HomeMy WebLinkAboutMINUTES - 10282008 - C.15 (19) CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
BOARD ACTION: OCTOBER 28, 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. you is your notice of the action taken
on your claim by the Board of
Supervisors. (Paragraph IV below),
given Pursuant to Government Code
AMOUNT: $3,312.72 Section 913 and 915.4. Please note all
USAA CASUALTY INS. C(SS"Ep 2 6 2008 "Warnings".
CLAIMANT: FOR: MARTHAGAYTANCcOUNTY COUNSEL
BY: SONIA M. SERUO►EZ,CALIF.
ATTORNEY: UNKNOWN DATE RECEIVED: SEPTEMBER 26, 2008
P.O. BOX 659476 SEPTEMBER 26, 2008
ADDRESS: SAN ANTONIO, TX 78265 BY DELIVERY TO CLERK ON:
BY MAIL POSTMARKED: SEPTEMBER 23, 2008
FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
SEPTEMBER 26, 2008 DAVID TWA, Cl
Dated: By: Deputy
Il. FROM: County Counsel TO: Clerk of the Board of S ervisors
(Ql"'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 lea_v/e to present a late claim (Section 911.3).
Y
(„ Other: (Di
e`7 s � o
Dated: O` By: 171 Deputy County Counsel
III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2)
O Claim was returned as untimely with notice to claimant(Section 911.3).
IV. J00ARD ORDER: By unanimous vote of the Supervisors present:
(� This Claim is rejected in full.
( ) Other:
I certify that this is a true and correct copy of the Board's Order entered in its minutes for
this date.
Dated ,daoAVID TWA, CLERK, By Deputy Clerk
WARNING (Gov. 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 with this matter. If 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.
Datedg,aX4V.Z9 Z04PAVID TWA, CLERK, By puty Clerk
s
This warning does not apply to claims which
are not subject torthe California Tort Claims
Act such as actions in.inverse condemnation,
actions for specific relief sash 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 dust
be filed 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
i
09/19/2008 12:11 9259449576 WALGREENS PHARMACY PAGE 01
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
INSTRVQTIONS TO r-LAMI?,.NT
A. A claim relating to a cause of action for death or for injury to person of 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
ager 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 1.06,
County Administration'Building, 651 Pine Street,Martinez,CA 94553.
C. If claim 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 fraudulaw claims,Penal Code Sec. 72 at the end of this farm.
•RRR RFR R\Rp..RRRRRh.•RIR RR'IR I R Ramp"•Rall aa.MINIM ban Ra■Rpm•R■R••a R AR R R R■RIO I R■R■PI
RE: Claim.By: Reserved for Clerk's filing stamp
usm CI S_0 4 6 4V )
� F,,
ECEIVED
Against the County of Contra Com or } EP 2 6 2008
�o tcnTy a t �Kt� lvS
District)
-- i-- — ERK BOARD OF SUPERVISORS
(Fill in the name) } CONTRA COSTA CO.
The undersigned claimant hereby males claim against the County of Contra Costa or the above-uamed
district in the sum of S.-3 12 ,-:�2- and in support of this claim represents as follows:
1. When did the damage or injury occur? (Clive exact date and hour)
0/l12/0 b' r&
2. Where did th d,ampage or in U1y occur? (Include city and county)
3. How dial the damage or m ury occur? (Give Hill details;use a �aper7}''{�required) `
10 tie, ve�fcte� JODo /5oC�q�e Jr&el by C'kr�S- pker rA, Sl`r�.ac o4r pa,,-Lev ve�cfe,
4. What particular act or Omission on the part of county or district officers,gpservants, or em loyees
caused the injury or damage? �e �4."�<c( `t!a tnw, �:, Caitvo ot- ve4ic�P,
a What are the names of county or district officers, servants,or employees causing the
damage or injury? �L
r�S �hRv wU. Y 12, -H
960 7a 7- -710a-a -7
p it �r i
09/19/2008 12:11 9259449576 WALGREENS PHARMACY PAGE 02
6. V:at damage or injuries do your claim resulted? (Give full extent of injuries cr damages
claimed. Attach two estimates fox auto damage.) ,.�/IIe4Se See q-ff--4 9)
7. How was the amount claimed above computed? (Include the estimated amount of any
prospective injury or darua.ge,) W 3 312. 12-
8.
12. 128. Names and addresses of witnesses,doctors, and hospitals:
9. List the expenditures you wade on account of this accident or injury:
5l(7/0� ')ATE ' a 12
q�l4wb�
/000- 010
■ ...■......0&*%u.o.q...r\...f.l...Opp.. gaseous...o8.sf.. fl...o.......1
.Gov. Code Sec. 910.2 provides"The claim shall be
signed by the claimant or by some person on his
behalf"
SEND NOTICES TO: (Attorney)
Name and address of Attorney )
)
(Claimant's Signature)
(Address)
Telephone No. )Telephone No. 960—S 31 —$22 2 X 2Sob3
.es.sf fs..s.ff■s.siss....Y.s..R.....fRR..sffRSRI..t..■......sse.sl
PUBLIC RECORDS NOTICE:
Phase be advised that this claim form, or aAy claim filed with the Canty under the Tart Claims Act, is subject to
public disclosure under the California Public Records Art (Gov, Code, 56 6500 et seq.) Furthermore, any
attachments,addendums, or supplements attached to the claim form, including medical records, are also subject to
public disclosure,
■..f.....ss.s■e...■■*OWN o.ls....es.so....s.WON o..s.sff.e....s.s...■s....f e..losses gal
NOTICE:
Section. 72 of the Penal Code provides:
Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or
to any county, city, or distriet board or officer, authorized to allow or pay the same if genuine, any false or
fraudulmut claim,bill, account voucher, or vTiting, is punishable either by imprisonment in the County jail for a
period of not more than one year, by a fine of not exceeding one thousand dollars ($1,000,00), or by both such
impnsottment and fine, or by iraprisontnent in the Mate prison, by a fine of not exceeding ten thousand dollars
($10,000), or by both such imprisonment and fine.
9800 Fredericksburg Road
San Antonio,Texas 78288
1 RECEIVE®
USAA®
SEP 2. 6 2008
CLERK BOARD OF SUPERVISORS
CONTRA COSTA CO.
CONTRA COSTA COUNTY September 23, 2008
THE BOARD OF SUPERVISORS CLERK
651 PINE ST., ROOM 106
MARTINEZ CA 94553
Reference: Request for payment
To Whom It May Concern,
We reimbursed our insured for damages sustained as a result of the loss referenced below. Our
investigation shows that your insured is responsible. This is notification that we intend to
recover the amount we paid.
USAA policyholder: Martha Gaytan
Claim #: 9630729-7102-27-7644
Date of loss: September 12, 2008
Loss location: Concord, California
USAA tax ID: 59-3019540
Your policyholder: CONTRA COSTA COUNTY
Your reference ##: Unknown
We ask that you not settle the claim with our insured without protecting our recovery rights.
Please see the attached Payment Summary for additional details.
If you need additional assistance, please call 1-800-531-8722. I, or one of my co-workers, will
assist you.
Sincerely,
Owuti
Sonia M Servantes
Subrogation Department
USAA Casualty Insurance Company
9630729 - 27 - CA 09/12/08 - 7644 - 88 - A109 54358-0308
CONTRA COSTA COUNTY September 23, 2008 Page 2
Payment Summary
USAA claim #: 9630729-7102-27-7644
Your reference ##: Unknown
Vehicle damages $ 3,312.72
Total payment requested $ 3,312.72
Collision deductible was waived.
• Make your certified check or money order payable to: USAA as subrogee of Martha
Gaytan.
• Provide claim## 9630729-7102-27-7644 on your check or money order.
• Send your payment to: USAA Subrogation Dept
P.O. Box 659476
San Antonio, Texas 78265-9476.
Any payment less than the full amount that we have requested will not satisfy our claim. We
will not waive our legal rights to enforce collection of the remaining unpaid amount unless we
provide you a written release.
9630729 - 27 - CA - 09/12/08 - 7644 - 88 - A109 54358-0308
Deliver to: Sonia Servantes Location:
Coverage total as of 09-23-2008 for member:9630729,loss number 027
COLL 000 $2,312.72 09802052 09-17-2008 MIKE ROSE AUTO BODY
INC
$1,000.00 09981263 09-19-2008 MIKE ROSE AUTO BODY
INC
Subtotal $3,312.72
Total $3,312.72
Print requested by: Sonia Servantes Page 1
Deliver to: Sonia Servantes Location:
Payments Issued as of 09-23-2008 for member:9630729,loss number 027
Draftl Payee/ Mode/
Bank Issue Date Coverage Claimant COL Amount Status
34 09-17-2008 09802052 MIKE ROSE AUTO BODY INC Automatic Print $2,312.72 Not cleared
COLL 000 $2,312.72
34 09-19-2008 09981263 MIKE ROSE AUTO BODY INC Printed $1,000.00 Not cleared
COLL 000 $1,000.00
Print requested by: Sonia Servantes Page 2
09/16/2008 AT 06: 04 PM JOB NUMBER:
40462
MIKE ROSE' S AUTO BODY INC. - VDM
LICENSE #: BAR# AG18474 FEDERAL ID #: 942621349
WHERE QUALITY COUNTS
2260 VIA DE M°RCADOS
CONCORD, CA 94520-4920
(925)689-1739 FAX: (925)689-0991
ESTI MATE OF RECORD
WRITTEN BY: RICK FARRELL 09/16/2008 01: 26 PM
ADJUSTER: 00021 (800)531-8222
INSURED: MARTHA GAYTAN CLAIM #009630729000000027001
OWNER: MARTHA GAYTAN POLICY #009630729
ADDRESS: 2401 ACACIA DR DEDUCTIBLE: $1000. 00
CONCORD, CA 94520-1700 DATE OF L055: 09/12/2008
DAY: (925)457-1339 TYPE OF LOSS: COLLISION
OTHER: (925)944-0192 POI NT OF I IMPACT: 11. LEFT FRONT
INSPECT M KE ROSE' S AUTO BODY INC. - VDM BUSI NESS: (925)689-1739
LOCATI ON: 2260 VI A DE NERCADOS
CONCORD, CA 94520-4920
INSURANCE USAA BUSINESS: (800)531-8222
COMPANY: P 0 BOX 15506 5 DAYS TO REPAI R
SACRAMENTO, CA 95852
1996 FORD MUSTANG COBRA 8-4. 6L-FI 2D CPE WHITE INT:
VIN: 1FALP47V3TF212027 LIC: NO PLATES PROD DATE: 06/1996 ODOMETER: 57532
Al R CONDI TI ONI NO REAR DEFOGGER TILT WHEEL
CRUISE CONTROL I NTERM TTENT Al PERS KEYLESS ENTRY
THEFT DETERRENT/ALARM TINTED GLASS DUAL M RRORS
CONSOLE/STORAGE FOG LANDS REAR SPOILER
CLEAR COAT PAINT POWER STEERING POWER BRAKES
PCVER WINDOWS POWER LOCKS PCWER DRIVER SEAT
PCAER MI RRORS PCWER TRUNK/TAI LGATE AM RADIO
FM RADIO STEREO CASSETTE
SEARCH/SEEK ANTI -LOCK BRAKES (4) DRIVER AIR BAG
PASSENGER AIR BAG 4.WHEEL DISC BRAKES POS ITRACT ION
CLOTH SEATS BUCKET SEATS RECLINE/LOUNGE SEATS
5 SPEED TRANSM SSI ON OVERDRIVE ALUM NUM/ALLOY WHEELS
-------------------------- ----------------------------------------------------
NO OP. DESCRI PTI ON QTY EXT. PRICE LABOR PAINT
1 FRONT LAMPS
2' REPL QUAL RECY PARTS LT HEADLAND 1 193. 75 0. 4•
ASSY W/COBRA +25% .
1
09/16/2008 AT 06: 04 PM J OB NUMBER:
40462
ESTIMATE OF RECORD
1996 FORD MUSTANG COBRA 8-4. 6L-FI 2D CPE WHI TE I NT:
-------------------------------------------------------------------------------
NO. OP. DESCRI PTI ON QTY EXT. PRICE LABOR PAINT
----------------------------------------------------------- -----
3 Al M HEADLAMPS 0. 4
4" REPL QUAL REPL PARTS LT 1 40. 00 INCL.
PARK/MARKER LAMP
5 O/H FRONT BUMPER 2. 0
6 REPL LT LENS ASSY COBRA 1 58. 38 INCL.
7 FRONT BUMPER
8" REPL RECOND BUMPER COVER W/COBRA 1 435. 00 INCL. 2. 7
PRI MED
9 ADD FOR CLEAR COAT 1. 1
10** REPL QUAL REPL PARTS CAPA MOUNT 1 95. 95 0. 5
PANEL
11* REPL QUAL RECY PARTS IMPACT BAR 1 156. 25 INCL. *
+25%
12 HOOD
13* RPR HOOD W/COBRA 1. 5* 2. 5
14 ADD FOR CLEAR COAT 1. 0
15 ADD FOR UNDERSIDE(COMPLETE) 1. 4
16# DEDUCT TO SPOT PAINT UNDERSIDE 1 -0. 5
17# DEDUCT FOR SPOT PAI NT W THI N 1 -0. 5
PANEL
18 FENDER
19* REPL QUAL RECY PARTS LT FENDER +25% 1 125. 00 2. 0* 2. 1*
20 OVERLAP Mql OR ADJ . PANEL -0. 4
21 ADD FOR CLEAR COAT 0. 3
22 ADD FOR EDGI NG 0. 5
23 ADD FOR CLEAR COAT 0. 1
24 DEDUCT FOR OVERLAP -0. 4
25** REPL QUAL REPL PARTS LT FENDER 1 25. 30 INCL.
LI NER
26 REPL LT NAMEPLATE COBRA 1 23. 03 0. 2
27 DOOR
28* RPR LT OUTER PANEL 0. 3' 2. 3
29 OVERLAP MAJ OR ADJ . PANEL -0. 4
30 ADD FOR CLEAR COAT 0. 4
31# DEDUCT FOR SPOT PAI NT 1 -0. 5
32 R&I LT BELT W STRIP 0. 3
33 R&I LT M RROR ASSY 0. 6
34 R&I LT HANDLE OUTSI DE 0. 4
35 R&I LT R&I TRIM PANEL 0. 5
361t REPL FLEX ADDITIVE 1 7. 50
37# COVER CAR 1 7. 50 0. 2
38# COLOR TINT 1 0. 5
2
09/16/2008 AT 06: 04 PM J OB NUMBER:
40462
ESTIMATE OF RECORD
1996 FORD MUSTANG COBRA 8-4. 6L-FI 2D CPE WHI TE I NT:
-------------------------------------------------------------------------------
NO. OP. DESCRI PTI ON QTY EXT. PRICE LABOR PAINT
-------------------------------------------------------------------------------
39# SUBL HAZARDOUS WASTE 1 5. 00 X
40# CORROSION PROTECTION 1 10. 00 0. 3
41 OTHER CHARGES
42# TOW NG 1 135. 00
-------------------------------------------------------------------------------
SUBTOTALS ==> 1317. 66 9. 7 12. 1
LI NE 2 SUPPLI ERS PART DESCRI PTI ON: H/LAMP ASSY, LT -LH CBRA-, COBRA
LI NE 11 SUPPLI ERS PART DESCRI PTI ON: BUMPER ASSY, FT
-BLK, CBRA, 2J 4, BCF-NG, COBRA W/O MYSTI C CLEARCOAT
LINE 19 SUPPLIERS PART DESCRIPTION: FENDER, LT C K
-------------------------------------------------------------------------------
ESTI MATE NOTES:
+kkRtfl*k11*4#ttttlltlR*+tf kt+}Y tf R+1+1411fI*11111*t#ifftlRR1f 4111*4f iRkf YY«f+
fY}ftlt}
t**Y****++++DTP ON FILE - PLEASE PAY SHOP************
DR: 9/12 DC: 9/12 DI : 9/15 SCHD: TONED IN ERT: 5 DAYS DRV: N
VEHI CLE OWNER EMAI LED A COPY OF THE DAMAGE REPORT PRI OR TO REPAI RS
VEHI CLE OWNER HANDED THE QRP BROCHURE PRI OR TO REPAI RS
PROD DATE: 6196
ADDI TI ONAL REMARKS:
ERT DAYS OF 5 WAS COMMUNICATED TO THE CUSTOMER ON 9/16/08.
♦+«ttYf««tttlf«k«Yf
USED PART SEARCH:
CONCORD AUTO / BRIAN . . . NO PARTS AVAILABLE
ROCK & ROLL / BRUCE . . . FENDER ONLY 5150
PACIFIC AUTO / M KE . . . NO PARTS AVAILABLE
-------------------------------------------------------------------------------
PRI OR DAMAGE NOTES:
NONE
PARTS 1177. 66
PARTS DI SCOUNT $ 81. 41 -5. 0% -4. 07
BODY LABOR 9. 7 HRS OS 70. 00/HR 679. 00
PAINT LABOR 12. 1 HRS CADS 70.00/HR 847.00
PAINT SUPPLIES 12. 1 HRS @S 30. 00/HR 363. 00
SUBLET/M SC. - 5. 00
OTHER CHARGES 135. 00
3
09116/2008 AT 06: 04 PM JOB NUMBER:
40462
ESTIMATE OF RECORD
1996 FORD MUSTANG COBRA 8-4. 6L-FI 2D CPE MITE I NT:
PRE-TAX DISCOUNT -0. 5% -16. 01
----------------------------------------------------
SUBTOTAL $ 3186. 58
SALES TAX $ 1528. 91 ® 8. 2500% 126. 14
----------------
GRAND TOTAL $ 3312. 72
ADJ USTMENTS:
DEDUCTIBLE 1000. 00
---------------------------------------------------
CUSTOMER PAY $ 1000. 00
INSURANCE PAY $ 2312, 72
THI S I S A PRELI M NARY ESTI MATE AND ADDI TI CNAL CHARGES MAY BE REQUI RED FOR THE
ACTUAL REPAIR.
PLEASE PRESENT A COPY OF THI S ESTI MATE TO A REPAI R FACI LI TY OF YOUR CHOI CE
*USAA SUBST DI ARIES I NCLUDE: UNI TED SERVI CES AUTOMOBI LE ASSOO ATI ON(USAA, USAA
CASUALTY I NSURANCE COMPANY(CI C), USAA GENERAL I NDEMNI TY COMPANY(G) C) USAA
COUNTY MUTUAL I NSURANCE(CMI ) AND GARRI SON PROPERTY CASUALTY I NSURANCE COMPANY.
GARRI SON PROPERTY AND CASUALTY I NSURANCE COMPANY, A SUBSI DI ARY OF USAA
CASUALTY INSURANCE COMPANY, IS AUTHORIZED TO USE THE USAA LOGO, A REGISTERED
TRADEMARK OF UNI TED SERVI CES AUTOMOBI LE ASSOCI ATI ON.
THI S 1 5 NOT AN AUTHORI ZATI ON TO REPAI R. FAI.LI NG TO PRESENT THI 5 ESTI MATE TO
THE REPAI Rt NG GARAGE BEFORE REPAI R MAY RESULT 1 N ADDI TI OVAL EXPENSES TO YOU. A
USAA APPRAI SER MUST AUTHORI ZE ANY SUPPLEMENTTO THI S ESTI MATE. REPAI RS TO THI S
VEHI CLE MAY REQUI RE SPECI FI C MELDI NG EQUI PMENT AS RECOMFJENDED BY THE
MANUFACTURER.
IF ALTERNATIVE QUALITY REPLACEMENT PARTS HAVE BEEN INCLUDED IN THIS APPRAISAL,
THE SOURCE FOR THESE PARTS HAS ALSO BEEN DISCLOSED, IF ALTERNATIVE QUALITY
REPLACEMENT PARTS AS LI STIED ON THE APPRAI SAL ARE ULTI MATELY USED I N THE REPAI R
OF YOUR VEHICLE, THE WARRANTY ON SUCH PARTS W LL BE EQUAL TO, OR GREATER THAN,
THE PARTS BEI NG REPLACED, AS STATED I N USAA' S LI M TED PARTS WARRANTY. USAA
WARRANTS THAT THE PARTS USED ON YOUR VEHI CLE W LL BE OF LI KE KI NO AND QUALI TY,
FUNCTION, FIT, SAFETY AND CORROSION PROTECTION AS THE PART OR PARTS THEY
REPLACE, USAA IDENTIFIES CAPA-CERTI FI ED PARTS FOR SHEET METAL REPLACEMENT
PARTS SUBJ ECT TO CAPA-CERTI FI CATI ON.
4
09/16/2008 AT 06: 04 PM JOB NUMBER:
40462
ESTIMATE OF RECORD
1996 FORD MUSTANG COBRA 8-4. 6L-FI 2D CPE WHI TE I NT:
CALIFORNIA LAW PROVIDES THAT YOU HAVE THE RIGHT TO SELECT THE REPAIR FACI LI TY
OF YOUR CHOICE.
THIS ESTIMATE HAS BEEN PREPARED BASED ON THE USE OF CRASH PARTS SUPPLIED BY A
SOURCE OTHER THAN THE MANUFACTURER OF YOUR MOTOR VEHICLE. ANY WARRANTIES
APPLICABLE TO THESE REPLACEMENT PARTS ARE PROVIDED BY THE MANUFACTURER OR
DISTRIBUTOR OF THE PARTS, RATHER THAN BY THE ORIGINAL MANUFACTURER OF YOUR
VEHI CLE.
IF ALTERNATIVE QUALITY REPLACEMENT PARTS HAVE BEEN INCLUDED IN THIS APPRAISAL,
THE SOURCE OF THESE PARTS HAS ALSO BEEN OfSCLOSED. IF ALTERNATIVE QUALITY
REPLACEMENT PARTS AS LI STED ON THI S APPRAI SAL ARE ULTI MATELY USED I N.THE
REPAIR OF YOUR VEHICLE, THE WARRANTY ON SUCH PARTS W LL BE EQUAL TO, OR
GREATER THAN, THE PARTS BEI NG REPLACED, AS STATED -I N USAA' S LI MI TED PARTS
WARRANTY. USAA WARRANTS THE PARTS USED ON YOUR VEHICLE W LL BE OF LIKE KIND
AND QUALI TY, FUNCTI ON, FI T AND CORROSI ON PROTECTI ON AS THE PART OR PARTS THEY
REPLACE. USAA IDENTIFIES THE USE OF CAPA-CERTIFIED PARTS FOR ANY SHEET METAL
REPLACEMENT PART SUBJ ECT TO CAPA CERTI FI CATI ON.
5
09/16/2008 AT 06: 04 PM JOB NUMBER:
40462
ESTI MATE OF RECORD
1996 FORD MUSTANG COBRA 8-4. 6L-FI 2D.CPE WHITE i NT:
FOR YOUR PROTECTI ON CALL FORNI A LAW REQUI RES THE FOLLOW NG TO APPEAR.ON THI S
F ORM
ANY PERSON WHO KNOWINGLY PRESENTS FALSE OR FRAUDULENT CLAIM FOR THE PAYMENT OF
A LOSS I S GUI LTY OF A CRI ME AND MAY BE SUB] ECT TO FI NES AND CONFI NEMENT IN
STATE PRISON.
THE FOLLOW NG 15 A LIST OF ABBREVIATIONS ORSYMBOLS THAT MAY BE USED TO
DESCRIBE NARK TO BE DONE OR PARTS TO BE REPAIRED OR REPLACED: MOTOR
ABBREVI ATI ONS/SYMBOLS: D=DI SCONTI NUED PART A=APPROXI MATE PRI CE LABOR TYPES:
B=BODY LABOR D=DI AGNOSTI C E=ELECTRI CAL F=FRAME G=GLASS WMECHANI CAL P=PAI NT
LABOR S=STRUCTURAL T=TAXED M SCELLANEOUS X=NON TAXED M SCELLANEOUS PATHWAYS:
ADJ =ADJ ACENT ALGN=AL1 GN A/WAFTERMARKET BLND=BLEND CAPA=CERT1 FI ED AUTOMaTI VE
PARTS ASSOCI ATI ON D&R=DI SCONNECT AND RECONNECT EST=ESTI MATE EXT. PRI CE=UNI T
PRICE MULTI PLI ED BY THE QUANTITY I NCL=1 NCLUDED M SC=M SCELLANEOUS
NAGS=NATI ONAL AUTO GLASS SPECI FI CATI ONS NON-ADJ =NON ADJACENT O/H=OVERHAUL
OP=OPERATION NO--LINE NUMBER QTY=QUANTITY QUAL RECY=QUALITY RECYCLED PART QUAL
REPL=QUALITY REPLACEMENT PART COMP REPL PARTS=COMPETITIVE REPLACEMENT PARTS
RECOND=RECONDI TI ON REFN=REFI NI SH REPL=REPLACE R&1 =REMOVE AND INSTALL
R&R=REMOVE AND REPLACE RPR=REPAI R RT=RIGHT SECT=SECTION SUBL=SUBLET LT=LEFT
W/D=IM THOUT W/_=W TH/_ SYMBOLS: #=MANUAL LI NE ENTRY *=OTHER [I E. . MOTORS
DATABASE INFORMATION WAS CHANGED) **=DATABASE LINE Al TH AFTERMARKET N=NOTES
ATTACHED TO LI NE. MQVP=MANUFACTURER' S QUALI FI CATI ON AND VALI DATI ON PROGRAM
OPT OEM=ORI GI NAL EQUI PMENT .MANUFACTURER PARTS EI THEIR OPTI ONALLY SOURCED OR
OTHERW SE PROVIDED W TH SONE UNI QUE PRI Cl NG OR DI SCOUNT. WCPP=NATI ONW DE
CRASH PARTS PROGRAM.
THIS ESTIMATE HAS BEEN PREPARED BASED ON THE USE OF CRASH PARTS SUPPLIED BY A
SOURCE OTHER. THAN THE MANUFACTURER OF YOUR MOTOR VEHICLE. ANY WARRANTI ES
APPLICABLE TO THESE REPLACEMENT PARTS ARE PROVIDED BY THE MANUFACTURER OR
DI STRI BUTOR OF THE PARTS, RATHER THAN BY THE'ORI GI NAL MANUFACTURER OF YOUR
VEHI CLE.
THIS ESTIMATE HAS BEEN BASED ON THE USE OF CRASH PARTS SUPPLIED BY A SOURCE
OTHER THAN THE MANUFACTURER OF YOUR MDTOR VEHICLE. ANY WARRANTI ES APPLICABLE
TO THESE REPLACMENT PARTS ARE PROVIDED BY THE MANUFACTURER OR DISTRIBUTOR OF
THE PARTS, RATHER THAN BY THE ORIGINAL MANUFACTURER OF YOUR VEHICLE.
RECYCLED PART COSTS BASED ON I NFORMATI ON PROVI DED BY CAR-PART. COM FOR
ASSISTANCE, CALL CCC AT 800-637-8511.
6
09/16/2008 AT 06: 04 PM J OB NUMBER:
40462
ESTIMATE OF RECORD
1996, FORD MUSTANG COBRA 8-4. 6L-FI 2D CPE WHI TE I NT:
ESTI MATE BASED ON MOTOR CRASH ESTI NATI NG GUI DE. UNLESS OTHERW SE NOTED ALL
I TEMS ARE DERI VIED FROM THE GUI DE DE2J C94, CCC DATA DATE 09/09/2008, AND THE
PARTS SELECTED ARE OEM-PARTS MANUFACTURED BY THE VEHICLES ORIGINAL EQUIPMENT
MANUFACTURER. OEM PARTS ARE-AVAILABLE AT OE/VEHICLE DEALERSHIPS. OPT OEM
(OPTI ONAL OEM OR ALT OEM (ALTERNATI VE 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 SPECI FI C, SPECIAL, OR
UNI QUE PRI Cl NG OR DI SCOUNT. OPT,OEM OR ALT' OEM PARTS MAY I INCLUDE 'BLEM SHED'
PARTS PROVI DED BY OEM S THROUGH OEM VEHI CLE DEALERSHI PS. ASTERI SK (*) OR
DOUBLE ASTERI SK (**) I NDI CATES THAT THE PARTS AND/OR LABOR I NFORMATI ON
PROVI DED BY MOTOR MAY HAVE BEEN MODIFIED OR MAY HAVE COME FROM AN ALTERNATE
DATA SOURCE. TI LDE SI GN (-) I TEMS I NDI CATE MOTOR NOT-I NCLUDED LABOR
OPERATIONS. NON-ORI GI NAL EQUI PMENT 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
PROVI DED BY NATI ONAL AUTO GLASS SPECI FI CATI ONS. LABOR OPERATION TIMES LISTED
ON THE U NE W TH THE NAGS INFORMATION ARE MOTOR SUGGESTED LABOR OPERATION
TI NES. NAGS LABOR OPERATION TI NES ARE NOT INCLUDED. POUND SIGN (#) ITEMS
I NDI CATE MANUAL ENTRI ES. SOME 2006 VEHICLES CONTAIN M NOR CHANGES FROM THE
PREVI OUS YEAR. FOR THOSE VEHI CLES, PRI OR TO RECEI VI NG UPDATED DATA FROM THE
VEHICLE MANUFACTURER, LABOR AND PARTS DATA FROM THE PREVIOUS YEAR MAY BE USED.
THE PATHWAYS ESTI MATOR HAS A COMPLETE LIST OF APPLICABLE VEHICLES. PARTS
NUMBERS AND PRI CES SHOULD BE CONFI RMED W TH THE LOCAL DEALERSHI P.
CCC PATHWAYS - A PRODUCT OF CCC I NFORMATI ON SERVICES I INC.
7
09/16/2008 AT 06: 04 PM - JOB NUMBER:
40462
ESTIMATE OF RECORD
1996 FORD MUSTANG COBRA 8-4. 6L-FI 2D CPE NMI TE I NT:
RECYCLED PART SUPPLIERS
LI NE LI NE DESCRI PTI ON PRICE
19 QUAL RECY PARTS LT FENDER +25% STOCK NO. :. WX117 S 125. 00.
M & M SALVAGE (800)662-4881
42130 CO. RD. 25 JUAN MUNOZ
WOODLAND, CA 95776
2 QUAL RECY PARTS LT HEADLA +25% STOCK NO. : R83345 S 193. 75
11 QUAL RECY PARTS IMPACT BA +25% STOCK NO. : R83345 $ 156. 25
LKQ - WEST (866)557-2677
AZ, NV, CA, UT
SANTA FE SPRING, CA 90670
8
09/16/2008 AT 06: 04 PM JOB NUMBER:
40462
ESTIMATE OF RECORD
1996 FORD MUSTANG COBRA 8-4. 6L-FI 2D CPE NMI TE I NT:
ALTERNATE PARTS SUPPLIERS
10 QUAL REPL PARTS CAPA MOUNT PART NO. F01221104 PRICE 95. 95
COLLISION PARTS NETMRK (800)498-9808
14306 NICKS BLVD. ,(510)895-8257
SAN LEANDR.O, CA 94578
8 RECOND BUMPER COVER W/COBRA PART NO. F01000238 PRICE 435. 00
FAITH BUMPER SERVICE (408)986-1226
1085 DI GI ULI O
SANTA CLARA, CA 95050
4 QUAL REPL PARTS LT PARK/MAR PART NO. FR182-000OL PRICE 40. 00
FACTORY MOTOR PARTS (916)452-4102
6779 Q STREET
SACRAMENTO, CA 95819
25 QUAL REPL PARTS LT FENDER L PART NO. F0010 PRICE 25. 30
SAN 1 OSE TRADI NG COMPANY, I NC. (408)434-9222
1945 LUNDY AVENUE (800)660-6069
SAN 1 OSE, CA 95131
9
09/16/2008 AT 06: 04 PM 10B NUMBER:
40462
ESTIMATE OF RECORD
1996 FORD MUSTANG COBRA 8-4. 6L-FI 2D CPE NMI TE I NT:
ALTERNATE PARTS USAGE
AFTERMARKET PARTS
AFTERMARKET SELECTION METHOD: AUTOMATICALLY SELECT
NO. OF TI MES USER VAS NOTI FI ED THAT AN AFTERMARKET PART WAS AVAI LABLE'. 12
NO. OF AFTERMARKET PARTS THAT APPEAR I N THE FI NAL ESTI MATE: 3
OPTIONAL OEM PARTS
OPTIONAL OEM SELECTION METHOD: AUTOMATICALLY SELECT
NO. OF TI MES USER 'AAS NOTI FI ED THAT AN OPTI ONAL OEM PART WAS AVAI LABLE: 0
t
NO. OF OPTI ONAL OEM PARTS THAT APPEAR I N THE FI NAL ESTI MATE: 0
RECONDI TI ONED PARTS _
RECONDITIONED SELECTI ON METHOD: AUTOMATI CALLY SELECT
NO. OF TI MES USER WAS NOTI FI ED THAT A RECONDI TI ONED PART WAS AVAI LABLE: 3
NO. OF RECONDI TI ONED PARTS THAT APPEAR IN THE FINAL ESTI MATE: 1
RECYCLED PARTS
NO. OF TIMES USER WAS NOTI-F.I ED THAT A RECYCLED PART WAS AVAILABLE: 11
NO. OF RECYCLED PARTS THAT APPEAR I N THE FI NAL ESTI MATE: 3
10
t
9800 Fredericksburg Road
Wk San Antonio,Texas 78288 RECEIVED
USAA®
SEP 2. 6 2008
CLERK BOARD OF SUPERVISORS
CONTRA COSTA CO.
CONTRA COSTA COUNTY September 23, 2008
THE BOARD OF SUPERVISORS CLERK
651 PINE ST., ROOM 106
MARTINEZ CA 94553
Reference: Request for payment
To Whom It May Concern,
We reimbursed our insured for damages sustained as a result of the loss referenced below. Our
investigation shows that your insured is responsible. This is notification that we intend to
recover the amount we paid.
USAA policyholder: Martha Gaytan
Claim#: 9630729-7102-27-7644
Date of loss: September 12, 2008
Loss location: Concord, California
USAA tax ID: 59-3019540
Your policyholder: CONTRA COSTA COUNTY
Your reference #: Unknown
We ask that you not settle the claim with our insured without protecting our recovery rights.
Please see the attached Payment Summary for additional details.
If you need additional assistance, please call 1-800-531-8722. I, or one of my co-workers, will
assist you.
Sincerely,
Ow4A LWWW'.-t
Sonia M Servantes
Subrogation Department
USAA Casualty Insurance Company
9630729 - 27 • CA • 09/12/08 - 7644 - 88 - A109 54358.0308
CONTRA COSTA COUNTY September 23, 2008 Page 2
Payment Summary
USAA claim##: 9630729-7102-27-7644
Your reference ##: Unknown
Vehicle damages $ 3,312.72
Total payment requested $ 3,312.72
Collision deductible was waived.
• Make your certified check or money order payable to: USAA as subrogee of Martha
Gaytan.
• Provide claim## 9630729-7102-27-7644 on your check or money order.
• Send your payment to: USAA Subrogation Dept
P.O. Box 659476
San Antonio, Texas 78265-9476.
Any payment less than the full amount that we have requested will not satisfy our claim. We
will not waive our legal rights to enforce collection of the remaining unpaid amount unless we
provide you a written release.
9630729 - 27 - CA - 09/12/08 • 7644 - 88 - A109 54358.0308
09/19/2988 12: 11 9259449576 WALGREENS PHARMACY PAGE 01
BOARD OF S PERWSORS OF CONTRA COSTA COUNTY
INSTRUCTIONS TO Cr.artt- ANT
A. A claim relating to a cause of action 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 mlating to any other cause of action shall be presented not later than one year
after the accrual of the cause of action.
((30v. 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 94553.
C. If claim is against a district governed by the Board of Supervisors, rather than the Cocurty, the
name of the District should be filled in.
D. If the Claim 15 against more than one public entity, separate claims must be filed against each,
public entity.
E. Fraud. See penalty for Emudlilent claims,Penal Code Sec. 72 at the end of this form..
as no aaa afaPusan aaa r MIN ass aaa,aaapis ISO aa■afaaaasa as a a■aaa MOWN a iiia two Raaf as NEWl
RE: �C/�la�im By. ( (/ Reserved for Clerk's filing stamp
�4c'l/s`/0 m a✓'t'H6 .64x h
RECEIVED
Against the County of Contra Costa or ) SEP 2 6 2008
4�� del d3 DLSSr1Ct) CLERK BOARD OF SUPERVISO;JS
(Fill inTire name) } CONTRA COSTA CO.
The undersigned claimant hereby makes claim against the County of Contra Costa or the aboNre-uamed
district in the sum of S 3 -i 12 and in support of this claim represents as follows;
1. When did the damage or injwy occur? (Crive exact date and hour)
9/a/0 e
2. Where did thj damage or 'in*
ury occur? (Include city and county)
CnCor , c4 — �a�+r4 Cos+i-, Count`y
3. How did the damage
_or mi JmT occur? ( ve frill /dretails;use aper =quirad) /
dLDU U4'c d✓,be-, 6 chriS�a�,1er S ac awrDa/ Pa� ve-kt e.
4. What particular act or omission an the part of county or district officers, servants, or em loyees
caused the injury or damage? ria4-��� ;k ;,, CaK{vo of �•� vel.c��,
5 What are the names of county or district officers, servants,or employees causing the
damage or injauy? �hriS�fe ht✓ ` 'fi d
P 2, 9630 7a 9 /aa
,d-1-- Al
09/19/2008 12:11 9259449576 WALGREENS PHARMACY PAGE 02
6. W ai damage or injuries do your claim resulted? (Give full extent,o/f injuries or or damages
claimed. Attach two estimates for auto damage.)„P IeQ&f S ee 4-[7*c 4 ecf
7. How was the amount claimed above computed? (Include the estimated amount of any
PrQsPwdvc injury or daw24a,) W 3 3 12. 2
S. Names and addresses of witnesses,doctors, and hospitals:
9. List the expenditures you made on account of this accident or injury
5lr71o8 a 3
TIME AMO
glr1000- 011
Eno mala ms a at n'*a a■all Rita a ram■a/Ino Neoax of *soon*■aa an*e*a*mono a■*&Bongo we l a aa■■nil a a to n*I
.Gov. Code Sec. 910.2 provides"The claim shall be
signed by the claimant or by some person on his
behalf,"
SEN
D NOTICES TO: lA raey� )
Name and address of Attorney )
(Claimant's 5igaatrue)
(Address)
Ilk ?12CS
Telephone No. )Teicphone No.
960-531 -8222 X 2500
wanm*osealamn massonamaat■am*shown a*laasamaso am a*a Rmaa a■are on olvanRnama■■■Rome to &Rapti
PUBLIC RECORDS NOTICE:
Fleas*be advised that this claim farm,or any claim filed with the Cormty wilder the Tort Claims Act,is subject to
public disclosure under the California Public Records Act, (Gov. Code, SS 6500 0 seq.) Furthermore, any
attachments,addendums, or sapplernents attached to the claim form,including medical records,are also subject to
public disclosure.
■*mason••alaaaRas*a■•fa* ■man■ on%memos •.ate, -
NOTICE:
Section 72 of the Penal Code provider:
Every person who, with intent to defraud, presents for allowaaee or fbr payment to any stats board or officer, or
to any colLmty, city, or district board or officer, authorized to allow or pay the same if genuine, any false or
fraudulent claim,bill, account voucher, or writing, is punishable either by imprisonment in the County jail for a
period of not more than one year, by a fine of not exceeding one tbousand dollars ($1,000.00), or by borth such
imprisonment and fine, or by impriaonment in the state prison,by a fine of not exceeding ten thousand dollars
($10,000), or by both such Vaprisoruncut and fine.
Deliver to: Sonia Servantes Location:
Coverage total as of 09-23-2008 for member:9630729,loss number 027
COLL 000 $2,312.72 09802052 09-17-2008 MIKE ROSE AUTO BODY
INC
$1,000.00 09981263 09-19-2008 MIKE ROSE AUTO BODY
INC
Subtotal $3,312.72
Total $3,312.72
Print requested by: Sonia Servantes Page 1
Deliver to: Sonia Servantes Location:
Payments Issued as of 09-23-2008 for member:9630729,loss number 027
Draft/ Payee/ Model
Bank Issue Date Coverage Claimant COL Amount Status
34 09-17-2008 09802052 MIKE ROSE AUTO BODY INC Automatic Print $2,312.72 Not cleared'
COLL 000 $2,312.72
34 09-19-2008 09981263 MIKE ROSE AUTO BODY INC Printed $1,000.00 Not cleared
COLL 000 $1,000.00
Print requested by: Sonia Servantes Page 2
09/16/2008 AT 06: 04 PM JOB NUMBER:
40462
MI KE ROGE' 5 AUTO BODY I NC. - VDM
LICENSE #: BAR# AG18474 FEDERAL ID #:942621349
WHERE QUALITY COUNTS
2260 VI A DE MERCADOS
CONCORD, CA 94520-4920
(925)689-1739 FAX: (925)689-0991
ESTI.MATE OF RECORD
WRITTEN BY: RI CK FARRELL 09/16/2008 01: 26 PM
ADJUSTER: 00021 (800)S31-8222
INSURED: MARTHA GAYTAN CLAIM #009630729000000027001
OWNER: MARTHA GAYTAN POLICY 4009630729
ADDRESS: 2401 ACACIA DR - DEDUCTIBLE: $1000. 00
CONCORD,. CA 94520-1700 - DATE OF LOSS: 09/12/2008
DAY: (925))457-1339 TYPE OF LOSS': COLLI SI ON
OTHER: (925)944-0192 P01 NT OF I IMPACT: 11. LEFT FRONT
INSPECT M KE ROSE' S AUTO BODY INC. - VDM BUSINESS: (925)689-1.739
LOCATI ON: 2260 VI A DE MERCADOS
CONCORD, CA 94520-4920
INSURANCE USAA BUSINESS: (800)531-8222
COMPANY: P 0 BOD( 15506 5 DAYS TO REPAIR
SACRAMENTO, CA95852
1996 FORD MUSTANG COBRA 8-4. 6L-FI 2D CPE MI TE 1 NT:
VI N: 1FALP47V3TF212027 LI C: NO PLATES PROD DATE: 06/1996 ODOMETER: 57532
Al R CONDI TI ONI.NG REAR DEFOGGER TILT WHEEL
CRUISE CONTROL INTERN TTENT W PERS KEYLESS ENTRY
THEFT DETERRENT/ALARM TINTED GLASS DUAL M RRORS
CONSOLE/STORAGE FOG LAMPS REAR SPOILER
CLEAR COAT PAINT PCWER STEERING POWER BRAKES
POKER W NDOk% POWER LOCKS POWER DRIVER SEAT
PCM,ER MI RRORS POAER TRUNK/TAI LGATE AM RADIO
FM RADIO STEREO CASSETTE
SEARCH/SEEK ANTI -LOCK BRAKES (4) DRIVER AIR BAG
PASSENGER AIR BAG 4.WHEEL DISC BRAKES POSI TRACT ON
CLOTH SEATS BUCKET SEATS RECLINE/LOUNGE SEATS
5 SPEED TRANSM SSI ON OVERDRIVE ALUM NUM/ALLOY WHEELS
-------------------------- ----------------------------------------------------
NO. OP. DESCRI PTI ON QTY EXT. PRICE LABOR PAINT
1 FRONT LAWS
2' REPL QUAL RECY PARTS LT HEADLAND 1 193. 75 0. 4'
ASSY W/COBRA +25%-
1
09/16/2008 AT 06: 04 PM J OB NUMBER:
40462
ESTIMATE OF RECORD
1996 FORD MUSTANG COBRA 8-4. 6L-FI 2D CPE VMI TE INT:
-------------------------------------------------------------------------------
NO. OP. DESCRI PTI ON QTY EXT. PRICE LABOR PAINT
---------------------------------------------- --------------------------------
3 Al M HEADLAMPS 0. 4
4'• REPL QUAL REPL PARTS LT 1 40. 00 1 NCL.
PARK/MARKER LAMP
5 O/H FRONT BUMPER 2. 0
6 REPL LT LENS ASSY COBRA 1 58. 38 I NCL.
7 FR8" REPL RE'COND BUM'ERECOCOVER W/COBRA 1 435. 00 INCL. 2. 7
PRI MED
9 ADD FOR CLEAR COAT 1. 1
10** REPL QUAL REPL PARTS CAPA MOUNT 1 95. 95 0. 5
PANEL
11* REPL QUAL -RECY PARTS IMPACT BAR 1 156. 25 INCL. *
+25%
12 HOOD
13* RPR HOOD W/COBRA 1. 5* 2. 5
14 ADD FOR CLEAR COAT 1. 0
15 ADD FOR UNDERSIDE(COMPLETE) 1. 4
16# DEDUCT TO SPOT PAI NT UNDERSI DE 1 -0. 5
17# DEDUCT FOR SPOT PAI NT W THI N 1 -0. 5
PANEL
18 FENDER
19* REPL QUAL RECY PARTS LT FENDER +25% 1 125. 00 2. 0* 2. 1*
20 OVERLAP MAJOR ADJ. PANEL -0. 4-
21 ADD FOR CLEAR COAT 0. 3
22 ADD FOR EDGING 0. 5
23 ADD FOR CLEAR COAT 0. 1
24 DEDUCT FOR. OVERLAP -0. 4
25** REPL QUAL REPL PARTS LT FENDER 1 25. 30 INCL.
LI NER
26 REPL LT NAMEPLATE COBRA 1 23. 03 0. 2
27 DOOR
28* RPR -LT OUTER PANEL 0. 3* 2. 3
29 OVERLAP MAJOR ADJ . PANEL -0. 4
30 ADD FOR CLEAR COAT .,0. 4
31# DEDUCT FOR SPOT PAI NT 1 -0. 5
32 R&I LT BELT W STRI P 0. 3
33 R&I LT M RROR ASSY 0. 6
34 R&I LT HANDLE OUTSIDE 0. 4
35 R&I LT R&I TRI M PANEL 0. 5
36# REPL FLEX ADDI TI VE 1 7. 50
37# COVER CAR 1 7. 50 0. 2
38# COLOR TI NT 1 0. 5
2
09/16/2008 AT 06: 04 PM - JOB NUMBER:
40462
ESTIMATE OF RECORD
1996 FORD MUSTANG COBRA 8-4.6L-Fl 2D CPE MITE I NT:
`-----------------------------------------------------------------------------
NO. OP. DESCRI PTI ON QTY EXT. PRICE LABOR PAINT
`----------------------`-------------------------------------------------------
39# SUBL HAZARDOUS WASTE 1 5. 00 X
40# CORROSI ON PROTECTI ON 1 10. 00 0. 3
41 OTHER CHARGES
42# TOW NG 1 135. 00
-------------------------------------------------------------------------------
SUBTOTALS =_> 1317. 66 9. 7 12. 1
LINE 2 SUPPLIERS PART DESCRI PTI ON: H/LAM' ASSY, LT -LH CBRA-,COBRA
LI NE 11 SUPPLI ERS PART DESCRI PTI ON: BUMPER ASSY, FT
-BLK, CBRA, 2J 4, BCF-NG, COBRA W/O WSTI C CLEARCCAT
LINE19 SUPPLI ERS PART DESCRI PTI ON: FENDER, LT C K
-------------------------------------------------------------------------------
ESTI MATE NOTES:
tiiarff ffxar•fx**fxfa**faxff**fraaaf**•if xrr iif rfrir xf*rr r*x*rrff•f xwrf fx*r xrr
xr xwafx xxwxxf xxxwxx - '
"**DTP ON FILE - PLEASE PAY SHOP******a*****
DR: 9/12 DC: 9/12 DI : 9/15 SCHD: TONED IN ERT: 5 DAYS DRV: N
VEHI CLE ONJER EMAI LED A COPY OF THE DAMAGE REPORT PRI OR TO REPAI RS
MI
VEHI CLE CER HANDED THE QRP BROCHURE PRI OR TO REPAI RS
PROD DATE: 6/96
ADDI TI ONAL REMARKS:
ERT DAYS OF 5 WAS COMMUNICATED TO THE CUSTOMER ON 9/16/08.
xiaa+x*xrfixx*i+arfaif*wxxaaar*riaafrraxa**aiaaaar ri*rar*i*rrxr x+axxr iaxsrr afr
xxff Y,xx xawxkw iaxxfw
USED PART SEARCH:
CONCORD AUTO / BRIAN . . . NO PARTS AVAILABLE
ROCK & ROLL / BRUCE . . . FENDER ONLY $150
PAC] FI.0 AUTO / M KE . . . NO PARTS AVAILABLE
-------------------------------------------------------------------------------
PRI OR DAMAGE NOTES:
NONE
PARTS 1177. 66
PARTS DI SCOUNT S 91. 41 -5. 0% -4. 07
BODY LABOR 9. 7 HRS DS 70.00/HR 679. 00
PAINT LABOR 12. 1 HRS OS 70. 00/HR 847. 00
PAI NT SUPPLI ES 12. 1 HRS 9$ 30. 00/HR 363. 00
SUBLET/M SC. - 5. 00
OTHER CHARGES 135. 00
3
09/1612008 AT 06: 04 PM JOB NUMBER:
40462
ESTI MATE OF RECORD
1996 FORD MUSTANG COBRA 8-4. 6L-FI 2D CPE MI TE I NT:
PRE-TAX DI SCOUNT -0. 5% -16. 01
----------------------------------------------------
SUBTOTAL $ 3186. 58
SALES TAX S 1528. 91 0 8. 2500% 126. 14
----------------------------------------------------
GRAND TOTAL S 3312. 72
ADJ USTMENTS:
DEDUCTIBLE 1000. 00
----------------------------------------------------
CUSTOMER PAY $ 1000. 00
INSURANCE PAY S 2312. 72
THI S I S A PRELI M NARY ESTI MATE AND ADDI TI ONAL CHARGES MAY BE REQUIRED FOR THE
ACTUAL REPAIR.
PLEASE PRESENT A COPY OF ?HI 5 ESTI MATE TO A REPAI R FACT LI TY OF YOUR CHOI CE
*USAA SUBS[ DI ARIES I NCLUDE: UNI TED SERVICES AUTOMDBI LE ASSOC[ATI ON(USAA), USAA -
CASUALTY I NSURANCE COMPANY(Cl C), USAA GENERAL 1 NOEMNI TY COMPANY(GI C) USAA
COUNTY MUTUAL INSURANCE(CM11 ) AND GARRISON PROPERTY CASUALTY INSURANCE CCMPANY.
GARRISON PROPERTY AND CASUALTY INSURANCE COMPANY, A SUBS[ DIARY OF USAA
CASUALTY INSURANCE COMPANY, IS AUTHORIZED TO USE THE USAA LOGO, A REGISTERED
TRADEMARK OF UNITED SERVICES AUTOMOBILE ASSOCIATION.
THI 5 15 NOT AN AUTHORI ZATI ON TO REPAIR. FAI LI NO TO PRESENT THIS ESTI MATE TO
THE REPAI RI NG GARAGE BEFORE REPAIR MAY RESULT IN ADDI TI ONAL EXPENSES TO YOU. A
USAA APPRAI SER MUST AUTHORIZE ANY SUPPLEMENT TO THI S ESTI.MATE. REPAI RS TO THI 5
VEHI CLE MAY REQUI RE SPECI FI C NELDI NG EQUI PMENT AS RECOMMENDED BY THE
MANUFACTURER.
I F ALTERNATI VE QUALI TY REPLACEMENT PARTS HAVE BEEN I NCLUDED I N THI 5 APPRAI SAL,
THE SOURCE FOR THESE PARTS HAS ALSO BEEN DISCLOSED. IF ALTERNATIVE QUALITY
REPLACEMENT PARTS AS LI STED ON THE APPRAI SAL ARE ULTI MATELY USED I N THE REPAI R
OF YOUR VEHICLE, THE WARRANTY ON SUCH PARTS W LL BE EQUAL TO, OR GREATER THAN,
THE PARTS BEI NG REPLACED, AS STATED I N USAA' S LI M TED PARTS WARRANTY. USAA
VARRANTS THAT THE PARTS USED ON YOUR VEHI CLE W LL BE OF LI KE KI NO AND QUALI TY,
FUNCTION, FIT, SAFETY AND CORROSION PROTECTION AS THE PART OR PARTS THEY
REPLACE. USAA IDENTIFIES CAPA-CERTI FI ED PARTS FOR SHEET METAL REPLACEMENT
PARTS SUBJ ECT TO CAPA-CERTI FI CATI ON.
4
09116/2006 AT 06: 04 PM JOB NUMBER:
40462
ESTIMATE OF RECORD
1996 FORD MUSTANG COBRA 8-4. 6L-FI 2D CPE NMI TE I NT:
5ft#k**RRRYY**#tk{Y<#tk}#Yf{YY*SkffiYY*R#*{}f ttt}{YS tttYY}ifii#Y{#*{{5*f
CALI FORM A LAW PROW DES THAT YOU HAVE THE RI GHT TO SELECT THE REPAI R FACT LI TY
OF YOUR CHOICE. -THIS ESTIMATE HASBEEN -PREPARED .BASED ON.THE' USE OF CRASH PARTS SUPPLIED BY A
SOURCE OTHER THAN THE MANUFACTURER OF YOUR MOTOR VEHICLE. ANY WARRANTIES
APPLICABLE TO THESE REPLACEMENT PARTS ARE PROW DED BY THE MANUFACTURER OR
DISTRIBUTOR OF THE PARTS, RATHER THAN BY THE ORIGINAL MANUFACTURER OF YOUR
VEHICLE.
1 F ALTERNATI VE QUALI TY REPLACEMENT PARTS HAVE BEEN I NCLUDED I N THI S APPRAI SAL,
THE SOURCE OF THESE PARTS HAS ALSO BEEN DI SCLOSED. I F ALTERNATI VE QUALI TY
REPLACE.KENT.PARTS AS LI STED ON THI S APPRAI SAL ARE ULTI MATELY USED I N.THE
REPAI R OF YOUR VEHI CLE, THE WARRANTY ON SUCH PARTS W LL BE EQUAL TO, OR
GREATER THAN, THE PARTS BEI NG REPLACED. AS STATED I N USAA' S LI MI TED PARTS
WARRANTY. USAA WARRANTS THE PARTS USED ON YOUR VEHICLE W LL BE OF LIKE KIND
AND QUALI TY, FUNCTI ON, FI T AND CORRO51 ON PROTECTI ON AS THE PART OR PARTS THEY
REPLACE, USAA IDENTIFIES THE USE OF CAPA-CERTI FI ED PARTS FOR ANY SHEET METAL
REPLACEMENT PART SUBJ ECT TO CAPA CERTI FI CAT[ ON.
fXf#RFR R4k R*tttR#**tiRt**tR{}{#Y#kR*}ttt*{}*ikk*Rtf{{Y*}{RRYf tt*#*t{}t '
5
09/16/2008 AT 06:04 PM JCB NUMBER:
40462
ESTI MATE OF RECORD
1996 FORD MUSTANG COBRA 8-4. 6L-FI 2D {PE HMI TE INT:
FOR YOUR PROTECTI ON CALI FORNI A LAW REQUI RES THE FOLLOW NG TO APPEAR.ON THI S
FORM
ANY PERSON WHO KNOW NGLY PRESENTS FALSE OR FRAUDULENT CLAIM FOR THE PAYMENT OF
A LOSS I S GUI LTY OF A CRI ME AND MAY BE SUBJ ECT TO FI NES AND-CONFINEMENT i N
STATE PRISON.
THE FOLLOW NG IS A LIST OF ABBREVI ATI ONS OR SYMBOLS THAT MAY BE USED TO -
DESCRI BE NARK TO BE DONE OR 'PARTS TO BE REPAIRED OR REPLACED: MOTOR
ABBREVI ATI ONS/SYMBOLS: D=DI SCONTI NUED PART A=APPROXI MATE PRI CE LABOR TYPES:
B=BODY LABOR D=DI AGN05TI C E=ELECTRI CAL F=FRAME .G=GLASS MkM?CHANI CAL P=PAI NT
LABOR S=STRUCTURAL T=TAXED M SCELLANEOUS X=NON TAXED M SCELLANEOUS PATHWAYS:
ADJ =ADJ ACENT ALGN=AL1 GN A/M=AFTERMPARKET BL.ND=BLEND CAPA=CERTI FI ED AUTOMOT1 VE
PARTS ASSOCI ATI ON D&R=DI SCONNECT AND RECONNECT EST=ESTI MATE EXT. PRI CE=UNI T
PRI CE MULTI PLI ED BY THE QUANTI TY I NCL=1 NCLUDED M SC=M SCELLANEOUS
NAGS=NATI ONAL AUTO GLASS SPECI FI CATI ONS NON-ADJ =NON ADJACENT O/H=OVERHAUL
OP=OPERATION NO=LINE NUMBER QTY=QUANTITY QUAL RECY=QUALITY RECYCLED PART QUAL
REPL=QUALI TY REPLACEMENT PART COMP REPL PARTS=CONPETI TI VE REPLACEMENT PARTS
RECOND=RECONDI Ti ON REFN=REFI NI SH REPL=REPLACE R&I =REMOVE AND I NSTALL
R&R=REMOVE AND REPLACE RPR=REPAIR RT=RIGHT SECT=SECTION SUBL=SUBLET LT=LEFT
W/0=W THCUT W/-=W TH/_ SYMBOLS: #=MANUAL LI NE ENTRY -=OTHER [I E, . MOTORS
DATABASE I NFORMATI ON WAS CHANGED] "=DATABASE LI NE W TH AFTERMARKET N=NOTES
ATTACHED TO LI NE. .MQVP=MANUFACTURER' S QUALI FI CATION AND VALI DATI ON PROGRAM
OPT OEM=ORIGINAL EQUI PMENT .MANUFACTURER PARTS EI THER OPTI ONALLY SOURCED OR
OTHERW SE PROVI DED W TH SOME UNIQUE :PRI Cl NG OR DI'S000NT. NVCP.P=NATI ONW DE
CRASH PARTS PROGRAM. - -
THIS ESTIMATE HAS BEEN PREPARED BASED ON THE USE OF CRASH PARTS SUPPLIED BY A
SOURCE OTHER THAN THE MANUFACTURER OF YOUR MOTOR VEHICLE. ANY WARRANTIES
APPLICABLE TO THESE REPLACEMENT _PARTS, ARE PROVI DED BY THE MANUFACTURER OR
DISTRIBUTOR OF THE PARTS, RATHER THAN BY THE OR) GINAL MANUFACTURER OF YOUR
VEHICLE,
THIS ESTIMATE HAS BEEN .BASED ON THE USE OF CRASH PARTS SUPPLIED BY A SOURCE
OTHER THAN THE MANUFACTURER OF YOUR MOTOR VEHICLE. ANY WARRANTIES APPLICABLE
TO THESE REPLACMENT PARTS ARE PROVIDED BY THE MANUFACTURER OR DISTRIBUTOR OF
THE PARTS, RATHER THAN BY THE ORIGINAL MANUFACTURER OF YOUR VEHICLE.
RECYCLED PART COSTS BASED ON INFORMATION PROVIDED BY CAR-PART. COM FOR
ASSISTANCE, CALL CCC AT 800-637-8511. -
6
09/16/2008 AT 06:.04 PMJ OB NUMBER:
40462
ESTIMATE OF RECORD
1996 FORD MUSTANG COBRA 8-4.6L-F1 2D CPE Wil TE I NT:- -
ESTIMATE BASED ON MOTOR CRASH ESTIMATING GUIDE. UNLESS OTHERW SE NOTED ALL
I TENS ARE DERIVED FROM THE GUI DE DE2J C94, CCC DATA DATE 09109/2008, AND THE"
PARTS SELECTED ARE OEM-PARTS MANUFACTURED BY THE VEHICLES ORIGINAL EQUIPMENT
MANUFACTURER. OEM PARTS ARE-AVAI LABLE AT OE/VEHI CLE DEALERS Hl PS. OPT OEM
(OPTI ONAL OEM) OR ALT OEM (.ALTE.RNATI VE OEM) PARTS ARE OEM PARTS THAT MAY BE
PROVIDED BY OR THROUGH ALTERNATE SOURCES OTHER THAN THE OEM VEHICLE
DEALERSHI.PS. OPT 'OEM OR ALT OEM PARTS MAY. REFLECT SOME SPECT FI C; SPECT-AL, OR
UNI WE PRI Cl NG OR DI SCOUNT. OPT OEM OR ALT OEM PARTS MAY I NCLUDE -BLEM SHED.
PARTS PROM DED BY OEM S THROUGH OEM VEHI CLE DEALERSHI PS. ASTERISK (*) OR
DOUBLE ASTER] SK ("•) I NDI CATES THAT THE PARTS AND/OR LABOR I NFORMATI ON
PROVIDED BY MOTOR MAY HAVE BEEN MODIFIED OR MAY HAVE COME FROM AN ALTERNATE
DATA SOURCE. TILDE SI GN (-) I TENS I NDI CATE MOTOR NOT-I NCLUDED LABOR
OPERATIONS. NON-ORI GI NAL EQUI PMENT MANUFACTURER AFTERMARKET PARTS ARE
DESCRIBED AS AM QUAL REPL PARTS OR COMP REPL PARTS WPI CH 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
PROJI DED BY NATI ONAL AUTO GLASS SPECT FI CATI ONS. LABOR OPERATI ON TI MES LI STIED
ON THE LINE W TH THE NAGS INFORMATION ARE MOTOR SUGGESTED LABOR OPERATION
TI MS. NAGS LABOR OPERATI ON TI NES ARE NOT I NCLUDED. POUND SI GN (#) I TENS
I NDI CATE MANUAL ENTRI ES. SOME 2006 VEHICLES CONTAI N M NOR CHANGES FROM THE
PREVIOUS YEAR. FOR THOSE VEHI CLES, PRIOR TO RECEI VI NG UPDATED DATA FROM THE
VEHICLE MANUFACTURER, LABOR .AND -PARTS DATA FROM THE PREVIOUS YEAR MAY BE USED.
THE PATHWAYS ESTI MATOR HAS A COMPLETE LIST OFAPPLICABLE VEHICLES. PARTS
NUMBERS AND PRICES SHOULD BE CONFIRMED W TH THE LOCAL DEALERSHIP.
CCC PATHWAYS - A PRODUCT OF CCC INFORMATION SERVICES INC.
7
09/16/2008 AT 06: 04 PM J OB NUMBER:
40462
ESTI MOTE OF RECORD
1996 FORD MUSTANG COBRA 8-4. 6L-Fl 2-0 CPE WHITE I NT:
RECYCLED PART SUPPLIERS
LINE LI NE DESCRI PTI ON PRICE
19 QUAL RECY PARTS LT FENDER +25% STOCK NO. : MA0117 S 125. 00
M & M SALVAGE (800)662-4881
42130 CO. RD. 25 - - J UAN MUNOZ
WOODLAND, CA 95776
2 QUAL RELY PARTS LT HEADLA +25% STOCK NO. : R83345 S 193. 75
11 QUAL RECY PARTS IMPACT BA +25% STOCK NO. : R83345 S 156.25
LKQ - WEST (866)557-2677
AZ, NV, CA, UT
SANTA FE SPRI NG, CA 90670
8
09/16/2008 AT 06:04 PM JOB NUMBER:
40462
ESTIMATE OF RECORD
1996 FORD MUSTANG COBRA 8-4.6L-FI 2-D CPE Wil TE I NT:
ALTERNATE PARTS SUPPLIERS
30 QUAL REPL PARTS CAPA MOUNT PART NO. F01222104 PRICE 95. 95 -
COLLISION PARTS NETWORK (800)498-9808
14306 WICKS.BLVD. (510)895-8257
SAN LEANDRQ CA 94578
8 RECORD BUMPER COVER W/COBRA PART NO. F01000238 PRICE 435. 00
FAITH BUMPER SERVICE (408)986-1226
1085 DI GI ULI O
SANTA CLARA, CA 95050
4 QUAL REPL PARTS LT PARK/MAR PART NO. FR182-000OL PRICE 40. 00
FACTORY MOTOR PARTS (916)452-4102
6779 Q STREET
SACRAMENTO, CA 95819
25 QUAL REPL PARTS LT FENDER L PART NO. F0010 PRICE 25. 30
SAN J OSE TRADI NG COMPANY, I NC. (408)434-9222
1945 LUNDY AVENUE (800)660-6069
SAN JOSE, CA 95131
y
09/16/2008 AT 06: 04 PM JOB NUMBER:
40462
ESTIMATE OF RECORD
1996 FORD MUSTANG COBRA 8-4. 61.-F1 2D CPE Nil TE,I NT:
ALTERNATE PARTS USAGE
AFTERMARKET PARTS
AFTERMARKET SELECTION METHOD: AUTOMATE CALLY SELECT
NO. OF TI MES USER WAS NOTI FI ED-THAT AN AFTERMARKET PART WAS AVAI LABLE: .12
NO. OF AFTERMARKET PARTS' THAT APPEAR I N THE FI NAL ESTI MATE: 3
OPTI OVAL OEM PARTS
OPTI ONAL OEM SELECTI ON METHOD: AUTOMATI CALLY SELECT
NO. OF TI MES USER MS NOTI FI ED THAT AN OPTI ONAL OEM PART WAS AVAI LABLE: 0
NO. OF OPTI ONAL OEM PARTS THAT APPEAR I N THE FI NAL ESTI MATE: 0
RECONDI TI ONED PARTS
RE CONDI TI ONED SELECTI ON METHOD: AUTOMATI CALLY SELECT
NO, OF TI MES USER OW.S NOTI FI ED THAT A RECONDI TI ONED PART MS AVAI LABLE: 3
NO. OF RECONDI TI ONED PARTS THAT APPEAR I N THE FI NAL ESTI MATE: 1
RECYCLED PARTS
NO. OF TIMES USER.WAS NOTI FLED THAT A RECYCLED PART NWS AVAILABLE: 11
NO. OF RECYCLED PARTS THAT APPEAR IN THE FI NAL ESTIMATE: 3
10
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