D.N: HHD-CV-17-6081144S
`
`: SUPERIOR COURT
`
`GEICO A/S/O
`ROBERT SPENGLER
`
`vs.
`
`MARRERO SANTOS
`
`: J.D. OF HARTFORD
`
`AT HARTFORD
`
`AFFIDAVIT
`
`Personally appeared, Shaun Adams, who upon being duly sworn
`
`deposes and says:
`
`1.
`
`2.
`
`3.
`
`That I am over the age of eighteen (18) years of age;
`
`That I believe in the obligation of an oath;
`
`That this affidavit has been made upon my first
`
`personal knowledge;
`
`4,
`
`5.
`
`That I am employed by GEICO;
`
`That I am the subrogation representative for the above-
`
`captioned matter;
`
`6.
`
`That on 09/05/2015,
`
`the defendant negligently and
`
`carelessly collided with plaintiff’s insured’s automobile causing
`
`damages in the amount of $8,808.30.
`
`7.
`
`The total damages of $8,808.30 are broken down as
`
`follows: $8,808.30 represents the property damage,
`
`less a
`
`deductible of $1,000.00, caused by the carelessness and
`
`negligence of the defendant.
`
`The plaintiff claims that all
`
`damages were caused by the negligence and carelessness of the
`
`uninsured defendant.
`
`The attached documents are true and
`
`accurate copies of the original documents.
`
`Sensitivity: Confidential
`
`

`

`8.
`
`The plaintiff has demanded that the defendant pay said
`
`amount, but the defendant has neglected and failed to do so.
`
`8.
`
`That I have read the foregoing affidavit and know it to
`
`be true.
`
`UA, Mdbouls
`
`Shaun Adams
`SUBROGATION REPRESENTATIVE
`
`STATE OF
`
`NEW YORK)
`)
`
`COUNTY OF ERIE
`
`)
`
`Subscribed and sworn to before me this ad
`Gry,
`
`day of
`
`cv|
`
`Notary Public, State of NewYork
`KAREN A. HERTEL
`No. OtHE6309021
`Qualified In Erie County |
`Commission EapiresSyoaB
`
`
`Commissioner of the Superior Court
`;
`:
`:
`Notary Public
`
`

`

`Claim Number
`Pay To The Order Of
`
`
`
`Financials
`Gross Amount
`Net Amount
`Backup Withholding
`
`PaymentIdentification
`Issued Date
`Mail To Name
`Mail To Address
`Memo
`
`Payment Type
`Check Number
`
`0287345540101063
`SLIPPY'S COLLISION and ROBERT J
`SPENGLER
`
`$7,353.95
`$7,353.95
`$0.00
`
`
`
`09/09/2015
`ROBERTJ SPENGLER
`41647 GOWANDASTATE RD, NORTH
`COLLINS, NY, 14111-9607
`COLLISION COVERAGE
`PARTIAL LOSS PAYMENT
`
`Manual Check
`616924078
`
`
`
`Documents
`‘Related
`e
`
`eo
`[DocumentName
`
`
`Reserve Line
`[Reserve Line
`
`Exposure.
`
`ler - Collision (2011 FORD)
`Robert J Speng
`
`Allocation
`
`
`
`
`
`

`

`Claim Number
`Pay To The Order Of
`
`0287345540101063
`SLIPPY $ COLLISION INC and ROBERTJ
`SPENGLER
`
`
`
`$454.35
`$454.35
`$0.00
`
`
`
`09/23/2015
`SLIPPY S COLLISION INC
`437 EATONST, SPRINGVILLE, NY, 14141-1124
`COLLISION COVERAGE
`SUPPLEMENT
`
`System Check
`476281655
`
`
`
`
`
`Financials
`Gross Amount
`Net Amount
`Backup Withholding
`
`
`PaymentIdentification
`Issued Date
`Mail To Name
`Mail To Address
`Memo
`
`Payment Type
`Check Number
`
`Related Documents
`[Document Neme SS
`
`Reserve Line Allocation
`|Exosue
`“
`:
`{
`| Robert J Spengler- Collision (2011 FORD)
`
`
`
`
`
`

`

`GEICO
`BUFFALO FIELD CLAIM OFFICE
`"VISIT US AT GEICO,COM"
`P.O. BOX 68
`STRYKERSVILLE, NY 14145
`Phone:
`(716) 982-6455
`Fax:
`(866) 947-3590
`Supplement of Record 1 SummaryHPFEee.
`Written By: MICHAEL O'DELL,License Number: 1a844513, 9/23/2015 9:24:28 AM
`Adjuster: CWCN
`
`0287345540101063-01
`52d8841le
`
`Claim #:
`Workfile ID:
`
`Insured:
`Type of Loss:
`Point of Impact:
`
`Robert Spengler
`Collision
`O1 Right Front
`
`OwnerPolicy #:
`Date of Loss:
`Deductible:
`
`4303043600
`09/05/2015 09:30 AM
`1000.00
`
`Claim #:
`Days to Repair:
`
`0287345540101063-01
`16
`
`Owner(Insured):
`Robert Spengler
`11647 Gowanda State Rd
`North Collins, NY 14411
`(716) 255-5707 Evening
`
`Inspection Location:
`Slippys Colision
`137 Eaton St
`Springville, NY 14141
`Other
`(716) 255-5707 Day
`09/09/2015 Date Inspected
`
`Appraiser Information:
`modell@geico.com
`(716) 982-6455
`
`Repair Facility:
`SLIPPY'S COLLISION
`137 EATON ST
`SPRINGVILLE, NY 14141-1124
`(716) 592-9533 Business
`(716) 592-5290 Fax
`161505695 Federal ID
`R5i51726 License Number
`
`ce
`
`VEHICLE
`
`License:
`State:
`VIN:
`
`92151ME
`NY
`iFTFW1IET6BFB76181
`
`Production Date:
`Odometer:
`Condition:
`
`39871
`
`Year!
`Make:
`Model:
`
`Color:
`Body Style:
`Engine:
`
`SILVERInt:
`4D SHORT
`6-3.5L-T
`
`2011
`FORD
` Fi50 4X4
`SUPERCREW XLT
`
`TRANSMISSION
`Privacy Glass
`Search/Seek
`SEATS
`Automatic Transmission
`Overhead Console
`CD Player
`Cloth Seats
`Overdrive
`CONVENIENCE
`Auxiliary Audio Connection
`WHEELS
`4 WheelDrive
`Air Conditioning
`SAFETY
`Aluminum/Alloy Wheels
`POWER
`Intermittent Wipers
`Drivers Side Air Bag
`PAINT
`PowerSteering
`Tilt Wheel
`Passenger Air Bag
`Clear Coat Paint
`Power Brakes
`Cruise Control
`Anti-Lock Brakes (4)
`OTHER
`Power Windows
`Keyless Entry
`4 Wheel Disc Brakes
`Fog Lamps
`Power Locks
`RADIO
`Traction Control
`TRUCK
`PowerMirrors
`AM Radio
`Stability Control
`Rear Step Bumper
`DECOR
`FM Radio
`Front Side Impact Air Bags
`Dual Mirrors
`Stereo
`Head/Curtain Air Bags
`
`9/23/2015 9:24:28 AM
`
`003174
`
`Page 1
`
`

`

`Supplement of Record 1 Summary
`OOSOOOOsOO
`2011 FORD F150 4X4 SUPERCREW XLT 4D SHORT 6-3.5L-T SILVER
`
`Claim #:
`Workfile ID:
`
`0287345540101063-01
`52d8841e
`
`eee
`Paint
`Labor
`Extended
`Qty
`Description
`ine
`Oper
`Price $
`
`aL
`
`1.8
`
`1.6
`
`2.6
`-0.4
`0.5
`
`445.00
`
`66.25
`
`230,00
`
`nNcom~ inio
`
`meMNeeReRe
`
`1.9
`Incl.
`0.4
`13
`
`2.0
`Incl.
`Incl.
`
`Incl.
`0.5
`
`Incl.
`
`_
`
`Indl.
`
`0.5
`
`Incl.
`
`Incl.
`Incl.
`Incl.
`
`—=iO
`= i
`
`eek
`oeON
`
`ntiSoO.
`at—oO.
`ht=OQ.
`eet=2.
`ialjm}2.:
`
`——O
`ed>iO.
`
`1
`
`FRONT BUMPER
`
`O/H front bumper
`A/M CAPA Bumper w/fog lamps chrome
`Add for fog lamps
`Upperfiller painted, w/o XL. w/o whee!lip
`Upperfiller painted, w/o XL w/o wheellip
`Valance panel w/carbon w/4WD
`End cover w/3.5 liter
`‘License bracket
`
`**
`
`Repl
`
`2 3
`
`4
`
`*
`*
`
`R&l
`5
`Rpr
`6
`R&I
`7
`Repl
`8
`9 Ra
`10
`FRONT LAMPS
`
`¥*
`
`ii
`12
`
`Repl
`
`A/M CAPA RT Headlamp assy
`Aim headlamps
`
`N
`N
`
`N
`
`N
`
`R&I
`13
`4RM
`15
`HOOD & GRILLE
`16
`Bind
`7 # RL
`18
`ELECTRICAL
`
`19
`
`R&I
`
`R&I
`~*
`20
`R&I
`*
`21
`2 * RM
`23
`FENDER
`
`=*
`
`Repl
`
`24
`25
`26
`
`N
`
`N
`
`N
`N
`N
`N
`N
`
`N
`
`N
`
`27,—*
`28
`«*
`29
`#
`——
`30
`31 WHEELS
`
`32
`330
`34.
`35
`36
`37
`
`=*
`0=«C**
`—O*
`*
`#
`#
`
`38 #
`39
`TIRES
`
`40
`41
`
`*
`*
`
`RT Fog lamp
`LT Fog lamp
`
`Hood (ALU)
`BUGFLECTOR
`
`Antenna mast
`
`RT Base-RT FENDER MOUNT
`TPMS sensor-RT FRONT WHEEL/TIRE REPL
`_TPMSsensor-RTREAR WHEEL/TIRE REPL
`
`LKQ RT fender assy +25%
`Overlap Major Adj. Panel
`Refn edges
`RT Fenderfiner w/3.5 liter
`RT Nameplate "F-150 XLT"
`ADHESIVE TEMPLATE FORD F-150 XLT
`RTMud shield carbon black.
`
`LKQ RT/Front Wheel, alloy type 2, painted +25%
`LKQ RT/Rear Wheel, alloy type 2, painted +25%
`LKQ RT/Front Wheel cap type 3, painted +25%
`LKQ RT/Rear Wheel cap type 3, painted +25%
`VALVE STEM
`
`MOUNT AND BALANCE
`SUSPENSION ALIGNMENT
`
`R&I
`R&d
`Repl
`Repl
`
`Repl
`Repl
`Repl
`Repl
`Repl
`
`Rep
`Repl
`
`FIRE P285/70R17 Destination AT OWL 117T B1i3%
`FIRE P285/70R17 Destination AT OWL 117T B13%
`
`9/23/2015 9:24:28 AM
`
`003174
`
`Page 2
`
`

`

`Claim #:
`Workfile ID:
`
`0287345540101063-01
`52d8841e
`
`Supplement of Record 1 Summary
`
`a 2
`
`011 FORD F150 4X4 SUPERCREW XLT 4D SHORT 6-3.5L-T SILVER
`
`2
`
`1
`
`latte
`
`5.00 X
`
`950.00
`
`25.00
`
`2.00
`
`2.00
`
`81.38
`
`724.83
`
`44.38
`
`451.82
`
`3.4
`-0.4
`
`13
`
`3.2
`-0.2
`2.5
`
`0.0.
`
`L5
`
`0.6
`0.2
`0.4
`0.3
`0.3
`0.5
`0.5
`
`0.3
`0.2
`
`__ 0.2
`
`0.3
`0.5
`15
`0.2
`0.2
`
`0.2
`
`0.2
`0.2
`
`0.3
`
`1.5
`
`12.0
`
`0.3
`0.4
`1.0
`
`25
`
`Incl.
`
`18
`Incl.
`-0.8
`
`42
`43
`
`# Repl
`FRONT DOOR
`
`[NYSTIRE DISPOSAL FEE
`
`LKQ RT door assy +25%
`Overlap Major Adj. Panel
`RT Transfer door glass
`RT Run channel
`
`RT W'strip on body
`RT Belt molding
`RT Mirror black
`RT Handle, outside w/keyless entry black
`RT R&d trim panel
`"SNAP ON" STICKER +25%
`RAIN GUARD
`RETAPE MOLDING-RAIN GUARD
`
`RT Outer panel
`RT Belt molding
`RT Handle, outside black
`TIE DOWN AND PRE PULL-RT APPERATURE PANEL
`RT REAR DOOR RAINGUARD
`RETAPE MOLDING-RAINGUARD
`
`RT Run channel
`
`TIE DOWN AND PRE PULL-RT HINGE PILLAR
`RT Aperture panel/HINGE PILLAR
`Overlap Major Non-Adj. Panel
`RT Seal
`
`RT Scuff plate front charcoal
`BUFF SCRATCHES RT CAB SIDE REAR
`
`Set back box assy
`RT Side panel w/o wheel opening molding
`Overlap Major Non-Adj. Panel
`Clear Coat
`
`RT Upper molding carbon black
`RT Decal "4X4" sterling gray
`PRE PULL RT SIDE INNER PANEL
`RT Inner panel
`
`RT Tail lamp assy w/bright trim
`
`*
`
`Repi
`
`R&I
`R&I
`R&I
`R&I
`R&I
`R&I
`
`Repl
`R&I
`
`Bind
`R&I
`R&I
`
`Algn
`R&I
`
`Ral
`
`Algn
`Rpr
`
`R&l
`
`Repl
`Rpr
`
`Repl
`Repl
`
`R&I
`
`Repl
`
`#
`#
`
`REAR DOOR
`
`#
`#
`
`# *
`
`CAB
`
`#
`*
`
`;
`#
`PICK UP BOX
`
`* Ree
`REAR LAMPS
`
`REAR BUMPER
`
`Repi
`
`O/H rear bumper
`Bumper chrome w/o reverse sensor B5%
`Deduct for Rear Bumper R&1
`
`N44
`45
`46
`47
`
`49
`50
`51
`52
`
`54
`
`55
`56
`57
`58
`59
`60
`
`61
`62
`
`64
`65
`
`67
`68
`
`70
`71
`
`74
`75
`76
`
`78
`
`80
`
`81
`82
`
`83
`
`85
`
`9/23/2015 9:24:28 AM
`
`003174
`
`Page 3
`
`

`

`Claim #:
`
`Workfile ID:
`
`0287345540101063-01
`52d8841e
`
`Supplementof Record 1 Summary
`COSHPO
`2011 FORD F150 4X4 SUPERCREW XLT 4D SHORT 6-3.5L-T SILVER
`86 RAL Step padw/otraller tow
`87
`MISCELLANEOUS OPERATIONS
`sg
`**
`Repl A/M A/M FULL PANEL BONDING KIT
`89
`#
`Repl COVER CAR / BAG
`90
`=**
`Repl A/M RESTORE CORROSION PROTECTION
`gol
`**
`Repl A/M GRAVEL GUARD
`92.
`«**
`Rep] A/M FLEX ADDITIVE
`93
`#
`MASK JAMBS
`94
`«Oo#
`///TOW BILL INCLUDED IN ESTIMATE FOR 231.00
`i PLUS TAXI/
`95
`FRONT SUSPENSION
`96
`=«O**
`S01
`Repl A/M RT Upper cntrl arm
`97
`S01
`Repl RT Knuckle
`98 SOL‘
`educt for Overlap
`99
`OTHER CHARGES
`100
`#
`Towing
`1
`231.00
`101
`#
`E.P.C.
`1
`3.21
`
`SUBTOTALS
`4,769.77
`45.8
`17.1
`SUBTOTASTO
`
`0.2
`
`_Ind.
`
`0.2
`0,3
`0.2
`
`0.9
`2.7
`05
`
`N
`
`N
`N
`
`N
`N
`
`1
`1
`1
`1
`1
`1
`1
`
`1
`1
`
`24.95 T
`
`10.00
`10.00
`8.00
`
`139.36 m
`132.73 m
`
`NOTES
`
`Line 5: Time not included with R&R bumper or overhaul.
`Time includes R&d/R&R headlamps.
`
`Line 6: TIME INCLUDES TO HEAT AND RESHAPE AND REPAIR GOUGES
`
`Line 8: PER ROBERT SPENGLER NOT DAMAGED PRIOR TO LOSS
`
`Line 11: SHANNON WITH LKQ 541-6198
`QUOTE # 3072145
`
`Line 24: LABOR:Timeis after headlamp assembly is removed, Time includes rear insulator,
`required.
`
`antenna mast, cap, base, and sealant application as
`
`Line 29: ADHESIVETEMPLATES.COM
`
`Line 32: SHANNON WITH LKQ
`QUOTE # 3072145
`
`Line 33: SHANNON WITH LKQ
`QUOTE # 3072145
`
`Line 34: SHANNON WITH LKQ
`QUOTE # 3072145
`
`Line 35: SHANNON WITH LKQ
`QUOTE # 3072145
`
`Line 36: PART # 9L3Z1700A
`
`9/23/2015 9:24:28 AM
`
`003174
`
`Page 4
`
`

`

`Supplement of Record 1 Summary
`SE
`2011 FORD F150 4X4 SUPERCREW XLT 4D SHORT 6-3.5L-T SILVER
`
`Line 38: TO REACH AP WITH JOELLE AT SLIPPYS COLLSION
`
`Claim #:
`
`Workfile ID:
`
`0287345540101063-01
`52d8841e
`
`Line 40: 9/10 32NDS PER CCC
`
`Line 41: 9/10 32NDS PER CCC
`BUCKLE IN SIDEWALL
`
`Line 44: SHANNON WITH LKQ
`QUOTE # 3072145
`
`Line 48: REPAIR/REFINISH CAB
`
`Line 53: SNAP ON TOOLS
`PER ROBERT SPENGLER
`
`Line 63: REFINISH
`
`Line 66: PAINT BEHIND AND BELOW APPERATURE
`
`Line 69: TAPED ON ONE TIME USE-REQUIRED FOR APPERATURE REFINISH
`
`Line 72: RT SIDE PANEL REPLACEMENT
`
`Line 73: CONFIRMED WITH DEALER
`BUCKLED METAL STRETCHED BEYOND REPAIR
`ACCESS TO REPAIR INNER PANEL
`
`Line 77: ONE TIME USE
`
`Line 79: ALIGNMENT INNER PANEL BUCKLE SEE PHOTOS
`
`Line 84: DING REAR BUMPER TO REACH AP WITH ROBERT SPENGLER
`
`Line 88: RT SIDE PANEL BONDINGKIT
`
`Line 91: RT CABSIDE REPAIR
`RT SIDE PANEL REPLACEMENT
`
`Line 93: FOR RT CAB SIDE REPAIR AND REFINISH
`
`Line 96; bent by ball joint
`
`Line 97: bent-touching coil spring
`
`Prior Damage Notes:
`REAR BUMPER DENT
`BED/TAILGATE SCRATCHES-DENTS
`TEXTURED MOLDINGS SCRATCHED/SCUFFED
`FRONT BUMPER END COVER SCRATCHES
`
`9/23/2015 9:24:28 AM
`
`003174
`
`Page 5
`
`

`

`Supplement of Record 1 Summary
`
`2011 FORD F150 4X%4 SUPERCREW XLT 4D SHORT 6-3.5L-T SILVER
`
`Claim #:
`Workfile ID:
`
`0287345540101063-01
`52d8841e
`
`ESTIMATE TOTALS
`Cost $
`Category
`4,505.61
`Parts
`2,152.60
`Body Labor
`803.70
`Paint Labor
`444.60
`Paint Supplies
`29.95
`Miscellaneous
`Other Charges
`234.21
`
`Subtotal
`8,170.67
`Sales Tax
`$8,165.67.
`@
`8.7500 %
`714.50
`Total Cost of Repairs
`8,885.17
`
`Deductible
`1,000.00
`FIRE P285/70R17 Destination AT OWL 117T
`26.15
`B13%
`FIRE P285/70R17 Destination AT OWL 117T
`B13%
`24.57
`Bumper chrome w/o reverse sensor B5%
`1,076.87
`Total Adjustments
`
`Net Cost of Repairs 7,808.30
`
`Rate
`
`$ 47.00 /hr
`$ 47.00 /hr
`$ 26,00 /hr
`
`26.15
`
`Basis
`
`458hrs
`i7.lhrs
`i7.1hrs
`
`@
`@
`@
`
`;
`
`9/23/2015 9:24:28 AM
`
`003174
`
`Page 6
`
`

`

`Claim #:
`Workfile ID:
`
`0287345540101063-01
`52d8841e
`
`Supplement of Record 1 Summary
`
`2011 FORD F150 4X4 SUPERCREW XLT 4D SHORT 6-3.5L-T SILVER
`
`SUPPLEMENT SUMMARY
`
`Line
`
`Oper
`
`Description
`
`Qty
`
`Extended
`Price $
`
`Labor
`
`Paint
`
`‘Added Items .
`95
`FRONT SUSPENSION
`96
`«=**
`S01
`Repl A/M RT Upper cntrl arm
`97
`S01
`Repl
`RT Knuckle
`98
`sol
`Deduct for Overlap
`
`N
`N
`
`1
`1
`
`139.36 m
`132.73 m
`
`SUBTOTALS
`
`272.09
`
`0.9
`2.7
`-0.5
`3.1
`
`0,0
`
`NOTES
`
`Line 96: bent bybail joint
`
`Line 97: bent-touching coil spring
`
`Prior Damage Notes:
`REAR BUMPER DENT
`BED/TAILGATE SCRATCHES-DENTS
`TEXTURED MOLDINGS SCRATCHED/SCUFFED
`FRONT BUMPER END COVER SCRATCHES
`
`TOTALS SUMMARY
`Category
`Basis
`Rate
`Cost $
`
`Parts
`272.09
`$ 47.00 /hr
`@
`3.Lhrs
`Body Labor
`145.70
`Subtotal
`417.79
`
`Sales Tax
`$417.79
`@
`8.7500 %
`36.56
`Total Supplement Amount
`454.35
`NET COST OF SUPPLEMENT
`454.35
`
`9/23/2015 9:24:28 AM
`
`003174
`
`Page 7
`
`

`

`Claim #:
`
`Workfile ID:
`
`0287345540101063-01
`
`52d8841e
`
`Supplement of Record 1 Summary
`
`2011 FORD F150 4X4 SUPERCREW XLT 4D SHORT 6-3.5L-T SILVER
`
`CUMULATIVE EFFECTS OF SUPPLEMENT(S)
`
`Estimate
`Supplement S01
`
`8,430.82
`454.35
`
`LISA SWANSON
`MICHAEL O'DELL
`
`8,885.17
`$
`Workfile Total:
`1,076.87
`$
`TOTAL ADJUSTMENTS:
`7,808.30
`$
`NET COST OF REPAIRS:
`
`
`This is not an authorization to repair.
`All GEICO customers have the right to have their vehicle repaired in the shopof their choice.
`
`No Supplementwill 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 equipmentto repair your vehicle.
`
`ALTERNATE PARTS DISCLAIMER:
`IF A QUALITY REPLACEMENTPART (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 MANUFACTURERORDISTRIBUTOR RATHER
`THAN BY THE MANUFACTURER OF YOUR VEHICLE.
`
`**kTN ADDITION TO ANY SUCH GUARANTEES, GEICO PROVIDES THE FOLLOWING:
`*KKOWNER LIMITED GUARANTEE**** WE GUARANTEE THAT ALL QUALITY REPLACEMENT BODYPARTS (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.
`
`9/23/2015 9:24:28 AM
`
`003174
`
`Page 8
`
`

`

`Supplement of Record 1 Summary
`
`2011 FORD F150 4X4 SUPERCREW XLT 4D SHORT 6-3.5L-T SILVER
`
`Claim #:
`
`Workfile ID:
`
`0287345540101063-01
`
`52d8841e
`
`ANY PERSON WHO KNOWINGLY AND WITH INTENT TO DEFRAUD ANY INSURANCE COMPANY OR OTHER PERSON
`FILES AN APPLICATION FOR COMMERCIAL INSURANCE OR A STATEMENT OF CLAIM FOR ANY COMMERCIAL OR
`PERSONAL INSURANCE BENEFITS CONTAINING ANY MATERIALLY FALSE INFORMATION, OR CONCEALS FOR THE
`PURPOSE OF MISLEADING, INFORMATION CONCERNING ANY FACT MATERIAL THERETO, AND ANY PERSON WHO,
`IN CONNECTION WITH SUCH APPLICATION OR CLAIM, KNOWINGLY MAKES OR KNOWINGLYASSISTS, ABETS,
`SOLICITS OR CONSPIRES WITH ANOTHER TO MAKEA FALSE REPORT OF THE THEFT, DESTRUCTION, DAMAGE OR
`CONVERSION OF ANY MOTOR VEHICLE TO A LAW ENFORCEMENT AGENCY, THE DEPARTMENT OF MOTOR
`VEHICLES OR AN INSURANCE COMPANY, COMMITS A FRAUDULENT INSURANCE ACT, WHICH IS A CRIME, AND
`SHALL ALSO BE SUBJECT TO A CIVIL PENALTY NOT TO EXCEED FIVE THOUSAND DOLLARS AND THE VALUE OF
`THE SUBJECT MOTOR VEHICLE OR STATED CLAIM FOR EACH VIOLATION.
`
`You are entitled to the return of all replaced parts, except warranty and exchange parts, but you must ask for them
`in writing before any workis done. If you authorize work by phone, the shop must keep any replacedparts, and
`make them available when you pick up the vehicle.
`
`THE PREPARATION OF THIS ESTIMATE MAY HAVE BEEN BASED ON THE USE OF CRASH PARTS SUPPLIED BY A
`SOURCE OTHER THAN THE MANUFACTURER OF YOUR MOTORVEHICLE. THERE ARE WARRANTIES APPLICABLE TO
`THESE REPLACEMENT PARTS. THESE WARRANTIES ARE PROVIDED BY THE MANUFACTURER AND/OR
`DISTRIBUTOR OF THE PARTS RATHER THAN BY THE ORIGINAL MANUFACTURER OF YOUR VEHICLE.
`
`9/23/2015 9:24:28 AM
`
`003174
`
`Page 9
`
`

`

`Claim #:
`Workfile ID:
`
`0287345540101063-01
`52d884ie
`
`Supplement of Record 1 Summary
`EES
`2014 FORD F150 4X4 SUPERCREW XLT 4D SHORT 6-3.5L-T SILVER
`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 DR2MA09, CCC Data Date 9/16/2015, and potentially other
`third party sources of data; and (b) the parts presented are OEM-parts manufactured by the vehicles Original
`Equipment Manufacturer. OEM parts are available at OE/Vehicle dealerships. OPT OEM (Optional OEM) or ALT OEM
`(Alternative OEM) parts are OEM parts that may be provided by or throughalternate sources other than the OEM
`vehicle dealerships. OPT OEM or ALT OEM parts may reflect some specific, special, or unique pricing or discount.
`OPT OEM or ALT OEM parts may include "Blemished" parts provided by OEM's through OEM vehicle dealerships.
`Asterisk (*) or Double Asterisk (**) indicates that the parts and/or labor data provided bythird party sources of data
`may have been modified or may have come from analternate data source. Tilde sign (~) items indicate MOTOR
`Not-Included Laboroperations. 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. NAGSPart Numbers and BenchmarkPrices are
`provided by National Auto Glass Specifications. Labor operation times listed on the line with the NAGSinformation
`are MOTOR suggested labor operation times. NAGSlabor operation times are not included. Pound sign (4) items
`indicate manual entries.
`Some 2016 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.
`Thefollowingisalist of additional abbreviations or symbols that may be used to describe work to be doneor parts to
`be repaired or replaced:
`SYMBOLS FOLLOWING PART PRICE:
`m=MOTORMechanical 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=Boronsteel.
`CAPA=Certified Automotive Parts Association. D&R=Disconnect and Reconnect. HSS=High Strength Steel.
`HYD=HydroformedSteel.
`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 estimateline.
`
`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.
`
`9/23/2015 9:24:28 AM
`
`003174
`
`Page 10
`
`

`

`Supplement of Record 1 Summary
`POE
`2011 FORD F150 4X4 SUPERCREW XLT 4D SHORT 6-3.5L-T SILVER
`
`Claim #:
`Workfile ID:
`
`0287345540101063-01
`52d8841e
`
`ALTERNATE PARTS SUPPLIERS
`
` Line Supplier Description Price
`
`
`3
`KEYSTONE - BUFFALO, NY
`#FO1002411DSC
`$ 445.00
`2871 BROADWAY SUITE 500
`A/M CAPA Bumper w/fog lamps chrome
`BUFFALO NY 14227
`Quote: 36973683
`(716) 894-6262
`Expires: 10/23/15
`KEYSTONE - BUFFALO, NY
`#FO2503287C
`2871 BROADWAYSUITE 500
`A/M CAPA RT Headlamp assy
`BUFFALO NY 14227
`Quote: 36990584
`(716) 894-6262
`Expires: 10/23/15
`oooGOD24 LKQ Buffalo #~114127660 $ 226.00
`
`
`2871 Broadway Suite 500
`LKQ RT fender assy +25%
`Buffalo NY 14227
`Fender 4DR, WITH IFL, PEINTURE ECAILLE DANS LE BAS,S#$VF990
`(888) 836-2336
`Quote: 36982696
`Expires: 10/23/15
`I44 LKQ Buffalo #~110023520 $ 760.00
`
`
`2871 Broadway Suite 500
`LKQ RT door assy +25%
`Buffalo NY 14227
`Door Assembly, Front 4DR,SIL,S#FD0657- ELECTRIC,R.,
`W/MOLDING MOUNTING HOLES
`Quote: 36982029
`Expires: 10/23/15
`#NCP2605244
`A/M RT Upper cntrl arm
`
`$ 230.00
`
`
`
`
`
`139,36
`
`$
`
`il
`
`(888) 836-2336
`
`96
`
`NAPA
`Preston Keanum
`2999 CIRCLE 75 PARKWAY
`ATLANTAGA 30339
`
`(800) 538-6272
`
`9/23/2015 9:24:28 AM
`
`003174
`
`Page 11
`
`

`

`Claim #:
`Workfile 1D:
`
`0287345540101063-01
`52d8841e
`
`Supplement of Record 1 Summary
`
`2011 FORD F150 4X4 SUPERCREW XLT 4D SHORT 6-3.5L-T SILVER
`
`TIRE PARTS SUPPLIERS
`
` Line Supplier Description Price
`
`
`
`
`37
`MOUNT AND BALANCE
`$ 22.95
`nnn
`38
`SUSPENSION ALIGNMENT
`$ 79.95
`aIT
`40
`Tire Rack
`FIRE P285/70R17 Destination AT OWL 117T B13%
`$ 184.99
`7101 VORDEN PKWY
`SOUTH BEND IN 46628
`
`(800) 445-0179
`tTT_T
`41
`Tire Rack
`FIRE P285/70R17 Destination AT OWL 117T B13%
`$ 184.99
`7101 VORDEN PKWY
`
`SOUTH BEND IN 46628
`
`(800) 445-0179
`
`9/23/2015 9:24:28 AM
`
`003174
`
`Page 12
`
`

`

`Supplement of Record 1 Summarypeth
`
`Claim #:
`
`Workfile ID:
`
`0287345540101063-01
`
`52d884ie
`
`2011 FORD F150 4X4 SUPERCREW XLT 4D SHORT 6-3.5L-T SILVER
`
`ALTERNATE PARTS USAGE
`
`Year:
`Make:
`Model:
`
`2011
`FORD
`Fi50 4X4
`SUPERCREW XLT
`
`Color:
`BodyStyle:
`Engine:
`
`SILVERInt:
`4D SHORT
`6-3.5L-T
`
`License:
`State:
`VIN:
`
`92151ME
`NY
`1FTFW1ET6BFB76181
`
`Production Date:
`Odometer:
`Condition:
`
`39871
`
`Alternate Part Type
`Aftermarket
`
`# Of Available Parts
`
`
` # Of Parts Selected
`aoo~
`
`Optional OEM
`Reconditioned
`
`
`Recycled
`
`9/23/2015 9:24:28 AM
`
`003174
`
`Page 13
`
`

`

`Claim #:
`
`Workfile ID:
`
`0287345540101063-01
`
`52d8841e
`
`Supplement of Record 1 Summary
`
`2011 FORD F150 4X4 SUPERCREW XLT 4D SHORT6-3.5L-T SILVER
`
`RECALL INFO
`
`Year:
`Make:
`Model:
`
`2011
`FORD
`F150 4X4
`SUPERCREW XLT
`
`Color:
`Body Style:
`Engine:
`
`SILVERInt:
`4D SHORT
`6-3.5L-T
`
`License:
`State:
`VIN:
`
`92151ME
`NY
`1FTFWLET6BFB76181
`
`Production Date:
`Odometer:
`Condition:
`
`39871
`
`
`
`The National Highway Transportation and Safety Administration (NHTSA) has issued 4 safety-related recall notice(s) that may apply to the selected
`vehicle.
`
`NHTSAID:
`
`11V128000
`
`Issued: Mar7,11
`
`Numberof Vehicles:
`
`00008022
`
`Electrical System: Software Fordis recalling certain model year 2011 Ford F-150, F-250, F-350, F-450, F-550, Edge, and Lincoln mkx trucks
`manufactured from October 25, 2010, through November 20, 2010. These Vehicles were inspected using integrated diagnostic system (ids) that
`had a custom software routine to read the suspect body control module (bcm) serial number, Based on the serial number the bcm waseither not
`affected or replaced. The custom software routine was not reading the correct set of characters, and was not able to identify a bcm that required
`replacement affected bcms may have the potential for an internal short. If an electrical short develops, an overheating condition may occur which
`could result in a Vehicle Fire. Dealer will inspect the body control module and if necessary replaceit free of charge. The safety recall began on
`March 7, 2011. Owners may contact Ford motor company Customer relationship center at 1-866-436-7332.
`
`NHTSAID:
`
`12V190000
`
`Issued:
`
`Numberof Vehicles:
`
`00010500
`
`Exterior lighting:Back up lights Ford is recalling certain model year 2011-2012 Ford F-150, 2012 Expedition and Lincoln Navigator, and 2012-2013
`Mustang Vehicles, for failing to comply with the requirements of Federal motor Vehicle safety standard nos. 102, "Transmission shift lever
`sequence, starter interlock, and Transmission braking effect" and 108 ?lamps, reflective devices and associated equipment.? these Vehicles may
`have a Transmission range sensor(trs) that was calibrated out of specification for reverse gear. If this condition exists, the Transmission may not
`go into reverse or when the Driver pushes theshift lever in the reverse ?R? position and the Vehicle?S Transmission does goin reverse, the ?R?
`may notilluminate on the dashboard of the F-150, Expedition, or Navigator models and/or the backup lampon therear of the F-150, Expedition,
`Navigator, or Mustang Vehicles may notilluminate. These conditions increase the risk of a crash or a pedestrian being struck due to the Vehicle?S
`not signaling it is in reverse. Ford will notify owners, and Dealers will inspect and replace the trs as necessary, free of charge. The safety recall is
`expected to begin on or about June 25, 2012, Owners may contact Ford motor company Customerrelationship center at 1-866-436-7332.
`
`NHTSAID:
`
`11V582000
`
`Issued:
`
`Numberof Vehicles:
`
`00016091
`
`Powertrain:Automatic Transmission Ford is recalling certain model year 2011 F-150 Vehicles manufactured from September 9, 2011, through
`September 22, 2011, and model year 2012 F-250, F-350, F-450 and F-550 heavy duty Vehicles manufactured from September 12, 2011, through
`September 22, 2011. These Vehicles fail to comply with the requirements of Federal motor Vehicle safety standard number 114, ?theft Protection.?
`the Transmission can be shifted out of the Park position without pressing the brake pedal due to brake shift interlock switch problem.Thiswill
`allow the operator to inadvertently shift the Vehicle into gear without the brake pedal being depressed, increasing therisk of a crash or injury to a
`nearby pedestrian. Ford will notify owners, and Dealers will inspect the brake shift interlock switch function and replace the switch if necessary,
`free of charge. The safety recall is expected to begin on or about December 19, 2011. Owners may contact the Ford motor company Customer
`relationship center at 1-866-436-7332.
`
`NHTSAID:
`
`10V659000
`
`Issued:
`
`Numberof Vehicles:
`
`00014737
`
`Structure:Body Ford is recalling certain model year 2011 F-150, F-250, F-350, F-450, F-550, Edge and Lincoln mkx Vehicles. During a six-day
`production period, the supplier of the body control module manufactured modules that may have the potential for an internal short. If an electrical
`short develops, an overheating condition may occur which can result in an unattended Vehicle Fire, Dealer will replace the body control module if
`necessary free of charge. The safety recall is expected to begin on or before January 10, 2011. Owners may contact Ford at 1-866-436-7332.
`
`9/23/2015 9:24:28 AM
`
`003174
`
`Page 14
`
`

`

`GEICO
`
`GEICO WOODBURY-NY
`EMAIL SUPPLEMENTSTO:
`R2ADSUPPSUF@GEICO.COM
`FAX SUPPLEMENTS TO: 516-213-1377
`750 WOODBURY RD
`WOODBURY, NY 11797
`Phone:
`(716) 200-9880
`Fax:
`(877) 803-7990
`
`Claim #:
`Workfile ID:
`
`0287345540101063-01
`52d8841e
`
`Estimate of Record
`
`a W
`
`ritten By: LISA SWANSON,License Number: 547117, 9/9/2015 11:59:59 AM
`Adjuster: CWCN
`4303043600
`09/05/2015 09:30 AM
`1000.00
`Appraiser Information:
`Iswanson@geico.com
`(716) 200-9880
`
`Insured:
`Type of Loss:
`Point of Impact:
`Owner(Insured):
`Robert Spengler
`11647 GowandaState Rd
`North Collins, NY 14111
`(716) 255-5707 Evening
`
`OwnerPolicy #:
`Robert Spengler
`Date of Loss:
`Collision
`Deductible:
`01 Right Front
`Inspection Location:
`Slippys Colision
`137 Eaton St
`Springville, NY 14141
`Other
`(716) 255-5707 Day
`09/09/2015 Date Inspected
`
`Claim #:
`Days to Repair:
`
`0287345540101063-01
`15
`
`Repair Facility:
`SLIPPY'S COLLISION
`137 EATON ST
`SPRINGVILLE, NY 14141-1124
`(716) 592-9533 Business
`(716) 592-5290 Fax
`161505695 Federal ID
`R5151726 License Number
`
`A V
`
`EHICLE
`
`License:
`State:
`VIN:
`
`92151ME
`NY
`LFTFW1ET6BFB76181
`
`Production Date:
`Odometer:
`Condition:
`
`39871
`
`Year:
`Make:
`Model:
`
`Color:
`Body Style:
`Engine:
`
`SILVERInt:
`4D SHORT
`6-3.5L-T
`
`2011
`FORD
`F150 4X4
`SUPERCREW XLT
`Ii
`TRANSMISSION
`Privacy Glass
`Search/Seek
`SEATS
`Automatic Transmission
`Overhead Console
`CD Player
`Cloth Seats
`Overdrive
`CONVENIENCE
`Auxiliary Audio Connection
`WHEELS
`4 Wheel Drive
`Air Conditioning
`SAFETY
`Aluminum/Alloy Wheels
`POWER
`Intermittent Wipers
`Drivers Side Air Bag
`PAINT
`PowerSteering
`Tilt Wheel
`Passenger Air Bag
`Clear Coat Paint
`Power Brakes
`Cruise Control
`Anti-Lock Brakes (4)
`OTHER
`Power Windows
`Keyless Entry
`4 Wheel Disc Brakes
`Fog Lamps
`Power Locks
`RADIO
`Traction Control
`TRUCK
`PowerMirrors
`AM Radio
`Stability Control
`Rear Step Bumper
`DECOR
`FM Radio
`Front Side Impact Air Bags
`Dual Mirrors
`Stereo
`Head/Curtain Air Bags
`
`9/9/2015 11:59:59 AM
`
`119836
`
`Page 1
`
`

`

`Estimate of Record
`
`2011 FORD F150 4X4 SUPERCREW XLT 4D SHORT6-3.5L-T SILVER
`
`‘Claim #:
`Workfile ID:
`
`0287345540101063-01
`52d8841e
`
`Oper
`
`Description
`
`Part Number
`
`Qty
`
`Extended
`Price $
`
`Labor
`
`Paint
`
`FRONT BUMPER
`
`FO1002411DSC
`
`1
`
`445.00
`
`DL3Z17D957APTM
`
`DL3Z17D957APTM
`
`O/H front bumper
`A/M CAPA Bumperw/fog lamps
`chrome
`Add for fog lamps
`Upperfiller painted, w/o XL w/o
`wheellip
`NOTE: Time not included with R&R bumperor overhaul.
`Time includes R&J/R&R headlamps.
`Upperfiller painted, w/o XL w/o
`wheellip
`NOTE: TIME INCLUDES TO HEAT AND RESHAPE AND REPAIR GOUGES
`Valance panel w/carbon w/4WD
`9L3Z17626B
`End cover w/3.5 liter
`BL3Z17E811AA
`NOTE: PER ROBERT SPENGLER NOT DAMAGED PRIOR TO LOSS
`License bracket STBAITABBBA Oi?
`
`1.9
`Incl.
`
`0.4
`1.3
`
`2.0
`
`Incl.
`Indl.
`
`1
`
`66.25
`
`1.8
`
`2.6
`
`-0.4
`0.5
`
`Line
`
`Nee
`
`**
`
`*
`
`*
`
`Repl
`
`R&I
`
`Rpr
`
`R&I
`
`Rep!
`
`10
`
`li
`
`Cn ROE
`FRONT LAMPS
`
`**
`
`Repl
`
`R&L
`
`ae
`HOOD & GRILLE
`Bind
`
`Fo
`ELECTRICAL
`
`*
`*
`
`*
`
`~ FENDER
`*
`
`*
`*
`
`#
`
`R&d
`
`R&I
`R&I
`R&I
`
`R&I
`
`Repl
`
`R&I
`R&1
`
`Rep!
`
`12
`13
`
`14
`15
`16
`
`a1
`
`8
`19
`20
`al
`
`22
`
`23
`
`24
`
`25
`26
`27
`28
`
`29
`
`A/M CAPA RT Headlamp assy
`NOTE: SHANNON WITH LKQ 541-6198
`QUOTE # 3072145
`
`FO2503287C
`
`1
`
`230.00
`
`Incl.
`
`Aim headlamps
`BL3Z15200A
`RT Fog lamp
`LT Fog lamp BL3Z15200A
`
`0.5
`Incl.
`oe ne ends
`
`9L3Z16612A
`Hood (ALU)
`BUGFLECTOR re a OS
`
`1.6
`
`Antenna mast
`RT Base-RT FENDER MOUNT
`TPMS sensor-RT FRONT.
`WHEEL/TIRE REPL
`TPMS sensor-RT REAR
`_WHEEL/TIREREPL
`
`AL3Z18813A
`CL3Z18A984B
`9L3Z1A189A
`
`9L3Z1A189A
`
`Incl.
`Incl.
`Incl.
`
`Incl.
`
`m
`
`m
`
`
`24
`287.50
`1
`~114127660
`LKQ RT fender assy +25%
`NOTE: LABOR:Timeis after headlamp assembly is removed. Time includes rear insulator, antenna mast, cap,
`base, and sealant application as required.
`Overlap Major Adj. Panel
`Refn edges
`RT Fenderliner w/3.5 liter
`RT Nameplate "F-150 XLT"
`ADHESIVE TEMPLATE FORD
`F-150 XLT
`
`1
`
`12.00
`
`Incl.
`0.2
`0.2
`
`BL3Z16102C
`9L3Z16720C
`
`9/9/2015 11:59:59 AM
`
`119836
`
`Page 2
`
`

`

`Estimate of RecordCECASSTT
`
`Claim #:
`Workfile ID:
`
`0287345540101063-01
`52d8841e
`
`2011 FORD F150 4X4 SUPERCREW XLT 4D SHORT 6-3.5L-T SILVER
`
`NOTE: ADHESIVETEMPLATES.COM
`
`_Real
`
`RT Mud shield carbon black
`
`SLIZ16GS54AMAA
`
`AL3Z1007D
`
`AL3Z1007D
`
`913Z1130A
`
`9L3Z1130A
`
`Repl
`
`Repl
`
`Repl
`
`Repl
`
`Repl
`
`LKQ RT/Front Wheel, alloy type
`2, painted +25%
`NOTE: SHANNON WITH LKQ
`QUOTE # 3072145
`
`LKQ RT/Rear Wheel, alloy type 2,
`painted +25%
`NOTE: SHANNON WITH LKQ
`QUOTE # 3072145
`
`LKQ RT/Front Wheel cap type 3,
`painted +25%
`NOTE: SHANNON WITH LKQ
`QUOTE # 3072145
`LKQ RT/Rear Wheel cap type3,
`painted +25%
`NOTE: SHANNON WITH LKQ
`QUOTE # 3072145
`VALVE STEM
`NOTE: PART # 9L3Z1700A
`MOUNT AND BALANCE
`SUSPENSION ALIGNMENT
`
`NOTE: TO REACH AP WITHJOELLE AT SLIPPYS COLLSION
`
`28,16
`
`45.90
`79.95
`
`Repl
`
`FIRE P285/70R17 Destination AT
`OWL 117T B13%
`
`Repl
`
`NOTE: 9/10 32NDS PER CCC
`FIRE P285/70R17 Destination AT
`OWL117T B13%
`
`NOTE: 9/10 32NDS PER CCC
`BUCKLE IN SIDEWALL
`
`Repl
`
`[NYS TIRE DISPOSAL FEE
`
`Repl
`
`R&I
`R&I
`
`R&I
`R&I
`
`R&I
`
`R&I
`
`LKQ RT door assy +25%
`NOTE: SHANNON WITH LKQ
`QUOTE # 3072145
`Overlap Major Adj. Panel
`RT Transfer door glass
`RT Run channel
`
`RT W'strip on body
`NOTE: REPAIR/REFINISH CAB
`
`RT Belt molding
`RT Mirror black
`
`RT Handle, outside w/keyless
`entry black
`RT R&I trim panel
`
`F104893
`
`184.99
`
`FI04893
`
`184.99
`
`~110023520
`
`5.00_X
`
`950.00
`
`3.4
`
`9L3Z1521536A
`BL3Z1520708A
`
`6L3Z1821452A
`BL3Z17682BA
`
`CL3Z1522404AB
`
`BL3Z1623942CA
`
`0.6
`0.2
`0.4
`
`0.3
`0.3
`0.5
`
`0.5
`
`# F
`
`*
`
`RONT DOOR
`
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`
`119836
`
`Page 3
`
`30
`31
`32
`
`WHEELS
`*
`
`t
`
`TIRES
`
`33
`
`34
`
`35
`
`36
`
`37
`38
`
`39
`40
`
`41
`
`42 —
`43
`44
`
`45
`46
`47
`48
`
`49
`50
`51
`
`52
`
`

`

`Claim #:
`Workfile ID:
`
`0287345540101063-01
`52d8841e
`
`Estimate of Record
`
`a 2
`
`011 FORD F150 4X4 SUPERCREW XLT 4D SHORT 6-3.5L-T SILVER
`
`1
`
`25,00
`
`0.3
`
`"SNAP ON" STICKER +25%
`
`NOTE: SNAP ON TOOLS
`PER ROBERT SPENGLER
`RAIN GUARD
`_RETAPEMOLDING-RAINGUARD_
`
`Repl
`
`R&I
`
`# #
`
`REARDOOR
`Bind
`R&I
`
`