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Vang, Tou RC��;��'I�� F�s � � 2c�3 NOTICE OF CLAIM FORM to the��t�:��°,��taGnt Paul, Minnesota Minnesota State Statute 466.05 states that "...every person...who claims damages from any municipality...shall cause to be presented to the governing body of the municipality within 180 days after the alleged loss or injury is discovered a notice stating the time,place,and circumstances thereof,and the amount of compensation or other relief demanded." Please complete this form in its entirety by clearly typing or printing your answer to each question. If more space is needed,attach additional sheets. Please note that you will not be contacted by tetephone to clarify answers,so provide as much information as necessary to explain your claim,and the amount of compensation being requested. You will receive a written acknowledgement once your form is received. The process can take up to ten weeks or longer depending on the nature of your claim. This form must be signed,and both pages completed. If something does not apply,write`N/A'. SEND COMPLETED FORM AND OTHER DOCUMENTS TO: CITY CLERK, 15 WEST KELLOGG BLVD, 310 CITY HALL, SAINT PAUL, MN 55102 �� 1 First Name .�� L Middle Initial Last Name �C�+�G3 Company or Business Name �! � Are You an Insurance Company? Yes/1� To If Yes,Claim Number? N 1 � Street Address ��'�� ?/!�� C1 Yy� ��- 7 7 , City � �f r�'��'-G� �'� State I��✓� Zip Code ��!�� Daytime Phone(�)�l9'�-7��/ Cell Phone(�) 1 //--��`t-L/nvening Telephone(6S/ )�7- �b`f! Date of Accidend Injury or Date Discovered_��-5 Time �-�S � am/� 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.sT i�-� 5u.h�n:�r �1� �i,'S l fitc`vrr ht'a^cu-s�' ,�ci S f'td��lC'i��/ �ticc c �c r �c�c-1� u.� �'r, f;7 "'�Ll r1 rr�s- t�G��,jLT�,�" s��!1 G� / l.�lt S !fl%3 i`N cC �Ch:ovc-� �G� �/�'�J ��✓! TL�L !��n!/n '�C[->l 2- �%�✓C�C. ��^� �'rir e-fz�i � �S ,,�1/ .� n � c: 1 j`'G^� if�� i � le-.�1 � L 5t�c��- ti•-c�C' Y-�•.z �1C-��'' �i'�'c�S' !��' sa. �t S'i ��i '�" � i c�lSS {�-Z_ .��Cri��f ��C r'�.C— _'• t cE 5�:.,�i?..- i`/�f"il ;"�y "� �t°-d�..a- �7 tr 'iL f � Irt'c:t�' �a��-cr:.i''fPi' �3t'r7r /�, l�-cr��?,< r� �-�K.<�' "ru'� ��c, r,jf-5 � r�% /i� �`i�' � c%�t � � —� �L / r � S��Z �-!4. C Ii 't1'S Is � 1� � �?,�,�fo�� r'r �– �' �1.+4/ T'G�,U� �-C�.L ( ,'�v, L f S f l"Ccu l c / � i �:'�•: •.0 ( t �'. -i-6..c.. �Pcz.�.��r� . 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 jz�.My vehicle was damaged by a plow ❑ My vehicle was wrongfully towed and/or ticketed ❑I was injured on City property ❑ Other type of property damage—please specify ❑ Other type of injury—please specify In order to process your claim vou need to include copies of all anplicable documents. For the claims types listed below,please be sure to include the documents indicated or it will delay the handling of your claim. Documents WILL NOT be returned and become the property of the City. You are encouraged to keep a copy for yourself before submitting your claim form. � Property damage claims to a vehicle: two estimates for the repairs to your vehicle if the damage exceeds $500.00; or the actual bills and/or receipts for the repairs O Towing claims: legible copies of any ticket issued and a copy of the impound lot receipt O Other property damage claims: two repair estimates if the damage exceeds$500.00;or the actual bills and/or receipts for the repairs;detailed list of damaged items O Injury claims: medical bills,receipts O 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 Failure to complete and return both pages will result in delay in the handling of your claim. All Claims—nlease comnlete this section Were there witnesses to the incident? Yes � Unknown (circle) Provide their names, addresses and telephone numbers: � Were the police or law enforcement led? Y No Unknown (circle If yes,what department or agency? ��%�`CZ - r �� Case#or report# i 3-- ��`s�`t�-s Where did the accident or injury take place? Provide street address,cross street, intersection,name of park or facility, clo�sest landmark,etc. Please be as detailed as possible. If necessary, at�ach a diagram. �J;� �5 ?7 _.k'��2 h �' � � �'�7 h 7 �'"r- f=�-..L. �i)�.C,l�G t_ri C-z�( c� '� �c�o/�f e'� 'f"�� C�2�� .�-��C[ �� C: . Please indicate the amount you are seeking in compensation or what you would like the City to do to resolve this claim to your satisfaction. � b�t.�t w�a.t�!-� f�c��-f �� Cci � �x !� rt 1��e. c�`L� �L� G 't� ��j�GLi �v�✓ S I�w�O .T � �-c r • Vehicle Claims— lease com lete this section ❑ check box if this section does not a 1 Your Vehicle: Year �c/�� Make_%«'�1�'.*�-� Model �f� ' <:.� '" � License Plate Number �=��t`� ��DIV State�Color w'h�• Registered Owner �j�' '�` ;�t �l;� G��.n�� Driver of Vehicle %��-� f�� /_-��1� Area Damaged,�?.�,��,<<,.�,2_.- ��c�s�-�:t« fr.; i��..� / , i3��.-� r�t i rti ti� �:� �� /� k�t- City Vehicle: Year��_Make N,/��"� Model /N � License Plate Number State�Color ��c' v�<: Driver of Vehicle(City Emp oyee's Nati�e) 7��, ��-� � = `J"Tt'c.�:-� Area Damaged '(i r 1 Iniurv Claims—alease comalete this section J�check box if this section does not avnlv 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 infornzation 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 � � �� Print the Name of the Person who Completed this Form: �� t�l�c%� _ � / � Signature of Person Making the Claim: � '' L Revised February 2011 � Accident Report Page 1 of 1 IACN.G56 N0. ��q�� T 13028425 A� °a 0 Hru».aM i,srnor va.aes au� .wnm t�w �� I� ?N �E�2�� 0 �0 IV 2 11 2013 �On 1451 m �I waow�rpxECnoN 10 1527 Idaho —I�S� B w ❑�`"0f'�r °R �.� g� 8; ew°F� z < OOUMVHD MREY R�PONf 62 ,� st aul �� P +_ F�cron� rosrt� aavenuc�rur�an sr��c wma aer�nis ros�nai awotuco�s�MaeEa.t scvE wes asr�nn O� 11 O1 s3651706741108 WI O1 O1 C163092081710 NIl�T D O1 r.�cronx rw��er,�.on�usn o�hocewn� w�►��nsr.�aoc�.usn w,eaewn� r+cranx Douglas J Strain il 11 67 TOU YENG VANG O1 18 87 . ur�rt �es w�wa rtES�PoC. �oor�.s mvia �acr �rt 17 923 Geiger St I3� O1 1654 MANTON ST N� O1 O1 pryga CfIY, AtEZP G1Y,8TATE.LP PIIYBCL O1 Osceola 54020 6512926600 . ST PAUL 55106 O1 acanc soc Eavr a�eovr �nwo �cr waEV � mc c�avr e�s�r�rr �o �ct weEV ncwro O1 � M . �2 � 02 06 05 N -Y-' M �4 "'�04 04 05 N O1 � ivre � ivre ro�qm mµaraar �►euu��amvr.e aur��uoert N.ew rm[ ows Tvre ro�aw inwarom tieunwc�eEavice qu�N�em � ? � p o�i�rt rFar� 'ar O�►m � O� ocaa orin+ertwu� �+e ore+Aerw� me ocav 0# City Of St Paul Public Works B� VANG TOU YENG � p� uo�.rr �oon�as row� �oow�sa 90 891 N Dale St N� 1654 MANTON ST �' �'�° � 03 w+us� cm:smh,a vuu«, ow�cr an:ern�zP wuwo owECr vExuae 13 St Paul, NIlJ 55125 '1�i 03 SAINT PAUL NR�1 55106 `""1q 07 O1 oMOwc wu� wooa ,vw caon wu� wooa v�e ewnn o�awe 06 yel TOYT HIG 01 IVR 04 waaEV wwhr srrtEa vuar�o � �°r,�n �.n "�a' nu�h� araEO rF,�rcr�a awue�uaEwns wsTwwu oroatv O1 03 03 649edn MN 13 03 � '� � 03 �2 ns�n� roucv wr.e�n +rouwu+ce n+�.r n voucr ruweEa City Of St Paul geico 4146836368 umo waw�. w�o .�no�. .mn.,�o�. w�rvm w�zw�r eor m¢ vu� � IF ACGDENT A COMMERCIAI.YOTOR VEFIICIE,SCHOOL BUB,OR NEAD START BU8 � REMEIABER TO Tf�BTME PA7TtOL(tiqulnd und�r IAS 109.7iS�nd 1E9ASN►. ? � m►s�aaKVtneaewuaEa�.waratuwa�nr� oorra�,eEn caws�cu�w�e��-�+oraa��waEnwv,� oorra�uea nueeraea�wmru�ES ' wr oc wc me w[ �wp ai[cr w�r ro mMS�r , . 0„� �►eae� nw�trBER W . �� ' �,� w,eae� rwM� � O� � �� ue,ennce wrwM..en oQ ' O� .L ��„��„��,,,��, ��„�,�.�,��, a.J � �� : � 03 acn�eus .--_. . .....__.___._.. 9 8 03 Vehicle 1 was snow plowing in front of 1527 ............ . .....___-___..... . ........._......... . ... �,�, Idaho. Vehicle 2 was WB idaho from�Prosperity. �� ————— ——��ry �ehicl�l...was._backing. ug..EB..,Ii13ho_aild_aS,XU�k.__._.... - 98 O1 � vehicle 2. There was no injuries. There was minor an ewoc� Q -damage.;_.. .. ... ... . . . ............. ... __....._._._...�_........ Nras N' � 1 ,��,� � _. _.... � .. ,__..__ .. ... .. __.... ... _____---- .__...._ oi '� 'c �� ia,n I ---.... ... ._ .. _ . wEwnea, �a I 0 2 ............ ... .. ... .. _ _---... _.. . _.._. ------.__....----....._.__ I . .... w�w,�x: ao�sor+ � . _.. . .... .. ... .. . ... . .. ..... _..._........._.._.._._,...__.._._.... OS lario _._._. `� � I ..... _. _---_.____ no sunc ._---.. . . .�... .. . 03 I O1 __.._.__ ... .____._._.._ � i ., _... . _. _.. __ _. _ ..._....... ..._ �m cww ou�w�u 02 09 OFFICER RNM.NM1E NA B/�DOE� � AOClIGY M7R011TA710N 801TE MiROL LpCJiI � police officer Sue Drutschmann 67r St Paul PD ea p,,,� 0�„�„ sk� r�s 6�• �hr � :� ��` " � . � �.,< ... � � ,.,,, ' � � .. � ��" `° "'' � �y, � �� , � � �: ��: �� ; � ; .�en — �:�: . . _;��...,_ . , � ��" � �� "u i .;,:. f i �w.. w��^ r ��; ,� .,'. �� '2%��' I� Wi'� ��F��1. . �,'�:� �_` �ib f � � j� S ��i 4h�'°�,P�/�v�'��F" ixl A�r � �,:+= �,.::. Y-�:;' �, k . �.�'s ��?� . d�F�'��#��§ . 'Yx 1�. 2 �.; t�� ,��o _ ... �'?;" .. � ' LAMETTRY'S COLLISION - Workfile ID: 89c7dclf MAPLEWOOD Federal ID: 411393089 "Every Customer Leaves With A Smile" 2951 MAPLEWOOD DR, SAINT PAUL, MN 55109 �� Phone: (651) 766-9770 �Q FAX: (651) 766-8660 Preliminary Estimate Customer: VANG,T01'� ��,� Written By:Jason Wheeler Insured: VANG,JQM' Policy#: Claim #: Type of Loss: ,�� Date of Loss: Days to Repair: 0 Point of Impact: Owner: Inspection Location: Insurance Company: VANG,TOM LAMETTRY'S COLLISION-MAPLEWOOD CITY OF ST.PAUL 1654 MANTON ST 2951 MAPLEWOOD DR ST.PAUL, MN 55106 SAINT PAUL, MN 55109 (651)497-7641 Day Repair Facility (651)766-9770 Business VEHICLE Year: 2010 Body Style: 4D UTV VIN: JTEBK3EH7A2159084 Mileage In: 27427 Make: TOYO Engine: 6-3.5L-FI License: 649EDN Mileage Out: Model: HIGHLANDER 4X4 Producaon Date: 2/2010 State: MN Vehicle Out: Color: PEARL Int:GREY Condition: Job#: TRANSMISSION Overhead Console Stereo Cloth Seats Automatic Transmission CONVENIENCE Search/Seek 3rd Row Seat 4 Wheel Drive Air Conditioning CD Player Captain Chairs(2) POWER Rear Defogger Auxiliary Audio Connection Retractable Seats Power Steering Tilt Wheel SAFETI( WHEELS Power Brakes Cruise Control Anti-Lock Brakes(4) Aluminum/Ailoy Wheels Power Windows Telescopic Wheel Driver Air Bag PAINT Power Locks Intermittent Wipers Passenger Air Bag Three Stage Paint Power Mirrors Keyless Entry Head/Curtain Air Bags OTHER DECOR Rear Window Wiper Front Side Impact Air Bags Rear Spoiler Dual Mirrors RADIO Traction Control Privacy Glass AM Radio Stability Control Console/Storage FM Radio SEATS 2/13/2013 3:31:14 PM 053108 Page 1 ' • Preliminary Estimate Customer: VANG,TOM Vehicle: 2010 TOYO HIGHLANDER 4X4 4D UlV 6-3.5L-FI PEARL Line Oper Description Part Number Qty Extended Labor Paint Price$ i REAR BUMPER 2 0/H bumper assy Z,p 3 R&I R8cI bumper cover Incl. 4 * Rpr Bumper cover � � NOTE: Base coat reduction 5 Add for Three Stage 1.5 6 # Flex Additive 1 6.00 X __.__..._____.__�.._..._.___.____....__........__... _.._...__.___......_..___.__V___......_._.___..._._.____._.__.__.._.._..._..�__..._.__.____..__.._._.____.._._.___..___.____._V____��.___.__.._______—_. �.__. 7 REAR LAMPS 8 Repl RT Combo lamp assy Base, 815500E050 1 215.12 1.2 Limited _..._ __... . .. ....... .. . ..... . .. .........._. ....... .......... 9 QUARTER PANEL 10 * Rpr RT Quarter panel $sQ 2.4 il Add for Three Stage 1.7 12 R&I RT Wheelhouse liner 0.3 13 # Refn Corrosion Protection 0.3 14 # Rpr Glass Precision Mask(Rope)Qtr 0.5 glass } 15 T REAR DOOR � 16 Bind RT Outer panei (HSS) 1.4 17 R&I RT Belt molding 0.3 18 R&I RT Fxed glass Toyota 0.5 19 R&I RT Handle,outside w/o Limited 0.3 beige 20 R&I RT R&I trim panel ' 0.5 ..__,_�..._.._____._.______._.------------.____..�___.__. _ ___�___. ___________.____._�__._.____...________._..__._._______._._..__...___-------�_�__._.__._____._---.- 21 ROOF 22 R&I RT Side rail Base 0.4 23 # Refn Blenr RT Roof rail 0.6 24 # Refn Car Cover 0.2 25 # Subl Hazardous Waste Disposal Fee 1 5.00 X SUBTOTALS 226.12 15.0 10.3 2/13/2013 3:31:14 PM 053108 Page 2 ' ' Preliminary Estimate Customer: VANG,TOM Vehicle: 2010 TOYO HIGHLANDER 4X4 4D UTV 6-3.5L-FI PEARL ESTIMATE TOTALS Category Basis Rate Cost$ Parts 215.12 Body Labor 15.0 hrs @ $56.00/hr 840.00 Paint Labor 10.3 hrs @ $56.00/hr 576.80 Paint Supplies 103 hrs @ $38.00/hr 391.40 Body Supplies 12.7 hrs @ $2.00/hr 25.40 Miscellaneous 11.00 Subtotal 2,059.72 Sales Tax $215.12 @ 7.1250% 15.33 Grand Total 2,075.05 Deductible 0.00 CUSTOMER PAY 0.00 INSURANCE PAY 2,075.05 THIS REPORT IS AND ESTIMATE ONLY, BASED ON OUR INITlAL INSPECTION AND DOES NOT COVER ADDITlONAL PARTS OR LABOR WHICH MAY BE REQUIRED AFTER THE WORK IS OPENED UP. PART PRICES SUBJECT TO CHANGE PER THE MANUFACTURER AND AVAILABILiTY. WARRANTY: LIFEi"IME AGAINST DEFECTS IN WORKMANSIHIP. WARRANTY REPAIRS DONE BY LAMETTRY'S COLLISION ONLY. NO WARRANTY ON RUST, CORROSION RESISTANCE OR REPLACEMENT RENTAL CARS. OUR ESTIMATED COMPLETION TIME DOES NOT INCLUDE INSURANCE OR PARTS DELAYS THAT WE MAY DCPERIENCE. 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. 2/13/2013 3:31:14 PM 053108 Page 3 ' ' Preliminary Estimate Customer: VANG,TOM Vehicle: 2010 TOYO HIGHLANDER 4X4 4D UN 6-3.5L-FI PEARL Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted ali items are derived from the Guide ARM8438, CCC Data Date 12/14/2012, 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. Used parts are described as LKQ, RCY, or USED. Reconditioned parts are described as Recond. Recored parts are described as Recore. NAGS Part Numbers and Benchmark Prices are provided by National Auto Glass 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 CCC ONE estimator has a complete list of applicable vehicles. Parts numbers and prices should be confirmed with the local dealership. The following is a list of additional abbreviations or symbols that may be used to describe work to be done or parts to be repaired or replaced: ' 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. Algn.=Align. ALU=Aluminum. A/M=Aftermarket part. BInd=6lend. BOR=Boron steel. CAPA=Certified Automotive Parts Association. 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. Refn=Refinish. Repl=Replace. R&I=Remove and Install. R&R=Remove and Replace. Rpr=Repair. RT=Right. SAS=Sandwiched Steel. Sect=Section. Subl=Sublet. UHS=UItra High Strength Steel. N=Note(s) associated with the estimate line. CCC ONE Estimating - A product of CCC Information Services Inc. The following is a list of abbreviations that may be used in CCC ONE Estimating 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. 2/13/2013 3:31:14 PM 053108 Page 4 ' HEPPNER'S AUTO BODY Worldle ID: fdea4c24 �P�� 395 E. 7TH ST., SAINT PAUL, MN 55101 r Phone: (651) 224-5644 FAX: (651) 224-6042 Preliminary Estimate Customer: VANG,TOU 7ob Number: Written By:Alex Claudon Insured: VANG,TOU Policy#: Claim#: Type of Loss: Date of Loss: Days to Repair: 0 Point of Impact: 05 Right Rear Owner: Inspection Location: Insurance Company: VANG,TOU HEPPNER'S AUTO BODY CIfY OF SAINT PAUL 1654 MANTON ST. 395 E.7TH ST. ST PAUL,MN 55106 SAINT PAUL,MN 55101 (651)497-7641 Cell Repair Facility (651)5543409 Business (651)2245644 Business VEHICLE Year: 2010 Body Style: 4D UTV � VIN: JTEBK3EH7A2159084 MileageIn: 27420 Make: TOYO Engine: 6-3.5L-FI License: 649EDN Mileage Out: Model: HIGHLANDER 4X4 Production Date: 2/2010 State: MN Vehicle Out: Color: WHII'E Int: Condifion: Job#: i TRANSMISSION Overhead Console Stereo Cloth Seats , Automatic Transmission CONVENIENCE Search/Seek 3rd Row Seat 4 Wheel Drive Air Conditioning CD Player Captain Chairs(2) POWER Rear Defogger Auxiliary Audio Connection Retractable Seats Power Steering Tilt Wheel SAFETY WHEELS ; Power Brakes Cruise Control Mti-Lock Brakes(4) Aluminum/Alloy Wheels � Power Windows Telescopic Wheei Driver Air Bag PAINT Power Locks Intermittent Wipers Passenger Air Bag Clear Coat Paint Power Mirrors Keyless Entry Head/Curtain Air Bags OTHER DECOR Rear Window Wiper Front Side Impad Air Bags Rear Spoiler Dual Mirrors RADIO Traction Controi Privacy Glass AM Radio Stability Control Console/Storage FM Radio SEATS 2/13/2013 2:47:32 PM 070412 Page 1 Preliminary Estimate Customer: VANG,TOU 7ob Number: Vehicle:2030 TOYO HIGHLANDER 4X4 4D U7V 6-3.5L-FI WHIT'E Line Oper Description Part Number Qty Extended Labor Paint Price; 1 REAR BUMPER Z * Rpr Bumper cover �Q 2 6 3 Add for Clear Coat 1.0 � 4 0/H bumper assy Z� 5 REAR LAMPS 6 ** Repl RECOND RT Combo lamp assy 8155148160 1 136.00 1.2 Base,Limited 7 QUARTER PANEL 8 * Rpr LT Quarter panel §�Q 2 4 9 Add for Clear Coat 1.0 10 # Rpr BODY PULL 1.0 11 # Refi PARTIAL PAINT -0.3 12 # Refn CLEAR BLND UPPER ROOF RAIL 0.5 13 # Subl R&I QTR CLASS 1 90.00 X 14 # Repl 'Glass-Installation Kit 1 30.00 15 # 'Glass-Rope Windshield 1 0.5 16 ROOF 17 R&I LT Side rail Base 0.4 18 # Repl 'Corrosion Protection 1 0.3 19 # 'Cover Vehicie 1 0.2 20 # Repl 'Flex Additive 1 5.00 21 # 'Hazardous Waste Disposal Fee 1 5.00 SWBTOTALS 266.00 13.1 7J ' ESTIMATE TOTALS ��9orN Basis Rate Cost� Pa� 176.00 Body Labor 13.1 hrs @ $52.00/hr 681.20 � Paint Labor 7.7 hrs @ $52.00/hr 400.40 ! Paint Supplies 7.7 hrs @ $32.00/hr 246.40 � Body Supplies 10.2 hrs @ $2.00/hr 20.40 Misceilaneous 90.00 Subtotal 1,614.40 Sales Tax $176.00 @ 7.6250% 13.42 Grand Total 1,627.82 Deductible 0.00 CUSTOMER PAY 0.00 INSURANCE PAY 1,627.82 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. 2/13/2013 2:47:32 PM 070412 Page 2 Preliminary Estimate Customer: VANG,TOU Job Number: Vehicle: 2010 TOYO HIGHLANDER 4X4 4D UTV 6-3.5L-FI WHIfE Estimate based on MOTOR CRASH ESTIMATING GUIDE. Uniess otherwise noted ail items are derived from the Guide ARM8438, CCC Data Date 2/8/2013, and the parts selected are OEM-parts manufactured by the vehicles Original Equipment Manufacturer. OEM parts are available at OE/Vehicle dealerships. OPT OEM (Optionai 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 (N) 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. Used parts are described as LKQ, RCY, or USED. Reconditioned parts are described as Recond. Recored parts are described as Recore. NAGS Part Numbers and Benchmark Prices are provided by National Auto Glass 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 CCC ONE estimator has a complete list of applicable vehicles. Parts numbers and prices should be confirmed with the local dealership. The following is a list of additional abbreviations or symbors 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 rnmponent. T=Miscellaneous Taxed charge category. X=Miscellaneous Non Taxed charge category. SYMBOLS FOLLOWING LABOR: II D=Diagnostic labor category. E=Electrical labor categoryl 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. Algn.=Align. ALU=Aluminum. A/M=Aftermarket part. BInd=Blend. BOR=Boron steel. CAPA=Certified Automotive Parts Association. 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. Refn=Refinish. Repl=Replace. R&I=Remove and Install. R&R=Remove and Replace. Rpr=Repair. RT=Right. SAS=Sandwiched Steel. Sect=Section. Subl=Sublet. UHS=UItra High Strength Steel. N=Note(s) associated with the estimate line. CCC ONE Estimating -A product of CCC Information Services Inc. The following is a list of abbreviations that may be used in CCC ONE Estimating 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. 2/13/2013 2:47:32 PM 070412 Page 3 � Preliminary Estimate Customer: VANG,TOU 7ob Number: Vehicle:2010 TOYO HIGHLANDER 4X4 4D UTV 6-3.5L-FI WHI'fE ALTERNATE PARTS SUPPLIERS Supplier: Keystone-Complete-Dubuque Location(s): 2400 KERPER BLVD, DUBUQUE IA 52001 (800)747-2500 (563)556-5030 3017 A HOOVER AVENUE,STEVENS POINT WI 54481 (800)218-4848 (715)342-0772 2700 29TH AVENUE N,ESCANABA MI 49829 (800)833-2030 (906)789-2200 3615 MARSHALL STREET NE,MINNEAPOLIS MN 55418 (800)328-1845 (612)789-1919 5969 HAASE ROAD,DEFOREST WI 53532 (800)356-7252 (608)249-4775 5085 WREN DRIVE,APPLETON WI 54913 (800)422-1995 (920)731-3030 Line Description Item# Price 6 RECOND RT Combo lamp assy Base,Limited T02801173R $ 136.00 2/13/2013 2:47:32 PM 070412 Page 4