Metropolitan Council (2) , � F
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:���'.�.:�E�r l.Y
�'� Metropolitan Council �t� 2 "� �p�2
ii
� �' ' ��4 Risk Management
September 20, 2012 �
CITY OF ST. PAUL
CITY CLERK
15 WEST KELLOGG BLVD.,
310 CITY HALL
ST. PAUL, MN 55102
Re.: Date of Accident: 6/18/12
Your Dept.: St. Paul Regional Water Servs.
Your Vehicle: 2009 STRG. MN Plate#: 930320
Your Driver: Robert Hamm
Our Vehicle: 2010 Ford Cargo Van, "T" Transit.
Our Driver: John Colbeth
Our Subrogation Claim: $21,905.83
Our Claim Number: 2012-00888
Dear Sir or Madam:
The Metropolitan Council is presenting our subrogation claim to you in the amount of
$21, 905.83. Attached is your completed claim form along with our supporting
documents.
Our claim consists as follows:
Vehicle ACV: $23,085.00
Less Salvage: ($2,300.00)
Total Vehicle $20,785.00
Cost to re-fit electronics on new vehicle: $1,120.83
Total Claim: $21,905.83
We appreciate your prompt consideration of our claim. If everything is in order,please
make your check payable to the Metropolitan Council, directing it to my attention and
claim number. If there are any questions,please contact me at (651) 602-1772.
Sincerely,
/ ` � -
Michael B. IVI
Claims Representative
Enclosure
www.metrocouncil.org
390 Robert Street North • St. Paul, MN 55101-1805 • (651) 602-1000 • Fax(651) 602-1771 • TTY(651) 291-0904
An Equa1 Opportunity EmpLoyer
_ ��PRc..�s ��4 �d—�'S
` ' (�(�?(1 a U�eC►��.(e�c��•�-
- NOTICE OF CLAIM FORM to the City of Saint Paul,�M nne ota`�3�`7�
Minnesota State Statute 466.05 states that " ...every person...who claims damages fi•om nny municipality...sha(1 cause to be presented to the
governing body of the municipaliry within 180 days after the a/leged loss o��injury is discovered a notice sdating the time,place,and
circumstances thereof,and the amount of compensation or other relief demanded."
Please comptete this form in its entirety by cleariy 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 yovr claim. This form must be signed,and both pages completed. If something does not appty,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 lGt.t'��L __ Middle Initial � Last Name
-- �/� YT/`( v c�,S�F r F�r -
Company or Business Name ��j--�i�U L � -T�y n�
( �L�/UG I L
Are You an Insurance Company? Yes/�If Yes,Claim Number2�Gf.�,v �vcn
- � /� - J
Street Address � g� ���j�r -� �T-
City��, ��. u � State � Zi Co -
P de U/ `�v�
Daytime Phone( ���� /rJ'72Ce1!Phone(
�� Evening Telephone(� _
Date of Accident/Inj ury or Date Discovered___��j���y Time '7 ��8' ar�%1 pm
Please state, in detail,what occurred(happened),and why you are submitting a claim. Please indicate why or how you
fee!the City of Saint Paui ar its employees are invoived and/or responsible for your damages. �Lc ;� �/'fr�v
��rl r_ --t-v ,? S-t� ,r=�, ►� �To Er�
YG� G (� r✓f���c v,
Y(.� C l� i.=f} t� v �= D N'T
_ 7`o H/�" G.A v !-i� r ,��i L u t/�� v 1/ �!
/N f=Yo!�T d F leu v ,r.�N ,
.�le�se 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 by a pothoie ur uonuitio7 o`th„s�r.,et � My v�ehicle was damaged during a tow '
o + „
� My vehicle was wrongfully towed and/or ticketed � c[e ss d�maae�hy a plc�vv ,
❑ Other type of praperty damage-please specify � � �'�'as injured on City property '
❑ Other type of injury-please specify i
I
In order to process your claim ou need to include conies of all anplicable documents.
For the claims types listed below lease b .
, p e sure to mctude 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 o elf before submitting your claim form.
Property damage claims to a vehicie: two estimates for the repairs to your vehicle if the damage exceeds I
500:00; or the actual bills and/or receipts for the repairs
O�owing claims: legible copies of any ticket issued and a copy of the impound lot receipt
,�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 I ury claims: medical bills, receipts
Photographs are always welcome to document and support our claim bu ���"�����°�
Y t w�ll not be returned.
Page 1 of 2-Please complete and return both pages of Claim Form ��� � � ���i�
R1SK M��
r�t'll�--('+l''R`���
� p
Failure to complete and return both pages will resutt in delay in the handling of your claim.
All Ciaims- lease com lete this section
Were there witnesses to the incident? �I...�'
Provide their names, addresses and telephone numbers: N� �F Unknown (circle)
'�t�` '= F_ Y�"h G►�S
Were the police or law enforcement ca11e �
If yes,what department or agency? T.� �� No Unknown (circle)
�'�'G�- Case#or report# �"�,�r.� •� _ ° 6�y�y-�
Where d�d the accident or injury take place? Provide street address, cross street, intersection, name of park or facili
closest landmark, etc. P ease be as detailed as ossib[e. If necessary, attach a diagram.
F_FLO G IL K W �A� �r N�'sA-� ��
T /�-(.t f. �..�
Please indicate the amou t you are seeking in compensation or what you would liice the City to do to resolve '
to your satisfaction. �- c���. �� th�s claim
Vehicle Claims- lease com lete this section
Your Vehicle: Year '� /�/ Make ❑check box if this section does not a 1
�-- ��ro Model �-�,,rsi r
License Plate Number ' ��_ r,��,s, r ��"N`�t � Lt G%1 r�p r�p��,�r.r
Registered Owner State��Color �-/�*�
T G o� j r/a-nl �Lc b,,G/�.
Driver of Vehicle — �
Area Damaged � r-�,� r� �B r *'�
C�ty Vehicle: Year G�' ��"�' r�_� �'
a�Make Model
License Plate Number � D State
Driver of Vehicle{City Em.loyee's Name Color _ L. •
Area Damaged rG N-� � �"r ru
�u ,_r.
In'u Claims- lease com lete this section
Now were you injured? ❑ check box if this section does not a 1
What part{s)of your body were injured?
Have you sought medical treatment? Yes
When did you receive treatment? Planning to Seek Treatment(circle)
Name of Medical Provider(s): (provide date(s))
Address
Did you miss work as a result of yonr injury? �,�5 Telephone
When did you miss work? No
Name of your Employer: (provide date(s)j
Address
Tetephone
�C'heck here if you are attaching rrt�re pages to this claim form. Number of
addihonal pages�,�
By signing this form,you are stating that all information you have provided is true and correct t
of your knowlealge. Unsigned forms will not be processed. o the best
Submitting a false claim can resutt in prosecution. Date form was completed
Print the Name of the Person who Completed this Form;
�/G' /•��L /� /�I.✓� ir�H
Signature of Person Making the Claim: ~
. `�����
Revised February 2p�� �/�l��� .
�iC
�� �°�-�e��`
�� �,� � U � _ ,�� �-
��� a-� i � _ ad���
�Motor�ehicle Printable Display Page 1 of 1
. , l.i��:
Motor Vehicle Query 6/19/2012 4:32:27 PM chovde Station: 6907 Deputy:
Title Printed Suspense Liens Flags Files
J0540Y756 Y N 0
Plate VIN Exp. Sticker Tax Prv. Plt
930320 (494) 2FZHAZCV79AAK1494 0214 P0084717 10.00
Year Make Model Style Color Class Empty Wt
2009 STRG STE TM BLU 61
Transfer Date Last Trans First Sale Base Odometer Reissue YR
R Ol 25 12 09 22 2008 000000 0000879
Owner DOB ID
ST PAUL REGIONAL WATER SERVS 00 00 0000 S927610786646
Street City County/State Zip
1900 N RICE ST ST PAUL RAMSEY 55113
Secured Party# 1 Date
Street City State Zip
PLATE/STICKER INFORMATION
Key Status Year Class Weight Issued By Updated Allocated
930320 (SOLD) 97 TE 149 MAPLEWOOD 02/23/09 11/13/07
Key Status Year Class Weight Issued By Updated Allocated
P0084717 (SOLD) 14 DY 149 MAPLEWOOD Ol/25/12 11/14/11
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https://www.dvsesupport.org/dvsinfoNH2O/V H2OPrint.asp?P1ate=930320&VINFu11=&Tit... 6/19/2012
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� MetrOpOlitari COU�1C11 Date: September 13, 20�2
Risk Management Dept. File No.: 2012-00888-0001
390 North Robert Street Re: PAUL REG. WATER SERVS ST
St. Paul, MN 55101 1900 N RICE ST
ST PAUL, MN 55113
Estimate of Repair
Accident Date June 18, 2012
Accident Location I-35E /MARYLAND AVE/LARPENTLTER AVE
Bus/Vehicle Number N-0437
Location of Dama e
Descri tion of Dama e ,rfs�-�-r..�� .�,�' u� ,y�-ur� _f�� �-�io /���' � �- �pD h�z
Name of Facility OHB - Fairbox e air ��NN�s�
Details of Repairs and Replacements
Replace Description Qt3'• Price of
Parts/Su lies
X Part# 1007993 Fuse 10 am mini red Gilli h brid 1.00 $0.20
X Part# 1010411 Unit radio lo ic 1.00 $0.01
X Part# 1012014 Anetenna kit '/4 wave 800 mhz cable& minu-u 1.00 $12.98
connector
X Part# 1012015 Anetenna s at575-97w-smaf 1.00 $86.27
X Part# 1012469 Cable s sma to sma 20 ft 1.00 $50.06
X Part# 1013597 Clam cable 23 in series 1 c s cir lastic conn. 1.00 $3.06
X Part# 1021043 Circuit mini fuse ta a 1.00 $4.56
X Part# 1003599 Decal "Metro Transit" 2.00 $10.76
X Part# 2358500 Ta hand lu '/4-20 4.00 $14.51
X Part#2358800 Ta hand lu 5/16-18 4.00 $17.40 '
�
Labor: 9.62 Hours @ $89.90/Hour $864.84
Parts $199.78
Minnesota State Sales Tax (6.5% on parts only) $56.21 ;
TOTAL ESTIMATE OF REPAIR $1,120.83
PLEASE REFERENCE THE FILE NUMBER ON YOUR REMITTANCE II
��
�'��,G � FOR OFFICE USE ONLY
� G '�'
�n� L V Date of Estimate:
cc: A.Moseng,Heywood -� f*
� � �
, �
, , METRO AREA APPRAISALS
physical damage apprasers
Assignment#: 33515 A.C.V Salvage Worksheet Claim#: 2012-00888
P.O. BOX 11804 Telephone: (651)683-0834
TWIN CITIES INTERNATIONALAIRPORT Fax: (651)683-9134
SAINT PAUL,MN 55111 Adjuster: MICHAEL MARTH
•kw:r::��er�wr�,.�:��+��r�:���xt+w+,t��:r::+��+,r+r:,v�+�trrt�t�rterr+r�twttr+ta+r#+w++�ritf+w+��+�w�r+����t��r���+����:�:��rr��+��+:++,e��:r:r,r�w�,rr,r
Insured: Claimant:
METROPOLITAN COUNCIL
390 ROERT STREET NORTH
ST PAUL,MN 55101 ,
Home: Home:
work: Work:
Insurance Company: METROPOLITAN COUNCIL Deductible: 0.00
Adjuster: MICHAEL MARTH
VEHICLE DESCRIPTION
LOCATION:
VIN: MILES:
LICENSE#: EXPIRES:
COLOR: EXTERIOR: INTERIOR:
TIRES: WARE: UF: UR: R/F: R/R: SPARE:
Dealer Quote
CCC PLUS INTERIOR ITEMS PLUS SALES TAX $23,085.00
Salvage Estimate
TOTLE LOSS BROKERS 651.448.6078"DAVID"@$2,300.00 $0.00
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, , METRO AREA APPRAISALS
physical damage apprasers
Assignment#: 33515 TOTAL LOSS WORKSHEET Claim#: 2012-00888
P.O. BOX 11804 Telephone: (651)683-0834
TWIN CITIES INTERNATIONALAIRPORT Fax: (651)683-9134
SAINT PAUL,MN 55111 Adjuster: LES
k**ffYe*A'*R**R**#ffe*}rfYr*fA#4*44*4*ff#4Rft#1�4*#f**#RA**#R**AM**ilAfrf**}ff*f*f**fAfe**M4i**fd#*ffR*f}feR*fR4i*1f**A*1rR*f*R1r1*Rf**f**1Mfrff**fR**1*f*f*Rfe
Insured: Claimant:
METROPOLITAN COUNCIL
390 ROERT STREET NORTH
ST PAUL,MN 55101 ,
Home: Home:
Work: Work:
Insurance Company: METROPOLITAN COUNCIL Deductible: 0.00
Adjuster: MICHAEL MARTH
VEHICLE DESCRIPTION
LOCATION:
VIN: MILES:
LICENSE#: EXPIRES:
CO LO R: EXTERIOR: I NTERIOR:
TIRES: WARE: UF: UR: R/F: R/R: SPARE:
N.A.D.A.
BASE PRICE $16,650.00 ADD DED
MILEAGE 75,875
TRANSMISSION
AUTO(X)MANUAL( )3 SPEED( )4 SPEED( )5 SPEED( )OVERDRIVE( )
AIR CONDITIONING( X)
TOP: VINYL( ) LANDAU( )
SUNROOF: MANUAL( ) ELECTRIC( )
RADIO: AM( ) FM( ) W/TAPE( ) AM-FM STEREO( ) CD( X)
POWER: WINDOWS( X) SEATS( ) LOCKS( X) STEERING( X) BRAKES( X)
TILT STEERING WHEEL( X)
CRUISE CONTROL( X)
DECOR INTERIOR( )
DECOR EXTERIOR( ) ,
LUXURY INTERIOR GROUP( )
ENGINE: GAS( X) DIESEL( ) HYBRID( ) OTHER FUEt( )
4-CYL(X) 6-CYL( ) 8-CYL( ) 10-CYL( ) 12-CYL( ) 2.0
WHEELS: ALLOY ,
OTHER: INTERIOR RACKING �4,950.00
�I
TOTAL N.A.D.A. a21,600.00 I
REMARKS:
�
1
, , METRO AREA APPRAISALS
physical damage apprasers
Assignment#: 33515 TRANSMITTAL LEITER Claim#: 2012-00888
P.O. BOX 11804 Telephone: (651)683-0834
TWIN CITIES INTERNATIONALAIRPORT Fax: (651)683-9134
SAINT PAUL, MN 55111 Adjuster: LES
«...................x...�...�.,.......�.,.,.......�.:.....,...,...........«..�....�.............................t.......,.....,.«.......>..<.......
Insured: Claimant:
METROPOLITAN COUNCIL
390 ROERT STREET NORTH
ST PAUL, MN 55101 ,
Home: Home:
Work: Work:
Insurance Company: METROPOLITAN COUNCIL Deductible: 0.00
Adjuster: MICHAE�MARTH
Received Date: 7/9/2012 Contact Date: 7/10/2012 Loss Date: 6/18/2012
Inspect Date: 7/10/2012 AP Date: 7/25/2012 AP Call Date: 7/25/2012
Routine Job: Close Date: 7/25/2012
Partial Loss Total Loss
Repairers Estimate: Guide Book: $21,600.00
estimated actual actual cash value $23,085.00
appraiser's estimate $18,602.41 $0.00 prior damage $0.00
agreed price tax $0.00
license fee $0.00
deductible $0.00 deductible 0.00
betterment + $0.00
total deductions $0.00 gross loss $23,085.00
net loss $18,602.41 $0.00 high salvage bid $0.00
supplement due $0.00 estimated net loss $23,085.00
approximate repair time
high salvage bid $0.00
10/JULY INSPECTED THIS VEHICLE WITH SCOTTAT THE BUS GARAGE, SCOTT IS GOING TO SECURE THE COST OF
THE INTERIOR RACKSAND CONTAINERS.
19/JULY WENT BACK AND TALKED WITH SCOTT WHO STATED HE IS HAVING SOME DIFFICULTY SECURING THE
ITEMS MENTIONEDABOVE,CALLED MIKE MARTH WITH THIS INFO
25/JULY I AM SENDING IN THE DAMAGE ANDACVAS PER CCC FOR THE VEHICLE. I WILLATTACH ALL THE IMAGES
AND FORWARD THE INTERIOR ITEMS AS SOON AS I GET THEM. I CALLED MIKE AND WAS GIVEN THE OK TO RUN
THIS THRU CCC.
26/JULY SUGGEST SETTLEMENTAS FOLLOWS
ACV AS PER CCC#47804059 @$16,650.00
REPLACEMENT OF INTERIOR RACKING AS PER INVOICE @$4,950.00
SALES TAX @ 6.875%_$1,485.00
---------------------------
SUGGESTED SETTLEMENT @$23,085.00
CALLED FOR APPROXIMATE SALVAGE THRU TOTAL LOSS BROKERS 651.448.6078"DAVID"@$2,300.00 BECAUSE OF
THE HIGH MILES
, , METRO AREA APPRAISALS
physical damage apprasers
Assignment#: 33515 TRANSMIITAL LEITER Claim#: 2012-00888
P.O. BOX 11804 Telephone: (651)683-0834
TWIN CITIES INTERNATIONALAIRPORT Fax: (651)683-9134
SAINT PAUL,MN 55111 Adjuster: LES
•���::R�+�:+r�ertan�,v�tes.�+�r�arw���w�::�w�:+t�w:,t:�x♦��w�������r�����w,r���rx::�xw::�x���w:::�r::�:x�:+�r:�++�,v��,r�+::,r�t,rr+�w+r�,�ttr+w��x+e+e+t�tr
Insured: Claimant:
METROPOLITAN COUNCIL
390 ROERT STREET NORTH
ST PAUL, MN 55101 ,
Home: Home:
Work: Work:
Insurance Company: METROPOLITAN COUNCIL Deductible: 0.00
Adjuster: MICHAEL MARTH
Received Date: 7/9/2012 Contact Date: 7/10/2012 Loss Date: 6/18/2012
Inspect Date: 7/10/2012 AP Date: 7/25/2012 AP Call Date: 7/25/2012
Routine Job: Close Date: 7/25/2012
Partial Loss Total Loss
Repairers Estimate: Guide Book: $0.00
estimated actual actual cash value $0.00
appraiser's estimate $18,602.41 $0.00 prior damage $0.00
agreed price tax $0.00
license fee $0.00
deductible $0.00 deductible " 0.00
betterment + $0.00
total deductions $0.00 gross loss $0.00
net loss $18,602.41 $0.00 high salvage bid $0.00
supplement due $0.00 estimated net loss $0.00 i
approximate repair time
high salvage bid $0.00 ,
10/JULY INSPECTED THIS VEHICLE WITH SCOTTAT THE BUS GARAGE,SCOTT IS GOING TO SECURE THE COST OF
THE INTERIOR RACKS AND CONTAINERS.
19/JULY WENT BACKAND TALKED WITH SCOTT WHO STATED HE IS HAVING SOME DIFFICULTY SECURING THE
ITEMS MENTIONEDABOVE,CALLED MIKE MARTH WITH THIS INFO
25/JULY I AM SENDING IN THE DAMAGE AND ACV AS PER CCC FOR THE VEHICLE. I WILLATTACH ALL THE IMAGES
AND FORWARD THE INTERIOR ITEMS AS SOON AS I GET THEM. I CALLED MIKE AND WAS GIVEN THE OK TO RUN ,
THIS THRU CCC. '
26/JULY SUGGEST SETTLEMENTAS FOLLOWS
ACV AS PER CCC#47804059 @$16,650.00 'i
REPLACEMENT OF INTERIOR RACKING AS PER INVOICE @$4,950.00
------------------------------
TOTAL SETTLEMENT W/O TAX @$21,600.00
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� ' Page 1 of 1
Metro Area Appraisals
From: <Valuescope@cccis.com>
To: <METROAREAAPPRAISALS@COMCAST.NET>
Sent: Wednesday, July 25, 2012 4':35 PM
Attach: 2012-00888.pdf
Subject: Claim number 2012-00888 CCC Valuescope MarketReport
CCC has valued a CRV claim with a proposed settlement amount of
$16,650.00. Please examine the attached CCC Valuescope Market Report in
detail before extending an offer to the vehicle owner.
Information about this claim:
Claim Number: 2012-00888
CCC Valuescope Office ID: 18377
CCC Valuation Request Number: 047804059
Adjuster Name: MICHAEL MARTH
Insured Name: METROPOLITAN COtTNCIL
Owner Name: METROPOLITAN COtJNCIL
Date of Loss: 06/18/20I2
Type of Loss: COLLISION
Vehicle: 20l 0
TRANSIT CONNECT XLT CARGO 4D VAN
Do not reply to this email. For assistance,ca11(800)621-8070.
Attachment:
i
I
I
7/25/2012
� .
07/25/2012 at 04 : 52 PM File ID: 2963
6359
METRO AREA APPR.AISALS INC.
EAGAN
GOD BLESS OUR TROOPS
PO BOX 11804
metroareaappraisals@comcast .net
ST PAUL, MN 55111
(651) 683-0834 Fax: (651) 683-9134
Written By: LES HANSON
For: METROPOLITAN COUNCIL -
Adjuster: MICHAEL MARTH (651) 602-1772
PRELIMINARY ESTIMATE
Insured: METROPOLITAN COUNCIL Claim #2012-00888
Owner: METROPOLITAN COUNCIL Policy #
Address: 390 ROBERT ST NORTH Date of Loss: 06/18/2012
ST PAUL, MN 55101 Type of Loss: Collision
Business: (651) 602-1772 Point of Impact: 6 . Rear
Inspect DRIVE IN
Location:
Repair Days to Repair
Facility: License #
2010 FORD TRANSIT CONNECT XLT CARGO 4-2 . OL-FI 4D VAN WHITE Int :
VIN: NMOLS7DN3AT006023 Lic: Prod Date: Odometer: 75875
Condition: Good
Air Conditioning Rear Defogger Tilt Wheel
Cruise Control Telescopic Wheel Intermittent Wipers
Keyless Entry Rear Window Wiper Dual Mirrors
Console/Storage Overhead Console Clear Coat Paint
Power Steering Power Brakes Power Windows
Power Locks Power Mirrors AM Radio
FM Radio Stereo Search/Seek �I
CD Player Auxiliary Audio Connectio Anti-Lock Brakes (4) ;
Driver Air Bag Passenger Air Bag Front Side Impact Air Bag i
4 Wheel Disc Brakes Cloth Seats Bucket Seats
Rear Step Bumper Automatic Transmission Overdrive '
Full Wheel Covers i
------------------------------------------------------------------------------- i
-__NO�-------OP. __---__---DESCRIPTION_----_-_-__QTY-EXT. PRICE LABOR PAINT i
--------------------------
1# SET UP TO PULL 1 1 . 0 �
2# REPAIR UNIBODY 1 6 . 0 F
3# ALL WHEEL ALIGNMENT 1 99 . 95 X '
4 FRONT BUMPER
5 O/H bumper assy 2 .3
6** Repl RECOND Bumper cover w/o fog 1 371 . 00 Incl . 3 . 0
lamps primed
7 Add for Clear Coat 1 . 2
8 Repl Lower grille 1 87 .40 Incl .
1
07/25/2012 at 04 : 52 PM File ID: 2963
6359
PRELIMINARY ESTIMATE
2010 FORD TRANSIT CONNECT XLT CARGO 4-2 . OL-FI 4D VAN WHITE Int :
-------------------------------------------------------------------------------
NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT
-------------------------------------------------------------------------------
9 Repl Impact bar (HSS) 1 861 . 53 Incl . 0 .4
10 Repl RT Side bracket cover primed 1 10 . 50 Incl . 0 . 2
11 Repl LT Side bracket cover primed 1 10 . 50 Incl . 0 . 2
12 Repl License bracket 1 21 . 78 0 . 2
13 FRONT LAMPS
14 Repl Aim headlamps 1 0 . 5
15 Repl LT Headlamp assy 1 401 .42 0 .4
16 Repl RT Side marker lamp 1 16 . 37 Incl .
17 Repl LT Side marker lamp 1 16 . 37 Incl .
18 ROOF
19* Rpr Roof w/o taxi 6 . 0 4 .2
20 R&I Front headliner 0 . 5
21 R&I Rear headliner 2 . 0
22 SIDE LOADING DOOR
23* Rpr LT Outer panel 2 . 0 3 . 0
24 Overlap Major Adj . Panel -0 .4
25 R&I LT Door w' strip 0 . 6
26 SIDE PANEL
27 Repl LT Side panel w/o window 1 2477 . 08 17 . 0 4 . 0
28 Overlap Major Adj . Panel -0 .4 '
29 Add for Inside 2 . 5
30* Rpr LT Inner panel w/o taxi s 8 . 0 1 .4
31* Rpr LT Rear pillar upper (HSS) 3 . 0 0 .4 ,,
32 BACK DOOR i
N 33* Repl LKQ RT door assy +30% 1 975 . 00 5 . 9 3 . 5
34 Overlap Major Adj . Panel -0 .4
35 RT Transfer door glass 1 . 8
N 36* Repl LKQ LT door assy +30% 1 975 . 00 5 . 9 3 . 5 '
37 Overlap Major Adj . Panel -0 .4 '
38 LT Transfer door glass 1 . 8 �
39* Repl LKQ RT Upper hinge w/270 1 0 .4 0 .3
degree check arm
40* Repl LKQ RT Lower hinge w/270 1 0 .4 0 .3
degree check arm
41* Repl LKQ LT Upper hinge w/270 1 0 .4 0 .3
degree check arm
42* Repl LKQ LT Lower hinge w/270 1 0 .4 0 . 3
degree check arm
43 Repl Emblem "FORD" oval 1 20 . 57 0 . 2
44 Repl Nameplate "TRANSIT" from 1 29 .48 0 . 2
4/28/10
45 Repl Nameplate "CONNECT" 1 20 . 35 0 . 2
46# Urathane kits 2 50 . 00
47 REAR LAMPS
48 Repl LT Tail lamp assy 1 147 . 68 Incl .
49 REAR BUMPER
50 Repl LT End cap primed 1 65 . 33 0 .4 0 . 8
51 Overlap Minor Panel -0 . 2
2
. �
07/25/2012 at 04 : 52 PM File ID: 2963
6359
PRELIMINARY ESTIMATE
2010 FORD TRANSIT CONNECT XLT CARGO 4-2 . OL-FI 4D VAN WHITE Int :
-------------------------------------------------------------------------------
N0. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT
-------------------------------------------------------------------------------
52 Clear Coat 2 . 5
53 Repl Step pad torque gray 1 65 . 57 0 . 3
54# Seam sealer 1 49 . 50
55# R&I Inner racks 2 . 0
56# Hazardous waste 1 3 . 00 X
57# Repl anticorrision protection 1 12 . 00 X
58# Repl car cover l 7 . 30 0 . 2
59# Refn mask jambs 0 .4
60# Interior racking as per 1 4950 . 00 X
invoice
-------------------------------------------------------------------------------
Subtotals =_> 11744 . 68 70 . 0 30 . 6
Line 33 : A.AA 651 . 322 . 6884 "MURPHY" REFERENCE#1809215
Line 36 : AAA 651 . 322 . 6884 "MURPHY" REFERENCE#1809215
Parts 6679 . 73
Body Labor 64 . 0 hrs @ $ 52 . 00/hr 3328 . 00
Paint Labor 30 . 6 hrs @ $ 52 . 00/hr 1591 . 20
Frame Labor 6 . 0 hrs @ $ 75 . 00/hr 450 . 00
Paint Supplies 30 . 6 hrs @ $ 32 . 00/hr 979 .20
Sublet/Misc. 5064 . 95
----------------------------------------------------
SUBTOTAL $18093 . 08 '
Sales Tax $ 6679 . 73 @ 7 . 62500 509 . 33
---------------------------------------------------- i
TOTAL COST OF REPAIRS $18602 .41
i
ADJUSTMENTS :
Deductible 0 . 00
TOTAL ADJUSTMENTS $ 0 . 00
NET COST OF REPAIRS $18602 .41 i
i
SERVING THE INSURANCE INDUSTRY SINCE 1991
NO SUPPLEMENT W/O PRIOR APPROVAL
THIS IS NOT AN AUTHORIZATION TO REPAIR
THIS ESTIMATE IS NOT AN ADMISSION OF LIABILITY
YOU HAVE THE RIGHT TO USE THE REPAIR SHOP OF YOUR CHOICE
MN ST 60A. 955 - A PERSON WHO FILES A CLAIM WITH INTENT TO DEFRAUD OR HELPS
COMMIT A FRAUD AGAINST AN INSURER IS GUILTY OF A CRIME.
3
` r
07/25/2012 at 04 : 52 PM File ID: 2963
6359
PRELIMINARY ESTIMATE
2010 FORD TRANSIT CONNECT XLT CARGO 4-2 . OL-FI 4D VAN WHITE Int :
Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived
from the Guide DR2MB10, CCC Data Date 07/02/2012, and the parts selected are OEM-parts
manufactured by the vehicles Original Equipment Manufacturer. OEM parts are available at
OE/Vehicle dealerships. OPT OEM (Optional OEM) or ALT OEM (Alternative OEM) parts are OEM
parts that may be provided by or through alternate sources other than the OEM vehicle
dealerships. OPT OEM or ALT OEM parts may reflect some specific, special, or unique pricing
or discount. OPT OEM or ALT OEM parts may include "Blemished" parts provided by OEM's
through OEM vehicle dealerships. Asterisk (*) or pouble Asterisk (**) indicates that the
parts and/or labor information provided by MOTOR may have been modified or may have come from
an alternate data source. Tilde sign (-) items indicate MOTOR Not-Included Labor operations.
The symbol (<>) indicates the refinish operation WILL NOT be performed as a separate
procedure from the other panels in the estimate. Non-Original Equipment Manufacturer
aftermarket parts are described as AM, 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 RECOR.
NAGS Part Numbers and Benchmark Prices are provided by National Auto Glass Specifications.
Labor operation times listed on the line with the NAGS information are MOTOR suggested labor
operation times. NAGS labor operation times are not included. Pound sign (#) items indicate
manual entries. Some 2012 vehicles contain minor changes from the previous year. For those
vehicles, prior to receiving updated data from the vehicle manufacturer, labor and parts data
from the previous year may be used. The Pathways estimator has a complete list of applicable
vehicles. Part numbers and prices should be confirmed with the local dealership. The
following is a list of additional abbreviations or symbols that may be used to describe work
to be done or parts to be repaired or replaced. SYMBOLS FOLLOWING PART PRICE: m=MOTOR
Mechanical component. s=MOTOR Structural component. T=Miscellaneous Taxed charge category.
X=Miscellaneous Non-Taxed charge category. SYMBOLS FOLLOWING LABOR: D=Diagnostic labor
category. E=Electrical labor category. F=Frame labor category. G=Glass labor category.
M=Mechanical labor category. S=Structural labor category. (numbers) 1 through 4=User
Defined Labor Categories. OTHER SYMBOLS AND ABBREVIATIONS: Adj .=Adjacent. A1gn.=Align.
ALU=Aluminum. A/M=Aftermarket part. B1nd=Blend. BOR=Boron steel. CAPA=Certified
Automotive Parts Association. Comp Repl=Competitive Replacement (part) . D&R=Disconnect and
Reconnect. HSS=High Strength Steel. HYD=Hydroformed Steel. Inc1.=Included. LKQ=Like Kind
and Quality. LT=Left. MAG=Magnesium. Non-Adj .=Non Adjacent. NSF=NSF International �
Certified Part. O/H=Overhaul. Qty=Quantity. Qual Recy=Quality Recycled (part) . Qual
Repl=Quality Replacement (part) . Refn=Refinish. Repl=Replace. R&I=Remove and Install.
R&R=Remove and Replace. Rpr=Repair. RT=Right. SAS=Sandwiched Steel. Sect=Section, j
Subl=Sublet. UHS=Ultra High Strength Steel. N=Note(s) associated with the estimate line. i
CCC Pathways - A product of CCC Information Services Inc. The following is a list of ,
abbreviations that may be used in CCC Pathways that are not part of the MOTOR CRASH j
ESTIMATING GUIDE: BAR=Bureau of Automotive Repair. EPA=Environmental Protection Agency. I
NHTSA=National Highway Transportation and Safety Administration. PDR=Paintless Dent Repair. ,
VIN=Vehicle Identification Number.
�
4
. �
07/25/2012 at 04 :52 PM File ID: 2963
6359
PRELIMINARY ESTIMATE
2010 FORD TRANSIT CONNECT XLT CARGO 4-2 . OL-FI 4D VAN WHITE Int :
ALTERNATE PARTS SUPPLIERS
6 RECOND Bumper cover w/o fog Part No. F01000660R Price $371 . 00
Keystone - Complete (800) 328-1845
3615 MARSHALL STREET NE (612) 789-1919
MINNEAPOLIS, MN 55418
I
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(
5
TRUCK UT/L/T/ES, /NC.
2370 English Street St.Paul,Minnesota 55109-2098 (651)484-3305 Fax(651)484-0076 Since 1963
July 18`h 2012
Scott Sorenson
Non Revenue Supervisor
Saint Paul,MN 55114
B.612.349.5009
C.612.8]6.R453
mailto:Scott.Sarenson(c�metastate.mn.us
We are please to quote a van interior for a Ford Transit Connect.
Sortimo Street Side unit
-Shelf Access from the side door 20"W x 42"H
� -Rear Shelf—40"W x 42"H
One High lip shelf �
One shelf with 3 Wide S-Boxxes
One slielf with 6 S-Boxxes
One Slielf with 2 M-Boxxes with handle
Sortimo Curb Side Unit
-Rear Shelf—40"W x 43"H
One Shelf witli 1 Wide S-Boxx and four S-Boxxes I
One Shelf with 1 Wide S-Boxx and four S-Boxxes
Lift Flap(Door)with high lip shelf
All shelves are equipped with dividers and anti-rattle mats
Sortimo Poly bulkhead with window
i
TotalInstalled $4,950
Your truck equipment specialists
www.truckutilities.com
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CCC VALUESCOPE Metro Appraisals
Claim Services Market Report
Report Reference Number: 47804059 Adjuster: Michael Marth
Claim reference: 2012-00888
Loss Incident Date: 06/18/2012 Claim Reported Date: 07/25/2012
Insured: Metropolitan Council Owner: Metropolitan Council
Appraiser: LES HANSON
Introduction
Metro Appraisals Insurance has conducted an appraisal of your 2010 Ford
Transit Connect XLT Cargo 4d Van located in Minneapolis/St Paul, MN. The
appraisal information was then used to conduct research in your market to
determine the local market value of your unit. This CCC Valuescope Market
Report details the results of that search. It contains the following
sections:
Section Title: Section Contents:
-----------------
-------------- -----------------
--------------
Equipment Summary Market Value and Equipment Detail
VINguard Identification Loss Unit configuration and VIN history
Valuation Methodology Method used to evaluate the vehicle
Comparable Units Supporting market data for loss unit
Appraisal and Valuation Notes Log notes for this file
_____________________________ Equipment SummarY =____________________________
Loss Unit Specifications
Class 1
2010 Ford Transit Connect XLT Cargo
4d Van
Condition is 2: Average
Odometer 75,875
Actual Cash Value $ 16,650.00
Major Equipment
Engine Desc/Model # 4-2.01-Fi
Trans Model #/Speed at
Interior Standard
# Axles 2
# Drive Axles 1
Front Axle Rating 2,500
Rear Axle Rating 3,500
Front Wheels Al1oy
O/S Rear Wheels Alloy
Fuel Tank Type Steel
Fuel Tank Size 1/25
Loss Unit Equipment:
Valuation Request: 47804059 (Continued) 2010 FORD TRANSIT CONNECT XLT CARGO
___________________ Equipment Summary (continued) __________________
Option Description
S1 - Spring Suspension
PS - Power Steering
PB - Power Brakes
PW - Power Windows
PL - Power Locks
AM - AM Radio
FM - FM Radio
ST - Stereo
CD - CD Player
AC - Air Conditioning
TW - Tilt Wheel
CC - Cruise Control
CS - Cloth Seats
Additional Equipment