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HomeMy WebLinkAbout04-46601. THIS IS AN ARBITRATION MATTER. ASSESSMENT OF DAMAGES HEARING REQUIRED. GORDON & WEINBERG, P.C. BY: PAUL M. SCHOFIELD, JR.,ESQUIRE Identification No.: 81894 21 S. 21st Street Philadelphia, PA 19103 (215) 988-9600 Allstate Insurance Co. 1301 Virginia Drive Fort Washington, PA 19034 Individually and as Subrogee on behalf of Michael Abbott and Michael Abbott 1030 Fox Chase Road Jenkintown, PA 19046 VS. Joseph Dudding Jr 306 W. Green Street Shiremanstown PA 17011 Attorney for Plaintiff COURT OF COMMON PLEAS CUMBERLAND COUNTY NOTICE YOU HAVE BEEN SUED IN COURT. IF YOU WISH TO DEFEND AGAINST THE CLAIMS 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 ATTORNEY AND FILING IN WRITING WITH THE COURT YOUR DEFENSES OR OBJECTIONS 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 JUDGEMENT MAY BE ENTERED 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 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. CUMBERLAND COUNTY BAR ASSOCIATION 32 S. BEDFORD STREET CARLISLE, PA 17013 (717)24903166 THIS IS AN ARBITRATION MATTER. ASSESSMENT OF DAMAGES HEARING REQUIRED. GORDON & WEINBERG, P.C. BY: PAUL M. SCHOFIELD, JR.,ESQUIRE Identification No.: 81894 21 S. 21s` Street Philadelphia, PA 19103 (215) 988-9600 Attorney for Plaintiff Allstate Insurance Co. 1301 Virginia Drive Fort Washington, PA 19034 Individually and as Subrogee on behalf of Michael Abbott and Michael Abbott 1030 Fox Chase Road Jenkintown, PA 19046 VS. Joseph Dudding Jr 306 W. Green Street Shiremanstown PA 17011 COURT OF COMMON PLEAS CUMBERLAND COUNTY NO. : 04 -14"0 (210-,L7;zetj COMPLAINT IN CIVIL ACTION 1. Michael Abbott (the "Plaintiff"), is an adult individual residing at the address above-captioned. 2. Plaintiff, Allstate Insurance Co. is a corporation duly authorized to conduct business within the Commonwealth of Pennsylvania, and is Subrogated to the rights of the Plaintiff arising out of the within claim. 3. Joseph Dudding Jr (the "Defendant"), is an individual residing at the above-captioned address. 4. On or about November 21, 2003, the Plaintiff did own and possess a certain motor vehicle, involved in the accident hereinafter referred to. 5. On or about November 21, 2003, the Defendant did operate and control a certain motor vehicle, involved in the accident hereinafter referred to. 6. On or about November 21, 2003, the motor vehicle of the Plaintiff was stopped at a legal red light at the intersection of Susquehanna Road and Meetinghouse Road in Montgomery County, Commonwealth of Pennsylvania. 7. On the aforesaid date, the motor vehicle of the Defendant was traveling on Susquehanna Road. The Defendant then struck the Plaintiff's motor vehicle, striking the rear of the car causing moderate damage. 8. The vehicle of the Defendant was being operated in such a negligent, careless, reckless and wanton manner that it came into violent contact with the Plaintiff's vehicle causing property damage to Plaintiff's motor vehicle. 9. At the time and place aforesaid, the negligence, carelessness, recklessness and wantonness of the Defendant consisted of the following: (a) Operating said vehicle at a high and excessive rate of speed under the circumstances; (b) Failing to give proper and sufficient warning of the approach of said vehicle; (c) Failing to have said vehicle under proper and adequate control at the time; (d) Operating said motor vehicle without due regard for the rights, safety and position of the Plaintiff herein at the point aforesaid; (e) Failing to sound a horn or other signaling device as to give warning to the Plaintiff; (f) Violating the rules and regulations of the road, ordinances of the County of Montgomery, and statutes of the Commonwealth of Pennsylvania; (g) operating said vehicle without observing and heeding the road and traffic conditions then and there existing; (h) Other acts of negligence, carelessness, recklessness, and/or wantonness which may be ascertained from information obtained during the course of discovery and/or trial of this matter; and (i) Being otherwise careless, reckless, negligent and wanton. 10. As a result of Defendant's negligent, careless, reckless and wanton operating of the motor vehicle, the Plaintiff's motor vehicle sustained damages in the amount of $7,586.20. True and correct copies of the police report and payment history from Allstate Insurance Co. are attached hereto and incorporated herein as Exhibit "A". 11. At all times material hereto the Plaintiff was insured by plaintiff, Allstate Insurance Co.. 12. As a further result of the Defendants' negligence, Allstate Insurance Co., has made compensation for said properly loss to the Plaintiff. 13. Plaintiff, Allstate Insurance Co., Individually and as Subrogee on behalf of the Plaintiff, has paid money to the Plaintiff for property damage in the amount of $7,586.20, for which Plaintiff demands remuneration from the Defendant. WHEREFORE, Plaintiffs, Michael Abbott and Allstate Insurance Co., Individually and as Subrogree on behalf of Michael Abbott, claim damages from the Defendant, in the amount of $7,586.20, and/or any other damages this Honorable Court deems just and proper, including attorney's fees and court costs from the Defendant, for arbitration purposes only. GORDON & WEINBERG, P.C BY: PAUld SCHOFIELD, JR.,ESQUIRE At o{{ney for Plaintiffs PO1D 2010012 VERIFICATION PAUL M. SCHOFIELD, JR.,ESQUIRE, hereby states that he is the attorney for the Plaintiff(s) in this action and verifies that the statements made in the foregoing pleading are true and correct to the best of his knowledge, information and belief. The undersigned understands that the statements herein are made subject to the penalties of 18 Pa.C.S.A. Section 4904 relating to unsworn falsification to authorities. SCHOFIELD, JR.,ESQUIRE Dated: September 13, 2004 APR. 16. 2004 12:35PM 225ALLSTATE-W. GROVE ARTMAN NO. 4005`P. 15/21 ,, _ n G {IJsa+IF?7 PAGE 01 ai.?FtIIPob.I??Nl1'y=':i.-)'. iii iviCS'y(?'J:l'•:.?Itj?-?. ? ? ?gg????II II?I°?I???lll?l???ll? ?1 P•F )C 2- : ao;-; '.^.CdTim- ?"3Y.1vt ? U 1,1' ?ra,<l,?umi+ur Ceaa Closed Rtoponable Crasn ?6ye + t It AA 500 1 aM Yes sa No Yee No L d f i; U6 7 P0517337 I inwdent Number - --?^'' - - Poll Patrol Zone Ilol31-IC-Islji9lsi' 1 1 i I i I I I I liy 61"') 01 e 7 8 g; Agency Name r Precinr. _ YrveetogAden Dare (MM-DD-YYYY) i?• i o I I 1 1 a ZI 1 '?Z I d la 13 l :I i A&WN T--W Toi,Wvr-w - P faoa ? ?/-Ix-4 poW is lC 1 JtapatCh Time Lm/q Arrival Tlma (mil) inveguiplor ? badge Number {12 a 1y?3;Ixiol'il?'{ 1 eve 4MRrs 0?6'1 j ;3IZI3 {y] royal Date (MM-DD-vYYY) a I er 3a3av Number An 1(?i7 idI/?!I__t_l° ?3 -171&jevv31 1 ?' v CourYe±• Ns:nta 39unklvaiNy .l:lunllmality NarAs oav r•3lAr?k MntiTd0in P, R.`( i 1 0{ l i t Al$iN[rT31J ?,?,dst+r? I O Sun O Thu 'I •j r:.aeh ?a,• 'MM-DD-Y-. YY) f'.'.Ch `rrr3 •ip N^ 9ooPie Wired Killed* vif y •70 ? 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( I ! ! t i i i p1 Ncrh Distance From Crash I a Scene ?o landmark t a' ins ,akEMO Slimes Name ,d!..Ig ?) gas l G=pr Crasr: he Vwer ,j a ! + ' I ' 1 , a I j ? P-"f?'T v1 iandrprR Y ano ++ ---j West { !a:^o%?.v9? k 7r -?YY:...i-i Ti. :.i±Y.?iAY"?ZLGC?:iYY??n•l- lMwJ.-..L?c•Y.N.?_. .•,/La_iI X+P .^..a. .s. ?.y- w-? ' ;ems ^Y^,' 3 iltt?.ee 3+!?cY c' a :a d5 _ ,_ - : E ,• • n i , ' s 1 . 1 :lc •:.C .__n^rsl C-e: rlf+ N Yi ld ••- Ii ? li °Aw'.V.'^ $i7n e i .- t O C2 ar of ; s I •,..,: Nat AppllCatle ? TFOINC Signal v ACdVe Al Crossing F'aglnan C Nc C=irols Other: T e TCO De"CC Fun ctioning I Y--t E'nargency l Preemptive ' °' •^•, s!ashing Traffic z1vols l) Stop S! n P i Si RR yp mprvpary - Signal g gna ve ass "- Crossing C ostn!s r'_M`..::wu., _: : -? +-? DeviCa Not :-Z Unknown { Fm+cdoning 40 Dev!Ce Functioning Prooed O Unknown. v . . ?.._exY wu-,sae..:.. :....r w... ,r+._ ara•;::-mn,u.. ,n.n_ -_ y PAGE 15121 ' RCVD AT 41161200411,15:18 AM [Cenlral Daylight Time] I SVR:118' DNIS:52501' CSID:215 293 8400' DURATION ]mm•ss):0746 APR. 16. 2004 12:37PNI ALLSTATE4, GROVE NO. 4iltsh P. 11/21 C.tsfv7rUid:tt'WE a,1°o N OF ??31fi1 jA?L+. POLIC2 4:.U5,11 A :p.MiNis: ,'Oww a? ,,? I II {Ilil! {I11Ilf t sear Number Case Cored `Reportable rash AA 500 1 40 Yes j= No s Yes ;D No ! P0517337 - i I' incident Number .. ... __ _.. ?. _ ?,?...?. .. Police Agency patrol -Zeal 101?- 1-I?)BIfl9Is1iiI1{ IiiI I1414111iii 1?1loll 8 Agency Name >radnct investl' anon Date (MM•DD-YYYV) } i t a T , I??i A)Ltrc?! 'tam+N9rj r,1 }?dCird l f /`?r,.4Aplu d?e.•?crjC 1 ! 1 - Z ) -? Z l a le I? l r t +I Dtscstch Time ((m10 Arrival rime (mip Investigator 1104 Number . ??:IZi°?`11311z+°-IY[sli oar. Crfc:a assr I l?lz13 1 A lade Number. roval,Dana (MM-Oo-YWY1 (/?) ;?, 1...1 ! ! 17 1"0 1 x!010+3 i noun county Vama Munici alt MunAidpall"Y Name Day,,; f ig (. Motii4?nLRY I l i 0 ) j n$%N&'rw ' ow4rmip 1 sun bmu r Crash Date MM•DD-YYf! ash Time NO No of tmf3 Peopfo injured Xliled' "If > 00 `' Mon ?r fd ? f i? i`_'^'.' 11 +1 -.•`?I Piles I- Tux C:) sat _??cp'.5,:210 I?I 14vI ZI LG ID zi i010 l nF '=Wed UUnki irlbT:kan20! yes cos Yes• '? No I f4hoci Due W ya . No 1 3+'haol tens C Yes M No NavN?HNNDCS'Q Ye a No ; Form 1 . Sxctlon 19) ?, , :taSaFad "listed (Vfalh irsance I ? )pemtctlen Tye IS 4 WaY'ntenetidn 1 'Y- 11110M46011 0 ? EFSetf Cn ? Off Ramp C) Railroad Crossing i '-ip?•:!C- i ¢ I? 1 r" Midblork Trafflc C;r6ei On Ramp CD Crossover G Other ') 11IG9CYCG (;, IT' intersection O pound About Q j = ?r _, _,.........._?..._._.,....,...... ._... .. _. ..,._._.., _,-,_ .. See +.Y¢r>?)7_ .. i r Route Number Bagman: (DPtiOral) 7ravei minas Speed Limit Q Nom 1 Homse Number ((f agpllGlbl!) 1 --?-? Q South ( I f l L-J l iattot Name 4 Street finding a cQ East Fc, Mid-block crashes only. Use d; a f I Q West P sw Noble Number and "Wr swe f ' ? l U 'S ©1 U I G I i{ I A• 1 I?' I N 'A I 1 I [ 1 1 0 Q Unknown Pri•,deal Roadway Street NAM# is 1 s ; I L ! (died in if wing this oPVon . +i >t Interstate Tunspilce C-. Turnpike sent County Local Road vQ Private C ONerf ?' SntA9 Q (Not Turnpike) I (£estMyest) Spur ., Highway Road or Street _ Road Unknown i Route Number 5ogmern (0000410 Vaivai Sanef d Limit Q North i? I ? ? fl SOUM k I I[ I I I I. t L_!_? Pea i Sueet Name Street Snelling O Ea:t , ' :• b 1//I 'r6 fi,. ?l iN ??l I?' 7? 15 I? I 1 1 I 7+cf? DI 1ZD Unknown i a Inurseatx v turnpiks CD Tumpike :l state CD County Is Local Road C Private Omar/ $@ (Not Turnpike) (Eatrwest) iPa Highway Road or $kreet Road Unknown' )4tarae?dng Rt Num Or "71ie rest Or Segmerri ARarkar r at i - 1[:?•` North is 1 I i' i ' ?! i I? l'. i 1 C') So= , I c 15 ?; Or IntanactIng Spaet?iame, alyt m Or Miles i O £nte? J 1 I ' I I 1_ 1 .. I I I i i west i t Information f ' t 1 L l k t La ?crr , I f l if Ussiinp arks Intenadihb (r Num Or '':Nre Font Or :agtY.eni ?slark7r _ Distance From Crash Z m 1 ( I I } I t Q N? Scene to WndfrArk 1 This Otion c 41 $ © South i St Z-1 eS Vi 0 liast (For CrgSh ioeswxan 3 s ,' Cr (n:eraec`Jt? Strobl Alamo r (endure; k 1 and ' yr i ! 1 I _+. .V 1 { J I _1 y£t 0West Lalydme.7r 2) 59sores Oecre2s ' 1^1-in--u+?t•:e?ssat^ bnds;? i.--__dA I W ?l?J • L.1?-1 i ' i».Mc Can'vf.DaOep Yeld Sign k1z; 'olKx Oyicar or wN??lx7 Emerganty Frogman .-. 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Unkmown -+`+y=?•- South :j 'Vest = tar, and west N t _ i'fiLF Yes W No N I 3G Min. , 7.3 his C:) 3.6 hrs Z-S Its -?" > 9 hours ,:i'Jnkncwn ..- ? ? ,1 c i 3 .GvG ?r _ Neva....y,..•.•_....,s--._...._...._____:?...____... au.u„uu_.r:vr '^A.G1 A.?.ta4n (l(ee) ?kaF. `v'"' PAGE M21"RCVDAT 41161200411:15:18AM [CentralDayightTime] "SVR118?"DNIS:52501"CSID:2152938400"DURATION imm45):01460E:6a 'eeezfsz ti A°R. 16. 2004 12:37PM ALLSTATE-W. GROVE NO. 4005-P. 18/21 ` "a?u2S•??lt;;?i?SlPI.e?u. ^i 53U" :•'Ixik:<._sc.v:2AiL:a ?????J????? i P+A'A.;ra.:?"2e9$.ri ?,..@GJca'Sc?9GTi s?uZ{J 1 a.xd»vCmber Pd7c! use only AA 500 2 - 1 pca:Z p0517337. ` Motor Vehicle in !r i Transpors C Hit 4, Run Vehicle illegally Parked Q Le9aly Parked Q Ncn -Motorized CommarrlaJ Vehlde { unit d Pedestvn Q Pedestrian on S%aees, C7 Disabled From d Train © Phantom Vehice Yes No 'I e, I in P Wheerchair, etc Previous Crash ` ;J1 OY Yes, Complete Form O (rf 'Pedestrian' or "PedaMlent on Skates, in Wheelchair, etc', .omp,ete Form M, Saceon 28 j urth No Cho :dame MI DA" W S1M hWDD•YY" y a? ?s'1a1s1?iQl+i! l u l l (! 1?? 2 `? ;i1yI6I?; k ! :est karne -440horts Plumber I Do' ul? {olu;, f?l?l ?i:si?l i _i J 1 i I I 1 170 -73-), Bps j f I A4dtesa J_cily f swto t e4 w k?MANs ra IN {{ rl 3 4G,Re6N Sr, fNl PA ,?L?17?dftlti 1, f river Uccnat Numaer stata ilas> X61711 idJ5 Far $: I I I i I 1 1 1 Akohoktratra SuPh,V$ Dthrer at Pedtairian PhAkal tindhion i rJ No "7:3 Illegal Drugs W medleation ? ADt"maa1n"' Riega! Dryq ? Wgua ? Medication it Ilse AkOhol Alccnol end pray: L-D Unknown Had, SIR Amp Unknown _ Ddnking ?1I ? y' A1ro?o17ast Y.vde ? r!/nar,- VOh1VB rod* wolatien CRargedl ? - to Test Not Given ,.:D 9reath C7 Qr:1ar , : Q 310od p urine v TPRrGO,rvtemnif 1 ?L GosJV,rl6 Ce a sxt -r ( # Yes C No i 7a ,Akishol Teztt Resulr:e Test Reused CD Briar{ vn Driver Jr'a Soot I •D(nmr.0perated 3..Drlver Fled scene Test Galen, vaKde 4.Hft and Run Contaminated Results 2.No Driver 4.tlnknawn OvanttlpdVer OOcNot Applicable 024MvMe vetude Not 04-SOW Police Vehicle 07=Mundpd Pollct Veh UP-Raderai Gov Veh Ol.Prrvate vehicle Ownadr Owne+l1.685ed by Driver OS.PSNNDOT Vehice as-Other Municipal 98.01h4r Z- Leased qy Griver O3=Renred vahicte 06.0ther Srate Gov veh Government Vehicle 99=unknown I ; s 1 - crNner 9;'Si Memo - ?__-T Owner Last Name or Business ;fame (if Pedesviata sop this Stcr,, •? - - ?} Same as 1 OrlverQ 1 1?':?? P1NI 1 1 IDIv Ipldli INI(4 ; 1 SIRI 1 1 J 1 1 1 1 1? f Agdrass 1 t:)ty ! S'+si Na : Zip Vehicle aaa(tx _ aP.eke coda; ill ??tL W. UaN 5T • ?r?rRttM?ftiST'c :.u P.4 j'70;i 11 CgWvlfcLZ-r 12 0 ! 117N .. _ r aModei Year Vehicle Model (set avDnay) 1 } :'Il ' l It,ID1CIE' tV13??jjtic y15trI11717131 r- CA U:arsa•Plata ?A,AIG., ?Mat?e 3st. speed W(G a Towed 'rowed ey If';?.1?f9?9;g1a1 1 1 I 1LLt?J 10 nYes pNO jJ}Rid?-adv Jre CMr• raxa 1nsuranca C--mpany Pocky Mo i T Yes d No CD knUn- crvn 1 5j'A"?'Lr FR tia?! I L) s- i s 6 s9 - s Y- N J' r 1 T 18r. q _ 1-7owfnb Pass. Ve d.Mobile.Mfodular Home 7.5em1•TraNer Tag No Tat 'tzar Tes It No, of -' 2=rowing Truck S.Csmoot 9.0ther T,41, Unre o . Units: 3=Taxing Ut10n, Trailer 6-Pull Trailer 9.Unknewn G?C?On or' i "1ahJtie ,?,}lNel1 11 U II II ova . - II ){ ?I "59z Sneaei i2ser? 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TYOa Spec Veh 99.unKM'm OS=ala4% 99=Unknown :n o?1 . :I t?•C; _ _- a• - c-?aa b'ta9r,Jr ^+as [ilk ::7ownrdll Ko6d ;.isr,+.re:at 't .- -, , i f"'" O.Nute 2=PUntdonai -"t a=dx:xn of .tiLL 1 f. 7xC rv e, {{, ' 00.Non-CDitlsion ?4al,nde::?nlage 1 'fit t:rdinor 3=05abhng to of 5rYCp of NS? 1 L 2=UrveG 1 `? l I 01-'.2•Clock Points 'SrTowed Urn l_ 1 1 LU 2=Uphill { T t3:lop 99.:;n%M1Cwn t 9.ilnkncwn 1 ___-. __ a.UnknOwr. t S.UMFns.vn 1 ?.?,.._... _.., e.auV.-,,.w:b+u+-a...:. .-,ws. _ae.. .rxwr+?-+u?G:s_ .•.• •.e-- .?_.. _ ...nsn.•?s!:ry..,_..:.s?e?ssc.i? C610:215 2938400 )AGE 18121 t RCVD AT 41161200411;15;18 AM )Central Day lgMTime)' SdRJ181 DNIS,52501 t "DURATION pnm ss):Old6 APR. 16, 2004 12:38PNI ALLSTATE-W. GROVE -NO. 4005-'P. 19/21 J .owTimh1JimoiitaAl7f/ MY l?yWaVSK? YN1?1? III IO??IYa?gOID whNembar tr176 = ZZ.ASM OSEi•W4fi7 HO "VOW Page: AA 500 1bYe?:lo?r i 3 P 0517337 Motor vehicle in rot & Rum Vehicle 0 IRe ally Parked O Legally Parked C:) Non - Motorized .I Transport 9 Commefdal Uehtde ar e 0 Pedestrian o "ddowWheelchair, skates, ? DPrormLis isabled CFrom rash O Train ©'Phantom Vehicle O Yes ! No 1 (rf Yes, Complete form Q ti(If •Pederraan ` or 'Pedemian on Skates, in WrieelChalr, etc', fompkie form M, SeeNon 28) _ t Unit Ato Film Name It11 Date of 81rth (MM-00-YYYYI " o z 1ml, Ie1 141A ILf I I I' I I ): 151 6 y ?? 111liel?1 Last Name _ Telgphone Number Dew? 1A[,g 1,0 1-7-Ir? I I I I I I I I I I I l l I E f Address ! CI#N / State 40 t { 11050 Fox cjif'of kcaa Jexldra:7PW? PrM (1 T R 1 d l if n 1 Drlver 1St IAe Numbor Hate oaes ' !?IsINIs?l?l?18161 I l i l i (III !. 1 ?TT-A] u?IdkvholrDCuas _'uspeC:ed ?riveraAldeatrlan Plrvsigtlkl Krndttion j 0 No illegal Dn;gs C7 Medication 40 N pmenuy Use a1 Drug Fatigue Medication i 0 Alcohol CD Alcorcl and Drugs 0 Unknown 0 Had Been ? Sick 0 Asleep 0 Unknown 1 1 Drinking , AleaHol Test rYwp MWV Yah)de [lode V)olarlsri Charged) is Test Not Given CD sheath O Other Q Unknown if 1 O Yes No I • C7 Blood CJ Udne Tut Given cohol 7ePlesu Refused" Unknown rJr!?fr Presgnae I.=Driver Operated 3?riwr Fled Scent Ai - >? [] Test d Results vehicle 4 Tart G'ven, -Hit and Run ' 1 1 FOR= CD Conun+inated Aesultt ( 2+N0 Driver 9=Unknown , Ownerlpr'iveY 00=Not Applicable 02-Pri4ate Vehicle Not oa+5tate Police Vehicle 07.Munidpal Pollee Vsh 09.11ederai Gov Von 01 =Private Vehicle Owwdl OwnedhLeased by Driver OS.PENNOOT Vehicle 06-0ther Municipal 98.Othe( Leased by Oliver O3=Rented Vehicle 040ther State Gov Veh Government Vehicle 99=Unknown I ?' ?i3mo Ommer Fbst me" O"err Lest Mama or evoinaas Name Of FedestIOM skip this Sec-on) I Driver 11 i, (I 1 I I, I 1( I -1 J f. I. I! I l v l l e l I I. l at i AdelMail f ;m,) xraaa, Op r ? I I ?.?D 1 1 2 1 Modes Year YehiM IModei (see ovadsyl? Vitt (FI I?1 131st i z i ?.lWj:5i3 it 131`11`?I I z[°I -o FzI I r-acs l! ` ' Urglise ?llot,4o Us. state Set- Speed Vehlda lowed Tow?te?d+ By 1 .NYI ?rC!•J , YrC \r?lttbt' 1' i 4 D I A 1 A I Jj l r 1 I I 1, 1 i J ! C p Q Yes U` aid ' insurance Company POW No _ nsafanCa Is Yes 4 No O knUn- own i t ?. s r'r'?'rE I 9014:??f 9 4 8 ! Z. JOS ,I I T?tl;;ta 1e7twing Pass. Veh 4=MOWaYModu14r Home 7cSemi-Trailer T o'0 No Tag Year Tag 5t 1 S1L rya of i CU 2=7Owin9 Truck S=Camper !1=Other t A i Uns s:gH 3=Towing UtlBty Trailer 6.Fvll Trailer 9=Unknown Un'is: Drr ?,0:: r x -110hie, !W sale ' fa?'E, Ltj p 12=Commercial Vahtde COror Veh)da rvoe 05=Large Truck 20+Unicyde, " "0% Passenger o5=Yallow 01eAutomosaa 06-5UV T^cYda 00=Noeapplkilble Cartier 07=Silver t 02+Motorgde 07-Van 21=Other Pedalcyck 01-Pyre vein 13.Tari (312.4 GoVd 03=8vs IO.Snowmob8e OKe G soggy 02+Ambuisnce 2t+Traaor Trailer 01.81ue 09.6rown ea=Small Truck ==m rae & Riper 03.POaca 22.Twin Trailer O2=Red log-Other Emergency 2)-Triple Trailer 10.0fange 'if '02', C mPretY ohm Equip 2 trim 02-Re hilt 11 RPurpfa M, section 26) IS.ATV 25=Trolley Vehicle 3t.Modifiad Veh 11) 04.Green 12,4AW (if'2000, '21 ; L"mpkte 19+UnM TTy etSpetcVeA 9.Unknowil tlaPupillranspOrt 99=Unknown 05=81ack 85=Unknown ?-b? ;y ce^';on ?7,? YP •. • I .oar1A irrdis:4Or "a 3=Downhill Abed Alfanmlrri :Y. n .n52i. ?_ 149 .--, 3 0=Nene 2.Fuhbional a=sottom el HRI 7•Suaight 1f i 00..vo0- Oilfsion 14.Underr4mage 1 1=Level 1 t.MiWr S=+Top of MII 2. unknown Lr Oh12=Top Paints 15=Towed Unit 9=Unknown Di""in" 2=Uph1N 95.Unkntrrrn 9:unkmo ,62601 __....,.-.,.--..._. ?....c...?-.«. 13=TOP, sr9.Ur,known PAGE 19121t UDAT41161206411,16,18AMPntNDaOghtTimeltSVRJ181DN?S"CSID,2162938466tDURATION(mmss?,Old6 APR. 16. 2004 12:38PM ALLSTATE-W. GROVE ';:oM 0iYwJ -ALf'9 Zip 7? il. ?NLli?iliLj tROLICB CRASH AV0iFrf;HG FORM _ ;'age AA 600 3 ors ur o"lr I 4 4 • Prrcen Tver: i A I=onve D 2.Passenger L 7:Pedasmsn B:.Othar 9=Unknown i { IB F--Ferrate M Male U Unknown C Nos -t Wljjlrld teKitleq 1=Major injury IvModerate injury 4-Minar injury B=Injury. Link SeverlCf s.unknown if Injury E v - Left Side Or FASSengger v . Middl¢ Position + • Flight Side )r Greater - N Greater - don N Greaer - .Ion of Truckcah )• dosed Ir Cargo Area kup, E[c.) Wilde Exterior i N0.4005--P. 20/21 1?Il?iilll?I?1 P 0517337 c"M urrme¢r 7 V j; -'Wable cted 1=TogJ12fi Elected 3sParsla l Jausd 9-Unknown H l r 1 I' EMS A9e01y: ? ?6ee Vy ?uS4PlGF5 kwiaas" SC modlcoi FadiitSe l_ Aslti'?r?:?.• ?7e,r°P;.?e /e?dSP'rT'pL _ +lnit No oeewn No a ? Otte of Mirth (MM-00-YYYY) °c ? e a- ti -1 + A 0 C 0 E Ic G H I f 11 l G 15171 0 0 .m®1'n Blame I Aodreas I Phone 1145 Transaort ; a as `-r 9P9r,t*r ? 1 *yes Q No " - t rlnit me Person No 1o z ?o J Sure o'7 Birth (MM-0O-YYM 0e? A B C D E F G h I Name I Adffixss ! Phone _ ame xa) .) - i HAS °,-lUleport Ogaratcr 1 t A Yet Q No „ Veit ?a Unl riff fM '00 ?'?1 ? 'E a{ ,. 11 11 II I I I I I L.y LJ 1J L?..LJ L__L_: Li Name /.1 ' 6dress 1 Phone EWS T:r„resert C3t>Faratnr .3d M, z' ' i C Yea Q Na °,fntr t'w'o ?groom No ?e1aQA Otte gi Birth (MM-OD-YYYY) A 0 C D E F Name ! A ddress ! Pllonx lies Trensrak s Serne es ilotra-SCr I Yes No 1 O ` , ua Lnlt >,Eo ?orson Ye bate or lonh IMMd)D-Yy" Ja)at¢t - A a B C 0 E?-- F vH I ?I F117 0F7117 I Name /AC!ziwss!pta e ?Mb'.rens.a;r: .? Soma aaiCr l 1 O Yes 0 Na Lfi)z :do 9srsors X'- ?--, --au c air:!I (MMAD-YYVY3 aele?a7 A ~B C D £ G H I { r-- r- F F7 • I :4:J;a? ,' ?f:cnta V:n:N ! • - 4-.V15 " rons^cr; q + i 54-6 Owr t- Yes PAGE 20121"RCVD AT 4116f2064111:18 AM (Cenha! Daylight Time)' SUR118 a DNIS:52501 I CSID:215293 8400 DURATION (mBNSS):0746 + 0 GcaDlx 1 1-trot Fated 3 d Z+???? By M Means 3.Nted 9y Non edan[ M¢Chani[al Mean3 r Unk S-'Unk .nam APR. 16. 2004 12:39PIM ALLSTATE-W. GROVE ?. oil lCilittlli t i is i 0v yi`?y,r7 iir A A 'OQ.rv,..: ir..MWMIZ" r4•., I?ni Pao* AA 500 4 i p"" "'t only t 7 1 1 1 ._.? r ...... (; 't rJetdiottM :uet$ O?Non•CoDsion 2= Head On f t t r .._J t.Pear End a.R 1ear I I d pelation t. Raadway d'"On Travel LAW h 3.MoMan 4 A ad ldi o !!! r-.:.1 oWCNr 2-S . s O r ' jJ q'I r•-- Jllumina"lor t_ _ i.DEYlight N N?, o 3sD,adc • 3t?aet ? 4 6 l b 3 L.J hfs 9 I JO pp u a ry r .•- Weather Candr¢PoM ?--'I ' I ? . t=i o Aaverna ?otdlt4orrs 3=Blast (Hall) ¢ a s ] 1? 2.Aain 4=$nOW r M Di t 1rud SttriaCo Conditions O.Ory rt. 2.8rd, ud, :.J itcWet 3t$now Covarad Hart. ent :/:t )8oe:'2 +mirtn' 4 %umher -? y F-.n t NO-4005-P. 21/21 P0517337. 4.Angle & ideevd same BTrecclm) O.F I, 5-pumids Traffluway 6=In Parking Lane 6-Dawn B.SIdOBwippa 0.H7 Paoe9fnan (Oppostto Olraction) 74fR Flxeo Obism Q.OtherrUnkno.n 7-CWv (Ramp ;ntet6aptlon) 9=Unknown 6- aorA.LhtUno cadwe?r u h"rr _ . g S.Fog µ 7=Sleet 8 Post 6aRain & Fog . B=Other e.Sfuah , E-lca Aatchea Salts 7.W V! r-. Standing oft or F , Vmr1'd efbnufliarm Brert9 .10k4lt Ponca =Hit Unit 1 3I.Hit Build !eHit Unit 2 32.Hit Cuve I.Hif Unit 3 33=Hit odd I.Hn Unit a 34=Hlt Para ;.Hit Unit 5 35-1-14 Bridg i=Hil Other TraMc Unit M1 35-Hit Soai ( Pima Put events in 3 Ll -i 09=Hit Other, r Se enHai `o ? OB.Collision V Fixed Obis ..h 1 rder sI ? [ I f i 1 I I i t I.Siruck 12=Stuck 9 I ! , y 13, k B I 5M t F y K t r :farm Eveitt ?R efest7 thlBty Pule Mumbar - uua ey I 15 S tr 8 ? y / 1 ?- tf ( 15=Struck By I 21=HIt Tree 0 ' Jnit No I---J 22.Hit Emban W , Q ' r7' ? R _? I 3 CD 1 I I I Zd-NN TA t i . 1„_..s _ 25=H Guutirrd 2 i le= nase s ir 3 1 i t l l •. t Guard 5=H 27?Hit Curb t , ve Sa4Uentla7 28oHit Concrn tongitudin ' Order 7?^ 1 I 20=HII Ditch ' rst unit NO ,Q 1 1 i Holm ?snt A')osC 'vnK No Norm °yant ' '1f,` A 1 G 1 0 •1 01 1 Or)ver Adlon 00-No contril of-0wrwa i 1 Rim 1 _ _ 1 i 1 " 02.DrlvingUS :..?.. ' _ oo rot aoeaf tn. v`n's" fn T.aae Na. y ._.. -_ .?. - .. h --'' 03aDrmn9 Us 04.Making lei er/1 05=1m rO aav i ?£svfittt:rrntailRaar ? s I Q JR ' 3 ? p p Fr 0 } Mlanfia( factar3 tF : i .13ro ead 01) 00.None 11=511 pary Road Conditions (Ice)Snow) On Roadwa Cle Clearance 0 OB i R 5 y 1>wlndy Conditions 12=Substance 02=Sudden Weather Conditions 13=Potholes . unn ng OSsftunnlnQ A I ! 'I 03=0ther Weather Conditions 1443token Or Cracked Pavement 04--Ober in Roadway t3.TCD Obstructed 104aNUre To Other Tral of. 01incia On ROadw 15.SOft 5huuld4r Or Shoulder Drop OtF Factor C R dw =allga ngl C 5 I` 06=Ocher Animal In Road 07=Glare !er way 2e.O ay oa 29.Oiher Bnvuonmental Factor 13=megtuly Sr r? , OS=Work Zane Related! 99.Unknown 14=Caraless P Change sz i a g v "Ible •/eh)t'e 5ariuras (t0 1 Yl n d Tin i6? 5 f bO=None 06rEth:ust 108 DOWS. 1100d, CtC t•Way -Way Sr rith Other Nan j ,H 3 !nn 1 4 )n4 2 4 )nk 3 4 9 nt5 7 )that TmfOC Unit 4 • Shrubbery 4 cment 5 ,Ole 5 Sign Aaii 5 Rail End 5 to Or ° al Barrier ` 5 (DJ r.. ,., I luting Action Oisvacted I ng Hand Hold Phone no Stands Free Phone 1 ,241 u•Tum :brelass Turning 2 rong Lane ;m W 2 After Step 2 e :op a S. O U e l I 2 R es d To Co0 n ur R C i D 2 e oriuo R r a )Vnny'topDm d Cn Road j Ippe using Or lane s m pillsin Myna c t Wrong g way On O=Unknown { IL-Other ' Or Will '- Ing ge En Or Abutment ' pet e Rail il + dat Or OOstedle w cr%7anuator B Box -, f6c island ay Bank nporary Construction 1 terawn r0 Fged OS ec eObjea mllloll Over By thrown Or Falling las Or Other On iRooadway y )n The Wrong Road Improper io Hghway tmpropcr brit gParWKmgNnpa(king 6atfon At Curve 1 B _ _ ... I •t: 01=Tires 02=HfaC.?ghts 024rake System OB.Siggtai lrghis 09=0t'ta! Ugh'S i I i:nit 4 s '40 ,. f' (?' ' 5-.-,---, _ 'q ? ' I I L I 1 i ng system 0305teer O4=5uspension 1b=140rn i 5. O S=Power Train 11-Mlrcors '?iri Trailer Lo ad ,Nol+ ? Y I p Z i j I I t I 3? UnIz I 1 ma li L) 20 wades en ,teH on t'p+ 02-Working P?'IQ t2• d 0'131 I I r<na7;ptsd b'rrne :'au+r oe hat nabm th'a Nrrfmfro" on ^ tini4 )h- Fvmr code f - ? ? . multgh piafL I ... .? * :^ x&? ;f ttis Mmr?actor 7ypr, reave Una NO bian;r 'DO.Nt? 04--pushing Vahicle ; 01 clinwring of Crossing At 0S•APproaching Or Leaving Vshkie SpeclSed lacaeon 06.Working On Vehide ' 02--Walking, g, Running, .bgging, 07B3.Standing Or Pl .Othet , Of Playm9 S9.Un% ? j I FACE 21121tRCVDAT 4N81244d11:15;18AM ]CentralDaylightTime]'SVR:116"DNIS;S2S01tCSID;21429x6400"DURATION(mm•ss):47d_- 'APR. 16. 2004. 12:36PM 21aALLSTATE-W. GROVE tr?,wsv??u+a?rh taf a?sv! ?fsa POLICE CUSH aRFpc rliNG'FCRM AA 600 6 f roue u,. ony i :ot 4 i , : i I 1 _...._._..t._....f_..... _ V0. 4005-P. 16/21 ARTMAN PAGE 01 ?'p1911i?lilll?l?il? ??.?;.?,•?,• ?f Pogo P0517337 E ....... i _?..,.._1..,.?.._i.. : - 1 I y_?VPkscra W2T.Q r. Address r. _. p Al ?hone jIMAJZRVgAawi.J ?ZZ4 PARK Ave. Poe-9160&0/ eA 1YOV6L I}t?s 663•$33! Marravv-4 fAd addlC=af wi2ae•.s®s: Accident !naesdW.1on Noffl Von s„yeO Pmp rty Damara O L6 siZ wrs 67z/ ro A-r rWc IwJrd`Rsctr,c? } '/"7Eff'/+ntGlleu.o' Ad.4.0A, 1FCANY.A AT'Tu-e 4?0 [,?.,SfT. ? j Gl.fwF s #! SrArt_YD Hd A10A3 ?QF/jfa%.] ?fr7fl1 ttd c'4 !ja- M GJi10p,;fo Y"elfIc10. Awl 5r.C,lc6 ilBfJ•c6d oz. 4tf,(K/msS ^?/ SrvrLrd PiUFT' I ] t l f8 9/ t4/e. r SE4 r#a- .049,E 1 :4 Al rs n. I of ?r r.e? ? / 7,r .rr - s>' i y'PC+eQ vo' i'f Css?.s/?. /E, ?rSYifd2 SnLr%a Tf?.rr IIfGN?cc?/ j ,!L?RcSSLrP O'(LG p?•IJPIlt ye'L.<i.:jr LI..?,9ry :• 2 r4 S " 'Yi.7•eT 9' ?i?, crC. I `d s ?ltgrog,' !?l 4 ?a)LYhIr+P',e',] AS luv»INty, lh- S7-,,,M) rN.ar• I ?'? ?t6 ?qfl.. +.a' F??,?r Cr!= JItM ?, ?A"f Cc -. as?,? fili9J '? Sfn?f?b's7 sa:9Pt?/?%Zf', {(P?VDO/.tSre%naLI Ndr k)A5 TiL'+/VFC, z+5 /R?l ?oX. X9?Tc LY 00 /yJ/?/? _I /o .-Lb rra r3 c, as, eA d o' o.,v ! L!o C.?, ? 'y?,P..:fG ?" C'?'.Hr.•?dr _ /E°.°+ /S?A1 lItJ,'?'lI. 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TD 1849 T)AVTSVTI.LE RD hIT1.1,010 r,;RnVT:-, r-•A 15?F}-m (215)A59-017:3 PAX: (2fg)b59^70172 SUPPLCMENT OF RECORD 1 W1,1-1 rNS? n?E'n OWNER ADDRESS: DAY: PUS TNESS- tRTCb1AI'l A131K..1,11' M1'rHAFt. ARROTT 1 ti?3 r nx r.:E•In.rl= RD .Ir.NKTNTnWN, PA f90AA--4f7A ('N G;) 74:5•-•540; (2t5)A4:3-•KA 33 1'14SPFC:1' 1•nrATTnN. 2f 5•-AR4--9T39, ABTNrTr)N AUTO PV1-IE'IJ A,r'I41'I.ADEf.r' t'A)St,IRAhJF.:r' ALLSTATE' t'N,SI,IRANCI? CUMPIA rnMPANY: 1301 VTRGTNTA PRTVEE SUT r-T WAS1-ITOCITOW, r•A lew ,4 nP 2002 FORD FTICI.IS 71:9 /+ -•".. rTi. -:rPRA. 1' 4D : D r,:41. VTN: iFArP32372W3;i1394 1.TC: .1 PA F•Rnl) PATE 'AR rnr..rEl. CR1,ITSF CONTROL TF1.F COPiF,. WHECFI. 1(I?YI.I:'SS F:'iJT"f;'Y ;:tf)Tj Pnr,, LAME S /,) t, f:r• nTLFR r)r:TALL rc: PA rNT -,p STIVE..Rrur; PnWFR WTNDnWS EER LOCKS Alm RAW'() FM RAD TO SEAT;t,:H/SFrK PE.AYFfi PANsr., ;FR ATR S. . CLOTH ITFATS AUTnMATTC TRANSMTSSTnN MTNUM/Al.lOY WHEELS Nn. ALLSTATE-W.GROVE D ES r.:R T P T T 0 N (.:1. ,4 POLL T) T' r lit. 1V 1.G$S: f 1 /2t /2003 \1.nss: r.:nLLTSTr.1y L1)AJT OF T' no 4005-P. 3/21 Y ,IOR N(.IMTtFR' I A05 ACT: b, REAR DAY: () -- DAYS TO REPAVR A ];? 5?„ 0!,/2.'RK! nDnMF.TFR: f 5R54 Tr).T WI-11E'Et. THTERMTTTEENT WPM! P1.01. mTRknRS r,.LEAR r0AT PANT r"0111 FR s?r1AKr;' PnWEtt MTRRnRS STISRE-n DRIVER ATR RA; BUCKE1, SF r:> RTY F.XT, PRTCF. LA£:nR PAINT Z 4 7 901 Ft C () f 5+ R'U S R:AR TtI,IMF'ER R1:P'I. LI(b? tt.lMr'Ei AS',1Y; f,:f.1?1( r'i DAN R. S'TD1i ?si'I"01:'L hIST'1. P%rpl, LT ST1) F SUPPORT I'll-PL PT 1.11-•NI R TsRAC. l-T REPl. LT UPPER DRACKEET Sol-P1. N:. 1 N 'Clr:f.:IC' li'N'r An f=nro c:l.r:?r-,r-: r.:r,1AT r1, AN E. 1'NSp'F.rT 1 :5,75 11,!)0-K 1 , 7 2 , Ft 1 311ft:3 f ??, 2=3 f 12,7; i 1:S . Ci`r.1 0.:3 1,1 PAGE 3121' RCVD AT 41161200411:14:18 AM (Centel Daylight Time] "SVR:118I DNIS;42301 I CSID:216 293 8400 `DURATION (mm ss):0146 APR. 16. 2004 12:32PIy1 ALLSTATE-W. GROVE -Na 4005-P. 4/21 1 i) RE;gF LAMPS U ii R171'"I. R'1' TATI. LAMS' ASSY 1 `17,190 i•Nri. 1 1211 °s7/' 2003 AT i i : 41 AM 72437 JO R NLI?SJ3li I : i fW)r5 XLlFr'I.f-MIi'NT CIF if9 f-:OND 1 hITTW TUMMAI2Y 2002 FORD Fqf:US 7TS 4- , nE. -Fr 41) SE:D GOLD MET NO, .... ....... OP, .......... .. DESCRTFTTON . _....... ........ .... ...... .... ..... ......... .... .. &!TY ................ .. EXT. PRTCF ........ . . I.-AVOR PAINT 12 RXT LT TA11. [,AMP ASSY . ... .. ............ ....... _.._.............. . YNP,.t., ........ _....... 1:i. R'?T bl1'C:I1 Mf,11,tN'1' LAMP 0, 5 14 TRI.lt¢K LTD t 5# REPL. U(P. TRUNK L.TD ASSY f - 12, 9DIE 0,4 1(, ADD FOR CLEAR COAT o ,? 17 REFN LINDE:RSTDE: i .7. i`R RFR'N SPOTLEP r?.£t 19 R&T SPOTE.ER O,A 20 f:P R'I. NAMr-- 'I. ATI: FOCUS 1 1 APR r) 12 21 REP1. NAMEPLATE M f f f, f 0 0.7 2;' i:EAl. Ttft7)Y b I''l.f,141: ?.3 RFPL. REAP, "DY PANEL. 1 13A.51) TNI"L., f.5 '4 OVE:'PLAP MAJOR AA.I. PANEL ---0,a 25 ADD FAR rt.EAR COAT 0.2 26 RRI I. PIS')'Kr'CIRCFMFNT 1 10128 27 REP1. REAR. FLOOR PAN 1 6174.27 70. (, f , 5 28x PPR I.T- Pl-.AR RATI. S 1 ,0 29 RE Pt, RT REAR RATU f 291,A7 S 715 50 DEDUCT FhR 0'0;'pt. Ar' --.A 3f REAR SUSKNSTON :.12 IL'hi' Rbl' s'LIST'GNSI'f.1iU T.tfi'i'iI S'TnC'.T M A 10? EXHAUST SYSTEM ::,.4 lRbr Rl-:AR MUFFLER SFDAN M 1',5 QUARTER PANEL 6 w r nL1ARTf,'R RANI:I. 1 691 , 9; 1 < , D ri 37 OVE,RL.AP MAJOR ADJ. PANEL. .•fr, A 8 AAA 1"C1R ct, Ap r001' 015 39 DEDL+CT FOR OVERE.AP -f , o 4') 1)1:'3)1.1(:T FOR RR'AI: TILIiMPFI;' R1j -110 A f N R P R RT TNNER QTR PANEL. S ¢fif A I+I?I`'i, fi`!' :ii'i,ASl1 Si-111,' .b 1 X4.1 :1 0 43 REPL. RT VENT ASSY 1 91 3f, 44 TAIND 1`'11i. DQf lh P.2 451 5471 REPL. FtfEL. POCKET 1 :33 73 qf,, r!(:. r'f. Fl' TAl'I. LAMP r't.LC,af {';T 1 , 21.'.55.1 47 OVERLAP MINOR PANEL. {y, AAD FOR CLEAR, GOAT X7,4 49 PrPOCT FOR QVrP1.AP t. 54) Dr .'DUCT FOR QYF.'RI,AP 1 ,s9 PAGE 4121' RCVD AT 41161200411:15:18 AM (Celdral041ght Time(' SVR:118I DMS:52501"CSID:215 293 84001 DURATION (mmss):07 46 OR. 16. 2404 12:33PM ALLSTATE-W. GROVE NO. 4005`P• 5/21 51 FOI RFPL. RT rORNFR RFTNF S 1 t), AO » :>,:' Ri='1'I- C?'C SYDf.' $UP•f'ftl:'T' 1 '..ISS,'7;+ PL.ND LT QUARTFR PANEL. 4 PTI-I.PPS, RnC:KI:'R x rLOOR 59 }t MI RT OUTER RRCKF,R C ;6 PtlClf' 57 RxT RT DRTP NnI.DTNG (), 3 r:1:'AI: nc1c1R 158 12/ 19/2 00'.? A'I' 1 1 : 41 AM 224,17 110 0119 JOB NUMBER: i?10,5 SUFF11.1`Mi,l'1T' O MCORD I WI-1,14 SUMMARY 2h(); FORD FOrUS 7.TS 4-2A )L-FT 4D SET) rr)1.1) KEY ........ Nn, _ .... ........ ... _--- . .._. .. . --- ..._.. nP, ... ......._.... ..,__._ ............ ...... ....._ ...._.......... _..........._ __...._.. DESCRTPTTnN ........_.... .. ...... ...._.... .... _. _.............._...._.........._ .........,__...............__....... QTY FXT, PRrrF ...................... . ... . ._...._........_..., I,APf1R ._ . ._.........._._... PAINT . . 594E . . . RPR ... . . RT MR SHF.L.L. SEDAN FROM .._. ._ .. ..._ . .... .._......._. 4, ()4f ......_............. 211 2/7/00 110 nVFf?I,AP MAJVR AD•.t, PANFI. +i ADD FOR CLEAR COAT 1152 RxT RT MY STU HI.Dr Pf'tTMET, XI'MAN A, WAGON R3 RAT RT RE'L.T W' STRTP SF,DAN l WArON 0, 2 h4 1:x I' R'1' 14ANDLE, clit'I'>1'Dt= •:?+ 0 65 RxT RT RbT TRTM PANEL. n, 4 All FRONT LAMPS A7 O/H FRONT PUMPER f.9 68 N.T PT STDIS MARKr:'R I.AMP YNC:1.. hp RxT LT STl)r MARKER LAMP INCL., 7f) Px1' RT' 1=nG LAMP ASSY TAICa.. 71 RbT L,T FOG LAMP ASSY TNCL., 'T' FRONT DUMPFF0 77 CAT RAT RUMPER COVER 7NCi., 74x rf'P B1.1mf'r:'R COVER XFDAW 7TS 75 ADD FOR CLEAR COAT 1 . () 76 I S1, i COr.11, TNG 77 S01 REPL. LOWER SHTFI,D 1 22, 3 7 0,3 751 Sf)1 RIS'PI. R'I' S'1'UI SI-111, 'I.A LI/AC i x,2.$7 f) 79 FOI RF.Pi. L.T STDE'. EHTrLG WJAC 1 22,37 h.3 <10 FRONT WOR 81 Bl,ND RT nVTFR PANEEL. 1 , 1 R 1. r RIT 14F.11, L1' STP TP HX RkT UT BODY STDF MI,DC: PRTMED 013 E14 P2-.T PT MYRROR ASSY P•Clidi:'Ii 016 f15 FZ,&T RT HANDLE, OUT.:TDEE (1) RbT RT RxT TRI'Ih 1"AiVIE'I. 0,4 7A 4 WHFsl. AI.TGNMFNT f 70,( T x221 )41 N['i-4 51"T a.Il" 1 11.110 WE 5121 ' RCVD AT 41161200411;15;18 AM (Central D*gMTlmej' SVR;118' DNIS;52501' CSID;215 2938400"DURATIDN (mm ss);Old6 NO 4005-R. 6/21 APR. 16. 2004 12:33PY ALLSTATE-W. GROVE - v 89: 1 F Ul. b Cf 1+AREUNTROrY f A, 0 . 901v S01.)NT> F?AT1 S 1 !> , r'17 !' 91 r COVER CAR f ti {.}0 T 0, 3 'a2Y C-L oSS NTT 2 24 Ott T' 93° SFAM SEAL (:AVLN f 10100 T '>4T 1,11JA1 I C:ffAT" 1 d,.vw) 'F 95; WF,I.n Tf{F{n!lrH PRT'ME'R f 5, 00 97: 901 TnWTNr . f 410,00 AIPTOM,$.' -> x51 FI, At 7{}, R 'N I 7?/f 9/200:3 AT 1 f : Al AM 2 24:X7 23.7 JOR NUMRFR.- i 8orl C!IF'PT,E_MF.NT of RECORD f WTTH YUMMARY -?,P/ FORD rTICUS 71-s A.-,? . q1. P 1 47} S1=n t:F.ll. n Mt: T PARTS 2988161 PARTS nT,St:nfJNT t 2296 ,11 ... 10,ox -.229,61 TIODY 1.ARrM f.4,$ HRS na: :3E1.00/HR 24b2,40 PATNT I.6pr..112 2: IT FIFE 44 :;6.110011-lre +1r7? Ai, FRAME. LABOR A, 0 HRS V$ 30, 00/f{R 2?R. (10 FATNT S1.IP'PI.T"FcS 00 SI,IRI.E"TtMT;;C, 1 : tt, 00 0T1-Ir'R C'IIAf.'f:F.'S Al ?.?:? SI"1F,;Tr.11'AI. 9f 'i 1 SO , 00 SA1.F,l' TAX S A770. 00 Pf A.0Of)01 4¢11„ 1'0 r,.RANR TOM. ADJUSTMENTS; Df:n1.IC7TRl.E: MISTOMFR PAY TMIMIRANCE" PAY CUSTOW'1 r Ir.1Tr..y;' fill-, reFrlt')T'r: S1.101.'s I YOIJ HAVE" NO f181.Tf;ATTON TO YOUR TNSURF.F{ TO HAVE. RE:PATF{S COMP1.uFT} AT 1=AC1"1.I'll,, T1.1( RE, TS' NO REG?{.{VR MENT Tri USE ANY SP'G"ra'r'fCri NHO . NaN•-r.IF;M nt'Sr,.{.!.?SURF El. {t(i f: n, r?r• 5G?-o-try 7G? SAGE 6(21' RCVD AT 41161200411,15;18 AM [Cenh Da#tTimel' SVR:1 MN18:52501 I C810:215 293 8400' DURATION (mmas):0746 - -- - N0. 4005`--'P. 7/21 APP,. 16. 2004 12:33PM ALLSTATE-W, GROVE THTS ESTTHATE. HAS BEEN PREPARED RAGED nN THE M.Kr, (OF AFTERMARti'ET rRASH PANTS. TF 'itlE' t1SIi (IF AN AF'TE'RMARKE"r CRAM-1 PART VOYDN TI-Ir. FXT.VTT'NG WARRANTY f1N Tl.n FART RETNr REPI.ArED OR ANY OTHER PART, THE ArTFRMARKF.T CRASH PART SHAU. HAVE A tJAR1:ANTY E'fi?1.lAL v.) nr' TSr"!"i'F'R Tl•IAN 1'1•!r' r.rMAT'i<1TIC f•11 'i'!•II" ITX1'ST'1'Nf.: WARRANTY, WARRANTIES APP1,TrARLE TO AFTTERMARKEET CRASH FARTS ARE. PROV1'DED RY THE MANUFAC:TURFR OR TFIF DY,STR1' XIT'QR OF T'IIf:'SiT P'ART'S Nrl'r TT-IE' QRTf..TNAl. MANUFACTURER OF YOUR VEHTCI.F.. AT)DTTrONA(. COST nTSCIAIRURE r•.n,TTS ATrnVE THE APPRATSFl1 AMOONT MAY RE THE RESPONSTRT0TY nF THE VFHTr.1.r; f11.INE R . ESTTMATOR SYr.NATORE ANT) DATE. I.TNE. E NTTMAITI R...,_._...._. 1211 AT t i : A E AM Jr.)P Ntlt•flt p : 1 '005 ry2n37 rl.n-'F'I.i Ml NT nF' IRIF ORD F 1:n'TH S1.MNARY 2002 Ff.1RD FOCUS 7TS 4-2.Dt.--FT 4D SEED rnt.D MET ANY PERSON WHO KNOWNGLY ANA Idj'TFI TN'E'ENT 'rrl Dr.'(-Y'AtIT) ANY 1'NSI.IRANri:' CCl(MPAPJY nR OTHER PERSt7N FTLF;: AN APPLTCAMN FOR TN+URANrr, OR STATEMENT Or MATM r,lQWTATNTNG ANY MATf'RTA1.t.Y F'Al.sl:' TNI'nrtiNA"TTnN nR r,:r,1Nf:I At.S FOR THE 1•11.1ror1r1,Sl:" r.1F' MTSt.EADTNr, TNFnRMATUIN VONCF.RNTNr ANY r•ArT MATERTAL THERETO COMMTTS A F'RAt+nrtl.E'NT TNSURIANcF.." Ar°r, wFnro Ts A riRT,sE AND S9.ITr.JGCTS THE Fli-PSON Tn r,.RTNTNAL AND CTVTt. PE:NAt-TTES. THE rOiA.nwTNr 1'S A LTST OF' ARRREVTATTONS OR SYMPOLS THAT MAY RE: USED TO DESr..Ftl'RF WORK TO RE DONE OR PARTS TO TIE REPATRED OR REPLACED: D=DTSf,:nNTTNUEED F'AR'(' A:wAF'F'ROXTMATE' F'P'1'CL' Tt-BODY I.ATInIR n=nYAr„?1r1,C'I'1'r,. E'r:i Lt't,:'rltit'fA(. F===FRAM(:' r., r,.LASt: M=MF.rHANTCAt. P=PAINT LAT{nR C-STRUrTURAt. T.-TAXED MT,rr,.E:tA.ANEEn1+S X=NON '['AXED N1'Sr'E'I.1.AN1 f11.IS An.IwAD lAr. N'T : t.r,,N-AL 1r,.;o AlMwRF`IT r.'iir1F j L''T TO.NTi=T+1. END rAPA=f.:ERTTFTF,D ALITOMOTTVE. PARTS ASSnCTATTnN D6P%-PTSr.ftNNFr.:T AND RFCnHNF'rT l S'1`=tY,S'T'YttA'1'1:' E'XT". r,RTr1 =uwT'r F'RTr'IM1.11,1'TFLIA-r E4Y 1+11' QUANTj"rY T'Nf=1. _:l'1?Gl,i.lAi?'7) MTSr-MT,l'f.:Et.t.ANEnI,1S NrIN--AD..I:NnN ADJACENT OiH==OttFRHAtIt, OP=nPE.RATTnN Nn:t.FNE' Ni,I?iTIF'1' G?'i'Y=nChaN'j'1'T'Y tu.1Ai. itl:'CY:::n1.lAt 1'T'Y rl:'rYr..!.FA PART Q1.01. f.FPL=:QUAL VT'Y REPt.Af:FMENT PART COMP RFP1. PARTS=Cr.lMPETTTTVF. REPLACEMENT PARTS 1'iJ,S''rATI, F15C'C1NA-Rf C'niJTyl"{'1'r,IN RIiFNwIRE'F'1'fJYS'M k1iTl.+ rf'F'I,AC:I tix i 12(E'i ftVf:' AND W.R=REMOVC AND REPLACE RPR=-RF.PATR RT=RTrHT SECT=SECTTnN SI.IDl.-S1,IRt.ET LT=t.F.FT ldtn=lJ1"Il•Ir1UT di...:oiJT'T1.1/,,, :i'i:`N>tAl. l.TNi' E'Nl"RY w-OTHI•:S' -TF-HOTnRS' AAT'ATtASI? TNFnRMATTON WA;; CNANr..En--, #4: DATARAl:r t.TNE. WTTH AFTr..r?MARYF.T N=NnTr.,q ATTACHED PAGE 7121' RCVD AT 41161200411;15:1S AM [Central Daylight They t SVR01S' DNIS;5291= CSID:215 2938400' DURATION (MM-0:0746 APR. 16. 2004 12:33PM ALLSTATE-N'. GROVE --- NO.4005"P. 8/21 TO !.i'N(= NAGS=NATi"(7UAl. AUTO GLASS SF E7:TF'i`f.:A1"I'nN,r„ Nf,?Vf +AfANLtt Af.:'f1,11:'IT1+"S rtt,AIJT'Y AND VAI,Ti)ATTDN PFtnGRAM, THE ATTACHED F.STTMATE REPRESENTS AN APPRATSAL nF THE Cr•IST OF REPATR FnR THE YE'ST3+LE' DAW;IE' TO 1'14F VF.'I-il'CI,F' NnTF)) AT TI-il TTMii' OF TNSF'I (.ITTUN NG'niFS'SAW TO RETURN THE VF,HTr:t•F. TLI TTS PRFDAMAr,.ED CONDTTTON, Cn :T,r ABOVE. THE APPRAISED AMOUNT MAY PF TNE, RE'SPCINST7.111TTY r)I: TI•il Yi:'iifta.i niilNE'f;, TNl=14E` TS Nri RE:I UI-REMFNT THAT THE VFHTCI.E OUNER USE ANY SPF.CTFTE D RF.PATR SHOP, TN ORMATTON RIFGARD1'Nr Rl-PATR FACT1.1'"i'TE'S WITCH LITLI. Pl' ' ' AF.{i.i:' TO RFF'ATR 11-11:' VEHTCU.' felt: T1-If;' APPRAi'SE:D AMOUNT MAY RF AVATLADLF rROM THE TNS).IRANCF. rOMPANY, TF I.1SE:D PARTS ARE., TEI(:'Y Ai: r:' l:I C?i,11'f:FD TO BF OF 1.1K1-" KIND AND f,?1,1A1.1-TY 'i•fi •i: HOSE, Pi'.'1'NF,; RE F'I,ACF:D, TNr:TDr.NTAL CHARr,.ES Sl.frii A$ TCIWTNr;, PRMTFCTTVF CARE, rf,1STODY, S''!'f.1CtAGi , rnc'I'Rf;'fa'A'C1'r1N, T.IA'i'Tii'R•Y AND Ti'RE' REPLAf.:li'MENT AR'E' Nf-1.7) 911i6N AF'f'I.TT,'AEfl.h'. E'CTTMATF CAt.CI.R.ATFI) USTNG A PRESET I,ISF.R THRFSH01.1) AWRINT rnR THE PATNT AND CONT. 12/19/2007, Al' 1 It 41 AN 7?4'37 .,Iri);i Ni•tt`YF. RI;!: c;t,lf'r'I.E'MF'NT nF" m-*.,r:Cirm i wrTfa SI,Immik-kY 2002, FORD FrIC1.F;; 7.TC A-T>-f)l. F T 4P SE:D r..nt.D NET 1'mPnrlllAw'T M,F+OUT AI.I,XTATI-l'S' fa•If,ITf.:IS' Q PARTS F'01.1"CY TH1'" FSTTMATE MAY t.TST PARTS FOR r1$E; TN THE REPATR qF YOUR VP:HTCLF THAT hRF MANUF'ACTf,lRCT) BY A r,:riMf'ANY CITl-IF1e TI-JAN '1'!-tl CIRi'GTNAL M,hNUF'AC:TI,FRETI! OF Yn1,1R VFHTCLE, THESE PARTS ARE CfiMMnNt.Y REFERRED Tn AS AFTE:RMARKE'T PARTS OR C:nNif'F."'C1"f 1'VI:' FARTS, AND kiT.ll.D F;iT DE'fiTt,:NA'J'f:'D fiN 'i'i-ITS i ,7TTMhTr" AN QUAI. R1 I' F•ARTF A/M OR CnMP RF.Pt, PARTS . SUCH PARTS MAY TNCI, 1W,' Cn'ZMC.TTC: nI.ITF?R li03)1• Cf ASi I PAR,I t9.lr:f•i hS E-ipriDS, F I-NDI"SS, TfUMC• ER C (I'?f9'RS, h1.1. S'1.ATE* MARANTEE,I' THE FTT AND CnRROSTnN RF'STSTANCF. OF ANY AFTFRMARKF-'T/rnMPE:'rTTTVF. 81.11,17.' T.tnDY ra+',aSl-i PACdTS 'E'1-EAT' ARE:' LI'STF.D ON 'E'l-ITS F;'S'E'TPEATF AND ACTIJALLY UN! "D TN THE REPATR nf. YCIJR 'dFHTCt.Fi FUN AS LONC- AS Ynl,i OWN TT, TF A PRORI.F.M Dk"U IPI'l;: Id1"rtd TNT:' i''1'T Cl(. r:4fRnS1'C1N RE',tl',ST'ANfa;• OF Ti•iE'S'i: P'ARTS, 'rlt1 Y Idi'E.i, Tali' TdI F'Ai'hIS'n CIS! RE PI,ACF D AT AI.t.STA7F.'t Ekf>F:NSE', 7HTS GS,IAFiANTsE TS LFM1'YFD Tf.) THE REPAIR RR R1- F9• Ai,:I'M( NT r11" Ti•IE' rw T . PAGE EI' RCVD AT 41161160411:15;18 AM (Central Daylight Timej' SVR:f 18' ONI8:52501' CSID:215 293 8400' DURATION (mm ss):67.46 APR. 16. 2004 12:34PM ALLSTATE-W. GROVE `..t NO. 4005-P. 9/21 HOWFVFR, 1'r YnU rHgn,U.. NOT Tn USF ONE E}R MnRF OF TFjr At'"i'Ff'TFAftI(F:"F'JrOMt'i;1'1"1'}'YE" 01.lT'Ff' WDY cr%ASI-I PARTS THAT MAY ))F IJSTFD ON '11-ITS ESTTMATF. TN THE: RFPATR OF YniIR VEHTCI.F, 41A.STATE WTIA. SPF.rTFY THE UFF OF fllR1'(a'NAl. F'f>>t,li'f'Ki'?IT' FFANi.!}'AftT'I,Ifa:'f+ F'AI:1",S, F1'TIIITR NEV OR' f r.'GYCLF'A AT AU..STACTF'.S' nP•TTON, AT NO APDTTTnNAI. COST Tn ynU, AI.I.STATE DOFS NOT SF.PARATFI.Y rUARANTF.E l1•tl:' F`F'r!FORMANCIF OF ORTGTNAt. r-.*QUTPt4FN'f MANUF'AC:TFIRE'R PARTS, AND MAKE'S NO REPREUNTATTON APOUT THE AVATI.APTLTTY OF ANY MANUFACTURER'S riIARANTEE, FSTTMATE PASEP ON MOTOR CRASH FSTTMATTNr rUTT)F, iINI.FSS nTHFRWTSF NOTED Ai.l. 1"rFMS ARE, A1=F1'VFA FROM THE.' GUI.' nr;2.0(*)Q DATABASE, DATE AND Ti 7( PARTS SE:I.ECTED ARE nF.M•-PARTS MANUFACTURED PY THE. VF.HTCI.rS ORTrTNAI. F. ?F.ITPMENT MANOFACTURE'R, AST'f RYNK (-x-) nR DOt.TILE, ASTFRT.U (*40 TNDTCATF.V TWAT THE PARTY; AN17tnR I.APnR TNFnRMATTnN PPZnVTDF.P PY MOTOR MAY HAVE PFFN MODTFTED nR MAY NAVE: WMF FROM AN Ai.T'E'IRNA7"F' DATA SOURCE'. NOU•-•OIRi'Gi'NAI. E'filil'F`i1F'N'f MANI,IF'AC:T't1t2i;'C' AFTERMARKF.T PARTS ARE PFSf.:RTPE) AS AM, QM.IAI, REPI. PARTS OR COMP REPt, PARTS WI.11'C:14 STANDS FOR CCIMFFT'1'T'TV1 RlPLAC:F.'ME'NT F'ART'S. I.IS'FD PART'S ARE, DF'SC:I.1'YtF'A> AS I.KF;, QUAl. RV-f.--Y KARTS, RCY, nR USFD, RE'C:nNTITTI'ONFTI PARTS AF.. nF'$rRI'}iF.P AS PFCfIN. E;1=CORE'D F'ARTSS ARF.' DFSCPI'BED AS RET"CIR.". NArS PART WI1M541. - f+'S AND F'Ri'f,:F.S ARE PrnUT11EP rRnM NATTONAI. AUTO GLASS SPF.CTFTCATTnNS, TNC. POUND STCN (0: 7'1i MS T10TC:ATE 0ANUAl. F`ATHWAY,S - A PWIDI.IC:T OF CCC: }'Ni•'t,IRaSA'fl"f.7N SF'iRVl't:f'S }'tJf.:, 12 / i I/I,I,?f1%11):' AT' 11 : ?1 AM 25!437 LIMt:'U'i' nP F1F'CnpD 1 1dTT'f-i Si,IMMARY U102 FORD FOrt'S US 4-2.0I.-^FT AP SE-0 rril.ry MET NO, nr•, Sr71 iRl4'1'L k'f MPPFR O KO F RE--.Pt. LT UPPER PFSCRTPTTDN AiIiIE711 TTFMS ..__.,..__.. F.i{RACKFt' PRAT, VFT QTY EXT, PRTCE I.APOR f ;.' . 75 f1,.35 PAi'NT PAGE 9121"RCVD AT 4f 16140041115:18 AM [CemN DayfigNtTime] I SVR,118"DNIS:525011 CSID,215 29384001 DURATION (mmis)A746 APR. 16-2004 12:34PM ALLSTATE-W, GROVE v 1 hr,m, Rr.,rN rK.1-tirwr 45 Sf11 RFPL FUEL P(IrVIF.T 5' 1 OI Icl;r{. t:T CORNER Rl=TNF 7A 01 r,OOLTNr•. 77 SW reF. r-•F. 1- 014 R SH TE F. n 7H S01 RF.PL RT ,STT)E 'ZWTrLT) W/Ar 71) 801 F.rrl. L"r srnr: sFITf7F.n {+var.: OTHER CHARGES: A1DnIA snf TOWTNr,. SUBTOTALS W 4005-P. 10/21-- - t t 1 f 1 S :ti , Lift 22,37 22,37 „2.X7 1 41q,F1{> `s58. 12 O,3 013 019 n, f) PARTS 1 4e. I 2 PARTS PTSCOUN7 S t nit, t' -f ?, t7X -14,81 1.+OAY LA7,1OR 1•IPv !tfs :5'rt,?7/'Wli 54.20 nTHrR CHARGES 410,00 ......._..... _ _.. .... _ .............. ..... _. SUBTOTAL S 577.5f SALFS TAX G if 7.`iS f,,t KflEooz 10. 05) ------------------------------- TOTAL SUPPLEMr.'N't' AIMr,11.NT ti !i'i`l.F f+ NET COST OF SUPPLEMENT S 587, 56 E.'S1-1'itATl 69918 1114 r'i~i'-+NN), MONAGHAN JR SI,IPPI.FMF.NT St 587.5-4 FRANNY MnNAGHAN 1 --------- - r:11S'-rr1Mr'w PAY 9: 0.0,) JOR TOTAL S 7586,20 TNSI.IRANCE: PAY S 7586,20 •-r f 19/2.003 AT 11:41 AM 224$7 10R NUMBER: I W', St, PLEEMFNT OF RE:CORP I WITH SUMMARY 2002 FORD FOCUS 7TS APi SE)) Gflf.A ME.'T PAGE 10121' RCVD AT 41161200411:15:18 AM [Central Daylight Timel"SVR:118' DNIS:52501' CSID,215 293 8400' DURATION fmm ss):0]46 4005'-'P. 11/21 APR. 16, 2004 12:34PM ALLSTATE-W. GROVE CUSTOMER Min?CF. OF RFPATR SHOPS YYII,I HAW" NO OFti. TGA'FTTON TO Ypl,IR TNS'i.: lJR TO HAW Ri-PATR,S AT '1 HTS Fgr..TI.TTY, THERE TF NO RFG?IITRFMF,NT TO 1.15E ANY k:PFr..TrT(-,T) SHOP, NON•-•01'. M DIX0.171ST.{RF THTS FKMIATF HAS TIFF.N PREPARED PASF.D ON THE 0.17F f.)F AFTF.RMARKET CRA;:H PARTS, IT TI-II" i1SF' OF AN AFTF TIA1RKET C:C,PSII PART VOIDS TME. f:'X1'ST'}"Nt IJAPR'ANT'Y ON T'HI PART HFTNG RE.PI.ACF:A OR ANY OTHER PART, THE. AFTF.RMARKFT CRASH PART SHAE.1. HAVE, A wf r,ANTY r.'q pl. l'f.} r 7.11-.TTER THAN THE RFMAYNDITP OF Ti-t} I:'xi'S't'YNI: },IAI:F:AN7'Y. WARRANTI'F.S AF'P(.TC,:ARE.E: TO AFTF.RMARKET CRASH PARTS ARE. PROVTT)FF VY THE. MAfoIJF V,)'1'i1T.CR OR 11-Iff A1'S'i'i?i'NLP1"C1P OF ITIFS1t PAR'1'.V NCt'1' 'TI4F ORI-C.:TNAL MANUFAC:TI.MrR nF YOUR, VF.HM.F.. ADDMONAL COST DTSCLnSVRF C:ftST'S r'SIOW, 1+117 AFY°if'r1}'Sh'D AMr.IMNT MAY BE' THE I I:'SF'fiWgi'>?I'(.I"f"Y 0 THE* 'Vla•1}'f.:LF' nwNER, ESTF'MATCIk STrNATUPIF AND DATE' IJNF F.ST TMATOR-__--_--_---_-,-_---,_--__--_----- PAGE 11121' RCVD AT 41161200411,13;18 AM [Ce*t Dwight T]mel' SVRJIS' DMS,52501 I CSID315 293 8400' DURATION (mm`ss);0746 APP,. 16. 2004 12:34PM ALLSTATE-W. GROVE v 4005'-P• 12/21 1 211 9 /200 3 AT f1:41 AM JGT? NUMBER: i RPS SI.tPPl,F.MFNT OF RECORD t WITH SUMMARY 2002 FORD Ff.)ra.V XTS fl :! .rel. •-f•' i' 4p SF)) GOLD FiFf ANY PERSON WHO YNOWTNrt.Y AND WTTH TNTE:N"T TO DEFRAUD ANY TNSiJRANrF COMPANY nR OTHER FTFRSON F1'I.E'S AN APPLYCAT'1'0N FOR TN,4URANCF OR ST'ATi""ENT OF CL A"i rnNTATNTNr ANY MATF.RTALLY FAI.SF. TNFnRMATTnN OR rriNf,:FALS FOR THF. F'L,fP%PnSF nF ?51'SLtiADi"Nr, TNia'ftf.`MA'fi'f.1iy C:fi1Ur.:1{f;Nl'Nt: ANY I-AcT PL:TI RTAI. THERE-TO r`r.1MlMTT.V A FRALIPI.R.ENT INSURANCE ACT, WHICH TS A CRTME AND SI,IR..irrTS THE PERSnN TO CRI'MiTNAL AND rTVTL PFNALTTE$, THF: FOL.I.OWTNr TS A I.TST OF ARRREVTATTONS PR RYMROL5 THAT MAY RE InIZU TO Dli'Sf.:Rl'3t1c' WORK TO F.tl pr,1Nl.1 OR PARTS Tri 73F. OR Pr FART A=APPROX'TMATE PRTCE R-DnDY LABOR D=DTAFNnSTTr F=FI,FGTRTCAL F=FRAME r:'-G1. ASb' ?3=FiGf.:WANI'r:Al. F 1''A TN'f L. AVOR S'-STRUCTURAL T=TAXF D T1 TSr:FI. L ANFf.1f f,V X-NfIN TAXED MTSr,:FLI.ANE7n1.IS Al)J=ADJAC:FNT AIXN=41,TrN A/M%AFTFRMARVrT RLND-RL.FNP r:AF'A-r:E"RT'TF'TF.'p AUT(IWIfTVF:' PARTS AxXVr.TA•t'1'0N p1?P+-D1'SC:tiNUHr;'{' AND r:FCr.)Nlvl?'CT EST=F,CTTMATF EXT. PRTCF=UNTT PRTCF. 4t.1LTTP(-Trl) BY THE' QLIANTTTY TNr:L=TNCI.UDF.D til',if,:c:jSTSr:F.'1,LANE'flI,1.S NON "AD..r NON ADJACENT NUMBER RTY=nUANTTTY QUAL. RF.F!Y=9!1JALTTY RUYUJ7.1) PART RI.IAL RFPI.=Ql.IA(.TTY f;FF'1 Ar,:f:'MFNT PART COMP REP'). 1='AR'CS=C:fJiSF`E"'I'i'"fl'VE' I:E'1•'1.Ari'cM1 N7" PARTS RFCOND-RFrf.INDTTTON RFFN=RF.FTNTSH REFL.=RFPI.ArE RXT= REMF,IVF AND TNSTAI.t. RX9l=RI:'M0VLF AND RFF9•ACC' RPR=Ri Vleiti:' R7":=r.'1"rf-lt, SF."[:'C=:S'L;"f,:'I'i"r"1N SLL>tt.:::Sy11eL1 '(' L'i'-d.ta=T' W/0--UTTHOUT W/_=WYTH/_ b--MANJJAL LINE ENTF?Y t#=OTHER --TF.,.MrJ70RS DATARASF 1'Nfl1('Mo-?('i'flU WAS f,:IIANrE"D-, a?i':a:DA'fAF,tASI:' 1,1'N1:' idT-11d A1T"FL'PfARKi?[ N=NnTF•V AT•i'Ar..:FlU TO I,TNF NA&$=NAT7nNAL AUTO rt.ASS SPFrTFTrATTONS. MQVP=•MANVFAC:TLIRFR';: QUALTTY AND VAL TDATTON PWGRt-M, THE: ATTA0WD F.STTMATE RFF>P,FSFNTS AN APPrATRAL Or THE COST OF RFPATR FnP, THE vTSTEtLE' DAMAGE T4 TNE' VE'l-11r:Lf" NOTE-p A.I. TTMF O i-NSPFf.'T"TON NErf sS'ARY '1'rl RFTURN THF VEHYCLF TO TTS PRrDAMAr.FD rnNDTTi'ON. r..nsT;: AROVE: THF APPRATSFD AMOUNT MAY F<R' '1'1.11: Rf9.if'ONS1"Tt i"I. i"TY OF T"1-ry; Vi:T-I Vc.l. 1-,* OYR, 'L'1-IFRF 1S Nfl RE-.QVTRF.MF:NT THAT THE VFHTr:I.E OWNER USF ANY cP•F.Cj-rTFD RFPATR SHOP, TNFORMATTnN R:EGARDIVN R1=PATR FAr:TL rrTFS idi•irra•i wri.i. PH API.F TO RE'P'AIR THE.' Vl-l•iTCt.r FOR 11-IE' APPRATSETS AMnQNT MAY BF AVATLARL,F FrtnM THE TWZUP,ANCE r:OMPANY, TV MSED PARTS ARE SF'(-C,:TFTFD, THEY 6Rf;' Ra:'RU1'3a:p TO BE OF LTKE' KTND AND RI.IAl.TTY To Eti Ttsr. REPLACE-J), TNCTDFNTAI- GHARGFS $UCH AS TnWTNr., PRnTE-r.TTVF CART, r1,fSTn.DY, ST"r1kAr1 , pFFr;E'r,:TATTON, BATT17RY AND TYRE- RF.rl.Arr.-mf:'NT' AI:- un-IFN APPI.Tr.:ATtL.F, FSTTMATF. rALCMI.ATE:D USTNG A PRESET USER THRFSHnt.D AMOUNT FOR THF PATNT AND PAGE 12121' RCVD AT 4!16!200411:15:18 AM (Central DaAght Timel' SVR:118"DNIS:52501' CSID:216 290 8400' DURATION (mm'ss),0146 APR. 16. 2004 12:35PM ALLSTATE-W. GROVE v 1 1'/111/1200: fl'{' S 1 : A5 A1i 7?4:1? .,, NO. 4005-P. 13/21 ..Irtjt WI,IMF.tI:'R': 1 Etta i SUPP'LF'MF'NT' OF RETlor'D 1 4t1'Tt•1 NUMMAR'Y 200:? FORT) rnC'US 7 .Ts 4-2,0L.-FT 41) SETS GOLD MET THPORTANT" TNFORMATITIN ABOUT ALLST'ATF''S CHOTCE., Of, F'AR'TS FY.R.TCY THTS ESTTMATE. MAY LTST PARTS FOR USE, TN THE REPATR OF YOUR VP-ITC(.(,'. THAT Al+t? MAWI,IF'Ar:'i"I,aa=n kY A r,,.ow Nt' nTt•in, TwAN Tmr., ORTGITN,AL MANLIF"Ar"TURER (IF YOUR VEHTr:LE:. THESE PARTS ARE' COMMONLY REFERRED TO AS AFTERMARKFT PARTS OR CnMI"FT"r'rTYr.' PAFO-rS, AN)) 1drtI.ll.r) Tfl'; Dr.-XTr:NATf:-P ON TOTS F'S'I'1'M,A'r!i AS f,?tl(-tl. RIi"f't. PARTS A/M nR CAMP RE.P1. PARTS SUCH FARTS MAY TNCI_UPF COSMFTTC OUTER BODY r,:RA,SFI FARTS Xfjr.34 AS NOWN, 1-'i NDFTaS, 71UMPF'R CrIv RS, CFTC, ALLST'A'TT GI.IARANTE:FS THE rTT ANT) E:ORROSTON RFS1'STANCF OF ANY AFTF,RMARKFT/r:nMPE'TTTTVF OI,YTF't' T.K.WY CRASH '-'ARTS THPT ARF LT'STE'D ON TNTS GSTTMATT.' AND ACTUALLY I.ISE'D T'N THE REPAIR OF YOUR MiTCLE FOR AS t.nNr AS YOU OWN TT. TF A PRMPLE.M DEVELOP; IA1"TI-I TFU: F'TT' nR corei:MNTON PFST'STANCF' OF' THE'sF' f•ART'S, lvrfl Y S.11'LI. FtF' Rf;'FATf F'n C1R RFPI,ACFP AT A1.1.STATE.'S EXPENSE., THTS rVARANTF.F TS t.TMTTF1) TO THE RFf>ATR OR OF THE PART, HnWFVE , TF YOU CHOOSF NOT TO USE ONE OR MORE'. OF THE ' ''FIAT MAY 7312.' LT,ST D ON TESTS til°"r"I I. sAt:xITT'/r.:fllsl'IS"f1"'f1'VF' OLI'fiR BODY r:R6SI.1 F'ART'S ESTTMATE TN THE. Rr.PATR OF YOUR VEHTCLF., At.I.STATE WTU. SPFt::TrY THE USE Or OR'1Y:1'NAI. F'f,?l,ll'r'MI=W1' MANtlF'Af.:T'tIRE'R p6jr1',Y, F'T't'HE: NIi6! OR RI:"f.:YQ,F."D AT nPTTnN, AT NO APT)TTTnNAI. CnST TO YOU, ALLSTATF DOES NOT SEPARATELY GUARANTE:F 1'141: PF'RI ORMANCEF rll' nRMTNAL rQJ.'TF'MTSWT MANUFACTURED PARTS, AND MAKE'S NO REPRFSENTATTON ABOUT THE. AVATLARTI.TTY Or ANY MANUFACTVRFR'S G'UARANTEF:. FSTTMATE RASEP nN MOTOR E:RASH E"TTMATI"N, GUTPF, 1,IN1.Eiss nTHFRWI'SE NOTED AU- TT'F'M'v AR'f:' nIFR'Y'i)IFn FTITIM THE f,.l.tl'DF nR.'•,Ixr7D DATAPAST:' DATE' 12/200.3 AND SELECTED ARE 0EM--PARTS MANUFAr.M.lRF.P BY THE. VF.HTCLES ORTrTNAI. Egl.lTPMFNT ,SANtlrArr't.Ir:F'R, aS'flSl+'1'Sx (x) OF Dftl,lSsi.lF AS'1'1i YNK (**1 l'NnE'f,:ATl-.'.V THAT TI-IF.' ANP/OR LABOR TNrnRMATTON PRf,IVTPED BY MOTOR MAY HAVE BEEN MCIPTFi'EP nR MAY HAVE COMM' FR'ON AN ALIT-RNAIT. DATA Sr1MACE•, NON•••nR1"f,:TWAI. F'r1itT1-'MS:'NT' MANI,I!'',.,f,;T't,IRtFR ArTERMARKF.T PARTS ARE PEECRTBEP AS AM, nl.lAl, REPI. PARTS AR COMP KEPI. PARTS 611-11,Q-1 STANDS F'r1P r.10MPE-1'11E1VI:' R(FPLAr:(:'M1 N'1' F'AR'ES, UNED PARTS ARF DFNC.RTBr-,'D A" I,KP, f l.1At. RELY PARTS, RCY, OR USED, RECONPTTTONCT) PARTS ARE PEECRTPE.1) AS PFCON. I+t;"CnRF'p PARTS' ARE' nt:';'ra.rrtF'n AS RF'CORIF, NAGS PART NUMBIFPS AND 1"RI'fa;'S ARE, PROVII)ED FROM NATTONAL AUTO rt.ASS SPF.CTFTCATTONS, TNC, POUND STrN ( ) T ITTig' MANUAL E=NTRT'F;S•, F',4-rmhiA1'S A F'RnDi ,.'r n!` rxx: 1'NI=r1F:1iA'T'1'fliJ SF.'R'acr.,S 1'Nr , PAGE 131211 RCVD AT 41161200411;16:18 AM (Central DaylightTime) I SVR:118`DNIS:52501I CSI0:215293 8400' DURATION (rnM-0:0746 APR. 1b. 2004 12:35PM AL LSTATE4 GROVE 4005--P• 14121 1211111/11.100:3 All' 1 1 : 4 t AN 2x7,4:37 JOB IyJIR IBER : 1 5 )VT OF OF CORD 1 S 11"T'1•I 91.1MMARY ^002 FARO FfJCUS MR 4--e.1, Flt.-FT 41) SEiP GRl.D MF.T AFTFCRMARNET FARTS WIT. reMARKET RFLEC:T'TC,N MFFTf•Inp: AtITClpifli'1'f,:Af.1.5" 1.TS'i' Nn, nF TTMF.S UFFR WAS NfiTTF7'F.D THAT AN AFTFRMARVFT PART WAS AVAIIAM.F.: 7 NO. VF AF'TIFRMARKY-T' PARTS THAT" APPFM TP TNE" 1 ).WAI. rsl.1.Mfl'i"?: l9 io PAGE 14121' RCVD AT 41161200411:15:18 AM jeeMral Daylight Time] I SVR:118 J ON18:52501 I CSID:215 2938400, DURATION om ss):0746 APR. 16-2004 12:32PM ALLSTATE-W. GROVE N0. 4005`P. 2121 ? ?. 1 cr) 1 : W 1 .e r. 00 N , x Q 1 [r u P CC o r•? . . ir o 1 *wry , .o a f - ow. f tj u t z ` LU f w V, LL t w 0?m a ( 1 w ¢ ? a ? f Q a 1 .. vw 2 Cl 2 e a x La .?? 1 Q Q N Q a x 01 W 1 ?? x •0. lc? 0. 1 y ¢ ti G ? ? 1 ` ? Q "? Q T'fw v. *- 1 ? taA Z) N0 , =k .0 g I? 1 ? = dC : x x . u o ? J vaA (. ¢ V , _s w wmr I ? i Eo PAGE NI' RCVD AT 41161200411:15:18 AM (Central Daylight Timej' SVR:(iS' DNIS:52501' CSID:215 2938400, DURATION (mm ss):0746 SEND T0: Z - **** COS SEARS A DRAFT HISTORY **** PAGE: 2 I OF 2 L09 OR CLAIM NUMBER: 2596095996 LINE: 1 9 AUTO-INDEMNIT Y DESK: : L19 PR POLICY NO: 90 1604998 EFFDT: 06/05103 FILE LOC: SUBRO SHELL M INSUREDS NAME : MICHAEL ABBOTT ACCOUNTING COMPANY: 060 ALLSTATE INDEMNITY DATE IT/CLMT TRANS TYPE TRSN P/CAC DRAFTNO MM TRANS AMOUNT ISSUER TYPE "" - „one rn/n. -%I ui.i ww DL IJ17FG1 K ^ '.©© nn? nn :(:JE :(?pW rk 2Vc 0/4TG1:_ CiiCnA /ten./n• `V 6f W 13i"TCry% :C nnn Cn en ^^ CGi 09 ?nT!"' CV CTCM ?+ n,nbCel OCC' ?A\MI?? 4.VJJ vo- =? ??oal x 1 LO e:a ::a?? n\/CY"• i slnnoa c.; c, ?o :'tiA1MILt:T ",?., JL c?lc . ?:000Q " ;LI L3 f,WIIEt:' 7 034SJC1 00 it 111) n lc-72 L'll- Q' G7l, ?0; Li NA14 ICt17 G ?r 1C 0 PAYMENT-LOSS 03 PAC 784998387 7,086.20 HNDO SYSTEM 122403 DD101 A? e ?e; s' 2 nn ne. vrt.. L"V Oc ^`CCnCCPQ nn ,1 ;CCY4 evnTE91_ I INIT REF 2 I/C STAT 3 TRAN HIS 4 DRFT HIS 5 LOSS HIS S B CAT D PRIOR SCRNIO EFT HIS NEXT SELECTION/TAB: CLAIM NUMBER/TAB: ITEM/TAB: CLMT/TAB: 7J' 491 CIO L2 N 6-- P CV) SHERIFF'S RETURN - NOT FOUND CASE NO: 2004-04660 P COMMONTWEALTH OF' PENNSYLVANIA COUNTY OF CUMBERLAND ALLSTATE INSURANCE CO ET AL VS DUDDING JOSEPH JR R. Thomas Kline ,Sheriff or Deputy Sheriff, who being duly sworn according to law, says, that he made a diligent search and inquiry for the within named DEFENDANT DUDDING JOSEPH JR unable to locate Him in his bailiwick COMPLAINT & NOTICE but was He therefore returns the NOT FOUND , as to the within named DEFENDANT 306 W GREEN STREET SHIREMANSTOWN, PA 17011 , DUDDING JOSEPH JR DEFENDANT NO LONGER LIVES AT GIVEN ADDRESS. NO FORWARDING ON FILE AT P Sheriff's Costs: Docketing 18.00 Service 9.62 Not Found 5.00 Surcharge 10.00 .00 42.62 SST OFFICE. So answers: - R. Thomas Klip--? Sheriff of Cumberl-and County GORDON & WEINBERG 09/23/2004 Sworn and subscribed to before me this day of ae_? a2oo c( hA. D. ? ?i Prot onoary 2010012 GORDON & WEINBERG, P.C. BY: FREDERIC I. WEINBERG, ESQUIRE Identification No.: 41360 PAUL M. SCHOFIELD, JR., ESQUIRE Identification No.: 81894 21 SOUTH 21ST STREET PHILADELPHIA, PA 19103 215/988-9600 Allstate Insurance Company 1301 Virginia Drive Fort Washington, PA 19034 Ind. A/S/O Michael Abbott and Michael Abbott 1030 Fox Chase Road Jenkintown, PA 19046 VS. Joseph Dudding Jr COURT OF COMMON PLEAS CUMBERLAND COUNTY DOCKET NO. : 04-4660 C PRAECIPE TO REINSTATE COMPLAINT TO THE PROTHONOTARY: Kindly reinstate the Plaintiffs, Complaint in Civil the above-captioned matter for an additional thirty (30) GORDON & WEINBERG, P.C. BY: FREDERI I. W BERG, ESQ PAUL M. IELD, JR., E Attorney for Plaintiff(s) ivil in ?U ?; ?' ? i } t, ]3, ' ? i {?7 L?J i ? ?_, Qi SHERIFF'S RETURN - OUT OF COUNTY CANE NO: 2004-04660 P COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND ALLSTATE INSURANCE CO ET AL VS DUDDING JOSEPH JR R. Thomas Kline Sheriff or Deputy Sheriff who duly sworn according to law, says, that he made a diligent sea: and inquiry for the within named DEFENDANT to wit: DUDDING JOSEPH JR but was unable to locate Him deputized the sheriff of BERKS serve the within COMPLAINT & NOTICE On 19th , 2005 , attached return from BERKS Sheriff's Costs: Docketing 18.00 Out of County 9.00 Surcharge 10.00 Dep Berks County 30.77 Postage .37 68.14 04/19/2005 GORDON & WEINBERG in his bailiwick. He theref being ch and County, Pennsylvanih, to s office was in So answers K. 1'nomas Kiine ?_._. Sheriff of Cumberland County Sworn and subscribed to before me this -,2 ?- day of p A.D. Pr-roo?thon tary dc) /C) a/_? 016ak ln?()rmct ?o e- o( vs Case No. Q y - `t 6 ? 0 S? i r1 J r Statement of Intention to Proceed To the Court: L ??a h l 1 intends to proceed with the above captioned matter. ? Print Name tl ? ? . wp' ?,1 S i Name Date: V (? 0 Attorney forI y-- Explanatory Comment The Supreme Court of Pennsylvania has promulgated new Rule of Civil Procedure 230.2 governing the termination of inactive cases and amended Rule of Judicial Administration 1901. Two aspects of the recommendation merit comment. 1. Rule of civil Procedure New Rule of Civil Procedure 230.2 has been promulgated to govern the termination of inactive cases within the scope of the Pennsylvania Rules of Civil Procedure. The termination of these cases for inactivity was previously governed by Rule of Judicial Administration 1901 and local rules promulgated pursuant to it. New Rule 230.2 is tailored to the needs of civil actions. It provides a complete procedure and a uniform statewide practice, preempting local rules. This rule was promulgated in response to the decision of the Supreme Court in Shop v. Eagle, 551 Pa. 360,710 A.2d 1104 (1998) in which the court held that "prejudice to the defendant as a result of delay in prosecution is required before a case may be dismissed pursuant to local rules implementing Rule of Judicial Administration 1901." Rule of Judicial Administration 1901(b) has been amended to accommodate the new rule of civil procedure. The general policy of the prompt disposition of matters set forth in subdivision (a) of that rule continues to be applicable. II Inactive Cases The purpose of Rule 230.2 is to eliminate inactive cases from the judicial system. The process is initiated by the court. After giving notice of intent to terminate an action for inactivity, the course of the procedure is with the parties. If the parties do not wish to pursue the case, they will take no action and "the Prothonotary shall enter an order as of course terminating the matter with prejudice for failure to prosecute." If a party wishes to pursue the matter, he or she will file a notice of intention to proceed and the action shall continue. a. Where the action has been terminated If the action is terminated when a party believes that it should not have been terminated, that party may proceed under Rule230(d) for relief from the order of termination. An example of such an occurrence might be the termination of a viable action when the aggrieved party did not receive the notice of intent to terminate and thus did not timely file the notice of intention to proceed. The timing of the filing of the petition to reinstate the action is important. If the petition is filed within thirty days of the entry of the order of termination on the docket, subdivision (d)(2) provides that the court must grant the petition and reinstate the action. If the petition is filed later than the thirty-day period, subdivision (d)(3) requires that the plaintiff must make a show in to the court that the petition was promptly filed and that there is a reasonable explanation or legitimate excuse both for the failure to file the notice of intention to proceed prior to the entry of the order of termination on the docket and for the failure to file the petition within the thirty-day period under subdivision (d)(2). B. Where the action has not been terminated An action which has not been terminated but which continues upon the filing of a notice of intention to proceed may have been the subject of inordinate delay. In such an instance, the aggrieved party may pursue the remedy of a common law non pros which exits independently of termination under Rule 230.2. r- v -t-t -a CY'"+ David D. Bueff Pr othonotary Kirks. Sohonage, ESQ Solicitor ?A ??- \?_ &nee X Simpson I" Deputy Prothonotary Irene E. Morrow 2nd Deputy ltothonotary office of the Prothonotary Cum6er(and County, Tennsy(vania n q "`"'l 4oll D CIVIL TERM ORDER OF TERMINATION OF COURT CASES AND NOW THIS 25TH DAY OF OCTOBER, 2011, AFTER MAILING NOTICE OF INTENTION TO PROCEED AND RECEIVING NO RESPONSE -THE ABOVE CASE IS HEREBY TERMINATED WITH PREJUDICE IN ACCORDANCE WITH PA R.C.P 230.2 BY THE COURT, DAVID D. BUELL PROTHONOTARY One Courthouse Square • Suite 100 9 Car(is(e, P.A 17013 • (717) 240-6195 0 Tax (717) 240-6573