Declaration CCP 585

Cal. Super. - 6th Dist.September 11, 2019

Electronically Filed by Superior Court of CA, County of Santa Clara, on 4/20/2020 10:18 AM Reviewed By: M Vu Case #19CV354782 Envelope: 4264450 19CV354782 M Vu 10 11 12 13 14' 15 16 17 18 19 20 21 22 23 24. 25 2‘6. 27 28 LAW OFFICES OF JAY W. SMITH - Jay'W. Smith, Es ., Sbn 1501 13 Nancy A. Young, sq., Sbn 183328 6644 Valjean Avenue, Suite 200 Van Nuys, Califomia 91406 T E818) 709-2556 F 81 8) 709~2513 Attorney for Plaintifi‘ SUPERIOR COURT OF THE STATE 0F CALIFORNIA FORTHE COUNTY OF SANTA CLARA LIMITED JURISDICTION ' VICTORIA FIRE & CASUALTY ) Case No; COMPANY, an Ohio corporation ) r Plaintifi‘, ) DECLARATIONm SUPPORT 0F ) DEFAULT JUDGMENT, PURSUANT TO vs. ) (2.0.9. 585(d) ) FRANKLYN OJBDA PAREDES aka ) FRANKLIN OJEDA PAREDES; ). DOES 1through 10, inclusive, ) ) Defendant. ) ) ) ) I ' ' I I, 1’! 0: th' ECLARE: 1. That the following, unless otherwise indicated, is within my own personal knowledge and if called upon as a witness, I could and would competently and truthfully testify thereto. 2. I am an employee of plaintiff, Victoria Fire 8c Casualty Company, an Ohio corporation (hereinafier referred to as ‘-‘P1aintifi”)_ and as part ofmy job responsibilities Ihavc been assigned Plaintifl’s file which is related to the acfion herein for the purpose ofpursuant to Plajfitifi’s subrogation claim against defendant, Franklyn Ojeda Parades aka Franklin Ojed'a Parades (he’tcinafier referred to as “F. Parades”). DECIARATION RE 585(d) 10 11 12 13 14 15 16 1‘7: 18 19 20 21' 22 23 24 25 26 27‘ 28 3. As part ofmy job responsibilities, I am a custodian of records of Plaintiff’s file inthis matter. Said records were prepared and obtained in the ordinary course of business of Plaintiff. ' 4. The documents and records Contained in Plaintiff s file were prepared and obtained in .the ordin’axy course ofbusiness by persons employed by Plaintifi‘ for the purpose ofpreparing said docmnenfs. They were prepared and/or obtained at or about the time the occunencm recited therein actually took place. Documents prepared by Plaintifi’s employees were prepared by 1 persons who were timely informed of said occurrences by other employees ofPlaintiffwho had personal knowledge of said instances. '5. Plainfiff’svfile indicatw, that on September 18, 2016 (hereinafier referred to as “D.O.L.”) Ivan Leos. aka Ivan Leos Franco (hereinafier referred to as “Insured?’) wasthe owner of a motor vehicle described as a 2013 Ford Fusion, bearing California license plate number "7MRY061 , (hereinafier referred to as, “Vehicle 1”). Vehicle 1 was coveted by the - aforementioned policy of insurance. 6. Plaintiff’s file fiirther indiCated that defendant, F. Parades was the owner and operator of a motor vehicle described as a 1986 Ford Mustang, bearing California license plate-number 7RLN229, (hereinafier referred to as “Vehiclé 2”). 7. On said D.O.L., F. Paredeswas operating Vehicle 2 northbound on Bal Harbor Way i just north. of Cortez Way in the city of: San Jose, California. Vehicie 1 was parked on Bal Harbor Way facing a southerly direction, unoccupied. F. Parades veered {o the left and the fiont of Vehicle 2 collided with the fiont driver’s side of Vehicle 1. 8-. As aresult of this collision, Vehicle 1 sUstained damage to its front driver’s side and was deemed a total loss. Vehicle 1’s valuation breakdown was in the sum of $1 1,737.04 less salvage proceeds 'm the sum of $821.50 plus $720.00 incidental damages for vehicle rental expenses, plus $ 1 8-5 .94 for car seat replacEment. Plaintifihas paid the sum of$l 1,821 ‘48, in property damages, loss of'uselrental, and car seat replacement. True and correct copies ofthe , estimate of repair, valuation report, valuationbreakdown, salvage invoice, photographs, rental invoice, car Seat invoice ‘as well as the check listing are attached hereto and marked as Exhibit (‘19! o DECLARATION RE 585 (d) m > 111 12 1.3 14 15 15 " 1'7 18 19. ‘ 2‘0 9. Based upon the foregoing, Plaintifi‘ seeks Judgment in the principal sum of . $1 17,821.48, together with interest thereon at the legal ratefiom date ofpayment I declare under penalty ofpetjury, under the laws of the State'of California, that the I'foregoi’ng is true and correct. DECLARANT 21' _ 22 23 24 25._ 2'6‘ 2‘7 28 DECLARATION RE 585 (d) EXHIBIT! ""1 ...- ...-, ...-. wma-v-x. i, 09/28/2016 WED 12:30 FAX [002/006 SUGE OF CALIFORNIA DEPARTMENT OF CALIFORNSA HISHWAY PATROL TRAFFIC COLLISION REPORT CHP555 Page1(Rev.4-11)0P|oso :. page c 0:6 SPEC IAL CONDITIONS ""MBER "‘7 4- RU" CITY JUDICIAL DISTMOT LOCAL REPORT NUMBE R mule?) rams: 6m i Sb SOPmud" ’6 v.2bl - OWb N0N E ngtw mlsgslaug‘mfl coum'v REPORTING DISTRICT scm' mw or ween ETcw away fl 5M“W CHmas C43 QM T w T F sL'vz-ts [flue cows Noccuaraenou gm om Yam Immaw; nc a omcmm, AL. Hmn. ws/ i‘i l 18m, N33 "£1343 £4333 MILEPos-rmmammon 595 cooaummss ' Bribfijéhkpxs av: [:ENONE ?EETMLES OF unmoa LonslTuoE t N {m} AT mrqseconon wm-x suns va nL-‘L o pt - DANQ . {‘Xou @mues N o: (@m’fég V EYES EXP“) i DRWE R'S UCENSE NUM86R STATE CMSS NR 6A5 SAfifiTY EQUIP. VEH. YEAR MAKEIMODEUCOLOR LICENSE NUMBER SYATE PA?"F157W3 (A C (n A) $0 fat?» msW‘» wk’fbiuuzzsa 0RIVER NAME [FIRS 7, MIDDLE MS T] fl ?%NKLYN 65w Q' PW£3 OWNER‘SNW9 [:AMC As DRIVER r LOCATION v S‘WEEY ADORESS “WEYMMww£f mfua:MQ‘MWWI&Eommmfimxgmasasz i wmsomvm " AR} o onwsmwzm l 315 W”\L-Mae! £4 ’95g3: __h -- 1""""" nor: 0F veutm t-t 0N omians or WFFICER l iDmVCR L ]°THER6954. (Av ~37zz W we HtvEs HEIGHT Wenom m slngmme RaceI a "' . ...... ~¢~-«--u...-n. ghw (9W Q6? i ‘30 g l é PR'OR MEWWCN- 05’5“»? E I I None APPARENT LE REFER To NARRATIVE omen s PHONE ”NW éusmess PHONE ‘V vemne Ioemncmmw Nummz: ‘ FAfiMgmfispszge 63 [a ”?gfi )7 l ’Z_ *0! q (1 N [fl‘ vamcLEma sesame venue mwmca " " ' SHADE IN DAMAGEo AREA EUNK, [JNONE EJMINOR ‘4',____:.‘.,__mINSURANCE CARRIER PouLv NUMBER ML PP) l r . _ .N ON g 0.. F}; , on, £9”me [ 1Rou.:..ov5r2 l" om or 0N smear onussnwm SPEED m maven, L IL Y % CA . 00" . i' \KH a0““ M I: d ‘EE W CAL-t _. ~ Icwr-sc Mcmx __ i “"5 """‘ "“ PAR“, amven-s uctsnsc numam sum cuss m am sway EQUIP. van, vem MAxemouaucown fgucemsns «UMBER 5mm .1.; * . 2 «--- r- w -~ --- 13 Fem) ragga wag; lima‘foef c4 ;. omveR umemns'r aroma usn g [:3 DMKw Véuw OWNER‘S W65 SAME As DRIVER - paces. smesTAouE """"" 'IUW LESTRIAN [.3 afifiéfiémn-rsg--m __:ISJMEAS.DRNER yen: a c'w'mwz’" _____715 6753901 QT[$301 figé.ra 9 §7/6 fl DlSPOSITION OF VEHICLE. 0N OROE RS 0F ‘OFFICER i [MI'1DRWER {XQTHER al'év. sex HAIR eves gnELm-x 'wszem ammo“: RACE GUST 3 Mo Day Yuan , ... ‘- vRIOR mecmwcm one cars. g NONE APPARENT 'BT'EER Home 9mm: / ausifiess PHONE ' vtnmc Ioewnmmm Nuwsnz 3ffiEEO”jgm ?_é27’,6 1’“; \ m vé "Tcic T?§E""' :wozs-cmn: v?fiEéLc 0AMAGE ' ”w Hw shave m DAMAch AREA ' msunmca cmmen poucmumeea n ?UNK NONE . vrIKAU h. [0‘107637 a 15%“ MOD KMAJOR; $33; ' on smear 0:: HiGHwJAv " ' spam) um:T CA Do, 1L a gen ..... g~- t fl NY 25 mu rcwpsc MCJMX PARTY Dawn's ucENss NUMBER sure cuss AIR BAG Mien 50m van, YEAR IAAxars:ooELIco:on uceuse NUMBER 3mm IN.) 3 ‘ CD DRIVER NAM; (pins i 'réibmisfmsn " ' .,. V _ I [W] “wms”N“ {gull SAME As DRIVER , PEDEs- STRE'é‘FAfisiiéés'" I - ....- h TR‘AN -“ _. ...v um [I OWNER'S Anoness ' - v. ‘ :PARKED cnwsyA-[QZ'IP "" mm-” ~533ch sax Hm: "" ' ‘LYEs iHEIGuT H ?'wam' ainfiionm " iRAcs I i/ i Mr; 11w Yum EI i ._...._......I l m i SAME As DRIVER DISPOSIYION OF VEHICLE ON ORDERS Of". ' NONE APPARI 1 Ft:JREFER to NARRATIVE f Homs mom: ausméss wows Z " sums IN ommceo AREA m 'ifi's'fi'r'aKfiEEK'n'Riiéfimu Poucv Nuifiéék ' ' - ' J . NONE iw"MINOR '_wmnw,mm__k g - ._ 2' \ g jwuort {j ROLL-OVER > x I DIR o; 0N STREET oa mnnmv ' réhEEEUWWNMRu CA ‘ L I I ' ’ j TQAV .. . mm. H-q-q-nu-u-m- ._.......~ h n" m_wn- _ fl E 4 L-‘r rcmpsc __ MCIMx _ "”7" "" ' memnen s NAME ‘ 013M104 NOTIFIED REVIEWER'S NAME OA‘IE fiEVIEWED ‘ . " ‘ r”? _0¥C SoHf»;1W3“! :st LJ~° m mfl/ww m- ¢/%//£m ‘ An Inrarnalionarly Accredited Agency ' hpsssum 1 Lpdl' ,. 5A an u A... .... 09/28/2016 WED 12:31 FAX [003/006 STATE OF CALIFORMA DEPARTMENT OF CAK IFORNIA HIGHWAY PATROL TRAFFIC COLLISION CODING CHP 565 Page 2 (Rev 4-1 1; OPI 960 --' ........ fags. 3'5 EEATE 0P comswn (M0 om vein) n15:12300) "W ‘ nan?" ' ' ' ‘ ' v ?ohiié'éfilfilw ' W W" " iwu man . llel/b 1363 é 73/3 937/ ,_ é 292.. 7Q? $5.... luv'éuens aims ' M " i'm-mcti s 'AD'oR'Ess monmao PROPERTY ; .. gnu. DAMAG E :'Lisscaapnon dr DAMAGE i SEATiNG POSlTlON i WW “m méAFéTY édUIFMENT I AER BAG NATYENTio ODES é quQufigfim Qfllggggmux B - UNKNOWN A - CELLPHONE HANDHELD E m v NONE m VEHICLE a - IN vaHacLE uses i L - MR BAG DEPLOYED e . CELLPHONE HANDSFREE g :3 . UNKNOWN R - 1N VEHKCLE NOT USED ; M - AIR BAG NOT oemoveo c - ELecmomc EQUIPMENT ‘2. 5c - LAP BELT USED s - EN VEHICLE use UNKNOWN ! N - OTHER o - RAmOI co 2 1 DRNER ED ~ LAP BELT NOT usso T . m VEHICLE mpnopm USE P » N01 REQUIRED E . SMOKENG ' E - SHOULDER HARNESS useo u . NONE w VEHICLE "““"-'-"""""""""""""""""""""""" F - EATING 2 To 6 - PASSENGERS p snoumea HARNESS nor uses - EJECTED FROM VEWCLE s .cmmam 7- STATIONWAGON REAR sG . Iflnwsmm DER HARM:ss user: M1camrcw tifiLMfiI f 0 ~ NOT EJECTED H - ANNALS 8- REAR OCC. TRK 0R VAN H LAPISHOULDER HARNFSS NOT USED QRNER pAssENGf-ZR : 1 - FULLY EJECTEO | t PERSONAL HYGIENE 9 POS'VON UNKNOWN gJ PASSIVE RESTRAINT user: v - No x . No g 2 ~ PARTIALLY EJECTED J- READING 0 OTHER 3K. PASSNE RESTRAmT N07 USED w was Y - Yes : 3 ' UNKNOWN K - OTHER jP_NOT REoumep ITEMS MARKED BELOW FOLLOWED BY AN ASTERISK (") SHOULD BE EXPLAINED IN TflE NARRATWE ‘ _ !sT‘mflggjfi‘gflgfiffgfifiuu n ‘ TRAFFIC CONTROL DEVICES 1 2 3 SPECIALmFORMATIOK m 1 ; 2 3 MOVE’$E°”LTUPS?§&E°'NG WS'WO'NW‘ED A CONTROLS FUNCTIONmG H A HAZARDOUS MATERIAL / A S?0PPEO i 23 jgiégl)“____ u _ B CONTROLS NOT FuncnomNG‘ B os_u."pnorgsfimoygwm use/ >( B PROCEEDWG STEMGHT " a OTHER IMPROPER DRIVING: ‘ " c CONTROLS OBSCURED h _‘ > U C céu. pHONE HANDSFREEINfiE c my_gfiffimo ’ p ~ x D No comafiqg {ngISENr/FACTOR5 ' ~ ’ D cm PHONE Noun use/ mm W D MAKING mam TURN H gonignjygggggygfij TYPE op cowspw __ E SCHOOL Bus Renae 5 MAKING LEFT TURN « ‘ F MAnge umRN _ __ g go ., w W, G BACKING , ,. I -. ‘ H SLowms/mopémc H '_ i l‘ PASJSINGp ' U‘Efikfiéfig . K PARKING MANEU R L ' L emcmNc 1m ‘ D yNKNOWNj F 75 m_mo'rpn‘inup N G P? FT ‘ “REE"..C WEATHERCM.?K..?T°“’5’“; D 959““ng 4. . . . . . i.X A CLEAR ___w_ _ EHIToeJECT B CLoubY _ F ovERTuRNED ‘ c RNNING ....__..... _ G. yam 1550.5 _. ‘ _ . ‘ ..... __wmmM_ WM. ED suowme H OTHER- _ M oiuén UNSAFE Tuamne _ ___ iE..i92.’.‘€'§'£"-ffi ..:._.-._......,.,FI:. ...... 4 4 . - ‘ ‘ ‘ /'N . N ’S‘NG'NTOQEEQJ'SQWVE 7F OTHER': ~ _ ’QOTORVEHrCLEmg‘w‘Ep wan; ,/ 0 U ’ I H _ K o PARKE?" H ~ __ ‘; _____E‘§__‘\£v_n_~_m_ __ mm“ A NON-COLUSION ' ‘ H . __ P MERGING ‘ _Lzeufmc __ _ H B PEDESTRQN ’ Q TRAVELHINLWRONG WAY _ __ i )5 A DAYiiGH‘r hmfiOTHER' .._ ., ‘ ‘ i 8 pusx- DAWN ( {MARK 1 T0 ?ITEMS) A vcsr-Lzuouvmumn I 238% B 7's scéyiéu'bxoimik- MOTOR VEH|?_L.E___M __ . FUNCTIOMNG‘ ' :H AmMAL: _ ROADWAYSURFACE ______ seamen! DRUG g 3 PHYSIcAL g (MARK 1 TOQITEMS) i , U A HAD NOT BEEN DRINang , , B_ _HBD- UNDERTHEINi-tuencé ‘ C nab NOYUNDERINPLUENCE- "'1" "F1Scébm6é'fii'6'f?" : W ICVSNQWY ICY J OTHER BBJEéTfiv-l D SUPPERHMUDQV (Sin. éTf) ROADWAY CONDITIONS G STOP&GO TRAWIC H M 1::‘Q_3§p_an1PAERME_NIiJ_§5Nowa_ "MR" ‘ 702”“???W H ENTER'NG’LEAVW/W" V V , ....... .5 UNREBR'EQEFFS’.WE’VE .7 . A HOLES QEEPRUT‘ “a PREVIOUS cowélgkww _ I m __ a B L995 5:91 Rm; owRomvway- ga caossmgmcmsswmx. G mmmmgm no~rxuow~ 2_ m m ATINTERSECTION ‘ H NOT AppuL‘ABLE E c cmssmem CRoaswnLK NOT ‘ AT :NTERsecnow i .. .A V. .D CROSSING- NOT'NCROSSWALK i ‘ omsa'. _ E 2N ROADMINCLUDES SHOULMR 4/ M omhR I W '1 i.“ H NouNUSUALconomows F Norm ROAD I I H / N" NONE AWARE.” " h - i i G APPROACHINGILEAVM SCHOOL Bus /, ' o RUNAWAY VEHICLE E FSKETCH MISCELLANEOUS i 1' ; A9}... moncuenoam 1i [10,11 N 5F NW vF CGE'Iég Lu? 6H L av ma, o:w Wat W 15m. Mm Long I/f "2:7,;(em23535;'a'ez'rzaézi'xgéh'c;"""" cnoSfiifim-W 09/28/2016 WED 12:31 FAX STATE OF CALIFORMA INJURED I WITNESS i PASSSENGERS CHP 555 Paqe 3 (Rev. 11-06)O DATE 0F COLLlsION om YEAR} TIME 124003» . I b NCIG fl WITNESS PASSENGER omv 05L? ‘GE 55" FAYAL E1“ l3 Cl {X 3.0.1833" 3EVERE OTHER VISIBL E JD.O. 8. {ADDRESS (Anon 3 ’ onm mmspomfio8Y1ms 1,0 lama Mama” ’fo ufm [2.165471NJURIES l D. O4 B. IADDRESS 0N LY) VRANSFORTED 8V: INJURIES ID. O. E, IAODRESS ONLY) mANSPORYED BY: msunlas I D. O. B. J ADDRESS ONLY) TRMSPORYED BY: INJURIES I D, O. B. IADDRESS ONLY) ?RANSPOIUED 8Y2 INJURIES I D‘ O. 6. I ADDRESS UNIX) TRANSPOR'I'EO BY: DiSCRSBE INJURIfiS l D. NUMBER ‘13“ PREPARE R‘S NAME 0C- q 3 13 Ex'rsm 0F INJURY ("x" ONE; CO MFLAINT OF PAIN TAKEN 70: TAKEN ?0: TAKEN T0: TAKEN TO: YAKEN TO: YAKEN T0: 'Mo. om YEAR .004/006 Page 3 MS _"““7’;’1 2e 2 - o ??Q PAR“ SEAT AIR P05. BAG EQUIP. OFFICER to. H39, §NJURED WAS ONE) DRIVER PASS. FED. BICYCLIST OTHERDUDE I 2. .- EJECTED VICTIM 0F VIOLENY CRIME NOTIFIED TELEDHONE worm oi= v50}.EMT CRIME women YELEPHONE VICTIM Oi? VIOLENI CRIME NOTIFIEO TELEPHONE WGTIM OF VIOLENT CRRME NUnFiEO TEtEPHDNE l i VICTIM OF VIOLENT CRIME NOTIFIED YSLEPHONE VtCTiM OF VIOLENT CRM‘JE NOTIFIED REVEEWER'S NAME MO. DAY YEAR fifi/K c555_l>06.lm my 7-.-<:~«.-.- :-:. V ,mu . a-‘:::-.~:.‘....a'.;z-c.'.-..;. ..; .deamxa- my. siren»: nu: -‘ .‘. www.wan- “4:327..- __ . ‘.._,.'.......,.A.V-..§‘.»,;.=..-,...A_-.-_.'....~..~.-_M.M....~r-‘;. a. ;' "V3523... 09/28/2016 WED 12:32 FAX [005/006 STATE OF CALIFORNIA NARRATIVE/SUPPLEM ENTAL PAGE ‘I or!) DAT: or mcmm - TIME (2400) NCIc omcm Io av: CAsz Human 09/18/16 1853 4313 4341 16-262--0776 Notification: On 09-18~16 at approximately 1853 hours, I was dispatched to the area ofBai Harbor Wy and Cortez Wy on a call of a vehicle accident into a parked car. Upon my arrival I saw that a white colored Ford Mustang (lic# 7MRY061) had sideswiped a parked vehicleflicfi! 7RLN229). All times, speeds; and measurments are approximate. Summagy: V1 was traveling NB on Ba] Harbor Wy at a high rate of speed, when it side swiped V2. V2 was legally parked along the W curbline ofBal Harbor Wy N of Cortex Wy. Traffic Controls: No roadway controls were present in the collision. Weather Conditions: At the time of the accident the weather was clear and dawn. NOTE: For further information on weather, lighting, roadway surface and roadway conditions, see CHPSSS page two. Statements: WI ~W1 stated that he was outside of his residence working on his car when he noticed V1 traveling at a high rate of speed.V1 sped up to approximately 50 plus mph, when it attempted to make a u-tum in the middle of the street and coliidcd with V2 which was parked. V2 was launched approximately 100 ft backwards. W1 stated that D1 was an Hispanic male adult that was approximately 30 years old, and who was approximately 5’7”. He believed Di weighed approximately 150 pounds and was wearing Raiders clothing. W1 saw DI exit V1 and with the assistance of his friends, who arrived on-scene after the crash, attempted to move the vehicie from the roadway. V1 was biocking all of Bal Harbor Wy, but D1 and his friends were able to move Vi to the W curbline of Bal Harbor Wy. D1 attempted to drive V1 but was unabie to operate the vehicle. W1 recognized Di as someone that resided close by in the neighborhood. DI-Dl admitted to driving and being in a crésh. For full detaiis regarding D 1 ’s Statement, refer to Ofc. Cruz’ #4333 DUI report. - Cause: Based on the statement ofW1 and DI , D! was at fault of the collision. 23 152 of the CVC, DUI, was the primary coilision factor with an associated factor of22350 of the CVC, unsafe speed. AOI: 40 ft N of the NCLX 0f Cortez Wy and 6 ft E of the WCL ofBal Harbor Wy. ADDITIONAL INFORMATION: D1 was arrested for suspicion of driving while under the influence of an alocoholic beverage. For more information refer to Ofc. Cruz’ #4333 DUI report. [followed Ofc. Cruz lo AIB to assist with D} ’s breath test. Iobserved DI unable to perform the breath test. D1 was not providing enough breath air into the machine. D1 stated that he had bad iungs and that he could not blow out any more air, nor could he blow any harder. Di was reminded that he needed t0 provided either a PREPARED BY: ID l! DATE REVIEWED 8Y2 DATE INDEXED BY I DATE Sohal 4341 09/19/16 5‘1, flfiwoipy'fxz ?//7 //g macs“ 09/28/2016 WED 12:32 FAX [006/006 STATE OF CALIFORNIA NARRATIVE/SUPPLEMENTAL pAcEZ') orb DAT: or mcsosw 'rms (2400) Nat: omceR :0 v: ' CASE numasn 09/18/16 1853 4313 4341 16‘262-0776 breath or biood sample. D1 stated that he would refuse a blood sample, but would try to perform the breath, despite stating that he was unable to perform the test. I then informed D1 that the PAS device'would be able to coliect a breath sample without him having to biow as much or as hard. D1 provided a PAS sample and I was able to obtain a manna} reading of . I92 Bac%. I used an Alco-Sensor V XL serial #5353 manufactured by Intoximeters, Inc. The time of the sample was 2106 hours and it was 22 degrees ceicius. D1 was unable to perform the Dragger machine breath test and refused to provide a blood sample. A forced blood draw, authorized by a signed warrant, was later obtained. For more information refer toOfc. Cruz’ #4333 DUI report. PREFARED BY: ID J! DATE REVIEWED BY: DATE INDEXEO BY f DATE Sohal 4341 09/19/16 2.7..flMW) 7497/2, 7/” M Claim: 788613-GD ISO Event Date Event Description 09/18/2016 Received Match Report from ISO 09/1 9/2016 Received Match Report from ISO 09/19/2016 Received Match Report from ISO 09/1 9/2016 Received Match Report from ISO 09/19/2016 Received Match Report from ISO 09/23/2016 Received error from ISO 02/1 5/2017 Received error from ISO Exposures # Type Coverage Claimant Adjuster tatu Future Paid ayment 1 Vehicle Collision IVAN Alicia N. Clos $11,570.98 LEOSFRA Macleod 2 Vehicle Rental IVAN Jennifer Clos $720.00 LEOSFRA Coder 3 Vehicle Collision - IVAN Alicia N. Clos - - Deductible LEOSFRA Macleod Waiver Financials: Transactions Type | Date | Amount | Exposure Coverage Cost Type Status User Payment 09/23/2016 $148.00 1 Collision Indemnity Submitted Kevin R Kiedrowski Payment 10/13/2016 $185.94 1 Collision Indemnity Submitted Taylor Gath Payment 10/14/2016 $1 1 ,237.04 1 Collision Indemnity Submitted Sara L Hartsell User: Erika Hernandez Page 26 10/05/201 7 07:07 PM Claim: 788613-GD Type Date | Amount Exposure Coverage Cost Type Status User Payment 11/09/2016 $660.00 2 Rental Indemnity Submitted System User Payment 11/21/2016 $60.00 2 Rental Indemnity Submitted System User Recovery 02/02/2017 $1,400.00 1 Collision Indemnity Submitted KaraA Dissinger Recovery 02/02/2017 ($100.50) 1 Collision Indemnity Submitted KaraA Dissinger Recovery 02/02/2017 ($478.00) 1 Collision Indemnity Submitted KaraA Dissinger Financials: Checks Check Number Pay To Gross Amount Issue Date Scheduled Status Bulk Invoice Payment Method Send Date 7571296 Caliber Collision Center- $148.00 09/23/2016 09/23/2016 Cleared Check San Jose Downtown 7694578 IVAN LEOSFRANCO $185.94 10/13/2016 10/13/2016 Cleared Check 7698918 Credit Acceptance $1 1 ,237.04 10/14/2016 10/1 4/2016 Cleared Check 7869579 ENTERPRISE $660.00 11/09/2016 11/09/2016 Cleared ERACEFTBAL101E Check HOLDINGS INC 7943356 ENTERPRISE $60.00 11/21/2016 11/21/2016 Cleared ERAC EFT BAL Check HOLDINGS INC 102616_691-750- SB Latest Notes User: Erika Hernandez SENT CA TITLE AND CA DOCS TO YARD 1, 778054566324 STOCK 37438906 -Anne Kingery (12/29/2016 01:22 PM) CALLED LH AND SPOKE TO KEISHA, ASKED FOR STATUS OF TITLE WITH RELEASING IT, SHE SAID THAT IT LOOKS LIKE IT WAS NEVER RELEASED, SHE SAID THAT SHE IS RELEASING IT FROM CA DMV TODAY AND GAVE HER ADDRESS. TOLD HER IF | DON'T GET TITLE IN 2 WEEKS | WILL CALL BACK Page 27 10/05/201 7 07:07 PM September 30, 2016 Claim # 788613-GD To: IVAN LEOSFRANCO 1817 Cortez Ave SAN JOSE, CA 95122-1910 Dear: IVAN LEOSFRANCO Victoria Fire & Casualty Company has reviewed all the available information regarding your claim for damages to your 2013 FORD FUSION. We have determined that your vehicle is a total loss. A vehicle is deemed a total loss if it is not economical to repair the vehicle. In these circumstances, it is our responsibility to pay you the cost of a comparable vehicle, less your deductible. The amount shall also include all applicable taxes and required DMV fees. What you can expect We have determined the actual cash value for your vehicle based upon the current market. The breakdown of our settlement payment is as follows: CCC Analysis Value Report #: 82279811 The total loss settlement amount of your claim is: Actual Cash Value: $10,629.00 Sales Tax: $930.04 Prorated License Fees and other annual fees (VLF): $163.00 DMV Transfer Fees: $15.00 Salvage Certificate (if applicable): $20.00 Less Salvage (if applicable): $2,218.28 Less Sales Tax [SALES TAX]% $194.10 Less Deductible (if applicable): $0.00 Other Deductions: $0.00 Net Total Loss Settlement to Vehicle Owner: $9,344.66 I will be retaining the loss vehicle This settlement offer is based upon you retaining the loss vehicle. Please know that if you retain the loss vehicle, notice of the salvage retention must be provided to the Department of Motor Vehicles which may affect the loss vehicle's future resale and/or insured value. Pursuant to Vehicle Code Section 11515(b), you must forward a properly endorsed Certificate of Ownership or other evidence of ownership to the Department of Motor Vehicles, along with the license plates and a $20.00 fee to the Department within ten days from the settlement of the loss. The Department will then issue a Salvage Certificate for the vehicle. You also have the right to seek a refund of the unused license fees from the Department of Motor Vehicles. I will not be retaining the loss vehicle If you decide not to retain the vehicle, the salvage value, applicable related sales tax and salvage certificate will be added to the settlement offer for a total payment of $11,737.04. The enclosed DMV forms and title must be signed and returned to me to allow transfer of ownership and complete your claim. My mailing address is 1100 Locust ST, Des Moines, IA 50391. Please advise as soon as practicable whether you wish to retain the loss vehicle or wish for Victoria Fire & Casualty Company to retain the loss vehicle so that we can complete your claim and issue payment. As a result of our settlement offer, please be advised that the company will discontinue paying for your rental car on: October 10, 2016 Please be advised that if you are unable to locate a comparable vehicle for the amount of the settlement offer within 35 days from the receipt of the cash settlement for your damaged vehicle we will reopen your claim. If you wish to request that the file be reopened, please notify me by fax at 855-211-5047 or by mail at the above address. Please address all faxes and mail to my attention, Alicia Macleod and refer to our claim number 788613-GD. Help when you need it If you have any questions or concerns about this claim, please feel free to contact me at the number listed below. Sincerely, Alicia Macleod Victoria Fire & Casualty Company 515-508-2375 855-211-5047 Enclosures: CCC Valuescope Valuation Breakdown For your protection, California law requires the following to appear on this form. Any person who knowingly presents a 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. Invoice COPART AUTO AUCTIONS 13895 LLAGAS AVE SAN MARTIN, CA 95946 PHONE (468) 683-9393 TAX ID# 942867490 Date 8/05/19 Visit us at www.copart.com All Amounts are in USD FINAL INVOICE Copart L0t# 37438906 6 CA - SAN JOSE Loss Date 9/18/16 Called In 10/12/16 P/U Cleared 16/12/16 Pickup Date 19/12/16 Original Title 12/29/16 Trans Title 1/04/17 Sale Document 1/16/17 Loss Type COLLISION Description 13 FORD FUSION SE Vehicle ID# 3FA6P8H75DR292716 License#/ST 7MRY961 CA Mileage 91,374 Pickup From CALIBER COLLISION 161 PATTERSON ST SAN JOSE, CA 95112 NWWE PIP779A CHERYL CONNER NATIONWIDE WESTERN CLAIM ZONE 1199 LOCUST ST DES MOINES, IA 50391 SILVR Claim# 788613-GD Policy# Loss Code Reference# Insured IVAN LEOSFRANCO Owner IVAN LEOSFRANCO (498) 279-4599 ADVANCE CHARGES PAID BY COPART TOW SERVICE . . . . . . . . . . . . . . 393. STORAGE . . . . . . . . . . . . . . . . 85. TOTAL ADVANCE CHARGES . . . . . . . . . 478. COPART SERVICE CHARGES TITLE PROCESSING. . . . . . . . . . . . 25. PIP PROGRAM CHARGE. . . . . . . . . . . 75. TOTAL COPART SERVICE CHARGES. . . . . . 199. TOTAL DUE COPART . . . . . . . . . . . . . . 578. PROCEEDS FROM SALE . . . . . . . . . . . . 1400. PREVIOUS PAYMENTS FROM COPART. . . . . . . . 821. NET DUE COPART . . COPART PAYMENTS DETAIL COPART CHECK# 66967789 91/30/17 821. SALE INFORMATION 59 SALVAGE CERTIFICATE 50 GBCR *Bid Raised By Internet* 59 59 Lot# 37438996 Sold To 367109 SERVICIOS MUNGUIA Sale Date 1/24/17 3106 PASEO ENSENADA Sale Amount 1466.96 CULIACAN, SA ACV 10629.08 (676) 444-5118 Return 13.1% Item# 3774 Invoice Date 1/30/17 Cert# 9521246 Invoice Amount .09 USD Payment From Buyer 1/27/17 REMIT TO: COPART 4610 WESTAMERICA DRIVE FAIRFIELD, CA 94534 https://seller.copart.com/lot-documents/invoice/37438906 Page 1 0f2 8/5/2019 " nterprise rent-a-car RENTAL AGREEMENT REF# 5P1 5JZ 806839 RENTER LEOSFRANCO, IVAN DATE & TIME OUT 9/1 9/2016 3:12 PM DATE & TIME IN 10/10/2016 10:57 AM BILLING CYCLE CALENDAR DAY VEH #1 2016 TOYO CAMR LE4 VIN 4T1 BF1 FK8GU56401 5 L|C# BFY4682 MILES DRIVEN 966 BILL TO ACCOUNT NATIONWIDE INS-VEC DES MOINES** ATTN: MACLEOD ALICIA DES MOINES, IA 50391 CLAIM INFO 78861 3-GD LOSS DATE: INSURED SHOP: TOTAL Loss VIA ARMS AUTO“ PHONE:() - ATTN: ENTERPRISE RENT-A-CAR co 0F SAN FRANCISCO, LLc 395 CURTNER AVE, SAN JOSE, CA 951251464 (408) 280-21 11 Charge Description Date Qty Per Rate TIME & DISTANCE 9/19 - 10/10 22 DAY $30.75 SALES TAX 9/19 - 10/10 8.8% VEHICLE LICENSE RECOVERY FEE 9/19 - 10/10 22 DAY $1 .00 Total Charges Bill TO Charge Description Date Rate NATIONWIDE INS-VEC DES TIME & DISTANCE 9/19 - 10/10 MOINES SALES TAX 9/19 - 10/10 VEHICLE LICENSE RECOVERY 9/19 - 10/10 FEE Subtotal Renter Charge Description Date TIME & DISTANCE 9/19 - 10/10 SALES TAX 9/1 9 - 10/10 VEHICLE LICENSE RECOVERY FEE 9/19 - 10/10 Deposits Payment Information Amount Paid Type Card Number 97.69 Visa xxxxxxxxxxxx8624 Total $676.50 $59.19 $22.00 $757.69 Total $660.00 Total $97.69 Workfile ID: 17c3bc45CALIBER - SAN JOSE - DOWNTOWN Federal ID: 33-0728858 RESTORING THE RHYTHM OF YOUR LIFE State EPA: CAL000410943 BAR: AR0281728161 PA'I'I'ERSON ST, SAN JOSE, CA 95112 Phone: (408) 279-4500 FAX: (408) 298-4043 Estimate of Record R0 Number: 1049000874 Written By: Chris Mueller, 9/23/2016 2:48:15 PM Adjuster: WCZ, OYSAR, (877) 777-2022 Business Insured: LEOSFRANCO, IVAN Policy #: 10404634 Claim #: COLL - Collision Date of Loss: 9/18/2016 7:00 PM Point of Impact: 15 Total Loss 788613-GD-1 Type of Loss: Days to Repair: 0 Owner: Inspection Location: Insurance Company: LEOSFRANCO, IVAN CALIBER - SAN JOSE - DOWNTOWN VICTORIA SPECIALTY INSURANCE COMPANY 795 JASPER ST 161 PA'I'I'ERSON ST CA SAN JOSE, CA 95116 SAN JOSE, CA 95112 5525 Parkcenter Circle (408) 679-8774 Evening Repair Facility Dublin, OH 43017 (408) 679-8774 Cell (408) 279-4500 Business (877) 777-2022 Business VEHICLE 2013 FORD FUSION SE 4D SED 4-2.5L-FI SILVER VIN: 3FA6POH75DR292716 Interior Color: Mileage In: 91,374 Vehicle Out: 10/7/2016 License: 7MRY061 Exterior Color: SILVER Mileage Out: State: CA Production Date: 4/2013 Condition: Job #: TRANSMISSION ConsoIe/Storage RADIO Head/Curtain Air Bags Automatic Transmission Overhead Console AM Radio Hands Free Device POWER CONVENIENCE FM Radio SEATS Power Steering Air Conditioning Stereo Cloth Seats Power Brakes Intermittent Wipers Search/Seek Bucket Seats Power Windows Tilt Wheel CD Player WHEELS Power Locks Power Mirrors Heated Mirrors Power Driver Seat DECOR Dual Mirrors Body Side Moldings Tinted Glass 9/23/2016 2:48:15 PM Cruise Control Rear Defogger Keyless Entry Alarm Message Center Steering Wheel Touch Controls Telescopic Wheel Climate Control Auxiliary Audio Connection Satellite Radio SAFETY Drivers Side Air Bag Passenger Air Bag Anti-Lock Brakes (4) 4 Wheel Disc Brakes Front Side Impact Air Bags 314133 Aluminum/Alloy Wheels PAINT Clear Coat Paint OTHER Traction Control Stability Control Signal Integrated Mirrors Power Trunk/Gate Release Page 1 Estimate of Record R0 Number: 1049000874 2013 FORD FUSION SE 4D SED 4-2.5L-FI SILVER Line Oper Description Part Number Qty Extended Labor Paint Price $ 1 # Tear Down Charges 2.0 x 1 74.00=148.00 2 FRONT BUMPER & GRILLE 3 O/H front bumper 2.7 4 ** Repl A/M CAPA Bumper cover w/o DS7Zl7D957AAPTM 1 361.00 Incl. 3.0 auto park w/o tow hook Add for Clear Coat 1.2 Repl RT Side trim w/o fog lamps w/o DS7Zl73814AA 1 68.43 Incl. engine heater 7 Repl LT Side trim w/o fog lamps w/o DS7Zl7B814AB 1 68.40 Incl. engine heater Repl RT Front retainer DS7Zl7E856A 1 49.85 0.1 Repl LT Front retainer DS7Zl7E857A 1 48.32 0.1 10 ** Repl A/M CAPA RT Side retainer DS7Zl7C947A 1 32.00 Incl. 11 ** Repl A/M CAPA LT Side retainer DS7Zl7C947B 1 32.00 Incl. 12 Repl Wire harness w/o fog lamps D69215K867A 1 26.13 13 ** Repl A/M AQRP Lower grille black DS7Zl7K945AB 1 87.00 Incl. texture 14 ** Repl A/M AQRP Lower molding chrome DS7Z8419BA 1 105.00 Incl. 15 ** Repl A/M AQRP Grille surround DS7Z8419AA 1 137.00 Incl. 16 ** Repl A/M AQRP Upper grille D5728200BA 1 98.00 Incl. 17 ** Repl A/M AQRP Insert # 1 D5728200DA 1 64.00 0.1 18 ** Repl A/M AQRP Insert # 2 D5728200EA 1 66.00 0.1 19 ** Repl A/M AQRP Insert # 3 DS728200FA 1 67.00 0.1 20 ** Repl A/M AQRP Insert # 4 DS7Z8ZOOGA 1 67.00 0.1 21 ** Repl A/M AQRP Insert # 5 DS728200HA 1 64.00 0.1 22 FRONT LAMPS 23 ** Repl A/M AQRP LT Headlamp assy DS7Zl3OOBB 1 m Incl. 24 Aim headlamps 0.5 25 RADIATOR SUPPORT 26 ** Repl A/M AQRP Mount panel DS721613SB 1 177.00 2.1 27 * Repl Upper tie bar DS7Z8A284A 1 m 1.2 0.8 28 ** Repl A/M AQRP Lower tie bar GS7Zl6138A 1 130.00 0.2 29 Repl Shutter assembly w/o adaptive DS728475A 1 615.30 0.4 crUIse 30 Repl Under cover w/o 2.0 liter turbo DG926P013E 1 218.45 0.3 31 ** Repl A/M CAPA Lower shield DS7Z8349B 1 99.00 0.3 32 COOLING 33 * Repl LKQ Radiator +25% DG928005D 1 137.50 2.5 34 Repl RT Lock shaft DG928A193A 1 7.05 35 Repl LT Lock shaft DGQZ8A193A 1 7.05 36 Repl RT Upper insulator 6GQZ8125A 1 5.77 37 Repl LT Upper insulator 6GQZ8125A 1 5.77 38 AIR CONDITIONER & HEATER 9/23/2016 2:48:15 PM 314133 Page 2 Estimate of Record R0 Number: 1049000874 2013 FORD FUSION SE 4D SED 4-2.5L-FI SILVER 39 4o 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 ** Repl HOOD Repl Repl Repl Repl Repl Repl Repl Repl FENDER Repl Repl Repl ** Repl ** Repl * * * Repl Repl Repl Repl Repl Repl ELECTRICAL Repl WHEELS Repl Repl Repl A/M Condenser Deduct for Overlap Hood Add for Underside(Complete) LT Front w'strip RT Front w'strip Release cable to 05/09/2013 Release handle RT Hinge LT Hinge Insulator retainer clip LT Apron assy w/o 2.0 liter DOHC (HSS) Overlap Minor Panel RT Fender Overlap Major Adj. Panel Add for Edging Deduct for Overlap Deduct for Overlap LT Fender Overlap Major Adj. Panel Add for Edging Deduct for Overlap Deduct for Overlap A/M CAPA RT Fender liner A/M CAPA LT Fender liner LT Fender ledge cvr RT Fender liner clip LT Fender liner clip RT Upper molding w/bright trim LT Upper molding w/bright trim LT Upper rail (HSS) Overlap Minor Panel Top cover LKQ Wheel, alloy type 1 +25% LKQ Wheel, alloy type 1 +25% LKQ Wheel, alloy type 1 +25% FRONT SUSPENSION Repl Repl 9/23/2016 2:48:15 PM O/H frt susp It LT Splash shield LKQ LT ABS sensor +25% DG9Zl9712C DS72166IZB DS7Zl6B990F DS7Zl6B990F DS7Zl6916D DS7Zl6B626C DS7Zl6796A DS7Zl6797A VV709688S300 GGQZl6055A DS7Zl6005A DS7Zl6006A D57216102A DS7Zl6103A DS7ZS802039A W7136105300 W713610$300 E57216004DA ES7Zl6003DA HG9Zl6155A DG9Zl4A003AA DS7ZlOO7N DS7ZlOO7N DS7ZlOO7N DG9ZZKOOSB DGQZZCZOSB 314133 HHHHHH 14 HHHmmHHH 21.40 77.15 77.15 62.95 19.37 59.77 59.77 15.96 595.40 217.20 217.10 Loo _\|\1 oooo 36.03 8.34 8.34 65.77 65.77 63.33 13.63 112.50 112.50 112.50 9.40 150.00 m 1.3 -0.2 1.7 Incl. Incl. 0.8 0.2 0.9 0.9 s 10.0 1.6 -0.3 -0.5 1.6 -O.3 -0.5 Incl. Incl. Incl. Incl. Incl. s Incl. 0.3 0.3 33 3.6 Incl. 3 m Incl. 2.8 1.4 0.4 0.4 3.0 -0.2 2.0 -0.4 0.5 2.0 -0.4 0.5 0.6 -O.2 Page 3 Estimate of Record R0 Number: 1049000874 2013 FORD FUSION SE 4D SED 4-2.5L-FI SILVER 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 Repl LT Brake hose Bleed brake system * Repl LKQ Engine cradle +25% Repl LT Lower cntrl arm Repl LT Knuckle * Wheel alignment align four wheels Deduct for Overlap * Repl LKQ LT Stabilizer link +25% Repl LT Strut 2.5 liter to 05/26/2014 Deduct for Overlap Deduct for Overlap * Repl LKQ LT Axle assy 2.5 liter Hermossilo plant +25% Deduct for Overlap Repl LT Axle assy retainer clip 2.5 liter Repl LT Axle nut STEERING GEAR & LINKAGE Repl LT Inner tie rod Repl LT Inner tie rod lock nut Repl LT Outer tie rod Deduct for Overlap Repl LT Outer tie rod lock nut PILLARS, ROCKER & FLOOR Repl LT Rocker molding primed Overlap Major Non-Adj. Panel Repl LT Front seal Repl RT Air deflector w/o AWD Repl LT Air deflector w/o AWD FRONT DOOR * Rpr LT Door shell Overlap Major Adj. Panel R&I LT Belt molding * Rpr LT Mirror assy to 07/13/2014 Overlap Minor Panel R&I LT Mirror cover R&I LT R&I mirror Blnd RT Door shell R&I RT Belt molding R&I RT R&I mirror R&I RT Handle, outside w/o passive entry R&I LT Handle, outside w/o passive entry QUARTER PANEL * Rpr LT Quarter panel 9/23/2016 2:48:15 PM DG9ZZO78B DG9ZSC145H GS7Z3079A DGQZ3K186B DGQZSK484A DG9218124P DG9Z3B437G BBSZ4B422B SEE FOOTNOTE DG923280A W713882$442 DG9Z3A13OB W5202 155440 DS7ZS410177A DS7ZS8101C36A DG9299 1 1782] DG92991 1782F 314133 18.70 581.25 121.63 101.75 50.00 87.83 62.50 2.80 68.28 1.06 40.55 1.49 233.93 33.72 264.90 267.72 333333 3 0.6 0.5 5.9 Incl. Incl. fl Incl. Incl. Incl. Incl. Incl. 1.1 0.8 Incl. -0.3 0.7 Incl. 0.2 0.2 0.1 0.4 0.3 0.4 0.3 0.3 1.8 -0.2 2.3 -0.4 0.5 -0.2 1.2 2.2 Page 4 Estimate of Record R0 Number: 1049000874 2013 FORD FUSION SE 4D SED 4-2.5L-FI SILVER 125 Overlap Major Non-Adj. Panel -0.2 126 Clear Coat 2.5 127 R&I LT Qtr glass FORD w/bright trim 1.1 128 REAR LAMPS 129 R&I LT Tail lamp assy w/o ENERGI 0.2 130 REAR BUMPER 131 R&I R&I bumper cover 1.1 132 # Subl alingment 1 65.00 X 133 OTHER CHARGES 134 # Towing 1 478.00 SUBTOTALS 8,715.46 49.4 26.9 NOTES Prior Damage Notes: Normal wear ESTIMATE TOTALS Category Basis Rate Cost $ Parts 8,172.46 Body Labor 49.4 hrs @ $ 74.00 /hr 3,655.60 Paint Labor 26.9 hrs @ $ 74.00 /hr 1,990.60 Paint Supplies 500.00 Miscellaneous 65.00 Other Charges 478.00 Pre-Tax Discount -1.0 % -148.62 Subtotal 14,713.04 Sales Tax $ 8,585.74 @ 8.7500 °/o 751.25 Grand Total 15,464.29 Deductible 500.00 CUSTOMER PAY 500.00 INSURANCE PAY 14,964.29 9/23/2016 2:48:15 PM 314133 Page 5 Looking for a no-hassle pricing on New 0r Used Car? Powered by TrueCar. The Auto Shopping Service. is here to help. S 10p Wlt COIl 1 Cl’lCC an S&VC, ISCOVCfll’lg great Ca S. We'll get you back 0n the road fast! Powered by TrueCar. The Auto Shopping Service. provides: o TrueCar® Certified Dealers dedicated to providing a no-hassle car buying experience. o What others paid for new vehicle in your area so you don't overpay. o A way t0 easily View and compare thousands 0fnew and used vehicles online. o TrueCar® representatives available to help you through the entire process. A service you can trust When you need it most Visit us today at www.nationwide.com/replacecar 0r call 877-924-2588 Your actual savings may vary based on multiple factors including the vehicle you select, region, dealer, and applicable manufacturer incentives. This no obligation program is administered by TrueCar, Inc. mSONE Prepared for VICTORIA SPECIALTY INSURANCE COMPANY g) REPORT SUMMARY M bi CLAIM INFORMATION Owner Leosfranco, Ivan San Jose, CA 951 16 Loss Vehicle 2013 Ford Fusion SE FWD Loss Incident Date 09/1 8/201 6 Claim Reported 09/23/2016 (i? INSURANCE INFORMATION Report Reference Number 82279811 Claim Reference 788613-GD-1 Adjuster Kiedrowski, Kevin Odometer 91 ,374 Last Updated 09/30/2016 11:37 AM VALUATION SUMMARY Base Vehicle Value $ 10,629.00 Adjusted Vehicle Value $ 10,629.00 Vehicular Tax (8.75%) + $ 930.04 Tax reflects applicable state, county and municipal taxes. DMV Fee + $ 178.00 Total $ 11,737.04 The total may not represent the total of the settlement as other factors (e.g. license and fees) may need to be taken into account. © Copyright 2016 CCC Information Services Inc. All Rights Reserved. The CCC ONE® Market Valuation Report reflects CCC Information Services |nc.’s opinion as to the value of the loss vehicle, based on information provided to CCC by VICTORIA SPECIALTY INSURANCE COMPANY. Loss vehicle has 72% greater than average mileage of 53,000. BASE VEHICLE VALU E This is derived from comparable vehicle(s) available or recently available in the marketplace at the time of valuation, per our valuation methodology described on the next page. ADJUSTED VEHICLE VALUE This is determined by adjusting the Base Vehicle Value to account for the actual condition of the loss vehicle and certain other reported attributes, if any, such as refurbishments and after factory equipment. Inside the Report Valuation Methodology............................. 2 Vehicle Information ................................... 3 Vehicle Condition ......................................6 Comparable Vehicles ............................... 8 Valuation Notes ...................................... 13 Supplemental Information ....................... 14 Page 1 of 22 CUJSONE MARKET VALUATION REPORT Sgrjfigzzifgfigfi'va” VALUATION METHODOLOGY How was the valuation determined? CLAIM INSPECTION VICTORIA SPECIALTY INSURANCE COMPANY has provided CCC with the zip code where the loss vehicle is garaged, loss vehicle VIN, mileage, equipment, as well as loss vehicle condition, which is used to assist in determining the value of the loss vehicle. DATABASE REVIEW CCC maintains an extensive database of vehicles that currently are or recently were available for sale in the U.S. This database includes vehicles advertised for sale by dealerships or private parties. CCC also obtains vehicle sales prices from a database of California Department of Motor Vehicles vehicle registration sold transactions. All of these sources are updated regularly. SEARCH FOR COMPARABLES When a valuation is created the database is searched and comparable vehicles in the area are selected. The zip code where the loss vehicle is garaged determines the starting point for the search. Comparable vehicles are similar to the loss vehicle based on relevant factors. CALCULATE BASE VEHICLE VALUE Adjustments to the price of the selected comparable vehicles are made to reflect differences in vehicle attributes, including mileage and options. Dollar adjustments are based upon market research. Finally, the Base Vehicle Value is the straight average of the adjusted values of the comparable vehicles. © Copyright 2016 CCC Information Services Inc. All Rights Reserved. Page 2 0f 22 UJJSONE MARKET VALUATION REPORT B VEHICLE INFORMATION VEHICLE DETAILS Location VIN Year Make Model Trim Body Style Body Type Engine - Cylinders Displacement Fuel Type Carburation Transmission SAN JOSE, CA 95116 3FA6POH7SDR292716 2013 Ford Fusion SE FWD Sedan 4 2.5L Gasoline Electronic Fuel Injection Automatic Transmission Curb Weight 3427 lbs VEHICLE ALLOWANCES Odometer 91 ,374 - 2,183 VEHICLE HISTORY SUMMARY CCC VlNguard® 1 Vehicle Market History Information No Title Problem FoundExperian AutoCheck National Highway Traffic 9 Recalls Safety Administration © Copyright 2016 CCC Information Services Inc. All Rights Reserved. 03/27/201 5 Owner: Leosfranco, Ivan Claim: 788613-GD-1 Vehicles sold in the United States are required to have a manufacturer assigned Vehicle Identification Number(VlN). This number provides certain specifications of the vehicle. Please review the information in the Vehicle Information Section to confirm the reported mileage and to verify that the information accurately reflects the options, additional equipment or other aspects of the loss vehicle that may impact the value. Allowances are factors influencing the value of the loss vehicle when compared to a typical vehicle. The typical vehicle is a vehicle of the same year, make, and model as the loss vehicle, including average mileage, and all standard equipment. These allowances are displayed for illustrative purposes only. The Base Vehicle Value is calculated from the comparable vehicles with adjustments to reflect the loss vehicle configuration Page 3 of 22 UJJSONE MARKET VALUATION REPORT B VEHICLE INFORMATION VEHICLE EQUIPMENT Odometer 91 ,374 Transmission Automatic Transmission Power Power Steering Power Brakes Power Windows Power Locks Power Mirrors Power Driver Seat Power Trunk/Gate Release DecorlConvenience Air Conditioning Climate Control Tilt Wheel Cruise Control Rear Defogger Intermittent Wipers Console/Storage Overhead Console Keyless Entry Telescopic Wheel Message Center Seating Cloth Seats Bucket Seats Radio AM Radio FM Radio Stereo Search/Seek CD Player Steering Wheel Touch Controls Auxiliary Audio Connection Satellite Radio Wheels Aluminum/Alloy Wheels Safetlerakes Air Bag (Driver Only) © Copyright 2016 CCC Information Services Inc. All Rights Reserved. <<<<<<<<<<<<<<<<<<<<<<<<<<<<<<< Owner: Leosfranco, Ivan Claim: 788613-GD-1 To the left is the equipment of the loss vehicle that VICTORIA SPECIALTY INSURANCE COMPANY provided to CCC. V Standard This equipment is included in the base configuration of the vehicle at time of purchase. a Additional Equipment that is not Standard but was noted to be on the loss vehicle. Page 4 of 22 CUJSONE MARKET VALUATION REPORT Sgfifigzzifgfigfi'va“ B VEHICLE INFORMATION VEHICLE EQUIPMENT Passenger Air Bag Anti-Iock Brakes (4) 4-wheel Disc Brakes Front Side Impact Air Bags Head/Curtain Air Bags Hands Free Alarm Traction Control Stability Control Exterior/Painthlass Dual Mirrors Heated Mirrors Body Side Moldings Tinted Glass Signal Integrated Mirrors E<<<<<<<<<<<<<< Clearcoat Paint © Copyright 2016 CCC Information Services Inc. All Rights Reserved. Page 5 of 22 UJJSONE MARKET VALUATION REPORT B VEHICLE CONDITION COMPONENT CONDITION Condition Inspection NoteslTypical Vehicle Value Impact Description MECHANICAL Engine AVERAGE Notes: No Comments $ 0 Typical Vehicle Desc: Minor to no seepage. Belts and hoses firm, and may show minimal wear. Minimal to zero dirt and grease in engine compartment. Transmission AVERAGE Notes: No Comments $ 0 Typical Vehicle Desc: Fluid slightly discolored. A few areas to no seepage. PAINT PAINT AVERAGE Notes: No Comments $ 0 Typical Vehicle Desc: Paint: Minimal surface chipping and/or a few small scratches. No peeling and/ or flaking. Minor to no swirl marks. Light to no fading. TIRES Front Tires AVERAGE Notes: No Comments $ O Typical Vehicle Desc: 41% to 90% of new. Example: Typical new car tires are 11/32, loss measures at 5/32 = 46% (5/11) Rear Tires AVERAGE Notes: No Comments $ 0 Typical Vehicle Desc: 41% to 90% of new. Example: Typical new car tires are 11/32, loss measures at 5/32 = 46% (5/1 1) BODY/GLASS BODY/ AVERAGE Notes: No Comments $ 0 GLASS Typical Vehicle Desc: Glass: Light to no surface scratches. Light to no pitting. Sheet Metal: Few to no dings. No dents. All panels intact and properly aligned. Trim: No broken and/or missing components. No dents. Few to no dings. © Copyright 2016 CCC Information Services Inc. All Rights Reserved. Owner: Leosfranco, Ivan Claim: 788613-GD-1 VICTORIA SPECIALTY INSURANCE COMPANY uses condition inspection guidelines to rate the condition of key components of the loss vehicle on a three-point scale. A rating of average condition results in a valuation of that component that is consistent with typical vehicles for that year, make and model of vehicle. If a component is rated in exceptional condition, then a positive monetary adjustment is made to reflect the impact of that condition level on the value of the loss vehicle. Similarly, if a component is rated in below average condition, then a negative monetary adjustment is made to reflect the impact of that condition level on the value ofthe loss vehicle. Inspection Notes, if any, reflect additional observations from the appraiser regarding the loss vehicle's condition. Monetary adjustments are based upon market research consisting of data gathered from dealerships in California. CCC makes dollar adjustments that reflect the impact the reported condition has on the value 0f the loss vehicle as compared to Average condition. These dollar adjustments are based upon interviews with dealerships across the United States. Page 6 of 22 CUJSONE MARKET VALUATION REPORT 0W“e“e°sra"°°f'va"Claim: 788613-GD-1 B VEHICLE CONDITION COMPONENT CONDITION Condition Inspection NoteslTypical Vehicle Value Impact Description INTERIOR INTERIOR AVERAGE Notes: No Comments $ 0 Typical Vehicle Desc: Headliner: Clean to very clean with no significant holes or burn marks. Light to no significant scuffing. Dashboard: A few small and/or insignificant scratches or gouges. Minimal to no damage to firmly intact and functional components. Light wear. Carpets: Clean to very clean with no significant tears, holes or burn marks. Light to no wear. No bare spots. Seats: Clean to very clean with no significant tears, holes or burn marks. Light to no wear. No bare spots. Total Condition Adjustments $ 0 © Copyright 2016 CCC Information Services Inc. All Rights Reserved. Page 7 0f 22 UJJSONE MARKET VALUATION REPORT COMPARABLE VEHICLES Options Odometer Automatic Transmission 4 Wheel Drive Power Steering Power Brakes Power Windows Power Locks Power Mirrors Power Driver Seat Power Passenger Seat Power Trunk/Gate Release Air Conditioning Climate Control Tilt Wheel Cruise Control Rear Defogger Intermittent Wipers Console/Storage Overhead Console Memory Package Entertainment Center Keyless Entry Telescopic Wheel Message Center Home Link Cloth Seats Bucket Seats AM Radio FM Radio Stereo Search/Seek CD Player Steering Wheel Touch Controls Auxiliary Audio Connection Premium Radio Satellite Radio Aluminum/Alloy Wheels Luggage/Roof Rack Drivers Side Air Bag Passenger Air Bag © Copyright 2016 CCC Information Services Inc. All Rights Reserved. Loss Vehicle 91 ,374 fl <.ax‘fl <.x <.‘Q‘Q <.<.‘§ <.<.‘§ x <.<.‘§ x x <.‘k Q <.‘Q‘Q <.<.‘§ x <.<.‘§‘< <.<.=< < Comp 1 30,031 Q Q x Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q x x Q Q Q Q Q Q Q Q Q x Q Q Q Q Q Q x Q Comp 2 41 ,786 4 Q Q Q Q x Q Q Q Q Q Q Q Q Q x Q Q Q Q x Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q x Q Comp 3 40,698 Q Q x Q Q Q Q Q Q Q Q Q Q Q Q x Q Q Q x Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Owner: Leosfranco, Ivan Claim: 788613-GD-1 Comp 1 Updated Date: 08/26/2016 2013 Ford Fusion Se Fwd 4 2.5l Gasoline Electronic Fuel Injection VIN 3FA6POH7ZDR362866 Dealership Frontier Ford Telephone (408) 241-1800 Source Dealer Ad Stock # P1703 Distance from San Jose, CA 5 Miles - San Jose, CA Comp 2 Updated Date: 08/1 7/2016 2013 Ford Fusion Se Fwd 4 2.5I Gasoline Electronic Fuel Injection VIN 3FA6POH75DR349450 Dealership Momentum Chevrolet Telephone (408) 249-31 31 Source Autotrader Stock # UP349450 Distance from San Jose, CA 6 Miles - San Jose, CA Comp 3 Updated Date: 09/08/2016 2013 Ford Fusion Se Fwd 4 2.5l Gasoline Electronic Fuel Injection VIN 3FA6POH720R349468 Dealership Momentum Chevrolet Telephone (408) 215-1014 Source Dealer Ad Stock # UP349468 Distance from San Jose, CA 8 Miles - Sunnyvale, CA Comparable vehicles used in the determination of the Base Vehicle Value are not intended to be replacement vehicles but are reflective of the market value, and may no longer be available for sale. List Price is the sticker price of an inspected dealer vehicle and the advertised price for the advertised vehicle. Distance is based upon a straight line between loss and comparable vehicle locations. Page 8 of 22 UJJSONE MARKET VALUATION REPORT COMPARABLE VEHICLES Options Loss Comp 1 Vehicle Anti-Iock Brakes (4) 4-wheel Disc Brakes Front Side Impact Air Bags Head/Curtain Air Bags Rear Side Impact Air Bags Communications System Hands Free Alarm Traction Control Stability Control Dual Mirrors Heated Mirrors Body Side Moldings Tinted Glass Fog Lamps Rear Window Wiper Signal Integrated Mirrors Clearcoat Paint Metallic Paint KQQKKQQQQQQQQKKQQQQ xx Efiq‘w(mmlMfi‘M many» am0Mmammalsmamnunkm mmrmarmow um 2715mlminmmfilmunm" LUSBE‘HHGRE MPH“; Em] ntmyinmum5mm mom ‘ film: 8550:1736" MOM“): 17:15] 3: mam (Ila? {mg}: film lummm.Mmmluyluimmwil1| Vu‘lfiifllflflh JUMEFGUIDI HSDR r i :3:::+- Fm UH ”WSA-nmm 9/21/2016 E01 9/21/2016 E01 Comments: Comments: 9/23/2016 8:54:00 AM Page 1 CALIBER - SAN JOSE - DOWNTOWN 161 PATrERsou ST, SAN JOSE, CA 95112 Phone: (408) 279-4500, Fax: (408) 298-4043 Ima-e Reort Owner: LEOSFRANCO, IVAN Insurance: VICTORIA Estimator: Chris Mueller Vehicle Out: 10/7/2016 RO Number: 1049000874 Claim Number: 788613-GD-1 Year: 2013 Color: SILVER License Plate: 7MRY061 Production Date: 4/2013 Make: FORD Body Style: 4D SED State: CA Mileage In: 91,374 Model: FUSION SE Engine: 4-2.5L-FI VIN: 3FA6POH75DR292716 Condition: x‘ > 9/21/2016 E01 9/21/2016 E01 Comments: Comments: 9/21/2016 E01 9/21/2016 E01 Comments: Comments: \ b 1”, 9/21/2016 E01 9/21/2016 E01 Comments: Comments: 9/23/2016 8:54:00 AM Page 2 CALIBER - SAN JOSE - DOWNTOWN 161 PATrERsou ST, SAN JOSE, CA 95112 Phone: (408) 279-4500, Fax: (408) 298-4043 Owner: LEOSFRANCO, IVAN Insurance: VICTORIA Estimator: Chris Mueller Vehicle Out: 10/7/2016 RO Number: 1049000874 Claim Number: 788613-GD-1 Year: 2013 Color: SILVER License Plate: 7MRY061 Production Date: 4/2013 Make: FORD Body Style: 4D SED State: CA Mileage In: 91,374 Model: FUSION SE Engine: 4-2.5L-FI VIN: 3FA6POH75DR292716 Condition: 9/21/2016 E01 9/21/2016 E01 Comments: Comments: 9/21/2016 E01 9/21/2016 E01 Comments: Comments: 9/21/2016 E01 9/21/2016 E01 Comments: Comments: 9/23/2016 8:54:00 AM Page 3 CALIBER - SAN JOSE - DOWNTOWN 161 PATrERsou ST, SAN JOSE, CA 95112 Phone: (408) 279-4500, Fax: (408) 298-4043 Owner: LEOSFRANCO, IVAN Insurance: VICTORIA Estimator: Chris Mueller Vehicle Out: 10/7/2016 RO Number: 1049000874 Claim Number: 788613-GD-1 Year: 2013 Color: SILVER License Plate: 7MRY061 Production Date: 4/2013 Make: FORD Body Style: 4D SED State: CA Mileage In: 91,374 Model: FUSION SE Engine: 4-2.5L-FI VIN: 3FA6POH75DR292716 Condition: . . _ _ rflij 1 9/21/2016 E01 9/21/2016 E01 Comments: Comments: Mlfllflli 13:21 9/23/2016 E01 9/23/2016 E01 Comments: Comments: [3;3- . 9/23/2016 E01 9/23/2016 E01 Comments: Comments: CALIBER - SAN JOSE - DOWNTOWN 161 PATrERsou ST, SAN JOSE, CA 95112 Phone: (408) 279-4500, Fax: (408) 298-4043 Owner: LEOSFRANCO, IVAN Insurance: VICTORIA Estimator: Chris Mueller Vehicle Out: 10/7/2016 RO Number: 1049000874 Claim Number: 788613-GD-1 Year: 2013 Color: SILVER License Plate: 7MRY061 Production Date: 4/2013 Make: FORD Body Style: 4D SED State: CA Mileage In: 91,374 Model: FUSION SE Engine: 4-2.5L-FI VIN: 3FA6POH75DR292716 Condition: é ,F L I I '1 L . xx 9/23/2016 E01 9/23/2016 E01 Commenm: Comments: 9/23/2016 8:54:00 AM Page 5 d (I 03,450 A .‘ "k fldpxij'l- 5’ Zflfl. 7 _ A 1 v "I _' ~ u I < ‘. \ a *-- " \ . , l I _ . \‘ - . u K 5. .- 4 a . ' a ‘ , ' ‘ w , o \ ‘ t , ’ ’ x