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Vang, Cher ■ Ciotiernment�mployees In,iirancc Company ■ GE.IC� General [nsurai�ce Cu�np3ny � �� ■ GLTCOIndcmnity Com�a��y ■ (iEICO Casualty Cotn�any Re�ionalOfficc: ��,� � � �� --,�-; -�295 Ocmulgc� �;astBivd. Macon.G.� 31?�S t�d0i`� ��=� «�w��-geico.com � � �O,�Z �h�' � �; ';+ ' �-�f`;, 02/07/2012 City of St. Paul Public Works Attn: Street Maintenance Division 873 Dale Street N St. Paul MN 55103 Claim Number: 0343938250101042 Insured: Cher Yang Loss Date: 02/21/2011 Your Claim Number:unknown Your Insured: Kurt Dornfield GEICO Claim Amount: $40,714.28 Deductible: $1000.00 Other Payments: $ Explain: Total Claim: $41,71428 Dear To whom it may concern: We request that you please review this claim, approve it and forward prompt payment to us. The pertinent file material is enclosed. Please indicate our claim number on your check and make the check payable to Geico General as subrogee of Cher Yang. This letter will serve as notice of our payment recovery claim and constitutes a sincere effort as required by conditions precedent to Inter-company Arbitration as stated by the Automobile and Property subrogation arbitration agreement. Thank you for your cooperation. JSincerely, i` .�harity L c ett Payment Recovery 8U0 841-9160 x5237 email: clockett@geico.com Fax: 703-543-0512 Pages to Follow sl6 template '� �;' d��-�3q 3$��0 � o�( c�� -p'� , �� _ . �� NOTICE OF CLAIlVI FORM to the City of Saint Paul, Minnesota Minnesota 5tate Starute 466OS states that"...every person.. who clatms damages,from any munictpal�ty...shai!cnuse to 6e presented to the , governing body of the rnunicipQlity within I80 days after the alleged loss or injury is drscovered a noJice stating the time,place,and � circumstances lhereof,and the amaunr of compensation or other relref,dentanded." Please complete this form in its entirety,by clearly typing or printing your answer to each qnestion. If more space is needed,attach additional sheets. Please note that you will not be contacted by;telephone to clairi�fy answers,so provide as much information as necessary to explain your claim,and the amount of compensation.being requested. You wiil receive a written acknowledgeiuent oace your form is received. The process caa Eake up to ten weeks or longer depending on the nature of your claim. This form must be signed,and both pages completed. If soniething does not apply,write'N/A'. SEND C4MPLETED FORM AND OTHER DOCIJMENTS TO: CITY CLERK, _ 15 WEST KELLOGG BLVD, 310 CITY HALL,SA1NT PAUL,MN 55102 First Name Middle Initial Last Name � Company or Business Name n ^ ��L.d ti t 1'� - ' ,Are Y.ou an Insurance Comp ? Y No If Yes,C1aim�Number? � "T' � � � � •Street Address_�`� �E.Z CO � t'1 � � , . City , f�v 1�(�I'l State�� Zip Code 3�a��.� x�3`7� � � Daytime Phone(��!L-c(f!.D Cell Phone( } �f r� 'Evening Telephone(_� �'� . •Date of,Accidend Injury or Date Discovered _ �r�,I I c�1 � Time c�'.�-t v am pm Please state,in detail;what occurred(happened),and why you are subnnitting a claim.Please indicate�why or how you • fee he City of Saint PauI o its employees are involved and/oi responsible for your dainages;, ' . ti r . E t�GS � k�M� �n Y '' �� C o+� `� C�r� r 1'�ur C7►r; � G W �� P..YI Cx. V. • e.c�;n vacl�J P_ire. ` t � e , L . riV2,Y M Q ��' � ��f ° , Please check the box(es)that most closely represent the reason for completing this form: �My vehicle was damaged in an accident ❑My vehicle was damaged during a tow ❑My vehicle was damaged by a pothole or condition of the street �,My vehicle was dama$ed by a plow �My vehicle was wrongfully towed and/or ticketed �,I was injured on City property ❑Other type of property damage-please sgecify , � ' ❑ Other type of injury-please specify � In order to pzocess your claim you need'to inclade eonies of all anvlicable documtents.� " For the claims types listed below,please he sure to include the documents indicated or it will del'ay the handling of your claim. Documents WII.L NOT be returned and become the property of the City. .Yo�are encouraged to keep a . copy for yourself before submitting your claim form. O Property damage claims to a vehicle:two estzmates for the repairs to your`vehicle if the damage exceeds $500.00;or the actnal bills andlor receipts for the repairs ` O Towing.claims:legible copies of any ricket issued and a copy�of the impound Iot receipt . O Other property damage claims:.two repair estimates if the damage exceeds$500.00; or the ac[ual bills ' andlor receipts for the repairs;detailed list of damaged items O Injury claims: medical bills,receipts , ' O Photographs are always welcome to document anc!support your cIaim but will not be returned. . � Page•1 of 2-Please complete and return both pages of Claizn Form . j" � �t,t..i��Y'�5 tx�e.:Y2 Q��r-Ps��`! .��-�- �z� �t�v r � , . � �, . . , � . Failure to compiete and return both pages wil[result in delay in the handling of your c.laim. All Claims--please camnlete this section � Were there wimesses to the inczdent? Yes No � Unknowr� (circle) ,�• 1'rovide their names,addresses and telephone numbers:'�f��e vs. u� n�r, u►�e�o(� ;�GSS.�'�t��i*- 1� c`�Ih V�2,�t;C 1�., /�CX �-� � Were the police or law enforcement called? Yes' No Unknown , (circle) • If yes,what department or agency? �a ti v� i�.�� D Case#or•report# �1�'O 5' M �� ` �3`�5 � � � Where did the accident or injury take place? Frovide street address,cross street,intersection,name of park or facility, closest landmark,etc. Please be as detailed as possible. ff necessary, attach a diagram. rY3�(�C�.f_�t� 11 i��;� � � Q 12��t.9_J Please indicate the amount you are see3cing in corz}pensation or what you would like the Ciry to do to resolve this ctaim to your satisfaction. _�C �I . '1 I`�. ��S Vehicle Claims- Iease com Iete this section ❑ check box if this section does not a 1 Your Vehicle: Year` t. Make �T� � Model ak�.� License Plate Number 1/J �t S StateN��Color ' Registered Owner rr Driver of Vehicle e..r � Area Damaged C'ty Vehicle: Year e Model �U��y� icense Plate Number State Color �river of Vehicle(City Employee's Name) Area Damaged '— In'ur CIaims-- lease com lete this section � ❑check box if this section iioes not a 1 ' ' How were vou iniuzed� 4 �`('L� r�fX�'�- What part(s)of youc body were injured?�Q c� Z v L-�ti , Have you sought medical treatment? Yes No . Planning to Seek Treatment(circIe) . When did you recaive treatment? � • (provide date(s)) Name of Medical Provider(s): 4 r� SL�-�lCp � �'•�Ll'�'10.Y�'�',� Address • Telephone Did you miss work as a resuit of your injury? Yes No When did you miss work? (provide date(s)) Name of your Employer: Address Telephone ❑ Check here if you are attaching more pages to this claim form. Number of addifional pages .�YeV!b��L� � �U�� 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. ' . Submifting a false claim can resuCt in prosecution. Date form was completed `�.'� ��'��` Print the Name of the Person who Connpleted this Form; ��Y� �-- e � Cd �� Signature of Person Making the Clai�n: '��°�� Revised Febrnary 2011 { ' • ` ; � ; , , sf,, . � ��/� i j . .`� . . , 1 • , : ''� ' This claim form is being retrzrned without'having been set up as a claim for the following � , . , � reasons: � � ' Failure to provide a written description as to what happened and why a claim form , was being subm'rtted(page one}. 1 �� Failure to provide the proper and required documentation(page one}.� � i �t.o �J�t c� a�° ��``=r�'� ��d? , Failuxe to provide a date o£accident or injzuy(page one). G�� , � a �Failura to indicate the amount�of compensation be�ing sought(page two). ' ' � Failure to provide infQnmation about the vehicle involved (page two}. � � ' Failure to provide information about the injury claimed(page two). , � ; ' Failure to sign the claim•form{page two). � Failure to print the name of the person who completed the claim form(page two). ; 1 �Other: �D � r �21�-�`� ��97 ' � � �- . , � , , . • Please rehun fihe completed claim form ta: `Q � ��G�%�'%�-� �'�� i/l�� r Office of the City Cierlc � � �� j City of Saix�t Paul � �Q �� { 15'W.Kellogg Blvd. /��!Q_� 31 Q City Hall ��/`� r � Saint Paul,MN 55102 . . , If you do not zeturn the completed claim fozm with the appropriate documentation or � information completed,then a claim file will NOT be established and an investigation � WILL NOT be done: 7n other words,NO FURTHER ACTION will ba taker�until the ' infonmation requested is provzded by you. � ' Please remember that it is a crime to submit a ciaim form or to pursue compensation � falsely oz under false cizcumstances. , , " I f'"� INRIANA OFFlCE12`S STANT�ARD CRASN REPOF2T pape 1 ot 4 Eloctronic Verslon 901593595 i.ocoi ta �'•'`l 11EC3789 �ate of Grash Ddy aF Wpnk Aeti��l Loe��SImR County Tewnnhip i!Moloe #Injurotl H Dead N Commerclal fl aeer Vchleles Vehlcfae 4211512411 TuP 9:49 AM LAKE NOR7Fi � p p D 0 aad Crnsh Ocn�rtod qn NOarvAtRntr.ryotdng RaadIMllnMnrkqr�InYorch�ngo M no�an Intrrscatian, 01rce4fon Rvatl Glaeelllcatlon numbcr of fcel From u�»� ��rvo a�,va us r�aurE Inalde Carpar�tB Llmlta7 ClrylTown or Nvarest ClbRown PropMty7 Crnsh�atituee Craeh Longltuuc YEa E`AST CHICAGO OTHER Dri�erql DrMorM2 Ddvcrl�3 Drncr 4 RIVEfL1.NAIDA y �E I m+ �I � I Ni �i �I Area Information I r r .� � m s m d d d � � t � � y 3 � � a } � � a Nlt nnd Run NO Drlvar Contrfbutin Clrcumstances Vehicle Contrihvtins Cir�umstan�es ° Aleeboilc Beveregee Eng�ae fetlure or De�eet3ve Sehool 2one IJO Ilegel bruge Aaeferetor Felluro or 6eFesdYa Proacrinfion Druae Bnka Fql�uro vr�bFodlvQ pumblo Strlpe NO Drivar peleep or Fafigued Tirc xalWrc er oefeeNvc , ONVer�Inee� He�dlipht�s)DeiecfWe or Hot On LeeaiHy Uneafe Speed Otl+x Ughte DefecOva f�URAI Fallura ta Yleld S�4 F�� Light CondlH4n plFrr.gordsignat WlndowlWlndshkkDeMdfve D,4YLIGMT LeR ei Center OverslxdOverwelght Losd yi(Qather ContlfHOn� � ImpraperPeealrtg bsearrelLeakyLoad CL�AR J 1 Improper Tuming 7ow Hfleh Fallure Imprnper Lane Uesge Dther Surf�ca Ca+dit�n FollowingTaoCloPely ✓ Nano DRY U,�sa►n ea�crng Environment Contribuanq CE�umstances 7ypa a1 Mcdi�n Overtorrnttlng G�arc DftIVABIE kan eR Roed Roedway&urface Typa af Roedway JuncGon Wrong Wxy on One VVay HoICSIRyh In Su�faee FOUR-WAY INTERSECTION Pcdcat�laA'x��en Bheuide��efeclMe Raptl Charoeter Pos�cnger Distreetion Road Under Conefrvctlon STRAIGHTlLEVEL ReetrleNon VlolaHon Sever�Crvsswindx Jwckknl�ing ObstrucFlan Not Marked Roe�lwey Surlesa Cnn PNOncUsege tene Merkfn�OAaeurad ASPHALT q4er TalematlCR vlew DBabveted Cnnstrue�ion fl Yns.Cenetrustron Type lSAVer dtetracted MImaYObJect tn Rondr.ay N� SvaedJWe�thar Condklon� Troffic CI1 tneplMts�ingtOhseurc T�p�c ConMol flcviecx Unxafc Lane Novemenl UuAry Wark TRAFFIC CONTROL SEGNAL a�,�� omgF •. .�/ None ✓ ✓ None T�t CopFrel Dovitc bpr.rMlensl7 YES 7otal Esttmatc or m darnage in�he Crnsh: $1�fl1 7�$Zb�O Wl9II1IB CI9BI1 tIl!�@6Utt Of 889f2BlfV!dflVlllA7 NQ Other Pmperty Damega(1) St�te Property Ownare Neme and Addnss ..�� ,. D1hcr Properly Oamage(21 Stete Proper[y Ovmer'e Name and Addrne i;,'.��!`�;!�R�,�J �3�:c��.E�:;;.!IF9P,'�S tif{, r II�.V.� 1 '1V�� - WitnesslOther ParticipanS NOn• otonat YUitnaes A Nnme Lbc1 Npmc,Flnt Mama�q Othar P��tk[ �nt Addreee etc. a1•M9toffSt TyOC Non•�i�A�Athnn Phone Locatlon et Tlmrt of �ab AppQroat Phys�tnl Contlillan Nlltneaa p N�me CiledT blractlon plhd�Pyrlitf �nk Addreeeetc. 5tmoHH�ghway pnone LaxtlM+at Tf+++e ot Grash Tralflc Control7 If yes,was treffic control operational7 � � � � _�Unit�. �1 ----�_—.--�_�- .�..... � �;d, �!. A � STAT� ROAI� 12 �. � � � , I�,�T 7�J �'✓�i.F�. GRAND ...,...._..W.._..._. _..._..._. BLVD 11 EC037S9 Page 1 of 11 02/24/2011 AT 08:25 AM 0343938250101042-01 102996 27H004VS GEICO ROSEVILLE, MN EMAILSUPPLIMENTSTOR3MOMNSUPP@GEICO.COM FAX SUPPLIMENTS TO 305-328-4105 PO BOX 130608 ROSEVILLE, MN 55113 (612)280-1491 FAX: (877)234-7520 ESTIMATE OF RECORD WRITTEN BY: PAUL WALZ 02/24/2011 08:21 AM ADJUSTER: PAUL WALZ (612)280-1491 INSURED: CHER YANG CLAIM #0343938250101042-01 OWNER: CHER YANG POLICY #4125108961 ADDRESS: 8421 XERXES AVE N DATE OF LOSS: 02/21/2011 AT 12 :00 AM BROOKLYN PARK, MN 55444-1468 TYPE OF LOSS: COLLISION EVENING: (651)260-9853 POINT OF IMPACT: 1. RIGHT FRONT BUSINESS: (218)387-4472 INSPECT HAMLINE AB OTHER LOCATION: 2520 BROADWAY ST LAUDERDALE, MN 55113 REPAIR HAMLINE AUTO BODY 6 DAYS TO REPAIR FACILITY: LICENSE # 2001 JEEP CHEROKEE 4X4 SPORT 6-4.OL-FI 4D UTV SILVER / A INT: VIN: 1J4FF48S81L587581 LIC: VJM 975 MN PROD DATE: ODOMETER: 82817 AIR CONDITIONING REAR DEFOGGER TILT WHEEL INTERMITTENT WIPERS KEYLESS ENTRY REAR WINDOW WIPER BODY SIDE MOLDINGS DUAL MIRRORS CONSOLE/STORAGE LUGGAGE/ROOF RACK CLEAR COAT PAINT POWER STEERING POWER BRAKES POWER WINDOWS POWER LOCKS POWER MIRRORS AM RADIO FM RADIO STEREO CASSETTE SEARCH/SEEK DRIVER AIR BAG PASSENGER AIR BAG CLOTH SEATS BUCKET SEATS RECLINE/LOUNGE SEATS 5 SPEED TRANSMISSION 4 WHEEL DRIVE OVERDRIVE STYLED STEEL WHEELS ---------------------------------------------------------------------------- NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT ------------------------------------------------------------------------------- 1 FRONT BUMPER 2 R&I RT END CAP FLAT BLACK BUMPER 0.4 3 FRONT PANELS 4 R&I GRILLE SE, SPORT BLACK 0.3 5* RPR GRILLE SE, SPORT SILVERSTONE 0.5* 1.0* ( ADD FOR CLEAR COAT 0•2 7 FRONT LAMPS 8* R&I RT SEALED BEAM 0.3* 9* R&I LT SEALED BEAM 0.3* N 10 REPL RT SIDE MARKER LAMP 1 16.20 0.2 11 R&I RT HEADLAMP DOOR BLACK 0•2 file://C:�Documents and Settings\u90j01\Local Settings\Temp\pdi\1045888818_10343938... 9/20/2012 Page 2 of 11 1 02/24/2011 AT 08:25 AM 0343938250101042-01 102996 27H004VS ESTIMATE OF RECORD 2001 JEEP CHEROKEE 4X4 SPORT 6-4.OL-FI 4D UTV SILVER / A INT: N0. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT ------------------------------------------------------------------------- 12 R&I LT HEADLAMP DOOR BLACK 0.2 13 HOOD 14* REPL LKQ HOOD +25� 1 218.75 0.5* 2.6* 15 ADD FOR CLEAR COAT 1.0 16 ADD FOR UNDERSIDE(COMPLETE) 1.3 17 REPL LATCH 1 30.75 0.3 18 R&I INSULATOR INCL. 19 REPL LATCH RODS 1 30.25 20 REPL SAFETY CATCH 1 9.75 INCL. 21 REPL HINGE CLIP LATCH & LINE 1 11.50 22 FENDER �3** REPL QUAL REPL PARTS CAPA RT FENDER 1 219.00 1.8 2.2 24 OVERLAP MAJOR ADJ. PANEL -0.4 25 ADD FOR CLEAR COAT 0.4 26 ADD FOR EDGING 0.5 N 27 REPL RT FENDER LINER 1 76.70 INCL. 28* RPR RT WHEEL FLARE FLAT BLACK 1.5* 29 REPL RT WHEEL FLARE RETAINER REAR 1 26.10 N 30* R&I RT BODY SIDE MLDG BODY COLOR 0.5* BLACK 31* RPR RT SIDE SILL S 4.0* 32 REPL RT FENDER LINER BRACKET 1 8.75 INCL. 33 FRONT DOOR N 34* RPR RT OUTER PANEL 4 DOOR 0.5* 1.8* 35 OVERLAP MAJOR ADJ. PANEL -0.4 3b ADD FOR CLEAR COAT 0.3 37 R&I RT BELT W'STRIP 2 DOOR 0.3 N 38* R&I RT BODY SIDE MLDG 4 DOOR, W/0 0.6* COUNTRY PACKAGE BLACK 39 R&I RT MIRROR MANiJAL W/GULF TYPE 0.5 MIRROR 40 R&I RT HANDLE, OUTSIDE 0.4 41 R&I RT R&I TRIM PANEL 0.5 42 REPL RT DECAL "CHEROKEE" ALL 1 44.25 0.2 43 REPL RT DECAL "SPORT" 1 29.75 0.2 44# REFN CAR COVER 0•2 45# REPL RESTORE CORROSION PROTECTION 1 10.00 0.2 46 RADIATOR SUPPORT 47* RPR RT SIDE BAFFLE S 0.5* 0.3 48 ADD FOR CLEAR COAT 0.1 49* R&I UPPER TIE BAR �•8* 50 COOLING 51 REPL SHROUD 1 46.75 0.3 52 INFORMATION LABELS 53 RPL INFORMATION LABELS �•3 file:UC:\Documents and Settings\u90jOl�I.ocai Settings\Temp\pdi\1045888818_10343938... 9/20/2012 Page 3 of 11 54 REPL INFO LABEL BELT ROUTING 4.0 1 2 .50 INCL. LITER 55 REPL CAUTION LABEL FAN 1 4.85 INCL. 2 02/24/2011 AT 08:25 AM 0343938250101042-01 102996 27H004VS ESTIMATE OF RECORD 2001 JEEP CHEROKEE 4X4 SPORT 6-4.OL-FI 4D UTV SILVER / A INT: NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT 56 ELECTRICAL 57* REPL IGNITION COIL BRACKET 4.0 1 13 .25* 0.3* LITER 58# RPR SHEET METAL/BODY PULL 1.0 59 OTHER CHARGES 60# E.P.C. 1 4.00 SUBTOTALS =_> 803 .10 17.6 11. 1 LINE 10 : NO LKQ AVAILABLE LINE 14 : SUPPLIERS PART DESCRIPTION: HOOD PTD,SUV,SPT,4.OL,4X4,GOLD,OPl,OT1 LINE 27 : NO LKQ AVAILABLE LINE 30 : ADDITIONAL TIME IS TO CLEAN AND RETAPE LINE 34 : BLEND WITHIN PANEL LINE 38 : ADDITIONAL TIME IS TO CLEAN AND RETAPE PRIOR DAMAGE NOTES: PRIOR UNRELATED DAMAGE NOTES: FRONT BUMPER: RT SIDE LT FENDER: NONE HOOD: NONE LT FRONT DOOR: NONE LT REAR DOOR: NONE ROOF: HAIL DAMAGE LT QUARTER PANEL: NONE DECKLID/TAILGATE: DENTS REAR BUMPER: NONE INTERIOR: NONE FRONT LAMPS: NONE RT FENDER: NONE GLASS: NONE RT FRONT DOOR: NONE RT REAR DOOR: NONE SUNROOF: NONE RT QUARTER PANEL: NONE REAR LAMPS: NONE BACK GLASS: NONE TIRES: NONE file://C:�Documents and Settings\u90jOl�I.ocal Settings\Temp\pdi\1045888818_10343938... 9/20/2012 Page 4 of 11 PARTS 799. 10 BODY LABOR 17. 6 HRS @$ 50.00/HR 880.00 PAINT LABOR 11.1 HRS @$ 50.00/HR 555.00 PAINT SUPPLIES 11.1 HRS @$ 30.00/HR 333 .00 OTHER CHARGES 4.00 SUBTOTAL $ 2571.10 3 02/24/2011 AT 08:25 AM 0343938250101042-01 102996 27H004VS ESTIMATE OF RECORD 2001 JEEP CHEROKEE 4X4 SPORT 6-4.OL-FI 4D UTV SILVER / A INT: SALES TAX $ 799. 10 @ 7.1250� 56.94 TOTAL COST OF REPAIRS $ 2628.04 TOTAL ADJUSTMENTS $ 1000.00 NET COST OF REPAIRS $ 1628.04 THIS IS NOT AN AUTHORIZATION TO REPAIR. BY SIGNING THIS ESTIMATE THE SHOP AGREES TO HAVE REVIEWED AND DISCUSSED THE ESTIMATE OF DAMAGE WITH A GEICO FIELD ADJUSTER AND HAVE AGREED TO ALL VISIBLE, (NON-HIDDEN) DAMAGE REPAIR, REFINISH OR REPLCACEMENT TIMES. THE SHOP ALSO AGREES TO THE LABOR AND MATERIAL RATES LISTED INT THE ESTIMATE AND ACKNOWLEDGES THE SUPPLEMENT REQUEST PROCEDURE LISTED BELOW. SHOP REPRESENTATIVE DATE NO SUPPLEMENTAL PAYMENT REQUEST WILL BE HONORED B Y GEICO UNLESS IT HAS BEEN INSPECTED AND AUTHORIZED IN WRITING BY A GEICO REPRESENTATIVE BEFOR� THE SUPPLEMENTAL REPAIRS ARE STARTED AND THE PROPER INVOICES HAVE BEEN SUPPLIED. SHOP PHOTOS OF ANY PART OR LABOR IS NOT A SUBSTITUTE FOR A GEICO PHYSICAL INSPECTION AND CAN NOT BE CONSIDERED. REPAIR SHOPS MUST ALSO PRESENT A COPY OF THE ORIGINAL GEICO ESTIMATE BEFORE ANY SUPPLEMENTAL CHARGES WILL BE CONSIDERED. THE NUMBER OF DAYS TO REPAIR ON THE FIRST PAGE OF THIS ESTIMATE IS THE MAXIMUM NTJMBER OF DAYS THAT GEICO DIRECT WILL PAY FOR A RENTAL CAR IF APPLICABLE. MN ST 60A.995 - A PERSON WHO FILES A CLAIM WITH INTENT TO DEFRAUD OR HELPS COMMIT A FRAUD AGAINST AN INSURER IS GUILTY OF A CRIME. 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. file://C:�Documents and Settin�s\u90j01\Local Settings\Temp\pdi\1045888818_10343938... 9/20/2012 Page 5 of 11 4 02/24/2011 AT 08:25 AM 0343938250101042-01 102996 27H004VS ESTIMATE OF RECORD 2001 JEEP CHEROKEE 4X4 SPORT 6-4.OL-FI 4D UTV SILVER / A INT: GEICO DIRECT ALTERNATE PARTS DISCLAIMER IF QUALITY REPLACEMENT PART (QRP) APPEARS ON THIS ESTIMATE, IT INDICATES THAT THIS ESTIMATE HAS BEEN PREPARED BASED ON THE USE OF ONE OR MORE CRASH PARTS SUPPLIED BY A SOURCE OTHER THAN THE MANUFACTURER OF YOUR MOTOR VEHICLE. WARRANTIES, IF ANY, APPLICABLE TO THESE REPLACEMENT CRASH PARTS ARE PROVIDED BY THE PART MANIJFACTURER OR DISTRIBUTOR RATHER THAN BY THE MANUFACTURER OF YOUR VEHICLE. *** IN ADDITION TO ANY SUCH WARRANTIES, GEICO PROVIDES THE FOLLOWING: **** OWNER LIMITED WARRANTY **** WE WARRANT THAT ALL QUALITY REPLACEMENT BODY PARTS (PARTS NOT MANUFACTURED BY THE MANUFACTURER) IDENTIFIED ON YOUR ESTIMATE, ARE FREE OF DEFECTS IN MATERIAL AND WORKMANSHIP AND MEET GENERALLY ACCEPTED INDUSTRY STANDARDS. THIS PARTS AND LABOR WARRANTY WILL BE IN EFFECT FOR AS LONG AS YOU OWN THE VEHICLE DESCRIBED IN THE ESTIMATE. THIS WARRANTY COVERS THE COST OF THE PART, LABOR TO INSTALL, AND INCIDENTALS SUCH AS PAINT AND MATERIALS AND IS SPECIFICALLY LIMITED TO THOSE ITEMS. THIS WARRANTY DOES NOT COVER LOSS OR DAMAGE THAT IS UNRELATED TO DEFECTS IN THE QUALITY REPLACEMENT PARTS. THIS IS NOT TRANSFERABLE. IF ANY QUALITY REPLACEMENT PARTS ARE DEFECTIVE IN EITHER MATERIAL OR WORKMANSHIP, CONTACT YOUR LOCAL GEICO REPRESENTATIVE. RECYCLED PART COSTS BASED ON INFORMATION PROVIDED BY CAR-PART.COM. FOR ASSISTANCE, CALL CCC AT 800-637-8511. ESTIMATE BASED ON MOTOR CRASH ESTIMATING GUIDE. UNLESS OTHERWISE NOTED ALL ITEMS ARE DERIVED FROM THE GUIDE DE3WB97, CCC DATA DATE 02/14/2011, AND THE PARTS SELECTED ARE OEM-PARTS MANUFACTURED BY THE VEHICLES ORIGINAL EQUIPMENT MANiJFACTURER. 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 file:UC:ADocuments and Settings\u90jO1�I.ocal Settings\Temp\pdi\1045888818_10343938... 9/20/2012 Page 6 of 11 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. NON-ORIGINAL EQUIPMENT MANUFACTURER AFTERMARKET PARTS ARE DESCRIBED AS AM, QUAL REPL PARTS OR COMP REPL PARTS WHICH STANDS FOR COMPETITIVE REPLACEMENT PARTS. USED PARTS ARE DESCRIBED AS LKQ, QUAL RECY PARTS, 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 2010 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 PATHWAYS ESTIMATOR HAS A COMPLETE LIST OF APPLICABLE VEHICLES. PARTS NUMBERS AND PRICES SHOULD BE CONFIRMED WITH THE LOCAL DEALERSHIP. 5 02/24/2011 AT 08:25 AM 0343938250101042-01 102996 27H004VS ESTIMATE OF RECORD 2001 JEEP CHEROKEE 4X4 SPORT 6-4.OL-FI 4D UTV SILVER / A INT: CCC PATHWAYS - A PRODUCT OF CCC INFORMATION SERVICES INC. file://C:ADocuments and Settings\u90j01�L.oca1 Settings\Temp\pdi\1045888818_10343938... 9/20/2012 Page 7 of 11 6 02/24/2011 AT 08:25 AM 0343938250101042-01 102996 27H004VS ESTIMATE OF RECORD 2001 JEEP CHEROKEE 4X4 SPORT 6-4.OL-FI 4D UTV SILVER / A INT: RECYCLED PART SUPPLIERS LINE LINE DESCRIPTION PRICE 14 LKQ HOOD +25o STOCK NO. : 7W1368 $ 218.75 AAA AUTO SALVAGE - QRP PARTNER (800)238-6664 2871 160TH ST. W. DAN PETERSON ROSEMOUNT, MN 55068 file:UC:ADocuments and Settings\u90jO1�I.oca1 Settin�s\Temp\pdi\1045888818_10343938... 9/20/2012 Page 8 of 11 � 02/24/2011 AT 08:25 AM 0343938250101042-01 102996 27H004VS ESTIMATE OF RECORD 2001 JEEP CHEROKEE 4X4 SPORT 6-4.OL-FI 4D UTV SILVER / A INT: ALTERNATE PARTS SUPPLIERS 23 QUAL REPL PARTS CAPA RT FEN PART NO. CH1241209PP PRICE 219.00 KEYSTONE - COMPLETE (800)328-1845 3615 MARSHALL ST. N.E. (612)789-1919 MINNEAPOLIS, MN 55418 KEYSTONE - COMPLETE (800)247-0861 2021 WEST DIVISION ST. (320)251-8494 ST. CLOUD, MN 56301 file://C:�Documents and Settin�s\u90jO1�I.ocal Settings\Temp\pdi\1045888818_10343938... 9/20/2012 Page 9 of 11 8 02/24/2011 AT 08:25 AM 0343938250101042-01 102996 27H004VS ESTIMATE OF RECORD 2001 JEEP CHEROKEE 4X4 SPORT 6-4. OL-FI 4D UTV SILVER / A INT: ALTERNATE PARTS USAGE AFTERMARKET PARTS AFTERMARKET SELECTION METHOD: AUTOMATICALLY LIST N0. OF TIMES USER WAS NOTIFIED THAT AN AFTERMARKET PART WAS AVAILABLE: 2 NO. OF AFTERMARKET PARTS THAT APPEAR IN THE FINAL ESTIMATE: 1 OPTIONAL OEM PARTS OPTIONAL OEM SELECTION METHOD: AUTOMATICALLY LIST NO. OF TIMES USER WAS NOTIFIED THAT AN OPTIONAL OEM PART WAS AVAILABLE: 2 NO. OF OPTIONAL OEM PARTS THAT APPEAR IN THE FINAL ESTIMATE: 0 file://C:ADocuments and Settin�s\u90j01\Local Settings\Temp\pdi\1045888818_10343938... 9/20/2012 Page 10 of 11 RECONDITIONED PARTS RECONDITIONED SELECTION METHOD: AUTOMATICALLY LIST NO. OF TIMES USER WAS NOTIFIED THAT A RECONDITIONED PART WAS AVAILABLE: 2 N0. OF RECONDITIONED PARTS THAT APPEAR IN THE FINAL ESTIMATE: 0 RECYCLED PARTS NO. OF TIMES USER WAS NOTIFIED THAT A RECYCLED PART WAS AVAILABLE: 7 NO. OF RECYCLED PARTS THAT APPEAR IN THE FINAL ESTIMATE: 1 9 02/24/2011 AT 08:25 AM 0343938250101042-01 102996 27H004VS ESTIMATE OF RECORD 2001 JEEP CHEROKEE 4X4 SPORT 6-4.OL-FI 4D UTV SILVER / A INT: VEHICLE RECALLS THE NATIONAL HIGHWAY TRANSPORTATION AND SAFETY ADMINISTRATION (NHTSA) HAS ISSUED 2 SAFETY-RELATED RECALL NOTICE(S) THAT MAY APPLY TO THE SELECTED VEHICLE. NHTSA ID: OOV366000 ISSUED: 11/06/00 NO. OF VEHICLES: 01211756 VEHICLE DESCRIPTION: CERTAIN PASSENGER VEHICLES, PICKUP TRUCKS AND SPORT UTILITY VEHICLES FAIL TO COMPLY WITH THE REQUIREMENTS OF FMVSS NO. 225, "CHILD RESTRAINT ANCHORAGE SYSTEMS. " SOME OF THE OWNER'S MANUALS FOR THESE VEHICLES ARE MISSING INSTRUCTIONS THAT PROVIDE A STEP-BY-STEP PROCEDURE, INCLUDING DIAGRAMS, FOR PROPERLY ATTACHING A CHILD RESTRAINT SYSTEM'S TETHER STRAP TO THE TETHER ANCHORAGE. IN THE EVENT OF A CRASH, THE CHILD SEAT MAY NOT BE PROPERLY ATTACHED INCREASING THE RISK OF INJURY TO THE CHILD. OWNERS WILL BE PROVIDED WITH AN ADDENDUM TO THE OWNER'S MANUALS. file://C:�Documents and Settings\u90j01\Local Settings\Temp\pdi\1045888818_10343938... 9/20/2012 Page 11 of 11 OWNER NOTIFICATION BEGAN NOVEMBER 12, 2000. OWNERS WHO DO NOT RECEIVE THE FREE OWNER'S MANiJAL ADDENDUM WITHIN A REASONABLE TIME SHOULD CONTACT DAIMLERCHRYSLER AT 1-800-853-1403 . ALSO CONTACT THE NATIONAL HIGHWAY TRAFFIC SAFETY ADMINISTRATION'S AUTO SAFETY HOTLINE AT 1-888-DASH-2-DOT (1-888-327-4236) . NHTSA ID: 02V104000 ISSUED: / / NO. OF VEHICLES: 01115320 FUEL:FUEL INJECTION:MECHANICAL:INJECTOR MANIFOLD VEHICLE DESCRIPTION: SPORT UTILITY VEHICLES EQUIPPED WITH A 4.OL ENGINE ONLY. THE DESIGN OF THE INTAKE AND EXHAUST MANIFOLDS COULD ALLOW DEBRIS TO ACCUMULATE AT THE #3 CYLINDER LOCATION. THIS COULD RESULT IN A VEHICLE FIRE. DEALERS WILL INSTALL A MANIFOLD SHIELD TO MODIFY THE AIR FLOW CHARACTERISTICS AND TO PREVENT THE ACCUMULATION OF DEBRIS IN THE AREA OF THE #3 CYLINDER. OWNER NOTIFICATION BEGAN MAY 13, 2002. OWNERS WHO TAKE THEIR VEHICLES TO AN AUTHORIZED DEALER ON AN AGREED UPON SERVICE DATE AND DO NOT RECEIVE THE FREE REMEDY WITHIN A REASONABLE TIME SHOULD CONTACT DAIMLERCHRYSLER AT 1-800-853-1403 . 10 file://C:�Documents and Settings\u90jO1�I.ocal Settings\Temp\pdi\1045888818_10343938... 9/20/2012 Photos for claim no 0343938250101042-01 Page 1 of 18 Photo 1 from Estimate for Claim no 0343938250101042-01 Photo date: 02/22/2011 12:41:08:00. Size: 66957 Description: Insured: YANG, CHER. Policy_no: 4125108961. Claimant: . Vehicle: 1, JEEP, CHEROKEE 4X4 SPORT. VIN: 1J4FF48S81L587581. Loss date: 02/21/11. Estimator: Paul Walz t � ��:. .� u . . �'r . � � _�� _ ; ,� ��._._- _�,r"" � . � � �� ' y;=� _ . ��-�� , .e.; �; �-_: � ;- � � , ��r�� - Photo 2 from Estimate for Claim no 0343938250101042-01 Photo date: 02/22/2011 12:41:08:00. Size: 69127 Description: Insured: YANG, CHER. Policy_no: 4125108961. Claimant: . Vehicle: 1, JEEP, CHEROKEE 4X4 SPORT. VIN: 1J4FF48S81L587581. Loss date: 02/21l11. Estimator: Paul Walz , � file://C:ADocuments and Settings\u90jOl�Local Settinas\Temp\pdi\1045888818_10343938... 9/20/2012 Photos for claim no 0343938250101042-01 Page 2 of 18 . � � .� �,. �F � � �� . , a fi � � � ° � � �� _ = �� :-�� ,. x .. �_ . _ , . , a�� ; � �� ,�� , � � � `�� + � ; xi � . � , . : �_ .�.. � � — g :� � � �� ,° r � � b� �_ �: �{ � �sr= :� �*�a�-' - �,.�..: .�,. �� . ,.� _ � � ._ �e, � � -. . ti � ...�: �r . �� . "� , " �,�"� =;o � ; �` # ; ' r �. ' # � � � �.. ��a _'��. � � �� . �� x � ' ! s x �`_' � � � ��; .ms�� ir._ r� ��"`�� " = �� - " � �x — ,_� � :� `c r �° x 'a r, .r _ _ '�� a �, �_ � � �� , f �� Photo 3 from Estimate for Claim no 0343938250101042-01 Photo date: 02/22/2011 12:41:09:00. Size: 60569 Description: Insured: YANG, CHER. Policy_no: 4125108961. Claimant: . Vehicle: 1, JEEP, CHEROKEE 4X4 SPORT. VIN: 1J4FF48S81L587581. Loss date: 02/21/11. Estimator: Paul Walz file://C:�Documents and Settings\u90j01\Local Settings\Temp\pdi\1045888818_10343938... 9/20/2012 Photos for claim no 0343938250101042-01 Page 3 of 18 � � �� . �� .�. � � � ��ii . _ �f.9� � i i �i . �n� i �.��9��'"' �,.. . �I II "'�11��, � —._ � . °�. � � ; , } _ , _ s — . �f, : _� ��.:� � =� - - � �<<��: _�, , .�. r iMF� . : � � � � y :� � fr..� �' ._� 4 L �4� � � :�� ., rvl. ��.� f=_ ,.,R�p'_ :sfa"a em ye � ' � A�- D 7 '' � — � �4M1.� �W.. Y.. . � n7,�� _ � r .�� q�„ ��- r=_ � s,, � �; _ � - � �a � � � ��. a "� � ,r .�::� z .�i x�� f� �� fv� �� £ _ "_..= T _ ,f"'�h:'v rc. . -- �M1s q,:�A'� �,e Photo 4 from Estimate for Claim no 0343938250101042-01 Photo date: 02/22/2011 12:41:09:00. Size: 54719 Description: Insured: YANG, CHER. Policy_no: 4125108961. Claimant: . Vehicle: 1, JEEP, CHEROKEE 4X4 SPORT. VIN: 1J4FF48S81L587581. Loss date: 02/21/11. Estimator: Paul Walz � li file://C:ADocuments and Settings\u90j01\Local Settings\Temp\pdi\1045888818_10343938... 9/20/2012 Photos for claim no 0343938250101042-01 Page 4 of 18 k � . .. ,�g�� :^�! h s"��: r.; .a - � �,y.: �� TT r �r`'x "Ir � _�i�� a =�' - 3 Y � � u � �� _ *, �.§5� .. �� 4 �� £� � � �� ,� � �r.�.�. �_.- Photo 5 from Estimate for Claim no 0343938250101042-01 Photo date: 02/22/20ll 12:41:09:00. Size: 63063 Description: Insured: YANG, CHER. Policy_no: 4125108961. Claimant: . Vehicle: 1, JEEP, CHEROKEE 4X4 SPORT. VIN: 1J4FF48S81L587581. Loss date: 02/21/1 l. Estimator: Paul Walz file://C:ADocuments and Settings\u90jO1�I.ocal Settings\Temp\pdi\1045888818_10343938... 9/20/2012 Photos for claim no 0343938250101042-01 Page 5 of 18 3; ��; � �� =a--�--��- - � &.8�� .'e`3;A s u�'�- �� . _ N.�..r . . �_ »�. . ' roro+'u----., �" �:=. :: z . .. �I {�� YIN �._:�:�AI � .s�� y�s <og . . _.' .... .� rFtF , � �Nf�� y �d i � s? r � n, � 4f _ -'� "e �` '_ ; �� 'a ; z ""N ' �' � t �� `� I�WV�_� � """�� _ rr, � � ,� - :^iti:. �. r � s.. I '- -*— �.... �Y f r ;�� _. : i,ti_ �, ..aa... .., � Photo 6 from Estimate for Claim no 0343938250101042-01 Photo date: 02/22/2011 12:41:09:00. Size: 77825 Description: Insured: YANG, CHER. Poli�y_no: 4125108961. Claimant: . Vehicle: 1, JEEP, CHEROKEE 4X4 SPORT. VIN: 1J4FF48S81L587581. Loss date: 02/21/11. Estimator: Paul Walz file://C:ADocuments and Settings\u90jOl�I.oca1 Settings\Temp\pdi\1045888818_10343938... 9/20/2012 Photos for claim no 0343938250101042-01 Page 6 of 18 t: � Ia ia � _ ,. . ,.�. .m- ' , . ..; ..: :: . � -�. . .. , �, . .. _:. ., .. .. � r:� �`- r�� - ^.� � _ . � :- 4e",?�. ° � � �. ; � � x. �r ..� �L ; _ : r� n �'�2.. > ; r �e �. �.�. _. :.-� -` ' ' a� 'F� .-,..- . �. �.� , � . .- . , . w-, m - " ' ,:'�.FF �� . � ^�{a I � � � _ � � �� j v r` � ��s� T.. .,� .. .� _ ..,�""�-� `-��.� . �� : .�� N , . -. .,�_ .r_ ° r�., � . . ,,. - .. ::.; - . .�,,,.,, . � . . _.:.,. .. _� a . �- .: �, .. . -� .� ....��°" ' . �� . . ..+""-. � .. � �� v� _ � '�;' _ r � =s _ �— , . . $'�� . ...., . �, .- _ ��""'--- _ '% . � Fx Photo 7 from Estimate for Claim no 0343938250101042-01 Photo date: 02/22/2011 12:41:09:00. Size: 71027 Description: Insured: YANG, CHER. Policy_no: 4125108961. Claimant: . Vehicle: 1, JEEP, CHEROKEE 4X4 SPORT. VIN: 1J4FF48S81L587581. Loss date: 02/21/11. Estimator: Paul Walz file://C:�Documents and Settings\u90jO1�L.ocal Settings\Temp\pdi\1045888818_10343938... 9/20/2012 Photos for claim no 0343938250101042-01 Page 7 of 18 �� °� �,� M_ � �; �� r�: � � �� ,. v _ a � �E � � �,a __� �,.. - . . .. .... .. '„„x`"�.`,�-:.�m-. r � � � -.r,�.;�. . ... . � .. . . ; ` �'w�,:..,._:,.. . "� _. . �� '�a.:.�.:,� .� . . . I � ��- _ ,^,#"�,. - i � ' � ,. w�� di� o: Photo 8 from Estimate for Claim no 0343938250101042-01 Photo date: 02/22/2011 12:41:09:00. Size: 52448 Description: Insured: YANG, CHER. Policy_no: 4125108961. Claimant: . Vehicle: l, JEEP, CHEROKEE 4X4 SPORT. VIN: 1J4FF48S81L587581. Loss date: 02/21/i l. Estimator: Paul Walz file:UC:ADocuments and Settings\u90jO1�I.oca1 Settings\Temp\pdi\1045888818_10343938... 9/20/2012 Photos for claim no 03439382_50101042-01 Page 8 of 18 � � � �.�� ,'"�'",�— - _. � � ..�� .. .: �� ..H �� <, � �� _ � . � __ u. �.., � � -� .� - ��n ..�--. �,,.. � , _ --�.� ..1 �. � .. . . :: � �� d�� -... �� „ - - �. ��_ _ _ � � � w :s . — o :��7 - : � � �� - � � �� r .� .�:.-_� � „..� �M��.�F a � z �t: � �'� ' �"��is��'' ". , i� �� 'i'i''' � �li ,�, 11 : � � � � �� .F�; '� .. � , - � -�� _ =a ��:� �.. � Photo 9 from Estimate for Claim no 0343938250101042-01 Photo date: 02/22/2011 12:41:09:00. Size: 50802 Description: Insured: YANG, CHER. Policy_no: 4125108961. Claimant: . Vehicle: 1, JEEP, CHEROKEE 4X4 SPORT. VIN: 1J4FF48S81L587581. Loss date: 02/21/11. Estimator: Paul Walz file://C:�Documents and Settings\u90jOl�L.oca1 Settin�s\Temp\pdiV045888818_10343938... 9/20/2012 Photos for claim no 0343938250101042-01 Page 9 of 18 � �� '��'�� [ i �� I ; ��a� � � � � r 3^;r j �` .�! � + �? � � .�� . . "� _. w(ar . . .,.� ��.: * ��'�x� � �` �� y �TM,� �; w -.s��.,. r ;., � �y�k. � � . ��', . �°' Photo 10 from Estimate for Claim no'.0343938250101042-01 Photo date: 02/22/2011 12:41:09:00. Size: 61066 Description: Insured: YANG, CHER. Policy_no: 4125108961. Claimant: . Vehicle: 1, JEEP, CHEROKEE 4X4 SPORT. VIN: 1J4FF48S81L587581. Loss date: 02/21/11. Estimator: Paul Walz file://C:ADocuments and Settings\u90jO1�Loca1 Settings\Temp\pdi\1045888818_10343938... 9/20/2012 Photos for claim no 0343938250101042-01 Page 10 of 18 � � � � �� ,�� .�� `", �� ;; s �k5+ r,�� „ �, �S�,� �� 4��',, x� �; r �� I,i � � � i ��— ; �� .�� y .r� i. �. , � . � ; � � � _. : _. �.�- .. A . . �., � � � � '.�' "s. ' S� "�u� .��,a�:� �� I �i�j � ,w � � '� ��. �� 1 ... }. t. � � u_ � - ,�� a , ,, �: � s � �: = � ,,�- � :�� 'y¢��i ��83 � �- � .. '�,!�° Photo 11 from Estimate for Claim no 0343938250101042-01 Photo date: 02/22/2011 12:41:09:00. Size: 56385 Description: Insured: YANG, CHER. Policy_no: 4125108961. Claimant: . Vehicle: 1, JEEP, CHEROKEE 4X4 SPORT. VIN: 1J4FF48S81L587581. Loss date: 02121/11. Estimator: Paul Walz file://C:\Documents and Settings\u90jOl�L.oca1 Settings\Temp\pdi\1045888818_10343938... 9/20/2012 Photos for claim no 0343938250101042-01 Page 11 of 18 k=� _� . - w _ .� � . �� ,u, , , '�"��' �W �� '� � � �� , .: t � � . � rr. � � �,�;- � , , , „ � � � � _ �'� �� .. � — � �� . �t�_ • � � � � ,. .��a �,�'��.� � W uu R3�v��hr�b� �i�:WS�M4t � t}'��-- -- - k 4�y� � � �y :�_7,�i �,. . 3a � �w" : � �. _��w°°r..�' � a� R� �- s� ..�r._� . � . - ,� _��°':. �`�1'.i 7 � _ � � , �>M �..�- . - . n u_ � ...: u , � :�. - a. ; .: ,, »-, ..-r �==:: , �;§,� x ; - �� i�_ r � r'� r s,,�., . � �*,�. �� __ . .� — Photo 12 from Estimate for Claim no 0343938250101042-01 Photo date: 02/23/2011 07:48:57:00. Size: 61983 Description: Insured: YANG, CHER. Policy_no: 4125108961. Claimant: . Vehicle: l, JEEP, CHEROKEE 4X4 SPORT. VIN: 1J4FF48S81L587581. Loss date: 02/21/1 l.. Estimator: Paul Walz file://C:�Documents and Settings\u90jO1�L,oca1 Settings\Temp\pdi\1045888818_10343938... 9l20/2012 Photos for claim no 0343938250101042-01 Page 12 of 18 � � � i ,.�,�. ��. � Photo 13 from Estimate for Claim no 0343938250101042-01 Photo date: 02/23/2011 07:48:57:00. Size: 70773 Description: Insured: YANG, CHER. Policy_no: 4125108961. Claimant: . Vehicle: 1, JEEP, CHEROKEE 4X4 SPORT. VIN: 1J4FF48S81L587581. Loss date: 02/21/11. Estimator: Paul Walz file://C:�Documents and Settings\u90jOl�I.oca1 Settings\Temp\pdi\1045888818_10343938... 9/20/2012 Photos for claim no 0343938250101042-01 Page 13 of 18 - I��r�� „��, ..; :. ; _ - i . _ � � �. .. �. i � ,� �� .:3 . . , � � , _ r_ �, , � ��: -, . � y ,Y 3"_ ✓ 3 x £y. w�1 y . _ � > _ : ��f�_ ... ��, �{ h_=� ., Photo 14 from Estimate for Claim no 0343938250101042-01 Photo date: 02/23/2011 07:48:57:00. Size: 79660 Description: Insured: YANG, CHER. Policy_no: 4125108961. Claimant: . Vehicle: 1, JEEP, CHEROKEE 4X4 SPORT. VIN: 1J4FF48S81L587581. Loss date: 02/21/11. Estimator: Paul Walz file://C:�Documents and Settings\u90jO1�L.ocal Settings\Temp\pdi\1045888818_10343938... 9/20/2012 Photos for claim no 0343938250101042-01 Page 14 of 18 �. :� � � �r�� ,� - � �_` ,. : .� � e � . � � � , I-�� i � ..� ., _ � � I _;� - ; .u� w�.�,.. =_� , ' #,_': � �_ � � � � � � � -�� ,p� . _ +�� , , �� ;,, „r � . r"" ' {i�,d � � ��a s- Photo 15 from Estimate for Claim no 0343938250101042-01 Photo date: 02/23/2011 07:48:57:00. Size: 58087 Description: Insured: YANG, CHER. Policy_no: 4125108961. Claimant: . Vehicle: 1, JEEP, CHEROKEE 4X4 SPORT. VIN: 1J4FF48S81L587581. Loss date: 02/21/11. Estimator: Paul Walz file://C:�Documents and Settings\u90jO1�I.ocal Settings\Temp\pdi\1045888818_10343938... 9/20/2012 Photos for claim no 0343938250101042-01 Page 15 of 18 � - �,:�� ; , � �. ,� - �" _�.4 °�. �"�k� �_ � � � Photo 16 from Estimate for Claim no 0343938250101042-01 Photo date: 02/23/2011 07:48:57:00. Size: 56193 Description: Insured: YANG, CHER. Policy_no: 4125108961. Claimant: . Vehicle: 1, JEEP, CHEROKEE 4X4 SPORT. VIN: 1J4FF48S81L587581. Loss date: 02/21/11. Estimator: Paul Walz file://C:�Documents and Settings\u90jO1�L.ocal Settings\Temp\pdi\1045888818_10343938... 9/20/2012 Photos for claim no 0343938250101042-01 Page 16 of 18 �I . � :�n � � �� rPr�-�+`�`i�� '� ��r , i �' � � ' , �� . � .. � � ..� .., � P V�"� t...i6;' a y, - . -w�' ��zo;�3+ ,f.,, r: ,,<, ,,.y. �, ..W,^,�%�j`,��..� �� '�. , :3'„'n �� "�.;��ryi ' II I i�Qp.�. x' f+j 1 . . . w ,� � � �III IIII z.,�� V ��"� ir I. ;�� , .r��t:� �. ,. , ;; �' hf u��.; �� , � P �vp& f� �r� a s �� , � '"°'�� ;�" ��. �. �� . „ , a, � q '�;. ��:� . �"�" a 6 i .� ��f�' �p��, Photo 17 from Estimate for Claim no 0343938250101042-01 Photo date: 02/23/2011 07:48:57:00. Size: 77715 Description: Insured: YANG, CHER. Policy_no: 4125108961. Claimant: . Vehicle: 1, JEEP, CHEROKEE 4X4 SPORT. VIN: 1J4FF48S81L587581. Loss date: 02/21/11. Estimator: Paul Walz file://C:\Documents and Settings\u90jOl�i.ocal Settin�s\Temp\pdi\1045888818_10343938... 9/20/2012 Photos for claim no 0343938250101042-01 Page 17 of 18 ,�� 7��.'` ��,o� � �� .. � � — <.��o ,�� LL— ,�` 1� �LL ? �,��x _ . �, = r ; � . �� -.-,: � �� i � ,., a, � ,� � � ¢�� .: h., �'��'"2 _` Photo 18 from Estimate for Claim no 0343938250101042-01 Photo date: 02/23/2011 07:48:57:00. Size: 56058 Description: Insured: YANG, CHER. Policy_no: 4125108961. Claimant: . Vehicle: 1, JEEP, CHEROKEE 4X4 SPORT. VIN: 1J4FF48S81L587581. Loss date: 02/21/11. Estimator: Paul Walz file://C:�Documents and Settings\u90jOl�I.ocal Settings\Temp\pdi\1045888818_10343938... 9/20/2012 Photos for claim no 0343938250101042-01 Page 18 of 18 , an� �� — � � ��_.___.-�—=— � �k �a - � �� -_ } � - d ��r ,y. �.; "�tw�� ' ,;�u�i is � T�:� �- ,� �w °uii � ��.: � � s�� -=.� � � � �� a` n�u � ,,"x �� "�� a � �" � r � , p� � . ,t� � y `� "�� ' �' - � . ��- �w �- _�_ � �t.� file://C:�Documents and Settings\u90jO1�I.ocal Settings\Temp\pdi\1045888818_10343938... 9/20/2012 Page 1 of 1 CLAIM PAYMENT Claim number: 034393825-0101-042 Loss date: 02/21/2011 0240PM Insured name: CHER C YANG Claimant name: Company: GEICO General Insurance Total check amount:$45.00 Check details Date issued: 02/22/11 Check number:011352872 Payment type: Bulk Payment Payment for: Loss Payment In payment of: 543111052 Payment to: KEN DICK AUTO EMERGENCY SERVIC Mail to: KEN DICK AUTO EMERGENCY SERVIC 500 3RD ST NEWPORT MN 55055 Miscellaneous Attorney gross: None IRS field: 47-1564770 Provider type: Out of network provider: Enclosure: Payment allocation O1 Collision (COL)CHER C YANG$45.00 fi le://�\r 12k0790\DATA\ecf�fax\out\l OS980-15391817-Payment.htm 9/20/2012 Page 1 of 1 CLAIM PAYMENT Claim number: 034393825-0101-042 Loss date: 02/21/2011 0240PM Insured name: CHER C YANG Claimant name: Company: GEICO General Insurance Total check amount:$19.20 Check details Date issued: 03/O1/11 Check number:011355129 Payment type: Bulk Payment Payment for: Loss Payment In payment of: 543111052 543111052 Payment to: KEN DICK AUTO EMERGENCY SERVIC Mail to: KEN DICK AUTO EMERGENCY SERVIC 500 3RD ST NEWPORT MN 55055 Miscellaneous Attorney gross: None IRS field: 47-1564770 Provider type: Out of network provider: Enclosure: Payment allocation O1 Collision (COL)CHER C YAI�?G$15.00 O1 Collision (COL)CHER C YANG$4.20 file:/n�r12k0790�DATA\ec�lfax\out\1OS980-15392318-Payment.htm 9/20/2012 Page 1 of 1 CLAIM PAYMENT Claim number: 034393825-0101-042 Loss date: 02/21/2011 0240PM Insured name: CHER C YANG Claimant name: Company: GEICO General Insurance Total check amount:$1,628.04 Check details Date issued: 03/04/11 Check number: E00215628 Payment type: Bulk EFT Payment for: Loss Payment In payment of: COLLISION COVERAGE 6943 Payment to: CLAIMS SERVICES GROUP INC Mail to: ADP PAYMENT SOLUTIONS 6111 BOLLINGER CANYON ROAD, SUITE 200 SAN RAMON, CA 9458 Miscellaneous Attorney gross: None IRS field: Provider type: Out of network provider: Enclosure: Payment allocation Ol Collision (COL)CHER C YANG$1,628.04 fi le:/n\r 12k0790\DATA\ecflfax\out\l OS980-15393019-Payment.htm 9/20/2012 ARMSO - Automated Rental Management System Page 1 of 1 Rental Company:ENTERPRISE RENT-A-CAR ,� . GE�C� Invoice: D589665-1957 Bill To: GE155MW �E�lT�L C3�TAtl.: GEICO ATTN:AUTO BODY GEICO RX-HAMLINE Rental Period: 2/22/11 to 3/4/11 (11 days) Billed Period: 2/22/11 to 3/4/11 (11 days) 1 GEICO CENTER MACON , GA 31296 � g��c��ar��nci>ervi��;� Rate Amount ' R�NT"�� I�CJF�MATiON: 11 DAYS @ 42.25 $464.75 ' Renter: YANG, CHER ' Tax�s ar=�i Ssa�ck��r�g�s ��-��I��: ' 1 MNRENTL 6.20% $28.81 Rental Branch Location: ENTERPRISE RENT-A-CAR(1957) 1 MNREGFEE 5.00% $23.25 ' 2520 BROADWAY DR STE 2 ' LAUDERDALE, MN 551135125 1 SALES TAX 7.12% $33.11 (651)631-1581 Total Charges: $549.92 ��s�-��y�yp��R�� g��,q�-��: Less Amount Received: $0.00 ; Claim Number:034393825-0101-042-01 Total Amount Due: $549.92 Claim Type: Insured Vehicle Condition: Driveable Date Of Loss:2/21/11 Insured Name:CHER YANG Owner's Vehicie:2001 JEEP CHERO Additional Driver: Repair Facility: HAMLINE AUTO BODY LAUDERDALE, MN 55113 (651)224-4717 1��lC��S RENTEa: Effective Date and Time Year Make Model VIN Rate Charged 2/22/11 2011 JEEP GCHE $42.25 ental invoic�e Please Return This Portion with Remittance Make Payment To: Total Charges: $549.92 ENTERPRISE RENT-A-CAR(1999) Less Amount Received: $0.00 2775 BLUE WATERS RD Total Amount Due.................... $549.92 EAGAN , MN 55121-1439 Federal ID:26-4548555 Please include on your check: Invoice: D589665-1957 https://www.armsweb.com/armsweb/closedcustomerfile.do 9/20/2012 Page 1 of 1 CLAIM PAYMENT Claim number: 034393825-0101-042 Loss date: 02/21/2011 0240PM Insured name: CHER C YANG Claimant name: Company: GEICO General Insurance Total check amount:$549.92 Check details Date issued: 03/07/11 Check number:E00215643 Payment type: Bulk EFT Payment for: Loss Payment In payment of: RENTAL REIMBURSEMENT COVG. 1957D589665 Payment to: ENTERPRISE RENT A CAR Mail to: ENTERPRISE RENT A CAR 600 CORPORATE PARK DRIVE ST.LOLTIS, MO 63105 Miscellaneous Attorney gross: None IRS field: 430724835 Provider type: Out of network provider: Enclosure: Payment allocation O l Rental Reimbursement (REN)CHER C YANG$549.92 fi le:/n\r 12k0790\DATA\ecfi�fax\out\I OS980-15393920-Payment.htm 9/20/2012 � c � E E 0 U r' T r r � � N N N N � a�1'� O O� O) CO W T T T T� w � 0 � � � � Q T Q � � � M CO � W C° � � � � � � ° � � T � � � � � � � � � � � � ° c�v � c i v � rn J r- � r co M � � (v 7 f� N �T � � � � � � �� LLj -p O (fl 00 N 0� lf� CO C'7 CO O O O O O O O O O O CO O O O O O � O � � C4 M O T �t T O O O O O O O O O O T O O O O O � Q —ry� 00 �' M N O r � C..O.F � ��MA OI� ��..F � �...F d�.F' �M OA O �...F � �t � O d' � W /R W C� r- M CO � M T V T W 1� V � V V W 1� � V T � O O� CF O...F �, LJ � ('f� ('!� N � � � T C� T r T T T C� T T M T Cr T T V � ��R � � VR C � (J C Q Q Q cf� c�iE� �TC-F?E�E��3 �FrE� cf3 �3�3 �rE� �JE�sc�3c�3c-F? s9� �Td9 �? � T r T r T r' T T O U N T O O O r T O T T T T T r T r T T T T r T T T T � T T N N N r r N T T T T T r' T T r T r r r T T T � � � C�O � � � O N � M c\O � M � � o�D � r � � C\O N � � � � � �N N \ N N � \ �O � � O N N � � O OO O N N � � � O OO OO N �� N N r' � *-' O o0 I� I� f� CO c0 (D CO Cfl CO CO � � � � � � � � � p � *- � � O O O O O O O O O O O O O O O O O O N N T T T T T T T T r T r T T T T r' T T r' T � � � � � � � � � � � � � � � � � � � � � � r N C'7 CO Ch M I� I� 00 QO CO cf � (fl N N LA � d) N � N O r O N N '- r O O N N N T T � O O N � � � � � � � � � � � � � � � � � � � � � � � O N O O O O O O O O O O O O O O O O O O O N N T r T T T r r r r T r T T r r T T T r T r T T ^` T T T T T T T T r T r T T T T T T T T T T T T T � W � � � 0 0 � � Q Q Q � � � � � 0 Q � � 0 0 � Q � Q � N N N N N N N N N N N N N N N N N N N N N N N N N 0 M e� N � ,- O O� O) O� c'� t() � oD 00 r � 00 N N r �A � O� � O Uj � N N � � � � � \N N � � � N N N � � � � ('\7 N N � � � W > M r- N r- O O o0 I� f� CD CO CO C� � � t(') � � � //[ �^' T T T �� U � � Q � _ U 0 0 °0. � r N (O D U U U U � � � � � � (n (n Cn � U � � � � � � T � zZZ Z ZWwO> wO> O> WWW �> Z � W � O � � O N � J J J J J Z Z > Z > > Z Z Z > -� � Z W ?) 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