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Stottlemyer, Kate (2)NOTICE OF CLAIM FORM to the City of Saint Paul, Minnesota Minnesota 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 alleged loss or injury is discovered a notice stating the time, place, and circumstances thereof, and the amount of compensation or other relief demanded.” Please complete this form in its entirety by clearly typing or printing your answers to each question. If you have additional documentation, you may add those documents to your submission. You will not be contacted by telephone unless clarification is needed. The claim process for investigations can take upwards of four (4) weeks. This form must be signed, dated with all applicable sections completed. Submission this completed form to the Saint Paul City Clerk’s Office by email (cityclerk@ci.stpaul.mn.us), fax (651-266-8574) or mail addressed to “Saint Paul City Clerk, 15 West Kellogg Blvd., Suite 310, Saint Paul, MN 55102”. Claimant: First Name: ________________________________ Last Name: _______________________________________________ Please Indicate Your Pronouns: ☐ She/Her/Hers, ☐ He/Him/His, ☐ They/ Them/Theirs Company or Business Name: ____________________________________________________________________________________ Is this claim being made by an Insurance Company? YES / NO If yes, what is your Claim/File Number? _________________________ Is this claim being made by an Attorney? YES / NO If yes, what is your File Number? _______________________________________ If yes, provide your Insured’s/ Client’s Name: _______________________________________________________________________ Street Address: _______________________________________________________________________________________________ City: ______________________________________________ State: ________________________ Zip Code: ___________________ Daytime/Work Phone: __________________________________ Cell Phone: _____________________________________________ Date of Incident or Date Discovered (Must Complete): _____________________________ Time: _____________________________ Please state, in detail, what happened that prompted you to file a Notice of Claim Form: ____________________________________ Please state why or how you feel the City of Saint Paul is responsible for your Damages? ____________________________________ Please check the reason that most closely describes the reason for your submitting a claim. Please note the documents that will need to be provided with your completed form. Photographs will be accepted. All documents submitted become the property of the City of Saint Paul and shall not be returned. ☐ Automobile damage from a motor vehicle accident: please provide two estimates for repairs or actual bill that has been paid. ☐ Automobile damage from a street defect or pothole: please provide two estimates for repairs or actual bill that has been paid. ☐ Automobile was towed and may or may not have sustained damage: please provide copy of towing ticket (if available), receipt from Impound Lot, and two estimates for repairs or actual bill that has been paid. ☐ Snow Emergency: please provide copy of towing ticket (if available), receipt from Impound Lot, and two estimates for repairs or actual bill that has been paid. ☐ Property damage: please provide two estimates for repairs or actual bill that has been paid. ☐ You were injured during a motor vehicle accident: please provide police report number, details about injury. ☐ You were injured in the City of Saint Paul: please provide police report number, witnesses, and details about injury. Continue to page 2 of Notice of Claim Form. Failure to complete and return both pages will result in delays. Revised March 2023 USAA Casualty Insurance Company a/s/o Kate Stottlemyer USAA Casualty Insurance Company Yes, 9762873-23 Yes, 9762873-23 USAA Casualty Insurance Company a/s/o Kate Stottlemyer 2929 N Central Expressway, Suite 320 Richardson Texas 75080 619-308-6550 3/21/2023 x A vehicle onwed by the City struck USAA's insured vehicle. The City owns the vehicle involved and is responsible for their driver, Jonathan Haakenson. This section must be completed for all claims. Is there a police report for this incident? YES / NO If yes, please provide the police report case number: ___________________________ If yes, what law enforcement agency responded? ____________________________________________________________ Where did the incident take place? Please provide a street address, intersection or name of city park or facility: ____________________________________________________________________________________________________________ What would you like to see happen to resolve this claim to your satisfaction? ____________________________________________________________________________________________________________ Were there witnesses to this incident? Please provide names and contact phone numbers: ____________________________________________________________________________________________________________ For property damage claims, including vehicle accidents. Your vehicle’s information: Year: _________ Make: _________________ Model: __________________ Color: __________________ License Plate #: _________________________ State vehicle is registered in: ___________________________ Registered owner of vehicle: _____________________________ Driver: __________________________________________ Area(s) damaged:______________________________________________________________________________________ If a City vehicle was involved, License Plate #: _________________________________ Color: _______________________________ Was there City insignia on the vehicle? YES / NO Driver’s Name: ______________________________________________________ Other property damaged: _______________________________________________________________________________________ For injury claims of any type. What part of your body was injured? _____________________________________________________________________________ Did you go to the emergency room or urgent care? YES / NO Where? ___________________________________________________ Was medical treatment received? YES / NO Where? ________________________________________________________________ First day of medical treatment? _____________ Are you still receiving medical treatment? YES / NO Did you miss any work as result of this incident? YES / NO Employer(s): _________________________________________________________________________________________________ How much time have you missed from work? _____________________________________________________________________ If you are submitting other documents, please state what you are attaching and how many pages: _________________________ By signing this form, you agree that all information provided is true and correct to the best of your knowledge. Please NOTE that submitting a false or misleading claim can and will result in prosecution under Minnesota Statutes. Name of Person completing form: _____________________________________________________________ Signature of Person submitting this form: _______________________________________________________ Relationship of person signing to Party making the claim: __________________________________________ Date document is being signed: _________________ Revised March 2023 Summit Ave & S Dale Street in Saint Paul, Minnesota N/A 2021 Mazda CX-5 White HAR419 Minnesota Kate Stottlemyer Left side of vehicle 960455 Jonathan Haakenson N/A Joanna Rodriguez filing on behalf of USAA Casualty Insurance Company a/s/o Kate Stottlemyer Authorized Rep. 2100429762 MN DVS DMV 7/05/2023 Reuimburse USAA for the $20,370.60 they paid regarding this accident. LIMITED POWER OF ATTORNEY United Services Automobile Association, on behalf of itself and its subsidiaries and affiliates ("USAA") hereby appoints Clerkin, Sinclair & Mahfouz, LLP ("Law Firm") to act as its attorney-in-fact for the for the sole and limited purpose of executing settlement agreement documents, including Settlement Agreements, Stipulations for Settlement, Stipulations for Judgment, Installment Agreements, and Releases, in the name of and on behalf of USAA and its subsidiaries and affiliates, received from the responsible party or their insurer on subrogation claim files placed with Law Firm for collection and/or litigation. Law Firm is herein authorized by and on behalf of USAA to bind USAA to enter into settlement agreements by settlement or stipulation in regards to collection and/or litigation of the subrogation claim files USAA has placed with Law Firm. This Limited Power of Attorney is executed in connection with the Master Engagement Agreement for Legal Services # 0000012231 entered into between USAA and Law Firm. Except as expressly stated herein, no other rights, powers duties, or authority is extended to Law Firm by the terms of this Limited Power of Attorney. This Limited Power of Attorney will remain in effect until written revocation of the Limited Power of Attorney by USAA, but in no event shall it remain in effect after written notification to terminate the Master Engagement Agreement described above. Dated: ______________________ UNITED SERVICES AUTOMOBILE ASSOCIATION BY: __________________________________ __________OFFICER_________________ (Title) Subscribed and sworn before me this ______ day of __________, 20____. State of: _______________________________ County of: _____________________________ ______________________________________ (Notary Public) Ohio Franklin DocVerify ID: 22299BF0-B5B1-4773-B11A-6CFEB2BC4B35 www.docverify.com22299BF0-B5B1-4773-B11A-6CFEB2BC4B35 --- 2022/09/20 06:03:01 -8:00 --- Remote NotaryPage 1 of 1 16CFEB2BC4B35 Notarial act performed by audio-visual communication 09/20/2022 249C5F2D1DB2 Signed on 2022/09/20 07:20:02 -8:00 Darla Berry 09/20/2022 DocVerifyShannon Darci Sparks Commission # 2018-RE-711127 Electronic Notary Public State of Ohio My Comm Exp. Mar 21, 2023 2C88DD0A093ANotary Stamp 2022/09/20 07:20:02 PST 2C88DD0A093A Signed on 2022/09/20 07:20:02 -8:00 EXHIBIT A 0901119cb5d5d809 0901119cb5d5e007 0901119cb5d5d7f7 0901119cb5d5e011 0901119cb5d5d827 0901119cb5d5e266 0901119cb5d5dfbe 0901119cb5d5e006 EXHIBIT B CALIBER - ROSEVILLE MN Workfile ID: Federal ID: State ID: Federal EPA: 0070e5b7 33-0730794 6144514 MNS000333664RESTORING THE RHYTHM OF YOUR LIFE 1914 West County Road C, Roseville, MN 55113 Phone: (651) 639-9848 FAX: (651) 639-9406 Supplement of Record 1 with Summary RO Number: 3311046811 Written By: Lee Stuessi, 3/31/2023 8:58:13 AM Adjuster: Martinez, Ray, (000) 000-0000 x22 Business Insured:STOTTLEMYER, KATE Policy #:009762873 Claim #:009762873000000023001 Type of Loss:Collision Date of Loss:3/21/2023 12:00 PM Days to Repair:15 Point of Impact:11 Left Front Owner:Inspection Location:Insurance Company: STOTTLEMYER, KATE CALIBER - ROSEVILLE MN USAA CASUALTY INSURANCE COMPANY 165 HAWES AVE 1914 West County Road C DRP-4187 SHOREVIEW, MN 55126 Roseville, MN 55113 Visit us at USAA.com or Call #8722 (612) 321-1933 Cell Repair Facility P.O. Box 33490 (612) 321-1933 Evening (651) 639-9848 Business San Antonio, TX 78265 (800) 531-8722 Business VEHICLE 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White VIN:JM3KFBEY8M0422323 Interior Color:Mileage In:25,693 Vehicle Out:5/31/2023 License:HAR419 Exterior Color:White Mileage Out:25,694 State:MN Production Date:5/2021 Condition:Job #: TRANSMISSION Tilt Wheel Stereo Electric Glass Sunroof Automatic Transmission Cruise Control Search/Seek SEATS 4 Wheel Drive Rear Defogger Auxiliary Audio Connection Bucket Seats POWER Keyless Entry Premium Radio Leather Seats Power Steering Message Center Satellite Radio Heated Seats Power Brakes Steering Wheel Touch Controls SAFETY Rear Heated Seats Power Windows Rear Window Wiper Drivers Side Air Bag Ventilated Seats Power Locks Telescopic Wheel Passenger Air Bag WHEELS Power Mirrors Heated Steering Wheel Anti-Lock Brakes (4)Aluminum/Alloy Wheels Heated Mirrors Climate Control 4 Wheel Disc Brakes PAINT Power Driver Seat Navigation System Traction Control Clear Coat Paint Power Passenger Seat Backup Camera Stability Control OTHER DECOR Parking Sensors Front Side Impact Air Bags Fog Lamps Dual Mirrors Surround View Camera Head/Curtain Air Bags Rear Spoiler Privacy Glass Remote Starter Hands Free Device Signal Integrated Mirrors Console/Storage Intelligent Cruise Xenon or L.E.D. Headlamps TRUCK Overhead Console Home Link Blind Spot Detection Power Trunk/Liftgate CONVENIENCE RADIO Heads Up Display 3/31/2023 8:58:14 AM 419802 Page 1 0901119cb5fd2d36 Supplement of Record 1 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White Air Conditioning AM Radio Lane Departure Warning Intermittent Wipers FM Radio ROOF 3/31/2023 8:58:14 AM 419802 Page 2 0901119cb5fd2d36 Supplement of Record 1 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White Line Oper Description Part Number Qty Extended Price $ Labor Paint 1 #==== Required Notes for USAA Drive Ins ==== 1 2 #For Supplements Use Estimate Share Within CCC One 1 3 #Have Questions or Non-CCC User? 1 4 #Call 800.637.8511 - Press 2 for Repair Facility 1 5 #Then Press 2 for Technical Support, 1 6 #Then Press 4 for "All Other"1 7 #==== End USAA Drive In Notes ==== 1 8 FRONT BUMPER & GRILLE 9 O/H bumper assy 2.9 10 <>Repl Bumper cover w/park sensor KN3L50031BB 1 365.95 Incl.2.8 11 Add for fog lamps 0.4 12 Add for park sensor m 0.4 13 Repl Grille assy w/surround view K26250710A 1 1,246.39 0.8 14 Repl Closure panel KB8A50717D 1 48.71 Incl. 15 Repl Upper molding KL2F507E19U 1 162.21 Incl.1.7 16 FRONT LAMPS 17 Repl LT Headlamp assy w/o directional beam KL2J51041D 1 694.34 0.6 18 Aim headlamps 0.5 19 HOOD 20 Repl Hood (HSS)KBY05231XB 1 683.39 1.6 2.8 21 Overlap Major Non-Adj. Panel -0.2 22 Add for Underside(Complete)1.4 23 R&I Insulator Incl. 24 R&I Front w'strip Incl. 25 R&I Front seal Incl. 26 R&I Rear w'strip Incl. 27 Repl RT Hinge KB7W52410 1 40.26 0.3 0.4 28 Repl LT Hinge KB7W52420 1 40.26 0.3 0.4 29 FENDER 30 S01 Repl LT Fender KB7W52211 1 378.11 2.1 2.0 31 S01 Overlap Major Adj. Panel -0.4 32 S01 Add for Edging 0.5 33 Repl LT Fender liner KB7W56140C 1 86.90 Incl. 34 Repl LT Front bracket KDPW52240 1 28.13 0.1 0.3 35 Repl LT Wheel opng mldg KB7W51W30E8N 1 139.79 Incl. 36 Repl LT Apron reinf (UHS)KB7W5428X 1 49.32 s 3.0 0.7 37 WHEELS 3/31/2023 8:58:14 AM 419802 Page 3 0901119cb5fd2d36 Supplement of Record 1 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White 38 Repl LT/Front Wheel, alloy 19x7 black metallic 9965507090 1 568.44 m 0.3 39 PILLARS, ROCKER & FLOOR 40 *Rpr LT W/S pillar reinf (UHS)s 4.0 41 FRONT DOOR 42 Repl LT Door shell (HSS)KBY05902XE 1 998.67 5.7 3.0 43 Overlap Major Adj. Panel -0.4 44 Clear Coat 2.5 45 R&I LT Door w'strip Incl. 46 Repl LT Window molding KB7W50985N 1 97.98 0.3 47 Repl LT Black out tape front K131508W1 1 5.77 0.3 48 Repl LT Black out tape rear K131508W3 1 7.97 0.3 49 R&I LT Belt molding Incl. 50 Repl LT Applique black KB7W50M20B 1 52.64 Incl. 51 Repl LT Lower molding KB7W51RB0E 1 50.18 0.4 52 R&I LT R&I mirror Incl. 53 R&I LT Door glass Mazda Incl. 54 *R&I LT Run channel Incl. 55 R&I LT R&I carrier assy Incl. 56 R&I LT Handle, outside w/o smart key crystal blue Incl. 57 *R&I LT Handle base Incl. 58 R&I LT Cyl & keys Incl. 59 R&I LT Lock assy Incl. 60 R&I LT Door check Incl. 61 R&I LT R&I trim panel Incl. 62 REAR DOOR 63 Blnd LT Door shell (HSS)1.1 64 Repl LT Lower molding KB7W51RD0D 1 49.43 0.4 65 R&I LT Belt molding 0.3 66 R&I LT Handle, outside crystal blue 0.4 67 VEHICLE DIAGNOSTICS 68 S01 Repl Pre-repair scan 1 50.00 X m 69 S01 Repl Pre-repair scan 1 m 0.5 70 S01 Repl Post-repair scan 1 70.00 X m 71 S01 Repl Post-repair scan 1 m 0.5 SUBTOTALS 5,914.84 26.4 18.6 NOTES Estimate Notes: DR = 3/21/2023 DC = 3/21/2023 DI = 3/21/2023 ERT = 15 DRV = no SCHD = 3/31/2023 8:58:14 AM 419802 Page 4 0901119cb5fd2d36 Supplement of Record 1 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White Prod Date = 06/2016 Vehicle owner KATE STOTTLEMYER (handed, mailed, faxed, e-mailed etc.) copy of damage report prior to repairs. No Vehicle owner KATE STOTTLEMYER (handed, mailed, faxed, e-mailed etc.) QRP Brochure. N Prior Damage = Preliminary damage report - do not issue payment (as/if applicable) Final Damage report OK To Pay (as/when applicable) Date of completed repair (when applicable, and when known) N/A ESTIMATE TOTALS Category Basis Rate Cost $ Parts 5,794.84 Body Labor 26.4 hrs @ $ 69.00 /hr 1,821.60 Paint Labor 18.6 hrs @ $ 69.00 /hr 1,283.40 Paint Supplies 18.6 hrs @ $ 50.00 /hr 930.00 Miscellaneous 120.00 Pre-Tax Discount -2.6 %-258.70 Subtotal 9,691.14 Sales Tax $ 6,549.99 @ 7.3750 %483.06 Grand Total 10,174.20 Deductible 1,000.00 CUSTOMER PAY 1,000.00 INSURANCE PAY 9,174.20 3/31/2023 8:58:14 AM 419802 Page 5 0901119cb5fd2d36 Supplement of Record 1 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White SUPPLEMENT SUMMARY Line Oper Description Part Number Qty Extended Price $ Labor Paint Changed Items 33 Repl LT Fender liner KB7W56140C 1 -86.90 -0.4 33 S01 Repl LT Fender liner KB7W56140C 1 86.90 Incl. 35 Repl LT Wheel opng mldg KB7W51W30E8N 1 -139.79 -0.6 35 S01 Repl LT Wheel opng mldg KB7W51W30E8N 1 139.79 Incl. Deleted Items 30 *Repl LKQ LT fender assy +25%KB7W52211 1 -385.00 -1.6 -2.0 31 Overlap Major Adj. Panel 0.4 32 Refn edges -0.5 Added Items 30 S01 Repl LT Fender KB7W52211 1 378.11 2.1 2.0 31 S01 Overlap Major Adj. Panel -0.4 32 S01 Add for Edging 0.5 67 VEHICLE DIAGNOSTICS 68 S01 Repl Pre-repair scan 1 50.00 X m 69 S01 Repl Pre-repair scan 1 m 0.5 70 S01 Repl Post-repair scan 1 70.00 X m 71 S01 Repl Post-repair scan 1 m 0.5 SUBTOTALS 113.11 0.5 0.0 TOTALS SUMMARY Category Basis Rate Cost $ Parts -6.89 Body Labor 0.5 hrs @ $ 69.00 /hr 34.50 Paint Labor 0.00 Paint Supplies 0.00 Miscellaneous 120.00 Pre-Tax Discount -2.6 %-3.84 Subtotal 143.77 Sales Tax $ -6.72 @ 7.3750 %-0.50 Total Supplement Amount 143.27 NET COST OF SUPPLEMENT 143.27 3/31/2023 8:58:14 AM 419802 Page 6 0901119cb5fd2d36 Supplement of Record 1 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White CUMULATIVE EFFECTS OF SUPPLEMENT(S) Estimate 10,030.93 Lee Stuessi Supplement S01 143.27 Lee Stuessi Job Total: $10,174.20 CUSTOMER PAY: $1,000.00 INSURANCE PAY: $9,174.20 ======================================================================= Caliber Collision is the industry leader in quality collision repair. Since day one, our highest purpose has been to get people just like you back on the road as quickly as possible and fully restored to the rhythm of your life. You can be sure we do everything possible to ensure your complete satisfaction including: Personalized, high quality service from the largest collision repair company in the U.S. Consistently ranked among the highest customer satisfaction scores in the industry. Approved by every major insurance company in the U.S. Expedited car rental and towing services to get you back on the road again in no time. Repair work backed by a written, lifetime warranty honored at every location. 24/7/365 customer service to answer questions and put your mind at ease. This is a preliminary estimate based on visible damage. There may be additional repairs needed once the vehicle is taken apart by our I-CAR Gold Class technicians to identify any additional damage. If an insurance company has written an estimate for you, please provide us with a copy. Properly endorsed insurance company checks are welcome as payment for the repair of your vehicle. Caliber Collision gladly accepts all major credit cards, debit cards, cashier's and traveler's checks. See your Caliber Collision center for details on acceptance of personal checks. Before leaving your vehicle with us, please remove all important personal and valuable items from your vehicle. Caliber Collision is not responsible for belongings left in your vehicle. Please let us know how we can be of further assistance, and when we can schedule an appointment for your vehicle to be repaired. Caliber Collision - Restoring The Rhythm Of Your Life ======================================================================= 3/31/2023 8:58:14 AM 419802 Page 7 0901119cb5fd2d36 Supplement of Record 1 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White AVOID DELAYS BY GETTING CLAIM AND PAYMENT INFORMATION IN JUST A FEW CLICKS! VISIT: http://www.usaa.com/bodyshop MEMBER NUMBER: Use Policy Number LOSS NUMBER: Use digits 16, 17, & 18 of the claim number (Ex. 012345670000000[003]001) LOSS DATE: Use Date of Loss Please Present A Copy Of This Estimate To A Repair Facility Of Your Choice *USAA Subsidiaries include: United Services Automobile Association(USAA), USAA Casualty Insurance Company(CIC), USAA General Indemnity Company(GIC) USAA County Mutual Insurance(CMI) and Garrison Property Casualty Insurance Company. Garrison Property and Casualty Insurance Company, a subsidiary of USAA Casualty Insurance Company, is authorized to use the USAA logo, a registered trademark of United Services Automobile Association. This is not an authorization to repair. Failing to present this estimate to the repairing garage before repair may result in additional expenses to you. A USAA appraiser must authorize any supplement to this estimate. Repairs to this vehicle may require specific welding equipment as recommended by the manufacturer. If alternative quality replacement parts have been included in this appraisal, the source for these parts has also been disclosed. If alternative quality replacement parts as listed on the appraisal are ultimately used in the repair of your vehicle, the warranty on such parts will be equal to, or greater than, the parts being replaced, as stated in USAA's limited parts warranty. USAA warrants that the parts used on your vehicle will be of like kind and quality, function, fit, safety and corrosion protection as the part or parts they replace. USAA identifies certified and validated parts for sheet metal replacement parts. MN ST 60A.955 - A PERSON WHO FILES A CLAIM WITH INTENT TO DEFRAUD OR HELPS COMMIT A FRAUD AGAINST AN INSURER IS GUILTY OF A CRIME. 3/31/2023 8:58:14 AM 419802 Page 8 0901119cb5fd2d36 Supplement of Record 1 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White Estimate based on MOTOR CRASH ESTIMATING GUIDE and potentially other third party sources of data. Unless otherwise noted, (a) all items are derived from the Guide ARH5471, CCC Data Date 03/17/2023, and potentially other third party sources of data; and (b) the parts presented are OEM-parts. OEM parts are manufactured by or for the vehicle's Original Equipment Manufacturer (OEM) according to OEM's specifications for U.S. distribution. OEM parts are available at OE/Vehicle dealerships or the specified supplier. 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 with discounted pricing. Asterisk (*) or Double Asterisk (**) indicates that the parts and/or labor data provided by third party sources of data 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, A/M or NAGS. 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 2023 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 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. Blnd=Blend. BOR=Boron steel. CAPA=Certified Automotive Parts Association. D&R=Disconnect and Reconnect. HSS=High Strength Steel. HYD=Hydroformed Steel. Incl.=Included. LKQ=Like Kind and Quality. LT=Left. MAG=Magnesium. Non-Adj.=Non Adjacent. NSF=NSF International Certified Part. O/H=Overhaul. Qty=Quantity. Refn=Refinish. Repl=Replace. R&I=Remove and Install. R&R=Remove and Replace. Rpr=Repair. RT=Right. SAS=Sandwiched Steel. Sect=Section. Subl=Sublet. UHS=Ultra High Strength Steel. N=Note(s) associated with the estimate line. CCC ONE Estimating - A product of CCC Intelligent 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. 3/31/2023 8:58:14 AM 419802 Page 9 0901119cb5fd2d36 Supplement of Record 1 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White *Limited Parts Warranty Curb the High Cost of Vehicle Repairs With USAA's Quality Replacement Parts Program USAA warrants replacement body and mechanical parts in the QRP program when installed during vehicle repairs and listed on our damage report. These parts will be like kind and quality to the function, fit, finish and corrosion protection of the damaged parts they replace, or the parts will be repaired or replaced at no cost to you. Our warranty on sheet metal and plastic replacement body parts is valid for the period of time equal to the remainder of the original manufacturer's warranty or three years from the date of the repair, whichever is greater. Our warranty on mechanical parts will be equal to the warranty period provided by an authorized original manufacturer for those parts when provided through your manufacturer's distributor as replacement parts. The USAA warranty on replacement parts automatically transfers with ownership of the vehicle. Excluded from this warranty is normal wear and tear and damage caused by accident, abuse, unreasonable use or improper maintenance of the vehicle. Any express warranty not provided herein is hereby excluded and disclaimed. Any implied warranties of merchantability and fitness for any particular purpose which may exist, are expressly limited to the period of time equal to the remainder of the original manufacturer's warranty for like kind, quality, function, fit, finish and corrosion protection or three years from the date of the original repair, whichever is greater. Some states do not allow limitations on how long an implied warranty lasts, so the above limitation may not apply to you. USAA shall not be liable to any person for any special, incidental or consequential damages, whether arising out of breach of warranty, breach of contract or otherwise. Some states do not allow the exclusion or limitation of special, incidental or consequential damages, so the above limitation or exclusion may not apply to you. USAA would like you to feel confident about the reasons for supporting the Quality Replacement Parts program (QRP). Together we can ensure the highest level of collision repair quality by supporting a program that promotes competition through use of alternative replacement parts. The following questions and answers may help you understand more about USAA's QRP program. Q. What are OEM, non-OEM, and recycled parts? A. OEM: Parts manufactured for or by the manufacturer of your vehicle. Non-OEM: Parts provided by a company or distributor other than the original equipment manufacturer. Recycled: Parts from a vehicle of the same or newer make, model, and year vehicle that they are to replace. Q. What assurances do I have that QRP parts are of high quality? A. USAA only includes QRP parts when readily available and equivalent in performance to the part requiring replacement on your vehicle in terms of like kind, quality, function, fit, finish and corrosion protection. Also, QRP parts carry an equal or better warranty than the original manufacturer's parts and are supported by our Limited Parts Warranty. * Glass, lights and lenses will meet DOT/SAE standards. * New sheet metal and plastic body replacement panels will be certified or validated through an independent third-party. * USAA will identify other parts included in the program that comply with federal safety standards including new, recycled, or rebuilt parts. Q. Why does USAA use parts from other manufacturers and distributors? A. We use these parts to help keep vehicle repairs competitive in terms of price when the parts are of like kind, quality, function, fit, finish, and corrosion protection or better quality. Q. Do I have a choice which parts are included in USAA's repair estimate? A. Yes, you do. If you choose to use new OEM parts or parts from other manufacturers and distributors, you will bear the responsibility for any cost difference. 3/31/2023 8:58:14 AM 419802 Page 10 0901119cb5fd2d36 Supplement of Record 1 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White Q. If I am dissatisfied with a non-OEM part used in my vehicle repair, who do I call? A. If you experience a problem, call your claims advisor. We will work with the repair shop and the parts supplier to correct the problem at no cost to you, so long as the part is still under USAA's warranty. Q. Will using a non-OEM part void the warranty on my vehicle? A. The overall warranty on your vehicle will not be adversely affected. QRP parts included in your vehicle's repair will carry USAA's Limited Parts Warranty. It is equal to or better than the warranty provided by the distributor for new OEM parts. Q. What should I do if my repair shop refuses to use QRP parts? A. Your repair shop has the right to conduct its business the way it chooses and can charge you more than the reasonable and competitive cost for the repair; so, you will have to choose where and how your vehicle will be repaired. If you choose not to use another repairer and/or your shop refuses to use QRP parts, you will have to pay any difference in the final repair cost. USAA Claims Philosophy It is the policy of USAA to handle all claims with fairness and integrity, exercising the highest standards of ethical and professional conduct while transacting claims business. We will provide timely and responsive service, with full recognition of our obligations to the insureds and the public. If you have questions about the program or warranty, log on to http://usaa.com or call 1-800-531-USAA (8722). 3/31/2023 8:58:14 AM 419802 Page 11 0901119cb5fd2d36 Supplement of Record 1 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White ALTERNATE PARTS USAGE 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White VIN:JM3KFBEY8M0422323 Interior Color:Mileage In:25,693 Vehicle Out:5/31/2023 License:HAR419 Exterior Color:White Mileage Out:25,694 State:MN Production Date:5/2021 Condition:Job #: Alternate Part Type Selection Method # Of Times Notified Of Available Parts # Of Parts Selected Aftermarket Automatically List 0 0 Optional OEM Automatically List 0 0 Reconditioned Automatically List 0 0 Recycled N/A 0 0 3/31/2023 8:58:14 AM 419802 Page 12 0901119cb5fd2d36 0901119cb5fd2d37 0901119cb5fd2d37 0901119cb5fd2d37 0901119cb5fd2d37 0901119cb5fd2d37 0901119cb5fd2d37 0901119cb5fd2d37 0901119cb5fd2d37 0901119cb5fd2d37 0901119cb5fd2d37 0901119cb5fd2d37 0901119cb5fd2d37 0901119cb5fd2d37 0901119cb5fd2d37 0901119cb5fd2d37 0901119cb5fd2d37 0901119cb5fd2d37 0901119cb5fd2d37 0901119cb5fd2d37 0901119cb5fd2d37 0901119cb5fd2d37 CALIBER - ROSEVILLE MN Workfile ID: Federal ID: State ID: Federal EPA: 0070e5b7 33-0730794 6144514 MNS000333664RESTORING THE RHYTHM OF YOUR LIFE 1914 West County Road C, Roseville, MN 55113 Phone: (651) 639-9848 FAX: (651) 639-9406 Supplement of Record 2 with Summary RO Number: 3311046811 Written By: Lee Stuessi, 5/4/2023 2:20:53 PM Adjuster: Martinez, Ray, (000) 000-0000 x22 Business Insured:STOTTLEMYER, KATE Policy #:009762873 Claim #:009762873000000023001 Type of Loss:Collision Date of Loss:3/21/2023 12:00 PM Days to Repair:15 Point of Impact:11 Left Front Owner:Inspection Location:Insurance Company: STOTTLEMYER, KATE CALIBER - ROSEVILLE MN USAA CASUALTY INSURANCE COMPANY 165 HAWES AVE 1914 West County Road C DRP-4187 SHOREVIEW, MN 55126 Roseville, MN 55113 Visit us at USAA.com or Call #8722 (612) 321-1933 Cell Repair Facility P.O. Box 33490 (612) 321-1933 Evening (651) 639-9848 Business San Antonio, TX 78265 (800) 531-8722 Business VEHICLE 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White VIN:JM3KFBEY8M0422323 Interior Color:Mileage In:25,693 Vehicle Out:5/31/2023 License:HAR419 Exterior Color:White Mileage Out:25,694 State:MN Production Date:5/2021 Condition:Job #: TRANSMISSION Tilt Wheel Stereo Electric Glass Sunroof Automatic Transmission Cruise Control Search/Seek SEATS 4 Wheel Drive Rear Defogger Auxiliary Audio Connection Bucket Seats POWER Keyless Entry Premium Radio Leather Seats Power Steering Message Center Satellite Radio Heated Seats Power Brakes Steering Wheel Touch Controls SAFETY Rear Heated Seats Power Windows Rear Window Wiper Drivers Side Air Bag Ventilated Seats Power Locks Telescopic Wheel Passenger Air Bag WHEELS Power Mirrors Heated Steering Wheel Anti-Lock Brakes (4)Aluminum/Alloy Wheels Heated Mirrors Climate Control 4 Wheel Disc Brakes PAINT Power Driver Seat Navigation System Traction Control Three Stage Paint Power Passenger Seat Backup Camera Stability Control OTHER DECOR Parking Sensors Front Side Impact Air Bags Fog Lamps Dual Mirrors Surround View Camera Head/Curtain Air Bags Rear Spoiler Privacy Glass Remote Starter Hands Free Device Signal Integrated Mirrors Console/Storage Intelligent Cruise Xenon or L.E.D. Headlamps TRUCK Overhead Console Home Link Blind Spot Detection Power Trunk/Liftgate CONVENIENCE RADIO Heads Up Display 5/4/2023 2:20:55 PM 419802 Page 1 0901119cb691f1ac Supplement of Record 2 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White Air Conditioning AM Radio Lane Departure Warning Intermittent Wipers FM Radio ROOF 5/4/2023 2:20:55 PM 419802 Page 2 0901119cb691f1ac Supplement of Record 2 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White Line Oper Description Part Number Qty Extended Price $ Labor Paint 1 #==== Required Notes for USAA Drive Ins ==== 1 2 #For Supplements Use Estimate Share Within CCC One 1 3 #Have Questions or Non-CCC User? 1 4 #Call 800.637.8511 - Press 2 for Repair Facility 1 5 #Then Press 2 for Technical Support, 1 6 #Then Press 4 for "All Other"1 7 #==== End USAA Drive In Notes ==== 1 8 INFORMATION LABELS 9 S02 Repl Emission label 2.5L Turbo PX2K69036 1 7.23 0.2 10 #S02 Repl Vin No. Label 1 1.00 11 #S02 Repl Tire info Label 1 1.00 12 FRONT BUMPER & GRILLE 13 O/H bumper assy 2.9 14 <>Repl Bumper cover w/park sensor KN3L50031BB 1 365.95 Incl.2.8 15 S02 Add for Three Stage 2.0 16 Add for fog lamps 0.4 17 Add for park sensor m 0.4 18 Repl Grille assy w/surround view K26250710A 1 1,246.39 0.8 19 Repl Closure panel KB8A50717D 1 48.71 Incl. 20 Repl Upper molding KL2F507E19U 1 162.21 Incl.1.7 21 S02 Add for Three Stage 0.7 22 S02 Repl LT Side bracket KB8A50163B 1 14.45 0.1 23 S02 Refn Tow eye cap 0.2 24 S02 Add for Three Stage 0.1 25 S02 Repl LT Bezel w/fog lamp KB8B50C21C 1 7.70 Incl. 26 S02 Repl LT Mount bracket w/fog lamp KB8B50C22B 1 21.68 Incl. 27 S02 R&I License frame 0.2 28 S02 Repl Prep unprimed bumper 1 0.7 29 S02 Repl Add for park sensor 1 m 0.4 30 S02 Repl Seal plate TK4856381 1 12.25 Incl. 31 S02 Repl LT Cover KB8A50102A 1 6.45 Incl. 32 S02 Repl RT Cover KB8A50101A 1 5.42 Incl. 33 S02 Repl Retainer arctic white KD4767UC5A33 1 6.84 0.2 34 S02 Add for Three Stage 0.1 35 S02 Repl Emblem w/adaptive cruise TK7951730 1 394.57 Incl. 36 S02 Repl Mount bracket w/adaptive cruise w/front camera KB8D50721 1 25.69 Incl. 37 S02 Repl LT Bumper cover nut C27450133 6 15.66 5/4/2023 2:20:55 PM 419802 Page 3 0901119cb691f1ac Supplement of Record 2 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White 38 S02 Repl LT Bumper cover clip B45A56146A 6 11.64 39 S02 Repl LT Side retainer KB8A500U1A 1 7.21 Incl. 40 S02 Repl LT Grille assy grommet KD4550ES1 1 1.36 41 S02 Repl RT Upper molding pin S51S51833 4 13.20 42 S02 Repl Upper molding rivet TK2150355 12 40.56 43 S02 Repl LT Grille assy pin KD45501K5A 1 1.24 44 S02 Repl Seal plate fastener GD7A50EA1 6 14.76 45 S02 Repl LT Park sensor inner arctic white GMK667UC133 1 85.76 m Incl.0.2 46 S02 Add for Three Stage 0.1 47 S02 Repl LT Wire harness K26267290A 1 47.13 Incl. 48 FRONT LAMPS 49 Repl LT Headlamp assy w/o directional beam KL2J51041D 1 694.34 0.6 50 Aim headlamps 0.5 51 S02 R&I RT R&I headlamp assy 0.4 52 S02 R&I RT Fog lamp assy Incl. 53 S02 Repl LT Fog lamp assy B63B51690A 1 259.64 Incl. 54 S02 Aim fog lamps 0.3 55 S02 Repl LT Lamp bracket KB8B51694 1 12.26 56 S02 Repl LT Wire connector K1Y967SH3 1 7.14 57 HOOD 58 Repl Hood (HSS)KBY05231XB 1 683.39 1.6 2.8 59 Overlap Major Non-Adj. Panel -0.2 60 S02 Add for Three Stage 1.0 61 Add for Underside(Complete)1.4 62 R&I Insulator Incl. 63 S02 Repl Front w'strip KB7W56770A 1 19.69 Incl. 64 R&I Front seal Incl. 65 R&I Rear w'strip Incl. 66 Repl RT Hinge KB7W52410 1 40.26 0.3 0.4 67 S02 Add for Three Stage 0.2 68 Repl LT Hinge KB7W52420 1 40.26 0.3 0.4 69 S02 Add for Three Stage 0.2 70 S02 Repl Insulator fastener TD1156694 11 23.87 71 FENDER 72 S01 Repl LT Fender KB7W52211 1 378.11 2.1 2.0 73 S01 Overlap Major Adj. Panel -0.4 74 S02 Add for Three Stage 0.6 75 S01 Add for Edging 0.5 76 Repl LT Fender liner KB7W56140C 1 86.90 Incl. 77 Repl LT Front bracket KDPW52240 1 28.13 0.1 0.3 78 S02 Add for Three Stage 0.1 79 Repl LT Wheel opng mldg KB7W51W30E8N 1 139.79 Incl. 80 Repl LT Apron reinf (UHS)KB7W5428X 1 49.32 s 3.0 0.7 81 S02 R&I RT Wheel opng mldg 0.6 5/4/2023 2:20:55 PM 419802 Page 4 0901119cb691f1ac Supplement of Record 2 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White 82 *S02 Rpr LT Apron assy (HSS)s 1.0 1.6 83 S02 Overlap Minor Panel -0.2 84 S02 Repl LT Lower molding KB7W51W80B 1 11.80 Incl. 85 S02 Repl LT End plate KB7W563K5 1 12.49 Incl. 86 S02 R&I LT End seal Incl. 87 S02 Repl LT Deflector shield KB7W56115B 1 15.40 Incl. 88 S02 Repl LT Lower seal KB7W56J13A 1 28.16 Incl. 89 S02 Repl LT Upper bracket KB7W5422Y 1 7.74 0.1 0.3 90 S02 Add for Three Stage 0.1 91 ELECTRICAL 92 S02 Repl Battery 0000800035WB 1 199.99 m 0.4 93 S02 Repl Fuse & relay box KD4566760A 1 254.03 94 WHEELS 95 Repl LT/Front Wheel, alloy 19x7 black metallic 9965507090 1 568.44 m 0.3 96 COWL 97 S02 R&I LT End cap 0.1 98 PILLARS, ROCKER & FLOOR 99 *S02 Rpr LT W/S pillar reinf (UHS)s 7.0 Note: Damage has streched metal and extends aound panel line into door jam Windshield will have to be removed 100 S02 R&I LT Front sill plate 0.2 101 *S02 Rpr LT Ctr plr & rocker 15.0 3.2 102 S02 Overlap Major Non-Adj. Panel -0.2 103 #S02 Rpr remove wrap and clean adhesive from a pillar 0.5 104 #S02 Subl wrap a pillar 1 150.00 X 105 FRONT DOOR 106 Repl LT Door shell (HSS)KBY05902XE 1 998.67 5.7 3.0 107 Overlap Major Adj. Panel -0.4 108 S02 Add for Three Stage 1.0 109 R&I LT Door w'strip Incl. 110 Repl LT Window molding KB7W50985N 1 97.98 0.3 111 Repl LT Black out tape front K131508W1 1 5.77 0.3 112 Repl LT Black out tape rear K131508W3 1 7.97 0.3 113 S02 Repl LT Belt molding KB7W50650C 1 36.67 Incl. 114 S02 Repl LT Corner molding piano black KB8A6916YC 1 29.99 0.1 115 S02 Repl LT Applique black KB7W50M20B 1 52.64 Incl. Note: LABOR: Time for R&I/R&R does not include removing or replacing double-sided tape. 116 Repl LT Lower molding KB7W51RB0E 1 50.18 0.4 117 R&I LT R&I mirror Incl. 118 R&I LT Door glass Mazda Incl. 119 *R&I LT Run channel Incl. 120 R&I LT R&I carrier assy Incl. 121 R&I LT Handle, outside w/o smart key Incl. 5/4/2023 2:20:55 PM 419802 Page 5 0901119cb691f1ac Supplement of Record 2 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White crystal blue 122 *R&I LT Handle base Incl. 123 R&I LT Cyl & keys Incl. 124 R&I LT Lock assy Incl. 125 R&I LT Door check Incl. 126 R&I LT R&I trim panel Incl. 127 S02 Repl LT Mirror cover white pearl TK48691N7A64 1 45.94 Incl.0.5 128 S02 Overlap Minor Panel -0.2 129 S02 Add for Three Stage 0.1 130 S02 Repl LT Mirror assy w/bld spot, w/pwr fold, w/surround view KJK969181A 1 417.03 Incl. 131 S02 R&I LT Side camera 132 *S02 R&I LT Mirror glass w/blind spot monitor w/heated Incl. 133 *S02 R&I LT Signal lamp Incl. 134 #S02 Subl wrap mirror cover 1 50.00 X 135 S02 Repl LT Handle, outside w/smart key white pearl TK495941XC64 1 94.52 Incl.0.5 136 S02 Overlap Minor Panel -0.2 137 S02 Add for Three Stage 0.1 138 S02 Dis/reassmble to refn 0.2 139 S02 R&I LT W'strip on body 0.3 140 REAR DOOR 141 *S02 Rpr LT Outer panel (HSS)2.0 2.1 142 S02 Overlap Major Adj. Panel -0.4 143 S02 Add for Three Stage 0.7 144 S02 R&I LT Lower molding 0.4 145 S02 Repl LT Belt molding KB7W50670C 1 40.01 0.3 146 R&I LT Handle, outside crystal blue 0.4 147 VEHICLE DIAGNOSTICS 148 S01 Repl Pre-repair scan 1 50.00 X m 149 S01 Repl Pre-repair scan 1 m 0.5 150 S01 Repl Post-repair scan 1 70.00 X m 151 S01 Repl Post-repair scan 1 m 0.5 152 #S02 Subl Static Calibration - Surround View (Non Toy/For/Nis) 1 475.00 X 153 #S02 Subl Static Calibration - Adaptive Cruise Control - Lidar/Doppler 1 600.00 X 154 #S02 Subl Alignment, 4-wheel 1 89.95 X 155 #S02 Repl Corrosion Protection 1 T 156 #S02 Cover Car for Overspray 1 12.00 X 0.3 157 #S02 Repl Caulk/Seam Sealer 1 T 158 TIRES 159 *S02 Repl TOYO P225/55R19 TYA36 RF BW 99V T16205 1 177.99 0.3 160 #S02 Repl Add for Chip Guard 1 18.00 T 0.5 5/4/2023 2:20:55 PM 419802 Page 6 0901119cb691f1ac Supplement of Record 2 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White 161 #S02 Cover Interior for Protection 1 6.00 X 0.3 162 #S02 Repl Cavity Wax 1 18.00 T 0.5 163 #S02 Subl Hazardous Waste Disposal 1 5.00 X 164 #S02 License Plate 1 T 0.2 165 #S02 Refn Left Roof Rail Clear Only 0.8 166 #S02 Mask Jambs, Opening, Entry 1 12.00 X 0.3 167 #S02 Remove Adhesive from Repaired Panel 1 3.00 X 0.5 SUBTOTALS 9,741.52 53.9 31.7 NOTES Estimate Notes: DR = 3/21/2023 DC = 3/21/2023 DI = 3/21/2023 ERT = 15 DRV = no SCHD = Prod Date = 06/2016 Vehicle owner KATE STOTTLEMYER (handed, mailed, faxed, e-mailed etc.) copy of damage report prior to repairs. No Vehicle owner KATE STOTTLEMYER (handed, mailed, faxed, e-mailed etc.) QRP Brochure. N Prior Damage = Preliminary damage report - do not issue payment (as/if applicable) Final Damage report OK To Pay (as/when applicable) Date of completed repair (when applicable, and when known) N/A ****Borderline Total Loss Tool**** Teardown: Yes License Plate State: MN Preliminary estimate of visible damage: $17486.99 Potential supplemental damage: $0 *Explanation: Vehicle value (pre-tax): $28762.00 Vehicle Value Taxes: $1889.53 Salvage Value: $5752.00 **** 1) Vehicle is currently at 70 % of 100 % total loss threshold; $7413 to reach threshold 2) Upload Estimate as Repairable - Damage Under Threshold (Prior to uploading the estimate, contact the USAA IPDS team to discuss the unrelated prior damage) 3) Ensure limited to no chance of significant engine, suspension, or transmission damage 5/4/2023 2:20:55 PM 419802 Page 7 0901119cb691f1ac Supplement of Record 2 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White ESTIMATE TOTALS Category Basis Rate Cost $ Parts 8,182.57 Body Labor 53.9 hrs @ $ 69.00 /hr 3,719.10 Paint Labor 31.7 hrs @ $ 69.00 /hr 2,187.30 Paint Supplies 31.7 hrs @ $ 50.00 /hr 1,585.00 Miscellaneous 1,558.95 Pre-Tax Discount -2.6 %-448.06 Subtotal 16,784.86 Sales Tax $ 9,548.67 @ 7.3750 %704.21 Grand Total 17,489.07 Deductible 1,000.00 CUSTOMER PAY 1,000.00 INSURANCE PAY 16,489.07 5/4/2023 2:20:55 PM 419802 Page 8 0901119cb691f1ac Supplement of Record 2 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White SUPPLEMENT SUMMARY Line Oper Description Part Number Qty Extended Price $ Labor Paint Changed Items 40 *Rpr LT W/S pillar reinf (UHS)s -4.0 99 *S02 Rpr LT W/S pillar reinf (UHS)s 7.0 NOTE: Damage has streched metal and extends aound panel line into door jam Windshield will have to be removed 50 Repl LT Applique black KB7W50M20B 1 -52.64 Incl. 115 S02 Repl LT Applique black KB7W50M20B 1 52.64 Incl. NOTE: LABOR: Time for R&I/R&R does not include removing or replacing double-sided tape. Deleted Items 24 R&I Front w'strip Incl. 44 Clear Coat -2.5 49 R&I LT Belt molding Incl. 63 Blnd LT Door shell (HSS)-1.1 64 Repl LT Lower molding KB7W51RD0D 1 -49.43 -0.4 65 R&I LT Belt molding -0.3 Added Items 8 INFORMATION LABELS 9 S02 Repl Emission label 2.5L Turbo PX2K69036 1 7.23 0.2 10 #S02 Repl Vin No. Label 1 1.00 11 #S02 Repl Tire info Label 1 1.00 15 S02 Add for Three Stage 2.0 21 S02 Add for Three Stage 0.7 22 S02 Repl LT Side bracket KB8A50163B 1 14.45 0.1 23 S02 Refn Tow eye cap 0.2 24 S02 Add for Three Stage 0.1 25 S02 Repl LT Bezel w/fog lamp KB8B50C21C 1 7.70 Incl. 26 S02 Repl LT Mount bracket w/fog lamp KB8B50C22B 1 21.68 Incl. 27 S02 R&I License frame 0.2 28 S02 Repl Prep unprimed bumper 1 0.7 29 S02 Repl Add for park sensor 1 m 0.4 30 S02 Repl Seal plate TK4856381 1 12.25 Incl. 31 S02 Repl LT Cover KB8A50102A 1 6.45 Incl. 32 S02 Repl RT Cover KB8A50101A 1 5.42 Incl. 33 S02 Repl Retainer arctic white KD4767UC5A33 1 6.84 0.2 34 S02 Add for Three Stage 0.1 35 S02 Repl Emblem w/adaptive cruise TK7951730 1 394.57 Incl. 36 S02 Repl Mount bracket w/adaptive cruise w/front camera KB8D50721 1 25.69 Incl. 37 S02 Repl LT Bumper cover nut C27450133 6 15.66 38 S02 Repl LT Bumper cover clip B45A56146A 6 11.64 5/4/2023 2:20:55 PM 419802 Page 9 0901119cb691f1ac Supplement of Record 2 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White 39 S02 Repl LT Side retainer KB8A500U1A 1 7.21 Incl. 40 S02 Repl LT Grille assy grommet KD4550ES1 1 1.36 41 S02 Repl RT Upper molding pin S51S51833 4 13.20 42 S02 Repl Upper molding rivet TK2150355 12 40.56 43 S02 Repl LT Grille assy pin KD45501K5A 1 1.24 44 S02 Repl Seal plate fastener GD7A50EA1 6 14.76 45 S02 Repl LT Park sensor inner arctic white GMK667UC133 1 85.76 m Incl.0.2 46 S02 Add for Three Stage 0.1 47 S02 Repl LT Wire harness K26267290A 1 47.13 Incl. 51 S02 R&I RT R&I headlamp assy 0.4 52 S02 R&I RT Fog lamp assy Incl. 53 S02 Repl LT Fog lamp assy B63B51690A 1 259.64 Incl. 54 S02 Aim fog lamps 0.3 55 S02 Repl LT Lamp bracket KB8B51694 1 12.26 56 S02 Repl LT Wire connector K1Y967SH3 1 7.14 60 S02 Add for Three Stage 1.0 63 S02 Repl Front w'strip KB7W56770A 1 19.69 Incl. 67 S02 Add for Three Stage 0.2 69 S02 Add for Three Stage 0.2 70 S02 Repl Insulator fastener TD1156694 11 23.87 74 S02 Add for Three Stage 0.6 78 S02 Add for Three Stage 0.1 81 S02 R&I RT Wheel opng mldg 0.6 82 *S02 Rpr LT Apron assy (HSS)s 1.0 1.6 83 S02 Overlap Minor Panel -0.2 84 S02 Repl LT Lower molding KB7W51W80B 1 11.80 Incl. 85 S02 Repl LT End plate KB7W563K5 1 12.49 Incl. 86 S02 R&I LT End seal Incl. 87 S02 Repl LT Deflector shield KB7W56115B 1 15.40 Incl. 88 S02 Repl LT Lower seal KB7W56J13A 1 28.16 Incl. 89 S02 Repl LT Upper bracket KB7W5422Y 1 7.74 0.1 0.3 90 S02 Add for Three Stage 0.1 91 ELECTRICAL 92 S02 Repl Battery 0000800035WB 1 199.99 m 0.4 93 S02 Repl Fuse & relay box KD4566760A 1 254.03 96 COWL 97 S02 R&I LT End cap 0.1 100 S02 R&I LT Front sill plate 0.2 101 *S02 Rpr LT Ctr plr & rocker 15.0 3.2 102 S02 Overlap Major Non-Adj. Panel -0.2 103 #S02 Rpr remove wrap and clean adhesive from a pillar 0.5 104 #S02 Subl wrap a pillar 1 150.00 X 108 S02 Add for Three Stage 1.0 113 S02 Repl LT Belt molding KB7W50650C 1 36.67 Incl. 5/4/2023 2:20:55 PM 419802 Page 10 0901119cb691f1ac Supplement of Record 2 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White 114 S02 Repl LT Corner molding piano black KB8A6916YC 1 29.99 0.1 127 S02 Repl LT Mirror cover white pearl TK48691N7A64 1 45.94 Incl.0.5 128 S02 Overlap Minor Panel -0.2 129 S02 Add for Three Stage 0.1 130 S02 Repl LT Mirror assy w/bld spot, w/pwr fold, w/surround view KJK969181A 1 417.03 Incl. 131 S02 R&I LT Side camera 132 *S02 R&I LT Mirror glass w/blind spot monitor w/heated Incl. 133 *S02 R&I LT Signal lamp Incl. 134 #S02 Subl wrap mirror cover 1 50.00 X 135 S02 Repl LT Handle, outside w/smart key white pearl TK495941XC64 1 94.52 Incl.0.5 136 S02 Overlap Minor Panel -0.2 137 S02 Add for Three Stage 0.1 138 S02 Dis/reassmble to refn 0.2 139 S02 R&I LT W'strip on body 0.3 141 *S02 Rpr LT Outer panel (HSS)2.0 2.1 142 S02 Overlap Major Adj. Panel -0.4 143 S02 Add for Three Stage 0.7 144 S02 R&I LT Lower molding 0.4 145 S02 Repl LT Belt molding KB7W50670C 1 40.01 0.3 152 #S02 Subl Static Calibration - Surround View (Non Toy/For/Nis) 1 475.00 X 153 #S02 Subl Static Calibration - Adaptive Cruise Control - Lidar/Doppler 1 600.00 X 154 #S02 Subl Alignment, 4-wheel 1 89.95 X 155 #S02 Repl Corrosion Protection 1 T 156 #S02 Cover Car for Overspray 1 12.00 X 0.3 157 #S02 Repl Caulk/Seam Sealer 1 T 158 TIRES 159 *S02 Repl TOYO P225/55R19 TYA36 RF BW 99V T16205 1 177.99 0.3 160 #S02 Repl Add for Chip Guard 1 18.00 T 0.5 161 #S02 Cover Interior for Protection 1 6.00 X 0.3 162 #S02 Repl Cavity Wax 1 18.00 T 0.5 163 #S02 Subl Hazardous Waste Disposal 1 5.00 X 164 #S02 License Plate 1 T 0.2 165 #S02 Refn Left Roof Rail Clear Only 0.8 166 #S02 Mask Jambs, Opening, Entry 1 12.00 X 0.3 167 #S02 Remove Adhesive from Repaired Panel 1 3.00 X 0.5 SUBTOTALS 3,826.68 27.5 13.1 5/4/2023 2:20:55 PM 419802 Page 11 0901119cb691f1ac Supplement of Record 2 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White TOTALS SUMMARY Category Basis Rate Cost $ Parts 2,387.73 Body Labor 27.5 hrs @ $ 69.00 /hr 1,897.50 Paint Labor 13.1 hrs @ $ 69.00 /hr 903.90 Paint Supplies 13.1 hrs @ $ 50.00 /hr 655.00 Miscellaneous 1,438.95 Pre-Tax Discount -2.6 %-189.36 Subtotal 7,093.72 Sales Tax $ 2,998.68 @ 7.3750 %221.30 Additional Supplement Taxes -0.15 Total Supplement Amount 7,314.87 NET COST OF SUPPLEMENT 7,314.87 CUMULATIVE EFFECTS OF SUPPLEMENT(S) Estimate 10,030.93 Lee Stuessi Supplement S01 143.27 Lee Stuessi Supplement S02 7,314.87 Lee Stuessi Job Total: $17,489.07 CUSTOMER PAY: $1,000.00 INSURANCE PAY: $16,489.07 5/4/2023 2:20:55 PM 419802 Page 12 0901119cb691f1ac Supplement of Record 2 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White ======================================================================= Caliber Collision is the industry leader in quality collision repair. Since day one, our highest purpose has been to get people just like you back on the road as quickly as possible and fully restored to the rhythm of your life. You can be sure we do everything possible to ensure your complete satisfaction including: Personalized, high quality service from the largest collision repair company in the U.S. Consistently ranked among the highest customer satisfaction scores in the industry. Approved by every major insurance company in the U.S. Expedited car rental and towing services to get you back on the road again in no time. Repair work backed by a written, lifetime warranty honored at every location. 24/7/365 customer service to answer questions and put your mind at ease. This is a preliminary estimate based on visible damage. There may be additional repairs needed once the vehicle is taken apart by our I-CAR Gold Class technicians to identify any additional damage. If an insurance company has written an estimate for you, please provide us with a copy. Properly endorsed insurance company checks are welcome as payment for the repair of your vehicle. Caliber Collision gladly accepts all major credit cards, debit cards, cashier's and traveler's checks. See your Caliber Collision center for details on acceptance of personal checks. Before leaving your vehicle with us, please remove all important personal and valuable items from your vehicle. Caliber Collision is not responsible for belongings left in your vehicle. Please let us know how we can be of further assistance, and when we can schedule an appointment for your vehicle to be repaired. Caliber Collision - Restoring The Rhythm Of Your Life ======================================================================= AVOID DELAYS BY GETTING CLAIM AND PAYMENT INFORMATION IN JUST A FEW CLICKS! VISIT: http://www.usaa.com/bodyshop MEMBER NUMBER: Use Policy Number LOSS NUMBER: Use digits 16, 17, & 18 of the claim number (Ex. 012345670000000[003]001) LOSS DATE: Use Date of Loss Please Present A Copy Of This Estimate To A Repair Facility Of Your Choice *USAA Subsidiaries include: United Services Automobile Association(USAA), USAA Casualty Insurance Company(CIC), USAA General Indemnity Company(GIC) USAA County Mutual Insurance(CMI) and Garrison Property Casualty Insurance Company. Garrison Property and Casualty Insurance Company, a subsidiary of USAA Casualty Insurance Company, is authorized to use the USAA logo, a registered trademark of United Services Automobile Association. This is not an authorization to repair. Failing to present this estimate to the repairing garage before repair may result in additional expenses to you. A USAA appraiser must authorize any supplement to this estimate. Repairs to this vehicle may require specific welding equipment as recommended by the manufacturer. If alternative quality replacement parts have been included in this appraisal, the source for these parts has also been disclosed. If alternative quality replacement parts as listed on the appraisal are ultimately used in the repair of your vehicle, the warranty on such parts will be equal to, or greater than, the parts being replaced, as stated in USAA's limited parts warranty. USAA warrants that the parts used on your vehicle will be of like kind and quality, function, fit, safety and corrosion protection as the part or parts they replace. USAA identifies certified and validated parts for 5/4/2023 2:20:55 PM 419802 Page 13 0901119cb691f1ac Supplement of Record 2 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White sheet metal replacement parts. MN ST 60A.955 - A PERSON WHO FILES A CLAIM WITH INTENT TO DEFRAUD OR HELPS COMMIT A FRAUD AGAINST AN INSURER IS GUILTY OF A CRIME. Estimate based on MOTOR CRASH ESTIMATING GUIDE and potentially other third party sources of data. Unless otherwise noted, (a) all items are derived from the Guide ARH5471, CCC Data Date 04/10/2023, and potentially other third party sources of data; and (b) the parts presented are OEM-parts. OEM parts are manufactured by or for the vehicle's Original Equipment Manufacturer (OEM) according to OEM's specifications for U.S. distribution. OEM parts are available at OE/Vehicle dealerships or the specified supplier. 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 with discounted pricing. Asterisk (*) or Double Asterisk (**) indicates that the parts and/or labor data provided by third party sources of data 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, A/M or NAGS. 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 2023 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 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. Blnd=Blend. BOR=Boron steel. CAPA=Certified Automotive Parts Association. D&R=Disconnect and Reconnect. HSS=High Strength Steel. HYD=Hydroformed Steel. Incl.=Included. LKQ=Like Kind and Quality. LT=Left. MAG=Magnesium. Non-Adj.=Non Adjacent. NSF=NSF International Certified Part. O/H=Overhaul. Qty=Quantity. Refn=Refinish. Repl=Replace. R&I=Remove and Install. R&R=Remove and Replace. Rpr=Repair. RT=Right. SAS=Sandwiched Steel. Sect=Section. Subl=Sublet. UHS=Ultra High Strength Steel. N=Note(s) associated with the estimate line. CCC ONE Estimating - A product of CCC Intelligent 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 5/4/2023 2:20:55 PM 419802 Page 14 0901119cb691f1ac Supplement of Record 2 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White Transportation and Safety Administration. PDR=Paintless Dent Repair. VIN=Vehicle Identification Number. 5/4/2023 2:20:55 PM 419802 Page 15 0901119cb691f1ac Supplement of Record 2 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White *Limited Parts Warranty Curb the High Cost of Vehicle Repairs With USAA's Quality Replacement Parts Program USAA warrants replacement body and mechanical parts in the QRP program when installed during vehicle repairs and listed on our damage report. These parts will be like kind and quality to the function, fit, finish and corrosion protection of the damaged parts they replace, or the parts will be repaired or replaced at no cost to you. Our warranty on sheet metal and plastic replacement body parts is valid for the period of time equal to the remainder of the original manufacturer's warranty or three years from the date of the repair, whichever is greater. Our warranty on mechanical parts will be equal to the warranty period provided by an authorized original manufacturer for those parts when provided through your manufacturer's distributor as replacement parts. The USAA warranty on replacement parts automatically transfers with ownership of the vehicle. Excluded from this warranty is normal wear and tear and damage caused by accident, abuse, unreasonable use or improper maintenance of the vehicle. Any express warranty not provided herein is hereby excluded and disclaimed. Any implied warranties of merchantability and fitness for any particular purpose which may exist, are expressly limited to the period of time equal to the remainder of the original manufacturer's warranty for like kind, quality, function, fit, finish and corrosion protection or three years from the date of the original repair, whichever is greater. Some states do not allow limitations on how long an implied warranty lasts, so the above limitation may not apply to you. USAA shall not be liable to any person for any special, incidental or consequential damages, whether arising out of breach of warranty, breach of contract or otherwise. Some states do not allow the exclusion or limitation of special, incidental or consequential damages, so the above limitation or exclusion may not apply to you. USAA would like you to feel confident about the reasons for supporting the Quality Replacement Parts program (QRP). Together we can ensure the highest level of collision repair quality by supporting a program that promotes competition through use of alternative replacement parts. The following questions and answers may help you understand more about USAA's QRP program. Q. What are OEM, non-OEM, and recycled parts? A. OEM: Parts manufactured for or by the manufacturer of your vehicle. Non-OEM: Parts provided by a company or distributor other than the original equipment manufacturer. Recycled: Parts from a vehicle of the same or newer make, model, and year vehicle that they are to replace. Q. What assurances do I have that QRP parts are of high quality? A. USAA only includes QRP parts when readily available and equivalent in performance to the part requiring replacement on your vehicle in terms of like kind, quality, function, fit, finish and corrosion protection. Also, QRP parts carry an equal or better warranty than the original manufacturer's parts and are supported by our Limited Parts Warranty. * Glass, lights and lenses will meet DOT/SAE standards. * New sheet metal and plastic body replacement panels will be certified or validated through an independent third-party. * USAA will identify other parts included in the program that comply with federal safety standards including new, recycled, or rebuilt parts. Q. Why does USAA use parts from other manufacturers and distributors? A. We use these parts to help keep vehicle repairs competitive in terms of price when the parts are of like kind, quality, function, fit, finish, and corrosion protection or better quality. Q. Do I have a choice which parts are included in USAA's repair estimate? A. Yes, you do. If you choose to use new OEM parts or parts from other manufacturers and distributors, you will bear the responsibility for any cost difference. 5/4/2023 2:20:55 PM 419802 Page 16 0901119cb691f1ac Supplement of Record 2 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White Q. If I am dissatisfied with a non-OEM part used in my vehicle repair, who do I call? A. If you experience a problem, call your claims advisor. We will work with the repair shop and the parts supplier to correct the problem at no cost to you, so long as the part is still under USAA's warranty. Q. Will using a non-OEM part void the warranty on my vehicle? A. The overall warranty on your vehicle will not be adversely affected. QRP parts included in your vehicle's repair will carry USAA's Limited Parts Warranty. It is equal to or better than the warranty provided by the distributor for new OEM parts. Q. What should I do if my repair shop refuses to use QRP parts? A. Your repair shop has the right to conduct its business the way it chooses and can charge you more than the reasonable and competitive cost for the repair; so, you will have to choose where and how your vehicle will be repaired. If you choose not to use another repairer and/or your shop refuses to use QRP parts, you will have to pay any difference in the final repair cost. USAA Claims Philosophy It is the policy of USAA to handle all claims with fairness and integrity, exercising the highest standards of ethical and professional conduct while transacting claims business. We will provide timely and responsive service, with full recognition of our obligations to the insureds and the public. If you have questions about the program or warranty, log on to http://usaa.com or call 1-800-531-USAA (8722). 5/4/2023 2:20:55 PM 419802 Page 17 0901119cb691f1ac Supplement of Record 2 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White TIRE PARTS SUPPLIERS Line Description Supplier Price 159 TOYO P225/55R19 TYA36 RF BW 99V MERCHANTS TIRE $ 177.99 10292 HARRY J PARRISH BLVD, MANASSAS VA 20110-0 (703) 257-2074 5/4/2023 2:20:55 PM 419802 Page 18 0901119cb691f1ac Supplement of Record 2 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White ALTERNATE PARTS USAGE 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White VIN:JM3KFBEY8M0422323 Interior Color:Mileage In:25,693 Vehicle Out:5/31/2023 License:HAR419 Exterior Color:White Mileage Out:25,694 State:MN Production Date:5/2021 Condition:Job #: Alternate Part Type Selection Method # Of Times Notified Of Available Parts # Of Parts Selected Aftermarket Automatically List 0 0 Optional OEM Automatically List 0 0 Reconditioned Automatically List 0 0 Recycled N/A 0 0 5/4/2023 2:20:55 PM 419802 Page 19 0901119cb691f1ac 0901119cb691f1ae 0901119cb691f1ae 0901119cb691f1ae 0901119cb691f1ae 0901119cb691f1ae 0901119cb691f1ae 0901119cb691f1ae 0901119cb691f1ae 0901119cb691f1ae 0901119cb691f1ae 0901119cb691f1ae 0901119cb691f1ae 0901119cb691f1ae 0901119cb691f1ae 0901119cb691f1ae 0901119cb691f1ae 0901119cb691f1ae 0901119cb691f1ae 0901119cb691f1ae 0901119cb691f1ae 0901119cb691f1ae 0901119cb691f1ae 0901119cb691f1ae 0901119cb691f1ae 0901119cb691f1ae 0901119cb691f1ae 0901119cb691f1ae 0901119cb691f1ae 0901119cb691f1ae 0901119cb691f1ae 0901119cb691f1ae 0901119cb691f1ae 0901119cb691f1ae 0901119cb691f1ae 0901119cb691f1ae 0901119cb691f1ae 0901119cb691f1ae 0901119cb691f1ae 0901119cb691f1ae 0901119cb691f1ae 0901119cb691f1ae 0901119cb691f1ae CALIBER - ROSEVILLE MN Workfile ID: Federal ID: State ID: Federal EPA: 0070e5b7 33-0730794 6144514 MNS000333664RESTORING THE RHYTHM OF YOUR LIFE 1914 West County Road C, Roseville, MN 55113 Phone: (651) 639-9848 FAX: (651) 639-9406 Supplement of Record 3 with Summary RO Number: 3311046811 Written By: Lee Stuessi, 5/23/2023 4:54:37 PM Adjuster: Martinez, Ray, (000) 000-0000 x22 Business Insured:STOTTLEMYER, KATE Policy #:009762873 Claim #:009762873000000023001 Type of Loss:Collision Date of Loss:3/21/2023 12:00 PM Days to Repair:15 Point of Impact:11 Left Front Owner:Inspection Location:Insurance Company: STOTTLEMYER, KATE CALIBER - ROSEVILLE MN USAA CASUALTY INSURANCE COMPANY 165 HAWES AVE 1914 West County Road C DRP-4187 SHOREVIEW, MN 55126 Roseville, MN 55113 Visit us at USAA.com or Call #8722 (612) 321-1933 Cell Repair Facility P.O. Box 33490 (612) 321-1933 Evening (651) 639-9848 Business San Antonio, TX 78265 (800) 531-8722 Business VEHICLE 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White VIN:JM3KFBEY8M0422323 Interior Color:Mileage In:25,693 Vehicle Out:6/2/2023 License:HAR419 Exterior Color:White Mileage Out:25,694 State:MN Production Date:5/2021 Condition:Job #: TRANSMISSION Tilt Wheel Stereo Electric Glass Sunroof Automatic Transmission Cruise Control Search/Seek SEATS 4 Wheel Drive Rear Defogger Auxiliary Audio Connection Bucket Seats POWER Keyless Entry Premium Radio Leather Seats Power Steering Message Center Satellite Radio Heated Seats Power Brakes Steering Wheel Touch Controls SAFETY Rear Heated Seats Power Windows Rear Window Wiper Drivers Side Air Bag Ventilated Seats Power Locks Telescopic Wheel Passenger Air Bag WHEELS Power Mirrors Heated Steering Wheel Anti-Lock Brakes (4)Aluminum/Alloy Wheels Heated Mirrors Climate Control 4 Wheel Disc Brakes PAINT Power Driver Seat Navigation System Traction Control Three Stage Paint Power Passenger Seat Backup Camera Stability Control OTHER DECOR Parking Sensors Front Side Impact Air Bags Fog Lamps Dual Mirrors Surround View Camera Head/Curtain Air Bags Rear Spoiler Privacy Glass Remote Starter Hands Free Device Signal Integrated Mirrors Console/Storage Intelligent Cruise Xenon or L.E.D. Headlamps TRUCK Overhead Console Home Link Blind Spot Detection Power Trunk/Liftgate CONVENIENCE RADIO Heads Up Display 5/23/2023 4:54:37 PM 419802 Page 1 0901119cb6ddff47 Supplement of Record 3 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White Air Conditioning AM Radio Lane Departure Warning Intermittent Wipers FM Radio ROOF 5/23/2023 4:54:37 PM 419802 Page 2 0901119cb6ddff47 Supplement of Record 3 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White Line Oper Description Part Number Qty Extended Price $ Labor Paint 1 #==== Required Notes for USAA Drive Ins ==== 1 2 #For Supplements Use Estimate Share Within CCC One 1 3 #Have Questions or Non-CCC User? 1 4 #Call 800.637.8511 - Press 2 for Repair Facility 1 5 #Then Press 2 for Technical Support, 1 6 #Then Press 4 for "All Other"1 7 #==== End USAA Drive In Notes ==== 1 8 INFORMATION LABELS 9 S02 Repl Emission label 2.5L Turbo PX2K69036 1 7.23 0.2 10 #S03 Repl Vin No. Label ADL0006 1 124.95 11 #S03 Repl Tire info Label ADL0031 1 31.95 12 FRONT BUMPER & GRILLE 13 O/H bumper assy 2.9 14 *<>S03 Repl Bumper cover w/park sensor KB8B50031FBB 1 367.02 Incl.2.8 15 S02 Add for Three Stage 2.0 16 Add for fog lamps 0.4 17 Add for park sensor m 0.4 18 *S03 Repl Grille assy w/surround view KJK950710A 1 1,126.70 0.8 19 *S03 Repl Closure panel KB8A50717D 1 49.68 Incl. 20 *S03 Repl Upper molding KL2F507E19U 1 165.46 Incl.1.7 21 S02 Add for Three Stage 0.7 22 S02 Repl LT Side bracket KB8A50163B 1 14.45 0.1 23 S02 Refn Tow eye cap 0.2 24 S02 Add for Three Stage 0.1 25 S02 Repl LT Bezel w/fog lamp KB8B50C21C 1 7.70 Incl. 26 S02 Repl LT Mount bracket w/fog lamp KB8B50C22B 1 21.68 Incl. 27 S02 R&I License frame 0.2 28 S02 Repl Prep unprimed bumper 1 0.7 29 S02 Repl Add for park sensor 1 m 0.4 30 S02 Repl Seal plate TK4856381 1 12.25 Incl. 31 S02 Repl LT Cover KB8A50102A 1 6.45 Incl. 32 S02 Repl RT Cover KB8A50101A 1 5.42 Incl. 33 *S03 Repl Retainer arctic white KD4767UC5A64 1 7.58 0.2 34 S02 Add for Three Stage 0.1 35 S02 Repl Emblem w/adaptive cruise TK7951730 1 394.57 Incl. 36 S02 Repl Mount bracket w/adaptive cruise w/front camera KB8D50721 1 25.69 Incl. 37 S02 Repl LT Bumper cover nut C27450133 6 15.66 5/23/2023 4:54:37 PM 419802 Page 3 0901119cb6ddff47 Supplement of Record 3 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White 38 S02 Repl LT Bumper cover clip B45A56146A 6 11.64 39 S02 Repl LT Side retainer KB8A500U1A 1 7.21 Incl. 40 S02 Repl LT Grille assy grommet KD4550ES1 1 1.36 41 S02 Repl RT Upper molding pin S51S51833 4 13.20 42 S02 Repl Upper molding rivet TK2150355 12 40.56 43 S02 Repl LT Grille assy pin KD45501K5A 1 1.24 44 S02 Repl Seal plate fastener GD7A50EA1 6 14.76 45 *S03 Repl LT Park sensor inner arctic white GMK667UC164 1 75.80 m Incl.0.2 Note: LABOR: Time is after bumper cover is removed. Time not included with R&R bumper cover and overhaul. Time is for one sensor. Refinish time is provided when required color is not available or for some repair situations. 46 S02 Add for Three Stage 0.1 47 *S03 Repl LT Wire harness KJK967290 1 113.85 Incl. 48 FRONT LAMPS 49 *S03 Repl LT Headlamp assy w/o directional beam KL2L51041E 1 1,280.93 0.6 50 Aim headlamps 0.5 51 S02 R&I RT R&I headlamp assy 0.4 52 S02 R&I RT Fog lamp assy Incl. 53 S02 Repl LT Fog lamp assy B63B51690A 1 259.64 Incl. 54 S02 Aim fog lamps 0.3 55 S02 Repl LT Lamp bracket KB8B51694 1 12.26 56 S02 Repl LT Wire connector K1Y967SH3 1 7.14 57 HOOD 58 *S03 Repl Hood (HSS)KBY05231XC 1 660.32 1.6 2.8 59 Overlap Major Non-Adj. Panel -0.2 60 S02 Add for Three Stage 1.0 61 Add for Underside(Complete)1.4 62 R&I Insulator Incl. 63 S02 Repl Front w'strip KB7W56770A 1 19.69 Incl. 64 R&I Front seal Incl. 65 R&I Rear w'strip Incl. 66 Repl RT Hinge KB7W52410 1 40.26 0.3 0.4 67 S02 Add for Three Stage 0.2 68 Repl LT Hinge KB7W52420 1 40.26 0.3 0.4 69 S02 Add for Three Stage 0.2 70 S02 Repl Insulator fastener TD1156694 11 23.87 71 FENDER 72 S01 Repl LT Fender KB7W52211 1 378.11 2.1 2.0 73 S01 Overlap Major Adj. Panel -0.4 74 S02 Add for Three Stage 0.6 75 S01 Add for Edging 0.5 76 *S03 Repl LT Fender liner KB7W56140C 1 88.64 Incl. 77 *S03 Repl LT Front bracket KDPW52240 1 28.68 0.1 0.3 78 S02 Add for Three Stage 0.1 79 *S03 Repl LT Wheel opng mldg KB7W51W30E8N 1 142.59 Incl. 80 Repl LT Apron reinf (UHS)KB7W5428X 1 49.32 s 3.0 0.7 5/23/2023 4:54:37 PM 419802 Page 4 0901119cb6ddff47 Supplement of Record 3 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White 81 S02 R&I RT Wheel opng mldg 0.6 82 *S02 Rpr LT Apron assy (HSS)s 1.0 1.6 83 S02 Overlap Minor Panel -0.2 84 S02 Repl LT Lower molding KB7W51W80B 1 11.80 Incl. 85 S02 Repl LT End plate KB7W563K5 1 12.49 Incl. 86 S02 R&I LT End seal Incl. 87 S02 Repl LT Deflector shield KB7W56115B 1 15.40 Incl. 88 S02 Repl LT Lower seal KB7W56J13A 1 28.16 Incl. 89 S02 Repl LT Upper bracket KB7W5422Y 1 7.74 0.1 0.3 90 S02 Add for Three Stage 0.1 91 ELECTRICAL 92 S02 Repl Battery 0000800035WB 1 199.99 m 0.4 93 S02 Repl Fuse & relay box KD4566760A 1 254.03 94 #S03 Repl Relay Cover grt866752 1 28.82 95 WHEELS 96 Repl LT/Front Wheel, alloy 19x7 black metallic 9965507090 1 568.44 m 0.3 97 WINDSHIELD 98 *S03 R&I Windshield Mazda, w/de-icer, w/smart brake w/heads up 0.0 99 S03 Repl Reveal molding KB7W50601A 1 40.72 Incl. 100 #S03 Subl Windshield pull 1 124.00 X 101 COWL 102 S02 R&I LT End cap 0.1 103 PILLARS, ROCKER & FLOOR 104 *S02 Rpr LT W/S pillar reinf (UHS)s 7.0 Note: Damage has streched metal and extends aound panel line into door jam Windshield will have to be removed 105 S02 R&I LT Front sill plate 0.2 106 *S02 Rpr LT Ctr plr & rocker 15.0 3.2 107 S02 Overlap Major Non-Adj. Panel -0.2 108 #S02 Rpr remove wrap and clean adhesive from a pillar 0.5 109 #S02 Subl wrap a pillar 1 150.00 X 110 FRONT DOOR 111 *S03 Repl LT Door shell (HSS)KBY05902XE 1 1,018.64 5.7 3.0 112 Overlap Major Adj. Panel -0.4 113 S02 Add for Three Stage 1.0 114 R&I LT Door w'strip Incl. 115 *S03 Repl LT Window molding KB7W50985N 1 99.95 0.3 116 Repl LT Black out tape front K131508W1 1 5.77 0.3 117 Repl LT Black out tape rear K131508W3 1 7.97 0.3 118 S02 Repl LT Belt molding KB7W50650C 1 36.67 Incl. 119 S02 Repl LT Corner molding piano black KB8A6916YC 1 29.99 0.1 120 *S03 Repl LT Applique black KB8A50M20F 1 55.19 Incl. 5/23/2023 4:54:37 PM 419802 Page 5 0901119cb6ddff47 Supplement of Record 3 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White Note: LABOR: Time for R&I/R&R does not include removing or replacing double-sided tape. 121 *S03 Repl LT Lower molding KB7W51RB0E 1 51.18 0.4 122 R&I LT R&I mirror Incl. 123 R&I LT Door glass Mazda Incl. 124 *R&I LT Run channel Incl. 125 R&I LT R&I carrier assy Incl. 126 R&I LT Handle, outside w/o smart key crystal blue Incl. 127 *R&I LT Handle base Incl. 128 R&I LT Cyl & keys Incl. 129 R&I LT Lock assy Incl. 130 R&I LT Door check Incl. 131 R&I LT R&I trim panel Incl. 132 S03 Repl LT Mirror cover white pearl TK48691N7A64 1 45.94 Incl.0.5 Note: LABOR: Refinish time is provided for those instances when required color is not available or for some repair situations. 133 S03 Overlap Minor Panel -0.2 134 S02 Add for Three Stage 0.1 135 S03 Repl LT Mirror assy w/bld spot, w/pwr fold, w/surround view KJL169181A 1 417.03 Incl. 136 S02 R&I LT Side camera 137 *S02 R&I LT Mirror glass w/blind spot monitor w/heated Incl. 138 *S02 R&I LT Signal lamp Incl. 139 #S02 Subl wrap mirror cover 1 50.00 X 140 S03 Repl LT Handle, outside w/smart key white pearl TK495941XC64 1 94.52 Incl.0.5 Note: LABOR: Time is after carrier assembly is removed. Time includes cap. Refinish time is provided for those instances when required color is not available or for some repair situations. 141 S02 Overlap Minor Panel -0.2 142 S02 Add for Three Stage 0.1 143 S02 Dis/reassmble to refn 0.2 144 S02 R&I LT W'strip on body 0.3 145 REAR DOOR 146 *S02 Rpr LT Outer panel (HSS)2.0 2.1 147 S02 Overlap Major Adj. Panel -0.4 148 S02 Add for Three Stage 0.7 149 S02 R&I LT Lower molding 0.4 150 S02 Repl LT Belt molding KB7W50670C 1 40.01 0.3 151 R&I LT Handle, outside crystal blue 0.4 152 S03 R&I LT R&I door assy 1.1 Note: for paint access 153 VEHICLE DIAGNOSTICS 154 S01 Repl Pre-repair scan 1 50.00 X m 155 S01 Repl Pre-repair scan 1 m 0.5 156 S01 Repl Post-repair scan 1 70.00 X m 5/23/2023 4:54:37 PM 419802 Page 6 0901119cb6ddff47 Supplement of Record 3 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White 157 S01 Repl Post-repair scan 1 m 0.5 158 #S02 Subl Static Calibration - Surround View (Non Toy/For/Nis) 1 475.00 X 159 #S02 Subl Static Calibration - Adaptive Cruise Control - Lidar/Doppler 1 600.00 X 160 #S02 Subl Alignment, 4-wheel 1 89.95 X 161 #S02 Repl Corrosion Protection 1 T 162 #S02 Cover Car for Overspray 1 12.00 X 0.3 163 #S02 Repl Caulk/Seam Sealer 1 T 164 TIRES 165 *S02 Repl TOYO P225/55R19 TYA36 RF BW 99V T16205 1 177.99 0.3 166 #S02 Repl Add for Chip Guard 1 18.00 T 0.5 167 #S02 Cover Interior for Protection 1 6.00 X 0.3 168 #S02 Repl Cavity Wax 1 18.00 T 0.5 169 #S02 Subl Hazardous Waste Disposal 1 5.00 X 170 #S02 License Plate 1 T 0.2 171 #S02 Refn Left Roof Rail Clear Only 0.8 172 #S02 Mask Jambs, Opening, Entry 1 12.00 X 0.3 173 #S02 Remove Adhesive from Repaired Panel 1 3.00 X 0.5 174 #S03 FREIGHT 1 175 #S03 CORE ON BATTERY 1 176 **S03 A/M FREIGHT 1 SUBTOTALS 10,627.16 55.0 31.7 NOTES Estimate Notes: DR = 3/21/2023 DC = 3/21/2023 DI = 3/21/2023 ERT = 15 DRV = no SCHD = Prod Date = 06/2016 Vehicle owner KATE STOTTLEMYER (handed, mailed, faxed, e-mailed etc.) copy of damage report prior to repairs. No Vehicle owner KATE STOTTLEMYER (handed, mailed, faxed, e-mailed etc.) QRP Brochure. N Prior Damage = Preliminary damage report - do not issue payment (as/if applicable) Final Damage report OK To Pay (as/when applicable) Date of completed repair (when applicable, and when known) N/A ****Borderline Total Loss Tool**** Teardown: Yes License Plate State: MN Preliminary estimate of visible damage: $17486.99 Potential supplemental damage: $0 *Explanation: Vehicle value (pre-tax): $28762.00 Vehicle Value Taxes: $1889.53 5/23/2023 4:54:37 PM 419802 Page 7 0901119cb6ddff47 Supplement of Record 3 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White Salvage Value: $5752.00 **** 1) Vehicle is currently at 70 % of 100 % total loss threshold; $7413 to reach threshold 2) Upload Estimate as Repairable - Damage Under Threshold (Prior to uploading the estimate, contact the USAA IPDS team to discuss the unrelated prior damage) 3) Ensure limited to no chance of significant engine, suspension, or transmission damage ESTIMATE TOTALS Category Basis Rate Cost $ Parts 8,944.21 Body Labor 55.0 hrs @ $ 69.00 /hr 3,795.00 Paint Labor 31.7 hrs @ $ 69.00 /hr 2,187.30 Paint Supplies 31.7 hrs @ $ 50.00 /hr 1,585.00 Miscellaneous 1,682.95 Pre-Tax Discount -2.6 %-473.06 Subtotal 17,721.40 Sales Tax $ 10,290.51 @ 7.3750 %758.93 Grand Total 18,480.33 Deductible 1,000.00 CUSTOMER PAY 1,000.00 INSURANCE PAY 17,480.33 5/23/2023 4:54:37 PM 419802 Page 8 0901119cb6ddff47 Supplement of Record 3 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White SUPPLEMENT SUMMARY Line Oper Description Part Number Qty Extended Price $ Labor Paint Changed Items 10 #S02 Repl Vin No. Label 1 -1.00 10 #S03 Repl Vin No. Label ADL0006 1 124.95 11 #S02 Repl Tire info Label 1 -1.00 11 #S03 Repl Tire info Label ADL0031 1 31.95 14 <>Repl Bumper cover w/park sensor KN3L50031BB 1 -365.95 Incl.-2.8 14 *<>S03 Repl Bumper cover w/park sensor KB8B50031FBB 1 367.02 Incl.2.8 18 Repl Grille assy w/surround view K26250710A 1 -1,246.39 -0.8 18 *S03 Repl Grille assy w/surround view KJK950710A 1 1,126.70 0.8 19 Repl Closure panel KB8A50717D 1 -48.71 Incl. 19 *S03 Repl Closure panel KB8A50717D 1 49.68 Incl. 20 Repl Upper molding KL2F507E19U 1 -162.21 Incl.-1.7 20 *S03 Repl Upper molding KL2F507E19U 1 165.46 Incl.1.7 33 S02 Repl Retainer arctic white KD4767UC5A33 1 -6.84 -0.2 33 *S03 Repl Retainer arctic white KD4767UC5A64 1 7.58 0.2 45 S02 Repl LT Park sensor inner arctic white GMK667UC133 1 -85.76 m Incl.-0.2 45 *S03 Repl LT Park sensor inner arctic white GMK667UC164 1 75.80 m Incl.0.2 NOTE: LABOR: Time is after bumper cover is removed. Time not included with R&R bumper cover and overhaul. Time is for one sensor. Refinish time is provided when required color is not available or for some repair situations. 47 S02 Repl LT Wire harness K26267290A 1 -47.13 Incl. 47 *S03 Repl LT Wire harness KJK967290 1 113.85 Incl. 49 Repl LT Headlamp assy w/o directional beam KL2J51041D 1 -694.34 -0.6 49 *S03 Repl LT Headlamp assy w/o directional beam KL2L51041E 1 1,280.93 0.6 58 Repl Hood (HSS)KBY05231XB 1 -683.39 -1.6 -2.8 58 *S03 Repl Hood (HSS)KBY05231XC 1 660.32 1.6 2.8 76 Repl LT Fender liner KB7W56140C 1 -86.90 Incl. 76 *S03 Repl LT Fender liner KB7W56140C 1 88.64 Incl. 77 Repl LT Front bracket KDPW52240 1 -28.13 -0.1 -0.3 77 *S03 Repl LT Front bracket KDPW52240 1 28.68 0.1 0.3 79 Repl LT Wheel opng mldg KB7W51W30E8N 1 -139.79 Incl. 79 *S03 Repl LT Wheel opng mldg KB7W51W30E8N 1 142.59 Incl. 106 Repl LT Door shell (HSS)KBY05902XE 1 -998.67 -5.7 -3.0 111 *S03 Repl LT Door shell (HSS)KBY05902XE 1 1,018.64 5.7 3.0 110 Repl LT Window molding KB7W50985N 1 -97.98 -0.3 115 *S03 Repl LT Window molding KB7W50985N 1 99.95 0.3 115 S02 Repl LT Applique black KB7W50M20B 1 -52.64 Incl. NOTE: LABOR: Time for R&I/R&R does not include removing or replacing double-sided tape. 120 *S03 Repl LT Applique black KB8A50M20F 1 55.19 Incl. NOTE: LABOR: Time for R&I/R&R does not include removing or replacing double-sided tape. 5/23/2023 4:54:37 PM 419802 Page 9 0901119cb6ddff47 Supplement of Record 3 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White 116 Repl LT Lower molding KB7W51RB0E 1 -50.18 -0.4 121 *S03 Repl LT Lower molding KB7W51RB0E 1 51.18 0.4 127 S02 Repl LT Mirror cover white pearl TK48691N7A64 1 -45.94 Incl.-0.5 132 S03 Repl LT Mirror cover white pearl TK48691N7A64 1 45.94 Incl.0.5 NOTE: LABOR: Refinish time is provided for those instances when required color is not available or for some repair situations. 135 S02 Repl LT Handle, outside w/smart key white pearl TK495941XC64 1 -94.52 Incl.-0.5 140 S03 Repl LT Handle, outside w/smart key white pearl TK495941XC64 1 94.52 Incl.0.5 NOTE: LABOR: Time is after carrier assembly is removed. Time includes cap. Refinish time is provided for those instances when required color is not available or for some repair situations. Deleted Items 128 S02 Overlap Minor Panel 0.2 Added Items 94 #S03 Repl Relay Cover grt866752 1 28.82 97 WINDSHIELD 98 *S03 R&I Windshield Mazda, w/de-icer, w/smart brake w/heads up 0.0 99 S03 Repl Reveal molding KB7W50601A 1 40.72 Incl. 100 #S03 Subl Windshield pull 1 124.00 X 133 S03 Overlap Minor Panel -0.2 152 S03 R&I LT R&I door assy 1.1 NOTE: for paint access 174 #S03 FREIGHT 1 175 #S03 CORE ON BATTERY 1 176 **S03 A/M FREIGHT 1 SUBTOTALS 885.64 1.1 0.0 TOTALS SUMMARY Category Basis Rate Cost $ Parts 761.64 Body Labor 1.1 hrs @ $ 69.00 /hr 75.90 Paint Labor 0.00 Paint Supplies 0.00 Miscellaneous 124.00 Pre-Tax Discount -2.6 %-25.00 Subtotal 936.54 Sales Tax $ 741.84 @ 7.3750 %54.75 Additional Supplement Taxes -0.03 Total Supplement Amount 991.26 NET COST OF SUPPLEMENT 991.26 5/23/2023 4:54:37 PM 419802 Page 10 0901119cb6ddff47 Supplement of Record 3 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White CUMULATIVE EFFECTS OF SUPPLEMENT(S) Estimate 10,030.93 Lee Stuessi Supplement S01 143.27 Lee Stuessi Supplement S02 7,314.87 Lee Stuessi Supplement S03 991.26 Lee Stuessi Job Total: $18,480.33 CUSTOMER PAY: $1,000.00 INSURANCE PAY: $17,480.33 ======================================================================= Caliber Collision is the industry leader in quality collision repair. Since day one, our highest purpose has been to get people just like you back on the road as quickly as possible and fully restored to the rhythm of your life. You can be sure we do everything possible to ensure your complete satisfaction including: Personalized, high quality service from the largest collision repair company in the U.S. Consistently ranked among the highest customer satisfaction scores in the industry. Approved by every major insurance company in the U.S. Expedited car rental and towing services to get you back on the road again in no time. Repair work backed by a written, lifetime warranty honored at every location. 24/7/365 customer service to answer questions and put your mind at ease. This is a preliminary estimate based on visible damage. There may be additional repairs needed once the vehicle is taken apart by our I-CAR Gold Class technicians to identify any additional damage. If an insurance company has written an estimate for you, please provide us with a copy. Properly endorsed insurance company checks are welcome as payment for the repair of your vehicle. Caliber Collision gladly accepts all major credit cards, debit cards, cashier's and traveler's checks. See your Caliber Collision center for details on acceptance of personal checks. Before leaving your vehicle with us, please remove all important personal and valuable items from your vehicle. Caliber Collision is not responsible for belongings left in your vehicle. Please let us know how we can be of further assistance, and when we can schedule an appointment for your vehicle to be repaired. Caliber Collision - Restoring The Rhythm Of Your Life ======================================================================= 5/23/2023 4:54:37 PM 419802 Page 11 0901119cb6ddff47 Supplement of Record 3 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White AVOID DELAYS BY GETTING CLAIM AND PAYMENT INFORMATION IN JUST A FEW CLICKS! VISIT: http://www.usaa.com/bodyshop MEMBER NUMBER: Use Policy Number LOSS NUMBER: Use digits 16, 17, & 18 of the claim number (Ex. 012345670000000[003]001) LOSS DATE: Use Date of Loss Please Present A Copy Of This Estimate To A Repair Facility Of Your Choice *USAA Subsidiaries include: United Services Automobile Association(USAA), USAA Casualty Insurance Company(CIC), USAA General Indemnity Company(GIC) USAA County Mutual Insurance(CMI) and Garrison Property Casualty Insurance Company. Garrison Property and Casualty Insurance Company, a subsidiary of USAA Casualty Insurance Company, is authorized to use the USAA logo, a registered trademark of United Services Automobile Association. This is not an authorization to repair. Failing to present this estimate to the repairing garage before repair may result in additional expenses to you. A USAA appraiser must authorize any supplement to this estimate. Repairs to this vehicle may require specific welding equipment as recommended by the manufacturer. If alternative quality replacement parts have been included in this appraisal, the source for these parts has also been disclosed. If alternative quality replacement parts as listed on the appraisal are ultimately used in the repair of your vehicle, the warranty on such parts will be equal to, or greater than, the parts being replaced, as stated in USAA's limited parts warranty. USAA warrants that the parts used on your vehicle will be of like kind and quality, function, fit, safety and corrosion protection as the part or parts they replace. USAA identifies certified and validated parts for sheet metal replacement parts. MN ST 60A.955 - A PERSON WHO FILES A CLAIM WITH INTENT TO DEFRAUD OR HELPS COMMIT A FRAUD AGAINST AN INSURER IS GUILTY OF A CRIME. THIS ESTIMATE HAS BEEN PREPARED BASED ON THE USE OF AUTOMOBILE PARTS NOT MADE BY THE ORIGINAL MANUFACTURER. THE INSURER WARRANTS THAT ANY NON-ORIGINAL EQUIPMENT MANUFACTURER PARTS SPECIFIED IN THIS ESTIMATE ARE AT LEAST EQUAL TO THE ORIGINAL EQUIPMENT MANUFACTURER PARTS IN TERMS OF KIND, QUALITY, SAFETY, FIT AND PERFORMANCE. 5/23/2023 4:54:37 PM 419802 Page 12 0901119cb6ddff47 Supplement of Record 3 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White Estimate based on MOTOR CRASH ESTIMATING GUIDE and potentially other third party sources of data. Unless otherwise noted, (a) all items are derived from the Guide ARH5471, CCC Data Date 05/16/2023, and potentially other third party sources of data; and (b) the parts presented are OEM-parts. OEM parts are manufactured by or for the vehicle's Original Equipment Manufacturer (OEM) according to OEM's specifications for U.S. distribution. OEM parts are available at OE/Vehicle dealerships or the specified supplier. 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 with discounted pricing. Asterisk (*) or Double Asterisk (**) indicates that the parts and/or labor data provided by third party sources of data 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, A/M or NAGS. 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 2023 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 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. Blnd=Blend. BOR=Boron steel. CAPA=Certified Automotive Parts Association. D&R=Disconnect and Reconnect. HSS=High Strength Steel. HYD=Hydroformed Steel. Incl.=Included. LKQ=Like Kind and Quality. LT=Left. MAG=Magnesium. Non-Adj.=Non Adjacent. NSF=NSF International Certified Part. O/H=Overhaul. Qty=Quantity. Refn=Refinish. Repl=Replace. R&I=Remove and Install. R&R=Remove and Replace. Rpr=Repair. RT=Right. SAS=Sandwiched Steel. Sect=Section. Subl=Sublet. UHS=Ultra High Strength Steel. N=Note(s) associated with the estimate line. CCC ONE Estimating - A product of CCC Intelligent 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. 5/23/2023 4:54:37 PM 419802 Page 13 0901119cb6ddff47 Supplement of Record 3 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White *Limited Parts Warranty Curb the High Cost of Vehicle Repairs With USAA's Quality Replacement Parts Program USAA warrants replacement body and mechanical parts in the QRP program when installed during vehicle repairs and listed on our damage report. These parts will be like kind and quality to the function, fit, finish and corrosion protection of the damaged parts they replace, or the parts will be repaired or replaced at no cost to you. Our warranty on sheet metal and plastic replacement body parts is valid for the period of time equal to the remainder of the original manufacturer's warranty or three years from the date of the repair, whichever is greater. Our warranty on mechanical parts will be equal to the warranty period provided by an authorized original manufacturer for those parts when provided through your manufacturer's distributor as replacement parts. The USAA warranty on replacement parts automatically transfers with ownership of the vehicle. Excluded from this warranty is normal wear and tear and damage caused by accident, abuse, unreasonable use or improper maintenance of the vehicle. Any express warranty not provided herein is hereby excluded and disclaimed. Any implied warranties of merchantability and fitness for any particular purpose which may exist, are expressly limited to the period of time equal to the remainder of the original manufacturer's warranty for like kind, quality, function, fit, finish and corrosion protection or three years from the date of the original repair, whichever is greater. Some states do not allow limitations on how long an implied warranty lasts, so the above limitation may not apply to you. USAA shall not be liable to any person for any special, incidental or consequential damages, whether arising out of breach of warranty, breach of contract or otherwise. Some states do not allow the exclusion or limitation of special, incidental or consequential damages, so the above limitation or exclusion may not apply to you. USAA would like you to feel confident about the reasons for supporting the Quality Replacement Parts program (QRP). Together we can ensure the highest level of collision repair quality by supporting a program that promotes competition through use of alternative replacement parts. The following questions and answers may help you understand more about USAA's QRP program. Q. What are OEM, non-OEM, and recycled parts? A. OEM: Parts manufactured for or by the manufacturer of your vehicle. Non-OEM: Parts provided by a company or distributor other than the original equipment manufacturer. Recycled: Parts from a vehicle of the same or newer make, model, and year vehicle that they are to replace. Q. What assurances do I have that QRP parts are of high quality? A. USAA only includes QRP parts when readily available and equivalent in performance to the part requiring replacement on your vehicle in terms of like kind, quality, function, fit, finish and corrosion protection. Also, QRP parts carry an equal or better warranty than the original manufacturer's parts and are supported by our Limited Parts Warranty. * Glass, lights and lenses will meet DOT/SAE standards. * New sheet metal and plastic body replacement panels will be certified or validated through an independent third-party. * USAA will identify other parts included in the program that comply with federal safety standards including new, recycled, or rebuilt parts. Q. Why does USAA use parts from other manufacturers and distributors? A. We use these parts to help keep vehicle repairs competitive in terms of price when the parts are of like kind, quality, function, fit, finish, and corrosion protection or better quality. Q. Do I have a choice which parts are included in USAA's repair estimate? A. Yes, you do. If you choose to use new OEM parts or parts from other manufacturers and distributors, you will bear the responsibility for any cost difference. 5/23/2023 4:54:37 PM 419802 Page 14 0901119cb6ddff47 Supplement of Record 3 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White Q. If I am dissatisfied with a non-OEM part used in my vehicle repair, who do I call? A. If you experience a problem, call your claims advisor. We will work with the repair shop and the parts supplier to correct the problem at no cost to you, so long as the part is still under USAA's warranty. Q. Will using a non-OEM part void the warranty on my vehicle? A. The overall warranty on your vehicle will not be adversely affected. QRP parts included in your vehicle's repair will carry USAA's Limited Parts Warranty. It is equal to or better than the warranty provided by the distributor for new OEM parts. Q. What should I do if my repair shop refuses to use QRP parts? A. Your repair shop has the right to conduct its business the way it chooses and can charge you more than the reasonable and competitive cost for the repair; so, you will have to choose where and how your vehicle will be repaired. If you choose not to use another repairer and/or your shop refuses to use QRP parts, you will have to pay any difference in the final repair cost. USAA Claims Philosophy It is the policy of USAA to handle all claims with fairness and integrity, exercising the highest standards of ethical and professional conduct while transacting claims business. We will provide timely and responsive service, with full recognition of our obligations to the insureds and the public. If you have questions about the program or warranty, log on to http://usaa.com or call 1-800-531-USAA (8722). 5/23/2023 4:54:37 PM 419802 Page 15 0901119cb6ddff47 Supplement of Record 3 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White PARTS SUPPLIER LIST Line Supplier Description Price 99 Morrie's Minnetonka Mazda #KB7W50601A $ 40.72 13700 Wayzata Blvd.Reveal molding Minnetonka MN 55305 Quote: 1518555828 Expires: 06/04/23 5/23/2023 4:54:37 PM 419802 Page 16 0901119cb6ddff47 Supplement of Record 3 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White TIRE PARTS SUPPLIERS Line Description Supplier Price 165 TOYO P225/55R19 TYA36 RF BW 99V MERCHANTS TIRE $ 177.99 10292 HARRY J PARRISH BLVD, MANASSAS VA 20110-0 (703) 257-2074 5/23/2023 4:54:37 PM 419802 Page 17 0901119cb6ddff47 Supplement of Record 3 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White ALTERNATE PARTS USAGE 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White VIN:JM3KFBEY8M0422323 Interior Color:Mileage In:25,693 Vehicle Out:6/2/2023 License:HAR419 Exterior Color:White Mileage Out:25,694 State:MN Production Date:5/2021 Condition:Job #: Alternate Part Type Selection Method # Of Times Notified Of Available Parts # Of Parts Selected Aftermarket Automatically List 0 1 Optional OEM Automatically List 0 0 Reconditioned Automatically List 0 0 Recycled N/A 0 0 5/23/2023 4:54:37 PM 419802 Page 18 0901119cb6ddff47 0901119cb6ddff48 0901119cb6ddff48 0901119cb6ddff48 0901119cb6ddff48 CALIBER - ROSEVILLE MN Workfile ID: Federal ID: State ID: Federal EPA: 0070e5b7 33-0730794 6144514 MNS000333664RESTORING THE RHYTHM OF YOUR LIFE 1914 West County Road C, Roseville, MN 55113 Phone: (651) 639-9848 FAX: (651) 639-9406 Supplement of Record 4 with Summary RO Number: 3311046811 Written By: Lee Stuessi, 6/6/2023 1:11:35 PM Adjuster: Martinez, Ray, (000) 000-0000 x22 Business Insured:STOTTLEMYER, KATE Policy #:009762873 Claim #:009762873000000023001 Type of Loss:Collision Date of Loss:3/21/2023 12:00 PM Days to Repair:15 Point of Impact:11 Left Front Owner:Inspection Location:Insurance Company: STOTTLEMYER, KATE CALIBER - ROSEVILLE MN USAA CASUALTY INSURANCE COMPANY 165 HAWES AVE 1914 West County Road C DRP-4187 SHOREVIEW, MN 55126 Roseville, MN 55113 Visit us at USAA.com or Call #8722 (612) 321-1933 Cell Repair Facility P.O. Box 33490 (612) 321-1933 Evening (651) 639-9848 Business San Antonio, TX 78265 (800) 531-8722 Business VEHICLE 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White VIN:JM3KFBEY8M0422323 Interior Color:Mileage In:25,693 Vehicle Out:6/6/2023 License:HAR419 Exterior Color:White Mileage Out:25,694 State:MN Production Date:5/2021 Condition:Job #: TRANSMISSION Tilt Wheel Stereo Electric Glass Sunroof Automatic Transmission Cruise Control Search/Seek SEATS 4 Wheel Drive Rear Defogger Auxiliary Audio Connection Bucket Seats POWER Keyless Entry Premium Radio Leather Seats Power Steering Message Center Satellite Radio Heated Seats Power Brakes Steering Wheel Touch Controls SAFETY Rear Heated Seats Power Windows Rear Window Wiper Drivers Side Air Bag Ventilated Seats Power Locks Telescopic Wheel Passenger Air Bag WHEELS Power Mirrors Heated Steering Wheel Anti-Lock Brakes (4)Aluminum/Alloy Wheels Heated Mirrors Climate Control 4 Wheel Disc Brakes PAINT Power Driver Seat Navigation System Traction Control Three Stage Paint Power Passenger Seat Backup Camera Stability Control OTHER DECOR Parking Sensors Front Side Impact Air Bags Fog Lamps Dual Mirrors Surround View Camera Head/Curtain Air Bags Rear Spoiler Privacy Glass Remote Starter Hands Free Device Signal Integrated Mirrors Console/Storage Intelligent Cruise Xenon or L.E.D. Headlamps TRUCK Overhead Console Home Link Blind Spot Detection Power Trunk/Liftgate CONVENIENCE RADIO Heads Up Display 6/6/2023 1:11:35 PM 419802 Page 1 0901119cb6f8c603 Supplement of Record 4 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White Air Conditioning AM Radio Lane Departure Warning Intermittent Wipers FM Radio ROOF 6/6/2023 1:11:35 PM 419802 Page 2 0901119cb6f8c603 Supplement of Record 4 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White Line Oper Description Part Number Qty Extended Price $ Labor Paint 1 #==== Required Notes for USAA Drive Ins ==== 1 2 #For Supplements Use Estimate Share Within CCC One 1 3 #Have Questions or Non-CCC User? 1 4 #Call 800.637.8511 - Press 2 for Repair Facility 1 5 #Then Press 2 for Technical Support, 1 6 #Then Press 4 for "All Other"1 7 #==== End USAA Drive In Notes ==== 1 8 INFORMATION LABELS 9 S02 Repl Emission label 2.5L Turbo PX2K69036 1 7.23 0.2 10 #S03 Repl Vin No. Label ADL0006 1 124.95 11 #S03 Repl Tire info Label ADL0031 1 31.95 12 FRONT BUMPER & GRILLE 13 O/H bumper assy 2.9 14 *<>S03 Repl Bumper cover w/park sensor KB8B50031FBB 1 367.02 Incl.2.8 15 S02 Add for Three Stage 2.0 16 Add for fog lamps 0.4 17 Add for park sensor m 0.4 18 *S03 Repl Grille assy w/surround view KJK950710A 1 1,126.70 0.8 19 *S03 Repl Closure panel KB8A50717D 1 49.68 Incl. 20 *S03 Repl Upper molding KL2F507E19U 1 165.46 Incl.1.7 21 S02 Add for Three Stage 0.7 22 S02 Repl LT Side bracket KB8A50163B 1 14.45 0.1 23 S02 Refn Tow eye cap 0.2 24 S02 Add for Three Stage 0.1 25 S02 Repl LT Bezel w/fog lamp KB8B50C21C 1 7.70 Incl. 26 S02 Repl LT Mount bracket w/fog lamp KB8B50C22B 1 21.68 Incl. 27 S02 R&I License frame 0.2 28 S02 Repl Prep unprimed bumper 1 0.7 29 S02 Repl Add for park sensor 1 m 0.4 30 S02 Repl LT Cover KB8A50102A 1 6.45 Incl. 31 S02 Repl RT Cover KB8A50101A 1 5.42 Incl. 32 *S03 Repl Retainer arctic white KD4767UC5A64 1 7.58 0.2 33 S02 Add for Three Stage 0.1 34 S02 Repl Emblem w/adaptive cruise TK7951730 1 394.57 Incl. 35 S02 Repl LT Bumper cover clip B45A56146A 6 11.64 36 S02 Repl LT Side retainer KB8A500U1A 1 7.21 Incl. 37 S02 Repl LT Grille assy grommet KD4550ES1 1 1.36 38 S02 Repl RT Upper molding pin S51S51833 4 13.20 6/6/2023 1:11:35 PM 419802 Page 3 0901119cb6f8c603 Supplement of Record 4 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White 39 S02 Repl Upper molding rivet TK2150355 12 40.56 40 S02 Repl LT Grille assy pin KD45501K5A 1 1.24 41 S02 Repl Seal plate fastener GD7A50EA1 6 14.76 42 *S03 Repl LT Park sensor inner arctic white GMK667UC164 1 75.80 m Incl.0.2 Note: LABOR: Time is after bumper cover is removed. Time not included with R&R bumper cover and overhaul. Time is for one sensor. Refinish time is provided when required color is not available or for some repair situations. 43 S02 Add for Three Stage 0.1 44 *S03 Repl LT Wire harness KJK967290 1 113.85 Incl. 45 FRONT LAMPS 46 *S03 Repl LT Headlamp assy w/o directional beam KL2L51041E 1 1,280.93 0.6 47 Aim headlamps 0.5 48 S02 R&I RT R&I headlamp assy 0.4 49 S02 R&I RT Fog lamp assy Incl. 50 S02 Repl LT Fog lamp assy B63B51690A 1 259.64 Incl. 51 S02 Aim fog lamps 0.3 52 S02 Repl LT Lamp bracket KB8B51694 1 12.26 53 S02 Repl LT Wire connector K1Y967SH3 1 7.14 54 HOOD 55 *S03 Repl Hood (HSS)KBY05231XC 1 660.32 1.6 2.8 56 Overlap Major Non-Adj. Panel -0.2 57 S02 Add for Three Stage 1.0 58 Add for Underside(Complete)1.4 59 R&I Insulator Incl. 60 S02 Repl Front w'strip KB7W56770A 1 19.69 Incl. 61 R&I Front seal Incl. 62 R&I Rear w'strip Incl. 63 Repl RT Hinge KB7W52410 1 40.26 0.3 0.4 64 S02 Add for Three Stage 0.2 65 Repl LT Hinge KB7W52420 1 40.26 0.3 0.4 66 S02 Add for Three Stage 0.2 67 S02 Repl Insulator fastener TD1156694 11 23.87 68 FENDER 69 S01 Repl LT Fender KB7W52211 1 378.11 2.1 2.0 70 S01 Overlap Major Adj. Panel -0.4 71 S02 Add for Three Stage 0.6 72 S01 Add for Edging 0.5 73 *S03 Repl LT Fender liner KB7W56140C 1 88.64 Incl. 74 *S03 Repl LT Front bracket KDPW52240 1 28.68 0.1 0.3 75 S02 Add for Three Stage 0.1 76 *S03 Repl LT Wheel opng mldg KB7W51W30E8N 1 142.59 Incl. 77 S02 R&I RT Wheel opng mldg 0.6 78 *S02 Rpr LT Apron assy (HSS)s 1.0 1.6 79 S02 Repl LT Lower molding KB7W51W80B 1 11.80 Incl. 80 S02 Repl LT End plate KB7W563K5 1 12.49 Incl. 81 S02 R&I LT End seal Incl. 6/6/2023 1:11:35 PM 419802 Page 4 0901119cb6f8c603 Supplement of Record 4 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White 82 S02 Repl LT Deflector shield KB7W56115B 1 15.40 Incl. 83 S02 Repl LT Lower seal KB7W56J13A 1 28.16 Incl. 84 S02 Repl LT Upper bracket KB7W5422Y 1 7.74 0.1 0.3 85 S02 Add for Three Stage 0.1 86 ELECTRICAL 87 S02 Repl Battery 0000800035WB 1 199.99 m 0.4 88 #S03 Repl Relay Cover grt866752 1 28.82 89 WHEELS 90 *S04 Repl LT/Front Wheel, alloy 19x7 black metallic 9965507090 1 154.00 m 0.3 91 WINDSHIELD 92 *S03 R&I Windshield Mazda, w/de-icer, w/smart brake w/heads up 0.0 93 S03 Repl Reveal molding KB7W50601A 1 40.72 Incl. 94 #S03 Subl Windshield pull 1 124.00 X 95 COWL 96 S02 R&I LT End cap 0.1 97 PILLARS, ROCKER & FLOOR 98 *S02 Rpr LT W/S pillar reinf (UHS)s 7.0 Note: Damage has streched metal and extends aound panel line into door jam Windshield will have to be removed 99 S02 R&I LT Front sill plate 0.2 100 *S02 Rpr LT Ctr plr & rocker 15.0 3.2 101 S02 Overlap Major Non-Adj. Panel -0.2 102 #S02 Rpr remove wrap and clean adhesive from a pillar 0.5 103 #S04 Subl wrap a pillar 1 250.00 X 104 FRONT DOOR 105 *S03 Repl LT Door shell (HSS)KBY05902XE 1 1,018.64 5.7 3.0 106 Overlap Major Adj. Panel -0.4 107 S02 Add for Three Stage 1.0 108 R&I LT Door w'strip Incl. 109 *S03 Repl LT Window molding KB7W50985N 1 99.95 0.3 110 Repl LT Black out tape front K131508W1 1 5.77 0.3 111 Repl LT Black out tape rear K131508W3 1 7.97 0.3 112 S02 Repl LT Belt molding KB7W50650C 1 36.67 Incl. 113 S02 Repl LT Corner molding piano black KB8A6916YC 1 29.99 0.1 114 *S03 Repl LT Applique black KB8A50M20F 1 55.19 Incl. Note: LABOR: Time for R&I/R&R does not include removing or replacing double-sided tape. 115 *S03 Repl LT Lower molding KB7W51RB0E 1 51.18 0.4 116 R&I LT R&I mirror Incl. 117 R&I LT Door glass Mazda Incl. 118 *R&I LT Run channel Incl. 119 R&I LT R&I carrier assy Incl. 120 R&I LT Handle, outside w/o smart key Incl. 6/6/2023 1:11:35 PM 419802 Page 5 0901119cb6f8c603 Supplement of Record 4 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White crystal blue 121 *R&I LT Handle base Incl. 122 R&I LT Cyl & keys Incl. 123 R&I LT Lock assy Incl. 124 R&I LT Door check Incl. 125 R&I LT R&I trim panel Incl. 126 S03 Repl LT Mirror cover white pearl TK48691N7A64 1 45.94 Incl.0.5 Note: LABOR: Refinish time is provided for those instances when required color is not available or for some repair situations. 127 S03 Overlap Minor Panel -0.2 128 S02 Add for Three Stage 0.1 129 S03 Repl LT Mirror assy w/bld spot, w/pwr fold, w/surround view KJL169181A 1 417.03 Incl. 130 S02 R&I LT Side camera 131 *S02 R&I LT Mirror glass w/blind spot monitor w/heated Incl. 132 *S02 R&I LT Signal lamp Incl. 133 #S04 Subl wrap mirror cover 1 187.50 X 134 S03 Repl LT Handle, outside w/smart key white pearl TK495941XC64 1 94.52 Incl.0.5 Note: LABOR: Time is after carrier assembly is removed. Time includes cap. Refinish time is provided for those instances when required color is not available or for some repair situations. 135 S02 Overlap Minor Panel -0.2 136 S02 Add for Three Stage 0.1 137 S02 Dis/reassmble to refn 0.2 138 S02 R&I LT W'strip on body 0.3 139 REAR DOOR 140 *S02 Rpr LT Outer panel (HSS)2.0 2.1 141 S02 Overlap Major Adj. Panel -0.4 142 S02 Add for Three Stage 0.7 143 S02 R&I LT Lower molding 0.4 144 S02 Repl LT Belt molding KB7W50670C 1 40.01 0.3 145 R&I LT Handle, outside crystal blue 0.4 146 S03 R&I LT R&I door assy 1.1 Note: for paint access 147 VEHICLE DIAGNOSTICS 148 S01 Repl Pre-repair scan 1 50.00 X m 149 S01 Repl Pre-repair scan 1 m 0.5 150 S01 Repl Post-repair scan 1 70.00 X m 151 S01 Repl Post-repair scan 1 m 0.5 152 #S02 Subl Static Calibration - Surround View (Non Toy/For/Nis) 1 475.00 X 153 #S04 Subl Clear Codes 1 125.00 X 154 #S02 Subl Alignment, 4-wheel 1 89.95 X 155 #S02 Repl Corrosion Protection 1 T 156 #S02 Cover Car for Overspray 1 12.00 X 0.3 6/6/2023 1:11:35 PM 419802 Page 6 0901119cb6f8c603 Supplement of Record 4 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White 157 #S02 Repl Add for Chip Guard 1 18.00 T 0.5 158 #S02 Cover Interior for Protection 1 6.00 X 0.3 159 #S02 Subl Hazardous Waste Disposal 1 5.00 X 160 #S02 License Plate 1 T 0.2 161 #S02 Refn Left Roof Rail Clear Only 0.8 162 #S02 Mask Jambs, Opening, Entry 1 12.00 X 0.3 163 #S02 Remove Adhesive from Repaired Panel 1 3.00 X 0.5 164 #S03 FREIGHT 1 165 #S03 CORE ON BATTERY 1 166 **S03 A/M FREIGHT 1 167 #S04 Gas 1 10.05 168 **S04 A/M Fender [Left] - Qty: 0.3 (Can(s)) - 3M Cavity wax amber 1 11.80 0.2 169 **S04 A/M Door Shell [Left,Rear] - Qty: 0.5 (Can(s)) - 3M Cavity wax amber 1 19.68 0.3 170 **S04 A/M Rocker Panel [Left] - Qty: 0.5 (Can(s)) - 3M Cavity wax amber 1 19.68 0.3 171 **S04 A/M Hood [] - Qty: 0.8 (Cartridge(s)) - 3M Bare metal seam sealer 1 49.74 0.5 172 **S04 A/M Door Shell [Front,Left] - Qty: 0.5 (Can(s)) - 3M Cavity wax amber 1 19.68 0.3 173 **S04 A/M Door Shell [Front,Left] - Qty: 1 (Sheet(s)) - 3M Sound deadening pads 1 13.27 0.2 174 **S04 A/M A-Pillar [Left] - Qty: 0.3 (Can(s)) - 3M Cavity wax amber 1 11.80 0.3 175 **S04 A/M Hood [] - Qty: 0.5 (Can(s)) - 3M Cavity wax amber 1 19.68 0.3 176 **S04 A/M Door Shell [Front,Left] - Qty: 0.7 (Cartridge(s)) - 3M Bare metal seam sealer 1 43.53 0.6 177 #S04 Repl A/M Clips/Fasteners & Retainers 1 33.52 T 178 #S04 Subl OE Tool Access Fee (software fees)** 1 75.00 X SUBTOTALS 9,749.71 54.2 31.2 NOTES Estimate Notes: DR = 3/21/2023 DC = 3/21/2023 DI = 3/21/2023 ERT = 15 DRV = no SCHD = Prod Date = 06/2016 6/6/2023 1:11:35 PM 419802 Page 7 0901119cb6f8c603 Supplement of Record 4 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White Vehicle owner KATE STOTTLEMYER (handed, mailed, faxed, e-mailed etc.) copy of damage report prior to repairs. No Vehicle owner KATE STOTTLEMYER (handed, mailed, faxed, e-mailed etc.) QRP Brochure. N Prior Damage = Preliminary damage report - do not issue payment (as/if applicable) Final Damage report OK To Pay (as/when applicable) Date of completed repair (when applicable, and when known) N/A ****Borderline Total Loss Tool**** Teardown: Yes License Plate State: MN Preliminary estimate of visible damage: $17486.99 Potential supplemental damage: $0 *Explanation: Vehicle value (pre-tax): $28762.00 Vehicle Value Taxes: $1889.53 Salvage Value: $5752.00 **** 1) Vehicle is currently at 70 % of 100 % total loss threshold; $7413 to reach threshold 2) Upload Estimate as Repairable - Damage Under Threshold (Prior to uploading the estimate, contact the USAA IPDS team to discuss the unrelated prior damage) 3) Ensure limited to no chance of significant engine, suspension, or transmission damage ESTIMATE TOTALS Category Basis Rate Cost $ Parts 8,213.74 Body Labor 54.2 hrs @ $ 69.00 /hr 3,739.80 Paint Labor 31.2 hrs @ $ 69.00 /hr 2,152.80 Paint Supplies 31.2 hrs @ $ 50.00 /hr 1,560.00 Miscellaneous 1,535.97 Pre-Tax Discount -2.6 %-447.26 Subtotal 16,755.05 Sales Tax $ 9,569.80 @ 7.3750 %705.77 Grand Total 17,460.82 Deductible 1,000.00 CUSTOMER PAY 1,000.00 INSURANCE PAY 16,460.82 6/6/2023 1:11:35 PM 419802 Page 8 0901119cb6f8c603 Supplement of Record 4 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White SUPPLEMENT SUMMARY Line Oper Description Part Number Qty Extended Price $ Labor Paint Changed Items 96 Repl LT/Front Wheel, alloy 19x7 black metallic 9965507090 1 -568.44 m -0.3 90 *S04 Repl LT/Front Wheel, alloy 19x7 black metallic 9965507090 1 154.00 m 0.3 109 #S02 Subl wrap a pillar 1 -150.00 X 103 #S04 Subl wrap a pillar 1 250.00 X 139 #S02 Subl wrap mirror cover 1 -50.00 X 133 #S04 Subl wrap mirror cover 1 187.50 X Deleted Items 30 S02 Repl Seal plate TK4856381 1 -12.25 Incl. 36 S02 Repl Mount bracket w/adaptive cruise w/front camera KB8D50721 1 -25.69 Incl. 37 S02 Repl LT Bumper cover nut C27450133 6 -15.66 80 Repl LT Apron reinf (UHS)KB7W5428X 1 -49.32 s -3.0 -0.7 83 S02 Overlap Minor Panel 0.2 93 S02 Repl Fuse & relay box KD4566760A 1 -254.03 159 #S02 Subl Static Calibration - Adaptive Cruise Control - Lidar/Doppler 1 -600.00 X 163 #S02 Repl Caulk/Seam Sealer 1 T 164 TIRES 165 *S02 Repl TOYO P225/55R19 TYA36 RF BW 99V T16205 1 -177.99 -0.3 168 #S02 Repl Cavity Wax 1 -18.00 T -0.5 Added Items 153 #S04 Subl Clear Codes 1 125.00 X 167 #S04 Gas 1 10.05 168 **S04 A/M Fender [Left] - Qty: 0.3 (Can(s)) - 3M Cavity wax amber 1 11.80 0.2 169 **S04 A/M Door Shell [Left,Rear] - Qty: 0.5 (Can(s)) - 3M Cavity wax amber 1 19.68 0.3 170 **S04 A/M Rocker Panel [Left] - Qty: 0.5 (Can(s)) - 3M Cavity wax amber 1 19.68 0.3 171 **S04 A/M Hood [] - Qty: 0.8 (Cartridge(s)) - 3M Bare metal seam sealer 1 49.74 0.5 172 **S04 A/M Door Shell [Front,Left] - Qty: 0.5 (Can(s)) - 3M Cavity wax amber 1 19.68 0.3 173 **S04 A/M Door Shell [Front,Left] - Qty: 1 (Sheet(s)) - 3M Sound deadening pads 1 13.27 0.2 6/6/2023 1:11:35 PM 419802 Page 9 0901119cb6f8c603 Supplement of Record 4 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White 174 **S04 A/M A-Pillar [Left] - Qty: 0.3 (Can(s)) - 3M Cavity wax amber 1 11.80 0.3 175 **S04 A/M Hood [] - Qty: 0.5 (Can(s)) - 3M Cavity wax amber 1 19.68 0.3 176 **S04 A/M Door Shell [Front,Left] - Qty: 0.7 (Cartridge(s)) - 3M Bare metal seam sealer 1 43.53 0.6 177 #S04 Repl A/M Clips/Fasteners & Retainers 1 33.52 T 178 #S04 Subl OE Tool Access Fee (software fees)** 1 75.00 X SUBTOTALS -877.45 -0.8 -0.5 TOTALS SUMMARY Category Basis Rate Cost $ Parts -730.47 Body Labor -0.8 hrs @ $ 69.00 /hr -55.20 Paint Labor -0.5 hrs @ $ 69.00 /hr -34.50 Paint Supplies -0.5 hrs @ $ 50.00 /hr -25.00 Miscellaneous -146.98 Pre-Tax Discount -2.6 %25.80 Subtotal -966.35 Sales Tax $ -720.71 @ 7.3750 %-53.19 Additional Supplement Taxes 0.03 Total Supplement Amount -1,019.51 NET COST OF SUPPLEMENT -1,019.51 CUMULATIVE EFFECTS OF SUPPLEMENT(S) Estimate 10,030.93 Lee Stuessi Supplement S01 143.27 Lee Stuessi Supplement S02 7,314.87 Lee Stuessi Supplement S03 991.26 Lee Stuessi Supplement S04 -1,019.51 Lee Stuessi Job Total: $17,460.82 CUSTOMER PAY: $1,000.00 INSURANCE PAY: $16,460.82 6/6/2023 1:11:35 PM 419802 Page 10 0901119cb6f8c603 Supplement of Record 4 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White ======================================================================= Caliber Collision is the industry leader in quality collision repair. Since day one, our highest purpose has been to get people just like you back on the road as quickly as possible and fully restored to the rhythm of your life. You can be sure we do everything possible to ensure your complete satisfaction including: Personalized, high quality service from the largest collision repair company in the U.S. Consistently ranked among the highest customer satisfaction scores in the industry. Approved by every major insurance company in the U.S. Expedited car rental and towing services to get you back on the road again in no time. Repair work backed by a written, lifetime warranty honored at every location. 24/7/365 customer service to answer questions and put your mind at ease. This is a preliminary estimate based on visible damage. There may be additional repairs needed once the vehicle is taken apart by our I-CAR Gold Class technicians to identify any additional damage. If an insurance company has written an estimate for you, please provide us with a copy. Properly endorsed insurance company checks are welcome as payment for the repair of your vehicle. Caliber Collision gladly accepts all major credit cards, debit cards, cashier's and traveler's checks. See your Caliber Collision center for details on acceptance of personal checks. Before leaving your vehicle with us, please remove all important personal and valuable items from your vehicle. Caliber Collision is not responsible for belongings left in your vehicle. Please let us know how we can be of further assistance, and when we can schedule an appointment for your vehicle to be repaired. Caliber Collision - Restoring The Rhythm Of Your Life ======================================================================= AVOID DELAYS BY GETTING CLAIM AND PAYMENT INFORMATION IN JUST A FEW CLICKS! VISIT: http://www.usaa.com/bodyshop MEMBER NUMBER: Use Policy Number LOSS NUMBER: Use digits 16, 17, & 18 of the claim number (Ex. 012345670000000[003]001) LOSS DATE: Use Date of Loss Please Present A Copy Of This Estimate To A Repair Facility Of Your Choice *USAA Subsidiaries include: United Services Automobile Association(USAA), USAA Casualty Insurance Company(CIC), USAA General Indemnity Company(GIC) USAA County Mutual Insurance(CMI) and Garrison Property Casualty Insurance Company. Garrison Property and Casualty Insurance Company, a subsidiary of USAA Casualty Insurance Company, is authorized to use the USAA logo, a registered trademark of United Services Automobile Association. This is not an authorization to repair. Failing to present this estimate to the repairing garage before repair may result in additional expenses to you. A USAA appraiser must authorize any supplement to this estimate. Repairs to this vehicle may require specific welding equipment as recommended by the manufacturer. If alternative quality replacement parts have been included in this appraisal, the source for these parts has also been disclosed. If alternative quality replacement parts as listed on the appraisal are ultimately used in the repair of your vehicle, the warranty on such parts will be equal to, or greater than, the parts being replaced, as stated in USAA's limited parts warranty. USAA warrants that the parts used on your vehicle will be of like kind and quality, function, fit, safety and corrosion protection as the part or parts they replace. USAA identifies certified and validated parts for 6/6/2023 1:11:35 PM 419802 Page 11 0901119cb6f8c603 Supplement of Record 4 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White sheet metal replacement parts. MN ST 60A.955 - A PERSON WHO FILES A CLAIM WITH INTENT TO DEFRAUD OR HELPS COMMIT A FRAUD AGAINST AN INSURER IS GUILTY OF A CRIME. THIS ESTIMATE HAS BEEN PREPARED BASED ON THE USE OF AUTOMOBILE PARTS NOT MADE BY THE ORIGINAL MANUFACTURER. THE INSURER WARRANTS THAT ANY NON-ORIGINAL EQUIPMENT MANUFACTURER PARTS SPECIFIED IN THIS ESTIMATE ARE AT LEAST EQUAL TO THE ORIGINAL EQUIPMENT MANUFACTURER PARTS IN TERMS OF KIND, QUALITY, SAFETY, FIT AND PERFORMANCE. 6/6/2023 1:11:35 PM 419802 Page 12 0901119cb6f8c603 Supplement of Record 4 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White Estimate based on MOTOR CRASH ESTIMATING GUIDE and potentially other third party sources of data. Unless otherwise noted, (a) all items are derived from the Guide ARH5471, CCC Data Date 05/16/2023, and potentially other third party sources of data; and (b) the parts presented are OEM-parts. OEM parts are manufactured by or for the vehicle's Original Equipment Manufacturer (OEM) according to OEM's specifications for U.S. distribution. OEM parts are available at OE/Vehicle dealerships or the specified supplier. 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 with discounted pricing. Asterisk (*) or Double Asterisk (**) indicates that the parts and/or labor data provided by third party sources of data 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, A/M or NAGS. 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 2023 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 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. Blnd=Blend. BOR=Boron steel. CAPA=Certified Automotive Parts Association. D&R=Disconnect and Reconnect. HSS=High Strength Steel. HYD=Hydroformed Steel. Incl.=Included. LKQ=Like Kind and Quality. LT=Left. MAG=Magnesium. Non-Adj.=Non Adjacent. NSF=NSF International Certified Part. O/H=Overhaul. Qty=Quantity. Refn=Refinish. Repl=Replace. R&I=Remove and Install. R&R=Remove and Replace. Rpr=Repair. RT=Right. SAS=Sandwiched Steel. Sect=Section. Subl=Sublet. UHS=Ultra High Strength Steel. N=Note(s) associated with the estimate line. CCC ONE Estimating - A product of CCC Intelligent 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. 6/6/2023 1:11:35 PM 419802 Page 13 0901119cb6f8c603 Supplement of Record 4 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White *Limited Parts Warranty Curb the High Cost of Vehicle Repairs With USAA's Quality Replacement Parts Program USAA warrants replacement body and mechanical parts in the QRP program when installed during vehicle repairs and listed on our damage report. These parts will be like kind and quality to the function, fit, finish and corrosion protection of the damaged parts they replace, or the parts will be repaired or replaced at no cost to you. Our warranty on sheet metal and plastic replacement body parts is valid for the period of time equal to the remainder of the original manufacturer's warranty or three years from the date of the repair, whichever is greater. Our warranty on mechanical parts will be equal to the warranty period provided by an authorized original manufacturer for those parts when provided through your manufacturer's distributor as replacement parts. The USAA warranty on replacement parts automatically transfers with ownership of the vehicle. Excluded from this warranty is normal wear and tear and damage caused by accident, abuse, unreasonable use or improper maintenance of the vehicle. Any express warranty not provided herein is hereby excluded and disclaimed. Any implied warranties of merchantability and fitness for any particular purpose which may exist, are expressly limited to the period of time equal to the remainder of the original manufacturer's warranty for like kind, quality, function, fit, finish and corrosion protection or three years from the date of the original repair, whichever is greater. Some states do not allow limitations on how long an implied warranty lasts, so the above limitation may not apply to you. USAA shall not be liable to any person for any special, incidental or consequential damages, whether arising out of breach of warranty, breach of contract or otherwise. Some states do not allow the exclusion or limitation of special, incidental or consequential damages, so the above limitation or exclusion may not apply to you. USAA would like you to feel confident about the reasons for supporting the Quality Replacement Parts program (QRP). Together we can ensure the highest level of collision repair quality by supporting a program that promotes competition through use of alternative replacement parts. The following questions and answers may help you understand more about USAA's QRP program. Q. What are OEM, non-OEM, and recycled parts? A. OEM: Parts manufactured for or by the manufacturer of your vehicle. Non-OEM: Parts provided by a company or distributor other than the original equipment manufacturer. Recycled: Parts from a vehicle of the same or newer make, model, and year vehicle that they are to replace. Q. What assurances do I have that QRP parts are of high quality? A. USAA only includes QRP parts when readily available and equivalent in performance to the part requiring replacement on your vehicle in terms of like kind, quality, function, fit, finish and corrosion protection. Also, QRP parts carry an equal or better warranty than the original manufacturer's parts and are supported by our Limited Parts Warranty. * Glass, lights and lenses will meet DOT/SAE standards. * New sheet metal and plastic body replacement panels will be certified or validated through an independent third-party. * USAA will identify other parts included in the program that comply with federal safety standards including new, recycled, or rebuilt parts. Q. Why does USAA use parts from other manufacturers and distributors? A. We use these parts to help keep vehicle repairs competitive in terms of price when the parts are of like kind, quality, function, fit, finish, and corrosion protection or better quality. Q. Do I have a choice which parts are included in USAA's repair estimate? A. Yes, you do. If you choose to use new OEM parts or parts from other manufacturers and distributors, you will bear the responsibility for any cost difference. 6/6/2023 1:11:35 PM 419802 Page 14 0901119cb6f8c603 Supplement of Record 4 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White Q. If I am dissatisfied with a non-OEM part used in my vehicle repair, who do I call? A. If you experience a problem, call your claims advisor. We will work with the repair shop and the parts supplier to correct the problem at no cost to you, so long as the part is still under USAA's warranty. Q. Will using a non-OEM part void the warranty on my vehicle? A. The overall warranty on your vehicle will not be adversely affected. QRP parts included in your vehicle's repair will carry USAA's Limited Parts Warranty. It is equal to or better than the warranty provided by the distributor for new OEM parts. Q. What should I do if my repair shop refuses to use QRP parts? A. Your repair shop has the right to conduct its business the way it chooses and can charge you more than the reasonable and competitive cost for the repair; so, you will have to choose where and how your vehicle will be repaired. If you choose not to use another repairer and/or your shop refuses to use QRP parts, you will have to pay any difference in the final repair cost. USAA Claims Philosophy It is the policy of USAA to handle all claims with fairness and integrity, exercising the highest standards of ethical and professional conduct while transacting claims business. We will provide timely and responsive service, with full recognition of our obligations to the insureds and the public. If you have questions about the program or warranty, log on to http://usaa.com or call 1-800-531-USAA (8722). 6/6/2023 1:11:35 PM 419802 Page 15 0901119cb6f8c603 Supplement of Record 4 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White PARTS SUPPLIER LIST Line Supplier Description Price 93 Morrie's Minnetonka Mazda #KB7W50601A $ 40.72 13700 Wayzata Blvd.Reveal molding Minnetonka MN 55305 Quote: 1518555828 Expires: 06/04/23 6/6/2023 1:11:35 PM 419802 Page 16 0901119cb6f8c603 Supplement of Record 4 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White ALTERNATE PARTS USAGE 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White VIN:JM3KFBEY8M0422323 Interior Color:Mileage In:25,693 Vehicle Out:6/6/2023 License:HAR419 Exterior Color:White Mileage Out:25,694 State:MN Production Date:5/2021 Condition:Job #: Alternate Part Type Selection Method # Of Times Notified Of Available Parts # Of Parts Selected Aftermarket Automatically List 0 10 Optional OEM Automatically List 0 0 Reconditioned Automatically List 0 0 Recycled N/A 0 0 6/6/2023 1:11:35 PM 419802 Page 17 0901119cb6f8c603 0901119cb6f8c604 0901119cb6f8c604 0901119cb6f8c604 0901119cb6f8c604 CALIBER - ROSEVILLE MN Workfile ID: Federal ID: State ID: Federal EPA: 0070e5b7 33-0730794 6144514 MNS000333664RESTORING THE RHYTHM OF YOUR LIFE 1914 West County Road C, Roseville, MN 55113 Phone: (651) 639-9848 FAX: (651) 639-9406 Supplement of Record 5 with Summary RO Number: 3311046811 Written By: Lee Stuessi, 6/15/2023 11:10:08 AM Adjuster: Martinez, Ray, (000) 000-0000 x22 Business Insured:STOTTLEMYER, KATE Policy #:009762873 Claim #:009762873000000023001 Type of Loss:Collision Date of Loss:3/21/2023 12:00 PM Days to Repair:15 Point of Impact:11 Left Front Owner:Inspection Location:Insurance Company: STOTTLEMYER, KATE CALIBER - ROSEVILLE MN USAA CASUALTY INSURANCE COMPANY 165 HAWES AVE 1914 West County Road C DRP-4187 SHOREVIEW, MN 55126 Roseville, MN 55113 Visit us at USAA.com or Call #8722 (612) 321-1933 Cell Repair Facility P.O. Box 33490 (612) 321-1933 Evening (651) 639-9848 Business San Antonio, TX 78265 (800) 531-8722 Business VEHICLE 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White VIN:JM3KFBEY8M0422323 Interior Color:Mileage In:25,693 Vehicle Out:6/6/2023 License:HAR419 Exterior Color:White Mileage Out:25,694 State:MN Production Date:5/2021 Condition:Job #: TRANSMISSION Tilt Wheel Stereo Electric Glass Sunroof Automatic Transmission Cruise Control Search/Seek SEATS 4 Wheel Drive Rear Defogger Auxiliary Audio Connection Bucket Seats POWER Keyless Entry Premium Radio Leather Seats Power Steering Message Center Satellite Radio Heated Seats Power Brakes Steering Wheel Touch Controls SAFETY Rear Heated Seats Power Windows Rear Window Wiper Drivers Side Air Bag Ventilated Seats Power Locks Telescopic Wheel Passenger Air Bag WHEELS Power Mirrors Heated Steering Wheel Anti-Lock Brakes (4)Aluminum/Alloy Wheels Heated Mirrors Climate Control 4 Wheel Disc Brakes PAINT Power Driver Seat Navigation System Traction Control Three Stage Paint Power Passenger Seat Backup Camera Stability Control OTHER DECOR Parking Sensors Front Side Impact Air Bags Fog Lamps Dual Mirrors Surround View Camera Head/Curtain Air Bags Rear Spoiler Privacy Glass Remote Starter Hands Free Device Signal Integrated Mirrors Console/Storage Intelligent Cruise Xenon or L.E.D. Headlamps TRUCK Overhead Console Home Link Blind Spot Detection Power Trunk/Liftgate CONVENIENCE RADIO Heads Up Display 6/15/2023 11:10:09 AM 419802 Page 1 0901119cb732dbe8 Supplement of Record 5 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White Air Conditioning AM Radio Lane Departure Warning Intermittent Wipers FM Radio ROOF 6/15/2023 11:10:09 AM 419802 Page 2 0901119cb732dbe8 Supplement of Record 5 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White Line Oper Description Part Number Qty Extended Price $ Labor Paint 1 #==== Required Notes for USAA Drive Ins ==== 1 2 #For Supplements Use Estimate Share Within CCC One 1 3 #Have Questions or Non-CCC User? 1 4 #Call 800.637.8511 - Press 2 for Repair Facility 1 5 #Then Press 2 for Technical Support, 1 6 #Then Press 4 for "All Other"1 7 #==== End USAA Drive In Notes ==== 1 8 INFORMATION LABELS 9 S02 Repl Emission label 2.5L Turbo PX2K69036 1 7.23 0.2 10 #S03 Repl Vin No. Label ADL0006 1 124.95 11 #S03 Repl Tire info Label ADL0031 1 31.95 12 FRONT BUMPER & GRILLE 13 O/H bumper assy 2.9 14 *<>S03 Repl Bumper cover w/park sensor KB8B50031FBB 1 367.02 Incl.2.8 15 S02 Add for Three Stage 2.0 16 Add for fog lamps 0.4 17 Add for park sensor m 0.4 18 *S03 Repl Grille assy w/surround view KJK950710A 1 1,126.70 0.8 19 *S03 Repl Closure panel KB8A50717D 1 49.68 Incl. 20 *S03 Repl Upper molding KL2F507E19U 1 165.46 Incl.1.7 21 S02 Add for Three Stage 0.7 22 S02 Repl LT Side bracket KB8A50163B 1 14.45 0.1 23 S02 Refn Tow eye cap 0.2 24 S02 Add for Three Stage 0.1 25 S02 Repl LT Bezel w/fog lamp KB8B50C21C 1 7.70 Incl. 26 S02 Repl LT Mount bracket w/fog lamp KB8B50C22B 1 21.68 Incl. 27 S02 R&I License frame 0.2 28 S02 Repl Prep unprimed bumper 1 0.7 29 S02 Repl Add for park sensor 1 m 0.4 30 S02 Repl LT Cover KB8A50102A 1 6.45 Incl. 31 S02 Repl RT Cover KB8A50101A 1 5.42 Incl. 32 *S03 Repl Retainer arctic white KD4767UC5A64 1 7.58 0.2 33 S02 Add for Three Stage 0.1 34 S02 Repl Emblem w/adaptive cruise TK7951730 1 394.57 Incl. 35 S02 Repl LT Bumper cover clip B45A56146A 6 11.64 36 S02 Repl LT Side retainer KB8A500U1A 1 7.21 Incl. 37 S02 Repl LT Grille assy grommet KD4550ES1 1 1.36 38 S02 Repl RT Upper molding pin S51S51833 4 13.20 6/15/2023 11:10:09 AM 419802 Page 3 0901119cb732dbe8 Supplement of Record 5 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White 39 S02 Repl Upper molding rivet TK2150355 12 40.56 40 S02 Repl LT Grille assy pin KD45501K5A 1 1.24 41 S02 Repl Seal plate fastener GD7A50EA1 6 14.76 42 *S03 Repl LT Park sensor inner arctic white GMK667UC164 1 75.80 m Incl.0.2 Note: LABOR: Time is after bumper cover is removed. Time not included with R&R bumper cover and overhaul. Time is for one sensor. Refinish time is provided when required color is not available or for some repair situations. 43 S02 Add for Three Stage 0.1 44 *S03 Repl LT Wire harness KJK967290 1 113.85 Incl. 45 FRONT LAMPS 46 *S03 Repl LT Headlamp assy w/o directional beam KL2L51041E 1 1,280.93 0.6 47 Aim headlamps 0.5 48 S02 R&I RT R&I headlamp assy 0.4 49 S02 R&I RT Fog lamp assy Incl. 50 S02 Repl LT Fog lamp assy B63B51690A 1 259.64 Incl. 51 S02 Aim fog lamps 0.3 52 S02 Repl LT Lamp bracket KB8B51694 1 12.26 53 S02 Repl LT Wire connector K1Y967SH3 1 7.14 54 HOOD 55 *S03 Repl Hood (HSS)KBY05231XC 1 660.32 1.6 2.8 56 Overlap Major Non-Adj. Panel -0.2 57 S02 Add for Three Stage 1.0 58 Add for Underside(Complete)1.4 59 R&I Insulator Incl. 60 S02 Repl Front w'strip KB7W56770A 1 19.69 Incl. 61 R&I Front seal Incl. 62 R&I Rear w'strip Incl. 63 Repl RT Hinge KB7W52410 1 40.26 0.3 0.4 64 S02 Add for Three Stage 0.2 65 Repl LT Hinge KB7W52420 1 40.26 0.3 0.4 66 S02 Add for Three Stage 0.2 67 S02 Repl Insulator fastener TD1156694 11 23.87 68 FENDER 69 S01 Repl LT Fender KB7W52211 1 378.11 2.1 2.0 70 S01 Overlap Major Adj. Panel -0.4 71 S02 Add for Three Stage 0.6 72 S01 Add for Edging 0.5 73 *S03 Repl LT Fender liner KB7W56140C 1 88.64 Incl. 74 *S03 Repl LT Front bracket KDPW52240 1 28.68 0.1 0.3 75 S02 Add for Three Stage 0.1 76 *S03 Repl LT Wheel opng mldg KB7W51W30E8N 1 142.59 Incl. 77 S02 R&I RT Wheel opng mldg 0.6 78 *S02 Rpr LT Apron assy (HSS)s 1.0 1.6 79 S02 Repl LT Lower molding KB7W51W80B 1 11.80 Incl. 80 S02 Repl LT End plate KB7W563K5 1 12.49 Incl. 81 S02 R&I LT End seal Incl. 6/15/2023 11:10:09 AM 419802 Page 4 0901119cb732dbe8 Supplement of Record 5 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White 82 S02 Repl LT Deflector shield KB7W56115B 1 15.40 Incl. 83 S02 Repl LT Lower seal KB7W56J13A 1 28.16 Incl. 84 S02 Repl LT Upper bracket KB7W5422Y 1 7.74 0.1 0.3 85 S02 Add for Three Stage 0.1 86 ELECTRICAL 87 S02 Repl Battery 0000800035WB 1 199.99 m 0.4 88 #S03 Repl Relay Cover grt866752 1 28.82 89 WHEELS 90 *S04 Repl LT/Front Wheel, alloy 19x7 black metallic 9965507090 1 154.00 m 0.3 91 #S05 Repl LT Front Wheel Bearing 1 291.59 92 #S05 Repl TPMS Sensor 1 59.99 93 #S05 Subl Wheel Bearing Instilation By midas 1 313.04 X 94 #S05 Subl Misc Supplies From midas 1 36.95 X 95 WINDSHIELD 96 *S03 R&I Windshield Mazda, w/de-icer, w/smart brake w/heads up 0.0 97 S03 Repl Reveal molding KB7W50601A 1 40.72 Incl. 98 #S03 Subl Windshield pull 1 124.00 X 99 COWL 100 S02 R&I LT End cap 0.1 101 PILLARS, ROCKER & FLOOR 102 *S02 Rpr LT W/S pillar reinf (UHS)s 7.0 Note: Damage has streched metal and extends aound panel line into door jam Windshield will have to be removed 103 S02 R&I LT Front sill plate 0.2 104 *S02 Rpr LT Ctr plr & rocker 15.0 3.2 105 S02 Overlap Major Non-Adj. Panel -0.2 106 #S02 Rpr remove wrap and clean adhesive from a pillar 0.5 107 #S04 Subl wrap a pillar 1 250.00 X 108 FRONT DOOR 109 *S03 Repl LT Door shell (HSS)KBY05902XE 1 1,018.64 5.7 3.0 110 Overlap Major Adj. Panel -0.4 111 S02 Add for Three Stage 1.0 112 R&I LT Door w'strip Incl. 113 *S03 Repl LT Window molding KB7W50985N 1 99.95 0.3 114 Repl LT Black out tape front K131508W1 1 5.77 0.3 115 Repl LT Black out tape rear K131508W3 1 7.97 0.3 116 S02 Repl LT Belt molding KB7W50650C 1 36.67 Incl. 117 S02 Repl LT Corner molding piano black KB8A6916YC 1 29.99 0.1 118 *S03 Repl LT Applique black KB8A50M20F 1 55.19 Incl. Note: LABOR: Time for R&I/R&R does not include removing or replacing double-sided tape. 119 *S03 Repl LT Lower molding KB7W51RB0E 1 51.18 0.4 6/15/2023 11:10:09 AM 419802 Page 5 0901119cb732dbe8 Supplement of Record 5 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White 120 R&I LT R&I mirror Incl. 121 R&I LT Door glass Mazda Incl. 122 *R&I LT Run channel Incl. 123 R&I LT R&I carrier assy Incl. 124 R&I LT Handle, outside w/o smart key crystal blue Incl. 125 *R&I LT Handle base Incl. 126 R&I LT Cyl & keys Incl. 127 R&I LT Lock assy Incl. 128 R&I LT Door check Incl. 129 R&I LT R&I trim panel Incl. 130 S03 Repl LT Mirror cover white pearl TK48691N7A64 1 45.94 Incl.0.5 Note: LABOR: Refinish time is provided for those instances when required color is not available or for some repair situations. 131 S03 Overlap Minor Panel -0.2 132 S02 Add for Three Stage 0.1 133 S03 Repl LT Mirror assy w/bld spot, w/pwr fold, w/surround view KJL169181A 1 417.03 Incl. 134 S02 R&I LT Side camera 135 *S02 R&I LT Mirror glass w/blind spot monitor w/heated Incl. 136 *S02 R&I LT Signal lamp Incl. 137 #S04 Subl wrap mirror cover 1 187.50 X 138 S03 Repl LT Handle, outside w/smart key white pearl TK495941XC64 1 94.52 Incl.0.5 Note: LABOR: Time is after carrier assembly is removed. Time includes cap. Refinish time is provided for those instances when required color is not available or for some repair situations. 139 S02 Overlap Minor Panel -0.2 140 S02 Add for Three Stage 0.1 141 S02 Dis/reassmble to refn 0.2 142 S02 R&I LT W'strip on body 0.3 143 REAR DOOR 144 *S02 Rpr LT Outer panel (HSS)2.0 2.1 145 S02 Overlap Major Adj. Panel -0.4 146 S02 Add for Three Stage 0.7 147 S02 R&I LT Lower molding 0.4 148 S02 Repl LT Belt molding KB7W50670C 1 40.01 0.3 149 R&I LT Handle, outside crystal blue 0.4 150 S03 R&I LT R&I door assy 1.1 Note: for paint access 151 VEHICLE DIAGNOSTICS 152 S01 Repl Pre-repair scan 1 50.00 X m 153 S01 Repl Pre-repair scan 1 m 0.5 154 S01 Repl Post-repair scan 1 70.00 X m 155 S01 Repl Post-repair scan 1 m 0.5 156 #S02 Subl Static Calibration - Surround View (Non Toy/For/Nis) 1 475.00 X 6/15/2023 11:10:09 AM 419802 Page 6 0901119cb732dbe8 Supplement of Record 5 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White 157 #S04 Subl Clear Codes 1 125.00 X 158 #S02 Subl Alignment, 4-wheel 1 89.95 X 159 #S02 Repl Corrosion Protection 1 T 160 #S02 Cover Car for Overspray 1 12.00 X 0.3 161 #S02 Repl Add for Chip Guard 1 18.00 T 0.5 162 #S02 Cover Interior for Protection 1 6.00 X 0.3 163 #S02 Subl Hazardous Waste Disposal 1 5.00 X 164 #S02 License Plate 1 T 0.2 165 #S02 Refn Left Roof Rail Clear Only 0.8 166 #S02 Mask Jambs, Opening, Entry 1 12.00 X 0.3 167 #S02 Remove Adhesive from Repaired Panel 1 3.00 X 0.5 168 #S03 FREIGHT 1 169 #S03 CORE ON BATTERY 1 170 **S03 A/M FREIGHT 1 171 #S04 Gas 1 10.05 172 **S04 A/M Fender [Left] - Qty: 0.3 (Can(s)) - 3M Cavity wax amber 1 11.80 0.2 173 **S04 A/M Door Shell [Left,Rear] - Qty: 0.5 (Can(s)) - 3M Cavity wax amber 1 19.68 0.3 174 **S04 A/M Rocker Panel [Left] - Qty: 0.5 (Can(s)) - 3M Cavity wax amber 1 19.68 0.3 175 **S04 A/M Hood [] - Qty: 0.8 (Cartridge(s)) - 3M Bare metal seam sealer 1 49.74 0.5 176 **S04 A/M Door Shell [Front,Left] - Qty: 0.5 (Can(s)) - 3M Cavity wax amber 1 19.68 0.3 177 **S04 A/M Door Shell [Front,Left] - Qty: 1 (Sheet(s)) - 3M Sound deadening pads 1 13.27 0.2 178 **S04 A/M A-Pillar [Left] - Qty: 0.3 (Can(s)) - 3M Cavity wax amber 1 11.80 0.3 179 **S04 A/M Hood [] - Qty: 0.5 (Can(s)) - 3M Cavity wax amber 1 19.68 0.3 180 **S04 A/M Door Shell [Front,Left] - Qty: 0.7 (Cartridge(s)) - 3M Bare metal seam sealer 1 43.53 0.6 181 #S04 Repl A/M Clips/Fasteners & Retainers 1 33.52 T 182 #S04 Subl OE Tool Access Fee (software fees)** 1 75.00 X SUBTOTALS 10,451.28 54.2 31.2 NOTES Estimate Notes: DR = 3/21/2023 DC = 3/21/2023 6/15/2023 11:10:09 AM 419802 Page 7 0901119cb732dbe8 Supplement of Record 5 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White DI = 3/21/2023 ERT = 15 DRV = no SCHD = Prod Date = 06/2016 Vehicle owner KATE STOTTLEMYER (handed, mailed, faxed, e-mailed etc.) copy of damage report prior to repairs. No Vehicle owner KATE STOTTLEMYER (handed, mailed, faxed, e-mailed etc.) QRP Brochure. N Prior Damage = Preliminary damage report - do not issue payment (as/if applicable) Final Damage report OK To Pay (as/when applicable) Date of completed repair (when applicable, and when known) N/A ****Borderline Total Loss Tool**** Teardown: Yes License Plate State: MN Preliminary estimate of visible damage: $17486.99 Potential supplemental damage: $0 *Explanation: Vehicle value (pre-tax): $28762.00 Vehicle Value Taxes: $1889.53 Salvage Value: $5752.00 **** 1) Vehicle is currently at 70 % of 100 % total loss threshold; $7413 to reach threshold 2) Upload Estimate as Repairable - Damage Under Threshold (Prior to uploading the estimate, contact the USAA IPDS team to discuss the unrelated prior damage) 3) Ensure limited to no chance of significant engine, suspension, or transmission damage ESTIMATE TOTALS Category Basis Rate Cost $ Parts 8,565.32 Body Labor 54.2 hrs @ $ 69.00 /hr 3,739.80 Paint Labor 31.2 hrs @ $ 69.00 /hr 2,152.80 Paint Supplies 31.2 hrs @ $ 50.00 /hr 1,560.00 Miscellaneous 1,885.96 Pre-Tax Discount -2.6 %-465.50 Subtotal 17,438.38 Sales Tax $ 9,912.24 @ 7.3750 %731.03 Grand Total 18,169.41 Deductible 1,000.00 CUSTOMER PAY 1,000.00 INSURANCE PAY 17,169.41 6/15/2023 11:10:09 AM 419802 Page 8 0901119cb732dbe8 Supplement of Record 5 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White SUPPLEMENT SUMMARY Line Oper Description Part Number Qty Extended Price $ Labor Paint Added Items 91 #S05 Repl LT Front Wheel Bearing 1 291.59 92 #S05 Repl TPMS Sensor 1 59.99 93 #S05 Subl Wheel Bearing Instilation By midas 1 313.04 X 94 #S05 Subl Misc Supplies From midas 1 36.95 X SUBTOTALS 701.57 0.0 0.0 TOTALS SUMMARY Category Basis Rate Cost $ Parts 351.58 Miscellaneous 349.99 Pre-Tax Discount -2.6 %-18.24 Subtotal 683.33 Sales Tax $ 342.44 @ 7.3750 %25.27 Additional Supplement Taxes -0.01 Total Supplement Amount 708.59 NET COST OF SUPPLEMENT 708.59 CUMULATIVE EFFECTS OF SUPPLEMENT(S) Estimate 10,030.93 Lee Stuessi Supplement S01 143.27 Lee Stuessi Supplement S02 7,314.87 Lee Stuessi Supplement S03 991.26 Lee Stuessi Supplement S04 -1,019.51 Lee Stuessi Supplement S05 708.59 Lee Stuessi Job Total: $18,169.41 CUSTOMER PAY: $1,000.00 INSURANCE PAY: $17,169.41 6/15/2023 11:10:09 AM 419802 Page 9 0901119cb732dbe8 Supplement of Record 5 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White ======================================================================= Caliber Collision is the industry leader in quality collision repair. Since day one, our highest purpose has been to get people just like you back on the road as quickly as possible and fully restored to the rhythm of your life. You can be sure we do everything possible to ensure your complete satisfaction including: Personalized, high quality service from the largest collision repair company in the U.S. Consistently ranked among the highest customer satisfaction scores in the industry. Approved by every major insurance company in the U.S. Expedited car rental and towing services to get you back on the road again in no time. Repair work backed by a written, lifetime warranty honored at every location. 24/7/365 customer service to answer questions and put your mind at ease. This is a preliminary estimate based on visible damage. There may be additional repairs needed once the vehicle is taken apart by our I-CAR Gold Class technicians to identify any additional damage. If an insurance company has written an estimate for you, please provide us with a copy. Properly endorsed insurance company checks are welcome as payment for the repair of your vehicle. Caliber Collision gladly accepts all major credit cards, debit cards, cashier's and traveler's checks. See your Caliber Collision center for details on acceptance of personal checks. Before leaving your vehicle with us, please remove all important personal and valuable items from your vehicle. Caliber Collision is not responsible for belongings left in your vehicle. Please let us know how we can be of further assistance, and when we can schedule an appointment for your vehicle to be repaired. Caliber Collision - Restoring The Rhythm Of Your Life ======================================================================= AVOID DELAYS BY GETTING CLAIM AND PAYMENT INFORMATION IN JUST A FEW CLICKS! VISIT: http://www.usaa.com/bodyshop MEMBER NUMBER: Use Policy Number LOSS NUMBER: Use digits 16, 17, & 18 of the claim number (Ex. 012345670000000[003]001) LOSS DATE: Use Date of Loss Please Present A Copy Of This Estimate To A Repair Facility Of Your Choice *USAA Subsidiaries include: United Services Automobile Association(USAA), USAA Casualty Insurance Company(CIC), USAA General Indemnity Company(GIC) USAA County Mutual Insurance(CMI) and Garrison Property Casualty Insurance Company. Garrison Property and Casualty Insurance Company, a subsidiary of USAA Casualty Insurance Company, is authorized to use the USAA logo, a registered trademark of United Services Automobile Association. This is not an authorization to repair. Failing to present this estimate to the repairing garage before repair may result in additional expenses to you. A USAA appraiser must authorize any supplement to this estimate. Repairs to this vehicle may require specific welding equipment as recommended by the manufacturer. If alternative quality replacement parts have been included in this appraisal, the source for these parts has also been disclosed. If alternative quality replacement parts as listed on the appraisal are ultimately used in the repair of your vehicle, the warranty on such parts will be equal to, or greater than, the parts being replaced, as stated in USAA's limited parts warranty. USAA warrants that the parts used on your vehicle will be of like kind and quality, function, fit, safety and corrosion protection as the part or parts they replace. USAA identifies certified and validated parts for 6/15/2023 11:10:09 AM 419802 Page 10 0901119cb732dbe8 Supplement of Record 5 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White sheet metal replacement parts. MN ST 60A.955 - A PERSON WHO FILES A CLAIM WITH INTENT TO DEFRAUD OR HELPS COMMIT A FRAUD AGAINST AN INSURER IS GUILTY OF A CRIME. THIS ESTIMATE HAS BEEN PREPARED BASED ON THE USE OF AUTOMOBILE PARTS NOT MADE BY THE ORIGINAL MANUFACTURER. THE INSURER WARRANTS THAT ANY NON-ORIGINAL EQUIPMENT MANUFACTURER PARTS SPECIFIED IN THIS ESTIMATE ARE AT LEAST EQUAL TO THE ORIGINAL EQUIPMENT MANUFACTURER PARTS IN TERMS OF KIND, QUALITY, SAFETY, FIT AND PERFORMANCE. 6/15/2023 11:10:09 AM 419802 Page 11 0901119cb732dbe8 Supplement of Record 5 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White Estimate based on MOTOR CRASH ESTIMATING GUIDE and potentially other third party sources of data. Unless otherwise noted, (a) all items are derived from the Guide ARH5471, CCC Data Date 05/16/2023, and potentially other third party sources of data; and (b) the parts presented are OEM-parts. OEM parts are manufactured by or for the vehicle's Original Equipment Manufacturer (OEM) according to OEM's specifications for U.S. distribution. OEM parts are available at OE/Vehicle dealerships or the specified supplier. 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 with discounted pricing. Asterisk (*) or Double Asterisk (**) indicates that the parts and/or labor data provided by third party sources of data 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, A/M or NAGS. 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 2023 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 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. Blnd=Blend. BOR=Boron steel. CAPA=Certified Automotive Parts Association. D&R=Disconnect and Reconnect. HSS=High Strength Steel. HYD=Hydroformed Steel. Incl.=Included. LKQ=Like Kind and Quality. LT=Left. MAG=Magnesium. Non-Adj.=Non Adjacent. NSF=NSF International Certified Part. O/H=Overhaul. Qty=Quantity. Refn=Refinish. Repl=Replace. R&I=Remove and Install. R&R=Remove and Replace. Rpr=Repair. RT=Right. SAS=Sandwiched Steel. Sect=Section. Subl=Sublet. UHS=Ultra High Strength Steel. N=Note(s) associated with the estimate line. CCC ONE Estimating - A product of CCC Intelligent 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. 6/15/2023 11:10:09 AM 419802 Page 12 0901119cb732dbe8 Supplement of Record 5 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White *Limited Parts Warranty Curb the High Cost of Vehicle Repairs With USAA's Quality Replacement Parts Program USAA warrants replacement body and mechanical parts in the QRP program when installed during vehicle repairs and listed on our damage report. These parts will be like kind and quality to the function, fit, finish and corrosion protection of the damaged parts they replace, or the parts will be repaired or replaced at no cost to you. Our warranty on sheet metal and plastic replacement body parts is valid for the period of time equal to the remainder of the original manufacturer's warranty or three years from the date of the repair, whichever is greater. Our warranty on mechanical parts will be equal to the warranty period provided by an authorized original manufacturer for those parts when provided through your manufacturer's distributor as replacement parts. The USAA warranty on replacement parts automatically transfers with ownership of the vehicle. Excluded from this warranty is normal wear and tear and damage caused by accident, abuse, unreasonable use or improper maintenance of the vehicle. Any express warranty not provided herein is hereby excluded and disclaimed. Any implied warranties of merchantability and fitness for any particular purpose which may exist, are expressly limited to the period of time equal to the remainder of the original manufacturer's warranty for like kind, quality, function, fit, finish and corrosion protection or three years from the date of the original repair, whichever is greater. Some states do not allow limitations on how long an implied warranty lasts, so the above limitation may not apply to you. USAA shall not be liable to any person for any special, incidental or consequential damages, whether arising out of breach of warranty, breach of contract or otherwise. Some states do not allow the exclusion or limitation of special, incidental or consequential damages, so the above limitation or exclusion may not apply to you. USAA would like you to feel confident about the reasons for supporting the Quality Replacement Parts program (QRP). Together we can ensure the highest level of collision repair quality by supporting a program that promotes competition through use of alternative replacement parts. The following questions and answers may help you understand more about USAA's QRP program. Q. What are OEM, non-OEM, and recycled parts? A. OEM: Parts manufactured for or by the manufacturer of your vehicle. Non-OEM: Parts provided by a company or distributor other than the original equipment manufacturer. Recycled: Parts from a vehicle of the same or newer make, model, and year vehicle that they are to replace. Q. What assurances do I have that QRP parts are of high quality? A. USAA only includes QRP parts when readily available and equivalent in performance to the part requiring replacement on your vehicle in terms of like kind, quality, function, fit, finish and corrosion protection. Also, QRP parts carry an equal or better warranty than the original manufacturer's parts and are supported by our Limited Parts Warranty. * Glass, lights and lenses will meet DOT/SAE standards. * New sheet metal and plastic body replacement panels will be certified or validated through an independent third-party. * USAA will identify other parts included in the program that comply with federal safety standards including new, recycled, or rebuilt parts. Q. Why does USAA use parts from other manufacturers and distributors? A. We use these parts to help keep vehicle repairs competitive in terms of price when the parts are of like kind, quality, function, fit, finish, and corrosion protection or better quality. Q. Do I have a choice which parts are included in USAA's repair estimate? A. Yes, you do. If you choose to use new OEM parts or parts from other manufacturers and distributors, you will bear the responsibility for any cost difference. 6/15/2023 11:10:09 AM 419802 Page 13 0901119cb732dbe8 Supplement of Record 5 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White Q. If I am dissatisfied with a non-OEM part used in my vehicle repair, who do I call? A. If you experience a problem, call your claims advisor. We will work with the repair shop and the parts supplier to correct the problem at no cost to you, so long as the part is still under USAA's warranty. Q. Will using a non-OEM part void the warranty on my vehicle? A. The overall warranty on your vehicle will not be adversely affected. QRP parts included in your vehicle's repair will carry USAA's Limited Parts Warranty. It is equal to or better than the warranty provided by the distributor for new OEM parts. Q. What should I do if my repair shop refuses to use QRP parts? A. Your repair shop has the right to conduct its business the way it chooses and can charge you more than the reasonable and competitive cost for the repair; so, you will have to choose where and how your vehicle will be repaired. If you choose not to use another repairer and/or your shop refuses to use QRP parts, you will have to pay any difference in the final repair cost. USAA Claims Philosophy It is the policy of USAA to handle all claims with fairness and integrity, exercising the highest standards of ethical and professional conduct while transacting claims business. We will provide timely and responsive service, with full recognition of our obligations to the insureds and the public. If you have questions about the program or warranty, log on to http://usaa.com or call 1-800-531-USAA (8722). 6/15/2023 11:10:09 AM 419802 Page 14 0901119cb732dbe8 Supplement of Record 5 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White PARTS SUPPLIER LIST Line Supplier Description Price 97 Morrie's Minnetonka Mazda #KB7W50601A $ 40.72 13700 Wayzata Blvd.Reveal molding Minnetonka MN 55305 Quote: 1518555828 Expires: 06/04/23 6/15/2023 11:10:09 AM 419802 Page 15 0901119cb732dbe8 Supplement of Record 5 with Summary RO Number: 3311046811 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White ALTERNATE PARTS USAGE 2021 MAZD CX-5 Signature AWD 4D UTV 4-2.5L Turbocharged Gasoline Gasoline Direct Injection White VIN:JM3KFBEY8M0422323 Interior Color:Mileage In:25,693 Vehicle Out:6/6/2023 License:HAR419 Exterior Color:White Mileage Out:25,694 State:MN Production Date:5/2021 Condition:Job #: Alternate Part Type Selection Method # Of Times Notified Of Available Parts # Of Parts Selected Aftermarket Automatically List 0 10 Optional OEM Automatically List 0 0 Reconditioned Automatically List 0 0 Recycled N/A 0 0 6/15/2023 11:10:09 AM 419802 Page 16 0901119cb732dbe8 0901119cb732dbe9 0901119cb732dbe9 0901119cb732dbe9 0901119cb732dbe9 0901119cb732dbe9 0901119cb732dbe9 EXHIBIT C 0901119cb68bf203 0901119cb68bf203 0901119cb68bf203 0901119cb68bf203 0901119cb68bf203 EXHIBIT D 0901119cb7632313 EXHIBIT F 0901119cb6f3c2b4 0901119cb7656b2a 0901119cb7656b2a 0901119cb7656b2a 0901119cb7656b2a 0901119cb7656b2a 0901119cb7656b2a 0901119cb7656b2a 0901119cb7656b2a 0901119cb7656b2a 0901119cb7656b2a 0901119cb7656b2a