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Dibble _ ��;�.{°;�'�'~f!�_�"� �rr C� 5 2012 �,, �,, -` �tiV� ;.�� , E..�� -- NOTICE OF CLAIM FORM to the City of Saint Paul,�1Vlinnesota Minnesatu Stute Statute 466.05 states thcet "...ei�ery pei•s�on...w/w claims dmnciges froni any municipality...shall cuuse to be presented to the ,�orerning boch�of the nn�nicipulit}�within 180 days after the cr[legecl loss or injury is discovered a natice stating the time,pluce,«��d circumstances thereof,and the umou��t 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. Tliis 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 l.�sON1� Middle Initial � Last Name ��: � lr, Company or Business Na►ne��R Are You an Insurance Company? Yes No If Yes,Claim Number? /l%�/�1 Street Address l I�('� ��` �J� �(? City Sp�t�'1 Sf �0.sr� State �� Zip Code S�C9� Daytime Phone(Eo'S�) Z' � -��Cell Phone (�)� i7� Evening Telephone( ) - Date of Accident/Injury or Date Discovered rb�Z]��Z Time N� am pm Please state,in detail, what occurred(happened),and why you are submitting a claim.Please indicate why or how yo�i feel the City of Saint Paul or its employees are involved and/or responsible for your damages. Se.L �'o�C.�t r'V�t.Y�� ( " IJO 1�'KafL A ✓2O� 0.. . Please check the box(es)that most closely represent the reason for completing this form: ❑ My vehicle was da►na�ed 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 ❑ My vehicle was wrongfully towed and/or ticketed ❑ I was injured on City property �,Other type of property damage—please specify M�1iG�G r.ia5 alarN0.��ve. h� ti�t lo��r.r�c.e o� ❑ Other type of injury—please specify 0. Ci1-v Y,wk)�C.�. In order to process your claim you need to include copies of all applicable documents. For the claims rypes 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 yourself before submitting your claim form. O Property damabe claims to a vehicle: two estimates for the repairs to your vehicle if the damage exceeds $500.00; or the actual bills and/or receipts for the repairs O Towing claims: legible copies of any ticket issued and a copy of the impound lot receipt 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 O Photo��raphs are always welcome to document and support your claim but will not be returned. Page 1 of 2—Please complete and return both pages of Claim Form Failure to complete and return both pages will result in delay in the handling of your claim. All Claims–please complete this section Were there witnesses to the incident? Yes No Unknown (circle) Provide their names,addresses and telephone numbers: �'Att�o�► � �. �t+ + ge 5T��.� t C�i°��l6-�l�Q VVl.ichacl rn�ka�ns j 3Bp w.�+�+�5+,st r��t mu ��zZZ-YYSS Were the police or law enforcement called? Yes � Unl:nown (circle) � If yes, what dep�u-tment or a�ency? Case#or report# _ W►�r,��_ r,id the accident or injury tai;e nlace° Provide street address,cross street irter�,ection, name of par]<or f.;:.i';;�,�. closest�]andm�u-1<,etc. Please be as detailed as possible. If necessary, attach a dia«ram. �ftl[_ bnmc�e► � e_v�r� i r�. t�h Al�cu I�h�no� f�or�c_.S l�v}-��. v�rt,,� Please indicate tne amount you are seeking in compensation or what you would�ii:e tne City to do to resolve thi�c�ai�?� to yoEU-satisfaction. ItA. � �.4� � qvt � � Sc:.c.k�n�i F-he �.v�e..(c�c�r C�Mc✓:ZE Fro�✓� rh.v tt►� es;Eievraft5 �i0'y5� I� Vehide Claims–nlease comnlete this section ❑check box if this section does no; «•�lv Your Vehicle:� Year LAOCo Make_ �ce� Model ��(,'Sd ('rex� �A6 � License Plate Number State Color �jGl�C. ', Registered O�mer e;o�.('S0!'l 'S t�,6�_ Driver of Vehicle �'hi5 �,{�h ie I� ��ar�( 'I � Area Damaged En r�,_ ft�A�t� 5 r ( ; Citv Vehicle: 1'ear Make Model � License Plate Number State Color Driver of Vehicle(Cit}�Employee's Name) � � Area Damaged ' In'urv Claims– lease com lete this section check box if this section does not a;mlv � How«�ere vou iuiured? �ll � What part(s)of your body were injured? N {� � � � Have you sou�rl�t�medical treatment? Yes No Planning to Seek Treatment(circle) �I When did you receive treatment? �j1A (provide date(si) i � Name of VIedical Provider(s): � � � � Address Telephone i Did you miss worl:as a result of your injury? Yes No � Whea did you miss work? �� (provide date(sjj � Name of your Employer: � ( Addr�ss Telephone f I E �Check here if you are attaching more pages to this claim form. Number of additional pages_. , ; By sig;�i;�g tkis fo�7n,you are stati�ig tha:all infor�nation you have provid�d is *rue and correct to tlze b�st � of yozu�k�rowledge. Unsigned f'or�ns will not be p�•ocessed. � _ __ � Subirziiti�zg a false claim can result in prosecutioii. Date form was completed_�I3��Z E - Print the Name of the Person who Completed this : �t�� D i'1 � i �"� I Signature of Person Making the Claim: "'—� —� � P � Revised Febru�u'y 301 I �� i. � 5 �: g:. i' �., I CARSON DIBBLE � 1159-NINTH AVENUE SOUTH ' SOUTH ST. PAUL,MN 55075 August 30, 2012 To Whom It May Concern: On August 29,2012, my truck was parked in a parking lot behind Bonfe's Auto Body&Mechanica) next to the alley behind this shop. At approximately 11:45 am, I noticed a City street sweeper making several passes up and down this ally. The sweeper was cleaning up several inches of loose pea gravel that had been spread by the City in weeks prior. (Attachment 2.) A few minutes later, I walked outside to speak with Michael Fritzkapps of Bonfe's about a vehicle that we are working on together. While I was speaking with Michael at the rear of the building,the sweeper made another pass through the ally. It was at that time that I noticed hundreds of rocks that the sweeper was attempting to remove bouncing off my truck,the neighbor's garage,and nearby buildings. I could hear the rocks bouncing off everything near the sweeper as well as see them flying everywhere. I asked Michael if he was seeing what I was,and said something to the effect of, "What do you bet that sweeper is peppering my new truck." (I had purchased this truck two days prior,on August 27.) Shortly after my work shift August 29, I had my first opportunity to look at my truck and saw the damage that extended down the entire side. The chips were obviously fresh,judging by the du5t that remained from the pulverized clear coat. There were also several rocks still resting on the truck's running board. I am confident that the negligent actions of the driver of this street sweeper caused this extensive damage to my new truck. I am a Collision Technician at Bonfe's Auto Service,and my witness is an Estimator here. We believe the Bonfe's estimate is accurate and appropriate, however, I have provided two additional estimates from reputable shops in the area(attached). If you have questions,or need additional information, please contact me at 651-746-9170. Sinc rely, c Carson Dibble Enclosures A�-0.�chnn��}-�l 380 west 7th st, st paul mn- Google Maps Page 1 of 1 To see all the details that are visible on the y_v,� screen, use the "PrinY' link next to the map. %�` �., _ . _ � � � � ; , :, . .,. �� ;�� ' ,, � r ' ;� �� z� � ��,. �� :� � �� '�� r� , � �-: �,� � , ,�-, � � � � ,� g �� ..' � ,.�� ; ,. , ,< � .�, ..,, � u.. __. � �� ' ��, �� ,-, �� :_ � � , . ` � . ; & � ' * �, ,, „ �. „�, � �:: ,��,,� �:� �� ,� � ��' �" �� —` �� > , <, t, : , r � �`m,; '� `"� � �;�� ° y>:. f�., •• ' � � .e, � 3: � �' � � � , � � �� r�� J " �� i � � � � �_ �`, ��. ��,` �� '�"' �a � �� ' � ;,,,, ;� �y x ,��_ � ;� ��'� � � � � . � � ��.� � � I g N�� 4 'i\� f� � � �� fi i ,F� � a� �}� � i^ - � � �°fN� � � � ' ` �' � ':• � '�X�: a*�yi/ �"`,,'�� , ��'� ��° � I �, � �� '�.°� .�..;�'� � � u '�i' � �� . �.�- �� a ,, ,. , ma� �- (� �; � �,r�,Y�- r � � r� ,�« �;�, a .� � � 7�g� � � � �� : � �� i„ " ,,,,y :. �- . "/+.... t f;, � � i�, '� ,:: _. � 3� � '� „' fa: � : � f/ ,r��`E''c �e �� .\�. � y4 `"'�" ,� :7: � � � �m � �M� � ��. .,i �,. � i� .:�� 4�;� F'9 '��'. �. �� %. ♦ � �N ,�, `w.,.� t � �I. �t�' ��5.: � � � �..�.�....u:�u,£. �` � ly� ��-. .. � �� y}r$�� ; � 9 ^� �� ✓..: ��?''; - � 3 �,� b� _ �� , wu-" h - 6:',a .. r � a�� N �q� ��'�� :.:,. , �. � `4 1 � �, � � � I http:/hnaps.google.com/maps?hl=en&q=380+west+7th+st,+st+paul+mn&bav=on.2,or.r g... 8/30/2012 ��,w�D,� � Page 1 of 1 , � _„ � C```�� . ._ � ��11� Ci � a VEHICLE Year: 2006 8ody Style: 40 PN VIN: iFTPW14V76KD00074 Mileage In: M�Ice: FORD Eng�ne: 8•5.41-Fl license� Mileage�t: Model: F 1 SO 4X4 51.IPERCREW Producnon Date: State: Vehide Out: xLT Color. InL CAnCl:tron: Job A TRANSMISSION puv M�rrors RADIO 4 Wheei Dlsc&akes Automahc Transmiss�on Pnvacy GWss AM Radw SEATS a Wheel Drive Doerhead Conwle FM Radw Goth Seau Overdnvc CONVENIENCE Stereo WHEELS POWER A�r Condi6onmg SeaKiU52ek Chrome Wh�ls Power Steenng Tilt Wheel CD Player PAINT vower erakes Cruise ConvW SAFETI' Oear Coat Pa�nt POweJ WinOows Intamlttent Wipers Anti-Lak&akes(4) TRUCK Pohti�r locks Keyless E�try Dnver Alr Bag Rear Step Bumper DECOR Message Center Passenger A�r Bag 8l30/2012 3:30:52 PM 3056�1 Page 1 https://docs.google.com/viewer?attid=0.1&pid=gmail&thid=1397a1 Oc3ff2ea6d&url=https... 8/30/2012 Page 1 of 1 i Preliminary Estimate 'I Customer:DIBBLE,CARSON 7ob Number: j Veh�de:2006 FORD F150 4X4 SUPERCRENJ XlT 4D P/U 8-SAl-FI � I I Une Oper Desvlpdon Part Number Qty Extended Labor Paint � � Price; � 1 FRONTBUMPER I 2 0/M bumper assy z 3 I 3 " <> Rpr &�mper cpver w/o wheel openmg 6L3Z17D957AAPTM Q,� 2.p ' molding 9 FENDER I 5 ' Rpr LT Fender w(o whCel Operong 5L3Z16006AA j,Q z,2 rnoldirx� 6 Overlap Major Non-Adj.Panel 0.2 % R&I RT Fenderlmer 8L3Z16102A 0.6 8 Repf RT Nameplate"F:50 XLT 5.4 SL3216720E 1 31.43 0.2 TRITON 9 R&I RT Mud guard front guard k�t E7TZ16A550A 0.3 LO R&1 RT Sto�e defle[tor w/v.�heel SL3Z16G554A�W 0.2 nwlding carUOn black 11 EIECTRICAI t2 R&1 RT Base 6L3218A984A p.a 13 R&1 Anteruia mast AL8Z38813A p.l 14 fRONT LAMPS :5 Rt�l RT Headlamp assy w/painted svrr 7L3213008EA 0.4 :6 CAB 17 R&I RT Runn�n�boara black 6L3Z16450DA 1.0 18 &r3d RT Urns�de assy 4L3Z16211A80AA s z.g 19 Repi RT weatherscnp SL3Z1651222M 1 93.92 0.5 20 FRONT DOOR 21 • RF� RT Outer panel regular&Crew 4L3Z1520200G1 LQ 2.4 c3b Irom 12/1/03 z� Overlap hta�or Non-Ad�.Panel .p z 23 R&I RT UODC�mo�ding regular,super 613Z1520554AA 0 3 cab w/o HARLEY DAVIDSON 24 RRI RT R&1 mirror 8L3Z17682D6 0.3 2S R&I RT 8elt w'Strtp outer Qew cab 6L321521452A Q.3 26 RQaI RT Handle,outs+de w/keyless 913Z15224048.4 0.4 27 R&I RT RRI tnm panel 6L321823441FAA p,5 78 R&I RT Door gW55 regular cab 4L321521410AA p,q � 29 RF�I R7 Run Channel wper Cab S13Z1821536AA 0.4 30 REAR DOOR 31 ' Rpr RT O�.ter pand 4L3Z162470pG4 ' LQ 2.4 32 pverlap MaJor Non-Adj.PanN .p z 33 R&! RT Upper mold�ng SL3ZIG255A34AAA 0.3 3•1 R&1 RT Oocr glass Fcrd 4L321625712AA OA 35 R&I RT BCY w'sUip outer 613Z1625596A 0.3 36 R&I RT Run channel outer 7L3Z1625766AA 0.4 37 R&I RT Handle,outslde 9L321626604A8 0.4 3R Rt41 RT R&1 Irim panel 6L3Z162740GUA 0.5 8,�30,�2012 3:35:15 PM 305622 pay2 2 https://docs.google.com/viewer?attid=0.1&pid=gmail&thid=1397a1 Oc3ff2ea6d&url=https... 8/30/2012 Page 1 of 1 Preliminary Estimate Customer: DIBBLE,CARSON lob Number: Vehrle:2006 fORD F150 4X4 SUPERCREW XLT 4D P/U B-S.4L-FI 39 DICK UP BOX 90 Rep Set Wck box assy 1 1.5 41 R&1 RT Upper mold+ng 5.5 foot bed SL3Z64291A40AAA 0.3 42 Re�l RT Detal"4x4'shadrnv grey 4L3Z99I5622EA8 1 40.00 0.3 y3 ' Rpr RT Slde panel 5.5 foot beA w/o 5L3Z84278a0M 2.5 2,8 wlil Opng 44 Overlap Ma�or Ady Vanel -0.� •IS Qed�Coat 1.5 a6 RE.I RT Stone guard w;o wheei SL3299292A22AAA 0.3 rr�dir�black 4) RfJ RT Mud guard E7TZ36ASSOA 0.2 48 r R&1 TOpper w/Wiring 1.0 49 REAR LAMPS 50 RfiI RT 7ail lamp assy 613Z1340�16A 0.3 51 REAR BUMPER 52 R!L] R&1 Gumper assy 8L3Z179068 0.6 53 n Rea Flex AddiUve 7 7.00 54 � Re� CArrOS�On Rotecttc� 1 15.00 0.5 55 .. Repl Car Cover . 14.00 0.2 56 r Repl Flazardous\Naste 1 7.00 I 57 n Refn Mask&Tape Jambs 03 ' 58 a Refn Cnior,Sand&Buff 1.0 � SUBTOTALS 208.35 22.1 17.4 ESTIMATE TOTALS Catepory Basis Race Cosc; !, Parts 208.35 I �Y�bor 221 hrs �a ;57.00/hf 1,259J0 I Pamt Laba 17.4 hrs �^a S 57.00!hr 991.80 I Paln;Supplie5 17.4 hrs t� ;37.00 Atr 6M13.80 � Body Su�l�s 9.2 hrs �y $5.00/hr 46.00 Subtotal 3,149.6 S Sales Tax g 208.35 �i� 7.6250°.G 15.89 I Grand Total 3,165.54 Deductiblc 0.00 CUSTOMER PAY 0.00 INSURANCE PAY 3,165.54 $�30,�2012 3:35:15 PM 305622 aage 3 https://docs.google.com/viewer?attid=0.1&pid=gmail&thid=1397a1 Oc3ff2ea6d&url=https... 8/30/2012 Page 1 of 1 Preliminary Estlmate Customer: DIBBLE,CARSON Job Number: Vehlde:2006 FORD FI50 4X4 SUPERCREIV XLT 4D P/U 8-5.4L-fl THIS REPORT IS AN ESTIMATE, BASED ON OUR INITIAL INSPECTION AND DOES NOT COVER ADDIlIONAL PARTS OR LABOR INHICH MAY BE REQUIRED AFfER TNE WORK IS OPENED UP. PART PRICES SUBJECT TO CHANGE PER MFGR. UFEfIME WARRANTY ON WORKMANSHIP, 30 DAYS ON WHEEL ALIGNMENTS. WARRANTY WORK MUST BE PERFORMED BY LAMETTRY'S COLLISION ONLY. PARTS WARRANTIED BY THE MANUFACTURER. NO WARRANTY ON RUS7 RESTORATION, CORROSION RESISTANCE OR REPLACEMENT RENTAL CARS. OUR REPAIR EST]MATED TIME DOES NOT INCLUDE INSURANCE OR PARTS DELAYS WE MAY EXPERIENCE. MN LAW-A PERSON WHO SUBMITS AN APPLICATION OR FILES A CWM WIT}i INTENT TO DEFRAUD OR HELPS COMMIT A FRAUD AGAINST AN INSURER IS GUILTY OF A CRIME IN h1INNESOTA. 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. 8,�30!2012 3:35:15 Pt4 305622 Vage 4 https://docs.google.com/viewer?attid=0.1&pid=gmail&thid=1397a1 Oc3ff2ea6d&url=https... 8/30/2012 � TOUSLEY COLLI�ION CENTEI� W�e ID: 047f5199 �\]��, Federal ID: 41-0609970 '�� 1493 COUNTY ROAD E E,WHITE BEAR LAKE, MN 55110 Phone: (651) 288-6262 Preliminary Estimate Customer: DIBBLE,CARSON �ob Number: Written By:Candy Tuttle Insured: DIBBLE,CARSON Policy#: Gaim#: Type of Loss: Date of Loss: Days to Repair: 5 Poir�t of Impad: 01 Right Front Owner: Inspection Location: It�.wrante ComParry: DIBBLE,CARSON ; � ��;s�� '. ,, . �i g '.��. i5 ( �' : �,� �pN��C�'G. �;5 rc�r� co�rv�o�- � rK.o�c�e;- W i�� Year. 2006 Body Style: 'Oo�� ►h� PW14V76KD00074 Mileage In: Make: FORD Engine: �� Mileage Out: ModeL• F150 4X4 SUPERCREW Production D__... �rate: MN Vehide Out: XLT Color: Int: Condition: ]ob#: TRANSMISSION Duai Mirrors RADIO 4 Wheel Disc Brakes Autanatic Transmission P�ivacy Glass AM Radio SEATS 4 Wheel Drive Overhead Consde FM Radio Cloth Seats Overdrive CONVENIENCE Stereo WHEELS POWER Air Conditioning Search/Seek Chrome Wheeis Power Steering Tilt Wheel CD Piayer PAINT Power Brakes Uvise Contrd SAFETY Clear Coat Paint Power Windows Intermittent Wip�s Mfi-Lodc Brakes(4) TRUQC Pow�Lodcs Keyless Entry Driver Air Bag R�r Step Bumper DECOR Message Center Passengc�Air Bag ' I I 8/30/2012 2:01:19 PM 065151 Page 1 �~ Preliminary Estimate Customer: DIBBLE,CARSON )ob Number: V�ide:20�i FORD F150 4X4 SUPERCREW XLT 4D P/U 8-5.4L-FI Une Oper Desaiption Part Number Qty Extended Labor Paint Price$ 1 FRONT BUMPER 2 RSd R&I bumper assy 6L3Z17D957AAP7M 1.5 3 * Rpr Bumper wver w/a wheel opening 6L3Z17D957AAPiM Q,� 2.0 molding 4 Add for Clear Coat p.g 5 R&I License bradcet 6L3Z17A385AAA 0.2 6 # Repl Hex addibve 1 4.00 7 FRONT LAMPS _ 8 R8d RT Headlamp assy w/painted�rr 7L3Z13008EA 0.4 9 FENDER 10 * Rpr RT Fender wJo wheel opening 613Z16005A �„Q 2.2 molding 11 Add for Clear Coat p,9 12 RBei RT FerMer liner 813Z16102A 0.6 13 R&I RT Stone deflecb�w/wheel 5L3Z16�554AAA 0.2 molding qrbon black 14 R&I RT Mud guard front guard kit E71Z16A55aA 0.3 15 Repl RT Namepiate"F150 XLT 5.4 SL3Z16720E 1 31.43 0.2 TRI'fON 16 ELECTRICAL 17 R&I Mtenna mast ALSZ18813A 0.1 18 R�I RT Base 6L3Z18A984A 0.4 19 CAB 20 R&I RT Running board 6L3Z1645UKA 1.0 21 Blnd RT Uniside assy 4L3Z16211A80AA s 2.8 22 Repl RT Lower seal strip 4L3Z16101CiGAA 1 6Q.88 23 FRONT DOOR 24 * Rpr RT Outer panel regular&a�ew 4L3Z1520200f.A ,�Q 2.4 cab from 12/1/03 25 Overiap Major Adj.PanH -0.4 26 Add for Clear Coat 0.4 27 R&I RT R&I mirr� 8L3Z17682EA 0.3 28 R&I RT Upper moiding regular,super 6L3Z1520554AA 0.3 cab w/o HARL.EY DAVIDSON 29 R&I RT Handle,outside w/keyl�s 9L3Z15224046A 0.4 30 R&I RT Run channel aew cab 5L3Z1521536AA 0.4 31 R&I RT Belt w'strip outer crew cab 6L3Z1521452A 0.3 32 REAR DOOR 33 * Rpr RT Outer panel 4t3Z1624700CA � 2.4 34 • Overlap Major Nan-Adj.Panel -0.2 35 Add for dear Coat 0.4 36 RSeI RT Seal strip 4L3Z16253A20AA 0.3 37 R&I RT Handle,outside 9L3Z1626604AB 0.4 38 R&I RT R8d trim panel 6L3Z1627406CAA 0.5 8/30J2012 2:01:19 PM 065151 Page 2 ` Preliminary Estimate Customer: DIBBLE,CARSON �ob Number• V�ide:2006 FORD F150 4X4 SUPERCREW XLT 4D P/U 8-5.4L-FI 39 R&I RT Belt��'ip outer 6L3Z1625596�1 03 40 R&I RT Run channel arter 7L3Z1625766AA 0.4 41 PICK UP BOX 42 * Rpr RT Side panel 5.5 foot bed w/o 513Z8427840AA � 3.0 whl opng 43 Werlap Major Adj.Panel -0.4 44 Add fw Clear C,oat 0.5 45 R&I R&I tailgate assy 8L3Z9940700A 0.5 46 R&I RT Upper mdding 5.5 foot bed 5L3Z84291A40AAA 0.3 47 Repl RT Decal"4x4°shadow grey 4L3Z9925622EA6 1 40.00 0.3 48 R&I RT Stone guard w/o wheel 5L3Z99292A22AAA 0.3 molding bladc 49 R�I RT Mud guard E7TZ16A550A 0.2 50 # R&I TOPPER WITH WIRING 1.0 51 REAR LAMPS 52 R&I RT Tail lamp assy 6L3Z13404BA 03 53 REAR BUMPER 54 R&I R&I bumper assy 8L3Zll906B 0.6 55 # Repl Corr�a�ion protection 1 12.00 0.5 56 # Repl Covercar 1 12.00 0.4 57 # Subl HAZARDOUS WASTE FEE 1 5.00 X 58 # Refn MASK AND TAPE JAMBS 0.3 59 # Refn COLOR SAND ANF BUFF 1.0 SUBTOTALS 16531 18.9 18.1 ESTIMATE TOTALS �gqy B�is Rate Cost$ pa� 160.31 g�y�� 18.9 hrs @ $56.00/hr 1,058.40 pa�� 1$.1 hrs @ $56.00/hr 1,013.60 pa�M�ppN� 18.1 hrs � $35.00/hr 633.50 Body Supplies 7.4 hrs @ $Z.00/hr 14.80 Miscellaneous 5.00 �� 2,885.61 Sales Tax #160.31 @ 7.1250% 11.42 6rand Ta�tal 2,897.03 Deductibie 0.00 CUSTOMER PAY 0.00 IN�IRANCE PAY 2,897.03 8/30/2012 2:01:19 PM 065151 Page 3 ' Preliminary Estimate Customer: DIBBLE, CARSON 7ob Number: Vehicle: 2006 FORD F150 4X4 SUPERCREW XLT 4D P/U 8-5.4L-FI QUALITY REPLACEMENT PARTS WARRANTY OUR REPAIR ESTIMATE MAY SPECIFY THE USE OF QUALITY REPLACEMENT PARTS. QUALTTY REPLACEMENT PARTS ARE PARTS NOT MANUFACTURED BY OR FOR THE ORIGINAL EQUIPMENT MANUFACTURER. WE WILL STAND BEHIND THE QUALI'fY REPLACEMENT PARTS THAT ARE SPECIFIED ON THIS EST'IMATE AND USED IN THE REPAIR OF YOUR VEHICLE, FOR AS LONG AS YOU OWN/LEASE THE VEHICLE. WE WARRANT THESE PARTS ARE OF LIKE IQND, QUALITY, SAFETY, FIT AND PERFORMANCE TO PARTS MANUFACTURED BY OR FOR THE ORIGINAL EQUIPMENT MANUFACTURER. THIS WARRANTY EXCLUSIVELY COVERS LOSS OR DAMAGE THAT IS REIATED TO DEFECTS IN THE QUALITY REPLACEMENT PART. THIS WARRANTY DOES NOT COVER DAMAGE OR PART FAILURE DUE TO IMPROPER INSTALLATION, MISUSE, NEGLECT, ABUSE, IMPROPER MAINTENANCE, ABNORMAL OPERATION, OR NORMAL WEAR &TEAR. SHOULD A SUPPLIER OF A PART SPECIFIED IN OUR REPAIR ESTIMATE, OR THE REPAIR FACILITY THAT PERFORMS THE REPAIR ON YOUR VEHICLE, BE UNABLE TO RESOLVE A LEGITIMATE COMPLAINT ABOUT THE QUALITY REPLACEMENT PART USED IN THE REPAIR, WE WILL MAKE EVERY EFFORT TO SEE THAT THE PROBLEM IS CORRECTED. THIS WARRANTY AND ANY REPRESENTATIONS MADE HEREIN ARE NON-TRANSFERABLE AND EXTEND ONLY TO THE PARTY OWNING/LEASING THE VEHICLE AT THE TIME OF THE REPAIR. FOR ASSISTANCE, PLEASE CONTACT THE NEAREST HELPPOINT CLAIM SERVICES OFFICE. DISCLAIMER: ANY PERSON WHO KNOWINGLY PRESENTS A FALSE OR FRAUDULENT INSURANCE CLAIM FOR THE PAYMENT OF A LOSS MAY BE GUIL�iY OF A CRIME AND MAY BE SUBJECT TO FINES AND CONFINEMENT IN STATE PRISON. THE LABOR AND TAX RATES USED WERE DEfERMINED BY THE VEHICLE INSPECTION LOCATION UNLESS THE REPAIR FACILITY WAS KNOWN AT THE TIME OF THE INSPECTION OR ANOTHER LOCATION WAS SPECIFIED BEFORE THE ESTIMATE WAS PREPARED 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. 8/30/2012 2:01:19 PM 065151 Page 4 Page 1 of 1 . , ��0'`�� BONFE'S AUTO SERVICE 8 BODY wo��io: oeo9ii» REPAIR_CF 380 7TH Sf W, SAIFIT PAUL, NN 55102 Phone: (651) 222-4458 FAX (651) 224-8640 Preliminary Estimate Customer: Dibble, Carson Wrilte��y:MCHAa FRITIXAPPS Inaured: DDble.Ca�on WlicyN: C�m Y: Type of Lo�- Otve ol Lo� Deys lo Repair 0 Pbint ot Impect: Owner: Inspection Localion: Inaurence Compeny: Obble.Car�on BONf£SAUTO SBiVICEB BDDY Fi�Ai R CF (951)222-4458 Buane� 380 7TH ST W SAI NT PAUI.hR1 55102 Fiepair Facilily (851)222-4458 Bueiness VEHI CLE Year 2a0B Body Style: 4D R'U VIN: t FTPW14V78Fm0007i A4�eape In: Meke: faRD Engire: 8-5.4L-R Liceiree: IJikaBe Out: 6bdel: F150 4X4 SUPERCRHN Production Dete: State: Vehicle Out: XL7 Cobr. Int Conditbn: Job#: TRANSMI SSI ON Dual birtors RADIO 4 Wheel Disc Brekes Automatic Trar�miseion Ptivacy Gle� AM Red'a SEATS 4 Wheel Drive Overheed Conwb FM Fiedio Cbth Seete Werdrive CO N V EN I EN CE Stereo W H EELS ��. POW ER Air Conditioning Search�Seek Chmme Wheels , Fbwer Slee�ng rn wneei CD Rayer PA1 NT Pbwer Brekes Crus Control SAFETY Clear Coa�i�int I Power Windows Inte�mdtent Wpe�s M�i-Lndc B�ces(4) TRUCK Pbwer Lndca Keyle�Entry DrFvar Air Bep Rear Sllep Bumper DECOR tito�a Centar P9aoangar A,ir Bep R'30�2012 11 17:55 AM 013793 �� PDF created with pdfFactory trial version www.pdffactory.com https://docs.google.com/viewer?attid=0.1&pid=gmail&thid=1397a1 cb5124859b&url=http... 8/30/2012 Page 1 of 1 Preliminary Estimate Customer: Dibble, Carson Vehicle:2008 faRD F/50 4X4 SUP6iCREW XlT 4D R'U B-5.4L-F Line Oper Deecription Part Number Qty Extended Labor Peint Piice S t FRONT BUMPER Z Q�H bumper es.y z.3 3 ' c> F�r Bumper cover wio wheel apening 9L3Z17D957AAPTM 0_5 2.D molding 4 Add br Clear Coet 0.8 5 FENDER 9 ' F�r RT Fender w o wheel opening 9L3Z18005A 1_� 2 2 mokfing 7 Overlep A�Ajor Non-Adj.Panel -0-2 g pdd lor Gkar Coet 0 4 9 p81 RT Fender lirer 8L3Z19102A �-B 10 Repl RT Nertieplate"F150 XLT 5.4 513Z18720E 1 31.43 0 2 TRITON >> fi81 RT Mud guard front guard kit E7TZ18A550A 0 3 12 R81 RT Stone defleclor w:wheel 5L3Z19C�i54AAA 0 2 moldirg carbon biadi 13 ELECTAICAL 14 RSI RT&�e 8L3218AB84A 0.4 15 R81 Antenna mest A18Z18613A 0 1 19 FRONT LAMPS �7 R81 RT Ha�dlamp�y w+painlvd auR 7L3Z13008EA 0.4 18 CAB 19 H81 RT Ru�ning board 913Z1 B450KA 1.0 20 Blyd RT Uniside ae[.y 4L3Z18211ABOAA s 2 8 21 Repl RT WeatAetatrp SL3Z1851222AA 1 93.92 0 5 22 FRONTOOOR 23 • F�r RT Outer panel regular&crew 4L3Z1520200CA 1 0 2.4 c�Imm 12�t!03 24 Overlep h�hqo�Adj.Parel -0.4 25 Add lor Ck�Coet 0 4 zg R81 RT Upper moldin0 regular.aupe� OL3Z152055iAA 0.3 c�w!o HAHLEY DAVID90N 27 R81 RT R81 mirror 8t3Z178H2EA 0.3 pg RSI RT BeN w'strp outer super ceb 913Z1821452A 0.3 Zg R81 RT Harulle.outside wrkeyle� 9L3Z15224048A 0.4 30 Fi81 RT R81 trim panel BL3Z1523942EAA 0.5 31 R81 RT Ooor glaaa reguk�r c� 4L3 21 521 41 0AA 0 4 3Z R81 RT Run channel s�er ceb 5L321821538AA 0.4 33 REAR DOOR 34 ' F�r RTOutarperwl 4L3Z192i700CA 1_0 2.4 35 Owerlep M�lor Non-Adj.Panel -0.2 38 Add lor Clear Coat 0.4 37 R81 RT Upper moldinp 5L3Z1B255A94AAA 0.3 38 R81 RT Door gla�Ford 3L3Z1925712AA 0.4 I 8•30�2012 11 17 55 AM 013793 �Z PDF created with pdfFactory trial version www.pdffactory.com https://docs.google.com/viewer?attid=0.1&pid=gmail&thid=1397a1 cb5124859b&url=http... 8/30/2012 Page 1 of 1 Preliminary Estimate Customer: Dibbte, Carson Vehicie-2008 FORD Fl 50 4X4 SUP6iCRE4V XLT 4D R'U 6-5.4L-R 39 R81 RT Belt w'strQ outer BL3Z162559BA 0.3 40 R81 RT Runchannelouter 7L3Z7925799AA 0 4 41 R81 RT Handle.outside 9L3Z1829604AB 0.4 42 R81 RT R81 trim panel BL32182740BCAA 0 5 43 PICK UP BOX 44 Repl S�l bedc box es.y 1 1.5 45 H8.1 RT Upper moidinp 5.5 foot bed 5L37B42Bi A40AAA 0 3 4B Repl RT Decal"4x4"shadow grey 4L3�925822FA8 1 40.00 0.3 47 ' f�r RT Sde panel 5.5 loot bed w�o S13�427B40AA 2_5 3 0 v�hl opng 48 Overlap NAjor Rdj.Panel -0.4 49 Add lor Clear Coat 0.5 50 fi81 RT Stone guerd w:o wheel 513�9292A22AAA 0 3 moldinp bledc 51 R81 RT Mud guerd E7TZt BA550A 0.2 52 +t R&I Toppar w:Wirirg 1.0 53 REAR LAMPS 54 R81 RT Teil bmp esy 9L3Z134048A 0.3 55 REAR BUMPER SB R81 R61 bumper e�y BL3Z17909B 0�8 57 • Repl FLEXADDITIVE 1 �_00 T 58 s Repi CORR090N PROTECTION 1 15.00 T 0.5 59 • Repl COV�t CAR COF,PLETE(2 7 14.00 T 0 2 n►.es� BO s Repl HAZARDOUS WASTE RB�JVAL 1 7.00 T B1 • Refn M4SK8TAPEJAMBS 03 B2 0 Refn COLOR.S4ND8 BUFFPAINT �-� 83 f PART PRICES SUBJCCT TO 1 IHVOtCE g4 t "" PDSS18lE HI DDEN DAMAC'aE 1 SUBTOTA�S 206.35 22.1 17.4 8r 30 2012 11_17:55 AM 013793 �3 PDF created with pdfFactory trial version www.pdffactory.com https://docs.google.com/viewer?attid=0.1&pid=gmail&thid=1397a1 cb5124859b&url=http... 8/30/2012 Page 1 of 1 Preliminary Estimate Customer: Dibble, Carson Vehick:ZOOB FURD F150 4X4 SUP6iCREW XLT 4D P'U 8-5.4L-Fl ESTI MATE TOTALS Cetegory Basis Rete Cost E Perts 195.35 Body L�or YL.1 hrs (�0 S 59.00�hr 1.237.90 Painl labor 17.4 hra (�'i S 59.00+hr 974.40 aa�nt s�ppi�s t 7 a n�s �a E 35.00�n. eoo.ao eody s�uea 92 n� @ f a.00:n. 2�eo hAiscelEv�eous 43-00 S�btolal 3.056.95 S�les T� S 208.35 Q 7_9250% 15-89 Grand Total 3.072.84 Oeduclble 0.00 CUSTOMER PAY 0-00 I N SURAHCE PAY 3.072.84 .............................................................................. THI S I S A V�SUAL ESTI MATE ONLY. ADDITI ONAL DAAMGE MAY BE FOUND AFfER TEAR DOWN OF VEHI CLE NO GUARArlTEE ON RUST WORK. .............................................................................. IW NNE90TA FHAUD WARNI NG A person who submits an application or files a Gaim with intent to defraud or helps commit a fraud against an insurer is guilty of a crime. N�1 ST 60A 9 55- A PERSON WHO Fl LES A CLAI M WI TH I NTENT TO DEFRAUD OR HELPS QOMMIT A FRAUD AGAI NSf AN I NSUREA 1 S GUI LTY OF A CRI ME &�30+2012 11 17 55 AM 013793 �4 PDF created with pdfFactory trial version www.pdffactory.com https://docs.google.com/viewer?attid=0.1&pid=gmail&thid=1397a1 cb5124859b&url=http... 8/30/2012 Page 1 of 1 Preliminary Estimate Customer: Dibble, Carson Vehicle: Z008 FORD F150 4X4 SUP6iCREW XI.T 4D P'U 8-5.4L-Fl Estimate based on MOTOR CRASH ESTI MATI NG GUI DE Unless otherwise noted all items are derived from the Guide OR2MA04, OCC Data Date 5�17�2012 and the parts selected are OEM-parts manufactured by the vehicles Orginal F.�uipment Manufacturer. OEM parts are available at OE/Vehicle dealerships. OPT OEM(Optional OEtv� or ALT OEM (Alternative DEM� parts are OEM parts that may be provided by or through alternate sources other than the OEM vehicle dealerships. OPf OEM or ALT OEM parts may reflect some specrfic, special, or unique pricing or discount. OPf OEM or ALT OEM parts may include'Blemished" parts provided by OEMs through OEM vehide dealerships. Asterisk(') or pouble Asterisk(") indicatesthat the parts andlor labor information provided by MOTOR may have been modified or may have come from an alternate data source. Tilde sign (�) items indicate MOTOR Not-I ncluded Labor operations. The symbol (<>j indicates the refinish operation WI Ll NOT be pertormed as a separate procedure from the othe► panels in the estimate. Non-Original Equipment Manufacturer aftermarket parts are described as AM. Used parts are described as lKo, RCY, or US�D. Reconditioned parts are described as Recond. Recored parts are described as Recore. NAGS Part Numbers and 8enchmark Prices are provided by National Auto qass Specifications. labor operation times listed on the line with the NAGS information are MOTOR suggested labor operation times. NAGSlabor 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 OOC ONE estimator has a complete tist 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: SYIuBOLS FOLLOWI NG PAliT PRI CE m-MOTOR Mechanical component. s-MOTOR Structural component. T-lufscellaneous Taxed charge category. X=Miscellaneous Non-Taxed charge category. SYWBOLS FOLLOVIA NG LABOR: �=Diagnostic labor category. E=Electrical labor category. F-Frame labor category. C�Glass labor category. MkMechanical labor category. �Structural labor category. (numbers) 1 through 4-User Defined �abor Categories. OTHEA SYbBOLS AND A�RENI ATI ONS Adj.-Adjacent. Algn.-Align. ALU_Aluminum. A+NkAftermarket part. 81nd-Blend. BOR=Boron steel. CAPA=Certified Automotive Parts Association. DSR=Disconned and Reconnect. HSS�High Strength Steel. HN�Hydroformed Steel. Incl.-lncluded. LKQ=LikelGnd and�uality. LT-Left. MAC�Magnesium. Non-Adj.=Non Adjacent. NS�=NSF International Certified Part. O!H=Overhaul. Qty=�uantity. Refn_Refinish. Repl=Replace. R&1=Remove and Install. RBR=Remove and Replace. F�r=Repair. RT-Right. .�A.�Sandwiched Steel. Sect=Section. SLbI-SLbleR. UHS�UItra High Strength Ste�. N=Note(s) associated with the estimate line. CAC ONE Estimating-A product oi COC 1 niormation Services I nc. The following is a list of abbreviations that may be used in CCC ONE Estimating that are not part of the MOTOR CRASH ESfI MATI NG G�lll DE BAR=Bureau ot Automotive Repair. EPA=Environmental PYOtection Agency. NHTSA= National Highway Transportation and Safety Administration. PDFl=Paintless Dent Repair. 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