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Thomas '�. � Adinnesoln Sln�e SYah�ie a66.Q5 srares rhar "...eve�7�persor�...�vho c(nims damnges fi•om nrip nu�rticipu(ilp...sl�at!crnrse!o be presef��er�to ryie " yoverning hocl��n/�the nvrnicipn/ih�i>>i��iin /80 dnys nj�er�he a!leged loss nr inj:u��is c/iscovered a notice sfa�i��g die time,p/ace,anc! circ�rnar�nnces lhereof,nnd the mm�un!qf compensntinn or alher relief demnndecL° Please complete tliis form in its enti►-ety by ctelrly typing or priuting your answer to each question. If more sp�ce is � needed,attach actctition�l sheets. Please note that you�viil not be cont�cted by telephone to clarify answers,so provide�s � mucli information as necessary to explain your claim,and the amount of compensation being requested. Yoii will receive� , written �clu�o�aledgement once your form is received. The process c�n talce up to ten weelcs or longer depending on the � nature of yo►n•ctaim. Tliis form must be signecl,and botl� p�ges completed. If something does not apply,write �N/A'. , S�ND COIVIPL�T�D TORM ANb OTH�R DOCUNC�NTS TO: CITY CLERT�, 1� WEST KELI.,OGG BLVD, 310 CITY HALT�, SAINT PAUL, MN 55102 First Narne�, _ Middle [nitial�Last N�me�i.,�Q� _— Comp�ny oc B isiness Name Ace You an Insurance Company? Yes/ f�1 If Yes, Claim Number? p r� Street Address _l City � State � ,,� � Zip Cocte��'�- � Ce(1 Phone 1 �I-��t4� �vening Tele�hane(_� �<'''�Q D�ytime I'hone(�,�-�� D�te of Accident/ lnjury ar Date Discovered � i O Time;�am pm Pfe�se state, in detail, what occurred(happened),�nd w iy you are submitting�claim. Please indicate�why or how you _ feel the City of Sain P�ul or its e �ployees are involved ai /or respo�ib e for your dama es.�. '�L� J ,� , � . � � � � � t� ��'" • �'1��k Please check the box(es)thlt inost closely represent the reason for coi��pleti+�g tl�is focm: ❑ My vehicle was damaged in an accident _ ❑ My vehicle was damaged durin�a to��v ❑ My vehicle was dam�►�ed by a pothole or candition of the street ❑ My vehicle wss damaged by a plow ❑ 1V�y vehicle was wrongfiilly towed and/oc ticketed � ❑ I was in'ured on City pcoperty Q�Other type of property dlmage–please specify ` �'�� ❑ Other type of injuiy–ple�se specify In order to process your claim you need to inchule copies of nll �ipplicnble documents. ('or the claims types listed below, pte�se be sure to include the documents indiclted or it will del�y the handling of your claim. Documents WILL NOT be returned and become the property of the City. You �re encouraged to 1<eep � n copy foc yourself before submitting your claim form. O Properly damage c{aims to a vehicle: two estii��ates for the repairs to your vehicle ifthe damage exceeds �500.00; or the actual bills and/or receipts for the repairs O Towing etaims: legible copies of any ticicet issued and a copy of the impound lot receipt O Other property damage elaims: two repair estimates if the damage exceeds $500.00; or the actual bills and/or receipts foc the re��airs;detai(ed list of damaged items O Inju►'y claims: medical bills, receipts O Photographs are always welcome to document and support your claim bui will not be returned. P�ge 1 of 2-1'lease complete�nd return both pages of Claim Form -,+v.�=:i AI}�,:laims—plense comi�lete this section , Were there witnesses to the incident? Yes No Unl:nown � �(circle) �'rovide their n�mes, addresscs 1nd telcphone numbers: � � a Y �J'�I � Lr Wei�e the police oc law enforcement called? Yes No Unl<tlOWll (circte) If yes, what departnlent or agency? Case#or repoct# �UN � � 20�2 Where did the accident or injury tal:e place? Provide street address,ccoss stceet, intersection, name of�l�'.`�� closest l�ndmarlc, etc. Please be as detailed as possible. If necessacy, att�ch a diagram. Ple�se indicate the ai unt you �re seel:in in c npensation ar what you would lil:e the City to do to resalve this claim � to your satisfaction. � Vehicle Clnims—plense com Iete this section ❑ check box if this section does not a»I Your Vehicle: Year� PT Mal:e Model Y�-i' License ate Number t State Color Registeced Owr�er i . Driver of Vehicle i c �..e.�l Are1 Damaged � � r l� �� City Vehicle: Ye�r Mal:e Model C��L�e,�� License Plate Number State Color �n Driver of Vehicle(City Tmployee's Name) 4lk�,��— Area D�maged 6-,Ir Yn'u Clnims— �lense com lete this section heck box if this section does not apply 1-tow were yot► injured? Wh�t plrt(s)of your body wece injured? Have you sought medical treatment? Yes No Planning to Seek"t'reatment(circle) � (provide date(s)) When did you �-eceive tceatment? Name of Medical Provider(s): Telephone Address No Did you miss wocl:ls � result of your inju�y? ��eS (pi•�vide date(s)) When did you miss worl:? Name of youc Employer: Telephone Address ❑ Checic here if you are�tt�ching mare pages to this cl�im fo�•m. Number of�dditional pages By sig��irig this form,yor� are str�tirrg tlecrt crll informntion yo�i /t�l�'e�r�vrde�C is true�rrrd cnrrect to tlie best �f yoin�knoivledge. Unsignerr fornTS ii�il!nnt be processed. Submitti►zg a fnlse c/nim can result in prosecrdio►e. Date for was co leted � s, S Print the Name of the Pe�•son��ho Completed this Form: � � �Ornk � ,�_,'�� ,� Signat�u•e of Person Making tl�e Claim: � Revised l�ebruary 201 I ; Saint Paul Police Impound Lot, 830 Barge Channel Road, Vehicle Release Form Make:03 FORD l.icense#: 169DRT CN: 12078948 Invoice#: 137219 Date/Time Released: 04/05/2012 17:33 Tow Charge: $ 54.50 Released to:TOTO Storage Charge: $ 0.00 Paid by: CREDIT CARD Admin Charge: $ 80.00 �� Reteased by: PATTY Tax: (7.625%) $ 10.26 � I,the undersigned,have recovered the vehicle described above. Subtotal: $ ��•76 I will check the vehicle for damage or any other problems that may have occurred while this vehicle was in the custody of the Senrice Charge: $ 0.00 Saint Paul Police Department. I acknowledge I will report damage and/or any othe�problems to the Impound Lot staff Total Charges: $ 144.76 on this form prior to leaving the impound lot. Damage and/or other problem: � 1�� i�!.��`1� ��—J ' '""G� ��=T i � � � � � � � � � � � �C i�t�'1S �or� MGy� (►'��f n(}�" bC �� , Int-eni� Corr,p�e N�! ��-� q�r�f-('li�wl �, Police Report made:Yes_No_ IF Yes,CN , If N0,Why. 5�1�� T PR T T Y R I HT REP RT ANY PR BLEMS/DAMAGE BEFORE LEAVING THE LOT l - ? Signature Y► 5�2000 nui c i uu.i�i�s■urys��ri�viounon. II�IIIIHNN�I�IINHII�IIII�I�IIN�II�II�I�II��Inp�ll Topy your ckation oNlne: 1�Yw�ndyy;¢g�y;cgurtg,�t�s;mn,gs CITATION For additlond information or to psy your M�by td�phon�usinp�crsdk card, Ck�tlon No.: cau:�est�2ss.e2o2. _ 620900584316 ; C�s�No.:12078948 Pl�us hw�your cltaiion numb�r and cndit c�rd av�il�bls. St Paul Pollce Department Mall peymsnts to: Ramaey Dlatrlet Court . 10 M�thotl: PhOtO ID � 7nTc Viol�tlon�Bunw ��*�yy363221319112 D�Statr.MN U8A CD' ��o 76 W�st Kdloqp Boulevard-Room 130 St.P�ul,MN 66102-1613 � Name�� N8pALE KEARNEY TNOMA8 Mak<ch�cks payabl�to: R�ms�y Dbtrict Caurt Addne�.3ab BURR ST (A eharae of up to S30.OU w�ll br assesesd on all rsturnetl checke! � City:•'9AIM'PAUL Stat�:MN U8A LP.x0�'� — j D08:1126H982r` Ey�s:BRO Hpt:603 Wp� i� S�x:M Vial�tions Bunau Locatiom ` vshlo�e ucross Numb�r: 168DRT state: StfiulCouM SuburMnCeuA L�wEnlorawu�nlGM�r �USA IW.N.ItogpBkdRM190 10AOWhIbBarAv■. 4264ror�Sh�N Maks:FORD Model:EXPLORER Typ�: Color:BLUE StPYULMN66701 Muppwootl,MN001W SthuI,MNEQ101 _. Dat�ofOM�ns� 4/5I2012 Tim�otOff�ns� 10:30 ' OR�ne�Location: ARCADE ST Interneetlny Strest SIMS AV -- ORlcs Houre:8:00 A.M.•430 P.M. Montlay-Friday(Excludinp Holltlays) Offenea Ctty: 8t.:=aut — Unk: H92 H�arinp Oftic�rs:By appolntmart ony-cdl(6B1)-266_gZ02 � P�rmtt Zonr. �r.' Payment and PenalUes Clted 8peed: MPH Posted Speetl:MPM you wlsh to pl�ad pullty and aubmk p�ymait►orthe oll�nss�a)on this eitatlon,you muat � g��/Ord UI►�ns� - a so within 21 deya hom the data th�ekation is flbd wkh th�Courl:It is your nsAa��ibility ' �prspnt your payment In a timsly mann�c Plspss allow 6 businss�daqrfOr¢Fd�'ds'stnq. »>2�.Z�RI�RJG AfTER REVOC � i6.00 late fse Is add�d to dl unpsld fin�bd�ne�e.ARer 40 days from the d�te th�eitation - fll�tl with ths Court additional dalinquent l�ss may be addtld to sll unpald fM�amourka. 168.791.2 NO PROOF INS/DRVR � 169•686•1(a)NOSEATBELT-0RVlPASS ftlitlonal penettlee may Inelutle:7)rofsrral to ths Dspartmsnt ofPublic Sdsty for drivsr's � msi�suspeneion,2)arrast warnnt bawd,�nd/or 3)rderral to a coll�ctions�pmcy. ' 162.027.3 MARIJ�tJ MV DR/OWN h�oR�nu is�p�tty mi�domqnor,tailur�to app�ar Niil bs contid�nd�pl�a o!Quilty 171.08 NO DL IN POSS d walvsr to th�ripht to trial unlsse the failure to appaar le dus to circumstancse beyond �p�non't corrtrol M.S.169.91). 189.471,1 TV VISIBLE TO DRVR _ � APp@al Accidmt:N InJury: Propsrty: P�d�ctrian FstaL i pHad not puilty,or to p:eaa puiky and oR�r�n�zpl�natlon: Book�d:Xis_ Driv�r;Yss ---- --- � 1)ARsr.f bualnese days,ca11861•266J202 to conflrm that the eNatlon hae bsan Bled End�nperinp LitslPropsrty: N Unaafs for Condkionn: N Commercfal V�hfcl�: N with th�couR. 2)Hthe citatlon hae been tlled,requeat a heuinq oRlcer nppolntment H�urdous Mat�riv:N WorN Zonr.N 9chool Zonr.N J)When yau�rrL e at th�Vlolations Bun�u,tell the canhfsr th�t you hsve�hnrinp BAC: Rdu��d:N Tsst Type: 8ub�t�nc�Found: oTCSr�ppolMmsnt.You mu�t h�ve e photo 10 with you. nderetand that by PAYING THIS f INE I AM ENTERING A PLEA OF GUILTY to thls ortsnes(e) � R—e1�18�1(g= d volunt�rfly waiw th�/ollowinp rlphb to: - �� A.a trid to the court,if oP�m�Is�p�tty misd�mnnor. � - B.alrial to ths eourt or to�Jury Hths of►�nfs Is a misdems�nor, C.npn��rd�tlon by courtsN, D.a pr�aumptlon o(Inno¢encs unttl provnn puiky bsyontl a rsaeonabls doub!, E.conhont and cros�-�ximin�all wftn�s��s apalnst m�,and ' oRicsr 9:Oficer R.KRUSE F.either rsm�in sllmt or to tssTlf�in my own b�haH. ORicrr Numb�r: 371800 so und�rstmd that it this oRms�ia a petty misd�me�nor,the maximum poaaibls sentsnu ORlur 2: , �300.00;if thla oRsnss Is a mi�demesnor,th�mucimum poaefble sentencs Is f1,000.00 ORlc�r Numb�r: s andJor90 tlaye ImpNSOnmsnt. --— Rnn�.y�� _.. —__.--_� _. .,,,.,,,_,_..�- cnu�oo No.� 820900384316 ___�...----- -------�--- ---- — -- ----- ...__,.--...._., . __,.� I , ' ' ABRA Auto Body & Glass - Maplewood Workfile ID: afa7f9fe FederalID: 41-1942823 - Right The First Time...On Time 2806 HIGHWAY 61, MAPLEWOOD, MN 55109 Phone: (651) 483-2145 FAX: (651) 483-2509 Preliminary Estimate Customer:Thomas,Cynthia Written By:Jerry Price Insured: Thomas,Cynthia Policy#: Claim#: . Type of Loss: Date of Loss: 5/15/2012 12:00:00 PM Days to Repair: 0 Point of Impact: 06 Rear Owner: Inspectio�Location: Insurance Company: Thomas,Cynthia ABRA Auto Body&Glass-Mapiewood CUSTOMER PAY 1946 Edgerton st.S. 2806 HIGHWAY 61 St. Paul,MN 55117 MAPLEWOOD, MN 55109 (651)331-9946 Business Repair Facility (651)483-2145 Business VEHICLE Year: 2003 Body Sryle: 4D UN VIN: 1FMZU62K13UA48290 Mileage In: 99 Make: FORD Engine: 6-4.OL-FI License: 169DRT Mileage Out: Model: EXPLORER 4X2 XLS Production Date: State: MN Vehicle Out: Coior: BLUE Int: Condition: Job#: 4 Wheel Disc Brakes Clear Coat Paint Luggage/Roof Rack Privacy Glass Air Conditioning Cloth Seats Overdrive Rear Defogger AM Radio Console/Storage Passenger Air Bag Rear Window Wiper Anti-Lock Brakes(4) Cruise Control Positraction Recline/Lounge Seats Automatic Transmission Driver Air Bag Power Brakes Search/Seek Body Side Moldings Dual Mirrors Power Locks Stereo Bucket Seats FM Radio Power Mirrors Styled Steei Wheels Cassette Intermittent Wipers Power Steering Tilt Wheel CD Player Keyless Entry Power Windows 5/15/2012 1:39:25 PM 014563 Page 1 � _=�' ' � Preliminary Estimate ..__ � Cuatorr:er: Thomas, Cynthia Vehicle: 2003 FORD DCPLORER 4X2 XLS 4D UTV 6-4.OL-FI BLUE i Line OperdtiOn Description Qty Extended Labor Paint Price� 1 LIFT GATE 2 Repi Handle 1 48.00 0.3 3 Repl Emblem Ford oval 1 28.97 0.2 4 Repi Applique 1 163.33 2.0 1.2 5 Add for Clear Coat 0.5 6 R&I R&I fim panel 0.3 7 INSTRUMENT PANEL 8 Repl Center bezel manual AC 1 218.50 0.3 9 * Repl Center duct 1 18.88 ,Q� 10 FRONT DOOR li * Repl LT Switch bezel 1 19.89 Q,4 SUBTOT/tLS 497.57 4.0 1.7 ESTIMATE TOTALS Category Basis Rate Cost$ Parts 497.57 Body Labor 4.0 hrs @ $54.00/hr 216.00 Paint Labor 1,7 hrs @ $54.00/hr 91.80 Paint Supplies 1.7 hrs @ $34.00/hr 57.80 Subtotal 863.17 Sales Tax $497.57 @ 7.1250% 35.45 Grand Total 898.62 Dedudible 0.00 CUSTOMER PAY 0.00 INSURANCE PAY 898.62 THIS IS A VISUAL INSPECTION ONLY. THERE MAY BE ADDI7IONAL DAMAGE AFTER DISASSEMBLY. PARTS ARE SUBJECT TO INVOICE. THERE ARE NO GUARANTEES ON RUST REPAIRS. "Minnesota law gives you the right to choose any rental vehicle company, and prohibits me from requiring you to choose a particular vendor." 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. 5/15/2012 1:39:25 PM 014563 Page 2 . � ' �' Preliminary Estimate Cu�tomer:Thomas, Cynthia ! Vehicie: 2003 FORD IXPLORER 4X2 XLS 4D UTV 6-4.OL-FI BLUE � Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from the Guide , DR2MF02, CCC Data Date 4J16/2012, and the parts selected are OEM-parts manufactured by the vehicles Original � Equipment Manufacturer. OEM parts are available at OE/Vehicle dealerships. OPT OEM (Optional OEM) or ALT OEM (Alternative OEM) parts are OEM parts that may be provided by or through aiternate sources other than the OEM vehicle ' dealerships. OPT OEM or ALT OEM parts may reflect some specific, special, or unique pricing or discount. OPT OEM or ALT OEM parts may include "Blemished" parts provided by OEM's through OEM vehicle dealerships. Asterisk (*) or Double Asterisk (**) indicates that the parts and/or labor information provided by MOTOR may have been modified or may have come from an alternate data source. Tilde sign (N) 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 AM. 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 Nationat 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 2012 vehicles contain minor changes from the previous year. For those vehicles, prior to receiving updated data from the vehicle manufacturer, labor and parts data from the previous year may be used. The CCC ONE estimator has a complete list of applicable vehicles. Parts numbers and prices should be con�rmed 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 categoty. X=Miscellaneous Non-Taxed charge category. SYMBOLS FOLLOWING LABOR: D=Diagnostic labor category. E=Electrical labor category. F=Frame labor category. G=Glass labor category. M=Mechanical labor category. S=Structural labor category. (numbers) 1 through 4=User Defined Labor Categories. OTHER SYMBOLS AND ABBREVIATIONS: Adj.=Adjacent. Algn.=Align. ALU=Aluminum. A/M=Aftermarket part. BInd=Blend. BOR=Boron steel. CAPA=Certified Automotive Parts Association. D&R=Disconnect and Reconnect. HSS=High Strength Steel. HYD=Hydroformed Steel. Inc1.=Included. LKQ=Like Kind and Quality. LT=Left. MAG=Magnesium. Non-Adj.=Non Adjacent. NSF=NSF International Certified Part. 0/H=Overhaul. Qty=Quantity. Refn=Refinish. Repl=Replace. R&I=Remove and Install. R&R=Remove and Replace. Rpr=Repair. RT=Right. SAS=Sandwiched Steel. Sect=Section. Subl=Sublet. UHS=UItra High Strength Steel. N=Note(s) associated with the estimate line. CCC ONE Estimating - A product of CCC Information Services Inc. The following is a list of abbreviations that may be used in CCC ONE Estimating that are not part of the MOTOR CRASH ESTIMATING GUIDE: BAR=6ureau of Automotive Repair. EPA=Environmental Protection Agency. NHTSA= National Highway Transportation and Safety Administration. PDR=Paintless Dent Repair. VIN=Vehicle Identi�cation Number. 5/15/2012 1:39:25 PM 014563 Page 3 r---- .JL�N-�4-201� 12:19 Froin: To:7939?37 Paae:1�3 .� ' HEPPNERS AUTO BODY INVER GROVE wor�ct�Ie to: oeso3or� HEIGHTS 6042 CLAUDE WAY E., INVER GROVE HEIGNTS, MN 55076 Phone: (651)455-7920 FAX: (651) 455-0140 Preliminary Estimate Cusbomer:TFIOMAS,CYNTHIA Written By� Melissa Thurrnger Insu�eti: THpMAS,CYNTHIA Policy#: Claim#: Type of Loss: date of Loss: Days to Repair: 0 Point of Impact: 0�� Inspedion Lotation: Insurance Company: THDMAS,CYNTNIA HEPPNERS AUTO BODY INVER GROVE HEIGFfT5 (651}331-9946 Evening 60�+2 CWUDE WAY E. (651)331-9946 Other INVER GROVE HEIGH75,MN 55076 Repair Facili�y (651)RSS-7920 Day VEMICtE Year� 2003 Body Style: 4D UTV VIN: 1FM2U62K33UA48290 Mileage In; Make: FORD Enqine: 6-4.Q�-FI License: F69DR7 Mileage Out: Model: EXPLORER 4X�XLS Produc0on Date� State� MN Vehide Out; GolOr: BLUE Int: Condition� )pb#; 4 Wheel Disc&akes qear Coat Paint Luggage/Roof Radt Privac.y Glass Air Conditioning Cloth Seats Overdrive Rear Defogger AM Radio ConSOIeJStorage Pdsseflger Air Bag Rear Window Wiper Mti-LOdc Brakes(4) Cruise ContPOl PoSitradion ReCline/Lounge Seats Automatic Transmission Driver Air Bag power&akes SearCh/Seek Body Side Moldings Dual Mirrors Power�ocks Stereo BuCket 5eats FM Radio POwer Mirrors Sty!@d Steel WhQeIS Cassette Intermittent Wipers Power Steering T;It YVheel CD Player KeyleSS Entry Power Wittdows 6/4/2412 1:01:37 PM D50505 • Page 1 JUN 04,2012 11:97 Page 1 . JUN-��-201� 1z:2� Frn�n: Tn:7939537 Paae:2'3 �-- ' Preliminary Estimate Customer:THQMAS,CY�17'HIA Vehicle: �003 F4RD EXRLORER 4X2 XlS�D UTV f�.0�-�i 84UE i.ine Operation pestription Qty F�cteltded Labor Paint PNte� i IIFI�GATE 2 Repl Apptique 1 16333 2.p 1.2 3 Add for Clear Coat 0.5 '� REAR LIhMPS 5 * Repl LKQ LiCenS2 Shield t25% 1 62�„50 Q,� 6 ItJSTRUMENT PANEL 7 # Repi auCt Assy 1 146.67 l.p 8 Repl Ceni�r beael auto AG warm steei 1 Z07.98 0.3 9 FRONT DOOR 10 '� Repl L7 SwiEch bezel 1 i9.$9 Q,� l i # 'Hazardous Waste Disposal Fee 1 5.00 12 # 'Cover arM Protec[Interiar 1 p_3 23 # pOSSIBLE HIdpEN DAMAG� 1 SUBTOTALS 6d5.37 3.4 Z.0 ESTTMATE TOTALS ��=9o►Y 8asis t�ate Cost¢ pa� G05.37 Body I.e�bor 3.9 hrs � $52.00/hr 202,Sp Paint L�3bor 2.0 hrs @ $52.Od/hr 104,00 Paint Supplies 2.0 hrs � $32.Q0/hr 64.00 8ody SUpplies 3.9 hrs �il ;2.00/hr 7-80 Subtqtal 9$3.9� Sak�s T1x �,605.3� @ 7.1250°k 43.13 Grand 7olal 1,027.10 DeduCtible Q.00 Ct1STOMER PAY - O.QO INSURANCE PAY 1,027.10 America First Insuranc�, Co�lorado Casuafty, Gold�n Eagte Insurance, Indiana Insurance, Liberty Agancy Underwriters, Liberty Northwest, Mantgomery Insurance, Qhio Casualty, Peerless Insurance and Safeco Insurance are part �f Liberty Mutuai Agency Markets, a business unit of Liberty Mutual Group. MN ST 6QA.955 - A PERSON WNO FIL�S A GLATM WTTFI INTENT TQ QE�RAUC?OR HELP� COMMII`A FRAUb AGAIN$T AN INSURER IS GUILTY OF A CRIME. 6/4/201Z 1:01:37 PM 050505 Page 2 JUN 04,2012 11:48 Page 2 JLiN-�4-��1� 12:20 From: T�:7939937 Paae:3'i Preliminary�stimate Customer:THOMAS,CYNTH3A Vehicle:2003 FORD EXFLflRER 4X2 XLS 4D UN 6-4AL-FT BLUE Estimat� based on MQTf7R CRASH ESTIMATTNG GUEDE. Unless otherwise noted al! items are derived from the Guide DR2MF02, CCC Data pate 6/�,/2412, and the parts seiected are OEM-parts manufactured by khe vehicles Original Equipment Ma�nufacturer. 4EM parts are available at OE/Vehicle dealerships. QPT OEM (Optional OEM) or ALT OEM (Riternative OEM) parts are OEM parts that may be provided by or through altemat� sources other than khe OEh�I vehicle dealerships. OPT OEM or ALT OEM parts may reflect some specific, speciai, or unique pricing ar discount. �PT QEM or ALT OEM parts may include 'Btemished" parts provided by OEM'�through QEM vehicle deaterships. Asterisk (*)or Dauble Asterisk (**) indicates that the parts and/or labor infarmation provided by MpTOR may have b�en modifi�t or may have come from an altemate data saurc�. T(Ide sig� (�) items indicate MOTOR Not-Includecf Labar operations. The symbol {¢>) indicates the refrnish operatiQn WILL NOT b� performed as a separate procedure fram the other panels in the estimate. Non-Origina! �quipment Manufacturer aft�rmarket parts are described as AM. Used parts are descrikred as LKQ, RCY, or USED. �teconditioned parts are tlescribed as Recond. Re�ored parts are described as Recore. NAGS Part Mumbers and Benchmark Prices are provided by National Auto Glass Specifications. Labc�r operaEian times listed on the linp with the t�AGS infarmation are M�TOF�suggested tabor operation times. NAGS labor operation times are not induded. Pound sign{#) items indicate manual entries. Some 24I2 vehicles contain minor thanges from the previous year. For those vehtcles, pFiQr to receiving updated data fram the vehicle manufacturer, labdr and parts data from the previous year may be used. The CCC ONE estimator has a comptete tist of applicable vehicles. Parts numbers and prices shauld be rnnfirmed with the lacal dealership. 7he following is a list of additi�nal abbreviations or symbols that may be used to deseribe work to be done or parts ta be repaired or replaced: SYMBOLS FOLLOWINC RART PRICE: m=MQTOR Mechanical camponent. s=MQTOR Structural compvnent. T=Miscella�n�ous Tax�d charge categary. X=Miscellaneous Non-Taxed charge category. SYMBOIS FOLLOWING IABC?R: D�biagnostic labor category, E=Electrical labar category. F-Frame labor category. G=Giass labor category, M=Mechanicai labor category. 5=5tructural labor categary. (numbers) 1 through 4=User Defined l.abor Categories. OTHER SYM80L$AND ABBREVIATIpNS: Adj.=Adjacent. Algn.=Align. ALU=Aluminum. A/M=Aftermarket part. BInd=6lend. BOR�Boron st�el. CAFA=Certified Automotive Parts Associativn. D&R=l7isconnect and Reeonnect. HSS=High Strength Ste�l. HYD=Hydroformed Steel. Inc1.=Included. UCQ=Like Kind and Quatity, LT=Left. MAG=Magnesium. Non-Adj.=Non Adjacent. NSF=NSF International Certified Part. O/H=Qverhaul. Qty=Quantity. Ftefn-Refinish. Repl=Repla�, RBc,I=Remove arrd InsfiaH. R&k-Rernove and Replace. Rpr=�tepair. RT=Right. SAS=Sandwiched Steel. SeCt�Section. SuW=Subtet. UHS=Ultra High Strength Steel. N=Note(s)associat�i with the estimate line. CCC�NE Estimating -A product of CCC Infarmation S�rvices Inc. The fo(lowing i5 a iist of abbreviations that may be used in CCC ONE Estimating that are not part of the MOTOR CRqSH ESfIMATING GUIpE: BAR=Bureau of Autamotive Rep�air. EPA=Environrn�ntal Pratection Agency. NFlTSA, Nat�onal Highway Transportation and Safety Administration. PDR=PainNess pent Repair. VIN=Vehicle Identification Number. 6/R/2032 1:U1:37 PM Q505Q5 Page 3 JUN 04,2412 11:48 Page 3 rla�nn11141y 4�It1111p�L^' CuBtomer:THOMAS,CYNTHia Vehicie:2QQ3 FORD EXPLORER 4X2 XLS 4D UTV 6-4.�1-FI BLUE Estimat� based on MpTOR CRASH ESTIMATiNG GUIDE. Unless otherwise noted ail items are derived from the Guide DR2MF02, CCC Data Date 6/1/2012, and the parts seiected are OEM-parts m�nufactured by the vehicies Originai Equipment Manufacturer. pEM parts are available at OE/Vehicle dealerships. QPT OEM (Option�l OEM) or ALT OEM (Aiternativ�OEM) parts are OEM parts that may be provided by or through altemate sources other than the OEM vehicle dealerships. OPT OEM or ALT OEM parts m�y r�flect�Qme sp�cific, special, or unique pricing ar discount. OPT(3�M or ALT OEM parts may include "Blemi5hecl" parts provided by OEM's through CfEM vehicie dealer�hips. Ast�rjsk (*) or Dauble Asterisk (**) indiCates that the parts and/or labor inFo�mation provided by Mf>TOR may have been modifie.ti or mdy hdv�corne f'�Ott1 an alterltate data source. Tfide sign (ti) items indicate MOTOR Not-Included LabQr operations. Th�Symbol (:>) indicates the refinish operation WItL NOT b� performed as a separate procedure from the ottter panef� in the �stimat�. Non-C?riginal �quipment Manufacturer aRermarket parts ar� described a5 AM. used parts are described as LKQ, RCY, or lJSEd. aeconditianed part, are described as Recond. Recored parts are described as Recore. NAG5 part Numbers and Benchmark Prices are provided by National Auto Glass Specification5. Labar pperation times list�ed on the line with the NAGS information are MOTOR suggested labor operation times. NAGS labor operation times are not induded. Paund sign (#) items indicate manual entrfes. Some 2012 vehicles contain minor changes from the previous yea�. �or those vehicles, pri�r to r�ceiving updated d�ta from the vehicle manufacturer, labor and parts dat,a f�'om the pt�eviaus yedr m�y be Used. The CCC ONE estirrtatOr has a compfete fist of applicable vehicles. Parts numbers and prices should be confirmed with th� local dealership. The following is a lisc aF additional abbreviations or symbols that may be used ta descrfbe work to be dpne or parts to be repaired or�ptaced: SYMBOLS FOLLOWING RART PRICE: m=MQTOR Mechanical �amponent. s=MOTOR Structural component. T=Miscellanevus Taxed charge category. X-Miscellaneous Non-T�xed charge categary. SYMSOLS FOLIOWING LqBOR: D�Aragnostic labor cacegory. E=Electrical labor category. F=Frame labor category, G=Giass labor category, M=Mechariical labor category. 5=5tructura! labor categoty. (numbers) 1 through 4=User pefined Labor Categories. OTHER SYMSOL5 AND ABBREVIATIQNS: Adj.=Adjacent. Algn.sAlign. AlU=Aluminum. A/M=Aftermdrket part. BInd=6lend. BOR�Boron ste�1, CAPA=Celtified Autam�tive Parts Association, t?&Ft=Qisconnect and Reconnect. HSS=Htgh Strength Steel, HYD=Hydroformed Steel. Incl.=Includ�tl. LKq=Uke Kind and Quality, LT=L�ft. MAG=Magnesium. Non-Adj.�Non Adjacent. NSF=NS� Int�mational Gertified R�rt, 0/H=Overh�ul. Qty=Quantity. Refn=Refinish. Repl=Replace, R&I=Remove and Install. R&R=Re111ove artd Replace, Rpr-ftepair. RT=Right. SAS=Sandwiehe�i Steel. Sect=Section. Sub!=Sublet. UHS=Ultra High Strength Steel. N=Note(s} associated with the estfmate line. CCC(JNE Estimating - A product of CCC Information Services Inc. The fo(lowing is a tfst of abbr�viat+ons that may be used in GCC ONE Estimating that are not part of the MpTOR CRASH ESRMATiNG GUipE: BAR�Bureau of Autarnotive Repair. EPA=�Environmental Protection Agency. NNTSA; National Highway Transportation and Safety Administration, PDR=Paintless Dent Repair. VIN=Vehicle Identification Number. 6/4(2012 1:d1:37 PM 050505 Page 3 JUN 09,2012 11:98 Page 3 Schoonover Bodyworks & Workfile ID: 58e55922 Glass-Shoreview We Can Fix That! 1060 County Road E W, Shoreview, MN 55126 Phone: (651) 483-6756 FAX: (651) 483-3460 Preliminary Estimate Customer: THOMAS, CYNTHIA Written By:Tom Nolan Insured: Policy#: Claim #: Type of Loss: Liability Date of Loss: Days to Repair: 0 Point of Impact: 09 Left T-Bone(Left Side) Owner: Inspection Location: Insurance Company: THOMAS,CYNTHIA Schoonover Bodyworks&Glass-Shoreview CITY OF ST. PAUL 1946 EDGERTON AVE 1060 County Road E W ST. PAUL, MN 55117 Shoreview, MN 55126 (651)331-9946 Day Repair Facility (651)483-6756 Business VEHICLE Year: 2003 Body Style: 4D UN VIN: 1FMZU62K13UA48290 Mileage In: 96755 Make: FORD Engine: 6-4.OL-FI License: 169DRT Mileage Out: Model: EXPLORER 4X2 XLS Production Date: 10/2002 State: MN Vehicle Out: Color: BLUE Int: Condition: Job#: 4 Wheel Disc Brakes Clear Coat Paint Luggage/Roof Rack Privacy Glass Air Conditioning Cloth Seats Overdrive Rear Defogger AM Radio Console/Storage Passenger Air Bag Rear Window Wiper Anti-Lock Brakes(4) Cruise Control Positraction Recline/Lounge Seats Automatic Transmission Driver Air Bag Power Brakes Search/Seek Body Side Moldings Dual Mirrors Power Locks Stereo � Bucket Seats FM Radio Power Mirrors Styled Steel Wheels Cassette Intermittent Wipers Power Steering Tilt Wheel CD Player Keyless Entry Power Windows 5/23/2012 10:30:58 AM 013550 Page 1 � Preliminary Estimate Customer: THOMAS, CYNTHIA Vehicle: 2003 FORD EXPLORER 4X2 XLS 4D UN 6-4.OL-FI BLUE Line Operation Description Qty Extended Labor Paint Price� 1 INSTRUMENT PANEL , 2 Repl Vent grille center 1 52.47 0.2 3 FRONT DOOR 4 * Repl LT Switch bezel 1 19.89 9� 5 R&I LT R&I trim panel 0.5 6 LIFf GATE 7 Repl Applique 1 163.33 2.0 1.2 8 Add for Clear Coat 0.5 9 R&I R&I trim panel 0.3 10 Repl Handle 1 48.00 03 11 Repl Emblem Ford oval 1 28.97 0.2 12 # Rpr ACCESS TIME 1.0 13 REAR LAMPS 14 Repl License shield 1 130.50 0.4 15 # Subl Hazardous waste removal 1 5.00 X 16 # Tint Color 1 0.5 17 # Repl Urethane kit 1 20.00 18 # ADDITIONAL DAMAGE POSSIBLE 1 Incl• ***************�� SUBTOTALS 468.16 5.2 2.2 ESTIMATE TOTALS Category Basis Rate Cost; pa� 463.16 Body Labor 5.2 hrs @ $52.00/hr 270.40 Paint Labor 2.2 hrs @ $52.00/hr 114.40 Paint Supplies 2.2 hrs @ $35.00/hr 77.00 Body Supplies 4.4 hrs @ $3.00/hr 13.20 Miscellaneous 5.00 Subtotal 943.16 Sales Tax $463.16 @ 7.1250% 33.00 Grand Total 976.16 CUSTOMER PAY 0.00 INSURANCE PAY 976.16 5/23/2012 10:30:58 AM 013550 Page 2 ' Preliminary Estimate Customer: THOMAS, CYNTNIA Vehicle: 2003 FORD EXPLORER 4X2 XLS 4D UN 6-4.OL-FI BLUE LIMITED WARRANTY Schoonover Bodyworks, Inc. takes great care to ensure that every repair meets our standards for quality. The labor performed by Schoonover Bodyworks, Inc. is guaranteed against any defect in workmanship for as long as you own your vehicle. Schoonover guarantees that for as long as you own your vehicle, Schoonover will, at its expense, correct or repair all defects which are attributable to defective or faulty workmanship in the repairs stated on the repair invoice, unless caused by or damaged resulting from unreasonable use, improper maintenance or care of the vehicle, and rust and/or corrosion. This guarantee covers labor only and does not apply to parts, materials or equipment which may be covered by manufacturer's warranty. "Minnesota law gives you the right to choose any rental vehicle company, and prohibits me from requiring you to choose a particular vendor." 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. 5/23/2012 10:30:58 AM 013550 Page 3 Preliminary Estimate Customer: THOMAS, CYNTHIA Vehicle: 2003 FORD EXPLORER 4X2 XLS 4D UTV 6-4.OL-FI BLUE Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from the Guide DR2MF02, CCC Data Date 5/16/2012, and the parts selected are OEM-parts manufactured by the vehicles Original Equipment Manufacturer. OEM parts are available at OE/Vehicle dealerships. OPT OEM (Optional OEM) or ALT OEM (Alternative OEM) parts are OEM parts that may be provided by or through alternate sources other than the OEM vehicle dealerships. OPT OEM or ALT OEM parts may reflect some specific, special, or unique pricing or discount. OPT OEM or ALT OEM parts may include "Blemished" parts provided by OEM's through OEM vehicle dealerships. Asterisk (*) or � Double Asterisk (**) indicates that the parts and/or labor information provided by MOTOR may have been modified or may have come from an alternate data source. Tilde sign (�) items indicate MOTOR Not-Included Labor operations. The symbol (<>) indicates the refinish operation WILL NOT be performed as a separate procedure from the other panels in the estimate. Non-Original Equipment Manufacturer aftermarket parts are described as AM. 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 2012 vehicles contain minor changes from the previous year. For those vehicles, prior to receiving updated data from the vehicle manufacturer, labor and parts data from the previous year may be used. The CCC ONE estimator has a complete list of applicable vehicles. Parts numbers and prices should be confirmed with the local dealership. The following is a list of additional abbreviations or symbols that may be used to describe work to be done or parts to be repaired or replaced: SYMBOLS FOLLOWING PART PRICE: m=MOTOR Mechanical component. s=MOTOR Structural component. T=Miscellaneous Taxed charge category. X=Miscellaneous Non-Taxed charge category. SYMBOLS FOLLOWING LABOR: D=Diagnostic labor category. E=Electrical labor.category. F=Frame labor category. G=Glass labor category. M=Mechanical labor category. S=Structural labor category. (numbers) 1 through 4=User Defined Labor Categories. OTHER SYMBOLS AND ABBREVIATIONS: Adj.=Adjacent. Algn.=Align. ALU=Aluminum. A/M=Aftermarket part. BInd=Blend. BOR=Boron steel. CAPA=Certified Automotive Parts Association. D&R=Disconnect and Reconnect. HSS=High Strength Steel. HYD=Hydroformed Steel. Inc1.=Included. LKQ=Like Kind and Quality. LT=Left. MAG=Magnesium. Non-Adj.=Non Adjacent. NSF=NSF International Certified Part. 0/H=Overhaul. Qty=Quantity. Refn=Refinish. Repl=Replace. R&I=Remove and Install. R&R=Remove and Replace. Rpr=Repair. RT=Right. SAS=Sandwiched Steel. Sect=Section. Subl=Sublet. UHS=UItra High Strength Steel. N=Note(s) associated with the estimate line. CCC ONE Estimating - A product of CCC Information Services Inc. The following is a list of abbreviations that may be used in CCC ONE Estimating that are not part of the MOTOR CRASH ESTIMATING GUIDE: BAR=Bureau of Automotive Repair. EPA=Environmental Protection Agency. NHTSA= National Highway Transportation and Safety Administration. PDR=Paintless Dent Repair. VIN=Vehicle Identification Number. 5/23/2012 10:30:58 AM 013550 Page 4