Dizon + �
Providing Insurance and Financial Services StateFarm�
Home Office, Bloomington, IL
September 16, 2013
City Clerk State Farm Claims
15 West Kellog Blvd P.O.Box 2371
310 City Hall Bloomington IL 61702-2371
St Paul, MN 55102
RECEIVED
SEP 2 3 2013
Certified Mail - Return Receipt Requested
' CITY CLERK
RE: Claim Number. 23-19D3-505
Our Insured: Antonio L Dizon
Date of Loss: May 06, 2013
Your Insured: City of St Paul
Your Insured Driver:
Loss Location: Jadcson St &Shepard Rd, St Paul, MN
Sir/Madam : �
Facts of Loss:
Our insured vehicle was parked and unoccupied and your driver backed into our insureds
vehicle.
It is our understanding that you are self insured. Our investigation indicates you are responsible
for this claim. Therefore, we are seeking recovery from you. This letter is to notify you of our
subrogation claim and request your cooperation in settling this matter.
To assist you in your review, here is a breakdown of the amounts State Farm�paid by Cause of '
Loss:
041/045- Uninsured Motorist BI $ I
042- Uninsured Motorist PD $
300 series/400- Comp/Collision $5,303.53
501 - Rental/Loss of Use $
600-050- Med Pay/PIP $
Other $
Salvage Recovery $
Amount State Farm Paid $5,303.53
Insured Deductible $500.00 '
Total Claim Amount $5,803.53
Based on the assessment of liability befinreen the parties, State Farm Mutual Automobile
Insurance Company is seeking 100 % of the Total Claim Amount listed above. The amount
payable to State Farm Mutual Automobile Insurance Company for this loss is $5,803.53.
Please remit payment of this claim and include our claim number on the payment. If you have
any questions or need additional information, please call me at the number listed below. If I am
not available, any other member of my team may assist you. Thank you for your cooperation.
�
23-19D3-505
Page 2
September 16, 2013
In order to assist you in evaluating and processing the subrogation claim we are asserting, we
may provide nonpublic personal information about our customer. We are sharing this
information to effect, administer, or enforce a transaction authorized by the consumer. However,
you are neither authorized nor permitted to: (1) use the customer information we provided for
any purpose other than to evaluate and process the subrogation claim, or(2)disclose or share
the customer information we provide for any purpose other than to evaluate and process the
subrogation claim.
Sincerely,
Jack Pitts
Claim Representative
(877)457-8276 Ext. 60
Fax: (866)231-9276
State Farm Mutual Automobile Insurance Company
Enclosure
i
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.
� = ; �3 - r� � 3 - � o s
NOTICE OF CLAIM FORM to the City of Saint Paul, Minnesota
Minnesota 5tate Statute 466.Q5 states thar"...every person...who claims danages fr�om any municipaliry...sFtalf cause to be presented to the
governiriR body�f the municipality within 180 driys after the ul(eged lvss nr injury is discovered a notice stating the time,place,�ncl
circumstances thereuf,a�ul tl�nmount of cam��ertsation ar other relief clemaruted."
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 may or may not be contacted by telephone to discuss your ctaim
circumstanees,so provide as much information as necessary to explain your claim,and the amount of compensation being
requested. This form must be signed,and both pages completed. If something does not appiy,write�NlA'.
SEND COMPLETED FORM AND OTHER DOCUMENTS TO:
CITY CLERK, 15 WI+;ST KELLOGG BLVD,310 CITY HALL,SAINT PAUL,���I VE D
First Name�t�"l�'o h i O Middle Initial �- Last Name �J i '2 0✓1
Company or Business Name,if applicabl.e �-�-Ct.��e. �G S rn. Zns '`��P�013
Street Address� � a o X �3 `[ i CITY CLERK
City ,�Dc� Wl�►��-Y� ,�1, State S-L- Zip Code � �Z o �--�
Daytime Telephone(�?Z}��_�(P ��.teJ Evening Telephone(._�
Date of Accidentl Injury or Date Discovered_ ���t �! � Time � ��V �/pm(circle)
�
Please state,in detail,what occurred,and why you are si�bmitting a claim. Please inclicate why or how you
feel the City of Saint Paul or its emptoyees are involved and/or responsible.
Please check the box(es) that most closely represent the reason for completing this form:
�Vehicle was damaged in an accidenr �Vehicle was damaged during a tow
L7 Vehicle was damaged by a pothole or condition of. the street ❑ Vehicle was damaged by a plow
❑ Vehicle was wrongfully towed and/or ticketed ❑ Injured on City property
O Other type of.property damage-please specify_ _ I
❑ Other type of injury-please specify '
❑ nther ty�e not listed-please specify�_ ! �
�
In order to process your claim you need to include conies of a]I a�plicable documents. This is a general i
guideline of, what should be submitted with a claim form,but it is not all inclusive. You may be asked t� '
provide additional inforrnation depending on your.claim. �
O Property damage claims to a vehicle: at least two esrimates for the repairs to your vehicle,or the
actual bills and/or receipts for the repairs
O Towing claims: legible copies of.any tickets issued and copies of the impound lot receipts �
O Other property damage: repair estimates,detailed list af damaged items
O Injury claims: medica.l bil.ls,receipts i
O Photographs can be provided but will not be returned.
Page 1 of 2-Please complete and return both pages of Claim Form
Failure to provide a completed claim form will resutt in delays in processing.
, ' . ;
Notice of Claim Form,City of Saint Paul,page two
All Claims–please comalete this section
Were there witnesses to the incident? Yes No tinknown (circle)
Lf yes,please provide their names,addresses and telephone numbers:
Were the police or law enforcement called? es Na Unlanown (circle)
If yes,what department or agency?�..�F' `��� � Case#ar report#1,,,��j P S� 7 2 a.–�
Where did the accident or injury take place? Provide street address,cross street,intersection,name of park
or facilit ,closest landmark,etc. Please be as det ' ed as possible. If helpful, attach a diagram.
c �.�o� S+ s �� ci r � (
Please indicate the amount you are seeking in compensation from this claim or what you would like the C:iry
to do to resolve this claim to your satisfaction.
__,_._S�?e 3 S 3
Vehicle Claims–please eomplete this seetion ❑ check box if this section does not applv
Your Vehicle: Year 10��+ Make tilodel S i e n nc3..
License Plate Number " StateM,IJ Color t�' �c~1' l l.J h,.�k-e.
Registered Owner � n-4-s� � 0 17� =..f)..n
Driver of Vekucle ��� 11 � �-�-r� o c c 4-e! c. .� __
Area Damaged�Ret.�� 3�t„�b�ta "�"� � L �,,,;,_c..h�S
City Vehicle: Year [ s 9 °r Ivlake G �►�.L Model � _
License Plate Number q o�, l Q �f State IVl[�Color
Driver of Vehicle (City Employee's Name)
Area Damaged
Iniurv Claims–please com�lete this section check 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? (provide date(s))
Name of Medical Provider(s): —
Address Telephone '
Did you�niss work as a result of youx injury? Yes No
When did you m.iss work? (provide date(s)) ,
Name of your Employer:
Address Telephone ..�
0 Check here if you are attaching more pages to this cla9m form. Number of additional pages
By signing this form,you are sloling that all injornwtron you have provided is true and correct to the best of your knowledge. Unsigned
forms witl not be processed. Submiuing a false claim can resuU in prosecution.
Print the Name of the Person who Completed this Fornn: � 1�"�s l4�?/S.�c:_�*' ��'m Srns i4/S�o
/}nfon�o L. L7��.on
Signature of Person Making the Claim:� � ��'
Qn�o-n.i o `o�, i.L/x->
Date form was completed 9� /G � �t� /3 Revised April 200�
� �z0007o
StateFarm State Farm Mutual Automobile Insurance Company
� Auto Payments by Participant/COL
�
Route To: Jean Newmister
BASIC CLAIM INFORMATION
Claim Number: 23-19D3-505
Date of Loss: 05-06-2013
Policy Number: 2169-477-23
Named Insured: DIZON,ANTONIO L
Named Insured(s)/400 - COLL
C denotes consolidated payment
E denotes EFT payment
P previously converted payment from CAT/CMR
Payment Issued Payable Pay Auth Rsn
Number Date Pavee COL Cd Status Amount ID Cd
105669859K E 05-28-2013 BONFE'S AUTO SERVICE 400 1 Paid $5,303.53 ECSAPY
Total: $5,303.53
I
�
I
i
Date: 09-16-2013 Page 1
FOR INTERNAL STATE FARM USE ONLY
Contains CONFIDENTIAL information which may not be disclosed without express written authorization.
1 1 . .
441922893
For Customer Support refer to the
L���� ���� �� appropriate platForm below:
OrderPoint
800-934-9698
Orderpoint support@lexisnexis com
Accurint for Insurance
866-277-8407
Accunnt support@lexisnexis com
Lexis.com
REPORT ATTACHED Law Firm accounts
800-543-6862
PAGE C�i TNT: 3
CLIENT : SF5215
DIVISI�N : 10605993657
AD]IJSTER : TDKO01
CLAIM : 23-19D3-505
TRANSACTIDN# : 441922893
DATE : 09/03/2013
DATE OF LaSS : 05/06/2013 TIME OF LOSS :
STREET :
CITY: ST PAUL
C�UNTY: RAMSEY
STATE : MN
INVESTIGATING AGENCY : MN DVS DMV
REPORT NUMBER : 13088772
REPDRT TYPE: Auto Accident
PARTY 1 : ANTOlVIO DIZON
PARTY 2 :
PARTY 3 :
CAR : MAKE: YEAR :
TAG :
DRIVER LICENSE :
ADDITIONAL INFO : i
POLICY#:
POLICY STATE:
LOSS KIND:
NOTE :
THANK YOU FOR YOUR ORDER�
�r.+s�aRn-�ss�
, i , i . .
441922893
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+ + BONFE'S AUTO SERVICE & BODY Workfile ID: b2034aef
REPAIR_CF
380 7TH ST W, SAINT PAUL, MN 55102
Phone: (651) 222-4458
FAX: (651) 224-8640
Supplement of Record 2 with Summary
RO Number: 34171
Written By: DAN DREELAN,5/28/2013 7:29:48 AM
Adjuster:TEAM R3 ACC CP, 3, (866)207-6046 Day
Insured: DIZON,ANTONIO L Policy#: Claim #: 23-19D3-50501
Type of Loss: COLL-Collision Date of Loss: 5/6/2013 9:20:00 AM Days to Repair: 6
Point of Impact: 07 Left Rear
Owner: Inspection Location: Insurance Company:
DIZON,ANTONIO L BONFE'S AUTO SERVICE&BODY STATE FARM INSURANCE COMPANIES
REPAIR_CF
738 4TH STREET 380 7TH ST W STATE FARM
ST PAUL, MN 55106 SAINT PAUL, MN 55102 PO Box 52272
(651)368-5206 Cell Other Phoenix,AZ 85072-2272
(651)222-4458 Business (866)207-6046 Business
Vehicle Drop Off Date: 05/06/2013 Promise Date: 05/23/2013 Repair Start Date: OS/09/2013
Repair Completion Date: 05/23/2013 Vehicle Pick Up/Return 05/24/2013
Date:
VEHICLE
Year: 2004 Body Style: 4D VAN VIN: STDZA22C64S116491 Mileage In: 122040
Make: TOYO Engine: 6-3.3L-FI License: 874EUD Mileage Out:
Model: SIENNA 4X2 XLE Production Date: 1/2004 State: MN Vehicle Out: 5/23/2013
Color: PEARL WHITE Int: Condition: Job#:
I
TRANSMISSION Anti-Lock Brakes(4) Equalizer EXTERIOR �
Automatic Transmission GLASS CD Player Power Mirrors ,,
Overdrive Privacy Glass INTERIOR Dual Mirrors
SEATS Rear Defogger Power Locks Body Side Moldings
Power Driver Seat Power Windows Air Conditioning Alarm
Cloth Seats Rear Window Wiper Dual Air Conditioning Keyless Entry
STEERING WHEELS Cruise Control Luggage/Roof Rack
Power Steering Aluminum/Alloy Wheels Driver Air Bag PICKUP/VAN EQUIPMENT
Tilt Wheel RADIO Passenger Air Bag Fog Lamps
Telescopic Wheel AM Radio Captain Chairs(4) PAINT
Steering Wheel Controls FM Radio Console/Storage Three Stage Paint
BRAKES Stereo Digital Clock Woodgrain
Power Brakes Cassette Intermittent Wipers �
5/28/2013 7:29:49 AM 013793 Page 1
' ' Supplement of Record 2 with Summary
RO Number: 34171
Vehicle: 2004 TOYO SIENNA 4X2 XLE 4D VAN 6-3.3L-FI PEARL WHITE
Line Oper Description Part Number Qty Extended Labor Paint
Price$
1 # Rpr SET UP FOR PULL&MEASURE 1.0
2 # Rpr PULL&SQUARE 2•� F
NOTE:side panel damage and buckle
3 #
4 FRONT LAMPS
5 0/H front bumper 2•5
6 R&I RT Fog lamp assy Incl.
7 R&I LT Fog lamp assy Incl.
8 FRONT BUMPER
9 R&I R&I bumper cover Incl.
10 * <> Rpr Bumper cover w/o park sensor 1_0 3.0
w/distance se
NOTE:Vehicle pushed over curb from impact-minor damage to lower It frt corner of bumper cover
11 Add for Three Stage 2•1
12 Repl Emblem 75314AE010 1 25.08 Incl.
13 # R&I Lic. Bracket 0•2
14 # Refn Base coat reduction -0.3
15 GRILLE
16 R&I Grille CE,LE,XLE Incl.
17 REAR BUMPER
18 SO1 Repl Prep unprimed bumper 1 0.7
19 SOl 0/H bumper assy 1.6
20 <> SOl Repl Bumper cover w/o reverse sensor 52159AE900 1 299.73 Incl. 2.6
NOTE:Aftermarket Bumper damaged Replacement cover 10 days out per Keystone-rear rebar was fine after pull
completed on rear body area
21 SOl Overlap Major Non-Adj. Panel -0•2
22 SOl Add for Three Stage 1.0
23 Repl LT Bumper bracket 52576AE010 1 66.29 Incl.
24 # R&I Rear Mudguards 0.4
25 # SOl Rpr Mask step pad area on rear cover 0.3 '
for refinish
26 REAR LAMPS
27 ** Repl A/M LT Combo lamp assy 81560AE010 1 107.00 0.4
28 R&I RT Combo lamp assy 0.3
29 Repl LT Combo lamp assy 81680AE010 1 115.02 0.3
NOTE: No Ikq per Action,AAA.
No a/m per AAA and Keystone
30 R&I High mount lamp w/o spoiler 0•3
31 LIFT GATE
32 * Rpr Lift gate w/power door,w/o 8_0 2.3
monitor w/o spoiler
33 Overlap Major Adj. Panel -0.4
34 Add for Three Stage 0•8
35 # S01 Refn Spot in underside of gate 0.5
5/28/2013 7:29:49 AM 013793 Page 2
' 1 Supplement of Record 2 with Summary
RO Number: 34171
Vehicle: 2004 TOYO SIENNA 4X2 XLE 4D VAN 6-3.3L-FI PEARL WHITE
36 * S01 Repl LKQ Glass NAGS w/solar,gray F621979YPN 1 312.50 2_2 G
privacy tint w/o hardware+25%
NOTE: Nags did not have privacy available,tinted only.
37 # Subl Glass Kit 1 15.00 X
38 R&I Wiperarm �•z
39 # Rpr Clean up Broken Glass Inside 1.0
shell and vehicle
40 R&I R&I liftgate assy 1•2
NOTE: For gate and Side panel repair access
41 Repl Emblem 75441AE010 1 27.35 0.2
42 Repl Nameplate'TOYOTA" 7544408010 1 34.82 0.2
43 Repl Nameplate"SIENNA" 75442AE010 1 30.43 0.2
44 Repl Nameplate"XLE" 7544308030 1 23.47 0.2
45 * R&I Molding assy w/o monitor pearl 0_3
white
46 R&I Lift gate trim fawn 0.3
47 R&I LT Window trim side,w/power 0•2
door stone
48 R&I RT Window trim side,w/power 0•2
door stone
49 R&I Window trim center,w/o power 0•2
rear seat stone
50 R&I LT Sensor 0.3
51 R&I LT Support cylinder 0•2
52 * R&I LT Stopper 0=2
53 # R&I Lic. Plate 0•2
54 R&I Noule �•Z
55 REAR BODY&FLOOR
56 * Rpr Rear end panel 2_0 1.3
57 * Rpr LT Gusset 1_0 0.4
5g Add for Three Stage 0•2
59 # Refn base coat reduction -0•2
60 RESTRAINT SYSTEMS
61 * R&I LT Belt&retractor outer charcoal 0_4
Dro
62 SIDE PANEL
63 * Rpr LT Side panel 12.0 2.7
64 Overlap Major Non-Adj. Panel -0�2
65 Add for Three Stage 1.0
66 # S01 Rpr Cut and weld patch panel 2•0
67 Repl LT Protector 58742AE010 1 3.16 0.2
6g R&I LT Molding center rail front 0.3
(9 R&I LT Glass Toyota w/o antenna 1.0
green,w/o sunshade
7p * Rpr LT Reinforcement back door 2_0 0.8
71 Overlap Minor Panel -0'2
7Z * R&I Vent duct 0_1
5/28/2013 7:29:49 AM 013793 Page 3
' Supplement of Record 2 with Summary
RO Number: 34171
Vehicle: 2004 TOYO SIENNA 4X2 XLE 4D VAN 6-3.3L-FI PEARL WHITE
73 R&I LT Trim panel assy trim code A,7 0.6
passenger stone
74 R&I LT Rear trim w/o power back Incl.
door stone
75 * R&I LT Seal 0_2
76 PILLARS,ROCKER 8e FLOOR
77 * Blnd LT uo�er Sail Panel s 0.7
78 WINDSHIELD
79 * R&I Reveal moldina/Mask for blend 0.3
80 FRONT DOOR
81 * R&I LT Surround w'strio stone/dro� 0.3
for sail blend
82 FENDER _.
83 * R&I LT Upper molding/for sail blend 0.2
84 RADIATOR SUPPORT
85 Repl Undercover 5144108010 1 151.30 0.3
NOTE:damaged from going over curb
86 ROOF
87 R&I LT Drip molding 0.5
88 R&I LT Side rail 0.5
89 Repl LT Drip w'strip 62382AE012 1 57.07 0.5
NOTE:Adhesive molding,need to r8ci for sail blend will not go back on
90 # Subl Front Wheel Alignment 1 69.95 X
NOTE: owner claims steering wheel off center since accident-vehicle pushed over curb in front end
91 # Repl COVER CAR COMPLETE(2 1 5.00 X 0.2
TIMES)
92 # S02 Repl FLIX ADDITIVE. 1 5.00 X
93 # Repl CORROSION PROTECTION 1 5.00 X 0.3
94 # Repl HAZARDOUS WASTE REMOVAL 1 5.00 X
95 # SOl MASK AND TAPE JAMBS 1 0.3
96 # SOl SEAM SEALER 1 5.00 X 0.5
97 # S01 Rpr FEATHER EDGE PRIMER AND 1.0
BLOCK REPAIR PANELS ,
NOTE:TIME TO BRING A REPAIR PANEL FROM 180 GR1T TO 320 GRIT IN PRIMER
SUBTOTALS 1,363.17 52.7 18.6
NOTES
Estimate Notes:
left at shop on 5-6-13-no appointment,no assignment
Natalie Knippel approved r&i of LT tail lamp and LT gate lamp to inspect tail lamp pocket and gate shell.
Owner approved a/m parts
5/28/2013 7:29:49 AM 013793 Page 4
> .
Supplement of Record 2 with Summary
RO Number: 34171
Vehicle: 2004 TOYO SIENNA 4X2 XLE 4D VAN 6-3.3L-FI PEARL WHITE
ESTIMATE TOTALS
Category Basis Rate Cost$
Parts 1,253.22
Body Labor 48.5 hrs @ $52.00/hr 2,522.00
Paint Labor 18.6 hrs @ $52.00/hr 967.20
Frame Labor 2.0 hrs @ $73.00/hr 146.00
Glass Labor 2.2 hrs @ $52.00/hr 114.40
Paint Supplies 18.6 hrs @ $32.00/hr 595.20
Miscellaneous 109.95
Subtotal 5,707.97
Sales Tax $ 1,253.22 @ 7.6250% 95.56
Grand Total 5,803.53
Deductible 500.00
CUSTOMER PAY 500.00
INSURANCE PAY 5,303.53
� ' �
For more information regarding State Farm's promise of satisfaction relating to new non-original equipment �
manufacturer(non-OEM)and recycled parts, please visit:htt�://st8.fm/7X4 or QR code. `
� ■
� �
Register online to check the status of your claim and stay connected with State Farmp.To register,go to http://www.statefarm.com/
and select Check the Status of a Claim. If you are already registered,thank you! Not available in New Mexico.
5/28/2013 7:29:49 AM 013793 Page 5
� Supplement of Record 2 with Summary
RO Number: 34171
Vehicle: 2004 TOYO SIENNA 4X2 XLE 4D VAN 6-3.3L-FI PEARL WHITE
SUPPLEMENT SUMMARY
Line Oper Description Part Number Qty Extended Labor Paint
Price$
a v.�°bei� _.. ,
Fp _ _
� - _
91 # Repl FLDC ADDITIVE 1 -5.00 X
92 # S02 Repl FLEX ADDITIVE. 1 5.00 X
SUBTOTALS 0.00 0.0 0.0
TOTALS SUMMARY
Category Basis Rate Cost$
Parts 0.00
Subtotal 0.00
CUMULATIVE EFFECTS OF SUPPLEMENT(S)
Estimate 5,668.84 DAN DREELAN
Supplement SOl 134.69 DAN DREELAN
Supplement S02 0.00 DAN DREELAN
)ob Total: $ 5,803.53
CUSTOMER PAY: $ 500.00
INSURANCE PAY: $ 5,303.53
******************************************************************************
THIS IS A VISUAL ESTIMATE ONLY.
ADDITIONAL DAMAGE MAY BE FOUND AFfER TEAR DOWN OF VEHICLE.
NO GUARANTEE ON RUST WORK. ,
******************************************************************************
MINNESOTA FRAUD WARNING
A person who submits an application or files a claim with intent to defraud or helps commit a fraud against an �
insurer is guilty of a crime.
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.
5/28/2013 7:29:49 AM 013793 Page 6
� ` Supplement of Record 2 with Summary
RO Number: 34171
Vehicle: 2004 TOYO SIENNA 4X2 XLE 4D VAN 6-3.3L-FI PEARL WHITE
Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from the Guide
ARM8530, CCC Data Date 5/16/2013, and the parts selected are OEM-parts manufactured by the vehicles Original
Equipment Manufacturer. OEM parts are available at OE/Vehicle dealerships. OPT OEM (Optional OEM) or ALT OEM
(Alternative OEM) parts are OEM parts that may be provided by or through alternate sources other than the OEM
vehicle dealerships. OPT OEM or ALT OEM parts may reflect some specific, special, or unique pricing or discount.
OPT OEM or ALT OEM parts may include "Blemished" parts provided by OEM's through OEM vehicle dealerships.
Asterisk(*) or pouble Asterisk (**) indicates that the parts and/or labor information provided by MOTOR may have
been modified or may have come from an alternate data source. Tilde sign (N) 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 2012 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 Defined Labor Categories.
OTHER SYMBOLS AND ABBREVIATIONS:
Adj.=Adjacent. Algn.=Align. ALU=Aluminum. A/M=Aftermarket part. BInd=Blend. BOR=Boron steel.
CAPA=Certified Automotive Parts Association. D&R=Disconnect and Reconnect. HSS=High Strength SteeL ,
HYD=Hydroformed Steel. Inc1.=Included. LKQ=Like Kind and Quality. LT=Left. MAG=Magnesium. Non-Adj.=Non
Adjacent. NSF=NSF International Certified Part. O/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=6ureau of Automotive Repair. EPA=Environmental Protection Agency. NHTSA= National Highway
Transportation and Safety Administration. PDR=Paintless Dent Repair. VIN=Vehicle Identification Number.
5/28/2013 7:29:49 AM 013793 Page 7
� � Supplement of Record 2 with Summary
RO Number: 34171
Vehicle: 2004 TOYO SIENNA 4X2 XLE 4D VAN 6-3.3L-FI PEARL WHITE
NON-ORIGINAL EQUIPMENT REPLACEMENT PARTS INFORMATION
Whenever ** appears next to the description of a part which is to be replaced,this means:
THIS ESTIMATE HAS BEEN PREPARED BASED ON THE USE OF AUTOMOBILE PARTS NOT MADE BY THE
ORIGINAL MANUFACTURER. PARTS USED IN THE REPAIR OF YOUR VEHICLE BY OTHER THAN THE
ORIGINAL MANUFACTURER ARE REQUIRED TO BE AT LEAST EQUAL IN LIKE KIND AND QUALITY IN
TERMS OF FIT, QUALITY AND PERFORMANCE TO THE ORIGINAL MANUFACTURER PARTS THEY ARE
REPLACING.
5/28/2013 7:29:49 AM 013793 Page 8
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