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Jablonic '�4:4.�'Y:;4 t+`f'.;..'��,% Ot,l I 2 2012 NOTICE OF CLAIM FORM to the City of Saint Pa�it; �i�riesota Minnesata State Stahtte 466.05 states that"...every persnn...who claims damages from any murticipality...shall cause to be presented to the governing body of the municipality within 180 days after the alleged loss or injury is discovered a norice stating the time,place,and circumstances thereof,and the amount of compensatiors 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 wiil receive a written aclmowledgement once your form is received. The process can take up to ten weeks or longer depending on the nature of your claim. This form must be signed,and both pages completed. If sometlung 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 �✓ ��`1�'1 Middle Initial�Last Name �J ��'J 1��G' Company or Business Name Are You an Insurance Company? Yes�ff Yes,Claim Number? Street Address ��4� H-aw tt�o�r�f�� E � City c.>�: �C�-�-1 State M� Zip Code��C� Daytime Phone�)�7t°-��ell Phone��)3��Evening Telephone�'�)�7(c �'�� Date of Accidend Injury or Date Discovered q�2"'� � 2 Time� ` � am/pm :. Please state,in detail,what occurred(happened),and why you are submitting a claim.Please indicate why or how you feel the City of Saint Paul or its employees are involved and/or responsible for your damages. �''1 S�'a •�-V�'►.V,�°(' �� 2a 'L G.t ar�n�urr�i q � o Yr. c� v�� w►v�l. ��-fi-� . f�s �re5��it c� �t �,tE- V�.TE- d l+Yv�� • bCs�.�i,e�t�r��. I�.car-k-l�-�f` ir�.c�,-�-�i"75 t�� -�k.�.- Fo«.tt- �k� C�-�c�-,��t f�ll c�.�"d55 t-� St-v�e'�f-- cLmc�ar,��1 c�('�Y'F��Jeh�c-lie5 . Ml�.,�J 11�h l'✓lP✓ VuI+J OY� � CB�Y'r� C-fl.L✓1'1r'1� b`�!'{'"�Pi -�-lte�/1 �irY1Vj: � G11'Y1 �J'G��K.��IG'1•t 1�'O(7, OV ��'1 r�e��rn�-�.w-Ym�v�-��.��t��►�{-��b�7 •#��av.•��SC�u.tS�� t� m.i •r"�in��l�_ �� -{-�-,,�'- -rrP�� "i�� f�-� i�c.dvbC-Pv'� rr�,r-tc�cA f�ar� irc.rr�c-i l C•� �g w�c� c-r�ca�^v�.��ror'al (cc��ti�� r�s�tln s � ��1- ct b r�Ke.in �k�t� ov-, ar, v-��P r t�rn�..�a r�1 c��'•o r�:fi�i 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 damaged by a plow ❑My vehicle was wrongfully towed and/or ticketed ❑I was in'ured on City property ,�Other type of property damage-please specify Vc°b��`G l� C��'�+'�u' - LJ� l� C1 d7� ��i ❑Other rype of injury-please specify In order to process your claim�ou need to include couies of all au�licable documents. For the claims types listed below,please be sure to include the documents indicated or it will delay the handling of your claim. Documents WII.L NOT be returned and become the property of the City. You are encouraged to keep a copy for yourself before submitting your claim form. •Property damage claims to a vehicle: two estimates for[he 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$500.00;or the actual bills and/or receipts for the repairs;detailed list of damaged items O Injury claims: medical bills,receipts •Photographs are always welcome to document and support your claim but will not be returned. Page 1 of 2-Please complete and return both pages of Claim Form � +�,� -i-r�.�r.t-z w��e,r-� m�s1-�r�n�r,�.5 w�-r-� gv�r�ww� c�.v,��,P IdvY- c�v-c��i6ts W e�'c� v r S► �v►+�=� � ��.{ -�-�.� Ca{-y � S�►+n�}- �'�,i.�.l i S ��- � 1��e�,us� �t-i� show��. ��c'Y,�+ Ir>� f-�r rvwJ olau,n--�c� Y � r��1�G�;.oy��, 1 v� r�pi- '(�troV i�/�^' '�'� C,lca�rlv� Cxr� �"�,C��Yt�1�S -h^P.�- ir� c%� i'►VV,�I,n �, J .! �'�P''Y�w�is�-�l J �� . Failure to complete and return both pages will result in delay in the handling of your claim. All Claims-please comvlete this section Were there witnesses to the incident? es No Unlrnown (circle) Provide their names,addresses and telephone numbers: �.J��GIVJ��i�' ��' HG�'t��DY"�� f�i--�-��-- t��5 C�hr i 5�k-1 O l vz �t -ttc�.�-��-�o� ��.�. [� �-�7 -Z l CJ l S+�Q h0�+'�i� M�v►� ' �^� `�l l�ie "v�l�c� -. G �t -��°-°5 21'7 Were the police or law enforcement called? Ye No Unlrnown (circle) If yes,what department or agency? O<<C-� (,.�, �iG Case#or report# Where did the accident or injury take place? Provide street address�,�cr�os�t r e�t,intersection,name of park or facility, c l o s e s t l an d m a r k,e t c. P l e a s e b e a s d e t a i l e d as o s s i b l e. I f n e c e s s a ry,a t t a c h a d i a g r a m.TrG-�°��l'� I�l�i�iU'�W� ot�- �'1�5�N-o�-t-l�.o�'v.��v� . •f�t l ac-ras5 �.��t-ra�- �.�,P c�w�;.r�u-� Z c��s • Tt-v��s rw.�. �` 3$" -t� 4� r c��:� v�� a-t ��.�t- � r�lt �5. Please indicate the amount you aze seeking in compensation or what you would like the City to do to resolve this claun to your satisfaction. �-+�� t�� C�+'V'��-��t'��r`�j�e� •-�- r� i v� � �/�b•,L ��t�v�nc,tt -}�o-t r�,l r��E1i r c-�S-� � t 2 5 ��' Vehicle Claims- lease com lete this section �check box if this section does not a 1 Your Ve}ucle: Year �v Make Model Sj�1�n0. License Plate Numbe �G State��Color `J(l tJ�P� Registered Owner�L'In�n / �Yw� �TG�h 1 o V"� Driver of Vehicle AreaDamaged �'JrG-IG Vv� ow F �,�-�.�� C,t,vt. �''vl� ��ivY��'1�'-C-� City Vehicle: Yeaz Make Model License Plate Number State Color Driver of Vehicle(City Employee's Natne) Area Damaged Injurv Qaims please comulete this section ❑check box if this section does not apply How were you injured? What part(s)of your body were injured? Have you sought medical treatment? Yes No Planning to Seek Treatment(circle) When did you receive treatment? (provide date(s)) Name of Medical Provider{s): Address Telephone Did you miss work as a result 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 additional pages By signing this form,you are stating that all information you have provided is true and correct to the best of your knowledge. Unsigned forms will not be processed. Submitting a false claim can result in prosecution. Date form was completed ��/ I 'U� �� Print the Name of the Person who Com leted this Form: ��('1��.J ��CJ Signature of Person Making the Claim: � 2�� Revised February 2011 09/25/2012 at 06: 46 PM File ID: 38129 73686 INDEPENDENT APPRAISAL SERVICES Serving The Greater Twin Cities Area E-Mail IASKROLL@Gmai1.COM 18660 Hiqhland Avenue Wayzata, MN 55391-3132 (952) 473-0886 Fax: (952) 475-6589 Written By: Kristopher Krol1 For: AUTO OWNERS INSURANCE - Minneapolis Branch (651) 777-8172 Fax: (651) 777-2849 Adjuster: Jon Weber (651} 777-8180x4206 � PRELIMINARY ESTIMATE Insured: John Jablonic Claim #67-3331-12 O�vner• John Jablonic Policy #48-300555-02 Address: 978 Hawthorne Avenue E Date of Loss: 09/21/2012 Saint Paul, MN 55106 Type of Loss: Comprehensive Day• (608) 240-0623 Point of Impact: 6. Rear Inspect Walser Toyota/Scion Business: (952) 888-5581 Location: 4401 American Blvd West REPAIR SHOP Bloomington, MN 55437 Repair WALSER COZLISION & GLASS - BLOOM Business: (952) 8$4-8884 Facility: 9001 Grand Avenue S Days to Repair Bloomington, MN 55420 License # 411985229 2006 TOYO SIENNA 4X2 LE 6-3.3Z-FI 4D VAN Silver Int:Grey VIN: STDZA23C36S404664 Lic: TCY 572 MN Prod Date: 10/2005 Odometer: 102725 Air Conditioning Rear Defogger Tilt Wheel Cruise Control Telescopic Wheel Intermittent Wipers Keyless Entry Dual Air Condition Rear Window Wiper Steering Wheel Controls Body Side Moldings Dual Mirrors Privacy Glass Console/Storage Overhead Console Luggage/Roof Rack Clear Coat Paint Power Steering Power Brakes Power Windows Power Locks Power Mirrors Heated Mirrors AM Radio FM Radio Stereo Search/Seek CD Changer/Stacker Auxiliary Audio Connectio Anti-Lock Brakes (4) Driver Air Bag Passenger Air Bag Head/Curtain Air Bags Front Side Impact Air Bag Cloth Seats Bucket Seats 3rd Row Seat Retractable Seats Automatic Transmission Overdrive Full Wheel Covers NO OP DESCRIPTION QTY EXT. PRICE LABOR PAINT ------------------------------------ 1 REAR LAMPS 2 R&I RT Combo lamp assy 0.3 3 R&I LT Combo lamp assy 0.3 4 R&I RT License lamp 0. 3 5 R&I LT License lamp 0.3 6 R&I High mount lamp w/o spoiler 0.3 1 09/25/2012 at 06:46 PM File ID: 38129 73686 PRELIMINARY ESTIMATE 2006 TOYO SIENNA 4X2 LE 6-3.3L-FI 4D VAN Silver Int:Grey ------------------------------------------------------------------------------- N0. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT ------------------------------------------------------------------------------- '7 LIFT GATE 8* Repl LKQ lift gate - LKQ Smart 1 1206.25 1.7 3. 3 #3515920 +250 9 Add for Clear Coat 1 .3 10 R&I Glass Toyota w/privacy � 2-2 11 Repl Emblem 1 27 .07 0..2 12 Repl Nameplate "TOYOTA" 1 25.83 0.2 13 Repl Nameplate "SIENNA" 1 34 .51 0.2 14 Repl Nameplate "LE" 1 25.86 0.2 15* R&I Molding assy w/o monitor 0.3 silver mica 16 Refn Molding assy w/o monitor 0. 9 silver mica 1� Add for Clear Coat 0. 1 18 R&I Lock assy 0 .4 19 R&I Wiper arm 0'2 2p Repl Wiper blade 1 15.11 0. 1 21* R&I Motor & bracket m 0.'7 22 R&I Nozzle 0.2 23 Repl Window trim center, w/o power 1 79.13 0.2 rear seat stone 24 R&I RT Window trim side, wlo 0.2 power door stone 25 R&I LT Window trim side, w/o �•2 power door stone 26 R&I Lift qate trim stone 0.3 2� ROOF 28* Subl Roof panel w/roof rack - PDR 1 175.00 X 2g* Repl RT End cover rear 1 44 .31 0.2 30 R&I Headliner CE, LE w/o garage 2•6 door opener ivory 31# Rpr Buff Roof Panel 1. 0 32 MISCELLANEOUS OPERATIONS 33# Rpr Interior Glass Clean Up 1.0 34 Repl Cover car/bag 1 0.2 35# Refn Corrosion Protection 0.3 36# Hazardous Waste Disposal 1 3.00 X Subtotals --> 1636.07 14 .0 5.4 ----------------------------------- Estimate Notes: IINRELATED DAMAGE TO RIGHT FRONT FENDER, SCRATCH ON RIGHT DOOR UPPER EDGE, REAR BUMPER COVER & WEAR & TEAR SCRATCHES ON REAR TRIM PANEL 2 09/25/2012 at 06: 46 PM _ File ID: 38129 73686 1— PRELIMINARY ESTZMATE 2006 TOYO SIENNA E 6-3.3L-FI 4 i ver Int:Grey Parts 1458 .07 Body Labor 14 .0 hrs @ $ 52.00 /hr 728 .00 Paint Labor 5.4 hrs @ $ 52.00 /hr 280.80 Paint Supplies 5.4 hrs @ $ 32.00 /hr 172 .80 Sublet/Misc. 178.00 ---------------------------------------------------- SUBTOTAL $ 2817 . 67 Sales Tax � $ 1458.07 @ 7.2750 % 106.07 ---------------------------------------.------------- TOTAL COST OF REPAIRS $ 2923.74 �.� ^_�� ADJUSTMENTS: Deductible 1000.00 TOTAL ADJUSTMENTS $ 1000.00 NET COST OF REPAIRS $ 1923.74 c�X�� T � � lJ�,�t:(�� '�, �� -,ss � *****************THIS IS NOT AN AUTHORIZATION TO REPAIR**************** ******************ALL SUPPLEMENTS REQIIIRE PRIOR APPROVAL*************** THIS PROPERTY DAMAGE APPRAISAL MUST BE PRESENTED TO YOUR CHOSEN REPAIR FACILITY PRIOR TO THE COMMENCEMENT OF ANY REPAIRS. IN THE EVENT THEY NEED TO CONTACT US, ALL PERTINENT CLAIM INFORMATION IS AVAILABLE TO THEM ON THIS FORM. IF ANY ADDITIONAL CHARGES FOR REPAIRS DO ARISE AND IT HAS BEEN DETERMINED THAT THIS APPRAISAL HAS NOT BEEN PROVIDED TO THE REPAIR FACILITY, SAID CHARGES MAY BE DECLINED AND COULD BECOME YOUR RESPONSIBILITY. LABOR RATES ON THIS APPRAISAL ARE BASED IIPON THE CURRENT PREVAILING COMPETITIVE BODY SHOP RATES ZN THE TWIN CITY AREA AND ARE ESTABLISHED BY THE COLLISION REPAIR INDUSTRY. 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 09/25/2012 at 06:46 PM File ID: 38129 73686 PRELIMINARY ESTIMATE 2006 TOYO SIENNA 4X2 LE 6-3.3L-FI 4D VAN Silver Int:Grey Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from the Guide ARM8530, CCC Data Date 09/10/2012, 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 ReplacemenL 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 cateqory. 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. 0/H=Overhaul. Qty=Quantity. Qual Recy=Quality Recycled (part) . Qual Repl=Quality Replacement(part) . Refn=Refinish. Repl=Replace. RsI=Remove and Install. RSR=Remove and Replace. Rpr=Repair. RT=Right. SAS=Sandwiched Steel. Sect=Section. Subl=Sublet. IIHS=Ultra High Strength Steel. N=Note(s) associated with the estimate line. 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 ESTIMATING GUIDE: BAR=Bureau of Automotive Repair. EPA=Environmental Protection Agency. NHTSA=National Highway Transportation and Safety Administration. PDR=Paintless Dent Repair. VIN=Vehicle Identification Number. 4 � � WALSER COLLISION & GLASS — WoricfilC ID: rn��sb BLOOMINGTON �deral ID: 753141113 9001 GRAND AVENUE S., BLOOMINGTON, MN 55420 Phone: (952) 884-8884 FAX: (952) 884-8898 Preliminary Supplement i with Summary RO Number: 29902 Written By: Duane Houle Adjuster:AUTO OWNERS,(651)777-8180 x4206 Business Insured: JABLONIC,JOHN Policy#: qaim#: 67-3331-2012 Type of Loss: Date of Loss: Days to Repair: 0 � Pant of Impact: Owner: Inspectlon Location: Insurance Company: JABLONIC,]OHN WALSER COLLISION&GLASS- AUTO OWNERS INSURANCE BLOOMINGTON 978 HAWTHORNE AVE E 9001 GRAND AVENUE S. ST PAUL,MN 55106 BLOOMING'fON, MN 55420 (651)338-4341 Cellular Repair Faality (651)776-8635 Other (952)884-8884 Business VEHICLE Year: 2006 Body Style: 4D VAN VIN: STDZA23q6S404664 Mileage In: 102725 Make: TOYO Engine: 6-3.3L-FI License: TCY572 Mileage Out: Model: SIENNA 4X2 LE Production Date: State: MN Vehicle Out: Cdor: SILVER Int: Condition: Job#: TRANSMISSION Privacy Glass Steering Wheel Controls Front Side Impact Air Bags AutomaGc Transmission Console/Storage RADIO ROOF Overdrive Overhead Console AM Radio Luggage/Roof Rack POWER CONVENIENCE FM Radio SEATS Power Steering Air Conditioning Stereo qoth Seats Power Brakes Rear Defogger Search/Seek eudcet Seats Power Windows Tilt Wheel CD Changer/Stadcer 3rd Row Seat Power locks Cruise Control A�ndliary Audio Connection Retractable Seats Power Mirrors Telescopic Wheel SAFETY WHEELS Neated Mirrors Intermittent Wipers Mtl-Lock&akes(4) Full Wheel Covers DECOR Keyless Entry Driver Air Bag PAINT Body Side Moldings Dual Air Condition Passenger Air Bag pear Coat Paint Duai Mirrors Rear Window Wiper Head/Curtain Air Bags SO/5/2012 2:55:37 PM 072704 Page i � Preliminary Supplement 1 with Summary RO Number: 29902 Vehide:2006 TOYO SIENNA 4X2 LE 4D VAN 6-3.3L-FI SILVER Une Oper DescNption Part Number Qty Exbended Labor Paint Price� 1 REAR LAMPS 2 R&I RT Combo lamp assy Incl. 3 S01 Repl LT Combo lamp assy 81680AE020 1 113.90 Incl. 4 R&I RT License lamp Ind. 5 R8d LT license lamp Incl. 6 R&I High mount lamp w/o spoiler • Ind. 7 LIFT GATE 8 * SOl Repl i� aat jNew gate installed 67005AE090 1 839.67 5.0 3.3 over used) 9 SO3 Add for Clear Coat 1.3 10 SOl Add for trnsf�'9�a� �'� il # SO1 12 * S01 Repl ,IC a�T4y��lRrivacv (NAGS1 68105AE020 1 29�,�� I�d• 13 # S01 Repl LIFfGATE 6U1SS INSTALL.KIT 1 20.00 14 # SO1 15 Repi Emblem 7544108010 1 27.07 0.2 16 Repl Nameplate'TOYOTA" 7544408020 1 25.83 0.2 17 Repl Nameplate"SIENNA" 7544208020 1 34.51 0.2 lg Repl Nameplate"LE" 7544308020 1 25.86 0.2 19 * R&I Molding assy w/o monitor silver . � mica 20 Refn Molding assy w/o monitor silver 0.4 mica 21 Add for Clear Coat 0.1 22 R&I Lock assy Incl. 23 501 Repl Wiperarm 8524120170 1 42.61 0.2 24 Repl Wiper blade 8521213031 1 15.11 Q.1 25 * R&I Motor&bracket m � 26 R&I Nozzle 0.2 27 Repl Window trim center,w/o power 67939AE01060 1 79.13 Ind. rear seat stone 2g R&I RT Window trim side,w/o power Incl. door stone 29 R&I LT Window trim side,w/o power I�• doorstone 3p R&I Lift gate trim stone Ind. open * 501 Repl Wiper arm cap NOT USED 1 2�l24 32 ROOF 33 * S01 Subl Roof p��l w/roaf rack-(PDR 1 4�,QQ X AI�tlPD 34 * 501 Rpr Roof panel w/roof rack � � 35 SOl Overlap Major Adj. Panei -0.4 36 S01 Add for Clear Coat 0.5 37 S01 R&I RT Drip molding 0.5 lOJS/2012 2:55:37 PM 072704 Page 2 � Preliminary Suppiement 1 with Summary RO Number: 29902 Vehide: 2006 TOYO SIENNA 4X2 LE 4D VAN 6-3.3L-FI SILVER 38 * Repl RT End cover rear 63493AE010 1 44.31 Q,� 39 * S01 R&I Ligadiiner -LOOSEN TO ACCESS L.Q ROOF DAMAGE 40 # GLASS CLEAN-UP 1 1.0 41 # COVER CAR COMPLETE 1 0.2 42 # Refn CORROSION PROTECTION 0.3 43 # Subl HAZARDOUS WASTE REMOVAL 1 3.00 X 44 SOl R&I LT Drip molding 0.5 45 S01 R&I RT Side rail � 0.5 46 S01 R&I LT Side rail • 0.5 47 SOl R&I Center support 48 S01 R&I Center support SUBTOTALS 1,567.35 14.1 8.5 NOTES Estimate Notes: 10-3 @ 2:16PM: SUPP.OK PER INS.APPR. KRIS KROLL,FORWARD FINAL WHEN REPAIRS ARE DONE. DUANE Prior Damage Notes: HAIL-ROOF,MARS VARIOUS PANELS. DH ESTIMATE TOTALS Category Basis. Rate Cost; Pa� 1,519.35 Body Labor 14.1 hrs @ $52.00/hr 733.20 Paint Labor 8.5 hrs @ $52.00/hr 442.00 Paint Supplies 8.5 hrs @ $32.00/hr 272.00 Miscelianeous 48.00 Subtotal 3,014.55 Sales Tax $1,519.35 @ 7.2750% 110.53 Grand Total 3,125.08 10/5/2012 2:55:37 PM 072704 Page 3 / �� r II� , - ► • .J j .,, � '" • . a+�71� J � lJ(�� - `"�C��J��V V V� `�� '�� i; . aY a, ` � � _ �,�- ' � . � � � � r .' 1 / � � , 1 � � � ,r�,i,,�U�„�.C. �,��nn�,- f �I'I'i ,� r �_ 9 *r , �A� � � � � � - � s s�A*A�� 1 � ��' - . • r� ��,�� c�� w : j . . i � , � � �e.� - �� 1 - a , . � �� . , �,� ,�� ,. ' �, .. . r , . '��, .�, ,.. . , � .t , , . �- •`� 'r t�'� �� - ' '� �' ?c�! ; �i ��ir' ��r'�'Y E..' r�a� ~t�'� .'r{� . •1� ,K .r � {Y .` ,.` .a.al..� !' - _ � .r.- ,- �� . S c� C:�.Q/�/v`'_ � r �. y � r v �c r .► � -�. � - �� . �. _ -�� .. >et-i. �.a_.,I.� � , � =„�^__. `. . � I �a�l �� . � .. �i. . . -. . . .,._' -�-+�,.. -..�� ,} ? � _ ,+,_".....-- � .",, — . ' - ��"'c�Lv�-e.��w-�.- 4. - � II �� . -�� `` �� ' ,� � � �•� �� a� a}'b , 4."4.• ; � � 1 � � � � � � � �C"��`'ti G�C'�,-"�^i`�., �__�G'��1,C�Y�-'t G� G'��4� i�l/1