Hansen, Gretchen Attorneys
W KENNETH L.Wi�aER(CO,IL) ?� ���E!�E� Phone: 800-313-5169
s' CHRISTWE CHANCE(FL,GA,IL) Fax: 800-313-5i79
'� PATRICK LIGHT{IL� JUL 11 2014 Tax ID: t,z-z6z8ou
� RACHAELPERRYQL) �'►�ILBER CITY CLERK
I�.�����ri�� [ i..�.v��r �4�i���:
City Clerk
310 City Hall
15 Kellogg Blvd. , West
Saint Paul, MN 55102
July 7, 2014
RE: Our Client: USAA
Our Client ' s Insured: GRETCHEN M HANSEN
Our File Number: 1109910 - 28
Your Insured: CITY OF ST PAUL
Your Claim/Policy Number:
Date of Accident : 04-01-14
Amount Claimed: $1, 556 . 06
Please be advised that we represent USAA
for a claim they paid to their policyholder. We have been
informed that there is possible coverage through your company.
Enclosed please find the supporting documents for your review.
After your review, please contact this office to discuss settlement
proceedings . If you have further questions, please contact
Kristi Loyer, who we have assigned to handle this claim.
Please note that all payments for this claim will need to be made
payable to USAA
and remitted to our office for proper handling.
Thank you for your immediate attentio to thi ter.
�l �_
WILBER D OCIATES
WNA/ps
Enclosure
Wilber&Associates,P.C.Attorneys at Law � Wilber Insurance Services � Wilber Consulting
�� zzo Landmark Dr� Normal,IL � 6i76i-zi94
����I!/ED
.IUL 11 2014
NOTICE OF CLAIM FORM to the City of��a�t �aul, Minnesota
Minnesota State Statute 466.05 states tlrat "...every person...who claims damages from an��municipaliry...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 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. The prceess 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 KELLO G BLVD 310 C�TY HALL, SAIN�PAUL, MN 55102
�,t be,�'Cti�1 Ce �Gc.���-�✓ i,��� � (z� (v�-r�.tt',�-P i� Jru�h
First Name Middle Initial Last Name
Company or Business Name�AC, � /l
Are You an Insurance Company? Yes/��' If Yes,Claim Number? I J l v
Street Address l�i�� ���'��������
� I � �
City ��'�V��-1 Stat� � Zip Code �-�
`�, 1 y" '" ��
Daytime Phone(�)l� � il?��XCell Phone( ) � �7_`_Evening Telephone( '`�'��
Date of Accident/Injury or Date Discovered � (( � �� Time l Z—'•`Q� air��
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 in olved and/or respo sible for xour damages.
' ' r1�;Y ,�U'�-.����-. ���,�[�
Please check the box(es)that most closely represent the reason for completing this form:
,'�My vehicle was damaged in an accident ❑ My vehicle was damaged during a tow
❑ My vehicle was damaged by a pothole or condition of the street ❑ My vehicle was damaged by a plow
❑ My vehicle was wrongfully towed and/or ticketed ❑ I was injured on City property
❑ Other type of property damage—please specify
❑ Other type of injury—please specify
In order to process your claim 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-nlease comulete this section ------ -
Were there witnesses to the incident? Yes No ��n% (circle)
Provide their names, addresses and telephone numbers:
Were the police or law enforcement c � n es� No Unknown cucle)
If yes, what department or agency? _���.�� 1�� Case#or report# ``��'�����':�`
Where did the accident or injury take place? Provide street address,cross street, intersecti�i na�o�,�p�.r�or facility,
closest landmark,etc. Please be as detailed as possible. If necessary, attach a diagram. � �+fv
Please indicate the a o�}nt ou are seeking in compensation or what you would like the City to do to resolve this claim
to your satisfaction.� 1���� • L>�a
Vehicle Claims- lease com lete this se tion check box if this section does not a 1
Your Vehicle: Year '��<<1-� Make '�� «-- Model � '����
License Plate Number "� .1 X � State►'K+'l� Color `���°�
Registered Owner U��e��`��1 '�'� ���
Driver of Vehicle
Area Damaged L'(. �
City Vehicle: Year �I� Make�y� � Model��'1.c�:t,�:>'l V �� '�� ��'
License Plate Number I State Color
Driver of Vehicle,(�C�',t,�;Emplo ee's Na�e)�f�(�1 G(/Yl ����✓ ��� .5�'l(.� % �
Area Damaged uV�-+�-��i��%r� �
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? Yes No
When did you miss work? (provide date(s))
Name of your Employer:
Address Telephone
,�l 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 inforination you have provided is true and correct to the best
of your knowledge. Unsigned forms will not be processed.
Submi,tting a false claim can result in prosecution. Date form was completed �� � 1 �
Print the Name of the Person who Completed thi rtn: ��� � T } �'' '�'�
_
Signature of Person Making the
Revised February 201]
I
HANSEN,GRETCHEl�M. - 013880207 - Loss Summary Page 1 of 1
oofbar �
�r��ES�'t ���si�; To
: � �Bo#tom
Payments Payment Settings
Payments �► CLR Help
Review Rayments
Requested Date Amount PaYees Issued Date Method Status (
D"o1OS/2014 $780.92 ABRA AUTO BODY AND 06/25/2014 Printed check Not Cleared
GLASS
04129/2d14 $525.14 ABRA AUTO B4DY AND 05J15/2014 Printed check Cleared
GLASS
�i#�E�r�s�' ��3Ct�;
To Top
0901119c�����t.usaa.com/inetJgas_pc_claim :� 6/27/2014
ABRA Auto Body & Glass - Federal ID: 41-1942823
Maplewood
Right The First Time...On Time
2806 HIGHWAY 61, MAPLEWOOD, MN 55109
Phone: (651) 483-2145
FAX: (651) 483-2509
Estimate of Record
Customer: HANSEN, GRETCHEN lob Number:
Written By: Paul Talbot,4/29/2014 3:32:43 PM
Adjuster: Lancaster,Elizabeth,(800)531-8722 Business
Insured: HANSEN,GRETCHEN Policy#: 013880207 Claim#: 013880207000000011001
Type of Loss: Collision Date of Loss: 4/1/2014 12:00:00 PM Days to Repair: 2
Point of Impact: 05 Right Rear
Owner: Inspection Location: Insurance Company:
HANSEN,GRETCHEN ABRA Auto Body&Glass-Maplewood USAA
1299 4TH ST E 2806 HIGHWAY 61 Colorado Springs--8187
SAINT PAUL, MN 55106 MAPLEWOOD, MN 55109 Visit"USAA.com"or call
(651)208-4406 Cell Repair Facility (800)531-8722 Business
(651)483-2145 Business ,
�
VEHI�LE
Year: 1998 Body Style: 4D SED VIN: 1HGCG5644WA121568 Mileage In: 151866
Make: HOND Engine: 4-2.3L-FI License: 849-JXP Mileage Out:
Model: ACCORD LX Production Date: 2/1998 State: Vehicle Out:
Color: GREEN Int: GREY Condition: Job#:
TRANSMISSION Dual Mirrors AM Radio Bucket Seats
Automatic Transmission Body Side Moldings FM Radio Reclining/Lounge Seats
Overdrive Console/Storage Stereo WHEELS
POWER CONVENIENCE Search/Seek Wheel Covers
Power Steering Air Conditioning Cassette PAINT
Power Brakes Intermittent Wipers SAFETY Clear Coat Paint
Power Windows Tilt Wheel Drivers Side Air Bag OTHER
Power Locks Cruise Control Passenger Air Bag Power Trunk/Gate Release
Power Mirrors Rear Defogger SEATS
DECOR RADIO Cloth Seats
4/29/2014 3:32:44 PM 014563 Page 1
0 9 01119 c 8 edl aeb e USAA Confidential
Estimate of Record
Customer: HANSEN, GRETCHEN lob Number:
Vehicle: 1998 HOND ACCORD LX 4D SED 4-2.3L-FI GREEN
Line Oper Description Part Number Qty Extended Labor Paint
Price�
1 REAR BUMPER
2 R&I R&I bumper cover 0•8
3 * Rpr Bumper cover 3_0 3.2
4 Add for Clear Coat 1.3
5 TRUNK LID
6 Repl Nameplate"LX"factory 75731S84A00 1 11.72 O.Z
7 .REAR LAMPS .
8 * Repl LKQ RT Lens&housing+25% 33501S84A01 1 62.50 0 4
9 QUARTER PANEL
10 R&I Mud guard set,rear 0.3
11 * Rpr RT Gutter 1_0 0_0
Note: align taillamp pocket _ _ _._ _
12 MISCELLANEOUS OPERATIONS
13 # �Hazardous Waste 1 3.00 X
14 # Repl �Flex Additive/Adhesion Promoter 1 8.00 T
SU6T10TAL5 85.22 5.7 4.5
ESTIMATE TOTALS
Category Basis Rate Cost$
Parts 74.Z2
Parts Discount $ 11.72 -4.8% -0.56
g�y��� 5.7 hrs @ $52.00/hr 296.40
Paint Labor 4.5 hrs @ $52.00/hr 234.00
Paint Supplies 4.5 hrs @ $32.00/hr 144.00
Miscellaneous 11.00
Subtotal 759.06
Sales Tax $225.66 @ 7.1250% 16.08
Grand Total 775.14
Deductible 250.00
CUSTOMER PAY 250.00
INSURANCE PAY 525.14
THIS IS A VISUAL INSPECTION ONLY. THERE MAY BE ADDITIONAL DAMAGE AFTER DISASSEMBLY. PARTS ARE
SUBJECT TO INVOICE. THERE ARE NO GUARANTEES ON RUST REPAIRS.
"Minnesota law gives you the right to choose any rental vehicle company, and prohibits me from requiring you to
choose a particular vendor."
4/29/2014 3:32:44 PM 014563 Page 2
0 9 01119 c 8 edlaebe USAA Confidentiat�
f
Estimate of Record
Customer: HANSEN, GRETCHEN 7ob Number:
Vehicle: 1998 HOND ACCORD LX 4D SED 4-2.3L-FI GREEN
Please Present A Copy Of This Estimate To A Repair Facility Of Your Choice
*USAA Subsidiaries include: United Services Automobile Association(USAA), USAA Casualty Insurance Company(CIC),
USAA General Indemnity Company(GIC) USAA County Mutual Insurance(CMI) and Garrison Property Casualty
Insurance Company. Garrison Properly and Casualty Insurance Company, a subsidiary of USAA Casualty Insurance
Company, is authorized to use the USAA logo, a registered trademark of United Services Automobile Association.
This is not an authorization to repair. Failing to present this estimate to the repairing garage before repair may result
in additional expenses to you. A USAA appraiser must authorize any supplement to this estimate. Repairs to this
vehicle may require specific welding equipment as recommended by the manufacturer.
If alternative quality replacement parts have been included in this appraisal, the source for these parts has also been
disclosed. If alternative quality replacement parts as listed on the appraisal are ultimately used in the repair of your
vehicle, the warranty on such parts will be equal to, or greater than, the parts being replaced, as stated in USAA's
limited parts warranty. USAA warrants that the parts used on your vehicle will be of like kind and quality, function, fit,
safety and corrosion protection as the part or parts they replace. USAA identifies certified and validated parts for
sheet metal replacement parts.
MN ST 60A.955 -A PERSON WHO FILES A CLAIM WITH INTENT TO DEFRAUD OR HELPS COMMIT A FRAUD
AGAINST AN INSURER IS GUILTY OF A CRIME.
4/29/2014 3:32:44 PM 014563 Page 3
0 9 01119 c 8 edlaebe �USAA Confidential
Estimate of Record
Customer: HANSEN, GRETCHEN Job Number:
Vehicle: 1998 HOND ACCORD LX 4D SED 4-2.3L-FI GREEN
Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from the Guide
AEG4422, CCC Data Date 4/16/2014, and the parts selected are OEM-parts manufactured by the vehicles Original
Equipment Manufacturer. OEM parts are available at OE/Vehicle dealerships. OPT OEM (Optional OEM) or ALT OEM
(Alternative OEM) parts are OEM parts that may be provided by or through alternate sources other than the OEM
vehicle dealerships. OPT OEM or ALT OEM parts may reflect some specific, special, or unique pricing or discount.
OPT OEM or ALT OEM parts may include "Blemished" parts provided by OEM's through OEM vehicle dealerships.
Asterisk(*) or pouble Asterisk (**) indicates that the parts and/or labor information provided by MOTOR may have
been modified or may have come from an alternate data source. Tilde sign (�) items indicate MOTOR Not-Included
Labor operations. The symbol (<>) indicates the refinish operation WILL NOT be performed as a separate procedure
from the other panels in the estimate. Non-Original Equipment Manufacturer aftermarket parts are described as Non
OEM or A/M. Used parts are described as LKQ, RCY, or USED. Reconditioned parts are described as Recond.
Recored parts are described as Recore. NAGS Part Numbers and Benchmark Prices are provided by National Auto
Glass Specifications. Labor operation times listed on the line with the NAGS information are MOTOR suggested labor
operation times. NAGS tabor operation times are not included. Pound sign (#) items indicate manual entries.
Some 2014 vehicles contain minor changes from the previou5 year. For those vehicles, prior to receiving updated
data from the vehicle manufacturer, labor and parts data frorri the previous year may be used. The CCC ONE
estimator has a complete list of applicable vehicles. Parts nutnbers and prices should be confirmed with the local
dealership.
The following is a list of additional abbreviations or symbols that may be used to describe work to be done or parts to
be repaired or replaced:
SYMBOLS FOLLOWING PART PRICE:
m=MOTOR Mechanical component. s=MOTOR Structural component. T=Miscellaneous Taxed charge category.
X=Miscellaneous Non-Taxed charge category.
SYMBOLS FOLLOWING LABOR:
D=Diagnostic labor category. E=Electrical labor category. F=Frame labor category. G=Glass labor category.
M=Mechanical labor category. S=Structural labor category. (numbers) 1 through 4=User Defined Labor Categories.
OTHER SYMBOLS AND ABBREVIATIONS:
Adj.=Adjacent. Algn.=Align. ALU=Aluminum. A/M=Aftermarket part. BInd=Blend. BOR=Boron steel.
CAPA=Certified Automotive Parts Association. D&R=Disconnect and Reconnect. HSS=High Strength Steel.
HYD=Hydroformed Steel. Inc1.=Included. LKQ=Like Kind and Quality. LT=Left. MAG=Magnesium. Non-Adj.=Non
Adjacent. NSF=NSF International Certified Part. O/H=Overhaul. Qty=Quantity. Refn=Refinish. Repl=Replace.
R&I=Remove and Install. R&R=Remove and Replace. Rpr=Repair. RT=Right. SAS=Sandwiched Steel.
Sect=Section. Subl=Subtet. UHS=UItra High Strength Steel. N=Note(s) associated with the estimate line.
CCC ONE Estimating -A product of CCC Information Services Inc.
The following is a list of abbreviations that may be used in CCC ONE Estimating that are not part of the MOTOR
CRASH ESTIMATING GUIDE:
BAR=Bureau of Automotive Repair. EPA=Environmental Protection Agency. NHTSA= National Highway
Transportation and Safety Administration. PDR=Paintless Dent Repair. VIN=Vehicle Identification Number.
4/29/2014 3:32:44 PM 014563 Page 4
0 9 01119 c 8 ed 1 aeb e USM Confidentiaf�
ABRA Auto Body & Glass - Workfile ID: c8fe3a31
Federal ID: 41-1942823
Maplewood
Right The First Time...On Time
2806 HIGHWAY 61, MAPLEWOOD, MN 55109
Phone: (651) 483-2145
FAX: (651) 483-2509
Supplement of Record 1 with Summary
Customer: HANSEN, GRETCHEN )ob Number:
Written By:Tooj Vang, 6/9/2014 5:37:41 PM
Adjuster: Lancaster, Elizabeth,(800)531-8722 Business
Insured: HANSEN,GRETCHEN Policy#: 013880207 Claim#: 013880207000000011001
Type of Loss: Coliision Date of Loss: 4/1/2014 12:00:00 PM Days to Repair: 2
Point of Impact: 05 Right Rear
Owner: Inspection Location: Insurance Company:
HANSEN,GRETCHEN ABRA Auto Body&Glass-Maplewood USAA
1299 4TH ST E 2806 HIGHWAY 61 Colorado Springs--8187
SAINT PAUL,MN 55106 MAPLEWOOD, MN 55109 Visit"USAA.com"or call ',
(651)208-4406 Cell Repair Faciliry (800)531-87Z2 Business
(651)483-Z145 Business
VEHICLE
Year: 1998 Body Style: 4D SED VIN: 1HGCG5644WA121568 Mileage In: 151866 '
Make: HOND Engine: 4-2.3L-FI License: 849-JXP Mileage Out:
Model: ACCORD LX Production Date: 2/1998 State: Vehicle Out:
Color. GREEN Int: GREY Condition: Job#:
TRANSMISSION Dual Mirrors AM Radio Bucket Seats '
Automatic Transmission Body Side Moldings FM Radio Reclining/Lounge Seats
Overdrive Console/Storage Stereo WHEELS
POWER CONVENIENCE Search/Seek Wheel Covers �
Power Steering Air Conditioning Cassette PAINT �
Power Brakes Intermittent Wipers SAFETY Clear Coat Paint �
Power Windows Tilt Wheel Drivers Side Air Bag OTHER
Power Locks Cruise Control Passenger Air Bag Power Trunk/Gate Release �
Power Mirrors Rear Defogger SEATS �
DECOR RADIO Cloth Seats �
I
6/9/2014 5:37:41 PM 014563 Page 1
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I
Supplement of Record i with Summary
Customer: HANSEN, GRETCHEN 7ob Number:
Vehicle: 1998 HOND ACCORD LX 4D SED 4-2.3L-FI GREEN
Line Oper Description Part Number Qty Extended Labor Paint
Price�
1 REAR BUMPER
2 R&I R&I bumper cover 0.8
3 * Rpr Bumper cover 3_0 3.2
4 Add for Clear Coat 1.3
5 TRUNK LID
6 * SOl Repl Nameplate"LX"factory 75731S84A00 1 11.92 0.2
7 # SOl �Clean&Retape Moiding 1 2.00 T 0.3
8 REAR LAMPS
9 ** SO1 Repl A/M CAPA RT Lens&housing 33501S84A01 1 79.00 0.4
10 REAR BODY&FLOOR
11 SO1 R&I Rear panel trim 0.4
12 SO1 R&I RT Trunk side trim 0.5
13 * SO1 Rpr Rear body panel 5_0 1.2
Note: Deep crease,fold,dents.
Inside body panel rt side with crease and folds.
14 501 Add for Clear Coat 0.5
15 SO1 Add for Inside 0.6
16 QUARTER PANEL
17 R&I Mud guard set,rear 0.3
18 * S01 Rpr RT Gutter � 0.4
19 SO1 Add for Clear Coat 0.1
20 * 501 Rpr RT Stiffener 0_5
Note: Bent and twisted no body paint needed
21 MISCELLANEOUS OPERATIONS
22 # �Hazardous Waste 1 3.00 X
23 # Repl �Flex Additive/Adhesion Promoter 1 8.00 T �
24 # SO1 Rpr �Color Tint 0.5
25 ** SO1 Repl A/M �Bumper Repair Kit 1 14.03 T '
26 # 501 Refn �Corrosion Protection 03
27 # SOl Fnal Bill 1 �
SUBTOTALS 117.95 14.9 7.6
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6/9/2014 5:37:41 PM 014563 Page 2
0 9 01119 c 8 f 2 0 3 dc a USAA Confidential
Supplement of Record i with Summary
Customer: HANSEN, GRETCHEN 7ob Number:
Vehicie: 1998 HOND ACCORD LX 4D SED 4-2.3L-FI GREEN
ESTIMATE TOTALS
Category Basis Rate Cost;
Parts 90.92
Parts Discount $11.92 -4.8% -0.57
Body Labor 14.9 hrs @ $52.00/hr 774.80
Paint Labor 7.6 hrs @ $52.00/hr 395.20
Paint Supplies 7.6 hrs @ $32.00/hr 243.20
Misceilaneous 27.03
Subtotal 1,530.58
Sales Tax $357.58 @ 7.1250% 25.48
Grand Total 1,556.06
Deductible 250.00
CUSTOMER PAY 250.00
INSURANCE PAY 1,306.06
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6/9/2014 5:37:41 PM 014563 Page 3
0 9 01119 c 8 f 2 0 3 dc a USM Confidential
Supplement of Record 1 with Summary
Customer: HANSEN, GRETCHEN )ob Number:
Vehicle: 1998 HOND ACCORD LX 4D SED 4-23L-FI GREEN
SUPPLEMENT SUMMARY
Line Oper Description Part Number Qty Extended Labor Paint
Price;
,Changed IEems '
5 Repl Nameplate"LX"factory 75731584A00 1 -11.72 -0.2
6 * 501 Repl Nameplate"LX"factory 75731584A00 1 11.92 0.2
Deleb�i:Items
7 REAR LAMPS
S * Repl LKQ RT Lens&housing+25% 33501S84A01 1 -62.50 -0.4
11 * Rpr RT Gutter -1.0 0_0
NOTE: align taillamp pocket
Added Items
7 # SO1 �Clean&Retape Molding 1 2.00 T 03
8 REAR LAMPS
9 ** SO1 Repl A/M CAPA RT Lens&housing 33501584A01 1 79.00 0.4
10 REAR BODY&FLOOR
11 SO1 R&I Rear panel trim 0.4
12 SO1 R&I RT Trunk side trim 0.5
13 * S01 Rpr Rear body panel 5_0 1.2
NOTE: Deep crease,fold,dents.
Inside body panel rt side with crease and folds.
14 SO1 Add for Clear Coat 0.5
15 S01 Add for Inside 0.6
18 * SO1 Rpr RT Gutter 3_0 0.4
19 SOl Add for Ciear Coat 0.1
20 * SO1 Rpr RT Stiffener �
NOTE: Bent and twisted no body paint needed ,
24 # SO1 Rpr �Color Tint �5 �
25 ** SO1 Repl A/M �Bumper Repair Kit 1 14.03 T ',
26 # 501 Refn �Corrosion Protection 0.3
27 # S01 Fnal Bill 1
SUBTOTALS 32.73 9.2 3.1
6/9/2014 5:37:41 PM 014563 Page 4
0 9 01119 c 8 f 2 0 3 dc a USAA Confidential
Supplement of Record 1 with Summary
Customer: HANSEN, GRETCHEN )ob Number:
Vehicle: 1998 HOND ACCORD LX 4D SED 4-23L-FI GREEN
TOTALS SUMMARY
Category Basis Rate Cost$
Parts 16.70
Parts Discount $0.20 -4.8% -0.01
Body Labor 9.2 hrs @ $52.00/hr 478.40
Paint Labor 3.1 hrs @ $52.00/hr 161.20
Paint Supplies 3.1 hrs @ $32.00/hr 99.20
Miscellaneous 16.03
Subtotal 771.52
Sales Tax $ 131.92 @ 7.1250% 9.41
Additional Supplement Taxes -0.01
Total Supplement Amount 780.92
NET COST OF SUPPLEMENT 780.92
CUMULATIVE EFFECTS OF SUPPLEMENT(S)
Estimate 775.14 Paul Talbot
Supplement SOl 780.92 Tooj Vang
)ob Total: $ 1,556.06
CUSTOMER PAY: � 250.00
INSURANCE PAY: $ 1,306.06
THIS IS A VISUAL INSPECTION ONLY. THERE MAY BE ADDITIONAL DAMAGE AFTER DISASSEMBLY. PARTS ARE ,
SUBJECT TO INVOICE. THERE ARE NO GUARANTEES ON RUST REPAIRS.
"Minnesota law gives you the right to choose any rental vehicle company, and prohibits me from requiring you to
choose a particular vendor."
II��
6/9/2014 5:37:41 PM 014563 Page 5
0 9 01119 c 8 f 2 0 3 dc a USAA Confidential �
Suppiement of Record 1 with Summary
Customer: HANSEN, GRETCHEN )ob Number:
Vehicle: 1998 HOND ACCORD LX 4D SED 4-2.3L-FI GREEN
Please Present A Copy Of This Estimate To A Repair Facility Of Your Choice
*USAA Subsidiaries incfude: United Services Automobile Association(USAA), USAA Casualty Insurance Company(CIC),
USAA General Indemnity Company(GIC) USAA County Mutual Insurance(CMI) and Garrison Property Casualty
Insurance Company. Garrison Property and Casualty Insurance Company, a subsidiary of USAA Casualty Insurance
Company, is authorized to use the USAA logo, a registered trademark of United Services Automobile Association.
This is not an authorization to repair. Failing to present this estimate to the repairing garage before repair may result
in additional expenses to you. A USAA appraiser must authorize any supplement to this estimate. Repairs to this
vehicle may require specific welding equipment as recommended by the manufacturer.
If alternative quality replacement parts have been included in this appraisal, the source for these parts has also been
disclosed. If alternative quality replacement parts as listed on the appraisal are ultimately used in the repair of your
vehicle, the warranty on such parts will be equal to, or greater than, the parts being replaced, as stated in USAA's
limited parts warranty. USAA warrants that the parts used on your vehicle will be of like kind and quality, function, fit,
safety and corrosion protection as the part or parts they replace. USAA identifies certified and validated parts for
sheet metal replacement parts.
MN ST 60A.955 -A PERSON WHO FILES A CLAIM WITH INTENT TO DEFRAUD OR HELPS COMMIT A FRAUD
AGAINST AN INSURER IS GUILTY OF A CRIME.
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6/9/2014 5:37:41 PM 014563 Page 6
0 9 01119 c 8 f 2 0 3 dc a USAA Confidential�
Suppiement of Record 1 with Summary
Customer: HANSEN, GRETCHEN Job Number:
Vehicle: 1998 HOND ACCORD LX 4D SED 4-2.3L-FI GREEN
Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from the Guide
AEG4422, CCC Data Date 6/6/2014, and the parts selected are OEM-parts manufactured by the vehicles Original
Equipment Manufacturer. OEM parts are available at OE/Vehicle dealerships. OPT OEM (Optional OEM) or ALT OEM
(Alternative OEM) parts are OEM parts that may be provided by or through alternate sources other than the OEM
vehicle dealerships. OPT OEM or ALT OEM parts may reflect some specific, special, or unique pricing or discount.
OPT OEM or ALT OEM parts may include "Blemished" parts provided by OEM's through OEM vehicle dealerships.
Asterisk (*) or pouble Asterisk (**) indicates that the parts and/or labor information provided by MOTOR may have
been modified or may have come from an alternate data source. Tilde sign (�) items indicate MOTOR Not-Included
Labor operations. The symbol (<>) indicates the refinish operation WILL NOT be performed as a separate procedure
from the other panels in the estimate. Non-Original Equipment Manufacturer aftermarket parts are described as Non
OEM or A/M. Used parts are described as LKQ, RCY, or USED. Reconditioned parts are described as Recond.
Recored parts are described as Recore. NAGS Part Numbers and Benchmark Prices are provided by National Auto
Glass Specifications. Labor operation times listed on the line with the NAGS information are MOTOR suggested labor
operation times. NAGS labor operation times are not included. Pound sign (#) items indicate manual entries.
Some 2014 vehicles contain minor changes from the previous year. For those vehicles, prior to receiving updated
data from the vehicle manufacturer, labor and parts data from the previous year may be used. The CCC ONE �
estimator has a complete list of applicable vehicles. Parts numbers and prices should be confirmed with the local
dealership. ',
The following is a list of additional abbreviations or symbols that may be used to describe work to be done or parts to ''
be repaired or replaced: '
SYMBOLS FOLLOWING PART PRICE:
m=MOTOR Mechanical component. s=MOTOR Structural component. T=Miscellaneous Taxed charge category.
X=Miscellaneous Non-Taxed charge category. i
SYMBOLS FOLLOWING LABOR: �
D=Diagnostic labor category. E=Electrical labor category. F=Frame labor category. G=Glass labor category. ;
M=Mechanical labor category. S=Structural labor category. (numbers) 1 through 4=User Defined Labor Categories. i
OTHER SYMBOLS AND ABBREVIATIONS: ,
Adj.=Adjacent. Algn.=Align. ALU=Aluminum. A/M=Aftermarket part. BInd=6lend. BOR=Boron steel. '
CAPA=Certified Automotive Parts Association. D&R=Disconnect and Reconnect. HSS=High Strength Steel. !
HYD=Hydroformed Steel. Inc1.=Included. LKQ=Like Kind and Quality. LT=Left. MAG=Magnesium. Non-Adj.=Non �
I
Adjacent. NSF=NSF International Certified Part. 0/H=Overhaul. Qty=Quantity. Refn=Refinish. Repl=Replace. �
R&I=Remove and Install. R&R=Remove and Replace. Rpr=Repair. RT=Right. SAS=Sandwiched Steel. !
Sect=Section. Subl=Sublet. UHS=UItra High Strength Steel. N=Note(s) associated with the estimate line. �
CCC ONE Estimating -A product of CCC Information Services Inc.
The following is a list of abbreviations that may be used in CCC ONE Estimating that are not part of the MOTOR ,
CRASH ESTIMATING GUIDE:
BAR=Bureau of Automotive Repair. EPA=Environmental Protection Agency. NHTSA= National Highway
Transportation and Safery Administration. PDR=Paintless Dent Repair. VIN=Vehicle Identification Number.
6/9/2014 5:37:41 PM 014563 Page 7
0 9 01119 c 8 f 2 0 3 dc a USAA Confidentiai
Supplement of Record 1 with Summary
Customer: HANSEN, GRETCHEN Job Number:
Vehicle: 1998 HOND ACCORD LX 4D SED 4-2.3L-FI GREEN
ALTERNATE PARTS SUPPLIERS
Supplier: Keystone-USAA-AQRP-A
Location(s): 3615 MARSHALL STREET NE, MINNEAPOLIS MN 55418 (800)328-1845 (612)789-1919
Line Description Item# Price
9 A/M CAPA RT Lens&housing H02801121C $79.00
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