Campbell, Tonetta R�CEIV�C� ',
JUN 26 20�4
NOTICE OF CLAIM FORM to the City of Saint Paul, Minn�slo��' CL�t'�'re
Miianesota State Statute 466.05 s�ates that"...every person...who claims dainages frnm any municipaliry...shall cause to be presented to the
governing body of the municipality wilhin 180 days after the alleged loss or injury is discovered a notice stating the time,place,and
circuinstances thereof,and the amount 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. T�e 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 O�HER DOCUMENTS TO: CITY CLERK,
15 WEST KELLOGG BLVD, 310 CITY HALL, SAINT PAUL, MN 55102
First Name C�►'1�t���� Middle Initial � Last Name l,��°':r�"7 n�����
Company or Business Name
Are You an Insurance Company? Yes/( 10, If Yes, Claim Number?
�.>
Street Address ��%' �L� ����7�►" �(�i C �,
City ��w'`l� �dl,� � Sta� �� �� Zip Code J'�_�J'�� �
Daytime Phone���-3�55�'Cell Phone(�3 ).�-3J�� Evening Telephone(7�)�- 3fcS�"
Date of Accidend Injury or Date Discovered ���� � �� Time 2;� 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 Pa 1 or its employees are involved and/or responsible for your damages.
.,��ti1 �r-�,� 'e 11 ►-►--i � . �:
s
.� C�.✓Yl �c.� `"���"lC� 1"�1 Y1�'1 � i'rr,� ��
�� t��u.�rr�r�c e �rr���rt r� • i-�1,� Cv..r ��a� ��t�.lp �� rir�� -t1�p 5 cac�c i�l�-
Ple se check the box(es)that most closely represent the reason for completing this form:
�My vehicle was damaged in an accident ❑ My vehicle was damaged during a tow
❑ My vehicle was damaged by a pothole or condition of the street ❑ My vehicle was damaged by a plow
❑ My vehicle was wrongfully towed and/or ticketed ❑ I was injured on City property
�Other type of property damage—please specify�. '�'�Y'e� � �� b!1 �D �U' Cf�c-�'•
❑ 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
Failure to complete and return both pages will result in delay in the handling of your claim.
All Claims–please complete this section I!'
Were there witnesses to the incident? Yes �To Unknow (circle)
Provide their names,addresses and telephone numbers
Were the police or law enforcement called? Yes �c Unknown (circle)
If yes, what department or agency? Case#or report#
Where did the accident or injury take place? Provide str�et address,cross street, intersection, name ofR ark or facility,
closest landmark, etc. Pl se be as detailed as possible. If necessary,attach a diagram. �ZO ZO C��G1i'le�^
P lac� Sa��- �aix I '�1 �N S�i I 1�
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. ���%.� ded�t c1-� b IE.. -
Vehicle Claims– lease com lete this section �check box if this section does not a 1
Your Vehicle: Year ZOc� Make �^ Model �1
License Plate Number ���i N c 1� State��Color
Registered Owner r� ��
Driver of Vehicle t7►'! �/
Area Damaged ��
City Vehicle: Year Make Model
License Plate Number State Color
Driver of Vehicle(City Employee's Name)
Area Damaged
Iniurv Claims–please complete 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? I 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�0 '��I �I'-�
Print the Name of the Person who Completed this Form: ` ��'1 C"�""� � ' �`�–�- ''��—
Signature of Person Making the Claim: U— Al,-�r1L
Revised February 201 1
Date: 6/16/2014 10:36 AM
Estimate ID: 14212860&01
Estimate Version: 0
Committed
Pr�le ID: 'MetroAll Parts7.t
�,���
10220 GOLDENROD STREET NW SUITE 100,COON RAPIDS,MN 55448
(50�676-0557
Damage Assessed By: TRAVIS MORTEL 'Claim Rep: NCRT WX02NCRT
(S00)776-4737
'Product Type Auto
`Date oi Loss: 6/14/2014
'Deductible: 500.00
'Claim Number: 142128603-01
Insured: TONETTA CAMPBELL
Owner: TONETTA CAMPBELL
Address: 2020 BORDNER PLACE,ST PAUL,MN 55116
Telephone: Home Phone: (763)656-3657 Cell Phone: (763)6563657
Contact Phone: (763)656-3657
Mitchell Service: 910026
Description: 2008 Ford Crown Vctoria Police Vehicle Produdion Dffie: 6/08
BaJy Style: 4D Sed 114"WB Drive Train: 4.6L Inj 8 Cyl 4A RWD
VIN: 2FAFP71V08X174906 License: 485HCN MN
Mileage: 130,400
OEM/ALT: A S�rch Code: ARDENHILL1
Cdor: BLACK
Line Entry Labor Line Item Part Type/ Ddlar Labor
Item Number Type Operation Description Part Number Amount Units
Front Bumoer
1 000208 BDY REMOVE/INSTALL Frt Bumper Cover 0.5'#
2 DROP/LOOSEN ONLY
Front Lamos
3 004095 BDY REMOVE/INSTALL L Front Combination Lamp 0.2 #
Hoo�
4 004116 BDY REPAIR Hood Panel Ebsting 1.0'
5 REF REFINISH Haod Outside C 3.2
FrontFender
6 000491 BDY REPAIR L Fender Panel E�dsdng 0.5'#
7 REF REFINISH/REPAIR L Fender Panel C 1.9'
8 MODIFIED REFINISH WITH FULL CLEAR COAT
Windshield
9 001448 GLS REMOVE/INSTALL Windshield 3.0 #
10 001437 BDY REMOVE/REPLACE W/Shield Moulding 4W7Z 5403144 AA 111.90
Cowl&Dash
11 003024 BDY REMOVE/REPLACE R Cawl/Dash Trim Panel 6W7Z 5402344 AAA 30.32 0.2
Front Door
12 000445 REF BLEND L Frt Door Outside C 1.0
13 003398 BDY REPAIR R Frt Door Repair Panel Ebsting 0.5'#
14 REF REFINISH/REPAIR R Frt Door Repair Panel � �•8`
15 MODIFIED REFINISH WITH FULL CLEAR COAT
16 000299 BDY REMOVE/INSTALL L Frt Otr Belt Moulding ��� #
17 000300 BDY REMOVE/INSTALL R Frt Upr poor Moulding 1.5 #
18 002620 BDY REMOVE/INSTALL R Frt Door Adhesive Moulding Ebsting 0.4'
19 INC CLEAN AND RETAPE
20 002621 BDY REMOVE/INSTALL L Frt Door Adhesive Moulding 6dsting 0.4'
2� INC CLEAN AND RETAPE
22 000344 BDY REMOVE/REPLACE R Frt Otr poor Belt Moulding 6W7Z 5421452 AA 57.42 0.3 #
23 BDY REMOVE/INSTALL R Frt Door Trim Panel INC
24 002628 BDY REMOVE/REPLACE R Frt Door Mirror Assy Used/Recycled 55.00 ` INC #
ps Line Markup%30.00 16.50
26 002629 BDY REMOVE/REPLACE L Frt Door Mirta Assy Used/Recycled 55.00 ' INC #
ESTIMATE RECALL NUMBER: 06/16/2014 10:35:37 14-2128603-01
Mitchell Data Version: OEM: APR_14_V0604
MAPP:APR_14_V0608 Copyright(C)1994-2014 Mitchell Intemational Page 1 of 5
Software Version: 7.1.164 All Rights Reserved
Date: 6/16/2014 10:36 AM
Estimate ID: 142128603-01
Estimate Version: 0
Committed
P�le ID: `MeVO All Parts7.1
27 Line Markup%30.00 16.50
28 002830 BDY REMOVE/REPLACE R Frt Door Mirror Cover YW7Z 17D742 DA 52.08
29 000372 BDY REMOVE/INSTALL L Frt Door Trim Panel INC
30 000238 BDY REMOVE/INSTALL R Frt Otr poor Handle 0.3 #
31 003944 BDY REMOVE/REPLACE L Frt Door Outside Handle 6W7Z 5422404 DB 83.08 0.3 #
32 000218 BDY REMOVE/REPLACE R Frt Door Glass Run FSAZ 5421596 AA 160.63 0.6 #
Rear poor
33 003402 BDY REPAIR R Rear Adhesive Banded Door Repair Panel Ebsting 1.0'#
34 REF REFINISH R R�r poor Outside C 2.1
35 003403 BDY REPAIR L Rear Adhesive Bonded Door Repair Panel E�dsting 0.5'#
36 REF REFINISH L Rear poor Outside C 2.1
37 001045 BDY REMOVE/INSTALL R R�r Upr poor Moulding 0.5 #
38 001046 BDY REMOVE/INSTALL L Rear Upr poor Moulding 0.5 #
39 001047 BDY REMOVElINSTA�L R R�r Otr Belt Moulding 0.3
40 001048 BDY REMOVE/INSTALL L R�r Otr Belt Moulding 0.3
41 002663 BDY REMOVE/INSTALL R Rear poor Adhesive Moulding Ebsting 0.2 r
42 002664 BDY REMOVE/INSTALL L R�r poor Adhesive Moulding Ebsting 0.4'
43 INC CLEAN AND RETAPE
44 001115 BDY REMOVE/INSTALL R Rear poor Trim Panel INC
45 001116 BDY REMOVE/INSTALL L Rear poor Trim Panel INC
46 000995 BDY REMOVE/INSTALL R Rear Otr poor Handle 0.3 #
47 001027 BDY REMOVE/REPLACE L Re�ar poor Outside Handle 6W7Z 5426605 AB 76.07 0.3 #
48 000979 GLS REMOVE/INSTALL R Rear poor Stationary uent Glass 6dsting 1.2 #r
49 000980 GLS REMOVE/INSTALL L Rear poor Stationary Vent Glass Epsting 1.2 #r
Roof
50 001324 BDY REPAIR Roof Panel F�dsting 8.0'
51 REF REFINISH Roof Panel Outside C 2.8
52 003631 BDY REMOVE/INSTALL R Roof Drip Moulding 0.3
53 003632 BDY REMOVE/INSTALL L Roof Drip Moulding 0.3
Back RlYindow
54 003573 GLS REMOVE/REPLACE Back Window Glass Used/RecyGed 70.00 ' 1.7 #
55 Line Markup%30.00 21.00
ua rPnl
56 000897 REF REFINISH L Quarter Panel Edge C 0.5
57 000881 BDY REPAIR R Quarter Outer Panel 6tisting 2.0'#
58 REF REFINISH R Quarter Panel Outside C 2.0
59 000882 BDY REPAIR L Quarter Outer Panel Epsting 7.0'#
60 REF REFINISH L Quarter Panel Outside � 2�0
Luaaaae Lid
61 000821 BDY REPAIR Luggage Lid Panel Ebsting 5.0`
62 REF REFINISH Luggage Lid Outside C 2.3
R r m s
63 001784 BDY REMOVE/INSTALL R ReerCombination L p 0.4
64 001785 BDY REMOVE/INSTALL L Rear Combination La 0.4
65 001753 BDY REMOVE/INSTALL Reflector Lamp Assy 0.3 #
Rear Bumcer
66 000957 BDY REMOVE/INSTALL Re�ar Bumper Cover �.2 #
ADDITIONAL OPERATIONS
67 REF ADD'L OPR Cl�r Coet 2•6
Additional Costs 8 Materials
68 ADD'L COST PairNJMaterials 826•2� `
69 900500 BDY' REMOVE/REPLACE CORROSION PROTECTION "Non-OEM 7.50 ' 0.3'
70 900500 GLS ' REMOVE/REPLACE URETHANE KIT(WINDSHIELD/BACK GLASS) Sublet 25.00 ' 0.0•
71 900500 GLS ' REMOVE/REPLACE URETHANE KIT(WINDSHIELD/BACK GLASS) Sublet 25.00 ` 0.0'
*-Judgment Item
#-Labor Note Applies
C-Included in Clear Coat Calc
r-CEG R&R Time Used For This Labor Operation
ESTIMATE RECALL NUMBER: 06/16/2014 10:35:37 14-2128603-01
Mftchell Data Version: OEM: APR_14_V0604
MAPP:APR_14_V0608 Copyright(C)1994-2014 Mitchell Intemational Page 2 of 5
Software Version: 7.1.164 All Rights Reserved
Date: 6/16/2014 10:36 AM
Estimate ID: 142128603-01
Estimate Version: 0
Committed
Pr�le ID: 'M�ro All Parts7.7
Recycler Information Section:
Pam's Auto-ARAPro
7505 Ridgewood Road
St Cloud MN 56303
800.560.7336320-363-4878
24 2008 Ford Cravn Victoria RIGHT DOOR MIRROR V0071 VA 55.00
Description:RGHT,BLK-TEXT,PWR,TESTED GD,
26 2008 Ford Cravn Victaia LEFT DOOR MIRROR V0071 VA 55.00
Description:LFT,BLK-TEXT,PWR,TESTED GD,
54 2008 Ford Cravn Victoria BACK WINDOW V0003 VA 70.00
Description:4DR,H EAT,T I NT-M 175,
DisGaimer:The price indications on recycled parts are real a composRe
values,based on the pricing option selected with QRP. Prices are the
latest available at time of inventory download and are subject to change
and availability.
To determine actual repairer net or whdesale price,call the automotive
recycler of your chace.
Certain parts located for this quote are interchangeable but are not an exact
match. Call the autanotive recycler of your chdce.
All manufacturers requirements regarding seat belt and supplemental
restraint system replacement must be adhered to. If additional parts
or operations are necessary to properly accomplish this, please
contact the estimating claims rep.
Estlm�b T�Is
Add'I
Labor Sublet
I. Labor Subtotals Unfts Rate Amount Amount Totals II. Part Replacement Summary Amount
Body 37.3 54.00 0.00 0.00 2,01420 Taxable Parts 809.00
Refinish 24.3 54.00 0.00 0.00 1,31220 Parts Adjustments 54.00
Glass 7.1 54.00 0.00 0.00 �383.40 Sale3 T3x (fij 7.125% 61.49
Non-TaxaWe Labor �,709.80 Tohal Replacement Parts Amount 924.49
Labor Summary 68.7 3,709.80
III. Additional Costs Amount IV. Adjustments Amount
Taxable Costs 826.20 Insurance Deductible 500.00-
Sales Tax � 7.125% 58.87
Customer Responsibility 500.00-
Total Add'Rional Costs 885.07
Paint Material Method:Rates
Init Rate=34.00
I. Total Labor: 3,709.80
II. Total Replacement Parts: 924.49
III. Total Additio�al Costs: 885.07
Gross Total: 5,519.36
IV. Total Adjustments: 500.00-
Net Total: 5,019.36
Pant(s)of Impact
16 Non-Cdlision(P)
ESTIMATE RECALL NUMBER: O6/16/2014 103537 14-212860�01
Mitchell Data Version: OEM: APR_14_V0604
MAPP:APR_14_V0608 Copyright(C)1994-2014 Mitchell Intemational Page 3 d 5
Soflware Version: 7.1.164 All Rights Reserved
Date: 6/16/2014 10:36 AM
Estimate ID: 142128603-01
Estimate Versian: 0
Committed
Profile ID: `Metro All Parts7.1
Alt.Location: PROGRESSIVE
Inspection Site: NotAvailable
Address: 2020 Bordner PI
St Paul,MN 55116
THIS IS A DAMAGE ASSESSMENT ONLY - NOT AN AUTHORIZATION TO REPAIR -
BASED ON DAMAGE VISIBLE OR CERTAIN AT THE TIME IT WAS WRITTEN.
IF FRAME OR UNIBODY REPAIR IS INCLUDED ON THIS ESTIMATE, THE AMOUNT
SHOWN INCLUDES TIME OR ALLOWANCE FOR MEASURING BEFORE, DURING AND
AFTER THOSE REPAIRS.
THE OWNER OF THE VEHICLE MAY SELECT THE REPAIR FACILITY OF HIS/HER
CHOICE.
TO ENSURE PROPER AND PROMPT PAYMENT FOR ADDITIONAL DAMAGE DISCOVERED
DURING THE COURSE OF REPAIRS, CONTACT PROGRESSIVE FOR SUPPLEMENT
HANDLING PROCEDURES.
PROGRESSIVE HONORS THE PREVAILING LABI"JR MARKET RATE IN YOUR AREA FOR
YOUR PROPERTY. IF YOU CHOOSE A SHOP THAT CHARGES IN EXCESS OF
PREVAILING LABOR MARKET RATES, YOU WILL BE RESPONSIBLE FOR THE
DIFFERENCE.
LIFETIME GUARANTEE FOR SHEET METAL AND PLASTIC BODY PARTS
The replacement parts written on the estimate are intended to return
your vehicle to its pre-loss condition with proper installation.
After repair, if any sheet metal or plastic body part included in the
estimate fails to return your vehicle to its pre-loss condition
(assuming proper installation) , in terms of form, fit, finish,
durability or functionality, Progressive will arrange and pay for the
replacement of the part, to the extent not covered by a
manufacturer's or other warranty. This service will be performed at
no cost to you (including associated !repair and rental car costs) . To
obtain service under this Guarantee, call Progressive at
1-800-274-4641. This Guarantee appli s as long as you own or lease
the vehicle. This Guarantee is not t�ansferable and terminates if you
sell or otherwise transfer your vehicle.
THIS GUARANTEE DOES NOT COVER NORMAL WEAR AND TEAR OR DAMAGE CAUSED
BY IMPROPER MAINTENANCE, NEGLECT, ABUSE OR SUBSEQUE�'�IT ACCIDENT. THIS
GUARANTEE IS LIMITED TO ARRANGING FOR THE SELECTION OF REPAIR PARTS
THAT WILL RETURN YOUR VEHICLE TO ITS PRE-LOSS CONDITION. ACCORDINGLY,
PROGRESSIVE WILL NOT BE LIABLE FOR ANY INDIRECT, INCIDENTAL OR
CONSEQUENTIAL DAMAGES THAT RESULT FROM THE INSTALLATION OR USE OF
THESE PARTS.
Part Type Terms and Abbreviations
NEW and OEM or part number displayed - These refer to a new, original
equipment manufacturer part.
NON-OEM and A/M and Qual REPL - These refer to an after-market part,
which is a new, non-original equipment manufacturer part.
USED/RECYCLED and LKQ - These refer to a used OEM part.
REMANUFACTURED and RECOND. and RECORE - These refer to used/recycled
OEM parts that have been refurbished.
REPAIR SHOP'S AUTHORIZED REPRESENTATIVE'S SIGNATURE INDICATING
AGREEMENT ON COST TO RETURN THE VEHICLE TO PRE-LOSS CONDITION
INCLUDING TOW/STORAGE CHARGES:
ESTIMATE RECALL NUMBER: O6/16/2014 1035:37 14-2128603-01
Mitchell Data Version: OEM: APR_14_V0604
MAPP:APR_14_V0608 Copyright(C)1994-2014 MRchell Intemational Page 4 of 5
Soflware Version: 7.1.164 All Rights Reserved
Date: 6/16/2014 10:36 AM
Estimate ID: 14212860301
Estimate Version: 0
Committed
Pr�le ID: �Metro All Parts7.1
SHOP SIGNATURE: EST. COMPLETION DATE:
ANY PERSON WHO, WITH INTENT TO DEFRAUD OR KNOWING THAT HE/SHE IS
FACILITATING A FRAUD AGAINST AN INSURER, SUBMITS AN APPLICATION OR
FILES A CLAIM CONTAINING A FALSE OR DECEPTIVE STATEMENT IS GUILTY OF
INSURANCE FRAUD.
Event Log
File Created: 06/16/2014 09:58:58 AM
Es6mate Started: O6/16/2014 09:59:53 AM
Estimate Printed: 06/16/2014 10:17:25 AM
Estimate Committed: O6/16/2014 10:35:37 AM
Estimate Uplaaded: 06/16/2014 10:36:00 AM
��
ESTIMATE RECALL NUMBER: O6/16/2014 10:35:37 14-212860301
Mitchell Data Version: OEM: APR_14_V0604
MAPP:APR_14_V0608 Copyright(C)1994-2014 Mitchell Intemational Page 5 of 5
Software Version: 7.1.164 All Rights Reserved
�' rnitchell
WorkCenter TM Total Loss
PREPARED FOR:
Progressive Group of Insurance Companies
(800)321-9843
Claim Summary: 14-2128603-01
Insurance Carrier: Progressive Group of Insurance Version#: 2
Companies Coverage Type of Loss: Comprehensive
Claim-SuffixlD: 14-2128603-01 Loss Date: O6/14/2014
Policy Number: Reported Date: 06/14/2014
Owner: TONETTA CAMPBELL Valuation Report Date: O6/19l2014 18:10:54
Address: 2020 BORDNER PLACE Valuation Report ID: 1004441746
ST PAUL,MN 55116 Vehicie T Other
YPe�
Owner Home Phone: (763)656-3657
Appraiser
Appraisal Company: Mitchell Intemational
Contact Name: WorkCenter Total Loss Service Center
Contact Phone: 1-800-710-2451
Appraisal Report: 2008 Ford Crown Victoria
VIN: 2FAFP71V08X174906 License Plate: 485HCN„Exp./
Year: 2008 , Make: Ford
Model: Crown Victoria � Zip/Postal Code: 55116
Loss Vehicle:2008 Ford Crown
Victoria Police 4 Door Sedan
114"WB 4.6L 8 Cyl Gas Injected
4 Speed Auto Trans RWD VIN:
Vehicle Data: 2FAFP71V08X174906
Mileage:130,400 miles Exterior
Color:
License Plate: Primary POI:
VehiGe Location:MN 55116
Options and Equipment:
Copyright(c)2011-Mitchell International.All Rights Reserved.�Page 1
Mitchell Generic Equipment:
PASSENGER AIRBAG
POWER LOCK
FM RADIO
MANUAL A�R CONDITION
POWER BRAKE
POWER DRIVER SEAT
POWER STEERING
POWER WINDOW
REAR WINDOW DEFOGGER I
TILT STEERING COLUMN i
Condition:
INTERIOR Condition
DOORS/INTERIOR PANELS 3 Good
SEATS 2 Fair 3 inch tear in driver's seat
HEADLINER 3 Good
CARPET 3 Good
GLASS 3 Good
DASH/CONSOLE 3 Good
EXTERIOR Condition
PAINT 2 Fair COLOR MISMATCH
BODY 2 Fair surface rust
TRIM 3 Good
VINYUCONVERTIBLE TOP Unknown
MECHANICAL Condition
ENGINE 2 Fair BELTS WORN
TRANSMISSION 3 Good
TIRE Condition 3 Good
The vehicle condi6on documents the pre-loss condition of the loss vehiGe. Condition is rated on a scale of 1-5,where 5 is excellent.
Base Value: $4,173.04
Prior Damage Adjustment: $0.00
Condition(LV 2.38 to Typical 3.00): -$116.65
, Market Value: $4,056.39
' Deductible: -$500.00
Final Value: $3,556.39
Comments:
Valuation Notes:
Market Sample Records:
Copyright(c)2011-Mitchell Intemational.All Rights Reserved.�Page 2
Comparable 7
Date: O6/19/2014 Seller: Asia Motors Inc
Contact: Dealer Listing Location: 60622
Stock#: 14105 Exterior Color:
Phone Number: 877-601-5082 Mileage: 108,684 miles
Condition: Typical Price: $4,595.00
VIN: 2FAFP71V58X103846
Vehicle: 2008 Ford Crown Victoria Police 4
Door Sedan 114"WB 4.6L 8 Cyl
Gas Injected 4 Speed Auto Trans
RWD
Equipment: Standard,Driver-Side Spot L�mp,
Speed Control,Power Driver eat
Adjustments
Adjustment Description Adjustment Amount
Mileage -$232.20
Driver-Side Spot Lamp -$90.00
Speed Control -$60.00
Power Driver Seat -$105.00
Adjusted Price: 54,107.80
Comparable 2
Date: 06/19/2014 Seller: Welcome Motors
Contact: Dealer Listing Location: 60618
Stock#: 2207 EMerior Color:
Phone Number: 866-800-1875 Mileage: 114,000 miles
Condition: Typical Price: $4,500.00
VIN: 2FAFP71VSSX161594
Vehicle: 2008 Ford Crown Victoria Police 4
Door Sedan 114"WB 4.6L 8 Cyl
Gas Injected 4 Speed Auto Trans
RWD
Equipment: Standard,Driver-Side Spot Lamp
Adjustments
Adjustment Description Adjustment Amount
Mileage -$171.73
Driver-Side Spot Lamp -$90.00
Adjusted Price: 54�23s•Z�
D/SCLA/MER
THIS VALUATION HAS BEEN RESEARCHED AND PROVIDED BASED SOLELY ON THE INFORMATION PROVIDED BY
THE INSURANCE COMPANY,AND IS TO BE USED FOR ITS INTENDED PURPOSE ONLY.
THE RESEARCH AND CALCULATIONS CONDUCTED CAN CONSIST OF MARKET RESEARCH OF DEALERSHIP
INVENTORIES,AUTOMOTIVE APPRAISAL GUIDES AND DIRECTORIES,AND MARKET SURVEYS OF SIMILAR
COMPARABLE VEHICLES.INFORMATION RECEIVED BY OR PROVIDED TO MITCHELL IS BELIEVED TO BE
RELIABLE BUT NO RESPONSIBIIITY IS ASSUMED BY MITCHELL OR ITS AGENTS FOR ERRORS,INACCURACIES OR
OMISSIONS OF THAT INFORMATION.
SINCE ADJUSTMENTS ARE MADE TO EACH COMPARABLE TO BRING IT IN LINE WITH THE LOSS VEHICLE,EQUAL
WEIGHTING FACTORS HAVE BEEN USED IN AVERAGING THE FAIR MARKET VALUE.
Copyright(c)2011 -Mitchell Intemational.All Rights Reserved.�Page 3
I