Roost, Donna REC�I\.���
SEP ?6 2�14
NOTICE OF CLAIM FORM to the City of Saint Pau1, 1V��s��°��
Minnesotu State Statute 466.05 states that"...every person...who claims damages from any municipality...shall cause to be presented to the
governing body of the municipality within 180 days after the alteged loss or injury is discovered a notice stating the time,place,and
circumstances ihereof,and the amount of compensation or other relief demanded."
Please complete this form in its entirety by clearly typing or priuting your answer to each questioa ff more space is
needed,attach additlonal sheets. Please note that you will not be contacted by telephone to clarify answers,so provide as
much information as necessary to e�lain 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 ���"111L�. Middle Initial � Last Name �D'C�`J�
Company or Business Name
Are You an Insurance Company? Yes(N�„�c^; If Yes,Claim Number?
Street Address 1 ��'2 � l�l.h GLI'�J� 1�� � .
City 5� - ���t„� State M�" Zip Code ����`1
Daytime Phone(����- ��''�Cell Phone(�)�y yZ�Evening Telephone(_) -
Date of Accident/Injury or Date Discovered_..][�r..n"1-?v �d�� Time ; a�' am/�
Please state,in detail,what occurred(happened),and why you are submitting a claim.Please indicate why or how you
feel the City of Saint Paul or its employees are involv d and/or responsible for your damages.
21� 7� - r ih,
7
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� S ' S L�
m i Dr S ' ��
�Pl se check the box(es)that most closely represent the reas4�for completing this form: / ��, � w�,rr�e�
My vehicle was damaged in an accident (�Y'�e 4�UJk�C ) ❑My vehicle was damaged during a tow .
❑M vehicle was dama ed b a othole or condrtion of the street CI M vehicle was dama ed b a low � ���Z'�
❑My vehicle was wrongfully towed and/or ticketed ❑I was in ured on Cit gro ey p �"'�bv.•�St c:�nK
.1 Y P P rtY n�a;- ���2"��y
O Other type of property damage—please specify � yw,tiri�+�L k�t�
❑Other type of injury—please specify Ns;�►U�:.� �da�'I�'
In order to process your claim vou need to include coaies of all aaalicable documents. �'°s r�'���.
For the claims types listed below,please be sure to include the documents indicated or it will delay the handling of
your claim. Documents WII.,L NOT be returned and become the property of the City. You are encouraged to keep a
cop or self before submitting your claim form.
������operty 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
� Other property damage claims: two repair esdmates 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-ulease comnlete this section
Were there witnesses to the incident? � No Unknown (circle)
Pr vide their names,adctresses and tele hone numbers: ' /2-" ��g'�`��5
- �- a _ �� i�z-�q�
Were the police or law enforcement called? Yes � Unknown (circle) ����
If yes, what department or agency? Case#or report#
Where did the accident or injury take place? Provide street address,cross street,intersection,name of park or facility,
closest landmark,etc. Please be a�d�led as possible. If necessary,attach a diagram.�'� /�
Please indicate the amount you e seekin in co nsation or what you would like the City to do to resolve this claim
to your satisfacrion._� ���l�� i°i�iYlA�
Vehicle Claims- lease com lete this section ❑check box if this section does not a 1
Your Vehicle: Year " Make r s G� Model
License Plate Number � 5� State Color �.�
Registered Owner n �'
N�Driver of Vehicle `
Area Damaged '
City Vehicle: Year Make Model
License Plate Number State Color
Driver of Vehicle(City Employee's Name)
Area Damaged
I 'u Claims- lease com lete this section ❑ check box if this section does not a 1
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
�heck here if you are attaching more pages to this claim form. Number of additional pag+es
By signing this form,you are stating that all informatiore 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�/� a��y
Print the Name of the Person who Completed this Form: � ��
Signature of Person Making the Claim: ` -"
Revised February 201I .�,f/ >( ' (Q 1 '��� �
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_ O {tPYM N�AUtoBOO�GO
RAYMOND AUTO BODY� INC. Workfile ID: bd19ce02
FederalID: 41-0888257
1075 PIERCE BUTLER RTE, SAINT PAUL, MN
55104
Phone: (651) 488-0588
FAX: (651) 488-4794
Preliminary Estimate
)ob Number:
Customer: ROOST, DONNA
Written By: JOHN JANASZAK
Insured: ROOST, DONNA Policy#:
Claim #:
Type of Loss:
Date of Loss: Days to Repair: 0
Point of Impact:
Owner: Inspection Location: Insurance Company:
ROOST, DONNA RAYMOND AUTO BODY,INC.
1142 HUBBARD AVENUE 1075 PIERCE BUTLER RTE
ST PAUL, MN 55104 SAINT PAUL, MN 55104
(651)641-1565 Day Repair Facility
(651)488-0588 Business
�AEHICLE
Year: 2008 Body Style: 4D SED VIN: 3N1A661E38U25783 Mileage In:
Make: NISS Engine: 4-2.OL-FI License:
Mileage Out:
Model: SENTRA
Production Date: State: Vehicle Out:
Color: blue Int: Condition: ]ob#:
Console/Storage Search/Seek Bucket Seats
TRANSMISSION WHEELS
Automatic Transmission CONVENIENCE CD Player
POWER Air Conditioning Auxiliary Audio Connection Wheel Covers
Power Steering
Intermittent Wipers SAFETY PAINT
Tilt Wheel Drivers Side Air Bag Clear Coat Paint
Power Brakes OTHER
Power Windows Rear Defogger Passenger Air Bag
Power Locks
RADIO Front Side Impact Air Bags Power Trunk/Gate Release
DECOR AM Radio Head/Curtain Air Bags
FM Radio SEATS
Dual Mirrors Cloth Seats
Tinted Glass Stereo
9/23/2014 4:35:00 PM
019495 Page 1
. ��`� �'i�
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Preliminary Estimate
Customer: ROOST, DONNA 7ob Number:
Vehicle: 2008 NISS SENTRA 4D SED 4-2.OL-FI blue
Line Oper Description Part Number Qty Extended Labor Paint
Price$
1 FRONT BUMPER
2 R&I R&I bumper cover 1.6
3 FRONT LAMPS
4 R&I LT Headlamp assy Base, S, SL 0.3
5 HOOD
6 * Rpr Hood �,Q 3.0
7 Add for Clear Coat 1•z
8 R&I Insulator pad 0.3
9 Repl Insulator pad clip 658464Z000 7 12.04
10 FENDER
11 * Rpr LT Fender Base,S,SL �4 2•3
12 Overlap Major Adj. Panel -0.4
13 Add for Clear Coat 0.4
14 R&I LT Fender liner Base 0.4
15 R&I LT Mud guard factory installed 0•2
2.0 liter
_
16 COWL
17 R&I LT Cowl grille �•�
18 FRONT DOOR
19 Repl LT Mirror assy w/power 96302ETOlE 1 199.65 0.3
20 Repl LT Mirror cover 96302ET03E 1 2037 0.3 0.8
21 Overlap Minor Panel "0•2
z2 Add for Clear Coat 0.1
23 Repl LT Inner cover w/power mirror 80293ET000 1 30.77
24 R&I LT R&I trim panel OS
25 MISCELLANEOUS OPERATIONS ,
26 Repl Cover car/bag i 1 �•2
27 # Hazardous waste removal 1 6.00 X
28 # Color tint/color match 1 0.5
29 # Repl Corrosion protection primer 1 0.4
SUBTOTALS 268.83 13.8 8.1
9/23/2014 4:35:00 PM 019495 Page 2
Preliminary Estimate
Customer: ROOST, DONNA 7ob Number:
Vehicle: 2008 NISS SENTRA 4D SED 4-2.OL-FI blue
ESTIMATE TOTALS
Category Basis Rate Cost�
Parts 262.83
Body Labor 13.8 hrs @ $59.00/hr 814.20
Paint Labor 8.1 hrs @ $59.00/hr 477.90
Paint Supplies 8.1 hrs @ $39.00/hr 315.90
Body Supplies 9.8 hrs @ $8.00/hr 78.40
Miscellaneous 6.00
Subtotal 1,955.23
Sales Tax $657.13 @ 7.6250% 50.11
Grand Total 2,005.34
Deductible 0.00
CUSTOMER PAY 0.00
INSURANCE PAY 2,005.34
WHILE WE HAVE MADE EVERY EFFORT TO WRITE A COMPREHENSIVE REPORT OF THE VISIBLE DAMAGE TO YOUR
VEHICLE, IT IS IMPORTANT TO REMEMBER THAT THIS IS ONLY AN ESTIMATE.
THERE ARE A NUMBER OF FACTORS THAT CAN AFFECT THE ACTUAL C05T OF REPAIRS, INCLUDING BUT NOT
LIMITED TO HIDDEN DAMAGE, PARTS PRICE CHANGES, AND INSURANCE COMPANY INVOLVEMENT.
PLEASE CONSIDER THIS WHEN MAKING DECISIONS REGARDING THE REPAIRS TO YOUR VEHICLE.
9/23/2014 4:35:00 PM 019495 Page 3
Preliminary Estimate
Customer: ROOST, DONNA 7ob Number:
Vehicle: 2008 NISS SENTRA 4D SED 4-2.OL-FI blue
QUALITY REPLACEMENT PARTS WARRANTY
OUR REPAIR ESTIMATE MAY SPECIFY THE USE OF QUALI'TY REPLACEMENT PARTS. QUALITY REPLACEMENT PARTS
ARE PARTS NOT MANUFACTURED BY OR FOR THE ORIGINAL EQUIPMENT MANUFACTURER. WE WILL STAND
BEHIND THE QUALITY REPLACEMENT PARTS THAT ARE SPECIFIED ON THIS ESTIMATE AND USED IN THE REPAIR
OF YOUR VEHICLE, FOR AS LONG AS YOU OWN/LEASE THE VEHICLE. WE WARRANT THESE PARTS ARE OF LIKE
KIND, QUALITY, SAFETY, FIT AND PERFORMANCE TO PARTS MANUFACTURED BY OR FOR THE ORIGINAL
EQUIPMENT MANUFACTURER.
THIS WARRANTY EXCLUSIVELY COVERS LOSS OR DAMAGE THAT IS RELATED TO DEFECTS IN THE QUALITY
REPLACEMENT PART. THIS WARRANTY DOES NOT COVER DAMAGE OR PART FAILURE DUE TO IMPROPER
INSTALLATION, MISUSE, NEGLECT, ABUSE, IMPROPER MAINTENANCE, ABNORMAL OPERATION, OR NORMAL WEAR
&TEAR.
SHOULD A SUPPLIER OF A PART SPECIFIED IN OUR REPAIR ESTIMATE, OR THE REPAIR FACILITY THAT PERFORMS
THE REPAIR ON YOUR VEHICLE, BE UNABLE TO RESOLVE A LEGITIMATE COMPLAINT ABOUT THE QUALITY
REPLACEMENT PART USED IN THE REPAIR, WE WILL MAKE EVERY EFFORT TO SEE THAT THE PROBLEM IS
CORRECTED.
THIS WARRANTY AND ANY REPRESENTATIONS MADE HEREIN ARE NON-TRANSFERABLE AND EXTEND ONLY TO
THE PARTY OWNING/LEASING THE VEHICLE AT THE TIME OF THE REPAIR.
FOR ASSISTANCE, PLEASE CONTACT THE NEAREST CLAIM DEPARTMENT OFFICE.
DISCLAIMER:
ANY PERSON WHO KNOWINGLY PRESENTS A FALSE OR FRAUDULENT INSURANCE CLAIM FOR THE PAYMENT OF A
LOSS MAY BE GUILTY OF A CRIME AND MAY BE SUBJECT TO FINES AND CONFINEMENT IN STATE PRISON.
THE LABOR AND TAX RATES USED WERE DETERMINED BY THE VEHICIE INSPECTION LOCATION UNLESS THE
REPAIR FACILITY WAS KNOWN AT THE TIME OF THE INSPECTION OR ANOTHER LOCATION WAS SPECIFIED
BEFORE THE ESTIMATE WAS PREPARED
THIS IS NOT AN AUTHORIZATION TO REPAIR.
TO ENSURE REPAIRS WILL BE COMPLETED BASED ON THIS ESTIMATE; PLEASE PROVIDE A COPY TO THE REPAIR
FACILITY PRIOR TO AUTHORIZING REPAIRS. FAILURE TO DO SO MAY RESULT IN YOU BECOMING RESPONSIBLE
FOR PAYING UNAPPROVED EXPENSES.
NO PAYMENT FOR A SUPPLEMENT WILL BE APPROVED OR ISSUED UNLESS THE REPAIRS WERE AUTHORIZED
PRIOR TO COMPLETING THE SUPPLEMENTAL REPAIRS. TO EXPEDITE THE HANDLING OF ANY SUPPLEMENTAL
DAMAGES, PLEASE ACCESS HTTP://WWW.THESHOPOFCHOICE.COM/FARMERS. IF YOU NEED TECHNICAL
ASSISTANCE REGISTERING OR UPLOADING ATTACHMENTS, CONTACT NUGEN IT CUSTOMER SUPPORT AT
(855)-684-3648 BEIINEEN 7 AM AND 7 PM CENTRAL TIME. POTENTIALLY, A REINSPECTION MAY BE NECESSARY.
CIRCLE OF DEPENDABILITY SUPPLEMENTS: CIRCLE OF DEPENDABILITY PROGRAM SHOPS WILL CONTINUE TO
PROCESS SUPPLEMENTS THROUGH THE NORMAL SUPPLEMENT PROCESS. PLEASE CONTACT YOUR FIELD OR
OFFICE CONSULTANT IF YOU HAVE ANY QUESTIONS.
THIS PROCESS DOES NOT APPLY TO BRISTOL WEST.
9/23/2014 4:35:00 PM 019495 Page 4
Preliminary Estimate
Customer: ROOST, DONNA ]ob Number:
Vehicle: 2008 NISS SENTRA 4D SED 4-2.OL-FI blue
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.
Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from the Guide
ARF3737, CCC Data Date 9/9/2014, 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 2015 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.
SYMBOLS FOLLOWING LABOR: ,
D=Diagnostic labor category. E=Electrical labor categor�. 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=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
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 Safety Administration. PDR=Paintless Dent Repair. VIN=Vehicle Identification Number.
9/23/2014 4:35:00 PM 019495 Page 5
LATUFF BROS., INC.
880 UNIVERSITY AVENUE
ST. PAUL, MINNESOTA 55104
(651)224-2828 FAX: (651)291-0677
FEDERAL ID#41-0777034
***PRELIMINARY ESTIMATE***
09/23/2014 03:57 PM
Owner
Owner: DONNA ROOST
Address: 1142 HUBBARD AVE Work/Day: (651)354-4208
Home/Evening: (651)641-1565
City State Zip: Saint Paul, MN 55104 Cell: (651)354-4208
`Inspection ____ —..—�
Inspection Date: 09/23/2014 03:56 PM Inspection Type: Drive In
Inspection Location: Latuff Brothers Inc Contact:
Address: 880 University Ave Work/Day: (651)224-2828x
FAX: (651)291-0677x
City State Zip: Saint Paul, MN 55104 Work/Day:
Email: general@latuffbrothers.com
Primary Impact: Left Front Side Secondary Impact:
Driveable: Yes Rental Assisted:
Appraiser Name: ROBERT LATUFF Appraiser License#:
Repairer_ _ __ �
Repairer: Latuff Brothers Inc Contact:
Address: 880 University Ave Work/Day: (651)224-2828
FAX: (651)291-0677
City State Zip: Saint Paul, MN 55104 ; WorklDay:
Email: general@latuffbrothers.com �I
Target Complete DateITime: ', Days To Repair: 3
Remarks �
3 DAY REPAIR
****�"*****PRELIMINARY ESTIMATE*"*'*"'"""""""""""
POSSIBLE ADDITIONAL DAMAGE MAY BE FOUND AFTER TEAR DOWN
Vehicle
2008 Nissan Sentra 2.0 4 DR Sedan
4cyl Gasoline 2.0
Continuously Variable Tr
Lic.Plate: 155DWA Lic State: MN
Lic Expire: VIN: 3N1 AB61 E38�725783
Prod Date: 05/2008 Mileage:
Veh Insp#: Mileage Type: Actual
Condition: Code: Z1774A
Ext.Color: BLUE Int.Color:
Ext.Refinish: Two-Stage Int. Refinish: Two-Stage
Ext.Paint Code: B23 Int.Trim Code:
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2008 Nissan SenVa 2.0 4 DR Sedan
Claim#: 09l23/2014 03:57 PM
Options
AM/FM CD Player Air Conditioning Automatic Trans
Bucket Seats Center Console Digital Clock
Dual Airbags Engine Block Heater Head Airbags
Intermittent Wipers Power Brakes Power poor Locks
Power Steering Power Windows Rear Window Defroster
Rem Trunk-L/Gate Release Side Airbags Tachometer
Theft Deterrent System Tilt Steering Wheel Tinted Glass
Velour/Cloth Seats
Damages
Line Op Guide MC Description MFR.Part No. Price ADJ% B% Hours R
Front End Panel And Lamns
1 RI 41 Headlamp Assy,Halogen LT R&I Assembly 1.7 SM
Front Bodv And Windshield
2 I 83 Panel,Hood Repair 4.0' SM
3 L 83 # Panel,Hood Refinish 3.8* RF
2.6 Surface
0.6 Two-stage setup
0.6 Two-stage
#=10, 13
»BLEND BASE FULL CLEAR COAT
4 I 103 Fender,Front LT Repair 1.0' SM
5 � 103 10 Fender,Front LT Refinish 2.2' RF
1.8 Surface
0.4 Two-stage
»BLEND BASE FULL CLEAR COAT
6 RI 125 Guard,Fender Mud LT R&I Assembly 0.1 SM
Front Bodv Interior Sheetmetal i
7 RI 107 Skirt,lnner Fender LT R&I As�embly 0.1 SM
i
Front Doors '
8 E 242 Cover,Frt Door Mirror LT 96302ETb3E $20.37 0.1 SM
9 L 242 Cover,Frt Door Mirror LT Refinish 0.6 RF
0.5 Surface
0.1 Two-stage
10 E 279 Housing,Mirror Outer LT 96302ETOOE $150.37 0.7 SM
Manual Entries
11 L M14 Corrosion Protection Refinish 0.3" RF
12 N M17 Cover Car Exterior Additional Labor $7.00* RF
13 SB M60 Hazardous Waste Removal Sublet Repair $5.00* SM
13 Items
MC Message
10 INCLUDES AUDATEX TIME TO CLEAR ENTIRE PANEL
13 INCLUDES 0.6 HOURS FIRST PANEL TWO-STAGE ALLOWANCE
Estimate Total&Entries
Gross Parts $170.74
Other Parts $7.00
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09/23/2014 04:00 PM
2008 Nissan Sentra 2.0 4 DR Sedan
Claim#: 09/23/2014 03:57 PM
Paint Materials $241.50
Parts&Material Total $419.24
Tax on Parts 8 Material @ 7.625% $31.97
Labor Rate Replace Repair Hrs Total Hrs
Hrs
Sheet Metal (SM) $55.00 2.7 5.0 7.7 $423.50
MechlElec(ME) $85.00
Frame(FR) $75.00
Refinish(RF) $55.00 6.9 6.9 $379.50
Paint Materials $35.00
Labor Total 14.6 Hours $803.00
Sublet Repairs $5.00
$1,259.21
Gross Total $1,259.21
Net Total
Alternate Parts No
SPPL Yes Zip Code:55104 Default
Audatex Estimating 7.0.334 ES 09/23/2014 04:00 PM REL 7.0.334 DT 09101/2014 DB 09/15/2014
Copyright(C)2013 Audatex North America,Inc.
1.7 HRS WERE ADDED TO THIS ESTIMATE BASED ON AUDATEX'S TWO-STAGE REFINISH FORMULA.
THIS ESTIMATE HAS BEEN PREPARED BASED ON T$iE USE OF ONE OR MORE CRASH PARTS
SUPPLIED BY A SOURCE OTHER THAN THE MANUFA�TURER OF YOUR MOTOR VEHICLE.
WARRANTIES APPLICABLE TO THESE REPLACEMENT PARTS ARE PROVIDED BY THE PARTS
MANUFACTURER OR DISTRIBUTOR RATHER THAN BY THE MANUFACTURER OF YOUR VEHICLE.
A PERSON WHO FILES A CLAIM WITH INTENT TO �EFRAUD OR HELPS COMMIT A FRAUD
AGAINST AN INSURER IS GUILTY OF A CRIME.
Op Codes
* = User-Entered Value E = Replace OEM NG= Replace NAGS
OE= Re lace PXN OE Srpls UE= Replace OE Surplus
EC= Replace Economy p EU= Replace Recycled
ET = Partial Replace Labor EP= Replace PXN
PM= Re lace PXN Reman/Reblt UM= Replace Reman/Rebuilt
TE = Partial Replace Price p
L = Refinish PC= Replace PXN Reconditioned UC= Replace Reconditioned
SB= Sublet Repair N = Additional Labor
TT = Two-Tone IT = Partial Repair
BR= Blend Refinish I = Repair
CG= Chipguard
RI = R&I Assembly P = Check
AA= Appearance Allowance RP= Related Prior Damage
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09/23/2014 04:00 PM
� , � .
2008 Nissan Senlra 2.0 4 DR Sedan
Claim#: 09/23/2014 03:57 PM
This report contains proprietary information of Audatex and may not be disclosed to any third party(other than
the insured, claimant and others on a need to know basis in order to effectuate the claims process)without
��p'���"�i� Audatex's priorwritten consent.
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a Ste)rrd ct7�ri�ym:'s�
--�---�*�Copyright(C)2013 Audatex North America, Inc.
Audatex Estimating is a trademark of Audatex North America, Inc.
Page 4 of 4
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