Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Vue, Soua (2)
Revised March 2023 NOTICE OF CLAIM FORM to the City of Saint Paul, Minnesota Minnesota State Statute 466.05 states that “…every person…who claims damages from any municipality…shall cause to be presented to the governing body of the municipality 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 answers to each question. If you have additional documentation, you may add those documents to your submission. You will not be contacted by telephone unless clarification is needed. The claim process for investigations can take upwards of four (4) weeks. This form must be signed, dated with all applicable sections completed. Submission this completed form to the Saint Paul City Clerk’s Office by email (cityclerk@ci.stpaul.mn.us), fax (651-266-8574) or mail addressed to “Saint Paul City Clerk, 15 West Kellogg Blvd., Suite 310, Saint Paul, MN 55102”. Claimant: First Name: ________________________________ Last Name: _______________________________________________ Please Indicate Your Pronouns: ☐ She/Her/Hers, ☐ He/Him/His, ☐ They/ Them/Theirs Company or Business Name: ____________________________________________________________________________________ Is this claim being made by an Insurance Company? YES / NO If yes, what is your Claim/File Number? _________________________ Is this claim being made by an Attorney? YES / NO If yes, what is your File Number? _______________________________________ If yes, provide your Insured’s/ Client’s Name: _______________________________________________________________________ Street Address: _______________________________________________________________________________________________ City: ______________________________________________ State: ________________________ Zip Code: ___________________ Daytime/Work Phone: __________________________________ Cell Phone: _____________________________________________ Date of Incident or Date Discovered (Must Complete): _____________________________ Time: _____________________________ Please state, in detail, what happened that prompted you to file a Notice of Claim Form: ____________________________________ Please state why or how you feel the City of Saint Paul is responsible for your Damages? ____________________________________ Please check the reason that most closely describes the reason for your submitting a claim. Please note the documents that will need to be provided with your completed form. Photographs will be accepted. All documents submitted become the property of the City of Saint Paul and shall not be returned. ☐ Automobile damage from a motor vehicle accident: please provide two estimates for repairs or actual bill that has been paid. ☐ Automobile damage from a street defect or pothole: please provide two estimates for repairs or actual bill that has been paid. ☐ Automobile was towed and may or may not have sustained damage: please provide copy of towing ticket (if available), receipt from Impound Lot, and two estimates for repairs or actual bill that has been paid. ☐ Snow Emergency: please provide copy of towing ticket (if available), receipt from Impound Lot, and two estimates for repairs or actual bill that has been paid. ☐ Property damage: please provide two estimates for repairs or actual bill that has been paid. ☐ You were injured during a motor vehicle accident: please provide police report number, details about injury. ☐ You were injured in the City of Saint Paul: please provide police report number, witnesses, and details about injury. Continue to page 2 of Notice of Claim Form. Failure to complete and return both pages will result in delays. Soua Vue Travelers claim #JAD8087 P.O. BOX 5076 Hartford CT 06102 (508)324-8332 11/01/2024 6:55 P.M. Our insured vehicle was struck by a city vehicle. Local P.D. found the city vehicle to be at-fault. Revised March 2023 This section must be completed for all claims. Is there a police report for this incident? YES / NO If yes, please provide the police report case number: ___________________________ If yes, what law enforcement agency responded? ____________________________________________________________ Where did the incident take place? Please provide a street address, intersection or name of city park or facility: ____________________________________________________________________________________________________________ What would you like to see happen to resolve this claim to your satisfaction? ____________________________________________________________________________________________________________ Were there witnesses to this incident? Please provide names and contact phone numbers: ____________________________________________________________________________________________________________ For property damage claims, including vehicle accidents. Your vehicle’s information: Year: _________ Make: _________________ Model: __________________ Color: __________________ License Plate #: _________________________ State vehicle is registered in: ___________________________ Registered owner of vehicle: _____________________________ Driver: __________________________________________ Area(s) damaged:______________________________________________________________________________________ If a City vehicle was involved, License Plate #: _________________________________ Color: _______________________________ Was there City insignia on the vehicle? YES / NO Driver’s Name: ______________________________________________________ Other property damaged: _______________________________________________________________________________________ For injury claims of any type. What part of your body was injured? _____________________________________________________________________________ Did you go to the emergency room or urgent care? YES / NO Where? ___________________________________________________ Was medical treatment received? YES / NO Where? ________________________________________________________________ First day of medical treatment? _____________ Are you still receiving medical treatment? YES / NO Did you miss any work as result of this incident? YES / NO Employer(s): _________________________________________________________________________________________________ How much time have you missed from work? _____________________________________________________________________ If you are submitting other documents, please state what you are attaching and how many pages: _________________________ By signing this form, you agree that all information provided is true and correct to the best of your knowledge. Please NOTE that submitting a false or misleading claim can and will result in prosecution under Minnesota Statutes. Name of Person completing form: _____________________________________________________________ Signature of Person submitting this form: _______________________________________________________ Relationship of person signing to Party making the claim: __________________________________________ Date document is being signed: _____________________ 24-206962 Saint Paul Police Dept. Intersection of Cayuga St. and Phalen Blvd. Travelers is seeking 100% repayment of our damages. Yes; Kaytheus Moore, (651)226-1019. 2017 Toyota Sienna Black LRF051 MN SOUA VUE SOUA VUE Front end; total loss. Bryan R. Powers Claim Handler as subrogee of Soua Vue 03/20/2025 Expand All | Collapse All Indemnity Net Paid Amount( LESS CREDITS): $39,095.01 Financials Financials Tuesday, May 27, 2025 NOL Insured Information:Claim Number: SOUA VUE 299 ATWATER ST SAINT PAUL, MN 55117-5302 JAD8087 RP Sequence Number: 001 Responsible Party Information: ST. PAUL EMS 375 JACKSON STREET SAINT PAUL , MN 55101 Loss Date:Accident State: 11/01/2024 SAINT PAUL, MN Summary of Loss: Claimant Summary Payment Details Expense Details Claimant Number Name Type Cov Code Deductible Reduction Total Subro Demand 001 SOUA VUE INSD COLL $ 500.00 $ 0.00 $ 39,595.01 001 CMT (SUBTOTAL) $ 0.00 $ 0.00 $ 39,595.01 TOTALS (AMOUNT DUE) $ 0.00 $ 0.00 $ 39,595.01 Clm Nbr PERS Auth Id Cov Cd Reference Seq Nbr Transaction Date Amount Payee or Sold to Name For Explanation 001 JZR1 COLL 0043951615 001 12/10/2024 $ 487.24 COPART AUTOAUCTIONS 001 SH6 COLL 0007631343 002 03/04/2025 $ 51,594.77 SOUA VUE TOTAL LOSS 001 CPT$COLL 0082209879-001 03/13/2025 $ 12,987.00 CREDIT SALVAGE 5/27/25, 4:24 PM JAD8087 | 000 | FILE LEVEL | SOUA VUE | 11/1/2024 https://claimportalch.prodlb.travp.net/claimportalcommon2/SubTabContainer.aspx?StartPage=https://claimplatformch2.prodlb.travp.net/ClaimSummary…1/1 TRAVELERS - THE STANDARD FIRE INSURANCE COMPANYUpper Midwest Claim Center (077)Request Supplements at https://supplements.travelers.comPO Box 650293Dallas, TX 75265Phone: (800) 348-6944Claim #:Workfile ID:JAD80870017d6cca6bSupplement of Record 2 SummaryWritten By: RAYMAN BASHIER, 12/23/2024 10:38:55 AMAdjuster: SH6, (800) 348-6944 BusinessInsured:SOUA VUEOwner Policy #:PT5010A6151172062031 Claim #:JAD8087001Type of Loss:CollisionDate of Loss:11/01/2024 12:00 PMDays to Repair:0Point of Impact:11 Left FrontDeductible:500.00Owner (Insured):Inspection Location:Appraiser Information:Repair Facility:SOUA VUE299 ATWATER STSAINT PAUL, MN 55117(651) 703-2791 Cellular(612) 968-6301 OtherVUE.CHOR@YAHOO.COM2989 Country DrLittle Canada, MN 55117Virtual(651) 633-8900 Businessrbashier@travelers.com(651) 408-3876Classic Collision Little Canada2989 Country DrLittle Canada, MN 55117(651) 633-8900 Business843930230 Federal IDVEHICLE2017 TOYO Sienna XLE FWD w/8-Passenger Seating 4D VAN 6-3.5L Gasoline Port/Direct Injection BLACK VIN: 5TDYZ3DC7HS867807Production Date: 06/2017Interior Color: BEIGELicense: LRF051Odometer: 43381Exterior Color: BLACKState: MNCondition: TRANSMISSIONIntermittent WipersSearch/SeekReclining/Lounge SeatsAutomatic TransmissionTilt WheelCD PlayerLeather SeatsPOWERCruise ControlAuxiliary Audio ConnectionHeated SeatsPower SteeringRear DefoggerSatellite Radio3rd Row SeatPower BrakesKeyless EntrySAFETYRetractable SeatsPower WindowsAlarmDrivers Side Air BagWHEELSPower LocksSteering Wheel Touch ControlsPassenger Air BagAluminum/Alloy WheelsPower MirrorsRear Window WiperAnti-Lock Brakes (4)Locking WheelsHeated MirrorsTelescopic Wheel4 Wheel Disc BrakesPAINTPower Driver SeatClimate ControlTraction ControlClear Coat PaintPower Passenger SeatDual Air ConditionStability ControlMetallic PaintDECORNavigation SystemFront Side Impact Air BagsOTHERDual MirrorsBackup CameraHead/Curtain Air BagsFog LampsBody Side MoldingsParking SensorsHands Free DeviceRear SpoilerPrivacy GlassDual Power Sliding DoorsBlind Spot DetectionCalifornia EmissionsConsole/StorageHome LinkROOFTRUCKOverhead ConsoleRADIOLuggage/Roof RackPower Trunk/LiftgateWood Interior TrimAM RadioElectric Glass Sunroof12/23/2024 10:38:56 AM120313 | 1.9.06.12060Page 1 Claim #:JAD8087001Workfile ID:7d6cca6bSupplement of Record 2 Summary2017 TOYO Sienna XLE FWD w/8-Passenger Seating 4D VAN 6-3.5L Gasoline Port/Direct Injection BLACK CONVENIENCEFM RadioSEATSAir ConditioningStereoBucket Seats12/23/2024 10:38:56 AM120313 | 1.9.06.12060Page 2 Claim #:JAD8087001Workfile ID:7d6cca6bSupplement of Record 2 Summary2017 TOYO Sienna XLE FWD w/8-Passenger Seating 4D VAN 6-3.5L Gasoline Port/Direct Injection BLACK LineOperDescriptionPart NumberQtyExtendedPrice $LaborPaint1#S02***TOTAL LOSS***1NOTE: CONSTRUCTIVE TOTAL2FRONT BUMPER3O/H front bumper2.24*ReplLKQ bumper assy +25%52119089041487.50Incl.3.05Add for Clear Coat1.26**ReplA/M RT Side supportTY5306FL8128.280.17R&ILT Side support52116080100.18R&IRT Pad5385108010Incl.9R&ILT Pad5385208010Incl.10*ReplRT Hole cover w/fog lamps w/ofrt park aid52127080301Incl.Incl.NOTE: Inc with lkq bumper assy11*ReplLT Hole cover w/fog lamps w/ofrt park aid52128080301Incl.Incl.NOTE: Inc with lkq bumper assy12*ReplLicense bracket75101080101Incl.0.2NOTE: Inc with lkq bumper assy13*ReplLower grille53112080101Incl.Incl.NOTE: Inc with lkq bumper assy14*ReplEnergy absorber52611080501Incl.Incl.15GRILLE16**ReplA/M Grille assy w/o distancesensor, XLETO12003991247.380.317FRONT LAMPS18**ReplA/M RT Headlamp assy L, LE,XLE, XLE PremTO25031991159.45Incl.19**ReplA/M LT Headlamp assy L, LE,XLE, XLE PremTO25021991154.25Incl.20Aim headlamps0.521**ReplA/M CAPA RT Fog lamp assy2122076RAC1109.890.222R&ILT Fog lamp assy81220080200.223ReplAim fog lamps10.424RADIATOR SUPPORT25S01Refinish Components1.726S01ReplRadiator support53201080401491.78s8.5Incl.NOTE: WELDED ON - USED NOT AN OPTION27COOLING28R&IRadiator assy w/AC condenser164000P370mIncl.29AIR CONDITIONER & HEATER30**ReplA/M CondenserACC300511104.32mIncl.31Refrigerant recoverym0.4M32Evacuate & rechargem1.4M12/23/2024 10:38:56 AM120313 | 1.9.06.12060Page 3 Claim #:JAD8087001Workfile ID:7d6cca6bSupplement of Record 2 Summary2017 TOYO Sienna XLE FWD w/8-Passenger Seating 4D VAN 6-3.5L Gasoline Port/Direct Injection BLACK 33HOOD34**ReplA/M CAPA Hood52441-551071269.281.22.635Add for Clear Coat1.036Add for Underside(Complete)1.337R&IInsulator5334108010Incl.38R&IFront seal5338108020Incl.39R&ILock assy w/anti theft5351008041Incl.40**ReplA/M RT HingeTY5302B2130.420.30.441Add for Clear Coat0.142ReplEmblem7544108020140.080.243FENDER44**ReplA/M CAPA RT Fender all (HSS)141406-551071165.862.22.045Overlap Major Adj. Panel-0.446Add for Clear Coat0.347Add for Edging0.548*BlndLT Fender all (HSS)53812080301.049R&IRT Fender liner w/o SE5380508030Incl.50R&ILT Fender liner w/o SE53806080300.451S01ReplRT Apron assy (HSS)53701080301606.83s5.51.552S01Overlap Major Non-Adj. Panel-0.253S01Deduct for Overlap-0.554S01ReplRT Rail assy (HSS)57027080111495.49s7.01.2NOTE: LABOR: Time is after bumper, headlamp, fender, suspension and all necessary bolted-on parts areremoved. Time is after apron assembly is removed.55S01Overlap Major Non-Adj. Panel-0.256S01ReplRT Front extn (HSS)5711308020164.07sIncl.0.457S01Add for Clear Coat0.158S01ReplRT Side plate (HSS)57025080101246.87sIncl.0.859S01Overlap Minor Panel-0.260#S01TRANSFER/REPAIR WELDED ONCONVERSION SUPPORTS-OPEN110.061ENGINE / TRANSAXLE62S01ReplR&I engine/trans assyNONE1m10.8M63EXHAUST SYSTEM64S01ReplConverter & pipe174200P47111,162.61m0.8M65COWL66*R&IRT Seal to hood side seal53866080200.167*R&ILT Seal to hood side seal53867080200.168INSTRUMENT PANEL69ReplLower trim panel gray5543208020B11242.3370CONSOLE71R&IR&I console assy5880108030E00.372RESTRAINT SYSTEMS73ReplDriver air bag black4513008100C01820.08m0.474ReplRT Ft seat air bag73910080141520.86m1.012/23/2024 10:38:56 AM120313 | 1.9.06.12060Page 4 Claim #:JAD8087001Workfile ID:7d6cca6bSupplement of Record 2 Summary2017 TOYO Sienna XLE FWD w/8-Passenger Seating 4D VAN 6-3.5L Gasoline Port/Direct Injection BLACK 75ReplKnee air bag tan7390008010E011,068.99m0.3NOTE: LABOR: Time is after lower dash panel is removed.76ReplLT Ft seat air bag73920080141520.86m1.077ReplRT Head air bag621700803311,545.05m0.778ReplLT Head air bag621800803311,545.05m0.779ReplRT Belt & retractor w/o adaptivecruise tan7321008083E01287.580.3NOTE: Time is after center pillar trim is removed.80ReplLT Belt & retractor w/o adaptivecruise tan7322008061E11287.580.3NOTE: Time is after center pillar trim is removed.81ReplDiagnostic unit w/o adaptivecruise89170081601314.42m1.0NOTE: LABOR: Time is after console assembly is removed.82ReplRT Ft impact sensor8917309899193.77mIncl.83ReplLT Ft impact sensor8917309899193.77mIncl.84SEATS & TRACKS85R&IRT R&I front seat0.486R&ILT R&I front seat0.487ReplRT Seat back pad71551080201207.280.188ReplRT Seat back cover XLE, XLELimited tan7107308200E11952.091.089ReplLT Seat back pad all71552080401207.280.190ReplLT Seat back cover XLE, XLEPremium tan7107408200E11952.591.091ROOF92ReplHeadliner XLE, w/o rear DVD,w/Bluetooth tan6332008993E012,354.475.293PILLARS, ROCKER & FLOOR94R&IRT Upr ctr plr trim LE, SE, XLE,Limited tan6241108060E1Incl.NOTE: Time is after lower center trim panel is removed.95R&ILT Upr ctr plr trim LE, SE, XLE,Limited tan6241208070E1Incl.NOTE: Time is after lower center trim panel is removed.96R&IRT Lwr ctr plr trim gray6241308060B00.3NOTE: Time is after front and rear scuff plate is removed.97R&IRT Scuff plate front gray6791308020B10.298R&ILT Lwr ctr plr trim gray6241408040B10.3NOTE: Time is after front and rear scuff plate is removed.99R&ILT Scuff plate front gray6791408020B10.2100R&IRT Scuff plate rear gray6791708060B00.2101R&ILT Scuff plate rear gray6791808060B00.2102FRONT DOOR103*RprRT Outer panel67111080201.02.1104Overlap Major Adj. Panel-0.412/23/2024 10:38:56 AM120313 | 1.9.06.12060Page 5 Claim #:JAD8087001Workfile ID:7d6cca6bSupplement of Record 2 Summary2017 TOYO Sienna XLE FWD w/8-Passenger Seating 4D VAN 6-3.5L Gasoline Port/Direct Injection BLACK 105Add for Clear Coat0.3106#RefnPartial Refinish Adjustment-0.2107*R&IRT Belt molding68160080200.3108R&ILower door trim w/kit gleamingchromePT29A081000.6NOTE: Inc clean and retape109*R&IRT Mirror assy 8791008113C10.3110R&IRT Handle, outside chrome69210080300.5111R&IRT R&I trim panel6761008120B00.4112VEHICLE DIAGNOSTICS113*RprPre-repair scanm0.5M114*RprPost-repair scanm0.5M115MISCELLANEOUS OPERATIONS116*ReplCover car/bag15.000.2117**ReplA/M Mask Jambs15.000.2118#ReplRestore Corrosion Protection1T 0.2119#RprAnchor Measure & Pull2.0120OTHER CHARGES121#Hazardous Waste15.00SUBTOTALS16,893.4174.720.1NOTESPrior Damage Notes: NESTIMATE TOTALSCategoryBasisRateCost $Parts16,888.41Body Labor60.3 hrs@$ 74.00 /hr4,462.20Paint Labor20.1 hrs@$ 74.00 /hr1,487.40Mechanical Labor14.4 hrs@$ 125.00 /hr1,800.00Paint Supplies999.00Other Charges5.00Subtotal25,642.01Sales Tax$ 17,892.41@9.8750 %1,766.88Total Cost of Repairs27,408.89Deductible500.00Total Adjustments500.00Net Cost of Repairs26,908.8912/23/2024 10:38:56 AM120313 | 1.9.06.12060Page 6 Claim #:JAD8087001Workfile ID:7d6cca6bSupplement of Record 2 Summary2017 TOYO Sienna XLE FWD w/8-Passenger Seating 4D VAN 6-3.5L Gasoline Port/Direct Injection BLACK SUPPLEMENT SUMMARYLineOperDescriptionPart NumberQtyExtendedPrice $LaborPaintAdded Items1#S02***TOTAL LOSS***1NOTE: CONSTRUCTIVE TOTALSUBTOTALS0.000.00.0NOTESPrior Damage Notes: NTOTALS SUMMARYCategoryBasisRateCost $Parts0.00Subtotal0.00CUMULATIVE EFFECTS OF SUPPLEMENT(S)Estimate20,977.24JOHN SCHLEICHERSupplement S016,431.65Michael FrederickSupplement S020.00RAYMAN BASHIERWorkfile Total: $27,408.89TOTAL ADJUSTMENTS: $500.00NET COST OF REPAIRS: $26,908.8912/23/2024 10:38:56 AM120313 | 1.9.06.12060Page 7 Claim #:JAD8087001Workfile ID:7d6cca6bSupplement of Record 2 Summary2017 TOYO Sienna XLE FWD w/8-Passenger Seating 4D VAN 6-3.5L Gasoline Port/Direct Injection BLACK All supplements must be pre-approved by Travelers.Supplement repair charges may be subject to rejection unless approved by Travelers prior to repairs.This instrument is a damage estimate only and not an acceptance of liability or authorization to repair. Repair must be pre-authorized by the vehicle owner.Vehicle owner maintains the right to repair vehicle at a repair facility of their choice.Please present this estimate to the repair facility prior to repairs.Necessary Information for Photograph and Video Estimates (READ CAREFULLY):This estimate may have been completed based wholly or in part using photographs and/or video. Because of the useof photographs and video, this estimate may not be complete, as there could be hidden damage. You should providethis estimate to the shop of your choice prior to commencement of work. If your shop finds additional damages orundiscovered damages, Travelers will work with your repairer to assess the appropriate scope of work. Your shop isinstructed in this estimate to contact Travelers through its supplement process and the damages they discover mustbe reviewed and approved prior to repairing the vehicle In the event that you are not repairing your vehicle andbelieve that our estimate does not account for all of your damages, please contact your Claim professional to discussand address your concerns and options.MN ST 60A.955 - A PERSON WHO FILES A CLAIM WITH INTENT TO DEFRAUD OR HELPS COMMIT A FRAUDAGAINST AN INSURER IS GUILTY OF A CRIME.Estimate calculated using a preset user threshold amount for the paint and material cost.12/23/2024 10:38:56 AM120313 | 1.9.06.12060Page 8 Claim #:JAD8087001Workfile ID:7d6cca6bSupplement of Record 2 Summary2017 TOYO Sienna XLE FWD w/8-Passenger Seating 4D VAN 6-3.5L Gasoline Port/Direct Injection BLACK Estimate based on MOTOR CRASH ESTIMATING GUIDE and potentially other third party sources of data. Unlessotherwise noted, (a) all items are derived from the Guide ARM8531, CCC Data Date 12/16/2024, and potentially otherthird party sources of data; and (b) the parts presented are OEM-parts. OEM parts are manufactured by or for thevehicle's Original Equipment Manufacturer (OEM) according to OEM's specifications for U.S. distribution. OEM partsare available at OE/Vehicle dealerships or the specified supplier. OPT OEM (Optional OEM) or ALT OEM (AlternativeOEM) parts are OEM parts that may be provided by or through alternate sources other than the OEM vehicledealerships with discounted pricing. Asterisk (*) or Double Asterisk (**) indicates that the parts and/or labor dataprovided by third party sources of data 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 refinishoperation WILL NOT be performed as a separate procedure from the other panels in the estimate. Non-OriginalEquipment Manufacturer aftermarket parts are described as Non OEM, A/M or NAGS. Used parts are described asLKQ, RCY, or USED. Reconditioned parts are described as Recond. Recored parts are described as Recore. NAGSPart Numbers and Benchmark Prices are provided by National Auto Glass Specifications. Labor operation times listedon the line with the NAGS information are MOTOR suggested labor operation times. NAGS labor operation times arenot included. Pound sign (#) items indicate manual entries.Some 2024 vehicles contain minor changes from the previous year. For those vehicles, prior to receiving updateddata from the vehicle manufacturer, labor and parts data from the previous year may be used. The CCC ONEestimator has a 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 tobe 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. CFC=Carbon Fiber.D&R=Disconnect and Reconnect. HSS=High Strength Steel. HYD=Hydroformed Steel. Incl.=Included. LKQ=LikeKind 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 andReplace. Rpr=Repair. RT=Right. SAS=Sandwiched Steel. Sect=Section. STS=Stainless Steel. Subl=Sublet. UHS=Ultra High Strength Steel. N=Note(s) associated with the estimate line.CCC ONE Estimating - A product of CCC Intelligent Solutions Inc.The following is a list of abbreviations that may be used in CCC ONE Estimating that are not part of the MOTORCRASH ESTIMATING GUIDE:BAR=Bureau of Automotive Repair. EPA=Environmental Protection Agency. NHTSA= National HighwayTransportation and Safety Administration. PDR=Paintless Dent Repair. VIN=Vehicle Identification Number.12/23/2024 10:38:56 AM120313 | 1.9.06.12060Page 9 Claim #:JAD8087001Workfile ID:7d6cca6bSupplement of Record 2 Summary2017 TOYO Sienna XLE FWD w/8-Passenger Seating 4D VAN 6-3.5L Gasoline Port/Direct Injection BLACK ALTERNATE PARTS SUPPLIERSLineSupplierDescriptionPrice6Pro-A Motors#TY5306FL8$ 28.286423 E. Washington BlvdA/M RT Side supportCommerce CA 90040Quote: 3020755067(323) 838-2988Expires: 11/18/2416Go-Parts (FedEx)#TO1200399$ 247.386485 SHILOH RD B #400A/M Grille assy w/o distance sensor, XLEALPHARETTA GA 30005Quote: 333q-1019273-7993(770) 965-6400Expires: 11/18/2418Original One Auto Parts-Salt Lake City#TO2503199$ 159.452080 Industrial RD Suite CA/M RT Headlamp assy L, LE, XLE, XLE PremSalt Lake City UT 84104Quote: 3020755067(877) 441-0001Expires: 11/18/2419Original One Auto Parts-Salt Lake City#TO2502199$ 154.252080 Industrial RD Suite CA/M LT Headlamp assy L, LE, XLE, XLE PremSalt Lake City UT 84104Quote: 3020755067(877) 441-0001Expires: 11/18/2421All Star Auto Lights - Florida#2122076RAC$ 109.89300 W GRANT STREETA/M CAPA RT Fog lamp assyORLANDO FL 38206Quote: 3020755067(407) 271-8949Expires: 11/18/2430AutomotiveCooling - PA#ACC30051$ 104.32191 S Keim StreetA/M CondenserPottstown PA 19464Quote: Q2411121801F110(888) 305-0030Expires: 11/18/2434PAM's Auto - Central#52441-55107$ 269.287505 Ridgewood RoadA/M CAPA HoodSt. Cloud MN 56303Quote: 152492731(800) 560-7336Expires: 11/18/2440Pro-A Motors#TY5302B2$ 30.426423 E. Washington BlvdA/M RT HingeCommerce CA 90040Quote: 3020755067(323) 838-2988Expires: 11/18/2444PAM's Auto - Central#141406-55107$ 165.867505 Ridgewood RoadA/M CAPA RT Fender all (HSS)St. Cloud MN 56303Quote: 15249273112/23/2024 10:38:56 AM120313 | 1.9.06.12060Page 10 Claim #:JAD8087001Workfile ID:7d6cca6bSupplement of Record 2 Summary2017 TOYO Sienna XLE FWD w/8-Passenger Seating 4D VAN 6-3.5L Gasoline Port/Direct Injection BLACK (800) 560-7336Expires: 11/18/2412/23/2024 10:38:56 AM120313 | 1.9.06.12060Page 11 Prepared for TRAVELERS - THE STANDARD FIRE INSURANCE COMPANY © Copyright 2021 CCC Intelligent Solutions Inc. All Rights Reserved.Page 1 of 15 REPORT SUMMARY CLAIM INFORMATION Owner Vue, Soua Saint Paul, MN 55117 Loss Unit Standard 2017 Toyota SIENNA 4X2 XLE 6cyl. 3.5l Mobility-Side Loss Unit Type CONVERSION VEHICLES Loss Incident Date 11/01/2024 Claim Reported 11/12/2024 The CCC ONE® Market Valuation Report reflects CCC Intelligent Solutions Inc.’s opinion as to the value of the loss unit, based on information provided to CCC by TRAVELERS - THE STANDARD FIRE INSURANCE COMPANY. INSURANCE INFORMATION Report Reference Number 122318088 Claim Reference JAD8087001 Adjuster Sh6 Appraiser Schleicher, John Odometer 43,381 Last Updated 11/13/2024 02:35 PM VALUATION SUMMARY Base Value $ 48,538.00 Adjusted Value $ 48,538.00 Tax ( 6.9162% )+ $ 3,356.99 Tax reflects applicable state, county and municipal taxes. Title, Registration and Other Fees + $ 199.78 Deductible - $ 500.00 Total $ 51,594.77 The total may not represent the total of the settlement as other factors (e.g. license and fees) may need to be taken into account. BASE VALUE This is derived from comparable unit(s) available or recently available in the marketplace at the time of valuation, per our valuation methodology described on the next page. Inside the Report Valuation Methodology.............................2 Loss Unit Information...............................3 Comparable Units.....................................7 Valuation Notes......................................11 Supplemental Information.......................12 Owner: Vue, Soua Claim: JAD8087001 © Copyright 2021 CCC Intelligent Solutions Inc. All Rights Reserved.Page 2 of 15 VALUATION METHODOLOGY How was the valuation determined? CLAIM INSPECTION TRAVELERS - THE STANDARD FIRE INSURANCE COMPANY has provided CCC with the zip code where the loss unit is garaged, loss unit VIN, mileage/hours, options and additional equipment, as well as loss unit condition, which is used to assist in determining the value of the loss unit. DATABASE REVIEW CCC maintains an extensive database of units that currently are or recently were available for sale in the U.S. This database includes units advertised for sale by dealerships or private parties. All of these sources are updated regularly. SEARCH FOR COMPARABLES When a valuation is created the database is searched and comparable units are selected. On current year units, new units for sale at the time of the valuation may have been used. The zip code where the loss unit is garaged determines the starting point for the search. Comparable units are similar to the loss unit based on relevant factors. If a sufficient number of comparable units cannot be located, CCC may also obtain dealer quotations for a unit with attributes as reported by the insurer. CALCULATE VALUATION Adjustments to the price of the selected comparable units are made to reflect differences in attributes, including mileage/hours, options, additional equipment, refurbishments, after factory equipment, and condition. Dollar adjustments are based upon market research. Finally, the Base Value is the straight average of the adjusted values of the comparable units. Due to the unique nature of the loss units valued in the Commercial and Recreational Vehicle division, a valuation specialist handles each request individually. Owner: Vue, Soua Claim: JAD8087001 © Copyright 2021 CCC Intelligent Solutions Inc. All Rights Reserved.Page 3 of 15 LOSS UNIT INFORMATION LOSS UNIT DETAILS Location Saint Paul , MN 55117 VIN 5TDYZ3DC7HS867807 Year 2017 Make Toyota Model SIENNA 4X2 XLE Drivetrain 4X2 LOSS UNIT CONDITION Condition Overall Rating Average Vehicles sold in the United States are required to have a manufacturer assigned Vehicle Identification Number(VIN). This number provides certain specifications of the vehicles . Please review the information in the Loss Unit Information Section to confirm the reported mileage and condition, and to verify that the information accurately reflects the options, additional equipment, refurbishments or other aspects of the loss unit that may impact the value. TRAVELERS - THE STANDARD FIRE INSURANCE COMPANY uses condition inspection guidelines to determine the condition of the loss unit prior to the loss. The guidelines describe physical characteristics for the loss unit, for the condition selected based upon age. Inspection Notes reflect observations from the appraiser regarding the loss unit’s condition. Owner: Vue, Soua Claim: JAD8087001 © Copyright 2021 CCC Intelligent Solutions Inc. All Rights Reserved.Page 4 of 15 LOSS UNIT EQUIPMENT CT - Transmission AUTOMATIC TRANSMISSION PQ - Power POWER STEERING POWER BRAKES POWER WINDOWS POWER LOCKS POWER MIRRORS POWER DRIVER SEAT POWER PASSENGER SEAT POWER TRUNK/LIFTGATE DUAL POWER SLIDING DOORS RM - Roof LUGGAGE/ROOF RACK ELECTRIC GLASS ROOF CW - Wheels ALUMINUM/ALLOY WHEELS LOCKING WHEELS CM - Convenience AIR CONDITIONING DUAL MIRRORS INTERMITTENT WIPERS TILT WHEEL CRUISE CONTROL REAR DEFOGGER KEYLESS ENTRY FOG LAMPS HEATED MIRRORS STEERING WHEEL TOUCH CONTROLS TELESCOPIC WHEEL CLIMATE CONTROL DUAL AIR CONDITIONING NAVIGATION SYSTEM HOME LINK CR - Radio AM RADIO FM RADIO STEREO SEARCH/SEEK CD PLAYER To the left is the equipment of the loss unit that TRAVELERS - THE STANDARD FIRE INSURANCE COMPANY provided to CCC. Owner: Vue, Soua Claim: JAD8087001 © Copyright 2021 CCC Intelligent Solutions Inc. All Rights Reserved.Page 5 of 15 LOSS UNIT EQUIPMENT AUXILIARY AUDIO CONNECTION SATELLITE RADIO IC - Seats/Interior BUCKET SEATS CONSOLE/STORAGE RECLINING/LOUNGE SEATS LEATHER SEATS OVERHEAD CONSOLE HEATED SEATS 3RD ROW SEAT WOOD INTERIOR TRIM RETRACTABLE SEATS SS - Safety AIR BAG (DRIVER ONLY) PASSENGER AIR BAG ANTI-LOCK BRAKES (4) 4-WHEEL DISC BRAKES TRACTION CONTROL STABILITY CONTROL FRONT SIDE IMPACT AIR BAGS HEAD/CURTAIN AIR BAGS HANDS FREE ALARM BACKUP CAMERA PARKING SENSORS BLIND SPOT DETECTION OC - Other BODY SIDE MOLDINGS PRIVACY GLASS REAR STEP BUMPER CALIFORNIA EMISSIONS PU - Crv Paint CLEARCOAT PAINT METALLIC PAINT ADDITIONAL EQUIPMENT Vmi Northstar Conversion Owner: Vue, Soua Claim: JAD8087001 © Copyright 2021 CCC Intelligent Solutions Inc. All Rights Reserved.Page 6 of 15 ADDITIONAL EQUIPMENT Power Wheelchair Ramp-Side Lowered Floor Kneeling System Tie Downs Missing Captain's Chairs (4) Owner: Vue, Soua Claim: JAD8087001 © Copyright 2021 CCC Intelligent Solutions Inc. All Rights Reserved.Page 7 of 15 COMPARABLE UNITS Loss Unit Comp 1 Comp 2 Comp 3 Price $48,900 $49,900 $49,900 Year/Make/Model 2017 Toyota SIENNA 4X2 XLE Xle 2018 Toyota SIENNA 4X2 XLE Xle 2018 Toyota SIENNA 4X2 XLE Xle 2018 Toyota SIENNA 4X2 XLE Xle Trim Xle Xle Xle Xle Odometer 43,381 42,040 56,761 52,823 Configuration Engine Cylinder 6 6 6 6 Model Description 3.5L 3.5L 3.5L 3.5L Door 4 4 Body Type MOBILITY- SIDE MOBILITY- SIDE MOBILITY- SIDE MOBILITY- SIDE Conversion Name VMI NORTHSTAR BRAUNABILITY MOBILITY BRAUNABILITY Drivetrain 4X2 4X2 4X2 4X2 Options 3S - 3rd Row Seat LN - Lane Departure Warning TW - Tilt Wheel PS - Power Steering DG - Head/Curtain Air Bags TX - Traction Control PT - Power Trunk/Liftgate HM - Heated Mirrors M3 - Auxiliary Audio Connection LS - Leather Seats PW - Power Windows PX - Backup Camera DM - Dual Mirrors DP - Dual Power Sliding Doors DT - Privacy Glass DV - Blind Spot Detection IC - Intelligent Cruise UR - Premium Radio AB - Anti-Lock Brakes (4) R3 - Retractable Seats EG - Electric Glass Roof Comp 1 Updated Date: 11/13/2024 2018 Toyota SIENNA 4X2 XLE Xle VIN 5TDYZ3DC7JS919510 Dealership ALTERNATIVE MOBILITY Location Watseka, IL Telephone (815) 515-4471 Source Dealer Ad Comp 2 Updated Date: 10/24/2024 2018 Toyota SIENNA 4X2 XLE Xle VIN 5TDYZ3DC9JS936423 Dealership UNITED ACCESS Location Saint Louis, MO Telephone (314) 888-9450 Source Dealer Ad Stock # JS936423A Comp 3 Updated Date: 10/16/2024 2018 Toyota SIENNA 4X2 XLE Xle VIN 5TDYZ3DC0JS949268 Dealership FOUR WAY AUTO Location York, PA Telephone (717) 356-3252 Source Dealer Ad Comparables used in the determination of the Base Value are not intended to be replacement units but are reflective of the market value, and may no longer be available for sale. Price is the amount that the dealership will accept to sell the unit, though a lower price may be obtainable through negotiation. Owner: Vue, Soua Claim: JAD8087001 © Copyright 2021 CCC Intelligent Solutions Inc. All Rights Reserved.Page 8 of 15 COMPARABLE UNITS Loss Unit Comp 1 Comp 2 Comp 3 AC - Air Conditioning MP - Metallic Paint AG - Drivers Side Air Bag IP - Clearcoat Paint EM - California Emissions AM - AM Radio IW - Intermittent Wipers RD - Rear Defogger B4 - Captain Chairs (4) AT - Automatic Transmission RG - Passenger Air Bag AW - Aluminum/Alloy Wheels RL - Reclining/Lounge Seats RR - Luggage/Roof Rack BD - Running Boards/Side Steps FL - Fog Lamps FM - FM Radio NV - Navigation System BN - Body Side Moldings SB - Rear Step Bumper C2 - Communications System BS - Bucket Seats SE - Search/Seek SH - Heated Seats KE - Keyless Entry WT - Wood Interior Trim SP - Power Driver Seat T1 - Stability Control GD - Home Link CC - Cruise Control CD - CD Player ST - Stereo CL - Climate Control CN - Console/Storage CO - Overhead Console KW - Locking Wheels XG - Front Side Impact Air Bags TD - Alarm PB - Power Brakes PC - Power Passenger Seat XM - Satellite Radio Owner: Vue, Soua Claim: JAD8087001 © Copyright 2021 CCC Intelligent Solutions Inc. All Rights Reserved.Page 9 of 15 COMPARABLE UNITS Loss Unit Comp 1 Comp 2 Comp 3 TL - Telescopic Wheel PJ - Parking Sensors PL - Power Locks PM - Power Mirrors TQ - Steering Wheel Touch Controls DA - Dual Air Conditioning HF - Hands Free DB - 4-Wheel Disc Brakes Additional Equipment Tie Downs Manual Wheelchair Ramp-Side Vmi Northstar Conversion Non Skid Floor Missing Captain's Chairs (4) Power Ramp-Side Lowered Floor Braunability Conversion Mobility Conversion Power Wheelchair Ramp-Side Kneeling System Retractable Tie Downs Condition Average Average Average Average Adjustments: Make/Model/Trim - $ 2,600 - $ 2,600 - $ 2,600 Additional Equipment Manual Wheelchair Ramp-Side $ 745 Non Skid Floor - $ 242 - $ 242 Missing Captain's Chairs (4)- $ 142 - $ 142 - $ 142 Retractable Tie Downs - $ 182 Options UR - Premium Radio - $ 150 - $ 150 BD - Running Boards/Side Steps - $ 150 - $ 150 - $ 150 NV - Navigation System $ 400 $ 400 $ 0 PJ - Parking Sensors $ 100 $ 100 $ 0 Odometer $ 927 $ 2,098 $ 1,785 Condition Owner: Vue, Soua Claim: JAD8087001 © Copyright 2021 CCC Intelligent Solutions Inc. All Rights Reserved.Page 10 of 15 COMPARABLE UNITS Adjusted Comparable Value $47,285 $49,214 $49,114 Owner: Vue, Soua Claim: JAD8087001 © Copyright 2021 CCC Intelligent Solutions Inc. All Rights Reserved.Page 11 of 15 VALUATION NOTES 11/13/2024 13:33 - AVERAGE MILEAGE: 113,900 11/13/2024 13:30 - STANDARD EQUIPMENT: 3S, AB, AC, AG, AM, AT, AW, B4, BS, CC, CD, CL, CN, CO, DA, DB, DG, DM, DP, DT, DV, EG, FD, FL, FM, GD, HF, HM, IP, IW, KE, LS, M3, PB, PC, PL, PM, PS, PT, PW, PX, R3, RD, RG, SB, SE, SH, SL, SP, ST, T1, TD, TL, TQ, TW, TX, WP, WT, XG, XM This Market Valuation Report has been prepared exclusively for use by TRAVELERS - THE STANDARD FIRE INSURANCE COMPANY, and no other person or entity is entitled to or should rely upon this Market Valuation Report and/or any of its contents. CCC is one source of valuations, and there are other valuation sources available. Owner: Vue, Soua Claim: JAD8087001 © Copyright 2021 CCC Intelligent Solutions Inc. All Rights Reserved.Page 12 of 15 SUPPLEMENTAL INFORMATION LOSS UNIT HISTORY INFORMATION Using the VIN for this loss unit, VINguard® detected discrepancies or prior history requiring additional research. Please review the information detailed below. VINguard® VINguard® Message: VINguard has decoded this VIN without any errors Previous Total Loss Submission: Duplicate VIN 122317835 - previously submitted by TRAVELERS(AE) on 11/12/2024 claim ref # JAD8087001 Owner: Vue, Soua Claim: JAD8087001 © Copyright 2021 CCC Intelligent Solutions Inc. All Rights Reserved.Page 13 of 15 SUPPLEMENTAL INFORMATION EXPERIAN® AUTOCHECK® VEHICLE HISTORY REPORT TITLE CHECK RESULTS FOUND Abandoned No Abandoned Record Found Damaged No Damaged Record Found Fire Damage No Fire Damage Record Found Grey Market No Grey Market Record Found Hail Damage No Hail Damage Record Found Insurance Loss No Insurance Loss Record Found Junk No Junk Record Found Rebuilt No Rebuilt Record Found Salvage No Salvage Record Found EVENT CHECK RESULTS FOUND NHTSA Crash Test Vehicle No NHTSA Crash Test Vehicle Record Found Frame Damage No Frame Damage Record Found Major Damage Incident No Major Damage Incident Record Found Manufacturer Buyback/Lemon No Manufacturer Buyback/Lemon Record Found Odometer Problem No Odometer Problem Record Found Recycled No Recycled Record Found Branded Title Auction No Branded Title Auction Record Found Water Damage No Water Damage Record Found VEHICLE INFORMATION RESULTS FOUND Accident Accident Record Found Corrected Title No Corrected Title Record Found Driver Education No Driver Education Record Found Duplicate Title No Duplicate Title Record Found Emissions Safety Inspection No Emissions Safety Inspection Record Found Fire Damage Incident No Fire Damage Incident Record Found Lease No Lease Record Found Lien No Lien Record Found Livery Use No Livery Use Record Found Government Use No Government Use Record Found Police Use No Police Use Record Found Fleet No Fleet Record Found Rental No Rental Record Found Fleet and/or Lease No Fleet and/or Lease Record Found Fleet and/or Rental No Fleet and/or Rental Record Found Repossessed No Repossessed Record Found Taxi use No Taxi use Record Found Theft No Theft Record Found CCC provides TRAVELERS - THE STANDARD FIRE INSURANCE COMPANY information reported by Experian® regarding the 2017 Toyota SIENNA 4X2 XLE 6cyl. 3.5l ( 5TDYZ3DC7HS867807 ). This data is provided for informational purposes. Unless otherwise noted in this Market Valuation Report, CCC does not adjust the value of the loss unit based upon this information. LEGEND : No Event Found Event Found Information Needed TITLE CHECK THIS VEHICLE CHECKS OUT AutoCheck's result for this loss unit show no significant title events. When found, events often indicate automotive damage or warnings associated with the unit. EVENT CHECK THIS VEHICLE CHECKS OUT AutoCheck's result for this loss unit show no historical events that indicate a significant automotive problem. These problems can indicate past previous car damage, theft, or other significant problems. VEHICLE INFORMATION INFORMATION FOUND AutoCheck found additional information on this loss unit. These records will provide more history for this loss unit ODOMETER CHECK THIS VEHICLE CHECKS OUT AutoCheck's result for this loss unit show no indication of odometer rollback or tampering was found. AutoCheck determines odometer rollbacks by searching for records that indicate odometer readings less than a previously reported value. Other odometer events can report events of tampering, or possible odometer breakage. Owner: Vue, Soua Claim: JAD8087001 © Copyright 2021 CCC Intelligent Solutions Inc. All Rights Reserved.Page 14 of 15 SUPPLEMENTAL INFORMATION FULL HISTORY REPORT RUN DATE: 11/13/2024 Below are the historical events for this vehicle listed in chronological order. EVENT DATE EVENT LOCATION ODOMETER READING DATA SOURCE EVENT DETAIL 06/12/2017 Independent Source Vehicle Manufactured and Shipped to Dealer 07/31/2017 SAINT PAUL, MN Motor Vehicle Dept.Registration Event/ Renewal 09/07/2017 SAINT PAUL, MN 10 Motor Vehicle Dept.Title (Lien Reported) 09/07/2017 SAINT PAUL, MN Motor Vehicle Dept.Registration Event/ Renewal 05/22/2018 SAINT PAUL, MN Motor Vehicle Dept.Registration Event/ Renewal 06/11/2019 SAINT PAUL, MN Motor Vehicle Dept.Registration Event/ Renewal 05/29/2020 SAINT PAUL, MN Motor Vehicle Dept.Registration Event/ Renewal 06/16/2021 SAINT PAUL, MN Motor Vehicle Dept.Registration Event/ Renewal 05/02/2022 SAINT PAUL, MN Motor Vehicle Dept.Title (Lien Reported) 05/02/2022 SAINT PAUL, MN Motor Vehicle Dept.Duplicate Title (Lien Reported) 07/27/2022 SAINT PAUL, MN Motor Vehicle Dept.Duplicate Title (Lien Reported) 07/27/2022 SAINT PAUL, MN Motor Vehicle Dept.Registration Event/ Renewal 08/31/2022 BURNSVILLE, MN 32320 Service Record Fuel System Serviced 08/31/2022 BURNSVILLE, MN Service Record Battery Serviced or Replaced 08/31/2022 BURNSVILLE, MN Service Record Multiple Point Vehicle Inspection 08/31/2022 BURNSVILLE, MN Service Record Engine Serviced 08/31/2022 BURNSVILLE, MN Service Record Chassis Serviced 08/31/2022 BURNSVILLE, MN Service Record Electrical System Serviced 08/31/2022 BURNSVILLE, MN Service Record Tires or Wheels Service Performed 06/12/2023 SAINT PAUL, MN Motor Vehicle Dept.Duplicate Title (Lien Reported) 06/12/2023 SAINT PAUL, MN Motor Vehicle Dept.Registration Event/ Renewal 06/13/2024 SAINT PAUL, MN Motor Vehicle Dept.Duplicate Title (Lien Reported) 06/13/2024 SAINT PAUL, MN Motor Vehicle Dept.Registration Event/ Renewal Owner: Vue, Soua Claim: JAD8087001 © Copyright 2021 CCC Intelligent Solutions Inc. All Rights Reserved.Page 15 of 15 SUPPLEMENTAL INFORMATION EVENT DATE EVENT LOCATION ODOMETER READING DATA SOURCE EVENT DETAIL 11/01/2024 MN State Agency Front Impact with Another Vehicle 11/01/2024 MN State Agency Air Bag Deployed 11/01/2024 MN State Agency Vehicle Was Towed AUTOCHECK TERMS AND CONDITIONS: Experian's Reports are compiled from multiple sources. It is not always possible for Experian to obtain complete discrepancy information on all vehicles; therefore, there may be other title brands, odometer readings or discrepancies that apply to a vehicle that are not reflected on that vehicle's Report. Experian searches data from additional sources where possible, but all discrepancies may not be reflected on the Report. These Reports are based on information supplied to Experian by external sources believed to be reliable, BUT NO RESPONSIBILITY IS ASSUMED BY EXPERIAN OR ITS AGENTS FOR ERRORS, INACCURACIES OR OMISSIONS. THE REPORTS ARE PROVIDED STRICTLY ON AN "AS IS WHERE IS" BASIS, AND EXPERIAN FURTHER EXPRESSLY DISCLAIMS ALL WARRANTIES, EXPRESS OR IMPLIED, INCLUDING ANY IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE REGARDING THIS REPORT. YOU AGREE TO INDEMNIFY EXPERIAN FOR ANY CLAIMS OR LOSSES, INCLUDING COSTS, EXPENSES AND ATTORNEYS FEES, INCURRED BY EXPERIAN ARISING DIRECTLY OR INDIRECTLY FROM YOUR IMPROPER OR UNAUTHORIZED USE OF AUTOCHECK VEHICLE HISTORY REPORTS. Experian shall not be liable for any delay or failure to provide an accurate report if and to the extent which such delay or failure is caused by events beyond the reasonable control of Experian, including, without limitation, "acts of God", terrorism, or public enemies, labor disputes, equipment malfunctions, material or component shortages, supplier failures, embargoes, rationing, acts of local, state or national governments, or public agencies, utility or communication failures or delays, fire, earthquakes, flood, epidemics, riots and strikes. These terms and the relationship between you and Experian shall be governed by the laws of the State of Illinois (USA) without regard to its conflict of law provisions. You and Experian agree to submit to the personal and exclusive jurisdiction of the courts located within the county of Cook, Illinois. COPART AUTO AUCTIONS Date 3/13/25 10588 CENTRAL AVE NE BLAINE, MN 55434 Visit us at www.copart.com PHONE (763) 781-1025 All Amounts are in USD TAX ID# 061423251 FINAL INVOICE Copart Lot# 86613654 37 MN - MINNEAPOLIS Loss Date 11/01/24 Called In 12/23/24 P/U Cleared 12/24/24 T611 PIP082A Pickup Date 12/24/24 CYNTHIA GILLESPIE Original Title 3/03/25 TRAVELERS INDEMNITY COMPANY Trans Title 3/05/25 60 LAKEFRONT BLVD Sale Document 3/05/25 STE 226 Loss Type COLLISION BUFFALO, NY 14202 Description 17 TOYT SIENNA XLE BLACK Vehicle ID# 5TDYZ3DC7HS867807 Claim# JAD8087001 License#/ST LRF051 MN Policy# UNKNOWN Mileage 43,381 Loss Code C Pickup From CLASSIC COLLISION LITTLE Reference# 001 COLL 2989 COUNTRY DRIVE Insured SOUA VUE LITTLE CANADA, MN 55117 Owner SOUA VUE (651) 633-8900 ADVANCE CHARGES PAID BY COPART ----------- TOTAL ADVANCE CHARGES . . . . . . . . . .00 COPART SERVICE CHARGES PIP FEE/SERVICE FEE . . . . . . . . . . 113.00 ----------- TOTAL COPART SERVICE CHARGES. . . . . . 113.00 TOTAL DUE COPART . . . . . . . . . . . . . . 113.00 PROCEEDS FROM SALE . . . . . . . . . . . . . 13100.00CR *Bid Raised By Internet* CHECK PAYMENT FROM COPART. . . . . . . . . . 12987.00 ------------ NET DUE COPART . . . . . . . . . . . . . . . .00 COPART PAYMENTS DETAIL COPART CHECK# 86591351 03/12/25 12,987.00 SALE INFORMATION Lot# 86613654 Sold To 107174 EUROPEAN AUTO BODY & SALE Sale Date 3/11/25 8229 S ROBERTS ROAD Sale Amount 13100.00 BRIDGEVIEW, IL 60455 ACV 48538.00 (708) 924-9600 Repair Es20977.24 Return 26.9% Item# 124 Invoice Date 3/12/25 Cert# 193488731 Invoice Amount .00 USD Payment From Buyer 3/11/25 REMIT TO: COPART Reported To NICB 3/11/25 4610 WESTAMERICA DRIVE FAIRFIELD, CA 94534 Lot #: 86613654 SELLER INVOICE Date: 3/13/25 2:04 AM Page 1 of 8 Lot #: 86613654 TRANSMITTAL FROM SELLER Date: 3/13/25 2:04 AM Page 2 of 8 Lot #: 86613654 TRANSMITTAL FROM SELLER Date: 3/13/25 2:04 AM Page 3 of 8 Lot #: 86613654 TRANSMITTAL FROM SELLER Date: 3/13/25 2:04 AM Page 4 of 8 Lot #: 86613654 ORIGINAL DOCUMENT - FRONT Date: 3/13/25 2:04 AM Page 5 of 8 Lot #: 86613654 ORIGINAL DOCUMENT - FRONT Date: 3/13/25 2:04 AM Page 6 of 8 Lot #: 86613654 SALES TITLE Date: 3/13/25 2:04 AM Page 7 of 8 Lot #: 86613654 SALES TITLE Date: 3/13/25 2:04 AM Page 8 of 8