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Yang, Maisee RECEIVED � JUL 12 2013 NOTICE OF CLAIM FORM to the City of Saint�a�uYl,��ta Minnesota State Statute 466.05 states that "...every person...who claims dmnages from any municipaliry...shall cause to be presented to the governing body of the mu��icipality within 180 days after the alleged loss or injury is discovered a notice stating the time,place,and circiunstances 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 Middle Initial Last Name Company or Business Name l^ Q. � ,n a 5 S�f OcQe, �� G1 � �P.C, '1/-1 rv o1 Are You an Insurance Company? �e /No If Yes,Claim Number? � 3 5�5�� 5 0�� o� 2 Street Address �r1�. l�� C,� \.211`�C� City 1�\ A C�.'�� State �� Zip Code 3 �Z�� Daytime Phone(��i3�� - 'S�y1'Cell Phone( ) - Evening Telephone( ) - Date of Accidend Injury or Date Discovered � ' �� ' � O 1 � Time ��5 l am/� Please state,in detail, what occurred(happened),and why you are submitting a claim. Please indicate why or how you eel the City of Sai�t Paul or its employees are involved and/or responsible for your d mages. \ �- � � �r'�.o �l C � v,, C, �� h� r��V n.`.1��l•.LC.� G:�'i �P.l (.t> �,Jf'� S �l�/' (��,-��1 '�-1 .�. � 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 f� My vehicle was damaged by a plow ❑ My vehicle was wrongfully towed and/or ticketed ❑ I was injured on City property ❑ Other type of property damage-please specify ❑ Other type of injury-please specify In order to process your claim vou neec� to include copies of all applicable documents. For the claims types listed below,please be sure to in�ude the documents indicated or it will delay the handling of your claim. Documents WILL NOT be returned and come 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? Yes No _nknow (circle) Provide their names, addresses and telephone numbers: Were the police or law enforcement called� Y�s% No Unknown (circle) If yes, what department or agency? ��, �Gi,,,\ �C� Case#or report# I 3r L�'�lZ 5 Where did the accident or injury take place? Provide street address,cross street, intersection,name of park or facility, closest landmark,etc. Please be as detailed as possible. If necessary, attach a diagram. 1 5 a1 �c�`c_V-��1 Please indicate the amount you are seeking in ompensation or what you would like the City to do to resolve this claim to your satisfaction. $� \ �,Sg\.� Z - �� ,��e n� Vehicle Claims— lease com lete this section ❑ check box if this section does not a 1 ' Your Vehicle: Year 'Z O\O Make (o�c r:� Model ��cti\��c r License Plate Number l,`l State M,N Color i/�h;� ' Registered Owner`�u � U Aiv� Driver of Vehicle � Area Damaged '�i-��ln� \ xr„f- 'i City Vehicle: Year Make Model License Plate Number State Color �l�o w Driver of Vehicle(City Employee's Name)�o��`a S S�-s'� �� Area Damaged Iniur_y Claims—please complete this section Q check box if this section does not applv i, How were you injured? ' What part(s)of your body were injured? Have you sought medical treatment? Yes No Planning to Seek Treatment(circle) When did you receive treatment? (provide date(s)) Name of Medical Provider(s): Address Telephone Did you miss work as a result of your injury? Yes No When did you miss work? (provide date(s)) Name of your Employer: Address Telephone �heck here if you are attaching more page�s to this claim form. Number of additional pages By signing this form,you are stating that all infdrmation you have provided is true and correct to the best of your knowledge. Unsigned forms will not be�rocessed. Submitting a false claim can result in prosecution. Date form was completed v`^�� z� � 3 Print the Name of the Person who Completed this Form: \ �.\�—� � R �\� Signature of Person Making the Claim: � � Revised February 2011 GEICO� GEICO General Insurance Company geico.com One Geico Center Macon,GA 3 1 296-000 1 07/09/2013 i City Clerk I To Whom It May Concern 15 Kellogg Blvd W 310 City Hall Saint Paul, MN 55102-1635 Company Name: Geico General Insurance Company Claim Number: 035956615-0101-092 II Loss Date: Monday, February 11, 2013 � Policyholder: Maisee Yang Driver: Tou Vang Your Insured: Douglas Strain Your Claim Number: Unknown To Whom It May Concern, Our investigation shows your insured to be at fault in the accident. We paid our insured's vehicle claim. Documentation is attached. Please honor our claim and remit payment. Our Interest: $1,161.47 Insured's Deductible: $500.00 Rental: $299.95 Total: $1,961.42 When remitting payment, please make your check payable to GEICO General Insurance Company as subrogee of Tou Vang. If you have questions, please contact me at the number below. Please refer to our claim number when writing or calling about this claim. Sincerely, Vicki Martin, Examiner Code S705 478-744-5148 ES0011 (04/2012) Payment Recovery Unit (Page 1 of 1) r�wiuGU�ice�n Page 1 of 1 �� 13028425 � a Mf�110PolY 1'Ip�MOr rBQ.g g A � �T �2 �0 �)0 i l�f '°` wo�r+.e rX --s'?'�' �cwE atm�rwa� , __ 2 i 1 013 �� 14 51 m w, lo � lsz7 Iaaho yos� �'�'�' Q��( a . m taxrrt�o � ert�� q�� s w rr�r W �_.Q_.err Sc �rr°`.b ri7+ 62 �,�u st paul `w�'rs ss�°o�°"r`°"`r� t_ a s�c rosu�qaewau�— 62 .,,� st paul t�. nwioe� ►�sc�ui urNC+ucseE�um�a s.uE uwss n�s ramr� can+cau�rcw,ao�.= sur[ a�a amaus 0/.1un� 1Z O1 53651706741108 WI DI O1 C163092081710 MN D O1 w.,on: .M.Ewmz�e.wn aaeaFarun wv�o�ut�u.uan oc..n� Douglas J Strain 11 11 $7 TOU YENG VANG �_ O1 18 87 . ..� � q � 17 923 Geiger St 13, O1 1656 MANfi'ON ST H� al 01 ..t� msw�v m�a O1 Osceola 54020 6su9assoo. ST PAUL 55105 � Ol �ex+.o �a sa � .ww E,x, r,s, �c e�r ��rr �na�a� [� w atv �eodurj oi X? P� . 2 �0 06 05 N � p� �4 04 0+1 D5 N O1 � r,.a � „�e ,o�v O..�wt.oRr ---::�� w,mw.nBe � ,,.a � „� .vw. ++ws.oar .�.,..ri� wMr� ' � �? Oa�ve ? ? 1+F' �•r f 0 arwe occu ar�nwuE ree owwwwE 0� City Of St Paul Public Works � V�}NG TOt7 YSNG pd, p� �r.. _ m,m .ao� � 90 891 N Dale St Pb 1654 MANTON sT � �3^" � .cau�rr tituc ce� mrsar�a � o.�c� w�w� 13 St PauJ., MN 55125 "1� 03 SAINT PAIIL NA�7 55106 .r 07 p7, n.owc .+v� �oos vew mae �we ow�oc 05 yel ToYT HIG oi � 04 o1csa wae� v�a .s,npw �+ao��ns � wr rwc� sr�ac Tffrt� � �a+.. a.o�er 01 03 � 03 649edn NIId 13 03 p3 02 +aw�rc� o"'c`Ka� 'auw""cE�+wra ►oucrK� Gity Of St Paul qeico 4I46836368 � aweo �x.w .wva - .�. .su..�oc. rnc .u� ' FK7CNBfiWVOLY�ACCM1�2pAI.M4TORVEiOCI$9CHODL6iJ5,�Rl1FJ1DSlART6U5 '�"�� RF.I�ER TO MCi1FYTTi'8'iA7E PATRCL(�IrW�aidx If3169.78i and 16L15tiL ? ! �+i+�lwEwG.[�tRmt�.►oroRawu6�wu[ OOi�t1A�t COwi�orlvoaaira�f-uv�wu+suenwK oorwueee ►�+r�arwnpsta ac � n*t ua �wc seer wsav �o�, � . � Qwa �� rarr►aet W a� + � °.�. �."� ""�..�` Q � p� � � �� ow. � � o� �e�o�o�.�ao.�o�,�o�.a��aa,�.,�,�,,�.�w�..�, �,w�,+�,.�e►a..w�sa �J l/1 noc,r. - - trmvnt � 03 ao..«e ---_..______ --- . _ .._..._.. _. . ..--•---•------- 98 03 Vehicle 1 vas saow ploving fn £�t of 1527 �.._--.._..------_-� ,....._.�_.�....__...._ wom� i��. vthtcle 2 was w3 Ida2io from Prosperity_ ————— ——A�� le-�-++as.�acki.�q.ssg_E�Ztu►LD.�nO_sJC�r.k._._._. �� Ol � � vehicla �. There was nD injuriea. Theze was minp 98 a1euac I ... _ . . . ._.......................___._ •-- � �rraa -.-.....__.. N�' T .Y.E�,� i _ __.. . .._.... _._._...- - --- _..........______....___.. o i se � � . °'� � .......... �� . . ._. ._ ._-.-••-------•..._.__ � �� ' � i --- --. ._ .... _. ._. .._ . .. .. .......__..,�__ �,�, � � 02 � ---.� __......._.......---- -......-- .....�__..._..---- w.nse� '�'°' � � .. .�., ., „ ,_ . . . . ...,........---- .__r._._......__ DB i �oma� I ......._...._ . ..... - - -�------__�....._.,. ...._._ umrt �3 1 .... O1 __ .... . ... . _ _. _ . _. ..__�—_... _. • _ _._ � ,._. . ........._ . . . _ _ .. .. ......_ . n �nawe. awoar .- __ .._�._... ... _. .. --'-.-..�-..__. ......._... .... . .. 09 D2 a�twNC�w�cnn.wa. �� --- .ouc� .a�n.su„a. po-lxce officer Sue Dn�tscrinann 67s' St Paul PA ea Q�� `�``� S.�c 70�s b x• , °� °�` Payment Details Page 1 of 1 Claim Number 0354566350301092 Pay To The Order Of ERAC FinanCials Gross Amount $299.95 Net Amount $299.95 8ackup Withholding $0.00 . Payment Identification Issued Date OS/20/2013 Mail To Name ERAC Mail To Address nullnullnull Memo PROPERTY COVERAGE Payment Type Electronic funds transfer Check Number E00381116 Related Documents . __... . . ..._--- ._... .,��tument Nam=_ ____._ .._....—._.. ....._.z'____—_�........_ �_..._____— ._..._ _—__._._...____ ___.....___—__—_ ... ., Reserve Line Allocat�on -- -- _—_ -- __ – __ _ _— ��ExFOSUre � � �Ree�r�e Line �� Cc t Type _.. 'Amc..nt � .__ __. ,...� .. _...._ . .._. _.. _.__–_ ....._.....�--- � -�- --.___._ —r _.. ........ _ _�___..._r. ..� _ _... .__... �Maisee Yang-Rental(2010 �� 'Rental Reimbursemen[ ;Loss '�...$Z99.95 '��..... TOYOTA) ' � _-__ __—_- ..... __ _ .__._�. http://ml up2093:1075/dms/fn/1789996174 Lhtml 7/8/2013 (Page 1 of 1) Rental Company:ENTERPRI SE R ENT-A-CAR � GE�CD Invoice: D286031-1901 .............,...,,....,.".,"., ,.,..."."., ...,.,,. ��GEICO Invoice: D286031-1901 Bill To: GEISSMW RENTAL DETAIL: GEICO ATTN: STEVEN CAZC-WILLIAMS Rental Period: 4l15/13 to 4/24J13(10 days} 1 GEICO CENTER Billed Period: 4/15(13 to 4/24/13(10 days) MACON, GA 31296 RENTER INF�RP�ATION: ' •� . � - Rate Amount ', Renter. YANG, MAISEE , RENT4L INFGRM�,TiON: �0 DAYS @ 25.35 I $253.50 : Rental Branch Location: ENTERPRISE RENT-A-CAR(1901) • • 1567 COUNTY ROAD E E • •' WHITE BEAR LAKE, MN 551105261 (651)484-2911 1 MNRENTL 6.20% `' $15,72 `' ADDITIONAL CL�IM INFDRMATIOt�: Claim Number:035956615-0101-092-01 ' � MNREGFEE i 5.00% " $12.67 Claim Type: Insured Vehicle Condition:Driveable � ; Date Of Loss:2/11113 1 SALES TAX 7.12% ; $18.06 ! Insured Name: MAISEE YANG ___.._.__r_ .____-- _--_. -___._ _:.._ _____..__-_; Owner"s Vehicle:2010 TOYOTA HIGHL Tota1 Charges: $299.95 Additional Driver: Repair Facility: Less Amount Received: $0.00 LAMETTREY'S-MAPLEWOOD MAPLEWOOD, MN 55109 Total Atnount Due: $299.95 (651) 766-9770 V€HI�L€�R€NT€B: Effective Date and Time Year Make Model VIN Rate Charged 4/15/13 2013 MAZD CX9 $25.35 Rental Invoice Please Return This Portion with Remittance Make Payment To: Total Charges: $299.95 ENTERPRISE RENT-A-CAR(1999) Less Amouirt Received: $0.00 2775 BLUE WATERS RD Total Amount Due.................... $299.95 EAGAN, MN 55'121-1439 Please include on your check: Federal ID:26-4548555 Invoice: D286031-1901 Payment Details Page 1 of 1 Ciaim Number 0359566150101092 Pay To The Order Of LAMETTRYS MAISEE YANG Financials Gross Amount $1,104.27 Net Amount $1,104.27 Backup Withholding $0.00 Payment Identification Issued Date 04/19/2013 Mail To Name LAMEI'TRYS Mail To Address 2951 Maplewood Drive,Maplewood,MN, 55109 Memo COLL]SION COVERAGE ORIGINAL PAYMENT Payment Type System Check Check Number 162619883 __ __-__ __._ Related Documents � ----. . _ ...._ .�-ocumeo*Name �'�� .' ._.... ___ .-- Reserve Line Aliocation �� .. _. ..---_...- -- �--- � - _.. ._ __.._—...._ _ ._... .._ . — _.. . . �.-,COaure '....Reserve:-ine �Cc z Type _. -Amount . � . ..... _..__.._._ ....... ......_ ._,_ ._ ...�... .. ..., . . -. _ .. .._....... ..�. _�__.�,._ _.,....�._.. ._ ...... �.... . .,_ .... -_. _._ . ___._ . -...._—'-. -- ' . Maisee Yang-Collision(2010 �Collision Loss ��:$1,104.27 � .�..TOYOTA) . . ._. .__ .... .. . . ..._. .. .... � http://m 1 up2129:1075/dms/fn/17899961871.html 7/8/2013 (Page 1 of 23) Details from Estimate for Claim no - 0359566150101092-01 Claim summary Number of photos 13 Number af photos 13 Folder Status 0 Company Name "VISIT US AT GEICO.COM" Addressl P.O. BOX 1306Q8 Address2 City,State,Zip ROSEVILLE,MN,55113 Phone 6123695645 E�timat� I�ngth 37422 Esti mate date 04/09/2013 License 649EDN MN COStS PARTS 161.5 6 BODY LABOR 12.4 HRS @$ 52.00/HR 644.80 PAINT LABOR 9.1 HRS @$ 52.00/HR 473.20 PAINT SUPPLIES 9.1 HRS @$ 32.00/HR 291.20 SUBLET/MISC. 18.00 OTHER CHARGES 4.00 SUBTOTAL $ 1592.76 SALES TAX $ 161.56 @ 7.12500 11.51 TOTAL COST OF REPAIRS $ 1604.27 ADJUSTMENTS: DEDUCTIBLE 500.00 � TOTAL ADJUSTMENTS $ 500.00 I NET COST OF REPAIRS $ 1104.27 Estimate Header 0359566150101092-01 Style 2010,TOYO,HIGHLANDER 4X4 Insured MAISEE YANG ' Loss date 02/11/2U13 Claim number 0359566150101092-01 Policy number 4146836368 Claim rep WILLIAMS, STEVE Shop name OC Claimant VIN JTEBK3EH7A2159084 Insurance Co. GEICO Insured is Owner Y Estimator STEVE WILLIAMS (Page 2 of 23) Photo O1 from Estimate for Claim no 0359566150101092-01-00 Photo date: 04/09/2013 11:13:50: Description: Insured: MAISEE YANG. Policy_no: 4146836368 CI,�L�ant:, „ ....�� ., .,.�. , ..,,..,_...,. ,� ,...,..,,...,.. Claimant: Vehicle: 2010,TOYO,HIGHLANDER 4X4. VIN: )TEBK3EH7A2159084 �9ss date; 02/11/2013. �stimater: STEV� WI��IAMS �� _ �,-: �� `� �k� , ��. �v � � � ,'�. � � � :a � ��_'-_ � _az �y"� � -� - � � - _ �� :_- �- ,��-� �` .,:� � k_ �� - . � s � rt � � �".��$ s 6 h d+qy5's ��i .� � � .qA 3 �f',�4� � -3��+ � ��" 4��;ld �5 �".ifl ��'il 4 �� i�i'� �� a.��, .�`_�� __ ._� �-._ _ � � _� - �,�` �. °� -v.¢�� __ � .. ` � Rav��`'�r� �`^F�,;:�r �f �,. � -�� .. �..:• '.t.,r w'��'._� �.,: "� .. ,�� -�— —_ '+ �� = ��, 'm"�� — � ,� � �'�'�"'�1"a M yti:�> ry�� ' — �."��y��,�4.'�r, ''"�-.`�'� ."�. � � ar�.. _- -_ ' �;�?'i ..: --r �:� � . . � � _ . __ ,. .'...'_ " -."�.�E�_.._..- ._ . ... � _ - . -s- - ��:� � _ - ` — -� � ..� .�- -- �_, _ � �'r �.� �� - .. � �_ . _ �r�j�k -� r�"�,� � w� ��„"'�^ P �� '`� ��'"��`� � -�� -� — ,��` � y � _ ''� r r �i1�_�3r� '*'-``�"¢�" * �=�� - F,�- `'�-. �.� 5�� . ._�,i:- - _ — �-� _� , -� 7i _�� . _ _ . � — �¢ .:'� �:- _ _� _� ...�=-- - _ r`.� - - — -- '- - - �i-_ _ _ __- _ ..��_� ,.,e,,-�- (Page 3 of 23) Photo 02 from Estimate for Claim no 0359566150101092-01-00 Photo date: 04/09/2013 11:13:50: Description: Insured: MAISEE YANG. Policy_no: 4146836368 ClaLrl'�d..nt', „ ....,�� „ ...�. , ,.,, ,� ,,,,,,,,,,,,,,, .,,_, „. Claimant: Vehicle: 2010,TOYO,HIGHLANDER 4X4. VIN: JTEBK3EH7A2159084 �oss date: 0�/11/2013, €stimater: ST�V� WIL-�IAMS �. - - - �;. �,,:� _ - _ �: �� _ _ _ _ � -� � t — f�;�� a — — ,� J � �r R �� `� � ��, , - � - '�{il�i �"�-�.��"�,�' � � ��9 � = �� `�i - � — t _ _ ,�� : �� '` — � ��M � �m �., - — _ V+f�$� — �y�4 �y9��2 �� `Y ��. _ ��'�—� - ° �� _ °�`—� =� � � — �`�r� � I�I F I � � ��4I� °�� :s �. ,_ — �. �` ... �" �.,,�� _ '°�' . � '� — — � � �-3 � _ �x� f,�, .� � .:�, I�. - �-,u� sa�`s� t� i _ �,_. h" fir"a�r �M r k��",.` �� _ �i _ .I��ii I �hYr�e��°9..�_ . N�� = ' ,�.� . ,s .� -. ," . . . �". . � �-f¢,�", . y _ -. , - _� q.��.� - k �k�� - — t�� ° - - �-� ,��.s 5 � ' � �` _ a - Y €#.�,�-�,a f� � _ . ,, a � 1"..� ,�. _ FI� — — f49 � �, y�d-^ �Y ' _ — ��`� - --- -- �' �- '..�. ^, _ . ... i�� " _ �� .�.'t a..� ,3 �y t y '� '`��xyn � �. _� � �� . ". . � �l., 5 1,? � - -`��-},��svR-"� t� :_' .. — S:. _ ��{7'- — — �� (Page 4 of 23) Photo 03 from Estimate for Claim no 0359566150101092-01-00 Photo date: 04/09/2013 11:13:49: Description: Insured: MAISEE YANG. Policy_no: 4146836368 Cl,�l..mant:, „ ...,�� „ ,,.... , ..,,,.,_,,.,. ,� ,,,,,,,,,,,,,,, Claimant: Vehicle: 2010,TOYO,HIGHLANDER 4X4. VIN: JTEBK3EH7A2159084 ��ss date; 0�/1�/�013. Estimator: ST�V� WI��IAMS .��, .��.� ��r.�y _- „��,-F- � _ �'° , � Y,. � _ . ��-�:;� :�� -.�'� .'".�� `;�� ,, '" . � ^ � ., ,� �� _ . _ _ � �� ,� , � � ';� �� r��,�',�� 4 �� _ �_ �� ` � �+� -� - � �= .,� '=� �-z �� F ,�` p � — .� � � � '� � �� : � ��M��',��; �y�'� .. � �` — — . —° = � �- — - � ��- .�� x.'�. �`" (Page 5 of 23) Photo 04 from Estimate for Claim no 0359566150101092-01-00 Photo date: 04/09/2013 11:13:49: Description: Insured: MAISEE YANG. Policy_no: 4146836368 Cl,airp�„nt:, „ ....�� „ .,..,. , ..,. .� ,.,.....,...,.. .,,_ .,. Claimant: Vehicle: 2010,TOYO,HIGHLANDER 4X4. VIN: )TEBK3EH7A2159084 Loss dat�: 0�/11/�0�3, �stimator; STEV€ WI��IAMS � � - ,� � k w�. � — � .-�, _., .�� :A � - _ . � � �:� - �� .;� _ , �� _� �: - .� __ �-_-:� ,� . � _ ,� : r a . z �. ,,,. , - �y - ,; R � _ �- �� } —��. � , � ., ; :x- . � ;� : �- � ,� . .-V � �, . �,;� .' �..�'�a � ��=��'�'�� _�� , ,�' - _ � , , � �� _�� . __y ' _� _-R.:_ . � - � — (Page 6 of 23) Photo 05 from Estimate for Claim no 0359566150101092-01-00 Photo date: 04/09/2013 11:13:49: Description: Insured: MAISEE YANG. Policy_no: 4146836368 CI,aLm�..nt:. .. ...,�� ,, .,.... . .,., .� ,.,.,..�...... ..,_ ... Claimant: Vehicle: 2010,TOYO,HIGHLANDER 4X4. VIN: JTEBK3EH7A2159084 �oss date; 02/11/�013. €stimator; ST€V€ WI��IAMS �� = _ E � - . . : : .. �, _ � .,� �� ,� � �: � � �� . : �, .. : , _ - �:-.._ . -,� * _ - � � � ��w�� ',�,',� r _ � �� p �, „ = - - -- .,�� _ � = � - � �_� T� . , � � - _ . �� _ - _ � �� * - = h �. � = _ - -�, �,�� '�y . arx� — — _ . �� +�"�;�c _� � �� - '�'a� � ' — :� — :- - �� ,; �,.a� � ,_ il� - M = - � � � . -' � . � _ � _ �'-�� , - _- � _ ■ 4�r:.��'4� = itl . - �. � :: �. : � : .. �,..,' . ,' � 7� i= _ _ � �y, y .,i _ ,_ �� ... 4- `�le 4 - — �� r `Y � y3y� �,°K 6� _ ��t �,�I1MXG �S�Y �� .r�l �'�.,� �. — �� Ch'} � _ _ �. �` �. — � 4 : zE _ � . � . �_ ��k� ,'� �I�� s I s 1 — � � 'rx �f =-�,_ - I, �� _ l ,�� 4 �I y�� (Page 7 of 23) Photo 06 from Estimate for Claim no 0359566150101092-01-00 Photo date: 04/09/2013 11:13:49: Description: Insured: MAISEE YANG. Policy_no: 4146836368 Cl,a l.m.s�..nt:, „ ....�� ., ...�. , .,,, .� ,.,,,...,...,,. .,,_ ,.,. Claimant: Vehicle; 2010,TOYO,HIGHLANDER 4X4. VIN: JTEBK3EH7A2159084 �oss dat�: 9�/11/�013. �stimator; ST�V€ WI��IAMS _�, �.- � , �, i �� ' � � ?� � ��=s��E �`�� — � _� ;„„ , E� _ � �r� _ � � �� — � � � -r - f�� ui �r.g p � � �„4� _ }� — r _ ��i�. ��_ _ � . .� . _ � q 3 - °•_�� — y�_ �-� � — ° z^� �� - �._�i d=.- ......��`�-- .� , __ - o � = �+M ��" �� ', -- . �-..� _ °'� -:._, =`ti .. ° �.�. ..�. ' i.�.. '��y i �. —� - — �. -:r �w- -- '"� � �� , ti.4 � „^� �� ` _ _ _ -�-' r� - _ � r� � - s^ � - ...., ��ti��r � — _ �� _ ; � - - w , �� k� � _ F — �.IY - _ — - ��P � � �..a�a` w .' .� — ° . - _ -� � -� �° . . 4 ' ,. " "�— .w — 2'8 .: i .�Id �{r R�' ,-„_ "..�; � s . �4� � �. - :_:' ..,_ .,A� . _. � t._y.._..-3. ��`� =,a�� _ .�.=3.,,s � � �&ti„d�, - II� # g ITI�'�i-��y -s�.":.�, . _ I (Page 8 of 23) Photo 07 from Estimate for Claim no 0359566150101092-01-00 Photo date: 04/09/2013 11:13:49: Description: Insured: MAISEE YANG. Policy_no: 4146836368 �la�„rpant:, „ ....�� ., .,.... , ..,,..,_.,... ,� ,.,.,.,.,...,., Claimant: Vehicle: 2010,TOYO,HIGHLANDER 4X4. VIN: )TEBK3EH7A2159084 �oss date; 0�/11/�013, €stimater; ST€V� WI��IAMS _ - -- � _ :-� �' � l = *; _ — — �� ==�k '� �y � g - ; ,�� = - � = -= -_ �� _ �._ °� - ,� E � � � � - . . � � � � � � �� - � _ _ ._,�, � - � z �..:. = =-�� - —�� _�,_ = (Page 9 of 23) Photo 08 from Estimate for Claim no 0359566150101092-01-00 Photo date: 04/09/2013 11:13:49: Description: Insured: MAISEE YANG. Policy_no: 4146836368 CI,aLm�„nt:, „ ....�� .. ...... . ,.,, .� ,,,,,,,,,,,,,,, ,,,_,,.,. Claimant: Vehicle: 2010,TOYO,HIGHLANDER 4X4. VIN: JTEBK3EH7A2159084 �9ss dat�; Q�/11/2013, �stimator; STEV� WI��IAMS . . , � `,�',� � =`�y--;£ , . �- - �� i � - -r� �,. � � �- �'�` �;��; ;f� �� — � "� 'u ��' � ` r? � .� � , ,,+ ' '°`��"� _ °� ._� n - -� �?t. �. � _ �� -�:��rk E;I� I i �� _��-- ��t M .��s ' � „p � -� � ' �� - i ��'riu�� Ij'�� u "'"�' l� ��#'�- �_ �, � �� uXi ..,I '�aull� I �a s�L s�- � � � — �`_� � �.r'� - , �s .,r - - �' — ,h� � � e � - �E r� �:.. I a i1 � ,�y�� i i � -^I��i �s§ � �� ° � ..��; �, .��-i`.' �I il � -="a.�xY—_.' :�i � -- ��i.",.." . 7�q .�� ,... �__ �; _ ..,_ ,,,: .;.. �. �-- � -�� --� ._-._ �s —�� -' ' _ .f = _ _ � �::. � � _ __ _ �� ;� , �y _°'� .� - .._ - -a. ��-. �, , ,:.�, ._ -_z __: - -3 �2�:.-._ �-- _ ,.. �-�_ .� __-: y � ��.. s.. s=y�: x ._ - ..F�r»�__ _. (Page 10 of 23) Photo 09 from Estimate for Claim no 0359566150101092-01-00 Photo date: 04/09/2013 11:13:49: Description: Insured: MAISEE YANG. Policy_no: 4146836368 CIaL,m�.nt:. „ ._..�� „ .,.... . ..,, ._ ,.............. ..,_. „. Claimant: Vehicle: 2010,TOYO,HIGHLANDER 4X4. VIN: JTEBK3EH7A2159084 ��ss dat�: 0�/�1/�013. €stimater: ST�V� WI��IAM� �� ss,. � a �, - _ ��=� � � - � �= ,_. , -_— — rr 4 "� �� .,,; �g - � �� ~ �� r�, �� "�' I�a� �� ul��' � � �" �'�� ; kt � - � - j�- �,_� - :�: - — — �- . � � — ��N,�'�— '�:� ' — r� I ` _ �� a"ri�,— — �� — - ��I � �_ '�� ' ' _ � � � — :. � ��`,�-��"'�; _;. -�� _��` =��4�,.. .-6' - -� Y 1 r�..—°��'�5� �s'�)�� :. r. �.+,��h�� "�� I ��ti:_ .. � � h � � L_ � _ � ' .�5.�'�� ° _ �..�,� t 7^��r �I� _ �°�°'ti�. _- �'3 � —� � �'� _ : �°� � -._i - ;��:.� ��I ��.-. __ �` � � � ��"- � ..'��` ^ a �� µ� r j � _ � "" �19 -�� `� �`` :'�V�� .I '< < — 3�`� � ��x� 6 — : -."S-��i'��q��' �,�_" 1 ,.-_ �k ter_— -'.7�r� �, ��'�"�4•� :..,- � s� :_�f�� Y1r :� fY u — _� - .: � :� �. �, � . _. -� . � �. Y 4�—" ., _. . '� :.. .__ �— � . ._— _ __ -- �__ '�. '-n',- I —_ — - i .__ -;�,��..a i.l � � ; :,�1�t,"` -�+..i�}.. 4y"hW'ayv. - —_ ��T '�ME (Page 11 of 23) Photo 10 from Estimate for Claim no 0359566150101092-01-00 Photo date: 04/09J2013 11:13:49: Description: Insured: MAISEE YANG. Policy_no: 4146836368 Clal,m�„nt:, „ ,...�� „ ...�. , ..,. ,� ,..,...,,.,,,.. � .,,_,,.,. Claimant: Vehicle: 2010,TOYO,HIGHLANDER 4X4. VIN: JTEBK3EH7A2159084 ��ss date; Q2/11/�013. �stimator: ST€V€ WI�LIAMS - � �, � ;.� -�,,��:� � = �.�-° ��ii r� . �� ,� � i�P��r i - - _ .,��,�„��,, .. �- ,�— �,� �,� .e� - i � { — �d��, �� y,� �� ,�,��.-��"�- �. g'� 49 ��` �.- '"' �a�'y"`c� �--�� 'y'�l�,yK.�."��.��,YI s.:V �o�l �4�� ' ,rfi.'� _ p i'�iG °z , P � � -� . ''- y-.:� ..g __.s� � : � �� 4� ' .� � ��'�' � �. .,.. � .� -�K��X�" �µ �^',�'�y �. .�r. � __ :�'nY" F �i�'��m,,�, � � >w„ ��'��.'. S:� — r.i� a �° � _ •� *� ��,-.-_ (i� I k�z c — _ J_V _ _. .:_ �.�- ' _- . . `�. . ,wf �_ ... . ,. - � " �--, � �- �� :- ,_. ��Ir:�"� _ e � . _� ` € - � . — �� z�=_ . ,�_ ��= �`;�`� � " = �� '� �� - � . � . - . �� ." s� _ �� F . . . - .—... -- �-�. � � `�_ ��, � �. �#- F i — �v�a�� r d — — � ° � c�,�F � �, A .,� ^,�s��hr _ ;, :�3 e- ��d f m..e � � k� � � ,�I�"4!.�'I� _ _ — �� .�� . � -�r'.. — ic. y�r��-�� `r�I��^ — `� � � . � '� � � �� - . - �� , �—� � �� '�' .�� -�� 3� �� = — �� - J�� ,� — �d�l,�� 4v 1� � � �u_ � , �- � r�� (Page 12 of 23) Photo 11 from Estimate for Ciaim no 0359566150101092-01-00 Photo date: 04/09/2013 11:13:49: Description: Insured: MAISEE YANG. Policy_no: 4146836368 Cl,airpant:, ,. ,...�� „ .,..... . .,.. ,� ,.,.,.,,,.,,,.. ..,_, ... Claimant: Vehicle: 2010,TOYO,HIGHLANDER 4X4. VIN: JTEBK3EH7A2159084 L�ss date: 0�/11/2013, €stimater; STEV€ WI��IAMS — � _ ��, — - �---� � } — ��_�� , :.�� =�Ta p� , _ ��_ — �_— _ - ��,� -— — , - �� _ A�": � , ��,� z�:�;� �-° � � z � �� - � � m = a �� '�a �� 4 ��fi � '� x` f� ��s �� K ��,�p q � ,.— �� —=�� :„ � s ��, r �a` ihy�� 4�qu 'T _ �, .�.4�# � � � .... � �' �_ � �� .� � ..�, _. -. � � ��t .��s � + a -; � � _�� =�"" �€��V�� I�� -.- r�� e .._�°�`� - " ,;� _ — — _ r — `.��,,# �_.i'� ��r r�7',�.�� P�„',,. _- ' — ;;' � � � _ ��.. 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'`�"� � �-� - �'� � - '�.� ,.� - ^`� �w�` � �.�T � �� '� �. k� r - � r M3 �� -_ - �£ - . "� - 3 �' . - � � � �` -�. � c€ - ..�''��.'�� - ' '� ! ,g - !i�v � - :.Y�+ ,�., �,' �_ �U �h�� c � i J�" � = z�`` ��'°�`"� _ Y� .� 4.=>�� -'�g� � � � _— j r�e+ . _ �n�� - - -'��s 4� F*�� , ` � - � ��_'�^4 . � �' g� A�yy�-�' — ! R- C` -'`f.� � ?�ufi. y__:��''- �� . } .:�� .. ��-�'�a� . � , — P ��_ _ - _ ,� '� �' $- - � 1 �}� � C _ '�� ' �.� � � �� - - _ ,�"Y ° � .. .a = > .,� '��,..��-��"� .��"x'= _ _ � _ � ay., � . . � �'°7'�--�-�.'."°� ��° '%��'ti� .��s.'�°'"�' � � �. � - PN r �.� . � �.tC� - _ � � _ _ � � ��,a ,� . �_� � ��,'"��: `�� - �;i . �_ _ ». . , a � . , �. . - � a— �,�� _ �_ � _: (Page 15 of 23) 04l0912013 �T 11 :35 AM 0359566150101092-01 94900 218428VB GEICO GEICO "VISIT US RT GEICO.COM" FOR SUPPLEMENTS PLEASE SEE ATTACHED FORM P.O. BOX 130608 ROSEVILLE, MN 55113-0006 (612 ) 369-5645 FAX: (305) 328-4105 ESTIMATE OF RECORD WRITTEN BY: STEVE WILLIAMS 04/09/2013 11: 21 AM ADJUSTER: STEVE WILLIAMS (612 ) 369-5645 INSURED: MAISEE YANG CLAIM #0359566150101092-01 OWNER: MAISEE YANG POLICY #4146836368 ADDRESS: 1876 MECHANIC AVE DATE OF LOSS: 02/11/2013 AT 04 : 00 PM SAINT PAUL, MN 55119-4821 TYPE OF LOSS: COLLISION BUSINESS: { 651) 554-3409 POINT OF IMPACT: 5. RIGHT REAR EVENING: ( 651 ) 497-7641 INSPECT COOKS ONE STOP BODY SHOP DAY: (651 ) �77-5555X0000 LOCATI4N: 179Q GERVAIS CT DRIVE IN SAINT PAUL, MN 55109-0000 REPAIR OC 5 DAYS TO REPAIR FACILITY: LICENSE # 2010 TOYO I�IGI�LAND�R 4X4 6=3.5L=FI 9D UTV WHITEJPEAR INT: VIN: JTEBK3EH7A2159084 LIC: 649EDN MN PROD DATE: ODOMETER: 29137 CONDITION: GOOD AIR CONDITIONING REAR DEFOGGER TILT WHEEL CRUISE CONTROL TELESCOPIC WHEEL INTERMITTENT WIPERS KEYLESS ENTRY REAR WINDOW WIPER DUAL MIRRORS PRIVACY GLASS CONSOLE/STORAGE aVERHEAD CONSOLE ' REAR SPOILER THREE STAGE PAINT POWER STEERING � POWER BRAKES POWER WINDOWS POWER LOCKS I POWER MIRRORS AM RADIO FM RADIO '' STEREO SEARCH/SEEK CD PLAYER ', AUXILIARY AUDIO CONNECTIO ANTI-LOCK BRAKES (4 ) DRIVER AIR BAG ', PASSENGER AIR BAG HEAD/CURTAIN AIR BAGS FRONT SIDE IMPACT AIR BAG TRACTION CONTROL STABILITY CONTROL CLOTH SEATS 3RD ROW SEAT CAPTAIN CHAIRS (2) RETRACTABLE SEATS AUTOMATIC TRANSMISSION 4 WHEEL DRIVE ALUMINUM/ALLOY WHEELS ------------------------------------------------------------------------------- NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT ------------------------------------------------------------------------------- 1 ROOF 2 R&I RT SIDE RAIL BASE 0. 4 3 R&I RT DRIP MOLDING FRONT 0. 4 4 R&I RT DRIP MOLDING CENTER 0. 4 5 R&I RT DRIP MOLDING REAR 0. 4 6# RPR ROPE W/SHIELD FOR PAINT 0. 2 7# BLND RT UPPER RAIL CLEAR ONLY 0. 6 8 QUARTER PANEL 1 (Page 16 of 23) 0410�/2013 AT 11 : 35 AM 0359566150101092=01 94900 218428VB ESTIMATE OF RECORD 2010 TOYO HIGHLANDER 4X4 6-3. 5L—FI 4D UTV WHITE/PEAR INT: �J111"1H1�, VC Kr,I�VKL 2010 TOYO HIGHLANDER 4X4 6-3. 5L—FI 4D UTV WHITE/PEAR INT: ------------------------------------------------------------------------------- N0. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT ------------------------------------------------------------------------------- 9* RPR RT QUARTER PANEL 4 . 5* 2 . 4 10 ADD FOR THREE STAGE 1 , 7 1] R&I RT QUARTER GLASS TOYOTA 3. 5 2 . 6 LITER 12# SUBL GLASS KIT 1 18. 00 X 13 REAR LAMPS 14 REPL RT COMBO LAMP ASSY BASE, 1 161 . 56 1 . 2 LIMITED 15 REAR BUMPER 16 R&I R&I BUMPER COVER 1 . 3 17* RPR BUMPER COVER 0. 8* 2 . 6 18 ADD FOR THREE STAGE 1 . 8 19 R&I LOWER COVER 0. 2 20 OTHER CHARGES 21# E. P.C. 1 4 . 00 ------------------------------------------------------------------------------- SUBTOTALS =—> 183. 56 12 . 4 9.1 ------------------------------------------------------------------------------- PRIOR DAMAGE NOTES: PRIOR UNRELATED DAMAGE NOTES:❑ ❑ FRONT BUMPER:❑ NONE LT FENDER:NON E❑ HOOD:❑ NONE4 LT FRONT DOOR:NONE❑ LT REAR DOC7R:N ONE❑ ROOF:❑ NONE I LT QUARTER PANEL:N ONE❑ DECKLID/TAILGATE:� NONE43 I REAR BUMPER:� NONE INTERIOR:❑ NONE FRONT LAMPS:NONE❑ RT FENDER:NONEO GLASS:❑ NONE3 RT FRONT DOOR:NONE❑ RT REAR DOOR:❑ NONE SUNROOF:❑ NON E RT QUARTER PANEL:❑ NONE REAR LAMPS:NONE❑ BACK GLASS:❑ NONE TIRES:❑ 2 (Page 17 of 23) 04J0912013 AT 11 :35 AM 0359566150101092-01 94900 218428VB ESTIMATE OF RECORD 2010 TOYO HIGHLANDER 4X4 6-3. 5L—FI 4D UTV WHITE/PEAR INT: �b111"lH1C, VC K�I.VKll 2010 TOYO HIGHLANDER 4X4 6-3. 5L—FI 4D UTV WHITE/PEAR INT: PARTS 161 . 56 BODY LABOR 12 . 9 HRS @$ 52. 00/HR 644 . 80 PAINT LABOR 9. 1 HRS @$ 52. 00/HR 473. 20 PAINT SUPPLIES 9. 1 HRS @$ 32 . 00/HR 291. 20 SUBLET/MISC. 18. 00 OTHER CHARGES 4 . 00 ---------------------------------------------------- SUBTOTAL $ 1592. 76 SALES TAX $ 161.56 @ 7 . 1250% 11 . 51 ---------------------------------------------------- TOTAL COST OF REPAIRS $ 1604 . 27 ADJUSTMENTS: DEDUCTIBLE 500. 00 ---------------------------------------------------- TOTAL ADJUSTMENTS $ 500. 00 NET COST OF REPAIRS $ 1104 . 27 3 (Page 18 of 23) 04/0912013 AT 11:35 AM 0359566150101092=01 94900 218428VB ESTIMATE OF RECORD 2010 TOYO HIGHLANDER 4X4 6-3. 5L—FI 4D UTV WHITE/PEAR INT: �J-111"lH-l�C� VC tC�I.,VKU 2010 TOYO HIGHLANDER 4X4 6-3. 5L—FI 4D UTV WHITE/PEAR INT: NO SUPPLEMENTAL PAYMENT REQUEST WILL BE HONORED BY GEICO UNLESS IT HAS BEEN II�iSPECTED AND AUTHORIZED IN WRITING BY A GEICO REPRESENTATIVE BEFORE THE SUPPLEMENTAL REPAIRS ARE STARTED AND THE PROPER INVOICES HAVE BEEN SUPPLIED. SHOP PHOTOS AF ANY PART OR LABOR IS NOT A SUBSTITUTE FOR A GEICO PHYSICAL INSPECTION AND CANNOT BE CONSIDERED. REPAIR SHOPS MUST ALSO PRESENT A COPY OF THE ORIGINAL GEICO ESTIMATE BEFORE 71NY SUPPLEMENTAL CHRRGES WILL BE CONSIDERED. MINNESOTA LAW GIVES YOU THE RIGHT TO CHOOSE ANY RENTAL VEHICLE COMPANY, AND PROHIBITS ME FROM REQUIRING YOU TO CHOOSE A PARTICULAR VENDOR NUMBER OF DAYS TO REPAIR ON THE FIRST PAGE OF THIS ESTIMATE IS THE MAXIMUM DAYS THAT GEICO WILL PAY FOR A RENTAL CAR IF APPLICABLE. NOTICE: NEW HIGH STRENGTH STEELS MAY REQUIRE THE USE OF A MIG WELDER FOR PROPER REPAIRS. NEW DESIGNS REQUIRE MEASUREMENT TO PROPERLY ALIGN THE VEHICLE. MAKE SURE YOUR SHOP HAS THE RIGHT EQUIPMENT TO REPAIR YOUR VEHICLE. MN ST 60A. 995 — A PERSON WHO FILES A CLAIM WITH INTENT TO DEFRAUD OR HELPS COMMIT A FRAUD AGAINST AN INSURER IS GUILTY OF A CRIME. THIS IS NOT AN AUTHORIZATION TO REPAIR ��*��***�*�****�*�***�******************�****�*�*************************�*�* �*************** BY SIGNING THIS ESTIMATE THE SHOP AGREES TO HAVE REVIEWED AND DISCUSSED THE i ESTIMATE OF DAMAGE WITH A GEICO FIELD ADJUSTER AND HAS AGREED TO ALL VISIBLE, � (NON—HIDDEN) DAMAGE REPAIR, REFINISH OR REPLACEMENT TIMES. THE SHOP ALSO 'i AGREES TO THE LABOR AND MATERIAL RATES LISTED IN THE ESTIMATE AND ACKNOWLEDGES I THE SUPPLEMENT REQUEST PROCEDURE LISTED BELOW. ; SHOP REPRESENTATIVE DATE 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. 4 (Page 19 of 23) 04109/2013 RT 11 : 35 RM 0359566150101092-01 94900 218428VB ESTIMATE OF RECORD 2010 TOYO HIGHLANDER 4X4 6-3. 5L—FI 4D UTV WHITE/PEAR INT: r,J1�11"1H�1C, Vr KC�I.VKll 2010 TOYO HIGHLANDER 4X4 6-3. 5L—FI 4D UTV WHITE/PEAR INT: ESTIMATE BASED ON MOTOR CRASH ESTIMATING GUIDE. UNLESS OTHERWISE NOTED ALL ITEMS ARE DERIVED FROM THE GUIDE ARM8438, CCC DArI'A DATE 04/Ol/2013, AND THE PARTS SELECTED RRE 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 PROVIDFD 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 DOUBLE RSTERISK (** ) INDICATES THAT THE PARTS AND/OR LABOR INFORMATION PROVIDED BY MOTOR MAY HAVE BEEN MODIFIED OR MAY HAVE COME FROM AN ALTERNATE DA1A 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, A/M, QUAL REPL PARTS OR COMP REPL PARTS WHICH STANDS FOR COMPETITIVE REPLACEMENT PARTS. USED PARTS ARE DESCRIBED AS LKQ, QUAL RECY PARTS, RCY, OR USED. RECONDITIONED PARTS ARE DESCRIBED AS RECOND. RECORED PARTS ARE DESCRIBED AS REC4R. NAGS PART NUMBERS AND BENCHMARK PRICES ARE PROVIDED BY NATIONAL AUTO GLASS SPECIFICATIONS. LABOR OPERATION TIMES LISTED ON THE LINE WITH THE NAGS INFORMATION ARE MOTOR SUGGESTED LABOR OPERATION TIMES. NAGS LABOR OPERATION TIMES ARE NOT INCLUDED. POUND SIGN ( #) ITEMS INDICATE MANUAL ENTRIES. SOME 2012 VEHICLES CONTAIN MINOR CHANGES FROM THE PREVIOUS YEAR. FOR THOSE VEHICLES, PRIOR TO RECEIVING UPDATED DATA FROM THE VEHICLE MANUFACTU�ER, LA�OR AND PA�T� DATA FROM TI�E PREVIOUS YEAR MAY �E USED. TI�E PATHWAYS ESTIMATOR HAS A COMPLETE LIST OF APPLICABLE VEHICLES. PART NUMBERS AND PRICES SHOULD BE CONFIRMED WITH THE LOCAL DEALERSHIP. THE FOLLOWING IS A LIST OF ADDITIONAL ABBREVIATIONS OR SYMBOLS THAT MAY BE USED TO DESCRIBE WORK TO BE DONE OR PARTS TO BE REPAIRED OR REPLACED. SYMBOLS FOLLOWING PART PRICE: M=MOTOR MECHANICAL COMPONENT. S=MOTOR STRUCTURAL COMPONENT. T=MISCELLANEOUS TAXED CHARGE CATEGORY. X=MISCELLANEOUS NON—TAXED CHARGE CATEGORY. SYMB�LS FOLLOWING LABOR: D=DIAGNOSTIC LABOR CATEGORY. E=ELECTRICAL LABOR CATEGORY. � F—FRAME LABOR CATEGORY. G=GLASS LABOR CATEGORY. M=MECHANICAL LABOR CATEGORY. j S=STRUCTURAL LABOR CATEGORY. (NUMBERS) 1 THROUGH 4=USER DEFINED LABOR CATEGORIES. OTHER SYMBOLS AND ABBREVIATIONS: ADJ.=ADJACENT. ALGN.=ALIGN. ALU=ALUMINUM. A/M=AFTERMARKET PART. BLND=BLEND. BOR=BORON STEEL. CAPA=CERTIFIED AUTOMOTIVE PARTS ASSOCIATION. COMP REPL=COMPETITIVE REPLACEMENT ( PART) . D&R=DISCONNECT AND RECONNECT. HSS=HIGH STRENGTH STEEL. HYD=HYDROFORMED STEEL. INCL.=INCLUDED. LKQ=LIKE KIND AND QUALITY. LT=LEFT. MAG=MAGNESIUM. NON—ADJ.=NON ADJACENT. NSF=NSF INTERNATIONAL CERTIFIED PART. O/H=OVERHAUL. QTY=QUANTITY. QUAL RECY=QUALITY RECYCLED (PART) . QUAL REPL=QUALITY REPLACEMENT ( PART) . REFN=REFINISH. REPL=REPLACE. R&I=REMOVE AND INSTALL. R&R=REMOVE AND REPLACE. RPR=REPAIR. RT=RIGHT. SAS=SANDWICHED STEEL. SECT=SECTION. SUBL=SUBLET. UHS=ULTRA HIGH STRENGTH STEEL. N=NOTE (S) ASSOCIATED WITH THE ESTIMATE LINE. 5 (Page 20 of 23) 04/0912013 RT 11 :35 AM 0359566150101092-01 94900 218428VB ESTIMATE OF RECORD 2010 TOYO HIGHLANDER 4X4 6-3. 5L—FI 4D UTV WHITE/PEAR INT: r�b�l 11"lH7�C� Vt' K�I.VKll 2010 TOYO HIGHLANDER 4X4 6-3. 5L—FI 4D UTjJ VJHITE/PEAR INT: CCC PATHWAYS — A PRODUCT OF CCC INFORMATION SERVICES INC. THE FOLLOWING IS A LIST OF ABBREVIATIONS THAT MAY BE USED IN CCC PATHWAYS THAT ARE NOT PART OF THE MOTOR CRASH ESTIMATING GUIDE: BAR=BUREAU OF AUTOMOTIVE REPAIR. EPA=ENVIRONMENTAL PROTECTION AGENCY. NHTSA=NATIONAL HIGHWAY TRANSPORTATION AND SAFETY ADMINISTRATION. PDR—PAINTLESS DENT REPAIR. VIN=VEHICLE IDENTIFICATION NUMBER. 6 (Page 21 of 23) 0410912013 RT 11 : 35 AM 0359566150101092=01 94900 218428VB ESTIMATE OF RECORD 2010 TOYO HIGHLANDER 4X4 6-3. 5L—FI 4D UTV WHITE/PEAR INT: C�J�111"1H1-� VC K�L.VKll 2010 TOYO HIGHLANDER 4X4 6-3. 5L—FI 4D UTV WHITE/PEAR INT: ALTERNATE PARTS USAGE AFTERMARKET PARTS AFTERMARKET SELECTION METHOD: AUTOMATICALLY LIST NO. OF TIMES USER WAS NOTIFIED THAT AN AFTERMARKET PART WAS AVAILABLE: 0 NO. OF AFTERMARKET PARTS THAT APPEAR IN THE FINAL ESTIMATE: 0 OPTIONAL OEM PARTS OPTIONAL OEM SELECTION METHOD: AUTOMATICALLY LIST NO. OF TIMES USER WAS NOTIFIED THAT AN OPTIONAL OEM PART WAS AVAILABLE: 0 N4. OF OPTIONAL OEM PARTS THAT APPEAR IN THE FINAL ESTIMATE: 4 RECONDITIONED PARTS RECONDITIONED SELECTION METHOD: AUTOMATICALLY LIST NO. OF TIMES USER WAS NOTIFIED THAT A RECONDITIONED PART WAS AVAILABLE: 0 NO. OF RECONDITIONED PARTS THAT APPEAR IN THE FINAL ESTIMATE: 0 RECYCLED PARTS NO. OF TIMES USER WAS NOTIFIED THAT A RECYCLED PART WAS AVAILABLE: 1 NO. OF RECYCLED PARTS THAT APPEAR IN THE FINAL ESTIMATE: 0 � Payment Details Page 1 of 1 Claim Number 0359566150101092 Pay To The Order Of LAMETTRVS MAISEE YANG Financials Gross Amount g57.20 Net Amount $57.20 Backup Withholding $0.00 Payment Identification Issued Date 04/19/2013 Mail To Name LAMEITRYS Mail To Address 2951 MAPLEWOOD DRIVE,MAPLEWOOD, MN,55109 Memo COLLISION COVERAGE SUPP 1 Payment Type System Check Chxk Number 162620084 Related Documents � �......Do - .:a�[N�^�e ._. ..... .._.. .. _.-.. _..---..._..___ _ . _...... ._._.._._..__.... - -- -- ..__ _ _ ..__ ._ __. . Reserve Line Ailocation --. _. -._- ----- ._ _. _... . ..__.. _ .__-_.. .__.-- Ex �su e ,Rese^;e Line :C�� --...�._..-- -... .�. .. -- -- , __tType =Am�;;nt _.... .....,. .__. .._._ . � ,.,... „ .- ,,.____.��,__ ...�....�_.____- -.�_ `-„�,,._. .....�_�_� -�...,_....�_ _.._°___._� , .�....„ ......_.�...._ .....,,. � .... .... . .....: Maisee Yang Collision(2010 Collision 'Loss :$57.20 � ',TOYOTA) .. _ �I I � http://ml up2093:1075/dms/fn/17899961981.htm1 7/8/2013 (Page 1 of 19) Details from Estimate for Claim no - 0359566150101092-01 Claim summary Number of photos 4 Number of photos 4 Folder Status 0 Company Name "VISIT US AT GEICO.COM" Addressl P.O. BOX 130608 Address2 City,State,Zip ROSEVILLE,MN,55113 Phone 6123695645 E�timat� I�ngth 5880fi Estimate date 04/19/2013 License 649EDN MN COStS PARTS 161.56 BODY LABOR 13.5 HRS @$ 52.00/HR 702.00 PAINT LABOR 9.1 HRS @$ 52.00/HR 473.20 PAINT SUPPLIES 9.1 HRS @$ 32.00/HR 291.20 SUBLET/MISC. 18.00 OTHER CHARGES 4.00 SUBTOTAL $ 1649.96 SALES TAX $ 161.56 @ 7.12500 11.51 TOTAL COST OF REPAIRS $ 1661.47 ADJUSTMENTS: DEDUCTIBLE 500.00 TOTAL ADJUSTMENTS $ 500.00 NET COST OF REPAIRS $ 1161.47 Estimate Header 0359566150101092-01 Style 2010,TOYO,HIGHLANDER 4X4 Insured MAISEE YANG Loss date 02/1i/2ai3 Claim number 0359566150101092-01 Policy number 4146836368 Claim rep WILLIAMS, STEVE Shop name LAMETTRYS MAPLEWOOD Claimant VIN JTEBK3EH7A2159084 Insurance Co. GEICO Insured is Owner Y Estimatar STEVE WILLIAMS (Page 2 of 19) Photo 01 from Estimate for Claim no 0359566150101092-01-01 Photo date: 04/19/2013 09:49:23: Description: Insured: MAISEE YANG. Policy_no: 4146836368 Clairp�„nt:, „ ._..�� „ .,..... . .,,, ,� .,,,,,,,,,,,,,, .,,_ ..,. Claimant: Vehicle: 2010,TOYO,HIGHLANDER 4X4. VIN: JTEBK3EH7A2159084 �gss date, Q2/11/�013, Estimator: ST�V� WI��IAMS � i �� - �Pr� � — ��,; : , '�� - - — �= —�� fi, -� - - � - ,�r� �� = _� =y�i . - = - - _ - = (Page 3 of 19) Photo 02 from Estimate for Claim no 0359566150101092-01-01 Photo date: 04/19/2013 09:49:23: Description: Insured: MAISEE YANG. Policy_no: 4146836368 CI.�Lm�.nt:, „ ....�� „ ...,.,. . .,.,..,_,,.,. .� ,.,.........,.. Claimant: Vehicle: 2010,TOYO,HIGHLANDER 4X4. VIN: JTEBK3EH7A2159084 ��ss date, 0�/11/�Q13. €stimator; �T�VE WI��IAMS - =` '` � ��: _ � �;�- = _ _ �� _ __ =6 _�— __ � - =� 4 _ ��+� �- . ��. .'- I --�-�- . _ -, . : d� � .. �� —�� '�`��[Ih� ,`= — � �� R �� - - _ �"'a; _ - � �. = f r.. _ �}�.=:r.;?�.. -' _ ��{ ��j �:��r'��.,.t �-` .- �_ __ s; ,,'.T i � i r3 ' _ i_ - � ' ..x- _ - s . .�. ' _ - _ - � ��awx°.e 'e ��,.P �, _ . , - .� _ y �� . .. .- . . � .�. = 5 . �- �z F i I¢_. >' .:�� t-...- A J � . _ i � � - ' -� - ��E-- � � .- , _ � -.. _ -_ . � --�::r �, i„_:. _ - ' - - .__ . - - � - _ s :s (Page 4 of 19) Photo 03 from Estimate for Claim no 0359566150101092-01-01 Photo date: 04/19/2013 09:49:23: Description: Insured: MAISEE YANG. Policy_no: 4146836368 CIaL��,.nt:, „ ,...�..� ., ,..�. , .,,, .� .......,...,,.. .,,_ .,. Claimant: Vehicle: 2010,TOYO,HIGHLANDER 4X4. VIN: JTEBK3EH7A2159084 ��s dat�; Q�/11/�013, �stimater; ST�VE WII��IAMS _ � — —� `� — s _ � '"� = � _� - � - � �� — — �� . ��J ry�L �� — ��s.�r�= ��,�.. �,��5�: , { .. — ._,._ : (Page 5 of 19) Photo 04 from Estimate for Claim no 0359566150101092-01-01 Photo date: 04/19/2013 09:49:23: Description: Insured: MAISEE YANG. Policy_no: 4146836368 �laLm�,.nt:, ., ....�� .. ...... . ..,,,,,_,,,,. ,� .,,.,.,...,.,.. Claimant: Vehicle: 2010,TOYO,HIGHLANDER 4X4. VIN: JTEBK3EH7A2159084 ��ss date; 0�/11/�013. €stimater; ST€V� WI��IAMS - ��,p ti � �_ � � � x .�� _ _� _ ��: _ '-,. ,;i� _ � _ .�� . i�w - � v � =� `_ ` _ � ; ` ,I� £s = _ ?� _ (Page 6 of 19) 04/19/2013 AT 10: 03 AM 0359566150101092-01 94900 218428VB GEICO GEICO "VISIT US AT GEICO.COM" FOR SUPPLEMENTS PLEASE SEE ATTACHED FORM P.O. BOX 130608 ROSEVILLE, MN 55113-0006 (612) 369-5645 FAX: (305) 328-4105 SUPPLEMENT OF RECORD 1 WITH SUMMARY WRITTEN BY: STEVE WILLIAMS 04/19/2013 09: 49 AM ADJUSTER: STEVE WILLIAMS (612) 369-5645 INSURED: MAISEE YANG CLAIM #0359566150101092—01 OWNER: MAISEE YANG POLICY #4146836368 ADDRESS: 1876 MECHANIC AVE DATE OF LOSS: 02/11/2013 AT 04 : 00 PM SAINT PAUL, MN 55119-4821 TYPE OF LOSS: COLLISION BUSINESS: ( 651 ) 554-3409 POINT OF IMPACT: 5. RIGHT REAR EVENING: ( 651 ) 497-7641 INSPECT COOKS ONE STOP BODY SHOP DAY: (651 ) 777-5555X0000 L�CATI4N: 179Q GERVAIS CT DRIVE IN SAINT PAUL, MN 55109-0000 REPAIR LAMETTRYS MAPLEWOOD 5 DAYS TO REPAIR FACILITY: LICENSE # 2010 TOYO �IIGHLANDE� 9X9 6s3.5L=FI 9D UTV WHITE/PEAR INT: VIN: JTEBK3EH�A2159084 LIC: 649EDN MN PROD DATE: ODOMETER: 29137 CONDITION: GOOD AIR CONDITIONING REAR DEFOGGER TILT WHEEL CRUISE CONTROL TELESCOPIC WHEEL INTERMITTENT WIPERS KEYLESS ENTRY REAR WINDOW WIPER DUAL MIRRORS PRIVACY GLASS CONSOLE/STORAGE OVERHEAD C(�NSOLE REAR SPOILER POWER STEERING POWER BRAKES POWER WINDOWS POWER LOCKS POWER MIRRORS AM RADIO F'M RADIO STEREO SEARCH/SEEK CD PLAYER AUXILIARY AUDIO CONNECTIO ANTI—LOCK BRAKES ( 4 ) DRIVER AIR BAG PASSENGER AIR BAG HEAD/CURTAIN AIR BAGS FRONT SIDE IMPACT AIR BAG TRACTION CONTROL STRBILITY CONTROL CLOTH SEATS 3RD ROW SEAT CAPTAIN CHAIRS (2} RETRACTABLE SEATS AUTOMATIC TRANSMISSION 4 WHEEL DRIVE ALUMINUM/ALLOY WHEELS THREE STAGE PAINT ------------------------------------------------------------------------------- NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT ------------------------------------------------------------------------------- 1 ROOF 2 R&I RT SIDE RAIL BASE 0. 4 3 R&I RT DRIP MOLDING FRONT 0. 4 4 R&I RT DRIP MOLDING CENTER 0. 4 5 R&I RT DRIP MOLDING REAR Q. 4 6# RPR ROPE W/SHIELD FOR PAINT 0. 2 7# BLND RT UPPER RAIL CLEAR ONLY 0. 6 8 QUARTER PANEL 1 (Page 7 of 19) 0411912013 �T 10: 03 AM 0359566150101092=01 94900 218428VB SUPPLEMENT OF RECORD 1 WITH SUMMARY 2010 TOYO HIGHLANDER 4X4 6-3. 5L—FI 4D UTV WHITE/PEAR INT: JUYt'LC�1"Ir,N1 Vr i(C�I.VKll 1 YV1lri �U1"11"1HKY 2010 TOYO HIGHLANDER 4X4 6-3. 5L—FI 4D UTV WHITE/PEAR INT: ------------------------------------------------------------------------------- N0. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT ------------------------------------------------------------------------------- 9* RPR RT QUARTER PANEL 4 . 5* 2 . 4 10 ADD FOR THREE STAGE 1 . 7 11 R&I RT QUARTER GLASS TOYOTA 3. 5 2 . 6 LITER N 12# SOl RPR BODY PULL RT QUARTER 1 . 0 13# SUBL GLASS KIT 1 18. 00 X 14 REAR LAMPS 15 REPL RT COMBO LAMP ASSY BASE, 1 161.56 1 . 2 LIMITED 16 REAR BUMPER 17 R&I R&I BUMPER COVER 1 . 3 18* RPR BUMPER COVER 0. 8* 2. 6 19 ADD FOR THREE STAGE 1 . 8 20 R&I LOWER COVER 0. 2 N 21 SOl R&I RT BUMPER COVER SIDE SUPPORT 0. 1 #2 22 OTHER CHARGES 23# E. P.C. 1 4 . 00 ------------------------------------------------------------------------------- SUBTOTALS =_> 183. 56 13. 5 9. 1 LINE 12 : ADDITIONAL TIME ALLOWED AS DAMAGES FALL WITHIN �ODY LINE AND DAMAGE EXTENDS INSIDE TAIL LAMP POCKET LINE 21 : ALLOWED FOR REFINISHING SEE PHOTO 2 (Page 8 of 19) 04/1912013 AT 10: 03 AM 0359566150101092=01 94900 218428VB SUPPLEMENT OF RECORD 1 WITH SUMMARY 2010 TOYO HIGHLANDER 4X4 6-3.5L-FI 4D UTV WHITE/PEAR INT: JUYYLr,I"1r,1V7 Vr tCC�I.VKL 1 VV11ri JU1"ll"1HKY 2010 TOYO HIGHLANDER 4X4 6-3. 5L-FI 4D UTV WHITE/PEAR INT: ------------------------------------------------------------------------------- PRIOR DAMAGE NOTES: PRIOR UNRELATED DAMAGE NOTES:❑ ❑ FRGNT BUMPER:❑ NONE LT FENDER:NON E❑ HOOD:❑ NONE4 LT FRONT DOOR:NONE❑ LT REAR DOOR:N ONE❑ ROOF:❑ NONE LT QUARTER PANEL:N ONE❑ DECKLID/TAILGATE:O NONE43 REAR BUMPER:❑ NONE INTERIOR:❑ NONE FRONT LAMPS:NONE❑ RT FENDER:NONE❑ GLASS:❑ NONE3 RT FRONT DOOR:NONE❑ RT REAR D40R:❑ NONE SUNROOF:❑ NON E RT QUARTER PANEL:❑ NONE REAR LAMPS:NONE❑ BACK GLASS:❑ NONE TIRES: PARTS 161. 56 BODY LABOR 13. 5 HRS @$ 52. 00/HR 702. 00 � PAINT LABOR 9. 1 HRS @$ 52. 00/HR 473. 20 ', PAINT SUPPLIES 9.1 HRS @$ 32 . 00/HR 291 . 20 SUBLET/MISC. 18. 00 OTHER CHARGES 4 . 00 ---------------------------------------------------- SUBTOTAL $ 1649. 96 SALES TAX $ 161.56 @ 7 . 1250°s 11. 51 ------------------------------------ TOTAL COST OF REPAIRS $ 1661 . 4� � ADJUSTMENTS: DEDUCTIBLE 500. 00 ---------------------------------------------------- TOTAL ADJUSTMENTS $ 500. 00 NET COST OF REPAIRS $ 1161 . 4� 3 (Page 9 of 19) 04l1�/2013 RT 10: 03 AM 0359566150101092=01 94900 218428VB SUPPLEMENT OF RECORD 1 WITH SUMMARY 2010 TOYO HIGHLANDER 4X4 6-3. 5L—FI 4D UTV WHITE/PEAR INT: JUYYL�I"1�IV�1� VC KC,I.,VKll 1 UVl�l�t1 JU1"ll"1HKT 2010 TOYO HIGHLANDER 4X4 6-3. 5L—FI 4D UTV WHITE/PEAR INT: NO SUPPLEMENTAL PAYMENT REQUEST WILL BE HONORED BY GEICO UNLESS IT HAS BEEN INSPECTED AND AUTHORIZED IN TnIRITING BY A GEICO REPRESENTATIVE BEFORE THE SUPPLEMENTAL REPAIRS ARE STARTED AND THE FROPER INVOICES HAVE BEEN SUPPLIED. SHOP PHOTOS AF ANY PART OR LABOR IS NOT A SUBSTITUTE FOR A GEICO PHYSICAL INSPECTION AND CANNOT BE CONSIDERED. REPAIR SHOPS MUST ALSO PRESENT A COPY OF THE ORIGINAL GEICO ESTIMATE BEFORE ANY SUPPLEMENTAL CHARGES WILL BE CONSIDERED. MINNESOTA LAW GIVES YOU THE RIGHT TO CHOOSE ANY RENTAL VEHICLE COMPANY, AND PROHIBITS ME FROM REQUIRING YOU TO CHOOSE A PARTICULAR VENDOR NUMBER OF DAYS TO REPAIR ON THE FIRST PAGE OF THIS ESTIMATE IS THE MAXIMUM DAYS THAT GEICO WILL PAY FOR A RENTAL CAR IF APPLICABLE. NOTICE: NEW HIGH STRENGTH STEELS MAY REQUIRE THE USE OF A MIG WELDER FOR PROPER REPAIRS. NEW DESIGNS REQUIRE MEASUREMENT TO PROPERLY ALIGN THE VEHICLE. MAKE SURE YOUR SHOP HAS THE RIGHT EQUIPMENT TO REPAIR YOUR VEHICLE. MN ST 60A. 995 — A PERSON WHO FILES A CLAIM WITH INTENT TO DEFRAUD OR HELPS COMMIT A FRAUD AGAINST AN INSURER IS GUILTY OF A CRIME. THIS IS NOT AN AUTHORIZATION TO REPAIR ****;�*********************�*****************�;********�;*********�*******�****** *****�******�*�* BY SIGNING THIS ESTIMATE THE SHOP AGREES TO HAVE REVIEWED AND DISCUSSED THE ESTIMATE OF DAMAGE WITH A GEICO FIELD ADJUSTER AND HAS AGREED TO ALL VISIBLE, (NON—HIDDEN) DAMAGE REPAIR, REFINISH OR REPLACEMENT TIMES. THE SHOP ALSO AGREES T� THE LABOR AND MATERIAL RATES LISTED IN THE ESTIMATE AND A�KNOWLEDGES THE SUPPLEMENT REQUEST PROCEDURE LISTED BELOW. SHOP REPRESENTATIVE DATE 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. 4 (Page 10 of 19) 0411912013 AT 10: 03 AM 0359566150101092=01 94900 218428VB SUPPLEMENT OF RECORD 1 WITH SUMMARY 2010 TOYO HIGHLANDER 4X4 6-3. 5L—FI 4D UTV WHITE/PEAR INT: �urrLr�ri�ivi �r t�r��,�rcu i wlln �uririr�ttr 2010 TOYO HIGHLANDER 4X4 6-3. 5L—FI 4D UTV WHITE/PEAR INT: ESTIMATE BASED ON MOTOR CRASH ESTIMATING GUIDE. UNLESS OTHERWISE NOTED ALL ITEMS ARE DERIVED FROM THE GUIDE ARM8438, CCC DATA DATE 04/Ol/2013, AND THE PARTS SELECTED ARE OEM—PAR`PS 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 DOUBLE 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, A/M, QUAL REPL PARTS OR COMP REPL PARTS WHICH STANDS FOR COMPETITIVE REPLACEMENT PARTS. USED PARTS ARE DESCRIBED AS LKQ, QUAL RECY PARTS, RCY, OR USED. RECONDITIONED PARTS ARE DESCRIBED AS RECOND. RECORED PARTS ARE DESCRIBED AS RECOR. NAGS PART NUMBERS AND BENCHMARK PRICES ARE PR4VIDED BY NATIONAL AUTO GLASS SPECIFICATIONS. LABOR OPERATION TIMES LISTED ON THE LINE WITH THE NAGS INFORMATION ARE MOTOR SUGGESTED LABOR OPERATION TIMES. NAGS LABOR OPERATION TIMES ARE NOT INCLUDED. POUND SIGN ( #) ITEMS INDICATE MANUAL ENTRIES. SOME 2012 VEHICLES CONTAIN MINOR CHANGES FROM THE PREVIOUS YEAR. FOR THOSE VEHICLES, PRIOR TO RECEIVING UPDATED DATA FROM THE VEHICLE MANUFACTU�ER, LA�Ok AND PARTS DATA FROM THE PREVIOU� YEA� MAY �E U�ED. TI�E PATHWAYS ESTIMATOR HAS A COMPLETE LIST OF APPLICABLE VEHICLES. PART NUMBERS AND PRICES SHOULD BE CONFIRMED WITH THE LOCAL DEALERSHIP. THE FOLLOWING IS A LIST OF ADDITIONAL ABBREVIATIONS OR SYMBOLS THAT MAY BE USED TO DESCRIBE WORK TO BE DONE OR PARTS TO BE REPAIRED OR REPLACED. SYMBOLS FOLLOWING PART PRICE: M=MOTOR MECHANICAL COMPONENT. S=MOTOR STRUCTURAL COMPONENT. T=MISCELLANEOUS TAXED CHARGE CATEGORY. X=MISCELLANEt�US NON—TAXED CKARGE CATEGORY. SYMBOLS FOLLOWING LABOR: D=DIAGNOSTIC LABOR CATEGORY. E=ELECTRICAL LABOR CATEGORY. F=FRAME LABOR CATEGORY. G=GLASS LABOR CATEGORY. M=MECHANICAL LABOR CATEGORY. S=STRUCTURAL LABOR CATEGORY. (NUMBERS) 1 THROUGH 4=USER DEFINED LABOR CATEGORIES. OTHER SYMBOLS AND ABBREVIATIONS: ADJ.—ADJACENT. ALGN.=ALIGN. ALU=ALUMINUM. A/M=AFTERMARKET PART. BLND=BLEND. BOR=BORON STEEL. CAPA=CERTIFIED AUTOMOTIVE PARTS ASSOCIATION. COMP REPL=COMPETITIVE REPLACEMENT (PART) . D&R=DISCONNECT AND RECONNECT. HSS=HIGH STRENGTH STEEL. HYD=HYDROFORMED STEEL. INCL.=INCLUDED. LKQ=LIKE KIND AND QUALITY. LT=LEFT. MAG=MAGNESIUM. NON—ADJ.=NON ADJACENT. NSF=NSF INTERNATIONAL CERTIFIED PART. O/H=OVERHAUL. QTY=QUANTITY. QUAL RECY=QUALITY RECYCLED (PART) . QUAL REPL=QUALITY REPLACEMENT ( PART) . REF[�1=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=ULTRA HIGH STRENGTH STEEL. N=NOTE {S) ASSOCIATED WITH THE ESTIMATE LINE. 5 (Page 11 of 19) 0411912013 AT 10: 03 AM 0359566150101092=01 94900 218428VB SUPPLEMENT OF RECORD 1 WITH SUMMARY 2010 TOYO HIGHLANDER 4X4 6-3. 5L—FI 4D UTV WHITE/PEAR INT: JUYYL�1"1�1V1 Vr K�I,VKll 1 VU1�lti bUl"11"IHKT 2010 TOYO HIGHLANDER 4X4 6-3.5L—FI 4D UTV WHITE/PEAR INT: CCC PATHWAYS — A PRODUCT OF CCC INFORMATION SERVICES INC. THE FOLLOWING IS A LIST OF ABBREVIATIONS THAT MAY BE USED IN CCC PATHWAYS THAT ARE NOT PART OF THE MOTOR CRASH ESTIMATING GUIDE: BAR=BUREAU OF AUTOMOTIVE REPAIR. EPA=ENVIRONMENTAL PROTECTION AGENCY. NHTSA=NATIONAL HIGHWAY TRANSPORTATION AND SAFETY ADMINISTRATION. PDR—PAINTLESS DENT REPAIR. VIN=VEHICLE IDENTIFICATION NUMBER. 6 (Page 12 of 19) 0411912013 AT 10: 03 AM 03595661501010�2-01 94900 218428VB SUPPLEMENT OF RECORD 1 WITH SUMMARY 2010 TOYO HIGHLANDER 4X4 6-3. 5L—FI 4D UTV WHITE/PEAR INT: JUYYL�1"1C�N1� VC K�I,VKll 1 VU1-lri JU1"11"1HKY 2010 TOYO HIGHLANDER 4X4 6-3. 5L—FI 4D UTV WHITE/PEAR INT: ------------------------------------------------------------------------------- N0. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT ------------------------------------------------------------------------------- ------- ADDED ITEMS ------- N 12# SOl RPR BODY PULL RT QUARTER 1 . 0 N 21 SOl R&I RT BUMPER COVER SIDE SUPPORT #2 0. 1 ------------------------------------------------------------------------------- SUBTOTALS =_> 0. 00 l . l 0. 0 LINE 12 : ADDITIOI�IAL TIME ALLOWED AS DAMAGES FALL WITHIN BODY LINE AND DAMAGE EXTENDS INSIDE TAIL LAMP POCKET LINE 21 : ALLOWED FOR REFINISHING SEE PHOTO ------------------------------------------------------------------------------- PRIOR DAMAGE NOTES: PRIOR UNRELATED DAMAGE NOTES:❑ ❑ FRONT BUMPER:❑ NONE LT FENDER:NON E❑ HOOD:❑ NONE4 LT FRONT DOOR:NONE❑ LT REAR DOOR:N ONE❑ ROOF:❑ NONE LT QUARTE� FANEL:N ONE❑ DECKLID/TAILGATE:❑ NONE43 REAR BUMPER:❑ NONE INTERIOR:❑ NONE FRONT LAMPS:NONE❑ RT FENDER:NONE❑ GLASS:❑ NONE3 RT FRONT DOOR:NONE❑ RT REAR DOOR:❑ NONE SUNROOF:❑ NON E RT QUARTER PANEL:❑ NONE REAR LAMPS:NONE❑ BACK GLASS:❑ NONE TIRES: PARTS 0. 00 BODY LABOR l . l HRS @$ 52 . 00/HR 57 .20 ---------------------------------------------------- SUBTOTAL $ 57 . 20 ---------------------------------------------------- TOTAL SUPPLEMENT AMOUNT $ 57 . 20 NET CQST OF SUPPLEMENT $ 57 . 20 7 (Page 13 of 19) 04/1912013 AT 10: 03 AM 0359566150101092=01 94900 218428VB SUPPLEMENT OF RECORD 1 WITH SUMMARY 2010 TOYO HIGHLANDER 4X4 6-3. 5L—FI 4D U'PV WHITE/PEAR INT: JUYYL�1"1C�N1- Vr K�I,VKU 1 YUl�l�ti JU1"11"1HKY 2010 TOYO HIGHLANDER 4X4 6-3. 5L—FI 4D UTV WHITE/PEAR INT: ESTIMATE 1604 . 27 STEVE WILLIAMS SUPPLEMENT S01 57 . 20 STEVE WILLIAMS -------- TOTAL ADJUSTMENTS $ 500. 00 WORKFILE TOTAL $ 1661 . 4`7 NET COST OF REPAIRS $ 1161 . 47 NO SUPPLEMENTAL PAYMENT REQUEST WILL BE HONORED BY GEICO UNLESS IT HAS BEEN INSPECTED AND AUTHORIZED IN WRITING BY A GEICO REPRESENTATIVE BEFORE THE SUPPLEMENTAL REPAIRS ARE STARTED AND THE PROPER INVOICES HAVE BEEN SUPPLIED. SHOP PHOTOS AF ANY PART OR LABOR IS NOT A SUBSTITUTE FOR A GEICO PHYSICAL INSPECTION AND CANNOT BE CONSIDERED. REPAIR SHOPS MUST ALSO PRESENT A COPY OF THE ORIGINAL GEICO ESTIMATE BEFORE ANY SUPPLEMENTAL CHARGES WILL BE CONSIDERED. MINNESOTA LAW GIVES YOU THE RIGHT TO CHOOSE ANY RENTAL VEHICLE COMPANY, AND PROHIBITS ME FROM REQUIRING YOU TO CHOOSE A PARTICULAR VENDOR NUMBER OF DAYS T4 REPAIR ON THE FIRST PAGE OF THIS ESTIMATE IS THE MAXIMUM DAYS THAT GEICO WILL PAY FOR A RENTAL CAR IF APPLICABLE. NOTICE: NEW HIGH STRENGTH STEELS MAY REQUIRE THE USE OF A MIG WELDER FOR PROPER REPAIRS. NEW DESIGNS REQUIRE MEASUREMENT TO PROPERLY ALIGN THE VEHICLE. MAKE SURE YOUR SHOP HAS THE RIGHT EQUIPMENT TO REPAIR YOUR VEHICLF. MN ST 60A. 995 — A PERSON WHO FILES A CLAIM WITH INTENT TO DEFRAUD OR HELPS COMMIT A FRAUD AGAINST AN INSURER IS GUILTY OF A CRIME. THIS IS NOT AN AUTHORIZATION TO REPAIR ��-��+� +��+��*��+�++��:��+��+� *+************** BY SIGNING THIS ESTIMATE THE SHOP AGREES TO HAVE REVIEWED AND DISCUSSED THE ESTIMATE OF DAMAGE WITH A GEICO FIELD ADJUSTER AND HAS AGREED TO ALL VISIBLE, (NON—HIDDEN) DAMAGE REPAIR, REFINISH OR REPLACEMENT TIMES. THE SHOP ALSO AGREES TO THE LABOR AP1D MATERIAL RATES LISTED IN THE ESTIMATE AND ACKNOWLEDGES THE SUPPLEMENT REQUEST PROCEDURE LISTED BELOW. SHOP REPRESENTATIVE DATE 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. 8 I (Page 14 of 19) 04l1912013 AT 10: 03 AM 0359566150101092-01 94900 218428VB SUPPLEMENT OF RECORD 1 WITH SUMMARY 2010 TOYO HIGHLANDER 4X4 6-3. 5L—FI 4D UTV WHITE/PEAR INT: JUYt'Lr,l"1C�N�1� Vr KC,I.VtCll 1 VU11�ri bUl"11"1HKY 2010 TOYO HIGHLANDER 4X4 6-3. 5L—FI 4D UTV WHITE/PEAR INT: ESTIMATE BASED ON MOTOR CRASH ESTIMATING GUIDE. UNLESS OTHERWISE NOTED ALL ITEMS ARE DERIVED FROM THE GUIDE ARM8438, CCC DATA DATE 04/Ol/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 DOUBLE ASTERISK (** ) INDICATES THAT THE PARTS AND/OR LABOR INFORMATION PROVIDED BY MOTOR MAY HAVE BEEN MODIFIED OR MAY HAVE COME FROM AN ALTERNRTE 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, A/M, QUAL REPL PARTS OR COMP REPL PARTS WHICH STANDS FOR COMPETITIVE REPLACEMENT PARTS. USED PARTS ARE DESCRIBED AS LKQ, QUAL RECY PARTS, RCY, OR USED. RECONDITIONED PARTS ARE DESCRIBED AS RECOND. RECORED PARTS ARE DESCRIBED AS REC4R. NAGS PART NUMBERS AND BENCHMARK PRICES ARE PROVIDED BY NATIONAL AUTO GLASS SPECIFICATIONS. LABOR OPERATION TIMES LISTED ON THE LINE WITH THE NAGS INFORMATION ARE MOTOR SUGGESTED LABOR OPERATION TIMES. NAGS LABOR OPERATION TIMES ARE NOT INCLUDED. POUND SIGN ( # ) ITEMS INDICATE MANUAL ENTRIES. SOME 2012 VEHICLES CONTAIN MINOR CHANGES FROM THE PREVIOUS YEAR. FOR THOSE VEHICLES, PRIOR TO RECEIVING UPDATED DATA FROM THE VEHICLE MANUFACTURER, LA�OR AND FARTS DATA F�OM THE FREVIOUS YEAR MAY BE USED. TI�E PATHWAYS ESTIMATOR HAS A COMPLETE LIST OF APPLICABLE VEHICLES. PART NUMBERS AND PRICES SHOULD BE CONFIRMED WITH THE LOCAL DEALERSHIP. THE FOLLOWING IS A LIST OF ADDITIONAL ABBREVIATIONS OR SYMBOLS THAT MAY BE USED TO DESCRIBE WORK TO BE DONE OR PARTS TO BE REPAIRED OR REPLACED. SYMBOLS FOLLOWING PART PRICE: M=MOTOR MECHANICAL COMPONENT. S=MOTOR STRUCTURAL COMPONENT. T=MISCELLANEOUS TAXED CHARGE CATEGORY. X=MISCELLANEOUS NON—TAXED CHARGE CATEGORY. SYMBOLS FOLLOWING LABOR: D=DIAGNOSTIC LABOR CATEGORY. E=ELECTRICAL LABOR CATEGORY. F=FRAME LABOR CATEGORY. G=GLASS LABOR CATEGORY. M—MECHANICAL LABOR CATEGORY. S=STRUCTURAL LABOR CATEGORY. (NUMBERS) 1 THROUGH 4=USER DEFINED LABOR CATEGORIES. OTHER SYMBOLS AND ABBREVIATIONS: ADJ.=ADJACENT. ALGN.=ALIGN. ALU=ALUMINUM. A/M=AFTERMARKET PART. BLND=BLEND. BOR=BORON STEEL. CAPA=CERTIFIED AUTOMOTIVE PARTS ASSOCIATION. COMP REPL=COMPETITIVE REPLACEP�IENT ( PART) . D&R=DISCONNECT AND RECONNECT. HSS=HIGH STRENGTH STEEL. HYD=HYDROFORMED STEEL. INCL.=INCLUDED. LKQ=LIKE KIND AND QUALITY. LT=LEFT. MAG=MAGNESIUM. NON—ADJ.=NON ADJACENT. NSF=NSF INTERNATIONAL CERTIFIED PART. O/H=OVERHAUL. QTY=QUANTITY. QUAL RECY=QUALITY RECYCLED (PART) . QUAL REPL=QUALITY REPLACEMENT ( PART� . REF[�1=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=ULTRA HIGH STRENGTH STEEL. N=NOTE (S) ASSOCIATED WITH THE ESTIMATE LINE. 9 (Page 15 of 19) 04119/2013 AT 10: 03 AM 0359566150101092-01 94900 218428VB SUPPLEMENT OF RECORD 1 WITH SUMMARY 2010 TOYO HIGHLANDER 4X4 6-3. 5L—FI 4D UTV WHITE/PEAR INT: JUYt'L�1"1r,IV1 VC Kr,l.Vt<ll 1 I/V11�tf JU1"11"1HKT 2010 TOYO HIGHLANDER 4X4 6-3. 5L—FI 4D UTV WHITE/PEAR INT: CCC PATHWAYS — A PRODUCT OF CCC INFORMATION SERVICES INC. THE FOLLOWING IS A LIST O� ABBREVIATIONS THAT MAY BE USED IN CCC PATHWAYS THAT ARE NOT PART OF THE MOTOR CRASH ESTIMATING GUIDE: BAR=BURERU OF AUTOMOTIVE REPAIR. EPA=ENVIRONMENTAL PROTECTION AGENCY. NHTSA=NATIONAL HIGHWAY TRANSPORTATION AND SAFETY ADMINISTRATION. PDR—PAINTLESS DENT REPAIR. VIN=VEHICLE IDENTIFICATION NUMBER. 10 (Page 16 of 19) 04l1912013 AT 10: 03 AM 0359566150101092-01 94900 218428VB SUPPLEMENT OF RECORD 1 WITH SUMMARY 2010 TOYO HIGHLANDER 4X4 6-3. 5L—FI 4D UTV WHITE/PEAR INT: �u rrLr�ri�iv i �r rcr�,vrcli L vul i n �uriru-�rcr 2010 TOYO HIGHLANDER 4X4 6-3.5L—FI 4D UTV WHITE/PEAR INT: ALTERNATE PARTS USAGE AFTERMARKET PARTS AFTERMARKET SELECTION METHOD: AUTOMATICALLY LIST NO. OF TIMES USER WAS NOTIFIED THAT AN AFTERMARKET PART WRS AVAILABLE: 0 NO. OF AFTERMARKET PARTS THAT APPEAR IN THE FINAL ESTIMATE: 0 OPTIONAL OEM PARTS OPTIONAL OEM SELECTION METHOD: AUTOMATICALLY LIST NO. OF TIMES USER WAS NOTIFIED THAT AN OPTIONAL OEM PART WAS AVAILABLE: 0 N4. OF OPTIONAL OEM PARTS THAT APPEAR IN THE FINAL ESTIMATE: 0 RECONDITIONED PARTS RECONDITIONED SELECTION METHOD: AUTOMATICALLY LIST NO. OF TIMES USER WAS NOTIFIED THAT A RECONDITIONED PART WAS AVAILABLE: 0 NO. OF RECONDITIONED PARTS THAT APPEAR IN THE FINAL ESTIMATE: 0 RECYCLED PARTS NO. OF TIMES USER WAS NOTIFIED THAT A RECYCLED PART WAS AVAILABLE: 1 NO. OF RECYCLED PARTS THAT APPEAR IN THE FINAL ESTIMATE: 0 11