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Sorenson, Benjamin �� !!G 0 4 20'4 1 � i � . ,, . �'�i`� C��K BENJAMIN C.SORENSON A PROFESSIONAL LIMITED ATTORNEY LIABILITY PARTNERSHIP 61 2.338.6000 BSORENSON@YOSTBAILL.COM July 31, 2014 City of St. Paul Clerk c/o Risk Management 15 West Kellogg Blvd 310 City Hall St. Paul, MN 55102 RE: State Farm Mutual Automobile Insurance Company vs. Justin, et al. Date of Loss: July 12, 2013 Our File No. 61615-11472 Court File No. Dear Sir or Madam: Enclosed, please tind a completed Notice of Claim Form, along with supporting documents, in relation to the above-mentioned matter. Please be advised that our office has been retained by State Farm Insurance Company, the carrier providing coverage to the above-insured. It is indicated from the materials provided to me by State Farm Insurance Company that the incident which occurred on the above date may have resulted from your negligence. As a result of this incident, State Farm Insurance Company and its insured have sustained damages. Please contact our office to discuss possible settlement or for any questions or concerns. Sincerely, Elizabeth M. Cederberg Paralegal to Benjamin C. Sorenson ecederberg@yostbailLcom Yost & Baill, LLP 220 South Sixth Street • Suite 2050 • Minneapolis, MN 55402 Telephone 612.338.6000 • Fax/Data 612.344.1689 • www.yostbaill.com ��s�� Il� �4 t�'i4 CI�Y CL��K NOTICE OF CLAIM FORM to the City of Saint Paul, Minnesota Minnesota Slate Statute�66.0�states that " ...every person...who claims damages from any nzunicipalitv...shul/caa�se to be presented to�he governing bodv of the municipalitv within /80 days after�he alleged loss or injurv is discove�•ed a notice stating�lae time,place.and circumstances thereof and�he amount of compensation or otdier 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 Benjamin Middle Initial C. Last Name Sorenson Company or Business Name Yost & Baill, LLP Are You an Insurance Company?No If Yes, Claim Number? Street Address 220 South Sixth Street. Suite 2050 City Minnea�olis State Minnesota Zip Code 55402 Daytime Phone(612) 338-6000 Cell Phone ( ) - Evening Telephone( ) - Date of Accident/ Injury or Date Discovered: July 12, 2013 Time: 12:37pm 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. On behalf of our client State Fann Mutual Automobile Insurance Company our office is pursuing a subro�ation claim a�ainst Andrew Justin who drove a motor vehicle in such a negli�ent manner as to cause a collision involvin�property damage owned bX State Farm's insured John Berg,stro�n Additionall�pursuant to Minn. Stat. �169.09 subd. Sa, the City of St Paul Municipal Equipment is responsible for damages arisin�from the accident descr�bed herein above. Please see attached police report and statement from John Bergstrom. Please check the box(es)that most closely represent the reason for completing this form: D My vehicle was damaged in an accident D My vehicle was damaged during a tow D My vehicle was damaged by a pothole or condition of the street D My vehicle was damaged by a plow D My vehicle was wrongfully towed and/or ticketed D I was injured on City property �Other type of property damage—please specify: Our insured's vehicle was dama�ed by a Citv emplovee who was operatin�a City-owned vehicle. D Other type of injury—please specify In order to process your claim you need to include copies of all applicable documents.: See attached. 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 ofthe 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 properry 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 Were there witnesses to the incident? �Yes No Unknown (circle) Provide their names, addresses and telephone numbers: Marion Ann Ber stg rom (651-453-1779) Were the police or law enforcement called? �Yes No Unknown (circle) If yes, what department or agency? St. Paul Police Department Case# or report#: 13144443 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: West 7`�' Street and Dou� Avenue. See attached police report. 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.: $10 167.23. Please see attached dama�e documents. Vehicle Claims—please complete this section D check box if this section does not apply Vehicle: Year: 2006 Make: Buick Color: Brown Registered Owner: John S. Ber st�rom Driver of Vehicle: John S. Ber st�rom Area Damaged: Rear Vehicle: Year Make Model License Plate Number State Color Driver of Vehic(e(City Employee's Name) Area Damaged Injury Claims—please complete this section � check box if this section does not apply How were you inj ured? 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: �Check here if you are By signing this form,you are stating thut ull information you huve provided is true and correct attaching more to the best ofyour know/edge. Unsigned forms will not be processed. pages to this daim form. Submitting a false claim can result in prosecution. Date form was completed Number of additional pages ?�' Print the Name of the Person who Complet this Form:6cnj�m�n C• SOr�sOn Signature of Person Making the Claim: � Revised February 201 1 i avvauvll�1\V�JVl l �� Page 1 of 1 E ;� �� _ �1 x�'' �� . ,_ _ . . ; uu�yn �r /� IDCRfwtCnOt h1lD6n �� Fn��44Y.f r � R' , ,(�t A�^.T.•.��Z�n � � 13Z44443 H � � �� •r��r��. 1�. y�, . ' � , < Nuuaw rurw. wnii � ,,,�u�o ;�,,,, g�6 i,�flV,�Gli�� .��lr}k=�az+, t.�i �.�''.�i� } - , } o N `I bz o0 oi r �'' �'� . , y�x r:nH .r��,,,,, a� - � �„� ti, � '�+� �ur��w«oa ,,,.� , .�r« ' �'°�w�..:owc,:rn, . �1�� 7 12 2013�ri �237 m lO 7tt� � ' ��, a � N f wwrrno M¢a asa�uwwr � --.�..�Brt Ba 8`r°Jr � 62 �� Bu �am�rr �eo�nc�.rac�ccowwxaw�we +.—_. •__r_._ I O Douglas . ! .�. 7 i�;:a..�ti'a�-.':.�::-..a L:"•::_ .:i. -. S..r..., . r.�� 4oenw fwvFx�+wer.e mut a.w amn.s* rorra w+a�uawer+�ecw.i •• t' n.'t- r• �� O1 E725041879014 1�4�1 p O1 • O1 F6460697£7616 "'� °'"' an.ns MN D O1 �� o�noa: wut6�ec�ne.iut� C[I!O/M1F ANDREW JAMES JUSTIN �'�`�""'`�"' a�+M � � OS 19 94 JOHN S BERGSTROM 03 13 32 �} O1 3Q5 POPLAR DR �� "° N; OI " 6865 BLACKHAWK TRAIL �� ,,,Y,a ,.K.c�. N� O 1 O 1 .xru+¢.ar ` (�- f O1 SHOREVIEP7 55126 651-233-3596 ; I��ER GROVE HTS 55077 65L-953-1779 01 U O 1 � M �9 "'t 0 4 6 0 5 N � Q" `°" '""`°" "",�" � � -Y;' M �4 "°E D 4 0 6 �S g 41..a �tbl ��7E d�W T'vE lUMJN LMMOqIR AYg1AINK�EpnC[ �1MM�ArfR � 98 1�,�. 98 AL• O"•e •+ca �.r� aaa �r.e roiav maro.ao .�eixN+ee,t+nnrE w..�.ne, � T p°"`."_.. .... .__. . . . �: 98 �" 9$ Y, ponrn SPFD OCLiP ,'OIMmIMK! .•,•• . �'',K WMINIYIi . �•_ •. 03 CZ OF S AUL MUNICIPRL EQtIIPT N � BERGSTROM JQHN S � "" °`�" biM M MD�iC4f �' O� 02 691 N DALE ST '°"ED °"°0"�" N.. . 6865 BLACKHAWK TRRIL `.°jr° 02"' KNLEB CflY.tY4ry.71P �VLLMG ORfCt 1 Pf):sT�R2► 16 ST PAUL MN 55103 '!9' 02 ; INVER GROVE HTS MN 55077 � 02 1°""� .u„ w,,, O1 02 ORD RW 200 BUIC p}{ pp C°`°" �� nnaer ru�. nico n.w�xa � �rJ ,runl� er�6o v//�w11e0 ar y � ortav 02 906659 MN 9 DI � . 2221HL MN 3 O1 03 '''Yw""cc ra+tr�+.er�c . .ar,wwaE n.rt a �•e �...� � Self insured ; State Farm 332 429B01236 cMm wsru M.,�tn�. .�.,mrt, .�...eaE, . � '�'� ., tT ACCIDEI(T(pVOLYEp A COMW EAClAL I,�pTpR yEHIC(�,SCiIOOL BUS,Dlt NEAC fTAR7 BU9 "�'� �"� "'�0°�D`' ��E�BER TO NO7T'TNE STATE PATRO6{npulny unM YS f K.7tT�nd 76lA671�, . � � W�MB7OKVfl�C�EMARR�.rotOIGM�ERwre pp��a � Omf�CUIYBSaIN11Mf1l7-IOlOR4Ml11w+R W�MFYfR _�_....__. ....�—_._..._"_.`__ iMYtMOB1l�wM'aFS � wi lr wi0i�l1 al me ae Na+G sGef witv m�no�nuwDaR ..__ _�_._'..—___"'` -""—__ - a.�sen M� 6arqetcow �631-{S)-17T9) 02 03 �/9/ f 04 04 06 OS N Y a� �p� """'"�" 1/'� � a�„ �.,� �,.,�, y o� �,� w.� .�,..�., s �� sow11�rO�Ot�IpyupFOPrtvFwirqoDGtf�nnonO�pwbFOMbFRryAGCwrF�aaWUaM�Yau{q � t+ b�WO�Iq¢r9f1YI�ilD�lAG1�tl� J• .a�rr e' �J O1 � :i- wwu„m _ w_, � .�,. � �'��' �� 9B F� r;j, �t Q3 y' / ':• Unit 2 was tcavelinq �ortheast on 7th. Unit 2 was;° ��TM ;• : � / '`': making a left �hand turn from 7Eh�St north'on � 'fi Q1 : ° � L� � ,'. Douglas. Unit 1 rear ended Un4.t 2. The .drzver. oE ;` W°�0w '� o.r�ooc i' $ � �.,,> Unit 2 was transported to Urtited Hospital with La 98 � ; moderate injuries. �:' M,� i I�1' .." / *�'r7 0!wt Y.f .� . `. 9s : ,:` a4 x: � � �: � �, ,:"r ;. '�4 ' 1 .t�' # .�,.�.�., �'," ':= / q� :.:i c / j�y '� ��s : _ OI � �.. f N `� �..�., OS 2' � ' - ,, �� /� � ol . -/� nr�r To sr-...�u6 ; . ,,. ' ;• - Q1 ,,. < t _ ._ . , "«� w u�w !�' Y O1 �:' �,. ��.�,�.,,o.�. 41 Officer Michael Fulton 408 ti�„�:�J St Ipaul PD ^�� a` � ,,� https:llwww.dvsiesupport,orgldvsinfo/accidentrecords_200 S/Inc ludes_LE/PrintReportIndi... 7I12/2413 �3-�2/xS-- �3�' AUT� ACCIDENT JULY 12, 2Q 13 Today July 12`�' at approximateiy one [I] P.M. Z drove my wife to DiGideos Restaurant on '�tTest 7`" Street in St. Paul, Minnesota. I was facing East waiting for tra�c to clear so I could negotiate a safe turn. My vvheels were straight ahead as specified in the 55 aiive driving courses. My signal vvas on and blinking. Suddenly there was a Iaud bang and my wife and I were thrown forward. Our car rolled several feet and remained in the center �ane. I Iooked into the rearview rnirror and saw a young man wearing a orange vest ; approaching our car. He came to the drivers side and asked me if we were okay. I rolled down the window and asked him what happened. He said he ran into the rear of our car. I told him to call 911 and ask for a para medic unit. I heard him call his off ce after he called 911. The police arrived in a few minutes. I presented them our insurance papers. I shut the car engine off and the palice taok the car keys. My wife and I v�ere assisted by the para medics. I received a collar because I felt a siight pain behind and above my right ear. I have three degenative discs in my iower back so I was laid on a board . My wife has a bruise on her right leg below the knee. My wife and I were transparted to United Hospital in St. Paul. We were examined by a doctor in the emergency roorn. Then I was taken to the imaging department where a ct scan vvas done on my neck back and chest. The nurse told us the scan was okay. She then told us wha� we should do when we got horrie. She gave us a document explaining the things she told us. We got horne , n ? 22 � � 13 shortly before 4 P.M. Our san Douglas Bergstrom drove us home. I immediately called our insurance agent and Ieft a message on their answering machine. The agent called me shortly and gave me instructions about getting the poiice report and renting a car. This concludes the events for July 12, 2013. The vehicle damaged is a 2006 Buick Lucerne. The Vin number is 1 G4HP57276U211420. The vehicle was purehased from Larry Reid's Arrow Pontiac Buick in 200b. It is presumed the vehicle has been towed to there deaiership in Inver Grove Heights, Minnesota. � � ? � � 2 � i3 12,175.08 'I'OTAL L4SS SETTLEMENT 250.00 + DEDUCTIBLE -------------------------- � 12,425.08 = 2,257.85 - SALVAGE -------------------------- 10,167.23 = TOTAL CLAIM AMOUNT RBZ00070 StateFarm State Farm Mutuai Automobile Insurance Company ��, Auto Payments by Participant/COL � Route To: Gwen Giesking � � BASIC CI.AIM INFORMATION Claim Number: 23-21X5-835 Date of Loss: 07-12-2013 Policy Number: 3325-429-23F Named insured: BERGSTROM,JOHN Named Insured{s)/400 - COLL C denotes consolidated payment E denotes EFT payment P previously converted payment from CAUCMR Payment Issued Payabie Pay Auth Rsn Number Oate Pavee COL Cd Status Amount IQ Cd 105756445J 08-02-2013 JOHN BERGSTROM 8 400 1 Paid $12,175.08 HGUL MARION BERGSTROM Total: $12,175.08 BE '`M, JOHN /050 - PIP Namedlns��red - Driver � �+ent � 'TICM R Payme�. Payable Pay ,tsn Number CO� Cd '' Cd 105758784J ' SAFETY Q51 9 �CSAPY 105760726J 0&t,L �51 —':�5.30 ECSAPY 105760800J 08-06-20�„ ' $523.00 HOAY 105760412J 08-06-2013 J(�, $3.10 CJRK 105802291J 09-03-2013 EMERG�. $394.00 ECSAPY CONSULTAtv, 105842414K E 10-01-2013 PHYSICIA�'� °aid $212.00 ECSAPY CLIN1�" 105842A14K E 10-01-2013 P' $212.00 ECSAPY 105856274J 10-1" Ob� $57.66 GYHU 105864577K E .. BACK 051 '�.00 CJRK 10586a'' .�� NECK 8 BACK 051 2 � �'� ..;S rNYSICIANS NECK& BACK 051 2 Paid � CLINICS � .�-2d13 PHYSICIANS NECK& BACK 051 2 Paid CLINICS l ' Date: 04-11-2014 Page 1 FOR INTERNAL STATE FARM USE ONLY Contains CONFIDENTIAL information which may not be disclosed wifhout express written aufhorization. Providing lnsurance and Frnanciai 5ervices ••S�ateFarm� f-lome Otfice,Btoomington. 1L August 02, 2013 John 8ergstrom State Farm Claims 6865 Blackhawk Tri PO Box 52267 Inver Grove MN 55077-2608 Phoenix AZ 85072-2267 RE: Claim Number: 23-21X5-835 Date of Loss: July 12, 2013 Our(nsured: John Bergstrom Vehicle: 2006 Buick LUCERNE Dear John We are providing you with our claim payment for the total loss of your vehicle. As we recently discussed, our policy provides for payment of the actual cash value of your vehicle, less any applicable deductible. Actual cash value is determined by the market value, age, and condition of your vehicle at the time the loss occurred. To assist us in determining actual cash value, we consider information obtained by our representatives, in#ormation provided by you, vehicle valuation services, and other sources. If now or later, you have additional information you wish us to consider or if you believe we have not correctly determined the actual cash value of your vehic(e, please contact us at the number indicated below. The amount payable to you was determined as follows: Base Price $11,564.00 + Taxes {if applicable) + $751.66 + License (if applicable} + $40.67 + Tit1e Fees(if applicable) + $32.75 + Transit Tax (if applicable} + $20.00 Actual Cash Value = $12,425.08 - Deductible - $250.00 - Owed to Lienholder -$0.00 Net Amount Payable to You = $12,175.08 As a State Farm°policyholder, you can enjoy the benefits of online registration. Benefits include checking the status of your claim online; managing your insurance information and accounts; and staying connected to State Farm. Just go to statefarm.com�to get registered. All you need to complete the process is your State Farm policy or account number, your email address, and about five minutes. If you are already registered, thank you! , 23-21 X5-835 Page 2 August 02, 2013 lf you have questions please contact us. Sineerely, Debbie Loveless Claim Processor 1-(8&6) 207-6046 Ext. 9 State Farm Mufual Automobile Insurance Company For your insurance and financial needs, please contact an agent or visit statefarm,com�. Totai Resource Auctians � 2.257.gg TRA Minneapolis 8001 Jefferson Hiqhway "'"''B'a' Z,sao.00 Maple Grove MN 55369 �� State Farm Insurance - Heartland Zone Poot Fee 65.o0 6215 Ranch Drive Poo( Tow o.o0 Little Rock AR 72223 Yard to Yard Transport o.o0 Tax 10# 58-'1620001 �'ool Starage o.o0 Resale Cert# Enhancements o.o0 Title Fees o,o0 Stock#J l.ot # : SpT048 / 760494 DMV Fees 20.�s Bond Fees o.00 6ranch• Maple Grove Taxes o.o0 insured: JOHN BERGSTROM VIN lnspection o.00 Owner: JOHN BEFtGSTRC7M Keys o.o0 Claim#: 2321 x5835 Re-Run a.ao Y�ar: 2006 Mai! Personats o.ao Make/Model: BUIC LUCERNE V6 CX VIR a.av VIN: 1G4HP57276U21102Q Toe,,vewcr�rr... BS.�s ACV: 91,564.00 el�tvp{.xan«�eirfio.m.tlon !1s!!�_ne.eh..o.. ARROW COLLISION CENTER Tow 140.00 INVER GROVE HEIGHTS MN 55077 Storage o.00 Administrative Fees o.00 s�o��r a�►..a.ro.,.�.s� Tea rd own a.a o AIEXANDRIA MOTOR PLAZA ��C Estimate Fe� o,o0 ALEXANDRIA MN 56308 Lien Fees o.o0 � Taxes is.ao Loss Date 07/1219 3 Clean Up o.o0 Assigned os��21�� EPA Ctean-Up a.o0 Released ag�p2»3 Parts Shop o.oa , Pick Up 48/02113 P��servation o.oo , Titie Received 08/19/13 aa""'"�'�"""T°+''� 156.a° I Sale Doc Received 08/27/13 Late Pick Up Credit o.o0 Auc#ion Date 10/08/13 Selier Damage Credit o.o0 Buyer Payment Oate Reported to N1CB �-��"�^� 2a2.is �'�C�� ti °rl � �SU �r�q�6 zel�.� ��O Z� ARROW PON7IAC/GMC TRUCK INC. 1111 EAST HIGHWAY 110 INVER GROVE HTS,MN 55077 PHONE: (651)552-2222 FAX: (651)552-2221 TONY GERLACH-MANAGER '**ESTIMATE*** 07/16/2013 08:03 AM __��__ .._____ Owner ___.- -- __._�� Owner: JOHN BERGSTROM Address: 6865 BLACKHAWK TRL Work/Day: (651)453-1779 HomelDay: (651)453-1779 City State Zip: INVER GROVE,MN 55077-2608 FAX: Controi Information � Claim#: 23-21 X5-83501 Insured Policy#: Loss Date/Time: 07/12l2013 07;00 AM Loss Type: Coliision Deductible: $250.00 Ins. Company: State Farm Company Contact: STATE FARM INSURANCE COMPANIES Address: PO BOX 82613 Work/Day: (888)248-6961 City State Zip: LINCOLN,NE 68501 FAX: Insured: JOHN BERGSTROM HomelDay: (651}453-1779 Claim Rep: TEAM R3 ACC CP Address: WorklDay: (866)207-6046 fnspection � Inspection Date: 07l16/2013 08:03 AM Inspection Type: Select Service Primary impact: Rear Secondary Impact: � Driveable: No Rentai Assisted: � Assigned Date/Time: Received DateITime: 07l19/2013 11:53 AM First Contact Date/Time: Appointment DatelTime: 07/19/2013 07:00 AM Appraiser Name: TONY GERLACH Appraiser License#: Address; 1111 EAST HWY 110 WorklDay: (651)552-2222x131 City State Zip: Inver Grove Heights, MN 55077 FAX: (651)552-2221 Email: tgeriach@arrowbuickgmc.com ..__ ...__ .w...__. --- ------_... Repairer -- ----------- ---- ___._.. . .. Repairer: ARROW COLLISION CENTER Contact: Tony R GERLACH Address: 1111 EAST HIGHWAY 110 Work/Qay: (651)552-2222x131 Cit State Zi �NVER GROVE HEIGHTS, MN y p"55077 FAX: (651)552-2221 Email: tgerlach@arrowbuickgmc.com Repair Start Date/Time: Vehicie Drop Off Date/Time: 07/15/2013 10:38 AM ----_____ _.____._ Remarks ��IT'.— ��___ ._ _ _a.____..__� ...._._. ._.... _�._ � , 07/22/2013 i t:16 AM Page 1 of 6 2006 Buick luceme CX 4 DR Sedan Claim tt: 23-21XS83501 07/t6l2013 08:03 AM checked Ikq avaiiable TOWED IN SENT IN VIR REC2UEST NO IN OR OUT DATES AT THIS TIME Vehicle ^� -___ ..___..._ __ � 2006 Buick Lucerne CX 4 DR Sedan 6cyl Gasoline 3.8 4 Speed Automatic Lic.Plate: 2211HL Lic State: MN Lic Expire: 10l2013 VIN: 1G4HP57276U211020 Prod date: Mileage: 63,084 Veh Insp#: Mileage Type: Actual Condition: Code: S4353A Ext.Color: TAN int.Color: Ext.Refinish: Two-Stage Int.Refinish: Two-Stage Options AMlFM CD Player Air Conditioning Alarm System Aluminum/Alloy Wheels Anti-Lock Brakes Auto Load Leveling Bucket Seats Center Consoie Cruise Control Dual Airbags Floor Mats Head Airbags Intermittent Wipers Keyless Entry System Lighted Entry System OnStar System Power Brakes Power poor Locks Power Drivers Seat Power Mirrors Power Steering Power Windows Rear Window Defroster Rem Trunk-UGate Release Side Airbags Strg Wheel Radio Control Tachometer Theft Deterrsnt System Tilt Steering Wheel Tinted Glass Traction Control System Trip Computer Velour/Cloth Seats Wood Interior Tnm Damages _ _.� __ . _ _ w . .._._.__ Line Op Guide MC Description MFR.Part No. Price ADJ% B% Nours R �lnibodvJFrame 1 I M00 Unibody-Frame Inci Setup Repair 1.0* SM ' St�ioes And Moutdinas 2 RI 180 MIdg,Rocker Panel LT R& I Assembly 0.4 SM 3 E 1377 CIip,Rocker Panel Midg LT MULTI-PART GM Part $�8.96 SM 4 RI 181 MIdg,Rocker Panel RT R& I Assembly 0.4 SM 5 E 1378 CIip,Rocker Panel Mldg RT MULTI-PART GM Part $78.96 SM 6 RI 333 MIdg,Rear poor Side LT R& I Assembly 0.4 SM 7 Ri 334 MIdg,Rear poor Side RT R&I Assembly 0.4 SM Front Susoension 8 N 987 Susp Align,4 Wheel ADDITIONAL OPERATION $109.99` 0.0' ME Rear Susnension 9 N 975 Suspension R&I, Rear ADDITIONAL OPERATION 3.1 ME Rear poors 10 BR 289 Pni,Rear poor�uter�T Biend Refinish 1.2 RF 0.8 Biend 0.4 Two-stage o�nsrzais+i:�s aM Pags 2 of 6 2006 Buick Luceme CX 4 DR Setlan Claim q: 23-21XS83567 Ol/16/ZU13 08:03 AM 11 BR 290 Pnl,Rear poor Outer RT Biend Refinish 1.2 RF 0.8 Blend D.4 Two-stage 12 RI 429 MIdg,Rear poor Belt LT R& I Assembly 0.1 SM 13 RI 430 MIdg,Rear poor Belt RT R&I Assembly 0.1 SM 14 RI 305 Handle,RR Door Outer LT R&I Assembly 0.6 SM 15 RI 306 Handle,RR Door Outer RT R&I Assembly 0.6 SM Quarter And Rocker Panei 16 TE 261 Q7 Panel Assy,Body Side LT Partial Replace Price $954.35 SM 17 TE 262 07 Panei Assy,Body Side RT Partial Replace Price $954.35 SM 18 BR 117 13 Panel,Bodyside�t�Upr LT Blend Refinish 1.3 RF 0.5 Blend 0.6 Two-stage setup 0.2 Two-stage 19 8R 118 Panel,Bodyside Otr Upr RT Biend Refinish 0.6 RF 0.4 Blend 0.2 Two-stage 2Q BR 187 Panel,Rocker LT Biend Refinish 0.9 RF 0.6 Biend 0.3 Two-stage 21 BR 188 Panel,Rocker RT Blend Refinish 0.9 RF 0.6 Blend 0_3 Two-stage 22 ET 365 Panel,4uarter LT Partiai Repiace Labor 12.4 SM 23 L 365 Panei,Quarter LT Refinish 4.2 RF 2.3 Surface 1.5 Edge 0.4 Two-stage 24 ET 366 Panei,Quarter RT Partiai Repiace Labor 11.5 SM 25 L 366 Panel,Quarter RT Reflnish 4.0 RF 2.2 Surface 1.5 Edge 0.3 Two-stage 26 L 397 Door,Fuel Filier LT Refinish 0.3 RF 0.3 Surface , INC Two-stage 27 283 07 Extn,Quarter Inner LT NEW PART INC gM 28 L 283 Extn,Quar�er Inner LT Refinish 0.2 RF 0.2 Surface 29 284 07 Extn,Quarter Inner RT NEW PART INC SM 30 L 284 Extn,Quarter Inner RT Refinish 0.2 RF 0.2 Surface 31 E 471 Duct,Quarter Panel LT 227Q2778 GM Part $29.17 INC SM 32 E 472 Duct,Quarter Panel RT 22702778 GM Part $29.17 INC SM Inner G2uarter&Panels 33 E 590 07 Sd Raii,Rear Frame LT 20849331 GM Part $1,091.65 6.4 SM High Strength Steel 34 L 590 Sd Rail,Rear Frame LT Refinish 0.5 RF 0.4 Surface 0.1 Two-stage 35 TE 426 # Panei,Bodyside Inner LT Partiai Repiace Price $1,129.80 SM #=01,07 36 E 407 Pocket,Fuei Filier LT 20895785 GM Part $39.20 1NC SM 37 L 407 Pocket,Fuel Fiiler LT Refinish 1NC RF INC Two-stage 38 ET 391 07 Pn1,Wheelhouse Outer LT Partiai Replace Labor 2.5 SM 39 L 391 Pni,Wheelhause Outer LT Refinish 0.5 RF 0.4 Surface 0.1 Two-stage 40 E 393 Shield,Quarter Inner LT 25891511 GM Part $48.95 INC 5M � 41 E 394 Shield,Quarter Inner RT 2589151 D GM Part $48.33 0.2 SM 0)/22l2013 it:t6 AM Paga 3 of 6 2006 Buick Luceme CX 4 DR Sedatr Claim#: 23-21 XS83501 07116/2013A8:03 AM Deck Lid And Back Giass 42 E 369 Back Glass,Heated 22737625 GM Part $$56.8d 1.8 SM »CAN"T SAVE MOLDING ON GLASS 43 EU 479 Deck Lid Assembly RECYCI_ED PART $550.00' +25.00 1.8 SM 44 l 479 Lid,Rear Deck Refinish 3.4 RF 2.1 Surface 1.1 Edge 0.2 Two-stage 45 E 492 N/Plate,Deck�id 25759430 GM Part $6.15 0.2 SM 46 E 516 N/Plate,Deck Lid 15221172 GM Part $63.67 0.2 SM 47 E 517 Emblem,Deck Lid 10336693 GM Part $61.47 0.2 SM 48 E 493 W/Strip,Deck Lid 25823550 GM Part $79.00 0.5 SM Rear umaer 49 PC 566 Cover,Rear Bumper RECOND PART $447.00 0.5 SM 5� L 566 Cover,Rear Bumper Refinish 3.2 RF 2.7 SurFace 0.5 Two-stage 51 E 565 Reinf,Rear Bumper 15840496 GM Part $265.00 INC SM 52 E 567 Absorber,Rear Bumper 2Q811985 GM Part $192.17 INC SM Rear Bodv. Lamns And Floor Pan 53 E 509 Panel,Rear Body 25947956 GM Part $373.00 3.2 SM 54 L 509 Panel,Rear Body Refinish 2.2 RF 1.3 Surface 0.5 Edge 0.4 Two-stage 55 E 589 Pan,Floor 22768930 GM Part $923.38 15.9 SM 56 L 589 Pan,Floor Refinish 2.0 RF 1.7 Surfece 0.3 Two-stage 57 E 513 Plate,Rear Body Siil 15941289 GM Part $76.55 INC SM 58 PC 533 Taillamp Assembly,Otr LT RECOND PART $187.00 INC SM 59 PC 534 Tailiamp Assembly,Otr RT RECOND PART $187.00 INC SM Manual Entries 60 E M03 Flex Additive NEW PART $6.00" RF 61 E M07 Pinstripes-Tape NEW PART $15.00` 0.5* SM 62 l M14 Corrosion Protection Refinish 0.3' RF 63 L M17 Cover Car Exterior Refinish 0.3� RF 64 SB M25 Tire-Left Rear,Balance Subiet Repair $20.00' SM 65 1 M47 Frame Sag,Rear Repair 2.0' FR 66 I M48 Frame Buckle,Rear Repair 2.0* FR 67 SB M60 Hazardous Waste Removal Sublet Repair $5.00* SM 68 I M65 Disabie Air Bag Repair 0.5* ME 69 E M68 Caulk NEW PART $53.00` SM 69 Items MC Message 01 CALL DEALER FOR EXACT PART#/PRICE 07 STRUCTURAL PART AS IDENTIFIED BY I-CAR 13 INCLUDES 0.6 HOURS FIRST PRNEL TWO-STAGE ALLOWANCE .__�_______ _.._ _,______�.�_ _�.__._ __. _._. � Estimate Totai 8�Entries Gross Parts $7,454.08 Other Parts $1,440.99 Paint Materials $794.60 Line Item Markup $137.50 Parts& Materiai Total $g,g27,�7 07122l207�11:16 AM Page 4 of 6 2006 BuiUc luceme CX 4 DR Sedan Claim#: 23-21 XS83507 07l76/2013 08:03 AM Tax On Parts Only @ 7.125% $643.57 Labor Rate Replace Repair Hrs Total Hrs H rs Sheet Metal(SM} $49.00 60.8 1.0 61.8 $3,02$.20 Mech/Elec(ME) $105.00 3.6 3.6 $378.00 Frame(FR} $71.00 4.0 4.0 $284.00 Refinish(RF) $49.00 27.4 27.4 $1,342.60 Paint A1laterials $29.00 Labor Totai 96.8 Hours $5,032.80 Sublet Repairs $25,pp Towing $146.00 Tax On Towing @ 7.125% $10.40 Gross Totai $15,684.94 Less:Deductible $250.00- Net Totai $15,434.94 �;��. ��jQ �' ,,: ;��;i;�i For more information regarding State Farm's promise of satisfaction relating to new non-original "�"y'�� f' equipment manufacturer(non-OEM)and recycled parts,please visit:htto:/lst8.fm/7X4 or QR coc}e. :+��'` ;+ T_� 'r,�� .��-'`'T• �^t'1 a�".r_:.l1�� Register on(ine to check the status of your claim and stay connected with State farm�.To register,go to statefarm.com and select Check the Status of a Claim. if you are already registered,thank you! Not available in New Mexico. Aiternate Parts Y/03/�3/00/00/00 CUM 03/03l00/00/00 Zip Code:55077 Default Audatex Estimating 7.0.019 ES 07122/2013 11:16 AM REl 7.0.019 OT Q7I01I2013 DB 07l15/2013 Copyright(C)2013 Audatex North America,Inc. 4.7 HRS WERE AODED TO THIS ESTCMATE BASED ON AUDATEX'S TWO-STAGE REFINISH FORMULA. ESTIMATE CALCULATED USING THE 2.5 HOUR MAXIMUM ALIOWANCE FOR TWO-STAGE REFINISH OF NON-FLEX,EXTEi210R SURFACES. THIS ESTIMATE HAS BEEN PREPARED BASED ON THE USE OF ONE OR MORE CRASH PARTS SUPFLIED BY A SaURCE OTHER THAN THE MANUFACTURER OF YOUR MOTOR VEHICLE. WARRANTIES APPLICABLE TO THESE REPLACEMENT PARTS ARE PROVIDED BY THE PAR`I'S MANUFACTURER OR DTSTRIBUTOR RATHER THAN BY THE MANUFACTURER OF YOUR VEHICLE. A PERSON WHO FILES A CLAIM WITH INTENT TO DEFRAUD OR HELPS COMMIT A FRAUD AGAINST AN INSURER IS GUILTY OF A CRIME. I� Op Codes II ` = User-Entered Value E = NEW PART NG= Replace NAGS EC= '*NON-OEM PART ET = Partiai Replace Labor EP= "' NON-OEM PART 07/22/2013 1 t:i6 AM Page 5 of 6 2006 Buitk Wcerne CX 4 DR Sed•an Claim tJ: 23-21 XS•83501 07/7 6120t3 08:03 AM EU = RECYCLED PART TE = Partial Repiace Price PM= REMAN/REBUtLT PART UM= REMAN/REBUI�T PART L = Refinish PC= RECOND PART UC= RECOND PART TT = Two-Tone SB= Sublet Repair N = ADDITIONAL OPERATION BR= Biend Refinish I = Rapair IT = Partial Repair CG= Chipguard RI = R&I Assembly P = Check RP= RP-RELATED PRIOR 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 cfaims process)withouf � l'1uU�rC.X Audatex's priorwritten consent. �+svle r�cur��p��py Copyright(Cj 2013 Audatex North America,Inc. Audatex Estimating is a trademark of Audatex North America, Inc. I 07l22/2013 71:16 AM Page 6 af 6 QUALITY REPLAGEMENT PARTS REPORT Vehicle � 2006 Buick Cucer�e CX 4 DR Sedan 6cyl Gasoline 3.8 4 Speed Automatic Options AM/FM CD Player Air Conditioning ACarm System AluminumlAiloy Wheels Anti-Lock Brakes Auto Load Leveling Bucket Seats Center Consale Cruise Control Dual Airbags Floor Mats Head Airbags Intermittent Wipers Keyless Entry System Lighted Entry System OnStar System Power Brakes Power poor Locks Power Drivers Seat Power Mi�rors Power Steanng Power Windows Rear Window Defroster Rem Trunk-UGate Release 5ide Airbags Strg Wheel Radio Control Tachometer Theft Deterrent System Tiit Steering Wheel Tinted Glass Traction Control System Trip Computer Velour/Cloth Seats Wood Interior Trim Line Part Descriptlon Supplier Part Number Substituted For OEM Supplier Code CLS SRC Part Number 49 Cover,Rear Bumper GM1100775R 19121117 > 1 R 3 GM1100775R 19121117 > 2 R 3 58 Taillamp Assembiy,Otr LT GM2818177R 25927355 > 1 R 3 59 Taiilamp Assembly,�tr RT GM2819177R 25927354 > 1 R 3 >=ESTIMATE TOTAL IS BASED ON PRICE QUOTED BY THIS SUPPLIER Key to Classification i Source Codes CLS=Classification Code C-CAPA CERTIFIED PART QUOTED BY USTED SUPPLIER M-REMANUFACTURED/REBUILT PART R-RECONDITIONED PART S-OEM SURPWS PART SRC=Source Code 1-NON ORIG�NAL EQUIPMENT MANUFACTURER PART 3-ORIGINAL EQUIPMENT MANUFACTURER{OEM)PART �,_ .._�. _._ ._._�..__. _._.en�_ .._....� `�—� Detailed Oistributor List I 1 PXN4840 KEYSTONE AUTO RCND (800}328-1845 3615 MARSHALL STREET NE �6�2�789�9�9 MINNEAPOLIS,MN 55418 2 PXN9249 KEYSTONE NWPP RCND 3615 MARSHALI STREET NE (800)328-1845 MINNEAPOLIS,MN 55418 (612)789-1919 Audatex Estimating 7.0.019 ES 07/22/2013 11:16 AM REL 7,0.019 DT 07/01/2013 D8 07/15l2013 Zip Code: 55Q77 Search Area� Default Copyrfght(C)2013 Audatex North America,inc. 07l22/2073 11:16 AM Page 1 of 2 200fi 8uick Lucema CX 4 DR Sedan This report coniains 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 �l uda�ex Prior written cansent. ��o?r�.r cua�;r�nti� Copyrighf(C)2013 Audatex North AmeriGa,Inc. Audatex Estimatin is a trademark of Audatex North America,Inc. i o�nzrso�s,,:,s aM Page 2 of 2 f 07/22/13 09 : 17 AUTQSOURCE Page 1 Via: Direct AS Request: 32852462 Version: 1 ADMINISTRATIVE DATA 2006 BUICK LUCERNE CX 4D SEDAN Arrow Coll Claimant: State Farm Insurance Insured:Bergstrom, John Burnsville Branch Claim: 23-21X5-835Q1 1285 Northland Drive Loss Date : 07/12/2013 Mendota Heights MN 55120 Loss Type :Collision Policy: Othex: Estimator Name: TONY GERLACH Estimator Phone: 651-552-2222 Vehicle Location: ARROW COLLISION CENTER License Number: 2211HL License State: MN License Expiration: OCT 2013 Specialty Plate Type: HANICAP Prior Damage AmountS : N/A Prior Damage Desc; N1A Supplement Amount S : 2000 . 00 Supplement Desc: MISC HIDDEN DAMAGES Tow / Other Charges : 146 . 000 Other Remarks : HARD HIT REAR VALUATTON DETAIL 2006 BUICK LUCERNE CX 4D SEDAN 1 . 2006 BUICK LUCERNE CX 4D SEDAN Comparable 1 Your Vehicle PRICE Hopkins , Mn $9 , 3yg Odometer 86 , 677 Mi(Actual ) 63 , 084 Mi(Actual ) 650 , Equipment XM Satellite Radio _�p Comparable 1 Adjusted Price 59 , 978 2 . 2Q06 BUICK LUCERNE CX 4D SEDAN Comparable 2 Your Vehicle PRICE Cokato , Mn $9 , 993 Odometer 71 , 614 Mi(Actual ) 63 , 084 Mi(Actual ) 235 Comparable 2 Adjusted Price 510 , 228 3. 2006 BUICK LUCERNE CX 4D SEDAN Comparable 3 Your Vehicle PRICE Saint Cloud . Mn 59 , 391 Odometer 92 , 590 Mi(Actual } 63 , 084 Mi{Actual ) 810 XM Satellite Radio -�p Comparable 3 Adjusted Price 510 , 131 4 . 2006 BUICK LUCERNE CX 4D SEDAN Comparable 4 Your Vehicle PRICE Rochester , Mn 58 , 455 07/22/13 09 : 17 AUTOSOURCE Page 2 Via: Direct AS Request: 32852462 Version: 1 VALUATION DETAIL (continued) 2006 BUICK LUCERNE CX 4D SEDAN Odometer 127 , 124 Mi (Actual ) 63 , 084 Mi(Actual ) 1 , 760 Comparable 4 Adjusted Price S1U , 215 Final Market Value Calculation 1 . 2006 Buick Lucerne CX 4D Sedan 59 , 9�g 2 . 2006 Buick Lucerne CX 4D Sedan 510 , 228 3 . 2006 Buick Lucerne CX 4D Sedan 510 , 131 4 . 2�06 Buick Lucerne CX 4D Sedan 510 , 215 Average Price 510 , 138 CONDITION Category Typical Condition Loss �ehicle Seats Condition Minor Wear Good 140 Carpets Condition Minor Wear Good 35 Int Trim Condition Minor Damage Good 55 Body Condition Minor Damage Good 225 Front Tires Good New 50 Rear Tires Condition Good New 50 Total Condition Adjusted N:arket Value 510 , 693 Deductible -250 . 00 Net Adjusted Value 510 , 443 . 00 The selling price may be substantially less than the asking price . In the case of this 2006 Buick Lucerne CX 4D Sedan, the difference between the asking price and selling price is generally 70_ This selling price adjustment has been applied to the advertised price. VEHICLE DESCRIPTION 2006 BUICK LUCERNE CX 4D SEDAN i VIN: 1G4HP57276U211020 I 2005 Buick Lucerne CX 4D Sedan 63 , 084 Miles Standard Air Conditioning Dual Airbags Auto Load Leveling Alarm System Ar.ti-Lock Brakes Cruise Control Center Console Rear Window Floor Mats Bucket Seats Head Airbags Intermittent Wipers Keyless Entry Lighted Entry Power Mirrors OnStar System Power Brakes Power poor Locks Power Steering Power Windows Power Drivers Seat AM/FM CD Player Rem Trunk-L/Gate Side Airbags Velour/Cloth Seats Strg Wheel Radio Tachometer Trip Computer Traction Control Theft Deterrent Tinted Glass Tilt Steering WheelAluminum/Alloy Wood Interior Trim 07/22/13 09 : 17 AUTQSOURCE Page 3 Via: Direct AS Request: 32852462 Version: 1 VEHICLE DESCRIPTION (continued) 2006 BUICK LUCERNE CX 4D SEDAN Trim Levels *CX, CXL V6 , CXL �8 , CXS * Indicates your trim level A detailed description of your vehicle was provided to Autosource by a trained appraiser. Contact State Far.m Insurance if revisions are necessary. VEHICLE CONDITION 2006 BUICK LUCERNE CX 4D SEDAN SEATS Good CARPETS Good INT TRIM Good GLASS Good HEADLINER Good BODY Gaod PAINT Minor Wear EXT TRIM Good ENGINE Minor Wear TRANSMISSION Minor Wear FRONT TIRES New REAR TIRES New COMPARABLE VEHICLE DETAILS 2006 BUICK LUCERNE CX 4D SEDAN The following information provides the details for the vehicles used to calculate the Autosource Value. 1 2006 BUICK LUCERNE CX 4D Adjusted 59 , 398 Stock# R012092 . 86677 Miles . 6 Cylinder 3 . 8 Engine , 4 Speed Automatic , Anti- Lock Brakes . Air Conditioning, Auto Load Leveling, Alarm System, Aluminum/Alloy Wheels , Bucket Seats , Cruise Control , AM/FM CD Player � Center Console � Dual Airbags , Rear Window Defroster, Power Drivers Seat , �loor Nats . Head Airbags , Intermittent Wipers , Keyless Entry System, Lighted Entry System- OnStar System� Power Brakes , Power poor Locks , Power Mirrors , Power Steering, Power Windows , Rem Trunk-L/Gate Release , Side Airbags , Strg Wheel Radio Control , Tachometer, Trip Computer, Traction Control System, Theft Deterrent System, Tinted Glass , Tilt Steering Wheel , Velour/Cloth Seats , Wood Interior Trim, XM Satellite Radio . Offered for sale by Walser Chrysler Jeep Dodge in Hopkins , MN, (952 )935-2400 . Advertised Q4/28/13 . The advertised price of 59 , 998 was adjusted to account for typical negotiation. i, i 2 2006 BUICK LUCERNE CX 4D Adjusted 59 , 993 Stock# 2411A. 71614 Miles . 6 Cylinder 3 . 8 Engine , 4 Speed Automatic , Anti- Lock Brakes , Air Conditioning� Auto Load Leveling , Alarm System� 0?/22/13 09 : 17 AUTOSOURCE Page 4 Via: Direct AS Request : 32852462 Version: 1 COMPARABLE VEHICLE DETAILS (continued} 2006 BUICK LUCERNE CX 4D SEDAN Aluminum/Alloy Wheels � Bucket Seats � Cruise Control , AM/FM CD Flayer, Center Console, Dual Airbags , Rear Window Defroster , Power Drivers Seat , Floor Mats , Head Airbags , Intermittent Wipers , Keyless Entry Sys�em , Lighted En�ry System, OnStar System, Power Brakes : Power poor Locks , Power Mirrors , Power Steering, Power Windows . Rem Trunk-L/Gate Release , Side Airbags , Strg Wheel Radio Control � Tachometer , Trip Computer, Traction Control System, Theft Deterrent System, Tinted Glass , Tilt= Steering Wheel , Velour/Cloth Seats , Wood Interior Trim, Maintenance Records , Original Owner of Vehicle . Offered for sale by Coka�o Motor Sales Inc in Cokato, MN� ( 320 )286-244I . Advertised 04/14/13 . The advertised price of 510 , 745 was adjusted to account for typical negotiation. 3 2006 BUICK LUCERNE CX 4D Adjusted 59 , 391 Stock# 63113A. 92590 Miles . 6 Cylinder 3 . 8 Engine , 4 Speed Automa�ic , Anti- Zock Brakes , Air Conditioning� Auto Load Leveling, Alarm System� Aluminum/Alloy Wheels , Bucket Seats , Cruise Control , AM/FM CD Player, Center Console , Dual Airbags , Rear Window Defroster , Power Drivers Seat , Floor Mats , Head Airbags - Intermittent Wipers , Keyless Entry System. Lighted Entry System, OnStar System, Power Brakes , Power poor Locks , Power Mirrors , Power Steering, Power Windows , Rem Trunk-L/Gate Release , Side Airbags , Strg Wheel Radio Control � Tachometer, Trip Computer , Traction Control System, Theft Deterrent System, Tinted Glass , Tilt Steeri�g Wheel � Velour/Cloth Seats , Wood Interior Trim, XM Satellite Radio. Offered for sale by Miller Auto Plaza in Saint Cloud , MN, ( 320 )251-8900 . Advertised 05/05/13 . The advertised price of 59 , 990 was adjusted to account for typical negotiation. 4 200b BUICK LUCERNE CX 4D Adjusted 58 , 455 Stock# 27782A. 127120 Miles . 6 Cylinder 3 . 8 Engine , 4 Speed Automatic , Anti- Zock Brakes , Air Conditioning , Auto Load Leveling. Alarm System, Aluminum/Alloy Wheels , Bucket Seats , Cruise Control , AM/FM CD Player� Center Console , Dual Airbags , Rear Window Defroster , Power Drivers Seat , Floor Mats , Head Airbags , Intermittent Wipers , Illuminated Visor Mirror, Keyless Entry System, Lighted Entry System. OnStar System� Power Brakes , Power poor Locks , Power Mirrors , Power Steering , Power Windows , Rem Trunk-L/Gate Release � Side Airbags : Strg Wheel Radio Control � Tachometer, Trip Computer , Traction Control System, Theft Deterrent System, Tinted Glass , Ti1t Steering Wheel , Velour/Cloth Seats , Wood Interior Trim, Floor Mats . Offered for sale by Kuehn Motor Company in Rochester , MN, ( 507 ?536-9859 . Advertised 07/17/13 . The advertised price of 58 , 995 was adjusted to account for typical negotiation. 07/22/13 09 :17 AUTOSOURCE Page 5 Via: Direct AS Request : 32852462 Version: 1 VINSOURCE ANAI.,YSIS 2Q06 BUICK LUCERNE CX 4D SEDAN VIN: 1G4HP57276U211020 Decodes as : 2006 Buick Lucerne CX 4� Sedan Accuracy: Decodes Correctly History: No activity was reported REPORTED PHONE NUMBER ANALYSIS 2006 BUICK LUCERNE CX 4D SEDAN no Vehicles Advertised at ( 651 ) 453-1779 VALUATION NOTES 2006 BUICK LUCERNE CX 4D SEDAN o Loss vehicle description was provided by State Farm Insurance o Adjustments of Special Note - The requested Exception valuation has been processed using one or more Comparables in order to meet state regulatory requirements . - A mileage adjustment of 2 . 75 cents per mile/kilome�er has b�en 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 . - No special adjustments were made for this vehicle. - All values are in U.S . dollars . o Autosource Valuation Process - Ovez 3 , 800 , 00o 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 . - The originating search area for this valuation was Inver Grove , Minnesota. - The market area expansion was authorized by Autosource Guidelines . j o Other Adjustments or Commer.ts - CLEAN CAR - There is no tax for the given zip code of 55077 . 07/22/13 09 : 17 AUTQSOURCE Page 6 Via: Direct AS Request: 32852462 Version: l I�ICB REPORT 200& BUICK LUCERNE CX 4D SEDAN NICB/ISO Member: 5037 STATE FARM MUTUAL RUTOMOBILE Claim: 2321X5835 Loss Date: 07/12/13 Type of Loss : PROPERTYlCASUALTY Phone: RECALL BULLETINS 2006 BUICK LUCERNE CX 4D SEDAN �at � l . Highway Traffic Safety Admin (US) has issued a total of 3 recall bulletins that may apply to this vericle . NHTSA ID Number: 06V105000 Date Issued: 04/04/06 Quantity Affected: 12 , 862 Defect: On certain vehicles equipped with a v8 engine , the power steering hose connectors may have been inadequately crimped which could result in a fluid leak. If this were to occur � power steering assist may be lost and increased steering effort would be required at low speeds . Also - if the power s�eering fluid were to contact hot engine parts � an engine compartment fire co�ald occur . Remedy: Dealers will replace the power steering gear inlet hose . The recall began on March 29 , 2006 . Owners may contact Buick at 1-866-608-8080 or Cadillac at 1-866-982-2339 . NHTSA ID Number: 08V441�00 Date Issued: 08/27/08 Quantity Affected: 857 , 735 Defect : GM is recalling 857 , 735 MY 2006-2008 Buick Lucerne ; Cadillac DTS; Hummer H21 ; MY 2007-2008 Cadillac Escalade , Escalade ESV, Escalade EXT; Chevrolet Avalanche , Silverado, Suburban, Tahoe; GMC Acadia , Sierra � Yukon, Yukon XL, Saturn Outlook; and MY 2008 Buick Enclave vehicles equipped with a heated wiper washer fluid system. A short circuit on the printed circuit board for the washer fluid heater may overheat the control-circuit ground wire. This may cause other electrical features to malfunction� create an odor, or cause smoke increasing the risk of a fire . Remedy: Dealers will install a wire harness with ar. in-line fuse free of charge. The manufacturer has not yet provided an owner notification schedule. Owners may contact Buick at 1-866-608-8800 ; Cadillac at 1-800-982-2339 or http://www. cadillac . com; Chevrolet at 1-800-630-2438 ; Saturn at 1-800-972-8876 or http://w�rw. saturn. com, GMC at 1-866-996-9436 ; or Hummer at 1-800-732-5493 : or mygmlink at http:/1www.gm. com/recall . GM Recall No. 08048 . Customers may contact the National Highway Traffic ***** CONT �D NEXT PAGE **** 07/22/13 09 :17 AUTOSOURCE Page 7 Via: Direct AS Request: 32852462 Version: 1 RECALL BULLETINS (continued) 2006 BUICK LUCERNE CX 4D SEDAN Safety: 1-800-424-9153 ) ; or go to http://www. safercar .gov. Customers May Contact : Customers may contact the National Highway Traffic Safety Administration' s Vehicle Safety Hotline at 1-888-327-4'�36 (TTY: 1-800-424-91537 ; or go to http://www. safercar.gov. NHTSA ID Number: 1OV240000 Date Issued: 06/04/10 Quantity Aftected: 1 , 365 � 070 Defect: GM is recalling certain model year 2006-2009 Buick� Lucerne; Cadillac DTS; Hummer H2 ; model year 2008-2009 Buick Enclave; Cadillac CTS; model year 2007-209 Cadillac Escalade . Escalade ESV, Escalade EXT; Chevrolet Avalanche , Silverado , Suburban, Tahoe; GMC Acadia , Sierra� Yukon. Yukon XL; Saturn Outlook; and model year 2009 Chevrolet Traverse vehicles equipped with a heated washer flu id system (HWFS) . A recall was implemented in 2008 to add a fuse to the central circuit harness to address the potential cor.sequences of a printed circuit board (PCB? electrical short . However , there have been new reports of thermal incidents on HWFS modules after this improvement was installed. These incidents resulted from a new failure mode attributed to the device ' s thermal protection feature. The significance varies from minor distortion to considerable melting of the plastic around the HWFS fluid chamber . It is possible for the heated washer module to igrite and a fire may occur . Remedy: Dealers will permanently disable and remove the (CONTINUED NEXT PAGE} Heated Washer Fluid: heated washer fluid module . An updated page for the owner manual will be provided and inserted in the owner manual to document that the feature has been permanently disabled and removed from the vehicle . The safety recall began on June 11 , 2010 . Owners may contact Buick at 1-86b-608-8080 , Cadillac at 1-866-982-2339 , Chevrolet at 1-800-630-2438 - Saturn at 1-800-972-8876 , GMC at 1-866-996-9463 and Hummer at 1-800-732-5493 or at the Owner Center at www.gmownercenter . com. Owners may also contact the National Highway Traffic Safety Administration� s Vehicle Safety Hotline at 1-888-327-4236 (TTY 1-800-424-9153 , or go to http://www. safercar . gov. ORIGINAL EQUIPMENT GUIDE 2006 BUICK LUCERNE CX 4D SEDAN 07/22/13 09 : 17 AUTOSOURCE Page 8 Via: Direct AS Request : 32852462 Version: 1 ORIGINAL EQUIPMENT GUIDE (continued} 2Q06 BUICK LUCERNE CX 4D SEDAN ----- -----Engine �ptions--- - -- --- -- ---- -- -Transmission Options--- --- -- * 6 Cylinder 3 . 8 Engine STD * 4 Speed Automatic STD -- ---other Optional Equipment------ --------Convenience Options--- --- -- * AnLi-Lock Bx�akes STD * Air Condi�ioning STD * Auto Load Leveling STD Automatic Dimming Mirror * Center Console ST� * Cruise Control STD * Dual Airbags STD * Rear Window Defroster STD Engine Block Heater S50 * Floor Mats STD * Head Airbags STD Garage Door Opener * Intermittent Wipers STD Illuminated Visor Mirror * Keyless Entry System STD Reverse Sensing System * Lighted Entry System STD Rain-Sensing W/S Wipers * OnStar System STD * Rem Trunk-L/Gate Release STD Remote Starter * Strg Wheel Radio Control STD * Side Airbags STD * Tilt Steering Wheel STD * Tachometer STD ---- - --- - Pawer Accessories---- ---- - * Trip Computer STD Heated Power Mirrors * Traction Control System STD * Power Drivers Seat STD * Tinted Glass STD Dual Power Seats 5350 * Wood Interior Trim STD * Power Brakes STD ---- -Radio/Phone/Alarm Options- --- - * Power poar Locks STD * Alarm System STD * Power Mirrors STD * AM/FM CD Player STD * Power Steering STD Harman Kardon Sound Sys 5470 * Power windows STD AM/FM In-dash CD Changer 5300 ---- -- --- --Seat Options---- -- ------ MP3 Player 5150 * Bucket Seats STD * Theft Deterrent System STD Split Front Bench Seat 5250 XM Satellite Radio 5325 * Velour/Cloth Seats STD -- ---------Roof Options--- -- --- -- - - -- -- --------Wheel Options- ----- ----- Power Moonroof 5900 * Aluminum/Alloy Wheels STD ---- ------- ------ ---- ------ - --Option Packages----- -- ---- � -------------------- Comfort & Convenience 5450 Includes Automatic Dimming Mirror , Heated Power N.irrors , Garage Door Opener, Illuminatd Visor Mirrors , Rain-Sensing W/S Wipers Driver Confidence 5595 Includes Remote Starter, Reverse Sensing System Entertainment Package 5795 Includes Harman Kardon Sound Sys . XM Satellite Radio Base retail price: 525 , 99� Loss Vehicle manufacturer ' s suggested retail price as reported: 525 , 990 Editions available for the same body style ( in order of original cost , increasing) : *CX, CXL V6 , CXL V8 , CXS 07/22/13 09 : 17 AUTOSOURCE Page 9 Via: Direct AS Request : 32852462 Version: 1 ORIGINAL EQUIPMENT GUIDE (continued ) 2006 BUICK LUCERNE CX 4D SEDAN * Indicates loss vehicle equipment . ABOUT YOUR VALUATION 2006 BUICK LUCERNE CX 4D SEDAN 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 wriL�en consent . If you are the insuz�ed or claiman� and have questions regarding the description of your vehicle. please contact the insurance company that is handling your claim. Information within VINsourcelNICB is provided solely ta identify potential duplicative claims activity. User- agrees to use such ir_formation solely for lawful purposes . 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