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Hughes CCFAX02 8/7/2013 10 :24 : 15 AM PAGE 1/015 Fax Server COUNTRY� Financial R��EIVED 1701 Towanda Ave AUG 07 ZQl3 Bloomington, IL. 61701 CITY CLERK Facsimile Transmission To: Name: 201-1188363 Company: Fax Number: 91651 -266-8574 Voice Phone: From: Name: Gebel, Dave Fax Number: Voice Phone: Fax Notes: THIS MESSAGE IS ONLY FOR THE USE OF THE ADDRESSEE AND MAY CONTAIN CONFIDENTIAL AND PRIVILEGED INFORMATION. Any dissemination, distribution or copying of this communication other than by the intended recipient is strictly prohibited. If you have received this communication in error, please notify us immediately by telephone, and destroy all copies of the communication. Thank you. Date and time of transmission: Wednesday, August 07, 2013 10:23:34 AM Number of pages including this cover sheet: 15 �� CCFAX02 8/7/2013 10 :24 : 15 AM PAGE 2/015 Fax Server � Subrog�liuo Dcparlmcnl Y O Baa:LOfI F 1 N A N C 1 A� B�oo�+agrofl,lL 6ll02-21UU r��:�a66�is;-�96t 08J07/2013 City of St Paul Office of the City Clerk, Claims Attn: Sandra Bodensteiner 15 W Kel(ogg Blvd, 310 City Half St. Paul, MN 55'!02 RE: Your Insured: City employee Our Claim No.: 201-1188363 Our Insured: HUGHES STEVEN & KARLA Date of Loss: 6/1 8120 1 3 Amount of Damages� 6$ 39.25 damaae to our vehicle from obiect thrown from Lawn mower beinq operated by Citv Employee. Dear Claims Dept.: The result of our investigation of the above captioned incident indicates that your employee's negfigence caused the damage to hfUGHES STEVEN& KARLA's vehicle. This letter is to place you on notice of our subrogation or reimbursement recovery interest against you. Enclosed is our documentation to support our claim. Please forward your draft made payable to COUNTRY Mutual`'on behalf of HUGHES STEVEN & 4CARLA to my attentian at your earliest conven{ence. If you have any questions you may contact me at(866)618-7326. My offrce hours are 6�00 a.m. to 2:30 p.m.CST Monday through Friday. Sincerely, COUNTRY Mutual lnsurance Company�, Bloomington, IL Dave Gebel Subrogation Specialist dave.gebel@countryfinancial.com Fax: (866)255-7961 Enclosure � CCFAX02 8/7/2013 10: 24 : 15 AM PAGE 3/015 Fax Server PRUCESSED ELECTRC)_A�IC:dLL�' °'n`''z°'3 ss�;.,n 201-1�883G7 AA710(i07t 059R250 Shrven Flughes 2-�!)0 8 5p 55"o.i8 C 0&'1B;20t:1 HUGHES STEVEN 8 KARLA G8663 25U N 1'ROCI;SSElll ELIC'71t0��'IC�iLLY °��Zn'2"'_j $56.t 6 2Q1-t7883F.3 AA7106071 054kt250 Sleven tiuyhes 2-p0U 8 5U 558.10 C Ub'1812U73 HUGHES S IEVtN G KARLA 06563 2an rv 201-1188363 Comprehensive Sleven Huylx+s 9�.1� HUGHtS STEVEN&KARLA U6i 18,'"2013 July 20:2013 CUUNI'RY Mu(ual Insuranc;e Corn;�anys 201-11hP:t63 H�7106�T1 059A250 Ofir18l2Q13 HUCNES STEVEN tS KARIA Fifty Six and 1 W100 56.16 GREGGS AUTO BODY CCFAX02 8/7/2013 10 : 24 : 15 AM PAGE 4/015 Fax Server PROC'ESSED ELECTRONIC_�iLL 2` °"°3'z`''3 $d3.1U 201-Y 883G3 AA71(?fi071 �59R250 Str.ven hlughes 2-000 8 5D S83.i0 C 0&'18;2U73 HUGHES STEVEN 8 KARLA GH663 250 N 1'kOC'L•'SSL;D ELLC?RO1�ICi1LLY o�roa:zo�:3 3s3.,o 201-i�A63F.3 AA7706U77 f154ki2,5U Sleven I luyhes 2-�00 8 SU 583.10 C UQ'7812U73 HUGHES SfEV'tN 8 KARLA 08663 290 N 201-1188363 Comprehensivv. Slevr.n Huyl�s SH3.10 HUGHtS STEVEN&KARLA U6i 18;'2013 July 3,2013 COUNI'RY Mu(u�l Insuranc;e Campar.yti 20b�11h8:i63 kA710fi�71 C59A250 OE�t812013 HUCHES STEVEN tS KARLA Eighty Three and 101100 83.10 STEVEN HUGHES 8� GREGGS AUTO BODY CCFAX02 8/7/2013 10: 24 : 15 AM PAGE 5/015 Fax Server COUNTRY FINANCIAL "'SUPPLEMENT 1 "` 07�03?2013 01:49 PM S1 07/26/2013 02:01 PAA .. ...... ....... ... . . ' Owner Oumer: Steven J. Hughes Address: 6S8 Holly Ave Apt 6 HomelDay: l651�343-6851 Cell: f651}303-6851 City State Zip: Saint Paul,MN 55104-7557 :......................................._....................... ....... .............. i Control intormatlon Claim#: 201-1188363 Insured Policy#: AA7106071 Loss Date.+Time: 06:18;`2013 07:00 AM Loss Type: Comprehensive Deductible: $500.00 File#: Accounting#: 0598250-0 Ins.Company: Insurance Company Contact: John Meyer Address: P O Bex 2020 Cell: {612)209-0566 City State Zlp: Bloomington, IL 61702 FAX: (888}253-4721 Email: john.meyer@countryfinancial.com Agent: Ca:ey Nichols Address: Worlu'Day: (866j739-3715 Insured: HUGHES STEVEN 8 KARLA Clalmant: Steven J. Hughes Address: 688 Holly Ave Apt 6 Home;Day: (651'�303-6�51 Cell: (651}3Q3-6851 City State Zip: Saint Paul,MN 55104 Claim Rep: Casey Nichols Address: Work,"Day: (666j739-3715 ;..... .. ._. . < Inspectio� •��.��. Inspection Date: 07,'OZ2013 Ot 38 PM InspecUon Type: Field Inspection Location: Work Contact: City State Zip: SAINT PAUL,MN 55104 Primary Impact: Nfln-Collision Secondary Impact: Driveable: Yes Rernal Assisted: Asslgned DaterTlme: Recelved Date�Tlme: 06i28i2(113 12.21 �M Flrst Contact Date/Time: Appointment Date/Time: 06!28/2013 12:08 PM Company: COUNTRY FINANGIAL Appraiser License#: Contact: JOHN MEYER Address: P.�. EtOX 2020 WorkiDay: (612�209-0566 City State Zip: Bloomington. IL 61702 FAX: (8881253-4721 Email: john.meyer@countryfinancialcom O�ig Campany: COUNTRY FINANCIAL Appraise�License#: ContacL JOHN MEYER Address: P.O. BOX 2420 WorklDay: (612)209-0566 City State Zip: 6loomington, IL 61702 FAX: 1888)253-4721 Email• john meyer@countryfinancial.com PEru:�r��o �,,.;5nn?�n�tt��E - CCFAX02 8/7/2013 10 :24 : 15 AM PAGE 6/015 Fax Server 2�.)'2 I o��o�"venza XLE V6 a iY:W��on 0?r.,�:�p�3 0�-.c9�'y i:i�arok� L:'1-11]03r,�i ' ii�,-'�i�pil3p;�q1°U ... ......................................... .......,.....,.,.. . .. ...... . ... . ...................................,....... . .. ._............................_........., .. ................. . ; RePafrer....._. ......................... . . .... .... .........,....................,.. .... ......................................... . ........ ....... ..................... ......... . ........ ................ ...,.. .,._ • Repalrer: Gregg's Auto Body Contact: Gregg Rosenberger Address: 581 e 7th Street �651)774-8211 City State Zip: Saint Paul,MN 55130 FAX: (651)774-0174 Target Complete Date�Time: Days To Repair: 2 ........................_....,......._..._........._.........................................._....._...._.............__......._.... .......... ........ ....__........... .._.... ........ ............... ........ .._... .... ? Remarks E MAIL AODRESS JOHN.MEYER@COUNTRYFINANCIAL.CGM PLEASE PRESENT THIS ESTIMATE TO THE SHOP OF YOUR CHOICE FOR REPAIRS. ESTIMATE.ORAFT AND EXCESS LETTER LEFT WITH OWNER OF VEHIGLE. ALL SUPPLEMENTS MUST BE APPROVED BY APPRAISER FOF PRQPER PAYMENT OWNER ASKED AND WANTS ALL OEM PARTS ,.................................................................,..........._..,..........,....,.............................,...._.................._..._......,....... .. . .. . .... .... ... ; Vehlcle ` 2012 Toyota Venza XLE V6 4 DR Wagon 6cyl Gasoiine 3.5 6-Speed Automatic Lic.Plate: 613-JWE lic State: MN Uc Expire: 08i2013 VIN: 4T36K3BB4CU071771 Prod Date: Mileage: 21,333 Veh Insp1F: Mileage Type: Actual CondKfon: Good Code: Y24036 Ext.Color: BARCELONA RED MICA Int.Color: Ext.Reflnish: Two-Stage Int Reflnish: Ext.Paint Code: 3R3 Int,Trim Code: Options 2nd Row Head Airbags 4-Wheel Drive AM:FM CD Player Air Conditioning Alarm Sy�tem Aluminum�Alloy Wheels Anti-Lock 6rakes Auto HeadlamF Ccntrol Automatic Dimming Mirror Bucket Seats Center Cansole Cruise Control Daytime Runrnng Lights Driver Knee Airbag Dual Airbags Dual Po�ver Seats Dual Pwr Lumbar Supports Dual 2one Auto A�C Fog Lights Garage Door Opener Halogen Headlights Head Airbags Heated Front Seats Heated Power Mirrors Heated W;S Wiper Washers IPOO Control Illuminated Visor Mirror Intermittent Wipers Keyless Entry System Leather Seats Leather Steering Wheel Liqhted Entry System MP3 Player Overhead Console Power BraKes Power poor Locks Power Liftgate Power Steering Power Windows Rear Spoiler Rear V�ew Camera Rear Window Defroster Rear Window Wiper,'Washer Rem Trunk•UGate Release Reverse Sensing SyMem Side Aiibags Spld Folding Rear Seat Stabflfty Cntrf Suspensn Strg Wheel Radlo Control Tachometer Tilt&Telescopic Stesr Tinted Glass T�re Pressure Monitor TonneauiCargo Cover Traction Control Synem Trip Computer US6 Audio Input Wheel Locks Wireless Audio Streaming Wireless Phone Gonned XM Satellite Radio ;.................. ........ . ...... : Damages .....__............ ,._........ ..........._................................... ......... ................. .................._.........................._.............._........_........ ............ ...... Line Op Guide MC Oescriptlon MFR.Part No. Price ADJ°/, B°b Hours R �,,,;�,:�ri?�q7�i�if Paqr,i r,�� CCFAX02 8/?/2013 10 :24 : 15 AM PAGE 7/015 Fax Server 20'.2 foyo?a Yenza Xlt V6 a i)�:W�con O;:J2:201'01-.[g?J ... i;u:ia•�il ?:'1�1 1 i1039? ' 117,.'rl�%jll l�li'il�=�M1J! Tailaate 1 I 479 SheIl.Tailgaie Repair S1 3.2* SM »inc align 2 L 479 13 She1l,Tailgate Refini�h 3.1 RF 2.1 Surface 0.6 Two-stage setup U.4 T�vo-stage 3 RI 219 Pnl.Tailgaie Finish R 8 I Assembly OJ SM 4 E 508 NiPlate.Tailgate 75443AE01� �23.39 0.2 SM 5 E 528 N/Plate.Tailgate 75443oT030 $26.12 0.2 SM 6 E 154d Cushion,7ailgate LT 75129AG010 $10.29 S1 SM 7 E 1545 Gushion,Tailgate RT 75129AG010 $10.29 S1 SM 8 Rl 351 Pni.T'G Inner Trim R& i Assembly S1 INC SM 9 Rl 398 Pnl.Tlv Inner Trim R 8 I Assembly Si 0.1 SM 10 RI 552 PnI.TrG Inner Trim LT R 8 I Assemb(y S1 0 1 SM 11 RI 553 PnI.T.%G Inner Trim RT R 8 I Assembly S1 0 1 SM Rear Bodv.Lames And Floor Pan 12 RI 546 Taillamp Assembly,lnr LT R 8 I Assembly INC SM 13 RI 547 Taillamp Assembly,lnr RT R 8� I Assembly INC SM Manual Entries 14 IT M60 Hazardous Waste Removal Partial Repair S3.00` O.o' SM 15 N E-COAT.rGORRdSION PROT. Additional Labor 55.00" 0 5' SM »Mn 16 E Mid seal Replace OEM 52.52' S1 INC` SM" 17 EC Lic Plate protectors 2 QUALITY REPL. PART S4.00' S1 INC' SM" 17 Items MC Message 13 INCLUDES 0 6 HOURS FIRST FANEL TWO-STAGE ALLGWANGE . ............................................._._.,.........................,., � Esilmate Total&Entrles ......................................................_....._...........................: Gross Pans 5�2.6� Other Parts ��z� Paint Materlals 5105 40 Parts d�Material Total 5190 01 Tax On Parts Only @ 7.625�� 6 45 �� Rate Replace Repalr Hrs ToL�I Hrs Hrs Sheet Metal(SM) $54.00 1.4 3.7 5.1 fi275 40 Mech�Elec(ME} $85.00 Frame(FR) $75.00 Reflnlsh(R� $54.00 3.1 3.1 �167.40 Palnt Materlals $34.00 Labor Total 8.2 Hours S442.80 Gross Total $639.26 Less:Deductible $500 00- Nei Total ��39.26 Actual Supplement Tobl 556.16 Less:P�evious NetTotal s� �� Net Supplemeni Total �'�6 Alternate Parts Yr00�00/00i00r00+:.UM 00100.00.�00;00 Zip Code-55164 ST PAUL, MN Recycled Parts Y�Q•`0 Zip Code:55164 INV DATE:07'26'2013 P��u;a,:i� o,,.:s->ri;?na�i»t / • / / I � � • , � � .' �:.'��i'�'4�ti�'i'� � ��":,'� .,i'.t ... - .,. . :. .� . .. � : [ / : :'_. .[i +�+�+� 4 4 � y .: i • � ..:'[ .. : �.: � . : ....:�� .. ,: ''� i � . �" .�::. . 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JOHN MEVER Inspection Lacalion 1Nork � Repairable O AgreeG on Price Repair Facility: Gregg's Auto Body � O�r.�ner Choice of Repairer O VehiGe Driveable Appraiser Estimata: $5E3 10 0 Estimate Copy to Owner ❑ Rental Assisted Repairer Estimate: 50.00 O Estimate Copy to Repairer O OKner Letter I^,sued Met Estimate Hmount �139.26 O Excess Letter Parts Intormatlon ❑ Altemate Parts Ap�licable ❑ Recycled Real Steel Applicable � QRP P2mphlet � Altemate Parts Search � Recycled Real Stael Search ❑ LKO Pamphlet ❑ PJtemate Parts Available D Recyr.led Re�l Steel Available Recycled Part Supplier Called Suppfier 1: h4etro Contacc Supplier 2 fiiteway Gontact Sup�plier 3: Elite Contact: �etails ❑ Apply Appearance Allowance ❑ Appy Bettertnent ❑ Apply Relatad Prior Damage ❑ Apply Less Other Charges Repair Days: 2 Start Aepair Date,Time ❑ Rent�l Vehicle Rental Agency: Rental Days St2rt Rentai DatelTime: � Temporary Repair�Applicable Amount $0.00 O Supplement Possibte Amourri: $0.00 � Draft Issued AmouM: '.683.10 Oraft Number: 5032198 O Supplement�fafl Issued � Supplement Letter ^xapplemeM Dra(i PJumber 5032741 Total Loss Information O Total Loss O Unrelated Prior Damages O Claim Rep PJotified Notified Date+Time: ❑ Permis�ion to Mo��e Vehicle Permission From: ❑ Salvage Vehide hioved Pickup Request DaterTime: S�Ivage Location: Stack Wumber Salvage Opinion $0.00 To►ving Am�unt: $0.00 Storage Amount: $0.00 Daily Storage Rate: $0.00 Comments Called in,.ecp.co�.with�500.00 ded and�.kill,ae ai►vork�aed.Inspected comp.loss for gamage to tail gate.Agreed with shop and went over est.and issued draft and letter and sent up paper work.Shop called in add for trim panel removal and lic.plate cushions and Fxotector and i;ail part ot Ioss..AdddraR i^,sued to shop and letler to otimer and sent up paper ivork CCFAX02 8/7/2013 10: 24 : 15 AM PAGE 14/015 Fax Server °""`��°`''°". 11�1�.r 1 V Glr 1 Title:DAM TO MV o � Disposition:ActivelPending o Incident Type:Damage to Property CiWdon Issued:No V � Needs Fotbw-up:No � Investigation Needed:No CAD#:13010067 0+ Admin Revtew Needed:No How Inidated:In Person Orug Related:No Gang Related:No OFFfCER iNFORMA710N " Agency �ge Ty� Name Primary Michaei Smith South St.Paul 2�29 EVENT DATES On Scene C�eared Reported Z��.21 07;45 2013-08-2107:29 2013-06-2107:30 INCIDENT DETAILS Address:2008 CONCORD Stteet N;SSP,MN 55075;US Start Date:2013-06-18 07:00 End Date:2013-06�-1815:30 Partles Involved PER50N 001 Role�s):Repo�tingPerson Association(s):613JW6-2012 TOYOTA LENZA(Owne�): S�: �ast:HUGHES Frst:STEVEN Middte:JAMES — Is Juvenile:No � Date of Birth:1957-06-21 Age:56 A Resldence:688 HOLLY Avenue;ST.PAUL,MN 55104;US _ Cell Phone:(651)303-6851 ��p��n� a m Hei ht: Weight: Hair. Ey�= a Sex:Male 9 �* Ethnic'ity: Build: Complexion: Race:White 7� EMPLOYMENT INFORMATION � � Name:USPS Ty�" O Occupation:POSTAL WORKER Shift: ; Vehicles Involved VEHICLE 001 Role(s):Involved Associated viiith:STEVEN JAMES HUGHES(OM►ner) Regular Passerige�Automobile Plates Number.613.lWB Authority:MINNESOTA Tab:(2013) IYlodel:LENIA Year:2012 Style:4 Ooor Sedan Make:TOYOTA VIN: Primary Color:RED Secondary Color: Odorneter Reading: EsUmatod Value: Keys with Vehicle:No Keys Locaaon: poors Locked:No Ignttfoo Locked:No Trun�c Locked:No Vehicie Inventory:�ENT/PUNCIURE REAR TAILGATE South S�Pau1(MN0190600} Page 1 of 2 Creatl0n:Michael Smith 2013-06-2141:44:08 aiuxo�a � CCFAX02 8/7/2013 10: 24 : 15 AM PAGE 15/015 Fax Server South St Paul Case Number:1300t716 _, r Disposition:Active/Pending i N G I D E N T r�le:DAM TO MV o ,� o STATEMENT � On 6/21/2013 at 0705 hrs Hughes reported that on 6/18/2013 he had parked his Toyota Len2a � (613JW6)in the 200 block of North Concord Street facing southbound from 0700 hrs to 1530 hfs. °' Upon returning to his vehicle he discovered a 1 inch denUpuncture hole on the passenger side of his rear taillgate. Hughes requested e report for insurance purposes. O�icer Mike Smith 2129 . � � a w � M � � � � 1 R South S�Paul(MN0190600) Page 2 of 2 Creation:Michael Smith 2013-08-21 07:40:08 8/T/2013 �