Syring �
��c�p����
INJURY LAW "U` Z � 2Q�2
TERRY i SLANE �E�•�;� ^�J���{;
RUGHONEN
July 23, 2012
City of St. Paul
Attn: City Clerk
15 West Kellogg Blvd
310 City Hall
Saint Paul, MN 55102 �
RE: My Client: Donna Syring
DOL: 7-2-12
Dear Sir or Madam:
Enclosed please find a completed Notice of Claim form, copy of the police report, photographs
of my client's vehicle, and a copy of the Raymond's Auto Body estimate for my client's vehicle.
Please advise if anything further is needed to set up this claim.
Very truly yours,
Injury Law
Patric K. Kranz
PKK:dma
Direct Dial: 952-832-3594
patrick@TSRInj uryLaw.com
Enclosure
Terry,Slane&Ruohonen,PLLC � 7760 France Avenue South Suite 820 Bloomington, MN 55435 � �952.832.5800 f952.835.8900
TSRINJURYLAW.COM
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 municipaliry...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 answer to each question. If more space is
needed,attach additional sheets. Please note that you will not be contacted by telephone to clarify answers,so provide as
much information as necessary to explain your claim,and the amount of compensation being requested. You will receive a
written acknowledgement once your form is received. The process can take up to ten weeks or longer depending on the
nature of your claim. This form must be signed,and both pages completed. If something does not apply,write`N/A'.
SEND COMPLETED FORM AND OTHER DOCUMENTS TO: CITY CLERK,
15 WEST KELLOGG BLVD, 310 CITY HALL, SAINT PAUL, MN 55102
First Name ��V`� Middle Initial Last Name ��t Y ��I
Company or Business Name
Are You an Insurance Company? Yes No If Yes,Claim Number?
Street Address /�� J W�UG�II l'��1�,'c\V� � `lV
City �)� � C�V` State Iv��V Zip Code�
Daytime Phone���-��Cell Phone( ) - Evening Telephone( ) -
Date of Accident/Injury or Date Discovered �� "2��� Time a ' �� am pm
Please state,in detail,what occurred(happened),and why you are submitting a claim. Please indicate w or how you
e 1 e Ci of S�int P 1 or its em lo e s are in�volved an r resp nsible f r your ar,�►a es.
�� t
c e tri
Pl ase check the box(es)that most closely represent the reason for completing this form:
�My vehicle was damaged in an accident ❑ My vehicle was damaged during a tow
❑My vehicle was damaged by a pothole or condition of the street ❑ My vehicle was damaged by a plow
❑ ivly venicle was wrongfully towed and/or ticketed 0 I was injured on Cit}�property
�Other type of property damage—please ci y
Other type of injury—please specify�n��
In order to process your claim you need to include copies of all applicable documents.
For the claims types listed below,please be sure to include the documents indicated or it will delay the handling of
your claim. Documents WILL NOT be returned and become the property of the City. You are encouraged to keep a
copy for y urself before submitting your claim form.
Property damage claims to a vehicle:two estimates for the repairs to your vehicle if the damage exceeds
500.00; or the actual bills andlor receipts for the repairs
O Towing claims: legible copies of any ticket issued and a copy of the impound lot receipt
O Other property damage claims: two repair estimates if the damage exceeds$500.00;or the actual bills
and/or receipts for the repairs;detailed list of damaged items
O Injury claims: medical bills,receipts
�Photographs are always welcome to document and support your claim but will not be retumed.
Page 1 of 2—Please complete and return both pages of Claim Form
Failure to complete and return both pages will result in delay in the handling of your claim.
All Claims–please complete this section
Were there wimesses to the mcident? Yes No Unl�own (circle)
Provide their names,addresses and telephone numbers:
� o Unknown (circle
Were the police or law enforcement c�a'1}e . U, �� e � �t��. Case#or report# 2
If yes,what department or agency.
Where did the accident or injury take place? Provide street address,cross street, interse on,name of ark or�acility,
closest landmark,etc. Pl e e as detai d a os ible If necess attach a diagram.��C��� �.1'�
V���e�ilC���� �,�1 1�n��nY�e<� ��
Please indicate the amount ou ar s e 'n in m ensation or what you would like the City to do to resolve this claim
to your satisfaction._.T.T— -
Vehicle Claims– leas c m lete this ti n
❑c eck box if this section does not a 1
Your Vehicle: Year Make �1 Model
License Plate Num er �- State Colo
Registered Owner
Driver of Vehi , L
Area Damaged
City Vehicle: Year Make Model
License Plate Number State C lor
Driver of Vehicle(City Employee's Name)
Area Damaged
❑ che k o if thi s ction does not a 1
In'ur Claims– lease com lete this sec 'on � ,
How wer� ou igj ed? �
t
What pazt(s)of your body wer injured?
Have you sought medical treatmen . Ye o1 Planning to Seek Treatment(circle)
(provide date(s))
When did you receive treatment?
Name of di 1 P odder(s): �� U Telephone
Address � � YeS No
Did you miss work as a result of your injury. (provide date(s))
When did you miss work?
Name of your Employer: Telephone
Address
�Check here if you are attaching more pages to this claim form. Number of additional pages
By signing this form,you are stating that all information you have provided is true and correct to the best
of your knowledge. Unsigned forms will not be processed.
Submitting a false claim can result in prosecution. Date form was completed
�� Zl�- 1Z-
Print the Name of the Person who Completed this Form:����`
� �
ignature of Person Making the Claim:
p... �,
Revised February 2011
. � Page 1 of 1
' Accident Report
- „
�
���� � o
12-156-04D � °
w� vw� ^� c
w�
M�MA+IfM ruernov .T+aaa au� �n i� 7 L 2£}12 �n 2151 m
;a �r b2 tSa 'bn Y pZ
IIW�EbtIfFY IWUi4NW d!!SNlEfMME � Im1d�W'lNRCnO�'� ,��}�� � �nn.3i���T �� ���� _
1� R2C� SC � s "'
eowrr«o r+rneu aesere�cc wwtm �otrtcr.mrM..misuu�*.o�r�runc
��++� ��. 20 Wheelock ave
62 .�..
ad�c wn R��s wuets�er�•� snac a�a nsr�nn xn,a��
�.crc„,, aos�.mr, o�w�,a�ru,a.a�^ E+IN D Q 1 U 1
15 pl V9g2279936514 MI3 D OI O1 K841140100913
.sas.wre� e•�a..uo�.usn u.,5or.wm s,�c,os:
F,w,a�x w.��.ac..00�eusn 06 25 70 O1
02 MICHAEL ANTHONY DETOI+4AS0 Q7 1$ 70 DONNA DOAOTHY SYRING
G�1MIl 114 iT . . � MMOL RE3TULT �MMR
uw.rvEw es N.� �1. �1
05 3b7 Grove st t3, Q1 273 COTTAGE AVE W
�.
a,�.� an,arers.rr � � �'��"�'� 651-324-2903 �j
01 ST PIkQL 55107 651-291-I11I $T PAUL 5�1Z7
!� .ueev ecew.o
0 `°�'E: M �9 "°� 03 OS °8 N F '"tT9 `"04 04 �°8 C OI
•1GYL tYl'E 01XIG �YVE SOXp9F 111N�iCItS YMa/�MCl6dlWCF RMMttr9� JJ..'14 T'V� OM/t0 tv/Q TC1GV Q �NRtA%CEtlIIMG! MIMMMEM
� 98 �4�T 98 N:: a� �, 98 � 9$ N�, p�.
� �
�,. �� � �,u,,. N� 03
pI Ci[y of St Paul N SYRIflG DONNA DOROTHY
VENIY� �100FE8S WiY61 110GRF7i iOMiD �'lIIM
O1 367 Grove st � Y: 273 COT'£AGE AVE W N Q1
vwus «n.aT+uEZ� naun cet� carc�a�c.a �� 42 OI�
p7 St Paul, mn, 55207 "t�, 08 ST PAUL MN 55117 `"� �
ou�eoe wu�e woa r�ue eua� aoo�oe
01 ford bik DODG INT 994� 03
�+� «.,,�s m,� ,�� .�.�d� t�..u�.M �� �.� ,�M�B .m.. °`,,.. ��` O2�
03 OI � 02 vg1518 MN 12 Q1
MacAlWf'.E ra6YNraae wuV)r.lN�TT wUCVMMMe� �
self insuzed state farm c199299-e01-231
�rso w�z.,, wwco nmree,�or.. rar.woes r.Nm w�su,c. �
*rr[ �uc IFACCiDENTINVOLVEOACON4fERC44.MlOTORYEHN:LE.6CH00i.8lJS.ORNEADSTARTBUS vt�C
• R£MEMBER TO N0T1FY 7XE 8?ATE PA7RQL(nWhd un�t N!iKJli rW 7fAA511�.
CoMkfllO�LVf1aRENUl+eF11f-4[i'd1Gwn¢NwM! DDTMIE� �W.vfM0.iNfMlRF-tOfdtCMl�YRww.F 06TMMlR
MV6EMOE��IMRfEDQ� IM WlOR �E1( TYR WE �H�M ElGT WILV TDIIOr TW�� r.�
Q �,y�� � NNM111sFa p �
srittney Deanctra Syrin� p2 pfi stzot F' p$ 04 06 98 R N�; �y�,"�,e„ ��
�� �� `
sm.ma Rose Syzing 02 G9 '/i/ F Cl4 04 J6 9$ N N' .g� �4
�� �� �� �
• ���
cnw,.RO.o�ia�w,ua».�ooew�van�scciaa.q«aFaw.omv�a.ca�.,aaoRVn�o.�uoi....o�s� mr�m�.imac�,v,re,cow�.o+,.�.ee� � _
-. . . . . . . .. � o�cE
rcc*-. f ' ���:
pi .. _.._.... _ . . ..:
g8
.... .
fQN11' On 07-02-12 a� 2151 hrs� i sqd.205 IStiff) was
Q3 ,. sent to a squad accideni ivith no inguries �Z �� ` ��
�TM — J' .spoke.aiih .the.dciver..of.v�2 whe..said_.9he was..... gg
�1 - Northhaand on R�1e2 St approaching the.Koliday Gas
a+wnca • 1 Statioa entranee/exit.- Drivec�o£�v#2--said s:?e - °"."�`
�
� "'"""" saw a sqe�act car exiting the lot she thought the Q1
,��� sqvad Ha's`gbi�rg 'eb stop �ut i�' eonti�nued.' Driver
"�. �. o.f 'vt2 said she swerved te avoid being 'hit and �
98 ' rA was struck on the pas�erger side. . .
��i�wu+nv[ �� i �. ...... . ... ... ...... .. .. ... ..... . ._ .... ... _ �c
NMI R+.
� �;, ( � � �hen spoke. with driver of the squad car Officer �1
oaue„ :�; � Mike DeTamasa. Ofticez DeT�omaso said.he r�as. . ..�,n�R:
T ., exitinq the Aoliday Gas station and hfs attention
„a,a„ F{. � was dfvided by an intoxica.ted�femal-e who Nas" 01
�i. �� w.w.�..r.0
Q� �• walking on the stceet. Officer DeS`csmaso exi'ea s*a�:
a�, _. _
��, � � on [o Aica St col]iding »ith vf2
�9
.. _ . ._ ._ .....__.
0 i �; _ _ .. .,^9�'S
: } � __ ... ... _.
� } Y
4 � . � CpiMOW
_ .... ..... ....... . .. . . .. .
ROCWUI � . .. ... ... ... .... . . �� OZ
V 2 �D�. � � il- ... . . _.
. �� 1aq11R34f�OM Q CTItIFIMT1ml LOGI
°i�`""""""`�"�fMOi"0�' St Panl PD ❑aw� O� �
Sergeant Jeffrey Sti€f 187
1,rmz�/twww.dv5iesunnort.ar�/dvsinfolaccidentrecords 2Q08lInctudes LE/PrintReportIndiv... 7/3/2Q12
�,*�
;��
4�,
�;
/ �� � � � � �
,���''
�.��
`� �Y
.
,,�,,;
��.,. � � �
���:.
�,.�a-
�� ���
��� � � � �
��.rt= �
� � i
�� �
�'
�_�;
�,='
_ �� ,
,_ x�: _
a
�� �'"� � � �
-.- -�
� ��;, �;, �
Y r�
P�
�'
�, _
x ;,
,�:'.#',-'..
v ""y��'«�. ' .
��.
€
�':
�.�,
.��
.��: '�F'•"•• .
v'
C
�'` '
t.
F
. �
:�
�G
?
._1R #�}
-v�. �
w���x. ����5m.,... . .
`q1 ��� � A�t ��-�u�z . .. . . _ . . �. � .
� f ��#k
-�N ` /_ ' rs�.. 8s< � . _
V =} .:
y... °�
\
.k� �
.
A,� g f
�
`\, A�
\
µr
2 i
r �
�
�
� (, ,
^��
'yG`
• � ,
�:.� „ ����, �
� ;� � ����
.;
�s � ��
,, 3
�.
.:,:�
��
,-��� � ��
., r�� ;
,
�. �
i�
�'�
Y,�:
� �p± `
i Z�
W�
!
�
r};:
�t �
:
���.
E�,.
���2,
� :
�{
.y}
.�'
.a�.J...= .
v `
�,..kr.' ��
E5k
�
. � .
� `y�,� . �. - . , . . � . .
> �
. ,du€ �z .�: _ _,.,:,.
. � �•-. �.a - � - . .. . . .._
.,ar a. - . " � ..
%`�
j� i�
��� � "r���'a'° qY :s�
:� Y �:: � ',�* , ..
� �
c
� a �t� ;� � . . �,�. - .
� ri
��-� � .� �� . . ' ,
�" � �a
�� � . 4� � ��r ;
� ��
�z� � � ; � �
� � �
_ ��� � �a-v.� � ;
� �� ��':�, � � � � �
�� ,
"�
-� �
��
�
• ���;� � � � � � . . , �
� .
. w
JT� �. > ; .
�
�� 1 •
�
0
`�::
3;.
. t
;�
�:
E`� � } �
°�= '-
�. �
�,: � �
���
�;
�;�,
�
�=:
�,
���.
���
� � � _-
, �
, .�� r ;��
�`�,"��.� �
�
�
� ���;
s�� .� fi�`` �`�,.�
5�{��:r�e.
��``��M �:� .\:\ .
'" �r�y�." :� \ �`
� - .,
. . ,;
�,�.
s�k�`.�t`y -
�� ���� , ' �
�f�� � �
�� � -
° �
., fy1�.„ti� 4� � � ..
G�,� � �,
�,��-���'°,.�°- •�
b�� �� .�
r }
t� ��'�t�;J
� X ' tk� ,
�� �r-� ���..
r �a°a
�>..� � _
� � w�;
. *.
i�.. � � - z-.
. . .., �
;. � � ��„�,xk �
�
� � .
`.` ..� ;��x�r T�3 'a �-"''s`-u� �'°�. ' +�e':�re�..1
„� ` : �� �w ..y
_�i. '.: n-...,�. t.'.
3''
07Y10/2012 14:22 6514884794 RAYM PAGE 01/05
� � RAYMONDAUTO BODY� TNC. w�fe1D� �OcOB50ai�
].075 PxERCE BllTLER RTE, SAINT PAUL, MN 55104 ���zD: 41-0�2s1;
Phone: (651) 488-0588
FAX: (651)488-4794 �
Preliminary Est�mate
Custonfe�: SVRING, DONNA
Wrltte�l BY:STEVE SUNDERLAND
Insured: SYRING,DONNA Policy�:
Claim#�:
Tvae of Loss: Date of Loss:
Days to Repair: 0
Point of Impact: �
� � .
Cwner. tnspeetion Location: insurancs Company:
SYRING, DONNA` RAYMOND AUTO BOOY,INC. �'
273 COTTAGE AVE W 1075 DiERCE eURER R7� , �S
' SAINT PAU�,MN 55117-4301 SAINT PAUL,MN 551oa �"
(651)469-942g Ev�ning R�air Fadllly
(651)488-0588 Buslness � �
veHxc�E �
Year: x994 : Body Sty�e; 4D SED VIN: 2B3ED46T5RH292595 Mlleage In:
Make: DODG Englne: 6-3.3L-FI Ucense;
�leage out:
Model: IMREpID Production Date: State: Vehide put:
Color: xnt: Condltlon: ]ob�:
Air CondiUoning : Clpq��� Intelmittent Wipers Stereo "
AM Radio ,., Console/Storege OvercJrive ' Tllt 1Alheel `
Automa�c Trar�'ril�slon ptiver q��gay P k .
assenger Afr Bag ����� . r;
Body Side Moldlrigs Dual Mirrors Power Brakes '
&'���� ' FM Radio Rea�Defogger "
dear Coat Paint� Full Wheel Covers Redine/I.ounge Seats �`
.
, ;
.. �
. �
< t� �
„�. '�
7/10/2012 3:31:48 PM 019495 pa�i
, 07710/2012 14:22 6514884794 RAYM PAGE 02/05
Preliminary Estimate
Customer: SYRING,DONNA ,
Vehlde: 199<►DODG INTREPID 4D SED 6-3.3L-FI
Line opera�Jon Desaiption Qb Extended labor
Peint
prioe;
� FRONT BUMPER
2 � R&I R&I bumper tov�r '
3 . 1.0
, FROM'LAMPS .
� R�I RT Headlamp assy R
g 0.3 �
FENDER
6 Blnd RT Fender
7 1.3
R&I RT Fender liner 0.5
$ PILLARS,ROCKER&FLOOR
9 R&I RT Rodcer molding front,base peari whice
�,p 0.5
R&I RT Rodcer mdcNng rear,base peari white 0.5 �
� 11 , FRONT DOOR
12 '� ' 0 Repl RT Door she11 1~ 789.00 4.5 '
13 3.2
Add for CJear Coat
14 1.3
, Add for mlrror 0.4
15 Repl RT Nameplate"3.5L 24 VALVE" 1 3735 0.2
16 Repl RT Body side mldg upper 1. 88.45 0.3
�� , REAR DOOR �
18 • 0 Repi RT Door shell 1 335.00 4.0 3.2
19 Overlap Major Ad�.Panel
zo � -o.a:.
Add for C�ear Coat 0.6 t
�l ReP� RT BodY slde mldg upper 1 60.20 0.3
22 ' eAIX GIASS
� * � Rpr RT Reveal mdding upper,side �
24 QUARTER PANEL �
�5 �ind RT Quarter panel 1.1
26 REAR LAMPS
Z� R&I RT Tail lamp assy „ �4
28 ' RF�4R BUMDER
29 R&I R&I bumper CO�er lA
30 MISCELtANEOUS OPERATIONS
31 * Repl Cover car/bag i p,�
32 # Subl Wazardous waste removal � 6.00 X ;
33 # ' Cdor tlnt/oolor match 1 � OS !
3'� �' ' Repl Corrosion probection primer i 0.4 �
35 # .. Repl Flex addlqve 1 8.00 X �
��T� 1r324.00 14.Z 31.4� �
i
7/10/20�Z 3:31:48 PM 0�9495 Page 2
, , 0T/10/2012 14:22 6514884794 RAYM PAGE 03/05
Preliminary Estimate
Customer:SYR�NG,DONNA
Vehlde: 1994 OpDG INTREpID 4D SED�3.3L-Fi
, ESTtMATE TOTALS ti
�ry Besls Rate Cost�-
Parts
eody LAbor ; 1,310.00
14.2 hrs � $52.00/hr 738.40
Paint Labpr 11.4 hl5 � $52.00/hr 592.80
Paint Supplies 1�.4 hrs �l $32.00/hr 364,gp
Mlscellaneous
Subt�l
14.00
• 3,020.00
Shc@S TeX $1,310.00 f� 7.6250% 99.89
Grand Totel
Deducdble 3,119.s9
0.00
CUSTOMFR PAY 0.�
: INSURANCE PAY 3,119.69
WHII.E WE HAVE MADE kVERY EFFORT TO WRITE A COMPREHENSNE REPORT OF THE VISIBLE DAMAGE TO YOUR
VEHICLE, IT IS IMPORTANT TO REMEMBER TWAT THIS IS ONLY AN ESRMATE. THERE AR� A NUMBER OF FACTORS ;;
THAT CAN AFFECT THE ACRIAL COST OF REPAIRS, INCLUDING BUT NOT LIMITED TO HIDDEN DAMAGE, PARTS,PRICE ,.
CWANGES, AND INSURANCE COMPANY xNVOLVEMEfYT. PLEASE CONSIDER?NIS WHEN MAIQNG DECISIONS
REGARDING TI-IE REPAIRS TO YOUR VEHICLE.
YOUR COMPLk7E SATISFACTION VNITH TI-IE RESTORATION OF YOUR VEHICL�TO ITS PRE�ACC�pENT CONDITlON IS
OUR NUMBER ONE CONCERN AT RAYMONp AUTO BODY.
WHEN YOU CHOOS� RAYMOND AUTO BODY TO REPAIR YOUR VEHICLE, YOU ARE GUARAM'EED COMPLETE
SATlSFACTION W1TH 7HE QUALTIY OF T1-IE REPAIR,,AND ALSO W1TH THE SERVICF 1NE WILL pROVIDE YOU.
OVER HAI.F A CEMURY AGO, A PERSONAL COMMITMENT WAS MADE TO D(CELLENCE IN CUSTOMER SERVICE AND
WORKMANSHIP. TH(tEE GENERATIONS LATER, THE S�OMKOWSKI FAMII,Y IS STILI: UNCOMPROMISING IN THAT
COMMZTMENT.
WHATEV�R YOUR NEEDS OR CONCERNS, WE APPRECIATE THE OPPORTUNITY TO BE OF SERVICE TO YOU. PLEASE
CAI.I US W1TH AfYY QUESTIONS. WE LOOK FORWARD TO ASSISTING YOU WITH TNE REPAIR OF YOUR VEWI0.E.
* REMEMBER.`,`- IN THE STATE OF MINNESOTA, YOU HAVE THE RIGHT TO HAVE YOUR VLHICLE REPAIRED AT TFi� �
ShIOP OF YOUR CHOICE. THANK YOU FOR CHOOSING RAYMOND.AUTO BODY! � �'' �
"CUSTOMERS'ARE OUR MOS7 VALUABIE ASSET!"
7/10/2012 3:31 c48 PM 019495 '� Page 3
� � i
i.
. 07/10/2012 14:22 6514884794 RAYM PAGE 04/05
Preliminary�stimate :�
Customer: SYRING, DONNA �
Vehlde: i994 DODG xNTREpzp 4D Seo 6-3.3L-FI
AUTO CLUB INSURANCE ASSOCIATlON, MEMB�RSELECT'INSURANCE COMPANY OR AUTO CLUB GROUP INSURANCE
COMPANY (HERQN INDIVZpUALLY AND COLLECTIVELY REFERRED TO AS ACIA) GUARANTEES THAT IT WILL REpIACE
THE QUALITY REPIACEMENT PARTS (PARTS NOT MANUFACTURED BY THE ORIGINQL EQUIPMENT MANUFACTURER)
IDENTIFZED ON ThIE VEHICLE ESTIMAT�ASSOCIAATED WIT�H TI-�IS GUARANTEE ZF A DEFECT IS DISCOVERED.
ACIA FURTHER GUARAM'EES THAT TH� QUAL�TY REPLACEMENT PARTS, DCCLUDING GLASS AND MECHANICAL �
PARTS, ARE CERTIFIED OR VALZpATED TO BE OF OEM �UALI7Y IN RLL INSTANCES WHEN THIS CERTIFICATION OR
VALIDATlON IS AVAILABLE FOR THE PART, 11�1IS 6UARAN7EE IS ZN EFFECT FOR AS LONG AS YOU OWN THE REPAIR
VEHICLE AND.IS NOT TRANSFERABLE TO ANOTHER PARTY AT ANY TIME. THIS GUARAN7FE COVERS TI-IE COST OF
THE PART, I./�BOR TO INSTALL, PAINT AND MAl�RIAIS IF REQUIRED, AMD REASONABLE RENTAL COST OF A SIMILAR
TEMPORARY REPIACEMENT 1/�HICLE DURING TI-IE REPAIRS. THIS GUARANTEE DOES NOT COVER CLAIMS FOR
DIMINUTION IN VALUE OR CONS�QUENTIAL DAMAGES.
IF A DEFECT�N A QUALIT'Y R�PLACEMEI�lT' PART IS DZSCOVER�D, CONTACT YOUR LOCAL ACIA (IAiMS DEPAR7MENT
IMMEDIATEI.Y AND ACIA WILL REPLACE THE PART W�TH A NEW ORIGINAI EQUIPMENT MANUFACTUR�R PART. ZF AN "
ORI6INAL EQUIPMENT MANUFACTURER PART xS NOT RFASONABLY COMMERCTALLY AVAiLABL.E, AQA WILL REPLACE
THE DEFEGTNE pART WITH AN07NER QUALITY REPLAC�MENT PART.
MN ST 60A.955 - A PERSON WHO FILES A C1AIM IMTH INTENT TO DEFRAUD OR HELPS COMMIT A FRAUD AGAINST
AN INSURER IS GUILlI'OF A CRIME. �
s
� , �,
' ' " ;f
t: , ,
.;
, •.
r.
' r
7/�0/2412 3:31:48 PM 019495 Page 4
. . 07/10/2012 14:22 6514884794 RAYM PAGE 05/05
Preliminary Estimate ��
Customer: SYRING, DONNA .
Vehide: 1994 DODG INTR�ID 4D SED 6-3.3L-FI
Estimate based on MOTOR CRASH ESTIMATlNG GUIDE. Unless otherwise noted all items are derived from �he Gufde
DE3PW93, CCC Data Date 7/2/2012, and the parts selected are OEM-parts manufactured by the vehicles Origlnaf
Equipment Manufacturer. OEM pans are available at OE/Vehicle dealerships, OPT OEM (Optfonai O�M) or AlT OEM
(Altemative OEM) parts are OEM part,that may be provided by or through altemate sources other than the OEM vehicle
dealerships, bPT OEM or ALT oEM parts may reflect some specific, special, or unique pricing or discount. OPT OEM or
ALT OEM parts may (nclude "Blemished" parts provided by OEM's through OEM vehide dealerships. Asterisk (*) or
Double Astensk (**) indicates ifiat the parts and/or labor information provided by MOTOR may have been modified or
may have corr�e from an aft�ernate data source. Tilde sign (N) items indipte MOTOR;Not-Included Labor operations.
The symbol (<>) indicates the refinlsh opera0on 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 SpecificaGons. Labor operation times
l;sted on the line with the NAGS infonnation are MOTOR suggested labor operation times. NAGS labor operation t3mes
are not included. Pound sign (#) items indicate manual entries, �
Some 2012 vehicles contain minor changes from the previous year. For those vehides, prior to receiving updated data
ftom the vehicie manufacturer, labor and paris data from tl�e prevfous year may be used. The CCC ONE estimator has a
complete list of applicabie vehicles. Parts numbers and prices should be canfinned with the local dealership.
The following�is a Ilst of additional abbreviatio�s or symbols that may be used to describe work to be done or parts to be
repaired or replaced;
SYMBOL$FOliL01NZN6 PART p�tICE; �
m=MOTOR Mechanical oompooent s=MOTOR Structvral component, T=Miscellaneous Taxed charge category,
X=Miscellaneous Non-Taxed cfiarge category.
SYMBOI.S FOLLOVIQNG IABOR:
D=Diagnostle�labor category. �=Electrica� labor category. F=Frame labor category. G=Glass labor category, �
M=Mechanical labor category. 5=Structural labor category. (numbers) �, through 4=User Defi�ed Labor Categories. '
OTNER SYMBOLS AND ABBREI/IATIONS: � �
�:
Adj.=Adjacent. Algn.=A(ign. ALU=Aluminum, A/M=Aftermarket part. BInd=6lend. .-BOR=6oron steel. CAPA=Certified
Automotive Parts Association. D&R=Disconnect and Reconnect, WSS=High Strength�Steel. HYD=Hydroformed Steel.
Ind.=included. LKQ=Like Kind and Quality. LT=Left, MAG=Magnesium. Non-Adj.=Non Adjacent. NSF=NSF
Intemational �Certified Part. O/H=Overhaul. Qty=Quantlty. Refi=Refnish. Repl=Rep(ace. R&I=Remove and Install.
R&R=Remove and Replace. Rpr=Repair. RT=Rtght SAS=Sandwiched Steel. Sect=Section. Subl=Subfet. UHS=UItra
High Strengtli��Steel. N-Nate(s) associated with the estimate line. �
CCC ONE Esti,r`nating -A product of CCC InfoRnat(on Services Inc. , ;
The following;�is a list of abbreviations that may be used in CCC ONE Esstimab�g that are not part of the MOTOR CRASH
ESRMATING;GUIDE:
BAR=Bureau�of Automotive Repair. EPA=Environmental Protecdon Agency. NHTSA= Nationai Highway TransportaUon
and Safety Administratlon. PDR=Paintless Dent Repalr. VIN=Vehicle Identlffcation Number.
,.
.,
7/10/2012 3:3�:48 PM 019495 Page 5