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Nordquist NOTICE OF CLAIM FORM to the City of Saint Paul, Minneso�aC�IVED Minnesota State Stat:�te 466.05 states that "...eve erson...who claims dama es rom an munici ali shall cause to be re�ULd 1�e�O�� �7'P S I Y P �Y•-� P governing body of the municipaliry within 180 days after tlie alleged loss or injury is discovered a notice stating the time,���LERI� circumstances thereof,and the amount of compensation or other relief demanded." Please complete this form in its entirety by clearly typing or printing your answer to each question. If more space is needed,attach additional sheets. Please note that you will not be contacted by telephone to clarify answers,so provide as much information as necessary to explain your claim,and the amount of compensation being requested. You will receive a written acknowledgement once your form is received. The process can take up to ten weeks or longer depending on the nature of your claim. This form must be signed,and both pages completed. If something does not apply,write`N/A'. SEND COMPLETED FORM AND OTHER DOCUMENTS TO: CITY CLERK, 15 WEST KELLOGG BLVD, 310 CITY HALL, SAINT PAUL, MN 55102 First Name S2r Middle Initial�Last Name � (�C (.Q S Company or Business Name Are You an Insurance Company? Yes/�If Yes, Claim Number? Street Address �1 City Stat� 1 C I � 1 Zip Code_�> � /� � Daytime Phone�����Cell Phone ���(Evening Telephone((�)��C.�(p j Date of Accident/Injury or Date Discovered � ��� - ZfS � �_Time��jc-�am pm Please state, in detail, what occurred(happened), and why you are submitting a claim. Please i dicate why or how you fee the City of Saint Paul or its employees are involved and/or responsible for your damages. �. � 1 olY` -2.� � 6 � � r�e,e-� � � d- Please check the box(es)that most closely represent the reason for completing this form: ❑ My vehicle was damaged in an accident � My vehicle was damaged during a tow ❑ My vehicle was damaged by a pothole or condition of the street � My vehicle was damaged by a plow ❑ My vehicle was wrongfully towed and/or ticketed ❑ I was i �ured on City property S �� �Other type of property damage-please specify� �n „ ��J,� � i (? Q ���4- -�-� � ❑ Other type of injury-please specify � �L � In order to process your claim vou need tp include copies of all applicable documents. C � � � �� For the claims types listed below,please be sure to include the documents indicated or it will delay the handling of your claim. Documents WILL NOT be returned and become the property of the City. You are encouraged to keep a copy for yourself before submitting your claim form. O Property damage claims to a vehicle: two estimates for the repairs to your vehicle if the damage exceeds $500.00; or the actual bills and/or receipts for the repairs O Towing claims: legible copies of any ticket issued and a copy of the impound lot receipt O Other property damage claims: two repair estimates if the damage exceeds $500.00; or the actual bills and/or receipts for the repairs; detailed list of damaged items O Injury claims: medical bills,receipts O Photographs are always welcome to document and support your claim but will not be returned. Page 1 of 2-Please complete and return both pages of Claim Form Failure to complete and return both pages will result in delay in the handling of your claim. All Claims—please complete this section Were there witnesses to the incident? � No Unknown (circle) , � �ovide their names, addresses and tel pho e numbers: ' � _ or ° Were the police or law enforcement called? Yes No Unlrnown (circle) If yes,what department or agency? Case#or report# Where did the accident or injury take place? Provide street address, cross street, intersection,name of park or facility, clo est 1 dmar , etc. Please be as detailed as possible. If necessary, attach a diagram. � �-�— : ✓�- � h/1��1y5 ��- C��- �`o r �I��-G �� � j-� g ���.�A�-1--�-�-.�-s-�r a�..� Please indicate the amount you are seekin in compensation or what you woul like the City to do to resol this claim to yo r satisfa,ction. �� d' Q � � � � � Vehicle Claims— lease com lete this sec ion � check box if this section does not a 1 � Your Vehicle: Year�� Make � a Model ," License Plate Number State{/ �Color 0.r' � 1 Registered Owner /� �-- � �^ e�' Driver of Vehicle Area Damage f ^ � �•,'�� 'R-� City Vehicle: Year Make Model � License ber S olor Driver of Vehicle(City ' ame) ' Area Damaged In'ur Claims— lease com lete this section heck box if this section does not a 1 How were you injured? What part(s)of your body were injured? Have you sought medical treatment? Yes No Planning to Seek Treahnent(circle) When did you receive treatment? (provide date(s)) Name of Medical Provider(s): Address Telephone Did you miss work as a result of your injury? Yes No Whzn di�you miss work? - (provide�ate{s�; Name of your Employer: Address Telephone ❑ Check here if you are attaching more pages to this claim form. Number of additional pages By signing this form,you are stating that all information you have provided is true and correct to the best of your knowledge. Unsigned forms will not be processed. Submitting a false claim can result in prosecution. Date form was completed � Print the Name of the Pers�lm-E'oa ' Form: !� Signature of Person Making the Revised February 201 1 LATUFF BROS., INC. 880 UNIVERSITY AVENUE ST. PAUL, MINNESOTA 55104 (651)224-2828 FAX: (651)291-0677 FEDERAL ID#41-0777034 ***PRELIMINARY ESTIMATE**' 07/05/2013 03:49 PM __.�...__._._�._.__ __ _.��.._______�_.,_._.��v____._._.____._.__�_________�______._._____...����_____________.__ ___�_,___ _____�.. ._..._�__._._..._..., ' Owner �....__.._.__ __.... .. __. , _. . ��..___ . ..._._�. _ __�____. ._ _�.. ��.,_�.�_ _ __�...__.. _._ __e ___�a�..._�.__ _.� ...._. _ _..�._._ _ __... ._��.___�.i Owner: BECKY NORDQUIST Address: 675 PORTLAND AVE Work/Day: Home/Evening: (651)246-2461 City State Zip: Saint Paul, MN 55104 F�� �...__.___�__ . �.�_. �__.__ _. _ ��_.�_..._.�. �__ �..�._._ _ ___� ________.__a�._� Inspection Inspection Date: 07/05/2013 03:48 PM Inspection Type: Drive In Inspection Location: Latuff Brothers Inc Contact: Address: 880 University Ave Work/Day: (651)224-2828x FAX: (651)291-0677x City State Zip: Saint Paul, MN 55104 Work/Day: Email: general@latuffbrothers.com Primary Impact: Non-Collision Secondary Impact: Driveable: Yes Rental Assisted: Appraiser Name: ROBERT LATUFF Appraiser License#: __ _ � . ___ __.._� I Repairer� �___..._ _.. __.___ _.. __..�._._ �_.__.�_�...� ___- � ���Repairer. Latuff Brothers Inc Contact: Address: 880 University Ave Work/Day: (651)224-2828 FAX: (651)291-0677 City State Zip: Saint Paul, MN 55104 Work/Day: Email: general@latuffbrothers.com �____.____. __-__ ._. _ . �_._.. ..��_� . ����_�.�..�_-____. , '�� Remarks _.________ ______ _ _.. .�____ _ ******"***PRELIMINARY ESTIMATE"""""""""�'' POSSIBLE ADDITIONAL DAMAGE MAY BE FOUND AFTER TEAR DOWN E-ESTIMATES ARE SUBJECT TO PHYSICAL AUDIT PRIOR TO REPAIRS REPAIRS EXCEED VALUE ________ ..�.__..-� 1 Vehicle ____ _________ _.._.__�._.�._____ 2000 Ford Explorer XLS 4 DR Wagon 6cyl Gasoline 4.0 5 Speed Automatic Lic.Plate: UNKNOWN Lic State: MN Lic Expire: VIN: 1 FMZU72XOYUA83010 Veh Insp#: Mileage Type: Actual Condition: Code: P8433G Ext.Color: BLUE Int.Color: Ext.Refinish: Two-Stage Int.ReFnish: Two-Stage Options Page 1 of 4 07/05/2013 03:57 PM i 2000 Ford Explorer XLS 4 DR Wagon 07l05/2013 03:49 PM l;laim#: 4-Wheel Drive AM/FM Stereo Tape Air Conditioning Aluminum/Alloy Wheels Anti-Lock Brakes Automatic Trans Captain Chairs(2) Center Console Duai Airbags Intermittent Wipers Lighted Entry System Power Brakes Power poor Locks Power Mirrors Power Steering Power Windows Rear Window Defroster Rear Window Wiper/Washer Rem Trunk-L/Gate Release Roof/Luggage Rack Tachometer Tinted Glass Vinyl Seats .,.,�,,_._ ............._ .,.. . ..., _ ., ..,., ... ., ___ ..,. W v ___ _.._..___ .._.,,,,,,... _._.,,._...__�_.� �,,,,�..��.,�___.._� Damages . _ ._��_.___ .._.. . _. ...._..�� � Line Op Guide MC Description MFR.Part No. Price ADJ% B% Hours R Front Body And Windshield p.g SM 1 E 83 02 Panel,Hood F87Z166126A $630.18 5.4 RF 2 L 83 13 Panel,Hood Refinish 2.8 Surface 12 Edge 0.6 Two-stage setup 0.8 Two-stage 3 E 103 Fender,Front LT XL2Z16006DA $606.82 3.6 SM 4 L 103 Fender,Front LT Refinish 3.0 RF 2.0 Surface 0.5 Edge 0.5 Tv�o-stage 5 E 104 Fender,Front RT XL2Z160d5AA $696.55 1.6 SM 6 L 104 Fender,Front RT Refinish 3.0 RF 2.0 Surface 0.5 Edge 0.5 Two-stage 7 E 122 Mast,Antenna RT AL8Z18813A $30.00 0.1 SM 8 E 462 Cover,Antenna RT F5TZ18A927A $7.29 INC SM 9 NG 143 Windshield,Shaded NAGS DW1206-GB $191.70 2.7 SM 10 EC 144 Sealant Kit,W/Shield Replace Economy $25.00* INC SM 11 E 179 MIdg,W/S Reveal Upper YL2Z7803144AA $96.88 INC SM 12 E 180 Grille,Upper Cowl LT F57Z78022A69A $�5•22 INC SM Roof XL2Z785D202AA $585.43 20.1 SM 13 E 341 02 Panel,Roof 3.8 RF 14 L 341 Panel,Roof Refinish 3.7 Surface 0.1 Two-stage 0.5 SM 15 E 387 # Rack Assembly,Luggage F67Z7855100AAA $210.03 #=01,02 Front Doors 5.3 SM 16 E 207 02 Door SheIl,Front LT XL2Z78201256A $441.85 3.6 RF 17 L 207 Door SheIl,Front LT R 2 OS SurFace 1.0 Edge 0.6 Two-stage INC SM 18 E 249 02 MIdg,Front Door Scalp LT F67Z7820493AAA $68•12 INC SM 19 E 229 Mirror,0uter R/C LT F87Z17683AA6 $229•$� 0.7 SM 20 E 230 Mirror,0uter R/C RT F87Z17682AAA $238.23 Man �al Entries 0.3` SM" 21 EC M14 Corrosion Protection Replace Economy $�•��* RF 22 EC M17 Cover Car Exterior Replace Economy 7.00' Page 2 of 4 07I05/2013 03:57 PM 2000 Ford Evplorer XLS 4 DR Wagon 07/05/2013 03:49 PM Claim#: 23 SB M60 Hazardous Waste Removal Sublet Repair $5.00* SM 24 EC 8308 SEAM SEALER Replace Economy $49.50* SM* 24 Items MC Message 01 CALL DEALER FOR EXACT PART#/PRICE 02 PART NO. DISCONTINUED,CALL DEALER FOR EXACT PART NO. 13 INCLUDES 0.6 HOURS FIRST PANEL TWO-STAGE ALLOWANCE �_.�.�...,,�..,..___._...,____ ...���_..,,,.. _. ,,,,,...._,_. ._ �„�_.� ___.�..� �...,�� �_.__ _.�....�.�...__�_� ', Estimate Total 8�Entries ._----�---------------------- Gross Parts $3,916.40 Other Parts $280.20 Paint Materials $601.60 Parts&Material Total $4,798.20 Tax on Parts&Material @ 7.625% $365.86 Labor Rate Replace Repair Hrs Total Hrs H rs Sheet Metal(SM) $52.00 35.8 35.8 $1,861.60 Mech/Elec(ME) $85.00 Frame(FR) $75.00 Refinish(RF) $52.00 18.8 18.8 $977.60 Paint Materials $32.00 Labor Total 54.6 Hours $2,839.20 Sublet Repairs � $5.00 Gross Total $8,008.26 $8,008.26 Net Total Alternate Parts No I SPPL Yes Zip Code:55104 Default Audatex Estimating 7.0.019 ES 07/05/2013 03:57 PM REL 7.0.019 DT 05/0112013 DB 07/01/2013 Copyright(C)2013 Audatex North America,inc. 3.1 HRS WERE ADDED TO THIS ESTIMATE BASED ON AUDATEX'S TWO-STAGE REFINISH FORMULA. ESTIMATE CALCULATED USING THE 2.5 HOUR MAXIMUM ALLOWANCE FOR TWO-STAGE REFINISH OF NON-FLEX,EXTERIOR SURFACES. THIS ESTIMATE HAS BEEN PREPARED BASED ON THE USE OF ONE OR MORE CRASH PARTS SUPPLIED BY A SOURCE OTHER THAN THE MANUFACTURER OF YOUR MOTOR VEHICLE. WARRANTIES APPLICABLE TO THESE REPLACEMENT PARTS ARE PROVIDED BY THE PARTS MANUFACTURER OR DISTRIBUTOR RATHER THAN BY THE MANUFACTURER OF YOUR VEHICLE. A PERSON WHO FILES A CLAIM WITH INTENT TO DEFRAUD OR HELPS COMMIT A FRAUD AGAINST AN INSURER IS GUILTY OF A CRIME. Op Codes Page 3 ot 4 07I05I2013 03:57 PM i . � 2000 Facd E�eplorer XLS 4 DR Wagon Claim#: 07/OSf2013 03:49 PM * = User-Entered Value E = Replace OEM NG= Replace NAGS EC= Replace Economy OE= Replace PXN OE Srpls UE= Replace OE Surplus ET = Partial Replace Labor EP= Replace PXN EU = Replace Recycled 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 ��/����V Audatex's prior written consent. ��,� �1. a SeN+nr�crunp,�rY Copyright(C)2013 Audatex North America, Inc. Audatex Estimating is a trademark of Audatex North America, Inc. Page 4 0(4 07IO5I2013 03:57 PM - ROERING AUTOBODY Workfile ID: 95a39aac - FederalID: 411827490 90 N. DALE ST., SAINT PAUL, MN 55102 Phone: (651) 221-0919 FAX: (651) 221-1946 Preliminary Estimate Customer: Nordquist, Becky 7ob Number: Written By: Chad Mear Insured: Nordquist,Becky Policy#: Claim#: Type of Loss: Date of Loss: Days to Repair: 0 Point of Impad: Owner: Inspection Location: Insurance Company: Nordquist, Becky ROERING AUTOBODY 675 Pordand Ave 90 N. DALE ST. St Paul,MN 55104 SAINT PAUL,MN 55102 (651)246-2461 Other Repair Facility (651)221-0919 Day VEHICLE Year: 2000 Body Style: 4D UTV VIN: 1FMZU72XOYUA83010 Mileage In: Make: FORD Engine: 6-4.OL-FI License: 045LAK Mileage Out: Model: IXPLORER 4X4 XLS Production Date: State: MN Vehicle Out: Color: BLUE Int: GRAY Condition: Job#: TRANSMISSION DECOR AM Radio ROOF 5 Speed Transmission Body Side Moldings FM Radio Luggage/Roof Rack 4 Wheel Drive Dual Mirrors Stereo SEATS Overdrive Console/Storage Cassette Cloth Seats POWER CONVENIENCE Search/Seek Captain Chairs(2) Power Steering Air Conditioning SAFETY WHEELS Power Brakes Rear Defogger Anti-Lock Brakes(4) Aluminum/Alloy Wheels Power Windows Intermittent Wipers Driver Air Bag PAINT Power Locks Rear Window Wiper Passenger Air Bag Clear Coat Paint Power Mirrors RADIO 4 Wheel Disc Brakes 7/5/2013 3:22:33 PM 076657 Page 1 . Preliminary Estimate ' � - Customer: Nordquist, Becky ]ob Number: Vehicle: 2000 FORD IXPLORER 4X4 XLS 4D UTV 6-4.OL-FI BLUE Line Oper Description Part Number Qty Extended Labor Paint Price; 1 FRONT BUMPER 2 R&I R&I bumper assy 1.0 3 GRILLE _ 4 R&I Grille Sport,XL&XLT painted I���• 5 * Rpr Grille Sport,XL&XLT painted 1.4 1•8 6 Add for Clear Coat �•� _7 HOOD _ open Repl Hood F87Z166128A 1 630.18 1.3 2.8 9 Overlap Major Adj. Panel '0•4 10 Add for Clear Coat 0.5 il Add for Underside(Complete) 1.4 12 Repl RT Hinge XL2Z16796AA 1 37.32 0.3 0.3 13 Add for Clear Coat 0.1 14 Repl LT Hinge � F5TZ16797A 1 58.15 0.3 0.3 15 Add for Clear Coat 0.1 16 FENDER 17 Repl LT Fender w/o Sport XL2Z16006AA 1 892.02 2.8 2•5 lg Overlap Major Adj. Panel -0.4 i9 Add for Clear Coat 0.4 20 Add for Edging 0.5 21 Repl RT Fender w/o Sport XL2Z16005AA 1 696.55 3.0 2.5 22 Overlap Major Adj. Panel -0.4 23 Add for Clear Coat 0.4 24 Add for Edging _ 0.5 25 INSTRUMENT PANEL open Repl Instrument panel mediumn XL5Z10043206AC 1 1,722.35 6.3 graphite __ 27 PILLARS,ROCKER 8e FLOOR open Repl LT Uniside assy 4 door XL2Z78211A11A6 1 942.40 s 21.0 4.0 29 Overlap Major Adj. Panel -0.4 30 * Add for Clear Coat 0.7 31 ROOF _ open Repl Roof panel w/o sunroof w/rack 4 XL2Z7850202AA 1 585.43 21.5 3.8 door 33 Overlap Major Non-Adj. Panel -�'Z 34 * Add for Clear Coat 0.7 35 Add for luggage rack 1.5 open Repl Rack assy accessory kit XL2Z7855100AAA 1 265.67 Incl. 37 FRONT DOOR 3g Repl LT Mirror w/o power 3L2Z176836AA 1 145.40 0.4 39 ** Repl A/M RT Mirror w/o power 3L2Z17682BAA 1 73.00 0.4 40 WINDSHIELD 41 Repl Windshield Ford tinted F57Z7803100A 1 186.87 Incl. 7/5/2013 3:22:33 PM 076657 Page 2 _ Preliminary Estimate Customer: Nordquist, Becky 7ob Number: Vehicle: 2000 FORD IXPLORER 4X4 XLS 4D UTV 6-4.OL-FI BLUE 42 # Repl GLASS KIT 1 50.00 43 # Subl Hazardous waste removal 1 5.00 X 44 # Repl Car Cover 1 5.00 45 # Frame repair 1 5.0 F 46 # Setup time&measure 1 2.0 F 47 # Rpr Damage from unibody clamps 1.0 1.0 SUBTOTALS 6,295.34 68.8 23.2 ESTIMATE TOTALS Category Basis Rate Cost� Pa� 6,290.34 Body Labor 61.8 hrs @ $55.00/hr 3,399.00 Paint Labor 23.2 hrs @ $55.00/hr 1,276.00 Frame Labor 7.0 hrs @ $80.00/hr 560.00 Paint Supplies 23.2 hrs @ $32.00/hr 742.40 Body Supplies 59.3 hrs @ $3.95/hr 234.24 Miscellaneous 5.00 Subtotal 12,506.98 Sales Tax $7,266.98 @ 7.6250% 554.11 Grand Total 13,061.09 Deductible 0.00 CUSTOMER PAY 0.00 INSURANCE FAY 13,061.09 Roering Auto Body, takes great care to ensure that every repair meets your satisfaction. The labor performed by Roering Auto Body is guaranteed against any defect in workmanship for as long as you own your car. Roering Auto Body guarantees that for as long as you own your vehicle, Roering will, at its expense, correct or repair all defects which are attributable to defective or faulty workmanship in the repairs stated on the repair invoice, unless caused by or damaged resulting from unreasonable use, improper maintenance or care of vehicle, and rust and/or corrision. This guarantee covers labor only and does not apply to parts, materals or equipment which may be covered by manfacturer's warranty. MN ST 60A.955 - A PERSON WHO FILES A CLAIM WITH INTENT TO DEFRAUD OR HELPS COMMIT A FRAUD AGAINST AN INSURER IS GUILTY OF A CRIME. 7/5/2013 3:22:33 PM 076657 Page 3 _ Preliminary Estimate Customer: Nordquist, Becky 7ob Number: Vehicle: 2000 FORD IXPLORER 4X4 XLS 4D UlV 6-4.OL-FI BLUE Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from the Guide DE2MF95, CCC Data Date 6/14/2013, and the parts selected are OEM-parts manufactured by the vehicles Original Equipment Manufacturer. OEM parts are available at OE/Vehicle dealerships. OPT OEM (Optional OEM) or ALT OEM (Alternative OEM) parts are OEM parts that may be provided by or through alternate sources other than the OEM vehicle dealerships. OPT OEM or ALT OEM parts may reflect some specific, special, or unique pricing or discount. OPT OEM or ALT OEM parts may include "Blemished" parts provided by OEM's through OEM vehicle dealerships. Asterisk (*) or pouble Asterisk (**) indicates that the parts and/or labor information provided by MOTOR may have been modified or may have come from an alternate data source. Tilde sign (�) items indicate MOTOR Not-Included Labor operations. The symbol (<>) indicates the refinish operation WILL NOT be performed as a separate procedure from the other panels in the estimate. Non-Original Equipment Manufacturer aftermarket parts are described as Non OEM or A/M. Used parts are described as LKQ, RCY, or USED. Reconditioned parts are described as Recond. Recored parts are described as Recore. NAGS Part Numbers and Benchmark Prices are provided by National Auto Glass Specifications. Labor operation times listed on the line with the NAGS information are MOTOR suggested labor operation times. NAGS labor operation times are not included. Pound sign (#) items indicate manual entries. Some 2014 vehicles contain minor changes from the previous year. For those vehicles, prior to receiving updated data from the vehicle manufacturer, labor and parts data from the previous year may be used. The CCC ONE estimator has a complete list of applicable vehicles. Parts numbers and prices should be confirmed with the local dealership. The following is a list of additional abbreviations or symbols that may be used to describe work to be done or parts to be repaired or replaced: SYMBOLS FOLLOWING PART PRICE: m=MOTOR Mechanical component. s=M07"OR Structural component. T=Miscellaneous Taxed charge category. X=Miscellaneous Non-Taxed charge category. SYMBOLS FOLLOWING LABOR: ; D=Diagnostic labor category. E=Electrical labor category. F=Frame labor category. G=Glass labor category. M=Mechanical labor category. S=Structural labor categary. (numbers) 1 through 4=User Defined Labor Categories. OTHER SYMBOLS AND ABBREVIATIONS: Adj.=Adjacent. Algn.=Align. ALU=Aluminum. A/M=Aftermarket part. BInd=Blend. BOR=Boron steel. CAPA=Certified Automotive Parts Association. D&R=Disconnect and Reconnect. HSS=High Strength Steel. HYD=Hydroformed Steel. Inc1.=Included. LKQ=Like Kind and Quality. LT=Left. MAG=Magnesium. Non-Adj.=Non Adjacent. NSF=NSF International Certified Part. 0/H=Overhaul. Qty=Quantity. Refn=Refinish. Repl=Replace. R&I=Remove and Install. R&R=Remove and Replace. Rpr=Repair. RT=Right. SAS=Sandwiched Steel. Sect=Section. Subl=Sublet. UHS=UItra High Strength Steel. N=Note(s) associated with the estimate line. CCC ONE Estimating - A product of CCC Information Services Inc. The following is a list of abbreviations that may be used in CCC ONE Estimating that are not part of the MOTOR CRASH ESfIMATING GUIDE: BAR=6ureau of Automotive Repair. EPA=Environmental Protection Agency. NHTSA= National Highway Transportation and Safety Administration. PDR=Paintless Dent Repair. VIN=Vehicle Identification Number. 7/5/2013 3:22:33 PM 076657 Page 4 �'"�l = „ ��� x , .� �1;��'. '''1 -,•� r�� � � � - �?i _ �s -- '"_ - '/Ils�. - �,�- _ �4 �� ��� '_ S�•.� j� 1 _ ''�' ti ♦�> - " `� . / � f , l �:.;+� �._ ::-- - -� - < r ... � � _t - a, �� � � �'' � _ ,� rt> s , :��. _` r � . Z • .�.; ' •�� � . ' / � � f f • „ . 'S. - " � . . - . 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