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Home My WebLink About09-3452IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION PROGRESSIVE INSURANCE COMPANY, Subrogee of Vikas Patel CASE NO: 09 -345a 051-ja-rem Plaintiff, V. TYPE OF PLEADING: COMPLAINT IN CIVIL ACTION FANUS COETZEE Defendant. FILED ON BEHALF OF: Plaintiff COUNSEL OF RECORD OF THIS PARTY: AUGUST J. OBER, IV, ESQUIRE Pa. I.D. #94701 WELTMAN, WEINBERG & REIS CO., L.P.A. 325 Chestnut Street Suite 501 Philadelphia, PA 19106 (215) 599-1500 WWR #07346166 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION PROGRESSIVE INSURANCE COMPANY, Subrogee of Vikas Patel CASE NO: Plaintiff, V. TYPE OF PLEADING: COMPLAINT IN CIVIL ACTION FANUS COETZEE Defendant. NOTICE TO DEFEND NOTICE YOU HAVE BEEN SUED IN COURT. If you wish to defend against the claim set forth in the following pages, you must take action within twenty (20) days after this complaint and Notice are served, by entering a written appearance personally or by an attorney in filing in writing with the Court your defenses or objections to to the claims set forth against you. You are warned that if you fail to do so the case may proceed without you and a judgment may be entered against you by the Court without further notice for money claimed in the Complaint or for any other claim or relief requested by the plaintiff. You may lose money or property or other rights important to you. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP: AVISO LE HAN DEMANDADO A USTED EN LA CORTE. Si usted quiere defenderse de estas demanddeas expuestas en las paginas siguientes, usted tiene veinte (20) dias de plazo al partir de la fecha dela demanda y la notificacion. Hace falta asentar una comparencia escrita o en persona o con un abogado y entregar a la corte en forma escrita sus defensas o sus objeciones a las demandas en contra de su persona. Sea avisado que si usted no se defiende, la corte tomara medidas y puede continuar la demanda en contra suya sin previo aviso o notificacion. Ademas, la corte puede decidir a favor del demandante y requiere que usted cumpla con todas las provisiones de esta demanda. usted puede perder dinero o sus propiedadas u otros drechos importantes para usted. LLEVE ESTA DEMANDA A UN ABOGADO INMEDIATAMENTA. SI NO TIENE ABOGADO O SINO TIENE EL DINERO SUFFICIENTE DE PAGAR TAL SERVICO, VAYA EN PERSONA O LLAME FOR TELEFONO A LA OFICINA CUYA DIRECCION SE ENCUENTRA ESCRITA ADAJO PARA AVERIGUAR DONDE SE PUEDE CONSEGUIR ASISTENCIA LEGAL. LAWYER REFERRAL SERVICE CUMBERLAND COUNTY BAR ASSOCIATION 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 (717) 249-3166 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION PROGRESSIVE INSURANCE COMPANY, Subrogee of Vikas Patel Plaintiff, V. FANUS COETZEE Defendant. CASENO: 49'- 3'15.2 60vj 7a TYPE OF PLEADING: COMPLAINT IN CIVIL ACTION COMPLAINT IN CIVIL ACTION AND NOW COMES, Plaintiff by and through its counsel, WELTMAN, WEINBERG & REIS, CO., L.P.A., and hereby files this Complaint against Defendant. In support thereof, Plaintiff avers as follows: 1. Plaintiff, Progressive Insurance Company ("Progressive"), is a corporation with a registered office located at P.O. Box 43258, Richmond Heights, Ohio. 2. Defendant, Fanus Coetzee, is an adult individual with a last known address of 1733 Weatherburn Drive, New Cumberland, PA 17070. 3. Progressive issued a policy of insurance where Progressive agreed to insure a 2006 Toyota Camery ("Insured Vehicle"), owned by Plaintiff s insured. 4. On or about June 4, 2007 a motor vehicle owned and operated by Defendant, Fanus Coetzee, did negligently, carelessly and/or recklessly collide with the Progressive Insured's vehicle on Route 581, Camp Hill, Cumberland County, Pennsylvania. 5. As a direct and proximate result of Defendant's negligence, the Progressive's Insured vehicle sustained property damage in the amount of $11,247.70. 6. Pursuant to the terms and conditions of the insurance policy, Progressive paid the sum of $310,747.70. A true and correct copy of the payment and damage documentation is attached hereto and marked as Exhibit "I". 7. The insured also sustained damages of $500.00 representing her deductible. 8. Pursuant to the insurance policy issued by Progressive and as a result of said aforesaid payment, Progressive became subrogated to the claim of its Insured against Defendant. 9. Pursuant to Progressive's right of subrogation, Progressive is presently due and owed from Defendant the sum of $11,247.70. 10. Repeated demands have been made upon Defendants for payment of the aforesaid sum; however, Defendant has willfully failed and refused to pay the sum due and owing to Progressive. WHEREFORE, Plaintiff demands Judgment against Defendant in the amount of $11,247.70 plus interest and costs. Respectfully Submitted: WELTMAN, WEINBERG & REIS, CO., L.P.A. EXHIBIT I PROGRESSIVE 5920 Landerbrook Dr. Mayfield Hts., OH 44124 Progressive. com CMSD2340 /CMSM2340 P A C M A N FEB 27 09 - 9:53 OPID: CEV0002 CLAIM PAYMENT INQUIRY TERMID: ?004 INSD: PATEL, VIKAS K POL: 55492337 -8 DOL : JUN 04 07 PA-MECHAN-BRN- CLM: 073920065 ACTIVE REP: M VEREB PAY TO THE ORDER OF: TOTAL DRAFT AMOUNT: 10,747.70 LINE 1• NOAKER'S BODY SHOP INC. ONLY ******************************* LINE 2• ************************************************************ LINE 3: ADDRESS: 819 NEW BLOOMFIELD RD CITY: DUNCANNON ST/PR* PA ZIP/CPC: 17020 CNTRY* USA IN PAYMENT OF: COLLISION DAMAGE TO 06 CAMRY LESS 500 DED 1099 ? Y FEDERAL TAX ID: 251896604 LAST UPDT REP: SWWO006 CDS CODE * 09 PCL EFT TRACE #: ISSUING REP: S WITHJACK BANK CODE* AS2 ISSUE DATE JUN 29 07 APPROVED BY: STATE * PA AREA * REVIEW DATE: 00 00 STOP RSN * DRAFT # 452016097 REVIEWED BY: Date: 06/29/2007 04:14 PM Estimate ID: 07-3920065-01 Estimate Version: 2 Supplement: 2 (F) 06/29/2007 04:14:17 PM Profile ID: Network All Parts Pl,6NEUME Damage Assessed By: Lic # 439445 Lindsay Lowe Claim Rep: Matt Vereb (717) 791-5171 Supplemented By: LICENSE #151141 SCOTT WITHJACK * Product Type Auto * Date of Loss: 06/04/2007 * Deductible: 500.00 Policy No: 55492337 Insured: VIKAS PATEL Claimant: VIKAS PATEL Address: 6 CAROTHERS CIRCLE, MECHANICSBURG, PA 17055 Telephone: Work Phone: (717) 766-4728 Home Phone: Owner: VIKAS PATEL Address: 6 CAROTHERS CIRCLE, MECHANICSBURG, PA 17055 Telephone: Work Phone: (717) 766-4728 Home Phone: Mitchell Service: 910754 * Claim Number. 07-3920065-01 (717) 697-7185 (717) 697-7185 Description: 2006 Toyota Camry LE Vehicle Production Date: 9/05 Body Style: 4D Sed Drive Train: 2.4L Inj 4 Cyl 5A FWD VIN: 4T1BE32K36U120933 License: GKG7336 PA Mileage: 40,523 OEM/ALT: A Search Code: LANCASTERI Color: BLACK Options: AIR CONDITIONING, POWER WINDOWS, POWER DOOR LOCKS, TILT STEERING WHEEL CRUISE CONTROL, ELECTRIC DEFOGGER, AUTOMATIC TRANSMISSION, POWER DRIVER SEAT AM-FM STEREO/CDPLAYER(SINGLE), PASSENGER-FRONT AIR BAG, POWER REMOTE MIRROR SINGLE EXHAUST, 4-DOOR, DRIVER-FRONT AIR BAG Line Entry Labor Line Item Part Type/ Dollar Labor Item Number Type Operation Description Part Number Amount Units FRONT BUMPER 1 BDY OVERHAUL FRT BUMPER ASSY 2.4 # 2 004246 BDY REPAIR FRT BUMPER COVER Existing 4.0* # 3 REF REFINISH FRT BUMPER COVER C 2.4 4 004274 BDY REMOVE/REPLACE FRT BUMPER IMPACT CUSHION 52611-AA040 54.36 INC 5 004275 BDY REMOVE/REPLACE FRT BUMPER REINFORCEMENT BAR 52021-AA040 154.47 INC 6 REF REFINISH/REPAIR FRT BUMPER REINFORCEMENT BAR 1.0* 7 004277 BDY REMOVEIREPLACE FRT UPR BUMPER REINFORCEMENT 52029-AA030 26.37 INC 8 REF REFINISH/REPAIR FRT UPR BUMPER REINFORCEMENT 0.5* FRONT INNER STRUCTURE 9 000527 BDY REMOVE/REPLACE R FRONT BODY BUMPER REINFORCEMENT 57117-06030 50.30 1.5 10 REF REFINISH/REPAIR R FRONT BODY BUMPER REINFORCEMENT 0.3* EXHAUST 11 BDY REMOVE/REPLACE EXHAUST SYSTEM COMPONENTS 1.4 # 12 003670 BDY REMOVE/REPLACE FRT EXHAUST GASKET 90917-A6001 14.63 0.0* 13 001274 BDY REMOVE/REPLACE FRT EXHAUST PIPE ORDER FROM DEALER 855.27 INC 14 001276 BDY REMOVE/REPLACE REAR EXHAUST GASKET 90080-43033 3.37 0.0* 15 001277 BDY REMOVE/REPLACE REAR EXHAUST PIPE ORDER FROM DEALER 214.81 INC 16 001279 BDY REMOVE/REPLACE EXHAUST GASKET 90080-43026 1.86 0.0* 17 004469 BDY REMOVE/REPLACE EXHAUST MUFFLER 17430-OH140 219.60 INC REAR DOOR 18 002560 BDY REPAIR L REAR DOOR REPAIR PANEL Existing 1.0* # 19 REF REFINISH/REPAIR L REAR DOOR REPAIR PANEL C 1.0* Thi s estimate has been re-calculated with a modified profile. ESTIMATE RECALL NUMBER: 06/05/2007 14 :37:56 07-3920065-01 UltraMate is a Trademark of Mitchell International Mitchell Data Version: JUN_07_A - Copyright (C) 1994 - 2005 Mitchell International Page 1 of 6 UltraMate Version: .0.025 6.0.625 All Rights Reserved Date: 06/29/2007 04:14 PM Estimate ID: 07-3920065-01 Estimate Version: 2 Supplement: 2 (F) 06/29/2007 04:14:17 PM Profile ID: Network All Parts 20 21 002566 BDY REMOVE/INSTALL S1 22 002570 BDY REMOVE/INSTALL 23 24 002652 BDY REMOVE/INSTALL 25 002686 BDY REMOVE/INSTALL 26 002879 BDY REMOVE/INSTALL 27 002880 BDY REMOVE/INSTALL MODIFIED REFINISH WITH FULL CLEAR COAT L REAR BELT MOULDING L REAR DOOR ADHESIVE MOULDING Existing .2 added to clean and retape L REAR DOOR TRIM PANEL L REAR DOOR HANDLE ROOF R ROOF DRIP MOULDING L ROOF DRIP MOULDING BACK WINDOW BACK WINDOW REVEAL MLDG 75571-AA040 QUARTER PANEL ADD TO R&I BACK GLASS R QUARTER OUTER PANEL Existing R QUARTER PANEL OUTSIDE REPAIRS AFTER PULL L QUARTER OUTER PANEL 61612-AA030 L QUARTER PANEL OUTSIDE L QUARTER PANEL EDGE L ADD FOR PILLAR R QUARTER PROTECTOR 58747-AA010 L QUARTER PROTECTOR 58748-AA010 L OTR QUARTER WHEELHOUSE PANEL Existing REPAIRS AFTER PULL L INR QUARTER WHEELHOUSE PANEL -S Existing REPAIRS AFTER PULL LUGGAGE LID LUGGAGE LID PANEL Existing LUGGAGE LID OUTSIDE LUGGAGE LID LATCH 64600-AA020 LUGGAGE LID LATCH STRIKER 64621-AA010 LUGGAGE LID GARNISH Includes R&I Luggage Lid Trim LUGGAGE LID ADHESIVE EMBLEM 75441-AA050 LUGGAGE LID ADHESIVE NAMEPLATE 75447-AA020 TOYOTA NAMEPLATE LUGGAGE LID ADHESIVE NAMEPLATE 75442-AA020 CAMRY NAMEPLATE LUGGAGE LID ADHESIVE NAMEPLATE 75443-AA100 LE NAMEPLATE REAR SUSPENSION R REAR SUSP REAR ROD -M 48730-AA030 REAR SUSP CROSSMEMBER -M 51206-OE013 REAR BODY REAR BODY PANEL 58307-AA02C REAR BODY PANEL ADD FOR EDGE & INSIDE Deduct 2.5 for Each Quarter Panel Removed, Deduct REAR BODY REAR CROSSMEMBER 57654-33010 REAR BODY FLOOR PAN 58311-06040 FLOOR PAN ASSY w/Rear Body Panel Removed, Deduct 1.5 for Each Re R REAR BODY SIDE PANEL 58305-06030 R REAR BODY SIDE PANEL L REAR BODY SIDE PANEL 58306-06010 L REAR BODY SIDE PANEL R REAR BODY FLOOR PAN REINF 58336-33010 R REAR BODY FLOOR PAN REINF L REAR BODY FLOOR PAN REINF 58337-33020 0.3 0.6* 0.4 0.3 0.4 0.4 90.03 0.3 7.0* # C 2.1 28 003021 BDY REMOVE/REPLACE 29 003039 BDY REMOVE/REPLACE 30 003045 BDY REPAIR 31 REF REFINISH 32 33 003046 BDY REMOVE/REPLACE 34 REF REFINISH 35 REF REFINISH 36 REF REFINISH 37 003651 BDY REMOVE/REPLACE 38 003652 BDY REMOVE/REPLACE 39 003094 BDY REPAIR 40 41 003100 BDY REPAIR 42 43 003170 BDY REPAIR 44 REF REFINISH S2 45 003197 BDY REMOVE/REPLACE 46 003201 BDY REMOVE/REPLACE 47 003223 BDY REMOVE/INSTALL 48 49 003225 BDY REMOVE/REPLACE 50 003228 BDY REMOVE/REPLACE 51 52 003231 BDY REMOVE/REPLACE 53 54 003235 BDY REMOVEIREPLACE 55 56 003400 MCH REMOVE/REPLACE 57 004879 MCH REMOVE/REPLACE 58 003505 BDY REMOVE/REPLACE 59 REF REFINISH 60 REF REFINISH 61 62 003515 BDY REMOVE/REPLACE 63 003517 BDY REMOVE/REPLACE 64 REF REFINISH 65 66 003519 BDY REMOVE/REPLACE 67 REF REFINISH/REPAIR 68 003520 BDY REMOVE/REPLACE 69 REF REFINISH/REPAIR 70 003521 BDY REMOVE/REPLACE 71 REF REFINISH/REPAIR 72 003522 BDY REMOVE/REPLACE This estimate has been re-calculated with a modified profile. 667.32 18.5 # C 1.7 C 0.5 C 0.5 4.20 10.46 1.0* 1.0* 1.0* C 1.8 191.91 0.3 # 5.14 0.2 0.6 # 20.72 0.2 19.98 0.2 22.24 0.2 17.35 0.2 127.72 1.1 # 268.51 2.8 # 246.60 4.7 # C 1.2 0.8 76.42 1.0 428.01 11.0 # 1.5 81.54 2.0 0.5* 69.99 2.0 0.5* 23.84 0.4 0.3* 22.49 0.4 ESTIMATE RECALL NUMBER: 06105/2007 14:37:56 07-3920065-01 UltraMate is a Trademark of Mitchell International Mitchell Data Version: JUN_07_A Copyright (C) 1994 - 2005 Mitchell International Page 2 of 6 UltraMate Version: 6.0.025 All Rights Reserved Date: 06/29/2007 04:14 PM Estimate ID: 07-3920065-01 Estimate Version: 2 Supplement: 2 (F) 06/29/2007 04:14:17 PM Profile ID: Network All Parts 73 REF REFINISH/REPAIR L REAR BODY FLOOR PAN REINF 0.3* 74 003523 BDY REMOVE/REPLACE REAR BODY SPARE MOUNT BRACKET 58351-33010 8.06 0.4 75 003528 BDY REMOVE/REPLACE REAR BODY EXHAUST BRACKET 5823441010 22.09 0.3 76 004782 BDY REMOVE/REPLACE R REAR BODY REAR SIDEMEMBER -S 57615-06911 104.97 ` 2.5 # 77 004783 BDY REMOVE/REPLACE L REAR BODY REAR SIDEMEMBER -S 57616-06903 104.97 2.5 # 78 003554 BDY REMOVE/REPLACE REAR BODY TRIM PANEL 58387-AA020 236.10 INC 79 003566 BDY REPAIR L REAR BODY TRIM PANEL COVER Existing 0.3* 80 HEAT TO RESTORE COLOR 81 003587 BDY REMOVE/REPLACE R REAR BODY COMPARTMENT COVER 58703-06040 22.18 0.1 * 82 003590 BDY REMOVE/REPLACE REAR BODY SPARE TIRE COVER ORDER FROM DEALER 98.86 0.1* REAR LAMPS 83 004811 BDY REMOVE/REPLACE R REAR COMBINATION LAMP ASSEMBLY " Non-OEM 130.00 0.1 84 FROM KEYSTONE, LYNN, 800-524-4349 REAR BUMPER 85 BDY OVERHAUL REAR BUMPER ASSY 0.7 86 003624 BDY REMOVE/REPLACE REAR BUMPER COVER " Non-OEM 184.00 INC 87 REF REFINISH REAR BUMPER COVER C 2.4 88 FROM KEYSTONE, LYNN, 800-5244349 89 003632 BDY REMOVE/REPLACE R REAR BUMPER RETAINER 52562-AA010 13.12 0.2* 90 003633 BDY REMOVE/REPLACE L REAR BUMPER RETAINER 52563-AA010 13.12 0.2* 91 003642 BDY REMOVE/REPLACE REAR BUMPER IMPACT CUSHION ** Non-OEM 41.00 INC 92 FROM KEYSTONE, LYNN, 800-524-4349 93 003644 BDY REMOVE/REPLACE REAR CTR BUMPER REINFORCEMENT 52172-33020 27.14 INC 94 003645 BDY REMOVE/REPLACE REAR BUMPER REINFORCEMENT BAR 52171-AA040 167.28 INC 95 REF REFINISH/REPAIR REAR BUMPER REINFORCEMENT BAR 1.0* ADDITIONAL COSTS & MATERIALS 96 936012 ADD'L COST HAZARDOUS WASTE DISPOSAL 3.00 ` ADDITIONAL OPERATIONS 97 REF ADD'L OPR CLEAR COAT 3.3 98 933004 BDY ADD'L OPR UNDERCOATING 10.00 0.2* ADDITIONAL COSTS & MATERIALS 99 ADD'L COST PAINT/MATERIALS 475.00 ` MANUAL ENTRIES 100 900500 FRM * ALIGN SETUP & MEASURE Existing 2.0" 101 900500 FRM * ALIGN STRUCTURAL PULL Existing 6.5* 102 900500 BDS' ALIGN CAR COVER Sublet 3.00 * 0.3* 103 900500 REF * REMOVE/REPLACE FLEX ADDITIVE Sublet 12.00 * 0.0* 104 TWO COVERS 105 900500 BDY * ADD'L LABOR OP WELD. THRU PRIMER Sublet 5.00 " 0.2* 106 900500 BDS * ALIGN CORROSION PROTECTION Sublet 15.00 " 0.0* 107 900500 MCH* REMOVE/REPLACE ALIGNMENT Sublet 59.99 * 0.0* 108 900500 BDY * REMOVE/REPLACE MUFFLER HEAT SHIELD ORDER FROM DEALER 60.13 " 0.3* 109 PART #58327-33010 110 GARY, HARRISBURG TOYOTA, 545-4726 111 900500 BDY * REMOVE/REPLACE FRONT EXHAUST HANGER ON CROSSMEMBER ORDER FROM DEALER 27.27 ` 0.3* 112 HARRISBURG TOYOTA, GARY, 545-4726 113 900500 REF * REMOVEIREPLACE GRAVEL GUARD Sublet 0.00 * 0.5' 114 900500 BDY * REMOVE/REPLACE SOUND DETENING SHEETS ** Non-OEM 20.00' 0.3* 115 900500 BDS * ALIGN SEAM SEALER Sublet 68.00 * 0.0* 116 TWO TUBES AT 34/EACH 117 900500 BDY * REMOVE/REPLACE SPARE TIRE HOLD DOWN ORDER FROM DEALER 22.75 * 0.1* 118 HARRISBURG TOYOTA, 545-4726 S1 119 900500 BDY * REMOVE/REPLACE AMBIENT TEMP SENSOR CLIP New 0.89 * 0.1* 120 HARRISBURG TOYOTA, 545-4726, CHRIS This estimate has been re-calculated with a modified profile. ESTIMATE RECALL NUMBER: 06/05/2007 14:37:56 07-3920065-01 UltraMate is a Trademark of Mitchell International Mitchell Data Version: JUN_07_A Copyright (C) 1994 - 2005 Mitchell International Page 3 of 6 .0.025 All Rights Reserved UltraMate Version: 6.0.625- Date: 06/29/2007 04:14 PM Estimate ID: 07-3920065-01 Estimate Version: 2 Supplement: 2 (F) 06/29/2007 04:14:17 PM Profile ID: Network All Parts * - Judgment Item # - Labor Note Applies ** Non-OEM - Non-Original Equipment Manufacturer Replacement Part C - Included in Clear Coat Calc KEYSTONE AUTOMOTIVE 575 MARYLAND AVE. YORK PA 17404 (717) 843-8927 (800) 524-4349 83 T02801155 130.00 86 ** T01100203 184.00 91 T01170121 41.00 Prior Damage DENT IN HOOD, RIGHT MIRROR SWIPED, R/F, R/R, L/F WHEEL COVERS, RIGHT FENDER LIGHT SCRATCHES NEAR HEADLIGHT All manufacturers requirements regarding seat belt and supplemental restraint system replacement must be adhered to. If additional parts or operations are necessary to properly accomplish this, please contact the estimating claims rep. THIS IS A DAMAGE ASSESSMENT ONLY - NOT AN AUTHORIZATION TO REPAIR -BASED ON DAMAGE VISIBLE OR CERTAIN AT THE TIME IT WAS WRITTEN. IF FRAME OR UNIBODY REPAIR IS INCLUDED ON THIS ESTIMATE, THE AMOUNT SHOWN INCLUDES TIME OR ALLOWANCE FOR MEASURING BEFORE, DURING AND AFTER THOSE REPAIRS. THE OWNER OF THE VEHICLE MAY SELECT THE REPAIR FACILITY OF HIS/HERCHOICE. TO ENSURE PROPER AND PROMPT PAYMENT FOR ADDITIONAL DAMAGE DISCOVERED DURING THE COURSE OF REPAIRS, CONTACT PROGRESSIVE FOR SUPPLEMENT HANDLING PROCEDURES. Add'I Labor Sublet 1. Labor Subtotals Units Rate Amount Amount Totals II. Part Replacement Summary Amount Body 73.8 42.00 10.00 5.00 3,114.60 T Taxable Parts 5,305.44 Bdy-S 0.3 42.00 0.00 86.00 98.60 T Sales Tax @ 6.000% 318.33 Refinish 24.1 42.00 0.00 0.00 1,012.20 T Frame 8.5 44.00 0.00 0.00 374.00 T Non-Taxable Parts 59.99 Mechanical 3.9 44.00 0.00 0.00 171.60 T Total Replacement Parts Amount 5,683.76 Taxable Labor 4,771.00 Labor Tax @ 6.00 0% 286.26 Labor Summary 110.6 5,057.26 This estimate has been re-calculated with a modified profile ESTIMATE RECALL NUMBER: 06/05/2007 14:37:56 07-3920065-01 UltraMate is a Trademark of Mitchell International Mitchell Data Version: JUN_07_A Copyright (C) 1994 - 2005 Mitchell International Page 4 of 6 UltraMate Version: 6.0.025 All Rights Reserved Date: Estimate ID: Estimate Version: Supplement: Profile ID: III. Additional Costs Taxable Costs Sales Tax @ 6.000% Total Additional Costs Amount IV. Adjustments 478.00 Insurance Deductible 28.68 506.68 Customer Responsibility Amount 500.00- 500.00- I. Total Labor: 5,057.26 II. Total Replacement Parts: 5,683.76 III. Total Additional Costs: 506.68 Gross Total: 11,247.70 IV. Total Adjustments: 500.00- Net Total: 10,747.70 Less Original Net Total: 10,560.46 Net Supplement Amount: 187.24 S1: Lic # 439445 Lindsay Lowe 32.11 S2: LICENSE #151141 SCOTT W ITHJACK 155.13 THIS ESTIMATE HAS BEEN PREPARED BASED ON THE USE OF AFTERMARKET CRASH PARTS SUPPLIED BY A SOURCE OTHER THAN THE MANUFACTURER OF YOUR VEHICLE. THE AFTERMARKET CRASH PARTS USED IN THE PREPARATION OF THIS ESTIMATE ARE WARRANTED BY THE MANUFACTURER OR DISTRIBUTOR OF SUCH PARTS, RATHER THAN THE MANUFACTURER OF YOUR MOTOR VEHICLE. Point(s) of Impact 6 Rear Center (P), 4 Right Rear Side (S), 5 Right Rear Comer (S), 7 Left Rear Comer (S), 8 Left Rear Side (S), 12 Front Center (S) Inspection Site: CAMP HILL SERVICE CENTER Address: HARTZDALE DRIVE CAMP HILL, PA Inspection Date: 06/05/2007 PROGRESSIVE HONORS THE PREVAILING LABOR MARKET RATE IN YOUR AREA FOR YOUR PROPERTY. IF YOU CHOOSE A SHOP THAT CHARGES IN EXCESS OF PREVAILING LABOR MARKET RATES, YOU WILL BE RESPONSIBLE FOR THE DIFFERENCE. LIFETIME GUARANTEE FOR SHEET METAL AND PLASTIC BODY PARTS The replacement parts written on the estimate are intended to return your vehicle to its pre-loss condition with proper installation. After repair, if any sheet metal or plastic body part included in the estimate fails to return your vehicle to its pre-loss condition (assuming proper installation), in terms of form, fit, finish, durability or functionality, Progressive will arrange and pay for the replacement of the part, to the extent not covered by a manufacturer's or other warranty. This service will be performed at no cost to you (including associated repair and rental car costs). To obtain service under this Guarantee, call Progressive at 1-800-274-4641. This Guarantee applies as long as you own or lease the vehicle. This Guarantee is not transferable and terminates if you This estimate has been re-calculated with a modified profile. ESTIMATE RECALL NUMBER: 06/05/2007 14:37:56 07-3920065-01 UltraMate is a Trademark of Mitchell International Mitchell Data Version: JUN_07_A Copyright (C) 1994 - 2005 Mitchell International Page 5 of 6 UltraMate Version: 6.0.025 All Rights Reserved 06/29/2007 04:14 PM 07-3920065-01 2 2 (F) 06/29/2007 04:14:17 PM Network All Parts • Date: 06/29/2007 04:14 PM Estimate ID: 07-3920065-01 Estimate Version: 2 Supplement: 2 (F) 06/29/2007 04:14:17 PM Profile ID: Network All Parts THIS GUARANTEE DOES NOT COVER NORMAL WEAR AND TEAR OR DAMAGE CAUSED BY IMPROPER MAINTENANCE, NEGLECT, ABUSE OR SUBSEQUENT ACCIDENT. THIS GUARANTEE IS LIMITED TO ARRANGING FOR THE SELECTION OF REPAIR PARTS THAT WILL RETURN YOUR VEHICLE TO ITS PRE-LOSS CONDITION. ACCORDINGLY, PROGRESSIVE WILL NOT BE LIABLE FOR ANY INDIRECT, INCIDENTAL OR CONSEQUENTIAL DAMAGES THAT RESULT FROM THE INSTALLATION OR USE OF THESE PARTS. Part Type Terms and Abbreviations NEW and OEM or part number displayed - These refer to a new, original equipment manufacturer part. NON-OEM and A/M and Qual REPL - These refer to an after-market part, which is a new, non-original equipment manufacturer part. USED/RECYCLED and LKQ - These refer to a used OEM part. REMANUFACTURED and RECOND. and RECORE - These refer to used/recycled OEM parts that have been refurbished. BDY=BODY, BDS=BODY STRUCTURE, REF=REFINISH, GLS=GLASS, FRM=FRAME, MCH=MECHANICAL, ADD'L COST=ADDITIONAL COST, ADD'L OPR=ADDITIONAL OPERATION, FRT=FRONT, RR=REAR, L=LEFT, R=RIGHT,UPR=UPPER,LWR=LOWER, OTR=OUTER, INR=INNER, ASSY=ASSEMBLY, SUSP=SUSPENSION, EXT=EXTENSION, BRK=BRACKET, INST=INSTRUMENT, ATG=ASSEMBLY TIME GUIDE. REPAIR SHOP'S AUTHORIZED REPRESENTATIVE'S SIGNATURE INDICATING AGREEMENT ON COST TO RETURN THE VEHICLE TO PRE-LOSS CONDITION INCLUDING TOW/STORAGE CHARGES: SHOP SIGNATURE: EST. COMPLETION DATE: (o 7i_ ANY PERSON WHO, WITH INTENT TO D UD OR KNOWING THAT HE/SHE IS FACILITATING A FRAUD AGAINST AN NSURER, SUBMITS AN APPLICATION OR FILES A CLAIM CONTAINING 1?FAL OR DECEPTIVE STATEMENT IS GUILTY OF INSURANCE FRAUD. // APPRAISER SIGNATURE Event Log File Created: 06/05/2007 09:38:15 AM Estimate Started: 06/29/2007 04:11:21 PM Estimate Printed: 06/29/2007 04:14:50 PM Estimate Committed: 06/29/2007 04:14:46 PM Estimate Uploaded: Estimate not uploaded This estimate has been re-calculated with a modified profile. ESTIMATE RECALL NUMBER: 06/05/2007 14:37:56 07-3920065-01 UltraMate is a Trademark of Mitchell International Mitchell Data Version: JUN_07_A Copyright (C) 1994 - 2005 Mitchell International Page 6 of 6 .0.025 All Rights Reserved UltraMate Version: 6.0.625- VERIFICATION PAGE The undersigned does hereby verify subject to the penalties of 18 Pa.C.S. § 4904 relating to unsworn falsification to authorities, August J. Ober, IV, Esquire is duly authorized to make this Verification, and that the facts set forth in the foregoing Complaint are true and correct to the best of his/her knowledge, information and belief. i Date Q Lt 11 l) J i fl i'? L V i i a V' t.! "Y *78. so Pa AI-4 cev Sq 10887 P:r* aa,5019 Sheriffs Office of Cumberland County R Thomas Kline '6%r at 4LUMbrr nawara L scnorpp x 4# Sheriff' ill r Solicitor Ronny R Anderson Jody S Smith Chief Deputy OMCE OF THE sKERIFF Civil Process Sergeant SHERIFF'S RETURN OF SERVICE 05/28/2009 05:42 PM - Shawn Harrison, Deputy Sheriff, who being duly swom according to law, states that on May 28, 2009 at 1742 hours, he served a true copy of the within Writ of Summons, upon the within named defendant, to wit: Fanus Coetzee, by making known unto himself personally, defendant at 1733 Weatherbum Drive New Cumberland, Cumberland County, Pennsylvania 17070 its contents and at the same time handing to him personally the said true and correct copy of the same. SHERIFF COST: $43.30 SO ANSWERS, ? .r May 29, 2009 R THOMAS KLI E, SHERIFF 2009-3452 Progressive Insurance v Fanus Coetzee ' 7 4? rv IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION PROGRESSIVE NORTHERN INS Plaintiff vs. FANUS COETZEE Defendant and MEMBERS 1sT FCU Garnishee No. 09 3452 Aa.>s~.c~~s (~ INTERROGATORIES IN ATTACIIMENT XXX-XX-4150 C N ~' o ''~'1 . ~'r. x. ~7 E°` ~ FILED ON BEHALF OF: ~ ~~~ Plaintiff ~ ~ ~ ~4 ~ ~ , ~ COUNSEL OF RECORD OF ~- r THIS PARTY: ~ ~ Michael J Dougherty, Esquire PA I.D. #76046 WELTMAN, WEINBERG & REIS CO., L.P.A. 325 CHESTNUT STREET STE 501 PHILADELPHIA, PA 19106 (215)599-1500 WWR# 06057107 IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION PROGRESSIVE NORTHERN 1NS Plaintiff vs. FANUS COETZEE Defendant and MEMBERS 1sT FCU Garnishee Civil Action No.: 09 3452 TO: MEMBERS 1sT FCU Suggested Reference No.: XXX-XX-4150 130 OLD YORK ROAD NEW CUMBERLAND, PA 17070 IlVIPORTANT NOTICES TO GARNISHEE! A. You are required to file answers to the following interrogatories within twenty (20) days after service upon you. Failure to do so may resuh in Judgment against you. B. Herein, the word "defendant" means any one or more of the defendants against whom the writ of Execution is issued. C. While service of Writ upon the Garnishee attaches all property of the Defendant subject to attachment which is then in the hands of the garnishee, it also attaches all property of the defendant which comes into the Garnishee's possession thereafter, until Judgment is entered against the Garnishee. For example, the resultant liability of a Garnishee-Bank would not be measured by the balance in the debtor's account, either at the time of service of the Writ or at the time of Judgment against the Garnishee, but rather by the amounts deposited and withdrawn during the intervening period. INTERROGATORIES IN ATTACHMENT 1. At the time you were served or at any subsequent time did you owe the defendant any money or were you liable to him on any negotiable or other written instrument, or did he claim that you owed him any money or were liable to him for any reason? 1 a. If the answer to Interrogatory 1 is in the affirmative, state the following: the amount of money you owe or owed to defendant, and, if such money is in the form of a fund, the present location thereof; the terms, face amount and amount you owe or owed to defendant on each of such negotiable or other written instruments and the present location of each of such instruments; the amount or amounts that defendant claims or claimed that you owe or owed to him; and the nature and amount of each of such liabilities. ~' 2. At the time you were served or at any subsequent time was there in your possession, custody or control of yourself and one or more other persons any property of any nature owned solely or in part by the defendant. 3. At the time you were served or at any subsequent time did you hold legal title to any property of any nature owned solely or part by the defendant or in which defendant held or claimed any interest? ~~ 4. At the time you were served or at any subsequent time did you hold as fiduciary any property in which the defendant had an interest? ~~ 5. At any time before or after you were served, did the defendant transfer or deliver any property to you or to any person or place pursuant to your directions or consent and if so what was the consideration thereof? 6. At any time after you were served did you pay, transfer, or deliver any money or property to the defendant or to any person or place pursuant to his direction or otherwise discharge any claim of the defendant against you? ~ ~ 7. If you are a bank or other financial institution, at the time you were served or at any subsequent time did the defendant have funds on deposit in an account in which funds are deposited electronically on a recurring basis and which are identified as being funds that upon deposit are exempt from execution, levy or attachment under Pennsylvania or federal law? If so, Identify each account and state the reason for the exemption, the amount being withheld under each exemption and the entity electronically depositing those funds on a recurring basis. ~ v 8. If you are a bank or other financial institution, at the time you were served or at any subsequent time did the defendant have funds on deposit in an account in which the funds on deposit, not including any otherwise exempt funds, did not exceed theQamo~unt of the general monetary exemption under 42 Pa.C.S. § 8123? If so, identify each account. ~ Jam- `Q°- ~~ WELTMAN, WEINBERG & REIS CO., L.P.A. By: Michael J Dougherty, Esquire PA I.D. #76046 WELTMAN, WEINBERG & REIS CO., L.P.A. 325 CHESTNUT STREET STE 501 PHILADELPHIA, PA 19106 (215)599-1500 WWR#07346166 St MEMBERS 1St FEDERAL CREDIT UNION February 25, 2010 Name: Fanus I Coetzee Address: 1733 Weatherburn Drive New Cumberland Pa 17070 Account Number: XXX743 Name on Account: Fanus I Coetzee Savings: $00.00 Checking: $175.95 $ 50.00 processing fee $125.95 $300.00 Statutory Exemption was not taken out. ~~ ~ ~ ~ ~~ __~~~- ody urkholder Deposit Operations Analyst 5000 Louise Drive P.O. Box 40 Mechanicsburg, Pennsylvania 17055 (800) 283-2328 wwwmemberslst.org VERIFICATION The undersigned does hereby verify subject to the penalties of 18 PA. C.S. 4904 relating to unsworn falsifications to authorities, that he/she is Jody L. Burkholder (Name) Deposit Operations AnalystofMembers 1st Federal Credit Union (Title) (Company) garnishee herein, that he/she is duly authorized to make this verification, and the facts set forth in the foregoing Answer to Interrogatories are true and correct to the best of his/her knowledge, information and belief. ~~~~~2 (SI NATURE) i i WELTMAN, WEINBERG & REIS CO., L.P.A. BY: Michael J. Dougherty, Esquire I.D. No. 76046 325 Chestnut Street, Suite 501 Philadelphia, PA 19106 Phone: 215.599.1500 Fax: 215.599.1505 File # 07346166 Attorney for Plaintiff(s) C'7 a C c', Z E.~., v . ~: ~ yfr~ ~ >.. } :~ `_. "~ PROGRESSIVE NORTHERN INS } CUMBERLAND County~''~~ ~ } Court of Common Pleas N v; vs. } cr FANUS COETZEE } NO. 09 3452 PRAECIPE TO DISSOLVE WRIT OF EXECUTION AS TO GARNISHEE MEMBERS 1 FCU TO THE PROTHONOTARY: "' C~ ~E -c Kindly Dissolve Plaintiff's Writ of Execution as to Garnishee, MEMBERS 1ST FCU, in the above-captioned matter. WELTMAN, WEINBERG & REIS CO., L.P.A. By Michael J. Dougherty, Esquire Attorney for Plaintiff $8. o~ ~ err`/ U~~' 445b547 P.~a39~189 WELTMAN, WEINB RG & REIS CO., L.P.A. BY: August J Ober, I ,Esquire I.D. No. 94701 325 Chestnut Street, Suite 501 Philadelphia, PA 19 06 Phone: 215.599.150 Fax: 215.599.1505 File # 07346166 PROGRESSIVE I Vs. FANUS COETZEE TO THE PROTH( Kindly issue a Fanus Coetzee, 2 COMPANY 'ARY: Attorney for Plaintiff(s) Cumberland County E? ~ : Court of Common Pleas ~ ~ c = ,~ , , .,. _._ rx.~ iT;7 r W ~... J ~T i ~ - ~I ~.~. ~. ' ~ .. .. ` - ~ N0.09 3452 ~ r_, of Motor Vehicle Judgment against the Defendant(s), named in the amount of $10,547.70. WELTMAN, W~INBEFj~G~J~EIS CO., L.P.A. BY_. '~ August O e , Iv, Esquire BOO PD AT'Ny ~~' ~481v33a ~ aysyga .-. ,-' w Ronny R Anderson Sheriff Jody S Smith Chief Deputy Richard W Stewart Solicitor SHERIFF'S OFFICE OF CUMBERLAND COUNTY ~4L1t11~'' Ot 1[Ihi~r~~,f~~~ a~, ~,_ ~~ AGE, O ~ 'r r ~ ~~RIF~ o~ NARY' 1Q AUG 3 I AM 8~ 52 ~v~~ Progressive Insurance Co. vs. Fanus Coetzee Case Number 2009-3452 SHERIFF'S RETURN OF SERVICE 02/25/2010 William Cline, Deputy Sheriff, who being duly sworn according to law, states that on February 25, 2010 at 0957 hours, attached as herein commanded all goods, chattels, rights, debts, credits, and monies of the within named defendant, to wit: Fanus Coetzee, in the hands, possession, or control of the within named garnishee, Members 1st Federal Credit Union, 1166 Walnut Bottom Road, Carlisle, Cumberland County, Pennsylvania 17015, by handing to Brian Peters, personally three copies of interrogatories together with three true and attested copies of the writ of execution and made the contents there of known to him. The writ of execution and notice to defendant was mailed on March 8, 2010. 08/30/2010 Ronny R. Anderson, Sheriff, who being duly sworn according to law, states this writ of execution is returned as ABANDONED. No action on writ in over 6 months. SHERIFF COST: $91.17 August 30, 2010 SO ANSWERS, RON R ANDERSON, SHERIFF B aron R. Lantz ~ Co ~,~ ~ ~ t' ~ o ~- s.~ ~~ ~a ~~~ ~~~ R-~~'y~ s ;cj CountySuRe Shenfl. Teleosoft. inc. FILEDaoHa?QTAR OF THE Z0 P'Ij L,: 18 102$ ct! mS IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION PROGRESSIVE INSURANCE CO Plaintiff vs. Civil Action No. 09 3452 FANUS COETZEE Defendant PRAECIPE FOR CERTIFICATION OF MOTOR VEHICLE JUDGMENT TO THE PROTHONOTARY: Kindly issue a Certification of Motor Vehicle Judgment against the Defendant, Fanus Coetzee, above named in the amount of $10,547.70 with 6% interest accruing from July 23, 2009. Date of Accident was 06/04/07, Claim Number, 073920065. WELTMAN,,WIEII`4$ERG & REIS CO., L.P.A. J Ober IV, Esquire P .#94701 eltman, Weinberg & Reis Co., L.P.A. 325 Chestnut Street Suite 501 Philadelphia, PA 19106-2611 (215) 599-1500 WWR#07346166 CIO ? ? sass ?a