The URL can be used to link to this page

Xiong, Soua & Mailee Kong (2) AMERICAN FAMILY ,�� - 6131 Blue Circle Drive � Eden Prairie MN 55343-9130 I amfam.com Mailing Address:PO Box 1246 I Minneapolis,MN 55440-1246 ( Phone:t952)933-4884 June 23, 2014 39-PMZ001 RECEIVED CITY CLERK CITY QF ST PAUL JUN 2 5 2�1� 15 WEST KELLOGG BLVD ST AUL MNL 55102 CITY CI.ERK RE: Your Insured Name: St Paul Police Department Your File Number: Unknown Our Claim Number: 00-345-072902 3905 Our Insured: Soua& Mailee Kong Xiong Date of Accident: May 17, 2014 Total Claim: $9,203.25 Company Portion: $8,703.25 Insured's Deductible: $500.00 Dear City Clerk: We are notifying you that American Family Mutual Insurance Company has now made payment on the above referenced claim and our supporting documentation and proof of payment is enclosed. The facts support that this incident was caused by your insured's negligence. Please forward the total claim amount indicated. We will reimburse our insured their deductible. We look forward to concluding this matter soon. Thank you for your attention to this matter. When sending correspondence, please include 'Attn: Subrogation Dept'. Respectfully, �� Pat Zoerb Subrogation Senior Adjuster American Family Mutual Insurance Company 1-800-MYAMFAM (1-800-692-6326) X 66303 pzoerb @ amfam.com Fax: (866) 833-5599 www.amfam.com/claims Enc: I - - NOTICE OF CLAIM FORM to the City of Saint Paul, Minnesota 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 municipality within 180 days after the alleged loss or injury is discovered a notice stating the time,place,and circumstances thereof,and the amoun�of compensation or other relief demanded." Please complete this form in its entirety by clearly typing or printing your answer to each question. If more space is needed,attach additional sheets. Please note that you will not be contacted by telephone to clarify answers,so provide as much information as necessary to explain your claim,and the amount of compensation being requested. You will receive a written acknowledgement once your form is received. The process can take up to ten weeks or longer depending on the nature of your claim. This form must be signed,and both pages completed. If something does not apply,write`N/A'. SEND COMPLETED FORM AND OTHER DOCUMENTS TO: CITY CLERK, 15 WEST KELLOGG BLVD, 310 CITY HALL, SAINT PAUL, MN 55102 First Name PAT Middle Initial M Last Name ZOERB Company or Business Name AMERICAN FAMILY INSURANCE EIVED Are You an Insurance Company? Yes/No If Yes,Claim Number? ��—D��2 JU N 2 5 2014 StreetAddress P O BOX 1246 CITY CLERK City MINNEAPOLI S State MN Zip Code 5 5 4 4 0 Daytime Phone�9 2�6 3 2 6 X 6 6 3CeIl Phone N - NA _ ( � Evening Telephone( ) Date of Accident/Injury or Date Discovered 0 5-17—2 014 Time 4 :3 0 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 Paul or its employees are involved and/or responsible for your damages. THE ST PAUL POLICE VEHICLE WAS WB IN AN ALLEY AND ENTERED FORFST STRTKING THE MOUA VEHICLE. THE ST PAUL POLICE VEHICLE WENT UP A RB AND �nNmTNUED ' SB ON FOREST. OUR INSURED DRIVER, SENG CHRISTOPHER XIC1T , WAS ND nN FOREST. OUR INSURED DRIVER PULLED TO THE RIGHT CURB AND STOPPED mHF ST PAi1T pOLICE VEHICLE LOST CONTROL, CROSSED THE CENTER LINE AND STRU K O R TNSTRFI�' S STOPPED '' VEHICLE. Please check the box(es)that most closely represent the reason for completing this form: �f 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 i In order to process your claim vou need to include conies of all anplicable 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 �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 comulete this section Were there witnesses to the incident? Yes No Unknown (circle) Provide their names, addresses and telephone numbers. Were the police or law enforcement called? (Yes�� No Unknown (circle) If yes,what department or agency?ST PAUL POL�"CE Case#or report# 14 0 9 5 615 Where did the accident or injury take place? Provide street address,cross street,intersection,name of park or facility, closest landmark,etc. Please be as detailed as possible. If necessary, attach a diagram. SEE ATTACHED POLICE REPORT. LOCATION OF THE ACCIDENT WAS 553 FOREST, ST. PAUL, MN. 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. $9 ,2 0 3 . 2 5 Vehicle Claims-nlease comolete this section ❑ check box if this section does not applv Your Vehicle: Year 2003 Make CADILLAC Model ESCALADE ESV License Plate Number VXT4 3 8 State I"IN Color BLACK Registered Owner SOUA XIONG Driver of Vehicle SENG CHRISTOPHER XIONG Area Damaged FRONT & DRIVER SIDE THAT TOTALED VEHICLE. City Vehicle: Year 2�0 9 Make FORD Model CVP License Plate Number NONE LISTEDState Color BLACK Driver of Vehicle(City Employee's Name)DANIEL CHRISTOPHER MICHENER Area Damaged FRONT Injury Claims-nlease comnlete this section � 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 attac�ing more pages to this claim form. Number of additional pages�. i �� 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�� l� Print the Name of the Person who Completed t ' orm: �1� ��''��-� Signature of Person Making the Claim: � Revised February 2011 ' AMERICAN FAMILY � • - 6131 Blue Circle Drive I Eden Prairie MN 55343-9130 ( amfam.com Mailing Address:PO Box 1246 I Minneapolis,MN 55440-1246 I Phone:(952)933-4884 June 23, 2014 39-PMZ001 CITY CLERK CITY OF ST PAUL 15 WEST KELLOGG BLVD 320 CITY HALL ST PAUL MN 55102 RE: Your Insured Name: St Paul Police Department Your File Number: Unknown Our Claim Number: 00-345-072902 3905 Our Insured: Soua & Mailee Kong Xiong Date of Accident: May 17, 2014 Total Claim: $9,203.25 Company Partion: $8,703.25 Insured's Deductible: $500.00 Dear City Clerk: ! We are notifying you that American Family Mutual Insurance Company has now made payment on the I above referenced claim and our supporting documentation and proof of payment is enclosed. The facts support that this incident was caused by your insured's negligence. Please forward the total claim amount indicated. We will reimburse our insured their deductible. We look forward to concluding this matter soon. Thank you for your attention to this matter. When sending correspondence, please include 'Attn: Subrogation Dept'. Respectfully, �� Pat Zoerb Subrogation Senior Adjuster American Family Mutual Insurance Company 1-800-MYAMFAM (1-800-692-6326) X 66303 pzoerb @ amfam.com Fax: (866) 833-5599 www.amfam.com/claims Enc: (Page 1 of 2) - � Accident Report ��D7� �+�� Page 1 of 2 i t� � ��p S � �.�.- p 14095615 f7 '� � � �� ';�&� .'�ty''raT, ►'.'„�� .rrua� n�er wwn wio �w •+ ' cuu� ' ' ni auu� o t� � �3 b0 �f2 �2 5 17 2014�at 16�0 � N �w.e a,raoaaoaar�wa �* � y 10 553 Foreat ��: : �.�""'� °" ——.�R 8� 8w°� � N aouarw .naa wrr +nntsn oma�nucmruqa�waw < 0 62 �� Saint Paul f_ � 10 553 Forest � rans ariauenrrra.i �� un ows ��ius�iasia arnauea�aerana.t r. ann a�as atu�n� � ueaae 3 � Q1 Y965205661220 MN D 01 �O1 M0008129230905 WI D 99 � o �.� wuev.sumawn aa.a.nm� �wsswxcumswn o�+co.�m, raaa� � 9� DAt�IIEL CHRSSTOPNER MICHENER 04 07 79 '�Tou Lee Moua 08 29 92 � 09 367 Grove Street Np 02 '890 Forest Street, #1 N� 02 O1 v NmG �1G�wLa ryp�,a �yd O1 Saint Paul 55106 Saint Paul 55106 'risa9�2s�2 pl �w �a evr �eori �ww aaer �uw � �a �vr �w�a �ucr wav �cow O1 � M �4 09 Ol OS e � M �9 04 06 05 C Ol .m,. ,,.. eua ,r.. �n�e..n�w�a�e.uu..a.a�.s «,rK..a .u. ,n. bw „na ,ows ,ti�a..i.nwa.o�s �urr�a '� 93 �` 98 Y� p� '� 98 1�` 98 Y� o� St Paul Med 14426 - . . .. . .. _. . .. ....,. eed. awawae ni[ oY.nnwr � -��-ne�. . �y 0� St panl Police D Sr't�*�._. N Nhi.a Kou Moua I$ 07t �a„� rmos— - 01 1675 £nezgy Park Drive Y? �•1130 Meridan Hgts Dr , #8 �C Olm vG1�[ anNwea wro oe�t QR�Ra - N1W0 �� 07 Saint Baul, MN 55108 'iff� . O7 . Esu Claire, WI 59703 "L� �i Ol I1 Eord CvP 200 Bik Hond Civi 99 62k if�" m�ev w�va� a� vn�nies ag�e�o�� wr n�oe� sram wwieo wrw.� anuv OS MN 019 O1 38 O1 215RLT WI 019 O1 pl "` O1 �9 � i41CYMll�a MwI�N�+A fa+.YMI�W City o� Saint Paul Seif Insured State Parm 2300733C2423 j � +w[ra w..ed octvn �wa.aai rACCDE11TUlVOWffiACOItY6tC�LYOTOR wan� wx�v nr �"Fj � VlWttl.lCNOOlEt140ki(l�D6TI1Rr9Yi � ruj rn[ REYE]16FRTD11011F771QdfAtRMT7ep.(npn6tlu�eir W 1tl.TifaMltlAiit�, ea1v161LYMaawll�af.�amllcA�waw�t mtnYU mwa�cwra[�t�rq.�omawqwua OmMllill i �r++ma+rs ua a �a trw u� �w.a ua wav m�err nwia�r 8henq Houa 03 03 5/'� M 09 09 Ofi O5 N N; �"' ��`�` ""��` D� � 0� iwc� wwru 1 � Q°"r � - 0„Y wm�sa wew�� D� awm�aonaiawomwioiormoomesno.vo�r�sor�nanNaa�rnia�nmrumm� - ei.ww�eraarnnw.m.a� _ Hilario ld4t Gareta Retaiaing pail � � �� rS, � .i wpawt . aMCe 01 1t 98 wc.. � � ----- „"�---- ?',._ __ . 03 ' �. Vehicle !1 (marked polfce vehicle) was W/8 in the� � „�,s � �ro� k �. al2ey and en£ered the roadxay,�strikinq vehicie–; �q O1 � ;.A.2 Vehicle Nl Chen went,up pYBLxh4 cttL'b. � 98 a� f ,, continuad to Czavel S/a, strikinq the North � �;, rnet o! a�c�aent reWlninq++ali in front o£.547 .rm N� �' • • Eoreat Vehicle then traveled back onta the i ^"«"�� .... roadway, E/B'anfl struck VehScle M3;�tf3ch hard ' 0@ gg � ?'� pulled to the right curb dnd sLOpped prior to :� � �r� � � being struek Dcivee ot Veh B1 (dilicer} ` : � sustained minor cutslabrns.i,pns to hi,8 lelL _ �� I F 3s � � hand/arm Driver ot Veh f2 snitially claimed no t �_ � +�,Lnjusy 6ut latar camplainad of neck�fhend.gain �� ,� � I ;� � was transported to Regions Hospital Photos .. � �� : 'Yaken CRO mapped scene xo�eitarinns•fssved OB � - �• aC scene � uvn �10�lV �� •• � - ��. J Si` _ i� OZ i� ,,� r � � w,ouw .� ———..._. ��..__� t• '1 °� '��. O1 � OS ' e�na.w+uwe.m..eee. � � .eoe. � p.wnN+n wo,. i Serqeant Patricia Engiund 262 �L � � St Paul PD - /� ar.+� []owu �,�� ,��'t' • �1 ,7 V� ' ��V https.//dvscrash.x.sta.te.mn.us/dvsinfo/accideatrecords 2008/Tncludes_LE/PrmtReporttndiv 5/17/2014 (Page 2 of 2) • - Accident Report i� � _ � p" 10GLGl7MD ,�IOO� - � :5+�- �� f�� j e 14095615 ? �� ' -�;�,;��r t'.� �.$k=,qc�'� • ��.,�.; d� � Kr+�eww �usn�o. w+nu ia�m , �r � oyi oir � � A � � # ti # � O - C�1 �[ �� O�oi� a� '8� B� 4.lw Q� � — L.1 O CaM1YND � Mial 116vmQrOR !OUl�M �0/1Ctt11OCLRI�VR.A1Rl7Y�t O �511� }� („ ,'If1 t'-R t M R-I • 'A J � tancx uwu��saus�eua tnat a,ut e�rtAi+a rener �euRatraawroe.a ~ aaoe aar atuna nmmR� N � O1 5599103766923 (yttl Q � .�c+w: ,uu�vw,c�cscwn aaca.�m wrown,�cwcwq oiao.a.m rwan,� � SEPIG CHRISTOPHER XIONG OS 23 93 N 11 �1931 Selby Atienue tZj ��` �, � � v /1t�7y cmiswLa a s�er(u OI St Paul Park 55071 � �[wo � �rr .��r �w�o �ar wav .� � ��o� �r[iorr �..0 rscr outw �mw 02 � M �4 04 06 OS N 7 raa rrt eun Tx mros nu�eroia ,u�wourw� wrr� � �rra � ms roiav m��sa�r�+re.s+anra u�w�et � se �` 98 t� a;�„ ? ? o o, . . - --.. . ... . . . .-•- - - p IX ONG SOUA�. �T �� v�n. 03 840 JODY LN S 'Y� �' '� K"'� vaus mt�w�as +uua owsr m�wca � o�eet rd+se O1 COTTAGE GROVE MN 55026 't�i 41 ? oiowe .�a �mn ,�w ma 'w�a reee� .rM ma. ow�oe ii c�wz ssc 20o aLx �.� �. .,� ,..,� ,�. �a�° .._. M,.. n.� ..M� ,,;, ,.�, �� .� 04 VXT93B NIlZ 4 02 02 .aN�.a .aicr�...e� . �aur� rwnwo American Family Mutu 1376620378FPPAMN � w�[wr wrnm rrra�s�• w�mn BACGOlNtlIVOLVEDACOiOIE�ALY070R �m �uira �er � ? �TONOTFYTI�sTATfi�AiROI. ��•iCf1OCL61A.ORl�AD6TARf6W ' ru� � (MCU4WundKit67/P.7i��nd1�0Al11�. -! m�o�o�WeotrYOe�-�vtatulVCe+we emra�a mYW�l�e�o[rME�t.Yalo0dwleerrE obrw�u namowrmmim wr awcer wx nn ua ,w+o uer wsv mws ncwean .rtenst wNN.m 'F � �� ,Y �+.�arra arxa�� . 9 a� f Q� II��1�X W IH�G `�� . � 0�, � a+w�araw�awaanv�anwomaart�erwuamr�nnruaoRnsa.00� owuamrwanrre�ara�sra�a "'�' I, � I �oetrr � - ".,.� . - ."T^'»"' . . . �� .� . .. . wwwnc awx , �oaitw ' i , ! _. _ i,� . _ . — _ � I', � � ` ... « _ _. � t �� I,I _ �r � � � W�IOOf : .t. .�. �� .. � ... �... y Mlm I ' •j _1" 4. I �� j 11AOS �. �. , �tY� � , � r � a ' �� . _ �rcuem�, � � � " .� "' '�reens�� ww i - �F � 0 v udn �owr _ — _ } s -• -,.. '� �� ; �. '� � M Se gea�nt Patsicia Enqlund 262 3t Paul PD �� p� https.//dvscrash.x.state.mn.us/dvsinfo/accidentrecords 2008/Includes_LE/PrintReportIndiv 5/17/2014 ICS: Vehicle Total Loss Worksheet Date Prepared: 06/19/2014 02:50 PM CDT Clm#: 00-345-072902 Polic holder: XIONG,SOUA&MAILEE KONG DOL: 05/17/2014 Polic : 1713766203 Status: OPEN Summa TLW Status:Completed as Total Loss Owner: XIONG,SOUA 8�MAILEE Primary File Handler: Stephanie Nustad(SKN001) KONG Year/Make/Model: 2003/CADILLAC VIN:3GYFK66NX3G322049 License Plate:VXT438 License Plate State:MN Mileage: 120884 Miles /ESCALADE ESV Total Loss Worksheet TLW File Handler Type: Amfam File Handler TLW File Handler: Ann M Cartwright(AMC037) Office: Eden Prairie N Pd 35 Unit: SHELLEY PD 36 Vehicle Dama e Estimate Amount i Comments Re air Estimate: $10412.52 Rental: $0.00 Hidden Dama e: $1000.00 atdditional r r time on 1/4s, air ride sus nsion li ht on,tires, Diminished Value: $0.00 Other: $0.00 Dama e Percenta e Ad�.: $0.00 Dama e Percenta e: 99.33% Airbags Deployed: NADA Book Valuation NADA Clean Retail Value: $0.00 Comments: Autosource Request#34222668,version 1 Integrated NADA: No Condition Ratin s Ad'ustments IComments Exterior: 0% $0.00 Tires: 0% $0.00' Interior: 0% $0.00 Mechanical: 0% $0.00, Overall Ratin : 0% $0.00 Ad usted Book Value: gp.� Excessive Milea e Mileage Over 150,000 Miles: 0.0 Per Mile Adjustment: $0.00 NADA Base Clean Trade In Value: $0.00 NADA Mileage Adjustment: $0.00 ', Excessive Mileage Adj.Options: NONE Suggested Excessive Mileage Adj.: $0.00 ', Excessive Mileage Deduction: Comments: I Excessive Milea e Ad.Book Value: $0.00 OO 2014 American Family Mutual Insurance Company.All rights reserved.Internal use information. Page 1 of 3 ICS: Vehicle Total Loss Worksheet Date Prepared: 06/19/2014 02:50 PM CDT Clm#: 00-345-072902 Polic holder: XIONG,SOUA&MAILEE KONG DOL: 05/17/2014 Polic : 1713766203 Status: OPEN Settlement Sources Amount Comments Automated: $10483.00 Autosource Re uest#34222668,version 1 Private Com 1: $0.00 Private Com 2: $0.00 Dealer Com 1: $0.00 Dealer Com 2: $0.00 Dealer Quote 1: $0.00 Dealer Quote 2: $0.00 Other Source: $0.00 Prior Damage Estimate: $0.00 Prior Damage Adj.Options: Current Brand: Clear Title Brand Adj.Options: High Prior Damage Adj.: 0.0% $0.00 High Salvage Title Adj.: 0.0% $0.00 Low Prior Damage Adj.: 0.0% $0.00 Low Salvage Title Adj.: 0.0% $0.00 Valuations Amount Comments Value Before Ad�ustment: $10483.00 Prior Dama e Ad'ustment: Title Brand AdLstment Misc Additions: $0.00 Misc Deductions: $0.00 � ACV: $10483.00 Misa Fees: $�7.q2 I, License Registration Transfer: $60.75 Deductible: $500.00 Estimated Salvage Value: $925.00 Salvage Quote From: IAASalvageW Quote Number: Syste S m Recove � Recovery Status: Released Method of Sale: Via Salvage Vendor Stock Number: 13210100 ! Salvage Vendor. IAA-ST.PAUL Address: 1280 JACKSON ST ' ST.PAUL,MN 55117 , Contact Person: Jason Phone Number: 651-488-0581 Fax Number: 651-488-3644 I Email Address: Date Cailed: 05/22/2014 Date Moved: 05/22/2014 i Brand Title As: Salvage Ke s Obtained: Yes OO 2014 American Family Mutual Insurance Company.All rights reserved.Internal use information. Page 2 of 3 ICS: Vehicle Total Loss Worksheet Date Prepared: 06/19/2014 02:50 PM CDT Clm#: 00-345-072902 Polic holder: XIONG,SOUA&MAILEE KONG DOL: 05/17/2014 Polic : 1713766203 Status: OPEN Vehicle Pa ment Apply Sales Tax: Yes Sales Tax Rate: 6.500% Sales Tax Amount: $681.40 AmFam GAP Coverage: No GAP Payment Adjustment: $0.00 GAP Payment: $0.00 Comparative Negligence: No Total Payment Due: $10742.57 Net Cost To Repair: $10912.52 Payment To Lienholder: $0.00 Net Cost To Replace: $9817.57 Pa ment to Owner: $10742.57 Advanced Char es Char e T e Amount Comments Towin : $0.00 Tear pown: $0.00 Stora e: $0.00 Other Costs: $0.00 Total Cost: $0.00 TLW File Handler: Ann M Cartwright(AMC037) Date Settled: 05/28/2014 Pa ment B User ID: AMC037 Name: Ann M Cartwri ht Date Paid: 05/28/2014 , i OO 2014 American Family Mutual Insurance Company.All rights reserved.Internal use information. Page 3 of 3 ICS: Vehicle Salvage Log Date Prepared: 06/19/2014 02:50 PM CDT Cim#: 00-345-072902 Polic holder: XIONG,SOUA&MAILEE KONG DOL: 05/17/2014 Polic : 1713766203 Status: OPEN . . Summa Salvage Log Status:Completed Owner: XIONG,SOUA 8 MAILEE Primary File Handler: Stephanie Nustad(SKN001) KONG Year/Make/Model: 2003/CADILLAC VIN:3GYFK66NX3G322049 License Plate:VXT438 License Plate State:MN Mileage: 120884 Miles /ESCALADE ESV Salva e Lo File Handler Type: Amfam File Handler Salvage Log File Handler: Dianne Poteet(DXP003) Office: Eden Prairie N Cas 2 34 Unit: SHERMAN SUPPORT 9 Recove Recovery Status: Released Method of Sale: Via Salvage Vendor Stock Number: 13210100 Salvage Vendor: IAA-ST.PAUL Address: 1280 JACKSON ST Gross Bid: $2,300.00 ST.PAUL,MN 55117 Pool Charge: $95.00 Contact Person: Jason Pool Title Charge: Phone Number: 651-488-0581 Fax Number: 651-488-3644 Email Address: Date Cailed: 05/22/2014 Date Title Sent: 05/30/2014 Date Moved: 05/22/2014 Date Sold: O6/11/2014 Date Completed: O6/19/2014 Brand TiUe As: Salvage Keys Obtained: Yes ' Net Recovery: $2,039.32 Percent Recove : 19.45% I Vehicle Pa ment ACV: $10,483.00 Apply Sales Tax: Yes i Sales Tax Rate: 6.500% I Sales Tax Amount: $681.40 % AmFam GAP Coverage: No GAP Payment Adjustment: $0.00 GAP Payment: $0.00 Comparative Negligence: No Total Payment Due: $10,742.57 j I Payment To Lienholdec $0.00 � Pa ment to Owner: $10,742.57 Advanced Char es Char e T e Amount Comments Towin : $70.68 Tear pown: $0.00 Stora e: $15.00 Other Costs: $80.00 admin fee Total Cost: $165.68 Salvage Log File Handler: Dianne Poteet(DXP003) Date Settled: 05/28/2014 Pa ment B User ID: AMC037 Name: Ann M Cartwri ht AMC037 Date Paid: 05/28/2014 OO 2014 American Family Mutual Insurance Company.All rights reserved.Internal use information. Page 1 of 1 udaExplor� Autos o u rce Market-Driven ValuationT"" American Family Insurance is dedicated to Market Value delivering exceptional service to you in reference to your claim 00345072902-0 on a �1 �,483 2003 Cadillac Escalade ESV STD 4WD 4D Wagon.American Family Insurance has selected Audatex, an independent vehicle valuation company, to prepare a comprehensive vehicle valuation for your vehicle.This valuation report was prepared specifically for your vehicle and represents a fair and accurate value driven by the retail used vehicle market. In these pages, you will find: _> Vehicle Inspection _> Valuation Detail The Valuation Process The breadth and depth of the Audatex used vehicle database makes Autosource the most comprehensive market-driven valuation process available. Audatex has been determining locally sensitive, fair, and accurate market values for vehicles since 1985, with more than 30 million vehicles valued. The Autosource Market Value includes vehicles for sale at dealerships and private party sellers,starting right in the local market. Vehicle Base Mileage Options Condition Market Value -=� <., n,� �kf`�''�' �� + �.ti. "�' � + �, �i = Vehicle Description VIN: 3GYFK66NX3G322049 , 2003 Cadillac Escalade ESV STD 4WD 4D Wagon 120,884 Miles Actual 8cyl Gasoline 6,0 4 Speed Automatic Interior Duat Air Conditioning Alarm System Dual Zone Auto A/C 2003 Cadillac Escalade ESV STD 4WD 4D Wagon , _ Second Row Bucket Seats Cruise Contro/ Cenfer Console Garage Door Opener Heated Frnt&Rear Seats Intermittent Wipers Lighted Entry System Overhead Conso/e Power poor Lodcs Power Windows Power Adjustab/e Pedals Dua/Power Seats Rear Heater Leather Seats Leather/Wood Steer Wheel Tachometer Trip Computer Third Seat(trucks) Tilt Steering Wheel Wood Interior Trim Exterior BodysideCladding RunningBoards Rear�ndowDefroster Fender Flares Key/ess Entry System Heated Power Mirrors Privacy G/ass Roof/Luggage Rack Rear�ndow�per/Washer Side Mirror Lighting Power Moonroof Tonneau/Cargo Cover Tinted Glass Trailer Hitch Chromed Alloy Wheels Mechanicai Auto Adjust Suspension Auto Load Leveling Power Brakes Power Steering Stability Cntr/Suspensn Camper/Towing Package Safety Automatic Dimming Mirror Dua/Airbags Anti-Lock Brakes Fog Lights Reverse Sensing System Side Airbags Traction Control System Entertainment Bose Sound System OnStar System In-Dash CD Changer&Tape Rear Seat Audio Controls XM Sateflite Radio Strg Wheel Radio Control Aftermarket Rear Entertainment Systm Remote Starter Trim Levels 'STD *Indicates your trim level A detailed description of your vehicle was provided to Autosource by a trained appraiser. Through a partnership with Cadillac, Audatex AudaVIN retrieves the individual vehicle specifications to identify the vehicle specifications including equipment,packages, engine and transmission. Contact American Family Insurance if revisions are necessary. The bold/italic font indicates options reported by the manufacture. I Vehicle Condition � I Seats Minor Wear.Wrinkling On Left And Right Front And Rear Seats Not Cradced Thru Slightsmoke Smell I Ca�pets Minor W�ear. Light Staining Around Mats Alot Of Debris From Loss In Interior So Di�cultto Comment Any Further Int Trim Minor Damage. Light Wear On Buttons On Dash And Rear Center Area, Light Soiliing On Alltrim Dash Has Small Spot Either Black Paint Or Ink Right Side Glass Good.Numerous Small Pits In Windshield Headliner Good.Very Negligible Wear On Headliner Body Moderate Damage.Rust Starting On Left Side Quarter,This Area Has Been Repaired Previously Paint Moderate Damage. Vehicle Very Dirty At Time Of Inspect, Scrapes 2 On Rear poor Credit Card Inlength Rock Chips On Hood, Light Buffable Scratches On Right Fender Rated Astypical ExtTrim Moderate Damage. Rear Cover Paint Flaking In Multiple Areas Chrome Coming Off All 4 Rims Inspoke Areas Engine Minor Wear.Nable To Open Hood To See Rated As Typical Transmission Minor Wear.Unable To See Rated As Typical Front Tires New:$186 04/25/14 Rear Tires New:$186 04/25/14 Claim 00345072902-0 Request 34222668 Page 2 2003 Cadiilac Escalade ESV STD 4UVD 4D Wagon . .Market Overview ��_�;;:� . ' ft, What is my Vehicle Market Value based on? �: � , � '' 550711257,Grey Cloud Island Minnesota--Research for your vehicle was based on market analysis originating from your zip code. - ,� Fair and accurate market valuations must balance geographic location with comparability of one r � vehicle to others. Having the largest and most current database of vehicles for sale provides a ,� comprehensive view of your vehicle's market. In addition to the vehicle inventories received directly " � .f � ' n from dealerships, Autosource finds comparable vehicle information for vehicles in the same places � ` � most buyers look for them--local and national intemet websites, vehicle guides, publications and t , .� partnerships representing more than 10,000 independent vehicle sources. fr� How did Autosource make adjustments for my vehicle? The main factors that affect the retail selling price and marketability of a vehicle are mileage, equipment and condition. Therefore, Autosource valuations include adjustments that fairly consider the differences between your vehicle and the typical vehicle found in the market. o Mileage � Typical mileage is based on hundreds of inspected vehicles � The mileage adjustment is based on 225 cents per mile specific to the 2003 Cadillac Escalade ESV STD 4WD 4D Wagon in the state of Minnesota.Mileage adjustments are capped at 40%of the vehicle's starting value. o Equipment � Typical equipment represents the most common options for the 2003 Cadillac Escalade ESV STD 4WD 4D Wagon in the United States � Equipment adjustments are based on the manufacturer's retail price,adjusted for depreciation o Condition � Typical condition is based on hundreds of inspected vehicles � Condition adjustments are based on a percentage of the vehicle's value Valuation Detail Typical VehiGe Your Vehicle Adjustment Vehicle Base Price Grey Cloud Island Market 59,514 Odometer 158,043 Mi(Typical) 120,884 Mi(Actual} 835 Other Optional Equipment Remote Starter 240 Radio/Phone/Alarm Options XM Satellite Radio 35 Body Condition Minor Damage Moderate Damage -300 Ext Trim Condition Minor Damage Moderate Damage -65 Front Tires Condition Good New 112 Rear Tires Condition Good New 112 Market Driven Value $10,483 Deductible -500.00 Net Adjusted Market Value $9,983.00 o Adjustments of Special Note � The loss vehicle was reported to have an aftermarket Rear Entertainment Systm. The date of purchase was not provided. � The loss vehicle was reported to have an aftermarket Remote Starter purchased 4 months ago at a cost of$370. Claim 00345072902-0 Request 34222668 Page 3 2003 Cadillac Escalade ESV STD 4WD 4D Wagon , '.Comparable Vehicle Details The following comparables represent a sample of the vehicles used to calculate the Vehicle Base Price. The complete list of vehicles is available upon request.These vehicles have been recently offered for sale in the market place. 1 2003 Cadillac Escalade ESV STD 4WD 4D Wagon 3GYFK66N83G322339 Adjusted Price: $10,225 Stock#2140269. 125,702 Miles. 4 Speed Automatic,Anti-Lock Brakes,Automatic Dimming Mirror,Auto Adjust Suspension, Auto Load Leveling, Alarm System, Aluminum/Alioy Wheels, Bodyside Ciadding, Bose Sound System, Cruise Control, In-Dash CD Changer&Tape, Center Console, Dual Airbags, Dual Air Conditioning, Rear Window Defroster, Heated Power Mirrors, Dual Zone Auto AJC, Dual Power Seats, Fender Flares, Fog Lights, Garage Door Opener, Heated Frnt & Rear Seats, intermittent Wipers, Keyless Entry System, Lighted Entry System, Leather Seats, Leather/Wood Steer Wheel, Overhead Console, OnStar System, Power Brakes, Power poor Lodcs, Privacy Glass, Power Steering,Power Windows, Power Adjustable Pedals, Roof/Luggage Rack, Rear Heater, Running Boards, Rear Seat Audio Controls, Reverse Sensing System, Rear Window Wiper/Washer, Side Airbags, Stability Cntrl Suspensn, Side Mirror Lighting, Second Row Bucket Seats, Strg Wheel Radio Control, Tachometer, Trip Computer, Traction Control System,Third Seat(trucks),Tonneau/Cargo Cover,Tinted Glass,Tilt Steering Wheel,Wood Interior Trim.Offered for sale by University Auto Sales in Saint Paul, MN, (651)641-1616. Advertised 05/12/14. The advertised price of$10,995 was adjusted to account for typical negotiation. 2 2003 Cadillac Escalade ESV STD 4WD 4D Wagon 3GYFK66N13G291208 Adjusted Price: $8,361 Stock# PL30465B. 139,053 Miles. 8 Cylinder 6.0 Engine, Automatic Transmission, Automatic Dimming Mirror, Auto Adjust Suspension, Dual Air Conditioning, Dual Airbags, Auto Load Leveling, Alarm System, Anti-Lock Brakes, Dual Zone Auto A/C, Bodyside Cladding, Second Row Bucket Seats, Running Boards, Bose Sound System, Cruise Control, Center Console, Rear Window Defroster, Fender Flares, Fog Lights,Garage Door Opener, Heated Frnt&Rear Seats, Intermittent Wipers, Keyless Entry System, Lighted Entry System, Heated Power Mirrors, Overhead Console, OnStar System, Power Brakes, Power poor Locks, Privacy Glass, Power Steering, Power Windows, Power Adjustable Pedals, Dual Power Seats, Roof/Luggage Radc, In-Dash CD Changer&Tape, Rear Heater, Rear Seat Audio Controls, Reverse Sensing System, Rear Window WiperMhasher, Side Airbags, Stability Cntrl Suspensn, Leather Seats, Side Mirror Lighting,XM Satellite Radio, Strg Wheel Radio Control, Leather/Wood Steer Wheel, Tachometer, Trip Computer, Traction Control System, Third Seat (trudcs), Tonneau/Cargo Cover, Tinted Glass, Tilt Steering Wheel, Aluminum/Alloy Wheels, Wood Interior Trim. Offered for sale by White Bear Acura-Subaru-Isuzu in Saint Paul, MN, (651)481-7000.Advertised 05/21/14.The advertised price of$8,990 was adjusted to account for typical negotiation. 3 2003 Cadillac Escalade ESV STD 4WD 4D Wagon 3GYFK66N13G272173 Adjusted Price: $9,289 Stock# 3227C. 126,881 Miles. 8 Cylinder 6.0 Engine, Automatic Transmission, Automatic Dimming Mirror, Auto Adjust Suspension, Dual Air Conditioning, Dual Airbags, Auto Load Leveling, Alarm System, Anti-Lodc Brakes, Dual Zone Auto A/C, Bodyside Cladding, Second Row Budcet Seats, Running Boards, Bose Sound System, Cruise Control, Center Console, Rear Window Defroster, Fender Flares, Fog Lights, Garage Door Opener, Heated Frnt&Rear Seats, Intermittent Wipers, Keyless Entry System, Lighted Entry System, Heated Power Mirrors, Overhead Console, OnStar System, Power Brakes, Power poor Locks, i Privacy Glass, Power Steering, Power Windows, Power Adjustable Pedals, Dual Power Seats, Roof/Luggage Radc, In-Dash CD I Changer&Tape, Rear Heater, Rear Seat Audio Controls, Reverse Sensing System, Rear Window WipedWasher, Side Airbags, Stability Cntrl Suspensn, Leather Seats, Side Mirror Lighting,XM Satellite Radio, Strg Wheel Radio Control, LeathedWood Steer I� Wheel, Tachometer, Trip Computer, Traction Control System, Third Seat (trudcs), Tonneau/Cargo Cover, Tinted Glass, Tilt ' Steering Wheel, Aluminum/Alloy Wheels, Wood Interior Trim. Offered for sale by Davis Motors in Litchfield, MN, (320)693-3224. j Advertised 05/19/14.The advertised price of$9,988 was adjusted to account for typical negotiation. 4 2003 Cadillac Escalade ESV STD 4WD 4D Wagon 3GYFK66N23G308839 Adjusted Price: $10,225 Stock# G26696. 171,000 Miles. 8 Cylinder 6.0 Engine, Automatic Transmission, Automatic Dimming Mirror, Auto Adjust Suspension, Dual Air Conditioning, Dual Airbags, Auto Load Leveling, Alarm System, Anti-Lodc Brakes, Dual Zone Auto A/C, Bodyside Cladding, Second Row Bucket Seats, Running Boards, Bose Sound System, Cruise Control, Center Console, Rear Window Defroster, Fender Flares, Fog Lights, Garage Door Opener, Heated Frnt& Rear Seats, Intermittent Wipers, Keyless Entry System, Lighted Entry System, Heated Power Mirrors, Overhead Console, OnStar System, Power Brakes, Power poor Locks, Privacy Glass, Power Steering, Power Windows, Power Adjustable Pedals, Dual Power Seats, Roof/Luggage Rack, In-Dash CD , Changer&Tape, Rear Heater, Rear Seat Audio Controls, Reverse Sensing System, Rear Window WiperlWasher, Side Airbags, ' Stability Cntrl Suspensn, Leather Seats, Side Mirror Lighting, Strg Wheel Radio Control, Leather/Wood Steer Wheel, Tachometer, Trip Computer, Traction Control System, Third Seat (trucks), Tonneau/Cargo Cover, Tinted Glass, Tilt Steering Wheel, Aluminum/Alloy Wheels,Wood Interior Trim. Offered for sale by Salmon Motors in Tracy, MN, (507)629-3400.Advertised 05/18/14. The advertised price of$10,995 was adjusted to account for typical negotiation. 5 2003 Cadillac Escalade ESV STD 4WD 4D Wagon Adjusted Price: $7,673 Claim 00345072902-0 Request 34222668 Page 4 2003 Cadillac Escalade ESV STD 4WD 4D Wago� , 125,000 Miles. 8 Cylinder 6.0 Engine, Automatic Transmission, Automatic Dimming Mirror, Auto Adjust Suspension, Dual Air Conditioning, Dual Airbags, Auto �oad Leveling, Alarm System, Anti-�ock Brakes, Dual Zone Auto A/C, Bodyside Cladding, Second Row Bucket Seats, Running Boards, Bose Sound System, Cruise Control, Center Console, Rear Window Defroster, Fender Flares, Fog Lights, Garage Door Opener, Heated Frnt& Rear Seats, Intermittent Wipers, Keyiess Entry System, Lighted Entry System, Heated Power Mirrors, Overhead Console, OnStar System, Power Brakes, Power poor Locks, Privacy Giass, Power Steering, Power Windows, Power Adjustable Pedals, Dual Power Seats, Roof/Luggage Radc, In-Dash CD Changer&Tape, Rear Heater, Rear Seat Audio Controis, Reverse Sensing System, Rear Window Wiper/Washer, Side Airbags, Stability Cntrl Suspensn, Leather Seats, Side Mirror Lighting, Strg Wheel Radio Control, Leather/Wood Steer Wheel, Tachometer, Trip Computer, Traction Control System, Third Seat(trucks), Tonneau/Cargo Cover, Tinted Glass, Tilt Steering Wheel,Aluminum/Alloy Wheels, Wood Interior Trim, Good Exterior. Offered for sale by Dealer in Duluth, MN, (218)269-7999. Advertised 04/10/14. The advertised price of$8,250 was adjusted to account for typical negotiation.VIN Not Advertised. Minnesota Regulatory Statement A person who files a claim with intent to defraud or helps commit a fraud against an insurer is guilty of a crime. Report Generated by Audatex,a Solera Company US Pat.No 791274062 US Pat.No 820051362 US Pat.No 8468038B2 O 2014 Audatex North America, Inc.All Rights Reserved. I Claim 00345072902-0 Request 34222668 Page 5 2003 Cadiliac Escalade ESV STD 4WD 4D Wagon � rAdministrative Data Ann Cartwright Claimant American Family Insurance Insured Xiong,Soua&Mailee Kong Minnesota Branch Claim 00345072902-0 Scanning Center Loss Date 05/17/2014 6000 American Parkway Loss Type Collision Madison WI 53783 Policy 1713766203 Other Owner Name XIONG Owner First Name SOUA&MAILEE KONG inspection City St Paui Inspection State MN Reinspection Event VINSOURCE Analysis VIN 3GYFK66NX3G322049 Decodes as 2003 Cadillac Escalade ESV STD 4WD 4D Wagon Accuracy Decodes Correctly History Activity was reported AudaVIN Yes o Autosource activity:(NONE). o Autotrak activity:(NONE). o Audatex/Estimating activity: Reported by AMERICAN FAMILY - EDEN PRAIRIE CRP on July 21, 2010. Call them at (651)459-0581 regarding Claim:00241611536-OC.DOL:06/25/2010 with a primary impact point of Non-Collision. o Sales history activity:(NONE) NICB Report NICB/ISO A075 AMERICAN FAMILY MUTUAL INSURANCE COMPANY I Member '; Claim 00345072902 Loss Date 05/17/14 Type of Loss PROPERTY/CASUALTY Phone 6082424100 Vehicle Salvage Title Summary No Branded title history found for this VIN. Processed on 05/22/14 7:38 AM.Title History is powered by Experian AutoCheck.The Experian data contained in this report involves the conveyance of information provided to Experian by other �qutoCtieck sources.Accordingly, neither Experian nor Audatex can,or will,be an insurer or guarantor of the .. . , accuracy or reliability of the Experian data Reported Phone Number Analysis No Vehicles Advertised at(651)329-1753 No Vehicles Advertised at(651)528-0354 Claim 003450?2902-0 Request 34222668 Page 6 2003 Cadillac Escalade ESV STD 4WD 4D Wagon � +Vehicle Description VIN: 3GYFK66NX3G322049 2003 Cadillac Escalade ESV STD 4WD 4D Wagon � 120,884 Miles Actual 8cyt Gasoline 6.0 4 Speed Automatic interior Dual Air Conditioning Alarm System Duai Zone Auto A/C Second Row Bucket Seats Cruise Control Center Conso/e Garage Door Opener Heated Frnt&Rear Seats Intermittent Wipers Lighted Entry System Overhead Console Power poor Locks Pbwer wndows Power Adjustable Pedais Dua/Power Seats Rear Heater Leather Seats Leather/Wood Steer Wheel Tachometer Trip Computer Third Seat(trucks) Tilt Steering Wheel Wood Interior Trim Exterior Bodyside Cladding Running Boards Rear�ndow Defroster Fender Flares Keyless Entry System Heated Power Mirrors Privacy G/ass Roof/Luggage Rack Rear�ndow�per/Washer Side Mirror Lighting Power Moonroof Tonneau/Cargo Cover Tinted Glass Trailer Hitch Chromed Alloy Wheels Mechanical Auto Adjust Suspension Auto Load Leveling Power Brakes Power Steering Stability Cntrl Suspensn Camper/Towing Package Safety Automatic Dimming Mirror Dual Airbags Anti-Lock Brakes Fog Lights Reverse Sensing System Side Airbags Traction Control System Entertainment Bose Sound System OnStar System In-Dash CD Changer 8�Tape Rear Seat Audio Controls XM Satellite Radio Strg Wheel Radio Contro/ Aftermarket Rear Entertainment Systm Remote Starter Trim Levels *STD 'Indicates your trim level A detailed description of your vehicle was provided to Autosource by a trained appraiser. Through a partnership with Cadillac, Audatex AudaVIN retrieves the individual vehicle specifications to identify the vehicle specifications including equipment, packages, engine and transmission. Contact American Family Insurance if revisions are necessary. The bold/italic font indicates options reported by the manufacture. Vehicle Valuation Detail Typical Vehicle . . • . City/State Grey Cloud Island, MN Grey Cloud Island, MN Price $9,514 $9,514 . Claim 00345072902-0 Request 34222668 Page 7 2003 Cadiliac Escalade ESV STD 4WD 4D Wagon • • Year 2003 2003 Make Caditlac Cadillac Model Escalade ESV Escalade ESV Edition STD STD Door 4D 4D Body Wagon Wagon Drive 4WD 4WD Size Not Applicable Not Applicable Engine 8 Cylinder 6.0 Engine 8 Cylinder 6.0 Engine 0 Transmission 4 Speed Automatic 4 Speed Automatic 0 Color Not Applicable Black Odometer 158,043 Mi(Typical) 120,884 Mi(Actual) 835 Convenience Options Automatic Dimming Mirror Automatic Dimming Mirror Tiit Steering Wheel Tilt Steering Wheei Dual Air Conditioning Dual Air Conditioning Rear Window Defroster Rear Window Defroster Garage Door Opener Garage Door Opener Reverse Sensing System Reverse Sensing System Dual Zone Auto A/C Dual Zone Auto A!C Strg Wheel Radio Control Strg Wheel Radio Control Cruise Control Cruise Control Side Mirror Lighting Side Mirror Lighting , Other Optional Equipment Anti-Lodc Brakes Anti-Lock Brakes Auto Load Leveling Auto Load Leveling , Tachometer Tachometer � Dual Airbags Dual Airbags Running Boards Running Boards Fender Flares Fender Flares j Fog Lights Fog lights � Bodyside Cladding Bodyside Cladding Rear Window WiperlWasher Rear Window Wiper/Washer � Tonneau/Cargo Cover Tonneau/Cargo Cover � Keyless Entry System Keyless Entry System Lighted Entry System Lighted Entry System , Rear Entertainment Systm Rear Entertainment Systm Overhead Console Overhead Console OnStar System OnStar System , Privacy Glass Privacy Glass Power Adjustable Pedals Power Adjustable Pedals Wood Interior Trim Wood Interior Trim Auto Adjust Suspension Auto Adjust Suspension Trailer Hitch Trailer Hitch Camper/Towing Package CamperJTowing Package Tinted Glass Tinted Glass Roof/Luggage Rack Roof/Luggage Rack Trip Computer Trip Computer Leather/Wood Steer Wheel Leather/Wood Steer Wheel Claim 00345072902-0 Request 34222668 Page 8 2003 Cadillac Escalade ESV STD 4WD 4D Wagon , , • . Rear Heater Rear Heater Remote Starter 240 Side Airbags Side Airbags Intermittent Wipers Intermittent Wipers Stability Cntrl Suspensn Stabiliry Cntrl Suspensn Center Console Center Console Traction Controi System Traction Control System Power Accessories Power Brakes Power Brakes Power Steering Power Steering Power Windows Power Windows Power poor Locks Power poor Lodcs Duai Power Seats Dual Power Seats Heated Power Mirrors Heated Power Mirrors Radio/Phone/Alarm Options Bose Sound System Bose Sound System In-Dash CD Changer&Tape In-Dash CD Changer 8�Tape Alarm System Alarm System XM Satellite Radio 35 Rear Seat Audio Controls Rear Seat Audio Controls Roof Options Power Moonroof Power Moonroof Seat Options Third Seat(trudcs) Third Seat(trucks) Second Row Bucket Seats Second Row Bucket Seats Leather Seats Leather Seats Heated Frnt&Rear Seats Heated Frnt&Rear Seats Wheel Options Chromed Alloy Wheels Chromed Alloy Wheels Autosource Value Before Condition Adjustments 10,624 • Seats Minor Wear Minor Wear Carpets Minor Wear Minor Wear Int Trim Minor Damage Minor Damage Glass Good Good Headliner Good Good . • Body Minor Damage Moderate Damage -300 Paint Moderate Damage Moderate Damage Ext Trim Minor Damage Moderate Damage -65 Engine Minor Wear Minor 1Near Transmission Minor Wear Minor Wear Front Tires Good New 112 Rear Tires Good New 112 . . . . . • . -141 Prior Damage 0 Condition Adjustment -141 . . . � . -141 . . . . . � . -. $10,483 Claim 00345072902-0 Request 34222668 Page 9 2003 Cadillac Escalade ESV STD 4WD 4D Wagon . . General Sales Taxr% Titie Feel The market value displayed may not Transfer Fee�� reflect the activity detected by ~ VINSOURCE and/or NICB research. Deductible -500.00 Net Adjusted Value� SalvagelOther - REPRESENTATIVE VEHICLES The Autosource database contains inspected dealer inventories, dealer advertisements, phone verified vehicles, and private party advertisements from thousands of sources including automotive pubiications, newspapers and Web sites. Autosource uses vehicles comparable in year, make and model within the specified market area, expanding as necessary, to determine the loss vehicle's local market value. This valuation includes a representative sample of the vehicles used to calculate the typical starting price. The market search originated from Zip Code 550711257, as determined by the vehicle owner's principally garaged area. Autosource located 19, 2003 Cadillac Escalade ESV vehicles which were used to determine the typical vehicle price.Adjustments have been made to the comparable vehicles for value differences in vehicle description as indicated in the"Veh Adj"field. The sum of the 19 comparable vehicles is$194,372 for an average price of$10,230. The asking or actual sale price is displayed for each vehicfe. If a vehicfe has been sold, the sold price is displayed with an (S) indicator. The selling price may be substantially less than the asking price. In the case of this 2003 Cadillac Escalade ESV, the difference between the asking price and selling price is generally 7%. This selling price adjustment has been applied to the typical price. Additional adjustments have been made to the typical vehicle price taking into consideration the loss vehicle's mileage, equipment and condition. All adjustments are vehicle specific and reflect driving habits and condition for the vehicle's market. A mileage adjustment of 225 cents per mile has been applied. Taking into consideration the vehicle specifics,the fair market value is$10,483. 1 Vehicle 2003 Cadillac Escalade ESV STD 4WD 4D Wagon Phone (651)641-1616 City Saint Pau� State MN Price $10,995 Date 05/12l14 Distance 12mi Veh Adj $0 VIN 3GYFK66N83G322339 Stodc 2140269 Adj Price $10,995 Seller University Auto Sales Odometer 125,702 Source City Pages Minneapolis I Details 4 Speed Automatic,Anti-Lodc Brakes,Automatic Dimming Mirror,Auto Adjust Suspension,Auto Load Leveling,Alarm System, Aluminum/Alloy Wheels, Bodyside Cladding, Bose Sound System, Cruise Control, In-Dash CD Changer &Tape, Center Console, Dual Airbags, Dual Air Conditioning, Rear Window Defroster, Heated Power Mirrors, Dual Zone Auto A/C, Dual Power Seats, Fender Flares, Fog Lights, Garage Door Opener, Heated Frnt & Rear Seats, Intermittent Wipers, Keyless Entry System, Lighted Entry System, Leather Seats, LeathedWood Steer Wheel, Overhead Console, OnStar System, Power Brakes, Power poor Lodcs, Privacy Glass, Power Steering, Power Windows, Power Adjustable Pedals, Roof/Luggage Radc, Rear Heater, Running Boards, Rear Seat Audio Controls, Reverse Sensing System, Rear Window Wiper/Washer, Side Airbags, Stability Cntrl Suspensn, Side Mirror Lighting, Second Row Bucket Seats, Strg Wheel Radio Control, Tachometer, Trip Computer, Traction Control System, Third Seat(trucks),Tonneau/Cargo Cover,Tinted Glass,Tilt Steering Wheel,Wood Interior Trim 2 Vehicle 2003 Cadillac Escalade ESV STD 4WD 4D Wagon Phone (651)481-7000 City Saint Paul State MN Price $8,990 Date 05/21/14 Distance 16mi Veh Adj $0 VIN 3GYFK66N13G291208 Stodc PL30465B Adj Price $8,990 Seller White Bear Acura-Subaru-Isuzu Odometer 139,053 Source Cars.com Claim 00345072902-0 Request 34222668 Page 10 2003 Cadi�lac Escalade ESV STD 4WD 4D Wagon _ , Detaiis 8 Cylinder 6.0 Engine, Automatic Transmission, Automatic Dimming Mirror, Auto Adjust Suspension, Dual Air Conditioning, Duai Airbags, Auto Load Leveling, Alarm System, Anti-Lock Brakes, Dual Zone Auto A/C, Bodyside Cladding, Second Row Bucket Seats, Running Boards, Bose Sound System, Cruise Control, Center Console, Rear Window Defroster, Fender Flares, Fog Lights, Garage Door Opener, Heated Frnt& Rear Seats, Intermittent Wipers, Keyless Entry System, Lighted Entry System, Heated Power Mirrors, Overhead Console, OnStar System, Power Brakes, Power poor Locks, Privacy Glass, Power Steering, Power Windows, Power Adjustabie Pedals, Dual Power Seats, Roof/Luggage Rack, In-Dash CD Changer&Tape, Rear Heater, Rear Seat Audio Controls, Reverse Sensing System, Rear Window Wiper/Washer,Side Airbags, Stabitity Cntrl Suspensn, Leather Seats, Side Mirror Lighting,XM Satellite Radio, Strg Wheel Radio Control, Leather/Wood Steer Wheel, Tachometer, Trip Computer, Traction Control System,Third Seat(trucks},Tonneau/Cargo Cover,Tinted Glass,Tilt Steering Wheei,Aluminum/Alloy Wheels,Wood Interior Trim 3 Vehicie 2003 Cadiilac Escalade ESV STD 4WD 4D Wagon Phone (320)693-3224 City Litchfield State MN Price $9,988 Date 05/19/14 Distance 77mi Veh Adj $0 VIN 3GYFK66N13G272173 Stodc 3227C Adj Price $9,988 Seller Davis Motors Odometer 126,881 Source Cars.com Details 8 Cylinder 6.0 Engine, Automatic Transmission, Automatic Dimming Mirror, Auto Adjust Suspension, Dual Air Conditioning, Dual Airbags, Auto Load Leveling, Alarm System, Anti-Lock Brakes, Dual Zone Auto A/C, Bodyside Cladding, Second Row Bucket Seats, Running Boards, Bose Sound System, Cruise Control, Center Console, Rear Window Defroster, Fender Flares, Fog Lights, Garage Door Opener, Heated Frnt& Rear Seats, Intermittent Wipers, Keyless Entry System, Lighted Entry System, Heated Power Mirrors, Overhead Console, OnStar System, Power Brakes, Power poor Locks, Privacy Glass, Power Steering, Power Windows, Power Adjustable Pedals, Dual Power Seats, Roof/Luggage Radc, In-Dash CD Changer B�Tape, Rear Heater, Rear Seat Audio Controls, Reverse Sensing System, Rear Window WiperMlasher,Side Airbags,Stability Cntrl Suspensn, Leather Seats,Side Mirror Lighting,XM Satellite Radio, Strg Wheel Radio Control, LeatherMfood Steer Wheel, Tachometer, Trip Computer, Traction Gontrol System,Third Seat(trucks),Tonneau/Cargo Cover,Tinted Glass, Tilt Steering Wheel,Aluminum/Alloy Wheels,Wood Interior Trim 4 Vehicle 2003 Cadillac Escalade ESV STD 4WD 4D Wagon Phone (507)629-3400 City Tracy State MN Price $10,995 Date 05/18/14 Distance 135mi Veh Adj $0 VIN 3GYFK66N23G308839 Stock G2669B Adj Price $10,995 Seller Salmon Motors Odometer 171,000 Source Autotrader.com ' Details 8 Cylinder 6.0 Engine, Automatic Transmission, Automatic Dimming Mirror, Auto Adjust Suspension, Dual Air I Conditioning, Dual Airbags, Auto Load Leveling, Alarm System, Anti-Lodc Brakes, Dual Zone Auto AIC, Bodyside j Cladding, Second Row Budcet Seats, Running Boards, Bose Sound System, Cruise Control, Center Console, Rear ', Window Defroster, Fender Flares, Fog Lights, Garage Door Opener, Heated Frnt& Rear Seats, Intermittent Wipers, � Keyless Entry System, Lighted Entry System, Heated Power Mirrors, Overhead Console, OnStar System, Power Brakes, Power poor Lodcs, Privacy Glass, Power Steering, Power Windows, Power Adjustable Pedals, Dual Power , Seats, Roof/Luggage Rack, In-Dash CD Changer&Tape, Rear Heater, Rear Seat Audio Controls, Reverse Sensing � System, Rear Window WiperMlasher, Side Airbags, Stability Cntrl Suspensn, Leather Seats, Side Mirror Lighting, Strg Wheel Radio Control, LeathedWood Steer Wheel, Tachometer, Trip Computer, Traction Control System, Third Seat(trudcs),Tonneau/Cargo Cover,Tinted Glass,Tilt Steering Wheel,Aluminum/Alloy Wheels,Wood Interior Trim 5 Vehicle 2003 Cadillac Escalade ESV STD 4WD 4D Wagon Phone (218)269-7999 City Duluth State MN Price $8,250 Date 04/10/14 Distance 142mi Veh Adj $0 ' VIN Stock Adj Price $8,250 Seller Dealer Odometer 125,000 Source craigslist Details 8 Cylinder 6.0 Engine, Automatic Transmission, Automatic Dimming Mirror, Auto Adjust Suspension, Dual Air Conditioning, Dual Airbags, Auto Load Leveling, Alarm System, Anti-Lock Brakes, Dual Zone Auto A/C, Bodyside Cladding, Second Row Bucket Seats, Running Boards, Bose Sound System, Cruise Control, Center Console, Rear Window Defroster, Fender Flares, Fog Lights, Garage Door Opener, Heated Frnt 8� Rear Seats, Intermittent Wipers, Keyless Entry System, Lighted Entry System, Heated Power Mirrors, Overhead Console, OnStar System, Power Claim 00345072902-0 Request 34222668 Page 11 2003 Cadillac Escalade ESV STD 4WD 4D Wagon _ , Brakes, Power poor Lodcs, Privacy Glass, Power Steering, Power Windows, Power Adjustable Pedals, Dual Power Seats, Roof/Luggage Rack, In-Dash CD Changer&Tape, Rear Heater, Rear Seat Audio Controis, Reverse Sensing System, Rear Window Wiper/Washer, Side Airbags, Stability Cntrl Suspensn, Leather Seats, Side Mirror Lighting, Strg Wheel Radio Controi, Leather/Wood Steer Wheel, Tachometer, Trip Computer, Traction Control System, Third Seat(trucks), Tonneau/Cargo Cover, Tinted Giass, Tilt Steering Wheel,Aluminum/Alloy Wheels, Wood Interior Trim, Good Exterior Valuation Notes o Loss vehicie description was provided by American Family Insurance o Adjustments of Special Note n No adjustment was made for the reported aftermarket Rear Entertainment Systm as the comparable has similar equipment.The date of purchase was not provided. n An adjustment of$240 was made for the reported aftermarket Remote Starter purchased 4 months ago at a cost of $370. � Loss vehicle was reported to have: ° Front Tires described as New valued at$186 purchased on 04/25/14. ° RearTires described as New valued at$186 purchased on 04/25/14. � A mileage adjustment of 2.25 cents per mile/kilometer has been applied. This adjustment is based on the vehicle year, vehicle category and market area.Mileage adjustments are capped at 40%of the vehicle's starting value. 4 All values are in U.S.dollars. o Autosource Valuation Process p Over 3,800,000 vehicles are entered weekly into the database used for researching this value. This database includes dealer inspected,dealer inventory,dealer advertised,phone verified and advertised private party vehicles. n The originating search area for this valuation was Grey Cloud Island, Minnesota. o Conditioning Notes � INTERIOR ° Seats:wrinkling on left and right front and rear seats not cradced thru slight smoke smell ° Carpets:light staining around mats alot of debris from loss in interior so difficult to comment any further ° Int Trim: light wear on buttons on dash and rear center area, light soiliing on all trim dash has small spot either black paint or ink right side ° Glass:numerous small pits in windshield ° Headliner:very negligible wear on headliner I � EXTERIOR ' ° Body:rust starting on left side quarter,this area has been repaired previously ' ° Paint: vehicle very dirty at time of inspect, scrapes 2 on rear door credit card in length rodc chips on hood, light buffable scratches on right fender rated as typical , ° ExtTrim:rear cover paint flaking in multiple areas chrome coming off all 4 rims in spoke areas � MECHANICAL ° Engine:nable to open hood to see rated as rypical ° Transmission:unable to see rated as typical j � Salvage Valuation . Inspection Location Grey Cloud Island,MN Autosource Market Value $10,483 Repair Estimate $8,716 Total Loss Percentage 83.14% Point of Impact Left Front .. Predicted Salvage Value $925 Low Salvage Value $925 Claim 00345072902-0 Request 34222668 Page 12 2003 Cadiliac Escalade ESV STD 4WD 4D Wagon . . High Salvage Value $925 Number of Vehicles 1 This salvage value was provided by IAA on May 22,2014. Salvage Value is derived from data provided to Audatex by IAA. Since the Salvage Value is a prediction of gross salvage return, there is no guarantee that the salvage vehicle will be sold for the predicted value. Neither IAA nor Audatex can, or will, be an insurer or guarantor of the accuracy or reliability of the IAA data. The above information is provided as a tool to assist the insurance company in determining whether a vehicle is economically repairable.The determination of whether a motor vehicle is a total loss is solely the responsibility of the insurance company. Recall Builetins Nat'I.Highway Tra�c Safety Admin(US)has issued a total of 1 recall bulletin that may apply to this vehicle. • � •- 04V045 Date issued 02/01/04 Quantity Affected 68,875 Dates Of Manufacture May-June 2003 Noncompliance Certain sport utility vehicles, pickup trucks, and passenger vans fail to comply with the requirements of Federal Motor Vehicle Safety Standard No. 135, "Passenger Car Brake Systems." Some of these vehicles were produced with an out-of-specification brake hydro-boost housing relief valve bore. Consequently, the valve O-ring seal may fracture. Steering efforts may be slightly increased while braking or parking. Under certain driving conditions, a fractured seal may also require an increase in the applied brake pedal effort to achieve the same vehicle deceleration. Remedy Dealers are to replace the hydro-boost relief valve. The manufacturer has reported that owner notification is expected to begin during the second quarter of 2004. Owners may contact Cadillac at 1-866-982-2339; Chevrolet at 1-800-630-2438; GMC at 1-866-996-9463; or Hummer at 1-866- 486-6376. Original Equipment Guide Engine Options Transmission Options " 8 Cylinder 6.0 Engine STD ' 4 Speed Automatic STD Other Optional Equipment Corrvenience Options " Anti-Lock Brakes STD * Automatic Dimming Mirror STD " Auto Adjust Suspension STD " Cruise Control STD ' Auto Load Leveling STD Dual Air Conditioning STD ' Bodyside Cladding STD * Rear Window Defroster STD Special Factory Paint $995 * Dual Zone Auto A/C STD * Center Console STD ` Garage Door Opener STD "` Dual Airbags STD Reverse Sensing System STD * Fender Flares STD * Side Mirror Lighting STD ` Fog Lights STD ' Strg Wheel Radio Control STD ` Intermittent Wipers STD ' Tilt Steering Wheel STD * Keyless Entry System STD Power Accessories " Lighted Entry System STD ' Heated Power Mirrors STD " Leather/Wood Steer Wheel STD * Dual Power Seats STD Navigation System $1,995 ' Power Brakes STD ' Overhead Console STD * Power poor Locks STD * OnStar System STD ' Power Steering STD * Privacy Glass STD ` Power Windows STD Claim 00345072902-0 Request 34222668 Page 13 2003 Cadiliac Escaiade ESV STD 4WD 4D Wagon , . * Power Adjustable Pedals STD Radio/Phone/Alarm Optlons ` Roof/Luggage Rack STD ' Alarm System STD Rear Entertainment Systm $1,295 * Bose Sound System STD � Rear Heater STD ` In-Dash CD Changer&Tape STD ' Running Boards STD AM/FM In-dash CD Changer " Rear Window Wiper/Washer STD * Rear Seat Audio Controls STD ' Side Airbags STD * XM Sateliite Radio $325 ' Stability Cntrl Suspensn STD Seat Options ' Tachometer STD " Heated Frnt&Rear Seats STD * Trip Computer STD ` Leather Seats STD ' Traction Controi System STD ' Second Row Bucket Seats STD " Tonneau/Cargo Cover STD " Third Seat(trucks) STD ' Tinted Glass STD Wheel Options " Camper/Towing Package $190 Aluminum/Alloy Wheels STD ' Trailer Hitch TYP * Chromed Alloy Wheels $795 ' Wood Interior Trim STD Roof Options * Power Moonroof $1,550 Base retail price $56,620 • ••- -• • - • -• $59,480 Editions available for the same body style(in order of original cost,increasing):*STD 'Indicates loss vehicle equipment. Vehicle Locator Service ' After your claim is settled,Autosource provides free assistance in locating your next vehicle. Your request can be submitted online 24hrs. per day at http://www.support.audatex.us. Under Additional Services clidc the Autosource Vehicle Locator Service Form link to complete the VLS form. Or you can call us Monday through Friday, between 8:00 AM and 5:00 PM, Pacific time at(800)351- 3133,ext 7428.Our specialists will work with you to find a new or used vehicle in your area. AboutYour Valuation This report contains proprietary information of Audatex and shall not be disclosed to any third party (other than the insured or claimant)without Audatex's prior written consent. If you are the insured or claimant and have questions regarding the description of ! your vehicle, please contact the insurance company that is handling your claim. Information within VlNsource/NICB is provided solely to identify potential duplicative claims activity.User agrees to use such information solely for lawful purposes. Tax rates contained herein are based on general sales tax data provided by Vertex Inc. Excise, use, registration, licensing and � other taxes and fees that may be applicable are not included. Audatex makes no representations or warranties concerning the applicability or accuracy of such tax data. Minnesota Regulatory Statement A person who files a claim with intent to defraud or helps oommit a fraud against an insurer is guilty of a crime. Claim 00345072902-0 Request 34222668 Page 14 2003 Cadiliac Escalade ESV STD 4WD 4D Wagon � � Report Generated by Audatex,a Solera Company US Pat.No 791274062 US Pat.No 820051362 US Pat.No 846803862 O 2014 Audatex North America, Inc.All Rights Reserved. Claim 00345072902-0 Request34222668 Page15 AMERICAN FAMILY INSURANCE SCANNING CENTER 6000 AMERICAN PARKWAY MADISON,WI 53783-0001 1-800-MYAMFAM (1-800-692-6326) ***ESTIMATE"** 05/22/2014 08:36 AM Owner � -- - --- ._� _ _�....�.�,o.�_._�.�..1 Owner: SOUA&MAILEE KONG XIONG Address: 1431 SELBY AVE Home/Day: (651)329-1753 Home/Day: (651)528-0354 City State Zip: ST PAUL PARK, MN 55071-1257 Control Information � Claim#: 00345072902-0 Insured Policy#: 1713766203 Loss Date/Time: 05/17/2014 07:00 AM Loss Type: Collision Deductible: $500.00 Ins.Company: American Family Insurance Insured: SOUA&MAILEE KONG XIONG Address: Home/Day: (651)329-1753 (651)528-0354 Inspection � � �� Inspection Date: 05/22/2014 08:27 AM Inspection Type: Field Inspection Location: St Paul Police Impound Lot Contact: Address: 830 Barge Channel Rd Home/Day: City State Zip: St Paul, MN 55107 i Primary Impact: Left Front Side Secondary Impact: ' Driveable: No Rental Assisted: Assigned Date/Time: Received Date/Time: 05/19/2014 10:11 AM ��, First Contact Date/Time: Appointment Date/Time: 05/20/2014 08:00 AM ', Appraiser Name: ANN CARTWRIGHT Appraiser License#: , Address: Work/Day: (651)263-0197 , Email: acartwri@amfam.com ', il Repairer � j ____.._. ___.____.��W______ __ �_______�.._.._._� �.__ _W ._._...__`.__�.____�.._�.__._..�..___�._..._�._�__.._.... I Target Complete Date/Time: Days To Repair: 8 Vehicle �� 2003 Cadillac Escalade ESV STD 4 DR Wagon 8cyl Gasoline 6.0 4 Speed Automatic Lic.Plate: VXT438 Lic State: MN Lic Expire: 10/2014 VIN: 3GYFK66NX3G322049 Prod Date: 06/2003 Miteage: 120,884 Veh Insp#: Mileage Type: Actual 05/22/2014 02:17 PM Page 1 of 4 2003 Cadillac Escalade ESV STD 4 DR Wagon Claim Yf: 00345072902-0 05/22/2014 08:36 AM Condition: Code: T7113A Ext.Color: Black Int.Color: Ext. Refinish: Two-Stage Int. Refinish: Options -AudaVIN Information Received 4-Wheel Drive Alarm System Anti-Lock Brakes Auto Adjust Suspension Auto Load Leveling Automatic Dimming Mirror Bodyside Cladding Bose Sound System CamperlTowing Package Center Conso/e Chromed Alloy Wheels Cruise Control Dual Air Conditioning Dual Airbags Dual Power Seats Dual Zone Auto A/C Fender Flares Fog Lights Garage Door Opener Heated Frnt&Rear Seats Heated Power Mirrors In-Dash CD Changer&Tape Intermittent Wipers Keyless Entry System Leather Seats LeatheNWood Steer Wheel Lighted Entry System OnStar System Overhead Conso/e Power Adjustable Pedals Power Brakes Power poor Locks Power Moonroof Power Steering Power�ndows Privacy G/ass Rear Entertainment Systm Rear Heater Rear Seat Audio Controls Rear Window Defroster Rear Window�per/Washer Remote Starter Reverse Sensing System Roof/Luggage Rack Running Boards Second Row Bucket Seats Side Airbags Side Mirror Lighting Stability Cntrl Suspensn Strg Wheel Radio Control Tachometer Third Seat(trucks) Tilt Steering Wheel Tinted Glass Tonneau/Cargo Cover Traction Control System Trailer Hitch Trip Computer Wood Interior Trim XM Satellite Radio AudaV/N options are listed in bolditalic fonts Damages � Line Op Guide MC Description MFR.Part No. Price ADJ% B% Hours R 1 OE 5 Cover,Front Bumper Replace PXN OE Srpls $331.25 2.0 SM »Pam's Auto 320-363-7336 »7505 Ridgewood Rd »St Cloud MN 56303 »Quote#231399451966007, Stock#NEW171, Flip, Rob, or Jim 2 L 5 13 Cover,Front Bumper Refinish 3.8 RF 2.7 Surtace 0.6 Two-stage setup 0.5 Two-stage 3 E 103 Fender,Front LT 88980448 GM Part $898.17 3.5 SM 4 L 103 Fender,Front LT Refinish 3.9 RF 2.4 Surtace 1.0 Edge 0.5 Two-stage 5 E 952 Wheel,Front RT 9596873 GM Part $416.11 0.2 SM 6 E 954 Wheel,Rear RT 9596873 GM Part $416.11 0.3 SM 7 EP 654 Arm,Lower Control R/F Replace PXN $253.76 1.8 ME 8 E 660 01 Absorber,Shock R/F 12477659 GM Part $206.80 0.2 ME 9 ET 625 Pillar,Windshield LT Partial Replace Labor 5.0 SM 10 L 625 Pillar,Windshield LT Refinish 0.5 RF 0.5 Surface 11 TE 172 # Frame,Door Opening LT Partial Replace Price $704.90 SM #=01, 02 12 ET 627 Panel,Rocker LT Partial Replace Labor 8.5 SM 13 L 627 Panel,Rocker LT Reflnish 1.5 RF 1.3 Surtace 0.2 Edge INC Two-stage 14 E 19 Board,Running LT 12477823 GM Part $265.00 0.5 SM , 15 E 537 Pad Side Step Panel LT 15751762 GM Part $625.60 INC SM 05/22/2014 02:17 PM Page 2 of 4 . 2003 Cadillac Escalade ESV STD 4 DR Wagon Claim 4: 00345072902-0 0522/2014 08:36 AM 16 OE 207 Door SheIl,Front LT Replace PXN OE Srpls $43125 4.7 SM »Pam's Auto 320-363-7336 »7505 Ridgewood Rd »St Cloud MN 56303 »Quote#231399451966007, Stock#NEW173, Flip, Rob, or Jim 17 L 207 Door SheIl,Front LT Refinish 4.0 RF 2.5 Surface 1.0 Edge 0.5 Two-stage 18 L 439 MIdg,Front Door Side LT Refinish 0.6 RF 0.6 Surtace INC Two-stage 19 E 445 MIdg,Rear poor Side LT 88944319 GM Part $590.33 0.4 SM 20 L 445 MIdg,Rear poor Side LT Refinish 0.6 RF 0.6 Surtace INC Two-stage 21 I 389 Panel,Quarter LT Repair 10.0" SM 22 L 389 Panel,Quarter LT Refinish 3.2 RF 2.7 Surface 0.5 Two-stage 23 I 390 Panel,Quarter RT Repair 8.0" SM 24 L 390 Panel,Quarter RT Refinish 3.1 RF 2.7 Surface 0.4 Two-stage 25 RI 395 Qtr Glass R&I LT R& I Assembly 2.9 SM 26 RI 396 Qtr Glass R&I RT R& I Assembly 2.3 SM 27 E 534 Taillamp Assembly RT 15079079 GM Part $271.03 0.3 SM 28 SB alignment Sublet Repair $59.95" SM" 29 SB mount and balance Sublet Repair $40.00* SM* 29 Items MC Message 01 CALL DEALER FOR EXACT PART#/PRICE 02 PART NO. DISCONTINUED, CALL DEALER FOR EXACT PART NO. 13 INCLUDES 0.6 HOURS FIRST PANEL TWO-STAGE ALLOWANCE Estimate Total&Entries � Gross Parts $4,394.05 OE Surplus Parts $762.50 Other Parts $253.76 Paint Materials $678.40 Parts 8�Material Total $6,088.71 Tax on Parts&Material @ 7.625% $464.26 Labor Rate Replace Repair Hrs Total Hrs Hrs Sheet Metal(SM) $52.00 30.6 18.0 48.6 $2,527.20 Mech/Elec(ME) $65.00 2.0 2.0 $130.00 Frame(FR) $65.00 Refinish(RF) $52.00 21.2 21.2 $1,102.40 Paint Materials $32.00 Labor Total 71.8 Hours $3,759.60 Sublet Repairs $99.95 Gross Total $10,412.52 Less: Deductible $500.00- Net Total $9,912.52 TOTAL LOSS 05/222014 02:17 PM Page 3 of 4 2003 Cadillac Escalade ESV STD 4 DR Wagon Claim M: 00345072902-0 05/22/2014 08:36 AM Alternate Parts Y/01/01/00/00/00 CUM 01/01/00/00/00 Zip Code: 55343 METRO OLD 0411 Recycled Parts Y/5/0 Zip Code: 55343 INV DATE: 05/19/2014 Audatex Estimating 6.0.843 ES 05/22/2014 02:17 PM REL 6.0.843 DT 05/01/2014 DB 05/15/2014 Copyright(C)2011 Audatex North America,Inc. 3.0 HRS WERE ADDED TO THIS ESTIMATE BASED ON AUDATEX'S TWO-STAGE REFINISH FORMULA. ESTIMATE CALCULATED USING THE 2.5 HOUR MAXIMUM ALLOWANCE FOR TWO-STAGE REFINISH OF NON-FLEX, EXTERIOR SURFACES. "'ANY AND ALL SUPPLEMENTS MUST BE WRITTEN BY AND HAVE PRIOR APPROVAL FROM A REPRESENTATIVE OF THIS COMPANY. ** THIS ESTIMATE MAY INCLUDE AFTER-MARKET OR CRASH PARTS SUPPLIED BY A SOURCE OTHER THAN THE MANiJFACTURER OF YOUR VEHICLE. THESE PARTS CAN BE IDENTIFIED BY THE DESIGNATION "**QRP/QUALITY REPLACEMENT PARTS" ON THE ESTIMATE. WARRANTIES APPLICABLE TO THESE REPLACEMENT PARTS ARE PROVIDED BY THE MANUFACTURER OR DISTRIBUTOR OF THESE PARTS, RATHER THAN THE MANiJFACTURER OF YOUR VEHICLE. FOR YOUR PROTECTION, MINNESOTA LAW REQUIRES US TO INFORM YOU: A PERSON WHO SUBMITS AN APPLICATION OR FILES A CLAIM WITH INTENT TO DEFRAUD OR HELP COMMIT A FRAUD AGAINST AN INSURER IS GUILTY OF A CRIME. I, � Op Codes * = User-Entered Value E = Replace OEM NG= Replace NAGS EC= Replace Economy OE= Replace PXN OE Srpis UE= Replace OE Surplus ', ET = Partial Replace Labor EP= Replace PXN EU= RECYCLED PART �, TE = Partial Replace Price PM= Replace PXN Reman/Reblt UM= Replace Reman/Rebuilt I L = Refinish PC= Replace PXN Reconditioned UC= Replace Reconditioned j TT = Two-Tone SB= Sublet Repair N = Additional Labor I BR= Blend Refinish I = Repair IT = Partial Repair � CG= Chipguard RI = R& I Assembly P = Check � AA= Appearance Allowance RP= Related Prior Damage �� This report contains proprietary information of Audatex and may not be disclosed to any third party(other than the insured, claimant and others on a need to know basis in order to effectuate the claims process)without ��,�� Audatex's prior written consent. a 3o#eta c�r�r►V Copyright(C)2071 Audatex North America, Inc. Audatex Estimating is a trademark of Audatex North America, Inc. OS/22/2014 02:17 PM Page 4 of 4 Photos for Claim Number 00345072902-0 Page 1 of 3 - _ _ __ _ _ _ _ --__ __ _ __ _ _ _ . , _ n� T� � Y; �� 3 ...v�II'`�I� H _ Y' . �y°"�5i 1 �. f. } :�IMUI�I�.v9�� .� ' ••-'-+� • - t �l� Attached: 05/22/14 02:19pm Attached:05/22/14 02:19pm Attached: 05/22/14 02:20pm - Ct, - G, - G� � J J . �� __ :,, _ _ � � �,� � r � �y'1`1 Yytl :F- t� Attached: 05/22/14 02:20pm Attached: 05/22/14 02:19pm Attached: 05/22/14 02:20pm - C�, - C:t - 4� � � � _ _ _ _ _ _ _ _ __ __. _ _ � _ ,. � i _ .�_ . I u�I�� .� Y ...:. ..« I .c,.�h- ��,:��ti. F � �k .' i � . ��-. �( � . ; ,. , � � , - 4 �`n � `��:. ..rr'?• . . _. ,. .K. . _ . � .. Attached:05/22/14 02:19pm Attached:05l22/14 02:20pm Attached:05/22/14 02:19pm - G� - f�� - G' 1 J _J =1 ___ _ _ ___ 111 _ _,: . _ : „ ;� .,;� ,�.r Attached:05/22/14 02:20pm Attached:05/22/14 02:19pm Attached:05/22/14 02:20pm G � C;. ' �. . , � J https://www.audatexsolutions.com/searchview/DispPhoto.asp?wa_pk=312027192&clai m_... 6/23/2014 Photos for Claim Number 00345072902-0 Page 2 of 3 " � i u i �� J � _ _ � ,,� , y,,� � • � � - � �� II '�°-- ��i :.��1 ` _-�..,� ri ��!!�.� �ti,.�. �'. ,�. �,�� Attached: 05/22/14 02:20pm Attached:05/22/14 02:19pm Attached: 05/22/14 02:19pm � - G`,, - c:�,, _ � � J � ._ . _ _.. ._ _._ _. _ I�� - V� � �� ,� y r. 1��1 7h' '� � �+ �-� _, � 'a. . ..+ � F4._ . .c�. �i �� Attached: 05/22/14 02:20pm Attached:05/22/14 02:20pm Attached:05/22/14 02:20pm - tJ � - G - Ct '� 4 � � � � _.. �... ........ - — - ._..._ ...._._�n. ___.._.,.. � -d wrts��'la . .-.�.:_ " .�: . _.._ � __. _ .. . . � . .._.� ..f � ! li=� �; <.,f � � � �� f � �T �... .. . .. .. . . .r ,,�.r�.t..�;��. �.. . . .. . Attached:05/22/14 02:20pm Attached:05/22/14 02:20pm Attached:05/22/14 02:20pm � C� _ C;, - C� , . J =1 =� https://www.audatexsolutions.com/searchview/DispPhoto.asp?wa_pk=312027192&claim_... 6/23/2014 Photos for Claim Number 00345072902-0 Page 3 of 3 � � 2 __ _ ___ ..�.__. ,_.� _ �. ' �I! .,; 6� 9 p ry . I. . .- •�� . .. . ........ ,..... .. ....,.. . Attached:05/22/14 02:20pm Attached:05/22/14 02:20pm Attached:05/22/14 02:20pm � [z - {-i - C� � ' , � � � � __.,_.�_ _�_. . � � � �� _ � -: _- ____ z �� ^,.�. 3t�9 ��. .� . F •?Y�` �Y[�� v��/'/' - p� Attached: 05/22/14 02:20pm Attached:05/22/14 02:20pm Attached:05/22/14 02:20pm - � - �,, =1 �% ti J _! =� *. .,�. �: Attached:05/22/14 02:20pm � � � , � https://www.audatexsolutions.com/searchview/DispPhoto.asp?wa_pk=312027192&claim_... 6/23/2014 � � REMITTANCE: 12796508 � DATE: 06/12/2014 � INSiJRAI'�iC�; A�AUCT[OIV�a Remittance Payable To: Insurance Auto Auctions, Inc. American Family Insurance- Eden Prairie Auto Claim Attn: Settlement Group 6131 Blue Circle Drive 1280 Jackson Street Eden Prairie, MN 55343-9130 St. Paul, MN 551174613 Attn: Salvage Dept Phone (6511488-0581 Fax: (6511488-3644 E-mail IAA_ASAP_StPaul@iaai.com Total Salvage Information Account of Sale Ac ' i %ACV IAA Stock#: 000-13210100 Sales $2,300.00 21.94 IAA Branch: Minneapolis/St. Paul IAA Charges Fed. Tax I.D. 953790111 Consignment Flat Fee $40.00 0.38 Adjuster: Ann Cartwright Inbound Tow $45.00 0.43 Insured: Soua 8� Mailee Kong Xiong State/Local Transfer Fee $10.00 0.10 Owner: Soua & Mailee Kong Xiong Claim#: 00345072902-0 Policy#: Less IAA Charges ($95.00) (0.91) Vehicle: 2003 CADILLAC ESCALADE Net IAA Return $2,205.00 21.03 Damage: Left& Right Side/Suspension Outside Charges Advanced by IAA Mileage: 120884 Administrative Fee $80.00 0.76 Mileage Type: Actual Storage $15.00 0.14 VIN: 3GYFK66NX3G322049 Advance Tow $60.00 0.57 ACV: $10,483.00 Tax $10.68 NICB Date� 6l12/2014 Less Outside Charges ($165.68) (1.58) Payment Amount $2,039.32 19.45% Buyer Information Pams Auto Inc. 7505 Ridaewood Rd. Saint Cloud. MN 56303-9413 Resale Certificate# : 22892 (MN) Elansed Days Analy�is Date of Event: Date Davs Loss 5/17/2014 _- Assigned 5/22/2014 6 Released 5/23/2014 2 Pickup 5/22/2014 � Title Rec'd 6/2/2014 �2 Sale Doc. Rec'd 6/2/2014 � . Auction Date 6/11/2014 10 Buyer Payment N/A � Remittance 6/12/2014 2 Elapsed Total Days: 2� IAA Doc.RP002.rpt �aint Pau! Pc�lic� Imp�und Lat, 830 B�r�� Ch�nr�e� Ftn�d, VeF��c1e Release F�rm . ., ��k�.�3,GApILLi4G Li�ense�:V?CT438 CAI: 140956�5 tnvoice�: 150635 DatefTim�Keteased;05122t2414 48_46 Tow Ch�rge: $ 60.00 �eieas�ti to� T'CTR Stor�ge Charge: $ 15.Q0 Paid by:CHEGK Adrnin Charge; S 80.Q0 Released by: PERLlTA Tax:(7.��a�/fl)' $ 1t1:68 I.the uhdersige��i,hau�reCQV�red th�vehicle d��ribed�bor�e, Subfcrta#: 1�riii c1'�c�c th�vehici�4or damage�r any other prablerns that � 16�.68 rn�y i��ave accurred v�f�ife this vehi�ie was tn ihe custody of the S�rvice Charge: � 0:0� Saint,P�ul p�iice t�epa�rnent, I acknawtedge 1 witi repott darr�ag��nd/vr any ather problems to ihe impoun�Lot staff ToGal Charges� $ 165:6$ 4n this fc�rrrt prit�r to leaving#he impoun�lc�. Q�tmag��andit�r�ther problerrt�� I�� I��l��!(i��l��(��I� (��I�� IAAI TQW 1354911f�#3�1�9b02 T4�ddOCE>—` . SiQ�k#;P32L�1°d$ STU?�ReC�3p#" Pa�i�Repart m�r,ie:Y�s lUct IF Yes; CN 1 --.-�.._,_..,___F If NQ:Why? T�PRdT�CT�OUR RIGNTS RERt?RT A�V1'FR{3B �MSIt�AMAGE�EFpRE l,EA'VfNC��ktE L(7T Sign�fure: � .3�-��j((�.� 3 �o�a� ' � � � 0 -o 0 U °' � � y � oi Q �o �, a � ' •T � in � v � U u O N sf c � � � � � p o N Q fp M e,� N o O � � � M � f� n fl. � � V N a 'o c i � a d .. co � � a rn 'o = d � w � � O � o � N � n N � � o � J •v O .` o ia d >, � m Z ,rn "o O � � Y n a N w ° N � J � � O Q � a C � O N � .� � _ j 7 a �d � � � V � .. � ` � Z � a� a rn y .c ,� O o a W J � O d X U w C7 J Z a Y C9 a Z J J Y m � W � U � J Q Q Q W � � � � � � � � a o "' z `r X O F j N ai � O � E a cn o z Z � O � a � o z m 2 m ',� � � d � � � U rn O � � � f0 H E � a V o .� w � U v� m � O =o L rn U (0 Z V � i1 � � Q � Q C � fN/1 � r � (� Q � N O W J p p � N y £ a �' W H w i» c ui rn a� E R J C Z' � c J N a�i U N � � p� � � � y N c� � °� V � rn � � r2 N C !a U � w �+ � m �S O C � � m � o c Z' � F`- E � op t- a � a v � R � O r � � p � d o o � E x r ui `�- � ° T � fn o � H o N N o LL � � 3 m � r aEi � o c�6i .� o � � � C U � - e6 v i0 �. E � �` � °� � E LL °o c d a °� o m � o N c � N � � m H o � � � +_�-' p � l0 7 N y ` � N U C) LL IL J U N (A O � H O OO