HomeMy WebLinkAboutMINUTES - 01082008 - C.25 ' CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
•
BOARD ACTION: JANUARY 08, 2008
Claim Against the County, or District Governed by )
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT
and Board Action. All Section references are to ) The copy of this document mailed to
California Government Codes. = I you is your notice of the action taken
onour claim U the Board of
Y Y
DEC 0 `' 2007 v Supervisors. (Paragraph IV below),
given Pursuant to Government Code
COUNTY COUNSEL Section 913 and 915.4. Please note all
AMOUNT: TO BE DETERMIVED .k_!ARTINEZ CALIF.
AMCO INSURANCE COMPANY Warnings„.
CLAIMANT: FOR: LONG CHAO
BY: RACHEL STUCK
ATTORNEY: UNKNOWN DATE RECEIVED: DECEMBER 031 2007
ADDRESS: 3820 109th ST. , DEPT. 5577 BY DELIVERY TO CLERK ON: DECEMBER 03, 2007
DES MOINES, IA 50391-5577
BY MAIL POSTMARKED: NOVEMBER 30, 2007
FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
JOHN CULLEN, C r
Dated: DECEMBER 03, 2007
By: Deputy
II. FROM: County Counsel TO: Clerk of the Board of Su ervisors
( This claim complies substantially with Sections 910 and 910.2.
( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so
notifying claimant. The Board cannot act for 15 days (Section 910.8),
( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and
send warning of claimant's right to apply for leave to present a late claim (Section 911.3).
O Other:
Dated: ` �'25— U 7 By: Deputy County Counsel
III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2)
( ) Claim was returned as untimely with notice to claimant (Section 911.3).
IV. BOARD ORDER: By unanimous vote of the Supervisors present:
This Claim is rejected in full.
O Other:
I certify that this is a true and correct copy of the Board's Order entered in its minutes for
this date.
Date s.f -& N CULLEN, CLERK, Byzw�__
Deputy Clerk
WA ING (Gffv. code section 913)
Subject to certain exceptions,you have only six(6) months from the date this notice was personally served
or deposited in the mail to file a court action on this claim.See Government Code Section 945.6.You may
seek the advice of an attorney of`your choice in connection wide this matter. ff'you want to consult an
attorney,you should do so immediately. *For Additional Warning See Reverse Side of This Notice.
AFFIDAVIT OF MAILING
I declare under penalty of perjury that I am now, and at all times herein mentioned, have
been a citizen of the United States, over age 18; and that today I deposited in the United
States Postal Service in Martinez, California, postage fully prepaid a certified copy of this
Board Order and Notice to Claimant, addressed to the claimant as shown above.
DatedlQ ?-!t '�' o Zo�OHN CULLEN, CLERK By Deputy Clerk
This warning does not apply to claims which
are not subject to the California Tort Claims
Act such as actions in inverse condemnation,
actions for specific relief' such as mandamus or
injunction, or Federal Civil Rights claims. The
above list is not exhaustive and legal
consultation is essential to understand all the
separate limitations periods that may apply.
The limitations period within which suit must
be tiled may be shorter or longer depending on
the nature of the claim. Consult the specific
statutes and cases applicable to your particular
claim.
The County of Contra Costa does not waive any
of its rights under California Tort Claims Act
nor does it waive rights under the statutes of
limitations applicable to actions not subject to
the California Tort Claims Act
Allied Pacific Coast Regional Office Claim Dept.
3820109th St.,Dept.5577
Insurance Des Moines,IA 50391-5577
a Nationwide®company (800)552-2437
On Your Side* FAX 800-742-1341
November 19, 2007
RECEIVED
DEC 0 3 2001
County Administration Building
Clerk of the Board of Supervisors, Rm 106 CLERK BOARD OF SUPERVISORS
651 Pine Street CONTRA COSTA CO.
Martinez, CA 94553
Our Insured: Long Chao
Our Claim#: 84m88704
Date of Loss: October 31, 2007
Your Insured: Charles Simms, Contra Costa County Probation Department
Your Claim# 69315
Dear Ms. Bailey,
The Contra Costa County claim form, along with an initial estimate and supplemental
estimate for our insured vehicle are enclosed.
If you need any further information or have questions regarding the investigation of this
claim, please contact me at 1-800-552-2437 ext 4059, Monday through Friday 9:30AM-
6:OOPM.
re and
R el Stuck
Casualty Claims Representative
AMCO Insurance Company
Phone: 1-800-552-2437 ext 4059
Fax: 1-800-742-1341
P
BOARD Off' SUPERVBORS OF CONTRA COS PM�
i6t.�u9INf Y�fldl f awll pAepue;Slee;uaal Wtl Z7 69 61100Z16U66
,INSTRUCTIONS TO CLAIN ANT
A. A claim relating to a cause of aeon for death or for injury to person or to personal property or
growing crops shall be presented not later than six months after the accrual of the cause of
action. A claim relating to any other cause of action shall be presented not later than one year
after the accrual of the cause of action-
(Gov. Code § 911.2.)
B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106,
County Administration Building, 651 Pine Street,Martinez,CA 945 53.
C. Lf claw is against a district governed by the Board of Supervisors, rather than the County, the
name of the District should be filled in.
D. If the claim is against more than one public entity, separate claims must be filed against each
public entity.
E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form,
!!■Y Y a!Y!i a!a c^!i!MR,MR■!!R R!11!!!!!L!A! i R a F t■R F..KKR A!!!!.R a!!a..........r.e 1
RE: Claim By. Reserved for Clerk's filing stamp
1/f ff� ) RECEIVED
} DEC 0 3 7007
Against t4k County of Contra Costa.or )
CLERK BOARD OF SUPERVISORS
District) CONTRA COSTA CO.
(Fill in the name) )'
The undersigned claimant her makes claim against the County of Contra Costa or the above-named
district in the sum of S and in support of this claim represents as Follows:
1. When did the damagge or injury occur? (Give exact date and hour)
l� 7
2. Where did the damage or injury occur? (Include city and county)
S h�wv d) J vg e 14Ye 1-- q/ �4 � Sri o, 6-A
3. How did the damage or ' uzy occur? Crave full d ,us extra paper if req ed)
A,-e,`V4- 0 f ��1c�'Lu QLD f
4. Wlat particular act or omission on the part of county or district officers, s ants, or employees
m ,
caused the injury or damage? Yv�N d fel ve4- ru.lLC
vL-# 0 'F O'�it�s' G�i7`✓
ev
`�
r� f Le
5 tt,
are the Ska
nam of co/unty or district officers, servants,or employees causing the
damage or injury?
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NO 7698 9900ddV9dnV1[amt paepuelS lei}ua�I NV Z7:695 6�100 e6 17
6. 'What damage or injuries do your claim resumed? (Give full extent of injuries or damages
claimed. Attach two estimates for auto damage.)
C7P
computed? (
P C�
7. How was the amount claimed above corn elude the estimated amoo�=t hof y��
prospective injury or damage,)
S. Names and addresses o wztnesse doctors, and hospitals:
Shi�l l� ✓ 5�� -Cts/-CP3�
� y
9. List the expenditures you made on account of this accident or injury:
DATE Tllvo AMOUNT
R R■■■■ANNWINl ANN..Ian a ZAK a a..R a a a a R a.R s R F R R R R R A.A.....■..M...■..R R no Kum R on MR M.a R..■■■
-Gov.Code Sec. 910.2 provides"The claim shall be
}signed by the claimant or by some person on his
be
SEND NOTICES TO: (Attozzzey) )
Name and address of Attorney } c
s Si�ature)
0 71, -?
(Address)
Telephone No. ) 'Telephone No._ �On J5 )6�i,91fl
■MAMMEAMNSIMEME MEIN a BRIM a l l a s a a a a R s R a F i R F R R R a a R t■.R R..■R R.■■...N.I..........1...R a a a a
PUBLIC RECORDS NOTICE:
Please be advised that this claim form., or any claim filed with the County under the Tort Claims Act, is subject to
public disclosure under the California Public Records Act. (Gov. Code, §§ 6500 et seq.) F rthermon, any
attachments,addendums, or supplements attached to the claim form, including medical records, are also subject to
public disclosure.
7 R RERUN sass l■.■ASK"my ...R F.R.F.■....R■■M.■■...&■■■.a■1.R r RUMMERMANKESKRES Rana s.s INN"R i
NOTICE:
Section 72 of the Penal Cade provides:
Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or
to any count`!, city, or district board or officer, authorized to allow or pay the same if gczaine, any false or
fraudulent claim, bill, account voucher, or writing, is punishable either by imprisonment in the Conuty jail for a
period of not mora than om year, by a Twe of not exceedih&orae thousand dollars ($1,000.00), or by both such
imprisonment and fine, or by imprisonment in the state prison, by a ane of not exceeding ten thousand dollars
($10,000), or by both such imprisonment and fine.
ti 'd K 'ON AlAIDMA MS 000 NVD:6 LOH '6Z MN j
11/27/2007 AT 05:59 PM JOB NUMBER:
16472
MALICK MOTORS, INC.
LICENSE #:BL004093 FEDERAL ID #:941397360
MALICK MOTORS
510 E. ACEQUTA STREET
VISALIA, CA 93292
(559)732-5909 FAX: (559)732-5999
ESTIMATE OF RECORD
WRITTEN BY: BILL STARK 11/27/2007 05:59 PM
ADJUSTER: ADJUSTER UNKNOWN
INSURED: LONG CHAO CLAIM #84M88704/I012
OWNER: LONG CHAO POLICY #AMCO INSURANCE COMPANY
ADDRESS: 2424 E HAROLD CT DEDUCTIBLE: $500.00
VISALIA, CA 93292-8048 DATE OF LOSS: 10/31/2007 AT 12:01 AM
EVENING: (209) 732-3271 TYPE OF LOSS: COLLISION
POINT OF IMPACT: 1. RIGHT FRONT
INSPECT DAY: () -
LOCATION:
INSURANCE ALLIED INSURANCE
COMPANY: DAYS TO REPAIR
2001 TOYO TACOMA 4X2 PRERUNNER DOUBLECAB 6-3 .4L-FI 4D P/U GREEN INT:GREY
VIN: STBGN92N91Z792809 LIC: 7T55Z37 CA PROD DATE: 02/2001 ODOMETER: 116328
CONDITION: GOOD
AIR CONDITIONING TILT WHEEL INTERMITTENT WIPERS
DUAL MIRRORS CONSOLE/STORAGE CLEAR COAT PAINT
POWER STEERING POWER BRAKES AM RADIO
FM RADIO STEREO CASSETTE
SEARCH/SEEK DRIVER AIR BAG PASSENGER AIR BAG
CLOTH SEATS BUCKET SEATS AUTOMATIC TRANSMISSION
OVERDRIVE FULL WHEEL COVERS
-------------------------------------------------------------------------------
NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT
-------------------------------------------------------------------------------
1#
2 FRONT BUMPER
3 O/H FRONT BUMPER 1.5
4** REPL QUAL REPL PARTS NWCPP UPPER 1 96.00 INCL. 1.2
COVER
5 ADD FOR CLEAR COAT 0.5
6** REPL QUAL REPL PARTS NWCPP BUMPER 1 228.00 INCL.
CHROME
7** REPL QUAL REPL PARTS NWCPP VALANCE 1 106.00 INCL. 0.0*
PANEL
8 FRONT LAMPS
9** REPL QUAL REPL PARTS NWCPP RT 1 149.00 0.3
HEADLAMP ASSY
10 AIM HEADLAMPS 0.5
1
11/27/2007 AT 05:59 PM JOB NUMBER:
16472
ESTIMATE OF RECORD
2001 TOYO TACOMA 4X2 PRERUNNER DOUBLECAB 6-3 .4L-FI 4D P/U GREEN INT:GREY
***ALLIED INSURANCE GUARANTEE***
THE VEHICLE OWNER IS GUARANTEED THAT THE ALLIED APPRAISAL:
-IS FAIRLY PRICED AND INCLUDES ALL DAMAGE RELATED TO THE ACCIDENT THAT WAS
EVIDENT WHEN THE VEHICLE WAS APPRAISED; AND -WILL ALSO INCLUDE IN THE REPAIRS
AND THE SETTLEMENT ANY HIDDEN OR MISSED DAMAGE CAUSED BY THE ACCIDENT.
IN ADDITION, YOUR ASSIGNED ALLIED CLAIM REPRESENTATIVE WILL BE AVAILABLE TO
ASSIST IN RESOLVING ANY CONCERNS YOU, THE VEHICLE OWNER, MAY HAVE ABOUT THE
QUALITY OF REPAIRS
ALLIED INSURANCE WILL REPLACE ANY DEFECTIVE LIKE KIND AND QUALITY (USED,
RECONDITIONED OR REMANUFACTURED) AND ANY NON-OEM PARTS FOR AS LONG AS THE
OWNER NAMED BELOW OWNS THE VEHICLE. THIS IS LIMITED TO REPAIRS AND PARTS
SPECIFIED ON THE ATTACHED APPRAISAL.
DATE OF ISSUE SIGNATURE OF CLAIM
REPRESENTATIVE
THIS IS NOT TRANSFERABLE OR ASSIGNABLE TO ANY SUBSEQUENT OWNER OF THE REPAIRED
VEHICLE. TO REPORT AN ALLIED INSURANCE CLAIM FOR THIS APPRAISAL, PLEASE CALL
1-800-282-9445.
IMPORTANT! ALL SERVICE PROVIDERS MUST COMPLY WITH STATE AND FEDERAL PRIVACY
LAWS, INCLUDING THE PRIVACY PROVISIONS OF THE GRAMM-LEACH-BLILEY ACT AND WITH
ALLIED'S PRIVACY STATEMENT AND PROCEDURES. ACCORDINGLY, YOU ARE HEREBY
NOTIFIED THAT CUSTOMER INFORMATION SHARED WITH OR OBTAINED BY SERVICE
PROVIDERS SHALL BE USED SOLELY FOR THE PURPOSE FOR WHICH IT WAS PROVIDED AND
FOR NO PURPOSE WHATSOEVER.
ALLIED/NATIONWIDE'S BLUE
RIBBON REPAIR SERVICE
PROGRAM GUARANTEE
THE VEHICLE OWNER WHO ELECTS TO PARTICIPATE IN THE ALLIED/NATIONWIDE INSURANCE
BRRS PROGRAM, RECEIVES OUR GUARANTEE FOR REPAIR OF ANY DEFECTS IN PARTS OR
WORKMANSHIP OF THE APPRAISED AND COMPLETED REPAIRS FOR AS LONG AS YOU
OWN THE VEHICLE. WE GUARANTEE TO REPAIR ANY WORKMANSHIP DEFECTS OR
REPLACE ANY PARTS (EXCLUDING PARTS AND MATERIALS COVERED BY THE ORIGINAL
MANUFACTURER'S WARRANTY) WHICH DO NOT MEET GENERALLY ACCEPTED VEHICLE
REPAIR INDUSTRY QUALITY STANDARDS. OUR OBLIGATION UNDER THIS GUARANTEE IS
LIMITED TO THIS REPAIR OR REPLACEMENT TO CORRECT ANY DEVIATION FROM
THOSE STANDARDS.
"WE ARE PROHIBITED BY LAW FROM REQUIRING THAT REPAIRS
BE DONE AT A SPECIFIC REPAIR SHOP. YOU ARE ENTITLED TO
SELECT THE AUTO BODY SHOP THAT WILL REPAIR YOUR DAMAGED
VEHICLE. AS YOU HAVE AGREED TO USE OUR RECOMMENDED
REPAIR SHOP, WE WILL CAUSE THE DAMAGED VEHICLE TO BE
RESTORED TO ITS CONDITION PRIOR TO THE LOSS AT NO
ADDITIONAL COST TO YOU OTHER THAN AS STATED IN THE
INSURANCE POLICY OR OTHERWISE ALLOWED BY LAW. IF YOU
EXPERIENCE A PROBLEM WITH THE REPAIR OF YOUR VEHICLE,
PLEASE CONTACT US IMMEDIATELY FOR ASSISTANCE. "
THIS APPLIES ONLY TO WORKMANSHIP OF REPAIRS COMPLETED BY MALICK MOTORS
3
11/27/2007 AT 05:59 PM JOB NUMBER:
16472
ESTIMATE OF RECORD
2001 TOYO TACOMA 4X2 PRERUNNER DOUBLECAB 6-3.4L-FI 4D P/U GREEN INT:GREY
ESTIMATE BASED ON MOTOR CRASH ESTIMATING GUIDE. UNLESS OTHERWISE NOTED ALL
ITEMS ARE DERIVED FROM THE GUIDE ARM8510, CCC DATA DATE 11/01/2007, 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 GEM'S THROUGH OEM VEHICLE DEALERSHIPS. ASTERISK (*) OR
DOUBLE 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. NON-ORIGINAL EQUIPMENT MANUFACTURER AFTERMARKET PARTS ARE
DESCRIBED AS AM, QUAL REPL PARTS OR COMP REPL PARTS WHICH STANDS FOR
COMPETITIVE REPLACEMENT PARTS. USED PARTS ARE DESCRIBED AS LKQ, QUAL RECY
PARTS, 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 2006 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 PATHWAYS ESTIMATOR HAS A COMPLETE LIST OF APPLICABLE VEHICLES. PARTS
NUMBERS AND PRICES SHOULD BE CONFIRMED WITH THE LOCAL DEALERSHIP.
CCC PATHWAYS - A PRODUCT OF CCC INFORMATION SERVICES INC.
5
11/27/2007 AT 05:59 PM JOB NUMBER:
16472
ESTIMATE OF RECORD
2001 TOYO TACOMA 4X2 PRERUNNER DOUBLECAB 6-3.4L-FI 4D P/U GREEN INT:GREY
ALTERNATE PARTS SUPPLIERS
4 QUAL REPL PARTS NWCPP UPPER PART NO. 8105 2200 PRICE 96.00
7 QUAL REPL PARTS NWCPP VALAN PART NO. 8105 229+C PRICE 106.00
ACTION CRASH - NWCPP (800) 832-8733
2115 SOUTH UNION AVENUE (661) 832-8733
BAKERSFIELD, CA 93307
ACTION CRASH - NWCPP (866)247-1391
1951 WILLIAM STREET (510) 895-1875
SAN LEANDRO, CA 94577
ACTION CRASH - NWCPP (866)247-1391
2041 NAVY DRIVE (209) 946-4437
STOCKTON, CA 95206
6 QUAL REPL PARTS NWCPP BUMPE PART NO. TO1002174 PRICE 228.00
9 QUAL REPL PARTS NWCPP RT HE PART NO. TO2503136 PRICE 149.00
11 QUAL REPL PARTS NWCPP RT PA PART NO. TO2521160 PRICE 49.00
24 QUAL REPL PARTS NWCPP GRILL PART NO. TO1200248 PRICE 198.00
KEYSTONE - NWCPP - B (800)339-5033
4067 WEST SHAW AVE (559)271-6750
FRESNO, CA 93722
KEYSTONE - NWCPP - B (800)421-7866
1754 CEDAR ST. STE A (909) 986-4586
ONTARIO, CA 91761
KEYSTONE - NWCPP - B (800)263-9727
1627 ARMY COURT (209) 948-1101
STOCKTON, CA 95206
KEYSTONE - NWCPP - B (800)243-4340
751 E. KINGS HILL PLACE (310) 329-3624
CARSON, CA 90746
7
11/27/2007 AT 06:05 PM JOB NUMBER: 602
16472
MALICK MOTORS, INC.
LICENSE #:BL004093 FEDERAL ID #:941397360
MALICK MOTORS
510 E. ACEQUTA STREET
VISALIA, CA 93292
(559) 732-5909 FAX: (559) 732-5999
SUPPLEMENT OF RECORD 1 WITH SUMMARY
WRITTEN BY: BILL STARK 11/27/2007 06:05 PM
ADJUSTER: ADJUSTER UNKNOWN
INSURED: LONG CHAO CLAIM #84M88704/I012
OWNER: LONG CHAO POLICY #AMCO INSURANCE COMPANY
ADDRESS: 2424 E HAROLD CT DEDUCTIBLE: $500.00
VISALIA, CA 93292-8048 DATE OF LOSS: 10/31/2007 AT 12:01 AM
EVENING: (209) 732-3271 TYPE OF LOSS: COLLISION
POINT OF IMPACT: 1. RIGHT FRONT
INSPECT
LOCATION:
INSURANCE ALLIED INSURANCE
COMPANY: DAYS TO REPAIR
2001 TOYO TACOMA 4X2 PRERUNNER DOUBLECAB 6-3.4L-FI 4D P/U GREEN INT:GREY
VIN: 5TBGN92N91Z792809 LIC: 7T55Z37 CA PROD DATE: 02/2001 ODOMETER: 116328
CONDITION: GOOD
AIR CONDITIONING TILT WHEEL INTERMITTENT WIPERS
DUAL MIRRORS CONSOLE/STORAGE CLEAR COAT PAINT
POWER STEERING POWER BRAKES AM RADIO
FM RADIO STEREO CASSETTE
SEARCH/SEEK DRIVER AIR BAG PASSENGER AIR BAG
CLOTH SEATS BUCKET SEATS AUTOMATIC TRANSMISSION
OVERDRIVE FULL WHEEL COVERS
-------------------------------------------------------------------------------
NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT
--------------------------------------------------------------------------------
1# Sol SIGNED AUTHORIZATION TO PAY 1
SECURED ON 11/17/2007
2# SO1 COPY OF FINAL INVOICE TO 1
VEHICLE OWNER
3# SO1 11/17/2007 1
4# S01 NO USED PARTS AVAIL OHNSTEADS 1
5# Sol AUCTION TRUCK AND HIGGONS 1
6# SO1 RPS RAN NOV 12 07 1
7 FRONT BUMPER
8 O/H FRONT BUMPER 1.5
9** REPL QUAL REPL PARTS NWCPP UPPER 1 96.00 INCL. 1.2
COVER
10 ADD FOR CLEAR COAT 0.5
ll** REPL QUAL REPL PARTS NWCPP BUMPER 1 228.00 INCL.
CHROME
1
11/27/2007 AT 06:05 PM JOB NUMBER: 602
16472
SUPPLEMENT OF RECORD 1 WITH SUMMARY
2001 TOYO TACOMA 4X2 PRERUNNER DOUBLECAB 6-3 .4L-FI 4D P/U GREEN INT:GREY
----------------------------------------------------
CUSTOMER PAY $ 500.00
INSURANCE PAY $ 1445.11
***ALLIED INSURANCE GUARANTEE***
THE VEHICLE OWNER IS GUARANTEED THAT THE ALLIED APPRAISAL:
-IS FAIRLY PRICED AND INCLUDES ALL DAMAGE RELATED TO THE ACCIDENT THAT WAS
EVIDENT WHEN THE VEHICLE WAS APPRAISED; AND -WILL ALSO INCLUDE IN THE REPAIRS
AND THE SETTLEMENT ANY HIDDEN OR MISSED DAMAGE CAUSED BY THE ACCIDENT.
IN ADDITION, YOUR ASSIGNED ALLIED CLAIM REPRESENTATIVE WILL BE AVAILABLE TO
ASSIST IN RESOLVING ANY CONCERNS YOU, THE VEHICLE OWNER, MAY HAVE ABOUT THE
QUALITY OF REPAIRS
ALLIED INSURANCE WILL REPLACE ANY DEFECTIVE LIKE KIND AND QUALITY (USED,
RECONDITIONED OR REMANUFACTURED) AND ANY NON-OEM PARTS FOR AS LONG AS THE
OWNER NAMED BELOW OWNS THE VEHICLE. THIS IS LIMITED TO REPAIRS AND PARTS
SPECIFIED ON THE ATTACHED APPRAISAL.
DATE OF ISSUE SIGNATURE OF CLAIM
REPRESENTATIVE
THIS IS NOT TRANSFERABLE OR ASSIGNABLE TO ANY SUBSEQUENT OWNER OF THE REPAIRED
VEHICLE. TO REPORT AN ALLIED INSURANCE CLAIM FOR THIS APPRAISAL, PLEASE CALL
1-800-282-9445.
IMPORTANT! ALL SERVICE PROVIDERS MUST COMPLY WITH STATE AND FEDERAL PRIVACY
LAWS, INCLUDING THE PRIVACY PROVISIONS OF THE GRAMM-LEACH-BLILEY ACT AND WITH
ALLIED'S PRIVACY STATEMENT AND PROCEDURES. ACCORDINGLY, YOU ARE HEREBY
NOTIFIED THAT CUSTOMER INFORMATION SHARED WITH OR OBTAINED BY SERVICE
PROVIDERS SHALL BE USED SOLELY FOR THE PURPOSE FOR WHICH IT WAS PROVIDED AND
FOR NO PURPOSE WHATSOEVER.
ALLIED/NATIONWIDE'S BLUE
RIBBON REPAIR SERVICE
PROGRAM GUARANTEE
THE VEHICLE OWNER WHO ELECTS TO PARTICIPATE IN THE ALLIED/NATIONWIDE INSURANCE
BRRS PROGRAM, RECEIVES OUR GUARANTEE FOR REPAIR OF ANY DEFECTS IN PARTS OR
WORKMANSHIP OF THE APPRAISED AND COMPLETED REPAIRS FOR AS LONG AS YOU
OWN THE VEHICLE. WE GUARANTEE TO REPAIR ANY WORKMANSHIP DEFECTS OR
REPLACE ANY PARTS (EXCLUDING PARTS AND MATERIALS COVERED BY THE ORIGINAL
MANUFACTURER'S WARRANTY) WHICH DO NOT MEET GENERALLY ACCEPTED VEHICLE
REPAIR INDUSTRY QUALITY STANDARDS. OUR OBLIGATION UNDER THIS GUARANTEE IS
LIMITED TO THIS REPAIR OR REPLACEMENT TO CORRECT ANY DEVIATION FROM
THOSE STANDARDS.
"WE ARE PROHIBITED BY LAW FROM REQUIRING THAT REPAIRS
BE DONE AT A SPECIFIC REPAIR SHOP. YOU ARE ENTITLED TO
SELECT THE AUTO BODY SHOP THAT WILL REPAIR YOUR DAMAGED
VEHICLE. AS YOU HAVE AGREED TO USE OUR RECOMMENDED
REPAIR SHOP, WE WILL CAUSE THE DAMAGED VEHICLE TO BE
RESTORED TO ITS CONDITION PRIOR TO THE LOSS AT NO
3
11/27/2007 AT 06:05 PM JOB NUMBER: 602
16472
SUPPLEMENT OF RECORD 1 WITH SUMMARY
2001 TOYO TACOMA 4X2 PRERUNNER DOUBLECAB 6-3.4L-FI 4D P/U GREEN INT:GREY
THIS IS AN ESTIMATE ONLY AND NOT AN AUTHORIZATION TO REPAIR. ADDITIONAL
PAYMENT WILL BE MADE ONLY WITH THE APPROVAL PRIOR TO REPAIR.
NATIONWIDE WILL REPLACE ANY DEFECTIVE LIKE, KIND AND QUALITY (USED) ,
RECONDITIONED, RECYCLABLE AND ANY QUALITY REPLACEMENT AFTERMARKET (NON-OEM)
PARTS AS SPECIFIED ON THE APPRAISAL FOR AS LONG AS YOU OWN OR LEASE THE
VEHICLE.
NWPP= NATIONWIDE PARTS PROGRAM
NWCPP= NATIONWIDE CRASH PARTS PROGRAM
THE ESTIMATE HAS BEEN PREPARED BASED ON THE USE OF AUTOMOBILE PARTS NOT MADE
BY THE ORIGINAL MANUFACTURER. NWPP OR NWCPP PARTS SPECIFIED ON THE APPRAISAL
BY OTHER THAN THE ORIGINAL MANUFACTURER ARE REQUIRED TO BE OF EQUIVALENT LIKE,
KIND AND QUALITY IN TERMS OF FIT, QUALITY AND PERFORMANCE TO THE ORIGINAL
MANUFACTURER PARTS THEY ARE REPLACING.
ESTIMATE BASED ON MOTOR CRASH ESTIMATING GUIDE. UNLESS OTHERWISE NOTED ALL
ITEMS ARE DERIVED FROM THE GUIDE ARM8510, CCC DATA DATE 11/01/2007, 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
DOUBLE 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. NON-ORIGINAL EQUIPMENT MANUFACTURER AFTERMARKET PARTS ARE
DESCRIBED AS AM, QUAL REPL PARTS OR COMP REPL PARTS WHICH STANDS FOR
COMPETITIVE REPLACEMENT PARTS. USED PARTS ARE DESCRIBED AS LKQ, QUAL RECY
PARTS, 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 2006 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 PATHWAYS ESTIMATOR HAS A COMPLETE LIST OF APPLICABLE VEHICLES. PARTS
NUMBERS AND PRICES SHOULD BE CONFIRMED WITH THE LOCAL DEALERSHIP.
CCC PATHWAYS - A PRODUCT OF CCC INFORMATION SERVICES INC.
5
11/27/2007 AT 06:05 PM JOB NUMBER: 602
16472
SUPPLEMENT OF RECORD 1 WITH SUMMARY
2001 TOYO TACOMA 4X2 PRERUNNER DOUBLECAB 6-3 .4L-FI 4D P/U GREEN INT:GREY
NOTIFIED THAT CUSTOMER INFORMATION SHARED WITH OR OBTAINED BY SERVICE
PROVIDERS SHALL BE USED SOLELY FOR THE PURPOSE FOR WHICH IT WAS PROVIDED AND
FOR NO PURPOSE WHATSOEVER.
ALLIED/NATIONWIDE'S BLUE
RIBBON REPAIR SERVICE
PROGRAM GUARANTEE
THE VEHICLE OWNER WHO ELECTS TO PARTICIPATE IN THE ALLIED/NATIONWIDE INSURANCE
BRRS PROGRAM, RECEIVES OUR GUARAN'T'EE FOR REPAIR OF ANY DEFECTS IN PARTS OR
WORKMANSHIP OF THE APPRAISED AND COMPLETED REPAIRS FOR AS LONG AS YOU
OWN THE VEHICLE. WE GUARANTEE TO REPAIR ANY WORKMANSHIP DEFECTS OR
REPLACE ANY PARTS (EXCLUDING PARTS AND MATERIALS COVERED BY THE ORIGINAL
MANUFACTURER'S WARRANTY) WHICH DO NOT MEET GENERALLY ACCEPTED VEHICLE
REPAIR INDUSTRY QUALITY STANDARDS. OUR OBLIGATION UNDER THIS GUARANTEE IS
LIMITED TO THIS REPAIR OR REPLACEMENT TO CORRECT ANY DEVIATION FROM
THOSE STANDARDS.
"WE ARE PROHIBITED BY LAW FROM REQUIRING THAT REPAIRS
BE DONE AT A SPECIFIC REPAIR SHOP. YOU ARE ENTITLED TO
SELECT THE AUTO BODY SHOP THAT WILL REPAIR YOUR DAMAGED
VEHICLE. AS YOU HAVE AGREED TO USE OUR RECOMMENDED
REPAIR SHOP, WE WILL CAUSE THE DAMAGED VEHICLE TO BE
RESTORED TO ITS CONDITION PRIOR TO THE LOSS AT NO
ADDITIONAL COST TO YOU OTHER THAN AS STATED IN THE
INSURANCE POLICY OR OTHERWISE ALLOWED BY LAW. IF YOU
EXPERIENCE A PROBLEM WITH THE REPAIR OF YOUR VEHICLE,
PLEASE CONTACT US IMMEDIATELY FOR ASSISTANCE. "
THIS APPLIES ONLY TO WORKMANSHIP OF REPAIRS COMPLETED BY MALICK MOTORS
ON BEHALF OF VEHICLE OWNER AND AS SPECIFIED ON THE ATTACHED APPRAISAL. THIS IS
NOT TRANSFERABLE OR ASSIGNABLE TO ANY SUSEQUENT OWNER OF THE REPAIRED
VEHICLE. TO REPORT A BLUE RIBBON REPAIR SERVICE PROGRAM CLAIM FOR A
REPAIRED
VEHICLE, PLEASE CALL 1-800-282-9445.
7
11/27/2007 AT 06:05 PM JOB NUMBER: 602
16472
SUPPLEMENT OF RECORD 1 WITH SUMMARY
2001 TOYO TACOMA 4X2 PRERUNNER DOUBLECAB 6-3 .4L-FI 4D P/U GREEN INT:GREY
ESTIMATE BASED ON MOTOR CRASH ESTIMATING GUIDE. UNLESS OTHERWISE NOTED ALL
ITEMS ARE DERIVED FROM THE GUIDE ARM8510, CCC DATA DATE 11/01/2007, 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 GEM'S THROUGH OEM VEHICLE DEALERSHIPS. ASTERISK (*) OR
DOUBLE 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. NON-ORIGINAL EQUIPMENT MANUFACTURER AFTERMARKET PARTS ARE
DESCRIBED AS AM, QUAL REPL PARTS OR COMP REPL PARTS WHICH STANDS FOR
COMPETITIVE REPLACEMENT PARTS. USED PARTS ARE DESCRIBED AS LKQ, QUAL RECY
PARTS, 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 2006 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 PATHWAYS ESTIMATOR HAS A COMPLETE LIST OF APPLICABLE VEHICLES. PARTS
NUMBERS AND PRICES SHOULD BE CONFIRMED WITH THE LOCAL DEALERSHIP.
CCC PATHWAYS - A PRODUCT OF CCC INFORMATION SERVICES INC.
9
11/27/2007 AT 06:05 PM JOB NUMBER: 602
16472
SUPPLEMENT OF RECORD 1 WITH SUMMARY
2001 TOYO TACOMA 4X2 PRERUNNER DOUBLECAB 6-3.4L-FI 4D P/U GREEN INT:GREY
ALTERNATE PARTS SUPPLIERS
9 QUAL REPL PARTS NWCPP UPPER PART NO. 8105 2200 PRICE 96.00
12 QUAL REPL PARTS NWCPP VALAN PART NO. 8105 229+C PRICE 106.00
ACTION CRASH - NWCPP (800) 832-8733
2115 SOUTH UNION AVENUE (661) 832-8733
BAKERSFIELD, CA 93307
ACTION CRASH - NWCPP (866)247-1391
1951 WILLIAM STREET (510) 895-1875
SAN LEANDRO, CA 94577
ACTION CRASH - NWCPP (866)247-1391
2041 NAVY DRIVE (209) 946-4437
STOCKTON, CA 95206
11 QUAL REPL PARTS NWCPP BUMPE PART NO. TO1002174 PRICE 228.00
14 QUAL REPL PARTS NWCPP RT HE PART NO. TO2503136 PRICE 149.00
16 QUAL REPL PARTS NWCPP RT PA PART NO. TO2521160 PRICE 49.00
29 QUAL REPL PARTS NWCPP GRILL PART NO. 701200248 PRICE 198.00
KEYSTONE - NWCPP - B (800) 339-5033
4067 WEST SHAW AVE (559)271-6750
FRESNO, CA 93722
KEYSTONE - NWCPP - B (800)421-7866
1754 CEDAR ST. STE A (909) 986-4586
ONTARIO, CA 91761
KEYSTONE - NWCPP - B (800)263-9727
1627 ARMY COURT (209) 948-1101
STOCKTON, CA 95206
KEYSTONE - NWCPP - B (800)243-4340
751 E. KINGS HILL PLACE (310)329-3624
CARSON, CA 90746
11
Allied °,0-,ros`,
Insurance
a Nationwide"company �.j '}s �---- w,NFVAuwEs
On Your Side" Q h-� j� 0 2 1 M $ 0 g 1-039
wW ,-- Onn4230261 NOV 30 2007
_a
1100 LOCUST ST DEPT 1100L1 MAILED FROM ZIP CODE 95815
DES MOINES IA 50391-1100
RETURN SERVICE REQUESTED
UEC 0 3 7007
'!.ERK 80TRD OF SUPERVISORS
CONTRA COSTA CO. j
22.127(02-06)00