HomeMy WebLinkAboutMINUTES - 11182008 - C.12 (15) CLAIM
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
BOARD ACTION: NOVEMBER 18, 2008
Claim Against the County, or District Governed by )
the Board of Supervisors, Routing Endorsements, ) jOTICE TO CLAIMANT
and Board Action. All Section references are to ) he copy of this document mailed to
California Government Codes. JRy1EJD you is your notice of the action taken
on your claim by the Board of
OCT 17 Z008 Supervisors. (Paragraph IV below);
given Pursuant to Government Code
COUNTY COUNSEL Section 913 and 915.4. Please note all
AMOUNT: $5,851.33 MARTINEZ, CALIF. 'Wings".
CLAIMANT: LIED INSURANCE
FOR: LAWRENCE ROMINE/ERIN ROMINE
BY: DARCI McMAINS
ATTORNEY: UNKNOWN DATE RECEIVED: OCTOBER 17, 2008
ADDRESS: 1700 LOCUST ST, DEPT.#2019Y DELIVERY TO CLERK ON:OCTOBER 17, 2008
DES MOINESi,"'IA 50391-2019
RECEIVED FROM RISK
BY MAIL POSTMARKED: MANACEMFNT
FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
OCTOBER 17, 2008 DAVID TWA, Cler
Dated: By: Deputy
11. FROM: County Counsel TO: Clerk of the Board of Supe6isors Jr
(� 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: By: m t✓ ?-QjO `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.
Dated:Adt r+#.d e/���AVID TWA, CLERK, ByDeputy 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 Waring 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.
Dated: 6'0'_'A eeAVID TWA, CLERK, By Deputy Clerk
This warning' es not-apply to claims which
are not subject to the•Ca..lifornia 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 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,dpes it waive rights under the statutes of
limitations applicable to actions not subject to
the California Tort Claims Act
z
i
's
'�. N
, 3
... �] SHARON HYMES'OFEORD
Allied
I Insurance
a member of Natnonwfde Insurance /
County of Contra Costa gust 19, 2008 --��
2530 Arnold Drive, Suite 140
Martinez, CA 94553
RECEIVE®
Date of loss: 05/22/08 � OCT 1 7 2008
Our Insured: Lawrence Romine/Erin omine �I�JyM
Your Insured: Gary Faria
CLERK BOARD OF SUPERVISOR
Our claim#: 84P38858 CONTRA COSTA CO.
Your claim#: unk
Attn: Penny Bailey
Documents to support our subrogation demand are enclosed Our subrogation demand totals$5,851.33 which
includes our insured's$500.00 deductible. j
I have provided an estimate, payment screen, photos and all pertinent information regarding this claim. If you
need additional information, please feel free to contact me.
Please review the information provided and remit payment to:
Allied Insurance
1100 Locust St Dept#2019
Des Moines, IA 50391-2019
Penny Bailey
sine OCT 1.4°2008
Darci McMains CONTRA.COSTA COUNTY
Subrogation Support Tech G�
Allied Insurance AUS Z 8 2008
mcmaind@nationwide.com D O
1-800-879-6707 ext#2745 �J RISK MAHA(aww
O E7
Penny Bailey
OCT 14-2008
(A) .Passport . zws - PASSPORT _ gust 19, 2008, 13 : 22 : 51
P/N POLICY PPC 0012494031 1 LOSS DATE 052208 CLAIM 84P38858
AUTOMATED CLAIMS SYSTEM - PAYMENT HISTORY
CO 03 EFF 05/22/08 EXP 11/22/08 TERM 06 AGENT 78 84 07565
INS1 ROMINE, LAWRENCE D INS2 ROMINE, PATRICIA A
UNIT 0009 COV 554 COLLISION - CLASS G46120 CLMNT 000 CLM CODE 05
CHECK TRAN CHECK M CC SD DEPOSIT LOSS ADJ BLDG
NUMBER AMOUNT DATE DATE T CF IP R DATE TYPE CA LDI NO.
378348998 5 , 231 . 33 073108 073108 P CC 18 22
PAY TO: JIM' S CALIFORNIA AUTO BODY IRS 942227228
*** 5 , 231 . 33 TOTAL PAID
*** 5, 231 . 33 NET PAID
UNIT 0009 COV 567 BROADENED RE CLASS G46120 CLMNT 000 CLM CODE 09
CHECK TRAN CHECK M CC SD DEPOSIT LOSS ADJ BLDG
NUMBER AMOUNT DATE DATE T CF IP R DATE TYPE CA LDI NO.
378348014 120 . 00 072108 072108 P 18 00
PAY TO: ENTERPRISE RENT-A-CAR COMPANY OF SAN FRANC IRS 363041733
*** 120 . 00 TOTAL PAID
*** 120 . 00 NET PAID
CONTRA COSTA COUNTY
MEUIVED
AUU 2 5 2008
RISK MANNEIVIENT
EhoicePoint Inc. 6/6608 2 : 06 PM PAGE 1/004 Ox Server
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C h o i c e PO i n t Choice Point Police Records
P.O.Box 740167
Atlanta, GA 30374-0167
Phone: 1.800.934.9698 Fax 1.800.934.6449
Email: orderpoint.support@choicepoint.com
REPORT ATTACHED
PAGE COUNT:4
CLIENT : 5382
DIVISION : 03
ADJUSTER : GRIMSHRI
CLAIM : 84P38858
TRANSACTION# : 239301772
DATE : 06/06/2008
DATE OF LOSS : 05/22/2008 TIME OF LOSS : : AM
STREET :
CITY : WALNUT CREEK
COUNTY : CONTRA COSTA
STATE : CA
INVESTIGATING AGENCY : WALNUT CREEK PD
REPORT NUMBER : 11970
REPORT TYPE : Auto Accident
PARTY 1 : ERIN ROMINE
PARTY 2 :
PARTY 3 :
CAR : MAKE : YEAR :
TAG :
DRIVER LICENSE :
ADDITIONAL INFO :
925-935-6400
NOTE :
4 615120081:07:09 PM[Central Daylight Time]IADSMAPP0019 8594 ChoicePolnt Inc.01b6
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239301772
STATE PF CALIFORNIA
DEPARTMENT OF CALIFORNIA HIGHWAY PATROL
TRAFFIC COLLISION REPORT -Property Damage Only
CHP 555-03(Rev.7-03) OPI 061 Original to Often'copy(ies)to involved parfy(ies)
SPECIAL CONOMONS HIT&RUN :CITY JUDICIAL DISTRICT MB I
COUNTY REPORTINGUSTRICT REAL 'REPOJITINGOFFICER
COLL 0 MO DAY TI NCIC OFFICER Lp.
,J� 66 ,717
❑ AT WTE SECTION WITH DAY OF WEK TOW AWAY STATE HIGHWAY LATED
Or. Mees a ❑ Yes ❑ Yes o
D vERs NSE ER srArE c aR sAF EouIPMEHr SHADE (ALLIED AGENCY U ONLY)
DAMAGED ReporttakenE es ❑ NO
E(FIFt57 MIDDLE. T) TELEPHONE NUMBER --AREA
�r� 0 Exchange of information [] Yes �o
PEO jEETRES (COY) (Slab) R Cade)
.� I
I
P$y.FR BI SURANCE CARRIER a POLICY NUMBER 1 I
B ILICYCJI LE.UK L ONS ET OR HIGHWAY BPE I INDICATE/
JNORTH
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DAMAGED
0 IVER NAME(FIRST,WOOLF LA5 T EPHONE NUMBER AREA
Pp� ,STREETAUDRESS (CNy) (Stale) (Lp Code)
PKQ�Ein rDl:eL
I D / INSURANCE CARRIER POLICY NUMBER
LJI /Y/ 1
BICYCLE 5 UTORHIGHWAY SPE
OT IR VEN,yE/�R M /MODa./C LI E UMBER STATE• VEIV� PARTY
IIJI /VT/W � o 2
WIT AGE SEX I NAM D S NSF N i TY N0.
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❑ ❑ AGE SEX NAMfaJ }�/ ADD PHONE NUMBER PAITY NG.
PROP. NAME / ( ADDRESS �JVG /T DAMAGED PROPERTY
PRIMARY COLLISION FACTOR TRAFFIC CONTROL DEVICES SPECIAL INFORMATION MOVEMENT PRECEDING
LIST NUMBER /1I OF PARTY AT FAULT COLLISION
/ A VC SECTION VIOIAT CONTROLS FUNCTIONING _ A HA7ARDOUS MATERIAL STOPPED
B —
�)(( B CON LS NOT FUN it IN CELL PHONE D IN 0
HANDHELD _ PROCEEDING STRAIGHT
# B OTHER IMPROPER DRIVING' C C OLS OBSCUk C CELL PHONE HANDSFREE IN USE C RAN OFF ROAD
D NO CONTROLS PRESENTIFACTOW D CELLPRESENT/FACT PHONE NOT IN USE D MAKING RIGLIT TURN _
C OTHER T AN DRIVERTYPE E E MAKING LEFT TURN
() UNKNOWN' A H ON F -AKING U TURN _
E SIDESWIPE _ IG G BACKING •__
REAR END H _ H SLOWING ISTOPPIN
D BR IDE I _ I PASSING OTHER VEHICLE
CLEAR -JE—HIT OBJECT _ CHANGING LAN
B CLOUDY IF OVERTURNED K _ _ K RAB61NG MANEUVER
C WING G VE
E/PEDESTRIAN L _ L EN RING TRAFFIC
ING M 4 M OTHER UNSAFE TURNING
E FOGfVISSI ITY MOTOR VEHICLE INVOLVED WITH N N I INTO OPPOSING LANE
F OTHER:' A N USION _ O PARKED _
IN B PEOE I _ jAY P MERGINGOTH R OR VE I OTHER ASSOCIATED FACTOR($)D MOTOR V LE ON OTHER (MARK 1 TO t?EMS R OTHER".'
B -DAWN PARKED M VEHICLE A VC SECTION VIOLATION:
OA -STREET LIGHTS F TRAIN -
D OARK-NO STREETLIGHTS G BICYCLE B VC SECTION VIOLATION: "--
E DARK-STREET LIGHTS NOT H ANIMAL:
FUNCTIONING' _ SOBRIETY•DRUG I PHYSICAL
ROADWAY SURFACE I FIXED OBJECT; MARK 1 TO 21TEWS
DRY A HAD NO7 BEEN D KING
'B WET J OTHER OBJECT: _ 'B D-UNDERINF�JENCE
WY-ICY _ C HBD-NO UNDER INFLUENCE'
5 I ) PEDESTRUH'8 ACTIONS F INATTENTION* _ HBD-IMPAIRMENT UNKN __
ROADWAYCONDITION($I _ PSGO TRAFFIC _ E UNDER DR IN LUENCE' _
MARK1iOYITEM9 NO PEDESTRIAN INVOLVED HNT GlLEAVIN RMP F IMPAIRMENT-PHYSICAL*
IA HOLES,_ P RUTS' B CROSSING IN CROSSWALK AT _ I PREVIOUS COLLISION 0 IMPAIRMENT N T KNOWN
18 DOSE MATERIAL ON ROADWAY' INTERSECTION J UNFAMILLAR WITH ROAD H NOT APPLICABLE
OBSTR TN ON ROADWAY' IC CROSSING IN CROSSWALK-NOT AT K DEFECTIVE VEH.EQUIP.: I SLEEPY/
D CONSTHUCTON- AIR ZON INTERSECTION
RED WAV ROS LNG•N TIN K L
ODER' OAD-IN SSH 1
ER': T IN R NONE APPgRENT: _
O UNCONDITI APPROACHING!LEAVING SCHOOLORUNAW YVEHICLE
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239301772 . I...
STATE OF CALIFORNIA
DEPARTMENT OF CALIFORNIA HIGHWAY PATROL
TRAFFIC COLLISION REPORT -Property Damage Only �� Z
CHP 555-03(Rev.7-03) OPI 061 Orlginal to Officer;copy(ies)to invotved party(ies)
SPECIAL CONDI TIONS HIT B RUNGTY JL
DIS ICT NUyBG6�
`!/17VC
COUNnY � REPORTING DISTRICT REP OFfICfA
COLL18I_ OCyVRRED�
VA_ l�C 7 I(�� J �' Y ,IM NCIG (-Z, 0 • .D
AT INTERSECTIONWITN � ] DAYOFWEEK TOW AWAY STATE HIGHWAY RFJATED
or. Fe ues (("/OI 1,4 V_ ❑ Yes TRfwO ❑ Yes NO
DPoVFR' LI ST TE CUSS AIR G s �EQUIPMENT SHADE (ALLIED AGENCY USE ONLY)
G DAMAGED Report taken�es ❑ No
NAME IFIRST•MIDDLE.LAn AREA
Exchange of information ❑ Yes o
O STREE A SS (City) (S=) (Zjv )r,
p H TH TE E RIER POLICY NUMBER
BILE DIR.T8�IG4 ON TREETOR HIGHWAY SPEED T �j IINN1•�jDIICATE
0 R VEH.AR MAKE;MODEL! LICEN NUMBER ST E VFH- PARTY - G✓Q_" �TVH�j..q'- .
Z 1
VE 1 E C AIRSA SAF/E�EWIPMENT SHADE l l
V DAMAGED r
NA (FIRST,MIDDLE,LAST) PHONE MEER AREA ' I
STRE DRESS, (Cqy) ($U(ef! (IIp CO �r .3
P H S i TEINSURANCE CARRIER POLICY NUMSE OI v-Z
BICY�LE DIR. L ET HIGHWAY SPE I T y I
OyHER VEHyF�jt MAKEiN E COLOR LIf�NSj ISN BTATE VEa,I_]'j1E PARTY I I
❑ /VICJ/ /��T�.�j( VR I/ 2 11
WIAGE ISEX NAME O ADD 5 HO rNUM E l AR NO.
�'-I y�y❑�+ AGE SEX NAMFGgJ�fr ADDRE%Tr ,PHONE NUMBER .PARTY N0.
PROP. NAME 'ADDRESS DAMAGED PROPERTY
PRIMARY COLLISION FACTOR TRAFFIC CONTROL DEVICES SPECIAL INFORMATION MOVEMENT PRECEDING
UST NUMBER(0)OF PARTY AT FAULT COLLISION
# A VC SECTION VIOLATED: IA CONTROLS FUNCTI NING A HAZA DOLS MATERIAL PPED _
_ _ B CONTROLS NOT FUNCTIONING B CIELL PHONE HANDHELD IN Vg B P OCEEDIN STRAIGHT
k B OTHER IMPROPER DRIVING' C CONTROLS OBSCURED i C CELL PHONE HANDSFREE IN USE C RAN OFF ROAD
Q NO CONTROLS PRE TlFACTVG
D CELL PHONE N01 IN USE AKING RI TURN
C T R TH RIV R' P F L 1 E AKING L T TURN
.DT UNKNOWN' A HEAD-ON F F AKING T RN
E B I ESWIPE IG BACKING
C REAREND _ __ H I H SLOWING!STOPPING
D BROADSIDE I I PASSING OTHER VEHICLE
CLEAR .HITOB CT j J CHANGING LANE
_ CL Y F OVERT NED K PA% O MANE R
C RAINING +G ICLE/PEDESTRIAN L LENT RING IC
10 SNOWING H M M OTHER UNSAFE TURNING _
F ISIBI rY MOTOR VEHICLE IKVOLVEO WITH N XING INTO OPPOSING LANE
R" NOWCOLLISION D 10 PARKED
-T-ra WINE) B P TR16N P MERGING
LIGHTINGER MOT y HIE CLE OTHER ASSOCIATED FACTOR(S) T VELJNG WRONG WAV
DAYLIGHT_ D MOLOR VEHICLE ON OTHER HIGHWAY J TO 1 gEMSf R T ER:'
DUSK-DAWN :E PARKED MOTOR YFHICLE A VC SECTION VIOLATION:
ARK-STREET LIGHTF TRAIN
D K-NO ST T LIGHTS B VC SECTION VIOLATION: - -
E DARK-STREET LIGHTS NOT H ANIMAL:
FUNCTIONING'
SOBRIETY-DRUG 7 PHYSICAL
ROADWAY SURFACE I I FI%ED OBJECT: MARK J TO 2ITEMS
A nRyHAONQT BEEN DRINKING _
WE J OTHER OBJECT: 3 HBO-UNDER INFLUENCE
N -I C H -NO UNDERINFL E-
PEDESTRIAN'SACTIONS F INATTENTION' D H -IMPAIRMENT UNKNOWN*
ROADWAYCONDITION(S) A NO PEDESTRIAN INVOLVEDG STOP&GO TRAFFIC _ E UNDER RUG INFLUENCE*
MARK T TO 2ITEMS H ENTERING/LEAVING RAMP. F IMPAIRMENT-P ICAL'
'A HOLES,DEE UTS' B CROSSING IN CROSSWALK AT I PREVIOUS ISION G IMPAIRMENT NOT KNOWN
LOOSE MATERIAL ON ADWAY' INTERSECTION J UNFAMILIARWITH ROA H N PPL)
QDSTRUCTIQN ON WAY' C CROSSING IN CROSSWALK-NOT AT K DEFECTIVE VEH.EQUIP I SLEEPY FATIGUED'
CONSTRUCTI PAIR ZONE INTERSECTION
CED ROADWAY WIDTH D CROSSING-NOT IN ROSSWALK L
E L - E IN ROAD-INCLUDES OULDE
OTHER' F NOT IN ROAD A NQNFAFTAR NT _
NO UNUSUAL CONDITIONS G APPROACHING/LEAVINC SCHOOL 1 O RUNAWAY VEHICLE
Destroy previous editions. C6M503-3.frp
4 61620081:07:09 PM[Central Daylight Time]IADSMAPP0019 8694 CholcePolnt Inc.01.66
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239301772
DATZ OF COLLISION TIME(7400) NCIC NUMBER OFFICER I.D. NUMBER PAGE
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461820081:07:09 PM[Central Daylight Time]IAOSMAPP00198594 CholcePoln[Inc.01 L8 ^'*Ob -S dff2 Of J195 09 OSP 0379252
ARMS®-Automated Rental MaQement System Page 1 of 1
Rental Company.ENTERPRISE RENT-AZAR
® ALLIED INS Invoice: DW8748,2307
.. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ..
Bill To: Billing Detail:
ALLIED INS
ATTN:CAfNV DRIVE RMS Rental Period: 7115108 to 7118108(4 days)
5525 PARK CE NTE RCIRCLE Bll led Period: 7115108 to 7118108(4 days)
DUBLIN , OH 43017
'Descriptbn Rate: ............
RENTER INFORMATION: 4 DAYS $28.25
Renter: ROMINE, ERIN 14 DAYS DW $13.90
4 DAYS PAI $3.00
RENTAL INFORMATION: '1 FUEL 18.75
Rental Branch Location: '1 SALES TAX 968.25
ENTERPRISE RENT,A-CAR(2307)
2550 MONUMENT BLVD TOTAL CHARGES
CONCORD, CA 945203107
(925)68&8900 'Lees Amount Reoeived:
ADDI IONALCLJ4IMINFORMATION: AMOUNTOUE_--_.
.....................................................
Claim Number:84P388M
Claim Type: Insured
Vehicle Condition: Driveable
Date Of Looe:
Insured Name:
Owner's Vehicle:2006 TAYO RAF 4
Additional Driver:
Repair Facility:
JIM'S AUTO BODY-CONCORD
CONCORD, CA94520
(925)689-6117
VEHICLES RENTED:
Effecthre Starting Ending
Date and Year Malin Model VIN Mileage Mileage Mileage Rate
Time
1 15 PM 2007 DO DG CALL 1B3HB48B47037MI30 18563 law 103 $28.25
Rental Invoice
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . .
Please Return This Portion with%rriftance
Make Paym ant To: Total Charges: $190.58
ENTERPRISE RENT41-CAR(23CC) Less Amount Received: $70.58
3000 EXECUTIVE PKWY STE 225 Total Amount Due.-___----- $120A0
SAN RAMON,,CA 9485834254
Federal I D:38-3D41733 Please include an your check:
Invdoe: D328748-2307
https:ttwww.enterprise.com/armsweb/payinvoice 7PW2008
21111ON 3:06:06 PM[Cenh Day ightTiime]IADSMAPP00191003 00-00
07/29/2008 AT 10:00 AM JOB NUMBER: 8482
13030
JIM'S CALIFORNIA AUTO BODY INC.
LICENSE #:AF178743 FEDERAL ID #:942227228
EST. 1962
2520 MONUMENT BLVD.
CONCORD, CA 94520
(925) 689-6117 FAX: (925)689-7836
SUPPLEMENT OF RECORD 2 WITH SUMMARY
WRITTEN BY: BRIAN MAHLER 07/29/2008 09:29 AM
ADJUSTER: ADJUSTER UNKNOWN (877) 777-2022
INSURED: LAWRENCE D ROMINE CLAIM #84P38858/I009
OWNER: LAWRENCE D ROMINE POLICY #ALLIED P & C INS CO
ADDRESS: 622 HARROGATE CT DEDUCTIBLE: $500.00
WALNUT CREEK, CA 94598-4015 DATE OF LOSS: 05/22/2008 AT 12:01 AM
DAY: (510) 652-1844 TYPE OF LOSS: COLLISION
EVENING: (925) 930-7809 POINT OF IMPACT: 6. REAR
INSPECT
LOCATION:
INSURANCE ALLIED INSURANCE BUSINESS: (877) 777-2022
COMPANY: DAYS TO REPAIR
2006 TOYO RAV4 4X2 4-2.4L-FI 4D UTV SILVER MET INT:GREY
VIN: JTMZD33VX65014021 LIC: STRZ404 CA PROD DATE: 02/2006 ODOMETER: 34045
CONDITION: GOOD
AIR CONDITIONING REAR DEFOGGER TILT WHEEL
CRUISE CONTROL TELESCOPIC WHEEL INTERMITTENT WIPERS
KEYLESS ENTRY REAR WINDOW WIPER DUAL MIRRORS
PRIVACY GLASS CONSOLE/STORAGE REAR SPOILER
CLEAR COAT PAINT POWER STEERING POWER BRAKES
POWER WINDOWS POWER LOCKS POWER MIRRORS
AM RADIO FM RADIO STEREO
SEARCH/SEEK CD PLAYER ANTI-LOCK BRAKES (4)
DRIVER AIR BAG PASSENGER AIR BAG 4 WHEEL DISC BRAKES
POSITRACTION TRACTION CONTROL STABILITY CONTROL
CLOTH SEATS BUCKET SEATS AUTOMATIC TRANSMISSION
OVERDRIVE FULL WHEEL COVERS
-------------------------------------------------------------------------------
NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT
------------ --------------------------- --------------------------
1# S02 FINAL AUTHORIZATION SECURED/ 1
DTP UPLOADED
24 S02 COPY OF FINAL INVOICE GIVEN 1
TO OWNER
3# S02 *+****+++*++*,t**t**+•x+**++++* 1
4# HYPERQUEST RAN TRANSACTION # 1
1621554
5# xt**+*+***+r* rtx+x++x*tt++**+ 1
1
07/29/2008 AT 10:00 AM JOB NUMBER: 8482
13030
SUPPLEMENT OF RECORD 2 WITH SUMMARY
2006 TOYO RAV4 4X2 4-2.4L-FI 4D UTV SILVER MET INT:GREY
-------------------------------------------------------------------------------
NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT
--------------- ------------------ ---
6# 3 ADDITIONAL USED PART SEARCH 1
DOCUMENTED
7# LKQ - KENNY- QUOTE #762314 1
866-205-2734
8# MCHUGES WRECKERS -HERMAN- 1
925-686-2343
9# CONCORD AUTO DISMANTLERS 1
-925-825-7231
10# ****************************** 1
******************************
11 REAR BUMPER
12 O/H REAR BUMPER 1.8
13** REPL RECOND BUMPER COVER W/O FLARE 1 192.00 INCL. 2 .6
14 ADD FOR CLEAR COAT 1.0
15 REPL PROTECTOR 1 73 .07 INCL.
16 BACK DOOR
17 REPL DOOR SHELL 1 476.15 5.2 3 .6
18 ADD FOR CLEAR COAT 1.4
19 ADD FOR TRNSFR GLASS 0.7
20 REPL ACCESS COVER W/O WOOFER 1 15.35
21 REPL EMBLEM 1 21.18 0.2
22 REPL NAMEPLATE "TOYOTA" 1 20.41 0.2
23 REPL NAMEPLATE "RAV4" 1 22.75 0.2
24 REPL RT TRIM COVER LOWER BEIGE 1 94 .46 0.3 1.0
25 REPL LT TRIM COVER LOWER DARK GRAY 1 157.30 0.3 1.0
26 S01 R&I LT TRIM COVER UPPER SILVER 0.3
27 S01 REPL RT TRIM COVER UPPER SILVER 1 73 .39 0.3 0.7
28 S01 REPL RT TRIM COVER LOWER SILVER 1 94 .46 0.3 1.0
29* S01 REPL LT TRIM COVER RETAINER BLUE *10 7.40
30# SO1 REPL LT TRIM COVER RETAINER ORANGE 8
31# SO1 REPL RT TRIM COVER RETAINER YELLOW 4
32 SPARE TIRE CARRIER
33* SO1 REPL SPARE SPARE COVER FACTORY 1 394.06 0.1 INCL.*
SILVER
34 FRONT BUMPER & GRILLE
35 O/H FRONT BUMPER 2.1
36** REPL RECOND BUMPER COVER W/O FLARE 1 187.00 INCL. 2.8
37* SO1 ADD FOR CLEAR COAT 0.1*
38** REPL A/M GRILLE UPPER 1 2.00 INCL.
39** REPL A/M GRILLE LOWER 1 2.00 INCL.
40 REPL LT BUMPER COVER HOLE COVER 1 10.26 INCL.
41 REPL LT SIDE BRACKET 1 13 .40 INCL.
42** REPL A/M FLEX AGENT. (CODE A/M) 1 5.00
43# REPL HAZARDOUS WASTE REMOVAL (CODE 1 4.00 X
E.P.C. )
44 SO1 REPL REINFORCEMENT 1 163.82 INCL.
45 SO1 REPL ENERGY ABSORBER 1 6.92 INCL.
46 SO1 REAR BODY & FLOOR
2
07/29/2008 AT 10:00 AM JOB NUMBER: 8482
13030
SUPPLEMENT OF RECORD 2 WITH SUMMARY
2006 TOYO RAV4 4X2 4-2.4L-FI 4D UTV SILVER MET INT:GREY
-------------------------------------------------------------------------------
NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT
-------------------------------------------------------------------------------
47 SOl REPL INNER PANEL 1 305.11 5.5 0.7
48 SO1 REPL OUTER PANEL 1 154.90 INCL. 1.3
49 S01 OVERLAP MAJOR NON-ADJ. PANEL -0.2
50* SOl ADD FOR CLEAR COAT INCL.*
51# SOl D&R BATTARY 1 0.2
52# SO1 RE-SET ELECTRONIC MEMORYS 1 0.3
53# S01 R&I REAR WIRING FOR WELDING 0.5
ACCESS "NOT INCLUDED IN LABOR
It
54 SO1 EXHAUST SYSTEM
55* S01 R&I TAILPIPE M 0.4*
56# SO1 RPR FRAME FLOOR SETUP 1.0
57# SOl PULL REAR BODY AND FLOOR 1 1.0
BEFORE REPLACEMENT
58**SO1 REPL A/M RESTORE CORRISION 1 15.00
PROTECTION (CODE A/M)
59**SO1 REPL A/M WELD THROUGH PRIMER 1
(CODE AM)
60 SOl RADIATOR SUPPORT
61 SO1 REPL LT DEFLECTOR 1 40.10 0.2
-------------------------------------------------------------------------------
SUBTOTALS =_> 2551.49 21.1 17.0
PARTS 2547.49
BODY LABOR 21.1 HRS @$ 68.00/HR 1434.80
PAINT LABOR 17.0 HRS @$ 68 .00/HR 1156.00
PAINT SUPPLIES 350.00
SUBLET/MISC. 4.00
-- --------- -----------
SUBTOTAL $ 5492 .29
SALES TAX ----------- $ 2897.49 @ 8.2500%, 23'9'0'4
------------ --------
GRAND TOTAL $ 5731.33
ADJUSTMENTS:
DEDUCTIBLE 500.00
----------------------------------------------------
CUSTOMER PAY $ 500.00
INSURANCE PAY $ 5231.33
*****VISA / MASTERCARD / ATM - ACCEPTED FOR DEDUCTIBLE*****
DUE TO MANY UNFORSEEN CIRCUMSTANCES IN THE REPAIRING OF AUTOMOBILES, WE REGRET
THAT WE CAN ONLY ESTIMATE, NOT PROMISE A COMPLETION DATE AND TIME.
3
07/29/2008 AT 10:00 AM JOB NUMBER: 8482
13030
SUPPLEMENT OF RECORD 2 WITH SUMMARY
2006 TOYO RAV4 4X2 4-2 .4L-FI 4D UTV SILVER MET 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 ?????????????
4
07/29/2008 AT 10:00 AM JOB NUMBER: 8482
13030
SUPPLEMENT OF RECORD 2 WITH SUMMARY
2006 TOYO RAV4 4X2 4-2 .4L-FI 4D UTV SILVER MET INT:GREY
ON $EHALF OF VEHICLE OWNER AND AS SPECIFIED ON THE ATTACHED APPRAISAL. THIS IS
NOT TRANSFERABLE OR ASSIGNABLE TO ANY SUSEQUENT OWNER OF THE REPAIRED
VEHICLE. TO REPORT A BLUE RIBBON REPAIR SERVICE PROGRAM CLAIM FOR A
REPAIRED
VEHICLE, PLEASE CALL 1-800-282-9445.
FOR YOUR PROTECTION CALIFORNIA LAW REQUIRES THE FOLLOWING TO APPEAR ON THIS
FORM:
ANY PERSON WHO KNOWINGLY PRESENTS FALSE OR FRAUDULENT CLAIM FOR THE PAYMENT OF
A LOSS IS GUILTY OF A CRIME AND MAY BE SUBJECT TO FINES AND CONFINEMENT IN
STATE PRISON.
THE FOLLOWING IS A LIST OF ABBREVIATIONS OR SYMBOLS THAT MAY BE USED TO
DESCRIBE WORK TO BE DONE OR PARTS TO BE REPAIRED OR REPLACED: MOTOR
ABBREVIATIONS/SYMBOLS: D=DISCONTINUED PART A=APPROXIMATE PRICE LABOR TYPES:
B=BODY LABOR D=DIAGNOSTIC E=ELECTRICAL F=FRAME G=GLASS M=MECHANICAL P=PAINT
LABOR S=STRUCTURAL T=TAXED MISCELLANEOUS X=NON TAXED MISCELLANEOUS PATHWAYS:
ADJ�ADJACENT ALGN=ALIGN A/M=AFTERMARKET BLND=BLEND CAPA=CERTIFIED AUTOMOTIVE
PARTS ASSOCIATION D&R=DISCONNECT AND RECONNECT EST=ESTIMATE EXT. PRICE=UNIT
PRICE MULTIPLIED BY THE QUANTITY INCL=INCLUDED MISC=MISCELLANEOUS
NAGS=NATIONAL AUTO GLASS SPECIFICATIONS NON-ADJ=NON ADJACENT 0/H=OVERHAUL
OP=OPERATION NO=LINE NUMBER QTY=QUANTITY QUAL RECY=QUALITY RECYCLED PART QUAL
REPL=QUALITY REPLACEMENT PART COMP REPL PARTS=COMPETITIVE REPLACEMENT PARTS
RECOND=RECONDITION REFN=REFINISH REPL=REPLACE R&I=REMOVE AND INSTALL
R&R�REMOVE AND REPLACE RPR=REPAIR RT=RIGHT SECT=SECTION SUBL=SUBLET LT=LEFT
W/O�WITHOUT W/ =WITH/ SYMBOLS: #=MANUAL LINE ENTRY *=OTHER [IE. .MOTORS
DATABASE INFORMATION WAS CHANGED] **=DATABASE LINE WITH AFTERMARKET N=NOTES
ATTACHED TO LINE. MQVP=MANUFACTURER'S QUALIFICATION AND VALIDATION PROGRAM.
OPT OEM=ORIGINAL EQUIPMENT MANUFACTURER PARTS EITHER OPTIONALLY SOURCED OR
OTH$RWISE PROVIDED WITH SOME UNIQUE PRICING OR DISCOUNT. NWCPP=NATIONWIDE
CRASH PARTS PROGRAM.
ESTIMATE CALCULATED USING A PRESET USER THRESHOLD AMOUNT FOR THE PAINT AND
MATERIAL COST.
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
VEHICLE.
5
07/29/2008 AT 10:00 AM JOB NUMBER: 8482
13030
SUPPLEMENT OF RECORD 2 WITH SUMMARY
2006 TOYO RAV4 4X2 4-2.4L-FI 4D UTV SILVER MET 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 ARM8450, CCC DATA DATE 07/01/2008, AND THE
PARTS SELECTED ARE OEM-PARTS MANUFACTURED BY THE VEHICLES ORIGINAL EQUIPMENT
MANUFACTURER. OEM PARTS ARE AVAILABLE AT OE/VEHICLE DEALERSHIPS. OPT OEM
(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 M 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.
6
07/29/2008 AT 10:00 AM JOB NUMBER: 8482
13030
SUPPLEMENT OF RECORD 2 WITH SUMMARY
2006 TOYO RAV4 4X2 4-2.4L-FI 4D UTV SILVER MET INT:GREY
-- ---- ---- -------------------------------------
NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT
--------
------- ADDED ITEMS -------
1# S02 FINAL AUTHORIZATION SECURED/ 1
DTP UPLOADED
2# S02 COPY OF FINAL INVOICE GIVEN 1
TO OWNER
3# S02 ***********************:r****** 1
-------------------------------------------------------------------------------
SUBTOTALS =_> 0.00 0.0 0.0
PARTS 0.00
----------------------------------------------------
SUBTOTAL $ 0.00
ESTIMATE 4070.20 BRIAN MAHLER
SUPPLEMENT SO1 1661.13 BRIAN MAHLER
SUPPLEMENT S02 0.00 BRIAN MAHLER
CUSTOMER PAY $ 500.00
JOB TOTAL $ 5731.33 INSURANCE PAY $ 5231.33
*****VISA / MASTERCARD / ATM - ACCEPTED FOR DEDUCTIBLE*****
DUE TO MANY UNFORSEEN CIRCUMSTANCES IN THE REPAIRING OF AUTOMOBILES, WE REGRET
THAT WE CAN ONLY ESTIMATE, NOT PROMISE A COMPLETION DATE AND TIME.
***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
7
07/29/2008 AT 10:00 AM JOB NUMBER: 8482
13030
SUPPLEMENT OF RECORD 2 WITH SUMMARY
2006 TOYO RAV4 4X2 4-2.4L-FI 4D UTV SILVER MET INT:GREY
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
ERRS 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 ?????????????
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.
8
07/29/2008 AT 10:00 AM JOB NUMBER: 8482
13030
SUPPLEMENT OF RECORD 2 WITH SUMMARY
2006 TOYO RAV4 4X2 4-2.4L-FI 4D UTV SILVER MET INT:GREY
FOR YOUR PROTECTION CALIFORNIA LAW REQUIRES THE FOLLOWING TO APPEAR ON THIS
FORM:
ANY PERSON WHO KNOWINGLY PRESENTS FALSE OR FRAUDULENT CLAIM FOR THE PAYMENT OF
A LOSS IS GUILTY OF A CRIME AND MAY BE SUBJECT TO FINES AND CONFINEMENT IN
STATE PRISON.
THE FOLLOWING IS A LIST OF ABBREVIATIONS OR SYMBOLS THAT MAY BE USED TO
DESCRIBE WORK TO BE DONE OR PARTS TO BE REPAIRED OR REPLACED: MOTOR
ABBREVIATIONS/SYMBOLS: D=DISCONTINUED PART A=APPROXIMATE PRICE LABOR TYPES:
B=BODY LABOR D=DIAGNOSTIC E=ELECTRICAL F=FRAME G=GLASS M=MECHANICAL P=PAINT
LABOR S=STRUCTURAL T=TAXED MISCELLANEOUS X=NON TAXED MISCELLANEOUS PATHWAYS:
ADJ=ADJACENT ALGN=ALIGN A/M=AFTERMARKET BLND=BLEND CAPA=CERTIFIED AUTOMOTIVE
PARTS ASSOCIATION D&R=DISCONNECT AND RECONNECT EST=ESTIMATE EXT. PRICE=UNIT
PRICE MULTIPLIED BY THE QUANTITY INCL=INCLUDED MISC=MISCELLANEOUS
NAGS=NATIONAL AUTO GLASS SPECIFICATIONS 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=RECONDITION REFN=REFINISH REPL=REPLACE R&I=REMOVE AND INSTALL
R&R=REMOVE AND REPLACE RPR=REPAIR RT=RIGHT SECT=SECTION SUBL=SUBLET LT=LEFT
W/O=WITHOUT W/_=WITH/_ SYMBOLS: #=MANUAL LINE ENTRY *=OTHER [IE. .MOTORS
DATABASE INFORMATION WAS CHANGED] **=DATABASE LINE WITH AFTERMARKET N=NOTES
ATTACHED TO LINE. MQVP=MANUFACTURER'S QUALIFICATION AND VALIDATION PROGRAM.
OPT OEM=ORIGINAL EQUIPMENT MANUFACTURER PARTS EITHER OPTIONALLY SOURCED OR
OTHERWISE PROVIDED WITH SOME UNIQUE PRICING OR DISCOUNT. NWCPP=NATIONWIDE
CRASH PARTS PROGRAM.
ESTIMATE CALCULATED USING A PRESET USER THRESHOLD AMOUNT FOR THE PAINT AND
MATERIAL COST.
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
VEHICLE.
9
07/29/2008 AT 10:00 AM JOB NUMBER: 8482
13030
SUPPLEMENT OF RECORD 2 WITH SUMMARY
2006 TOYO RAV4 4X2 4-2.4L-FI 4D UTV SILVER MET 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 ARM8450, CCC DATA DATE 07/01/2008, AND THE
PARTS SELECTED ARE OEM-PARTS MANUFACTURED BY THE VEHICLES ORIGINAL EQUIPMENT
MANUFACTURER. OEM PARTS ARE AVAILABLE AT OE/VEHICLE DEALERSHIPS. OPT OEM
(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 RELY
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 M 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.
10
07/29/2008 AT 10:00 AM JOB NUMBER: 8482
13030
SUPPLEMENT OF RECORD 2 WITH SUMMARY
2006 TOYO RAV4 4X2 4-2.4L-FI 4D UTV SILVER MET INT:GREY
ALTERNATE PARTS SUPPLIERS
13 RECOND BUMPER COVER W/O FLA PART NO. TO1100241R PRICE 192.00
KEYSTONE - COMPLETE (800)263-9727
1627 ARMY COURT (209) 948-1101
STOCKTON, CA 95206
36 RECOND BUMPER COVER W/O FLA PART NO. TO1000319R PRICE 187.00
KEYSTONE - NWPP (800)263-9727
1627 ARMY COURT (209) 948-1101
STOCKTON, CA 95206
38 A/M GRILLE UPPER PART NO. XTY18790 PRICE 2.00
39 A/M GRILLE LOWER PART NO. XTY18782 PRICE 2 .00
CARRO PACIFIC, INC. (800) 660-9918
545 JEFFERSON BLVD. #4
WEST SACRAMENTO, CA 95605
11
07/29/2008 AT 10:00 AM JOB NUMBER: 8482
13030
SUPPLEMENT OF RECORD 2 WITH SUMMARY
2006 TOYO RAV4 4X2 4-2.4L-FI 4D UTV SILVER MET INT:GREY
ALTERNATE PARTS USAGE
AFTERMARKET PARTS
AFTERMARKET SELECTION METHOD: AUTOMATICALLY LIST
NO. OF TIMES USER WAS NOTIFIED THAT AN AFTERMARKET PART WAS AVAILABLE: 6
NO. OF AFTERMARKET PARTS THAT APPEAR IN THE FINAL ESTIMATE: 5
OPTIONAL OEM PARTS
OPTIONAL OEM SELECTION METHOD: AUTOMATICALLY LIST
140. OF TIMES USER WAS NOTIFIED THAT AN OPTIONAL OEM PART WAS AVAILABLE: 0
NO. OF OPTIONAL OEM PARTS THAT APPEAR IN THE FINAL ESTIMATE: 0
RECONDITIONED PARTS
RECONDITIONED SELECTION METHOD: AUTOMATICALLY LIST
NO. OF TIMES USER WAS NOTIFIED THAT A RECONDITIONED PART WAS AVAILABLE: 4
NO. OF RECONDITIONED PARTS THAT APPEAR IN THE FINAL ESTIMATE: 2
RECYCLED PARTS
NO. OF TIMES USER WAS NOTIFIED THAT A RECYCLED PART WAS AVAILABLE: 4
NO. OF RECYCLED PARTS THAT APPEAR IN THE FINAL ESTIMATE: 0
12
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