affidavit of employee

Cal. Super. - 1st Dist.October 4, 2021

1 2 3 4 5 6 LAW OFFICE OF DARLENE ROHR Katie R. Aul - 306491 Attorneys At Law 14111 Danielson Street, Suite 100 Poway, CA 92064 Allom•J• & Support Staff are EmplO)lttS of Govm1111enr EmploJees J11s11rnnce Company Telephone: Fax:· 858-513-5030 858-513-5299 7 Attorneys for Plaintiff Government Employees Insurance 8 9 10 1 1 12 13 14 SUPERIOR COURT FOR THE STATE OF CALIFORNIA, COUNTY OF SAN FRANCISCO GOVERNMENT EMPLOYEES INSURANCE COMPANY, PLAINTIFF, vs. MICHAEL DEPAULO; AND DOES 1 1 5 THROUGH 20, INCLUSIVE,, 16 DEFENDANTS. 17 I, MICHELLE VOGT, declare: CASE NO. CGC-19-579981 AFFIDAVIT OF PLAINTIFF'S EMPLOYEE MICHELLE VOGT [C.C.P. §585(d)] 18 1. I am an employee of Government Employees Insurance Company (GEICO), the 1 9 plaintiff in the above-captioned lawsuit. I have personal knowledge of the following facts 2 0 and, if sworn to testify as a witness, I could and would competently testify thereto. 21 2. On Monday, May 13, 2019, Milton Vance III had a valid Auto Liability Insurance 2 2 contract with Government Employees Insurance Company that provided the insured and/or 2 3 insured vehicle with insurance coverage for collisions, comprehensive coverage, and rental 2 4 coverage. The policy contract gives GEICO a Right of Subrogation. 25 3. We respectfully request that the Court enter judgment upon the information and 2 6 supporting documentation provided within this declaration. 27 28 AFFIDAVIT OF PLAINTIFF'S EMPLOYEE MICHELLE VOGT Page 1 ELECTRONICALLY F I L E D Superior Court of California, County of San Francisco 02/07/2020 Clerk of the Court BY: NADITA MASON Deputy Clerk 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 4. My review of the above-captioned matter revealed the following facts concerning the automobile accident in the subrogation matter as follows: a. Date of Accident: Monday, May 13, 2019 b. Location of Accident: Mission Street & Laskie Street, San Francisco, CA c. Owner of GEICO-insured vehicle: Milton Vance III d. GEICO's insured's vehicle & 2017 Nissan NV1500, California license license plate no.: plate no. 75109L2 e. Operator of defendant vehicle: Michael Charles DePaulo f. Owner of defendant vehicle: Michael Charles DePaulo g. Defendant's vehicle & license 2006 Toyota Sienna, California license plate no: plate no. 5XXG05 l 5. Thereafter, Plaintiff GEICO's insured, Milton Vance ill, reported the loss, including sending GEICO a photo of the collision taken by him at the scene. Settlement of the property damage were concluded between Plaintiff GEICO and its insured Milton Vance ill as follows: 6. ~ GEICO's payment for repairs to insured vehicle: ~ GEICO's payment for its insured's use of a rental vehicle while their vehicle was undergoing repairs: ~ GEICO's insured's deductible: $7,498.26 $1,196.08 + $500.00 TOTAL PAYMENTS MADE= $9,194.34 Unfortunately, GEICO miscalculated its damages incurred on this matter and GEICO only sued for $8,632.48 in this action. As such, GEICO is seeking a judgment for its claimed damages amount of just $8,632.48. AFFIDAVIT OF PLAINTIFF'S EMPLOYEE MICHELLE VOGT Page2 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 7. All exhibits described herein are true and correct copies of the document that was created by GEICO employees during the course and scope of this claim handling OR were received by a GEICO employee during the course and scope of the claim handling. EXHIBIT LIST Collision Information Card - Prepared at the scene concerning the EXHIBIT A Defendant and his Vehicle Photo of the damaged GEICO-insured vehicle and the Defendant's EXHIBIT B vehicle - taken at the scene of the collision. 51 Color Digital Photographs of the GEICO-insmed vehicle EXHIBIT c showing the damage thereto, taken after the collision. Repair Estimates (initial and supplemental [final]) for the GEICO- EXHIBIT D insured vehicle EXHIBIT E Rental Car Invoices - Hertz and Enterprise Rent-A-Car EXHIBIT F Claim Payment Screens - for Repair Payments EXHIBIT G Claim Payment Screens - for Rental Car Payments I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed this ._:Q__ day of January, 2020, at Fredericksburg, Virginia. AFFIDAVIT OF PLAINTIFF'S EMPLOYEE MICHELLE VOGT Page3 EXHlBlT A COLLISION INFORMATION CARD - SAN FRAf\lCISCO POLICE DEPARTMENT COLLIS ION OCCURRED ON (STREET) ., ll ·t:.~c ).11 / <. _,, "'"" ~;> AT INTERS CTION WITH I OR NEAREST INTERSECTION .i ,). -- /' / !,,..--..-. -- \. ,;-_ V/ ADDRESS ""'SAME AS DRIVER OFF. AT SCENE DRIVER'S INSURANCE corv:~y __ A~~£--~~~~~~~~~-, I " . fxtt\rirr ts ~·;-. , .. ;::;. ~-,,· ..... @ ;J C L ~ c r Claim Number : 0805222310000001 -01 Year: 2017 Category: Estimate Make: NISSAN Sub Category : Model : NV1500 SV Image FileName : cc124559266-1557949492004.jpg VIN: 1N6BFOKY2HN8121 01 Image Label : image Loss Date: 05/13/2019 Insured: Milton Vance Iii Adjuster: Policy Number : 9100249083 Photo Taken Date : 2019-05-15T12:44:52 Vehicle Owner : Milton Vance Iii Supplement Number : 00 ,. 8 1- - i~~·j}E:.-;;- Claim Number : 0805222310000001-01 Year : 2017 Category : Estimate Make : NISSAN Sub Category : Model : NV1500 SV Image FileName : cc124559266-1557949484006.j pg VIN : 1N6BFOKY2HN812101 Image Label : image Loss Date : 05/13/2019 Insured: Milton Vance Iii Adjuster : Policy Number : 9100249083 Photo Taken Date : 2019-05-15T12:44:44 Vehicle Owner : Milton Vance Iii Supplement Number : 00 I I Claim Number : 0805222310000001-01 Year : 2017 Category : Estimate Make: NISSAN Sub Category : Model: NV1500 SV Image FileName : cc124559266-1557949505001.j pg VIN: 1 N6BFOKY2H N812101 Image Label : image Loss Date: 05/13/2019 Insured : Milton Vance Iii Adjuster: Policy Number : 9100249083 Photo Taken Date : 2019-05-15T12:45:05 Vehicle Owner : Milton Vance Iii Supplement Number : 00 Claim Number : 0805222310000001-01 Year: 2017 Category: Estimate Make: NISSAN Sub Category: Model: NV1500 SV Image FileName : cc124559266-1557949265016.jpg VIN: 1N6BFOKY2HN812101 Image Label : image Loss Date: 05/13/2019 Insured : Milton Vance Iii Adjuster: Policy Number: 9100249083 Photo Taken Date : 2019-05-15T12:41 :05 Vehicle Owner : Milton Vance Iii Supplement Number: 00 . ~ "'\ • ---~~----· ·-·· .. \, . ~. Claim Number: 0805222310000001-01 Year : 2017 Category : Estimate Make : NISSAN Sub Category : Model : NV1500 SV Image FileName : cc124559266-1557948479021.jpg VIN : 1N6BFOKY2HN812101 Image Label : image Loss Date : 05/13/2019 Insured : Milton Vance Iii Adjuster : Policy Number : 9100249083 Photo Taken Date : 2019-05-15T12:27:59 Vehicle Owner : Milton Vance Iii Supplement Number : 00 ..--.. .~ .... - ' -·-..2~- ~ \ .~,~ <. ;• Claim Number : 0805222310000001-01 Year: 2017 Category: Estimate Make: NISSAN Sub Category : Model : NV1500 SV Image FileName : cc124559266-1557948481024.jpg VIN: 1N6BFOKY2HN812101 Image Label : image Loss Date : 05/13/2019 Insured: Milton Vance Iii Adjuster: Policy Number : 9100249083 Photo Taken Date : 2019-05-15T12:28:01 Vehicle Owner : Milton Vance Iii Supplement Number : 00 Claim Number : 0805222310000001-01 Year: 2017 Category : Estimate Make : NISSAN Sub Category : Model : NV1500 SV Image FileName : cc124559266-1557949473008.jpg VIN: 1N6BFOKY2HN812101 Image Label : image Loss Date : 05/13/2019 Insured : Milton Vance Iii Adjuster: Policy Number : 9100249083 Photo Taken Date : 2019-05-15T12:44:33 Vehicle Owner : Milton Vance Iii Supplement Number : 00 -- - - I Claim Number : 0805222310000001-01 Year: 2017 Category: Estimate Make: NISSAN Sub Category : Model: NV1500 SV Image FileName : cc124559266-1557948464027.jpg VIN : 1 N6BFOKY2HN812101 Image Label : image Loss Date: 05/13/2019 Insured: · Milton Vance Iii Adjuster: Policy Number : 9100249083 Photo Taken Date : 2019-05-15T12:27:44 Vehicle Owner : Milton Vance Iii Supplement Number: 00 ){""*'. '€' ......... \ ., ~ . Claim Number : 0805222310000001 -01 Year: 2017 Category: Estimate Make: NISSAN Sub Category : Model : NV1500 SV Image FileName : cc124559266-1557948470029.j pg VIN: 1N6BFOKY2HN812101 Image Label : image Loss Date: 05/13/2019 Insured : Milton Vance Iii Adjuster: Policy Number : 9100249083 Photo Taken Date : 2019-05-15T12:27:50 Vehicle Owner : Milton Vance Iii Supplement Number : 00 .• _,,...., _. Claim Number: 0805222310000001-01 Year: 2017 Category: Estimate Make: NISSAN Sub Category : Model: NV1500 SV Image FileName : cc124559266-1557949 332013.j pg VIN : 1 N6BFOKY2H N812101 Image Label : image Loss Date: 05/13/2019 .Jnsured: Milton Vance Iii Adjuster: Policy Number : 9100249083 Photo Taken Date : 2019-05-15T12:42:12 Vehicle Owner : Milton Vance Iii Supplement Number : 00 Claim Number: 0805222310000001-01 Year: 2017 Category: Estimate Make: NISSAN Sub Category : Model: NV1500 SV Image FileName : cc124559266-1557949329014.jpg VIN: 1N6BFOKY2HN812101 Image Label : image Loss Date: 05/13/2019 Insured: Milton Vance Iii Adjuster: Policy Number : 9100249083 Photo Taken Date : 2019-05-15T12:42:09 Vehicle Owner : Milton Vance Iii Supplement Number : 00 Claim Number: 0805222310000001-01 Year: 2017 Category: Estimate Make: NISSAN Sub Category : Model: NV1500 SV Image FileName : cc124559266-15579484 72022.j pg VIN: 1N6BFOKY2HN812101 Image Label : image Loss Date: 05/13/2019 Insured : Milton Vance Iii Adjuster: Policy Number : 9100249083 Photo Taken Date: 2019-05-15T12:27:52 Vehicle Owner : Milton Vance Iii Supplement Number : 00 Claim Number : 0805222310000001-01 Year : 2017 Category : Estimate Make : NISSAN Sub Category : Model : NV1500 SV Image FileName : cc124559266-155794847 4023.jpg VIN: 1N6BFOKY2HN812101 Image Label : image Loss Date : 05/13/2019 Insured : Milton Vance Iii Adjuster : Policy Number : 9100249083 Photo Taken Date : 201 9-05-15T12:27:54 Vehicle Owner : Milton Vance Iii Supplement Number : 00 Claim Number : 0805222310000001-01 Year : 2017 Category: Estimate Make : NISSAN Sub Category : Model : NV1500 SV Image FileName : cc124559266-155794933501 O.jpg VIN : 1N6BFOKY2HN812101 Image Label : image Loss Date : 05/13/2019 Insured: Milton Vance Iii Adjuster : Policy Number : 9100249083 Photo Taken Date : 2019-05-15T12:42:15 Vehicle Owner : Milton Vance Iii Supplement Number : 00 Claim Number: 0805222310000001 -01 Year : 2017 Category : Estimate Make : NISSAN Sub Category : Model : NV1500 SV Image FileName : cc124559266-1557948462030.jpg VIN : 1N6BFOKY2HN812101 Image Label : image Loss Date: 0511312019 Insured: Milton Vance Iii Adjuster : Policy Number: 9100249083 Photo Taken Date : 2019-05-15T12:27:42 Vehicle Owner : Milton Vance Iii Supplement Number : 00 ,. j l :,;,~;._<:c ":/))..., ·~C€L ~Nf~tf>.STS;)~O II/IP l.E VN . .2018 G 2 .,.11 WC E r;~vt:r ~~"£0 31Y 06/0612Dt8 T\lTAI rr~~ PN) ~)Co'ALJ:t:> sses.oo 34 STICIEll lllS11WCT\OWS 11 CWll"'J!!C'.:- bl!'-=--;n-y• l"IU.1•crrs11 ..... wu 111~ !~fX: Kr:R ISS'UED\ p;i1cA HISTC>AY f-(Oj !.11\lbt-~JVr:rNrn ~rr:1r.rnrc11 tn.!ru"'O M '¥=1EO·lt0 T1~l in.c!alrimi_;_iuoawi ..,..,.,.JHm'Jl"fUL- IJlli; 1) rucEc$rii:iu111 Mlii ,~ AS'1lt111111111.0W , JCOZ6Cl286 REGISTERED. QWNER VANCE' MILTONTKOMAS JH 6813:JONNIE'wAY F.AIR OAKS CA 9§62'8 LIENHOLDER . NISSAN MTR'ACPTCOR.P POBX25464B SACPAMENTO CA.. 95865 4 06/05/20~8 VA6060016 w R L 00154 .o005s 00220 A()O 060518 31 75109l2101 ~;mn11im:X'~ MifCll9~£!1CiiL 1!11CUS 11m11:~ew.D .- 'llltQa In~"".,.,._' ~~ 'IORmT Nil.. DQ.f'llll!IA 7-510sl2 • J.\"OnWIT tlSTRue:lll.~;.1.1..Q. ~r -'12.8 -~ 10111 9100 LB:. GA~ FR.~ JBS KG .. 3&2£: LS: ~ wrnl li245t70R17 £:-TfRES, 17X7 .5. ~ R!MS 'AT .so· P.Si" ~ COLD SIN~E ZGG,-;S, • _ - ~RR... . KG- - , 587-5: Lf - ~- wrn!>L ll4S"/-70Rlrl JIRE5 ,,_, = lJX.7. )\ Rif.IS AT ao~PSI ~ COLD SING\:[ - - 5 1HIS' VEHICl.:E .CONFORMS, T0'=-=- ·ALL APP-UCABLE ·F.EDERAL e: ·i"OTOR VEHIClE SAF.E'fY.. ~ 1 s:rAliDAADS-dN EFFECT. ON 5 ---0C: 1 IRE .OAiE :OF MMUFACTURE Sb@& \ SHO'ft'N ABOVE. _ . -· ~?4 1,. 1N6BF0KY.2tltr8"12101 ~iF TRUCK:- 1oms-- - I ·,.iboEL: :y[KVLCK.F80EµA---.- . -co.Loi: .QM TRIM: K zslQA. ~ '- :Z.019-0 5-15T12:44."21. Claim Number : 0805222310000001-01 Year : 2017 Category : Estimate Make : NISSAN Sub Category : Model: NV1500 SV Image FileName : cc124559266-1557949461012.jpg VIN: 1N6BFOKY2HN812101 Image Label : image Loss Date: 05/13/2019 Insured : Milton Vance Iii Adjuster : Policy Number : 9100249083 Photo Taken Date: 2019-05-15T12:44:21 Vehicle Owner : Milton Vance Iii Supplement Number : 00 Claim Number: 0805222310000001-01 Year : 2017 Category: Estimate Make: NISSAN Sub Category : Model: NV1500 SV Image FileName : cc124559266-1557949305015.jpg VIN: 1N6BFOKY2HN812101 Image Label : image Loss Date: 05/13/2019 Insured : Milton Vance Iii Adjuster: Policy Number : 9100249083 Photo Taken Date: 2019-05-15T12:41 :45 Vehicle Owner : Milton Vance Iii Supplement Number: 00 Claim Number : 0805222310000001-01 Year : 2017 Category : Estimate Make : NISSAN Sub Category : Model: NV1500 SV Image FileName : cc124559266-1557949261017 .jpg VIN: 1N6BFOKY2HN812101 Image Label : image Loss Date : 05/13/2019 Insured : Milton Vance Iii Adjuster : Policy Number : 9100249083 Photo Taken Date : 2019-05-15T12:41 :01 Vehicle Owner : Milton Vance Iii Supplement Number : 00 Claim Number: 0805222310000001 -01 Year: 2017 Categoiy: Estimate Make: NISSAN Sub Categoiy: Model: NV1500 SV Image FileName : cc124559266-1557949304018.jpg VIN: 1N6BFOKY2HN812101 Image Label : image Loss Date: 05/13/2019 Insured: Milton Vance Iii Adjuster: Policy Number : 9100249083 Photo Taken Date: 2019-0.5-15T12:41 :44 Vehicle Owner : Milton Vance Iii Supplement Number : 00 Claim Number : 0805222310000001-01 Year : 2017 Category : Estimate Make : NISSAN Sub Category : Model : NV1500 SV Image FileName : cc124559266-1557949296019.jpg VIN: 1N6BFOKY2HN812101 Image Label : image Loss Date: 05/13/2019 Insured : Milton Vance Iii Adjuster : Policy Number : 9100249083 Photo Taken Date : 2019-05-1 5T12:41 :36 Vehicle Owner : Milton Vance Iii Supplement Number : 00 Claim Number: 0805222310000001-01 Year: 2017 Category: Estimate Make: NISSAN Sub Category : Model: NV1500 SV Image FileName : cc124559266-1557949259020.jpg VIN: 1N6BFOKY2HN812101 Image Label : image Loss Date: 05/13/2019 Insured : Milton Vance Iii Adjuster: Policy Number : 9100249083 Photo Taken Date : 2019-05-15T12:40:59 Vehicle Owner : Milton Vance Iii Supplement Number: 00 ~~ ~ -----=;:. ........ l Claim Number : 0805222310000001-01 Year: 2017 Category: Estimate Make: NISSAN Sub Category: Model: NV1500 SV Image FileName : cc124559266-1557948476026.jpg VIN: 1N6BFOKY2HN812101 Image Label : image Loss Date: 05/13/2019 Insured : Milton Vance Iii Adjuster: Policy Number : 9100249083 Photo Taken Date : 2019-05-15T12:27:56 Vehicle Owner : Milton Vance Iii Supplement Number: 00 Claim Number: 0805222310000001-01 Year: 2017 Category: Estimate Make: NISSAN Sub Category : Model: NV1500 SV Image FileName : cc124559266-1557948467028.jpg VIN: 1N6BFOKY2HN812101 Image Label : image Loss Date: 0511312019 Insured : Milton Vance Iii Adjuster: Policy Number : 9100249083 Photo Taken Date : 2019-05-15T12:27:47 Vehicle Owner : Milton Vance Iii Supplement Number : 00 Claim Number: 0805222310000001-01 Year: 2017 Category : Supplement Make: NISSAN Sub Category : Model: NV Cargo 2500 HD S Standard Roof Image FileName : cc125038861-155968307 4000.jpg VIN: 1N6BFOKY2HN812101 Image Label : image Loss Date: 0511312019 Insured : Milton Vance Iii Adjuster: Brad Bost Policy Number : 9100249083 Photo Taken Date : 2019-06-04T14:17:54 Vehicle Owner : Milton Vance Iii Supplement Number : 01 Claim Number: 0805222310000001-01 Year : 2017 Category : Supplement Make: NISSAN Sub Category : Model : NV Cargo 2500 HD S Standard Roof Image FileName : cc125038861-1559588339002.j pg VIN : 1NSBFOKY2HN812101 Image Label : image Loss Date : 05/13/2019 Insured : Milton Vance Iii Adjuster: Brad Bost Policy Number : 9100249083 Photo Taken Date : 2019-06-03T11 :58:59 Vehicle Owner : Milton Vance Iii Supplement Number: 01 Claim Number: 0805222310000001-01 Year: 2017 Category: Supplement Make: NISSAN Sub Category : Model: NV Cargo 2500 HD S Standard Roof Image FileName : cc125038861-1559683070001.jpg VIN: 1N6BFOKY2HN812101 Image Label : image Loss Date: 05/13/2019 Insured: Milton Vance Iii Adjuster: Brad Bost Policy Number : 9100249083 Photo Taken Date : 2019-06-04T14:17:50 Vehicle Owner : Milton Vance Iii Supplement Number : 01 Claim Number : 0805222310000001-01 Year : 2017 Category : Supplement Make : NISSAN Sub Category : Model : NV Cargo 2500 HD S Standard Roof Image FileName : cc125038861-1559588342003.jpg VIN : 1N6BFOKY2HN812101 Image Label : image Loss Date : 05/13/2019 Insured : Milton Vance Iii Adjuster: Brad Bost Policy Number : 9100249083 Photo Taken Date : 2019-06-03T11 :59:02 Vehicle Owner : Milton Vance Iii Supplement Number : 01 ..,,.. Claim Number: 0805222310000001-01 Year: 2017 Category: Supplement Make: NISSAN Sub Category : Model: NV Cargo 2500 HD S Standard Roof Image FileName : cc125038861-1559588032017.jpg VIN: 1N6BFOKY2HN812101 Image Label : image Loss Date: 05/13/2019 Insured: Milton Vance Iii Adjuster: Brad Bost Policy Number : 9100249083 Photo Taken Date : 2019-06-03T11 :53:52 Vehicle Owner : Milton Vance Iii Supplement Number: 01 -~-__ I :Wt9·0lCA 2.019-06,()3111 ':~3:34 Claim Number : 0805222310000001-01 Year: 2017 Category: Supplement Make: NISSAN Sub Category : Model: NV Cargo 2500 HD S Standard Roof Image FileName : cc125038861-1559588014018.jpg VIN: 1N6BFOKY2HN812101 Image Label : image Loss Date : 05/1 3/2019 Insured: Milton Vance Iii Adjuster: Brad Bost Policy Number : 9100249083 Photo Taken Date : 2019-06-03T11 :53:34 Vehicle Owner : Milton Vance Iii Supplement Number : 01 Claim Number : 0805222310000001 -01 Year : 2017 Category: Supplement Make : NISSAN Sub Category : Model : NV Cargo 2500 HD S Standard Roof Image FileName : cc125038861-1559588346004.jpg VIN: 1N6BFOKY2HN812101 Image Label : image Loss Date: 05/13/2019 Insured: Milton Vance Iii Adjuster : Brad Bost Policy Number : 9100249083 Photo Taken Date : 2019-06-03T11 :59:06 Vehicle Owner : Milton Vance Iii Supplement Number: 01 Claim Number : 0805222310000001-01 Year: 2017 Category : Supplement Make: NISSAN Sub Category : Model : NV Cargo 2500 HD S Standard Roof Image FileName : cc125038861-1559588354005.jpg VIN: 1N6BFOKY2HN812101 Image Label : image Loss Date: 05/13/2019 Insured: Milton Vance Iii Adjuster : Brad Bost Policy Number : 9100249083 Photo Taken Date : 2019-06-03T11:59:14 Vehicle Owner : Milton Vance Iii Supplement Number: 01 Claim Number : 0805222310000001-01 Year: 2017 Category : Supplement Make: NISSAN Sub Category : Model : NV Cargo 2500 HD S Standard Roof Image FileName : cc125038861-1559588351006.jpg VIN : 1N6BFOKY2HN812101 Image Label : image Loss Date: 05/13/2019 Insured: Milton Vance Iii Adjuster: Brad Bost Policy Number : 9100249083 Photo Taken Date : 2019-06-03T11 :59:11 Vehicle Owner : Milton Vance Iii Supplement Number : 01 Claim Number : 0805222310000001-01 Year: 2017 Category : Supplement Make : NISSAN Sub Category : Model: NV Cargo 2500 HD S Standa~d Roof Image FileName : cc125038861-1559588361008.jpg VIN: 1N6BFOKY2HN812101 Image Label : image Loss Date : 05/13/2019 Insured: Milton Vance Iii Adjuster : Brad Bost Policy Number : 9100249083 Photo Taken Date : 2019-06-03T11 :59:21 Vehicle Owner : Milton Vance Iii Supplement Number : 01 :~s-~· 1·~· ' lj . , I \~-.;->.:~ ' --- @ Claim Number : 0805222310000001-01 Year: 2017 Category: Supplement Make: NISSAN Sub Category : Model : NV Cargo 2500 HD S Standard Roof Image FileName : cc125038861-1559588023016.jpg VIN : 1N6BFOKY2HN812101 Image Label : image Loss Date : 05/13/2019 Insured: Milton Vance Iii Adjuster: Brad Bost Policy Number : 9100249083 Photo Taken Date : 2019-06-03T11 :53:43 Vehicle Owner : Milton Vance Iii Supplement Number : 01 Claim Number : 0805222310000001-01 Year : 2017 Category : Supplement Make : NISSAN Sub Category : Model: NV Cargo 2500 HD S Standard Roof Image FileName : cc125038861-1559588042014.jpg VIN : 1N6BFOKY2HN812101 Image Label : image Loss Date : 05/13/2019 Insured : Milton Vance Iii Adjuster : Brad Bost Policy Number : 9100249083 Photo Taken Date : 2019-06-03T11 :54:02 Vehicle Owner : Milton Vance Iii Supplement Number : 01 ti zo1'ii-o~Hln11;~9;~. Claim Number : 0805222310000001-01 Year: 2017 Category: Supplement Make: NISSAN Sub Category : Model: NV Cargo 2500 HD S Standard Roof Image FileName : cc125038861-1559588363007.jpg VIN : 1N6BFOKY2HN812101 Image Label : image Loss Date: 05/13/2019 Insured: Milton Vance Iii Adjuster : Brad Bost Policy Number : 9100249083 Photo Taken Date : 2019-06-03T11 :59:23 Vehicle Owner : Milton Vance Iii Supplement Number: 01 2.019,()(;,QSTr.?:11 :za. Claim Number : 0805222310000001-01 Year: 2017 Category: Supplement Make: NISSAN Sub Category: Model: NV Cargo 2500 HD S Standard Roof Image FileName : cc125038861-155958908301 O.jpg VIN: 1N6BFOKY2HN812101 Image Label : image Loss Date: 05/13/2019 Insured: Milton Vance Iii Adjuster: Brad Bost Policy Number : 9100249083 Photo Taken Date: 2019-06-03T12:11 :23 Vehicle Owner : Milton Vance Iii Supplement Number: 01 Claim Number : 0805222310000001-01 Year: 2017 Category : Supplement Make: NISSAN Sub Category : Model: NV Cargo 2500 HD S Standard Roof Image FileName : cc125038861-1559589090011 .jpg VIN: 1N6BFOKY2HN812101 Image Label : image Loss Date: 05/13/2019 Insured : Milton Vance Iii Adjuster: Brad Bost Policy Number : 9100249083 Photo Taken Date: 2019-06-03T12:11 :30 Vehicle Owner : Milton Vance Iii Supplement Number : 01 Claim Number: 0805222310000001-01 Year: 2017 Category: Supplement Make: NISSAN Sub Category : Model: NV Cargo 2500 HD S Standard Roof Image FileName : cc125038861-1559588039013.jpg VIN: 1N6BFOKY2HN812101 Image Label: image Loss Date: 05/13/2019 Insured : Milton Vance Iii Adjuster: Brad Bost Policy Number : 9100249083 Photo Taken Date: 2019-06-03T11 :53:59 Vehicle Owner : Milton Vance Iii Supplement Number: 01 OHlBrr D GEICO SAN DIEGO Request a supplement at partners.geico.com partners.geico.com/gvbps/Logon.aspx 14111 DANIELSON STREET POWAY, CA 92064 Phone: (916) 601-5487 Claim#: Workfile ID: 0805222310000001-01 15b3b0b4 Supplement of Record 1 Summary Written By: BRADLEY BOST, 6/4/2019 3:00:29 PM Adjuster: DOOC Insured: Milton Vance Iii Collision Owner Policy #: Claim#: 0805222310000001-01 Type of Loss: Point of Impact: 12 Front Date of Loss: Deductible: 05/13/2019 12:00 AM 500.00 Owner (Insured): Inspection Location: Appraiser Information: (916) 601-5487 Miiton Vance Iii Caliber Sibley Folsom Caliber Sibley Folsom 1128 SIBLEY ST FOLSOM, CA 95630 Drive-in (916) 985-6002 Day VEHICLE 2017 NISS NV Cargo 2500 HD S Standard Roof 3D VAN 6-4.0L Gasoline Sequential MPI WHITE VIN: License: State: TRANSMISSION 1N6BFOKY2HN812101. 75109L2 CA Production Date: Odometer: Condition: AIR CONDmONING 9976 PASSENGER AIR BAG Days to Repair: 5 Repair Facility: CALIBER COLLISION SIBLEY 1128 SIBLEY FOLSOM FOLSOM, CA 95630 (916) 985-6002 Evening 330728858 Federal ID Interior Color: Exterior Color: WHITE DUAL MIRRORS AUTOMATIC TRANSMISSION RADIO FRONT SIDE IMPACT AIR BAGS TINTED GLASS DRIVER CONVENIENCE AM RADIO HEAD/CURTAIN AIR BAGS SEATS MESSAGE CENTER FM RADIO PAINT CLOTH SEATS POWER MIRRORS STEREO CLEARCOAT PAINT CAPTAIN CHAIRS (2) INTERMITTENT WIPERS SEARCH/SEEK FRONT END WHEELS TILT WHEEL CD PLAYER POWER STEERING 4-WHEEL DISC BRAKES INSTRUMENT PANEL AUXILIARY AUDIO CONNECTION POWER BRAKES STYLED STEEL WHEELS TRACTION CONTROL SAFETY ANTI-LOCK BRAKES (4) TRUCK & TOWING STABILITY CONTROL DRIVERS SIDE AIR BAG GLASS & MIRRORS REAR STEP BUMPER 6/4/2019 3:00:30 PM 133201 I 1.7.04.10120 Page 1 Supplement of Record 1 Summary 2017 NISS NV Cargo 2500 HD S Standard Roof 3D VAN 6-4.0L Gasoline Sequential MPI WHITE Line Op er Description 1 FRONT BUMPER 2 3 * 4 5 6 7 8 9 10 ** 11 12 -13 14 GRILLE O/H front bumper Repl Bumper black S01 Repl RT Inner bracket Repl RT Outer bracket Repl LT Outer bracket S01 Repl RT Upper bracket all Repl RT Side bracket #2 Repl RT Side bracket #1 Repl Non OEM Upper cover Add for Clear Coat R&I License bracket S01 Repl Cover reinf Part Number 620221PAOA 622161PAOA 622241PAOA 622251PAOA 622201PAOA 622261PAOA 622221PAOA NI1014101 962101PAOA 622909JHOA Qty 1 1 1 1 1 1 1 1 1 Claim#: Workfile ID: Extended Price$ 448.44 47.02 13.13 16.40 18.45 11.87 38.44 362.00 336.09 0805222310000001-01 15b3b0b4 Labor 1.4 Incl. 0.1 0.1 0.1 Incl. 0.2 0.3 Paint 1.2 0.5 15 -~-- _ -~-Non OEM_~rille black NI12002710E 1 465.00 Incl. !1.Q 16 FRONT LAMPS 17 ** Repl Non OEM NSF RT Headlamp assy 18 .. ~im.~eadlanp~ 19 RADIATOR SUPPORT 20 21 22 # 23 24 25 S01 R&I Upper tie bar Repl RT Side panel R&I SET BACK WIRING S01 R&I Lower tie bar S01 R&I Under cover S01 R&I Sight shield 26 S01 27 COOLING 28 S01 R&I Radiator NI2503209 F25121PAMB F25201PAMA F25301PAMB 508101PAOB 628211PAOA 628221PAOA 214601PAOA NOTE: ACCESS TO REPAIR RT INNER FENDER PANEL 29 30 S01 R&I Shroud assy S01 R&I Trans cooler 31 _ __?.01 -· R&I_ . R~servoir as~y 32 AIR CONDITIONER & HEATER 33 34 35 HOOD 36 37 38 39 * S01 R&I Condenser SOl R_':_Pi AC ~e.r:'.!~~.~~acl:!_~t~ & r~ch~ge Repl Hood (HSS) Add for Clear Coat Add for Underside(Complete) SOl Repl USED RT Hinge +25% 214769JEOB 216061PE1B 217101PE1A 921001PAOA 651001PAOA .-v207732761 NOTE: HOOD OVELAPS LT FENDER 6/4/2019 3:00:30 PM 133201 I 1.7.04.10120 1 1 245.27 190.02 s s m m m m m 1 m 1 1,038.31 1 31.25 0.3 0.5 0.3 3.0 0.2 0.3 Incl. 0.2 0.1 2.8 Incl . 0.6 Incl. 0.8 1.4 0.9 0.7 2.4 1.0 1.2 0.3 Page 2 Claim#: 0805222310000001-01 Workfile ID: 15b3b0b4 Supplement of Record 1 Summary 2017 NISS NV Cargo 2500 HD S Standard Roof 3D VAN 6-4.0L Gasoline Sequential MPI WHITE 40 SOl Add for Clear Coat 0.1 41 * SOl Rep! USED LT Hinge +25% ~207732760 31.25 0.3 0.3 NOTE: HOOD OVELAPS LT FENDER 42 SOl Add for Clear Coat 0.1 ...... ·-·· ·--·-·-· 43 FENDER 44 Rep! RT Fender 631001PAOA 1 342.33 1.2 2.0 45 Overlap Major Adj. Panel -0.4 46 Add for Clear Coat 0.3 47 Add for antenna 0.4 48 Add for Edging 0.5 49 Add for Clear Coat 0.1 50 Rep I RT Fender liner 638301PAOA 1 84.13 Incl. 51 Rep! RT Liner extension 638401PAOA 1 79.27 Incl. 52 R&I RT Mud guard 638501PAOA 0.2 53 SOl Rep! RT Front reinf F41801PAMA 1 160.20 s 2.5 54 * SOl Rpr RT Upper panel 641101PAOA s 4.0 NOTE: 1 HR FLOOR SET/PULL 3HR DAMAGE REPAIR ·- . ·---··· -- . .. - -· .. ·- .,._.,. . 55 ELECTRICAL 56 * SOl Rpr Engine harness 4.0 liter 240119JEOA 2.0 NOTE: NUMEROUS WIRES DAMAGED 57 S01 R&I Battery all 24410ZZ50B m 0.3 58 * SOl R&I Fuse & relay box 243827S110 0.4 59 SOl R&I ECM all 237039BMOA m 0.5 NOTE: ACCESS FOR FENDER REPAIRS --- --·---· ·--~--· ·----·-- _,. _____ --------· --·- -- ---- . - - ·--~-· - ···--·- .. ··------ 60 FRAME 61 -~~1 _ _R..ep! Crossmember #1 E10101PAMA 1 208.31 2.5 ----- ---- .. -··- .. - ·-- .. . .. 62 TIRES 63 * SOl Rep I FIRE LT245/70R17 119/116R E FI04066 1 196.24 0.3 Transforce HT BW 119R B25% +25% ·- -· - -·- - - - .. · ·-· -- . - ~ .. . -· -· -· ... 64 COWL 65 S01 R&I RT Cowl grille 668101PAOA 0.5 ·--·- . - - . -- .. 66 FRONT DOOR 67 Bind RT Outer panel 801521PAOA 1.3 NOTE: FRT EDGE CHIPING FROM FENDER 68 R&I RT Belt molding 808201PAOA 0.3 69 R&I RT R&I mirror 963011PA7E 0.3 70 R&I RT Run channel 803301PAOA 0.3 71 R&I RT Handle black 80640ZS05A 0.4 NOTE: ACCESS THROUGH DOOR PLUG NO TRIM PANEL NEEDED _ .. ... --- ·------· -- .... . -- . -- ·- ----··· .... ..... .. . .. . 72 MISCELLANEOUS OPERATIONS 73 # Agreement Reached 1 74 # Rep I COVER CAR COMPLETE 1 0.2 6/4/2019 3:00:30 PM 133201 I 1.7.04.10120 Page 3 Claim#: Workfile ID: Supplement of Record 1 Summary 2017 NISS NV Cargo 2500 HD S Standard Roof 3D VAN 6-4.0L Gasoline Sequential MPI WHITE 75 # __ ·- _Repl --- -~ --· - 76 OTHER CHARGES 77 # Prior Damage Notes: Front Bumper - Lt Fender - FLEX ADDITIVE . -------- E.P.C. Lt Frt Door - HANDLE SCRATCHES Lt Rear Door - Lt Qtr- Rear Bumper - REAR DOORS-LT DOOR IMPACT DAMAGE .. - --··· Rt Qtr - IMPACT DAMAGE UPPER CENTER AND LOWER REAR Rt Rear Door - DENT CENTER Rt Frt Door - Rt Fender- Hood- Glass- Roof- Wheels- other- ESTIMATE TOTALS Category Parts Body Labor Paint Labor Paint Supplies Miscellaneous Other Charges Subtotal Sales Tax Total Cost of Repairs Deductible .. ... .. SUBTOTALS NOTES FIRE LT245/70Rl7 119/116R E Transforce HT BW 119R 825% +25% Total Adjustments Net Cost of Repairs 6/4/2019 3:00:30 PM 133201 I 1.7.04.10120 1 5.00 T 1 3.00 4 ,371.42 Basis 30.3 hrs @ 11.8 hrs @ 11.8 hrs @ $ 4,734.22 @ 0805222310000001-01 15b3b0b4 30.3 Rate $ 70.00 /hr $ 70.00 /hr $ 31.00 /hr 7.7500 % 11.8 Cost $ 4,363.42 2,121.00 826.00 365.80 5.00 3.00 7,684.22 366.90 8,051.12 500.00 52.86 552.86 7,498.26 Page 4 Supplement of Record 1 Summary 2017 NISS NV Cargo 2500 HD S Standard Roof 3D VAN 6-4.0L Gasoline Sequential MPI WHITE SUPPLEMENT SUMMARY Line Added Items 4 7 13 20 23 24 25 26 27 COOLING Oper Description SOl Repl RT Inner bracket SOl Repl RT Upper bracket all SOl Repl Cover reinf SOl R&I Upper tie bar SOl R&I Lower tie bar SOl R&I Under cover SOl R&I Sight shield SOl R&I RJ:.~i~ 2uide 28 S01 R&I Radiator Part Number 622161PAOA 622201PAOA 622909JHOA F25121PAMB F25301PAMB 508101PAOB 628211PAOA 628221PAOA 214601PAOA NOTE: ACCESS TO REPAIR RT INNER FENDER PANEL 29 30 SOl R&I Shroud assy 214769JEOB SOl R&I Trans cooler 216061PE1B _ ~·--·- _ SOl _ R&I _Rese~oir_assy _ _ -----. ____ -··-· _ 32 AIR CONDITIONER & HEATER 33 SOl R&I Condenser 34 39 * 40 41 * 42 53 54 * SOl Repl AC Service evacuate & recharge SOl Repl USED RT Hinge +2S% NOTE: HOOD OVELAPS LT FENDER SOl Add for Clear Coat SOl Repl USED LT Hinge +25% NOTE: HOOD OVELAPS LT FENDER SOl Add for Clear Coat SOl Repl RT Front reinf SOl Rpr RT Upper panel NOTE: 1 HR FLOOR SET/PULL 3HR DAMAGE REPAIR 55 56 ELECTRICAL * SOl Rpr Engine harness 4.0 liter 57 58 * 59 60 FRAME 61 62 63 TIRES * NOTE: NUMEROUS WIRES DAMAGED SOl R&I Battery all SOl R&I Fuse & relay box SOl R&I ECM all NOTE: ACCESS FOR FENDER REPAIRS SOl SOl Repl FIRE LT245/70Rl7 119/116R E Transforce HT BW 119R B25% 217101PE1A 921001PAOA .v207732761 .v207732760 F41801PAMA 641101PAOA 240119JEOA 24410ZZ50B 243827S110 237039BMOA E10101PAMA FI04066 6/4/2019 3:00:30 PM 133201 I 1.7.04.10120 Qty 1 1 1 1 1 1 1 1 1 Claim#: Workfile ID: Extended Price$ 47.02 18.45 336.09 31.25 31.25 s m m m m m m 160.20 s s m m 208.31 0805222310000001-01 15b3b0b4 Labor 0.1 0.3 0.3 0.3 I ncl. 0.2 0.1 2.8 Incl. 0.6 Incl. O.B 1.4 0.3 2.5 1,Jl 0.3 0.4 0.5 2.5 0.3 Paint 0.1 0.3 0.1 Page 5 Supplement of Record 1 Summary 2017 NISS NV Cargo 2500 HD S Standard Roof 3D VAN 6-4.0L Gasoline Sequential MPI WHITE +25% · - -- -- ··· ..... .. . - ·-·~ . .. .. -. - ··- .... . , 64 COWL 65 S01 R&I RT Cowl grille 668101PAOA SUBTOTALS NOTES Prior Damage Notes: Front Bumper - Lt Fender - Lt Frt Door - HANDLE SCRATCHES Lt Rear Door - Lt Qtr - Rear Bumper - REAR DOORS-LT DOOR IMPACT DAMAGE Rt Qtr - IMPACT DAMAGE UPPER CENTER AND LOWER REAR Rt Rear Door - DENT CENTER Rt Frt Door- Rt Fender - Hood- Glass- Roof- Wheels- Other- RATE CHANGES Body Labor (Est) 9.8 hrs @ $ -4.76 /hr 74.76 Paint Labor (Est) 11.0 hrs @ $ -4.76 /hr 74.76 Paint Supplies (Est) 11.0 hrs @ $ -4.30 /hr 35.30 6/4/2019 3:00:30 PM 133201 I 1.7.04.10120 Claim#: Workfile ID: 1,028.81 to 70.00) to 70.00) to 31.00 ) 0805222310000001-01 15b3b0b4 0.5 20.5 0.8 -46.65 -52.36 -47.30 Page 6 Claim#: Workfile ID: Supplement of Record 1 Summary 2017 NISS NV Cargo 2500 HD S Standard Roof 3D VAN 6-4.0L Gasoline Sequential MPI WHITE 6/4/2019 3:00:30 PM TOTALS SUMMARY Category Parts Body Labor Paint Labor Additional Supplement Labor Paint Supplies Additional Supplement Materials/Supplies Subtotal Sales Tax Total Supplement Amount FIRE LT245/70R17 119/116R E Transforce HT BW 119R B25% +25% Supplement Adjustments NET COST OF SUPPLEMENT Basis 20.5 hrs @ 0.8 hrs @ 0.8 hrs @ $ 1,006.31 @ CUMULATIVE EFFECTS OF SUPPLEMENT(S) Estimate 5,574.83 BRADLEY BOST Supplement SOl 2,476.29 BRADLEY BOST Workfile Total: $ 8,051.12 TOTAL ADJUSTMENTS: $ 552.86 NET COST OF REPAIRS: $ 7,498.26 133201 I 1.7.04.10120 0805222310000001-01 15b3b0b4 Rate $ 70.00 /hr $ 70.00 /hr $ 31.00 /hr 7.7500 % Cost$ 1,028.81 1,435.00 56.00 -99.01 24.80 -47.30 2,398.30 77.99 2,476.29 52.86 52.86 2,423.43 Page 7 Claim # : Workfile ID: 0805222310000001-01 15b3b0b4 Supplement of Record 1 Summary 2017 NISS NV Cargo 2500 HD S Standard Roof 3D VAN 6-4.0L Gasoline Sequential MPI WHITE No Supplement will be honored unless authorized by GEICO. NOTICE: Vehicles constructed of special metals may require the use of specialized welding and bonding equipment. Proper measuring and structural repair systems are required on today's vehicle to accurately accomplish vehicle repairs. Make sure your shop has the proper equipment to repair your vehicle. ALTERNATE PARTS DISCLAIMER: IF A QUALITY REPLACEMENT PART (A/ M, LKQ, RECOND OR OPT OEM) APPEARS ON THIS ESTIMATE, IT INDICATES THAT THIS ESTIMATE HAS BEEN PREPARED BASED ON THE USE OF ONE OR MORE CRASH PARTS SUPPLIED BY A SOURCE OTHER THAN THE MANUFACTURER OF YOUR MOTOR VEHICLE. GUARANTEES, IF ANY, APPLICABLE TO THESE REPLACEMENT CRASH PARTS ARE PROVIDED BY THE PART MANUFACTURER OR DISTRIBUTOR RATHER THAN BY THE MANUFACTURER OF YOUR VEHICLE. ***IN ADDITION TO ANY SUCH GUARANTEES, GEICO PROVIDES THE FOLLOWING: ****OWNER LIMITED GUARANTEE**** WE GUARANTEE THAT ALL QUALITY REPLACEMENT BODY PARTS (PARTS NOT MANUFACTURED,.,...BY THE MANUFACTURER) IDENTIFIED ON YOUR ESTIMATE, ARE FREE OF DEFECTS IN MATERIAL AND WORKMANSHIP AND MEET GENERALLY ACCEPTED INDUSTRY STANDARDS. THIS PARTS AND LABOR GUARANTEE WILL BE IN EFFECT FOR AS LONG AS YOU OWN THE VEHICLE DESCRIBED IN THE ESTIMATE. THIS GUARANTEE COVERS THE COST OF THE PART, LABOR TO INSTALL, AND INCIDENTALS SUCH AS PAINT AND MATERIALS AND IS SPECIFICALLY LIMITED TO THOSE ITEMS. THIS GUARANTEE DOES NOT COVER LOSS OR DAMAGE THAT IS UNRELATED TO DEFECTS IN THE QUALITY REPLACEMENT PARTS. THIS IS NOT TRANSFERABLE. IF ANY QUALITY REPLACEMENT PARTS ARE DEFECTIVE IN EITHER MATERIAL OR WORKMANSHIP, CONTACT YOUR LOCAL GEICO REPRESENTATIVE. 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. CCC ONE: 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, 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. OPT OEM=ORIGINAL EQUIPMENT MANUFACTURER PARTS EITHER OPTIONALLY SOURCED OR OTHERWISE PROVIDED WITH SOME UNIQUE PRICING OR DISCOUNT. "CURE TIME" MEANS THE LENGTH OF TIME THAT, PER THE ADHESIVE MANUFACTURER, THE WINDSHIELD ADHESIVE NEEDS TO CURE UNTIL THE WINDSHIELD CAN PROPERLY FUNCTION AS A SAFETY DEVICE PURSUANT TO THE FEDERAL MOTOR VEHICLE SAFETY STANDARDS AND THE VEHICLE MANUFACTURER'S SPECIFICATIONS. 6/4/2019 3:00:30 PM 133201 I 1.7.04.10120 Page 8 Claim#: Workfi le ID: 0805222310000001-01 15b3b0b4 Supplement of Record 1 Summary 2017 NISS NV Cargo 2500 HD S Standard Roof 3b VAN 6-4.0L Gasoline Sequential MPI WHITE 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. Estimate based on MOTOR CRASH ESTIMATING GUIDE and potentially other third party sources of data. Unless otherwise noted, (a) all items are derived from the Guide ARF3628, CCC Data Date 5/16/2019, and potentially other third party sources of data; and (b) the parts presented are OEM-parts. OEM parts are manufactured by or for the vehicle's Original Equipment Manufacturer (OEM) according to OEM's specifications for U.S. distribution. OEM parts are available at OE/Vehicle dealerships or the specified supplier. 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 with discounted pricing. Asterisk(*) or Double Asterisk(**) indicates that the parts and/or labor data provided by third party sources of data may have been modified or may have come from an alternate data source. Tilde sign("') items indicate MOTOR Not-Included Labor operations. The symbol (<>)indicates the refinish operation WILL NOT be performed as a separate procedure from the other panels in the estimate. Non-Original Equipment Manufacturer aftermarket parts are described as Non OEM, A/M or NAGS. Used parts are described as LKQ, RCY, or USED. Reconditioned parts are described as Recond. Recored parts are described as Recore. NAGS Part Numbers and Benchmark Prices are provided by National Auto Glass Specifications. Labor operation times listed on the line with the NAGS information are MOTOR suggested labor operation times. NAGS labor operation times are not included. Pound sign (#) items indicate manual entries. Some 2019 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 CCC ONE estimator has a list of applicable vehicles. Parts numbers and prices should be confirmed with the local dealership. The following is a list of additional abbreviations or symbols that may be used to describe work to be done or parts to be repaired or replaced: SYMBOLS FOLLOWING PART PRICE: m=MOTOR Mechanical component. s=MOTOR Structural component. T= Miscellaneous Taxed charge category. X=Miscellaneous Non-Taxed charge category. · SYMBOLS FOLLOWING LABOR: D=Diagnostic labor category. E=Electrical labor category. F=Frame labor category. G=Glass labor category. M=Mechanical labor category. S=Structural labor category. (numbers) 1 through 4=User Defined Labor Categories. OTHER SYMBOLS AND ABBREVIATIONS: Adj. =Adjacent. Algn.=Align. ALU=Aluminum. A/M=Aftermarket part. Blnd=Blend. BOR=Boron steel. CAPA=Certified Automotive Parts Association. D&R=Disconnect and Reconnect. HSS=Hlgh Strength Steel. HYD= Hydroformed Steel. Incl.=Included. LKQ=Like Kind and Quality. LT=Left. MAG=Magnesium. Non-Adj.=Non Adjacent. NSF=NSF International Certified Part. O/H=Overhaul. Qty=Quantity. Refn=Refinish. Repl=Replace. R&I=Remove and Install. R&R=Remove and Replace. Rpr=Repair. RT=Right. SAS=Sandwiched Steel. Sect=Section. Subl=Sublet. UHS=Ultra High Strength Steel. N=Note(s) associated with the estimate line. 6/4/2019 3:00:30 PM 133201 I 1.7.04.10120 Page 9 Claim#: Workfile ID: 0805222310000001-01 15b3b0b4 Supplement of Record 1 Summary 2017 NISS NV Cargo 2500 HD S Standard Roof 3D VAN 6-4.0L Gasoline Sequential MPI WHITE CCC ONE Estimating - A product of CCC Information Services Inc. The following is a list of abbreviations that may be used in CCC ONE Estimating that are not part of the MOTOR CRASH ESTIMATING GUIDE: BAR=Bureau of Automotive Repair. EPA=Environmental Protection Agency. NHTSA= National Highway Transportation and Safety Administration. PDR=Paintless Dent Repair. VIN=Vehicle Identification Number .. WE WARRANT THAT ALL PARTS USED IN THE REPAIR OF THIS VEHICLE ARE EQUAL TO THE ORIGINAL EQUIPMENT MANUFACTURER PARTS IN TERMS OF KIND, QUALITY, SAFETY, FIT AND PERFORMANCE. THIS PARTS AND LABOR WARRANTY WILL BE IN EFFECT FOR AS LONG AS YOU OWN THE VEHICLE DESCRIBED IN THE ESTIMATE. THIS WARRANTY COVERS THE COST ASSOCIATED WITH RETURNING THE PART AND THE COST TO REMOVE AND REPLACE THE NON-ORIGINAL EQUIPMENT MANUFACTURER PART WITH A COMPLIANT NON-ORIGINAL EQUIPMENT PART OR AN ORIGINAL EQUIPMENT MANUFACTURER PART. THIS WARRANTY DOES NOT COVER LOSS OR DAMAGE THAT IS UNRELATED TO DEFECTS IN THE QUALITY REPLACEMENT PARTS. THIS WARRANTY IS NOT TRANSFERABLE. IF ANY QUALITY REPLACEMENT PARTS ARE DEFECTIVE IN EITHER MATERIAL OR WORKMANSHIP, YOU MUST CONTACT YOUR LOCAL GEICO REPRESENTATIVE. If a customer subsequently chooses a repair shop, GEICO shall prepare a supplement using the prevailing rate in the Geographic Area of the customer's chosen shop. This is not an authorization to repair. The undersigned repair facility is in agreement to the estimate prepc:ired by GEICO in the amount of$ . No supplements will be honored by GEICO without prior approval. Signed: _______ _ _ Print Name: _ _ _____ _ Date: _ _ _____ _ _ _ We are required under sect 2695. 7(b) of the Unfair Claims Settlement Practices Regulations to provide the following notice: If you believe that your claim has been wrongfully denied or rejected, you also have the right to have the California Department of Insurance review this matter. The Department of Insurance is located at 300 South Spring Street, Los Angeles, CA 90013, telephone number (800) 927-4357. 6/4/2019 3:00:30 PM 133201 I 1.7.04.10120 Page 10 Supplement of Record 1 Summary 2017 NISS NV Cargo 2500 HD S Standard Roof 3D VAN 6-4.0L Gasoline Sequential MPI WHITE ALTERNATE PARTS SUPPLIERS Line Supplier Description 10 KEYSTONE - STOCKTON, CA # NI1014101 1627 ARMY COURT Non OEM Upper cover STOCKTON CA 95206 Quote: 356641095 (209) 948-1101 Expires: 06/28/19 15 KEYSTONE - STOCKTON, CA #NI12002710E 1627 ARMY COURT Non OEM Grille black STOCKTON CA 95206 Quote: 356641095 (209) 948-1101 Expires: 06/28/19 17 1001 Best Autolite Dist. #NI2503209 Crystal Springs Rd Non OEM NSF RT Headlamp assy San Dimas CA 91773 Quote: 429193838 (866) 567-3500 Expires: 05/21/19 39 LKQ Northern CA (Redding) #r.1207732761 2850 Viking Way USED RT Hinge +25% Redding CA 96003 Hood Hinge R, R.,S#$C1737 (800) 424-2002 Quote: 364295405 Expires: 07/17/19 41 LKQ Northern CA (Redding) #r.1207732760 2850 Viking Way USED LT Hinge +25% Redding CA 96003 Hood Hinge L, L.,S#$C1737 (800) 424-2002 Quote: 364295405 Expires: 07/17/19 6/4/2019 3:00:30 PM 133201 I 1.7.04.10120 Claim#: Workfile ID: 0805222310000001-01 15b3b0b4 Price $ 362.00 $ 465.00 $ 245.27 $ 25.00 $ 25.00 Page 11 Claim # : Workfile ID: Supplement of Record 1 Summary 2017 NISS NV Cargo 2500 HD S Standard Roof 3D VAN 6-4.0L Gasoline Sequential MPI WHITE Line Supplier 63 Big 0 199 S HARDING BLVD ROSEVILLE CA 95678 (916) 784-2219 6/4/2019 3:00:30 PM TIRE PARTS SUPPLIERS Description FIRE LT245/70R17 119/116R E Transforce HT BW 119R B25% +25% 133201 I 1.7.04.10120 0805222310000001-01 15b3b0b4 Price $ 196.24 Page 12 Supplement of Record 1 Summary 2017 NISS NV Cargo 2500 HD S Standard Roof 3D VAN 6-4.0L Gasoline Sequential MPI WHITE ALTERNATE PARTS USAGE 2017 NISS NV Cargo 2500 HD S Standard Roof 3D VAN 6-4.0L Gasoline Sequential MPI WHITE VIN: License: State: 1N6BFOKY2HN812101 75109L2 CA Alternate Part Type Aftermarket Optional OEM Reconditioned Recycled 6/4/2019 3:00:30 PM Production Date: Odometer: 9976 Condition: # Of Available Parts 8 0 0 3 133201 I t.7.04.10120 Claim#: Workfile ID: Interior Color: Exterior Color: 0805222310000001-01 15b3b0b4 WHITE # Of Parts Selected 3 0 0 2 Page 13 GEICO SAN DIEGO Request a supplement at partners.geico.com partners.geico.com/gvbps/Logon.aspx 14111 DANIELSON STREET POWAY, CA 92064 Phone: (916) 601-5487 Estimate of Record Written By: BRADLEY BOST, 5/15/2019 3:37:59 PM Adjuster: DOOC Claim#: Workfile ID: 0805222310000001-01 15b3b0b4 Insured: Milton Vance Iii Collision Owner Policy#: Claim#: 0805222310000001-01 Type of Loss: Point of Impact: 12 Front Date of Loss: Deductible: 05/13/2019 12:00 AM 500.00 Owner (Insured): Inspection Location: Appraiser Information: (916) 601-5487 Milton Vance Iii Caliber Sibley Folsom Caliber Sibley Folsom 1128 SIBLEY ST FOLSOM, CA 95630 Drive-in (916) 985-6002 Day VEHICLE 2017 NISS NV Cargo 2500 HD S Standard Roof 3D VAN 6-4.0L Gasoline Sequential MPI WHITE VIN: License: State: TRANSMISSION 1N6BFOKY2HN812101 75109L2 CA Production Date: Odometer: Condition: AIR CONDmONING 9976 PASSENGER AIR BAG Days to Repair : 5 Repair Facility: CUSTOMER'S CHOICE 7.75% TAX SACRAMENTO SACRAMENTO, CA 95834 Interior Color: Exterior Color: WHITE DUAL MIRRORS AUTOMATIC TRANSMISSION RADIO FRONT SIDE IMPACT AIR BAGS TINTED GLASS DRIVER CONVENIENCE AM RADIO HEAD/CURTAIN AIR BAGS SEATS MESSAGE CENTER FM RADIO PAINT CLOTH SEATS POWER MI RRORS STEREO CLEARCOAT PAINT CAPTAIN CHAIRS (2) INTERMITTENT WIPERS SEARCH/SEEK FRONT END WHEELS TILT WHEEL CD PLAYER POWER STEERING 4-WHEEL DISC BRAKES INSTRUMENT PANEL AUXILIARY AUDIO CONNECTION POWER BRAKES STYLED STEEL WHEELS TRACTION CONTROL SAFETY ANTI-LOCK BRAKES (4) TRUCK & TOWING STABILITY CONTROL DRIVERS SIDE AIR BAG GLASS & MIRRORS REAR STEP BUMPER 5/15/2019 3:38:00 PM 133201 I 1.7.04.10120 Page 1 , Estimate of Record 2017 NISS NV Cargo 2500 HD S Standard Roof 3D VAN 6-4.0L Gasoline Sequential MPI WHITE Line Op er Description 1 FRONT BUMPER 2 O/H front bumper 3 4 5 6 7 * 8 ** 9 10 11 GRILLE Repl Bumper black Repl RT Outer bracket Repl LT Outer bracket Repl RT Side bracket #2 Repl RT Side bracket # 1 Rep! Non OEM Upper cover Add for Clear Coat R&I License bracket 12 13 ** ---~epl N?!: .~EM ~i!le ~l~c~ - FRONT LAMPS 14 ** Repl Non OEM NSF RT Headlamp assy --~ --·--·--· Aim headlamps 16 RADIATOR SUPPORT 17 18 # 19 HOOD 20 21 22 23 FENDER 24 25 26 27 28 29 30 31 Rep! RT Side panel R&I SET BACK WIRING Repl Hood (HSS) Add for Clear Coat Ad_? .!~!. _l!_n~~~~d~~con:iplete) . . Repl RT Fender Overlap Major Adj. Panel Add for Clear Coat Add for antenna Add for Edging Add for Clear Coat Repl RT Fender liner Repl RT Liner extension 32 ···-··· __ R&I ~T !"1_~9. gua!~ _ 33 FRONT DOOR Part Number 620221PAOA 622241PAOA 622251PAOA 622261PAOA 622221PAOA NI1014101 962101PAOA NI12002710E NI2503209 F25201PAMA 651001PAOA 631001PAOA 638301PAOA 638401PAOA 638501PAOA 34 Bind RT Outer panel 801521PAOA 35 36 37 38 NOTE: FRT EDGE CHIPING FROM FENDER R&I RT Belt molding 808201PAOA R&I RT R&I mirror R&I RT Run channel R&I RT Handle black NOTE: ACCESS THROUGH DOOR PLUG NO TRIM PANEL NEEDED 963011PA7E 803301PAOA 80640ZS05A 39 MISCELLANEOUS OPERATIONS 5/15/2019 3:38:00 PM 133201 I 1.7.04.10120 Qty 1 1 1 1 1 1 1 1 1 1 1 Claim#: Workfile ID: Extended Price $ 448.44 13.13 16.40 11.87 38.44 362.00 465.00 245.27 190.02 s 1,038.31 342.33 0805222310000001-01 15b3b0b4 Labor 1.4 Incl. 0.1 0.1 Incl. 0.2 Incl. 0.3 0.5 3.0 0.2 0.9 1.2 0.4 Paint 1.2 0.5 0.7 2.4 1.0 1.2 2.0 -0.4 0.3 0.5 0.1 1 84.13 I ncl. 1 79.27 Incl. 0.2 0.3 0.3 0.3 0.4 1.3 Page 2 Estimate of Record 2017 NISS NV Cargo 2500 HD S Standard Roof 3D VAN 6-4.0L Gasoline Sequential MPI WHITE 40 # 41 # Rep! 42 # ~~~I -· 43 OTHER CHARGES 44 # Prior Damage Notes: Front Bumper - Lt Fender - Agreement Reached COVER CAR COMPLETE FLEXADDffiVE .. ~ -.- ....,.._. -~-· E.P.C. Lt Frt Door - HANDLE SCRATCHES Lt Rear Door - Lt Qtr - Rear Bumper - REAR DOORS-LT DOOR IMPACT DAMAGE Rt Qtr - IMPACT DAMAGE UPPER CENTER AND LOWER REAR Rt Rear Door - DENT CENTER Rt Frt Door - Rt Fender - Hood- Glass- Roof - Wheels- Other - 5/15/2019 3 :38:00 PM ESTIMATE TOTALS Category Parts Body Labor Paint Labor Paint Supplies Miscellaneous Other Charges Subtotal Sales Tax Total Cost of Repairs Deductible Total Adjustments Net Cost of Repairs SUBTOTALS NOTES . 133201 I 1.7.04.10120 Claim#: Workfile ID: 1 08052223 10000001-01 15b3b0b4 1 Q2 1 5.00 T 1 3.00 3,342.61 Basis 9.8 hrs @ 11.0 hrs @ 11.0 hrs @ $ 3,727.9 1 @ 9.8 Rate $ 74.76 / hr $ 74.76 / hr $ 35.30 / hr 7.7500 % 11.0 Cost$ 3,334.61 732.65 822.36 388.30 5.00 3.00 5,285.92 288.91 5,574.83 500.00 500.00 5,074.83 Page 3 Estimate of Record 2017 NISS NV Cargo 2500 HD S Standard Roof 30 VAN 6-4.0L Gasoline Sequential MPI WHITE No Supplement wi ll be honored unless authorized by GEICO. Claim#: Workfile ID: 0805222310000001-01 15b3b0b4 NOTICE: Vehicles constructed of special metals may require the use of specialized welding and bonding equipment. Proper measuring and structural repair systems are required on today's vehicle to accurately accompl ish vehicle repairs. Make sure your shop has the proper equipment to repair your vehicle. ALTERNATE PARTS DISCLAIMER: IF A QUALITY REPLACEMENT PART (A/M, LKQ, RECOND OR OPT OEM) APPEARS ON THIS ESTIMATE, IT INDICATES THAT THIS ESTIMATE HAS BEEN PREPARED BASED ON THE USE OF ONE OR MORE CRASH PARTS SUPPLIED BY A SOURCE OTHER THAN THE MANUFACTURER OF YOUR MOTOR VEHICLE. GUARANTEES, IF ANY, APPLICABLE TO THESE REPLACEMENT CRASH PARTS ARE PROVIDED BY THE PART MANUFACTURER OR DISTRIBUTOR RATHER THAN BY THE MANUFACTURER OF YOUR VEHICLE. ***IN ADDITION TO ANY SUCH GUARANTEES, GEICO PROVIDES THE FOLLOWING: ****OWNER LIMITED GUARANTEE**** WE GUARANTEE THAT ALL QUALITY REPLACEMENT BODY PARTS (PARTS NOT MANUFACTURED BY THE MANUFACTURER) IDENTIFIED ON YOUR ESTIMATE, ARE FREE OF DEFECTS IN MATERIAL AND WORKMANSHIP AND MEET GENERALLY ACCEPTED INDUSTRY STANDARDS. THIS PARTS AND LABOR GUARANTEE WILL BE IN EFFECT FOR AS LONG AS YOU OWN THE VEHICLE DESCRIBED IN THE ESTIMATE. THIS GUARANTEE COVERS THE COST OF THE PART, LABOR TO INSTALL, AND INCIDENTALS SUCH AS PAINT AND MATERIALS AND IS SPECIFICALLY LIMITED TO THOSE ITEMS. THIS GUARANTEE DOES NOT COVER LOSS OR DAMAGE THAT IS UNRELATED TO DEFECTS IN THE QUALITY REPLACEMENT PARTS. THIS IS NOT TRANSFERABLE. IF ANY QUALITY REPLACEMENT PARTS ARE DEFECTIVE IN EITHER MATERIAL OR WORKMANSHIP, CONTACT YOUR LOCAL GEICO REPRESENTATIVE. 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. CCC ONE: 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, 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 LIN E. OPT OEM=ORIGINAL EQUIPMENT MANUFACTURER PARTS EITHER OPTIONALLY SOURCED OR OTHERWISE PROVIDED WITH SOME UNIQUE PRICING OR DISCOUNT. "CURE TIME" MEANS THE LENGTH OF TIME THAT, PER THE ADHESIVE MANUFACTURER, THE WINDSHIELD ADHESIVE NEEDS TO CURE UNTIL THE WINDSHIELD CAN PROPERLY FUNCTION AS A SAFETY DEVICE PURSUANT TO THE FEDERAL MOTOR VEHICLE SAFETY STANDARDS AND THE VEHICLE MANUFACTURER'S SPECIFICATIONS. 5/15/2019 3:38:00 PM 133201 I 1.7.04.10120 Page 4 Claim#: Workfile ID: 0805222310000001-01 15b3b0b4 Estimate of Record 2017 NISS NV Cargo 2500 HD S Standard Roof 3D VAN 6-4.0L Gasoline Sequential MPI WHITE 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. Estimate based on MOTOR CRASH ESTIMATING GUIDE and potentially other third party sources of data. Unless otherwise noted, (a) all items are derived from the Guide ARF3628, CCC Data Date 5/9/2019, and potentially other third party sources of data; and (b) the parts presented are OEM-parts. OEM parts are manufactured by or for the vehicle's Original Equipment Manufacturer (OEM) according to OEM's specifications for U.S. distribution. OEM parts are available at OE/Vehicle dealerships or the specified supplier. 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 with discounted pricing. Asterisk (*) or Double Asterisk (**) indicates that the parts and/or labor data provided by third party sources of data may have been modified or may have come from an alternate data source. Tilde sign ( N) items indicate MOTOR Not-Included Labor operations. The symbol ( < >) indicates the refinish operation WILL NOT be performed as a separate procedure from the other panels in the estimate. Non-Original Equipment Manufacturer aftermarket parts are described as Non OEM, A/M or NAGS. Used parts are described as LKQ, 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 Specificat ions. Labor operation times listed on the line with the NAGS information are MOTOR suggested labor operation times. NAGS labor operation t imes are not included. Pound sign (#) items indicate manual entries. Some 2019 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 CCC ONE estimator has a list of applicable vehicles. Parts numbers and prices should be confirmed with the local dealership. The following is a list of additional abbreviations or symbols that may be used to describe work to be done or parts to be repaired or replaced: SYMBOLS FOLLOWING PART PRICE: m=MOTOR Mechanical component. s= MOTOR Structural component. T= Miscellaneous Taxed charge category. X=Miscellaneous Non-Taxed charge category. SYMBOLS FOLLOWING LABOR: D=Diagnostic ·labor category. E=Electrical labor category. F=Frame labor category. G= Glass labor category. M=Mechanical labor category. S=Structural labor category. (numbers) 1 through 4=User Defined Labor Categories. OTHER SYMBOLS AND ABBREVIATIONS: Adj. =Adjacent. Algn.= Align. ALU=Aluminum. A/M=Aftermarket part. Blnd=Blend. BOR=Boron steel. CAPA=Certified Automotive Parts Association. D&R=Disconnect and Reconnect. HSS=High Strength Steel. HYD=Hydroformed Steel. Incl.=Included. LKQ= Llke Kind and Quality. LT=Left. MAG= Magnesium. Non-Adj. =Non Adjacent. NSF=NSF International Certified Part. O/H=Overhaul. Qty=Quantity. Refn= Refinish. Repl= Replace. R&I=Remove and Install. R&R=Remove and Replace. Rpr= Repair. RT=Right. SAS=Sandwiched Steel. Sect=Section. Subl=Sublet. UHS=Ultra High Strength Steel. N= Note(s) associated with the estimate line. 5/15/2019 3:38:00 PM 133201 I 1.7.04.10120 Page 5 Claim#: Workfile ID: 0805222310000001-01 15b3b0b4 Estimate of Record 2017 NISS NV Cargo 2500 HD S Standard Roof 3D VAN 6-4.0L Gasoline Sequential MPI WHITE CCC ONE Estimating - A product of CCC Information Services Inc. The following is a list of abbreviations that may be used in CCC ONE Estimating that are not part of the MOTOR CRASH ESTIMATING GUIDE: BAR=Bureau of Automotive Repair. EPA=Environmental Protection Agency. NHTSA= National Highway Transportation and Safety Administration. PDR=Paintless Dent Repair. VIN=Vehicle Identification Number. WE WARRANT THAT ALL PARTS USED IN THE REPAIR OF THIS VEHICLE ARE EQUAL TO THE ORIGINAL EQUIPMENT MANUFACTURER PARTS IN TERMS OF KIND, QUALITY, SAFETY, FIT AND PERFORMANCE. THIS PARTS AND LABOR WARRANTY WILL BE IN EFFECT FOR AS LONG AS YOU OWN THE VEHICLE DESCRIBED IN THE ESTIMATE. THIS WARRANTY COVERS THE COST ASSOCIATED WITH RETURNING THE PART AND THE COST TO REMOVE AND REPLACE THE NON-ORIGINAL EQUIPMENT MANUFACTURER PART WITH A COMPLIANT NON-ORIGINAL EQUIPMENT PART OR AN ORIGINAL EQUIPMENT MANUFACTURER PART. THIS WARRANTY DOES NOT COVER LOSS OR DAMAGE THAT IS UNRELATED TO DEFECTS IN THE QUALITY REPLACEMENT PARTS. THIS WARRANTY IS NOT TRANSFERABLE. IF ANY QUALI~ REPLACEMENT PARTS ARE DEFECTIVE IN EITHER MATERIAL OR WORKMANSHIP, YOU MUST CONTACT YOUR LOCAL GEICO REPRESENTATIVE. If a customer subsequently chooses a repair shop, GEICO shall prepare a supplement using the prevailing rate in the Geographic Area of the customer's chosen shop. This is not an authorization to repair. The undersigned repair facility is in agreement to the estimate prepared by GEICO in the amount of $ . No supplements wi ll be honored by GEICO without prior approval. Signed: ______ __ _ Print Name: _ ______ _ Date: _________ _ We are required under sect 2695.7(b) of the Unfair Claims Settlement Practices Regulations to provide the following notice: If you believe that your claim has been wrongfully denied or rejected, you also have the right to have the California Department of Insurance review this matter. The Department of Insurance is located at 300 South Spring Street, Los Angeles, CA 90013, telephone number (800) 927-4357. 5/15/2019 3:38:00 PM 133201 I 1.7.04.10120 Page 6 Estimate of Record 2017 NISS NV Cargo 2500 HD S Standard Roof 3D VAN 6-4.0L Gasoline Sequential MPI WHITE ALTERNATE PARTS SUPPLIERS Line Supplier Description 8 KEYSTONE - STOCKTON, CA #NI1014101 1627 ARMY COURT Non OEM Upper cover STOCKTON CA 95206 Quote: 356641095 (209) 948- 1101 Expires: 06/28/19 12 KEYSTONE - STOCKTON, CA #NI12002710E 1627 ARMY COURT Non OEM Grille black STOCKTON CA 95206 Quote: 356641095 (209) 948-1101 Expires: 06/28/19 14 1001 Best Autolite Dist. #NI2503209 Crystal Springs Rd Non OEM NSF RT Headlamp assy San Dimas CA 91773 Quote: 429193838 (866) 567-3500 Expires: 05/21/19 5/15/2019 3:38:00 PM 133201 I 1.7.04.10120 Claim#: Workfile ID: 0805222310000001-01 15b3b0b4 Price $ 362.00 $ 465.00 $ 245.27 Page 7 Estimate of Record 2017 NISS NV Cargo 2500 HD S Standard Roof 30 VAN 6-4.0L Gasoline Sequential MPI WHITE ALTERNATE PARTS USAGE 2017 NISS NV Cargo 2500 HD S Standard Roof 3D VAN 6-4.0L Gasoline Sequential MPI WHITT VIN: License: State: 1N6BFOKY2HN812101 75109L2 CA Alternate Part Type Aftermarket Optional OEM Reconditioned Recycled 5/15/2019 3:38:00 PM Production Date: Odometer: 9976 Condition: # Of Available Parts 9 0 0 1 133201 I 1.7.04.10120 Claim # : Workfile ID: Interior Color: Exterior Color : 0805222310000001-01 15b3b0b4 WHITE # Of Parts Selected 3 0 0 0 Page 8 ®ARMS GE1co Biii To: GEl3284 GEICO ATTN:BRADLEY CMB2-BOST P.O. BOX 509090 SAN DIEGO, CA 921509090 RENTER INFORMATION: Renter: VANCE, MIL TON Address: Home Phone: Office Phone: RENTAL INFORMATION: Rental Branch Location: ENTERPRISE RENT-A-CAR(3034) 340 PLAZA DR FOLSOM, CA 956304742 ADDITIONAL CLAIM INFORMATION: Claim Number: 080522231000000101 Claim Type: Insured Vehicle Condition: Driveable Date Of Loss: 05/13/2019 Insured Name: VANCE 111,MILTON Owner's Vehicle: 2017 NISSAN Assign type: Drive By ClaimNumber: 0805222310000001 IPNumber: 01 Internet Self Serve: No Days To Repair: 5 RenterName: MIL TONVANCE NumberofDaysAuthorized: 0 Invoice Target: ATLAS Source: PD Shop Code: Automated Extension: Line of Business: Class Segment: Repair Facility: CALIBER #0086 FOLSOM FOLSOM, CA 95630 (916) 985-6002 VEHICLES RENTED: Effective Date Time 05/21/2019 9:03 AM Year 2019 Make RAM Rental Company: Invoice: Enterprise Rent-A-Car 3034D572099 Alternate Invoice Number: RENTAL DETAIL: 5TVFOM Rental Period: 05/21/2019 to 06/03/2019 (14 days) Billed Period: 05/21/2019 to 06/03/2019 (14 days) Description Rate Amount 14 TIME & DISTANCE $39.50 $553.00 1 REFUELING CHARGE $0.00 $0.00 14 YOUNG RENTER FEE $0.00 $0.00 1 PREVENTATIVE MAINTENANCE CHARG 1 MISCELLANEOUS CHARGE 14 VEHICLE LICENSE RECOVERY FEE 1 SALES TAX $610.00 $58.00 $2.74 7.75% Total Charges: Less Amount Received: Total Amount Due: Model VIN Mllea e C15C 1C6RR7TT4KS566513 483 $610.00 $58.00 $38.36 $42.86 $1302.22 $668.00 $634.22 Please Return This Portion with Remittance Make Payment To: ENTERPRISE RENT-A-CAR P.O. BOX 840086 KANSAS CITY, MO 641840086 Federal ID: 43-0724835 en ta nvoice Total Charges: Less Amount Received: Total Amount Due .......... . Please Include on your Check: lnvoice:3034D572099 $1302.22 $668.00 $634.22 HERTZ LOCAL EDITION Phone: 1-888-777-3700 Fa1: E-1ai I: CUSllJ1ERB ILLINGIJllERTZ.ro~ Direct Al l Inquiries To: HERTZ LOCAL EDITION HLE INSURANCE DEPT 1139 PO BOX 121139 DALLAS, TX 75312-1 139 TAX I d: 13- 1938568 DIANA TAYLOR GEICO-TORRANCE PO BOX 509119 ATTN CLAIMS DEPT SAN DIEGO, CA 92150- 9119 RENTAL REFERENCE Rental Agreement No: A19986411 Reservation ID: OKRCU66352 BILLING INFORMATION CJ ai m No: 08052223100000 01 Pol i cy No: Oate of Loss: 2019-05-13 a Type of Loss : Repa i r Facility: Authorized Rate: CALIBER - FOLSOM/WEB 50.00 5 Author i zed Oays: Adjuster: Insured: DIANA TAYLOR o MISCELLANEOUS INFORMATION TOTAL RENTAL DAYS BI LLEO TO CUSTOMER TOTAL RENTAL CHARGES PAYMENT DUE UPON RECEIPT REMIT TO: llERTZ LOCAL EDITION llLE INSURANCE DEPT 1139 PO BOX 121139 DALLAS, TX 75312-11 39 UNITED STATES Phone: 1-888-777-3700 11 311. 86 561. 86 E-mail : CUSTOMERS ILL ING!!HERTZ. COM He~tz Renl:~l Agreement: Invoice Dal:e: @ Document : LOCAL EDITION Renter: ORIGINAL INVOICE Account No.: CDP No .: COP Name: RENTAL DETAILS No: · A19986411 06/25/2019 609099250741 MILTON VANCE 1227796 HLE GEICO SAN DIEGO Rate Plan: IN: HIOA OUT: HID Rented On: 06/05/2019 14:34 LOCtt 726701 ROSEVILLE, CA Returned On: 06/09/2019 23:59 LOCtt 726701 ROSEVILLE, CA Car Description: TRANS IT CARGOM 2567DR2 VIN tt: 1FTYR2CM8KKA88662 CAR CLASS Charged: R MILEAGE In: 1,923 Rented: N4 Out: 1, 237 Reserved: 99 Dr I ven: 686 BILLING DETAILS DAYS 5 @ 45. 75 SUBTOTAL VEHICLE LICENSE FEE TAX 7. 75'/, TOTAL CllARGES AMOU~T DUE THANK YOU FDR RENTING FROM llERTZ 228. 75 228. 75 3.27 17.98 250. 00 USO 250. 00 USO · PLEASE INCLUDE RENTAL AGREEMENT NO. ON YOUR CJJECK. 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