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Warren (3) .. . ... ....... .... ..... ..... ....... . ... .... .. .. � . .. .. � ( THOMAS GEORGE ASSOCIATES, LTD II TGA � Insurance Recovery Division � Post Office Box 30 i East Northport NY 11731 0030 (631) 261-8800 April 8 , 2013 CITY OF ST. PAUL 310 CITY HALL 15 KELLOGG BLVD WEST SAINT PAUL, NIl�T 55102-0000 Attention: CITY CLERK OUR CLIENT: LIBERTY MUTUAL GROUP "4" OUR INSURED: WARREN, JAMES CLIENTS CLAIM#: 023900160 OUR CASE #: 610204-21 AMT OF DAMAGES: $5, 6$5.27 YOUR INSURED: OFFICER: TIMOTHY C. FILIOWICH YOUR CLAIM#: PLEASE SET UP YOUR POLICY#: DATE OF LOSS: 08/30/12 Please be advised that we are the recovery agents for the above referenced client and are aiding them in their subrogation rights as result of the above captioned lo�s. The information obtained through our investigation places the liability on your insured for the damages incurred by our client' s insured. Please notify this writer as to the alaim number and individual handling this claim. When processing this claim, make your aheck payable to our client, and mail it to the address listed above, and kindly reference our case number on all correspondence. If any additional information is needed, please feel free to contact me at the above number. Very truly yours, Will Umana � AME0.1GnN C044iCTOAS p�� •J10(11f10M 11�[�jt/ �� , � NOTICE UF CLAIM FORM to the City of Saint Paul, Minnesota i ;t/iii�rrsr�la Slurr.Sl�NWe--lb/i.O_�.�7ult•.r rlrn! "...rt�r�.r per.sun...irh�,clnim.s dmua,Se•s�rnnt tiii�•nuuxic'ipulilr....sltul!cuus�•1u bc�prc�.eenlcd!n llle ' ,r�r<•r��in,t h��r/} r�/lhe�inu��ici/�ulitr wilhin !8U d��•.s u%lc�r Ihc•ri!/<',S��d lu.+'.s ur i�{jtri�•i.f dl.scr�rert•d n nuiice.�7iilin,,7he li�ne•,/�luCe,Ulr�l crrcu�nsYrmcr.s N�eve��/.rrnd iftn auiauN uf c��m/�en.calirm nr ulhcv relin/'e/euiandrd.•, Yicase co�npletc this form in its entirety by ciearly typing ur printin�your answer to euch yuestion. lf more space is necdcd,attach additic�nal sheets. 1'lease note that}�ou��i►1 not be rontacte�l by telephone to cl�rify answers,so provide as ruucl�information as necessary to explain your cluim,and the amount of co�upensation being rcyuestcd. You�vill receive a written ackno�vledgement once your ti�rm is received. The process c1n take up to ten weeks or longer depending on the nature of your claim. 'Chis form must be signed,and both pn�es completed. If san►ething does not��pply,write`N/A'. SEND COIVIPLETED FURM AND 4THER DOCUIVIENTS TO: CITY CLERK, 15 WEST KELLOGG BLVD, 31U CITY HALL, SAINT PAUL, MN 55102 First Name _J a m e s_ _ ___ Nliddle lnitial R • Last Name Wa r r e n CorupanyorBusinessName Thomas George Associates Are You an Insurance Company'? Ye� /No If Yes, Claim Number? 610 2 04 StrcctAcidress 10 Larkfield Rd . Ci�Y ___E.a_S_t......_N_or_th._P._.°..._r._t..._.....___. _ State __NY _Zip Code _1 1731 Daytime Phone �631 � 261_-8800Ce11 Phone ( ) - EvenincTelephone ( ) - Uate of'Acrident/Injury or Date Discovere� Au g . 30 , 2012 'I'yt�� 10 : 10 ,��,�r- I'lease state, in detail, what orcurced (happened), and why you �u�e �ubmittin�a claim.I'lease iudic<ite why ol�how you feel the City of Saint Yaul or its emplc�yees are involved and/or res�.�onsible f<�r your damlges. 6fficer Filiowich was traveling s/b on Johnson Pkwy approac ing _....._Ma_r_g_aret._..._wh_e_n._..he___1_ooked___down at _his computer and then rear—ended vPh #� cai�G; nQ vehirle #2 to strike veh #3 which was stopped in t o ve 2 Veh #2 was driven by Lee S Xiong Ylease check the box(es)that most closely represent the rea�on for completing this form: I�'I My vehirle was d�ui�aged in an accident ❑ My vehicle was dama`�ed during a tow ❑ h'ly vehirle was darnaged by a potho(e or condition of the street ❑ My vehicle was dan�aged by a ple�w ❑ My v�hicle was wrc�n,*t�ully towed and/or tick�ted ❑1 w,is injw�cd on City property ❑ Othex type of pcoperty dama�e—please specify ❑ Other type of injui�y—ple�se specify In order to process your claim_yr�u need to include conies of all annlicable documents For tlie cfaims types listed below,please be sure to include the documents indicated or it wi(i delay the handling of yow�claim. Docui»ents WII_I., NO"I'bc retw�ned and become the proPerty of the City. You are encouraged tc�keep a copy for yourself bef'ore submitting your rlaim form. O Property damage claims to a vehicle: two estimates for the repairs co your vehicle i('the damage exceeds �5pp.00: or the acxua] bills and/or receipts for[he repairs O Towin�=claims: legibl�copies of any tirket istiued and a copy of'the impound lot receipt O Other property damage claims: two r�pair estimates if'che damage exc�eds $SOO.Up; or the actual bills and/or receipls for the repairs; detailed list of damaged items O lnjury claim.s: �ncdical bills, recCipts O Photo��raphs are al�vays welrome. to clocument and support your claim but will not be returned. Pa�;e 1 of 2-1'lease complete and return both pa�;es of Cl�im Form 1 , � , � ., F�ilure to complete and return both pages�vill result in delay in the hundling c►f your cl�im. i All Cl��ims—��le�ise complete this section ( Wer� thei•e witnessc:s to the incident`? Yes No Unknown (cirrle) Yrovicie their nameti, addresses and telephone numbers: I Were the 2.�olice or law enforce;ment called'? �Ye. No Unknown (circle) � 1l'ves. what cle 11'llllc;lll C)1'.t��enc �`.' S t . P a u 1 P D ' 1 , p � ) Case#or report# 2 2 0 819 6 Where did thc acrident or injury take place'? Provide street address,Cl'OSS S�I'CCL, intersection, name of park or facility, closest landmark, etc. Please be as detailed as possible. If necessary,attach a diagram. J o h n s o n P k w y . _______a_n d__E .Ma rg_a r e t_S t r e e t_____ Pleatie inciicate the amoune you are seekin�in eompensation or whlt you would like the Ciry to do to resolve this claim to your satisfaction._ $5 , 685 . 27 Vehicle Claims—nlease ccunplete this section O check bor if this section dc�es not a�plv Your Vehicle: Year 2001 Nlake Buick Model LeSabre I..irense Plate Nurnber XMY 616 State MN. Calor Re�Tistered Owner Warren , James Robert D�i ver o f V ehi cl e W a r r e n , J a m e s R o b e r t----�--^----------------------- Area Dama�ed r e a r City Velricic: Year__�Q_Q�_Make Forci Model Crown V; ct�r; a Licenle Pfate Numher n/a State MN Color WB Driver of Vehicle�ri�Employee's Name) T i m o t h y C . F i 1 i o w i c h Area Dam��ed Injurv Claims—please comulete this section ❑ check bc�x if this section doe5 not a�lv How were you injured?_ What part(s) of your body were injuced? Have you souoht medical treatment`? Yes No P(anning to Seek Treatment (circle) When ctid you receive treatment? (provide date(s)) Name of Meclical Pro��ider(s}: Addre�a._ ___ Telephone_ ! llicl you miss�vork as a result of your injury? Yes No w�,�r� d�a you rniss work? (provide datc(s)) Name of your Employer: ---------------------- -------------------- Acldress � Telephone ❑ Check here if you are attaching more pages to this cl�im form. Number of additional pages By signiirg tliis forrn,you are stati�rg that all information yoz� have provided is triae and correct to t/te best �/�your knowledge. U�zsigned,f'�rms wil!not be processed. Sul�nzitting�false claim can result in prosecution. Date form w�s completed 4/8/13 Will Umana Print the Nume ot'the Yerson�vho Completed this Form: ,___________________._________.__________.___ Signature ot'Person Nlaking the Claim: T h o ma s G e o r g e A s s o c . a s a g e n t s f o r Liberty Mutual Ins . Co . a/s/o it�4„cdt-�bru�u�� 2o�� James Robert Warren . 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' .... ...:. : . .. � ; . . - ' � ' svaEMn10�Q�OW' ?:::,i",� � xau�..� -. , . .. . ..... ... .. �. .. . . � ' ' • S� Paul PD N"'ao`s*,�r+ Q s� O y�nen : .?� � .�'-� °`�w'�`w��TOdd FCYOni• 7.1� � S�rgcant .:,,;•�� • � '��` _. . , BG2711200263 _ QNV��C�`�O �� FINAL 1 ICE — 0 0 � ALL AMOUNTS IN USD � � Gaim# 02390016Q ' Policy# DALLAS.TX 75254 Loss Code Phone:(707)639-5000 Reference# , Tax ID: Insured �1ME$WARREN i Owner JAMES WARREN � Lot# 23289922(r/\�� ; Sale Date "\ Sale Amount g.pp , ACV g,pp ', Repair Est ;.pp ' Return .096 ' Cerc# L397 PIP720A $old To DAWN MARSHALL Resale# LIBERTY MUTUAL INSURANCE-TLE t�' r_7 Z720 i BELLA VISTA PARKWAY ^J WARRENVILIE IL 60555-1619 • �a �r rr Invoice Date p9/p�12 rti.� Cp CD TRANSACTION DETAILS FiNANCIAL DETAILS ^`� ct� Copart Faciliry 080 MN-MINNEAPOLIS NORTH Advance Charges Paid By Copart �`� 1526 BUNKER LAKE BLVD Total Advance Charges 5.00 HAM LAKE.MN 55304 6921 �pan Service Charges (763)772-0700 TOTAL LIBERTY EXPRESS g25.00 Loss Date 08/30/12 TOW IN Zone 05 Called In OS/31/12 $70.00 P/U Cleared 09/04/l 2 TOW OUT Zune 05 470.00 Pickup Date ��pS��Z Total Copart Service Charges 5165.00 Original Tide Total Due Copart $I 65.00 Trans Title Net Due Copart S I 65.00 Sate Document Sale Date Buyer Paymenc Date Date reported to NICB Loss Type COLtI510N Description 01 BUIC LESABRE CU BLUE RECEIV�D Vehicle ID# IG4HP54K4IU163733 License#/S7 Mileage 94,290 SEP 1� 2�� Pickup From RENTAL PRQPERTY 1931 KENWOOD DRIVE EAST �yq��ryVIII.E MAPLEWOOD,MN 551 17 (65 I)776-5792 0414 iw-�.a�itsr�ipi�i-» O I � REM{T TO: COPART,INC. 4b10 WEST AMERICA DRIVE FAIRFIELD.CA 94534 TOTAL DUE COPART S 165.00 FoR LOT# 23289922 CLAIhUREF# 023900160 LOSS DATE 08/30/12 102-T.p4.p�325FI1.p01 31-33 � � c�o � ' °o � � � a co � � c�D � (�O >� 0�0 0�0 � b9 M 69 ;� H3 Ef3 � .� �.: �. .: M "a �O O fty ' N iir a a � � � N M � � O � � . .�. � . � . � a J a f� � U .. . . �� ... � � � �� .�., . � O � J Z � � V �,, N '� � �� ; � � � � � Z 0 � 0 c � � ,; d ,r o ' � � t '� N � � •Q � N N N � � N U O O O � O Z � 0�0 � Z c�0 � � .� . 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M O N � N M O N N � N a m � 0 � � c co � C� Rental Company: Enterprise Rent-A-Car '"r LIBERTY MUTUAL-PERSONAL MARKET Invoice: 1934 D948815 Bill To: LM115TL RENTAL DETAIL: LIBERTY MUTUAL-PERSONAL MARKET Rental Period: 08/31/2012 to 09/28/2012(29 days) ATTN:RENTAL'*UNIT gi��1 period: 08/31/2012 to 09/28/2012(29 days) 27201 Bella Vista Parkway, Sui Warrenville, IL 60555 Description Rate Amount RENTER INFORMATION: 29 DAYS @ $25.24 $731.96 Renter: WARREN,DEBRA 1 SURCHARGE% 11.20 $81.98 Address: 1931 KENWOOD DR E 1 SALES TAX $7.62 $55.81 MAPIEWOOD, MN 551172249 Home Phone: (651)776-5792 Total Charges: $869.75 Office Phone: (651)341-9892 Less Amount Received: $0.00 Total Amount Dus: 5869.75 RENTAL INFORMATION: Rental Branch Location: ENTERPRISE RENT-A-CAR(1934) 395 EAST 7TH STREET SAINT PAUL, MN 551012450 ADDITIONAL CLAIM INFORMATION: Claim Number: PD41402390016004 Claim Type: Insured Vehicle Condition: Total Loss Date Of Loss: 08l31/2012 Insured Name: Owner's Vehicle: 2001 BUICK LESAB File Escalated: No Upgrade Requested: No TLC Shop: NO Waiting on Estimate: No Repair Facility: CENTURY AVENUE COLLISION N ST PAUL, MN 55109 (651)777-6055 VEHICLES RENTED: Effective Date Time Year Make Model VIN Mllea e 08/31/2012 5:12 PM 2011 CHEV IMPA 2G1WG5EK1B1304290 1128 Rental Invoice Please Return This Portion with Remittance Make Payment To: Total Charges: $869.75 ENTERPRISE RENT A-CAR , Less Amount Recelved: $0.00 P.O. BOX 840086 Total Amount Due........... 5869.75 KANSAS CITY, MO 641840086 ', Please Include on your Check: FederallD:43-0724835 Invoice:1934 D948815 NOTEBOOK: 9/29/12 5:19 AM Invoice sent for Approval/Payment AMOUNT DUE$869.75 9/28/12 11:28 AM Ticket 948815 closed on 9/28/12 at 1127 AM. 9/19/12 11:24 AM Authorization changed by O'BOYLE,LISA at 1124 AM. Rental transferred from 0414 WARRENVILLE APD to 0414 WARRENVILLE TOTAL LOSS Rental transferred by O'BOYLE,LISA at 11:24 AM. Vehicle Condition changed from Non-Driveable to Total Loss by O'BOYLE,LISA at 1124 AM. 9/19/12 11:22 AM Authorization changed by O'BOYLE, LISA at 11:22 AM. Extended 15 days up to$30.00/day. Last authorized day will be 9/29/12. Last day of rental set by O'BOYLE, LISA at 11:22 AM. Last Day Set--Settlement made 9/18/12 11:43 AM Authorization changed by O'BOYLE, LISA at 11:43 AM. Rental extended by O'BOYLE, LISA at 11:43 AM for 3 day(s). Current authorized date is 9/14/12. Extended 3 days up to$30.00/day. 9/17/12 11:38 AM PLEASE EXTEND OR ADVISE.THANKS 9/14/12 8:21 AM ENTERED UPDATED SHOP INFO PLEASE EXTEND OR AD VISE.THANKS 9/14/12 8:21 AM Repair Facility changed from UNKNOWN SHOP to CENTURY AVENUE COLLISION. 9/11/12 12:54 PM Authorization changed by O'BOYLE, LISA at 12:54 PM. Waiting on Estimate changed to No Message sent by O'BOYLE, LISA at 12:54 PM. branch please find out shop informtaion for extension-in house Repair Facility changed from POSSIBLE TOTAL to UNKNOWN SHOP. 9/11/12 12:53 PM Authorization changed by O'BOYLE, LISA at 12:53 PM. Rental extended by O'BOYLE, LISA at 12:53 PM for 2 day(s). Current authorized date is 9/11/12. Extended 2 days up to$30.00/day. Labor Hours changed from 0.0 to 16.4 Rental transferred from 0414 WARRENVILLE TOTAL LOSS to 0414 WARRENVILLE APD Rental transferred by O'BOYLE,LISA at 12:53 PM. Vehicle Condition changed from Total Loss to Non-Driveable by O'BOYLE, LISA at 12:53 PM. 9/11/12 10:12 AM PLEASE UPDATE OR EXTEND.THANKS 9/10/12 3:23 PM PLEASE UPDATE OR EXTEND.THANKS 9/4/12 9:46 AM Authorization changed by O'BOYLE, LISA at 9:46 AM. Rental transferred from 0414 WARRENVILLE APD to 0414 WARRENVILLE TOTAL LOSS Rental transferred by O'BOYLE,LiSA at 9:46 AM. Upgrade Requested changed to No 8/31/12 5:27 PM Ticket 948815 opened on 8/31/12 at 5:12 PM. 8/31/12 1:12 PM Repair Facility set to POSSIBLE TOTAL. 8/31/12 12:43 PM Authorization confirmed by Enterprise at 12:43 PM. Reservation number 026648. 8/31/12 12:43 PM Authorization sent at 12:43 PM for 10 days up to$30.00/day. Authorization sent with$30.00/day/$900.00/max. Authorized by RICHARDS,CATHERINE. File Owner is File is Managed By Direct Bill Authorization set at 100% Mobile: (651)341-9892 Rentals will be extended until repairs are complete,or if the insured reaches the 30 ' day policy max.DO NOT involve the customer in ANY rental extension questions. Questions must be addressed to the ERAC In-House team at Liberty Mutual. I� 'All times are in CST ' � AUTO APPRAISAL REPORT � LIBERTY MUTUAL INSURANCE COMPANY 27201 BELLA VISTA PARKWAY WARRENVILLE, IL 60555 PHONE(800)838-7103 FAX(603)334-8305 ***ESTIMATE*"* 09/06/2012 12:59 PM _........ __...._..,,, �.__.�..�. ___.._____.__..__..��..� Owner Owner: JAMES WARREN Address: 1931 KENWOOD DR E Cell: (651)341-9892 Home/Day: (651)776-5792 City State Zip: MAPLEWOOD, MN 55117-2249 FAX: Email: jwarren179@live.com � .._ �._�__ _ Controi Information �� Claim#: 023900160-03 Insured Policy#: XXXXX Loss Date/Time: 08/30/2012 07:00 AM Loss Type: Collision Deductible: $250.00 Ins. Company: Liberty Mutual Insured: JAMES WARREN Loss Payee: SOO LINE CU _ �.... _.�.�_._�..�.__. Y.._�____ Inspection Inspection Date: 09/06/2012 Inspection Type: Office Handled Claim City State Zip: Warrenville, IL 60555 Primary Impact: Rear Secondary Impact: Front Driveable: No Rental Assisted: Assigned Date/Time: Received Date/Time: 09/04/2012 08:16 AM First Contact Date/Time: Appointment Date/Time: 09/03/2012 07:00 AM Appraiser Name: BILL STORY Appraiser License#: _.__ _. __M_____ ..�_._��._ � _ _� Repairer � _, �`[ �1 Repairer: Copart Ham Lake Contact: �� Address: 1526 Bunker Lake Blvd City State Zip: Ham Lake, MN 55304 _. __. _. __.,..__..__. �..�.._ __.�_.� �.__._...�_____ Remarks ) """'*'All Supplements require prior approval***""***** PLEASE submit supplements to:0414Dispatcher@libertymutual.com or FAX to: 603-334-8305 Be sure to include the Customer Name, Claim Number and all necessary invoices and photos COOLING SYSTEM DAMAGES ARE OPEN FOR INSPECTION Vehicl �� _ � e _.... _ _... _ .....�_.. _..._.__------____..._�._____.._.__.________.________ 09/O6/2012 01:16 PM Page 1 of 5 2001 Buick Le Sabre Cuslom 4 DR Sedan Claim#: 023900160-03 09/06/20�2 12:59 PM 2001 Buick Le Sabre Custom 4 DR Sedan 6cyl Gasoline 3.8 4 Speed Automatic Lic.Plate: XMY616 Lic State: MN Lic Expire: VIN: 1 G4HP54K41 U163733 Prod Date: Mileage: 94,290 Veh Insp#: Mileage Type: Actual Condition: Good Code: S4343A Ext.Color: Light Blue Int.Color: Ext. Refnish: Two-Stage Int. Refinish: Options AM/FM Stereo Tape Air Conditioning Anti-Lock Brakes Auto Load Leveling Cruise Control Dual Airbags Intermittent Wipers Keyless Entry System Lighted Entry System Overhead Console Power Brakes Power poor Locks Power Drivers Seat Power Mirrors Power Steering Power Windows Rear Window Defroster Rem Trunk-UGate Release Side Airbags Split Front Bench Seat Strg Wheel Radio Control Tilt Steering Wheel Tinted Glass Twilight Sentinel Velour/Cloth Seats � Damages��_��_�.� Line Op Guide MC Description MFR.Part No. Price ADJ% B% Hours R 1 N 27 Frt Bumper Cvr Overhau Additional Labor 2.6 SM 2 I 6 Cover,Front Bumper Repair 2.5* SM 3 L 6 # Cover,Front Bumper Refinish 2.9* RF 1.8 Surface 0.6 Two-stage setup 0.5 Two-stage #= 10, 13 » BLEND REFINISH/FULL CLEAR 4 EU 11 Grille Assemb�y LIKE KIND&QUALITY $60.00 +25.00 INC SM » Pam's Auto(QRP)320-363-7336 »7505 Ridgewood Rd »St Cloud MN 56303 5 N 973 Headlamps Aim Additional Labor 0.4 SM 6 E 45 Panel,Headlamp Mtg 19150632 GM Part $584.58 1.3 SM 7 N 31 RR Bumper Cvr Overhaul Additional Labor 1.4 SM 8 I 566 Cover,Rear Bumper Repair 3.0' SM 9 L 566 10 Cover,Rear Bumper Refinish 2.3' RF 1.8 Surface 0.5 Two-stage »BLEND REFINISH/FULL CLEAR 10 E 567 Absorber,Rear Bumper 25649535 GM Part $122.86 INC SM 11 SB M60 Hazardous Waste Removal Sublet Repair $3.00' SM 11 Items MC Message ' 10 INCLUDES AUDATEX T1ME TO CLEAR ENTIRE PANEL 13 INCLUDES 0.6 HOURS�IRST PANEL TWO-STAGE ALLOWANCE ,.._...._...._...__._.__...._....._.._..._..____________--------- ---� ' i Estimate Total&Entries Gross Parts $707.44 , I 09/06/2012 01:16 PM Page 2 of 5 I 2001 Bwck Le Sabre Custom 4 DR Sedan Claim#: 023900160-03 09/O6/2012 12:59 PM Other Parts $60.00 Paint Materials $166.40 Line Item Markup $15.00 Parts&Material Total $948.84 Tax on Parts&Material @ 7.000% $66.42 Labor Rate Replace Repair Hrs Total Hrs H rs Sheet Metal(SM) $52.00 1.3 9.9 11.2 $582.40 Mech/Elec(ME) $75.00 Frame(FR) $70.00 Refinish(RF) $52.00 5.2 5.2 $270.40 Paint Materials $32.00 Labor Total 16.4 Hours $852.80 Sublet Repairs $3.00 Gross Total $1,871.06 Less: Deductible $250.00- Net Total $1,621.06 Aiternate Parts Y/00/00/00/00/00 CUM 00/00/00/00/00 Zip Code:55410 Minneapolis MN Recycled Parts Y/1/0 Zip Code: 60606 INV DATE:09/04/2012 Audatex Estimating 6.0.626 ES 09/06/2012 01:16 PM REL 6.0.626 DT 08/01/2072 DB 09/01/2012 Copyright(C)2011 Audatex North America, Inc. 1.6 HRS WERE ADDED TO THIS ESTIMATE BASED ON AUDATEX'S TWO-STAGE REFINISH FORMULA. "THIS IS NOT AN AUTHORIZATION TO REPAIR. PRESENT THIS APPRAISAL TO THE REPAIRING GARAGE BEFORE REPAIRS BEGIN.WE RESERVE THE RIGHT TO INSPECT ANY ADDITIONAL DAMAGE BEFORE CONSIDERING PAYMENT OF SUPPLEMENTAL REPAIR CHARGES." NUMBER OF DAY TO REPAIR....... THIS ESTIMATE HAS BEEN PREPARED BASED ON THE USE OF CRASH PARTS SUPPLIED BY A SOURCE OTHER THAN THE MANUFACTURER OF YOUR MOTOR VEHICLE. THE AFTERMARKET CRASH PARTS USED IN THE PREPARATION OF THIS ESTIMATE ARE WARRANTED BY THE MANUFACTURER OR DISTRIBUTOR OF SUCH PARTS RATHER THAN THE MANUFACTURER OF YOUR VEHICLE. DEAR LIBERTY MUTUAL CUSTOMER, A LIBERTY MUTUAL APPRAISER OR APPROVED REPAIR FACILITY HAS COMPLETED AN APPRAISAL OF THE DAMAGES TO YOUR VEHICLE. A COPY OF THE APPRAISAL WILL BE MAILED IF ONE IS NOT ATTACHED. WITH LIBERTY MUTUAL YOU MAY CHOOSE WHO WILL COMPLETE REPAIRS TO YOUR VEHICLE. YOU MAY CHOOSE A SHOP YOU ARE FAMILIAR WITH OR ONE OF OUR TOTAL LIBERTY CARE SHOPS. (IF YOU DESIRE WE WILL PROVIDE YOU WITH A LIST OF OUR TOTAL LIBERTY CARE SHOPS . PLEASE PRESENT THE APPRAISAL TO THE SHOP OF YOUR CHOICE. ) THE SHO � ARTT T ATTN � TN 0 7 TOTAT, T,TRFRTY C''ARF p , AM O R YO BOTH 09/06/2012 01:16 PM Page 3 of 5 2001 Bwck Le Sabre Cusrom 4 DR Sedan � Claim#: 023900160-03 09/O6/2012 12:59 PM A WRITTEN GUARANTEE AND QUALITY REPAIRS. LIBERTY MUTUAL, HOWEVER CAN ONLY OFFER A GUARANTEE AT OUR APPROVED TOTAL LIBERTY CARE SHOPS. SHOULD THE REPAIR SHOP FIND ADDITIONAL DAMAGE, THEY ARE REQUIRED TO CONTACT LIBERTY MUTUAL PRIOR TO PERFORMING ADDITONAL REPAIRS. SUPPLEMENTAL CHARGES SUBMITTED WITHOUT PRIOR AUTHORIZATION FROM LIBERTY MUTUAL WILL BE DENIED. IF YOU WOULD LIKE LIBERTY MUTUAL TO ISSUE PAYMENT TO THE REPAIR SHOP YOU HAVE SELECTED DIRECTLY, PLEASE SIGN AND DATE THE AUTHORIZATION BELOW. ------------------------------------------------------------------------------ . DIRECT PAYMENT AUTHORIZATION . I AUTHORIZE LIBERTY MUTUAL TO PAY ON MY BEHALF FOR THE REPAIR OF COVERED DAMAGES TO MY VEHICLE. VEHICLE OWNER'S SIGNATURE DATE **************************CAPA SHEET METAL OPTION***************************** A CAPA CERTIFIED SHEETMETAL PART IS AVAILABLE FOR YOUR VEHICLE FOR THE FOLLOWING PARTS. LEFT FENDER OEM $ QRP $ DIFFERENCE $ RIGHT FENDER OEM $ QRP $ DIFFERENCE $ HOOD OEM $ QRP $ DIFFERENCE $ LEFT DOOR OEM $ QRP $ DIFFERENCE $ RIGHT DOOR OEM $ QRP $ DIFFERENCE $ DECK LID OEM $ QRP $ DIFFERENCE $ YOUR TOTAL SAVINGS IF YOU CHOOSE CAPA PARTS WOULD BE: $ AS THE OWNER YOU HAVE THE CHOICE ***TOTAL DIFFERENCE SUBJECT TO PART AVAILABLILITY AND PRICE FLUCTUATION. USE OF CAPA CERTIFIED SUBSTITUTE SHEET METAL DOES NOT AFFECT YOUR WARRANTY. I HEREBY GIVE THE SHOP PERMISSION TO USE THE ABOVE CAPA PARTS Op Codes ' = User-Entered Value E = Replace OEM NG= Replace NAGS EC= QUALITY REPL. PART OE= OEM SURPLUS PART UE= OEM SURPLUS PART ET= Partial Replace Labor EP= QUALITY REPL. PART EU= LIKE KIND&QUALITY TE = Partial Replace Price PM= Replace PXN Reman/Reblt UM= Replace Reman/Rebuilt L = Refinish PC= Replace PXN Reconditioned UC= Replace Reconditioned TT = Two-Tone SB= Sublet Repair N = Additional Labor BR= Blend Refinish I = Repair IT = Partial Repair CG= Chipguard RI = R& I Assembly P = Check AA= Appearance Allowance RP= Related Prior Clamage 09/06/20t2 01:16 PM Page 4 of 5 � 2001 Buick Le Sabre Custom 4 DR Sedan � Claim#: 023900160-03 09I06/2012 12:59 PM This report contains proprietary information of Audatex and may not be disclosed to any third party(other than the insured,claimant and others on a need to know basis in order to effectuate the claims process)without ��t� Audatex's prior written consent. a s�tere twr�p.tr'rk - Copyright(C)2011 Audatex North America, Inc. Audatex Estimating is a trademark of Audatex North America, Inc. 09/O6/20'12 01:'16 PM Page 5 of 5 AUTO APPRAISAL REPORT LIBERTY MUTUAL INSURANCE COMPANY 27201 BELLA VISTA PARKWAY WARRENVILLE,IL 60555 PHONE(800)838-7103 FAX(603)334-8305 Recycled Real Steel Locate Report Owner Name: JAMES WARREN Claim#: 023900160-03 � ._ -_ - -- -------- Vehicle 2001 Buick Le Sabre Custom 4 DR Sedan 6cyl Gasoline 3.8 4 Speed Automatic Options AM/FM Stereo Tape Air Conditioning Anti-Lock Brakes Auto Load Leveling Cruise Control � Dual Airbags Intermittent Wipers Keyless Entry Systeml Lighted Entry System Overhead Console Power Brakes Power poor Locks Power Drivers Seat Power Mirrors Power Steering Power Windows Rear Window Defroster Rem Trunk-UGate Release Side Airbags Split Front Bench Seat Strg Wheel Radio Control Tilt Steering Wheel Tinted Glass Twilight Sentinel Velour/Cloth Seats Line Part Description Year/Make / Notes VIN? Cleanup Supplier ID Stock# 4 Grille Assembly Y APU100016 Q0234 >=ESTIMATE TOTAL IS BASED ON PRICE QUOTED BY THIS SUPPLIER.REPAIRERS MAY USE THE SUPPLIER OF THEIR CHOICE AND MAY NEGOTIATE SPECIFIC TERMS OF PURCHASE WITH THAT SUPPLIER. Detailed Distributor List� �mT APU100016 Pam's Auto(QRP)320-363-7336 7505 Ridgewood Rd St Cloud MN 56303 Audatex Estimating 6.0.626 ES 09/06/2012 01:16 PM REL 6.0.626 DT 08/01/2012 DB 09/01/2012 Zip Code: 60606 Search Area: Default Copyright(C)2011 Audatex North America,Inc. This report contains proprietary information of Audatex and may not be disclosed to any third party(other than the insured,claimant and others on a need to know basis in order to effectuate the ciaims process)without Audatex's �� C�71� priorwrittenconsent. d SuJrr,�cum�ran} —�,,�.�..�wrM�Copyright(C)2011 Audatex North America,Inc. Audatex Estimating is a trademark of Audatex North America,Inc. 09I06/2012 0�:16 PM P8g8 1 Of 1 APU Audit Availability Report Claim Information Claim#:023900160-03 RO#: Insurance Co:Liberty Mutual Adjustor Name: Regional Office: Local Office: Auto Owner:JAMES WARREN Owner Status:insured Date of Loss:08/30/2012 7:OOAM Postal Code Searched:55304 Shop Name:Liberty Mutual(W.Story) APU Submit Date:09/06/2012 1:06PM Vehicle Information Year/Make/Model: Body Type: Body Style: Axle Type: Odometer: 2001 Buick LeSabre Sedan 4 Door FWD 94290 VIN: Engine: Fuel Type: 1G4HP54K41U163733 V6,3.8L Gas Parts Information Part Quotes Priced Used Preliminary Difference Status Received Estimate Price Bumper Energy Absorber,Rear 0 $0.00 Not Used on Estimate Grille 2 $75.00 $151.39 $76.39 Recommended MounUHeader Panel 0 $0.00 Not Used on Estimate Header Panel Assembly 4 $0.00 Not Used on Estimate Bumper Cover,Rear 0 $0.00 Not Used on Estimate Bumper Cover,Front 4 $0.00 Not Used on Estimate Total: $75.00 Difference: $76.39 Red status text above indicates that an audit exception has been generated for this recommendation. Claim Activity Summary Part Total Price Seller Comments Status Grille $75.00 Pam's Auto(QRP) Year:2002 Conditions and Options:ASSY,CHRM,W- Used on EMBLEM,PITTED,CRACKED Units of Damage:0.0 Estimate COND:0.0 Stock Number:Q0234APU Grade: N/A APU Quote#:2313 4629 6994 621 Local-Located within local delivery area All Quoted Parts Part Total Price Seller Comments Status Grille $75.00 Pam's Auto(QRP) Year:2002 Conditions and Options:ASSY,CHRM,W- Used on EMBLEM,PITTED,CRACKED Units of Damage:0.0 Estimate COND:0.0 Stock Number:Q0234APU Grade:; N/A APU Quote#:2313 4629 6994 621 Local-Located within local delivery area Grille $75.00 Chucks Auto Damage:None Year:2001 Conditions and Not Salvage Inc Options:SLVR,CUSTOM Units of Damage:0.0 COND: Used on 0.0 PartRating:A Stock Number:2D0060APU Estimate Grade:;A APU Quote#:2313 4629 6994 621 Regional-May need additional shipping charges Header Panei $312.50 Metro Auto Salvage 000,BARE Year:2003 Units of Damage:0.00 Not Assembly COND:A Stock Number:00008858APU Used on Grade:;A APU Quote#:2313 4629 6994 Estimate 621 Local-Located within local delivery area Price found is not cost effective Header Panel $468.75 LKQ Smart Parts Header Panel Assembly LESABRE BARE Not Assembly Part Number:$LF950-940 Condition:A Used on Year:2004:; Stock Number:$LF950-940 Estimate Grade:;A APU Quote#:2313 4629 6994 621 Local-Located within local delivery area Header Panel $368.75 PRP-Automotive CUSTOM,BARE,HOOD LATCH ASSY ONLY Not Assembly Parts Solutions Year:2001 Units of Damage:0.00 COND:A Used on Stock Number:00007878APU Grade:; Estimate N/A APU Quote#:2313 4629 6994 621 Local-Located within local delivery area Header Panel $237.50 Elmers Auto Inc GRY W/LATCH ASSM,RH headlight mounting Not Assembly broke,inspect first Year:2003 Units of Damage:0.00 Used on COND:A Stock Number:K314472APU Grade:; Estimate N/A APU Quote#:2313 4629 6994 621 Regional-May need additional shipping charges Bumper Cover,Front $364.00 Keystone-Minneapolis AMPP Certified Part Platinum Plus Part BUMPER Not COVER.FRONT,W/CUSTOM PACKAGE,SMOOTH Used on LOWER BUMPER,REMANUFACTURED OE Estimate Part Number:GM1000583R:; Stock Number: GM1000583R APU Quote#:2313 4629 6994 621 Local-Located within local delivery area Bumper Cover,Front $331.25 LKQ Smart Parts Bumper Cover-Front BARE CVR ONLY,12335610 Not Part Number:LGH020-559 Condition:A Year:2005:; Used on Stock Number:LGH020-559 APU Quote#:2313 4629 Estimate 6994 621 Local-Located within local delivery area Bumper Cover,Front $256.86 Rydell Chevrolet 00-05 BUICK LESABRE CUSTOM Part Number: Not Surplus OEM 12335610-S Stock Number:12335610-SAPU Used on Grade:;N/A APU Quote#:2313 4629 6994 Estimate 621 Local-Located within local delivery area Bumper Cover,Front $256.86 Rydell Chevrolet 00-OS LESABRE CUSTOM FRONT FASCIA Part Not Surplus OEM Number:12335610-P Stock Number:12335610- Used on PAPU Grade:;N/A APU Quote#:2313 4629 Estimate 6994 621 Local-Located within local delivery area Pa s Vendors Company Address Phone Contact Name Chucks Auto Salvage Inc 29999 East Bass Lake Rd.'�, 800-300-6281 Spencer Parts Vendors Company Address Phone ConWct Name Grand Rapids, MN 55744 Elmers Auto Inc N 877 Elmers Rd 800-362-5004 Eric x221 or Jim x223 Fountain City, WI 54629 Keystone-Minneapolis 3615 Marshall Street NE 800-328-1845 Cary Welter Minneapolis, MN 55418 LKQ Smart Parts N4079 Highway E 800-349-5850 option 2 Sales Staff Hustisford. WI 53034 Metro Auto Salvage 11710 East 263rd St 952-461-2186 Ron. Lakeviile, MN 55044 PRP-Automotive Parts 1495 Broadway Street West 320-685-5557 Amy or poug Solutions Rockville, MN 56369 Pam's Auto(QRP) 7505 Ridgewood Rd 320-363-7336 Flip,Rob,or Jim. St Cloud, MN 56303 Rydell Chevrolet Surplus OEM 1328 E.San Maranan Dr. 800-383-4601 Brian Teniey Waterloo, IA 50702 Insurance Company Adjuster Name/Company Phone Liberty Mutual Liberty Mutual(W.Story) 800-838-7103 ext 3964 AUTO APPRAISAL REPORT LIBERTY MUTUAL INSURANCE COMPANY 27201 BELLA VISTA PARKWAY WARRENVILLE, IL 60555 PHONE(800)838-7103 FAX(603)334-8305 **"SUPPLEMENT 1 *** 09/06/2012 S 1 09/20/2012 10:10 AM �. _._,__�_�_______ . �__ _____ Owner Owner: JAMES WARREN Address: 1931 KENWOOD DR E Cell: (651)341-9892 Home/Day: (651)776-5792 City State Zip: MAPLEWOOD, MN 55117-2249 FAX: Email: jwarren179@live.com �__.�___.__ _.._____.___.__ _�_._... Control information Claim#: 023900160-03 Insured Policy#: XXXXX Loss Date/Time: 08/30/2012 07:00 AM Loss Type: Collision Deductible: $250.00 Ins.Company: Liberty Mutual Insured: JAMES WARREN Claim Rep: PATRICIA HUNTER X78244 Loss Payee: SOO LINE CU _..._ __.._. _..__._. _.___.____.____, ' Inspection Inspection Date: 09/20/2012 Inspection Type: Field Inspection Location:CTENTURY AVENUE COLLISION Contact: City State Zip: North Saint Paul, MN 55109 Primary Impact: Rear Secondary Impact: Front Driveable: No Rental Assisted: Assigned Date/Time: Received Date/Time: 09/04/2012 08:16 AM First Contact Date/Time: Appointment Date/Time: 09/03/2012 07:00 AM Appraiser Name: DAN ZUNIGA Appraiser License#: Orig Appraiser Name: BILL STORY Appraiser License#: _ __....__ _.__._.__. �.._..._.___ ____ —_ � ; Repairer _�_____.. ______�._ �Repairer: CENTURYAVE COLLISION CTR Contact: KATHY/GARY Address: 2501 CENTURYAVE Work/Day: (651)777-6055 City State Zip: NO. ST. PAUL, MN 55109 FAX: (651)779-9417 '._ Remarks � rt_ CALLED CUSTOMER, REVIEWED THE APPRAISAL AND LEFT COPY WITH REPAIR SHOP ALL LKQ/USED PARTS MUST BE APPROVED BY A LIBERTY MUTUAL REPRESENTATIVE PRIOR TO RETURN FOR PART EXCHANGE AND/OR PAYMENT CONSIDERATION. 09/20/2012 11:23 AM Page 1 of 5 2001 Buick Le Sabre Custom 4 DR Sedan 09/O6/2012 Claim#: 023900160-03 09/20/2012 10:10 AM ***"*""All Supplements require prior approval"***'***'* PLEASE submit supplements to:0414Dispatcher@libertymutual.com or FAX to: 603-334-8305 Be sure to include the Customer Name, Claim Number and all necessary invoices and photos COOLING SYSTEM DAMAGES ARE OPEN FOR INSPECTION SUPPLEMENT REPLACE HOOD,A/C CONDENSOR, FRT ABSORBER, RT H/L, RT BMPR EXTEN. RECHARGE A/C, BLEND FNDRS, REPLACE EMBLEMS, FLEX,CAR CVR, REFRIG.,ADDITIONAL REPAIRS TO CVRS W/FULL REFINISH, DRIVER'S SEAT FRAME. Vehicle �� 2001 Buick Le Sabre Custom 4 DR Sedan 6cyl Gasoline 3.8 4 Speed Automatic Lic.Plate: XMY616 Lic State: MN Lic Expire: VIN: 1G4HP54K41U163733 Prod Date: Mileage: 94,290 Veh Insp#: Mileage Type: Actual Condition: Code: S4343A Ext. Color: MEDIUM BLUE PRL MET Int.Color: Ext. Refinish: Two-Stage Int.Refinish: Ext. Paint Code: 55,417G Int.Trim Code: Options Air Conditioning Aluminum/Alloy Wheels Anti-Lock Brakes Auto Load Leveling Compact Disc W/Tape Cruise Control Dual Airbags Intermittent Wipers Keyless Entry System Lighted Entry System Overhead Console Power Brakes Power poor Locks Power Drivers Seat Power Mirrors Power Steering Power Windows Rear Window Defroster Rem Trunk-UGate Release Side Airbags Split Front Bench Seat Strg Wheel Radio Control Tilt Steering Wheel Tinted Glass Twilight Sentinel Velour/Cloth Seats _.._ __._.._ _ ....__._...___--____m...__._. Damages � Line Op Guide MC Description MFR.Part No. Price ADJ% B% Hours R 1 N 27 Frt Bumper Cvr Overhau Additional Labor S1 1.0 SM 2 I 6 Cover,Front Bumper Repair S1 4.0* SM » REPAIRS TO LWR&GRILLE TABS 3 E 100 Extn,Front Bumper Otr RT 25693090 GM Part $41.50 S1 INC SM 4 E 7 Absorber,Front Energy 25649528 GM Part $130.50 S1 1.6 SM 5 EU 11 Grille Assembly LIKE KIND&QUALITY $60.00 +25.00 INC SM » Pam's Auto(QRP)320-363-7336 »7505 Ridgewood Rd »St Cloud MN 56303 6 EU 41 Headlamp Assy,Halogen LT LIKE KIND 8�QUALITY $90.00 +25.00 S1 INC SM »Alliance OEM Auto Parts 888-775-2961 »2197 Pineridge Dr SW Suite 500 »Grand Rapids MI 49428 7 N 973 Headlamps Aim Additional Labor 0.4 SM 8 E 45 Panel,Headlamp Mtg 19150632 GM Part $584.58 1.3 SM 9 EU 83 Panel,Hood LIKE KIND&QUALITY $350.00 +25.00 S1 0.8 SM » Pam's Auto(QRP)320-363-7336 »7505 Ridgewood Rd »St Cloud MN 56303 1f1 I R'� 1� PanalHnnri Rafinich S1 5d RF 09/20/2012 17:23 AM Page 2 of 5 2001 Bwck Le Sabre Cuslom 4 DR Sedan 09/06/2012 Claim#: 023900160-03 09/20l20'12 10:10 AM 3.0 SurFace 1.2 Edge 0.6 Two-stage setup 0.6 Two-stage 11 RI 86 Pad,lnsulator Hood R&I Assembly S1 0.4 SM 12 N 980 A/C Evac Rechrg&Rcvr Additional Labor S1 1.8 ME 13 EU 731 Condenser,A/C LIKE KIND&QUALITY $55.00 +25.00 S1 1.1 ME »Sharp Auto Parts 651-439-2604 »2910 Quant Ave »Stillwater MN 55082 14 BR 103 Fender,Front LT Blend Refinish S1 1.1 RF 0.7 Blend 0.4 Two-stage 15 BR 104 Fender,Front RT Blend Refinish S1 1.1 RF 0.7 Blend 0.4 Two-stage 16 E 452 Emblem,Front Fender LT 25713251 GM Part $35.68 S1 0.2 SM 17 E 453 Emblem,Front Fender RT 25713251 GM Part $35.68 S1 0.2 SM 18 EU 421 Frame,Front Seat LT LIKE KIND&QUALITY $150.00" +25.00 S1 INC SM » PAM'S 320-363-7336 QUOTE#725814 JASON 19 RI 417 Cover,Seat Cushion LT R&I Assembly S1 1.9 SM 20 RI 419 Cover,Seat Cushion LT R&I Assembly S1 INC SM 21 RI 520 Armrest R&I Assembly S1 INC SM 22 N 31 RR Bumper Cvr Overhaul Additional Labor 1.4 SM 23 I 566 Cover,Rear Bumper Repair S1 4.0* SM 24 L 566 Cover,Rear Bumper Refinish S1 32 RF 2.7 Surface 0.5 Two-stage 25 E 567 Absorber,Rear Bumper 25649535 GM Part $122.86 INC SM 26 EC M03 Flex Additive QUALITY REPL. PART $6.00` S1 RF 27 EC M17 Cover Car Exterior QUALITY REPL. PART $5.00* S1 RF 28 EC M21 Refrigerant QUALITY REPL. PART $45.00' S1 SM 29 SB M60 Hazardous Waste Removal Sublet Repair $5.00" S1 SM 29 Items MC Message 13 INCLUDES 0.6 HOURS FIRST PANEL TWO-STAGE ALLOWANCE � �Estimate Total&Entries � Gross Parts $950.80 Other Parts $761.00 Paint Materials $345.60 Line Item Markup $176.25 Parts&Material Total $2,233.65 Tax On Parts Only @ 7.125% $134.52 Labor Rate Replace Repair Hrs Total Hrs H rs Sheet Metal(SM) $52.00 6.4 10.8 17.2 $894.40 Mech/Elec(ME) $75.00 1.1 1.8 2.9 $217.50 Frame(FR) $70.00 Refinish (RF) $52.00 10.8 10.8 $561.60 Paint Materials $32.00 Labor Total 30.9 Hours $1,673.50 Sublet Repairs $5.00 Gross Total $4,046.67 Less: Deductible $250.00- Net Total $3,796.67 Rates/Taxes Adjustment S1 09I20/2012 11:23 AM Page 3 of 5 2001 Buick Le Sabre Custom 4 OR Sedan 09/06/2012 Claim#: 023900160-03 09/20/2012 10:10 AM Actual Supplement Total $2,175.61 Less: Previous Net Total $1,621.06- Net Supplement Total $2,175.61 Alternate Parts Y/00/00/00/00/00 CUM 00/00/00/00/00 Zip Code:55407 MPLS/ST. PAUL Recycled Parts NOT REQUESTED Audatex Estimating 6.0.626 S1 09/20/2012 11:23 AM REL 6.0.626 DT 08/01/2012 Copyright(C)2011 Audatex North America,Inc. 2.5 HRS WERE ADDED TO THIS ESTIMATE BASED ON AUDATEX'S TWO-STAGE REFINISH FORMULA. "THIS IS NOT AN AUTHORIZATION TO REPAIR. PRESENT THiS APPRAISAL TO THE REPAIRING GARAGE BEFORE REPAIRS BEGIN.WE RESERVE THE RIGHT TO INSPECT ANY ADDITIONAL DAMAGE BEFORE CONSIDERING PAYMENT OF SUPPLEMENTAL REPAIR CHARGES." NUMBER OF DAY TO REPAIR....... THIS ESTIMATE HAS BEEN PREPARED BASED ON THE USE OF CRASH PARTS SUPPLIED BY A SOURCE OTHER THAN THE MANUFACTURER OF YOUR MOTOR VEHICLE. THE AFTERMARKET CRASH PARTS USED IN THE PREPARATION OF THIS ESTIMATE ARE WARR�INTED BY THE MANUFACTURER OR DISTRIBUTOR OF SUCH PARTS RATHER THAN THE MANUFACTURER OF YOUR VEHICLE. DEAR LIBERTY MUTUAL CUSTOMER, A LIBERTY MUTUAL APPRAISER OR APPROVED REPAIR FACILITY HAS COMPLETED AN APPRAISAL OF THE DAMAGES TO YOUR VEHICLE. A COPY OF THE APPRAISAL WILL BE MAILED IF ONE IS NOT ATTACHED. WITH LIBERTY MUTUAL YOU MAY CHOOSE WHO WILL COMPLETE REPAIRS TO YOUR VEHICLE. YOU MAY CHOOSE A SHOP YOU ARE FAMILIAR WITH OR ONE OF OUR TOTAL LIBERTY CARE SHOPS. (IF YOU DESIRE WE WILL PROVIDE YOU WITH A LIST OF OUR TOTAL LIBERTY CARE SHOPS . PLEASE PRESENT THE APPRAISAL TO THE SHOP OF YOUR CHOICE. ) THE SHOPS PARTICIPATING IN OUR TOTAL LIBERTY CARE PROGRAM OFFER YOU BOTH A WRITTEN GUARANTEE AND QUALITY REPAIRS. LIBERTY MUTUAL, HOWEVER CAN ONLY OFFER A GUARANTEE AT OUR APPROVED TOTAL LIBERTY CARE SHOPS. SHOULD THE REPAIR SHOP FIND ADDITIONAL D1IMAGE, THEY ARE REQUIRED TO CONTACT LIBERTY MUTUAL PRIOR TO PERFORMING ADDITONAL REPAIRS. SUPPLEMENTAL CHARGES SUBMITTED WITHOUT PRIOR AUTHORIZATION FROM LIBERTY MUTUAL WILL BE DENIED. IF YOU WOULD LIKE LIBERTY MUTUAL TO ISSUE PAYMENT TO THE REPAIR SHOP YOU HAVE � SELECTED DIRECTLY, PLEASE SIGN AND DATE THE AUTHORIZATION BELOW. I'' ------------------------------------------------------------------------------ . DIRECT PAYMENT AUTHORIZATION . . 09/20l2072 t 123 AM Page 4 of 5 2001 Buick Le Sabre Custom 4 DR Sedan 09/O6/2012 Claim#: 023900160-03 09/20/2012 10:10 AM I AUTHORIZE LIBERTY MUTUAL TO PAY ON MY BEHALF FOR THE REPAIR OF COVERED DAMAGES TO MY VEHICLE. VEHICLE OWNER'S SIGNATURE DATE **************************CAPA SHEET METAL OPTION***************************** A CAPA CERTIFIED SHEETMETAL PART IS AVAILABLE FOR YOUR VEHICLE FOR THE FOLLOWING PARTS. LEFT FENDER OEM $ QRP $ DIFFERENCE $ RIGHT FENDER OEM $ QRP $ DIFFERENCE $ HOOD OEM $ QRP $ DIFFERENCE $ LEFT DOOR OEM $ QRP $ DIFFERENCE $ RIGHT DOOR OEM $ QRP $ DIFFERENCE $ DECK LID OEM $ QRP $ DIFFERENCE $ YOUR TOTAL SAVINGS IF YOU CHOOSE CAPA PARTS WOULD BE: $ AS THE OWNER YOU HAVE THE CHOICE ***TOTAL DIFFERENCE SUBJECT TO PART AVAILABLILITY AND PRICE FLUCTUATION. USE OF CAPA CERTIFIED SUBSTITUTE SHEET METAL DOES NOT AFFECT YOUR WARRANTY. I HEREBY GIVE THE SHOP PERMISSION TO USE THE ABOVE CAPA PARTS Op Codes * = User-Entered Value E = Replace OEM NG= Replace NAGS EC= QUALITY REPL. PART OE= OEM SURPLUS PART UE= OEM SURPLUS PART ET = Partial Replace Labor EP= QUALITY REPL. PART EU= LIKE KIND&QUALITY TE = Partial Replace Price PM= Replace PXN Reman/Reblt UM= Replace RemanlRebuilt L = Refinish PC= Replace PXN Reconditioned UC= Replace Reconditioned TT = Two-Tone SB= Sublet Repair N = Additional Labor BR= Blend Refinish I = Repair IT = Partial Repair CG= Chipguard RI = R& I Assembly P = Check AA= Appearance Allowance RP= Related Prior Damage This report contains proprietary information of Audatex and may not be disclosed to any third party(other than the insured,claimant and others on a need to know basis in order to effectuate the claims process)without Au��"�� Audatex's prior written consent. a 3uJera turrr{rarty Copyright(C)2011 Audatex North America,Inc. Audatex Estimating is a trademark of Audatex North America, Inc. 09/20/2012 11:23 AM Page 5 of 5 �� AUTO APPRAISAL REPORT LIBERTY MUTUAL INSURANCE COMPANY 27201 BELLA VISTA PARKWAY WARRENVILLE,IL 60555 PHONE(800)838-7103 FAX(603)334-8305 Recycled Real Steel Locate Report Owner Name: JAMES WARREN Claim#: 023900160-03 __.. � _ .�.__� __.�......... __---------- -----------___ �___� Vehicle 2001 Buick Le Sabre Custom 4 DR Sedan 6cyl Gasoline 3.8 4 Speed Automatic Options Air Conditioning Aluminum/Alloy Wheels Anti-Lock Brakes Auto Load Leveling Compact Disc W/Tape Cruise Control Dual Airbags Intermittent Wipers Keyless Entry System Lighted Entry System Overhead Console Power Brakes Power poor Locks Power Drivers Seat Power Mirrors Power Steering Power Windows Rear Window Defroster Rem Trunk-L/Gate Release Side Airbags Split Front Bench Seat Strg Wheel Radio Control Tilt Steering Wheel Tinted Glass Twilight Sentinel Velour/Cloth Seats Line Part Description Year/Make / Notes VIN? Cleanup Supplier ID Stock# 5 Grille Assembly Y APU100016 Q0234 6 Headlamp Assy,Halogen LT Y APU231333716261757 A1010 9 Panel,Hood Y APU100016 Q0881 13 Condenser,A/C Y APU771239329070003 MCO276 >=ESTIMATE TOTAL IS BASED ON PRICE QUOTED BY THIS SUPPLIER.REPAIRERS MAY USE THE SUPPLIER OF THEIR CHOICE AND MAY NEGOTIATE SPECIFIC TERMS OF PURCHASE WITH THAT SUPPLIER. !Detailed Distributor List� APU 100016 Pam's Auto(QRP)320-363-7336 7505 Ridgewood Rd St Cloud MN 56303 APU231333716261757 Alliance OEM Auto Parts 888-775-2961 2197 Pineridge Dr SW Suite 500 Grand Rapids MI 49428 APU100016 Pam's Auto(QRP)320-363-7336 7505 Ridgewood Rd St Cloud MN 56303 APU771239329070003 Sharp Auto Parts 651-439-2604 2910 Quant Ave Stillwater MN 55082 Audatex Estimating 6.0.626 S1 09/20/2012 1123 AM REL 6.0.626 DT 08/01/2012 Zip Code: 60606 Search Area: Default Copyright(C)2011 Audatex North America,Inc. 09/20/2012�123 AM Page 1 of 2 2001 Buick Le Sabre Custom 4 DR Sedan Claim#: 023900160-03 This report contains proprietary information of Audatex and may not be disclosed to any third party(other than the insured,claimant and others on a need to know basis in order to effectuate the claims process)without Audatex's �I■��/ prior written consent. i.t I�\4 a 5�1rr,t twrr�dtry� �Copyright(C)2011 Audatex North America,Inc. Audatex Estimating is a trademark of Audatex North America,Inc. 09/20/2012 1123 AM Page 2 of 2 '""SUPPLEMENT RECONCILIATION"** Supplement S1 Claim#: 023900160-03 Insured Policy#: XXXXX File#: Claim Rep: PATRICIA HUNTER X78244 Insured: JAMES WARREN Inspection DatelTime: 09/20/2012 Owner Name: JAMES WARREN Appraiser Name: DAN ZUNIGA Vehicle: 2001 Buick Le Sabre Custom 4 DR Sedan _.. __ _....� ._...... _... _....... ... _.._�... ._._ __._....��.____�------.____....._ ___.__._.___.__�_______. Deleted Lines ________.�. _-------___._� _._.___._.__.__ _____._� Line Guide Part Operation Price ADJ% B°/a Labor Rate 1 6 Cover,Front Bumper Refinish 2.9' RF , .�.._........._..__,.�_�.._._�.._..___...�.._____.�..�...�..�_.. :Added Lines Line Guide Part �� Operation Price ADJ% B% Labor Rate 2 7 Absorber,Front Energy Replace OEM S1 $130.50 1.6 SM 3 41 Headlamp Assy,Halogen LT LIKE KIND&QUALITY S1 $90.00 +25.00 INC SM 4 83 Panel,Hood LIKE KIND&QUALITY S1 $350.00 +25.00 0.8 SM 5 83 Panel,Hood Refinish S1 5.4 RF 6 86 Pad,Insulator Hood R 8�I Assembly S1 0.4 SM 7 100 Extn,Front Bumper Otr RT Replace OEM S1 $41.50 INC SM 8 103 Fender,Front LT Blend Refinish S1 1.1 RF 9 104 Fender,Front RT Blend Refinish S1 1.1 RF 10 417 Cover,Seat Cushion LT R&I Assembly S1 1.9 SM 11 419 Cover,Seat Cushion LT R&I Assembty S1 INC SM 12 421 Frame,Front Seat LT LIKE KIND&QUALITY S1 $150.00* +z5.00 INC SM 13 452 Emblem,Front Fender LT Replace OEM S1 $35.68 0.2 SM 14 453 Emblem,Front Fender RT Replace OEM S1 $35.68 0.2 SM 15 520 Armrest R&I Assembly S1 INC SM 16 731 Condenser,A/C LIKE KIND 8�QUALITY S1 $55.00 +25.00 1.1 ME 17 980 A/C Evac Rechrg&Rcvr Additional Labor S1 1.8 ME 18 M03 Flex Additive QUALITY REPL.PART S1 $6.00* RF 19 M17 Cover Car Exterior QUALITY REPL.PART S1 $5.00' RF 20 M21 Refrigerant QUALITY REPL.PART S1 $45.00` SM iChanged Lines� �� Line Guide�Part � � Operation Price ADJ% B% Labor Rate 21 6 Cover,Front Bumper Repair S1 4.0* SM Cover,Front Bumper 2.5' SM 22 27 Frt Bumper Cvr Overhau Additional Labor S1 1.0 SM Frt Bumper Cvr Overhau 2.6 SM 23 566 Cover,Rear Bumper Repair S1 4.0' SM Cover,Rear Bumper 3.0' SM 24 566 Cover,Rear Bumper Refinish S1 3.2 RF Cover,Rear Bumper 2.3' RF 25 M60 Hazardous Waste Removal Sublet Repair S1 $5.00* SM Hazardous Waste Removal $3.00' SM _.�.. _�..�...��.�_ _..�. .._._.._�_.._M__m..�__� --_�___� Calculation Changes � _.____._. �_._ . _ .__.__-_..._____ � _ From To Difference Gross Parts $707.44 $950.80 $243.36+ Other Parts $60.00 $761.00 $701.00+ Paint Materials $32.00 $166.40 $32.00 $345.60 $179.20+ Line Item Markup $15.00 $176.25 $161.25+ �� Tax on Parts&Material 7.000% $66.42 7.125% $134.52 $68.10+ SM-Sheet Metal $52.00 $582.40 $52.00 $894.40 $312.00+ ME-Mech/Electrical $75.00 $0.00 $75.00 $217.50 $217.50+ RF-Refinish $52.00 $270.40 $52.00 $561.60 $291.2p+ Sublet Repairs $3.00 $5.00 $2.00+ Actual Supplement 1 Net Total $2,175.61+ _.� __4.___.�.___e_ ._ �._� �.�_�_ Summa 7 � 09/20/2012 11:23 AM Page 1 of 2 2001 Buick Le Sabre Custom 4 DR Sedan Claim#: 023900160-03 Net Total Date Time Appreiser Original Estimate $1,621.06 09/04/2012 08:15 AM BILL STORY Supplement 1 $3,796.67 09/20/2012 10:10 AM DAN ZUNIGA This report contains proprietary information of Audatex and may not be disclosed to any third party(other than the insured,claimant and others on a need to know basis in order to effectuate the claims process)without Audatex's ��"��'�i� prior written consent. a Svlt�ra cc��t��Y -� .�.�+�Copyright(C)2011 Audatex North America,Inc. Audatex Estimating is a trademark of Audatex North America,Inc. i 09/20/2012 1123 AM Page 2 of 2 APU Audit Availability Report Claim Information Claim#:023900160-03 RO#: Insurance Co:Liberty Mutual Adjustor Name: Regional Office: Local Office: Auto Owner:JAMES WARREN Owner Status:insured Date of Loss:08/30/2012 7:OOAM Postal Code Searched:55304 Shop Name:Liberty Mutual(D.Zuniga) APU Submit Date:09/20/2012 10:58AM Vehicle Information Year/Make/Model: Body Type: Body Style: Axle Type: Odometer: 2001 Buick LeSabre Sedan 4 Door FWD 94290 VIN: Engine: Fuel Type: 1G4HP54K41U163733 V6,3.8L Gas Parts Information Part Quotes Priced Used Preliminary Difference Status Received Estimate Price Bumper Energy Absorber,Rear 0 $0.00 Not Used on Estimate Grille 2 $75.00 $151.39 $76.39 Recommended MounUHeader Panel 0 $0.00 Not Used on Estimate Header Panel Assembly 4 $0.00 Not Used on Estimate Bumper Cover,Rear 0 $0.00 Not Used on Estimate Bumper Cover,Front 4 $0.00 Not Used on Estimate AC Condenser 29 $68.75 $310.82 $242.07 Recommended Bumper End Cap,Front,Passenger 0 $0.00 Not Used on Estimate Bumper Energy Absorber,Front 0 $0.00 Not Used on Estimate Headlamp Assembly,Driver 22 $112.50 $412.92 $300.42 Recommended Hood 12 $437.50 $685.02 $247.52 Recommended Front End Assembly 2 $0.00 Not Used on Estimate Seat,Front,Driver 0 $0.00 Not Used on Estimate Total: $693.75 Difference: 3866.40 Red status text above indicates that an audit exception has been generated tor this recommendation. Claim Activity Summary Part Total Price Seller Comments '' Status Grille $75.00 Pam's Auto(QRP) Year:2002 Conditions and Options:ASSY,CHRM,W- Used on EMBLEM,PITTED,CRACKED Units of Damage:0.0 Estimate Claim Activity Summary Part Totai Price Seller Comments Status COND:0.0 Stock Number:Q0234APU Grade:N/A APU Quote#:2313 4629 6994 621 Local-Located within local delivery area AC Condenser $68.75 Sharp Auto Parts Year:2001 Units of Damage:0.00 COND:A:; Used on Please allow up to 48 hours for delivery. Stock Estimate Number:MCO276APU Grade:A Mechanicai Mileage:164890 APU Quote#:2313 4802 1561 322 Local-Located within local delivery area Headlamp $112.50 Alliance OEM Damage:None Year:2004 Conditions and Used on Assembly,Driver Auto Parts Options:INSURANCE QUALITY OEM READY Estimate TO SHIP Units of Damage:0.0 COND:0.0 PartRating:A Stock Number:A1010APU Grade:A APU Quote#:2313 4802 1561 322 Local-Located within local delivery area Hood $437.50 Pam's Auto(QRP) Year2004 Conditions and Options:ASSY,GRY Units Used on of Damage:0.0 COND:1.0 Stock Number:Q0881APU Estimate Grade:A APU Quote#:2313 4802 1561 322 Local-Located within local delivery area AlI Quoted Parts Part Total Price Selier 'Comments Status Grille $75.00 Pam's Auto(QRP) Year.2002 Conditions and Options:ASSY,CHRM,W- Used on EMBLEM,PITTED,CRACKED Units of Damage:0.0 Estimate COND:0.0 Stock Number:Q0234APU Grade:; N/A APU Quote#:2313 4629 6994 621 Local-Located within local delivery area Grilie $75.00 Chucks Auto Damage:None Year:2001 Conditions and Not Salvage Inc Options:SLVR,CUSTOM Units of Damage:0.0 COND: Used on 0.0 PartRating:A Stock Number:2DOO60APU Estimate Grade:;A APU Quote#:2313 4629 6994 621 Regional-May need additional shipping charges Header Panel $312.50 Metro Auto Salvage 000,BARE Year:2003 Units of Damage:0.00 Not Assembly COND:A Stock Number:00008858APU Used on Grade:;A APU Quote#:2313 4629 6994 Estimate 621 Local-Located within local delivery area Price found is not cost effective Header Panel $468.75 LKQ Smart Parts Header Panel Assembly LESABRE BARE Not Assembly Part Number:$LF950-940 Condition:A Used on Year:2004:; Stock Number:$LF950-940 Estimate Grade:;A APU Quote#:2313 4629 6994 621 Local-Located within local delivery area Header Panel $368.75 PRP-Automotive CUSTOM,BARE,HOOD LATCH ASSY ONLY Not Assembly Parts Solutions Year.2001 Units of Damage:0.00 COND:A Used on Stock Number:00007878APU Grade:; Estimate N!A APU Quote#:2313 4629 6994 621 Local-Located within Ixal delivery area Header Panel $237.50 Elmers Auto Inc GRY W/LATCH ASSM,RH headlight mounting Not Assembly broke,inspect first Year:2003 Units of Damage:0.00 Used on i COND:A Stock Number.K314472APU Grade:; Estimate N/A APU Quote#:2313 4629 6994 621 Regional-May need additional shipping charges Bumper Cover,Front $364.00 Keystone- AMPP Certified Part Platinum Plus Part BUMPER Not Minneapolis ', COVER,FRONT,W/CUSTOM PACKAGE,SMOOTH Used on LOWER BUMPER,REMANUFACTURED OE Estimate All Quoted Parts Part Total Price Seller Comments - Status Part Number:GM1000583R:; Stock Number: GM1000583R APU Quote#:2313 4629 6994 621 Local-Located within local delivery area Bumper Cover,Front $331.25 LKQ Smart Parts Bumper Cover-Front BARE CVR ONLY,12335610 Not Part Number:LGH020-559 Condition:A Year:2005:; Used on Stock Number:LGH020-559 APU Quote#:2313 4629 Estimate 6994 621 Local-Located within local delivery area Bumper Cover,Front $256.86 Rydell Chevrolet 00-05 BUICK LESABRE CUSTOM Part Number: Not Surplus OEM 12335610-S Stock Number:12335610-SAPU Used on Grade:;N/A APU Quote#:2313 4629 6994 Estimate 621 Local-Located within local delivery area Bumper Cover,Front $256.86 Rydell Chevrolet 00-OS LESABRE CUSTOM FRONT FASCIA Part Not Surplus OEM Number:12335610-P Stock Number:12335610- Used on PAPU Grade:;N/A APU Quote#:2313 4629 Estimate 6994 621 Local-Located within local delivery area AC Condenser $68.75 Sharp Auto Parts Year:2004 Units of Damage:0.00 COND:A:; Not Please allow up to 48 hours for delivery. Stock Used on Number:MC0570APU Grade:;A Mechanical Estimate Mileage:112261 APU Quote#:2313 4802 1561 322 Local-Located within local delivery area AC Condenser $68.75 Sharp Auto Parts Year:2002 Units of Damage:0.00 COND:A:; Not Please allow up to 48 hours for detivery. Stock Used on Number:BC0863APU Grade:;A Mechanical Estimate Mileage:149805 APU Quote#:2313 4802 1561 322 Local-Located within local delivery area AC Condenser $68.75 Sharp Auto Parts Year2001 Units of Damage:0.00 COND:A:; Used on Please allow up to 48 hours for delivery. Stock Estimate Number:MCO276APU Grade:;A Mechanical Mileage:164890 APU Quote#:2313 4802 1561 322 Local-Located within local delivery area AC Condenser $81.25 LKQ Smart Parts Condenser 3.8,COLUMN,159K,FWD LESABRE Part Not Number:$JF619-502 Condition:A Year:2004:; Used on Stock Number:$JF619-502 Grade:;A Mechanical Estimate Mileage:159269 APU Quote#:2313 4802 1561 322 Local-Located within local delivery area AC Condenser $81.25 AqA Auto Damage:None Year:2002 Conditions and Not Salvage(QRP) Options:4DR,CUST,3.8L,AOD,FWD Units of Used on Damage:0.0 COND:0.0 PartRating:A:; Stock Estimate Number:2S6140APU Grade:;A Mechanical Mileage:127948 APU Quote#:2313 4802 1561 322 Local-Located within local delivery area AC Condenser $81.25 AAA Auto Damage:None Year:2002 Conditions and Not Salvage(QRP) Options:LIM,3.8L,ATOD,FWD Units of Used on Damage:0.0 COND:0.0 PartRating:A:; Stock Estimate Number:1Y6312APU Grade:;A Mechanical Mileage:132251 APU Quote#:2313 4802 1561 322 Local-Located within local delivery area AC Condenser $81.25 AAA Auto Damage:None Year:2002 Conditions and Not Salvage(QRP) Options:CUST,3.8L,ATOD,FWD Units of Used on Damage:0.0 COND:0.0 PartRating:A:; Stock Estimate Number:1Y6299APU Grade:;A Mechanical Mileage:146442 APU Quote#:2313 4802 1561 322 Local-Located within local delivery area All Quoted Parts Part Total Price Seller Comments Status AC Condenser $81.25 AAA Auto Damage:None Year:2003 Conditions and Not Salvage(QRP) Options:SE.3.8L,ATOD,FWD Units of Used on Damage:0.0 COND:0.0 PartRating:A:; Stock Estimate Number:1X6280APU Grade:;A Mechanical Mileage:104650 APU Quote#:2313 4802 1561 322 Local-Located within local delivery area AC Condenser $81.25 AAA Auto Damage:None Year.2001 Conditions and Not Salvage(QRP) Options:CUST,3.8L,ATOD,FWD Units of Used on Damage:0.0 COND:0.0 PartRating:A:; Stock Estimate Number:1U6208APU Grade:;A Mechanical Mileage:107915 APU Quote#:2313 4802 1561 322 Local-Located within local delivery area AC Condenser $81.25 Pam's Auto(QRP) Year:2004 Conditions and Options:ASSY,FIN Not DAMAGE,TESTED GD,LIFETIME Units of Used on Damage:0.0 COND:0.0 Stock Number:Q0881APU Estimate Grade:;A Mechanical Mileage:115591 APU Quote#:2313 4802 1561 322 Local-Located within local delivery area AC Condenser $81.25 Pam's Auto(QRP) Year:2005 Conditions and Options:ASSY,TESTED Not GD,FIN DAMAGE,LIFETIME W Units of Damage:0.0 Used on COND:0.0 Stock Number:Q0822APU Grade:;A Estimate Mechanical Mileage:99922 APU Quote#:2313 480 1561 322 Local-Located within local delivery area AC Condenser $81.25 LKQ Smart Parts Condenser LESABRE Part Number:$C07423-580 Not Condition:A Year:2002:; Stock Number: Used on $C07423-580 Grade:;A Mechanical Estimate Mileage:117000 APU Quote#:2313 4802 1561 322 Local-Located within local delivery area AC Condenser $87.50 LKQ Smart Parts Condenser LESABRE Part Number:$WJ773-540 Not Condition:A Year:2002:; Stock Number: Used on $WJ773-540 Grade:;A Mechanical Estimate Mileage:76000 APU Quote#:2313 4802 1561 322 Local-Located within local delivery area AC Condenser $106.25 LKQ Smart Parts Condenser LESABRE Part Number: Not $LF950-940 Condition:A Year:2004:; Stock Used on Number:$LF950-940 Grade:;A Mechanical Estimate Mileage:99139 APU Quote#:2313 4802 1561 322 Local-Located within local delivery area AC Condenser $106.25 LKQ Smart Parts Condenser SLE Part Number:$SL751-930 Condition: Not A Year.2001 :; Stock Number:$SL751-930 Grade:;A Used on Mechanical Mileage:87077 APU Quote#:2313 480 Estimate 1561 322 Local-Located within local delivery area AC Condenser $106.25 LKQ Smart Parts Condenser LESABRE Part Number:$D8345-910 Not Condition:A Year:2001 :; Stock Number: Used on $D8345-910 Grade:;A Mechanical Estimate Mileage:114088 APU Quote#:2313 4802 1561 322 Local-Located within local delivery area AC Condenser $81.25 AAA Auto Damage:None Year:2005 Conditions and Not Salvage(QRP) Options:CUST,3.8L,ATOD,FWD Units of Used on Damage:0.0 COND:0.0 PartRating:B:; Stock Estimate Number:2P6050APU Grade:;B Mechanical Mileage:151190 APU Quote#:2313 4802 1561 322 Local-Located within local delivery area AC Condenser $81.25 LKQ Smart Parts Condenser FIN DAMAGE Part Number: Not $E6779-570 Condition:B Year:2002:; Stock Used on Number:$E6779-570 Grade:;B Mechanical Estimate All Quoted Parts Part Total Price Seller Comments Status Mileage:177889 APU Quote#:2313 4802 1561 322 Loral-Located within local delivery area AC Condenser $81.25 LKQ Smart Parts Condenser 3.8,COLUMN.139K,FWD LESABRE Not CK TABS Part Number:$NF240330 Condition: Used on A Year:2004:; Stock Number:$NF240-330 Estimate Grade:;N/A Mechanical Mileage:138628 APU Quote#:2313 4802 1561 322 Local-Located within local delivery area AC Condenser $57.50 Elmers Auto Inc Year:2002 Units of Damage:0.00 COND:A Stock Not Number:K214382APU Grade:;A Mechanical Used on Mileage:172122 APU Quote#:2313 4802 1561 Estimate 322 Regional-May need additional shipping charges AC Condenser $62.50 Remington Auto CONDENSER 3.8L AT Year.2003 Hourly Not Salvage(QRP) Damage:0.00 COND:B Stock Number: Used on 00110289APU Grade:;B Mechanical Mileage:121 Estimate APU Quote#:2313 4802 1561 322 Regional -May need additional shipping charges AC Condenser $62.50 Remington Auto CONDENSER 3.8L AT Year:2002 Hourly Not Salvage(QRP) Damage:0.00 COND:B Stock Number: Used on 00110300APU Grade:;B Mechanical Mileage:127 Estimate APU Quote#:2313 4802 1561 322 Regional -May need additional shipping charges AC Condenser $125.00 Chesney CK HARD HIT Year2003 COND::; Stock Number: Not Auto Salvage 038965 Grade:;N/A APU Quote#:2313 4802 1561 Used on 322 Regional-May need additional shipping charges Estimate AC Condenser $118.75 Pam's Auto(QRP) Year2005 Conditions and Options:NEW Not AFTERMARKET IN STOCK-SHIPS TODAY Used on Units of Damage:0.0 COND:0.0 Stock Number: Estimate NT1009APU APU Quote#:2313 4802 1561 322 Local-Located within local delivery area AC Condenser $120.00 AAA Auto Damage:None Year:2005 Conditions and Not Salvage(QRP) Options:NEW,AM,4950,LIST 152.00 Units Used on of Damage:0.0 COND:0.0:; Stock Number: Estimate N9999APU APU Quote#:2313 4802 1561 322 Local-Located within local delivery area AC Condenser $150.00 1 800 Radiator Part Number:4950VP Description:00-02 Not LESABRE,BONNEVILLE Stock Number: Used on 4950VP APU Quote#:2313 4802 1561 Estimate 322 Local-Located within local delivery area AC Condenser $150.00 Performance Part Number:4950 Description:2000-2005 Not Radiator of Chicago BUICK/PONTIAC BONNEVILLE,LESABRE Stock Used on Number:4950 APU Quote#:2313 4802 1561 Estimate 322 Local-Located within local delivery area AC Condenser $155.00 Keystone- AMPP Certified Part AC CONDENSER EXC GXP Not Minneapolis MODELS Part Number:CNDDPI4950:; Stock Used on Number:CNDDPI4950 APU Quote#:2313 4802 Estimate 1561 322 Local-Located within local delivery area AC Condenser $123.75 Chucks Auto Damage:None Year2005 Conditions and Not Salvage Inc Options:NEW LIFETIME WARRANTY,1 BIZ DAY Used on Units of Damage:0.0 COND:0.0 Stock Number: Estimate LIFETIAPU APU Quote#:2313 4802 1561 322 Regional-May need additional shipping charges Headlamp $112.50 Alliance OEM Damage:None Year:2004 Conditions and Used on Assembly,Driver Auto Parts Options:INSURANCE QUALITY OEM READY Estimate TO SHIP Units of Damage:0.0 COND:0.0 All Quoted Parts , ____ Part Total Price '$eller Comments Status PartRating:A Stock Number:A1010APU Grade:;A APU Quote#:2313 4802 1561 322 Local-Located within local delivery area Headlamp $156.25 Action Auto Parts Year:2002 Conditions and Options:BLUE,CUS Not Assembly,Driver Units of Damage:0.0 COND:0.0 Stock Number: Used on 115148APU Grade:;A APU Quote#:2313 4802 Estimate 1561 322 Local-Located within local delivery area Headlamp $168.75 PRP-Automotive 4DR,CUSTOM Year:2002 Units of Damage:0.00 Not Assembly,Driver Parts Solutions COND:A Stock Number:00007982APU Used on Grade:;A APU Quote#:2313 4802 1561 Estimate 322 Local-Located within local delivery area Headlamp $193.75 All Star Auto Lights LH OEM HALOGEN CUSTOM Year:2004 COND: Not Assembly,Driver Ohr:;Please allow up to 48 hours for delivery. Stock Used on Number:AL0312 Grade:;A APU Quote#:2313 4802 Estimate 1561 322 Local-Located within local delivery area Headlamp $193.75 All Star Auto Lights LH OEM HALOGEN CUSTOM Year:2003 COND: Not Assembly,Driver Ohr:;Please allow up to 48 hours for delivery. Stock Used on Number:AL0112 Grade:;A APU Quote#:2313 4802 Estimate 1561 322 Local-Located within local delivery area Headlamp $218.75 LKQ Smart Parts Headlamp Assembly Custom,L.PITS Part Number: Not Assembly,Driver $E7020-570 Condition:B Year:2001 :; Stock Number: Used on $E7020-570 Grade::B APU Quote#:2313 4802 Estimate 1561 322 Local-Located within local delivery area Headlamp $218.75 LKQ Smart Parts Headlamp Assembly Custom,LH,PITTS Part Number: Not Assembly,Driver $JF238-502 Condition:B Year:2004:; Stock Number: Used on $JF238-502 Grade:;B APU Quote#:2313 4802 Estimate 1561 322 local-Located within local delivery area Headlamp $218.75 LKQ Smart Parts Headlamp Assembly KNICKS ON LENS.CFD Not Assembly,Driver Part Number:$C07173-580 Condition:B Used on Year:2004:; Stock Number:$C07173-580 Estimate Grade:;B APU Quote#:2313 4802 1561 322 Local-Located within local delivery area Headlamp $218.75 LKQ Smart Parts Headlamp Assembly Custom,L.Part Number: Not Assembly,Driver $JF619-502 Condition:B Year:2004:; Stock Number: Used on $JF619-502 Grade:;B APU Quote#:2313 4802 Estimate 1561 322 Local-Located within local delivery area Headlamp $106.25 Pam's Auto(QRP) Year:2004 Conditions and Options:ASSY,LFT,LENS Not Assembly,Driver CRACKLE,SCRATCHES Units of Damage:0.0 Used on COND:0.0 Stock Number:Q0881APU Grade:; Estimate N/A APU Quote#:2313 4802 1561 322 Local-Located within local delivery area Headlamp $106.25 Pam's Auto(QRP) Year:2004 Conditions and Not Assembly,Driver Options:ASSY,LFT,PITTED,LENS CRACKLE,NOTES Used on Units of Damage:0.0 COND:0.0 Stock Number: Estimate M0781APU Grade:;N/A APU Quote#:2313 4802 1561 322 Local-Located within local delivery area Headlamp $125.00 Jerrys Auto Salvage L HEADLAMP SAND PITS Year:2001 Hourly Damage: Not Assembly,Driver 0.00 COND:A Stock Number:00015715APU Used on Grade:;N/A APU Quote#:2313 4802 1561 Estimate 322 Local-Located within local delivery area Headlamp $181.25 Sharp Auto Parts GRADE A-,MINOR PITTING Year:2001 Units of Not Assembly,Driver Damage:0.00 COND:A:;Please allow up to 48 Used on hours for delivery. Stock Number:MC0392APU Estimate Grade:;N/A APU Quote#:2313 4802 1561 322 Local-Located within local delivery area All Quoted Parts Part Total Price Seller Comments - Status Headlamp $137.50 Elite Auto Damage:None Year:2001 Conditions and Not Assembly,Driver Options:ASSY Units of Damage:0.0 COND:0.0 Used on PartRating:A:;Invoices under$50 will be shipped Estimate and subject to shipping charges. Stock Number: 120002APU Grade:;A APU Quote#:2313 4802 1561 322 Regional-May need additional shipping charges Headlamp $143.75 Chucks Auto Damage:None Year:2001 Conditions and Not Assembly,Driver Salvage Inc Options:SLVR.CUSTOM Units of Damage:0.0 COND: Used on 0.0 PartRating:A Stock Number:2DOO60APU Estimate Grade:;A APU Quote#:2313 4802 1561 322 Regional-May need additional shipping charges Headlamp $158.75 Elmers Auto Inc NICE Year:2003 Units of Damage:0.00 COND: Not Assembly,Driver A Stock Number:K314472APU Grade:;A Used on APU Quote#:2313 4802 1561 322 Regional Estimate -May need additional shipping charges Headlamp $81.25 Chesney -Cust,L.Year:2002 COND::; Stock Number:029937 Not Assembly,Driver Auto Salvage Grade:;N/A APU Quote#:2313 4802 1561 322 Used on Regional-May need additional shipping charges Estimate Headlamp $168.75 Elite Auto Damage:None Year:2003 Conditions and Not Assembly,Driver Options:l NONE MOUNTING TAB BROKE Used on Units of Damage:0.0 COND:0.0 PartRating:A:; Estimate Invoices under$50 will be shipped and subject to shipping charges. Stock Number:090108APU Grade:;N/A APU Quote#:2313 4802 1561 322 Regional-May need additional shipping charges Headlamp $187.50 AAA Auto Damage:None Year:2005 Conditions and Not Assembly,Driver Salvage(QRP) Options:BLC,DRIVER SIDE,2S6140,20405,000 Units Used on of Damage:0.0 COND:0.0 PartRating:A:; Stock Estimate Number:BL0812APU APU Quote#:2313 4802 1561 322 Local-Located within local delivery area Headlamp $351.00 Keystone- AMPP Certified Part Platinum Plus Part Not Assembly,Driver Minneapolis HEAD LAMP ASSEMBLY,LH,CUSTOM, Used on W/MARKER LAMP,SMOOTH HIGH BEAM Estimate SURFACE,REMANUFACTURED OE Part Number:GM2502204R:; Stock Number: GM2502204R APU Quote#:2313 4802 1561 322 Local-Located within local delivery area Headlamp $237.50 LKQ Smart Parts Headlamp Assembly LH,ASSY,OEM,BOXED,19245377 Not Assembty,Driver Part Number:LGH022-559 Condition:OEM Used on Year:2005:; Stock Number:LGH022-559 Estimate APU Quote#:2313 4802 1561 322 Local-Located within local delivery area Headlamp $237.50 LKQ Smart Parts Headlamp Assembly LH,ASSY,OEM,BOXED,19245377 Not Assembly,Driver Part Number:CLR005-303 Condition:OEM Used on Year:2005:; Stock Number.CLR005-303 Estimate APU Quote#:2313 4802 1561 322 Local-Located within local delivery area Hood $437.50 Pam's Auto(QRP) Year:2004 Conditions and Options:ASSY,GRY Used on Units of Damage:0.0 COND:1.0 Stock Number: Estimate Q0881APU Grade:;A APU Quote#:2313 4802 1561 322 Local-Located within local delivery area Hood $443.75 LKQ Smart Parts Hood LESABRE,BRN Part Number:$WJ773-540 Not Condition:A Year:2002:; Stock Number:$WJ773-540 Used on Grade:;A APU Quote#:2313 4802 1561 Estimate 322 Local-Located within local delivery area ______. AlI Quoted Parts Part Total P�ice Seller 'Comments Status Hood $456.25 LKQ Smart Parts Hood 4DR,SIL,140K,CUSTOM LESABRE Not SILVER Part Number:$A888&560 Condition: Used on A Year:2001 ; Stock Number:$A8888-560 Estimate Grade:;A APU Quote#:2313 4802 1561 322 Local-Located within local delivery area Hood $350.00 Sharp Auto Parts GRADE B-,5P1.5,BLUE Year2001 Units of Not Damage:1.50 COND:B:;Please allow up to 48 Used on hours for delivery. Stock Number:MC0392APU Estimate Grade:;B APU Quote#:2313 4802 1561 322 Local-Located within local delivery area Hood $456.25 LKQ Smart Parts Hood 4DR,WHT,159K,CUSTOM LESABRE,7HAIL Not DINGS Part Number:$JF619-502 Condition: Used on B Year:2004:; Stock Number:$JF619-502 Estimate Grade:;B APU Quote#:2313 4802 1561 322 Local-Located within local delivery area Hood $456.25 LKQ Smart Parts Hood TAN,LITE COROSION ALONG SEEM Not Part Number:$C07881-580 Condition:B Used on Year.2002:; Stock Number:$C07881-580 Estimate Grade:;B APU Quote#:2313 4802 1561 322 Local-Located within local delivery area Hood $456.25 LKQ Smart Parts Hood LESABRE WHT.5D1 Part Number:$LF950-940 Not Condition:B Year:2004:; Stock Number:$LF950-940 Used on Grade:;B APU Quote#:2313 4802 1561 Estimate 322 Local-Located within local delivery area Hood $456.25 LKQ Smart Parts Hood LESABRE,2R1,8D0.5 Part Number:$SL311-930 Not Condition:B Year:2002:; Stock Number:$SL311-930 Used on Grade:;B APU Quote#:2313 4802 1561 Estimate 322 Local-Located within local delivery area Hood $456.25 LKQ Smart Parts Hood LESABRE BLK.2R2 Part Number:$LF528-940 Not Condition:B Year:2004:; Stock Number:$LF528-940 Used on Grade:;B APU Quote#:2313 4802 1561 Estimate 322 Local-Located within local delivery area Hood $606.25 LKQ Smart Parts Hood BARE,OEM,BOXED,25752376 Part Number: Not BWS088-540 Condition:OEM Year:2005:; Stock Used on Number:BWSOSS-540 APU Quote#:2313 4802 Estimate 1561 322 Local-Located within local delivery area Hood $618.75 LKQ Smart Parts Hood BARE,OEM,BOXED,25752376 Part Number: Not J12005-502 Condition:OEM Year:2005:; Stock Used on Number:J12005-502 APU Quote#:2313 4802 Estimate 1561 322 Local-Located within local delivery area Hood $618.75 LKQ Smart Parts Hood BARE,OEM BOXED,25752376 Part Number: Not BPM077-390 Condition:OEM Year:2005:; Stock Used on Number:BPM077-390 APU Quote#:2313 4802 1561 Estimate 322 Regional-May need additional shipping charges Front End Assembly $93.75 Certified Auto Damage:None Year:2003 Conditions and Not Recyclers Options:4 DR,CSTM,3.8,AT,BRWN,FWD,RT.INNR Used on Units of Damage:0.0 COND:0.0 PartRating: Estimate A Stock Number:OK0097APU Grade:;A APU Quote#:2313 4802 1561 322 Local-Located within local delivery area Front end not required Front End Assembly $1293.75 Elmers Auto Inc WHT,3.8ATAC-FBR COVER&RFEN Not � Year.2003 Units of Damage:0.00 COND:A Used on ; Stock Number:K314472APU Grade:;A Estimate I APU Quote#:2313 4802 1561 322 Regional -May need additional shipping charges Parts Vendors Company Address Phone Contact Name 1 800 Radiator 4401 Park Road 800-406-4738 Rebecca,Tammy,or Jade Benicia, CA 94510 AAA Auto Salvage(QRP) 2871 West 160th Street 651-423-2432 Patrick M Rosemount, MN 55068 Action Auto Parts 106 Arlington Ave E. 800-243-2448 Ken,Jim,Don,or Choua St.Paul, MN 55117 AI�Star Auto Lights 38309 Abruui Dr 877-204-0074 Quaz G. Westiand, MI 48189 Alliance OEM Auto Parts 2197 Pineridge Dr SW Suite 888-775-2961 Big Dave,Little Dave,and 500 Todd Grand Rapids, MI 49428 Certified Auto Recyclers 3827 Crosstown Blvd 800-791-5150 Bennie Ham Lake, MN 55304 Chesney Auto Salvage 6250 Beaver River Rd 800-826-2941 Gary,Kevin,or Dick Duluth, MN 55803 Chucks Auto Salvage Inc 29999 East Bass Lake Rd. 800-300-6281 Spencer Grand Rapids. MN 55744 Elite Auto 2325 West Wayzata Bivd 800-886-2298 Shane Long Lake, MN 55356 Elmers Auto Inc N 877 Elmers Rd 800-362-5004 Eric x221 or Jim x223 Fountain City, WI 54629 Jerrys Auto Salvage 20798 US Hwy 10 763-263-2600 Jake or Tammy Big Lake, MN 55309 Keystone-Minneapolis 3615 Marshall Street NE 800-328-1845 Cary Welter Minneapolis, MN 55418 LKQ Smart Parts N4079 Highway E 800-349-5850 option 2 Sales Staff Hustisford. WI 53034 Metro Auto Salvage 11710 East 263rd St 952-461-2186 Ron. Lakeville, MN 55044 PRP-Automotive 1495 Broadway Street West 320-685-5557 Amy or poug Parts Solutions Rockville, MN 56369 Pam's Auto(QRP) 7505 Ridgewood Rd 320-363-7336 Flip,Rob,or Jim. St Cloud, MN 56303 Performance 17081 South Westview Ave., 708-333-5400 Sales Staff Radiator of Chicago Suite A Chicago, IL 60473 Remington Auto 4004 Curvue Road (800)871-2560 Sales Staff Saivage(QRP) Eau Claire, WI 54703 Rydell Chevrolet 1328 E.San Maranan Dr. 800-383-4601 Brian Tenley Surplus OEM Waterloo, IA 50702 Parts Vendors Company Address' Phone ' Contact Name ' Sharp Auto Parts 2910 Quant Ave 651-439-2604 Bob Monson Stillwater, MN 55082 Insurance Company Adjuster Name/Company ' Phone Liberty Mutual Liberty Mutual(W.Story) 800-838-7103 ext 3964 AUTO APPRAISAL REPORT LIBERTY MUTUAL INSURANCE COMPANY 27201 BELLA VISTA PARKWAY WARRENVILLE, IL 60555 PHONE(800)838-7103 FAX(603)334-8305 ***SUPPLEMENT 2*** 09/05/2012 S2 10/05/2012 01:30 PM _ ___.. ..�..�.....�._.._.____.___. Owner � Owner: JAMES WARREN Address: 1931 KENWOOD DR E Cell: (651)341-9892 Home/Day: (651)776-5792 City State Zip: MAPLEWOOD, MN 55117-2249 FAX: Email: jwarren179@live.com � Control lnformation �� Claim#: 023900160-03 Insured Policy#: XXXXX Loss Date/Time: 08/30/2012 Loss Type: Collision Deductible: $250.00 Ins.Company: Liberty Mutual City State Zip: WI FAX: Insured: JAMES WARREN Claim Rep: PATRICIA HUNTER X78244 Loss Payee: SOO LINE CU _....�__.�._._._�._�_._.�.� � ; Inspection Inspection Date: 10/05/2012 01:32 PM Inspection Type: Office Handled Claim Inspection Location: OFFICE Contact: City State Zip: De Forest,WI 53532 Primary Impact: Rear Secondary Impact: Front Driveable: No Rental Assisted: Appraiser Name: WADE LADWIG Appraiser License#: Orig Appraiser Name: BILL STORY Appraiser License#: � _ �� , . _ _____ __� Repairer � � Repairer: CENTURY AVE COLLISION CTR Contact: KATHY/GARY Address: 2501 CENTURY AVE Work/Day: (651)777-6055 City State Zip: NO. ST. PAUL, MN 55109 FAX: (651)779-9417 s Remarks �� """'**'*SUPPLEMENTS FOR LIBERTY MUTUAL INSURANCE***'*'**`***** "`""'*"'*"**"""All Supplements require prior approval"'*****"••***�"•*'*"• Please submit all supplements;the supplemental damage photos and invoices to e-mail address---Liberty0469@libertymutual.com or FAX to:603-334-8305. This is not an authorization for repair until you hear back from a Liberty rep '""'Liberty Mutual will notify you upon receipt of your supplement notice.**** 10/OS/2012 02:08 PM Page 1 of 5 2001 Buick Le Sabre Cuslom 4 DR Sedan 09/05/2012 Claim#: 023900160-03 10/05/2012 01:30 PM (Please include claim number,owners name,and my name on both email and fax) ALL LKQ/USED PARTS must be approved by a Liberty Mutual Representative PRIOR to return for part change and or payment consideration. .........�.............��...,.,........�,,........,....«�.........,.#........... SUPPLEMENT HANDLED AS DESK REVIEW ASSIGNMENT COOLING SYSTEM DAMAGES ARE OPEN FOR INSPECTION SUPPLEMENT REPLACE HOOD,A/C CONDENSOR, FRT ABSORBER, RT H/L, RT BMPR EXTEN. RECHARGE A/C, BLEND FNDRS, REPLACE EMBLEMS,FLEX, CAR CVR, REFRIG.,ADDITIONAL REPAIRS TO CVRS W/FULL REFINISH, DRIVER'S SEAT FRAME. ' Vehicle� �....�......� �..____.._._._.___�__.� �.n___.. 2001 Buick Le Sabre Custom 4 DR Sedan 6cyl Gasoline 3.8 4 Speed Automatic Lic.Plate: XMY616 Lic State: MN Lic Expire: VIN: 1G4HP54K41U163733 Prod Date: Mileage: 94,290 Veh insp#: Mileage Type: Actual Condition: Code: S4343A Ext.Color: MEDIUM BLUE PRL MET Int.Color: Ext. Refinish: Two-Stage Int.Refinish: Ext. Paint Code: 55,417G Int.Trim Code: Options Air Conditioning Aluminum/Alloy Wheels Anti-Lock Brakes Auto Load Leveling Compact Disc W/Tape Cruise Control Dual Airbags Intermittent Wipers Keyless Entry System Lighted Entry System Overhead Console Power Brakes Power poor Locks Power Drivers Seat Power Mirrors Power Steering Power Windows Rear Window Defroster Rem Trunk-UGate Release Side Airbags Sp�it Front Bench Seat Strg Wheel Radio Control Tilt Steering Wheel Tinted Glass Twilight Sentinel Velour/Cloth Seats ___- __. __�_.__� _ ___..__.___�___.�_� � Damages Line Op Guide MC Description MFR.Part No. Price ADJ% B% Hours R 1 N 27 Frt Bumper Cvr Overhau Additional Labor S1 1.0 SM 2 I 6 Cover,Front Bumper Repair S1 4.0* SM » REPAIRS TO LWR&GRILLE TABS 3 L 6 13 Cover,Front Bumper Refinish S2 3.7 RF 2.6 Surface 0.6 Two-stage setup 0.5 Two-stage 4 E 100 Extn,Front Bumper Otr RT 25693090 GM Part $41.50 S1 INC SM 5 E 7 Absorber,Front Energy 25649528 GM Part $123.97* S2 1.6 SM »PPD 6 E 11 Grille Assembly 25767965 GM Part $148.88 S2 INC SM »LKQ BAD 7 E 44 # Headlamp Assy,Halogen RT 19245I370 GM Part $270.38 S2 INC SM #=01,46 I 8 N 973 Headlamps Aim Additi�nal Labor 0.4 SM 9 E 45 Panel,Headlamp Mtg 19150�32 GM Part $574.83* S2 1.3 SM » PPD 10 EU 83 Panel,Hood LIKE KIND&QUALITY $400.00* +25.00 S2 0.8 SM »Pam's Auto(QRP)320-363-7336 »7F(1F Riri�awnnrl Rr1 '10/OS/2012 02:08 PM Page 2 of 5 2001 Buick Le Sabre Custom 4 DR Sedan 09/05/2012 Claim#: 023900'160-03 10I05/2012 01:30 PM »St Cloud MN 56303 11 L 83 Panel,Hood Refinish S2 4.8 RF 3.0 Surface 1.2 Edge 0.6 Two-stage 12 RI 86 Pad,lnsulator Hood R&I Assembly S1 0.4 SM 13 N 980 A/C Evac Rechrg&Rcvr Additional Labor S1 1.8 ME 14 EU 731 Condenser,A/C LIKE KIND&QUALITY $65.00` +25.00 S2 1.1 ME »Sharp Auto Parts 651-439-2604 »2910 Quant Ave »Stiliwater MN 55082 15 BR 103 Fender,Front LT Blend Refinish S1 1.1 RF 0.7 Blend 0.4 Two-stage 16 BR 104 Fender,Front RT Blend Refinish S1 1.1 RF 0.7 Blend 0.4 Two-stage 17 E 452 Emblem,Front Fender LT 25713251 GM Part $35.68 S1 0.2 SM 18 E 453 Emblem,Front Fender RT 25713251 GM Part $35.68 S1 0.2 SM 19 EU 421 Frame,Front Seat LT LIKE KIND&QUALITY $150.00* +25.00 S1 INC SM » PAM'S 320-363-7336 QUOTE#725814 JASON 20 RI 417 Cover,Seat Cushion LT R& I Assembly S1 1.9 SM 21 RI 419 Cover,Seat Cushion LT R& I Assembly S1 INC SM 22 RI 520 Armrest R&I Assembly S1 INC SM 23 N 31 RR Bumper Cvr Overhaul Additional Labor 1.4 SM 24 I 566 Cover,Rear Bumper Repair S1 4.0' SM 25 L 566 Cover,Rear Bumper Refinish S1 3.2 RF 2.7 Surface 0.5 Two-stage 26 E 567 Absorber,Rear Bumper 25649535 GM Part $120.82' S2 INC SM » PPD 27 EC M03 Flex Additive QUALITY REPL. PART $6.00* S1 RF 28 EC M17 Cover Car Exterior QUALITY REPL. PART $5.00* S1 RF 29 EC M21 Refrigerant QUALITY REPL. PART $45.00" S1 SM 30 SB M60 Hazardous Waste Removal Sublet Repair $5.00' S1 SM 31 EC FASTENERS AND RETAINER- QUALITY REPL. PART $32.16* S2 SM' 31 Items MC Message 01 CALL DEALER FOR EXACT PART#/PRICE 13 INCLUDES 0.6 HOURS FIRST PANEL TWO-STAGE ALLOWANCE 46 PRINTABLE ALTERNATE PARTS COMPARE ��Estimate Total&Entries � ��.__._�______._______._ Gross Parts $1,351.74 Other Parts $703.16 Paint Materials $444.80 Line Item Markup $153.75 Parts&Material Total $2,653.45 Tax On Parts Only @ 7.125% $157.37 Labor Rate Replace Repair Hrs Total Hrs H rs Sheet Metal(SM) $52.00 6.4 10.8 17.2 $894.40 Mech/Elec(ME) $75.00 1.1 1.8 2.9 $217.50 Frame(FR) $70.00 Refinish (RF) $52.00 13.9 13.9 $722.80 Paint Materials $32.00 Labor Total 34.0 Hours $1,834.70 10/OS/2012 02:08 PM Page 3 of 5 2001 Buick Le Sabre Cuslom 4 DR Sedan 09/OS/2012 Claim#: 023900160-03 10/OS/2012 01:30 PM Sublet Repairs $5.00 Gross Total $4,650.52 Less: Deductible $250.00- Net Total $4,400.52 Rates/Taxes Adjustment S1 Actual Supplement Total $603.85 Less: Previous Net Total $3,796.67- Net Supplement Total $603.85 Alternate Parts Y/01/00/00/01/01 CUM 01/00/00/01/01 Zip Code:53066 S Wisconsin Recycled Parts Y/3/0 Zip Code:53066 INV DATE: 10/05/2012 Audatex Estimating 6.0.626 S2 10/05/2012 02:08 PM REL 6.0.626 DT 08/01/2012 DB 10/01/2012 Copyright(C)2011 Audatex North America, Inc. 3.0 HRS WERE ADDED TO THIS ESTIMATE BASED ON AUDATEX'S TWO-STAGE REFINISH FORMULA. "THIS IS NOT AN AUTHORIZATION TO REPAIR. PRESENT THIS APPRAISAL TO THE REPAIRING GARAGE BEFORE REPAIRS BEGIN.WE RESERVE THE RIGHT TO INSPECT ANY ADDITIONAL DAMAGE BEFORE CONSIDERING PAYMENT OF SUPPLEMENTAL REPAIR CHARGES." NUMBER OF DAY TO REPAIR....... THIS ESTIMATE HAS BEEN PREPARED BASED ON THE USE OF CRASH PARTS SUPPLIED BY A SOURCE OTHER THAN THE MANUFACTURER OF YOUR MOTOR VEHICLE. THE AFTERMARKET CRASH PARTS USED IN THE PREPARATION OF THIS ESTIMATE ARE WARRANTED BY THE MANUFACTURER OR DISTRIBUTOR OF SUCH PARTS RATHER THAN THE MANUFACTURER OF YOUR VEHICLE. DEAR LIBERTY MUTUAL CUSTOMER, A LIBERTY MUTUAL APPRAISER OR APPROVED REPAIR FACILITY HAS COMPLETED AN APPRAISAL OF THE DAMAGES TO YOUR VEHICLE. A COPY OF THE APPRAISAL WILL BE MAILED IF ONE IS NOT ATTACHED. WITH LIBERTY MUTUAL YOU MAY CHOOSE WHO WILL COMPLETE REPAIRS TO YOUR VEHICLE. YOU MAY CHOOSE A SHOP YOU ARE FAMILIAR WITH OR ONE OF OUR TOTAL LIBERTY CARE SHOPS. (IF YOU DESIRE WE WILL PROVIDE YOU WITH A LIST OF OUR TOTAL LIBERTY CARE SHOPS. PLEASE PRESENT THE APPRAISAL TO THE SHOP OF YOUR CHOICE. ) THE SHOPS PARTICIPATING IN OUR TOTAL LIBERTY CARE PROGR.AM OFFER YOU BOTH A WRITTEN GUARANTEE AND QUALITY REPAIRS. LIBERTY MUTUAL, HOWEVER CAN ONLY OFFER A GUARANTEE AT OUR APPROVED TOTAL LIBERTY CARE SHOPS. SHOULD THE REPAIR SHOP FIND ADDITIONAL D�GE, THEY ARE REQUIRED TO CONTACT LIBERTY MUTUAL PRIOR TO PERFORMING ADDITO]�TAL REPAIRS. SUPPLEMENTAL CHARGES SUBMITTED WITHOUT PRIOR AUTHORIZATION FRO�I LIBERTY MUTUAL WILL BE DENIED. IF YOU WOULD LIKE LIBERTY MUTUAL TO ISSUE PAYMENT TO THE REPAIR SHOP YOU HAVE SELECTED DIRECTLY, PLEASE SIGN AND DATE THE AUTHORIZATION BELOW. �0/OS/2012 02:08 PM Page 4 of 5 2001 Buick Le Sabre Custom 4 DR Sedan 09/05I2012 Claim#: 023900160-03 10I05/2012 01:30 PM ------------------------------------------------------------------------------ . DIRECT PAYMENT AUTHORIZATION . I AUTHORIZE LIBERTY MUTUAL TO PAY ON MY BEHALF FOR THE REPAIR OF COVERED DAMAGES TO MY VEHICLE. VEHICLE OWNER'S SIGNATURE DATE **************************CAPA SHEET METAL OPTION***************************** A CAPA CERTIFIED SHEETMETAL PART IS AVAILABLE FOR YOUR VEHICLE FOR THE FOLLOWING PARTS. LEFT FENDER OEM $ QRP $ DIFFERENCE $ RIGHT FENDER OEM $ QRP $ DIFFERENCE $ HOOD OEM $ QRP $ DIFFERENCE $ LEFT DOOR OEM $ QRP $ DIFFERENCE $ RIGHT DOOR OEM $ QRP $ DIFFERENCE $ DECK LID OEM $ QRP $ DIFFERENCE $ YOUR TOTAL SAVINGS IF YOU CHOOSE CAPA PARTS WOULD BE: $ AS THE OWNER YOU HAVE THE CHOICE ***TOTAL DIFFERENCE SUBJECT TO PART AVAILABLILITY AND PRICE FLUCTUATION. USE OF CAPA CERTIFIED SUBSTITUTE SHEET METAL DOES NOT AFFECT YOUR WARRANTY. I HEREBY GIVE THE SHOP PERMISSION TO USE THE ABOVE CAPA PARTS Op Codes ' = User-Entered Value E = Replace OEM NG= Replace NAGS EC= QUALITY REPL. PART OE= OEM SURPLUS PART UE= OEM SURPLUS PART ET= Partial Replace Labor EP= QUALITY REPL. PART EU = LIKE KIND 8�QUALITY TE = Partial Replace Price PM= Replace PXN Reman/Reblt UM= Replace Reman/Rebuilt L = Refinish PC= Replace PXN Reconditioned UC= Replace Reconditioned TT = Two-Tone SB= Sublet Repair N = Additional Labor BR= Blend Refinish I = Repair IT = Partial Repair CG= Chipguard RI = R&I Assembly P = Check AA= Appearance Allowance RP= Related Prior Damage This report contains proprietary information of Audatex and may not be disclosed to any third party(other than the insured,claimant and others on a need to know basis in order to effectuate the claims process)without ��"C�7r� Audatex's prior written consent. d��t�rv rs�rrr{r.��ty Copyright(C)2011 Audatex North America,Inc. Audatex Estimating is a trademark of Audatex North America, Inc. 70/OS/2012 02:08 PM Page 5 of 5 "*"SUPPLEMENT RECONCILIATION*'* Supplement S2 Claim#: 023900160-03 Insured Policy#: XXXXX File#: Claim Rep: PATRICIA HUNTER X78244 Insured: JAMES WARREN Inspection Date/Time: 10/05/2012 01:32 PM Owner Name: JAMES WARREN Appraiser Name: WADE LADWIG Vehicle: 2001 Buick Le Sabre Custom 4 DR Sedan E ......... ._..._............... _ ....,. .... .......__....__......__._.. �_.....,.........-_ _ .�....._........ .__ ....v_... €Deleted Lines Line Guide Part Operation Price ADJ% B% Labor Rate 1 11 Grille Assembly LIKE KIND&QUALITY $60.00 +25.00 INC SM 2 41 Headlamp Assy,Halogen LT LIKE KIND 8�QUALI7Y S1 $90.00 +25.00 INC SM ;Added Lines Line Guide Part Operation , Price ADJ% B% Labor Rate 3 6 Cover,Front Bumper Refinish S2 3.7 RF 4 11 Grille Assembly Replace OEM S2 $148.88 INC SM 5 44 Headlamp Assy,Halogen RT Replace OEM S2 $270.38 INC SM 6 FASTENERS AND RETAINER- QUALITY REPL.PART S2 $32.16' SM' �.... .......__.._.._.....�_.__......__..__........___....___..�_.._._......____......_......._.___..___.._�.._.__..�._.�._._. _ _. _�_.�_._.._�� __...._.._._._..W_______� iChanged Lines Line W Guide Part Operation Price ADJ% B% Labor Rate 7 7 Absorber,Front Energy Replace OEM S2 $123.97' 1.6 SM Absorber,Front Energy S1 $130.50 1.6 SM 8 45 Panel,Headlamp Mtg Replace OEM S2 $574.83' 1.3 SM Panel,Headlamp Mtg $584.58 1.3 SM 9 83 Panel,Hood LIKE KIND&QUALITY S2 $400.00* +25.00 0.8 SM Panel,Hood S1 $350.00 +25.00 0.8 SM 10 83 Panel,Hood Refinish S2 4.8 RF Panel,Hood S1 5.4 RF 11 567 Absorber,Rear Bumper Replace OEM S2 $120.82' INC SM Absorber,Rear Bumper $122.86 INC SM 12 731 Condenser,A/C LIKE KIND 8�QUALITY S2 $65.00' +25.00 1.1 ME Condenser,A/C S1 $55.00 +25.00 1.1 ME _.__�� ;Calculation Changes __....___. _.____.___.__._ ----� - From To Difference Gross Parts $950.80 $1,351.74 $400.94+ Other Parts $761.00 $703.16 $57.84- Paint Materials $32.00 $345.60 $32.00 $444.80 $99.20+ Line Item Markup $176.25 $153.75 $22.50- Tax On Parts Only 7.125% $134.52 7.125% $157.37 $22.85+ RF-Refinish $52.00 $561.60 $52.00 $722.80 $161.20+ Actual Supplement 2 Net Total b603.85+ _.__----�.._.._____._..._....._.__._._------__�..___---__�____.__.....�___________________� =Summar�� Net Total Date Time Appraiser Supplement 1 $3,796.67 09/20/2012 10:10 AM DAN ZUNIGA Supplement 2 $4,400.52 10/05/2012 01:30 PM WADE LADWIG This report contains proprietary inforrt'ation of Audatex and may not be disclosed to any third party(other than the insured,claimant and others on a nee�d to know basis in order to effectuate the claims process)without Audatex's ��f��'�Y priorwrittenconsent. ', i./ A ar 3ralerar x;ti�mpart} - Copyright(C)2011 Audatex North�America,Inc. Audatex Estimating is a trademark of Audatex North America,Inc. 10/OS/2012 02:09 PM Page 1 of 1 Claim:023900160-03 Autosource Valuation 2001 Buick Le Sabre Custom 4D Sedan AS Request:31427077 '�Audatex Autosource Valuation .io�r.<a�. � . ■. t� .. . � . •.. Bill Story Claimanf Liberty Mutual Insurance Insured Warren,James Midwest Branch ' Glaim 023900160-03 27201 Bella Vista Parkway Loss Date 08/30/2012 Warrenville IL 60555 Loss Type Collision Policy XXXXX Other s �� . R . VIN 1G4HP54K41U163733 Decodes as''2001 Buick Le Sabre Custom 4D Sedan Accuracy Decodes Correctly History Activity was reported o Autosource activity: (NONE). o Autotrak activity: (NONE). o Audatex/Estimating activity: (NONE) o Sales history activity: (NONE) �� .. . � � •.. No recall bulletins have been issued that apply to this vehicle . . st .. . � � •.. After your claim is settled,Autosource provides free assistance in locating your next vehicle. Your request can be submitted online 24hrs. per day at http://www.support.audatex.us. Under Additional Services click the Autosource Vehicle Locator Service Form link to complete the VLS form. Or you can call us Monday through Friday, between 8:00 AM and 5:00 PM, Pacific time at (800)351- 3133, ext 7428. Our specialists will work with you to find a new or used vehicle in your area. . . . . �� .. . . � •.. Odometer, equipment, trim level and condition must all be carefully considered on this vehicle. The vehicle's typical mileage and condition is based on comparison of dealer and private party vehicles of the same year, vehicle type and state/province. The average miles driven for this vehicle is 138,876. Numerous descriptions have been described within each condition sub-category rating and are separated by a period. Each description is meant to be independent, but can also be interpreted as an "and/or" statement. . . . ■- � . - •- Seats Minor Wear Slight stains. Slight wear. Seams worn. Seams strained. 1-3 burn marks or holes smaller than a dime. slight odor or smoke smell. 1 tear smaller than a credit card. Leather shows slight surface cracks. Mold that can be removed with detail.Slight fading or discoloration. Carpets Minor Wear Slight stains. Slight wear, usually under pedals. Light fading. 1-3 burn marks or holes smaller than a dime. 1 tear smaller than a credit card. Molded inserts in carpet are cracked or have slight separation. Mold that can be removed with detail. Version: 1 Pa e:1 0 / 1 9 9 06/ 2 11:17 Claim:023900160-03 Autosource Valuation 2001 Buick Le Sabre Custom 4D Sedan AS Request:31427077 . . . �• . . Int'Trim Minor Damage Slight discoloration or wear. Slight scuffs or scratches. 1-3 burn marks or holes smaller than a dime. 1 crack no greater than 1 credit card in size. 1-2 control knobs or switches missing. 1-2 gauges or control switches not working.Cracked speaker covers. Mold that can be removed with detail. Glass Good No obvious damage. Numerous small pits. Light scratches visible on close inspection. Headliner Good No damage. Very negligible wear visibie on close inspection. Soiling removable with cleaning.No fading or discoloration. - •- Body Minor Damage Noticeable or multiple parking lot dings. 1-3 dents or creases no greater than 1 credit card in size. No large impacts or collision dents. No surface rust. Paint Moderate Damage Visible oxidation or fading. Discoloration that can't be buffed out. More than 3 scrapes or large scratches up to 6 credit cards in length or diameter. Extensive chipping. Checking on 3 or more panels. 1 primer area. Obvious mismatched paint on 1 panel. Poor quality complete vehicle repaint. Ext Trim Minor Damage Slight impact damage. Slight scratches to chrome or bumper covers. Discoloration in color-keyed sections including molding and lenses.Tear or gouge in cladding no greater than 1 credit card in size. Slight cracks in 1-2 lens covers. One emblem missing. Slight rust, oxidation or corrosion on 1- 2 items.Slight scrapes or marks on wheeis or wheel covers. 1 mismatched wheel. Hub cap or wheel cover missing. Engine Minor Wear Belts or accessories show slight wear or corrosion. Slight oil or fluid seepage around gaskets or covers. Poor fitting aftermarket cosmetic components. Transmission Minor Wear Obvious oil seepage around any of the following: transmission housing, transaxle, differential, transfer case. Recommended maintenance may not have been performed. Front Tires Good Tires are in good condition.30-79%of tread remains. Rear Tires Good Tires are in good condition.30-79%of tread remains. Having a clean, well maintained vehicle will add to its market value Prior body damage, rust, extensive interior damage or mechanical problems will all decrease the market value of this vehicle. . . �� .. - . . � � -.. Autosource has been chosen by Liberty Mutual Insurance to assist in establishing a fair and reasonable market value for your vehicle.We are proud to offer you the most current and comprehensive automotive valuations available today. Your vehicle was inspected and/or described to Autosource by a trained representative of Liberty Mutual Insurance. Autosource has evaluated all aspects of your vehicle provided by Liberty Mutual Insurance as well as those features identified by the Vehicle Identification Number(VIN)or known to be standard equipment for your vehicle. The market value of your vehicle is determined by comparing it to other vehicles in your area of similar make, model, equipment, mileage and condition that have been offered for sale or sold. The sources for this comparison include new and used car dealers, newspapers, traders, specialty journals and the Internet. Our exclusive Dealer Access program provides us with electronic inventories from thousands of a�liated dealers in North America. Each week, over 3,800,000 vehicles are listed from these sources, representing over 100,000 dealerships and 3400 publications, making our database the largest in the industry.We utilize the industry's largest electronic network and leading edge technology to provide you with the most current inspected, surveyed or advertised market data. We will find the closest vehicle matches in the area nearest your home. � i� .. . � •.. . . ' • 'Price $4,999 $4,999 Version: 1 Page:2 09/06/12 11:17 Claim:023900160-03 Autosource Valuation 2001 Buick Le Sabre Custom 4D Sedan AS Request:31427077 Engine 6 Cylinder 3.8 Engine 6 Cylinder 3.8 Engine Transmission 4 Speed Automatic 4 Speed Automatic Odometer 138,876 Mi(Typical) 94,290 Mi(Actual) 1,225 Equipment/Package Adjustment(See Valuation Detail) -35 Autosource Value Before Condition Adjustments 6,189 Total Condition Adjustments(See Condition Adjustment Detail) 0 • . • • • ' • -• $6,189 General'Sales Tax` *a/° � _ Title Fee! � . The market value displayed may not Transfer Fee i _�I reflect the activity detected by VINSOURCE and/or NICB research. Deductible -250.00 Net Adjusted Value !I -Salvage/Other!,- ; . �• i� .. . � � -.. . . • . City/State Little Canada, MN Little Canada, MN Price $4,999 $4,999 .• . . Year 2001 2001 Make Buick Buick Model Le Sabre Le Sabre Edition Custom Custom Door 4D 4D Body Sedan Sedan Drive 2WD 2WD Engine 6 Cylinder 3.8 Engine 6 Cylinder 3.8 Engine p Transmission 4 Speed Automatic 4 Speed Automatic p Color Not Applicable Light Blue Odometer 138,876 Mi(Typical) 94,290 Mi(Actual) 1,225 Convenience Options Air Conditioning Air Conditioning Tilt Steering Wheel Tilt Steering Wheel Cruise Control Cruise Control Rear Window Defroster Rear Window Defroster Strg Wheel Radio Control Strg Wheel Radio Control Rem Trunk-UGate Release Rem Trunk-L/Gate Release Other Optional Equipment Dual Airbags Dual Airbags Anti-Lock Brakes Anti-Lock Brakes Intermittent Wipers Intermittent Wipers Lighted Entry System Lighted Entry System Overhead Console Overhead Console Keyless Entry System Keyless Entry System Twilight Sentinel Twilight Sentinel Version: 1 Page:3 09/O6/12 11:17 Claim:023900160-03 Autosource Valuation 2001 Buick Le Sabre Custom 4D Sedan AS Request:31427077 . . • . Auto Load Leveling Auto Load Leveling Tinted Glass Tinted Glass Side Airbags Side Airbags Power Accessories Power Mirrors Power Mirrors Power Drivers Seat Power Drivers Seat Power Windows Power Windows Power Steering Power Steering Power poor Locks Power poor Locks Power Brakes Power Brakes Radio/Phone/Alarm Options Compact Disc W/Tape AM/FM Stereo Tape -20 Seat Options Velour/Cloth Seats Velour/Cloth Seats Split Front Bench Seat Split Front Bench Seat Wheel Options Aluminum/Alloy Wheels -15 Packages Premium Package Premium Package Autosource'Value Before Condition Adjustments 6,189 Total Condition Adjustments(See Condition Adjusfinent Detaii) 0 . . . . . . � . , a6,189 . . . �� .. • . � � •.. o Adjustments of Special Note � A mileage adjustment of 2.75 cents per mile/kilometer has been applied. This adjustment is based on the vehicle year, vehicle category and market area. Mileage adjustments are capped at 40%of the vehicle's starting value. � No special adjustments were made for this vehicle. o Information provided by Liberty Mutual Insurance ° Loss vehicle description was provided by Liberty Mutual Insurance � All values are in U.S.dollars. o Autosource Valuation Process � Over 3,800,000 vehicles are entered weekly into the database used for researching this value. This database includes dealer inspected,dealer inventory,dealer advertised,phone verified and advertised private party vehicles. � The originating search area for this valuation was Little Canada,Minnesota. o Other Adjustments or Comments � No obvious prior damages were evident other than typical wear � There is no tax for the given zip code of 55117. . . . • . .- �� .. • . , . •.. . • ' � - • - � Seats Minor Wear Minor Wear Carpets Minor Wear Minor Wear Int'Trim Minor Damage Minor Damage Glass Good Good Headliner Good ', Good • i Body Minor Damage i� Minor Damage Paint Moderate Damage ' Moderate Damage Ext Trim Minor Damage Minor Damage Version: 1 Page:4 09/06/12 11:17 Ciaim:023900160-03 Autosource Valuation 2001 Buick Le Sabre Custom 4D Sedan AS Request:31427077 • . � . Engine Minor Wear Minor Wear Transmission Minor Wear Minor Wear . Front Tires Good Good 'Rear Tires Good Good . . . . . • . $0 . �. ..• $0 . . . � . $0 s �f . . • -.. **N.A.D.A.Vehicle Description:2001 BUICK Lesabre-V6 Sedan 4D Custom N.A.D.A. values are as of August,2012 from the Official Older Used Car Guide,National Edition. Base Value $5,350 Mechanical Engine $0 Transmission $0 Equipment Equipment Subtotal $0 Mileage:94,290 Mi $1,475 ' • •• • . $6,825 These current N.A.D.A.values are furnished under license from NADASC.All values Copyright O NADASC 2012. The values in the N.A.D.A. guide assume a vehicle in clean condition. Appropriate deductions should be made to put a vehicle in salable condition. Special Note on Older Vehicles: N.A.D.A.'s editors believe that most optional equipment has little or no value on older vehicles. This is especially true of options that cost relatively little to begin with and which deteriorate with age or use. �t .. . , • •.. The Autosource database contains inspected dealer inventories, dealer advertisements, phone verified vehicles, and private party advertisements from thousands of sources including automotive publications, newspapers and Web sites. Autosource uses vehicles comparable in year, make and model within the specified market area, expanding as necessary, to determine the loss vehicle's local market value. This valuation includes a representative sample of the vehicles used to calculate the typical starting price. The market search originated from Zip Code 551172249, as determined by the vehicle owner's principally garaged area. Autosource located 36, 2001 Buick Le Sabre vehicles which were used to determine the typical vehicle price. Adjustments have been made to the comparable vehicles for value differences in vehicle description as indicated in the "Veh Adj"field. The sum of the 36 comparable vehicles is$195,594 for an average price of$5,433. The asking or actual sale price is displayed for each vehicle. If a vehicle has been sold, the sold price is displayed with an (S) indicator. The selling price may be substantially less than the asking price. In the case of this 2001 Buick Le Sabre,the difference between the asking price and selling price is generaliy 8%. This selling price adjustment has been applied to the typical price. Additional adjustments have been made to the typical vehicle price taking into consideration the loss vehicle's mileage,equipment and condition. All adjustments are vehicle specific and reflect driving habits and condition for the vehicle's market. A mileage adjustment of 2.75 cents per mile has been applied. Taking into consideration the vehicle specifics,the fair market value is$6,189. 1 Vehicle 2001 Buick Le Sabre Custom 2WD 4D Sedan " Phone'(651)982-2665 City Forest Lake State'MN Price $6,999 Version: 1 Page:5 09/06/12 11:17 Claim:023900160-03 Autosource Valuation 2001 Buick Le Sabre Custom 4D Sedan AS Request:31427077 Date 06/18/12 bistance 9mi VehAdj $0 VIN 1G4HP54KX14236829 Stock 236829 Adj Price $6,999 Seller Allegiance Auto Sales Odometer 78,115 Source Dealer Specialties Details 4 Speed Automatic, Premium Package,Anti-Lock Brakes,Air Conditioning,Auto Load Leveling, Cruise Control, Dual Airbags, Rear Window Defroster, Power Drivers Seat, AM/FM Stereo Tape, Intermittent Wipers, Keyless Entry System, Lighted Entry System, Overhead Console, Power Brakes, Power poor Locks, Power Mirrors, Power Steering, Power Windows, Rem Trunk-UGate Release, Side Airbags, Spiit Front Bench Seat, Strg Wheel Radio Control,Tinted Glass,Tilt Steering Wheel,Twilight Sentinel,Velour/Cloth Seats,fuel injected 2 Vehicle 2001 Buick Le Sabre Custom 2WD 4D Sedan Phone (651�58-9458 City Saint Paul State MN Price $5,900 Date 09/02/12 Distance-9mi VehAdj $0 VIN 1G4HP54K71U293537 Stock 293537 Adj Price $5,900 Seller Newport Auto Sales Inc -0dometer 181,780 Source Autotrader.com Details 6 Cylinder 3.8 Engine, Automatic Transmission, Premium Package, Air Conditioning, Dual Airbags, Auto Load Leveling, Anti-Lock Brakes, Cruise Control, Rear Window Defroster, Split Front Bench Seat, Intermittent Wipers, Keyless Entry System, Lighted Entry System, Power Mirrors, Overhead Console, Power Brakes, Power poor Locks, Power Steering, Power Windows, Power Drivers Seat, AM/FM Stereo Tape, Rem Trunk-UGate Release, Side Airbags, Velour/Cloth Seats, Strg Wheel Radio Control, Tinted Glass, Tilt Steering Wheel, Twilight Sentinel, Overdrive 3 Vehicle 2001 Buick Le Sabre Custom 2WD 4D Sedan Phone (763)780-5500 City Minneapolis State MN Price $5,999 Date 06/14/12 Distance 10mi Veh Adj $0 VIN 1G4HP54K31U108450 Stock 12607 Adj Price $5,999 Seller Midwest Car Search&Service Odometer 134,539 Source Cars.com Details 6 Cylinder 3.8 Engine, 4 Speed Automatic, Premium Package, Air Conditioning, Dual Airbags, Auto Load Leveling, Anti-Lock Brakes, Cruise Control, Rear Window Defroster,Split Front Bench Seat, Intermittent Wipers, Keyless Entry System, Lighted Entry System, Power Mirrors, Overhead Console, Power Brakes, Power poor Locks, Power Steering, Power Windows, Power Drivers Seat, AM/FM Stereo Tape, Rem Trunk-UGate Release, Side Airbags, Velour/Cloth Seats,Strg Wheel Radio Control,Tinted Glass,Tilt Steering Wheel,Twilight Sentinel 4 Vehicle 2001 Buick Le Sabre Custom 2WD 4D Sedan Phone (763)561-8111 City Minneapolis State MN Price $5,950 Date 07/08/12 'Distance 14mi Veh Adj $0 VIN 1G4HP54K514296484 Stock 121755A AdjPrice $5,950 Seller Luther Brookdale Honda Odometer 86,177 Source Autotrader.com Details 6 Cylinder 3.8 Engine, Automatic Transmission, Premium Package, Air Conditioning, Dual Airbags, Auto Load Leveling, Anti-Lock Brakes, Cruise Control, Rear Window Defroster, Split Front Bench Seat, Intermittent Wipers, Keyless Entry System, Lighted Entry System, Power Mirrors, Overhead Console, Power Brakes, Power poor Locks, Power Steering, Power Windows, Power Drivers Seat, AM/FM Stereo Tape, Rem Trunk-UGate Release, Side Airbags, Velour/Cloth Seats, Strg Wheel Radio Control, Tinted Glass, Tilt Steering Wheel, Twilight Sentinel, Overdrive 5 ; Vehicle 2001 Buick Le Sabre Custom 2WD 4D Sedan�� Phone (952)881-6200 City Minneapolis � State-MN Price $4,888 Date 08/08/12 Distance 15mi Veh Adj $0 VIN 1G4HP54K514296890 Stock,W57264 Adj Price $4,888 Seller Luther Bloomington Acura Subar . Odometer 110,731 Version: 1 Page:6 09/O6/12 11:17 Claim:023900160-03 Autosource Valuation 2001 Buick Le Sabre Custom 4D Sedan AS Request:31427077 Source Cars.com Details 4 Speed Automatic, Premium Package,Anti-Lock Brakes,Air Conditioning,Auto Load Leveling, Cruise Control, Dual Airbags, Rear Window Defroster, Power Drivers Seat, AM/FM Stereo Tape, Intermittent Wipers, Keyless Entry System, Lighted Entry System, Overhead Console, Power Brakes, Power poor Locks, Power Mirrors, Power Steering, Power Windows, Rem Trunk-L/Gate Release, Side Airbags, Split Front Bench Seat, Strg Wheel Radio Control,Tinted Glass,Tilt Steering Wheel,Twilight Sentinel,Velour/Cloth Seats 6 Vehicle 2001 Buick Le Sabre Custom 2WD 4D Sedan Phone (715)386-2334 City Hudson State WI Price $5,995 Date 09/02/12 Distance 18mi Veh Adj $0 VIN 1G4HP54KX1U214619 Stock 1622A Adj Price $5,995 Seller Dave Holt Ford-Mercury Odometer 133,268 Source Autotrader.com Details 6 Cylinder 3.8 Engine, Automatic Transmission, Premium Package, Air Conditioning, Dual Airbags, Auto Load Leveling, Anti-Lock Brakes, Cruise Control, Rear Window Defroster, Split Front Bench Seat, intermittent Wipers, Keyless Entry System, Lighted Entry System, Power Mirrors, Overhead Console, Power Brakes, Power poor Locks, Power Steering, Power Windows, Power Drivers Seat, AM/FM Stereo Tape, Rem Trunk-L/Gate Release, Side Airbags, Velour/Cloth Seats, Strg Wheel Radio Control, Tinted Glass, Tilt Steering Wheel, Twilight Sentinel, Overdrive 7 Vehicle 2001 Buick Le Sabre Custom 2WD 4D Sedan Phone (763)428-4500 City Osseo State MN Price $5,988 Date 08/05/12 Distance 25mi Veh Adj $0 VIN 1G4HP54K714284868 Stock T5532A Adj Price $5,988 Seller Dealer Odometer 138,026 Source Autotrader.com Details 6 Cylinder 3.8 Engine, Automatic Transmission, Premium Package, Air Conditioning, Dual Airbags, Auto Load Leveling, Anti-Lock Brakes, Cruise Control, Rear Window Defroster, Split Front Bench Seat, Intermittent Wipers, Keyless Entry System, Lighted Entry System, Power Mirrors, Overhead Console, Power Brakes, Power poor Locks, Power Steering, Power Windows, Power Drivers Seat, AM/FM Stereo Tape, Rem Trunk-L/Gate Release, Side Airbags, Velour/Cloth Seats, Strg Wheel Radio Control, Tinted Glass, Tilt Steering Wheel, Twilight Sentinel, Overdrive,Automatic Transmission 8 Vehicle 2001 Buick Le Sabre Custom 2WD 4D Sedan Phone (952)442-5000 City Chaska State MN Price $3,995 Date 07/09/12 Distance 35mi Veh Adj $0 VIN 1G4HP54K01U213706 Stock 13738P6 Adj Price $3,995 Seller Valley Pontiac GMC Odometer 123,408 Source Cars.com Details 4 Speed Automatic, Premium Package, Anti-Lock Brakes, Air Conditioning, Auto Load Leveling, Cruise Control, Compact Disc W/Tape, Dual Airbags, Rear Window Defroster, Power Drivers Seat, Intermittent Wipers, Keyless Entry System, Lighted Entry System, Overhead Console, Power Brakes, Power poor Locks, Power Mirrors, Power Steering, Power Windows, Rem Trunk-UGate Release, Side Airbags, Split Front Bench Seat, Strg Wheel Radio Control,Tinted Glass,Tilt Steering Wheel,Twilight Sentinel,Velour/Cloth Seats 9 Vehicle 2001 Buick Le Sabre Custom 2WD 4D Sedan Phone (507)645-5619 City Northfield Statei MN Price-$5,399 Date 08/04/12 Distance'38mi Veh Adj $0 VIN 1G4HP54K814294325 Stock N1300Z6 Adj Price $5,399 Seller Apple Chevrolet Buick Odometer 108,071 Source Cars.com Details 6 Cylinder 3.8 Engine, 4 Speed Automatic, Premium Package, Air Conditioning, Dual Airbags, Auto Load Leveling, Anti-Lock Brakes, Cruise Control, Rear Window Defroster, Split Front Bench Seat, Intermittent Wipers, Keyless Entry System, Lighted Entry System, Power Mirrors, Overhead Console, Power Brakes, Power poor Locks, Power Version: 1 Page:7 09/06/12 11:17 Claim:023900160-03 Autosource Valuation 2001 Buick Le Sabre Custom 4D Sedan AS Request:31427077 10 Steering, Power Windows, Power Drivers Seat, AM/FM Stereo Tape, Rem Trunk-UGate Release, Side Airbags, Velour/Cloth Seats,Strg Wheel Radio Control,Tinted Glass,Tilt Steering Wheel,Twilight Sentinel Vehicle 2001 Buick Le Sabre Custom 2WD 4D Sedan Phone (507)732-5194 City Zumbrota State MN Price $5,795 Date 09/02/12 Distance'S4mi Veh Adj $0 VIN 1G4HP54KX1U280961 Stock 12246C Adj Price $5,795 Seller GroverAuto Company Odometer 101,899 Source Autotrader.com Detaiis 6 Cylinder 3.8 Engine, Automatic Transmission, Premium Package, Air Conditioning, Dual Airbags, Auto Load Leveling, Anti-Lock Brakes, Cruise Control, Rear Window Defroster, Split Front Bench Seat, Intermittent Wipers, Keyless Entry System, Lighted Entry System, Power Mirrors, Overhead Console, Power Brakes, Power poor Locks, Power Steering, Power Windows, Power Drivers Seat, AM/FM Stereo Tape, Rem Trunk-UGate Release, Side Airbags, Velour/Cloth Seats, Strg Wheel Radio Control, Tinted Glass, Tilt Steering Wheel, Twilight Sentinel, Overdrive • . . . .- �� .. • . � � -.. Engine Options Transmission Options " 6 Cylinder 3.8 Engine STD " 4 Speed Automatic STD Other Optional Equipment Convenience Options ' * Anti-Lock Brakes STD " Air Conditioning STD ` Auto Load Leveling STD Automatic Dimming Mirror Analog Gauges ' Cruise Control STD Center Console Cargo/Trunk Net "` Dual Airbags STD ' Rear Window Defroster STD Driver Information Sys Garage Door Opener ' Intermittent Wipers STD Rain-Sensing W/S Wipers ' Keyless Entry System STD * Rem Trunk-L/Gate Release STD ` Lighted Entry System STD " Strg Wheel Radio Control STD Leather Steering Wheel * Tilt Steering Wheel STD ' Overhead Console STD Power Accessories OnStar System Heated Power Mirrors ' Side Airbags STD * Power Drivers Seat STD Stripe(s) Dual Power Seats $330 Traction Control System $175 ` Power Brakes STD ` Tinted Glass STD ' Power poor Locks STD ' Twilight Sentinel STD ' Power Mirrors STD Upgraded/Add'I Speakers ' Power Steering STD Seat Options " Power Windows STD Bucket Seats $70 Radio/Phone/Alarm Options Heated Front Seats $260 Alarm System Leather Seats $780 Compact Disc W/Tape $200 ' Split Front Bench Seat STD ' AM/FM Stereo Tape STD ' Velour/Cloth Seats STD Wheel Options , Aluminum/Alloy Wheels $165 O�tion Packages Gran Touring Package $2$5 Includes 3.05 Axle Ratio; Variable Assist Power Steering; i Touring Tires; Polished Alloy Wheels; Higher Rate Front ' Springs; Rear Stabilizer Bar; Gran Touring Suspension; Leather Wrapped Steering Wheel. Version: 1 Page:8 09/O6/12 11:17 Claim:023900160-03 Autosource Valuation 2001 Buick Le Sabre Custom 4D Sedan AS Request:31427077 Luxury Package $1,120 Includes Dual Illuminated Visor Vanity Mirrors; Concert Speaker System;Steering Wheel Controls; Cargo Net;Body Side Stripes; Inside Automatic Day/Night Mirror; Alloy Wheels;Air Filtration System;Analog Group Package. ' Premium Package STD Includes am/fm Stereo With Cassette; Power Driver Seat. Prestige Package $2,344 Includes Luxury Package; am/fm Stereo With Cd And Cassette; Onstar System; Inside Automatic Day/Night Mirror With Compass; Alarm System; Garage Door Opener; Rain Sensing W/S Wipers; Power Passenger Seat. Base�etail price $24,915 • ••- -• • -•• •• $24,915 Editions available for the same body style(in order of original cost, increasing):*Custom, Limited ` Indicates loss vehicle equipment. .. :. . �i .. . � i •.. A person who files a claim with intent to defraud or helps commit a fraud against an insurer is guilty of a crime. :.. �� .. . • � •.. NICB/ISO L005 LIBERTY MUTUAL INSURANCE COMPANY Member Claim 023900160 Loss Date 08/30/12 Type of Loss PROPERTY/CASUALTY Phone 6125467550 - :• • - .: �� .. . . . •.. No Vehicles Advertised at(651)341-9892 No Vehicles Advertised at(651)776-5792 � .. . . �� . . • . . � •.. This report contains proprietary information of Audatex and shall not be disclosed to any third party (other than the insured or claimant)without Audatex's prior written consent. If you are the insured or claimant and have questions regarding the description of your vehicle, please contact the insurance company that is handling your claim. Information within VlNsource/NICB is provided solely to identify potential duplicative claims activity. User agrees to use such information solely for lawful purposes. Tax rates contained herein are based on general sales tax data provided by Vertex Inc. Excise, use, registration, licensing and other taxes and fees that may be applicable are not included. Audatex makes no representations or warranties concerning the applicability or accuracy of such tax data. Report Generated by Audatex,a Solera Company US Pat.No 791274062 US Pat. No 8200513B2 O 2012 Audatex North America, Inc.All Rights Reserved. Version: 1 Page:9 09/06/12 11:17