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Home My WebLink About99-03835MAH/kkc A. ARTHUR HANAMIRIAN, P.C. BY: MICHAEL A. HANAMIRIAN, ESQUIRE ATTORNEY I.D. NO. 49457 1608 WALNUT STREET, SUITE 803 PHILADELPHIA, PA 19103 (215) 735-4235 ATTORNEY FOR PLAINTIFF ANNA CONCETTA DEVITA 207 Jacobs Street East Berlin, PA 17316 VS TEVON N. SAMUELS 2206 L Cedar Run Drive Camphill, PA 17011 and QUINTA N. SAMUELS 2206 L Cedar Run Drive Camphill, PA 17011 •YOU HAVE BERN SUED IN COURT. IF YOU WISH TO DSPEND AGAINST THE CLAIMS SET FORTH IN MR FOLLOWING PAGES, YOU MUST TAHB ACTION WITHIN TWENTY (20 DAYS AFTER MIS COMPLAINT AND NOTICE ARE SERVED, BY ENTERING A WRITTEN APPEARANCE PERSONALLY OR BY ATTORNEY AND PILING IN WRITING WITH ME COURT YOUR DEFENSES OR OBJECTIONS TO THE CLAIMS BST FORTH AGAINST YOU. YOU MR WARNED THAT IF YOU PAIL TO DO SO THE CASE MAY PROCEED WITHOUT YOU AND A JUDGMENT MAY BE SNTBRED AGAINST YOU BY THE COURT WITHOUT FURTHER NOTICE FOR ANY MONEY CLAIMED IN THE COMPLAINT OR FOR ANY OTHER CLAIM OR RELIEF REQUESTED BY THE PLAINTIFP. -YOU SHOULD TAKE MIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, 00 TO OR TELEPHONE THE OFFICE SET POEM BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. CUMBERLAND COUNTY COURT OF COMMON PLEAS CIVIL TRIAL DIVISION NO. q q - ,?eJ/ •AVISO LB HAN DBMANDADO A LISTED EN LA CORTE. BI USTBD QUISRB DBPSNDBRSS DE BETAS DBMANDAS EAPUESTAS BN LAS PAGINAS BIGUIBNTBS, UBTRD TIRE VBINIB (20) DIM DR PLATO AL PARTIR DO LA PECNA DS LA DEMANDA Y LA NOTIPICACION. RACE FALTA ABBNTAR MA COMPARENCIA SSCRITA O ON PERSONA O CON ON ABOGADO Y ENTRSGAR A LA CORTE ON FORMA BSCRITA BUS DBFBNSAS 0 BUS OSJBCIONSS A LAS DOMANDAS BE CONTRA SUVA SIN PREVIO AVISO O NOTIFICACION. AMMAR, LA CORTR PURGE DSCIDIR A FAVOR DEL DBMANOANr6 Y RBQUISRE QUE LISTED CUMPLA CON TODAS LAS PROVISIONER DR BSTA DRMANDA. USTED FOODS POWER DINBRO 0 BUS PROPISDADBS U OTROS DERECHOS IMPORTANTES PARR USTED •LLRVE ESTA DBMANDA A UN MOSAIC IMMBDIATAMENTS, BI NO TIENB ABOGADO O BI NO TIERS RL DINBRO SUPICIENTE DR PAGAR TAL BERVICIO, VAYA BN PERSONA O LLAMB OR TELBPONO A LA OPICINA CUYA DIRSCCION BE ENCUSNTRA BSCRITA ABAJO PARA AVBRIOUAR DONOR BE PUBDE CONSRGUIR ASISTENCIA LEGAL. SBRVICIO DE RSPERENCIA LEGAL CUMBERLAND COUNTY BAR ASSOCIATION 2 LIBERTY AVENUE CARLISLE PA 17013 (717) 249 3166 or 1 800 990 9108 Lawyer Referral Service (717) 240-6200 COURT ADMINISTRATOR 4th Floor Cumberland County Courthouse Carliale. PA 17013 MAH/kkc A. ARTHUR HANAMIRIAN, P.C. BY: MICHAEL A. HANAMIRIAN, ESQUIRE ATTORNEY I.D. NO. 49457 1608 WALNUT STREET, SUITE 803 PHILADELPHIA, PA 19103 (215) 735-4235 ATTORNEY FOR PLAINTIFF ANNA CONCETTA DEVITA 207 Jacobs Street East Berlin, PA 17316 vs. CUMBERLAND COUNTY COURT OF COMMON PLEAS CIVIL TRIAL DIVISION & 99• 383-7 ? e -r -- TEVON N. SAMUELS 2206 L Cedar Run Drive Camphill, PA 17011 AND QUINTA N. SAMUELS 2206 L Cedar Run Drive Camphill, PA 17011 CIVIL ACTION 1. Plaintiff, Anna Concetta Devita, is an adult individual who resides at 207 Jacobs Street, City of East Berlin, Commonwealth of Pennsylvania. 2. Defendant, Tevon N. Samuels, is an individual residing at 2206 L Cedar Run Drive, Camphill, PA 17011. 2. Defendant, Quinta N. Samuels, is an individual residing at 2206 L. Cedar Run Drive, Camphill, PA 17011. 3. On or about August 13, 1997, Plaintiff was the owner of a 1995 Ford Mustang, VIN 1FALP4048SF227834 thus lawfully traveling east on Carlisle Road approaching Orchard Road in the Township of Lower Allen, County of Cumberland, Commonwealth of Pennsylvania. 4. At the time and place stated above, Defendant Tevon N. Samuels possessed, controlled, and operated a 1980 Ford Mustang owned by Defendant, Quinta N. Samuels, and attempted to turn left onto Orchard Road from Carlisle Road with disregard of oncoming traffic, causing the vehicle he was operating to violently collide with Plaintiff's vehicle, resulting in severe property damage to the Plaintiff. 5. The aforesaid occurrence was caused solely by the negligence of the Defendants and the Plaintiff was in no manner contributorily negligent. 6. On the aforesaid accident date, the negligence, carelessness, and recklessness of the Defendants consisted inter alia of: (a) operating said vehicle in a careless, reckless, and negligent manner; (b) operating said vehicle without due regard for the rights, safety and position of the Plaintiff; (c) failure to operate vehicle in an attentive manner; (d) failure to keep proper look-out; (e) failure to use due care under the circumstances; (f) failure to yield; (g) failure to stop; (h) violating the motor vehicle statutes of Pennsylvania. 7. As a result of the aforesaid occurrence, the Plaintiff's motor vehicle was damaged in and about its pertinent parts the fair and reasonable value of the repairs amounting to $2267.99. Attached hereto and marked as Exhibit "A" is an estimate of repairs. 8. As a result of the aforesaid occurrence, the Plaintiff incurred rental charges for the rental of a motor vehicle while her vehicle was being repaired. The fair and reasonable value of the rental totals $641.40. Attached hereto and marked as Exhibit 11B11 is the Rental Agreement. WHEREFORE, Plaintiff claims to recover from the Defendants damages in the amount of $2909.39, plus costs. A. ARTHLIR HANAMIRIAN, P.C. BY: FOR PLAINTIFF V E R I F I C A T I O N MICHAEL A. HANAMIRIAN, ESQUIRE states that he is the attorney for Plaintiff, Anna Concetta Devita, in the above- captioned matter, and that the facts set forth in the foregoing Civil Action Complaint are true and correct to the best of her knowledge, information and belief, and that this statement is made subject to penalties of IS Pa. C.S. Section 4904 relating to unsworn falsifications to authorities. No Affidavit is required pursuant to Rule 206. DATED: 11K Z/4 MICHAEL NAMIRIAN, ESQUIRE r ALLSTATE INSURANCE COMPANY HARRISBURG MCO 6345 FLANK DRIVE HARRISBURG, PA 17112 (717) 540-7500 CD LOG NO 365 -1 DATE 09-16-97 SUPPLEMENT CLAIM INFORMATION CLAIM # 1552831867DOI COMPANY ALLSTATE INSURED DEVITA, ANNA CLAIMANT INSPECTION TYPE APPRAISER NAME LICENSE # WORK PHONE ADDRESS CITY STATE ZIP OWNER FIELD SAM CUNNINGHAM 3002112 (800) 755-0747 x30 6345 FLANK DR HARRISBURG 17112- NAME DEVITA, ANNA ADDRESS 207 JACOBS ST CITY STATE E BERLIN PA ZIP 17316-8601 REPAIR REPAIR PAC SHOP PHONE ATTENTION ADDRESS CITY STATE ZIP POLICY # 698021815 AGENT LOSS DATE 08-13-97 LOSS TYPE COLLISION FAX (717) 630-1110 x INSP DATE 08-19-97 PA LOCATION LEASE'S A/B CITY STATE EAST BERLIN WORK PHONE (000) 000-0000 x HOME PHONE (717) 259-7220 x CLITY LEASE'S AUTO BODY & PAINT (717) 259-7664 x KERRY RD 1 BOX 847 EAST BERLIN PA 17316- VEHICLE 1995 FORD MUSTANG STD 2 DR COUPE 6CYL GASOLINE 3.8 OPTIONS TWO-STAGE - EXTERIOR SURFACES POWER WINDOWS REAR SPOILER AUTOMATIC TRANS BODY COLOR GREEN MET CONDITION GOOD LICENSE # ABB1532 LICENSE STATE PA FAX CAR IN CAR OUT DAYS TO REPAIR 4 REG. ID POWER DOOR LOCKS HEATED BACK GLASS AIR CONDITIONING CRUISE CONTROL MILEAGE 16,160 VIN IFALP4048SF227834 CODE P125 VEH INSP # PA REMARKS: FOR SUPPLEMENTS CALL SUPPLEMENT HOTLINE.. 1-800-726-8890 X 30301111111 ALL SUPPLEMENTS MUST BE CALLED IN PRIOR TO REPAIRING[I INVOICES ARE REQUIRED. > > >DO NOT CALL THE ADJUSTER FOR SUPPLEMENTS I I I < < < -1- ti i vj "A T' 95 FORD MUSTANG 2 DOOR S1aUAN DATE 09-16-97 CLAIM # 1552831867D01 LOG 365 -i HIDDEN COMPONENTS WILL BE OPEN FOR INSPECTION PEND ING DISASSEMBLY. EST. COVER VISIBLE DAMAGES ONLY ECON. PARTS AT KEYSTONE AUTOMOTI VE AT 800-524-4349 SALVAGE PARTS AT BILL FOX MUSTANGS AT 717-292-2537 PART GDE OPERATION PRICE LABOR RT FRONT BUMPER Cover,Front Bumper 0016 Refinish 3.7 RF Surface 2.6 Two-stage 0.5 Two-stage setup 0.6 Bumper,Front 0005 Replace Economy 79.00* 2.3 SM FRONT END PANEL AND LAMPS Panel,Headlamp Mtg 0019 Replace OEM 92.17 1.2 SM F7ZZBA284AA Headlamp Assy,Halogen RT 0042 Replace -PXN 102.88 INC SM Parklamp Assembly RT 0056 Replace Economy 34.00* INC SM Headlamps Aim 0973 Additional, Labor 0.5 SM RADIATOR SUPPORT Panel,Radiator Supt 0073 Repair 0.5* SM FRONT BODY AND WINDSHIELD Fender,Front RT 0104 Replace Salvage 156.25* S1 1.4 SM Salv User Markup 25t Fender,Front RT 0104 Refinish 2.4 RF Surface 1.6 Edge 0.5 Two-stage 0.3 Panel,Hood 0083 Refinish 3.2 RF Surface 2.7 Two-stage 0.5. FRONT BODY INTERIOR SHEETMETAL Brace,Front Fender R/F 0112 Replace OEM 3.00 SM. F4ZZ16A023A Brace,Front Fender R/F 0112 Refinish 0.1 RF Surface 0.1 Reinf,Inner Fender RT 0134 Repair 0.5* sM MANUAL ENTRIES PINSTRIPES-TAPE M007 Replace Economy 10.00* 0.3* SM* RT FRT LOWER RAIL Repair 0.5* SM* FRT NOSE COVER Replace OEM 100.00* S1 0.3* SM* RT ROOF DRIP MLDG FRT Replace OEM 58.11* 1.1* SM* RT ROOF DRIP MLDG FRT Refinish 0.5* RF* COLOR BLEND M016 Refinish 1.0* RF* FRT BUMPER COVER Replace Salvage 312.50* INC* SM* Salv User Markup 25V HOOD PANEL Replace Salvage 312.50* 1.2* SM* Salv User Markup 258 21 ITEMS FINAL CALCULATIONS & ENTRIES PARTS GROSS PARTS $ 253.28 -2- 95 FORD MUSTANG 2 DOOR SUDAN DATE 09-16-97 CLAIM # 1552831867D0I LOG 365 -1 OTHER PARTS PAINT MATERIAL ADJUSTMENTS DISCOUNT MARKUP PARTS TOTAL TAX ON PARTS & MATERIAL ® 6.000V $ 1,006.13 $ 152.60 $ 1,412.01 $ 84.72 LABOR RATE REPLACE HRS REPAIR HRS 1-SHEET METAL $ 30.00 7.8 2.0 $ 294.00 2-MECH/ELEC $ 34.00 3-FRAME $ 32.00 4-REFINISH $ 30.00 10.9 $ 327.00 5-PAINT $ 14.00 LABOR TOTAL $ 621.00 TAX ON LABOR 0 6:000* $ 37.26 SUBLET REPAIRS TOWING p /s $ 113.00 STORAGE 9? a NET SUPPLEMENT TOTAL $ C> ? LESS: ORIGINAL NET TOTAL $ 1,691.8 GROSS TOTAL $ Z,267.99 LESS: NET DEDUCTIBLE _ $ .500.00 NET TOTAL $ 1,767.99 PXN Yes Geocode: 17112 HARRISBURG SPPL No ADP PENPRO W0312 S1 LOG 365 -1 09-16-97 15:24:32 REL 3.12 CD 09/97 COPYRIGHT, AUTOMATIC DATA PROCESSING, INC. 1997 SALVAGE PRICE REFLECTS MARKUP 1.9 HOURS WERE ADDED TO THIS ESTIMATE BASED ON ADP'S TWO-STAGE REFINISH FORMULA: 20t OF REFINISH HOURS, AFTER OVERLAP, PLUS 0.6 HOURS FOR THE FIRST MAJOR PANEL, WHERE NOTED. ------------------------------------------------------------------------------- TO ALL REPAIR FACILITIES: BEFORE USING AN AFTERMARKET SHEETMETAL PART, BE SURE TO LOOK FOR THE CAPA SEAL. THIS IS NOT AN AUTHORIZATION FOR REPAIR. SUPPLEMENTS MUST BE APPROVED PRIOR TO REPAIR. IF YOUR CAR IS OF UNITIZED CONSTRUCTION, IN SOME CASES THE REPAIR SHOP MAY NEED SPECIAL EQUIPMENT TO PROPERLY REPAIR THE CAR. YOU SHOULD DETERMINE IF THE SHOP YOU SELECT TO COMPLETE THE REPAIRS IS PROPERLY EQUIPPED. -3- r CD LOG NO 365 -1 DATE 09-16-97 VEHICLE 1995 FORD MUSTANG STD 2 DR COUPE 6CYL GASOLINE 3.8 OPTIONS TWO-STAGE - EXTERIOR SURFACES POWER WINDOWS REAR SPOILER AUTOMATIC TRANS SUPPLIER PART' PART DESCRIPTION NUMBER POWER DOOR LOCKS HEATED BACK GLASS AIR CONDITIONING CRUISE CONTROL SUBSTITUTED FOR OEM,PART SUPPLIER CLS SRC NUMBER CODE FRONT END PANEL AND LAMPS Headlamp Assy,Halogen RT H114R F4ZZ13008E >001 > = ESTIMATE TOTAL IS BASED ON PRICE QUOTED BY THIS SUPPLIER KEY TO CLASSIFICATION/SOURCE CODES CLS CLASSIFICATION CODE: C - CAPA CERTIFIED PART QUOTED BY LISTED SUPPLIER R - RECONDITIONED PART SRC SOURCE CODE: 1 - NON ORIGINAL EQUIPMENT MANUFACTURER PART 3 - ORIGINAL EQUIPMENT MANUFACTURER (OEM) PART DETAILED DISTRIBUTOR LIST 001 - PXN4081 BRITE STAR GROUP PO BOX 5317 WEST BABYLON, NY 11707 (800) 638-5901 (516) 422-8449 ADP PENPRO W0312 S1 LOG 365 -1 09-16-97 15:24:35 REL 3.12 CD 09/97 GEOCODE: 17112 SA: HARRISBURG COPYRIGHT, AUTOMATIC DATA PROCESSING, INC. 1997 NOTE: NON-OEM SHEET METAL PARTS MUST BE CAPA CERTIFIED. 1 -1- 314 1lamsburg JI SUPPLEMENTAL LIABILITY INSURANCL j EAST BERLIN, PA 17318 717.259-6334 1-800-248-0395 ER N2 001425, A SPEEDOMETER IN SPEE?ETER MILES URNEN MILES ALLOWED CHARGEABLE MILES DE E 114 1rz GS X4 FUEL MAX. PAVLOAD . RATES DO NOT INCLUDE FUEL HOURS Ot PERHDUR >< DAYS *I O Z. bU $ WEEKS OI O $ MONTHS O S $ MILES O It PER MILE $ E 114 112 TOTAL MILEAGE AND RENTAL CHARGES S 314 FUEL GALS. O S S P, SUBTOTAL $ 18 1 55: t- -- PER DAY. ZJ• yy PER WEEK • $ BY INITIALING, CUSTOMER ACCEPTS OR DECLINES COMPREHEN- $ SUS TOTAL SIVEICOLLISION DAMAGE WAIVER AT THE RATES LISTED ABOVE. BY DECLINING WAIVER, CUSTOMER ACCEPTS FULL RESPONSIBILITY SALES TAX FO *L OSS/DAMAGE TO THE RENTED VEHICLE UP TO DEOINES _ $ WG PER OCCURRENCE, REGARDLESS OF CAUSE. NOTICE: ??TAX S WAIVER DOES NOT COVER LOSS OR DAMAGE RESULTING FROM X SULOMMY PATAX S ANY VIOLATION OF PARAGRAPH 1. OR 2. ON PAGE 1 OF THIS AGREEMENT, FOR _ MISSING VEHICLE PARTS OR FOR INTERIOR VEHICLE DAMAGE OTHER THAN $ NORMAL WEAR AND TEAR CAUSED BY VEHICLE OCCUPANTS INCLUDING ANIMALS. GCOW IS NOT INSURANCE TOTAL CHARGES $ VVW CONDITION .. _... coal. wrt. LESS DEPCSR S CREDIT CARD CO. EXP. DATE VERIFIED Please return this vehicle with the Same amoum Of fuel as you recoived it. Any additional fuel chmq-s will be added to your bill. You will be charred per quarter tank. ?±a-Ds jz4 3 U ? s 4 REFUND CUSTOMER I AM PM KII TOLL FREES: 1? 2,14-0684 FAX: F--)M (f I, 6 ,, .a e LL M '-l CASE NO:'1999-03835 P SHERIFF'S RETURN - NOT FOUND COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND DEVITA ANNA CONCETTA VS. SAMUELS TEVON N ET AL R. Thomas Kline Sheriff, who being duly sworn according to law, says, that he made a diligent search and inquiry for the within named defendant, to wit: SAMUELS TEVON N but was unable to locate Him in his bailiwick. He therefore returns the NOTICE AND CIVIL ACTION NOT FOUND , as to the within named defendant SAMUELS TEVON N PROVIDED W/COPIES AND INST. FROM ATTY TO SERVE AT THIS ADDRESS, HOWEVER DEFT. IS ARE IN DAUPHIN CO Sheriff's Costs: So answers Docketing 18.00 NotvFound 5.00 Surcharge 8.00 R-T omas ine, eri $33769 07/1RTHUR HANAMIRIAN /1999 Sworn and subscribed to before me this gc& day of ' 1999 A. D. 3:-U o- - CASE N0:"1999-03835 P SHERIFF'S RETURN - NOT FOUND COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND DEVITA ANNA CONCETTA VS. SAMUELS TEVON N ET AL R. Thomas Kline Sheriff, who being duly sworn according to law, says, that he made a diligent search and inquiry for the within named defendant, to wit: SAMUELS QUINTA N but was unable to locate Her in his bailiwick. He therefore returns the NOTICE AND CIVIL ACTION NOT FOUND , as to the within named defendant SAMUELS QUINTA N COPIES W/INSTRUCTIONS FROM ATTY TO SERVE DEFT'S AT ABOVE ADDRESS, HOWEVER DEFT.'S ARE IN DAUPH CO Sheriff's Costs: So answ Docketing 6.00 Service .00 Not Found 5.00 Surcharge 8.00 R-If marine??? eri $TY= 07/ RTHUR9HANAMIRIAN 15/ Sworn and subscribed to before me this IS6 day of 197,9_ A.D. ?j r? 4? 0 ono army SHERIFF'S RETURN - OUT OF COUNTY CASE NO:-1999-03835 P COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND DEVITA ANNA CONCETTA VS. SAMUELS TEVON N ET AL R. Thomas Kline Sheriff, who being duly sworn according to law, says, that he made a diligent search and inquiry for the within named defendant, to wit: SAMUELS TEVON N but was unable to locate Him in his bailiwick. He therefore deputized the sheriff of DAUPHIN County, Pennsylvania. to serve the within NOTICE AND CIVIL ACTION On July 15th, 1999 , this office was in receipt of the attached return from DAUPHIN County, Pennsylvania. Sheriff fIs Costs: So answe Docketing 18.00 Out of County 9.00 ?:' Surcharge 8.00 omas. M eri DEP. DAUPHIN CO 35.25 $0.25 ARTHUR HANAMIRIAN Sworn and subscribed to before me this /5 day of Qlt-tlx 19 49 A. D. ?.?(,'. r nonocary SHERIFF'S RETURN - OUT OF COUNTY CASE NO:' 1999-03835 P COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND DEVITA ANNA CONCETTA VS. SAMUELS TEVON N ET AL R. Thomas Kline Sheriff, who being duly sworn according to law, says, that he made a diligent search and inquiry for the within named defendant, to wit: SAMUELS QUINTA N but was unable to locate Her in his bailiwick. He therefore deputized the sheriff of DAUPHIN County, Pennsylvania. to serve the within NOTICE AND CIVIL ACTION On July 15th, 1999 , this office was in receipt of the attached return from DAUPHIN County, Pennsylvania. Sheriff's Costs: So answers. Docketing 6.001 Out of County .00 Surcharge 8.00 R- Anomas i e, i 4i14.UU A. ARTHUR HANAMIRIAN 07/151999 Sworn and subscribed to before me this /5ccl day of 19 ef-9 A.D. C. )1U1;11 4 ro c nc,I IU L a? (?f fire Of *P ,?*hrrfff Mary Jane Snyder Real Estate Deputy. ; William T. Tulle t Solicitor Dauphin County Harrisburg. Pennsylvania 17101 ph:(717)255.26M fax:(717)255.2889 Jack Lotwick Sheriff Commonwealth of Pennsylvania DEVITA ANNA CONCETTA V9 County of Dauphin SAMUELS QUINTA N Sheriff's Return No. 1330-T - - -1999 OTHER COUNTY NO. 99-3835 Ralph G. McAllister Chic(M-puty Michael W. Rinehart Assistant Chief Deputy I, Jack Lotwick, Sheriff of the County of Dauphin, State of Pennsylvania, do hereby certify and return, that I made diligent search and inquiry for SAMUELS QUINTA N the DEFENDANT named in the within NOTICE and that I am unable to find him/her in the County of Dauphin, and therefore return same NOT FOUND, July 8, 1999 MOVED FROM THIS ADDRESS PER APT MANAGERS. Sworn and subscribed to before me this 8TH day of JULY, 1999 PROTHONOTARY So Answers, ? lel? Sheriff of Dauphin County, Pa. By Deputy Sheriff Sheriff's Costs: $35.25 PD 07/01/1999 RCPT NO 125504 (?# tCE of t4E s4pr- Man Jane Snyder Real l rime DLputy William T. Tully 0 Solicitor Dauphin County Harrisburg. Pennsylvania 17101 ph: (717) 255.266() fax: (717) 255-2889 Jack Lotwick Sheriff Commonwealth of Pennsylvania County of Dauphin DEVITA ANNA CONCETTA Vs SAMUELS QUINTA N Sheriff's Return No. 1330-T - - -1999 OTHER COUNTY NO. 99-3835 Ralph G. McAllister Chief Deputy Michael W. Rinehart Assistant Chief Deputy I, Jack Lotwick, Sheriff of the County of Dauphin, State of Pennsylvania, do hereby certify and return, that I made diligent search and inquiry for SAMUELS TEVON N the DEFENDANT named in the within NOTICE and that I am unable to find him/her in the County of Dauphin, and therefore return same NOT FOUND, July 8, 1999 MOVED FROM THIS ADDRESS AS PER APT MANAGER. Sworn and subscribed to before me this 8TH day of JULY, 1999 PROTHONOTARY So Answers, Sheriff of Dauphin County, Pa. By Deputy Sheriff Sheriff's costs: $35.25 PD 07/01/1999 RCPT NO 125504 Anna Concetta Devita vs. Tevon N. Samuels Serve: Quinta N. Samuels No. 99-3935 Civil 19 Now, 6/30/99 19_, 1 SHF,RIFF OF CUMBERLAND COUNTY, PA do hereby deputize the Sheriff of Dauphin County to execute this Writ, this deputation being made at the request and risk of the Plaintiff. Sheriff of Cumberland County, Pa. Affidavit of Service 19 , at o'clock M, served the at by handing to attested copy of the original the contents thereof. So answers, Sheriff of COSTS Sworn and subscribed before me this day of SERVICE S 19 MILEAGE AFFIDAVIT Counrv, Pa. a true and and made known to S Anna Concetta Devita VS. Tevon N. Samuels, et. al. Serve: Tevon N. Samuels No. 99-3835 Civil 19 Now, 6/30/99 19_, f SHERIFF OF CUMBERLAND COUNTY, PA do hereby deputize the Sheriff of Dauphin County to execute this Writ, this deputation being made at the request and risk of the Plaintiff. eow - 2 Sheriff of Cumberland County, Pa. Affidavit of Service Now. at by handing to attested copy of the original the contents thereof. Sworn and subscribed before me this day of_, 19 ,at So answers, o'clock M, served the a true and and made known to Sheriff of COSTS SERVICE S 19 MILEAGE AFFIDAVIT County, Pa. S MAH/kkc A. ARTHUR HANAMIRIAN, P.C. BY: MICHAEL A. HANAMIRIAN, ESQUIRE ATTORNEY I.D. NO. 49457 1608 WALNUT STREET, SUITE 803 PHILADELPHIA, PA 19103 (215) 735-4235 ATTORNEY FOR PLAINTIFF ANNA CONCETTA DEVITA 207 Jacobs Street East Berlin, PA 17316 VS TEVON N. SAMUELS 2206 L Cedar Run Drive Camphill, PA 17011 and QUINTA N. SAMUELS 2206 L Cedar Run Drive Camphill, PA 17011 •YOU HAVE BOSH SUED IN COURT. IF YOU WISH TO DEPEND AGAINST THE CLAIMS SET FORTH IN THE FOLLOWING PAGES, YOU MUST TAKE ACTION WITHIN TWENTY (10 DAYS AFTER THIS COMPLAINT AND NOTICE ARE SERVED, BY RNMRING A WRITTEN APPEARANCE PERSONALLY OR BY ATTORNEY AND PILING IN WRITING WITH THE COURT YOUR DEFENSES OR OBJECTIONS TO THE CLAIMS SET FORTH AGAINST YOU. YOU ARE WARNED THAT IF YOU PAIL TO DO SO THE CASH RAY PROCEED WITHOUT YOU AND A JUDGMENT MAY BE ENTREES AGAINST YOU BY INS COURT WITHOUT FURTHER NOTICE FOR ANY MONEY CLAIMED IN THE COMPLAINT OR FOR ANY OTHER CLAIM OR RELIEF REQUESTED BY THE PWIWIPF. 'YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IV YOU DO NOT HAVE A LAWYER OR CANNOT APPORD ONE, W TO OR TELEPHONE MR OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GOT LEGAL HELP. WWyer Referral Service (717) 140-6100 COURT ADWINISTRATOR 4th Floor Cumberland County Courthouse Carlisle, PA 17011 TRUE W" FROM REOOFiD In Tog" whereof, I twre unto w my hwl and ;Mot sai c U Carfi*, h A_ T AY ??-t CUMBERLAND COUNTY COURT OF COMMON PLEAS CIVIL TRIAL DIVISION NO. C? y - 3P3 S •AVISO ?L LB MAN DEMANDADO A USTBD BN LA CORTE. BI USTBD QUIBRB DSPSNDOkSS DR BETAS DBMANDAS BAPUBSTAS ON LAS PAOINAe SIGUIBNTBS, USTBD TIEN VRINfB (10) DIM DR PLABO AL PARTIR DB W PECHA DB LA DEMANDA Y LA NOTIPICACION. MACE PALTA ASSWAR UNA, COMPARBNCIA BSCRITA 0 RN PERSONA 0 CON ON ABOGADO Y BNIREGAR A LA CORTE ON FORMA ESCRITA BOB DBPBNSAS O BUD OWSCIONSS A LAS DSMANDAS EN CONTRA SOYA SIN FERVID AVISO 0 NOTIPICACION. ADOXAS, LA CORM FORDS DBCIDIR A FAVOR VOL DBMANOANTS Y RBQUISRE QUE USTBD CUMPLA CON TODAS LAS PROVISIONER DB BETA DBMANDA. LISTED PURSE FEEDER DINBRO 0 SUB PROPIBDADES U MOB DERSCHOS IMPORTANTBS PARA USTBD •LLBVB BETA DEMANDA A ON ASOGADO IMMSDIATAMBNTM, SI NO TIME ABOGADO O SI NO TIBNB EL OINSRO SUPICIBNTB DR PAGAR TAL SBRVICIO, VAYA ON PERSONA 0 LLAMS OR TBLBPONO A LA OPICINA CUYA DIRBCCION SE BNCUBNTRA BSCRITA AMAJO PARA AVERIGUAR DONOR SO FUROR CONSBGUIR ASISTENCIA LEGAL. SBRVICIO OB RBPBRENCIA LEGAL Lawyer Referral Service (717) 140-6100 COURT ADMINISTRATOR 4th Floor Cumberland County Courthouse Carlisle, PA 17013 MAH/kkc A. ARTHUR HANAMIRIAN, P.C. BY: MICHAEL A. HANAMIRIAN, ESQUIRE ATTORNEY I.D. NO. 49457 1608 WALNUT STREET, SUITE 803 PHILADELPHIA, PA 19103 (215) 735-4235 ATTORNEY FOR PLAINTIFF ANNA CONCETTA DEVITA 207 Jacobs Street East Berlin, PA 17316 CUMBERLAND COUNTY COURT OF COMMON PLEAS CIVIL TRIAL DIVISION VS. TEVON N. SAMUELS 2206 L Cedar Run Drive Camphill, PA 17011 AND QUINTA N. SAMUELS 2206 L Cedar Run Drive Camphill,.PA 17011 CIVIL ACTION 1. Plaintiff, Anna Concetta Devita, is an adult individual who resides at 207 Jacobs Street, City of East Berlin, Commonwealth of Pennsylvania. 2. Defendant, Tevon N. Samuels, is an individual residing at 2206 L Cedar Run Drive, Camphill, PA 17011. 2. Defendant, Quinta N. Samuels, is an individual residing at 2206 L. Cedar Run Drive, Camphill, PA 17011. 3. On or about August 13, 1997, Plaintiff was the owner of a 1995 Ford Mustang, VIN 1FALP4048SF227834 thus lawfully traveling east on Carlisle Road approaching Orchard Road in the Township of Lower Allen, County of Cumberland, Commonwealth of Pennsylvania. 4. At the time and place stated above, Defendant Tevon N. Samuels possessed, controlled, and operated a 1980 Ford Mustang owned by Defendant, Quints, N. Samuels, and attempted to turn left onto Orchard Road from Carlisle Road with disregard of oncoming traffic, causing the vehicle he was operating to violently collide with Plaintiff's vehicle, resulting in severe property damage to the Plaintiff. 5. The aforesaid occurrence was caused solely by the negligence of the Defendants and the Plaintiff was in no manner contributorily negligent. 6. On the aforesaid accident date, the negligence, carelessness, and recklessness of the Defendants consisted inter alia of: (a) operating said vehicle in a careless, reckless, and negligent manner; (b) operating said vehicle without due regard for the rights, safety and position of the Plaintiff; (c) failure to operate vehicle in an attentive manner; (d) failure to keep proper look-out; (e) failure to use due care under the circumstances; (f) failure to yield; (g) failure to stop; (h) violating the motor vehicle statutes of Pennsylvania. 7. As a result of the aforesaid occurrence, the Plaintiff's motor vehicle was damaged in and about its pertinent parts the fair and reasonable value of the repairs amounting to $2267.99. Attached hereto and marked as Exhibit "All is an estimate of repairs. S. As a result of the aforesaid occurrence, the Plaintiff incurred rental charges for the rental of a motor vehicle while her vehicle was being repaired. The fair and reasonable value of the rental totals $641.40. Attached hereto and marked as Exhibit "B" is the Rental Agreement. WHEREFORE, Plaintiff claims to recover from the Defendants damages in the amount of $2909.39, Plus costs. A. ARTHUR HANAMIRIAN, P.C. BY: FOR PLAINTIFF MICHAEL A. HANAMIRIAN, ESQUIRE states that he is the attorney for Plaintiff, Anna Concetta Devita, in the above- captioned matter, and that the facts set forth in the foregoing Civil Action Complaint are true and correct to the best of her knowledge, information and belief, and that this statement is made subject to penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsifications to authorities. No Affidavit is required pursuant to Rule 206. DATED: I MICHAEL AMIRIAN, ESQUIRE r ALLSTATE INSURANCE COMPANY HARRISBURG MCO 6345 FLANK DRIVE HARRISBURG, PA 17112 (717) 540-7500 CD LOG NO 365 -1 DATE 09-16-97 SUPPLEMENT CLAIM INFORMATION CLAIM # 15528318671301 COMPANY ALLSTATE INSURED DEVITA, ANNA CLAIMANT INSPECTION TYPE APPRAISER NAME LICENSE # WORK PHONE ADDRESS CITY STATE ZIP OWNER NAME ADDRESS CITY STATE ZIP REPAIR REPAIR PAC SHOP PHONE ATTENTION ADDRESS CITY STATE ZIP FIELD SAM CUNNINGHAM 3002112 (800) 755-0747 x30 6345 FLANK DR 17112- DEVITA, ANNA 207 JACOBS ST E BERLIN 17316-8601 PA POLICY # 698021815 AGENT LOSS DATE 08-13-97 LOSS TYPE COLLISION FAX (717) 630-1110 x INSP DATE 08-19-97 PA LOCATION LEASE'S A/B CITY STATE EAST BERLIN PA WORK PHONE (000) 000-0000 x HOME PHONE (717) 259-7220 x CLITY LEASE'S AUTO BODY & PAINT (717) 259-7664 x KERRY RD 1 BOX 847 EAST BERLIN PA 17316- VEHICLE 1995 FORD MUSTANG STD 2 DR COUPE 6CYL GASOLINE 3.8 OPTIONS TWO-STAGE - EXTERIOR SURFACES POWER WINDOWS REAR SPOILER AUTOMATIC TRANS BODY COLOR GREEN MET CONDITION GOOD LICENSE # ABB1532 LICENSE STATE PA FAX CAR IN CAR OUT DAYS TO REPAIR 4 REG. ID POWER DOOR LOCKS HEATED BACK GLASS AIR CONDITIONING CRUISE CONTROL MILEAGE 16,160 VIN IFALP4048SF227834 CODE P125 VEH INSP # REMARKS: FOR SUPPLEMENTS CALL SUPPLEMENT HOTLINE..1-800-726-8890 X 3030111IfIt ALL SUPPLEMENTS MUST BE CALLED IN PRIOR TO REPAIRING[I INVOICES ARE REQUIRED. >>>DO NOT CALL THE ADJUSTER FOR SUPPLEMENTS I I I<<< -1- ryA I)11 95 FORD MUSTANG 2 DOOR SbOAN DATE 09-16-97 CLAIM $ 1552831867D01 LOG 365 HIDDEN COMPONENTS WILL BE OPEN FOR INSPECTION PENDING DISASSEMBLY. EST. COVER VISIBLE DAMAGES ONLY ECON. PARTS AT KEYSTONE AUTOMOTIVE AT 800-524-4349 SALVAGE PARTS AT BILL FOX MUSTANGS AT 717-292-2537 PART FRONT BUMPER Cover,Front Bumper Bumper,Front FRONT END PANEL AND LAMPS Panel,Headlamp Mtg. F7ZZ8A284AA Headlamp Assy,Halogen RT Parklamp Assembly RT Headlampe Aim RADIATOR SUPPORT Panel,Radiator Supt FRONT BODY AND WINDSHIELD GDE OPERATION 0016 Refinish Surface Two-stage Two-stage setup 0005 Replace Economy PRICE 78.00* 92.17 102.88 34.00* 156.25* S1 25t LABOR RT 3.7 RF 2.6 0.5 0.6 2.3 SM 0019 Replace OEM 00,42 Replace -PXN • 0056 Replace Economy 0973 Additional Labor 0073 Repair Fender,Front RT 0104 Replace Salvage Salv User Markup Fender,Front RT 0104 Refinish Surface Edge Two-stage Panel,Hood 0083 Refinish Surface Two-stage FRONT BODY INTERIOR SHEETMETAL Brace,Front Fender R/F 0112 Replace OEM F4ZZ16A023A Brace,Front Fender R/F 0112 Refinish Surface Reinf,Inner Fender RT 0134 Repair MANUAL ENTRIES PINSTRIPES-TAPE RT FRT LOWER RAIL FRT NOSE COVER RT ROOF DRIP MLDG FRT RT ROOF DRIP MLDG FRT COLOR BLEND FRT BUMPER COVER Salv User HOOD PANEL Salv User M007 Replace Economy Repair Replace OEM Replace OEM Refinish M016 Refinish Replace Salvage Markup Replace Salvage Markup 21 ITEMS FINAL CALCULATIONS & ENTRIES PARTS GROSS PARTS 3.00 10.00* 100.00* S1 58.11* 312.50* 25t 312.50* 25t 253.28 1.2 SM INC SM INC SM 0,5- SM 0.5* SM 1.4 SM 2.4 RP 1.6 0.5 0.3 3.2 RF 2.7 0.5. SM 0.1 RF 0.1 0.5* SM 0.3* SM* 0.5* SM* 0.3* SM* 1.1* SM* 0.5* RF* 1.0* RF* INC* SM* 1.2* SM* -2- r 95 FORD MUSTANG 2 DOOR STWAN CLAIM # 1552831867D01 OTHER PARTS PAINT MATERIAL ADJUSTMENTS DISCOUNT MARKUP PARTS TOTAL TAX ON PARTS & MATERIAL ® 6.OOOt LABOR RATE 1-SHBET METAL $ 30.00 2-MECH/BLEC $ 34.00 3-FRAME $ 32.00 4-REFINISH $ 30.00 5-PAINT $ 14.00 LABOR TOTAL TAX ON LABOR 0 6:000t SUBLET REPAIRS TOWING STORAGE $ 1,006.13 $ 152.60 DATE 09-16-97 LOG 365 -1 $ 1,412.01 $ 84.72 REPLACE HRS REPAIR HRS 7.8 2.0 $ 294.00 10.9 $ 327.00 NET SUPPLEMENT TOTAL LESS: ORIGINAL NET TOTAL GROSS TOTAL LESS: NET DEDUCTIBLE NET TOTAL $ 1,767.99 PXN Yes Geocode: 17112 HARRISBURG SPPL No ADP PENPRO W0312 S1 LOG 365 -1 09-16-97 15:24:32 REL 3.12 CD 09/97 COPYRIGHT, AUTOMATIC DATA PROCESSING, INC. 1997 SALVAGE PRICE REFLECTS MARKUP 1.9 HOURS WERE ADDED TO THIS ESTIMATE BASED ON ADP'S TWO-STAGE REFINISH FORMULA: 20t OF REFINISH HOURS, AFTER OVERLAP, PLUS 0.6 HOURS FOR THE FIRST MAJOR PANEL, WHERE NOTED. ------------------------------------------------------------------------------- TO ALL REPAIR FACILITIES: BEFORE USING AN AFTERMARKET SHEETMETAL PART, BE SURE TO LOOK FOR THE CAPA SEAL. THIS IS NOT AN AUTHORIZATION FOR REPAIR. SUPPLEMENTS MUST BE APPROVED PRIOR TO REPAIR. IF YOUR CAR IS OF UNITIZED CONSTRUCTION, IN SOME CASES THE REPAIR SHOP MAY NEED SPECIAL EQUIPMENT TO PROPERLY REPAIR THE CAR. YOU SHOULD DETERMINE IF THE SHOP YOU SELECT TO COMPLETE THE REPAIRS IS PROPERLY EQUIPPED. • $ 621.00 $ 37.26 $ 113.00 3?? $ 9;' $ 1,691.82- $ 2,267.99 $ 500.00- -3- r CD LOG NO 365 -1 DATE 09-16-97 VEHICLE 1995 FORD MUSTANG STD 2 DR COUPE 6CYL GASOLINE 3.8 OPTIONS TWO-STAGE - EXTERIOR SURFAC27S POWER WINDOWS REAR SPOILER AUTOMATIC TRANS SUPPLIER PART" PART DESCRIPTION NUMBER % F M i POWER DOOR LOCKS HEATED BACK GLASS AIR CONDITIONING CRUISE CONTROL SUBSTITUTED FOR OEM.MT SUPPLIER CLS SRC NUMBER' CODE FRONT END PANEL AND LAMPS Headlamp Aeay,Halogen RT B114R F4ZZ13008B >001 > . ESTIMATE TOTAL IS BASED ON PRICE QUOTED BY THIS SUPPLIER KEY TO CLASSIFICATION/SOURCE CODES CLS a CLASSIFICATION CODE: C - CARA CERTIFIED PART QUOTED BY LISTED SUPPLIER R - RECONDITIONED PART SRC SOURCE CODE: 1 - NON ORIGINAL EQUIPMENT MANUFACTURER PART 3 - ORIGINAL EQUIPMENT MANUFACTURER (OEM) PART DETAILED DISTRIBUTOR LIST 001 - PXN4081 BRITS STAR GROUP PO BOX 5317 WEST BABYLON, NY 11707 (800) 638-5901 (516) 422-8449 ADP PENPRO W0312 S1 LOG 365 -1 09-16-97 15:24:35 RBL 3.12 CD 09/97 GEOCODE: 17112 SA: HARRISBURG COPYRIGHT, AUTOMATIC DATA PROCESSING, INC. 1997 NOTE: NON-OEM SHEET METAL PARTS MUST BE CAPA CERTIFIED. 1 -1- t 'k '3 14 1lamsburg 51 EAST BERLIN, PA 17316 717.269.6334 1.800-246-0395 SUPPLEMENTAL LIABILITY INSURANCL 0142 L J_ - u/ &'EEOo mA _ IN DATE AND -- / . S no. ST DA DATE SPEl / .- I !I TH TE fOCIAL N NO. P IgNE / / VERIFIED MRFA DAWN ?-- MAX. PAYLOAD LOCAL CONTACT ADDRER PHONE ALLOW[D E%PIMTGN OF T "m r` I f V .- n VE to CHAFOR"LE MMES AN m REFERRED SY IIZED AS JSS THIS W1 E ARE 1M IR ASK 3N MCN IAL HATES DO NOT HOURS • DAYS S FUEL MONTHS O S IN MILES a ' E II ID 711 l ES: /' `"'• PER DAY.-%,j, W PER WEEK BY INITIALING, CUSTOMER ACCEPTS OR DECLINES COMPREHEN• SIVHCOLLISION DAMAGE WAIVER AT THE RATES LISTED ABOVE. BY DECLINING WAIVER, CUSTOMER ACCEPTS FULL RESPONSIBILITY FO .ALL LOSS/DAMAGE TO THE RENTED VEHICLE UP TO DECLINES $GDS' PER OCCURRENCE, REGARDLESS OF CAUSE. NOTICE: WAIVER DOES NOT COVER LOSS OR DAMAGE RESULTING FROM ANY VIOLATION OF PARAGRAPH 1. OR 2. ON PAGE 1 OF THIS AGREEMENT, FOR MISSING VEHICLE PARTS OR FOR INTERIOR VEHICLE DAMAGE OTHER THAN NORMAL WEAR AND TEAR CAUSED BY VEHICLE OCCUPANTS INCLUDING ANIMALS. C(CDW IS NOT INSURANCE PER HOUR i i t ? PER YM S TOTAL MILEAGE AND RENTAL CHARGES i RIEL DALE. *S S SUBTOTAL S i SUE TOTAL $ SALES TAX Is MPORTAO S 04MMY PTA TAN S i TOTAL CHARGES i LR/ DEPOSR S CREDIT CARD CO. EXP. DATE VERIFIED GASH REP Please return this vchicle with tin same amoun't of fuel as you received it. Any arlditional fuel chanlrrs will be added to your bill. YOU will be chargod $b.00 per quarter tank. ?ODS A?ACII` 2l C?la,c-?o f o? k,) 3 X42, m ORw IUR Rv W01.RV1n0 E ORDER TOLL ERR, H404II41NM FAX i A QrA n%j MAH/kkc A. ARTHUR HANAMIRIAN, P.C. BY: MICHAEL A. HANAMIRIAN, ESQUIRE ATTORNEY I.D. NO. 49457 1608 WALNUT STREET, SUITE 803 PHILADELPHIA, PA 19103 (215) 735-4235 ATTORNEY FOR PLAINTIFF ANNA CONCETTA DEVITA 207 Jacobs Street East Berlin, PA 17316 VS TEVON N. SAMUELS 2206 L Cedar Run Drive Camphill, PA 17011 and QUINTA N. SAMUELS 2206 L Cedar Run Drive Camphill, PA 17011 'YOU HAVE BEEN SURD IN COURT. IF YOU WISH TO DEPEND AGAINST THE CLAIMS SET FORTH IN THE FOLLOWING PAGES, YOU MUST TAKE ACTION WITHIN TWENTY (10 DAYS AFTER THIS COMPLAINT AND NOTICE ME SERVED, BY ENTERING A WRITTEN APPEARANCE PERSONALLY OR BY ATTORNEY AND PILING IN WRITING WITH THE MOST YOUR DEPSNass OR OBJECTIONS TO THE CLAIMS an FORTH AGAINST YOU. YOU ARE WARNED THAT IF YOU PAIL TO DO SO TUB CANE MAY PROCEED WITHOUT YOU AND A JUDGNRMT MAY BE ENTERED AGAINST YOU BY THE COURT WITHOUT FURTHER NOTICE FOR ANY MONEY CLAIMED IN US COMPLAINT OR FOR ANY OTHER CLAIM OR MLISP REQUESTED BY THE PLAINTIFF. 'YOU SHOULD TAKE MIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE MR OFFICE SET FORM BELOW TO FIND OUT WHERE YOU CAN On LEGAL HELP. Lawyer Referral Service (717) 140-6100 COURT ADMINISTRATOR 4th Floor Cumberland County Courthouee Carlisle, PA 17013 CUMBERLAND COUNTY COURT OF COMMON PLEAS CIVIL TRIAL DIVISION NO. t7q &4:Vim. -AVISO LB HAN DBMAC)ACO A USTBD BN LA CORTE. BI UBTBD QUIRES DBPRND8R88 DR BETAS DRMANDAS E%PUBSTAS BN LAS PAGINAS SIGUIENTBS, UBTBD TIBN VBIMB (30) DIM DS PLA80 AL PARTIR De LA FECHA DR LA DBMANDA Y LA NOTIFICACION. MACE SALTA ASBNTAR UNA COMPMENCIA 8SCRITA 0 RN PERSONA 0 CON ON MCKIA00 Y RNTRRGM A LA COSTS BE PORMA ESCRITA BUS DEPSNSAS 0 BUS OBJBCIONBB A LAS DBMANDAS EN CONTRA BUYA SIN PREVIO AVISO O NOTIFICACION. MEN", LA COSTS PURDB D8CIDIR A FAVOR DEL DBMANOANTS Y REQUIRES QVE UBTBD CUMPLA CON TODAS LAS PROVISIONER DR RnA DEMANDS. DOTED FUROR PERISH DINSRO 0 BUS PROPIECADSB U OTROS DERBCHOS IMPORTANTBS PAPA UBTBD 'LLSVE BETA DRMANDA A ON ABOOADO IMMBDIATMENT8, SI NO TIENE ABOOAW 0 SI NO ITEMS SL DINBRO SUPICIBNTB DB PAGAR TAL SBRVICIO, VAYA BN PERSONA 0 LLMB OR TELEFONO A LA OPICINA CVYA DIRSCCION BE SNCURnRA ESCRITA MAJO PARA AVBRIOUM COME BE PURDB CONSEGUIR ASISTBNCIA LEGAL. SBRVICIO DR RBPBRRNCIA LEGAL Lawyer Referral Service (717) 140-6100 COURT ADMINISTRATOR 4th Floor Cumberland County Courthouse Carlisle, PA 17013 In Tioftony whereof, I hero urrto tat my h" tz 1 rt of Carllsb, P?,? of sa r l ! of ca, ? t MAH/kkc A. ARTHUR HANAMIRIAN, P.C. BY: MICHAEL A. HANAMIRIAN, ESQUIRE ATTORNEY I.D. NO. 49457 1608 WALNUT STREET, SUITE 803 PHILADELPHIA, PA 19103 (215) 735-4235 ATTORNEY FOR PLAINTIFF ANNA CONCETTA DEVITA 207 Jacobs Street East Berlin, PA 17316 CUMBERLAND COUNTY COURT OF COMMON PLEAS CIVIL TRIAL DIVISION VS. TEVON N. SAMUELS 2206 L Cedar Run Drive Camphill, PA 17011 AND QUINTA N. SAMUELS 2206 L Cedar Run Drive Camphill, PA 17011 CIVIL ACTION 1. Plaintiff, Anna Concetta Devita, is an adult individual who resides at 207 Jacobs Street, City of East Berlin, Commonwealth of Pennsylvania. 2. Defendant, Tevon N. Samuels, is an individual residing at 2206 L Cedar Run Drive, Camphill, PA 17011. 2. Defendant, Quinta N. Samuels, is an individual residing at 2206 L. Cedar Run Drive, Camphill, PA 17011. 3. On or about August 13, 1997, Plaintiff was the owner of a 1995 Ford Mustang, VIN 1FALP4048SF227834 thus lawfully traveling east on Carlisle Road approaching orchard Road in the Township of Lower Allen, County of Cumberland, Commonwealth of Pennsylvania. 4. At the time and place stated above, Defendant Tevon N. Samuels possessed, controlled, and operated a 1980 Ford Mustang owned by Defendant, Quinta N. Samuels, and attempted to turn left onto Orchard Road from Carlisle Road with disregard of oncoming traffic, causing the vehicle he was operating to violently collide with Plaintiff's vehicle, resulting in severe property damage to the Plaintiff. 5. The aforesaid occurrence was caused solely by the negligence of the Defendants and the Plaintiff was in no manner contributorily negligent. 6. On the aforesaid accident date, the negligence, carelessness, and recklessness of the Defendants consisted inter alia of: (a) operating said vehicle in a careless, reckless, and negligent manner; (b) operating said vehicle without due regard for the rights, safety and position of the Plaintiff; (c) failure to operate vehicle in an attentive manner; (d) failure to keep proper look-out; (e) failure to use due care under the circumstances; (f) failure to yield; (g) failure to stop; (h) violating the motor vehicle statutes of Pennsylvania. 7. As a result of the aforesaid occurrence, the Plaintiff's motor vehicle was damaged in and about its pertinent parts the fair and reasonable value of the repairs amounting to $2267.99. Attached hereto and marked as Exhibit "A" is an estimate of repairs. 8. As a result of the aforesaid occurrence, the Plaintiff incurred rental charges for the rental of a motor vehicle while her vehicle was being repaired. The fair and reasonable value of the rental totals $641.40. Attached hereto and marked as Exhibit "B" is the Rental Agreement. WHEREFORE, Plaintiff claims to recover from the Defendants damages in the amount of $2909.39, plus costs. A. ARTH14R HANAMIRIAN, P.C. BY: FOR PLAINTIFF V E R I F I C A T I O N MICHAEL A. HANAMIRIAN, ESQUIRE states that he is the attorney for Plaintiff, Anna Concetta Devita, in the above- captioned matter, and that the facts set forth in the foregoing Civil Action Complaint are true and correct to the best of her knowledge, information and belief, and that this statement is made subject to penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsifications to authorities. No Affidavit is required pursuant to Rule 206. DATED : llllf'1114?? MICHAEL AMIRIAN, ESQUIRE ALLSTATE INSURANCE COMPANY HARRISBURG MCO 6345 FLANK DRIVE HARRISBURG, PA 17112 (717) 540-7500 CD LOG NO 365 -1 DATE 09-16-97 SUPPLEMENT CLAIM INFORMATION CLAIM # 1552831867D01 COMPANY ALLSTATE INSURED DEVITA, ANNA CLAIMANT INSPECTION TYPE APPRAISER LICENSE # WORK PHONE ADDRESS CITY STATE ZIP OWNER FIELD SAM CUNNINGHAM 3002112 (800) 755-0747 x30 6345 FLANK DR HARRISBURG 17112- POLICY # 698021815 AGENT LOSS DATE 08-13-97 LOSS TYPE COLLISION FAX (717) 630-1110 x INSP DATE 08-19-97 PA LOCATION LEASE'S A/B CITY STATE EAST BERLIN PA NAME DEVITA, ANNA ADDRESS 207 JACOBS ST CITY STATE B BERLIN PA ZIP 17316-8601 WORK PHONE (000) 000-0000 x ROME PHONE (717) 259-7220 x REPAIR REPAIR FACILITY LEASE'S AUTO BODY & PAINT SHOP PHONE (717) 259-7664 x ATTENTION KERRY ADDRESS RD 1 BOX 847 CITY STATE BAST BERLIN PA ZIP 17316- VEHICLE 1995 FORD MUSTANG STD 2 DR COUPE 6CYL GASOLINE 3.8 OPTIONS TWO-STAGE - EXTERIOR SURFACES POWER WINDOWS REAR SPOILER AUTOMATIC TRANS BODY COLOR GREEN MET CONDITION GOOD LICENSE # ABB1532 LICENSE STATE PA FAX CAR IN CAR OUT DAYS TO REPAIR 4 REG. ID POWER DOOR LOCKS HEATED BACK GLASS AIR CONDITIONING CRUISE CONTROL MILEAGE 16,160 VIN 1FALP4048SF227834 CODS P125 VEH INSP # REMARKS: FOR SUPPLEMENTS CALL SUPPLEMENT HOTLINE.. 1-800-726-8890 X 30301111111 ALL SUPPLEMENTS MUST BE CALLED IN PRIOR TO REPAIRINGII INVOICES ARE REQUIRED- >>>DO NOT CALL THE ADJUSTER FOR SUPPLEMENTS I I I<<< -1- 1= xr. 95 FORD MUSTANG 2 DOOR SkWAN DATE 09-1 6-97 CLAIM # 1552831867D01 LOG 365 -i HIDDEN COMPONENTS WILL BE OPEN FOR INSPECTION PENDING DISASSEMBLY EST. COVER VISIBLE DAMAGES ONLY . SCON. PARTS AT KEYSTONE AUTOMOTIVE AT 800-524-4349 SALVAGE PARTS AT BILL FOX MUSTANGS AT 717-292-2537 PART GDE OPERATION PRICE LABOR RT FRONT BUMPER Cover,Front Bumper 0016 Refinish 3.7 RF Surface 2,6 Two-stage 0.5 Two-stage setup 0.6 Bumper,Front 0005 Replace Economy 78.00* 2,3 S14 FRONT END PANEL AND LAMPS Panel,Headlamp Mtg 0019 Replace OEM 92.17 1.2 SM F7ZZ8A284AA Headlamp Assy,Halogen RT 0042 Replace-PXN 102.88 INC SN Parklamp Assembly RT 0056 Replace Economy 34.00* INC SM Headlamps Aim 0973 Additional. Labor 0.5 SM RADIATOR SUPPORT Panel, Radiator Supt 0073 Repair 0.5* SM FRONT BODY AND WINDSHIELD Fender,Front RT 0104 Replace Salvage 156.25* S1 1.4 SM Salv User Markup 25k Fender,Front RT 0104 Refinish 2.4 RP Surface 1.6 Edge 0.5 Two-stage 0.3 Panel,Hood 0083 Refinish 3.2 RF Surface 2.7 Two-stage 0.5. FRONT BODY INTERIOR SHBETMETAL Brace,Front Fender R/F 0112 Replace OEM 3.00 SM F4ZZ16A023A Brace,Front Fender R/F 0112 Refinish 0.1 RP Surface 0.1 Reinf,Inner Fender RT 0134 Repair 0.5* SM MANUAL ENTRIES PINSTRIPES-TAPE M007 Replace Economy 10.00* 0.3* SM* RT FRT LOWER RAIL Repair 0.5* SM* FRT NOSE COVER Replace OEM 100.00* S1 0.3* SM* RT ROOF DRIP MLDG FRT Replace OEM 58.11* 1.1* SM*' RT ROOF DRIP MLDG FRT Refinish 0.5* RF* COLOR BLEND M016 Refinish 1.0* RF* FRT BUMPER COVER Replace Salvage 312.50* INC* SM* Saly User Markup 25% HOOD PANEL Replace Salvage 312.50* 1.2* SM* Salv User Markup 25% 21 ITEMS FINAL CALCULATIONS & ENTRIES PARTS GROSS PARTS $ 253.28 -2- 95 FORD MUSTANG 2 DOOR SBUAN DATE 09-16-97 CLAIM # ISS2831867DOI LOG 365 -1 OTHER PARTS PAINT MATERIAL ADJUSTMENTS DISCOUNT MARKUP PARTS TOTAL TAX ON PARTS & MATERIAL ® 6.0001 LABOR RATE 1-SHEET METAL $ 30.00 2-MECH/ELEC $ 34.00 3-FRAME $ 32.00 4-REFINISH $ 30.00 5-PAINT $ 14.00 LABOR TOTAL TAX ON LABOR 0 6:000* SUBLET REPAIRS TOWING STORAGE NET SUPPLEMENT TOTAL LESS: ORIGINAL NET TOTAL GROSS TOTAL LESS: NET DEDUCTIBLE 621.00 37.26 113.00 1,691.82- $ 2,267.99 $ .500.00- NET TOTAL $ 1,767.99 PXN Yes Geocode: 17112 HARRISBURG SPPL No ADP PENPRO W0312 S1 LOG 365 -1 09-16-97 15:24:32 REL 3.12 CD 09/97 COPYRIGHT, AUTOMATIC DATA PROCESSING, INC. 1997 SALVAGE PRICE REFLECTS MARKUP 1.9 HOURS WERE ADDED TO THIS ESTIMATE BASED ON ADPIS TWO-STAGS REFINISH FORMULA: 201- OF REFINISH HOURS, AFTER OVERLAP, PLUS 0.6 HOURS FOR THE FIRST MAJOR PANEL, WHERE NOTED. ------------------------------------------------------------------------------- TO ALL REPAIR FACILITIES: BEFORE USING AN AFTBRMARKET SHERTMETAL PART, BE SURE TO LOOK FOR THE CAPA SEAL. THIS IS NOT AN AUTHORIZATION FOR REPAIR. SUPPLEMENTS MUST BE APPROVED PRIOR TO REPAIR. IF YOUR CAR IS OF UNITIZED CONSTRUCTION, IN SOME CASES THE REPAIR SHOP MAY NEED SPECIAL EQUIPMENT TO PROPERLY REPAIR THE CAR. YOU SHOULD DETERMINE IF THE SHOP YOU SELECT TO COMPLETE THE REPAIRS IS PROPERLY EQUIPPED. $ 1,412.01 $ 84.72 REPLACE HRS REPAIR HRS 7.8 2.0 $ 294.00 10.9 $ 327.00 S $ 1,006.13 $ 152.60 -3- r CD LOG NO 365 VEHICLE 1995 FORD MUSTANG STD 2 DR COUPE 6CYL GASOLINE 3.8 OPTIONS TWO-STAGE - EXTERIOR SURFACES POWER WINDOWS REAR SPOILER AUTOMATIC TRANS SUPPLIER PART PART DESCRIPTION NUMBER i i -1 DATE 09-16-97 POWER DOOR LOCKS HEATED BACK GLASS AIR CONDITIONING CRUISE CONTROL SUBSTITUTED FOR OEM,PART SUPPLIER CLS SRC NUMBER' CODE FRONT END PANEL AND LAMPS HeadlamP Assy,Halogen RT H114R F4ZZ13008B >001 > - ESTIMATE TOTAL IS BASED ON PRICE QUOTED BY THIS SUPPLIER KEY TO CLASSIFICATION/SOURCH CODES CLS CLASSIFICATION CODE: C - CAPA CERTIFIED PART QUOTED BY LISTED SUPPLIER R - RECONDITIONED PART SRC n SOURCE CODE: 1 - NON ORIGINAL EQUIPMENT MANUFACTURER PART 3 - ORIGINAL EQUIPMENT MANUFACTURER (OEM) PART DETAILED DISTRIBUTOR LIST 001 - PXN4081 BRITE STAR GROUP PO BOX 5317 WEST BABYLON, NY 11707 (800) 638-5901 (516) 422-8449 ADP PENPRO W0312 S1 LOG 365 -1 09-16-97 15:24:35 REL 3.12 CD 09/97 GEOCODE: 17112 SA: HARRISBURG COPYRIGHT, AUTOMATIC DATA PROCESSING, INC. 1997 NOTE: NON-OEM SHEET METAL PARTS MUST BE CAPA CERTIFIED. 1 -1- 31411anlsbur bl EAST BERLIN, PA 17316 717-259.6334 1.800.246-0395 FUCL E E AN 114 114 12 IQ NNE ]M SV i °_S: /• w PER DAYt.'SD - Lnj PER WEEK BY INITIALING, CUSTOMER ACCEPTS OR DECLINES COMPREHEW SIVEICOLLISION DAMAGE WAIVER AT THE RATES LISTED ABOVE. BY DECLINING WAIVER, CUSTOMER ACCEPTS FULL RESPONSIBILITY FO &660 SS/DAMAGE TO THE RENTED VEHICLE UP TO DE?E i PER OCCURRENCE, REGARDLESS OF CAUSE. NOTICE: WAIVER DOES NOT COVER LOSS OR DAMAGE RESULTING FROM X ANY VIOLATION OF PARAGRAPH 1. OR 2. ON PAGE 1 OF THIS AGREEMENT, FOR MISSING VEHICLE PARTS OR FOR INTERIOR VEHICLE DAMAGE OTHER THAN NORMAL WEAR AND TEAR CAUSED BY VEHICLE OCCUPANTS INCLUDING ANIMALS. C/CDW IS NOT INSURANCE CREDIT CARD 00, EXP. DATE VERRED Please return this vehicle with the same amount 1,1 fuel as you received it. Any additional fuel chRrrII1s will be added to your bill. YOU will be charged $It.00 per quarter tank. ?Ulta1s .?yL f ? Glcq 21 ?Ja.c,?d fo? - 3 IeN rVU P1ME: 1a 14 EM PAX: 141I441HEN 11PEEODIEIER w 4WEf00METER OV1 MILE{ DRIVEN MILES ALLOWED C DEB LE SUPPLEMENTAL LIABILITY 00142 u L RATES DO NOT HOURS • t DAYDAY WEEKS • i MONME 0 $ Mug • ' / AM w E FUEL PER HOUR i i O i i L PER MME i TOTAL MILEAGE AND RENTAL CHARGES i FUEL DALE. { Is SUB TOTAL i 11111111111311111 $ WE TOTAL i EMEA TAX Is EX MR TAX is ismOAVPTATAE : s TOTAL CIW10Ei i LEU DEPOfO i S i E win DAUPHIN COUNTY SHERIFF'S OFFICE 2q DAUPHNCUUNt ( COURTHDU,! r 14 1 Ua0 Pr. , .,,, RECLI V"-) W-W MAH/dd A. ARTHUR HANAMIRIAN, P.C. BY: MICHAEL A. HANAMIRIAN, ESQUIRE ATTORNEY I.D. NO. 49457 1608 WALNUT STREET, SUITE 803 PHILADELPHIA, PA 19103 (215) 735-4235 ATTORNEY FOR PLAINTIFF, ANNA CONCETTA DEVITA ANNA CONCETTA DEVITA CUMBERLAND COUNTY VS. COURT OF COMMON PLEAS CIVIL TRIAL DIVISION TEVON N. SAMUELS AND NO. 99-3835 QUINTA N. SAMUELS PRAECIPE TO REINSTATE PLAINTIFFS' COMPLAIN TO THE PROTHONOTARY: Kindly reinstate Plaintiffs' Complaint in connection with the above-captioned matter, Ret. Sec. leg. Date of original filing was June 23, 1999. A. ARTHUR HANAMIRIAN, P.C. BY: -M^ • IIw1riLUZc.Q/1V MICHAEL A. HANAMIRIAN, ESQUIRE ATTORNEY FOR PLAINTIFF MAH/kkc A. ARTHUR HANAMIRIAN, P.C. BY: MICHAEL A. HANAMIRIAN, ESQUIRE ATTORNEY I.D. NO. 49457 1608 WALNUT STREET, SUITE 803 PHILADELPHIA, PA 19103 (215) 735-4235 ATTORNEY FOR PLAINTIFF ANNA CONCETTA DEVITA 207 Jacobs Street East Berlin, PA 17316 VS TEVON N. SAMUELS 2206 L Cedar Run Drive Camphill, PA 17011 and QUINTA N. SAMUELS 2206 L Cedar Run Drive Camphill, PA 17011 t.J ? I r ! CUMBERLAND COUNTY COURT OF COMMON PLEAS CIVIL TRIAL DIVISION /,J NO. q 67,t v? •AVISO 'YOU HAVE BURN SURD IN COURT. IF YOU WISH TO DRPBND AGAINST MR CLAIMS SET FORM IN THE FOLLOWING PAGES, YOU MUST TARE ACTION WITHIN TWRNTY (20 DAYS AFTER THIS COMPLAINT AND NOTICE ARE SERVED, BY ENTERING A WRITTEN APPEARANCE PERSONALLY OR BY ATTORNEY AND FILING IN WRITING WITH THE COURT YOUR DSPSNSBB OR OBJUCTIONS TO THE CLAIMS SET FORTH AGAINST YOU. YOU ARE WARNED THAT IF YOU PAIL TO DO SO THE CARS MAY PROCEED WITHOUT YOU AND A JUDGMENT MAY BE ENTERED AGAINST YOU BY THE COURT WITHOUT FURTHER NOTICE FOR ANY MONEY CLAIMED IN THE COMPLAINT OR POR ANY OTHER CLAIM OR RELIEF REQUESTED BY THE PLAINTIPP. 'YOU SHOULD TARE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD OUR, GO TO OR TBLSPHONB MR OFFICE SET FORTH BELOW TO FIND OUT MERE YOU CAN GET LEGAL HELP. CUMBERLAND COUNTY BAR ASSOCIATION 2 LIBERTY AVENUE CARLISLE PA 17013 (717) 249 3166 or 1 800 990 9108 L8 RAN DBMANDADO A DEMO BN LA CORTE. SI UBTBD QUIRRB DEPENDBRSB DB BETAS DRMANDAS BBPGBSTAS BN LAD PAGINAB DIOVIENT88, UBTBD TIBN VBINTS (20) DIM DR PLAZO A, PARTIR D8 LA PSCHA DR LA DBMANDA Y LA NOTIPICACION. MACE PALTA "BRIAR UM COMPARENCIA RSCRITA O BN PERSONA 0 CON UN ABOOADO Y SNTREGAR A LA COSTS BN FORMA BSCRITA BUS DBPRNSAB 0 SUB OBJBCIONRB A LAS DHMANDAS ON CONTRA BUYA SIN PREVIO AVIsO O NOTIFICACION. ADBKAS, LA CORM PUSHI DECIDIR A FAVOR OHL DSMANOANTB Y REQUIRES QUO UBTBD CUMPLA CON MUM LAD PROVIBIONB9 DR BETA DBMANDA. USTBD FUNDS PERDER DINBRO 0 SUB PROPIRDADBS U OTROB DBRBCHOS INPORTANTBS PARA USTRD `LLSVE BETA DSMANDA A UN ABOGU)0 INMEDIATAMENTB, SI NO TIONS ABOGA00 0 BI NO TIENS BL DINERO 9UPICIRNTE D8 PAGAN TAL SBRVICIO, VAYA BN PERSONA 0 LLAMS OR TBLEFONO A LA OPICINA CUYA DIRECCION SO BNCUSNTRA ESCRITA ABAJO PARA AVBRIGUAR DOME BE PUBES CONSEGUIR ASISTSNCIA LEGAL. SSRVICIO DE ROPHRUNCIA LEGAL • e !ef 1 e 4071 2?p-6300 rli r P 901 MAH/kkc A. ARTHUR HANAMIRIAN, P.C. BY: MICHAEL A. HANAMIRIAN, ESQUIRE ATTORNEY I.D. NO. 49457 1608 WALNUT STREET, SUITE 803 PHILADELPHIA, PA 19103 (215) 735-4235 ATTORNEY FOR PLAINTIFF ANNA CONCETTA DEVITA CUMBERLAND COUNTY 207 Jacobs Street COURT OF COMMON PLEAS East Berlin, PA 17316 CIVIL TRIAL DIVISION VS. TEVON N. SAMUELS 2206 L Cedar Run Drive Camphill, PA 17011 AND QUINTA N. SAMUELS 2206 L Cedar Run Drive Camphill,.PA 17011 1. Plaintiff, Anna Concetta Devita, is an adult individual who resides at 207 Jacobs Street, City of East Berlin, Commonwealth of Pennsylvania. 2. Defendant, Tevon N. Samuels, is an individual residing at 2206 L Cedar Run Drive, Camphill, PA 17011. 2. Defendant, Quinta N. Samuels, is an individual residing at 2206 L. Cedar Run Drive, Camphill, PA 17011. 3. On or about August 13, 1997, Plaintiff was the owner of a 1995 Ford Mustang, VIN IFALP4048SF227834 thus lawfully traveling east on Carlisle Road approaching Orchard Road in the Township of Lower Allen, County of Cumberland, Commonwealth of Pennsylvania. 4. At the time and place stated above, Defendant Tevon N. Samuels possessed, controlled, and operated a 1980 Ford Mustang owned by Defendant, Quints. N. Samuels, and attempted to turn left onto Orchard Road from Carlisle Road with disregard of oncoming traffic, causing the vehicle he was operating to violently collide with Plaintiff's vehicle, resulting in severe property damage to the Plaintiff. 5. The aforesaid occurrence was caused solely by the negligence of the Defendants and the Plaintiff was in no manner contributorily negligent. 6. On the aforesaid accident date, the negligence, carelessness, and recklessness of the Defendants consisted inter alia of: (a) operating said vehicle in a careless, reckless, and negligent manner; (b) operating said vehicle without due regard for the rights, safety and position of the Plaintiff; (c) failure to operate vehicle in an attentive manner; (d) failure to keep proper look-out; (e) failure to use due care under the circumstances; (f) failure to yield; (g) failure to stop; (h) violating the motor vehicle statutes of Pennsylvania. 7. As a result of the aforesaid occurrence, the Plaintiff's motor vehicle was damaged in and about its pertinent parts the fair and reasonable value of the repairs amounting to $2267.99. Attached hereto and marked as Exhibit "A" is an estimate of repairs. 8. As a result of the aforesaid occurrence, the Plaintiff incurred rental charges for the rental of a motor vehicle while her vehicle was being repaired. The fair and reasonable value of the rental totals $641.40. Attached hereto and marked as Exhibit "Bit is the Rental Agreement. WHEREFORE, Plaintiff claims to recover from the Defendants damages in the amount of $2909.39, plus costs. A. ARTHEJR HANAMIRIAN, P.C. BY: FOR PLAINTIFF MICHAEL A. HANAMIRIAN, ESQUIRE states that he is the attorney for Plaintiff, Anna Concetta Devita, in the above- captioned matter, and that the facts set forth in the foregoing Civil Action Complaint are true and correct to the best of her knowledge, information and belief, and that this statement is made subject to penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsifications to authorities. No Affidavit is required pursuant to Rule 206. DATED: a?yj- MICHAEL I.XiANAMIRIAN, ESQUIRE r ALLSTATE INSURANCE COMPANY HARRISBURG MCO 6345 FLANK DRIVE HARRISBURG, PA 17112 (717) 540-7500 CD LOG NO 365 -1 DATE 09-16-97 CLAIM INFORMATION CLAIM # 1552831867D01 COMPANY ALLSTATE INSURED DEVITA, ANNA CLAIMANT INSPECTION TYPE APPRAISER LICENSE # WORK PHONE ADDRESS CITY STATE ZIP OWNER FIELD 9M SAM CUNNINGHAM 3002112 (800) 755-0747 x30 6345 FLANK DR HARRISBURG 17112- NAME DEVITA, ANNA ADDRESS 207 JACOBS ST CITY STATE 8 BERLIN PA ZIP 17316-8601 REPAIR REPAIR FACILITY LEASE'S AUTO BODY & PAINT SHOP PHONE (717) 259-7664 x ATTENTION KERRY ADDRESS RD 1 BOX 847 CITY STATE EAST BERLIN PA ZIP 17316- VEHICLE 1995 FORD MUSTANG STD 2 DR COUPE 6CYL GASOLINE 3.8 OPTIONS TWO-STAGS - EXTERIOR SURFACES POWER WINDOWS REAR SPOILER AUTOMATIC TRANS BODY COLOR GREEN MET CONDITION GOOD LICENSE # ABB1532 LICENSE STATE PA POLICY # 698021815 AGENT LOSS DATE 08-13-97 LOSS TYPE COLLISION PAX (717) 630-1110 x ._ 'INSP DATE 08-19-97 PA LOCATION LEASH'S A/B CITY STATE EAST BERLIN PA WORK PHONE (000) 000-0000 x HOME PHONE (717) 259-7220 x FAX CAR IN CAR OUT DAYS TO REPAIR 4 REG. ID POWER DOOR LOCKS HEATED BACK GLASS AIR CONDITIONING CRUISE CONTROL MILEAGE 16,160 VIN IFALP4048SP227834 CODE P125 VHH INSP # REMARKS: FOR SUPPLEMENTS CALL SUPPLEMENT HOTLINE.. 1-800-726-8890 X 30301111111 ALL SUPPLM48NTS MUST BE CALLED IN PRIOR TO REPAIRINGII INVOICES ARE REQUIRED- >>>DO NOT CALL THE ADJUSTER FOR SUPPLEMENTS I I I<<< -1- ru A I b,'4 "A 95 FORD MUSTANG; 2 DOOR ShJAN CLAIM # 1552831867DOI DATE 09-16-9' LOG 365 HIDDEN COMPONENTS WILL BE OPEN FOR INSPECTION PENDING DISASSEMBLY. EST. COVER VISIBLE DAMAGES ONLY BCON. PARTS AT KEYSTONE AUTOMOTIVE AT 800-524-4349 SALVAGE PARTS AT BILL FOX MUSTANGS AT 717-292-2537 PART FRONT BUMPER Cover,Front Bumper Bumper,Front FRONT END PANEL AND LAMPS Panel,Headlamp Mtg- F7ZZSA284AA Headlamp Assy,Halogen RT Parklamp Assembly RT Headlamps Aim RADIATOR SUPPORT Panel,Radiator Supt FRONT BODY AMID WINDSHIELD GDE OPERATION 0016 Refinish Surface Two-stage Two-stage setup 0005 Replace Economy 0019 Replace OEM 0042 Replace -PliN 0056 Replace Economy 0973 Additional Labor 0073 Repair Fender,Front RT 0104 Replace Salvage Salv User Markup Fender,Front RT 0104 Refinish Surface Edge Two-stage Panel,Hood 0083 Refinish Surface Two-stage FRONT BODY INTERIOR SHBETMETAL Brace,Front Fender R/F 0112 Replace OEM F4ZZ16A023A Brace,Front Fender R/F 0112 Refinish Surface Reinf,Inner Fender RT 0134 Repair MANUAL ENTRIES PINSTRIPES-TAPE RT FRT LOWER RAIL FRT NOSE COVER RT ROOF DRIP MLDG FRT RT ROOF DRIP MLDG FRT COLOR BLEND FRT BUMPER COVER Salv User HOOD PANEL Salv User 21 ITEMS FINAL CALCULATIONS & ENTRIES PARTS GROSS PARTS M007 Replace Economy Repair Replace OEM Replace OEM Refinish M016 Refinish Replace Salvage Markup Replace Salvage Markup PRICE LABOR M 3.7 RI 25t 2.6 0.5 0.6 78.00* 2.3 86 92.17 1.2 SP 102.88 INC 8N 34.00* INC SN 0?5- 8N 0.5* 8M 156.25* S1 1.4 814 2.4 RP 1.6 0.5 0.3 3.2 RF 2.7 0.5. 3.00 SM 0.1 RF 0.1 0.5* SM 10.00* 0.3* SM 0.5* SM 100.00* S1 0.3* SK 58.11* 1.l* SM^ 0.5* RF 1.0* RP, 312.50* INC* SM, 25t 312.50* 1.2* ON' 25t $ 253.28 -2- 95 FORD MUSTANG 2 DOOR SkDAN CLAIM # ISS2831867DOI OTHER PARTS PAINT MATERIAL ADJUSTMENTS DISCOUNT MARKUP PARTS TOTAL TAX ON PARTS & MATERIAL E 6.0001 r $ 1,006.13 $ 152.60 DATE 09-16-9; LOG 365 -7 $ 1,412.01 $ 84.72 LABOR RATE REPLACE HRS REPAIR HRS' 1-SHEET METAL $ 30.00 7.8 2.0 $ 294 00 2-MBCH/ELEC $ 34.00 . 3-FRAME $ 32.00 4-REFINISH $ 30.00 10.9 $ 327 00 5-PAINT $ 14.00 .. . LABOR TOTAL $ 621 00 TAX ON LABOR 0 6z000t . $ 37 26 SUBLET REPAIRS . TOWING $ 11 00 STORAGE . NET SUPPLEMENT TO TAL 3 / LESS* ORIGINAL NET TOTAL $ 1,691.82- GROSS TOTAL $ 2•,267.99 LESS: NET DEDUCTI BLE $ .500.00- NET TOTAL '$ 1,767.99 PXN Yee Geocode: 17112 HARRISBURG SPPL No ADP PENPRO W0312 S1 LOG 365 -1 09-16-97 15:24:32 REL 3.12 CD 09/97 COPYRIGHT, AUTOMATIC DATA PROCESSING, INC. 1997 SALVAGE PRICE REFLECTS MARKUP 1.9 HOURS WERE ADDED TO THIS ESTIMATE BASED ON ADPIS TWO-STAGS REFINISH FORMULA: 20t OF REFINISH HOURS, AFTER OVERLAP, PLUS 0.6 HOURS FOR TUB FIRST MAJOR PANEL, WHERE NOTED. ------------------------------------------------------------------------------• TO ALL REPAIR FACILITIES: BEFORE USING AN AFTBRMARKET SHEBTMETAL PART, BE SURE TO LOOK FOR THE CAPA SEAL. THIS IS NOT AN AUTHORIZATION FOR REPAIR SUPPLEMENTS MUST BE APPROVED PRIOR TO REPAIR. IF YOUR CAR IS OF UNITIZED CONSTRUCTION, IN SOME CASES THE REPAIR SHOP MAY NEED SPECIAL EQUIPMENT TO PROPERLY REPAIR THE CAR. YOU SHOULD DETERMINE IF THE SHOP YOU SELECT TO COMPLETE THE REPAIRS IS PROPERLY EQUIPPED. -3- r CD LOG NO 365 DATE 09-16-97 -1 VEHICLE 1995 FORD MUSTANG STD 2 DR COUPS 6CYL GASOLINE 3.8 OPTIONS TWO-STAGE - EXTERIOR SURFACES POWER WINDOWS REAR SPOILER AUTOMATIC TRANS POWER DOOR LOCKS HEATED BACK GLASS AIR CONDITIONING CRUISE CONTROL SUPPLIER PART' PART DESCRIPTION NUMBER ISTITUTED FOR OEM,PART SUPPLIER CLS SRC NUMBER' CODE FRONT END PANEL AND LAMPS Headlamp Aeey,Halogen RT H114R F4ZZ13008E >001 > - ESTIMATE TOTAL IS BASED ON PRICE QUOTED BY THIS SUPPLIER KBY TO CLASSIFICATION/SOURCE CODES CLS CLASSIFICATION CODE: C - CAPA CERTIFIED PART QUOTED BY LISTED SUPPLIER R - RECONDITIONED PART SRC - SOURCE CODE: 1 - NON ORIGINAL EQUIPMBNT MANUFACTURER PART 3 - ORIGINAL EQUIPMENT MANUFACTURER (OEM) PART DETAILED DISTRIBUTOR LIST 001 - PXN4081 BRITS STAR GROUP PO BOX 5317 WEST BABYLON, NY 11707 (800) 638-5901 (516) 422-8449 ADP PENPRO W0312 S1 LOG 365 -1 09-16-97 15:24:35 REL 3.12 CD 09/97 GEOCODE: 17112 SA: HARRISBURG COPYRIGHT, AUTOMATIC DATA PROCESSING, INC. 1997 NOTE: NON-OEM SHEET METAL PARTS MUST BE CAPA CERTIFIED. 1 -1- M ... . . ..............r .?w.?. . m1OMNANVL 717-269-6334 uI-MO-246-MOO 0 'I CUMMI1 N 00142 .Ili LFEED:YlIFA W. DATE 6"EDOUNTER KRFTD MM OMEN MORE AUAmug WEV KRVIFD CKyLMILE 7610 Raw e L M HOW i Rm LY DAM 06 i 'WMW e L FUEL O i H8 MONTHS e L i OUT EI MLFA • ' A M MLE i E E IN IN 12 112 TRENTAL CNAROES SL W4 F ? TAL i i 98: 16 " PER DAYL31' W PER WEEK SIT INITIALING, CUSTOMER ACCEPTS OR DECLINES COMPREHEW Sue Al TOT- i SIVE/COLLISION DAMAGE WAIVER AT THE RATES LISTED ABOVE. BY DECLINING WAIVER, CUSTOMER ACCEPTS FULL RESPONSIBILITY SAw TAE i FO At! OSSIDAMAOE TO THE RENTED VEHICLE UP TO e?w ??Y $ Or, ,S PER OCCURRENCE. REGARDLESS OF CAUSE. NOTICE: i WAIVER DOES NOT COVER LOSS OR DAMAGE RESULTING FROM K 1EdDOAY PTA TAE i ANY VIOLATION OF PARAGRAPH t. OR 2. ON PAGE 1 OF THIS AGREEMENT, FOR MISSINO VEHICLE PARTS OR FOR INTERIOR VEHICLE DAMAGE OTHER THAN i NORMAL WEAR AND TEAR CAUSED BY VEHICLE OCCUPANTS INCLUDING ANIMALS. C/CDW IS NOT INSURANCE Tmu GIAnoEE i D aAn.FLr. VJETI?DeR i O p?LpL? i CREDIT CARD CO. EXP. DATE VEP*XD CASH P04M yryLLe i Please return this vehicle with the same amount of fuel as you received it. Any additional fuel charrlos will be added to your bill. You will be charged $5.00 per quarter tank. OVI M: om-01LT: p-,11 rrm 0 DIN DAM HER RW4**eA0mML' OIDO TOLLMM I4I64II40I4 FAIL NMUHFFL FATIf ('6" 1 s > aA FZ ... (1 i (mot;. U t9 o c?