Abdi RECEIVED
APR 0 � 2014
NOTICE OF CLAIM FORM to the City of Saint Pau��Ii�i�s�K
Minnesota Stnte Statute 466.05 states that"...ever.y�persoii...w/2o clainis dmnages from om�naunrcipn/iq•...s/:nll cnuse to he presented to the
governing bocf��of d7e municipnlih�wit/Tin 180 dn��s after the alleged loss or injury is r/iscoi�ered n notice stnting the time,place,and
circiimstnnces tliereof,crnd tlte amount of compensation or other relief demmided."
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 �USS�� Middle Initial�Last Name {���r
Company or Business Name ��.�
Are You an Insurance Company? Yes/IVoJ% If Yes,Claim Number?
Street Address ��� �f�+�' �V�
City S�'�fl � IY�L� State l��if! Zip Code ,13 /d C1
Daytime Phone ( ) - Cell Phone(��+�) 7.�s-,22 J Evening Telephone( ) -
Date of Accident/Injury or Date Discovered M�irG l� �'7� �J/y Time � � am/�
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 Paul or its employees are involved and/or responsible for your damages. �n � W
1P P +/e �z/' ' . � f _1` �iEe
! L c .f � �/ r :t t�n ' .G�+s�e
�(; + : � i //` �n � r• � ;�- nti� J ��� J t+ ;�.� • -" -r fi
. � z� i✓ t ��� •y :,. a e. / 5 �� � f ''..f t��,d�
t� i /gi� �� r�j„�Y
�.r� " , '/,�� . ` y�,. �T y ' -. � �-.ltrif�N��
re�:�e_
.: f�iQ�R�e o� � ///� Clr.6�!�t' r'Pto.vs7` i�11L:`��t t=vt�'c9 .� e 7/a./ 141/4-�''t'J fi�e� %�`i e. l� i I`'T �i�Grek�
P1easC check the box(es)that most closely represent the reason for completing this form: �/t ti, -�-�,- ;n f����,,;, , ���«�:
❑ My vehicle was damaged in an accident ❑ My vehicle was damaged during a tow Q�rr�l.m.,/Q�`
�,'My vehicle was damaged by a pothole or condition of the street ❑ My vehicle was damaged by a plow w n t H�ivf��,
❑ My vehicle was wrongfully towed and/or ticketed ❑ I was injured on City property
❑ Other type of property damage—please specify
0 Other type of injury—please specify
In order to process your claim you 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 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.
O 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
�
�. . _ �.._ w.,
r
Failure to complete and return both pages will result in delay in the handling of your claim.
All Claims—please complete this section
Were there witnesses to the incident? Yes No Unknown (circle)
PrQvide their names, addresses and telephone numbers: ��l� :� �a�i.-Y �- L/rt 1�'srr �6�_'�31=2y�1
��✓,na sa�u�r �T�� �i�i�r�e ij .
Were the police or law enforcement called? Yes No Unknown (circle)
If yes, what department or agency?�_ lt3�� -E'YYil�zv Case#or report#
�,,/��, acl✓if��� ivtt fi5 c=wl� Ci�� '� S�'x��Lt� +�Yk1Gh L ���(.
Where did the accident or injury take place? Provide street address,cross street, intersection, name of park or facility,
closest landmark, e�tc. Please be as detailed as possible. If necessary, attach a diagram.
: � t b� h�o� ti.f �� �' f =7` 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.
Vehicle Claims— lease com lete this section ❑ check box if this section does not a 1
Your Vehicle: Year 2�� 4 Make L ��Y+�1-_Model �/'e c,
License Plate Number ��9 t V'y/ _ State�Color L� v`e-�
Registered Owner �r�,r-��f�� �l�ic/� � �c:,G� rct- �f�,.,c 3`l�y�_
Driver of Vehicle ' ' �
Area Damaged r :.L � c.,L" G-��.jr � � t . h'� �tu,�.��f � ��,��
City Vehicle: Year Make _Model � f��h �f s�%+�. rH
License Plate Number _ State Color `"�`�'`-`r�� �
Driver of Vehicle(City Employee's Name)
Area Damaged
Iniurv Claims please complete this secNon (�check 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)
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 �'3/-z G�/�
Print the Name of the Person who Completed this Form: � s s e�n �- � �� �
Signature of Person Making the Claim:
Revised February 201 1
/ ',\
I
�_.
1 �
i _/r
� co c c-->n< cu : --�
� � m
• rr' � � C � ° o�a m � 3
� r Z = --�� , �
� � � � '_'� a � � � O1 a
rn �r c.a "�i' * z p-
p -v �./� � � t.: n * �, O �� -� --_� r'�
C -T � O p V � W * � v' -O � �p.
�1 �C �� -T7 � � x ; � N C �O C
� d p � � O D ~' * � � D Z � �
� f'l �3 �7 C .�' -C-1 C*O ; N � C� �i �
—! m � Cn
--�� �' � r�'— � Q y� ^T' rn ; .=.�
�' � � � cn� � `
c� � � p�-� e �
G.T� �
� � Z � � � � i w
I
�
, Ail returns and warranty claims must
AUTO 754 Rice St. be accompanied by this original invoice.
St.Paul, MN 55117 See reverse side for additional store policies.
PA RTS Phone: (651) 2249479
Fax: (651) 293-0670 � � '
�araBeta.�ed� �929 WE BUY JUNK CARS! 982148 3/20/201-1 17:-t6
ace-autoparts.COfYI Mon.- Fri.8 a.m.-530 p.m. � �
sales@ace-autoparts.com Sat.8 a.m. - 1 p.m.
; 1
S Preferred Customer S Preferred Customer
� St. Paul, MN 55117 H
D p
T T
O p
SALES PERSON ORDER TYPE TAX ID/CODE SHIP VIA PAGE
1 - 1 ROB COLTNTER SALE MN 1
QUANTITY DESCRIPTION UNIT PRICE EXT. PRICE
1 560-06586 lU-Wheel; Stk# G31467; R09C002; WARRANTY DECLINED $49.00 $49.00
R 001671553; VIN#KL2TD66E89B647290; Requested:2009 AVEO; AVEO
09-11 14x5-1/2 (steel); Q:175894�; D:271396
1 Core charge $0.00 $0.00
R 001671553; D:271396
1 585.18560141U-TIRES $43.00 $43.00
R 001893364; Requested:2009 AVEO ; D:271396
1 TIRE MOUNT CAR $10.00 $10.00
D:271396
DUE TO THE FACT THAT MANY LUG NUTS ARE RUSTED OR
FROZEN ON,ACE WILL NOT BE RESPONSIBLE FOR ANY DAMAGE
TO A CUSTOMER'S CAR- LUG STUD BREAKAGE, ETC.
;�� ���. ��_ .
��.r�`� ecvysed a.rzd a;�e�zuted—�lz'a.c� y�uc�a+i ryr�u�z���a2e/
NOTES:
Ace is not responsible for TPMS sensor.
PAYMENT TOTALS: PAYMENT NOTES: TOTALS:
CHARGE FREIGHT
CASH DISCOUNT
CH ECK TAXAB LE $92.00
CREDIT CARD $109.02 NON TAX $10.00
DEBIT CARD TOTAL TAX $�•02
PAYPAL . ALL MERCHANDISE SOLD AS-IS
RECEIVED BY: INVOICE AMT. $109.02
.v�,_.,�.._d..s.
\
All returns and warranty claims must
AUTO �54 Rice St. be accompanied by this original invoice.
St.Paul, MN 55117 See reverse side for additional store policies.
PA RTS Phone: (651) 2249479
Fax: (651) 293-0670 • � '
��red�.c 1929 WE BUY JUNK CARS! 982149 3/20/201� 17:��
ace-autoparts.00111 Mon.- Fri.8 a.m. -530 p.m. • •
sales@ace-autoparts.com Sat.8 a.m. - 1 p.m. �
� 1
S Preferred Customer S Preferred Customer
� St. Paul, MN 55117 H
D p
T T
O p
SALES PERSON ORDER TYPE TAX ID/CODE SHIP VIA PAGE
1 - 1 DON COUNTER SALE MN 1
QUANTITY DESCRIPTION UNIT PRICE EXT. PRICE
1 TIRE DISPOSAL $3.00 $3.40
� , �
F �
G- q �g
i �? m � �SS
F�� ^� � u7 ��pNj �- ��
Q � � ; # u' `� � � °
� ze*- �' � m w '� � � �
� � O7 co ! o' � _ � � °b c�
� �� �' � � * � � � �
� � p� � � ' � `� ¢ �' � V � � y
`� r_ -,�� O o � « o � L.�� � p �+ n
; * eY- � V �y �-L � C.�
� _ ," * J �� � � W °.� � W
`O ' v c� V'� m � O c� '-�'�
�� j� \ #�� �# � �L� � C��-. �
y � N �1�� �= F.-._ � �] � L.� �
_ - .
._.._.__ ~ � CT] j U� � FU � Q `� � C7
Q L> �� � � � �
� � ��
C
���3P ,,
� _, �-.'., � -
-��...,.
��:��a� auf�se�.'a.rzd a���e:ate,s��l'� y.ocs �i rya'cvc,�'u�czG��
NOTES:
Ace is not responsible for TPMS sensor.
PAYMENT TOTALS: PAYMENT NOTES: TOTALS:
CHARGE FREIGHT
CASH DISCOUNT
CHECK TAXABLE $�•�
CREDIT CARD $3.00 NON TAX $3•�
DEBIT CARD TOTAL TAX $�•�
PAYPAL ALL MERCHANDISE SOLD AS-IS
i
� S3l�IH3�03�J`dAIFJS S30f11�X3. .��- ��=m� m m 10=�t N��� W cn
N lE BJOUI WEB� c a vm, m m c a�W�'m `o c�r vi ~ fn
N JO ESIE1C�dB UOI E�I O OU Jf10/�10 U8W Bd2 S2 E Jn0 ISI JE� o m�L v X� E �A a c� y a 3� � a Z
� I 3 I4 13 U 4 1 S 7 A' mr F-vm ; oar mmc �o � V —
^ �no�(��as ol�(em�a;es�o�a�dwis`�a�sB;e pui;�anau p,no,�•yseo ��o� ' E a- �a m � o `o �~ s` n Y � �
i a43 y31M�BME�12M II.noR`�daa�e no,t�l'uo��ipuo��o ssa�p�BBa� � o A � � m� m� E_`o � m o���o c � m
� �� 'apiyan .lNt/ alonb II.aM •(sn wa� �(n4 i�uop no�( ;i uan3) ;= �m � E m�o H m m�m � � z Q o�
�o I�!�n9 II.aM P�`d i�lwy�no�(usy�a�ow y�om aq Pino��e��no,� �,v ai c o Q�m��� n� o � c�i � ~ w �
�a�oiyaq pas��no��o;yse� Q o L m W t �,� � �� � y'� ���o � �
J c G�. E�.N 9 m.� O O.f0 !0 RS._ u!
� ' 0 ' Q10� 1n0000100 �
W � ' � ' �fcF 01000d'00 �
u � O � lOtO. �OOO1000 � � �
�
� Q
W
� fA LL
a��' � , , c' , ; : : c' . W W u
� . :_� v
.., .
f CNWC7�� • O (n Z
00 ot7 � • �CmC�(V(VX Z W -
U O � � � J dNC'7EfH (A O
Ow � � ' Z F- J_!J JJJJ �I �
: p � FQ--I¢-I-¢-al-¢-F¢-~ a � �.
H> Q � � ~ �F�-�F-�-HI-�-H ~ F UJ w
p � ; � 0 '� � _
o a H � V ~ � �'
�� � O
¢zd' '_' `�' ' � � � N
�x � � � . � G� � � fn
�s o m . � Z � W
c� � ° o � � � —� J
Z
�� '��, : � . , °zz 3� "�� � � 1=
�
Na ' � 3 • ��� �3 � Z
x� w�� E H� . W
� = X d � �~ W �
ZQ Z . � �- NaHW > � JW 1' . a
�����'���0 � d�� .+.. � N¢� w � � � a
U F- ; �1 w c.►_- � 1-Z-� F- - � Q �
•� O J
JLi WU Q � C7o � zEQ � 3Q w W
H �ZN � �j ' z° ' �_ � h� °° '.! J W
Ca -""Z W . �b�D9 . NGiZ Y y�d' �' � �
aS i-. � Zr-i � w HOs O QW � O
"'" ..F- � OJ � U �Z� � �p �. x�� Z H
C.7N .Od � �_ � � �OW � UN 2' ' i �� � �
W �
=N aF � �N • tn0 . �F-•-+ �1 U
' W � a � �V o �1
• Ua � c�iy � g a � WZ N �Or� � O
.F--W Jf � O= � W� � O�N --� NO � w
Z � �' �r� � �
q' U� N `��j�y�''\ �^'� Z a
" z �0 .�, , wwo � x° Y = Y ,t W
�=Z '��y ' N ' �N Qa'~ WQ Q a �J � .
� 0 J • N � Y W O F- H � - [ �. '-
�� LiC � aJ Wlr'�U Q �p N .r � v[, � (/� �
'�'� • Q UW00 (n O�F- � A-!t. R F"' �
�.UJ ..d� ; W � YZ � Q�= J Zd ►-� TJ� �/1 �
' � • WC7 � dfnN � ��� ~ W W '-t� 0.
� O . �� � W N U tn U J � ,/
� U ' =o ' �N~ a ��� W `•� J ^
W� ' F-W� N U W J N = � �I
� Q F-w �� � .,�Q 3 Q O
; �� �o � a�� o °z~� z° �
� N CO F-(n I-¢- J W Z W ~IWi�-�i ly,� W
• �O N� O JWO W v�r� 3 QU '
• E'"7 WU 1- QfnZ N JO :
a
� N
� � � �
� (� ~
� E
� � N M ao � ,„ \ � a .
� �t C �, z � \ �
� � r C � dl 0 o N m
O O � ��
� � � O d � � `� o aZC �» � o
O O � m � Z J � M z w 0 F o �
z � U
A '� V r � T_ r O N w c� p o a W Q z `a
_ .''' V'1 � � �`- � � pp a Z o o °> ° °"
¢ U C
a \ Y Z U W 7 �
Q � CJ Q > p m
� � N (O N t tD v • st � W N N Z w ¢ �m
� � t7 O� M ID 10 O . C � ^ � 0 a
N � � ID O V W ID O.•.. ' 1� Q � u
W 07 fDNr. TO� O �•.r � � � 2
2 � b NI� .-. Xm07 3 C �� � O F w m
U � m - .-.m X o vvi0 w I N°z W m
m _nov
w L O O p X } y J � �
J L = p �
tC ?- p ¢ J X O � v � lf1 � O
a � - o X i > �
Y Y � p V � X U OC W � 00
� o r- o o � X � W F N �n
� a -� o m ... Q X w Y U N 01
e �i, v, o X _
om ' � ° ti �' . � Q o\
w .-. X � v � m O dl � ¢
C .-.>• N � U � .. • O F_ N �Op J W �w�p O
� O_ W ii v � J w w Z � �L
N � » � � LLl a a � � � 2
►` ,• �
- mo N _ m " rc> p .. � ¢ H� � WYd z � �
� O \ 0 O T � 2�' � � i • ty1 N Z m ¢ = ui O � > ° ¢
� � t� .-. .. N �- a .- o J o Q �5 � o a
m o � �-- co ¢ _ �s a r o � a p 5 > > LL c� c°� o a �
U •• m � W � rjr�
ZL/LO b 14L099'J'J ��NLLNIV!!3 ue wo�sp�ou ea pue sp�ou aa eyl
.
.;�
, ,
I
x
\rfa�
. �
�
LUTHER BROOKDALE CHEVROLET
SPG REPAIR ESTIMATE
ESTIMATE # R0489452 ESTIMATE DATE: 03/22/2014
VEHICLE: Aveo VIN: RLiTD56E09B316542
ADVISOR # 210771 DANIEL R BAKER
CUSTOMER # 221450 HUSSEIN ABDI
ADDRESS: 878 FULLER AVE (H)
(B) (EXT)
ST. PAUL, NIN 55104
CUSTOMER QUOTE
OPERATION: 15PTCK Mu ti-Point Inspection A
MISC CODE MISC DESCRIPTION QUOTE MIN QUOTE MAX PRICE
SS SHOP SUPPLIES/HAZARDOUS WASTE 32.00 0.00
L�BOR $: 0.00 I
' PARTS $: 0.00
. GOG $: 0.00
MISC. $: 0.00
TAX $: 0.00
------------------------
SUBTOTAL $: 0.00
--------------------------------------------------------------------------------
OPERATION: E3530 Lower Control Arm, r&r OEM (ADD Alignment) 09/10 LH
QTY PART NUMBER PART DESCRIPTION PART PRICE EXT PRICE
1 GM95975941 ARM 107.72 107.72
MISC CODE MISC DESCRIPTION QUOTE MIN QUOTE MAX PRICE
SS SHOP SUPPLIES/HAZARDOUS WASTE 32.00 26.83
LABOR $: 206.38
PARTS $: 107.72
GOG $: 0.00
MISC. $: 26.83
TAX $: 7.84
------------------------
SUBTOTAL $: 348.77
--------------------------------------------------------------------------------
OPERATION: E8060 Outer Tie Rod, r&r OEM (ADD Alignment) 09/10 LH
QTY PART NZJMBER PART DESCRIPTION PART PRICE EXT PRICE
1 GM93740722 END 81.86 81.86
MISC CODE MISC DESCRIPTION QUOTE MIN QUOTE MAX PRICE
SS SHOP SUPPLIES/HAZARDOUS WASTE 32.00 11.22
LABOR $: 86.33
PARTS $: 81.86
GOG $: 0.00
MISC. $: 11.22
TAX $: 5.95
------------------------
SUBTOTAL $: 185.36
--------------------------------------------------------------------------------
OPERATION: E8040 Inner Tie Rod, r&r OEM (ADD Alignment) 09/10 One
QTY PART NUMBER PART DESCRIPTION PART PRICE EXT PRICE
1 GM95961355 ROD 80.90 80.90
MISC CODE MISC DESCRIPTION QUOTE MIN QUOTE MAX PRICE
SS SHOP SUPPLIES/HAZARDOUS WASTE 32.00 32.00
16:16:11 CUSTOMER COPY PAGE 1 OF 3
LUTHER BROOKDALE CHEVROLET
SPG REPAIR ESTIMATFs
ESTIMATE # R0489452 FSTIMATE DATE: 03/22/2014
VEHICLE: Aveo VIN: KL1TD56E09B316542
ADVISOR # 210771 DANIEL R BAKER
CUSTOMER # 221450 HUSSEIN ABDI
ADDRESS: 878 FULLER AVE (H)
(B) (EXT)
ST. PAUL, MN 55104
CUSTOMER QUOTE
LABOR 308.03
PARTS $: 80.90
GOG $: 0.00
MISC. $: 32.00
TAX $: 5.89
------------------------
� SUBTOTAL $: 426.82
--------------------------------------------------------------------------------
OPERATION: ALFW Align Front Wheels 09/10
MISC CODE MISC DESCRIPTION QUOTE MIN QUOTE MAX PRICE
. SS SHOP SUPPLIES/HAZARDOUS WASTE 32.00 8.52
T�AROR $: 65.50
PARTS $: 0.00
GOG $: 0.00
MISC. $: 8.52
TAX $: 0.00
------------------------
SUBTOTAL $: 74.02
-------------------------------------------------------------------------------- �
OPERATION: H0640 Master Cylinder, r&r 09/10 A/T W/ ABS
QTY PART NUMBER PART DESCRIPTION PART PRICE EXT PRICE
1 GM93744985 CYLINDER 171.30 171.30
1 GM19299818 FLUID 13.64 13.64
MISC CODE MISC DESCRIPTION QUOT�S MIN QUOTE MAX PRICE
SS SHOP SUPPLIES/HAZARDOUS WASTE 32.00 14.55
� LABOR $: 111.90
PARTS $: 184.94
GOG $: 0.00
MISC. $: 14.55
TAX $: 13.46
------------------------
SUBTOTAL $: 324.85
------=-------------------------------------------------------------------------
OPERATION: E3850 Front Shock Absorbers/Struts, r&r OEM (ADD Alignment)
2009 W/ ABS
QTY PART NUMBER PART DfiSCRIPTION PART PRICE EXT PRICE
1 GM96980827 STRUT 140.43 140.43
1 GM96980826 STRUT 140.43 140.43
MISC CODE MISC DESCRIPTION QIIOTE MIN QUOTE MAX PRICE
SS SHOP SUPPLIES/HAZARDOUS WASTE 32.00 32.00
T�AROR $: 521.98
PARTS $: 280.86
GpG $: 0.00
MISC. $: 32.00
TAX $: 20.43
------------------------
SUBTOTAL $: 855.27
--------------------------------------------------------------------------------
16:16:11 CUSTOMER COPY PAGE 2 OF 3
LUTHER BROOKDALE CHEVROLET
SPG REPAIR ESTIMATE
ESTIMATE # R0489452 ESTIMATE DATE: 03/22/2014
VEHICLE: Aveo VIN: KLiTD56E09B316542
ADVISOR # 210771 DANIEL R BAKER
CUSTON�R # 221450 HUSSEIN ABDI
ADDRESS: 878 FULLER AVE �B� (EXT)
ST. PAUL, MN 55104
CUSTOMER QUOTE
OPERATION: E2140 Front St i izer Bar Li s, r&r OEM 09 10 One
QTY PART NL7MBER PART DESCRIPTION PART PRICE EXT PRICE
1 GM95994977 LINK 98.48 98.48
MISC CODE MISC DESCRIPTION QUOTE MIN QUOTE MAX PRICE
SS SHOP SUPPLIES/HAZARDOUS WASTE 32.00 11.22
r.nROR $: 86.33
PARTS $: 98.48
GOG $: 0.00
MISC. $: 11.22
• TAX $: 7.18
------------------------
SUBTOTAL $: 203.21
--------------------------------------------------------------------------------
OPERATION: E9730 Steering Gear/Rack & Pinion Assy, r&r OEM 09/10
QTY PART NL7MBER PART DESCRIPTION PART PRICE EXT PRICE
1 GM95918421 GEAR 860.45 860.45
QTY G.O.G. & SUPPLIES UNIT PRICE EXT PRICE �
1.0 ATF FLUID - DEX 6 4.400 4.40
MISC CODE MISC DESCRIPTION QUOTE MIN QUOTE MAX PRICE
SS SHOP SUPPLIES/HAZARDOUS WASTE 32.00 32.00
T,AROR $: 367.69
PARTS $: 860.45
GOG $: 4.40
MISC. $: 32.00
' TAX $: 62.92
------------------------
SUBTOTAL $: 1327.46
--------------------------------------------------------------------------------
TOTAL LABOR $: 1754.14
TOTAL PARTS $: 1695.21
TOTAL GOG $: 4.40
TOTAL MISC. $: 32.00
TOTAL TAX $: 123.65
--------------------------------
ESTIMATE TOTAL $: 3609.40
CUSTOMER SIGNATURE
Thank you for allowing Luther Brookdale Chevrolet
to prepare your estimate.
********************THIS IS A PRELIMINARY ESTIMATE***********************
This estimate is based on our inspection or by your request. It does not
cover any additional parts or labor which may be required after the
components have been disassembTed. Occasionally, after the work has begun
worn or damaged parts are discovered which are not evident on the first
inspection. Because of this the above prices are not guaranteed, and
are valid for the actual month of this estimate.
Please contact our Service Department to schedule an appointment.
*************************************************************************
16:16:11 CUSTOMER COPY PAGE 3 OF 3
\
�'Vj'O � �'(6 d N��Y __..... w �
'J ;,�' �i���°'.p `«rcL ��'� � ¢ Z
S3l'JI V/�l`dS S c� T .o a i E m c m
U
J:J d3Hl�ll l�810W WB�O N m n Ft-'o m 3 ° E u m c�a� o a � CL �
i;�,i� 1 �dad sa�es mo 3isi�' L � � a m
� �` N T m 'O
N �o�esieadde uoi;B6i�qo ou ano�(�o��uaw�� ui �anau Il,nO�ae6ea ��,° � �9� n� E y� N r o � " 16 °- _
dwis`aalse� P � m o m L � m � t a
mo%��as o��enn�a�es�o�a� uo�i uoo�o ssa�p � �,E s L�m�'� m N m° E`o o ~ w O
� da�g no%}�' i.p .
M 041 4llnn�(enn2�i�leo^b 11 aM 'lsn WO!} l�flq l�u�p n0�aeo ano� >.v oi c o a u L�c`_ �N c N �m � >-
� �� il��(nq II ann P�`d i�1�!43 no�(uey3 aaow UUonn a4 PI c o o �a�t N� c �o a�c m m._ �,
as ano��o�4SE� a a� E.�N�o m._ �
.a��iva�p �
� ,�0000jpO '
oo�°,°. �
J �n � o � �� oi000�o° ;� W
� rn • �� �
w � o �y
v � ; � U W
W �
� a o
W N
z
:c�H � V W
N FN- tVj7 ' ••F- �UO . O N O
� � ,� , � ' � ��m�NN.4 Z � Z
� , 02! � O.l=/1 U' `�f'F- W W
°O ¢Q 'J =
� �� Z �
C� � ,���. � O O Fa-0 H Hp p O O F� . O �.
� �� O I- ��F-F_F-F-F'_ O
o N � J ; � ~ F- N
v,,..., � < . O , � N
p a f- , � �' W
J 4 � � � � /�� Z
�Q � ' N • F .�.�^'7 �
Wm � ' � O �q'_ .. � Z
O � ' .YY g C
. �U � ' } � �F-F" 3H . .
: W
��� �3 0.
r
�H , N � ""'�� � F"�,.. W � a
� „�::Q Q � 3 W � IWi Q �V...� Q �
�,�2 4-' • � ' � '�� N f'W W J K �" J W
3 � g t � � S Z F�- �
.. pJ .pZ ,, � � W�V W •~-+a W Z O
ZQ -.-+0 � z�¢ J 3� (b N
•� �`UF- �, � �� Z� ��� � �� � � �
�'p� �.NNa � . N �� r�.+� �� F�-O� p:.f � �
���c+frH� ' Z Z� � W � � � � r O
I �� Z J � U ' �O� � VN O
; a°� �, r-� �� °n- ; � � �� w �� LL � a
. us.�,'- , �Z n; ' F-a , LL. � ��J � � {LI
�.S<�W �� a Q-""'' �, �N �� CW'.7 O �• '�J= J VWi O � oC Z �
�
� ,�-':S I- , U a � 0 F- ' p 0.N S O � Z � �
N ; N.-i J
.:� Q0 �:.J� � W= � J3� ' WW� � Wa �'
�N � Z�F' '
�=Z � f� . � N ; YW � �OI- a �> W 0.
-gF- � N � U ��W �oF-t- Q'' �
=H 1����.�ILO. � y.Z 1� QO� Q C74W ~ � J LL
•Z ,-,�W O �� , m H � �N .-� N�i V J F- Q O
�U J •-.��dV �� W � �,_�r.., � �WFN' a F-�� � = W
� W� N N Q JQ� 3
,''� V_W O , ~W� � Z F"'r'' Z 0.
n. ' a �o � ��� � �-.1�H w
,,� �-N+O WU t�- QNZ N .�iJO 3
. ��
N ��
� o
� � � J � N ��a
---, _ M � Z � N �z
' � ►� � � Z M r
V � � � w O� � � �
N w o � w a
�' O ¢ � M Z u� a o 0
� ��1 � � Q � U N g a � � m a g ? ° W s � o
� Q O z r Y o
O /� a Q � � w z o =.-
�� �� v' `V 'J v � Z ^ > O N N � m
O V �' f=NN � o�o � m � � w �
� d'3 0 � N N � d' F- o
N C N z w lfl lp
� Vm � � � � � U N � i O �n � o�o
N _ w oC
�- m � ~ j� U H w� � w � c� o�i
O T� td � �Q Z W = F- N ..
, � � YQ aLL' � Qp�� Q ou rl N Mpm �
O W " w m o O� � �
� ��. W Z J J � . �O Z� N � w 2
� ¢ � F-{J 7 J J � z o rz ¢ a �
¢ '�Z w� Q W g ',� J Y i Ix � > a a
2 �w . �LL 0. ��Z : Z v �c 3 �'L {0 .p o ¢ ¢ u w7 S P I e tl W�SPlou e2f e 4 1
r � _ `� t/�GO ' = ? < < - S - U ` �:q�� �wyrMyy3
�� Fr _ ' _
,{
_ . �:
., _ i
� . . ,- „
�
. . . . . . � � - ,.i_ �
�
�
r
Hayford Automotive Repair
3403 CEDAR AVE S. INVOICE
Minneapolis, MN. 55407 4125
Phone-612-729-3223 Org.Est.#006206
INVOICE Print Date : 03l25/2014
2009 CHEVY-AVEO LT
HUSSEIN 1.6L
Lic# : 279 EW Odometer In :
Unit#:
Home 612-735-2219 Vin#:
Cust ID : 2344 Hat#: Ref#:
Part Description/Number Qty Sale Extended Labor Description Extended
LOWER CONTROL ARM REMOVE AND REPLACE: 200,00
0102 1.00 120.00 120.00 -LOWER CONTROL ARM
OUTER TIE ROD
023 1.00 90.00 90.00 REMOVE AND REPLACE:OUTER TIE ROD AND 250.00
INNER TIE ROD INNER TIE ROD
0104 1.00 90.00 90.00
MASTER CYLINDER REMOVE AND REPLACE:MASTER CYLINDER 160.00
0203 1.00 200.00 200.00
QUICK STRUT REMOVE AND REPLACE:QUICK STRUT 200.00
0402 1.00 170.00 170.00
SWAY BAR LINK REMOVE AND REPLACE:SWAY BAR LINK 150.00
0102 1.00 80.00 80.00
RACK AND PIIJION REMOVE AND REPLACE:RACK AND PII�TION 350.00
041023 1.00 880.00 880.00
Shop Supplies 5.00 5.00 Haz.ardous Materials 5.00
[Technicians:Please Select,Technician]
Org.Estimate 52,831.51 Revisions 50.00 Current Estimate S 2,831.51 Additional Cost Revised Estimate Labor: $1,315.00
Parts: $1,635.00
• Sublet: s0.00
Sub: 52,950.00
Tax: $127.12
Total: $3,077.12
[Payments- � Bal Due: �3,077.12
I hereby authorize the above repair work to be done along with the necessary material and hereby grant you and/or your employees
permission to operate the vehicle herein described on street,highways or elsewhere for the purpose to testing and/or inspection. An
express mechanic's lien is hereby acknowledged on above car or truck to secure the amount of repairs thereto.Warranty on new parts is
six months. There is no warranty on used parts. Warranty work has to be performed in our shop&cannot exceed the original cost of
repair.
SIGNATURE................................................................................................ Date......................................... Time.........................
<none>
Page 1 of 1 �.�.�i,,,ro;��
, :� •
� � � � � ` , � -.,
�� . .
f� .• } _ .. �t; .�
f :,r�'� �' -%�; '��� �`"` � � .
• � =-F-'.
� ,.�` � . � � �: o .
. ° � -
� � .�, �
� a�,'. ,Ir� . . �' `'_ ' .
k,y�k` R `it,k �i*sY�q„}.�-� �� , _- �_..r
'� ,� .�%�r'� Si.'X'�.� ,�'1�+�� '#'2j
���. '� } ��� � ����� �`' # . ��� -,� `°-�:
� "_. "* _
!'t�.f.� �� wtX � ` YY�� ��.g �'.`��^'�.
� �
�f y� a� q +y"
Fi"���&„'�"�a,�{'� .,.IhbS ��• '���.• � R � �fi
I 5�;„ �"��� �'.� .- '..
t .:.�,s�r i;��� 4�����in ,� 6y.,.e.
';". �� �'�.y�+'�� $. -�.��� a�.f���
� y f.: , �1,! .:t
,�f `� t-.a 1, A��;�P� -�,..� r�.'y .S t� Z
",�--��gd�.'�F �, {. t � ��y �r Y��i � $�°�;
� �.t" �'T 1 1�`� , ��� .� Tac$'�;;...� ' S- �p ' ;
tfd..�� � �� f'� d,..�� �t ��`'��
�:� �'^ -.,.i . �,y� �'$�. �'.
t _���.'�.��:�� °� .x.� :, �:�? J„�.
' ��K� •.T>s Y ,,,q..�;, �°�>.
�. �� �:'�� y ,
� ��', �;, a , �.
,fr , a
k �' .�����s� -��jg ,s � �<� � ���' ��<°"�"�'.���?n°g
t ' �� at �a..,. .+-�. � �, y� ��� � .s���+'`�i-'`�..
�'.� ,�r��� r.' . � �w� ��'- �1a�r�'�t�rl,
,�_ �r� ��`� f §. �q.o � b t 3 s° .
� 3
`�'.. �.`���.�"�� f` �;,y� a4�`����'� ���4,s.��',�
:� s, z'�> `� b��s� �.� .:'�a� � �r .�a��e�
._�._,.��.— -°-------1'e-�-�` _. . _ .. c ._.�„� _
__. --�-< . . - . �'-� - -
� ,. .. . �,- , ; -�-, � � , �..�q �� �� •°�—��_
�' ...� ,f ��,�-4�
' .
. ' y
, �: � " , � ��
,
�: �tr ; , � �.
# �,� ,� ti, `,a. � �� .,�� , �� . �' � �� °�`:
, ,
,' � '� ,�_ ' � -, •: , .. a;.�
, .
� i�
�} „�, , n. - ___�.. �.,�
�-
, ,
. .' ^�.. � °' . ,J� .fa tr � � ce ' � ��i''� �
„� . �p' . �t� fu"i
� � �t��
� � +�.� �,; A `
1` �- � a� � ;y� °' ''"t� ,,"`��� ;
/ . ����. � '� -.i.. a ��ti ,� #�, �� � �, '
r ;�� �F �" ;� ,v` � • �.. ' �:
� s
�,».a'';�, ,. . -���� 1' . '�-.-..., � i 'a'k!
�, ;s�,. ri
.. . ,
a /
4 a Y .., . . f. . .``� . _ . •°I
rv'' S�v
..s�• ,� : , ;,� �.�� ' ' .,�i
. - _ y �; .
<: . �� �
-� � �
� �.,
_ � _ . .:�,
. . ; . ,: � .,�. �,
. , --
.. . . ;
, � �.
�
. _.
.� � .�� ��4 �_ .��•�;
,� , ,� �
.
� �°� � �
�� �� � ���� � � � �.�
� ,
:. �� . �� F
£ .�
'i , s ���� �, � ;. �
j;; � �' ' � '�•
.; '� � :�� � ' ��s `
� �� ;� � �� .
, � ��� � _= .,� ;
� �. ���� .� • ,,�, � x �°�. 4���.��
� � � �; � ��:� �.� � ��.-Q ����!
' �i =,� �"'"� a ,�*'' ,�"� •; q '�` �. �`�, �`. �#� �
� � �., 4 ¢- -� . , �' � � �,� ° ��� r.�
. � .
�� . , . ,� �
.�� .r, t . _ e�� _ _. � . . . ��" .„ ;r
- "`, '°�-... ..�' j�
r..:�t (.' \ ,. . s#�'� :�.. .�. �� k 8�� ,� *� :•�
�
�l 1 ' 3�`+. . . . �� � ���� �./� ./i�/�` ' �,. i
����,� �.� �€_.�� ! °' y ..� ;�:a • v�� � / . 0 � I:
.. < .
.. . :-
, °
� <., :.l ' A +,
p�a .• "- . 8 ' - . 1..� � .. � � �I
,
.
r ' ' —�.;_ ,..u...e»-•��' - , ���.' .' �4
. ..b. .. ... . . . . , ..�.� . . . " . _..- . . ..� F. '�i�.. .. _ . . � _ a _ . . . ...__ r__._�_...._
.T _'_'. '_ _. _ . ._"._. _ ._._..__..
I _._ _ . . .. E .
. _ _.:\ . • • , ��"�� �
� #
� ---�-= ; � ,
�'�- �-�� `\<< ��;;;
r�" -�� - � �`��
� �.�,¢„� _,� `: �,� �
� ,
��� � , � ��
�� � � � � �.
s ` �
� ���� i �� , ��� ,
� `� � ¢�
� -�°� �� ,� � .�
9 °. f �
_ � .
I .
, , _ r
t � � �,�
�; � v .�� ��° '' � "'-
� � rr ,
��
�'
,.' _ ��-� `��( �� � • „
,., � �
� ,Ia: �� � ,�.
��
�4 �L " _ 4 , ,;�� �� ' }
' `.,j`. � ' � ' ; a '
�4 ,r�.,�... ; . .;-. a ..•�"���.
`o-� � ` . � + f �y("' � .-a H' � .a .
� � '�� �°
-�'��r � � +, ..� 1�'1
�. � ����.=a--- . y� �?` r. ,
e�` � 'r ,k�, '�� � x_� s -i ,:
��:� �:t # ,.t,t.`s��t 'i�� d�, .'. �".^ i x a .'i ���.
�!' ���,, �`��`�+��,� ,N' �'� a a �� i �4
�r . . .Ir� i}...s ' t c �� �S .
a�: � � �4;� z;; .
#�.
� a.. � �E i ` * � .`A
.._9� �.. :1 a."'4 .
- ' 1 _ '�_Y ! ,.. Ai„� i4'.
�'," �.sf� 'S'� �' i � � y, ?•�..
td. �° '� '..+. � �,
.`( �' ������ � 4 4a+ �
� ;. �,. �
a '"��. � �� ,� ` ,�
^. t , °� ♦ � ^-A
•A
�� f . � M � �h�� � '.!ri
:'.�"i2 f. W'€ `" -�' � -+.� � •��.
� ti'
...a.�,� � .�:.' _nP�...�_.a..�2,_... . ,..�..��_? ... _... _ ... .._.. _.� .
�-�� ,:��
��
� � ! .�,.
I 4.-
I� I II
�\\
I I�
a'3 rz<
d'+.
�
;�
d,;
�
4-:
cr' �
. 3�..,' K`..
il y ,
:�-
I I!� '' i ,
����
� � � � °� ���
�
k� �, � ���
� '=� ;_�� �; �:
� �
�
. ��.-
��� ����_,
� �
� ,
�:
'� �° � r ��� �. _,"�_.F`J
� .
,
.'���F k V .1.
�'' f.
d^# �",�2'� s �,
y .-
..
� __ .. � �.a .z�.
&,�iy'.... .
�lr�a�^�
��. �
� _
,� �� ,
^M 3:' � ' �' Y x 4`�
��..• ��... ��bfi �� g�' �������.
�. �9'�l�. #;' 7"�
,�, � E �
�e �
_ �" M^ti
� � � � , � �-�� . � 4
�� i��
�: �� �. � i
� � �
� �.g� n.:. ,T7' 23� ";�` <�
� �' � ,�. � �
��<, ,� � , - � . W,.� �
';� � � ��, � ��� ���
�� ?��� �
� � ., ' � � � �:
,,�� ,r ��� � �``- �� � � �w'�' �'�'�>` ��r ���,-� �
< ,
` �
� �� °,� ,� '�f' # � �^.�,
� � :�,
, � , , . � ��
r^
�. � ?? � .. .� . .`�"�_"' ... ,� .,.��,,�' ,.�' pr�.�.sk� . '*-+-�'�� �.��. . .
' . .. � .. .k� �:. . �� . .. ,.
; . �. �
J
µ ;z!is
� .' � .. . . - n .
: . � . , ' . r , y � ' - ,
, .
. � , . . � d»p?: .:
:. .�.. � �. ... . . .• 'a�-.:� �- .. �:� � 4 '}, .�.Ky�•".
:. . ..... �v . � . . . .��� Hy �:�_ �� y''. ' °
4 =�`�
. " a. . `� � .. "'-,:�.
. - � . - �� � y . { �•�x�
.., a . � ,. ..� . . .
- • ., r , t .'Y'R �..." '�`� �''$b
. . . . . `�_ .�.. �. e
. . . , �_ ' �.. :., ;s e xye •�' . � v M ,
. .. - � : , +� ti.�-�a :.:
. . n- ,,,s �.;�. : �,' __ ..tiu�� s .°�,y�. '-.
�G`� �_}� �'�,,. �� '33. d b . , 'S:x�: .
- 4 ^� ,�� h� `'�°: �^�b :;� '�$ 'a �
` � � �� �'�,� �y z:� �da 'f � � �``
_. . . ��� �� �, L^ 2� �" .=� Y4�' ,� �t .... a : � ,�.. �'
e �.� �. �- z��,`^e �. f � -��'s�'�y�a�.'"��� r �'�
�=�'3,t ~1�� s ����"�..,� �' , w� y� , ) ��.s, � � +' �k� � .Y . } 4� �u.
Y � c� Ri ✓ t.� i % ^. w"u
���' `j4 � � `3:.xfa-�i�J���., � 4._ �i� � �x � v, � � 1,,,,3.�
�Y y,x ,t'z F�%'��' �` a � F ��y�,� F �� � ��i '�'R� . �.
�� . : -� � �'1 Sy �',3 xP a�4E �Fd" k$ _� �f �:.tX
. ? 't�°,�i'•� �#l'�wa' �z �� �k*e t ������iir�� t��� �" .� s. . �, ;
.
�x
� � � t� � �y?}�y ;�'�w�.�$����a,�'7�2�' � �� �� � `�".+'C'�sy'§����d�,.�� � {�}����� � p�*t�
�' S.. � ;"�'F�j,i �` . �g�x ��. 14�1 Y6� a� �` y�2,Z,a �'£' 3,y,, S*�"'�. 3 nnN
.. .� � � �".` #.w .-}�`z � � a ��'« � +-���� ��?r '� ',� _
�'i= �`� �`� � �"�*' i� a � � .; �`�� "'�k �"��,a - a��a.� ,��,�� ,,i�.
�}`� � s����� b" ¢��� � � ������.r��� �'�`r���� ���w�� *�
,§�'o,�i�"" �'� ,w �� � 4 f�¢y� � � '�..n. �w' yF y� 'S^ ¢ .:�,�`'� � * 'g� +� � .
� �+ �',^�s�#�}�-�, ��` �,� _ � y,rX ,,@ ..#�,��� �„�,.. � � �M
��'�'4 k F. .wR:Z i'�'. �S� �y{ '�� xY "4f
�
�
Si �, �'�� .,�, i'[- -�,.'�r �' �°a��#°' � ��Fs `y�'� .� ��d�JL'�1 A 's
� E� � �p ���'k ��,�� g _.� � P. �'� . ��4c . �g ,�f�� ��`' �;�z �L
's; Yt NF �� '�4 � � �,'�' r� � . . �� �' � `�£�� �� Y�
�i*a `� ,M �*f G1 ��. a�: �r t .
�" �.� v,a, '�� .e`�.�,� �' ' _ .�. �#. ,� ,�` � `� ..
� � �� x `n�„� �"��'` , �, �a f, a E��, �si
r`
Y � �� � �h � ��� , Sk- , '� �,�t�,4'� -� -����_,'� k �_ ��� �r `s��'',� .
� � � .:� 5 [�� '�'� � �� � '���: � . � �r: '��5-�'. ,�,..E�y�l�
�..:P� ,y�..µ * i* .- . dY. � .� �., �#.�,"'YX�E �f
.'�� �� � �`� �: ' �. �..
'�,s: -�'�.;.a� `�"��,�� ,�" . � � + -� ',� ��e; ,;_ e, -��;�
� � �_�., � .
r .
��:
� � � � �r �
: �� ' y ,,� ��
. . - ,. . . � . . <:r�
. . .��„ _ <„ � s,, r
� '�t . ... . � ;'� ..
. . , . . . +r r 4e��� �� � �;�
� . � •ara�..w�a� t�„ �'_ }
r �
. . h . . .. - . ' c�+`., 'f��
{': - 5.�.k `�S .FJ
�n#},��,'
. 4 a�r�'��°��'�`�'"" � 1 a ��?!.
,x �,,� : �_ :t�.
,,
� s� t
� �� -.. ���' =.� ,R4�`' �'�
� : x
_. ��:, - � ..� ,
�