Lee, Jesse NOTIGE (�F CLAIl��� FC3R_l�T tc� the C;it�� of Saint Faul, l�Iinnesuta
:1)riirtesntcr Srutc•,Sratrur=1<i(i.1i±srutr.s that' ...rr•ev��jx�r.s�»i...u�lu�rf�rinrs elunrc{,rs frcrnt u�t�°nurrlic�iPrtliti•....�•htrf!cuusr tn 6e��rr.sr�rted m tltr
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�icedcd,.itt�ic}i acic(itianal shects. Plrusc n�}te that�•�►u F�iH nat lac contactcd br tclephonc t�r ctairili ans�rci•r,so pr��►ide as
much inti►rmatinn ati neccsti�u•r to c��l.un�v►ur claim,an�l thc<im��tant ��!'c�1m��en,ati��n I�ei3�F� ��€g��c-1�c�. 1';}=; 14 i�� i•c_�c�i�i��
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lluytirri�- I'honc f��)��� 1335�{'tl1 f'hc�r�� ((o (�� ��I;vcning'I'cl��h�mc{ �1 -
Datc crf.accide�ltJ Irtjury or D�itc Discovcrcd_ $�a.9'��3 Tin�c �_a��t�7 j�tn
1�E_�s�� ��:31�t= !I' i1T':�;�. tb�fl!'l t_��c�ltr�•�:� (l�it�Il��t�<<t�}. ;liirj i����• ��zy_i ilr� �li}lIl'•i';ri�1c� �3 ��;'.!'ll. ���:� i.�� if1C�l�lIIC �3:f1�'�ip ��,t�: L'�,}�_,
f�c1 the C'ity oF Sair�t Y��ul c�r its crnplc�_yccs arc invc71vc�1 a►ZC�I<>r respon�il�lc. fer�;°our dama�rs.
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❑ 1�7y v�}�icic�vas �trcm�,full4� tc�wcd anc3lor lickciccl � 1 wa, irijurccl on City pr��perty
❑ ()1}lt I' It'�7l' :}(s}j•�zr?i';'?l`Cl:illl:a`'l:—n��:?tit: tipf_'-_'!�i` -- — —
=i i)lf�cr t�'�>�- c�f�ir�jur'y- �alca,c specifti� � �
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Failurc to complctc t1I1(I CCtUt'Il hOtl] ]l��;CS �i'lII 1'C5t1]t lil [1CIa4'111 tI1C tl�ill(Illtl�;Of�'OLII'C�aim.
:�II (:l.�ims-��Iease cum�jietc�ihis secti�an
�1'crc thc.rc��•itzlcs5cs to thc incidcnt'? Ycs �r, L,TT]Iillt)L'1�n {cirr.lcj
1'rcjvicic thc:ir n�im�;, �►dclrc.titic5:ind lcic��h«nc ni.irnix.r�:
1'V'cec thc �xilicr�>r I:t�� cnfc�rct;mcnt c�llcd? Ycs \o Unknc�tikn (circl�j
If�yes. ��hat �epcir•tment or a�'znc�.=> ST,, ��'Ur Ca�e#or re�x>rt# I 3' � gs' �J7g
�1'Vhcrc did thc accicicnt c�r injury takc �lacc? Prc�vidc st.rcct zitldress,crc�tis sl.rccl, inlcr�ccticm, namc�"�f����a�r�k_c.��.r.f�►�ci�lii.�y�_j
c1o�c;Y fandmark. ctc. I'Ica;� he,3�delailrcl;.�s E�o;�iblc. lf nec+:��ar��, attach a di.�gratn.,�,Q�. C��Ca.'.t,a.�yV�Tl4.IQ-�1JC
- Please indicate the f1I11,�0UpI11�,VI�U are seeki��� in corn��en,�lUt)Il �r +�hat you «ould like the City tc�clo to r�� I�e this c�iim
tu�''Ol1Y S.ltiSfll�il0tl. /�`�C��ti���
�/`-�""� ���Q�(iYW.' ,
�`ehicle Clatnis-please complete this section ❑check box if llii� section docs not ,�.�Iv
Yc�ur V'chicic;: Y��t�- I q9 Makc 1 Mc>dci
1.icrn,c Pl�tc \tti�ihcr C�O 3 L � Statr M� Cc�lur
Regi�tered ()wner .,�T'z�S E ��..E
I�rivcr of Vc}iicic
n,-L�� u��rr,s��� DR►t1�RtS 5 � o Oo�a. , n�t.Ner�.oR RoK�N, cNl�v��,�J-1
C�'i(y Vehic-it: Y�ar R'[.ike A9odel Q R•0 K.�1V
I_icen5c Pla[c \TUrnbcr . � � � � State Cr�lcir '� ; � �
1)rivcr iif Vchiclr (Cit� (;m�lc�}'cc ti Namcj -
Arr�� llama�,�cd '
(njur� Cl:iims-plcase cumPlctc�this sectism [,�cl�cck box ii this scctic>n dc>c�nui apply
Il���� �ti�crc �c�u injur�d''
«'h�it part{s)ot your t�cx3ti �vi�rc injurcd''
Have vau sot�Rht medical treatment'? Yes o Plantiin��to Seek Treatment icircle)
��'hui clic3 yc�u rcccivc trcatrncnt? � (}�rc�vitic c3ulc(s}j
N..tmc n( t'[cdical Prc�vidrr(s):
.�dilcCSti TC1C�huoc
Dicl you r��iss �iork a�a rc5ult c�f your injury`? Ycs ' Nc� '
1'��licn clicl �c�u rnixs �t•cfrk'l (prc�viclr. dalc(.j)
N.11lll' l�� L`011l' �IIi�?IO�Ci.: _ _
�����'e�;, Tele��hc�ne �
(�1 C'heck here if yc�u c�re.�ttaching more pages to this claim form. numUer af aciclitional pages I�L . '
Ry si;�tirt�,�tltie�or»t, 1'��tt nre stcitint;thcrl ctll in/'or►nalinrt y��rn c�tvc�proi�it(ed is trrre antf cnrreci t�� tlic best
uf'your k�to+�'IL'Cj�('. L'�IISI�s�ic�d f��rrns �nfll rrr�t be�7T'UCL'SSB[I.
SEfI)!?IIlIU1��Ct�[1I.1'G CI[tf/lI CIl)Z 7'[S1lI/ Ut f)1'Ol'BCltl101t. �):��i I4Tf1T1 ti1�14 COIllOIl'-Il'CL L -L I �--
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Print ihc \a�nc ol'the Person �+ho Cumplctcd this t'orm: ����.��------
Si�nat�re of Person�I<ll�lIl� ttle Clainl:
lletiited rehruar� �f)I 1
RECEIVED
SEP 2 4 2�13
CITY CLERK
September 20, 2013
To Office of the City Clerk,St. Paul, Minnesota
My name is Jesse Lee,and I am writing to you in regards to the accident involving my vehicle,
and a St. Paul city vehicle on 8/29/13. My vehicle,a 1999 Kia Sephia was purchased on
8/23/13,a week before the accident. As a result, l have yet to receive my official title for the
vehicle. I was told by the clerk at the city of Richfield Motor Vehicle license department that I
would receive the title in about 2-3 weeks.
Therefore, I am enclosing a copy of the State of Minnesota Certificate of Title signed by me and
the previous owner. I am also enclosing 2 repair estimates,and pictures of the damages
requested, plus insurance information.
I hope that the enclosed information will be sufficient enough to move forward with my claim.
Your cooperation will be greatly appreciated.
Sincerely,
�
Jesse Lee
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1fSIR1 �OORlpll OIbVERt�LFNfE/OMIBER.1 61�TFybAlLt 0.li�TU4 'POIYTION MMRl11YM5iNlMIBEA•7
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� �� ��� ���� ���� F ACCIpEHT INVOLY�A COIAMERCiAI MOTOR VEHICIE,SCHOOL BUS,OR NEAD dTART BU6 w� �� �
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^*E°Fm??` �;; a heavy steel gate on the tailgate. Photos were
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https://dvslesupport.org/dvsinfo/accidentrecords_2008/Includes_LE/PrintReportIndiv_LE.... 8/3 0/2013
ABRA Auto Body & Glass - East Workfile ID: 220d274a
FederalID: 41-1942823
Bloomington
Right the First Time...On Time
1000 AMERICAN BLVD. W, BLOOMINGTON, MN
55420
Phone: (952) 888-0333
FAX: (952) 885-9778
Preliminary Estimate
Customer: LEE,JESSE 7ob Number:
Written By: Heather Mendoza
Insured: LEE,JESSE Policy#: Claim #:
Type of Loss: Date of Loss: Days to Repair: 0
Point of Impact: 09 Left T-Bone(Left Side)
Owner: Inspection Locatio�: Insurance Company:
LEE,JESSE ABRA Auto Body&Glass-East CUATOMER PAY
Bloomington
5556 35TH AVE S 1000 AMERICAN BLVD.W
MINNEAPOLIS, MN 55417 BLOOMINGTON, MN 55420
(612)227-1334 Day Repair Facility
(952)888-0333 Business
VEHICLE
Year: 1999 Body Style: 4D SED VIN: KNAF61210X5764621 Mileage In: 126958
Make: KIA Engine: 4-1.8L-FI License: 003LDN Mileage Out:
Model: SEPHIA Production Date: 8/1999 State: MN Vehicle Out:
Color: GREEN Int: Condition: Job#:
TRANSMISSION Dual Mirrors SAFETY Bucket Seats
Automatic Transmission Console/Storage Drivers Side Air Bag PAINT
POWER CONVENIENCE Passenger Air Bag Clear Coat Paint
Power Brakes Intermittent Wipers SEATS
DECOR Rear Defogger Cloth Seats
9/9/2013 1:33:21 PM 014565 Page 1
Preliminary Estimate
Customer: LEE,7ESSE Job Number:
Vehicle: 1999 KIA SEPHIA 4D SED 4-1.8L-FI GREEN
Line Oper Description Part Number Qty Extended Labor Paint
Price$
1 # PRELIMINARY ESTIMATE ONLY- 1
2 FRONT DOOR _
PRICE SUBJECT TO CHANGE
3 R&I LT Belt w'strip 0.3
4 * Repl LKQ LT door assy+30% OK2AA59020E 1 195.00 1.5 3.2
NOTE: RHINELANDER AUTO VIA CAR-PART.COM
5 Add for Clear Coat 1.3
6 R&I LT Door w'strip 0.5
7 # R&I LT FRONT BODY SIDE MLDG 0.3
8 # Blnd LT FRONT BODY SIDE MLDG 0.5
9 * Repl LKQ LT Mirror assy manual+30% OK2A169180BXX 1 �2.Q0 Q� �.3
NOTE: LKQ SMART PARTS VIA CAR-PART.COM
10 Add for Clear Coat 0.1
il # �Clean&Retape Molding 1 2.00 X 0.3
12 * Repl LKQ LT Door glass Kia OK2A359511 1 Incl. 0_5
13 R&I LT Handle,outside 0.4
14 R&I RT Hinge 0.3
15 R&I LT Hinge 0.3
16 R&I RT R&I trim panel 0.5
___
__ _ __ __ _ _ _ _
17 MISCELLANEOUS OPERATIONS
18 # Refn 'Corrosion Protection 0.3
19 # �Hazardous Waste 1 5.00 X
20 # Refn 'Color Tint 0.5
SUBTOTALS 241.00 5.2 6.2
ESTIMATE TOTALS
Category Basis Rate Cost$
Pa� 234.00
Body Labor 5.2 hrs @ $54.00/hr 280.80
Paint Labor 6.2 hrs @ $54.00/hr 334.80
Paint Supplies 6.2 hrs @ $34.00/hr 210.80
Miscellaneous 7.00
Subtotal 1,067.40
Sales Tax $444.80 @ 7.2750% 32.36
Grand Total 1,099.76
Dedudible 0.00
CUSTOMER PAY 0.00
INSURANCE PAY 1,099.76
"Minnesota law gives you the right to choose any rental vehicle company, and prohibits me from requiring you to
choose a particular vendor."
9/9/2013 1:33:21 PM 014565 Page 2
Preliminary Estimate
Customer: LEE,]ESSE Job Number:
Vehicle: 1999 KIA SEPHIA 4D SED 4-1.8L-FI GREEN
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.
Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from the Guide
AEY2401, CCC Data Date 9/3/2013, 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 provid d by or through alternate sources other than the OEM
vehicle dealerships. OPT OEM or ALT OEM parts may refl�ct some specific, special, or unique pricing or discount.
OPT OEM or ALT OEM parts may include "Blemished" parts provided by OEM's through OEM vehicle dealerships.
Asterisk (*) or pouble Asterisk (**) indicates that the parts and/or labor information provided by MOTOR may have
been modified or may have come from an alternate data source. Tilde sign (�) items indicate MOTOR Not-Included
Labor operations. The symbol (<>) indicates the refinish operation WILL NOT be performed as a separate procedure
from the other panels in the estimate. Non-Original Equipment Manufacturer aftermarket parts are described as Non
OEM or A/M. Used parts are described as LKQ, RCY, or USED. Reconditioned parts are described as Recond.
Recored parts are described as Recore. NAGS Part Numbers and Benchmark Prices are provided by National Auto
Glass Specifications. Labor operation times listed on the line with the NAGS information are MOTOR suggested labor
operation times. NAGS labor operation times are not included. Pound sign (#) items indicate manual entries.
Some 2014 vehicles contain minor changes from the previous year. For those vehicles, prior to receiving updated
data from the vehicle manufacturer, labor and parts data from the previous year may be used. The CCC ONE
estimator has a complete list of applicable vehicles. Parts numbers and prices should be confirmed with the local
dealership.
The following is a list of additional abbreviations or symbols that may be used to describe work to be done or parts to
be repaired or replaced:
SYMBOLS FOLLOWING PART PRICE:
m=MOTOR Mechanical component. s=MOTOR Structural i omponent. 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=6lend. BOR=6oron steel.
CAPA=Certified Automotive Parts Association. D&R=Discannect 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=Bureau of Automotive Repair. EPA=Environmental Protection Agency. NHTSA= National Highway
Transportation and Safety Administration. PDR=Paintless Dent Repair. VIN=Vehicle Identification Number.
9/9/2013 1:33:21 PM 014565 Page 3
ABRA Auto Body & Glass - East Workfile ID: 220d274a
FederalID: 41-1942823
Bloomington
Right the First Time...On Time
1000 AMERICAN BLVD. W, BLOOMINGTON, MN
55420
Phone: (952) 888-0333
FAX: (952) 885-9778
Preliminary Estimate
Customer: LEE,7ESSE ' i 7ob Number:
Written By: I eather Mendoza
Insured: LEE,JESSE Policy#: Claim#:
Type of Loss: Date of Loss: Days to Repair: 0
Point of Impact: 09 Left T-Bone(Left Side)
Owner: Inspection Location: Insurance Company:
LEE,JESSE ABRA Auto Body&Glass-East CUATOMER PAY
Bloomington
5556 35TH AVE S 1000 AMERICAN BLVD.W
MINNEAPOLIS, MN 55417 BLOOMINGTON, MN 55420
(612)227-1334 Day Repair Facility
(952)888-0333 BusinBSs
VEHICLE
Year: 1999 Body Style: 4D SED VIN: KNAF61210X5764621 Mileage In: 126958
Make: KIA Engine: 4-1.8L-FI License: 003LDN Mileage Out:
Model: SEPHIA Production Date: 8/1999 State: MN Vehicle Out:
Color: GREEN Int: Condition: Job#:
TRANSMISSION Dual Mirrors � SAFETY Bucket Seats
Automatic Transmission Console/Storage Drivers Side Air Bag PAINT
POWER CONVENIENCE Passenger Air Bag Clear Coat Paint
Power Brakes Intermittent Wipers SEATS
DECOR Rear Defogger Cloth Seats
9/9/2013 1:33:51 PM 014565 Page 1
Preliminary Estimate
Customer: LEE,JESSE 7ob Number:
Vehicle: 1999 KIA SEPHIA 4D SED 4-1.8L-FI GREEN
Line Oper Description Part Number Qty Extended Labor Paint
Price$
1 # PRELIMINARY ESTIMATE ONLY- 1
PRICE SUBJECT TO CHANGE
2 FRONT DOOR _
3 R&I LT Belt w'strip I 03
4 * Repl LKQ LT door assy+30% I OK2AA59020E 1 195.00 1.5 3.2
NOTE: RHINELANDER AUTO VIA CAR-pART.COM
5 Add for Clear Coat 1.3
6 R&I LT Door w'strip 0.5
7 # R&I LT FRONT BODY SIDE MLDG 0.3
8 # Blnd LT FRONT BODY SIDE MLDG 0.5
9 * Repl LKQ LT Mirror assy manual +30% OK2A169180BXX 1 39.00 0_3 0_3
NOTE: LKQ SMART PARTS VIA CAR-PART.COM
10 Add for Clear Coat 0.1
11 # �Clean&Retape Molding 1 2.00 X 03
12 * Repl LKQ LT Door glass Kia OK2A359511 1 Incl. 0_5
13 R&I LT Handle,outside 0.4
14 R&I RT Hinge 03
15 R&I LT Hinge 0.3
16 R&I RT R&I trim panel 0.5
_ _ _ _._
_ .___ _ _ __ __ _
_
17 MISCELLANEOUS OPERATIONS
18 # Refn 'Corrosion Protection 03
19 # �Hazardous Waste 1 5.00 X
20 # Refn 'Color Tint 0.5
S BTOTALS 241.00 5.2 6.2
ESTIMATE TOTALS �
Category Basis Rate Cost�
pa� 234.00
Body Labor 5.2 hrs @ $54.00/hr 280.80
Paint Labor 6.2 hrs @ $54.00/hr 334.80
Paint Supplies 6.2 hrs @ $34.00/hr 210.80
Miscellaneous 7.00
Subtotal 1,067.40
Sales Tax $444.80 @ 7.2750% 32.36
Grand Total 1,099.76
Deductible 0.00
CUSTOMER PAY 0.00
INSURANCE PAY 1,099.76
"Minnesota law gives you the right to choose any rental vehicle company, and prohibits me from requiring you to
choose a particular vendor."
9/9/2013 1:33:51 PM 014565 Page 2
Preliminary Estimate
Customer: LEE,)ESSE lob Number:
Vehicle: 1999 KIA SEPHIA 4D SED 4-1.8L-FI GREEN
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.
Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from the Guide
AEY2401, CCC Data Date 9/3/2013, 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 refl�ct some specific, special, or unique pricing or discount.
OPT OEM or ALT OEM parts may include "Blemished" parts provided by OEM's through OEM vehicle dealerships.
Asterisk (*) or pouble Asterisk (**) indicates that the parts and/or labor information provided by MOTOR may have
been modified or may have come from an alternate data source. Tilde sign (�) items indicate MOTOR Not-Included
Labor operations. The symbol (<>) indicates the refinish operation WILL NOT be performed as a separate procedure
from the other panels in the estimate. Non-Original Equip ent Manufacturer aftermarket parts are described as Non
OEM or A/M. Used parts are described as LKQ, RCY, or U�ED. 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. i
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=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. 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=Bureau of Automotive Repair. EPA=Environmental Protection Agency. NHTSA= National Highway
Transportation and Safety Administration. PDR=Paintless Dent Repair. VIN=Vehicle Identification Number.
9/9/2013 1:33:51 PM 014565 Page 3
KEY COLLISION AND PAINT CENTER Workfile ID: c2bOb3c8
FederalID: 41-1112517
480 AMERICAN BLVD WEST, BLOOMINGTON, MN
55420
Phone: (952) 884-6272
FAX: (952) 703-0940
Preliminary Estimate
Customer: LEE,7ESSE )ob Number:
Written By: �1IKE BOWLING
Insured: LEE,JESSE Policy#: I Claim #:
Type of Loss: Date of Loss: Days to Repair: 0
Point of Impact: 10 Left Front Pillar(Left
Side)
Owner: Inspection Location: Insurance Company:
LEE,)ESSE KEY COLLISION AND PAINT CENTER
5556 35TH AVE S 480 AMERICAN BLVD UUEST
MPLS, MN 55417 BLOOMINGTON, MN 5$420
(622)271-1334 Cell Repair Facility
(952)884-6272 Business
VEHICLE
Year: 1999 Body Style: 4D SED VIN: KNAF61210X5764621 Mileage In:
Make: KIA Engine: 4-1.8L-FI License: 003LDN Mileage Out:
Model: SEPHIA Production Date: State: MN Vehicle Out:
Color: DK GREEN Int: Condition: Job#:
TRANSMISSION Dual Mirrors SAFETY Bucket Seats
5 Speed Transmission Console/Storage Drivers Side Air Bag PAINT
POWER CONVENIENCE ' Passenger Air Bag Clear Coat Paint
Power Brakes Intermittent Wipers SEATS
DECOR Rear Defogger Cioth Seats
9/9/2013 1:05:37 PM 008850 Page 1
Preliminary Estimate
Customer: LEE,7ESSE .7ob Number:
Vehicle: 1999 KIA SEPHIA 4D SED 4-1.8L-FI DK GREEN
Line Oper Description Part Number Qty Extended Labor Paint
Price$
1 FRONT DOOR
2 * Repl LKQ LT door assy+30% OK2AA59020E 1 325.00 1.5 3.2
3 Add for Clear Coat 1•3
4 R&I LT Belt w'strip 0.3
5 R8cI LT Surround w'strip 0.3
6 ** Repl A/M LT Mirror assy manual OK2A1691806XX 1 163.00 0.3 0.3
7 Add for Clear Coat 0.1
8 * R&I Side molding complete side incl 9�
clean&retane
9 R8cI LT Handle,outside 0•4
10 R&I LT Door glass Kia 0.5
11 R&I LT R&I trim panel ' 0.5
12 # Cover Car to Prevent Overspray ; 1 3.00
13 # Subl Hazardous Waste Disposal 1 4.00
SUBTOTALS 495.00 4.6 4.9
ESTIMATE TOTALS
Category Basis Rate Cost$
pa� 495.00
Body Labor 4.6 hrs @ $54.00/hr 248.40
Paint Labor 4.9 hrs @ $54.00/hr 264.60
Paint Supplies 4.9 hrs @ $32.00/hr 156.80
Subtotal 1,164.80
Sales Tax $651.80 @ 7.2750% 47.42
Grand Total 1,212.22
Deductible � 0.00
CUSTOMER PAY 0.00
INSURANCE PAY 1,212.22
THIS ESTIMATE IS BASED ON A VISUAL INSPECTION AND DOES NOT INCLUDE ADDITIONAL PARTS OR LABOR
THAT MAY BE REQUIRED TO COMPLETE REPAIRS. PART PRICES ARE CURRENT AND SUBJECT TO INVOICE.
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.
9/9/2013 1:05:37 PM 008850 Page 2
Preliminary Estimate
Customer: LEE,7ESSE Job Number:
Vehicle: 1999 KIA SEPHIA 4D SED 4-1.8L-FI DK GREEN
Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from the Guide
AEY2401, CCC Data Date 8/16/2013, 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 (�) 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 previ4us 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=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. 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.
9/9/2013 1:05:37 PM 008850 Page 3
Preliminary Estimate
Customer: LEE,JESSE ]ob Number:
Vehicle: 1999 KIA SEPHIA 4D SED 4-1.8L-FI DK GREEN
ALTERNATE PARTS SUPPLIERS
Supplier: Keystone-Complete-Minneapolis
Location(s): 3615 MARSHALL STREET NE, MINNEAPOLIS MN 55418 (800)328-1845 (612)789-1919
I
Line Description Item # Price
6 A/M LT Mirror assy manual I KI13201030E $ 163.00
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JESSE LEE
�— Rolicy#: 901fi28445
08/26/2013 - 02/26/2014
Ptatinum Membersh(p
Policy Summary g(� t � 3
�ontact �
�amed insured: JESSE LEE p��;
lddress: 5556 35TH AVE 5 (Home) 6i2-227-1334
Minneapolis, Minnesota 55417Emaii: jleeali@yahoo.com
�OIICy
�olicy number. 90l628445
Total policy rate: ;409.00
�olicy status: Active Policr period; 08/26/2013 to 02/25/2014
rociuct: Auto
>river(s)
ESSE LEE
ate of birth: ••j••/1938 State lioensed; Minnesota
ucial Security number: •••-•.-2935 Driver's lice�e eumber: •••......7508
ender: Male EducaUwn: Graduate work or graduate
arital status: Single degree
elationship: Named insured �5��driver wish to Yes
waive Pe�sonal Injury
river status: Insured driver Income Loss ge�efits?
Has this driver aompleted No
cense status: Valid a senior driver wurse
within the pa�3 year�s?
�ling� No
���= 0 view drfving record
�hicle(s)
�99 KIA SEPHIA
:hicie ident�ficatio� KNAFB1210X5764621
imber(VIN): '
�dy style: 4DR 4CYL
�ti-theft device: No
owplow: No
imary use: Pieasure
'mary location: Minnesota, 55417
�verages and Rate
irrM�nary of Cou�es and Ra�be
fiide �
�9 KIA SEPHIA $409.00
tal policy rate:
�409.00