Vehicle: 2001 DODG GRAND CARAVAN 4X2 SPORT 4D VAN 6-3.3L-FI WHITE
Line Oper Description Part Number Qty Extended Labor Paint
Price�
1 FRONT BUMPER
2 0/H bumper assy Z•4
3 * Repl Bumper cover w/2 tone stone UB321W1AA 1 44. Incl. 1.2
white
4 Add for Clear Coat 0.5
5 ** Repl A/M NSF Absorber 4857883AA 1 230.00 Incl.
6 Repl License bracket 4857351AB 1 30.00 0.2
7 FRONT LAMPS
8 Repl LT Headlamp assy 4857701AC 1 265.00 Incl.
9 Aim headlamps 0.5
10 FENDER
11 Repf LT Fender 5018443AA 1 195.00 2.7 1.8
12 Add for Clear Coat �•�
13 Add for Edging 0.5
14 Add for Clear Coat 0.1
15 Deduct for Overlap -0.4
16 R&I LT Fender liner all Incl.
ll ELECTRICAL j
18 Repl Horn 4686000AC 1 66.95 m 0.2
19 INSTRUMENT PANEL
20 * R&I Upper cover gray 9.�
21 FRONT DOOR
22 Bind LT Outer panel 1.0
23 R&I LT Applique 0.3
24 * Repl LT Upper molding Caravan Sport, RQ49TZZAA 1 111.00 0.3 �
EX,Voyager LX,T&C LX bright
silver
25 Repl LT Nameplate"DODGE" 5113300AA 1 43.75 0.2
26 R&I LT Mirror assy fold away Incl.
27 R&I LT Handle,outside white 0.3
28 R&I LT Belt molding 0.3
29 R&I LT R&I trim panel 0.4
30 MISCELLANEOUS OPERATIONS
31 * Repl Cover car/bag 1 � 0_2
32 # Hazardous waste removal 1 6.00 X
33 # Color tint/color match 1 0.5
34 # Repl Flex additive 1 8.00
35 # Repl Rental car 5 175.00
SUBTOTALS 1,774.70 7.9 6.5
3/10/2014 1:56:21 PM 019495 Page 2
� Preliminary Estimate
Customer: ABENTH, STEVE ]ob Number:
Vehicle: 2001 DODG GRAND CARAVAN 4X2 SPORT 4D VAN 6-3.3L-FI WHITE
ESTIMATE TOTALS
Category Basis Rate Cost$
Parts 1,768.70
Body Labor 7.9 hrs @ $54.00/hr 426.60
Paint Labor 6.5 hrs @ $54.00/hr 351.00
Paint Supplies 6.5 hrs @ $34.00/hr 221.00
Miscellaneous 6.00
Subtotal 2,773.30
Sales Tax $ 1,989.70 @ 7.6250% 151.71
Grand Total 2,925.01
Deductible 0.00
CUSTOMER PAY 0.00
INSURANCE PAY 2,925.01`�
WHILE WE HAVE MADE EVERY EFFORT TO WRITE A COMPREHENSIVE REPORT OF THE VISIBLE DAMAGE TO YOUR
VEHICLE, IT IS IMPORTANT TO REMEMBER THAT THIS IS ONLY AN ESTIMATE.
THERE ARE A NUMBER OF FACTORS THAT CAN AFFECT THE ACTUAL COST OF REPAIRS, INCLUDING BUT NOT
LIMITED TO HIDDEN DAMAGE, PARTS PRICE CHANGES, AND INSURANCE COMPANY INVOLVEMENT.
PLEASE CONSIDER THIS WHEN MAKING DECISIONS REGARDING THE REPAIRS TO YOUR VEHICLE.
AUTO CLUB INSURANCE ASSOCIATION, MEMBERSELECT INSURANCE COMPANY OR AUTO CLUB GROUP INSURANCE
COMPANY (HEREIN INDIVIDUALLY AND COLLECTIVELY REFERRED TO AS ACIA) GUARANTEES THAT 1T WILL
REPLACE THE QUALITY REPLACEMENT PARTS (PARTS NOT MANUFACTURED BY THE ORIGINAL EQUIPMENT
MANUFACTURER) IDENTIFIED ON THE VEHICLE ESTIMATE ASSOCIATED WITH THIS GUARANTEE IF A DEFECT IS
DISCOVERED.
ACIA FURTHER GUARANTEES THAT THE QUALITY REPLACEMENT PARTS, EXCLUDING GLASS AND MECHANICAL
PARTS, ARE CERTIFIED OR VALIDATED TO BE OF OEM QUALITY IN ALL INSTANCES WHEN THIS CERTIFICATION
OR VALIDATION IS AVAILABLE FOR THE PART. THIS GUARANTEE IS IN EFFECT FOR AS LONG AS YOU OWN THE
REPAIR VEHICLE AND IS NOT TRANSFERABLE TO ANOTHER PARTY AT ANY TIME. THIS GUARANTEE COVERS THE
COST OF THE PART, LABOR TO INSTALL, PAINT AND MATERIALS IF REQUIRED, AND REASONABLE RENTAL COST
OF A SIMILAR TEMPORARY REPLACEMENT VEHICLE DURING THE REPAIRS. THIS GUARANTEE DOES NOT COVER
CLAIMS FOR DIMINUTION IN VALUE OR CONSEQUENTIAL DAMAGES.
IF A DEFECT IN A QUALITY REPLACEMENT PART IS D15COVERED, CONTACT YOUR LOCAL ACIA CLAIMS
DEPARTMENT IMMEDIATELY AND ACIA WILL REPLACE THE PART WITH A NEW ORIGINAL EQUIPMENT
MANUFACTURER PART. IF AN ORIGINAL EQUIPMENT MANUFACTURER PART IS NOT REASONABLY COMMERCIALLY
AVAILABLE, ACIA WILL REPLACE THE DEFECTIVE PART WITH ANOTHER QUALITY REPLACEMENT PART.
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.
3/10/2014 1:56:21 PM 019495 Page 3
Preliminary Estimate
Customer: ABENTH, STEVE 7ob Number:
Vehicle: 2001 DODG GRAND CARAVAN 4X2 SPORT 4D VAN 6-33L-FI WHITE
Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from the Guide
DR3TE01, CCC Data Date 3/6/2014, 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 catego�y. F=Frame labor category. G=Glass labor category.
M=Mechanical labor category. S=Structural labor cate�ory. (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.
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.
3/10/2014 1:56:21 PM 019495 Page 4
� Preliminary Estimate
Customer: ABENTH, STEVE Job Number:
Vehicle: 2001 DODG GRAND CARAVAN 4X2 SPORT 4D VAN 6-3.3L-FI WHITE
ALTERNATE PARTS SUPPLIERS
Supplier: Keystone-P+A-Minneapolis
Location(s): 2700 REEVES STREET, DOTHAN AL 36303 (800)448-2677 (334)794-6674
2701 PROGRESSIVE BLVD,SELLERSBURG IN 47172 (800)662-2955 (812)948-2329
2040 CREATIVE DRIVE STE 250, LEXINGTON KY 40505 (800)345-7309 (859) 281-6620
35660 CLINTON STREET,WAYNE MI 48184 (800)594-9084 (734)542-9264
1935 MELROSE STREEr, PINEVILLE LA 71360 (800)737-8686 (318)445-3669
1709 7TH STREET, PARKERSBURG WV 26101 (800)696-3064
580 JOE TAMPLIN INDUSTRIAL BLV, MACON GA 31217 (800)554-4122 (478)746-5164
5235 KOOIMAN ROAD,THEODORE AL 36619 (800)431-2677 (251)653-1942
5830 GREEN POINTE DRIVE SOUTH,GROVEPORT OH 43125 (800)820-3962 (614) 272-8600
11950 MOSTELLAR ROAD,CINCINNATI OH 45206 (800)848-6345 (513)961-5500
1500 WATERFIELD DRIVE,GARNER NC 27529 (800)683-9443 (919)661-5165
2400 KERPER BLVD, DUBUQUE IA 52001 (800)747-2500 (563)556-5030
110 THUNDERBIRD LANE, EAST PEORIA IL 61611 (800)322-2415 (309)698-0700
3017 A HOOVER AVENUE,STEVENS POINT WI 54481 (800)218-4848 (715)342-0772
5658 WESTMINSTER DRIVE,CEDAR FALLS IA 50613 (800)373-6215 (319)277-7005
1700 PARKER DRIVE,CHARLOTTE NC 28208 (800)432-7771 (704) 599-6981
1136 WHITE HORSE ROAD,GREENVILLE SC 29605 (800)275-1816 (864)277-5999
4550 RIVERS AVENUE, NORTH CHARLESTON SC 29405 (800)821-6701 (803)552-4303
6340-A BURNT POPLAR ROAD,GREENSBORO NC 27409 (800) 222-2075 (336)292-3180
110 LOTT COURT,WEST COLUMBIA SC 29169 (800)543-0960 (803)796-6760
501 MANSON ROAD STE 260, LA VERGNE TN 37086 (800)966-3300 (615)226-9090
215 COUNTY ROAD 490,CULLMAN AL 35055 (800)988-0090 (256)734-3411
865 BOLING STREET,JACKSON MS 39209 (800)939-9669 (601)948-8222
2888 CARGO CIRCLE, MEMPHIS TN 38118 (800)976-7898 (901)794-7898
145 CHALLENGER COURT,COLUMBUS GA 31904 (888)336-3379 (706)321-9333
34 REBEL ROAD,JACKSON TN 38301 (800)434-2799 (731)427-2700
2134 INDUSTRIAL BLVD, BRISTOL TN 37620 (888)399-8533 (423)844-0669
3475 NORTHBEND CIRCLE SUITE B,ALCOA TN 37701 (888)289-2309 (865)694-4325
849 WHTi'AKER ROAD, PLAINFIELD IN 46168 (800) 525-4639 (317)895-0530
275 CROSS FARM LANE,YORK PA 17406 (800) 524-4349 (717)843-8927
822 CENTRAL AVENUE, LINTHICUM MD 21090 (800)390-4600 (410)636-4600
2871 BROADWAY, BUFFALO NY 14227 (800)258-0008 (716)894-6262
8 CAIRN STREET, ROCHESTER NY 14611 (800)836-2839 (585)328-4420
433 LAWRENCE STREEf,OLD FORGE PA 18518 (800)446-7066 (570)457-6464
3658 ROUTE 378, BE7HLEHEM PA 18015 (800)441-4200 (610)866-0313
209 ALAMAR STREET, FT.OGLETHORPE GA 30742 (706)866-9199 (800)875-0673
1101 SAM'S AVENUE, HARAHAN LA 70123 (800)783-0473 (504)733-2231
8206 J STREET,OMAHA NE 68127 (800)642-1432 (402)553-0230
615 ALPHA DRIVE REAR, PITTSBURGH PA 15238 (800)445-5215 (724)339-1800
320 DOBSON STREET,WINDBER PA 15963 (800)438-2510 (814)467-5531
5100 WEST 123RD STREET SUITE B,ALSIP IL 60803 (800)622-0096 (708)629-3333
3/10/2014 1:56:21 PM 019495 Page 5
Preliminary Estimate
Customer: ABENTH, STEVE ]ob Number:
Vehicle: 2001 DODG GRAND CARAVAN 4X2 SPORT 4D VAN 6-3.3L-FI WHITE
2700 29TH AVENUE N, ESCANABA MI 49829 (800)833-2030 (906)789-2200
9532 W.CARMEN AVENUE, MILWAUKEE WI 53225 (800)924-8230 (414)463-1019
960 FREEMAN AVENUE SW,GRAND RAPIDS MI 49503 (800)968-9350 (616)452-6066
1149 S PENNSYLVANIA AVENUE, LANSING MI 48912 (800)968-7509 (517)482-0046
4810 KIMMEL DRIVE, DAVENPORT IA 52802 (800) 233-0518 (563)323-3697
3615 MARSHALL STREET'NE, MINNEAPOLIS MN 55418 (800)328-1845 (612)789-1919
5969 HAASE ROAD, DEFOREST WI 53532 (800)356-7252 (608)249-4775
5085 WREN DRIVE,APPLETON WI 54913 (800)422-1995 (920)731-3030
4401 N.W. 112TH STREET, URBANDALE IA 50322 (800)845-1515 (515)727-7857
26691 ECKEL ROAD, PERRYSBURG OH 43552 (877)901-7278 (419)873-1044
3502 W. MCGILL STREET,SOUTH BEND IN 46528 (888)540-8609 (574)294-2600
1435 TRIPLETf BLVD,AKRON OH 44306 (800)822-5555 (216)398-7788
3535 RENNIE SCHOOL ROAD,TRAVERSE CITY MI 49684 (888)200-9323 (231)947-0202
901 W. 12TH STREET, ERIE PA 16501 (814)459-1300 (888)566-7844
Line Description Item# Price
5 A/M NSF Absorber CH1070133N $230.00
3/10/2014 1:56:21 PM 019495 Page 6
•Y
�'�'��'�������f�����: BONFE'S COLLISION CENTER Workfile ID: 3cc7950e
�"��'�d�'�`��"�� Federal ID: 410986303
IWIIWIMYIIIYY iWINYWiWOWW �
CAR CARE BY PEOPLE WHO CARE
380 7TH ST W, SAINT PAUL, MN 55102
�'� . Phone: (651) 222-4458
x
FAX: (651) 224-8640
Preliminary Estimate
�ustomer: Abenth, Steve
Written By: MICHAEL FRITZKAPPS
Insured: Abenth, Steve Policy#: Claim#:
Type of l.oss: Date of Loss: Days to Repair: 0
Point of Impact: il Left Front
Owner: Inspection Location: Insurance Company:
Abenth, Steve BONFE'S COLLISION CENTER
2023 Pinehurst 380 7TH ST W
St. Pdul, MN 55116 SAINT PAUL, MN 55102
(651)492-6986 Cell Repair Facility
;651) 251-1425 Evening (651) 222-4458 Business
VEHICLE
Year: 2001 Body Style: 4D VAN 'I VIN: 2B4GP44331R332170 Mileage In:
Make: DODG Engine: 6-3.3L-FI License: 4116DY Mileage Out:
Model: GRAND CARAVAN 4X2 Production Date: 4/2001 State: MN Vehicle Out:
SPORT
Color: White Int: Condition: Job#:
TRANSMISSION DECOR Rear Defogger Passenger Air Bag
Automatic Transmission Dual Mirrors Rear Window Wiper Anti-Lock Brakes(4)
Overdrive Body Side Moldings RADIO SEATS
POWER Tinted Glass AM Radio Cloth Seats
Power Steering Console/Storage FM Radio Bucket Seats
Power Brakes CONVENIENCE Stereo 3rd Row Seat
Power Windows Air Conditioning Search/Seek WHEELS
Power Locks Intermittent Wipers �', Cassette Wheel Covers
Power Mirrors Tilt Wheel SAFETY PAINT
Heated Mirrors Cruise Control Drivers Side Air Bag Clear Coat Paint
3/10/2014 2:25:43 PM 013793 Page 1
,.
Preliminary Estimate
� Customer: Abenth, Steve
Vehicle: 2001 DODG GRAND CARAVAN 4X2 SPORT 4D VAN 6-3.3L-FI White
Line Oper Description Part Number Qty Extended Labor Paint
Price$
1 FRONT BUMPER
2 O/H bumper assy 2,4
3 <> Repl Bumper cover w/o 2 tone w/o fog 5018608AA 1 574.00 Incl. 2.8
lamps
4 Add for Clear Coat �.1
5 R&I License bracket 0.2
6 Repl LT Bumper cover retainer 4857611AA 1 8.10 Incl.
7 GRILLE
8 R&I Grille Incl.
9 FRONT LAMPS
10 Repl LT Headlamp assy 4857701AC 1 265.00 Incl.
11 Aim headlamps 0.5
12 FENDER
13 Repl LT Fender 5018443AA 1 195.00 2.7 t.8
14 Overlap Major Non-Adj. Panel �.Z
15 Add for Clear Coat ��.3
16 Add for Edging 0.5
17 Deduct for Overlap -0.4
18 R&I LT Fender liner podge Incl.
19 R&I LT Mud guard Caravan SE, Incl.
Voyager dark gray
20 FRONT DOOR
21 Bind LT Outer panel 1.0
22 R&I LT Applique 0.3
23 R&I LT Belt molding 0.3
24 Repl LT Nameplate"DODGE" 5113300AA 1 43.75 0.2
25 * R&I LT Upper molding Caravan SE, 0.3
Voyager dark gray
26 R&I LT Mirror assy fold away Incl.
27 R&I LT Handle,outside white 0.3
28 R&I LT R&I trim panel 0.4
29 # Repl COVER CAR COMPLETE(2 1 14.00 T 0.2
TIMES) ,
30 # Repl FLEX ADDITIVE 1 7.00 T
31 # Repl CORROSION PROTECTION 1 15.00 T 0.5
32 # Repl HAZARDOUS WASTE REMOVAL 1 7.00 T I
33 # Refn MASK&TAPE JAMBS p,3
34 # Refn COLOR, SAND&BUFF PAINT 0.5
35 # Repl CLEAN&RE-TAPE MLDG 1 5.00 T 0.4
36 # PART PRICES SUBJECT TO 1
INVOICE
37 # **** POSSIBLE HIDDEN DAMAGE 1
*****
SUBTOTALS 1,133.85 8.3 8.1
3/10/2014 2:25:43 PM 013793 Paye 2
" ..
Preliminary Estimate
• Customer: Abenth, Steve
Vehicle: 2001 DODG GRAND CARAVAN 4X2 SPORT 4D VAN 6-3.3L-FI White
ESTIMATE TOTALS
Category Basis Rate Cost$
Parts 1,085.85
Body Labor 8.3 hrs @ $ 56.00/hr 464.80
Paint Labor 8.1 hrs @ $ 56.00/hr 453. ,0
Paint Supplies 8.1 hrs @ $35.00/hr 283.50
Body Supplies 4.0 hrs @ $3.00/hr 12.00
Miscellaneous 48.00
Subtotal 2,347.75
Sales Tax $ 1,429.35 @ 7.6250% 108.99
Grand Total 2,456.74
Deductible 0.00
CUSTOMER PAY .00
INSURANCE PAY 2,456.7 -
k k�k*********�K*�K**�K***�k*�k*****************�K****�k****�k�k�k**********�k�k**�k�K********
TI1IS IS A VISUAL ESTIMATE ONLY.
ADDITIONAL DAMAGE MAY BE FOUND AFTER TEAR DOV�✓N OF VEHICLE.
NO GUARANTEE ON RUST WORK. I
k i*************�K****�k*�K�K�k************�K�K�K******�k****�k�k�k�k************�K**********
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.
*You have the right to choose any repair facility to have your vehicle repaired*
THIS IS NOT AN AUTHORIZATION TO REPAIR ALTHOUGH IT IS AGREED BEfWEEN THE REPAIR FACILITY AND
ESURANCE THAT THE ABOVE VEHICLE CAN BE REPAIRED BY THE REPAIR FACILITY FOR THE AMOUNT STATED IN
TIiE GROSS TOTAL SECTION. ONLY THE VEHICLE OWNER CAN AUTHORIZE THE REPAIR OF THE VEHICLE AND ALL
COSTS OF REPAIR ARE THE SOLE RESPONSIBILITY OF THE VEHICLE OWNER.
THIS APPRAISAL WAS BASED ON VISIBLE OR CERTAIN DAMAGES AT THE TIME OF INSPECTION. TO REQUEST A
SUPPLEMENT, PLEASE CALL (866) 514 4788. PLEASE FAX THE SUPPLEMENT AND ALL SUPPORTING DOCUMENTS
WITH CLAIM NUMBER TO (866) 454 0890. THE REPAIR FACILITY AND ESURANCE WILL REACH AN AGREED PRICE
PRIOR TO BEGINNING ANY OF THE SUPPLEMENTAL REPAIRS. THE REPAIR FACILITY WILL THEN SEEK
AUTHORIZATION FROM THE VEHICLE OWNER FOR THE ADDITIONAL REPAIRS. NO SUPPLEMENTS WILL BE
HONORED UNLESS APPROVED IN ADVANCE BY ESURANCE.
RFPAIR FACILITY MUST BE PROVIDED A COPY OF THIS ESTIMATE PRIOR TO COMMENCEMENT OF REPAIR.
F;�ILURE TO DO SO MAY SUBJECT THE VEHICLE OWNER TO ADDITIONAL EXPENSE.
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.
3/10/2014 2:25:43 PM 013793 Page 3
Preliminary Estimate
• Customer: Abenth, Steve
Vehicle: 2001 DODG GRAND CARAVAN 4X2 SPORT 4D VAN 6-3.3L-FI White
Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from the Guide
DR3TE01, CCC Data Date 3/6/2014, 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
I�een 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 syrr�bols that may be used to describe work to be done or parts to
be repaired or replaced: '
SYMBOLS FOLLOWING PART PRICE:
�r�=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 categpry. F=Frame labor category. G=Glass labor category.
N1=Mechanical labor category. S=Structural labor cat�gory. (numbers) 1 through 4=User Defined Labor Categories.
OTHER SYMBOLS AND ABBREVIATIONS: I
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.
-ri�e 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 Safery Administration. PDR=Paintless Dent Repair. VIN=Vehicle Identification Number.
3J10/2014 2:25:43 PM 013793 P��)�'4