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O'Leary (2) ��i V ��..� SEP o 5 2013 NOTICE OF CLAIM FORM to the�'i�yYo�F'�i�Paul, Minnesota Minnesota State Statute 466.05 states that "...every person...who claims damages from any municipaliry...shall cause to be presented to the governing body of the municipaliry within 180 days after the alleged loss or injury is discovered a notice stating the time,place,and circumstances thereof,and the amount of compensation or other relief demanded." Please complete this form in its entirety by clearly typing or printing your answer to each question. If more space is needed,attach additional sheets. Please note that you will not be contacted by telephone to clarify answers,so provide as much information as necessary to elcplain 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 dces 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_C,'��j�/�r Company or Business Name r ��-.�� / �i�� Are You an Insurance Company? Yes� If Yes,Claim Number? Street Address �f'/�� `��/�� City t�� L-- St�te Zip Code �,.�l��d Dayti��one ((�)�.�Cell Phone(� ��_�,Z 7 N Evening Telephone(ft�/)�-�_L� Date of Accidenb Injury or Date Discovere�L//��Q19 ��D��F,2�Time �� `.�� a�m l-�^ ��t� Please state,in detail,what occurred(happened),and why you are submitting a claim.Please indicate why or how you feel the City of Saint Paul or its employees are involved and/or responsible for your damages. �' b �J��1� 1 lL'��,� r ��9 � ��/ I l 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 ��y vehicle was damaged by a�et�e��condition of the street ❑ 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 i ❑ Other type of injury—please specify_ In order to process your claim youu need to include couies of all anplicable documents. For the claims types listed below,please be sure to include the documents indicated or it will delay the handling of your claim. Documents WII.L 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 andlor receipts for the repairs;detailed list of damaged items R E C E I V E D O Injury claims: medical bills,receipts O Photographs are always welcome to document and support your claim but will not be returneaSEP o 5 2013 Page 1 of 2—Please complete and return both pages of Claim Form CITY CLERK I Failure to complete and return both pages will result in delay in the handling of your claim. All Claims-please comnlete this section Were there witnesses to the incident? es No ,�nknown (circle - Provide thei�names,addresses and telepl�one numbers: �//�'� ?�C�� C 1�✓_�x� L'�7�}�CC l_ ��j��-�J�(�L-..�� 95�8 n �_,Att�'� `/ ��id'z" _ ��7; �'�-1L�1 �ii�.'�>>?�'C< � ��fc,�� %� � ��'� �/ � � � Were the police or law enforcement called? .. ,� No Unknown (circle) If yes,what department or agency?�--1V�� 11[=�,',L-�E/�,'c'1� Case#qr report# ;�-- ��rc, t��, ,� �<; � ,� � �� -��Ks � r��=C. � -C,T� �'� �-�'.-Kf � �-.f� ,-� rcr�L`�� Where did the accident or in�ury take place? Provide street addres ,cross street, mtersection,name of�Park or a,c�ilitY, closest landmark,etc. Please be as detailed a�s possible. If necessary,attach a diagram. �'�ttk�E'( �.�7. f�f r�?�I� ��-r� r-- I��It��S.`�i/'� G✓Iv� ��J . I ��I L Please indicate the amount you are seeking in compensation or what ou would like the City to do to resolve this cl�im to your satisfaction. � � �- ," `'� �}l" -� �' • �:/t�l //k'.S� /��F=.-'l�C I-1�� !�%�'/'�J� 7�'z_-�'�Z�-�' ---- :;l � .r(%f�f)/� l lti�:� r��U �iC/ /) I L /^ �-- ��°(' 11/�)�j�;�. ._ Vehicle Claims- lease com lete this section ❑check box if this section does not a 1 Your Vehicle: Yeaz `�� Make '' �a �'�.�, Model_ �� /-t?� = License Plate Number �� -�C �, State /�'1 ' Color��C-{ �� '��L �,` Registered Owner �1 � �^ �; �' � %E ��,��;'ti'� Driver of Vehicle ",,f-t/I-�(�C_� � / ;o� '�-,��y Area Damaged I�'��",� �� v� �.,�1��-� �ib�V�hi�le:^ Year Make Model License Plate Number State Color Driver of Vehicle(City Employee's Name) Area Damaged Injurv Claims-please comnlete this section °C� heck box if this section does not applv 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?_ i (provide date(s)) Name of Medical Provider(s): Address Telephone Did you miss work as a result of your injury? Yes No When did you miss work? (provide date(s)) Name of your Employer: Address Telephone �Check here if you are attaclung more pages to this claim form. Number of additional pages +�—� ��;� ' t��'�Rll� �y7;Ji7+�i��- 1� �� f� �-- 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. t..�- f �,�'t�'� >w��j� Submitting a false claim can result in prosecution. Date form was completed " " ) ' 6 `� '� �� , Print the Name of the Person who Completed thi��orm: � �'j �-- : � � �� 7' � ., � ' _ . , - -_i� ,-/�/ �' ' � !'�- : Signature of Person Making the El,a�� -l�.L�� !�--� �� ' � � - Revised February 2011 � ��` � `� �� . i Drove from home,picked up Kim Kedrowski [carpool passenger], then to work at Green Tree. I take 6th Street [West], left onto Market Street [South], cross over Sth Street and then left in Landmark Towers Parking Ramp every day. It is important to know that when driving on Market, especially between 6t" Street and Sth Street,there are always people who don't look, don't obey signs and lights and just step right out in front of you. And, that my eyes are always roving to watch for those people and watch the light to make sure I enter the cross walk on Sth when the light is green. That day, I kept watching people and light and all of a sudden both Kim and I are frantically saying: "Oh My God" and then the large bar that is used to block off Market Sth was closed; HOWEVER, it was not closed at the corner of 6�' and Market where I entered. In addition, in order for those bars to be doing their job when blocking off that street,there are red and white slanted reflectors so people can see those bars during both day and night. The bar from the `inside' does not have those reflectors, so they blend in with the background and are not noticeable. I hit the bar, it came across the entire hood of my car while I was braking, scratching and gouging it. Comments: I am so thankful that there wasn't anybody in that cross walk [at Sth and Market] because they would have been seriously hurt or even `the worst' after being hit with that bar, as the bar swung out. And, after the bar slowed its swing of 180 degrees, it hit a man on the sidewalk while he waited for the light to turnigreen for him; he kept hopping back and back and then the end of the bar brazed his handlebar and he lost his balance and toppled over. My carpool passenger got out of the car and asked if he was all right and he said: "Yes, if my bike is okay, I'm okay". After I settled down a bit and realized everyone was okay [around 7:50 AM], I parked in the ramp, got to my desk and immediately called the non-emergency police number, explained what had happened—she asked if any injuries and damage to vehicle and then had me call Public Works and a Kathy answered; she too was concerned and said she wondered why the bars were open and one end of the block and closed at the other; also asked about me and my car. Kathy had me call Trafficing and a Cindy answered; she too was concerned and said she wondered why the bars were open and one end of the block and closed at the other—OMG! Then Cindy had me call Parks and Rec and a Joe [Buzicky sp?] amswered; he said: "I can't for the life of ine tell you why that mishap occurred,that if open at one end, the other end should be open!!" He asked about me and my car and I said the hood itself is totaled. He said he was certain that the bar is fine; he didn't know if someone had tampered with it because the chains on the bars should be locked. I said yes,thank God no one was hurt or killed. And he knew what I was talking about with red and white reflectors NOT on the bar and seen from the inside. He then instructed me to call the City Clerk and find the Claim Form and follow the instructions from there. He ' apologized for the error and if I needed anything else, to get in touch with him---ALL ' CONTACTS VERY PROFESSIONAL, CONSIDERATE AND HELPFUL!!! ' €�1'P _P.t'1 t�'P�' Re: PASSENGER WITNESS - Thursday, June 27, 2013 Accident � �"' Kim X Kedrowski to: Kathy M O'Leary 07/26/2013 09:34 AM WOW, KATHY, THAT WAS A GREAT RECOLLECTION, ON YOUR PART!! GOOD JOB!! YES, DEFINITELY, RECAPPED VERY WELL... THANKS, KIM Kim Kedrowski Green Tree Mailroom 651-293-3409 X43409 � Kim_X_Kedrowski@gtservicing.com Kedrowski_Kim.vcf Kathy M O'Leary Hi Kim: Would you mind reading through the len... 07/26/2013 09:28:17 AM From: Kathy M O'Leary/MHD/GT/GTFC To: Kim X Kedrowski/CNT/GT/GTFC@GTFC, Date: 07/26/2013 09:28 AM Subject: PASSENGER WITNESS-Thursday,June 27,2013 Accident Hi Kim: Would you mind reading through the len�thy explanation of what happened the morning of the 'street closing bars' accident. I think I have detail d everything to be accurate and the truth. Please let me know. This, then,will be attached to my claim form along with the estimates we're getting next week. Thanks a bunch!!!! KO -----Forwarded by Kathy M O'Leary/MHD/GT/GTFC on 07/26/2013 09:25 AM----- From: "SPAMMFPI"<SPAMMFPI@gt-cs.com> To: "Kathy O'Leary"<kathy.m.o'leary@gt-cs.com> Date: 07/26/2013 09:21 AM Subject: Send data from SPAMMFPI 07/26/2013 09:18 ��`� �Q� Scanned from SPAMMFPI. Date: 07/26/2013 09:18 � �� Pages:l � Resolution:200x200 DPI � ---------------------------------------- ' � ' ti' �� :�� ,� � :;M, �� -� D00072613.pdf � � � ��_. � `� � � � 4 ' i ` � � -��t �� I , . ��5�� , � ii � �� , LI LD ��1.y �i-l�--C� ----� �N�1�1' �-� __-- ; ! �� '�,j � �� GREGG'S AUTO BODY Workfile ID: 68e5bdeb ' FederalID: 411353442 HONEST AND CONSISTENT QUALITY , 581 E. 7th Street, St. Paul, MN 55130 Phone: (6 1) 774-8211 FAX: (65�) 774-0174 Prelimina�ry Estimate Customer: OLEARY, KATHY Written By: Gregg Rosenberger Insured: OLEARY, KATHY Policy#: Claim#: Type of Loss: Date of Loss: Days to Repair: 0 Point of Impact: 12 Front Owner: Inspection Location: Insurance Company: OLEARY, KATHY GREGG'S AUTO BODY 1671 CASE AVE 581 E.7th Street ST PAUL, MN 55106 St. Paul,MN 55130 (651)774-6940 Evening Repair Facility (612)868-2338 Cell (651)774-8211 Business VEHICLE Year: 1994 Body Style: 4D SED VIN: 1G4HR52URH473286 Mileage In: 171862 Make: BUIC Engine: 6-3.8L-FI License: Mileage Out: Model: LESABRE LIMITED Production Date: State: Vehicle Out: Color: GREEN METALLIC Int: Condition: Fair ]ob#: TRANSMISSION DECOR Keyless Entry Anti-Lock Brakes(4) Automatic Transmission Dual Mirrors RADIO SEATS Overdrive Body Side Moldings AM Radio Cloth Seats POWER Tinted Glass FM Radio Reclining/Lounge Seats Power Steering CONVENIENCE Stereo WHEELS Power Brakes Air Conditioning Search/Seek Aluminum/Alloy Wheels Power Windows Intermittent Wipers Cassette PAINT Power Locks Tilt Wheel SAFETIf Clear Coat Paint Power Mirrors Cruise Control Drivers Side Air Bag OTHER Power Driver Seat Rear Defogger Passenger Air Bag Power Trunk/Gate Release 8/21/2013 1:10:56 PM 034178 Page 1 Preliminary Estimate Customer: OLEARY, KATHY , Vehicle: 1994 BUIC LESABRE LIMIT�D 4D SED 6-3.8L-FI GREEN METALLIC Line Oper Description Part Number Qty Eutended Labor Paint Price$ 1 FRONT BUMPER 2 R&I R&I bumper assy 1.3 3 GRILLE _ _ _ 4 R&I Grille 0.3 5 FRONT LAMPS _ _ _ _ 6 R&I RT Side marker lamp w/cornering 0.3 lamp 7 R&I LT Side marker lamp w/cornering 0.3 lamp 8 HOOD __ _ open * Repl LKQ Hood+30% 12374493 1 25�2Q 2.5� � 10 Add for Clear Coat 1.4 11 Add for Underside(Complete) 1.6 12 Add for Clear Coat 0.3 13 R&I Insulator Incl. 14 FENDER 15 * Rpr RT Fender LSZ Z•5 16 Overlap Major Adj. Panel -0.4 17 Add for Clear Coat 0.4 18 * Repl LKQ LT fender assy; 88 Royai 25602CC3 1 130.00 2.3 2.5 +30% 19 Overlap Major Adj. Panel -0.4 20 Add for Clear Coat 0.4 21 Deduct for Overlap -0.4 22 R&I LT Fender liner 0.3 23 R&I RT Wheel opng mldg 0.3 24 R&I LT Wheel opng mldg 0.3 25 * R&I RT Body side mldg Limited � 26 * R&I LT Body side mldg Limited � 27 # Car Cover 1 0.2 28 # Subl Hazardous Waste 1 5.00 X SUBTOTALS 395.00 8.6 12.0 8/21/2013 1:10:56 PM 034178 Page 2 Preliminary Estimate Customer: OLEARY, KATHY • Vehicle: 1994 BUIC LESABRE LIMITED 4D SED 6-3.8L-FI GREEN METALLIC ESTIMATE TOTALS � Category � Basis Rate Cost� Parts 390.00 Body Labor 8.6 hrs @ $55.00/hr 473.00 Paint Labor 12.0 hrs @ $55.00/hr 660.00 Paint Supplies 12.0 hrs @ $35.00/hr 420.00 Body Supplies 1.0 hrs @ $8.00/hr 8.00 Miscellaneous 5.00 Subtotal 1,956.00 Sales Tax $818.00 @ 7.6250% 62.37 Grand Total 2,018.37 Deductible 0.00 CUSTOMER PAY 0.00 INSURANCE PAY 2,018.37 GREGG'S AUTO BODY takes great care to ensure that every repair meets our standards for quality. GREGG'S AUTO BODY guarantees labor performed for as long as you own your vehicle on workmanship and will, at our expense repair or correct all defects which are attributable to defective or faulty workmanship in the repairs stated on the repair invoice. This guarantee covers labor only and does not apply to parts, materials or equipment which may be covsred by and subject to terms of manufacturer or vendors warranty. This guarantee does not include damage caused by or resulting from rust or corrosion, unreasonable use, improper maintenance or care of the vehicle.The above is an estimate based on our inspection and does not cover additional parts or labor which may be required after the work has been opened up.Parts price subject to change without notice. YOU HAVE A RIGHT TO CHOOSE A REPAIR FACILITY OF YOUR CHOICE. WE GREATLY APPRECIATE YOUR BUSINESS. 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. 8/21/2013 1:10:56 PM 034178 Page 3 Preliminary Estimate Customer: OLEARY, KATHY Vehicle: 1994 BUIC LESABRE LIMITED 4D SED 6-3.8L-FI GREEN METALLIC Estimate based on MOTOR CRASH ESTIMATING GUIDE. nless otherwise noted all items are derived from the Guide DElAA92, CCC Data Date 8/16/2013, and the parts select d are OEM-parts manufactured by the vehicles Original Equipment Manufacturer. OEM parts are available at OE/ ehicle 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 "Btemished" 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=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 Defned Labor Categories. OTHER SYMBOLS AND ABBREVIATIONS: Adj.=Adjacent. Algn.=Align. ALU=Aluminum. A/M=Aftermarket part. BInd=6lend. BOR=6oron steel. CAPA=Certified Automotive Parts Association. D&R=Disconnect and Reconnect. HSS=High Strength Steel. HYD=Hydroformed Steel. Inc1.=Included. LKQ=Like Kind and Quality. LT=Left. MAG=Magnesium. Non-Adj.=Non Adjacent. NSF=NSF International Certified Part. 0/H=Overhaul. Qty=Quantity. Refn=Refinish. Repl=Replace. R&I=Remove and Install. R&R=Remove and Replace. Rpr=Repair. RT=Right. SAS=Sandwiched Steel. Sect=Section. Subl=Sublet. UHS=UItra High Strength Steel. N=Note(s) associated with the estimate line. CCC ONE Estimating -A product of CCC Information Services Inc. The following is a list of abbreviations that may be used in CCC ONE Estimating that are not part of the MOTOR CRASH ESTIMATING GUIDE: BAR=Bureau of Automotive Repair. EPA=Environmental Protection Agency. NHTSA= National Highway Transportation and Safety Administration. PDR=Paintless Dent Repair. VIN=Vehicle Identification Number. 8/21/2013 1:10:56 PM 034178 Page 4 HEPPNER'S AUTO BODY (Downtown) Workfile ID: efedd6f5 Ep�NERlJ�' 395 E. 7TH ST., SAINT PAUL, MN 55101 • s : • � Phone: (651) 224-5644 FAX: (651) 224-6042 Preliminary Estimate Customer: O'LEARY, KATHY 7ob Number: Written By:Grant Almeida Insured: 0'LEARY, KATHY Policy#: Claim#: Type of Loss: Date of Loss: Days to Repair: 0 Point of Impact: 12 Front Owner: Inspecdon Location: Insurance Company: 0'LEARY, KATHY HEPPNER'S AUTO BODY(Downtown) SELFPAY 1671 CASE AVE. 395 E.7TH ST. ST.PAUL, MN 55106 SAINT PAUL, MN 55101 (651)774-6940 Day Repair Facility (612)868-2338 Cell (651)224-5644 Business i VEHICLE Year: 1994 Body Style: 4D SED VIN: 1G4HR52VRH473286 Mileage In: 171747 Make: BUIC Engine: 6-3.8L-FI License: 851-ACB Mileage Out: Model: LESABRE LIMITED Production Date: State: MN Vehicle Out: Color: GREEN Int: Condition: ]ob#: TRANSMISSION DECOR Keyless Entry Anti-Lock Brakes(4) Automatic Transmission Dual Mirrors RADIO SEATS Overdrive Body Side Moldings AM Radio Cloth Seats POWER Tinted Glass FM Radio Reclining/Lounge Seats Power Steering CONVENIENCE Stereo WHEELS Power Brakes Air Conditioning Search/Seek Aluminum/Alioy Wheels Power Windows Intermittent Wipers � Cassette PAINT Power Locks Tilt Wheel SAFETY Clear Coat Paint Power Mirrors Cruise Control Drivers Side Air Bag OTHER Power Driver Seat Rear Defogger Passenger Air Bag Power Trunk/Gate Release 8/7/2013 1:54:00 PM 070412 Page 1 Preliminary Estimate Customer: O'LEARY, KATHY )ob Number: Vehicle: 1994 BUIC LESABRE LIMITED 4D SED 6-3.8L-FI GREEN Line Oper Description Part Number Qty Extended Labor Paint Price$ 1 FRONT BUMPER 2 R&I R&I bumper assy 1.3 . ____..�.__._.�.,._�....._�_....__..__ ...�...__.__...�,. ��_._ _.._.__........ _.__.__.__�_�__ _. _,... _,._.._,,,,,,.._...___.._....__,_.._.,�,.�_ .....__. �,.,,�,.,.,.,._�_.. 3 FRONT LAMPS 4 R&I RT Headlamp assy w/o black 0.6 edge 5 R&I LT Headlamp assy w/o black 0.6 edge __�. .�..__.�______.w ---_�____,�__._._._ __��.�...� .__�_�_..._.��_._�._---------- �.�_�.___._,�_._._______._�.___�..___. .____�___ _.... 6 HOOD open * Repl LKQ Hood+30% 12374493 1 260.00 � � 8 Add for Clear Coat 1.4 9 Add for Underside(Complete) 1.6 10 Add for Clear Coat 0.3 11 R&I Insulator Incl. 12 # POSSIBLE BENT HINGES NEEDS ' 1 TEAR DOWN I .�__-_____---__�_�..�...�. .._ _,....._---______°__� ._ �w__....___..�_��__��______�.�.______�... _._._____.�.��_.......��___........___..................._..�....�.v..._.�..._._m.... 13 FENDER 14 * Repl LKQ LT fender assy;88 Royal 25602003 1 188.50 2.3 2.5 +30% 15 Overlap Major Adj. Panel -0.4 16 Add for Clear Coat 0.4 17 Deduct for Overlap -0.4 18 R&I LT Fender liner 0.3 19 * R&I LT Body side midg Limited 9� 20 * Rpr RT Fender 1.� 2•5 21 Overlap Major Adj. Panel -0.4 22 Add for Clear Coat 0.4 23 * R&I RT Body side mldg Limited 4,� 24 R&I LT Fender liner 0.3 _��____ ��.��_ __..r ��____ �� __ _.. ____.___�.�___ _. __� �_ _ _.�.______ ____...._�_ 25 FRONT DOOR 26 Blnd LT Outer panel ' 1•2 27 R&I LT Body side mldg Limited 0.4 28 R&I LT Belt molding 0.3 29 R&I LT Mirror assy electric 1.0 30 * R&I LT Handle, inside � 31 * R&I LT Key cylinder � 32 R&I LT R8cI trim panel 0.5 33 # �Cover Vehicle 1 0.2 34 # �Hazardous Waste Disposal Fee 1 3.50 35 # �Stripe-Tape-per panel 1 15.00 0.3 36 # POSSIBLE HIDDEN DAMAGE 1 SUBTOTALS 467.00 11.9 13.2 8/7/2013 1:54:00 PM 070412 Page 2 Preliminary Estimate Customer: O'LEARY, KATHY 7ob Number: Vehicle: 1994 BUIC LESABRE LIMITED 4D SED 6-3.8L-FI GREEN ESTIMATE TOTALS Category Basis Rate Cost� Parts 467.00 Body Labor 11.9 hrs @ $51.00/hr 606.90 Paint Labor 13.2 hrs @ $51.00/hr 673.20 Paint Supplies 13.2 hrs @ $32.00/hr 422.40 Subtotal 2,169.50 Sales Tax $889.40 @ 7.6250% 67.82 Grand Total 2,237.32 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. • � 8/7/2013 1:54:00 PM 070412 Page 3 � HEPPNER'S AUTO BODY (Downtown) 395 E. 7TH ST.,SAINT PAUL, MN 55101 Phone: (651) 224-5644, Fax: (651) 224-6042 . . - - . . Owner: 0'LEARY,KATHY Insurance: SELFPAY Estimator: Grant Almeida Vehicle Out: Job Number: Claim Number: Year: 1994 Color: GREEN License Plate: 851-ACB Produdion Date: Make: BUIC Body Style: 4D SED State: MN Mileage In: 171,747 Model: LESABRE LIMITED Engine: 6-3.8L-FI VIN: iG4HR52L7RH473286 Condition: �.,�"�� :a MI'�I��,,",: -°��eu � 8/7/2013 E01 8/7/2013 E01 Comments: Comments: � : � ..� �€ -�, � ' ..� .i :�. � . ,�. . . . .. .. . .n . ... 8/7/2013 E01 8/7/2013 E01 Comments: Comments: . I � i� lii .,�� ;��„ �� .:. �,:.,, ;< � ; f 1� ?<��W �a 4 K ^ :4`�-. �a��.P�-b �.��F �� _�� ,. . . _ �� ..:,: .. . iz. , s.'4S� � 8/7/2013 E01 8/7/2013 E01 Comments: Comments: 8/7/2013 1:53:54 PM Page 1 HEPPNER'S AUTO BODY (Downtown) 395 E. 7TH ST., SAINT PAUL, MN 55101 Phone: (651) 224-5644, Fax: (651) 224-6042 . . . Owner: 0'LEARY, KATHY Insurance: 5ELFPAY Estimator: Grant Almeida Vehicle Out: Job Number: Claim Number: Year: 1994 Color: GREEN License Plate: 851-ACB Production Date: Make: BUIC Body Style: 4D SED State: MN Mileage In: 171,747 Model: LESABRE LIMITED Engine: 6-3.8L-FI VIN: iG4HR52VRH473286 Condition: _„ I�. 8/7/2013 E01 8/7/2013 E01 Comments: Comments: >�'i ^I i '�" ��I�B� � � ' �,;; ; u, 8/7/2013 E01 ', 8/7/2013 E01 Comments: Comments: r,, , ��,�; � ��,;�aA�� a � � ��. ��' � r: 8/7/2013 E01 8/7/2013 E01 Comments: Comments: 8/7/2013 1:53:54 PM Page 2 HEPPNER'S AUTO BODY (Downtown) 395 E. 7TH ST.,SAINT PAUL, MN 55301 Phone: (651) 224-5644, Fax: (651) 224-6042 . . - - . � Owner: 0'LEARY, KATHY Insurance: SELFPAY Estimator: Grant Almeida Vehicle Out: ]ob Number: Claim IVumber: Year: 1994 Color: GREEN License Plate: 851-ACB Production Date: Make: BUIC Body Style: 4D SED State: MN Mileage In: 171,747 Model: LESABRE LIMITED Engine: 6-3.8L-FI VIN: 1G4HR52L7RH473286 Condition: ,, �,..., i I �uu,�•��I�� 8/7/2013 E01 Comments: 8/7/2013 1:53:54 PM Page 3