The URL can be used to link to this page

Sweeney, Robert / IZ%I�i�2�1� � St. Patil Region�il Vdater Seri-ices ��; .-�ttn: I�ath�' Tr�ivis �_f��'T'�'�� 1900 Ric� St Saint Paul, ��1N ��l 13 R�CEIV�D �-�ur Insureci: St. Paul Re�gional Water Serviczs Y"our Claim No: Loss Date : 07�'21!'2014 � ��C 2 � �Q�� Our Iilsured: Robert S��•aznzti� C�'�`Y CLE�K Date of Loss: U7i21r'2014 Dzductiblz: $O.UO �mount of Loss: 52.76 L 66 �� Our _=�ccount'Vo: SBB482384 Dear•I�ath� Travis: i Eticlosed are copies of our supporting doeumznts ��hicli are e�-id�nce of oiu � subrogation de�liand. Our inve��tigatiou re��eals th�t��out•instired ��as negli�cr�t. �� Tliere�fore, ��e are� s�eking to reco��e�r $2,761.66 in dam�ges. � ��'e are requestiug tliat��ou pleasz rei�iz�i�tlie e�nclosed docun�ents as soon as p�ssible aiid ad�-ise us of eour positio�i on sattlemzirt of our cl�iim and thz inslired'� decittictible. If vo��i have �ilraadv rairnbursad our insur�d his!�her deductible and'or aii��:� othe�r e�pense�s, ple�asa contact us at the telephone number provided belo«�.�� PLE_=�5� REh�iIT ,�LL P�YD�IENTS Tn: TFIE H�RTI'ORD, PO B(�� 72�7-�77�4. PHILADELPHIA. P:� 19170-77�44. Siuczrel��, (',��..��-�-ti� �`'�ti�� .� �;��u�� C�ntral Recovery C�parations 866-509-357�4 E�t. 7�� Propert�° And Casualt��Ins. CatYipan��C�f Hai�tf�i�d �� Po F3o�: 1�4272 � Leli�i�toti, ILI" �U�12-�272 F'a�: 866 285 5111 � dnld��'CBP NOTICE OF CLAIM FORM to the City of Saint Paul, Minnesota Minnesota State Statute 466.05 states that "...every person...who claime�damages from any municipality...shall cause to he presented to the governing body of the rr�unicipaliry within 180 days after the ctlleged loss or injury is discovered a notice stating the time,place,and circumstances thereof,and the amount of compenscttion or other relief demanded." Please complete this form in its entirety by clearly typing or printing your answer to each question. If more space is needed,attach additional sheets. Please note that you will not be contacted by telephone to clarify answers,so provide as much information as necessary to explain your claim,and the amount of compensation being requested. You will receive a written acknowledgement once your form is received. The process can take up to ten weeks or lon�er depending on the nature of vour claim. This form must be signed,and both pages completed. If something does not apply,write `�/A'. SEND COMPLETED FORM AND OTHER DOCUMENTS TO: CITY CLERK, 15 WEST KELLOGG BLVD, 310 CITY HALL, SAINT PAUL, MN 55102 First Name '�'��fi Middle Initial Last Name S�'��n�'��1 l� 1�-1�r�� `-�v�,,�-� Company or Business Name_ i�z K�t�c`�''� l•�5� �','�"�7°�'�e S� ��/ G�r�,,,.,� �� S�� `f �"�.�,:� `t Are You an Insurance Company?�Yes/I�To If Yes, Claim Nuinber? h� ��u Street Address �J t��''�C l`F �7-�. Lt�c:�.-�_� k �/ �(� s I�- ,r-��„f !�/1�:,( �2�:; L,.�l��&1��'r� l � t� � /� __ cf.�7 '.27`f City :.--�c�x��.� State l � Zip Code `� _ � �,, . F - . � � � � � 357y z'''.r.,, Daytnne Phone (��)�J�f- Cell Phone( )_ - Evening Telephone ( ) - Date of Accident/Injury or Date Discovered 7 �� Time �� am/<p1"�a 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 far your damages. - ,�'I!!�� _ DEC � �-?n�� C'I"�v ri �� 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 dama�ed by a pothole or condition of the street ❑ My vehicle was dama�ed by a plow ❑ My vehicle was wrongfully towed and/or ticketed ❑ I was iujured on City property ❑ Other type of property damage-please specify ❑ Other type of injury-please specify _ In order to process your claim vou need to include copies of all annlicable documents. Far the claims types listed below,please be sure to include the documents indicated or it will delay the handling ofi your claim. Documents WILL NOT be returned and become the property of the City. You are encouraged to keep a copy for yourself befo��e subinitting your claim form. O Pr�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: le�ible copies of any ticket iss�ied and a copy of the impound lot receipt O Other property damage claims: two repair esCimates if the damage exceeds $500.00; ar the actual hills and/or receipts for the repairs;detailed list of damaged items O ]njury 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 complete this section Were there witnesses to the incident? Yes �I� Lnknown (circle) � Provide their names, addresses and telephone numbers _ Were the police or law enforcement called? �Ye� No Unknown (circle) , If yes, what department or abency? ,S'-� �G J( �� Case#or report# L� �Y� �5� -v v � Where did the accident or injury take place? Provide street address,cross sU�eet, intersection, name of park or facility, closest landm�k, etc. Please be as detailed as possible. If necessal-y, attach a diabram.�r�s f �- �_ u w�/w-.d, Jf�n �` ; ��l �t��; 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.___��7�l ,!v �-' Vehicle Claims- lease com lete this section ❑check box if this section does not a 1 Your Vehicle: Year �Uv v Make �� Model � c� � ' LicensePlate Number �� .5 � L' K� State � Color ,^��-f� ��c L��i,� �5 l�t Re�istered Owner `��d��r F S�z�r�e� Driver of Vehicle �i../�' Area Damaged �Z�-,'� �� City Vehicle: Year �u I Z Make � r� Model � 3 5 v Liceuse Plate Number State Color Driver of Vehicle(City Employee's Name) _ Area Damaged _ IniurV Claims-please complete this section II�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 inju�y? Yes No When did you miss work? (provide date(s)) Name of your Employer: Address Telephone �d Check here if you are attaching more pages to this claim form. Number of additional pages__. By sigriing this form,you are statirzg that all iizforrnation you have provided is true and correct to the best of your knowledge. Dnsigned forms will not be processed. Subntitting a false claim can result in prosecz�tion. Date form was completed Print the Name of the Person who Completed this Form: � �z�'��' �''�'� �� Signature of Person Making the Claim: v►�'� ��rUr�C� { � ��r`��/� S " h,v��c.�1� Revised February 201 1 f�l f�.t��/ {�1l 5/� (L�J{��'�'{" S w eCh � Requested By : Kashif Khan on 12/19/2014 at 12 :30: 12 AM Claim Number :Y14 KAC 53746 Policy Number : 55 PHJ 965551 Insured Name :ROBERT SWEENEY Claimant (s) . ROBERT SWEENEY (Y14 KAC 53796) ROBERT SWEENEY (Y14 KAC 53746) Date of Loss : 07/21/2014 16: 00: 00 Reporting Period :ALL **** Summary of Released Payments **** Total Indemnity Paid $ : 3263. 41 Total Expense Paid $ : 0 Handler : Jon Braun Supervisor : Joshua Aldridge Type Of Report :ALL PAYMENTS ----------------- [09/15/2019 12 :27 : 38 PM PAYMENTS (Y14 KAC 53746) KT5 ROBERT SWEENEY] PARTIAL; INDEMNITY;COLL;3234 .25; ; To ROBERT SWEENEY ; For Amount $ 3234 .25 ; COLL LOSS LESS DED $ 500. 00 ; Mailed to ROBERT SWEENEY , 5300 AYDEE CIR , , SAINT PAUL , MN , 55110 , 50074320 [09/15/2014 12 :27 : 38 PM PAYMENTS (Y14 KAC 53746) KT5 ROBERT SWEENEY] PARTIAL; INDEMNITY;COLL;29. 16; ; To ROBERT SWEENEY ; For Amount $ 29. 16 ; COLLISION LOSS ; Mailed to ROBERT SWEENEY , 5300 AYDEE CIR , , SAINT PAUL , MN , 55110 , 50079320 [11/Ol/2014 01 : 35:25 AM RECOVERY (Y19 KAC 53746) BXP ROBERT SWEENEY] CH50 -Salvage estimate Recovery for COLL is $550.The Salvage Recovery Serial is : 2263109. COPART AUTO AUCTIONS Date 10/30/14 1526 SUNKER LAKE BLVD HAM LAKE, M[J 55304 692Z Visit us at www.copart.cam PHONE (763) 7'72-0700 Al1 Amounts are in USD TAX ID# 061423251 FINAL SETTLEMENT STATEMEN£ Copart Lot# 28662974 80 NIIJ - MINNEAPOLIS NORTN Loss Date 7/21/14 Called In 9/08/14 PJU Cleared 9/12J14 H435 PIP866A Pickup Date 9/12/14 JOHN BRAUN Orzginai Title 9/18/14 FIARTFORD INSURANCE-CENTRAL Trans Title 9/23f14 P.O. BOX 68989 Sale DoCUment 10/10/14 INDIA�IAPOLIS, IN 46268 Loss Type COLLISION Description 00 FORD TAURUS SE BLUE Vehicle ID# 1FAFP53USYG263109 Claim# Y14AC53746 License#/ST Policy# 55PHJ9b5551 Mileage 128,671 Loss Code MW Pickup From ROBERT SWEENEY Reference# KT72089 53d0 AYDEE CIR Insured ROBERT SWEENEY WHITE BEAR LAKE, MN 55110 Owner ROBERT SWEEN�Y (612) 812-6468 ADVANCE CHARGES PAID BY COPART TOTAL ADVANCE CHARGES . . . . . . . . . .00 COPART SERVICE CHARGES TITLE PROCESSING. . . . . . . . . . . . 20.75 CLEAN TITLE PIP PROGRAM CHARGE. . . . . . . . . . . 27.50 I TOTAL COPAR'F SERVICE CHARGES. . . . . . 48.25 TOTAL DiJE COPART . . . . . . . . . . . . . . 4 8.2 5 PROCEEDS FROM SALE . . . . . . . . . . . . . 550_OOCR *Bid Raised By Internet* PREVIOi3S PAYMENTS FROi�1 COPART. . . . . . . . 501.75 NET DiTE COPART . . . . . . . . . . . . . . . .00 COFART PAYMENTS DETAIL COPART CHECK# 08308605 10/30/14 501. 75 SALE INFORMATION � Lot# 28662974 Sold To 67330 MASON AUTO � Sale DaCe 10/21/14 22390 CTY HWY E Sale Amount 550.00 MASON, WZ 54856 ACV 3020.66 (715) 746-2209 Repair Est 5184.07 Return 18.2� Item# 7 Check Date 1Oj30/14 � Cert# M275B0044 Check Amount 502.75CR USD ; I Proceeds Check# 8308605 �O 1 E:ai,vmsn,t3FXOm� i3iy�r 10/23/14 REMIT TO: COPART 4 f ll� 1 li t U 4610 WEST AMERICA DRIVE - -- — --FAiRFIELD� -CA-94534 -`- `- -' PCN: 30014201410313013013 DCN: 30014201410313013013001 Received Date/Time: 10I31/2014 7:00_00 AM Page 1 of 8 �' SUBRt7 DEMAND Total Loss Breakdown ] �ARTFORD Claim � SBB482384 �nsd Name ROBERT 5�1EEIV�Y I Year Mal<e Model Insured Vehicle 200� FORD TAiiF�iJS SE � �ir��rt�ial Revi�wr L1etlu�fiibl'e Appiietf' ACV �C20.66 Total Damage 326�.41 O.dCJ Total Paid 32E�3.41 UPD(-) 3C20.66 Deductible 4,00 Net ACV Tax t46.34 Tow Q.00 Other charges 29,t6 Misc (title/reg) 1 7.2� Sub Total '��'.�t Rental � G�O� L� Total Damage 3�E��.41 Salvage (+/-) -5C1.'5 Total Subro. 27E� �6 Demand BUERKLE COLLISION CENTER Workfile ID: b0ebb61d FederalID: 410711175 3350 HIGHWAY 61 N, SAINT PAUL, MN 55110 State EPA: MND023026289 Phone: (651)490-6606 FAX: (651) 490-6612 Estimate of Record Customer: SWEENEY, ROBERT Written By: BOB ULRICH,7/23/2014 12:49:23 PM Insured: SWEENEY,ROBERT Policy#: Claim#: 0748598297 Type of Loss: Collision Date of Loss: 7/21/2014 12:00:00 AM Days to Repair: 12 Point of Impact: 15 Total Loss Owner: Inspection Location: Insurance Company: SWEENEY, ROBERT BUERKLE COLLISION CENTER THE HARTFORD 5300 AYDEE CIRCLE 3350 HIGHWAY 61 N INDIANAPOLIS PERSONAL LINES CLAIMS WHITE BEAR LAKE,MN 55110 SAINT PAUL,MN 55110 P.O. BOX 14264 (612)812-6468 Evening Repair Facility LEXINGTON, KY 40512-4264 (651)490-6606 Business (877)230-3084 x55025 Business VEHICLE Year: 2000 Body Style: 4D SED VIN: 1FAFP53U5YG263109 Mileage In: 127706 Make: FORD Engine: 6-3.OL-FI License: 756GKH Mileage Out: Model: TAURUS SE Produdion Date: State: MN Vehicle Out: Color: BLUE Int: GREY Condition: )ob#: TRANSMISSION Dual Mirrors RADIO Cloth Seats Automatic Transmission Body Side Moldings AM Radio Bucket Seats Overdrive Console/Storage FM Radio WHEELS POWER CONVENIENCE Stereo Aluminum/Alloy Wheels Power Steering Air Conditioning Search/Seek PAINT Power Brakes Intermittent Wipers Cassette Clear Coat Paint Power Windows Tilt Wheel SAFETY OTHER Power Locks Cruise Control Drivers Side Air Bag Power Trunk/Gate Release Power Mirrors Rear Defogger Passenger Air Bag DECOR Keyless Entry SEATS 7/23/2014 12:51:16 PM 033486 Page 1 Estimate of Record Customer: SWEENEY, ROBERT Vehicle: 2000 FORD TAURUS SE 4D SED 6-3.OL-FI BLUE Line Oper Description Part Number Qty Extended Labor Paint Price$ 1 REAR BUMPER 2 0/H bumper assy Z,p 3 * Repl LKQ bumper assy; Sedan +25% 2F1Z17K835CA 1 312.50 Incl. 3.0 4 Add for Clear Coat 1,2 5 REAR LAMPS 6 * Repl LKQ RT Tail lamp assy+25% 3FSZ13404DA 1 3� 0 4 7 R&I LT Tail lamp assy 0.4 8 R&I RT License lamp 0.3 9 R&I LT License lamp 0.3 10 TRUNK lID li * Repl LKQ trunk lid assy+25% 3F1Z5440110AA 1 73 5.00 1.3 2.4 12 Add for Clear Coat 1.0 13 R&I Weatherstrip 0.5 14 * Repl LKQ RT Hinge YF1Z5442700AA 1 I� Q� Q,� 15 Add for Clear Coat 0.1 16 * Repl LKQ LT Hinge YF1Z5442701AA 1 Incl. 0�. 0� 17 Add for Clear Coat 0.1 18 R&I Latch 0.6 19 Repl Nameplate'TAURUS SE" YF1Z74425286A 1 45.82 0.2 20 R&I Shield graphite blue p,Z 21 R&I Trim panel 0.3 22 REAR BODY&FLOOR 23 * Rpr Rear body panei 3_0 0 6 24 Overlap Major Adj. Panel -0.4 25 Add for Clear Coat 0.1 26 QUARTER PANEL 27 * Repl LKQ RT quarter panel;sedan YF1Z5427840AA 1 13 2.50 18.5 3.2 +25% 28 Overlap Major Adj. Panel -0.4 29 Add for Clear Coat 0.6 30 Deduct for Rear 8umper R&I -1.6 31 # LKQ CUT, FIT AND TRIM 1 4.0 32 R&I Fuel door 0.3 33 Blnd Fuel door p,2 34 * Rpr LT Quarter panel p,� 2,2 35 Overlap Major Adj. Panel -0,4 36 Add for Clear Coat 0.4 37 # DEDUCT 1 -0.3 38 Repl LT Wheelhouse liner YF1Z5428457AA 1 27.87 03 39 R&I RT Qtr glass Ford 2.0 40 # GLASS KIT 1 15.00 T 41 BACK GLA55 42 * Repl LKQ Back glass Ford+25% YF1Z5442006AA 1 62.50 1_7 7/23/2014 12:51:16 PM 033486 Page 2 Estimate of Record Customer: SWEENEY, ROBERT Vehicle: 2000 FORD TAURUS SE 4D SED 6-3.OL-FI BLUE 43 REAR DOOR 44 Blnd RT Outer panel 1.1 45 R&I RT Belt w'strip sedan 0.3 46 * R&I RT Body side midg primed g� 47 # Clean and Retape Molding 1 3.00 T 0.3 48 R&I RT Handle,outside primed 0.4 49 R&I RT R&I trim panel p,q 50 PILLARS,ROCKER&FIOOR 51 R&I RT Rocker molding front 0.3 52 R&I LT Rocker molding front 0.3 53 R&I RT Rocker molding rear 0.3 54 R&I LT Rocker molding rear 0.3 55 # Rpr Pinchweld, rt rocker 0.5 0.5 56 # Rpr Pinchweld,It rocker 0.5 0.5 57 ROOF 58 * R&I RT Roof molding primed � 59 * R&I LT Roof molding primed 0.3 60 # Corrosion Protedion 1 5.00 0.3 1 61 # Subl Hazardous Waste Disposal 1 3.50 X 62 # Subl Fiex Additive 1 8.00 X 63 # Subi Car Cover 1 10.00 64 # Rpr UNIBODY SETUP 1.5 65 # Rpr UNIBODY REPAIR AND 3.0 F REALIGNMENT 66 # Refn Gravel Guard 0,5 SUBTOTALS 1,218.19 45.7 16.8 ESTIMATE TOTALS Category Basis Rate Cost$ Parts 1,188.69 Body Labor 42.4 hrs @ $ 52.00/hr 2,204.80 Paint Labor 16.8 hrs @ $52.00/hr 873.60 Frame Labor 3.0 hrs @ $70.00/hr 210.00 MISC LABOR 0.3 hrs @ $52,00/hr 15.60 Paint Supplies 16.8 hrs @ $32.00/hr 537.60 Miscellaneous 29.50 Subtotal 5,059.79 Sales Tax $ 1,744.29 @ 7.1250% 124.28 Grand Total 5,184.07 Deductible 0.00 CUSTOMER PAY 0.00 INSURANCE PAY 5,184.07 7/23/2014 12:51:16 PM 033486 Page 3 Estimate of Record Customer: SWEENEY, ROBERT Vehicle: 2000 FORD TAURUS SE 4D SED 6-3.OL-FI BLUE PRICES ARE SUBJECT TO INVOICE - NO WARRANTY ON RUST REPAIRS MAY REQUIRE ADDITIONAL PARTS AND LABOR WHEN VEHICLE IS DISMANTLED. THIS IS A VISUAL DAMAGE APPRAISAL, IT DOES NOT TAKE INTO ACCOUNT DAMAGE OR ADDITIONAL PARTS THAT ARE NOT VISIBLE UPON INSPECTION OF VEHIC�E, OLD PARTS ARE DISCARDED UNLESS OTHERWISE INSTRUCTED. PAYMENT IS REQUIRED UPON COMPLETION OF REPAIRS, UNLESS BILLING ARRANGEMENTS HAVE BEEN MADE PRIOR WITH YOUR INSURANCE COMPANY. PRICES ARE SUB)ECT TO INVOICE- NO WARRANTY ON RUST REPAIRS MAY REQUIRE ADDITIONAL PARTS AND LABOR WHEN VEHICLE IS DISMANTLED. THIS IS A VISUAL DAMAGE APPRAISAL, IT DOES NOT TAKE INTO ACCOUNT DAMAGE OR ADDTTIONAL PARTS WHICH ARE NOT VISIBLE UPON INSPECTION OF VEHICLE. OLD PARTS ARE DISCARDED UNLESS OTHERWISE INSTRUCTED. PAYMENT IS REQUIRED UPON COMPLETION OF REPAIRS, UNLESS BILLING ARRANGEMENTS HAVE BEEN MADE PRIOR WITH YOUR INSURANCE COMPANY. 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. 7/23/2014 12:51:16 PM 033486 Page 4 Estimate of Record Customer: SWEENEY, ROBERT Vehicle: 2000 FORD TAURUS SE 4D SED 6-3.OL-FI BLUE Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from the Guide DR2JN00, CCC Data Date 7/17/2014, 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. 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=6lend. BOR=6oron 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 ESfIMATING 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. 7/23/2014 12:51:16 PM 033486 Page 5 � � �+.� ..� �� . �>��...r.. � � - " � '> " y � °` ` " I ' Vehicle Valuation Report �a�t��'rB�€�r=�t�t��`��,�E:: .. Prepared for: Summary Claim Information C�aim Number: 0748598297-01 Version#: 1 Policy Numbec 55PHJ965551 Coverage Type of Loss. COLLISION Owner: ROBERT SWEENEY Loss Date: 07/21/2014 Address: 5300 AYDEE CIR Reported Date: 07/21/2014 SAINT PAUL,MN 55110 Valuation Report Date: 07/23/2014 09:58:24 Owner Work Phone: (612)812-6468 Valuation Report ID 6686780 Vehicle Information Loss Vehicle: 2000 FORD TAURUS SE 4D SDN 3.OL 6 Location: MN 55110 Cyl Gas A 2WD Exterior Color: METALLIC LIGHT BLUE VIN 1FAFP53USYG263109 License Plate: 756GKH,Minnesota,Exp,05/2015 Mileage: 127,706 miles Title History: No Valuation Summary Base Value: $2,526.96 Loss Vehicle Adjustments Condition Adjustment: $493.70 Prior Damage Adjustment: $0.00 After Market Parts Adjustment: $0 00 Refurbishment Adjustment: $0 00 Title History Adjustment: $0.00 Market Value: $3,020.66 Settlement Adjustments (6 500%)Tax: $196.34 Deductible -$500 00 Settlement Value: $2,717.00 Title History Comments: Mitchell � � Totat Loss Claim# 0748598297-01 �Copynght(c)2011-Mitchell Intemational All Rights Reserved.�Page 1 Loss Vehicle Detail Loss vehicle: 2000 FORD TAURUS SE 4D SDN 3.OL 6 Cyl Gas A 2WD Standard Equipment Exterior 5-Spoke Painted Aluminum Wheels,'16-In.X 6-In. Front and Rear Body Color 5 MPH Impact Absorbing Bumpers Full Perimeter Dual Seals Wth Third Seal On Door Frame High Mounted Stop Lamp Monochromatic Taillights With Amber Tum Signals Multi-Reflector Crystalline Lens Halogen Headlights Interior 2-Speed Variable Intermittent Front Windshield Wpers 5 Passenger Seating AM/FM Fuli Logic Radio Wth 24 Watt External Amplifier, 18 Presets Total Including 12 FM and 6 AM Presets, Seek/Scan and 2 Front Speakers and 2 Cloth Seating Surface Rear Speakers Hidden In Package Tray To Withstand Sun Damage With 4 Speakers Total; Cassette Player Wth Auto Day/Night Interior Rearview Mirror Dual Cloth Covered Sunvisors Dual Color-Keyed Power Adjustable Exterior Rearview Mirrors Dual Covered Vanity Mirrors Electtic Rear Window Defroster Electronic Speed Control Front Dual Reclining Bucket Seats With 2 Way Locking Headrests and Futl-Width Windshield Defroster Armrests Illuminated Steering Wheel Mounted Controls For Speed Co�trol Manual Single Zone Air Conditioning Particulate Air Filtration System Positive Shut Off Climate Controi Chrome Registers Power Window Lock-Out Switch �� Power Windows With Illuminated Fingertip Switches and Driver One-Touch Down Rear Bench Seat Rear Quarter Panel Mounted Fixed Whip Antenna Rear Seat Floor Heat Outlets Side Window Demisters Solar Tinted Glass On All Wndows Decreases Glare To Reduce Interior Heat Buildup For Increased Passenger Comfort As Well As Blocking Ultraviolet Rays To Protect Interior Trim and Fabrics From Fading Mechanical Power Assisted Front 277-mm X 25-mm Vented Disc Brakes and Power Power Vehicle Speed Sensitive Variable Assisted Rack and Pinion Assisted Rear 225-mm X 38-mm Drum Brakes Steering Tilt Steering Column Offers 5 Adjustment Positions Mitche�l Total Loss Claim 71:0748598297-01 �Copyright(c)2011-Mitchell Intemational All Rights Reserved.�Page 2 Safety Belt-Minder Uses Seatbelt Usage Sensor Located In Belt Buckle To 3-Point Seatbelts For All Rear Passengers Determine Whether Driver Is Wearing Seatbelt,Red Light In Instrument Cluster Illuminates and Chime Sounds As Reminder Child Seat Tether Anchors Are Located On Rear Seating Position Located In Emergency Inside Trunk Release With Giow In The Dark T Shaped Parcel Tray and Can Be Covered Up When Not In Use Handle Connected To Trunk Lock Mechanism Allows Release Of Decklid From Inside Trunk Emergency locking Retractors For All Outboard Seatbeits Energy Absorbing Interior Tnm Energy Absorbing Trim Uses Foam System To Absorb Energy During Impact Front and Rear Crumple Zones Front Driver Second Generation Dual Stage Airbag Uses Sensors To Determine Proper Rate Of Deployment Speed Based On Seat Track Fosition, Front Dual 3-Point Seatbelts Wth Manuai Height Adjustable D Rings Severity Of Crash and Whether Seatbelt Is Being Wom Front Dual Seatbelt Pretensioners Front Duai Seatbelts With Energy Management Retractors Front Passenger and Rear Outboard Seatbelts Include Automatic Locking Front Passenger Second Generation Dual Stage Airbag Uses Sensors To Retractors Determine Proper Rate Of Deployment Speed For Airbag Based On Severity Of Crash and Whether Seatbelt Is Being Wom Fuel Pump Inertia Shut Off Switch That Deactivates Fuel Pump Upon Rear Manual Child Safety Rear poor Locks Impact Multi-Fu�ction Remote Key Fobs Includes Selective Remote Panic Alarm Button Sounds Horn and Flashes Headlights and Parking LockinglUnlocking, Panic Alarm and Includes 2 Transmitters Lights For 3 Minutes Via Multi-Function Remote Fob Power Decklid/Liftgate Release Via Multi-Function Remote Power poor Locks With Illuminated Fingertip Switches Remote Decklid Release Remote Hood Release Remote Keyless Entry Allows Locking/Unlocking Of Driver poor or All Doors SecuriLock(TM)Passive Anti-Theft System Uses Electronically Coded and Liftgate/Decklid Up To 33 Feet Away Ignition Key To Start Vehicle Selective Locking/Unlocking Va Remote Keyless Entry Side Impact Beams and Cross Car Beams I Loss`Vehicle Base Value Loss vehicle: 2000 FORD TAURUS SE 4D SDN 3.OL 6 Cyl Gas A 2WD Comparable Vehicle Information Search Radius used for this valuation: 75 miles from loss vehicle zip/postal code. Typical Mileage for this vehicle: 141,000 miles # Vehicle Description Mileage Location Distance From Price Adjusted Loss Vehicle Value 2000 FORD TAURUS SE 4D SDN 6 3NORMAL $2,988.00 � GAS A 2WD 102,226 54016 17 miles List Price $2,405.60 Z 2000 FORD TAURUS SE 4D SDN 6 3NORMAL 166,444 55426 21 miles $2,394.00 $Z 769.96 GAS A 2WD List Price 3 Z000 FORD TAURUS SE 4D SDN 6 3NORMAL 22g�8� 55033 26 miles $1,982.00 $2 236.28 FLEXIBLE A 2WD list Price 4 2000 FORD TAURUS SE 4D SDN 6 3NORMAL g2,815 55378 29 miles $3,500 00 $2�51.75 GAS A 2WD List Price 5 2000 FORD TAURUS SE 4D SDN 6 3NORMAL ��5,325 55379 35 miles $2°�a�� $2,748.84 FLEXIBLE A 2WD List Price Mdcheil Total Loss Claim# 0748598297-Ot Co � pyright(c)2011-Mitchell intemational.All Rights Reserved-�Page 3 6 2000 FORD TAURUS SE 4D SDN 6 3NORMAL z2�,�Z8 55379 35 miles $�'997�� $2,249 34 GAS A 2WD List Price Base Value: $2,526.96 �oss Vehicle Adjustments Loss vehicle: 2000 FORD TAURUS SE 4D SDN 3.OL 6 Cyl Gas A 2WD Condition Adjustments Condition Adjustment: $493.70 Overall Condition: 4.13-Very Good Typical Vehicle Condition: 3.00 Category Condition Comments Interior CARPET 4 Very Good HEADLINER 5 Excellent GLASS 5 Excellent SEATS 4 Very Good DOORS/INTERIOR PANELS 4 Very Good DASHlCONSOLE 5 Excellent Exterior VINYL/CONVERTIBLE TOP Typical ;€�' ° g�r' , PAINT 4 Very Good BODY �'�� 4 Very Good ,,� , TRIM 5 Excelient Mechanical TRANSMISSION 4 Very Good ENGINE 4 Very Good Tire 4 Very Good Typical condition reflects a vehicle that is in ready-for-sale condition and reflects normal wear and tear for that vehicle type/age. Comments: Comparable Yehicles Loss vehicle: 2000 FORD TAURUS SE 4D SDN 3.OL 6 Cyl Gas A 2WD Comparabie Vehicles Mitchel I Total Loss Claim#:0748598297-01 �Copyright(c)2011-Mitchell IntemationaL All Rights Reserved.I Page 4 1 2000 FORD TAURUS SE 4D SDN 6 3 NORMAL GAS A2WD List Price: $2,988.00 VIN: 1FAFP53U3YG282354 Adjustments Loss Vehicle This Vehicle Amount Stock No: Projected Sold Ad�ustment -$446.00 Listing Date: 05/19/2014 Vehicle Configuration $70.31 Adjustment ZIP/Postal Code: 54016 Mileage 127,706 102,226 -$206J1 Distance from 17 miles Loss Vehicle: Total Adjustments: -$582.40 Source: DEALER WEB LISTING- Adjusted Price: $2,405.60 VAST.COM HUDSON AUTO MART 1000 OKEEFE RD HUDSON WI 54016 651-983-5655 2 2000 FORD TAURUS SE 4D SDN 6 3 NORMAL GAS A2WD List Price: $2,394.00 VIN: 1FAFP53U6YG148647 Adjustments Loss Vehicle This Vehicle Amount Stock No: HU1Z636A Pro�ected Sold Adjustment $0 00 Listing Date: 04/25/2014 Vehicle Configuration $66.22 Adjustment ZIP/Postal Code: 55426 Mileage 127,706 166,444 $309 74 Distance from 21 miles Loss Vehicle: Total Adjustments: $375 96 Source: DEALER WEB LISTING- Adjusted Price: $2,769.96 CARS.COM MORRIE'S 394 HYUNDAI 6661 WAYZATA BLVD ST LOUIS PARK MN 55426 952-449-2000 MiIChP,II . .... . ..... Tota)Loss Claim# 0748598297-01 �CopyrigM(c)2011-Mitchell Intemational.All Righis Reserved.I Page 5 3 2000 FORD TAURUS SE 4D SDN 6 3 NORMAL FLEXIBLE A2WD List Price: $1,982.00 VIN: 1FAFP532XYA238272 Adjustments Loss Vehicle This Vehicie Amount Stock No: A021403A Projected Sold Adjustment -$296 00 Listing Date: 05/15/2014 Veh�cle Configuration $46.63 Adjustment ZIP/Postal Code: 55033 Mileage 127J06 228 781 $503 65 Distance from 26 miles Loss Vehicle: Total Adjustments: $254.28 Source: DEALER WEB LISTING- Adjusted Price: $2,236.28 CARS.COM HASTINGS CHRYSLER CENTER 2980 VERMILLION ST HASTINGS MN 55033 651-437-5200 4 2000 FORD TAURUS SE 4D SDN 6 3 NORMAL GAS A2WD List Price: $3,500.00 VIN: 1FAFP53U6YG160992 Adjustments Loss Vehicle This Vehicle Amount Stock No: Projected Sold Adjustment -$523.00 Listing Date: 07/21/2014 Vehicle Conflguration $82.34 Adjustment ZIP/Postal Code: 55378 Mileage 127,706 92,815 -$307.59 Distance from 29 miles Loss Vehicle: Total Adjustments: -$748.25 Source: DEALER WEB LISTING- Adjusted Price: $2,751.75 VAST.COM MARTY'S AUTO SALES 7227 MINNESOTA 13 SAVAGE MN 55378 952-894-4656 Mitchell � � TOtal LoSS Claim#:0748598297-Ot �Copyright(c)2011-Mitchell Intemational.All Rights Reserved.�Page 6 5 2000 FORD TAURUS SE 4D SON 6 3 NORMAL FLEXIBLE A2WD List Price: $2,787.00 VIN: 1FAFP5325YG228519 Adjustments Loss Vehicle This Vehicle Amount Stock No: 64683A Projected Sold Adjustment $0.00 Listing Date: 07/12/2014 Vehicle Configuration $7�_pg Adjustment ZIP/Postal Code: 55379 Mileage 127,706 115 325 -$115.25 Distance from 35 miles Loss Vehicle: Total Adjustments: -$38.16 Source: DEALER WEB LISTING- Adjusted Price: $2,748.84 CARS.COM APPLE USED AUTOS SHAKOPEE 1400 1ST AVE E SHAKOPEE MN 55379 952-997-5712 6 2000 FORD TAURUS SE 4D SDN 6 3 NORMAL GAS A2WD List Price: $1,997.00 VIN: 1FAFP53U9YG247074 Adjustments Loss Vehicle This Vehicle Amount Stock No: A27626 Projected Sold Adjustment -$298.00 Listing Date: OS/20/2014 VehiGe Configuration $46.99 Adjustment ZIPlPostal Code: 55379 Mileage 127.]O6 227.728 $503.35 Distance from 35 miles Loss Vehicle: Total Adjustments: $252.34 Source: DEALER WEB LISTING- Adjusted Price: $2,249.34 CARS.COM APPLE USED AUTOS SHAKOPEE 1400 1 ST AVE E SHAKOPEE MN 55379 952-997-5712 Sub-Model Comparison Sub-Model Description Configuration Original MSRP 2000 FORD TAURUS SE 4D SDN 3.OL 6 Cyl Gas 2WD $19,630.00 Z000 FORD TAURUS SE 4D SDN 6 3 NORMAL GAS A 2WD $18,935.00 2000 FORD TAURUS SE 4D SDN 6 3 NORMAL FLEXIBLE A 2WD $18,935:00 Mil�hell �� Total LOSS Claim#:0748598297-01 �Copyright(c)2011-Mitchell Intemational.All Rights Reserved.I Page 7 Vehicle Valuation Methodology Explanation WorkCenter Total Loss was built through a joint partnership between J D. Power and Associates vehide valuation division Power Information Network (P.I.N)and Mitchell International,a leading provider of claims processing solutions to private passenger insurers. WorkCenter Total Loss produces accurate and easy-to-understand vehicle valuations via this five step process: Step 1 -Locate Comparable Vehicles Locate vehicles similar to the loss vehicle in the same market area WorkCenter Total Loss finds these vehicles in AutoTrader.com,Cars com, Vast.com and directly from dealerships. Step 2-Adjust Comparable Vehicies Make adjustments to the prices of the comparable vehicles.The comparable vehicles are identical to the loss vehicle except where adjustments are itemized.There are several types of comparable vehicle adjustments . Projected Sold Adjustment-an adjustment to retlect consumer purchasing behavior(negotiatfng a different price than the listed price). . Vehicle Configuration Adjustment-an adjustment for differences in configuration between the comparable vehicle and the loss vehicle(e.g. differences in trim). . Mileage Adjustment-an adjustment for differences in mileage between the comparabie vehicle and the loss vehicle. . Equipment-adjustments for differences in equipment between the comparable vehicle(e g.equipment packages and options)and the los vehicle Step 3-Calculate Base Vehicle Value The base vehicle value is calculated by averaging the adjusted prices of the comparable vehicles. Step 4-Calculate Loss Vehicle Adjustments There are four types of loss vehicle adjustments: . Condition Adjustment: Adjustments to account for the condition of the loss vehicle prior to the loss. . Prior Damage Adjustment: Adjustments to account for any prior damage present on the loss vehicle prior to the loss . After Market Part Adjustment: Adjustments to account for any after market parts present on the loss vehicle prior to the loss. . Refurbishment Adjustment: Adjustments to account for any refurbishment performed on the loss vehicle prior to the loss. Step 5-Calculate the Market Value The Market Value is calculated by appiying the loss vehicie adjustments to the base value Mitchell, Total Loss Claim#:0748598297-01 �Copyright(c)2011-Mitchell intemational.Ali Righis Reserved �Page 8 '^� INBOUND NOTIFICATION : FlllC RECEIVED SUCCESSFULLY �k TIME RECEIVED REMOTE CSID DURATION PAGES STATUS August 26, 2014 9:46:51 AM EDT Risk Solutions (A2) 129 2 Received Risk Solutions (A2? 8/26/2014 9:44 :47 AM PAGE 1/002 Fax Server 489910332 For Customer Support refer to the � ��I � A ��I �� appropriate platform below: �r� OrderPoint 800-934-9698 Order�oint support@lexisnexis com Accurint for Insurance 866-277-8407 Accu rint.su pport@lexisnexis.com Lexis.com La�v Firm accounts 800-543-6862 PAGF COi J'VT: 2 CLIEVT: �370 DNLS1[)N : ?59 AD.T[JSTER : 1B1�893 CLAIVI : 1'AO01199�2�18 IR/1NSACTI0�1#: 489410i3� DATF, : OR/26/201�1 Dt�I�OF�LOSS : Oi/?1/?O1� T1��1E OI�L[�5S : 0�:00 YM STREET : FOREST� «ARYI_A'�Ll C11'Y": SAII�1 PAC:L Ct)L�TY : RAMSF.Y STr�TE : M�1 I'VV"ESTIGATInG �1GE\CY : ST.P.4tiL PD R�POk'T NU'VIBER : Cv#14-1�1-0Oi hF,PORT TFPF? : �1uto Accident P!1RTY 1 : ROBERT Su-'EEti-EY PARTY Z : TTM(�THY.T. 1�IF,1lFMAYF,R P�1PTY 3 : CAR : TAiTRiJS SF 'v1AKF. : FORII YFA� : ?000 I A(i : DRIVF_.R LICENSE : k22427i''34408 ADlll'IIOVAL Il�FU : NOtF. : THANK YOU FOR YOUR ORDER! PCN: 30014201408261000277 DCN: 30014201408261000277001 Received DatelTime: 8/2612014 9:47:00 AM Page 1 of 2 Risk 5olutions (A2) 8/26/2014 9: 44 : 47 AM PAGE 2/002 Fax Server 489910332 ,! �cident Report Page 1 of 1 , 141 S 1007 _ •"N r�`"''�3fIUE0�f ��8lINNE30fA?'I�Vfl�1iC r�SA�11'�G,�e.""�.�?'�' s� A s� -�acaQExr.�aaRrt� fi ��..,,ri��,�:R��.� a M..o,_ .,..� ....o� u�.o o ,:o:� €;�-a��w�;��..��►n-,�;��., :� �,. �,oR �.�.A.,,�� N Y 62 00 DO Y ��,'.t�{ L-r..,-:{� :�'k 7 ?1 2014 162; m wTrtceYC�cu wu+ixwt�we�.crrw.ur �ww�s.a��+cn.�� — AM �� N n� �O. ry+ 10 FOREST ST a ��nr��v, c _ � � ca.�r..� � n�. nc�cx�o.�� .urn�i� .wnsm�rcdv�.+tmrwwc fi2 �,„. ST PAUL +_ 10 E MARYLAND AVE �y!/� ..Ir - -.il�� .4V�I�D�• :.I�a �� h`9110+ bW��IffMYMN��.t y, -•^fUl[ p.Vf�••0.>'�N1.Pt19Mf1 pR!llllff`!f[MI�MA> .•` li�n CJtl•••.xlr�M ��tM� O1 V732231073312 MN D 04 •• O1 X229275239408 MN D 0: ul fK^.�'1� WIWLGVd"' GRG�Fm�� i�N :�Mll.uuu��Yf GIlbl✓�V +�� TIMOTHY JAMES NI£DERMAYER 10 14 70 ' ROBERT JOSEPH SWE�NEY 12 03 98 r.na. �ciru ww� nro ' .eu u.�,u * u O1 1B97 HFZLEWCOD ST Y 0� ; 5300 AYDEE CTRC N, ' OiN 4�+ �i an.ei.n�, rm.e�.ar i. O1 MAPLEWOOD 55109 651-23C-909� � �yHITE BEAF LAKE 55110 61i-812-6a68 p�+ �OIY(; i,p�we� � }��L01 W�ffA MW �M� rl�Ti '.�f.WSt 4� O'1 � !LR N�aN: Ql '�"} �M 04 "r 04 04 OS N 1 c"5""' M �4 "`04 04 OS wN� O1 4C1Q MR �b �N �GMA� 1 YU.Wftii�V.l 4.wW�pf� M� 94UG 'YR TpMM� 144.CN9f IMN�wK�1E�HU iF/�MNfR �� 98 t3" 98 N o"�;, �nh� 98 �f'� 98 t� o"�',. ,�,.. �..�..� �.. '�......` ��.;� �..� ' O1 ST PAUL REG?ONAi WATER SERVS N SWEENEY ROBERT JOSEPH N O1 �a�.rv. .m.a ,c.n� �.mrces — ni,.ti n„rr 02 1900 N RICE ST N 5300 AYDEE CIRC N Oi .h+iiss .wrc+, '.cr,.-.,,..,. wu.r, yrc, +E.��r 16 ST�,�PAOL MN 551f3 `1P� 05 WE:iTE BEAR iAKE MN 55110 "17 05 Oi w�a�a wa u�m rux ttwta �uue cxa. nwr.�rc DB FORD SRW 201 BLU FORD T5E �000 eLU OA pW:1W 4�`i• �T�g �NpY: �++�� n..�1[• TRO ♦k/YbG .e•ud.. OZ 938594 MN 6 Oi � O1 � ' 75bGKH MN 5 O1 � � �� O1 03Y � ��WA�uC[ M�rvW�ICn rYalwAY�W1A r y�AUnfn i W rCITY OF ST PAUL PROP 6 CASOR:,:Y INS C 59F}i8�69551-209062 � cNwo" �ww• �,r.w ' neecc„o�. u,w...uo�, w.rFO �...u..~ :w�o�o. s.� � IFACGIOENTINYOL�EDALDYME/1WlYOTORVEM�[�,$CNDOlBVB,ORXEADSTMTEU! ri.c rt RENEYBEA 70 MOTIlr 7ME 7TATE PATROL(npuln0 untlor MS to.1N�ne�OAfttF LOMIK]NMrOfNIW��qRMC�th�M�s DOTM4�ll � RYrKL.N+QC�u![�]M110�itl�b�tM+Wt M1MWC� .resuaW�.m�w� it..urt��ua �.n ux .w.a iM ..,s roiwr�wavan 1 ' �� .rmc7 +wec+ � �,,,,�N ..«u y.+:. v.uw � �m t* �� " .--.__ 0� w��.ri r...vm � - � ' �o.�. Q ' '""'' _" '_". -___ . _. . .._ ._ . . .�rm�i�n.r:i<owrocer.w��^w�aa...ou..�.ax.,.�ortr�n��w�i.�..rwyl u�v�tcovrre,.:ni�or+��.:,�ar.. d ,.�. K��TM �f t t�t wva'ns. mcc O1 :.i� � .� 41 �O3" r I = A 4F UNiT 1 ORIVER NAS HEAD?NG S/B•ON EOR557 ST AT v i� _- � SIl Tf:E ZNTERSECTION OF FOREST ST AP7� E NARYI.AND AVE t, � """" I _ N DRT.vER TNOUGHT UN?7 2 WAS TI;NNIyG ?EfT HERDIKG ' O1 O: r.�+ � � E/v ON E HARYLAND EROM FOREST ST WHE4 UNIT 2 � Gi0'°`91 s?� m ` T� SUDDENLY S70PPED CAri'ER REAR E:7JED UNIT 2 ��• N � • s� ,,.....,<.n O S �nrc+rr� _ �� IfiIT 2 ORIVER WAS FACING'S/B ON ECREST ST �� (' — —' — — — f�� A?7ENPTING 70 NAKE A LEFY TURN HF�DING E/B ON E �� 98 k, � '�� MAnYLANO AVE FRON: FCREST SS DR?VER DLDN'T Si.E � 4 �.i iM {�I � � � � OhCOM:NG,TRAFFIC AND SI:DDENLY �TOPP6D DRIVER WASt +�+++•� r' . 32 STPUCK FROM BEHIND BY CNIT i �� —� — — — 1 ��M '� ��DRIVG2 OF UN17 1 ti:,$ ISSUED`A CiTATION F'OR i?`'��'�� ^"°" e,�+DaIVING AFTfR SUSPENS:ON {LITATLON 'u: �g � a I� m Ql 162094023�2fi51 �' I 0�� .e.w � I r.r�� tn St^.�C�.i� .�. o i ;r � . - :: .�� a � � � � � �� oi >, :Q T ' 01 1 �cu,�..�w.x.w�•ooe� ,ocK. �,�,�,,..v. psu�.�.n.a. �cr., OFC DOLLANSKY 599 St Paui PD p,...,� p a,,..� ��.� , � . https.//dvscrash.x.state.mn.us/dvsmfo/accidentrecords_2008/Includes_LE/PnntReportIndrv 7/22/2014 PCN: 30014201408261000277 DCN: 30014201408261000277001 Received DatelTime: 8/2612014 9:47:00 AM Page 2 of 2 I "'"�' �,.H , x. � � ow ' .- � �, w..� ��''`, � .�_..,� . , � �� $-. � ��'= �.�3,, �� z� .� '�yj'I �� `.� • .� + I u Y'� � ��. � � . 7i'Mf �., r �� s�.. �;�� '� , � � , : , -�� , . � ,. �� -� � � �..., . o .. . ��, �"t��; � . . ,.a. . > � - : �,�' � � � , .� y � '� I 6�$$��A �� s .�� . � l ��. `�. � `L � _ .- � s 1 � � � r . " ,..' .. .- .+wx w'� s. �s..""�—��._._. . �,. a ';"�. — . . . �;. ,. � ��. �.:ti �'�� ' �. e`�, q �y.._x�,.�..:�! , . .�� . �,��3 �•'� ,q,• ��nv �✓', ' ;,� �: . .; 5'.� .. .,. '3. _, . , . ._ , a� �...,.... �.. _ . � .: �_ } s :_ . < � . ` : ' �. i x � �: � , � � .� � - � �� • < � � �_ - ° . ..� _. - ., .� ��c :> `" I t a-. � ' I � �� i �_4� • i �. ��, � �� .. �� ;;��' � �i.�I �� •� >� �� (� � � i �&� ;M&� , � � rr^� �; $ F * � � , . � � �� ''� l� �,�y� � �� €+ _ � _ ' � � �._ _ r �� '. '�� ,,, � , .. ,, , s.. * , . a , �... ,,. � � ,�,-,�r; - .. ; _._,�_�� .;� � �;� _� � ,� ;� �;�� a#s° : ' i � � ,� d:� � �" ;�. ,i, i��•�� z. �' S x � �, � „;°� y, < ��,��. ��.� p `'�� _ �' � �,�� "�,.r�� . �� a,� �� ' � � € �� ` � �� . �. �.'` � . � _ '��` .. ,�'�` fyt. ,. .. . � �� . , . . . . .. . . r .,�;`�� ^�. . � .� � ��+� � '�.�" ° � �.�. � . � � � �� ' �� ..}��t�.. �fi �� 's� � : � P � , � •; „ 5��4" ~� .. �'' . "- � ` s �` � ' _.. � : � k�vx'a� � �i_ . . �m:" � �r �e�- � � �,�.�d ��'�� , , _� ,. �� :, � .pwM. . , ! ��. -, _ � _ ..: �� °�- �. ,x :, � -.� �:� .� ��I �" � � .� �= �; u � � � ,{ �; � �� ` �� '' � �� , ,„ `� I� �'' �. _ ; �� ., , , �a t ._ M , . � ��.� .� �„ ,r � T��.� .._. ��— .�. , w ,�� , r�:� ��.; I� �� ;�� . � ,� , � �:. � � � ;, . � rc : . . �� .�;� � . . � . � _� � � �. . �� .� �. . , � . � � . � �►� � � . _ _ , � . , ��.� � � ��,�— � ,� � � � �� °� r � � � ,r, i � —_ � — �� . � � � s� v . � �� ; �y s ` �� e '' �`' �� '� � }� `vd4 h J. � ha� �� r. � "�" i � u� U � � T} � , .: i F, . . q . � i � �._ # � �� Sl� n�� . « . ,,. � v.. " `�— , w 4�� i'�� Y ` _ � � 'z`� .. -_..=ac-_ 1 ; M t-�.;� �., � � � � *.r[.? �, ' � ; � . .:. � • ��l..t°l , '�� . �� . ��r��r� �� . '� a ,.. .� , _. L`..�. . � � ,s�,, . � f,r s a, � . � �s..-, : .� . � { A � .. . . ,��w."'��`�AS4v� ' .�. ,..� ., �w 3. .a�' $ �. �. . .,. . � r e v � i � "�� ' z�.. � ��, M � � � ��.�� ,, � �' � �� :� , , ,, � . ' � Y .;.��.c^ � ,. .. � } �� Z � , �w ��. :# �}},, �h. . . . . . . . � . � �� ..�` � E` .ry�j . .. . . . .. � , a , j ,�� . kr %z . ,. ;� . . l . . � . i� i �?;r 1"� �,: ;� '� � .. . .. . _ .... ... � J,4,. � � �'''3 i��;,"'6�.�� +n 8-�&"k a3 '";,^ j �.. � . . . � .�. � � �� a , .; � �.� ;,. - . � � a , � � �,� � e �.� � �► � $ � � w x .. � �� _��_ � �;� �. � � ,� .. .. , ;.. - , _ � _.�� . � �