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HomeMy WebLinkAbout12-0873THE LAW OFFICES OF STEWART C. CRAWFORD & ASSOCIATES By: Stewart C. Crawford, Jr., Esquire Attorney Id. No.: 202188 223 North Monroe Street Media, Pa 19063 LW Q A ? Telephone: (877)-992-6311, ext. 23 C U 3 E R L CC sWeb: www.subrolaw.us PEh!NSY'I t, AINIA E-Mail: scrawfordirksubrolaw.us Firm File No.N 11-0016 Attorney for Plaintiff, Nationwide Insurance Company IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NATIONWIDE AFFINITY INSURANCE COMPANY OF AMERICA One W. Nationwide Blvd. Columbus, OH 43215 Plaintiff, VS. GERALD LESEVER 1405 Wabank Rd, Lancaster, PA 17603 Defendant. CIVIL ACTION-LAW /? C"?V/ L C.A. No. IV-873 NOTICE TO DEFEND 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 an attorney and filing in writing with the court your defenses or objections to the claims set forth against you. You are further 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 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 LAWYEROR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. Le ban demandado a usted en la corte. Si usted quiere defenderse de estas demandas expuestas en las paginas siguientes, usted tiene veinte (20) dias de plaza al partir de la fecha de la demanda y la notificacion. Hace faita asentar una comparencia escrita o en persona o con un abogado y entregar a la corte en forma sus defensas o sus objectiones a las demandas en contra de su persona. Ses avisado que si usted no se defiende la corte tomara modidas ypuede continuar ila demanda en contra suya sin previo aviso o notificacion. Ademas, la corte puede decidir a favor del demandante y requiera que usted cumpia con todas las provisions de esta demands. Usted puede perder dinero o sus propiedaces u otros derechos importantes para usted. USTED DEBE LLEVAR ESTA AVISO A UN ABOGADO ENESEQUIDA. SI USTED NO TIENE UN ABOGADO Y NO PUEDEPAGAR LOS SERVICIOS DE UN ABOGADO, DEBE COMUNICARSE CON LA SIGUIENTE OFICINA PARA AVERIGUAR DONDE PUEDE OBTENER AYUDA LEGAL. Lawyer Referral Service 4th Floor, Cumberland County Courthouse Carlisle, PA 17013 (717) 240-6200 0 103. 7 T,0 7ef7 ?'9? Ar"' a-70 THE LAW OFFICES OF STEWART C. CRAWFORD & ASSOCIATES By: Stewart C. Crawford, Jr., Esquire Attorney Id. No.: 202188 223 North Monroe Street Media, Pa 19063 Telephone: (877)-992-6311, ext. 23 Web: www.subrolaw.us E-Mail: scrawfordjr@subrolaw.us Firm File No.N11-0016 Attorney for Plaintiff, Nationwide Insurance Company IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NATIONWIDE AFFINITY INSURANCE COMPANY OF AMERICA One W. Nationwide Blvd. Columbus, OH 43215 Plaintiff, VS. GERALD LESEVER 1405 Wabank Rd, Lancaster, PA 17603 Defendant. CIVIL ACTION-LAW C.A. No. COMPLAINT Plaintiff Nationwide Affinity Insurance Company of America ("Nationwide") by and through its undersigned attorney, hereby alleges and states as follows: The Parties Plaintiff Nationwide is an Ohio insurance company with a principal place of business at the above address. Nationwide is licensed and authorized to transact business in the Commonwealth of Pennsylvania. 2. On information and belief, defendant Gerald Lesever ("defendant") is an adult individual, who at all times relevant to this Complaint, resided in the Commonwealth of Pennsylvania and continues to reside in the Commonwealth of Pennsylvania. Factual Allegations Common To All Counts 3. On or about September 27, 2011, Nationwide had in effect a valid contract of automobile insurance with Linda D. Walterick (the "policyholder"), providing benefits in accordance with the laws of the Commonwealth of Pennsylvania and insuring against the risk of loss to a motor vehicle owned by the policyholder. In this action, the nature of the relationship between Nationwide and the policyholder is that of insurance carrier subrogee to insured subrogor. The policyholder is not a party to this lawsuit. 4. On the aforesaid date, the motor vehicle insured by Nationwide, hereafter referred to as the "insured vehicle", was involved in a collision with a motor vehicle owned and operated by defendant, hereafter referred to as the "defendant vehicle". 5. At the time of the collision, the vehicle insured by Nationwide was already established in the main aisleway of the Hampden Center parking lot located on Carlisle Pike, in the town of Mechanicsburg, Cumberland County, Pennsylvania. The Defendant vehicle was attempting to pull from a parking space to the right of the insured vehicle to enter the main aisleway. The Defendant vehicle carelessly struck the insured vehicle causing damages. The defendant vehicle was uininsured. 6. The operator of the defendant vehicle was negligent and careless and the cause of this incident in that the operator: 2 a. was careless, inattentive or distracted and otherwise operated their vehicle without regard for the safety of other persons or property in violation of 75 Pa.C.S. § 3714; b. did not operate their vehicle in a manner that maintained an assured clear distance and disregarded the hazard created by other vehicles on the roadway and did not operate their vehicle in a reasonably and prudently safe manner with respect to those conditions in violation of 75 Pa.C.S. § 3361; operated their vehicle in reckless, willful, or wanton disregard for the safety of persons or property in violation of 75 Pa.C.S. § 3736; d. failed to operate the vehicle in a safe manner from a parked position in violation of 75 Pa.C.S. § 3333; e. in addition to traditional negligence as alleged above, the operator of the defendant is negligent per se for violating the above referenced statutes and for breaching the duties of care which are reflected within those statutes; 7. Pursuant to the aforesaid policy of insurance, Nationwide became liable for damages that arose out of this accident. As a result of that liability, Nationwide indemnified its policyholder and made payments to or on behalf of its policyholder. 8. Due to this incident, Nationwide incurred economic damages in the form of property damage benefits, medical expenses, personal injury protection benefits, and uninsured and/or underinsured motorist bodily injury benefits paid to or on behalf of the policyholder in the amount of $2,411.87. 9. Pursuant to the principles of equity, the common law, certain statutory provisions, and the contract of insurance Nationwide is subrogated for all money paid and seeks recovery of all sums paid totaling $2,411.87. WHEREFORE, Plaintiff demands judgment for $2,411.87 in addition to interest from the date of the loss, the costs of this lawsuit, certain administrative costs, and whatever additional relief the Court may deem proper. COUNTI (Nationwide vs. defendant) 10. Nationwide repeats and realleges all of the foregoing paragraphs, as well as all of the following paragraphs, as if set forth at length within this Count. 11. As the financially responsible owner of the defendant vehicle, Defendant is responsible for the damages caused by the operation of the defendant vehicle. 12. Defendant is liable as the negligent driver. 13. Defendant is liable per se for allowing the defendant vehicle to be operated on the roadway without maintaining the required liability insurance. Defendant's actions in this regard constitute an ultra vires act; had defendant abided by the financial responsibility laws and refrained from operating the defendant vehicle on this occasion, the collision would not have occurred. WHEREFORE, Plaintiff demands judgment for $2,411.87 in addition to interest from the date of the loss, the costs of this lawsuit, certain administrative costs, and whatever additional relief the Court may deem proper. THE LAW OFFICES OF STEWART C. CRAWFORD & ASSOCIATES 4 By: Stewart Crawford, Jr. (Bar Id. No. 202188) Dated: Iq V17 Attorney for Plaintiff Nationwide Affinity Insurance Company of America VERIFICATION The undersigned hereby states that he is an authorized agent of Plaintiff insurance company in this action and verifies that the statements contained in the foregoing Complaint are true and correct. The undersigned understands that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904, relating to unworn falsification to authorities. By: C J Stewart Crawford, Jr. (Bar Id. No. 202188) .Attorney for Plaintiff Nationwide Affinity Insurance Company of America Dated: l 6 SHERIFF'S OFFICE OF CUMBERLAND COUNTY Ronny RAnderson Sheriff zcr of ?IfelbF11,1-1114 Jody S Smith Chief Deputy 2012 FEB 23 AFB g: 32 Richard W Stewart CUMBERLAND Ct?J TI Solicitor :OFF -F PENNSYLVANIA Nationwide Affinity Insurance Company of America Case Number vs. Gerald Lesever 2012-873 SHERIFF'S RETURN OF SERVICE 02/14/2012 Ronny R. Anderson, Sheriff who being duly sworn according to law states that he made a diligent search and inquiry for the within named defendant, to wit: Gerald Lesever, but was unable to locate him in his bailiwick. He therefore deputized the Sheriff of Lancaster County, Pennsylvania to serve the within Complaint and Notice according to law. 02/21/2012 09:40 AM - Lancaster County Return: And now February 21, 2012 at 0940 hours I, Terry A. Bergman, Sheriff of Lancaster County, Pennsylvania, do hereby certify and return that I served a true copy of the within Complaint and Notice, upon the within named defendant, to wit: Gerald Lesever by making known unto himself personally, at 1405 Wabank Raod, Lancaster, Pennsylvania 17603 its contents and at the same time handing to him personally the said true and correct copy of the same. SHERIFF COST: $37.00 February 24, 2012 SO ANSWERS, RON R ANDERSON, SHERIFF SHERIFF'S OFFfCE OF CUMBERLAND COUNTY Ronny R Anderson Sheriff Jody S Smith Richard W Stewart Chief Deputy ,F Solicitor Nationwide Affinity Insurance Company of America vs . Case Number 3 Gerald Lesever 2012-873 o SERVICE COVER SHEET N o Service Details: C Cl) Category: Civil Action - Complaint & Notice Zone: n X Manner: Deputize Expires: 03/09/2012 Warrant: w Notes: M O LCSO Clerk Yvette Turco 717 723-4519 Serve To; Name: Gerald Lesever Served: Personally AObIt In Charge Posted Other cn - -- a Primary 1405 Wabank Road Adult In Q Address: Lancaster, PA 17603 Charge: J _. p Phone: DOB: Relation: a .. IX Alternate Date: s (- J Time: Z Address: m Phone: Deputy: -Mileage: a c Attorney / Originator: v ............. Name: Stewart C. Crawford Phone: 610-5G5-7050 Stewart Crawford 223 N Monroe St_, Media PA 19063 Service Afterdpte; Date: r,_ 4 - Cn Time: k© 4 co Mileage: N Deputy: kA 4 r {? Notes l,Speck",ttructions: R# 5958 $150_00 $ 36.50 0 QJ W Now, February 14, 2012 I, Sheriff of Cumberland County, Pennsylvania do hereby deputize the Sheriff of Lancaster County tc 0 execute service of the documents herewith and make return thereof according to law. 0 > Return To: co Cumberland County Sheriffs Office J One Courthouse Square Carlisle, PA 17013 onny Anderspn, Sheriff e.F _.. Z? 44.4t NU3?0?'A t?~ ilk ?;?OToft THE LAW OFFICES OF STEWART C By: Stewart C. Crawford, Jr., Esquire Attorney Id. No.: 202188 223 North Monroe Street Media, Pa 19063 Telephone: (877)-992-6311, ext. 23 Web: www.subrolaw.us E-Mail: scrawfordjrksubrolaw.us Firm File No.N 11-0016 • 1? CRAWFORD & WMPEV , CUM YLYAN ? TY PEA Attorney for Plaintiff, Nationwide Affi nity Insurance Company of America IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NATIONWIDE AFFINITY INSURANCE ) COMPANY OF AMERICA ) One W. Nationwide Blvd. ) Columbus, OH 43215 ) Plaintiff, ) VS. ) GERALD LESEVER ) 1405 Wabank Rd, ) Lancaster, PA 17603 ) Defendant. ) CIVIL ACTION-LAW C.A. No. 12-873 -S 11., 66pd a ?gaa9a3 ?? a7 -7 31 (o PRA ECIPE FOR DEFAULT JUDGMENT AND ASSESSMENT OF DAMAGES TO THE PROTHONOTARY: Kindly enter a Default Judgment in favor of the Plaintiff and against the Defendant(s) GERALD LESEVER in the amount of $2,411.87 plus costs, interest, and attorney fees for failure to Answer the Complaint in Civil Action within twenty (20) days from the date of service. I hereby certify that pursuant to Local Rule of Court, I sent Notice to Defendant of intent to take Default. See attached. Stewart C. Crawford, Jr., esquire Attorney for Plaintiff, Nationwide Affinity Insurance Company ofAmerica ENTRY OF DEFAULT JUDGMENT AND NOW, to wit, this a$day of J une. , 2012 a Default Judgment is entered as above, namely in favor of the Plaintiff and jagainst efen t. w DTHONOTARY ¦. r?urn fete items 1, z, 4..u a. rusc+ :orrypl?« A. biy. u a f.a item 4 If Restricted'Deliveryis desired. X ? Agent ¦ Print your name and address on the reverse ? Address( so that we can return the card to you. B. Receive y (Printed Name) C. Date of Delive! ¦ Attach this card to the back of the mallpiece, or on the front if space permits. D. Is delivery address different from Item 17 ? Yes 1. Article Addressed to: If YES, enter delivery address below: EW No G?/?1 P i?J t j 3. ice Type l Certified Mail 0 Express Mail. ? Registered ? Retum Receipt for Merchandise ? Insured Mail ? C.O.D. 7010 2782 0001 2312 1689 ? Yes 2. Article Number `? f t , fir, (Transfer from service label)f PS Form 3811, February 2004 Domestic Return Receipt 102595-02-1A-1541 Postal CERTIFIED M AILrr RECEIPT co Only; . No Insurance Coverage Provided) a ' - LPA , IS MK t l? r, 'q M Postage $ #I.7G . 0063 0 Certified Fee' $2.95 03 C3 O Return Receipt Fee (Endorsement Required) #.`31J Postmark Here O Restricted Delivery Fee (Endorsement Required) #0 ?? ° CD r'* Total Postage & ,Fees 00 7 • 04/26/ 012 Sent To p A7No, or PO B 6 ..,_... Gi(y Sta f.. . ...................... THE LAW OFFICES OF STEWART C. CRAWFORD & ASSOCIATES By: Stewart C. Crawford, Jr., Esquire Attorney Id. No.: 202188 223 North Monroe Street Media, Pa 19063 Telephone: (877)-992-6311, ext. 23 Web: www.subrolaw.us E-Mail: scrawfordjrgsubrolaw.us Firm File No.NI 1-0016 Attorney for Plaintiff, Nationwide Insurance Company IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NATIONWIDE AFFINITY INSURANCE COMPANY OF AMERICA One W. Nationwide Blvd. Columbus, OH 43215 Plaintiff, VS. CIVIL ACTION-LAW C.A. No. 12-873 GERALD LESEVER 1405 Wabank Rd, Lancaster, PA 17603 Defendant. TO: GERALD LESEVER 1405 Wabank Rd, Lancaster, PA 17603 DATE OF NOTICE: April 19, 2012 IMPORTANT NOTICE You are in default because you have failed to take action required of you in this case. Unless you act within Ten (10) Days from the date of this notice, a Judgment may be entered against you without a hearing and you may lose property or other important rights. You should take this notice to a lawyer at once. If you do not have a lawyer or cannot afford one, go to or telephone the following office to find out where you can get legal help: Pennsylvania Lawyer Referral Service Pennsylvania Bar Association 100 South Street P.O. Box 186 Harrisburg, Pa 17108 Stewart C. Crawford, Jr., Attorney for Plaintiff, Nationwide Affinity Insurance Company of America THE LAW OFFICES OF STEWART C. CRAWFORD & ASSOCIATES By: Stewart C. Crawford, Jr., Esquire Attorney Id. No.: 202188 223 North Monroe Street Media, Pa 19063 Telephone: (877)-992-6311, ext. 23 Web: www.subrolaw.us E-Mail: scrawfordjrgsubrolaw.us Firm File No.N11-0016 Attorney for Plaintiff, Nationwide Insurance Company IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NATIONWIDE AFFINITY INSURANCE COMPANY OF AMERICA One W. Nationwide Blvd. Columbus, OH 43215 Plaintiff, VS. CIVIL ACTION-LAW C.A. No. 12-873 GERALD LESEVER 1405 Wabank Rd, Lancaster, PA 17603 Defendant. VERIFICATION OF VALUE OF REPAIRMAN UNDER PRCP # 1037 (B) (2) (I1) THE REPAIRMAN'S AFFIDAVIT Stewart C. Crawford, Jr., Esquire verifies, deposes and says that he is a representative for Plaintiff and has for many years, reviewed appraisals and estimates and damage documents on property and that the repairs itemized on the attached estimate were necessary to restore the property of the owner to the condition which existed immediately preceding the damage and that the prices set forth on the estimate for parts and labor were fair and reasonable and customarily charged at the time the attached repair estimate was prepared; or that the property was a total loss and the attached sheets correctly state the value of the property at the time of loss, less any salvage value. That the attached repair estimate was prepared by a qualified and licensed estimator or field claim representative. The undersigned understands that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904, relating to unsworn falsification to authorities. Stewart C. Crawford, Jr., Esq Attorney for Plaintiff, Nationwide Affinity Insurance Company of America THE LAW OFFICES OF STEWART C. CRAWFORD & ASSOCIATES By: Stewart C. Crawford, Jr., Esquire Attorney Id. No.: 202188 223 North Monroe Street Media, Pa 19063 Telephone: (877)-992-6311, ext. 23 Web: www.subrolaw.us E-Mail: scrawfordjrksubrolaw.us Firm File No.Nl 1-0016 Attorney for Plaintiff, Nationwide Affinity Insurance Company of America IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NATIONWIDE AFFINITY INSURANCE COMPANY OF AMERICA One W. Nationwide Blvd. Columbus, OH 43215 Plaintiff, VS. CIVIL ACTION-LAW C.A. No. 12-873 GERALD LESEVER 1405 Wabank Rd, Lancaster, PA 17603 Defendant. AFFIDAVIT UNDER SOLDIERS'AND SAILORS' CIVIL RELIEFACT OF 1940 AS AMENDED STATE OF PENNSYLVANIA: COUNTY OF CUMBERLAND: SS Stewart C. Crawford, Jr., Esquire, being duly sworn according to the law that according to information and belief defendant(s) GERALD LESEVER is/are not in the military service of the United States of America as defined by the Soldiers' and Sailors' Civil Relief Act of 1940 as amended; that said Defendant(s) is/are over 18 years of age and is/are employed. The undersigned understands that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904, relating to unsworn falsification to authorities. Stewart C. Crawford, Jr., squire Attorney for Plaintiff, Nationwide Affinity Insurance Company of America THE LAW OFFICES OF STEWART C. CRAWFORD & ASSOCIATES By: Stewart C. Crawford, Jr., Esquire Attorney Id. No.: 202188 223 North Monroe Street Media, Pa 19063 Telephone: (877)-992-6311, ext. 23 Web: www.subrolaw.us E-Mail: scrawfordirksubrolaw.us Firm File No.N 11-00 16 Attorney for Plaintiff, Nationwide Affinity Insurance Company of America IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NATIONWIDE AFFINITY INSURANCE COMPANY OF AMERICA One W. Nationwide Blvd. Columbus, OH 43215 Plaintiff, VS. CIVIL ACTION-LAW C.A. No. 12-873 GERALD LESEVER 1405 Wabank Rd, Lancaster, PA 17603 Defendant. AFFIDAVIT OF MAILING NOTICE STATE OF PENNSYLVANIA: COUNTY OF CUMBERLAND: SS Stewart C. Crawford, Esquire, being duly sworn according to law, deposes and says that he is attorney for Plaintiff and that on April 19, 2012 he sent by certified mail, return receipt requested, to the Defendant(s) GERALD LESEVER, the repair estimate, together with a notice that damages would be assessed on or after April 29, 2012 in the amount of the repair estimate unless prior to that date the Defendant(s) had, by written Praecipe, filed with the Prothonotary a request for trial on the issue of damages. The undersigned understands that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904, relating to unsworn falsification to authorities. Stewart C. Crawford, Jr., E uire Attorney for Plaintiff, Nationwide Affinity Insurance Company ofAmerica FAULKNER COLLISION CENTER OF Workfile ID: 67856e3b Federal ID: 23-2611806 CAMP HILL TO BE SURE! 3537 HARTZDALE DR, CAMP HILL, PA 17011 Phone: (717) 254-0041 FAX: (717) 254-0046 Supplement of Record Customer: Walterick, Linda D Insured: Walterick, Linda D Type of Loss: COLL-Collision Point of Impact: 01 Right Front Owner: Walterick, Linda D 1104 Rana Villa Ave Camp Hill, PA 17011-6927 (717) 695-4476 Evening (717) 798-0826 Cellular Written By: Shawn Feaser, 10/17/20119:11:15 AM Adjuster: ADJUSTER UNKNOWN, (800) 889-9872 x4309 Business Assignment Type: 75 Inspect and Repair Policy #: NATIONWIDE AFFINITY Claim #: 5837E INS 0841730927110IL/Wl l Date of Loss: 9/27/2011 12:00:00 AM Days to Repair: 6 Inspection Location: FAULKNER COLLISION CENTER OF CAMP HILL 3537 HARTZDALE DR CAMP HILL, PA 17011 Repair Facility (717) 254-0041 Business Insurance Company: NATIONWIDE ENTERPRISE HARRISBURG 1000 Nationwide Drive surras@nationwide.com HARRISBURG, PA 17110 (800) 889-9872 x4309 Business VEHICLE Year: 2001 Make: DODG Model: GRAND CARAVAN 4X2 SPORT Color: Red Int: Gray Body Style: 4D VAN Engine: 6-3.3L-FI Production Date: 1/2001 Condition: Good VIN: 2B4GP44371R248904 License: GVN-7800 State: PA Job #: Mileage In: 119953 Mileage Out: Vehicle Out: 3rd Row Seat Clear Coat Paint Heated Mirrors Air Conditioning Cloth Seats Intermittent Wipers AM Radio Console/Storage Overdrive Anti-Lock Brakes (4) Cruise Control Passenger Air Bag Automatic Transmission Driver Air Bag Power Brakes Body Side Moldings Dual Mirrors Power Locks Bucket Seats FM Radio Power Mirrors Cassette Full Wheel Covers Power Steering Power Windows Rear Defogger Rear Window Wiper Search/Seek Stereo Tilt Wheel Tinted Glass 10/17/20119:11:20 AM 007438 Page 1 Supplement of Record Customer: Walterick, Linda D Vehicle: 2001 DODG GRAND CARAVAN 02 SPORT 4D VAN 6-3.3L-FI Red Line Operation Description Qty Extended Price $ Labor Paint 1 # Sol Final estimate authorization to pay 1 2 # Sol and quality check sheet secured in file 1 3 FRONT BUMPER N 4 R&I R&I bumper cover 1.5 5 FRONT LAMPS 6 R&I RT Headlamp assy Incl. 7 FENDER N 8 ** Repl Qual Repl Parts NWCPP RT Fender 1 135.00 2.7 1.8 9 Add for Clear Coat 0.7 10 Add for Edging 0.5 it Deduct for Overlap -0.4 N 12 ** Repl Qual Repl Parts RT Fender liner Dodge 1 35.00 Incl. 13 ELECTRICAL 14 R&I Antenna mast 0.2 15 FRONT DOOR N 16 * S01 Rpr RT Outer panel 6.0 2.0 17 Overlap Major Adj. Panel -0.4 18 Add for Clear Coat 0.3 19 # Refn Deduct For Partial Refinish -0.2 20 * Rpr RT Door shell 1.0 Incl. 21 Add for Edging 0.5 22 R&I RT Applique 0.3 N 23 * R&I RT Upper molding Caravan SE, Voyager 0.3 bordeaux 24 R&I RT Belt molding 0.3 N 25 * Sol Rep] RT Nameplate "DODGE" 1 42.35 0.2 26 R&I RT Mirror assy w/power w/fold away Incl. 27 R&I RT Cover 0.1 N 28 R&I RT Handle, outside garnet red 0.3 N 29 R&I RT R&I trim panel 0.4 30 SIDE LOADING DOOR N 31 * Sol Rpr RT Outer panel 4.0 2.0 32 Overlap Major Adj. Panel -0.4 33 Add for Clear Coat 0.3 34 Add for Edging 0.5 35 # Refn Deduct For Partial Refinish -0.4 N 36 * R&I RT Upper molding Caravan, Voyager 113 WB 0.3 bordeaux N 37 * Rpr RT Door glass Chrysler tinted 0.3 N 38 R&I RT Handle, outside w/o key cylinder garnet red 0.4 39 R&I RT R&I trim panel 0.5 40 SIDE PANEL N 41 * S01 Rpr RT Side panel 113" WB 2.0 2.7 10/17/20119:11:20 AM 007438 Page 2 Supplement of Record Customer: Walterick, Linda D Vehicle: 2001 DODG GRAND CARAVAN 4X2 SPORT 4D VAN 6-3.3L-Fl Red 42 Overlap Major Adj. Panel -0.4 43 Add for Clear Coat 0.5 44 # Refn Deduct For Partial Refinish -0.4 N 45 * R&I RT Side molding Caravan SE, Voyager bordeaux 0.3 N 46 * Rpr RT Side glass Chrysler, 113" WB tinted, power 47 ROOF . 48 R&I RT Roof molding 113" WB 0.3 49 REAR LAMPS 50 R&I RT Combo lamp 0.3 51 REAR BUMPER 52 * R&I Partial R&I bumper cover 0.5 53 WHEELS N 54 * Sol Rep] RT/Front Wheel cover 15" code W5D 1 90.35 0_i 55 # TIRE MOUNT AND BALANCE 1 12.00 T 56 # TWO WHEEL ALIGNMENT 1 74.95 T 57 # MISC. 1 58 # CLEAN & RETAPE MOULDINGS 1 0.3 59 # CAR COVER 1 5.00 T 0.2 60 # HAZARDOUS WASTE REMOVAL 1 3.00 T SUBTOTALS 397.65 22.7 9.6 NOTES Line 4: PARTS: Order by color. LABOR: Time includes R&I/R&R headlamp assemblies and grille. Refinish time is body color portion only. Refinish time is provided for those instances when required color is not available or for some repair situations. Line 8: Quote #5577141 per JC @ Keystone, 800-334-9811, ( NWCPP Approved ) LABOR: Time is after headlamp is removed. Time includes R&I/R&R mud guard, lower molding and mirror. Line 12: Quote # 5577141 per JC @ Keystone, 800-334-9811, ( NWCPP Approved ) Line 16: Additional Repair Time Needed Once Repairs Were Started, See Images. Line 23: PARTS: Order by color and application. LABOR: Refinish time is provided for those instances when required color is not available or for some repair situations. Line 25: PARTS PRICE CHANGE Line 28: PARTS: Order by color. LABOR: Refinish time is provided for those instances when required color is not available or for some repair situations. Line 29: PARTS: Order by color and application. Line 31: Additional Repair Time Needed Once Repairs Were Started, See Images. Line 36: PARTS: Order by color and application. LABOR: Refinish time is provided for those instances when required color is not available or for some repair situations. Line 37: Time is to rope glass. Line 38: PARTS: Order by color. LABOR: Refinish time is provided for those instances when required color is not available or for some repair situations. Line 41: Additional Repair Time Needed Once Repairs Were Started, See Images. Line 45: PARTS: Order by color and application. LABOR: Refinish time is provided for those instances when required color is not available or for some repair situations. Line 46: Time is to rope glass. Line 54: PARTS PRICE CHANGE Estimate Notes: LKQ PARTS SEARCH: LKQ250, 800-334-9811, SPOKE TO JC, NOTHING NEW CUMBERLAND, 717-774-1190, SPOKE TO BARRY, NOTHING STOYSTOWN, 877-729-8770, SPOKE TO JOE, NOTHING A/M PARTS SEARCH: 10/17/20119:11:20 AM 007438 Page 3 Supplement of Record Customer: Walterick, Linda D Vehicle: 2001 DODG GRAND CARAVAN 4X2 SPORT 4D VAN 6-3.3L-FI Red KEYSTONE, 800-334-9811, SPOKE TO IC, # 5577141 (NWCPP APPROVED ) THERE MAY BE ADDITIONAL HIDDEN DAMAGE ONCE THE VEHICLE COMES IN FOR REPAIRS AND THE REPAIR PROCESS IS STARTED. Prior Damage Notes: Left Front Door Bodyside Moulding Missing Minor Dings & Scratches -- Normal For Age ESTIMATE TOTALS Category Basis Rate Cost $ Parts 302.70 Parts Discount $ 132.70 -5.0% -6.64 Body Labor 22.7 hrs @ $ 46.00 /hr 1,044.20 Paint Labor 9.6 hrs @ $ 46.00 /hr 441.60 Paint Supplies 9.6 hrs @ $ 27.00 /hr 259.20 Miscellaneous 94.95 Subtotal 2,136.01 Sales Tax $ 2,136.01 @ 6.0000% 128.16 Grand Total 2,264.17 Deductible 100.00 CUSTOMER PAY 100.00 INSURANCE PAY 2,164.17 10/17/20119:11:20 AM 007438 Page 4 Supplement of Record Customer: Walterick, Linda D Vehicle: 2001 DODG GRAND CARAVAN 4X2 SPORT 4D VAN 6-3.3L-FI Red SUPPLEMENT SUMMARY Line Operation Description Qty Extended Labor Paint Price $ Changed items 13 * Rpr RT Outer panel -4.0 -2.0 N 16 * S01 Rpr RT Outer panel 6.0 2.0 22 Repl RT Nameplate "DODGE" 1 -36.95 -0.2 N 25 * Sol Repl RT Nameplate "DODGE" 1 42.35 0.2 28 * Rpr RT Outer panel :2--o -2.0 N 31 * Sol Rpr RT Outer panel 4.0 2.0 38 * Rpr RT Side panel 113" WB -1.0 -2.7 N 41 * S01 Rpr RT Side panel 113" WB 2.0 2.7 51 * Repl RT/Front Wheel cover 15" code W51) 1 -87.70 -0.1 N 54 * SOS Repl RT/Front Wheel cover 15" code W513 1 90.35 0.1 Added Items 1 # S01 Final estimate authorization to pay 1 2 # S01 and quality check sheet secured in file 1 SUBTOTALS 8.05 5.0 0.0 TOTALS SUMMARY Category Basis Rate Cost $ Parts 8.05 Parts Discount $ 8.05 -5.0% -0.40 Additional Supplement Adjustments -0.01 Body Labor 5.0 hrs @ $ 46.00 /hr 230.00 Subtotal 237.64 Sales Tax $ 237.64 @ 6.0000% 14.26 Total Supplement Amount 251.90 NET COST OF SUPPLEMENT 251.90 CUMULATIVE EFFECTS OF SUPPLEMENT(S) Estimate 2,012.27 Shawn Feaser Supplement S01 251.90 Shawn Feaser Job Total: $ 2,264.17 CUSTOMER PAY: $ 100.00 INSURANCE PAY: $ 2,164.17 10/17/20119:11:20 AM 007438 Page 5 Supplement of Record Customer: Walterick, Linda D Vehicle: 2001 DODG GRAND CARAVAN 4X2 SPORT 4D VAN 6-3.3L-FI Red THE ABOVE IS AN ESTIMATE BASED ON OUR INSPECTION AND DOES NOT INCLUDE ADDITIONAL PARTS OR LABOR WHICH MAY BE REQUIRED AFTER THE REPAIR IS STARTED. OCCASIONALLY AFTER THE REPAIR HAS BEGUN, WORN OR DAMAGED PARTS ARE DISCOVERED. BECAUSE OF THIS THE ABOVE PRICES ARE NOT GUARANTEED. PRICES SUBJECT TO CHANGE AFTER 30 DAYS. WORKMANSHIP AND REFINISHING ARE GUARENTEED FOR AS LONG AS YOU OWN THE VEHICLE. The limit of your coverage is the actual cash value of your auto or its damaged parts at the time of loss. Fair market value, age and condition of your damaged vehicle will be considered when determining the actual cash value of a loss. Certain parts lose value or depreciate because of age, condition, and/or wear and tear. Betterment is the increase in value of a vehicle or any of its parts as a result of replacing certain parts damaged in a loss. If the replacement of certain parts results in an increase in value to your vehicle or any of its parts, a deduction for betterment may be made to your loss payment to reflect the actual cash value you are owed under your policy. This is an estimate only and not an authorization to repair. Additional payment will be made only with the approval prior to repair. Adjuster Signature vaLC Nationwide will replace any defective like kind and quality (used), reconditioned, recyclable and any quality replacement aftermarket (non-OEM) parts as specified on the appraisal for as long as you own or lease the vehicle. NWPP = NATIONWIDE PARTS PROGRAM NWCPP = NATIONWIDE CRASH PARTS PROGRAM 10/17/20119:11:20 AM 007438 Page 6 Supplement of Record Customer: Walterick, Linda D Vehicle: 2001 DODG GRAND CARAVAN 4X2 SPORT 4D VAN 6-3.3L-Fl Red ANY PERSON WHO KNOWINGLY AND WITH INTENT TO DEFRAUD ANY INSURANCE COMPANY OR OTHER PERSON FILES AN APPLICATION FOR INSURANCE OR STATEMENT OF CLAIM CONTAINING ANY MATERIALLY FALSE INFORMATION OR CONCEALS FOR THE PURPOSE OF MISLEADING, INFORMATION CONCERNING ANY FACT MATERIAL THERETO COMMITS A FRAUDULENT INSURANCE ACT, WHICH IS A CRIME AND SUBJECTS THE PERSON TO CRIMINAL AND CIVIL PENALTIES. THE FOLLOWING IS A LIST OF ABBREVIATIONS OR SYMBOLS THAT MAY BE USED TO DESCRIBE WORK TO BE DONE OR PARTS TO BE REPAIRED OR REPLACED: D= DISCONTINUED PART A=APPROXIMATE PRICE B=BODY LABOR D=DIAGNOSTIC E=ELECTRICAL F=FRAME G=GLASS M=MECHANICAL P=PAINT LABOR S=STRUCTURAL T=TAXED MISCELLANEOUS X=NON TAXED MISCELLANEOUS ADJ=ADJACENT ALGN=ALIGN A/M=AFTERMARKET BLND=BLEND CAPA=CERTIFIED AUTOMOTIVE PARTS ASSOCIATION D&R=DISCONNECT AND RECONNECT EST=ESTIMATE EXT. PRICE=UNIT PRICE MULTIPLIED BY THE QUANTITY INCL=INCLUDED MISC=MISCELLANEOUS NON-ADJ=NON ADJACENT O/H=OVERHAUL OP=OPERATION NO=LINE NUMBER QTY=QUANTITY QUAL RECY=QUALITY RECYCLED PART QUAL REPL=QUALITY REPLACEMENT PART COMP REPL PARTS= COMPETITIVE REPLACEMENT PARTS RECOND=RECONDITION REFN=REFINISH REPL=REPLACE R&I=REMOVE AND INSTALL R&R=REMOVE AND REPLACE RPR=REPAIR RT=RIGHT SECT=SECTION SUBL=SUBLET LT=LEFT W/O=WITHOUT W/_ WITH/_ #=MANUAL LINE ENTRY *=OTHER [IE..MOTORS DATABASE INFORMATION WAS CHANGED]. **=DATABASE LINE WITH AFTERMARKET N=NOTES ATTACHED TO LINE NAGS=NATIONAL AUTO GLASS SPECIFICATIONS. MQVP=MANUFACTURER'S QUALITY AND VALIDATION PROGRAM.OPT OEM=ORIGINAL EQUIPMENT MANUFACTURER PARTS EITHER OPTIONALLY SOURCED OR OTHERWISE PROVIDED WITH SOME UNIQUE PRICING OR DISCOUNT. NWCPP=NATIONWIDE CRASH PARTS PROGRAM. THE ATTACHED ESTIMATE REPRESENTS AN APPRAISAL OF THE COST OF REPAIR FOR THE VISIBLE DAMAGE TO THE VEHICLE NOTED AT THE TIME OF INSPECTION NECESSARY TO RETURN THE VEHICLE TO ITS PREDAMAGED CONDITION. COSTS ABOVE THE APPRAISED AMOUNT MAY BE THE RESPONSIBILITY OF THE VEHICLE OWNER. THERE IS NO REQUIREMENT THAT THE VEHICLE OWNER USE ANY SPECIFIED REPAIR SHOP. INFORMATION REGARDING REPAIR FACILITIES WHICH WILL BE ABLE TO REPAIR THE VEHICLE FOR THE APPRAISED AMOUNT IS AVAILABLE FROM THE INSURANCE COMPANY. IF USED PARTS ARE SPECIFIED, THEY ARE REQUIRED TO BE OF LIKE KIND AND QUALITY TO THOSE BEING REPLACED. INCIDENTAL CHARGES SUCH AS TOWING, PROTECTIVE CARE, CUSTODY, STORAGE, DEPRECIATION, BATTERY AND TIRE REPLACEMENT ARE NOTED WHEN APPLICABLE. AFTERMARKET CRASH PART - A NONORIGINAL EQUIPMENT MANUFACTURER (NON-OEM) REPLACEMENT PART, EITHER NEW OR USED, FOR ANY OF THE NONMECHANICAL PARTS THAT GENERALLY CONSTITUTE THE EXTERIOR OF THE MOTOR VEHICLE, INCLUDING INNER AND OUTER PANELS. THIS APPRAISAL WILL INDICATE IF AFTERMARKET CRASH PARTS ARE SPECIFIED. IF THE USE OF SUCH PARTS VOIDS THE WARRANTY ON THE PART BEING REPLACED OR ON ANY OTHER PART, THE AFTER MARKET CRASH PART WILL BE WARRANTED BY THE MANUFACTURER OR INSURANCE COMPANY EQUAL TO OR BETTER THAN THE REMAINDER OF THE EXISTING WARRANTY. This estimate has been prepared based on the use of automobile parts not made by the original manufacturer. NWPP or NWCPP Parts specified on the appraisal by other than the original manufacturer are required to be at least equal in like, kind, and quality in terms of fit, quality and performance to the original manufacturer parts they are replacing. 10/17/20119:11:20 AM 007438 Page 7 Supplement of Record Customer: Walterick, Linda D Vehicle: 2001 DODG GRAND CARAVAN 4X2 SPORT 4D VAN 6-3.3L-FI Red Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from the Guide DR3TE01, CCC Data Date 10/10/2011, and the parts selected are OEM-parts manufactured by the vehicles Original Equipment Manufacturer. OEM parts are available at OE/Vehicle dealerships. OPT OEM (Optional OEM) or ALT OEM (Alternative OEM) parts are OEM parts that may be provided by or through alternate sources other than the OEM vehicle dealerships. OPT OEM or ALT OEM parts may reflect some specific, special, or unique pricing or discount. OPT OEM or ALT OEM parts may include "Blemished" parts provided by OEM's through OEM vehicle dealerships. Asterisk (*) or Double Asterisk (**) indicates that the parts and/or labor information provided by MOTOR may have been modified or may have come from an alternate data source. Tilde sign (N) items indicate MOTOR Not-Included Labor operations. The symbol (<>) indicates the refinish operation WILL NOT be performed as a separate procedure from the other panels in the estimate. Non-Original Equipment Manufacturer aftermarket parts are described as AM, Qual Repl Parts or Comp Repl Parts which stands for Competitive Replacement Parts. Used parts are described as LKQ, Qual Recy Parts, RCY, or USED. Reconditioned parts are described as Recond. Recored parts are described as Recore. NAGS Part Numbers and Benchmark Prices are provided by National Auto Glass Specifications. Labor operation times listed on the line with the NAGS information are MOTOR suggested labor operation times. NAGS labor operation times are not included. Pound sign (#) items indicate manual entries. Some 2010 vehicles contain minor changes from the previous year. For those vehicles, prior to receiving updated data from the vehicle manufacturer, labor and parts data from the previous year may be used. The Pathways estimator has a complete list of applicable vehicles. Parts numbers and prices should be confirmed with the local dealership. CCC Pathways - A product of CCC Information Services Inc. 10/17/20119:11:20 AM 007438 Page 8 Supplement of Record Customer: Walterick, Linda D Vehicle: 2001 DODG GRAND CARAVAN 4X2 SPORT 4D VAN 6-3.3L-FI Red ALTERNATE PARTS SUPPLIERS Supplier: Keystone - NWCPP - A Location(s): 3221 ESPRESSO WAY, YORK PA 17406 Line Description 8 Qual Repl Parts NWCPP RT Fender Supplier: Keystone - NWPP Location(s): 3221 ESPRESSO WAY, YORK PA 17406 Line Description 12 Qual Repl Parts RT Fender liner Dodge (800) 524-4349 Item # CH1241228C (800) 524-4349 Item # CH1249113 (717) 843-8927 Price $ 135.00 (717) 843-8927 Price $ 35.00 10/17/20119:11:20 AM 007438 Page 9 f Supplement of Record Customer: Walterick, Linda D Vehicle: 2001 DODG GRAND CARAVAN 4X2 SPORT 4D VAN 6-3.3L-Fl Red ALTERNATE PARTS USAGE Year: 2001 Body Style: 4D VAN VIN: 2B4GP44371R248904 Mileage In: 119953 Make: DODG Engine: 6-3.3L-FI License: GVN-7800 Mileage Out: Model: GRAND CARAVAN 4X2 Production Date: 1/2001 State: PA Vehicle Out: SPORT Color: Red Int: Gray Condition: Good Job #: Alternate Part Type Selection Method # Of Times Notified Of Available Parts # Of Parts Selected ftermarket Automatically List 2 2 Optional OEM Automatically List 0 0 Reconditioned utomatically List 0 0 Recycled N/A 0 0 10/17/20119:11:20 AM 007438 Page 10 FILED-OFFICE File # N11-0016\mvg OF THE PROIHONOIAM' LAW OFFICES OF STEWART C. CRAWFORD BY: Stewart C. Crawford, Jr., Esquire Z014 APR 30 FM 53 ATTORNEY I.D. #202188 CUMBERLAND COUNTY 223 North Monroe Street PENNSYLVANIA P.O. BOX E Media, PA 19063 Telephone: (610) 565-7050 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NATIONWIDE AFFINITY INSURANCE : NO: 12-873 COMPANY OF AMERICA VS. GERALD LESEVER : IN CIVIL ACTION ORDER TO SATISFY TO THE PROTHONOTARY: Kindly mark the judgment SATISFIED, upon payment of your cost only. STEWART C. CRAWFORD, JR. Attorney for Plaintiff p d aW p� ea,sh 3&2o0