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Home My WebLink About12-2414"' t r ?r IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION ERIE INSURANCE GROUP, as CASE NO. 8vil subrogee for LAURA LAY and KEVIN LAY, CODE NO. Plaintiff, TYPE OF PLEADING: vs. COMPLAINT IN CIVIL ACTION WESTERN EXPRESS, INC., FILED ON BEHALF OF: Defendant. ERIE INSURANCE GROUP, as subrogee for LAURA LAY and KEVIN LAY, Plaintiff COUNSEL OF RECORD FOR THIS PARTY: GEORGE A. MILLER, ESQUIRE Pa. I.D. No. 22525 BROMBERG & MILLER FIRM I.D. No. 937 1030 Fifth Avenue, Suite 102 PITTSBURGH, PA 15219 File No: 58357 (412) 232-0440 LA Ck- t? 53bS tL?-a-7 39&T IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION ERIE INSURANCE GROUP, as subrogee for LAURA LAY and KEVIN LAY, Plaintiff, VS. WESTERN EXPRESS, INC., Defendant. No. COMPLAINT IN CIVIL ACTION AND NOW come(s) ERIE INSURANCE GROUP, as subrogee for LAURA LAY and KEVIN LAY, Plaintiff, by and through their attorney, GEORGE A. MILLER, ESQ., and BROMBERG & MILLER, Attorneys at Law, and file(s) the within COMPLAINT IN CIVIL ACTION as follows: The Plaintiff is Erie Insurance Group, an insurance group authorized to do business in Pennsylvania, whose business address is 100 Erie Insurance Place, Erie, PA 16590. 2. Defendant is Western Express, Inc., successor in interest to Smithway Motor Express (SMX), a business whose address is 7135 Centennial Place, Nashville, TN 37209. 3. The Plaintiff was at all times pertinent hereto the insurer of Laura Lay and Kevin Lay, Plaintiff's subrogors. 4. On or about April 12, 2011, an agent or employee of Western Express, Inc., or its predecessor, operating a tractor trailer motor vehicle, within the course and scope of his employment, northbound on Interstate 81, near Mile Marker 38, did negligently change from the right lane to the left lane oftraffic, thereby forcing the Plaintiff's subrogor driver, Laura Lay, to make an emergency maneuver to avoid a collision by driving into the median between the northbound and southbound lanes of Interstate 81. 5. Defendant Western Express, Inc., through its predecessor, negligently entrusted the operation of its motor vehicle to a driver whose negligence is more specifically described below: a. In failing to exercise due care; b. In being inattentive; C. In failing to maintain control of motor vehicle; d. In failing to check all lanes of traffic before making a lane change on the Interstate highway; e. In failing to maintain a proper lookout for the road conditions then and there in existence; and f. In failing to stop and render assistance at the scene of an accident. 6. As a direct and proximate result of the negligence of the Defendant, Plaintiff's subrogors sustained damages to their motor vehicle totaling Seven Thousand Two Hundred and Thirteen Dollars and Eighty-three Cents ($7,213.83). 3 7. Pursuant to a policy of insurance between Plaintiff and its subrogors, Plaintiff paid said amount, less any deductible, to or on behalf of Plaintiffs subrogors, and has a legal enforceable interest in subrogation in this matter. 8. Demand has been made upon the Defendant for payment, including the subrogors' deductible, which demand has been refused. 9. Attached hereto are repair estimates and a copy of the Police Accident Investigation, collectively identified as Exhibit "A," which Plaintiff intends to offer at trial pursuant to Pa. R.C.P. Rule 1305. The vehicle was repaired. WHEREFORE, the Plaintiff, Erie Insurance Group, demands judgment against the Defendant in the sum of Seven Thousand Two Hundred and Thirteen Dollars and Eighty-three Cents ($7,213.83), together with costs of suit. Respectfully submitted, BROMBERG & MILLER BY: GEORGE A. MILLER, Esquire Erie Insurance Group, as subrogee for Laura Lay and Kevin Lay, Plaintiff 3 VERIFICATION l/7`/'tee kC'%The undersigned, does hereby verify that he/she is the l t illi of C1 , Plaintiff J hisein, that he/she is authorized to make this verification on behalf of the Plaintiff, and that the facts contained in the foregoing COMPLAINT IN CIVIL ACTION are true and correct to the best of his/her knowledge and belief. This statement is made subject to the penalties of 18 Pa.C.S. Section 4904 relating to unworn falsification to authorities. ERIE INSURANCE GROUP By: tv Title File No. 58357 04/18/2011 AT 04:47 PM Req: MEHALICK H 010171151168001 ERIE INSURANCE GROUP HARRISBURG CLAIMS OFFICE 4901 LOUISE DRIVE P.O. BOX 2013 MECHANICSBURG, PA 17055 (717)245-9826 FAX: (717)240-0696 ESTIMATE OF RECORD WRITTEN BY: DAVID SWARNER #135102 04/18/2011 04:39 PM ADJUSTER: DAVID SWARNER #135102 INSURED: KEVIN & LAURA A LAY OWNER: KEVIN & LAURA A LAY ADDRESS: 493 CENTERVILLE RD NEWVILLE, PA 17241 CELLULAR: (717)226-4509 INSPECT HIPPENSTEEL'S AUTO LOCATION: 457 CENTERVILLE RD NEWVILLE, PA 17241 CLAIM #010171151168001 POLICY #Q040805098 DATE OF LOSS: 04/12/2011 AT 07:45 AM TYPE OF LOSS: COLLISION POINT OF IMPACT: 21. UNDERCARRIAGE REPAIR SUBWAY AUTO BODY FACILITY: 1231 RITNER HIGHWAY CARLISLE, PA 17013 1998 VW BEETLE TDI 4-1.9L-TD 2D CPE BLACK INT: VIN: 3VWBF61CXWM049289 LIC: ESP-7723 PA PROD AIR CONDITIONING REAR DEFOGGER CRUISE CONTROL TELESCOPIC WHEEL KEYLESS ENTRY ALARM DUAL MIRRORS CONSOLE/STORAGE POWER STEERING POWER BRAKES POWER LOCKS POWER MIRRORS POWER TRUNK/GATE RELEASE AM RADIO STEREO CASSETTE DRIVER AIR BAG PASSENGER AIR BAG CLOTH SEATS BUCKET SEATS 5 SPEED TRANSMISSION OVERDRIVE FULL WHEEL COVERS DAY: (717)776-3433 OTHER BUSINESS: (717)243-9978 21 DAYS TO REPAIR LICENSE # 251854056 DATE: 07/1998 ODOMETER: 163536 TILT WHEEL INTERMITTENT WIPERS TINTED GLASS CLEAR COAT PAINT POWER WINDOWS HEATED MIRRORS FM RADIO SEARCH/SEEK 4 WHEEL DISC BRAKES RECLINE/LOUNGE SEATS ALUMINUM/ALLOY WHEELS NO. OP. ------------- DESCRIPTION - QTY --------- -EXT.-PRICE- ------- LABOR ------ PAINT--- 1 FRONT BUMPER & GRILLE------ ----- ----------- ------- --------- 2 O/H FRONT BUMPER N 3** REPL A/M CAPA BUMPER COVER 1 198.00 4.1 INCL 2 8 4 ADD FOR CLEAR COAT . . 5 6 REPL TOW EYE CAP 1 11.50 INCL. 1.1 2 0 ADD FOR CLEAR COAT , 7** REPL A/M LOWER GRILLE W10 FOG LAMPS 1 43 00 INCL 0.1 8 RADIATOR SUPPORT . . N 9 REPL RADIATOR SUPPORT 1 145.00 S 4.2 1.0 1 Req: MEHALICK H 04/18/2011 AT 04:47 PM 010171151168001 ESTIMATE OF RECORD 1998 VW BEETLE TDI 4-1.9L-TD 2D CPE BLACK INT: NO. OP. DESCRIPTION ---------- QTY ----------------- EXT. PRICE LABOR ---------- PAINT 10 --- AIM HEADLAMPS ------ ------- --------- M 0.5 --- 11 EVACUATE & RECHARGE 1.4 M 12* REPL CENTER SHIELD MANUAL TRANS * 1 180.00 0.3 13 REPL RT SIDE COVER 1 45.30 0.3 14 REPL LT SIDE COVER 1 68.50 0.3 15 COOLING 16** REPL A/M RADIATOR 1 140.00 MINCL 17# REPL ANTIFREEZE/COOLANT- GAL 1 14.00 . T 18* REPL USED RT FAN ASSY +25% 1 43.75 MINCL * 19** REPL A/M INTERCOOLER TO VIN 1 248.00 . M 1.5 M 1CX460490 20# REPL OIL 5 12.50 21 REPL INTERCOOLER BRACKET 1 24.00 22 REPL AIR DUCT 1 51.90 M 0 3 23 AIR CONDITIONER & HEATER . 24* REPL USED CONDENSER ASSY +251k 1 56.25 MINCL * 25# REPL R134 FREON 1 30.00 . T 26# RPR AC COMPRESSOR PLUG 0.3 M 27 WHEELS 28 R&I RT/REAR R&I WHEEL M 0 1 29# TIRE MOUNT/BALANCE & CLEAN 1 20.00 . T BEAD 30# SUBL FOUR WHEEL ALIGNMENT 1 89.95 T 31 PILLARS, ROCKER & FLOOR 32* RPR RT ROCKER PANEL TO VIN S 5.0* 1 5 104403541 . 33 ADD FOR CLEAR COAT 34* RPR LT ROCKER PANEL TO VIN S 7.0* 0.6 1 5 1C4403541 . 35 OVERLAP MAJOR NON-ADJ. PANEL -0 2 36 ADD FOR CLEAR COAT . 37 QUARTER PANEL 0.3 38 REPL RT STONE GUARD TO VIN 1 24.00 0.2 104403519 C141 _ MISC. 1 4;# CLEAN UNDERCARRIAGE 1 41# FLEX AGENT (PER PANEL) 1 12 00 1.0 T 42# GRAVEL GUAURD 1 . 434 HAZARDOUS WASTE 1 5.00 T 0.8 44# ****************************** 1 ****************************** 45# AGREED PRICE/ (4) DAYS RENTAL 1 CYCLE TIME 46# WITH OWNER & JOHN ® REPAIR 1 SHOPS 47# ****************************** 1 ****************************** 2 04/18/2011 AT 04:47 PM Req: MEHALICK H 010171151168001 ESTIMATE OF RECORD 1998 VW BEETLE TDI 4-1.9L-TD 2D CPE BLACK INT: ---------- NO. ---------- ------------------------------------ OP. DESCRIPTION ----------------------------------- ------ QTY --------------------------- EXT. PRICE LABOR PAINT 48 - OTHER CHARGES ------ --------------------------- 49# TOWING 1 132.00 50# STORAGE 7 140.00 51# ---------- 2AND TOW TO SHOP --------------------------------- 1 75.00 --- SUBTOTALS =_> ------ --------------------------- 1809.65 26.5 9.7 LINE 3 LABOR: TIME INCLUDES R&R FENDERS, WHEELHOUSE LINER, HEADLAMPS, AND SIGNAL/MARKER LAMPS AS OUTLINED IN MANUFACTURERS BODY MANUAL. TIME IS FOR OVERHAUL. LINE 9 LABOR: TIME INCLUDES R&I/R&R RADIATOR, CONDENSER, LOCK SUPPORT, BUMPER REINFORCEMENT, FILLER PANEL, D&R OF HOOD RELEASE CABLE AND FRONT WIRING AS NECESSARY. TIME IS AFTER BUMPER COVER AND FENDERS AS AN ASSEMBLY ARE REMOVED. TIME DOES NOT INCLUDE R&I/R&R OF INTERCOOLER, INTAKE DUCT, AIR INLET, PRESSURE TUBES, PRESSURE HOSE OR AIR DUCT ON TURBO EQUIPT MODEL. REFINISH TIME IS PROVIDED FOR THOSE INSTANCES WHEN REQUIRED COLOR IS NOT AVAILABLE OR FOR SOME REPAIR SITUATIONS. LINE 18 SUPPLIERS PART DESCRIPTION: R.,MOTOR ONLY DUAL FAN R. LINE 24 SUPPLIERS PART DESCRIPTION: COOLING FAN MOTOR ONLY; 1.9L, 2.OL, A/C CONDENSER 2.0, PARTS 1291.70 BODY LABOR 23.3 HRS m$ 46.00/HR 1071.80 PAINT LABOR 9.7 HRS Q$ 46.00/HR 446.20 MECHANICAL LABOR 3.2 HRS ®$ 50.00/HR 160.00 PAINT SUPPLIES 9.7 HRS ®$ 26.00/HR 252.20 SUBLET/MISC. 170.95 OTHER CHARGES ------------------- - 347.00 SUBTOTAL ------ ----- ---- --------- $ -------- 3739.85 SALES TAX $ 3392.85 @ 6.0000% 203.57 TOTAL COST OF REPAIRS $ 3943.42 ADJUSTMENTS: DEDUCTIBLE 500.00 ---------------------------------------------------- TOTAL ADJUSTMENTS $ 500.00 NET COST OF REPAIRS $ 3443.42 04/18/2011 AT 04:47 PM Req: MEHALICK H 010171151168001 ESTIMATE OF RECORD 1998 VW BEETLE TDI 4-1.9L-TD 2D CPE BLACK INT: VEHICLE OWNER MUST AUTHORIZE ALL REPAIRS. ERIE INSURANCE RESERVES THE RIGHT TO REINSPECT ALL SUPPLEMENTS BEFORE PAYMENT IS MADE. THIS IS NOT AN AUTHORIZATION TO REPAIR. 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 SUCH 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 DS PART=DIAMOND STANDARD PART DS ASSY=DIAMOND STANDARD ASSEMBLY 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 RELY=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. 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. 4 04/18/2011 AT 04:47 PM Req: MEHALICK H ESTIMATE OF RECORD 010171151168001 1998 VW BEETLE TDI 4-1.9L-TD 2D CPE BLACK INT: RECYCLED PART COSTS BASED ON INFORMATION PROVIDED BY CAR-PART.COM. FOR ASSISTANCE, CALL CCC AT 800-637-8511. ESTIMATE BASED ON MOTOR CRASH ESTIMATING GUIDE. UNLESS OTHERWISE NOTED ALL ITEMS ARE DERIVED FROM THE GUIDE ERA9210, CCC DATA DATE 04/01/2011, 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 (-) ITEMS INDICATE MOTOR NOT-INCLUDED LABOR OPERATIONS. 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 CCC ONE ESTIMATOR HAS A COMPLETE LIST OF APPLICABLE VEHICLES. PARTS NUMBERS AND PRICES SHOULD BE CONFIRMED WITH THE LOCAL DEALERSHIP. 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: MOTOR ABBREVIATIONS/SYMBOLS: D=DISCONTINUED PART A=APPROXIMATE PRICE LABOR TYPES: 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 PATHWAYS: 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 NAGS=NATIONAL AUTO GLASS SPECIFICATIONS 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/_SYMBOLS: #=MANUAL LINE ENTRY *=OTHER IE..MOTORS DATABASE INFORMATION WAS CHANGED **=DATABASE LINE WITH AFTERMARKET N=NOTES ATTACHED TO LINE. OPT OEM=ORIGINAL EQUIPMENT MANUFACTURER PARTS EITHER OPTIONALLY SOURCED OR OTHERWISE PROVIDED WITH SOME UNIQUE PRICING OR DISCOUNT. NWCPP=NATIONWIDE CRASH PARTS PROGRAM. CCC PATHWAYS - A PRODUCT OF CCC INFORMATION SERVICES INC. 5 04/18/2011 AT 04:47 PM Req: MEHALICK H 010171151168001 ESTIMATE OF RECORD 1998 VW BEETLE TDI 4-1.9L-TD 2D CPE BLACK INT: RECYCLED PART SUPPLIERS LINE LINE DESCRIPTION PRICE 24 USED CONDENSER ASSY +25%- STOCK NO.: 100489 $ 56.25 CARLISLE AUTO & TRUCK SALVAGE, (717)238-1500 10 GASOLINE ALLEY FRED SCHMIDT CARLISLE, PA 17015 18 USED RT FAN ASSY +25$ STOCK NO.: $XK838 $ 43.75 LKQ - MIDWEST (866)557-2677 OH,IN,PA,MI,MD,IN,IL,WI,MN,IO LKQ CALL CENTER AKRON, OH 44306 6 04/18/2011 AT 04:47 PM Req: MEHALICK H 010171151168001 ESTIMATE OF RECORD 1998 VW BEETLE TDI 4-1.9L-TD 2D CPE BLACK INT: ALTERNATE PARTS SUPPLIERS 3 A/M CAPA BUMPER COVER 7 A/M LOWER GRILLE W/O FOG LA KEYSTONE - COMPLETE 320 DOBSON ST. WINDBER, PA 15963 KEYSTONE - COMPLETE 3658 ROUTE 378 BETHLEHEM, PA 18015 KEYSTONE - COMPLETE 3221 ESPRESSO WAY YORK, PA 17406 KEYSTONE - COMPLETE 433 LAWRENCE STREET OLD FORGE, PA 18518 16 A/M RADIATOR 19 A/M INTERCOOLER TO VIN 1CX4 PERFORMANCE RADIATOR-PA2 4322 BERMUDA STREET PHILADELPHIA, PA 19124 PART NO. VW1000134C PART NO. VW1200128 (800)438-2510 (814)467-5531 (800)441-4200 (610)866-0313 (800)524-4349 (717)843-8927 (800) 446-7066 (570)457-6464 PART NO. 2241 PRICE 140.00 PART NO. 660007 PRICE 248.00 (877)723-4286 (215)533-7237 PRICE 198.00 PRICE 43.00 7 04/18/2011 AT 04:47 PM Req: MEHALICK H 010171151168001 ESTIMATE OF RECORD 1998 VW BEETLE TDI 4-1.9L-TD 2D CPE BLACK TNT: ALTERNATE PARTS USAGE AFTERMARKET PARTS AFTERMARKET SELECTION METHOD: AUTOMATICALLY LIST NO. OF TIMES USER WAS NOTIFIED THAT AN AFTERMARKET PART WAS AVAILABLE: 6 NO. OF AFTERMARKET PARTS THAT APPEAR IN THE FINAL ESTIMATE: 4 OPTIONAL OEM PARTS OPTIONAL OEM SELECTION METHOD: MANUALLY LIST NO. OF TIMES USER WAS NOTIFIED THAT AN OPTIONAL OEM PART WAS AVAILABLE: 0 NO. OF OPTIONAL OEM PARTS THAT APPEAR IN THE FINAL ESTIMATE: 0 RECONDITIONED PARTS RECONDITIONED SELECTION METHOD: AUTOMATICALLY LIST NO. OF TIMES USER WAS NOTIFIED THAT A RECONDITIONED PART WAS AVAILABLE: 1 NO. OF RECONDITIONED PARTS THAT APPEAR IN THE FINAL ESTIMATE: 0 RECYCLED PARTS NO. OF TIMES USER WAS NOTIFIED THAT A RECYCLED PART WAS AVAILABLE: 8 NO. OF RECYCLED PARTS THAT APPEAR IN THE FINAL ESTIMATE: 2 8 07/12/2013- Claims Management System CSPP032B 07:20 Check Print Page: 1 Req: MEHALICK H -------------------------------------------------------------------------------- CHECK NO 1IF76916 CMS NO KF76916 DATE 04/19/2011 Pay THREE THOUSAND FOUR HUNDRED FORTY-THREE AND 42/100 KEVIN G LAY & $$$$$$3,443.42 LAURA A LAY Operator Loss Date To The 493 CENTERVILLE RD 932STORM 04/12/2011 Order NEWVILLE PA 17241-9584 of Claim Tax Id No 017-010171151168 For PAYMENT OF COLLISION DAMAGES 1998 VW BEETLE - ESTIMATE Cashed C 05/23/2011 ------------------------------------------------------------------------------- CHECK NO 11G54540 CMS NO KG54540 DATE 05/11/2011 Pay SEVEN HUNDRED TWENTY AND 00/100 ENTERPRISE RENT-A-CAR PENRAC, INC To The PO BOX 840086 Order KANSAS CITY, MO 64184 0086 of Operator 932STEELE Claim 017-010171151168 $$$$$$$$720.00 Loss Date 04/12/2011 Tax Id No 5216906650 For 57MA-006453/D737416-5710--001 TRANSPORTATION EXPENSE - COLLISION Cashed C 05/16/2011 AA-500 TX Incident Number: H02-2019806 Crash involves: C j' 0 Fatality C N!A 0 Work Zone Commonwealth of Pennsylvania PAGE 1 Police Crash Report REPORTABLE CRASH CI Hit and Run ?? Commercial Vehicle G State Police Vehicle Local Police Vehicle 0 ATV 0 Snowmobile Commonwealth Vehicle Local Gov Vehicle M Agency Name Case Closed Patrol Zone Investigation Date T PA STATE POLICE - CARLISLE NO 71 04/12(2011 _--_..-__ _. c Dispatch Time 'Arrival Time Invest[ ator Badye Number is 08:01 hrs. 08:01 hrs. ANDRYKA, ANDREW M 10761 Approval Date Reviewer Reviewer Badge Number d 04118/2011 _ AMMONS, DAWN R 08496 Date of Crash [Time of Crash 04/12/2011 08:00 Day of the Week (Crash Description hrs. 1 TUESDAY NON-COLLISION County Municipality CUMBERLAND PENN TWP 2 Weather Conditions Relation to Roadvray o r RAIN ON TRAVEL LANES m Illumination Road Surface Conditions v DAYLIGHT WET # of Units # of People of Injured Killed EMS Agency Medical Facility 002 002 001 000 NONE NONE School Bus Related School Zone Related PennDOT Notified (Type of Intersection Special Location NO NO _ NO MIDBLOCK NOTAPPLICABLE Work Zone Work Zone Type Where in Work Zone c NO Speed Limit Workers Present Officer Present Work Zone Characteristics -- - - -- -- -- -- ° Road Closed Work on Shoulder E] Lane Closure Intermittent or Flagger ? or Medi ith D t ? w an e our ol ? Other Moving Work ? Control V 0 Route Signing Route Number Segment Number Travel Lanes Speed Limit Orientation w INTERSTATE(NOTTURNPIKE) 0081 02 65MPH NORTH a House Number Street Name St. Ending ` 1 81 HIGHWAY a _ d Route Signing Route Number Segment Number ravel Lanes Speed Limit Orientation - - Used in Intersection _ d Crashes Street Name St. Ending 21 Route Number jOr Mile Post enths Or Segment marker Ramp Use Only Feet A E m c v .8 Street Name St Y reet Endin 9 Or Miles enths -r E 0 19 STATE HWY 3015 HIGHWAY pp 5 N Route Number Or Mile Post enths Or Segment Marker Ramp Use Only -- d M The above entry is the R w Strel et Name distance from the Crash Street Ending ^ b j CONNECTING ROAD ROAD Scene to Landmark 1 _ N n Latitude: Degrees 40 Minutes 08 Seconds 41 Decimal Lon itude Degrees Minutes Seconds Decimal ? 550 g : 77 19 14 368 o Traffic Control Device Traffic Control Functioning NOT APPLICABLE NO CONTROLS = J Lane Closed NOTAPPLICABLE Lane Closure Direction Traffic Detoured Estimated Time Closed Environmental ! Roadway Potential Factors (E/R) Factor 1 NONE Fact or 2 Factor 3 `o First Harmful Event in the Crash Most Harmful Event in the Crash Unit Number armful Event Unit Number armful Event 001 OTHER NON-COLLISION 001 OTHER NON-COLLISION indicated Prime Factor it Number Prime Factor Driver Action c DRIVER ACTION 001 CARELESS PASSING OR LANE CHANGE w Prime Factor EnviromentallRoadway Prime Factor Vehicle Failure Prime Factor Pedestrian Action Road Surface Type Special Jurisdiction Printed At: PA State Police - Carlisle 10/28/201102:44 PM Page 1 Form #: H02-2019806 AA-500 TX Incident Number: H0 2-2 01 980 6 Commonwealth of Pennsylvania PAGE 2 Crash Involves: Police Crash Report REPORTABLE CRASH : DUI ` Fatality */ Hit and Run Commercial Vehicle ??0 State Police Vehicle Local Police Vehicle CJ N/A C) Work Zone O ATV 0 Snowmobile `) Commonwealth Vehicle 01 Local Gov Vehicle Unit Number ype Unit Commercial Vehicle 001 Hit & Run Vehicle Yes First Name MI Last Name Suffix DOB Telephone Number 99/9911999 Street Address City State Zip Code Gender License Number License State Class Expiration Date O ner/Driver 0 U UNKNOWN ZZ UNKNOWN R Driver Presence Physical Condition Primary Vehicle Code Violation Person Charged £ 0 HITAND RUN UNKNOWN VC3334 NO Alcohol/Drugs Suspected I h l T t T co o es ype Alcohol Test Results UNKNOWN TEST NOT GIVEN Driver Action CARELESS PASSINGOR LANECHANGE d jZ Pedestrian Action Pedestrian Signals Pedestrian Clothing Pedestrian Location D _ 1st Harmful Event Lett or P.ight Side Most Harmful Utility Pole Number OTHER NON-COLLISION YES 2nd Harmful Event Left or Right Side Most Harmful Utility Pole Number 3rd Harmful Event Left or Right Side Most Harmful Utility Pole Number 4th Harmful Event Left or Right Side Most Harmful Utility Pole Number Owner First Narne Owner MI Owner Last Name or Business Name Suffix Street Address City State Zip Code Vehicle Type ;Special Usage Government Equipment Number LARGE TRUCK UNKNOWN Model Year Vehicle Make Vehicle Model ehicle Color VIN ( UNKNOWN WHITE License Plate Reg. State Est. Speed Vehicle Towed Towed By 2Z 055 NO Insurance Insurance Company Policy Number Expiration Date NO e ° Direction of Travel Vehicle Position Vehicle Movement Initial Impact Point p NORTH RIGHT OF TRAFFICWAY CHANGING LANES OR MERGING NON-COLLISION € Damage Indicator Gradient Road Alignment Possible Vehicle Failures `c UNKNOWN LEVEL STRAIGHT UNKNOWN v z # of Units Type Unit 1 a Number g Tag Year ag State V > 1 UNKNOWN UNKNOWN 2099 ZZ .4 Unit Make Unit Owner ? UNKNOWN UNKNOWN S Type Unit 2 ag Number Tag Year Tag State I Unit Make Unit Owner Engine Size Passenger? Saddle Bag/Trunk? Trailer? Driver Education? m cc i `o Driver Helmet Type elmet Stayed On? DOT/Snell Designation? Eye Protection? Long Sleeves? Long Pants? ver Ankle Boots? 0 Passenger Helmet Type elmet Stayed On? DOT/Snell Designation? Eye Protection? Long Sleeves? Long Pants? Over Ankle Boots? a v Passenger? Helmet? _ d Head Lights? Rear Refl ectors. a Printed At: PA State Police - Carlisle 10128/201102:44 PM Page 2 Form #: H02-2019806 AA-500 TX Incident Number: H02-2019806 Commonwealth of Pennsylvania PAGE 3 Crash Involves: Police Crash Report REPORTABLE CRASH DUN L Fatality 0 Hit and Run L) Commercial Vehicle O State Police Vehicle ` Local Police Vehicle 0 NIA 0 Work Zone 0 ATV 0 Snowmobile Commonwealth Vehicle Local Gov Vehicle Unit Number We Unit Commercial Vehicle 002 Motor Vehicle in Transport No First Name MI Last Name Suffix DOB Telephone Number LAURA A LAY 11/24/1969 (717) 226-4509 Street Address City State Zip Code 493 CENTERVILLE RD. NEWVILLE PA 17241 Gender License Number License State Class Expiration Date 10vmer/Driver 0 FEMALE 21978911 PA C 11/25/2013 PRIVATE VEHICLE OWNED/LEASED BY DRIVER Driver Presence Physical Condition Primary Vehicle Code Violation Person Charged E DRIVER OPERATED VEHICLE APPARENTLY NORMAL NONE No o _ Alcohol/Drugs Suspected cohol Test Type Alcohol Test Results NO TEST NOT GIVEN r ' a DriverAdion NO CONTRIBUTING ACTION d Pedestrian Action P edestrian Signals Pedestrian Clothing Pedestrian Location o - I st Harmful Event Left or Right Side Most Harmful Utility Pole Number HIT EMBANKMENT LEFT YES 2nd Harmful Event Left or Right Side Most Hammful Utility Pole Number 3rd Harmful Event Left or Right Side Most Harmful Utility Pole Number 4th Harmful Event Left or Right Side Most Harmful Utility Pole Number Owner First Name Owner MI Owner Last Name or Business Name Suffix LAURA A LAY Street Address city State Zip Code 493 CENTERVILLE RD. _ NEWVILLE PA 17241 Vehicle Type Special Usage Government Equipment Number AUTOMOBILE NOTAPPLICABLE Model Year Vehicle Make 1998 IVOLKSWAGEN Vehicle Model ehicle Color IN BUG BLACK 3VWBF61CXWM049289 License Plate Reg. State Est. Speed ehicle Towed Towed By ESP-7723 PA 055 YES HIPPENSTEEL'S TOWING Insurance Insurance Company Policy Number Expiration Date YES ERIE INSURANCE 0040805098H 10/08/2011 c Direction of Travel Vehicle Position Vehicle Movement I - nitial Impact Point a NORTH LEFT OF TRAFFICWAY GOING STRAIGHT NON-COLLISION Damage Indicator Gradient Road Alignment Possible Vehicle Failures 2 DISABLING LEVEL STRAIGHT NONE m M # of Units Type Unit 1 Tag Number Tag Year ag State 0 d ? w Unit Make Unit Owner c Type Unit 2 ag Number Tag Year Tag State Unit Make Unit Comer Engine Size Passenger? Saddle Bag/Trunk? Trailer? Driver Education? m cc Driver Helmet Type elmet Stayed On? DOT/Snell Designation? Eye Protection? Long Sleeves? Long Pants? Over Ankle Boots? E i Passenger Helmet Type Helmet Stayed On? DOT/Snell Designation? Eye Protection? Long Sleeves? Long Pants? Over Ankle Boots? 2 Passenger? Helmet? u _ Head Lights? Rear Reflectors? a Printed At: PA State Police -Carlisle 10/28/201102:44 PM Page 3 Form #: H02-2019806 AA-500 TX Incident Number: H02-2019806 Crash Involves. Ci DUI l Fatality 0 N/A C Work Zone Commonwealth of Pennsylvania PAGE 4 Police Crash Report REPORTABLE CRASH n* Hit and Run Commercial Vehicle State Police Vehicle `D Local Police Vehicle 0 ATV ? Snowmobile L Commonwealth Vehicle Local Gov Vehicle Unit Number Number of Axles Carrier Name Phone Number 01 99 SMX (999) 999-9999 Street Address City State Zip Code UNKNOWN UNKNOWN ZZ 99999-9999 u Cargo Body Type Vehicle Configuration GVWR Oversize Load USDOT Number ICC Number PUC Number Hazardous Materials V NO 99999999 NO Z HazMat Class 1 Release Indicator I E u HazMat Class 2 Release Indicator 2 HazMat Class 3 Release Indicator 3 HazMat Class 4 Release Indicator 4 Unit # Person No. First Name MI Last Name Suffix DOB 001 001 99!99/1999 Street Address city State Zip Code Phone Number EMS Transport Person Type Gender Injury Severity E o - NO DRIVER U UNKNOWN IF INJURY Seat Position Safety Equipment 1 m a DRIVER-ALL VEHICLES UNKNOWN d _ Safety Equipment 2 Extrication NONE USED/ NOT APPLICABLE NOTAPPLICABLE Ejection Ejection Path NOT APPLICABLE NOT EJECTEDMOT APPLICABLE U^R Pe soson No. IF r t Name M, La,t N m, - - eStrtfix DOB 002 002 1 LAURA A LAY 11124/1969 Street Address City State Zip Code = 493 CENTERVILLE RD. NEWVILLE PA 17241 16 Phone Number EMS Transport Person Type Gender Injury Severity (717) 226-4509 NO DRIVER FEMALE MINOR INJURY c Seat Position Safety Equipment 1 d DRIVER -ALL VEHICLES LAP AND SHOULDER BELT USED a d Safety Equipment 2 Extrication AIR BAG NOT DEPLOYED - UNK SWITCH SETTING NOTAPPLICABLE Ejection Ejection Path NOT APPLICABLE NOT EJECTED/NOT APPLICABLE J First Name MI Last Name Suffix Phone Number N W JOHN _ E GATTEN (717) 329-6724 3 Street Address City State ip Code 58 SOUTH HIGH ST. NEWVILLE PA 17241 Printed At: PA State Police - Carlisle 10/28/201102:44 PM Page 4 Form #: H02-2019806 AA-500 TX Incident Number: H02-2019806 Commonwealth of Pennsylvania PAGE 5 Crash Involves: Police Crash Report REPORTABLE CRASH L DUI ` Fatality Hit and Run Commercial Vehicle 0 State Police Vehicle ` Local Police Vehicle ": N/A 0, Work Zone n ATV Snowmobile C Commonwealth Vehicle Local Gov Vehicle Exit 37 (Nevwile) approxin- 2 miles Interstate81 MM 38 65 MPH southbound CV E - v R o Jcw ? --Unit #2 - ?? , ,° Unit #11 - - - - -- - - - C14 -- -- - - Unit #1 1 nterstate 81 MM 38 65 MPH northbound J NARRATIVE Crash Synopsis This crash occurred as Unit #1 was traveling northbound on Interstate 81 at MM38 in the right hand lane. Unit #2 was traveling northbound on Interstate 81 at MM38 in the left hand lane beside Unit #1. Unit #1 attempted to change lanes, causing Unit #2 to travel off of the roadway, down over the median. Unit #2 received moderate damage and was towed from the scene by Hippensteel's Towing. The operator of Unit #2 was wearing a seat belt and received minor injury. Unit #1, was a tractor trailer with SMX on the trailer and continued northbound on 181. Crash Details This crash occurred as Unit #1 was traveling northbound on Interstate 81 at MM 38 in the right hand lane. Unit #2 was traveling northbound on Interstate 81 at MM38 in the left hand lane beside Unit #1. Unit #1attempted to change lanes ely Printed At: PA State Police -Carlisle 10128/201102:44 PM Page 5 Form #: H02-2019806 AA-500 TX Incident Number: H02-2019806 Commonwealth of Pennsylvania PAGE 6 Crash Involves: .11 Police Crash Report REPORTABLE CRASH ti DUI 0 Fatality *J Hit and Run * Commercial Vehicle L State Police Vehicle IJ Local Police Vehicle C,I N/A. n Work Zone G ATV C Snowmobile 0, Commonwealth Vehicle Cj Local Gov Vehicle from the right lane into the left lane, causing Unit #2 to travel off of the roadway and down over the median. Physical evidence at the scene consisted of approximately 75 feet of tire marks in the median from Unit #2. There was also visible undercarriage damage to Unit #2. There was debris from the median in the left hand lane of the southbound lanes. On 04112/11 at approximately 0800 hrs. I was on stationary patrol sifting on Interstate 81 at MM41 crossover. At that time, witness, GATTEN pulled into the crossover and stated that a tractor trailer ran Unit #2 off of the roadway and Unit #2 traveled down over an embankment. As GATTEN was pulling into the crossover, I viewed a tractor trailer pull off to the right side of the roadway and GATTEN pointed to the tractor trailer pulling off of the roadway. I viewed that it was a white tractor with a white trailer, with the letters "SMX" on the side of the trailer. After speaking to GATTEN briefly at the crossover, I started southbound on Interstate 81 to check on the status of the occupants of Unit #2. On 04/12/11 at 0801 hrs. I arrived at the scene of the crash and viewed Unit #2 at final rest in the middle of the median facing southbound. On 04/12/11 at 0803 hrs. the operator of Unit #2, LAY was interviewed at the scene. LAY stated that she was traveling northbound on Interstate 81 at MM38 in the left hand lane. LAY stated that she was traveling approximately 55 MPH and was passing Unit #1. LAY stated that she was to approximately the cab on Uint #1, when Unit #1 started to come over into her lane. LAY stated that Unit #1 kept coming into her lane, causing her to travel further and further to the left, causing her to travel down over the median. LAY stated that her vehicle came to final rest in the southbound lanes of Interstate 81. LAY stated that she pulled into the median from the southbound lanes, to avoid being struck by traffic traveling southbound. LAY stated that she was wearing a seat belt and complained of pain to her left hand to the left side of her face. As I was pulling up to the scene, LAY was making arraignments with Hippensteel's Towing to remove her vehicle. GATTEN returned to the crash scene and was fully interviewed at the scene. GATTEN stated that he was traveling northbound on Interstate 81 at MM 38 in the right hand lane behind Unit #1. GATTEN stated that he viewed Unit #1 run Unit #2 off of the roadway. GATTEN stated that he continued to follow Unit #1, honking his horn and flashing his lights at it, attempting to get the driver's attention. GATTEN stated he then saw me sifting in the crossover and stopped and informed me of the crash. As I was at the scene of the crash, Tpr. Natalie A. WATKIN attempted to go to MM41 to speak to the operator of Unit #1. 1 was informed by Tpr. WATKIN that Unit #1 was no longer sifting along the roadway at MM41. A BOLO was put out to surrounding agencies looking for a white tractor trailer with SMX on the side of the trailer, with a negative result. A public news release was completed and a copy was placed in the attachment file. On 04/13111 at 1300 hrs. I located a telephone number for SMX. Printed At: PA State Police - Carlisle 10/281201102:44 PM Page 6 Form #: H02-2019806 AA-500 TX Incident Number: H02-2019806 Commonwealth of Pennsylvania PAGE 7 Crash Involves: Police Crash Report REPORTABLE CRASH C' DUI Fatality Hit and Run Commercial Vehicle State Police Vehicle ` Local Police Vehicle L NIA C, Work Zone 0 ATV C Snowmobile C, Commonwealth Vehicle Local Gov Vehicle I contacted Smithway Motors Xpress (SMX) at 800-316-7160 and left a voicemail with the claims manager in regards to this crash. Requesting to supplement this report pending speaking to the claims manager at SMX. Printed At: PA State Police - Carlisle 10/28/201102:44 PM Page 7 Form #: H02-2019806 10/13/2011 AT 03:35 PM 010171151168001 15633 OC290QA8 ERIE INSURANCE GROUP HARRISBURG CLAIMS OFFICE 4901 LOUISE DRIVE P.O. BOX 2013 MECHANICSBURG, PA 17055 (717)245-9826 FAX: (717)240-0696 SUPPLEMENT OF RECORD 1 WITH SUMMARY WRITTEN BY: DAVID SWARNER #135102 10/13/2011 03:35 PM ADJUSTER: DAVID SWARNER #135102 INSURED: KEVIN & LAURA A LAY CLAIM #010171151168001 OWNER: KEVIN & LAURA A LAY POLICY #Q040805098 ADDRESS: 493 CENTERVILLE RD DATE OF LOSS: 04/12/2011 AT 07:45 AM NEWVILLE, PA 17241 TYPE OF LOSS: COLLISION CELLULAR: (717)226-4509 POINT OF IMPACT: 21. UNDERCARRIAGE INSPECT HIPPENSTEEL'S AUTO DAY: (717)776-3433 LOCATION: 457 CENTERVILLE RD OTHER NEWVILLE, PA 17241 REPAIR SUBWAY AUTO BODY BUSINESS: (717)243-9978 FACILITY: 1231 RITNER HIGHWAY 21 DAYS TO REPAIR CARLISLE, PA 17013 LICENSE # 251854056 1998 VW BEETLE TDI 4-1.9L-TD 2D CPE BLACK INT: VIN: 3VWBF61CXWM049289 LIC: ESP-7723 PA PROD DATE: 07/1998 ODOMETER: 163536 AIR CONDITIONING REAR DEFOGGER TILT WHEEL CRUISE CONTROL TELESCOPIC WHEEL INTERMITTENT WIPERS KEYLESS ENTRY ALARM DUAL MIRRORS CONSOLE/STORAGE CLEAR COAT PAINT POWER STEERING POWER BRAKES POWER LOCKS POWER MIRRORS HEATED MIRRORS POWER TRUNK/GATE RELEASE AM RADIO FM RADIO STEREO CASSETTE SEARCH/SEEK DRIVER AIR BAG PASSENGER AIR BAG 4 WHEEL DISC BRAKES CLOTH SEATS BUCKET SEATS RECLINE/LOUNGE SEATS 5 SPEED TRANSMISSION OVERDRIVE FULL WHEEL COVERS TINTED GLASS POWER WINDOWS ALUMINUM/ALLOY W HEELS - NO• OP. --------------------- -------- DESCRIPTION ------------------ TY --------------- ------------ EXT. PRICE LABOR PAINT 1 ----------- FRONT BUMPER & GRILLE ---- ------------- ------- ------- 2 O/H FRONT BUMPER N 3**S01 REPL A/M CAPA BUMPER COVER 1 4.1 108.33* INCL 2 8 4 ADD FOR CLEAR COAT . . 5# S01 REPL SCREWS 2 1.00 INCL * 1.1 6 S01 REPL BUMPER COVER PROTECTOR 1 . 8.40 INCL 7 REPL 8 TOW EYE CAP 1 . 11.50 INCL. 0 2 ADD FOR CLEAR COAT . 9**SO1 REPL A/M LOWER GRILLE W/O FOG LAMPS 1 43 33* INCL 0.1 10 S01 REPL LOWER PANEL W/0 FOG LAMPS 1 . . 127.00 INCL. 1.1 1 10/13/2011 AT 03:35 PM 010171151168001 15633 OC290QA8 SUPPLEMENT OF RECORD 1 WITH SUMMARY 1998 VW BEETLE TDI 4-1.9L-TD 2D CPR BLACK INT: ------ NO. ------ ---- ----- ------ OP. ----- -------------------------------- DESCRIPTION ------------- ---- QTY --------------------------- EXT. PRICE LABOR PAINT 11 SO1 ------------------- ADD FOR CLEAR COAT ---- -------- ------------------- 0.4 12 S01 FRONT LAMPS 13 S01 REPL LT SIGNAL LAMP ASSY 1 54.00 INCL. 14 RADIATOR SUPPORT N 15* S01 REPL RADIATOR SUPPORT 1 153.00* S 4.2 1.0 16 AIM HEADLAMPS 0.5 17 EVACUATE & RECHARGE M 1.4 M 18* REPL CENTER SHIELD MANUAL TRANS * 1 180.00 0.3 19* S01 REPL RT SIDE COVER 1 50.00* 0.3 20 REPL LT SIDE COVER 1 68.50 0.3 21 COOLING 22* * REPL A/M RADIATOR 1 140.00 MINCL. 234 REPL ANTIFREEZE/COOLANT- GAL 1 14.00 T 24 SO1 REPL RT RADIATOR UPPER BRACKET 1 11.64 25 Sol REPL RT RADIATOR LOWER BRACKET 1 8.40 26* REPL USED RT FAN ASSY +25% 1 43.75 MINCL * 27 S01 REPL LOWER HOSE 1 62.00 M 0.6 28 S01 DEDUCT FOR OVERLAP -0.2 29 S01 REPL INTERCOOLER TO VIN ICX460490 1 300.00 M 1.5 304 REPL OIL 5 12.50 31 REPL INTERCOOLER BRACKET 1 24.00 32* S01 REPL AIR DUCT 1 56.00* M 0.3 33* S01 REPL A/M SERPENTINE BELT W/AC +25%* 1 41.99* M 0 7 34 AIR CONDITIONER & HEATER . 35**SO1 REPL A/M CONDENSER ASSY 1 160.00* MINCL 36# REPL R134 FREON 1 30.00 . T 37* S01 REPL USED COMPRESSOR 1 187.50* M 1 8* 38 SO1 DEDUCT FOR OVERLAP . -0 3 39# S01 REPL AC COMPRESSOR PLUG 1 13.50 . 0 3 M 40 S01 FENDER . 41 SO1 REPL RT STONE GUARD UPPER 2 12.80 0 2 42 SO1 REPL LT STONE GUARD UPPER 2 12.80 . 0 2 43 SOl ELECTRICAL . 44* SO1 R&I ALTERNATOR 120 AMP NEW M * 45# SC1 SUBL REBUILD ALTERNATOR + 25% 1 275 00 1.5 T 46 WHEELS . 47 R&I RT/REAR R&I WHEEL 48# TIRE MOUNT/BALANCE & CLEAN 1 20.00 M 0.1 T BEAD 49# S01 SUBL TWO WHEEL ALIGNMENT +25% 1 48 75 T 50 SO1 FRONT SUSPENSION . 51# S01 REPL BRAKE PINS 2 40 00 52# S01 REPL A/M BRAKE BOLTS +25% 2 . 56 86 53# SO1 SUBL ADJUST CALIPER PINS +25% 1 . 32 50 T 54* 55# S01 S0 REPL RT KNUCKLE 1 . 318.00 MINCL * * 1 SUBL CHANGE KNUCKLE +25% 1 32 50 T 56 * N ** S01 REPL A/M RT BEARING ASSY +25% * 1 . 51.11* MINCL * 57 SO1 REPL A/M LT BEARING ASSY +25% * 2 102.22* . MINCL.* 2 10/13/2011 AT 03:35 PM 010171151168001 15633 OC290QA8 SUPPLEMENT OF RECORD 1 WITH SUMMARY 1998 VW BEETLE TDI 4-1.9L-TD 2D CPE BLACK INT: ------ NO. ------ ---------- OP. ---------- -------------------------------- DESCRIPTION ---- --- QTY -------------------- EXT. PRICE LABOR -------- PAINT 58# S01 SUBL ---------------------------- CHANGE BEARINGS +25% --- 1 ---------- 65.00 ---------- T -------- N 59**SO1 REPL A/M RT STRUT +25% * 1 222.11* M 1.3 60 S01 DEDUCT FOR OVERLAP -0.5 N 61**SO1 REPL A/M LT STRUT +25% * 1 222.11* M 1.3 62 PILLARS, ROCKER & FLOOR 63* RPR RT ROCKER PANEL TO VIN S 5.0* 1.5 1C4403541 64 ADD FOR CLEAR COAT 0.6 65* RPR LT ROCKER PANEL TO VIN S 7.0* 1.5 1C4403541 66 OVERLAP MAJOR NON-ADJ. PANEL -0.2 67 ADD FOR CLEAR COAT 0.3 68 QUARTER PANEL 69 REPL RT STONE GUARD TO VIN 1 24.00 0.2 1C4403519 70# MISC. 1 71# CLEAN UNDERCARRIAGE 1 1.0 72# FLEX AGENT (PER PANEL) 1 12.00 T 73# GRAVEL GUAURD 1 0.8 74# HAZARDOUS WASTE 1 5.00 T 75# ***************wwwwwwwwwwwwwww 1 wwwwwwwwwwwwwwwwwwwwwwwwwwwwww 764 AGREED PRICE/ (4) DAYS RENTAL 1 CYCLE TIME 77# WITH OWNER & JOHN Q REPAIR 1 SHOPS 78# wwwwwwwwwwwwwwwwwwwwwwwwwwwwww 1 wwwwwwwwwwwwwwwwwwwwwwwwwwwwww 79 OTHER CHARGES 80# TOWING 1 132.00 81# STORAGE 7 140.00 82# 2AND TOW TO SHOP ------------------------ 1 75.00 ----- SUBTOTALS =_> ---- --------- 3810.10 ----------- 33.1 ------- 11.2 LINE 3 : LABOR: TIME INCLUDES R&R FENDERS, WHEELHOUSE LINER, HEADLAMPS AND SIGNAL/ MARKER , LAMPS AS OUTLINED IN MANUFACTURERS BODY MANUAL. TIME IS FOR OVERHAUL. 3 10/13/2011 AT 03:35 PM 010171151168001 15633 OC290QA8 SUPPLEMENT OF RECORD 1 WITH SUMMARY 1998 VW BEETLE TDI 4-1.9L-TD 2D CPE BLACK INT: LINE 15 : LABOR: TIME INCLUDES R&I/R&R RADIATOR, CONDENSER, LOCK SUPPORT, BUMPER REINFORCEMENT, FILLER PANEL, D&R OF HOOD RELEASE CABLE AND FRONT WIRING AS NECESSARY. TIME IS AFTER BUMPER COVER AND FENDERS AS AN ASSEMBLY ARE REMOVED. TIME DOES NOT INCLUDE R&I/R&R OF INTERCOOLER, INTAKE DUCT, AIR INLET, PRESSURE TUBES, PRESSURE HOSE OR AIR DUCT ON TURBO EQUIPT MODEL. REFINISH TIME IS PROVIDED FOR THOSE INSTANCES WHEN REQUIRED COLOR IS NOT AVAILABLE OR FOR SOME REPAIR SITUATIONS. LINE 26 : SUPPLIERS PART DESCRIPTION: COOLING FAN MOTOR ONLY; 1.9L, 2.OL, R.,MOTOR ONLY DUAL FAN R. LINE 57 2AND BEARING NEEDED DUE TO KNUCKLE REPLACEMENT LINE 59 COMPLETE ASSYS W/UPPER BEARING LINE 61 COMPLETE ASSYS W/UPPER BEARING PARTS 2928.35 BODY LABOR 31.4 HRS @$ 46.00/HR 1444.40 PAINT LABOR 11.2 HRS @$ 46.00/HR 515.20 MECHANICAL LABOR 1.7 HRS @$ 50.00/HR 85.00 PAINT SUPPLIES 11.2 HRS @$ 26.00/HR 291.20 SUBLET/MISC. 534.75 OTHER CHARGES ------------------- 347.00 SUBTOTAL ------- ----- --- ---------- $ -------- 6145.90 SALES TAX $ 5798. 90 @ 6.0000°% 347.93 TOTAL COST OF REPAIRS $ 6493.83 ADJUSTMENTS: DEDUCTIBLE 500.00 ---------------------------------------------------- TOTAL ADJUSTMENTS $ 500.00 NET COST OF REPAIRS $ 5993.83 VEHICLE OWNER MUST AUTHORIZE ALL REPAIRS. ERIE INSURANCE RESERVES THE RIGHT TO REINSPECT ALL SUPPLEMENTS BEFORE PAYMENT IS MADE. THIS IS NOT AN AUTHORIZATION TO REPAIR. 4 10/13/2011 AT 03:35 PM 010171151168001 15633 OC290QA8 SUPPLEMENT OF RECORD 1 WITH SUMMARY 1998 VW BEETLE TDI 4-1.9L-TD 2D CPE BLACK INT: 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 SUCH 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 DS PART=DIAMOND STANDARD PART DS ASSY=DIAMOND STANDARD ASSEMBLY EST=ESTIMATE EXT. PRICE=UNIT PRICE MULTIPLIED BY THE QUANTITY INCL=INCLUDED MISC=MISCELLANEOUS NON-ADJ=NON ADJACENT 0/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. 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 '.CHE 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. RECYCLED PART COSTS BASED ON INFORMATION PROVIDED BY CAR-PART.COM. FOR ASSISTANCE, CALL CCC AT 800-637-8511. 10/13/2011 AT 03:35 PM 010171151168001 15633 OC290QA8 SUPPLEMENT OF RECORD 1 WITH SUMMARY 1998 VW BEETLE TDI 1-1.9L-TD 2D CPE BLACK INT: ESTIMATE BASED ON MOTOR CRASH ESTIMATING GUIDE. UNLESS OTHERWISE NOTED ALL ITEMS ARE DERIVED FROM THE GUIDE ERA9210, CCC DATA DATE 09/01/2011, 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 (-) ITEMS INDICATE MOTOR NOT-INCLUDED LABOR OPERATIONS. 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 20:10 VEHICLES CONTAIN MINOR CHANGES FROM THE PREVIOUS YEAR. FOR THOSE VEHICLES, PRIOR TO RECEIVING UPDATED DATA FROM THE VEHICLE MANUFACTURER, LABOR AND PARTS DATA FROM THE PREVIOUS YEAR MAY BE USED. THE CCC ONE ESTIMATOR HAS A COMPLETE LIST OF APPLICABLE VEHICLES. PARTS NUMBERS AND PRICES SHOULD BE CONFIRMED WITH THE LOCAL DEALERSHIP. 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: MOTOR ABBREVIATIONS/SYMBOLS: D=DISCONTINUED PART A=APPROXIMATE PRICE LABOR TYPES: 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 PATHWAYS: ADJ=ADJACENT ALGN=ALIGN A/M=AFTERMARKET BLND=BLEND CAPA=CERTIFIED AUTOMOTIVE PARTS ASSOCIATION NSF=NSF INTERNATIONAL CERTIFIED PART D&R=DISCONNECT AND RECONNECT EST=ESTIMATE EXT. PRICE=UNIT PRICE MULTIPLIED BY THE QUANTITY INCL==INCLUDED MISC=MISCELLANEOUS NAGS=NATIONAL AUTO GLASS SPECIFICATIONS 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/ SYMBOLS: #=MANUAL LINE ENTRY *=OTHER (IE..MOTORS DATABASE INFORMATION WAS CHANGED] **=DATABASE LINE WITH AFTERMARKET N=NOTES ATTACHED TO LINE. OPT OEM=ORIGINAL EQUIPMENT MANUFACTURER PARTS EITHER OPTIONALLY SOURCED OR OTHERWISE PROVIDED WITH SOME UNIQUE PRICING OR DISCOUNT. NWCPP=NATIONWIDE CRASH PARTS PROGRAM. CCC PATHWAYS - A PRODUCT OF CCC INFORMATION SERVICES INC. 10/13/2011 AT 03:35 PM 010171151168001 15633 OC290QAB SUPPLEMENT OF RECORD 1 WITH SUMMARY 1998 VW BEETLE TDI 4-1.9L-TD 2D CPE BLACK INT: -- -- ---- NO. ---- ----- ----- ----- OP. ----- -------------------------------- DESCRIPTION ----------- ---- QTY ----------------- EXT. PRICE LABOR ---------- PAINT --------------------- ------- CHANGED ITEMS------- ---- -------- --------- ---------- - 2** REPL A/M CAPA BUMPER COVER 1 -198.00 INCL. -2.8 N 3**SO1 REPL A/M CAPA BUMPER COVER 1 108.33* INCL. 2.8 6** REPL A/M LOWER GRILLE W/O FOG LAMPS 1 -43.00 INCL. 9* *SO1 REPL A/M LOWER GRILLE W/O FOG LAMPS 1 43.33* INCL. N 8 REPL RADIATOR SUPPORT 1 -145.00 S -4.2 -1.0 N 15* S01 REPL RADIATOR SUPPORT 1 153.00* S 4.2 1.0 12 REPL RT SIDE COVER 1 -45.30 -0.3 19* S01 REPL RT SIDE COVER 1 50.00* 0.3 21 REPL AIR DUCT 1 -51.90 M -0.3 32* S01 REPL AIR DUCT 1 56.00* M 0.3 25# RPR AC COMPRESSOR PLUG -0.3 M 39# S01 REPL AC COMPRESSOR PLUG 1 13.50 0.3 M 29# SUBL FOUR WHEEL ALIGNMENT 1 -89.95 T 49# S01 SUBL TWO WHEEL ALIGNMENT +25% 1 48.75 T ------- DELETED ITEMS ------- 19** REPL A/M INTERCOOLER TO VIN 1 1CX460490 -248.00 M -1.5 M 24* REPL USED CONDENSER ASSY +25% 1 -56.25 MINCL.* ------- ADDED ITEMS ------- 5# SD1 REPL SCREWS 2 1.00 INCL. 6 SDl REPL BUMPER COVER PROTECTOR 1 8.40 INCL. 10 S01 REPL LOWER PANEL W/O FOG LAMPS 1 127.00 INCL. 1.1 11 S01 ADD FOR CLEAR COAT 0.4 12 S01 FRONT LAMPS 13 SO1 REPL LT SIGNAL LAMP ASSY 1 54.00 INCL. 24 SOl REPL RT RADIATOR UPPER BRACKET 1 11.64 25 SOl REPL RT RADIATOR LOWER BRACKET 1 8.40 27 S01 REPL LOWER HOSE 1 62.00 M 0.6 28 S01 DEDUCT FOR OVERLAP -0.2 29 S01 REPL INTERCOOLER TO VIN :LCX460490 1 300.00 M 1.5 33* S01 REPL A/M SERPENTINE BELT W/AC +25%* 1 41.99* M 0.7 35**SO1 REPL A/M CONDENSER ASSY 1 160.00* MINCL 37* S01 REPL USED COMPRESSOR 1 187.50* . M 1.8* 38 S01 DEDUCT FOR OVERLAP -0 3 40 S01 FENDER . 41 S01 REPL RT STONE GUARD UPPER 2 12.80 0.2 42 S01 REPL LT STONE GUARD UPPER 2 12.80 0 2 43 S01 ELECTRICAL . 44* S01 R&I ALTERNATOR 120 AMP NEW M 1 5* 45# S01 SUBL REBUILD ALTERNATOR + 25% 1 275.00 . T 50 S01 FRONT SUSPENSION 51# S01 REPL BRAKE PINS 2 40.00 52# S01 REPL A/M BRAKE BOLTS +25% 2 56 86 53# S01 SUBL ADJUST CALIPER PINS +25% 1 . 32.50 T 54* S01 REPL RT KNUCKLE 1 318.00 MINCL * 55# S01 SUBL CHANGE KNUCKLE +25% 1 32.50 T 56** S01 REPL A/M RT BEARING ASSY +25% * 1 51.11* MINCL.* 7 10/13/2011 AT 03:35 PM 010171151168001 15633 OC290QA8 SUPPLEMENT OF RECORD 1 WITH SUMMARY 1998 VW BEETLE TDI 4-1.9L-TD 2D CPE BLACK INT: ----------- NO. ------ OP. ------- ---------------------- DESCRIPTION ------ QTY --------------------------- EXT. PRICE LABOR PAINT ----------- N 57**S01 ------ REPL ------- A/M LT ---------------------- BEARING ASSY +25% ------ * 2 --------- 102.22* ------------------ MINCL.* 58# S01 SUBL CHANGE BEARINGS +25% 1 65.00 T N 59**SO1 REPL A/M RT STRUT +25% * 1 222.11* M 1.3 60 S01 DEDUCT FOR OVERLAP -0.5 N 61**SO1 ----------- REPL ------ A/M LT ------- STRUT +25% --------- * 1 222.11* M 1.3 ------------- SUBTOTALS =_> ------ --------- 2000.45 ------------------ 6.6 1.5 LINE 3 : LABOR: TIME INCLUDES R&R FENDERS, WHEELHOUSE LINER, HEADLAMPS, AND SIGNAL/MARKER LAMPS AS OUTLINED IN MANUFACTURERS BODY MANUAL. TIME IS FOR OVERHAUL. LINE 15 : LABOR: TIME INCLUDES R&I/R&R RADIATOR, CONDENSER, LOCK SUPPORT, BUMPER REINFORCEMENT, FILLER PANEL, D&R OF HOOD :RELEASE CABLE AND FRONT WIRING AS NECESSARY. TIME IS AFTER BUMPER COVER AND FENDERS AS AN ASSEMBLY ARE REMOVED. TIME DOES NOT INCLUDE R&I/R&R OF INTERCOOLER, INTAKE DUCT, AIR INLET, PRESSURE TUBES, PRESSURE HOSE OR AIR DUCT ON TURBO EQUIPT MODEL. REFINISH TIME IS PROVIDED FOR THOSE INSTANCES WHEN REQUIRED COLOR IS NOT AVAILABLE OR FOR SOME REPAIR SITUATIONS. LINE 57 2AND BEARING NEEDED DUE TO KNUCKLE REPLACEMENT LINE 59 COMPLETE ASSYS W/UPPER BEARING LINE 61 : COMPLETE ASSYS W/UPPER BEARING PARTS 1636.65 BODY LABOR 8.1 HRS @$ 46.00/HR 372.60 PAINT LABOR 1.5 HRS @$ 46.00/HR 69.00 MECHANICAL LABOR -1.5 HRS @$ 50.00/HR -75.00 PAINT SUPPLIES 1.5 HRS @$ 26.00/HR 39.00 SUBLET/MISC. 363.80 SUBTOTAL $ 2406.05 SALES TAX $ 2406.05 @ 6.0000% 144.36 TOTAL SUPPLEMENT AMOUNT $ 2550.41 NET COST OF SUPPLEMENT $ 2550.41 8 10/13/2011 AT 03:35 PM 15633 010171151168001 OC290QA8 SUPPLEMENT OF RECORD 1 WITH SUMMARY 1998 VW BEETLE TDI •4-1.9L-TD 2D CPE BLACK INT: ESTIMATE 3943.42 DAVID SWARNER SUPPLEMENT S01 2550.41 DAVID SWARNER -------- TOTAL ADJUSTMENTS $ 500.00 WORKFILE TOTAL $ 6493.83 NET COST OF REPAIRS $ 5993.83 VEHICLE OWNER MUST AUTHORIZE ALL REPAIRS. ERIE INSURANCE RESERVES THE RIGHT TO REINSPECT ALL SUPPLEMENTS BEFORE PAYMENT IS MADE. THIS IS NOT AN AUTHORIZATION TO REPAIR. 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 SUCH 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=CER'T'IFIED AUTOMOTIVE PARTS ASSOCIATION D&R=DISCONNECT AND RECONNECT DS PART=DIAMOND STANDARD PART DS ASSY=DIAMOND STANDARD ASSEMBLY EST=ESTIMATE EXT. PRICE=UNIT PRICE MULTIPLIED BY THE QUANTITY INCL=INCLUDED MISC=MISCELLANEOUS NON-ADJ=NON ADJACENT 0/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. 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. 10/13/2011 AT 03:35 PM 010171151168001 15633 OC290QA8 SUPPLEMENT OF RECORD 1 WITH SUMMARY 1998 VW BEETLE TDI •4-1.9L-TD 2D CPE BLACK INT: 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. RECYCLED PART COSTS BASED ON INFORMATION PROVIDED BY CAR-PART.COM. FOR ASSISTANCE, CALL CCC AT 800-637-8511. 10 10/13/2011 AT 03:35 PM 010171151168001 15633 OC290QA8 SUPPLEMENT OF RECORD 1 WITH SUMMARY 1998 VW BEETLE TDI 4-1.9L-TD 2D CPE BLACK INT: ESTIMATE BASED ON MOTOR CRASH ESTIMATING GUIDE. UNLESS OTHERWISE NOTED ALL ITEMS ARE DERIVED FROM THE GUIDE ERA9210, CCC DATA DATE 09/01/2011, 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 (-) ITEMS INDICATE MOTOR NOT-INCLUDED LABOR OPERATIONS. 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 CCC ONE ESTIMATOR HAS A COMPLETE LIST OF APPLICABLE VEHICLES. PARTS NUMBERS AND PRICES SHOULD BE CONFIRMED WITH THE LOCAL DEALERSHIP. 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: MOTOR ABBREVIATIONS/SYMBOLS: D=DISCONTINUED PART A=APPROXIMATE PRICE LABOR TYPES: 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 PATHWAYS: ADJ=ADJACENT ALGN=ALIGN A/M=AFTERMARKET BLND=BLEND CAPA=CERTIFIED AUTOMOTIVE PARTS ASSOCIATION NSF=NSF INTERNATIONAL CERTIFIED PART D&R=DISCONNECT AND RECONNECT EST=ESTIMATE EXT. PRICE=UNIT PRICE MULTIPLIED BY THE QUANTITY INCL=INCLUDED MISC=MISCELLANEOUS NAGS=NATIONAL AUTO GLASS SPECIFICATIONS 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/_SYMBOLS: #=MANUAL LINE ENTRY 'k =OTHER [IE..MOTORS DATABASE INFORMATION_WAS CHANGED] **=DATABASE LINE WITH AFTERMARKET N=NOTES ATTACHED TO LINE. OPT OEM=ORIGINAL EQUIPMENT MANUFACTURER PARTS EITHER OPTIONALLY SOURCED OR OTHERWISE PROVIDED WITH SOME UNIQUE PRICING OR DISCOUNT. NWCPP=NATIONWIDE CRASH PARTS PROGRAM. CCC PATHWAYS - A PRODUCT OF CCC INFORMATION SERVICES INC. 11 10/13/2011 AT 03:35 PM 010171151168001 15633 OC290QA8 SUPPLEMENT OF RECORD 1 WITH SUMMARY 1998 VW BEETLE TDI 4-1.9L-TD 2D CPE BLACK INT: RECYCLED PART SUPPLIERS LINE LINE DESCRIPTION PRICE 26 USED RT FAN ASSY +25% STOCK NO.: $XK838 $ 43.75 LKQ - MIDWEST (866)557-2677 OH,IN,PA,MI,MD,IN,IL,WI,MN,IO LKQ CALL CENTER FT. WRIGHT, KY 41017 12 10/13/2011 AT 03:35 PM 15633 SUPPLEMENT OF RECORD 1 WITH SUMMARY 1998 VW BEETLE TDI 4-1.9L-TD 2D CPE BLACK INT: 010171151168001 OC290QA8 ALTERNATE PARTS SUPPLIERS 3 A/M CAPA BUMPER COVER 9 A/M LOWER GRILLE W/O FOG LA KEYSTONE - COMPLETE 320 DOBSON ST. WINDBER, PA 15963 KEYSTONE - COMPLETE 3658 ROUTE 378 BETHLEHEM, PA 18015 PART NO. VW1000134C PART NO. VW1200128 (800)438-2510 (814)467-5531 PRICE 108.33 PRICE 43.33 KEYSTONE - COMPLETE 3221 ESPRESSO WAY YORK, PA 17406 KEYSTONE - COMPLETE 433 LAWRENCE STREET OLD FORGE, PA 18518 22 A/M RADIATOR 35 A/M CONDENSER ASSY PERFORMANCE RADIATOR-PA2 4322 BERMUDA STREET PHILADELPHIA, PA 19124 (800)441-4200 (610)866-0313 (800)524-4349 (717)843-8927 (800)446-7066 (570)457-6464 PART NO. 2241 PART NO. 4932 (877)723-4286 (215)533-7237 PRICE 140.00 PRICE 160.00 13 I 10/13/2011 AT 03:35 PM 010171151168001 15633 OC290QA8 SUPPLEMENT OF RECORD 1 WITH SUMMARY 1998 VW BEETLE TDI 4-1.9L-TD 2D CPE BLACK INT: ALTERNATE PARTS USAGE AFTERMARKET PARTS AFTERMARKET SELECTION METHOD: AUTOMATICALLY LIST NO. OF TIMES USER WAS NOTIFIED THAT AN AFTERMARKET PART WAS AVAILABLE: 12 NO. OF AFTERMARKET PARTS THAT APPEAR IN THE FINAL ESTIMATE: 8 OPTIONAL OEM PARTS OPTIONAL OEM SELECTION METHOD: MANUALLY LIST NO. OF TIMES USER WAS NOTIFIED THAT AN OPTIONAL OEM PART WAS AVAILABLE: 0 NO. OF OPTIONAL OEM PARTS THAT APPEAR IN THE FINAL ESTIMATE: 0 RECONDITIONED PARTS RECONDITIONED SELECTION METHOD: AUTOMATICALLY LIST NO. OF TIMES USER WAS NOTIFIED THAT A RECONDITIONED PART WAS AVAILABLE: 2 NO. OF RECONDITIONED PARTS THAT APPEAR IN THE FINAL ESTIMATE: 0 RECYCLED PARTS NO. OF TIMES USER WAS NOTIFIED THAT A RECYCLED PART WAS AVAILABLE: 8 NO. OF RECYCLED PARTS THAT APPEAR IN THE FINAL ESTIMATE: 2 14 Stephen E. Geduldig, Esquire E-mail: seduldig@tthlaw.com Attorney I.D. No. 43530 (717) 237-7119 Jason C. Giurintano, Esquire E-mail: jiuOntano@tthlaw.com Attorney I.D. No. 891777 (717) 237-7157 THOMAS, THOMAS & HAFER, LLP 305 North Front Street Post Office Box 999 Harrisburg, Pennsylvania 17108-0999 FAX (717) 237-7105 t- FLED Y r : , HE PRCTfjON' r ? 2012 MA y I I PM 2: 19 CUMBERLAND COUNT'l, PENNSYLVANIA Attorneys for Defendant: WESTERN EXPRESS, INC. ERIE INSURANCE GROUP, as subrogee for LAURA LAY and KEVIN LAY, Plaintiffs V. WESTERN EXPRESS, INC., Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNA NO. 12-2414 CIVIL JURY TRIAL DEMANDED PRAECIPE FOR ENTRY OF APPEARANCE TO THE PROTHONOTARY: Please enter the appearance of Stephen E. Geduldig, Esquire, Jason C. Giurintano, Esquire, and Thomas, Thomas & Hafer, LLP, as attorneys for Defendant, Western Express, Inc., in the above-captioned matter, reserving our right to answer or otherwise plead to Plaintiffs' Complaint. Respectfully 1087541 THOMAS, LLP STEPHEN E DULDIG, ESQUIRE Attorney o. 43530 By: JASON C. GIURINTANO, ESQUIRE Attorney I.D. No. 89177 Attorneys for Defendant, WESTERN EXPRESS, INC. J ERIE INSURANCE GROUP, as subrogee for LAURA LAY and KEVIN LAY, Plaintiffs V. WESTERN EXPRESS, INC., Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNA NO. 12-2414 CIVIL JURY TRIAL DEMANDED CERTIFICATE OF SERVICE I hereby certify that a true and correct copy of the foregoing ENTRY OF APPEARANCE was served by depositing the sam the United States Mail, postage prepaid, at Harrisburg, Pennsylvania, on the 1 day of May, 2012, on all counsel of record as follows: George A. Miller, Esquire BROMBERG & MILLER 103o Fifth Avenue, Suite 102 Pittsburgh, Pennsylvania 15219 Attorneys for Plaintiffs 1087624.1 THOMAS, THO" & HAFER, LLP Jason C. Giurin)&_W Esquire • ?. f d I i i ir' J _ ? ti tF 1 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION ERIE INSURANCE GROUP, as subrogee for LAURA LAY and KEVIN LAY, CASE NO. 12-2414 Civil CODE NO. Plaintiff, vs. WESTERN EXPRESS, INC., by and through JOHN DOE, an unidentified individual, TYPE OF PLEADING: AMENDED COMPLAINT IN CIVIL ACTION FILED ON BEHALF OF: ERIE INSURANCE GROUP, Defendant. as subrogee for LAURA LAY and KEVIN LAY, Plaintiff COUNSEL OF RECORD FOR THIS PARTY: GEORGE A. MILLER, ESQUIRE Pa. I.D. No. 22525 BROMBERG & MILLER FIRM I.D. No. 937 1030 Fifth Avenue, Suite 102 PITTSBURGH, PA 15219 File No: 58357 (412) 232-0440 7 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION ERIE INSURANCE GROUP, Case No. 12-2414 Civil as subrogee for LAURA LAY and KEVIN LAY, Plaintiff, VS. WESTERN EXPRESS, INC., by and through JOHN DOE, an unidentified individual, Defendant. 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 attorney and filing in writing with the court your defense 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 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 BRING 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. LAWYER REFERRAL SERVICE Cumberland County Bar Association 32 South Bedford Street Carlisle, PA 17013 (717) 249-3166 (800) 990-9108 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION ERIE INSURANCE GROUP, as subrogee for LAURA LAY and KEVIN LAY, No. 12-2414 Civil Plaintiff, VS. WESTERN EXPRESS, INC., by and through JOHN DOE, an unidentified individual., Defendant. AMENDED COMPLAINT IN CIVIL ACTION AND NOW come(s) ERIE INSURANCE GROUP, as subrogee for LAURA LAY and KEVIN LAY, Plaintiff, by and through their attorney, GEORGE A. MILLER, ESQ., and BROMBERG & MILLER, Attorneys at Law, and file(s) the within AMENDED COMPLAINT IN CIVIL ACTION as follows: 1. The Plaintiff is Erie Insurance Group, an insurance group authorized to do business in Pennsylvania, whose business address is 100 Erie Insurance Place, Erie, PA 16590. 2. Defendant is Western Express, Inc., successor in interest to Smithway Motor Xpress (SMX), a business whose address is 7135 Centennial Place, Nashville, TN 37209. I ' 3. John Doe is an adult individual whose identity is otherwise unknown, and who was at all relevant times the operator of a tractor-trailer motor vehicle marked SMX (Smithway Motor Xpress), a trucking company now integrated into Western Express, Inc., the within Defendant. 4. The Plaintiff was at all times pertinent hereto the insurer of Laura Lay and Kevin Lay, Plaintiff s subrogors. 5. On or about April 12, 2011, John Doe, an agent or employee of SMX (Smithway Motor Xpress) now known as Western Express, Inc., was operating a tractor trailer motor vehicle, within the course and scope of his employment, northbound on Interstate 81, near Mile Marker 38, and did negligently change from the right lane to the left lane of traffic, thereby forcing the Plaintiff s subrogor driver, Laura Lay, to make an emergency maneuver to avoid a collision by driving into the median between the northbound and southbound lanes of Interstate 81. 6. The actions of John Doe in operating the motor vehicle in such manner was negligent, both generally and in the following particulars: a. In failing to exercise due care; b. In being inattentive; C. In failing to maintain control of motor vehicle; d. In failing to check all lanes of traffic before making a lane change on the Interstate highway; e. In failing to maintain a proper lookout for the road conditions then and there in existence; and f. In failing to stop and render assistance at the scene of an accident. 2 y. 7. Defendant is responsible for the negligence of John Doe under the doctrine of respondeat superior. 8. As a direct and proximate result of the negligence aforedescribed, Plaintiff's subrogors sustained damages to their motor vehicle totaling Seven Thousand Two Hundred and Thirteen Dollars and Eighty-three Cents ($7,213.83). 9. Pursuant to a policy of insurance between Plaintiff and its subrogors, Plaintiff paid said amount, less any deductible, to or on behalf of Plaintiffs subrogors, and has a legal enforceable subrogation interest in this matter. 10. Demand has been made upon the Defendant for payment, including the subrogors' deductible, which demand has been refused. 11. Attached hereto are repair estimates and a copy of the Police Accident Investigation, collectively identified as Exhibit "A," which Plaintiff intends to offer at trial pursuant to Pa. R.C.P. Rule 1305. The vehicle was repaired. WHEREFORE, the Plaintiff, Erie Insurance Group, demands judgment against the Defendant in the sum of Seven Thousand Two Hundred and Thirteen Dollars and Eighty-three Cents ($7,213.83), together with costs of suit. Respectfully submitted, BROMBERG & MILLER BY: GEORGE A. MILLER, Esquire Erie Insurance Group, as subrogee for Laura Lay and Kevin Lay, Plaintiff 3 I VERIFICATION The undersigned, / Q 71 does hereby verify that he/she is the l'lOl Q S of /-1-l Plaintiff v herein, that he/she is authorized to make this verification on behalf of the Plaintiff, and that the facts contained in the foregoing AMENDED COMPLAINT IN CIVIL ACTION are true and correct to the best of his/her knowledge acid belief. This statement is made subject to the penalties of 18 Pa.C.S. Section 4904 relating to unworn falsification to authorities. ERIE INSURANCE GROUP ,. 4jl Title File No. 58357 04/18/2011 AT 04:47 PM Req: MEHALICK H 010171151168001 ERIE INSURANCE GROUP HARRISBURG CLAIMS OFFICE 4901 LOUISE DRIVE P.O. BOX 2013 MECHANICSBURG, PA 17055 (717)245-9826 FAX: (717)240-0696 ESTIMATE OF RECORD WRITTEN BY: DAVID SWARNER #135102 04/18/2011 04:39 PM ADJUSTER: DAVID SWARNER #135102 INSURED: KEVIN & LAURA A LAY OWNER: KEVIN & LAURA A LAY ADDRESS: 493 CENTERVILLE RD NEWVILLE, PA 17241 CELLULAR: (717)226-4509 INSPECT HIPPENSTEEL'S AUTO LOCATION: 457 CENTERVILLE RD NEWVILLE, PA 17241 CLAIM #010171151168001 POLICY #Q040805098 DATE OF LOSS: 04/12/2011 AT 07:45 AM TYPE OF LOSS: COLLISION POINT OF IMPACT: 21. UNDERCARRIAGE DAY: (717)776-3433 OTHER REPAIR SUBWAY AUTO BODY FACILITY: 1231 RITNER HIGHWAY CARLISLE, PA 17013 BUSINESS: (717)243-9978 21 DAYS TO REPAIR LICENSE # 25185'4056 1998 VW BEETLE TDI 4-1.9L-TD 2D CPE BLACK INT: VIN: 3VWBF61CXWM AIR CONDITIONING 049289 LIC: ESP-7723 PA PROD DATE: 07/1998 ODOMETER: 163536 CRUISE CONTROL REAR DEFOGGER TELESCOPIC WHEEL TILT WHEEL KEYLESS ENTRY ALARM INTERMITTENT WIPERS DUAL MIRRORS CONSOLE/STORAGE TINTED GLASS POWER STEERING POWER BRAKES CLEAR COAT PAINT POWER LOCKS POWER MIRRORS POWER WINDOWS POWER TRUNK/GATE RELEASE AM RADIO HEATED MIRRORS STEREO CASSETTE FM RADIO DRIVER AIR BAG PASSENGER AIR BAG SEARCH/SEEK CLOTH SEATS BUCKET SEATS 4 WHEEL DISC BRAKES 5 SPEED TRANSMISSION OVERDRIVE RECLINE/LOUNGE SEATS FULL WHEEL COVERS ALUMINUM/ALLOY WHEELS ---NO--------OP-- ---------DESCRIPTION---- QTY EXT? PRICE LABOR---PAINT--- 1 ------- FRONT BUMPER & GRILLE - - --------------------- 2 O/H FRONT BUMPER N 3** REPL A/M CAPA BUMPER COVER 1 4.1 198 00 INCL 4 ADD FOR CLEAR COAT . . 2.8 5 REPL TOW EYE CAP 1 1.1 6 ADD FOR CLEAR COAT 11.50 INCL. 0,2 7** REPL A/M LOWER GRILLE W/O FOG LAMPS 1 0.1 43 00 INCL 8 RADIATOR SUPPORT . . N 9 REPL RADIATOR SUPPORT 1 145 00 S 4 2 1 . . 1.0 PLAW s EXHIBIT I 04/18/2011 AT 04:47 PM ESTIMATE OF RECORD 1998 VW BEETLE TDI 4-1.9L-TD 2D CPE BLACK INT: Req: MEHALICK H 010171151168001 NO. OP. DESCRIPTION - QTY ----------------- EXT. PRICE LABOR ---------- PAINT 10 --- AIM HEADLAMPS ------ ------- ---------- 0.5 -- 11 EVACUATE & RECHARGE M 1.4 M 12* REPL CENTER SHIELD MANUAL TRANS * 1 180.00 0.3 13 REPL RT SIDE COVER 1 45.30 0.3 14 REPL LT SIDE COVER 1 68.50 0.3 15 COOLING 16** REPL A/M RADIATOR 1 140.00 MINCL 17## REPL ANTIFREEZE/COOLANT- GAL 1 14.00 . T 18* REPL USED RT FAN ASSY +25W 1 43.75 MINCL.* 19** REPL A/M INTERCOOLER TO VIN 1 248.00 M 1.5 M 1CX460490 20# REPL OIL 5 12.50 21 REPL INTERCOOLER BRACKET 1 24.00 22 REPL AIR DUCT 1 51.90 M 0.3 23 AIR CONDITIONER & HEATER 24* REPL USED CONDENSER ASSY +25%- 1 56.25 MINCL * 25# REPL R134 FREON 1 30.00 . T 26# RPR AC COMPRESSOR PLUG 0.3 M 27 WHEELS 28 R&I RT/REAR R&I WHEEL M 0.1 29# TIRE MOUNT/BALANCE & CLEAN 1 20.00 T BEAD 30# SUBL FOUR WHEEL ALIGNMENT 1 89.95 T 31 PILLARS, ROCKER & FLOOR 32* RPR RT ROCKER PANEL TO VIN S 5.0* 1.5 104403541 33 ADD FOR CLEAR COAT 0 6 34* RPR LT ROCKER PANEL TO VIN S 7.0* . 1.5 IC4403541 35 OVERLAP MAJOR NON-ADJ. PANEL -0 2 36 ADD FOR CLEAR COAT . 0 3 37 QUARTER PANEL . 38 REPL RT STONE GUARD TO VIN 1 24.00 0.2 IC4403519 39# MISC. 1 40# CLEAN UNDERCARRIAGE 1 1 0 41# FLEX AGENT (PER PANEL) 1 12.00 . T 42# GRAVEL GUAURD 1 43# HAZARDOUS WASTE 1 5.00 T 0.8 44# ****************************** 1 ****************************** 45# AGREED PRICE/ (4) DAYS RENTAL 1 CYCLE TIME 464 WITH OWNER & JOHN ® REPAIR 1 SHOPS 474 ****************************** 1 ****************************** 2 04/18/2011 AT 04:47 PM Req: MEHALICK H 010171151168001 ESTIMATE OF RECORD 1998 VW BEETLE TDI 4-1.9L-TD 2D CPE BLACK INT: ---------- NO. --------- ------------------------------------ OP. DESCRIPTION ------------------------------------ ------ QTY --------------------------- EXT. PRICE LABOR PAINT - 48 OTHER CHARGES ------ --------------------------- 49# TOWING 1 132.00 50# STORAGE 7 140.00 51# --------- 2AND TOW TO SHOP ------------------------------ 1 75.00 - ------- SUBTOTALS ==> ----- --------------------------- 1809.65 26.5 9.7 LINE 3 LABOR: TIME INCLUDES R&R FENDERS, WHEELHOUSE LINER, HEADLAMPS, AND SIGNAL/MARKER LAMPS AS OUTLINED IN MANUFACTURERS BODY MANUAL. TIME IS FOR OVERHAUL. LINE 9 LABOR: TIME INCLUDES R&I/R&R RADIATOR, CONDENSER, LOCK SUPPORT, BUMPER REINFORCEMENT, FILLER PANEL, D&R OF HOOD RELEASE CABLE AND FRONT WIRING AS NECESSARY. TIME IS AFTER BUMPER COVER AND FENDERS AS AN ASSEMBLY ARE REMOVED. TIME DOES NOT INCLUDE R&I/R&R OF INTERCOOLER, INTAKE DUCT, AIR INLET, PRESSURE TUBES, PRESSURE HOSE OR AIR DUCT ON TURBO EQUIPT MODEL. REFINISH TIME IS PROVIDED FOR THOSE INSTANCES WHEN REQUIRED COLOR IS NOT AVAILABLE OR FOR SOME REPAIR SITUATIONS. LINE 18 : SUPPLIERS PART DESCRIPTION: COOLING FAN MOTOR ONLY; 1.9L, 2.OL, R.,MOTOR ONLY DUAL FAN R. LINE 24 : SUPPLIERS PART DESCRIPTION: A/C CONDENSER 2.0, PARTS 1291.70 BODY LABOR 23.3 HRS ?$ 46.00/HR 1071.80 PAINT LABOR 9.7 HRS le?$ 46.00/HR 446.20 MECHANICAL LABOR 3.2 HRS ?$ 50.00/HR 160.00 PAINT SUPPLIES 9.7 HRS ?$ 26.00/HR 252.20 SUBLET/MISC. 170.95 OTHER CHARGES ------------------- ---- 347.00 SUBTOTAL --- ----- ---- --------- $ -------- 3739.85 SALES TAX $ 3392. 85 @ 6.0000 203.57 TOTAL COST OF REPAIRS $ 3943.42 ADJUSTMENTS: DEDUCTIBLE 500.00 ---------------------------------------------------- TOTAL ADJUSTMENTS $ 500.00 NET COST OF REPAIRS $ 3443.42 , 04/18/2011 AT 04:47 PM Req: MEHALICK H 010171151168001 ESTIMATE OF RECORD 1998 VW BEETLE TDI 4-1.9L-TD 2D CPE BLACK INT: VEHICLE OWNER MUST AUTHORIZE ALL REPAIRS. ERIE INSURANCE RESERVES THE RIGHT TO REINSPECT ALL SUPPLEMENTS BEFORE PAYMENT IS MADE. THIS IS NOT AN AUTHORIZATION TO REPAIR. 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 SUCH 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 DS PART=DIAMOND STANDARD PART DS ASSY=DIAMOND STANDARD ASSEMBLY EST=ESTIMATE EXT. PRICE=UNIT PRICE MULTIPLIED BY THE QUANTITY INCL=INCLUDED MISC=MISCELLANEOUS NON-ADJ=NON ADJACENT 0/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. 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. 4 04/1$/2011 AT 04:47 PM Req: MEHALICK H ESTIMATE OF RECORD 010171151168001 1998 VW BEETLE TDI 4-1.9L-TD 2D CPE BLACK INT: RECYCLED PART COSTS BASED ON INFORMATION PROVIDED BY CAR-PART.COM. FOR ASSISTANCE, CALL CCC AT 800-637-8511. ESTIMATE BASED ON MOTOR CRASH ESTIMATING GUIDE. UNLESS OTHERWISE NOTED ALL ITEMS ARE DERIVED FROM THE GUIDE ERA9210, CCC DATA DATE 04/01/2011, 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 (-) ITEMS INDICATE MOTOR NOT-INCLUDED LABOR OPERATIONS. 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 CCC ONE ESTIMATOR HAS A COMPLETE LIST OF APPLICABLE VEHICLES. PARTS NUMBERS AND PRICES SHOULD BE CONFIRMED WITH THE LOCAL DEALERSHIP. 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: MOTOR ABBREVIATIONS/SYMBOLS: D=DISCONTINUED PART A=APPROXIMATE PRICE LABOR TYPES: 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 PATHWAYS: 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 NAGS=NATIONAL AUTO GLASS SPECIFICATIONS NON-ADJ=NON ADJACENT O/H=OVERHAUL OP=OPERATION NO=LINE NUMBER QTY=QUANTITY QUAL RELY=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/-SYMBOLS: #=MANUAL LINE ENTRY *=OTHER IE..MOTORS DATABASE INFORMATION WAS CHANGED **=DATABASE LINE WITH AFTERMARKET N=NOTES ATTACHED TO LINE. OPT OEM=ORIGINAL EQUIPMENT MANUFACTURER PARTS EITHER OPTIONALLY SOURCED OR OTHERWISE PROVIDED WITH SOME UNIQUE PRICING OR DISCOUNT. NWCPP=NATIONWIDE CRASH PARTS PROGRAM. CCC PATHWAYS - A PRODUCT OF CCC INFORMATION SERVICES INC. 5 04/18/2011 AT 04:47 PM Req: MEHALICK H 010171151168001 ESTIMATE OF RECORD 1998 VW BEETLE TDI 4-1.9L-TD 2D CPE BLACK INT: RECYCLED PART SUPPLIERS LINE LINE DESCRIPTION PRICE 24 USED CONDENSER ASSY +25W STOCK NO.: 100489 $ 56.25 CARLISLE AUTO & TRUCK SALVAGE, (717)238-1500 10 GASOLINE ALLEY FRED SCHMIDT CARLISLE, PA 17015 18 USED RT FAN ASSY +25W STOCK NO.: $XK838 $ 43.75 LKQ - MIDWEST (866)557-2677 OH,IN,PA,MI,MD,IN,IL,WI,MN,IO LKQ CALL CENTER AKRON, OH 44306 6 04/18/2011 AT 04:47 PM ESTIMATE OF RECORD 1998 VW BEETLE TDI 4-1.9L-TD 2D CPE BLACK INT: ALTERNATE PARTS SUPPLIERS 3 A/M CAPA BUMPER COVER 7 A/M LOWER GRILLE W/O FOG LA KEYSTONE - COMPLETE 320 DOBSON ST. WINDBER, PA 15963 KEYSTONE - COMPLETE 3658 ROUTE 378 BETHLEHEM, PA 18015 KEYSTONE - COMPLETE 3221 ESPRESSO WAY YORK, PA 17406 KEYSTONE - COMPLETE 433 LAWRENCE STREET OLD FORGE, PA 18518 16 A/M RADIATOR 19 A/M INTERCOOLER TO VIN 1CX4 PERFORMANCE RADIATOR-PA2 4322 BERMUDA STREET PHILADELPHIA, PA 19124 PART NO. VW1000134C PART NO. VW1200128 (800)438-2510 (814)467-5531 (800)441-4200 (610)866-0313 (800)524-4349 (717)843-8927 (800)446-7066 (570)457-6464 PART NO. 2241 PRICE 140.00 PART NO. 660007 PRICE 248.00 (877)723-4286 (215)533-7237 PRICE 198.00 PRICE 43.00 Req: MEHALICK H 010171151168001 7 04/18/2011 AT 04:47 PM Req: MEHALICK H ESTIMATE OF RECORD 010171151168001 1998 VW BEETLE TDI 4-1.9L-TD 2D CPE BLACK INT: ALTERNATE PARTS USAGE AFTERMARKET PARTS AFTERMARKET SELECTION METHOD: AUTOMATICALLY LIST NO. OF TIMES USER WAS NOTIFIED THAT AN AFTERMARKET PART WAS AVAILABLE: 6 NO. OF AFTERMARKET PARTS THAT APPEAR IN THE FINAL ESTIMATE: 4 OPTIONAL OEM PARTS OPTIONAL OEM SELECTION METHOD: MANUALLY LIST NO. OF TIMES USER WAS NOTIFIED THAT AN OPTIONAL OEM PART WAS AVAILABLE: 0 NO. OF OPTIONAL OEM PARTS THAT APPEAR IN THE FINAL ESTIMATE: 0 RECONDITIONED PARTS RECONDITIONED SELECTION METHOD: AUTOMATICALLY LIST NO. OF TIMES USER WAS NOTIFIED THAT A RECONDITIONED PART WAS AVAILABLE: 1 NO. OF RECONDITIONED PARTS THAT APPEAR IN THE FINAL ESTIMATE: 0 RECYCLED PARTS NO. OF TIMES USER WAS NOTIFIED THAT A RECYCLED PART WAS AVAILABLE: 8 NO. OF RECYCLED PARTS THAT APPEAR IN THE FINAL ESTIMATE: 2 8 07/12/2011 Claims Management System CSPP032B 07:20 Check Print Page: 1 Req: MEHALICK H ------------------------------------ CHECK NO 11F76916 CMS NO KF76916 DATE 04/19/2011 Pay THREE THOUSAND FOUR HUNDRED FORTY-THREE AND 42/100 KEVIN G LAY & LAURA A LAY To The 493 CENTERVILLE RD Order NEWVILLE PA 17241-9584 of Operator 932STORM Claim 017-010171151168 $$$$$$3,443.42 Loss Date 04/12/2011 Tax Id No For PAYMENT OF COLLIS ION-DAMAGES 1998 VW BEETLE - ESTIMATE C Cashed 05/23/2011 ----- ------------------------------------------------------------ CHECK NO 11G54540 CMS NO KG54540 DATE 05/11/2011 Pay SEVEN HUNDRED TWENTY AND 00/100 ENTERPRISE RENT-A-CAR PENRAC, INC To The PO BOX 840086 Order KANSAS CITY, MO 64184 0086 of Operator 932STEELE Claim 017-010171151168 $$$$$$$$720.00 Loss Date 04/12/2011 Tax Id No 5216906650 For 57MA-006453/D737416-5710--001 TRANSPORTATION EXPENSE - COLLISION Cashed C 05/16/2011 • , AA-504 7X Incident Number: H02-2019806 Commonwealth of Pennsylvania PAGE 1 Crash'in:olves: Police Crash Report REPORTABLE CRASH DUI 0 Fatality (:t% Hit and Run Commercial Vehicle C% State Police Vehicle ? Local Police Vehicle t N/A 0 Work Zone L, ATV 0 Snowmobile L, Commonwealth Vehicle ?i Local Gov Vehicle 2 7 Agency Name o Case Closed PA STATE POLICE - CARLISLE Patrol Zone Investigation Date _ NO 71 04/12/2011 c Dispatch Time Arrival Time Investigator -i_ -- Badge Number a 08:01 hrs. 08:01 hrs. ANDRYKA, ANDREW M 10761 Approval Date Reviewer Reviewer Badge Number 7 3 CL 0411812011 AMMONS, DAWN R 08496 Date of Crash Time of Crash Day of the Week Crash Description 04112/2011 08:00 hrs. TUESDAY NON-COLLISION County Municipality CUMBERLAND PENN TWP Weather Conditions Relation to Roadvvay o r RAIN ON TRAVEL LANES Illumination Road Surface Conditions v DAYLIGHT WET # of Units # of People # of Injured Killed EMS Agency Medical Facility 002 002 001 000 NONE NONE School Bus Related School Zone Related 'PennDOT Notified Type of Intersection Special Location NO NO NO MIDBLOCK I NOTAPPLICABLE Work Zone Work Zone Type c Where in Work Zone NO o _ Speed Limit Workers Present Officer Present Work Zone Characteristics 0 Road Closed Work on Shoulder Intermittent or Flagger ? Lane Closure ? with Detour ? or Median ? Moving Work ? Control ? Other o MO Route Signing Route Number Segment Number ravel Lanes Speed Limit Orientation IQ: I'M INTERSTATE(NOTTURN PIKE) 0081 02 65 MPH NORTH o House Number Street Name 1 81 St. Ending HIGHWAY Used in Route Signing Route Number Segment Number ravel Lanes Speed Limit Orientation Intersection i Crashes (Street Name St. Ending x m Y Route Number Or Mile Post enths Or Segment Marker iRamp Use Only Feet R IJ O s E 4 J Street Name Street Ending STATE HWY 3015 r Miles Tenths o m HIGHWAY 00 5 N A Route Number Or Mite Post T Or Segment Marker Ramp Use Only m The above entry is the Street Name aing St distance from the Crash o ? CONNECTING ROAD ROAp Scene to Landmark 1 ur o? Degrees Minutes Seconds Decimal Latitude: 40 08 ' 41 Degrees Minutes ;Seconds Decimal L i 550 ong tude: 77 19 14 368 T raffic Control Device Traffic Control Functioning NOTAPPLICABLE NO CONTROLS d L ? A J ane Closed NOTAPPLICABLE Lane Closure Direction Traffic Detoured Estimated Time Closed Environmental / Roadway Potential Factors (E/R) F actor 1 Factor 2 NONE Factor 3 First Harmful Event in the Crash c Most Harmful Event in the Crash E U nit Number ar Event nit Number armful Event 001 OTH HER NON-COLLISION 001 In OTHER NON-COLLISION dicated Prime Factor Unit Number Prime Factor Driver Action c DRIVER ACTION 001 CARELESS PASSING OR LANE CHANGE t P rime Factor Enviromental/Roadway Prime Factor Vehicle Failure W Prime Factor Pedestrian Action R oad Surface Type Special Jurisdiction rrnnreu At: rA state Ponce - Carlisle 10/28/201102:44 PM Page 1 Form #: H02-2019806 AA-500 TX' Incident Number: H0 2-2 01 9806 Commonwealth of Pennsylvania PAGE 2 Crash Invoives: Police Crash Report REPORTABLE CRASH DUI ` Fatality ? Hit and Run Commercial Vehicle 0 State Police Vehicle `? Local Police Vehicle N/A 0, Work Zone 000 ATV 0 Snowmobile n Commonwealth Vehicle `0 Local Gov Vehicle Unit Number ype Unit Commercial Vehicle 001 r Hit & Run Vehicle Yes First Name MI Last Name Suffix DOB Telephone Number 99/99/1999 Street Address City State Zip Code Gender License Number License State Class Expiration Date Owner/Driver 0 U UNKNOWN ZZ UNKNOWN R Driver Presence Physical Condition Primary Vehicle Code Violation Person Charged E HITAND RUN UNKNOWN VC3334 NO 0 Al h l/D S co o rugs uspected Icohol Test Type Alcohol Test Results UNKNOWN TEST NOT GIVEN d Driver Action CARELESS PASSING OR LANE CHANGE 9 d Pedestrian Actio n Pedestrian Signals Pedestrian Clothing Pedestrian Location D 1st Harmful Event left or P,ight Side Most Harmful Utility Pole Number OTHER NON-COLLISION YES 2nd Harmful Event Left or Right Side Most Harmful Utility Pole Number 3rd Harmful Event Leff or Right Side Most Harmful Utility Pole Number 4th Harmful Event Left or Right Side Most Harmful Utility Pole Number Owner First Name Owter MI Owner Last Name or Business Name Suffix Street Address Cr State Zip Code Vehicle Type Special Usage Goverment Equipment Number LARGE TRUCK UNKNOWN Model Year Vehicle Make Vehicle Model ehicle Color VIN UNKNOWN WHITE License Plate Reg. State Est. Speed Vehicle Towed Towed By 71 055 NO Insurance Insurance Company Policy Number Expiration Date NO c o Direction of Travel Vehicle Position Vehicle Movement I nitial Impact Point 0 NORTH RIGHT OF TRAFFICWAY CHANGING LANES OR MERGING NON-COLLISION c Damage Indicator Gradient Road Alignment Possible Vehicle Failures _ UNKNOWN LEVEL STRAIGHT UNKNOWN d # of Units Type Unit 1 Tag Number g Tag Year Tag State 1 UNKNOWN UNKNOWN 2099 Z2 .4 Unit Make Unit Owner UNKNOWN UNKNOWN c Type Unit ? ag Number ag Year Tag State Unit Make Unit Cwtmer Engine Size Passenger? Saddle Bag/Trunk? Trailer? Drver Education? V cc o Dr ver Helnmet Type Helmet Stayed On? DOT/Snell Designation? Eye Protection? Long Sleeves? Long Pants? Over Ankle Boots? `o Passenger Helmet Type elmet Stayed On? DOT/Spell Designation? Eye Protection? Long Sleeves? Long Pants? Over Ankle Boots? a Passenger? Helmet? _U m a Mead Lights? Rear Reflectors? i anted At: PA State Police - Carlisle 10/281201102:44 PM Page 2 Form #: H02-2019806 AA-500 TX Incident Number: H0 2-2 01 9806 Crash Involves: DUI C Fatality NIA C,' Work Zone Commonwealth of Pennsylvania PAGE 3 Police Crash Report nnREPORTABLE CRASH /?`? Hit and Run CI Commercial Vehicle `J State Police Vehicle ? Local Police Vehicle `J ATV Snowmobile C Commonwealth Vehicle `? Local Gov Vehicle Unit Number ype Unit Commercial Vehicle 002 Motor Vehicle in Transport No First Name MI Last Name Suffix DOB Telephone Number LAURA A LAY 11124/1969 (717) 226.4509 Street Address City State Zip Code 493 CENTERVILLE RD. NEWVILLE PA 17241 Gender License Number License State Class Expiration Date o--er/Driver 'o FEMALE 21978911 PA C 11/2512013 PRIVATE VEHICLE OWNED/LEASED BY DRIVER R Driver Presence Physical Condition Primary Vehicle Code Violation Person Charged E DRIVER OPERATED VEHICLE APPARENTLY NORMAL NONE NO 0 Alcohol/Drugs Suspected Icoh l T t T o es ype Alcohol Test Results NO TEST NOT GIVEN Driver Action NO CONTRIBUTING ACTION d Ilk Pedestrian Action Pedestrian Signals Pedestrian Clothing Pedestrian Location 0 1 st Harmful Event Left or Right Side Most Harmful Utility Pole Number HITEMBANKMENT LEFT YES 2nd Harmful Event Left or Right Side Most Harmful Utility Pale Number 3rd Harmful Event le-ft or Right Side Most Hamiful Utility Pole Number 4th Harmful Event Left or Right Side Most Harmful Utility Pole Number Owner First Name Owner MI Owner Last Name or Business Name Suffix LAURA A LAY Sheet Address C rty State Zip Code 493 CENTERVILLE RD. NEWVILLE PA 17241 Vehicle Type SPecial Usage GovemnentEauipnentNumber AUTOMOBILE NOT APPLICABLE Model Year Vehicle Make Vehicle Model ehicle Color VIN 1998 VOLKSWAGEN BUG BLACK 3VWBF61CXWM049289 License Plate Reg. State Est. Speed Vehicle Towed Towed By ESP-7723 PA 055 YES HIPPENSTEEL'S TOWING Insurance Insurance Company Policy Number Expiration Date YES ERIE INSURANCE Q040805098H 101081201 1 c Direction of Travel Vehicle Position ehicle Movement - Initial Impact Point NORTH LEFT OF TRAFFICWAY GOING STRAIGHT NON-COLLISION °c Damage Indicator Gradient Road Alignment Possible Vehicle Failures 2 DISABLING LEVEL STRAIGHT NONE m # of Units Type Unit t Ta Number g Tag Year ag State r 0 v 4 ' Unit Make Unit Owner c S Type Unit 2 ag Number Tag Year ag State r Unit Make Unit Ovmer Engine Size Passenger? Saddle Ba glTrunk. Trailer? Driver Education? cc 0 Driver Helmet Type Helmet Stayed On? DOT/Spell Designation? Eye Protection? Long Sleeves? Long Pants? Over Ankle Boots? `o Passenger Helmet Type Helmet Stayed On? 50T1Snell Designation? Eye Protection? L ong Sleeves? Long Pants? Over Ankle Boots? 2 Passenger" Helmet? u _ d Head Lights? Rear Reflectors? a Printed At: PA State Police -Carlisle 10/28/201102:44 PM Page 3 Form #: H02-2019806 AA-500 TX Incident Number: H02-2019806 Commonwealth of Pennsylvania PAGE 4 Crasti Involves: Police Crash Report REPORTABLE CRASH 0 DUI 0 Fatality C % Hit and Run 0*) Commercial Vehicle State Police Vehicle Local Police Vehicle L; N/A G Work Zone 0 ATV Snowmobile 0 Commonwealth Vehicle 0 Local Gov Vehicle Unit Number j Number of Axles Carrier Name Phone Number 01 99 ( SMX (999) 999-9999 Street Address city UNKNOWN UNKNOWN State Z ip Code ZZ 99999-9999 Cargo Body Type Vehicle Configuration GVWR Oversize Load USDOT (dumber ICC Number PUC Number Hazardous Materials NO 99999999 NO Z E HazMat Class 1 Release Indicator 1 0 u HazMat Class 2 Release Indicator 2 HazMat Class 3 Release Indicator 3 HazMat Class 4 Release Indicator 4 it # U P N Fi n erson o. rst Name MI Last Name Suffix DOB 001 001 99199/1999 Street Address City State Zip Code Phone Number EMS Transport Person Type Gender Injury Severity E 0 NO DRIVER U UNKNOWN IF INJURY Seat Position Safety Equipment 1 a, DRIVER-ALL VEHICLES c UNKNOWN a°, ' Safety Equipment 2 Extrication a NONE USED/ NOT APPLICABLE NOTAPPLICABLE Ejection Ejection Path NOTAPPLICABLE NOT EJECTED/NOT APPLICABLE U ft * P M Fi ersor, n o. rst Name MI Last Narne Suttix 002 002 LAURA A LAY DOB 11124/1969 Street Address City - 0 493 CENTERVILLE RD. State NEWVILLE Zip Code PA 17241 m Phone Number EMS Transport Person Type Gender Injury Severity 8 ` (717) 226-4509 NO DRIVER FEMALE MINOR INJURY `_e Seat Position Safety Equipment 1 d DRIVER -ALL VEHICLES a LAP AND SHOULDER BELT USED wo Safety Equipment 2 Extrication AIR BAG NOT DEPLOYED - LINK SWITCH SETTING NOTAPPLICABLE Ejection Ejection Path NOT APPLICABLE NOT EJECTED/NOT APPLICABLE First Name MI JO HN st Narne one Number 1 - E GATTEN (717) 329-6724 S 1 treet Address ty T 58 SOUTH HIGH ST. NEWVILLE State Zip Code PA 17241 Printed At: PA State Police - Carlisle 10/28/2011 02:44 PM Page 4 Form #: H02-2019806 AA-500 TX, Incident Number: H02-2019806 Commonwealth of Pennsylvania PAGE 5 Crash Involves: Police Crash Report REPORTABLE CRASH L DUI 0 Fatality `!I Hit and Run Commercial Vehicle C- State Police Vehicle Local Police Vehicle NIA n Work Zone ATV 0 Snowmobile C Commonwealth Vehicle 0 Local Gov Vehicle NARRATIVE This crash occurred as Unit #1 was traveling northbound on Interstate 81 at MM38 in the right hand lane. Unit #2 was traveling northbound on Interstate 81 at MM38 in the left hand lane beside Unit #1. Unit #1 attempted to change lanes, causing Unit #2 to travel off of the roadway, down over the median. Unit #2 received moderate damage and was towed from the scene by Hippensteel's Towing. The operator of Unit #2 was wearing a seat belt and received minor injury. Unit #1, was a tractor trailer with SMX on the trailer and continued northbound on 181. This crash occurred as Unit #1 was traveling northbound on Interstate 81 at MM 38 in the right hand lane. Unit #2 was traveling northbound on Interstate 81 at MM38 in the left hand lane beside Unit #1. Unit #1attempted to change lanes Printed At: PA State Police - Carlisle 10/28/2011 02:44 PM Page 5 Form 7t: H02-2019806 AA-500 TX Incident Number: H02-2019806 Commonwealth of Pennsylvania PAGE 6 Crash Involves: Police Crash Report REPORTABLE CRASH C DUI CJ Fatality Hit and Run Commercial Vehicle L State Police Vehicle Local Police Vehicle 0' N/A 0 Work Zone C) ATV C Snowmobile 01 Commonwealth Vehicle `." Local Gov Vehicle from the right lane into the left lane, causing Unit #2 to travel off of the roadway and down over the median. Physical evidence at the scene consisted of approximately 75 feet of tire marks in the median from Unit #2. There was also visible undercarriage damage to Unit #2. There was debris from the median in the left hand lane of the southbound lanes. On 04/12/11 at approximately 0800 hrs. I was on stationary patrol sitting on Interstate 81 at MM41 crossover. At that time, witness, GATTEN pulled into the crossover and stated that a tractor trailer ran Unit #2 off of the roadway and Unit #2 traveled down over an embankment. As GATTEN was pulling into the crossover, I viewed a tractor trailer pull off to the right side of the roadway and GATTEN pointed to the tractor trailer pulling off of the roadway. I viewed that it was a white tractor with a white trailer, with the letters "SMX" on the side of the trailer. After speaking to GATTEN briefly at the crossover, I started southbound on Interstate 81 to check on the status of the occupants of Unit #2. On 04/12/11 at 0801 hrs. I arrived at the scene of the crash and viewed Unit #2 at final rest in the middle of the median facing southbound. On 04/12111 at 0803 hrs. the operator of Unit #2, LAY was interviewed at the scene. LAY stated that she was traveling northbound on Interstate 81 at MM38 in the left hand lane. LAY stated that she was traveling approximately 55 MPH and was passing Unit #1. LAY stated that she was to approximately the cab on Uint #1, when Unit #1 started to come over into her lane. LAY stated that Unit #1 kept coming into her lane, causing her to travel further and further to the left, causing her to travel down over the median. LAY stated that her vehicle came to final rest in the southbound lanes of Interstate 81. LAY stated that she pulled into the median from the southbound lanes, to avoid being struck by traffic traveling southbound. LAY stated that she was wearing a seat belt and complained of pain to her left hand to the left side of her face. As I was pulling up to the scene, LAY was making arraignments with Hippensteel's Towing to remove her vehicle. GATTEN returned to the crash scene and was fully interviewed at the scene. GATTEN stated that he was traveling northbound on Interstate 81 at MM 38 in the right hand lane behind Unit #1. GATTEN stated that he viewed Unit #1 run Unit #2 off of the roadway. GATTEN stated that he continued to follow Unit #1, honking his horn and flashing his lights at it, attempting to get the driver's attention. GATTEN stated he then saw me sifting in the crossover and stopped and informed me of the crash. As I was at the scene of the crash, Tpr. Natalie A. WATKIN attempted to go to MM41 to speak to the operator of Unit #1. 1 was informed by Tpr. WATKIN that Unit #1 was no longer sitting along the roadway at MM41. A BOLO was put out to surrounding agencies looking for a white tractor trailer with SMX on the side of the trailer, with a negative result. A public news release was completed and a copy was placed in the attachment file. On 04/13/11 at 1300 hrs. I located a telephone number for SMX. Printed At: PA State Police - Carlisle 10128/2011 02:44 PM Page 6 Form #: H02.2019806 • AA-500 TX Incident Number: H02-2019806 Commonwealth of Pennsylvania PAGE 7 Crash }evolves: _ Police Crash Report REPORTABLE CRASH DUI L) Fatality Hit and Run Commercial Vehicle C) State Police Vehicle ? Local Police Vehicle N/A G Work Zone L? ATV 0 Snowmobile 1 C Commonwealth Vehicle ` Local Gov Vehicle 1 contacted Smithway Motors Xpress (SMX) at 800-316-7160 and left a voicemail with the claims manager in regards to this crash. Requesting to supplement this report pending speaking to the claims manager at SMX. Printed At: PA State Police - Carlisle 10128/201102:44 PM Page 7 Form #: H02-201 9806 10/13/2011 AT 03:35 PM 010171151168001 15633 OC290QA8 ERIE INSURANCE GROUP HARRISBURG CLAIMS OFFICE 4901 LOUISE DRIVE P.O. BOX 2013 MECHANICSBURG, PA 17055 (717)245-9826 FAX: (717)240-0696 SUPPLEMENT OF RECORD 1 WITH SUMMARY WRITTEN BY: DAVID SWARNER #135102 10/13/2011 03:35 PM ADJUSTER: DAVID SWARNER #135102 INSURED: KEVIN & LAURA A LAY CLAIM #010171151168001 OWNER: KEVIN & LAURA A LAY POLICY #Q040805098 ADDRESS: 493 CENTERVILLE RD DATE OF LOSS: 04/12/2011 AT 07:45 AM NEWVILLE, PA 17241 CELLULAR: (717)226-4509 TYPE OF LOSS: COLLISION POINT OF IMPACT: 21. UNDERCARRIAGE INSPECT HIPPENSTEEL'S AUTO DAY: (717)776-3433 LOCATION: 457 CENTERVILLE RD OTHER NEWVILLE, PA 17241 REPAIR SUBWAY AUTO BODY BUSINESS: (717)243-9978 FACILITY: 1231 RITNER HIGHWAY 21 DAYS TO REPAIR CARLISLE, PA 17013 LICENSE # 251854056 1998 VW BEETLE TDI 4-1.9L-TD 2D CPE BLACK I NT: VIN: 3VWBF61CXWM049289 LIC: ESP-7723 PA AIR CONDITIONING PROD DATE: 07/1998 ODOMETER: 163536 REAR DEFOGGER CRUISE CONTROL TILT WHEEL TELESCOPIC WHEEL KEYLESS ENTRY INTERMITTENT WIPERS ALARM CONSOLE/STORAGE CLEAR COAT PAINT DUAL MIRRORS POWER BRAKES POWER LOCKS POWER STEERING HEATED MIRRORS POWER TRUNK/GATE FM RADIO POWER MIRRORS RELEASE AM RADIO STEREO SEARCH/SEEK CASSETTE DRIVER AIR BAG 4 WHEEL DISC BRAKES CLOTH SEATS PASSENGER AIR BAG BUCKET ATS RECLINE/LOUNGE SEATS 5 SPEED TRANSMISSION FULL WHEEL COVERS TINTED GLASS O VERDRIVE ALUMINUM/ALLOY WHEELS POWER WINDOWS ------------------------ DESCRIPTION QTY EXT. PRICE LABOR PAINT 1 FRONT BUMPER & GRILLE------ ----------------------------------- 2 O/H FRONT BUMPER N 3**SO1 REPL A/M CAPA BUMPER COVER 4.1 1 * 4 ADD FOR CLEAR COAT C L. 108.33 INCL. 2.8 5# S01 REPL SCREWS 1 .1 1.1 6 S01 REPL BUMPER COVER PROTECTOR 2 1.00 INCL.* 7 REPL TOW EYE CAP 1 8.40 INCL. 8 ADD FOR CLEAR COAT 1 11.50 INCL. 0.2 9**SO1 REPL A/M LOWER GRILLE W/O FOG LA 0.1 MPS 1 * 10 S01 REPL LOWER PANEL W/O FOG LAMPS 43.33 INCL. 1 127.00 INCL. 1.1 1 v y 10/13/2011 AT 03:35 PM 010171151168001 15633 OC290QA8 SUPPLEMENT OF RECORD 1 WITH SUMMARY 1998 VW BEETLE TDI 4-1.9L-TD 2D CPE BLACK INT: ------ NO. ------ ---- ---- ------ OP. ------ -------------------------------- DESCRIPTION -------------- ---- QTY --------------------------- EXT. PRICE LABOR PAINT 11 SO1 ------------------ ADD FOR CLEAR COAT ---- -------- ------------------- 0.4 12 S01 FRONT LAMPS 13 S01 REPL LT SIGNAL LAMP ASSY 1 54.00 INCL. 14 RADIATOR SUPPORT N 15* S01 REPL RADIATOR SUPPORT 1 153.00* S 4.2 1.0 16 AIM HEADLAMPS 0.5 17 EVACUATE & RECHARGE M 1.4 M 18* REPL CENTER SHIELD MANUAL TRANS * 1 180.00 0.3 19* S01 REPL RT SIDE COVER 1 50.00* 0.3 20 REPL LT SIDE COVER 1 68.50 0.3 21 COOLING 22* * REPL A/M RADIATOR 1 140.00 MINCL. 234 REPL ANTIFREEZE/COOLANT- GAL 1 14.00 T 24 S01 REPL RT RADIATOR UPPER BRACKET 1 11.64 25 S01 REPL RT RADIATOR LOWER BRACKET 1 8.40 26* REPL USED RT FAN ASSY +25% 1 43.75 MINCL * 27 S01 REPL LOWER HOSE 1 62.00 . M 0 6 28 S01 DEDUCT FOR OVERLAP . -0 2 29 S01 REPL INTERCOOLER TO VIN 1CX460490 1 300.00 . M 1 5 304 REPL OIL 5 12.50 . 31 REPL INTERCOOLER BRACKET 1 24.00 32* S01 REPL AIR DUCT 1 56.00* M 0 3 33* S01 REPL A/M SERPENTINE BELT W/AC +25%* 1 41.99* . M 0 7 34 AIR CONDITIONER & HEATER . 35**SO1 REPL A/M CONDENSER ASSY 1 160.00* MINCL 364 REPL R134 FREON 1 30.00 . T 37* S01 REPL USED COMPRESSOR 1 187.50* M 1 8* 38 S01 DEDUCT FOR OVERLAP . -0 3 39# S01 REPL AC COMPRESSOR PLUG 1 13.50 . 0 3 M 40 S01 FENDER . 41 SO1 REPL RT STONE GUARD UPPEF. 2 12.80 0 2 42 S01 REPL LT STONE GUARD UPPER 2 12.80 . 0 2 43 S01 ELECTRICAL . 44* S01 R&I ALTERNATOR 120 AMP NEW 45# SO1 SUBL REBUILD ALTERNATOR + 25% 1 275 00 M 1.5* T 46 WHEELS . 47 R&I RT/REAR R&I WHEEL 48# TIRE MOUNT/BALANCE & CLEAN 1 20.00 M 0.1 T BEAD 49# S01 SUBL TWO WHEEL ALIGNMENT +25% 1 48 75 T 50 SO1 FRONT SUSPENSION . 51# S01 REPL BRAKE PINS 2 524 SO1 REPL A/M BRAKE BOLTS +25% 2 40.00 53# * SO1 SUBL ADJUST CALIPER PINS +25% 1 56.86 32 50 T 54 S01 REPL RT KNUCKLE . 554 SO1 SUBL CHANGE KNUCKLE +25% 1 318.00 MINCL.* 56** S01 REPL A/M RT BEARING ASSY +25% * 1 1 32.50 * T N 57** SO1 REPL A/M LT BEARING ASSY 25% * 51.11 MINCL.* + 2 102.22* MINCL.* 2 3 , 10/13/2011 AT 03:35 PM 010171151168001 15633 OC290QA8 SUPPLEMENT OF RECORD 1 WITH SUMMARY 1998 VW BEETLE TDI 4-1.9L-TD 2D CPE BLACK INT: ------ NO. ------- ----------------------------------------- OP. DESCRIPTION -------------------- ---- QTY -------------------- EXT. PRICE LABOR -------- PAINT 58# -------------------- S01 SUBL CHANGE BEARINGS +25% ---- 1 --------- 65.00 ----------- T -------- N 59**SO1 REPL A/M RT STRUT +25% * 1 222.11* M 1.3 60 SO1 DEDUCT FOR OVERLAP -0.5 N 61**S01 REPL A/M LT STRUT +25% * 1 222.11* M 1.3 62 PILLARS, ROCKER & FLOOR 63* RPR RT ROCKER PANEL TO VIN S 5.0* 1.5 1C4403541 64 ADD FOR CLEAR COAT 0 6 65* RPR LT ROCKER PANEL TO VIN S 7.0* . 1.5 IC4403541 66 OVERLAP MAJOR NON-ADJ. PANEL -0 2 67 ADD FOR CLEAR COAT . 0 3 68 QUARTER PANEL . 69 REPL RT STONE GUARD TO VIN 1 24.00 0.2 104403519 70# MISC. 1 71# CLEAN UNDERCARRIAGE 1 1 0 72# FLEX AGENT (PER PANEL) 1 12.00 . T 73# GRAVEL GUAURD 1 0 8 74# HAZARDOUS WASTE 1 5.00 T . 75# ****************************** 1 ****************************** 76# AGREED PRICE/ (4) DAYS RENTAL 1 CYCLE TIME 77# WITH OWNER & JOHN @ REPAIR 1 SHOPS 784 ****************************** 1 ****************************** 79 OTHER CHARGES 80# TOWING 1 132 00 81# STORAGE 7 . 140 00 82# 2AND TOW TO SHOP ------ 1 . 75.00 ------- SUBTOTALS ==> ---- --------- 3810.10 ---------- 33.1 -------- 11.2 LINE 3 : LABOR: TIME INCLUDES R&R FENDERS, WHEELHOUSE LINER HEADLAMPS AND SIGNAL/MARKER , , LAMPS AS OUTLINED IN MANUFACTURERS BODY MANUAL. TIME IS FOR OVERHAUL. 3 10/13/2011 AT 03:35 PM 010171151168001 15633 OC290QA8 SUPPLEMENT OF RECORD 1 WITH SUMMARY 1998 VW BEETLE TDI 4-1.9L-TD 2D CPE BLACK INT: LINE 15 : LABOR: TIME INCLUDES R&I/R&R RADIATOR, CONDENSER, LOCK SUPPORT, BUMPER REINFORCEMENT, FILLER PANEL, D&R OF HOOD RELEASE CABLE AND FRONT WIRING AS NECESSARY. TIME IS AFTER BUMPER COVER AND FENDERS AS AN ASSEMBLY ARE REMOVED. TIME DOES NOT INCLUDE R&I/R&R OF INTERCOOLER, INTAKE DUCT, AIR INLET, PRESSURE TUBES, PRESSURE HOSE OR AIR DUCT ON TURBO EQUIPT MODEL. REFINISH TIME IS PROVIDED FOR THOSE INSTANCES WHEN REQUIRED COLOR IS NOT AVAILABLE OR FOR SOME REPAIR SITUATIONS. LINE 26 SUPPLIERS PART DESCRIPTION: COOLING FAN MOTOR ONLY; 1.9L, 2.OL, R.,MOTOR ONLY DUAL FAN R. LINE 57 2AND BEARING NEEDED DUE TO KNUCKLE REPLACEMENT LINE 59 COMPLETE ASSYS W/UPPER BEARING LINE 61 COMPLETE ASSYS W/UPPER BEARING PARTS 2928.35 BODY LABOR 31.4 HRS @$ 46.00/HR 1444.40 PAINT LABOR 11.2 HRS @$ 46.00/HR 515.20 MECHANICAL LABOR 1.7 HRS @$ 50.00/HR 85.00 PAINT SUPPLIES 11.2 HRS @$ 26.00/HR 291.20 SUBLET/MISC. 534.75 OTHER CHARGES ------------------ 347.00 - SUBTOTAL -------- ---- ---- ---------- $ ------- 6145.90 SALES TAX $ 5798. 90 @ 6.000096 347.93 TOTAL COST OF REPAIRS $ 6493.83 ADJUSTMENTS: DEDUCTIBLE 500.00 ---------------------------------------------------- TOTAL ADJUSTMENTS $ 500.00 NET COST OF REPAIRS $ 5993.83 VEHICLE OWNER MUST AUTHORIZE ALL REPAIRS. ERIE INSURANCE RESERVES THE RIGHT TO REINSPECT ALL SUPPLEMENTS BEFORE PAYMENT IS MADE. THIS IS NOT AN AUTHORIZATION TO REPAIR. 4 M r ft 10/13/2011 AT 03:35 PM 010171151168001 15633 OC290QAB SUPPLEMENT OF RECORD 1 WITH SUMMARY 1998 VW BEETLE TDI 4-1.9L-TD 2D CPE BLACK INT: 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 SUCH 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 DS PART=DIAMOND STANDARD PART DS ASSY=DIAMOND STANDARD ASSEMBLY 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. 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. RECYCLED PART COSTS BASED ON INFORMATION PROVIDED BY CAR-PART.COM. FOR ASSISTANCE, CALL CCC AT 800-637-8511. Is " w 10/13/2011 AT 03:35 PM 010171151168001 15633 OC290QA8 SUPPLEMENT OF RECORD 1 WITH SUMMARY 1998 VW BEETLE TDI 4-1.9L-TD 2D CPE BLACK INT: ESTIMATE BASED ON MOTOR CRASH ESTIMATING GUIDE. UNLESS OTHERWISE NOTED ALL ITEMS ARE DERIVED FROM THE GUIDE ERA9210, CCC DATA DATE 09/01/2011, 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 (-) ITEMS INDICATE MOTOR NOT-INCLUDED LABOR OPERATIONS. 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 CCC ONE ESTIMATOR HAS A COMPLETE LIST OF APPLICABLE VEHICLES. PARTS NUMBERS AND PRICES SHOULD BE CONFIRMED WITH THE LOCAL DEALERSHIP. 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: MOTOR ABBREVIATIONS/SYMBOLS: D=DISCONTINUED PART A=APPROXIMATE PRICE LABOR TYPES: 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 PATHWAYS: ADJ=ADJACENT ALGN=ALIGN A/M=AFTERMARKET BLND=BLEND CAPA=CERTIFIED AUTOMOTIVE PARTS ASSOCIATION NSF=NSF INTERNATIONAL CERTIFIED PART D&R=DISCONNECT AND RECONNECT EST=ESTIMATE EXT. PRICE=UNIT PRICE MULTIPLIED BY THE QUANTITY INCL=INCLUDED MISC=MISCELLANEOUS NAGS=NATIONAL AUTO GLASS SPECIFICATIONS NON-ADJ=NON ADJACENT 0/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/-SYMBOLS: #=MANUAL LINE ENTRY *=OTHER [IE..MOTORS DATABASE INFORMATION WAS CHANGED] **=DATABASE LINE WITH AFTERMARKET N=NOTES ATTACHED TO LINE. OPT OEM=ORIGINAL EQUIPMENT MANUFACTURER PARTS EITHER OPTIONALLY SOURCED OR OTHERWISE PROVIDED WITH SOME UNIQUE PRICING OR DISCOUNT. NWCPP=NATIONWIDE CRASH PARTS PROGRAM. CCC PATHWAYS - A PRODUCT OF CCC INFORMATION SERVICES INC. 1 10/13/2011 AT 03:35 PM 010171151168001 15633 OC290QA8 SUPPLEMENT OF RECORD 1 WITH SUMMARY 1998 VW BEETLE TDI 4-1.9L-TD 2D CPE BLACK INT: -- -- ---- NO. ---- ---- ---- ------ OP. ------ -------------------------------- DESCRIPTION ------------ ---- QTY ----------------- EXT. PRICE LABOR ---------- PAINT --- -------------------- ------- CHANGED ITEMS------- ---- -------- --------- ------- - 2* * REPL A/M CAPA BUMPER COVER 1 -198.00 INCL. -2.8 N 3* *SO1 REPL A/M CAPA BUMPER COVER 1 108.33* INCL. 2.8 6* * REPL A/M LOWER GRILLE W/O FOG LAMPS 1 -43.00 INCL. 9* *S01 REPL A/M LOWER GRILLE W/0 FOG LAMPS 1 43.33* INCL. N 8 REPL RADIATOR SUPPORT 1 -145.00 S -4.2 -1.0 N 15* S01 REPL RADIATOR SUPPORT 1 153.00* S 4.2 1.0 12 REPL RT SIDE COVER 1 -45.30 -0.3 19* S01 REPL RT SIDE COVER 1 50.00* 0.3 21 REPL AIR DUCT 1 -51.90 M -0.3 32* S01 REPL AIR DUCT 1 56.00* M 0.3 254 RPR AC COMPRESSOR PLUG -0.3 M 39# S01 REPL AC COMPRESSOR PLUG 1 13.50 0.3 M 29# SUBL FOUR WHEEL ALIGNMENT 1 -89.95 T 49# S01 SUBL TWO WHEEL ALIGNMENT +25% 1 48.75 T ------- DELETED ITEMS ------- 19** REPL A/M INTERCOOLER TO VIN 1 1CX460490 -248.00 M -1.5 M 24* REPL USED CONDENSER ASSY +25% 1 -56.25 MINCL.* ------- ADDED ITEMS ------- 5# S01 REPL SCREWS 2 1.00 INCL. 6 S01 REPL BUMPER COVER PROTECTOR 1 8.40 INCL. 10 S01 REPL LOWER PANEL W/O FOG LAMPS 1 127.00 INCL. 1.1 11 SO1 ADD FOR CLEAR COAT 0.4 12 S01 FRONT LAMPS 13 S01 REPL LT SIGNAL LAMP ASSY 1 54.00 INCL. 24 S01 REPL RT RADIATOR UPPER BRACKET 1 11.64 25 S01 REPL RT RADIATOR LOWER BRACKET 1 8.40 27 S01 REPL LOWER HOSE 1 62.00 M 0.6 28 S01 DEDUCT FOR OVERLAP -0.2 29 S01 REPL INTERCOOLER TO VIN 1CX460490 1 300.00 M 1 5 33* S01 REPL A/M SERPENTINE BELT W/AC +25%* 1 41.99* . M 0 7 35**S01 REPL A/M CONDENSER ASSY 1 160.00* . MINCL 37* S01 REPL USED COMPRESSOR 1 187.50* . M 1 8* 38 S01 DEDUCT FOR OVERLAP . -0 3 4C S01 FENDER . 41 S01 REPL RT STONE GUARD UPPER 2 12.80 0 2 42 S01 REPL LT STONE GUARD UPPER 2 12.80 . 0 2 43 S01 ELECTRICAL . 44* S01 R&I ALTERNATOR 120 AMP NEW M 1 5* 454 S01 SUBL REBUILD ALTERNATOR + 25% 1 275 00 . T 50 SO1 FRONT SUSPENSION . 51# S01 REPL BRAKE PINS 2 40 00 52# S01 REPL A/M BRAKE BOLTS +25% 2 . 56 86 53# S01 SUBL ADJUST CALIPER PINS +25% 1 . 32 50 T 54* S01 REPL RT KNUCKLE 1 . 318 00 MINCL * 554 S01 SUBL CHANGE KNUCKLE +25% 1 . 32 50 . T 56** SO1 REPL A/M RT BEARING ASSY +25% * 1 . 51.11* MINCL * 7 # u f 10/13/2011 AT 03:35 PM 010171151168001 15633 OC290QA8 SUPPLEMENT OF RECORD 1 WITH SUMMARY 1998 VW BEETLE TDI 4-1.9L-TD 2D CPE BLACK INT: ---------------- NO. OP. ------ ---------------------------- DESCRIPTION ----------------------------------- QTY EXT. PRICE LABOR PAINT ---- ---------- N 57**SO1 REPL ---------------------------- A/M LT BEARING ASSY +25% ----------------- * 2 102.22* -------------- MINCL.* 58# S01 SUBL CHANGE BEARINGS +25% 1 65.00 T N 59**SO1 REPL A/M RT STRUT +25% * 1 222.11* M 1.3 60 S01 DEDUCT FOR OVERLAP -0.5 N 61**SO1 REPL ----------------- A/M LT STRUT +25% ------------ * 1 222.11* M 1.3 ---- --------------- SUBTOTALS == ----------------- > 2000.45 -------------- 6.6 1.5 LINE 3 : LABOR: TIME INCLUDES R&R FENDERS, WHEELHOUSE LINER, HEADLAMPS, AND SIGNAL/MARKER LAMPS AS OUTLINED IN MANUFACTURERS BODY MANUAL. TIME IS FOR OVERHAUL. LINE 15 : LABOR: TIME INCLUDES R&I/R&R RADIATOR, CONDENSER, L OCK SUPPORT, BUMPER REINFORCEMENT, FILLER PANEL, D&R OF HOOD RELEASE CABLE AND FRONT WIRING AS NECESSARY. TIME IS AFTER BUMPER COVER AND FENDERS AS AN ASSEMBLY ARE REMOVED. TIME DOES NOT INCLUDE R&I/R&R OF INTERCOOLER, INTAKE DUCT, AIR INLET, PRESSURE TUBES, PRESSURE HOSE OR AIR DUCT ON TURBO EQUIPT MODEL. REFINISH TIME IS PROVIDED FOR THOSE INSTANCES WHEN REQUIRED COLOR IS NOT AVAILABLE OR FOR SOME REPAIR SITUATIONS. LINE 57 2AND BEARING NEEDED DUE TO KNUCKLE REPLACEMENT LINE 59 COMPLETE ASSYS W/UPPER BEARING LINE 61 COMPLETE ASSYS W/UPPER BEARING PARTS 163 6.65 BODY LABOR 8.1 HRS @$ 46.00/HR 37 2.60 PAINT LABOR 1.5 HRS @$ 46.00/HR 69.00 MECHANICAL LABOR -1.5 HRS @$ 50.00/HR --/5.00 PAINT SUPPLIES 1.5 HRS @$ 26.00/HR 39.00 SUBLET/MISC. ---- 3(53.80 -- SUBTOTAL ------- ----- --- - $ --- ---- 24076.05 SALES TAX $ 2406. 05 @ 6.0000% 14 4.36 TOTAL SUPPLEMENT AMOUNT $ 255 0.41 NET COST OF SUPPLEMENT $ 25S 0.41 8 Stephen E. Geduldig, Esquire E-mail: sgeduldig@tthlaw.com Attorney I.D. No. 43530 (717) 237-7119 Jason C. Giurintano, Esquire E-mail: jiurintano@tthlaw.com Attorney I.D. No. 89177 (717) 237-7157 THOMAS, THOMAS & HAFER, LLP 305 North Front Street Post Office Box 999 Harrisburg, Pennsylvania 17108-0999 FAX (717) 237-7105 E '? ;1 = s .r.e 1 V! r3 i'w Attorneys for Defendant: WESTERN EXPRESS, INC. ERIE INSURANCE GROUP, as subrogee for LAURA LAY and KEVIN LAY, Plaintiffs V. WESTERN EXPRESS, INC., Defendant TO: Plaintiff and Counsel: IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNA NO. 12-2414 CIVIL JURY TRIAL DEMANDED NOTICE TO PLEAD YOU ARE HEREBY NOTIFIED TO FILE A WRITTEN RESPONSE TO THE ENCLOSED NEW MATTER WITHIN TWENTY (20) DAYS OF SERVICE HEREOF OR A JUDGMENT OF NON PROS MAY BE ENTERED AGAINST YOU. Respectfully THOMAS, THOMAS & Date: By: Stephe eduldig, Esquire PA or y ID No.: 43530 J on C. Giurintano, Esquire A Attorney ID No.: 89177 305 North Front Street P.O. Box 999 Harrisburg, PA 17108-0999 (717) 237-7157 (t) (717) 237-7105 (f) Attorneys for Defendant E-mail: sgeduldig@tthlaw.com Attorney I.D. No. 43530 (717) 237-7119 Jason C. Giurintano, Esquire E-mail: jiurintano@tthlaw.com Attorney I.D. No. 89177 (717) 237-7157 THOMAS, THOMAS & HAFER, LLP 305 North Front Street Post Office Box 999 Harrisburg, Pennsylvania 17108-0999 FAX (717) 237-7105 Attorneys for Defendant: WESTERN EXPRESS, INC. ERIE INSURANCE GROUP, as subrogee for LAURA LAY and KEVIN LAY, Plaintiffs V. WESTERN EXPRESS, INC., Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNA : NO. 12-2414 CIVIL JURY TRIAL DEMANDED DEFENDAN'T' WESTERN EXPRESS. INC.'S ANSWER WITH NEW MATTER AND NOW, comes Defendant, Western Express, Inc. (hereinafter "Defendant"), and files the following Answer with New Matter, stating as follows. 1. Defendant is without sufficient information to form a belief as to the truth of the matters averred in this paragraph, therefore, the averments are DENIED and strict proof is demanded at time of trial. 2. ADMITTED. 3. Defendant is without sufficient information to form a belief as to the truth of the matters averred in this paragraph, therefore, the averments are DENIED and strict proof is demanded at time of trial. By way of further response, Defendant has no 2 knowledge of any of its drivers operating a tractor trailer marked "SMX" on the date and location in question. Based upon information and belief, Defendant did not have any vehicles in the area on the date and time in question. 4. Defendant is without sufficient information to form a belief as to the truth of the matters averred in this paragraph, therefore, the averments are DENIED and strict proof is demanded at time of trial. 5. DENIED. Defendant has no knowledge of any of its drivers operating a tractor trailer marked "SMX" on the date and location in question. Based upon information and belief, Defendant did not have any vehicles in the area on the date and time in question. All other averments are DENIED generally pursuant to Pa.R.Civ.P. 1o29(e). 6. DENIED generally pursuant to Pa.R.Civ.P. 1029(e). By way of further response, Defendant has no knowledge of any of its drivers operating a tractor trailer marked "SMX" on the date and location in question. Based upon information and belief, Defendant did not have any vehicles in the area on the date and time in question. 7. This paragraph is a conclusion of law to which no response is required. To the extent a further response is deemed necessary, all averments are DENIED because Defendant has no knowledge of any of its drivers operating a tractor trailer marked "SMX" on the date and location in question. Based upon information and belief, Defendant did not have any vehicles in the area on the date and time in question. 8. DENIED generally pursuant to Pa.R.Civ.P. 1029(e). 9. This paragraph is a conclusion of law to which no response is required. lo. Admitted that Defendant has paid no moneys to Plaintiff. 3 11. The documents referenced in this paragraph speak for themselves, and any attempts by Plaintiff to paraphrase or interpret their contents are hereby DENIED. WHEREFORE, Defendants respectfully request that judgment be entered in their favor, and against all other parties, with costs. NEW MATTER 12. The previous paragraphs of this pleading are incorporated hereto as though set forth in full. 13. Plaintiffs Complaint fails, in whole or in part, to state a claim against Defendant upon which relief can be granted. 14. As discovery may show, any and all damages, injuries and losses allegedly sustained by Plaintiff may have been a result of the negligent and careless conduct of Plaintiff. 15. As discovery may show, any and all damages, injuries or losses allegedly sustained by the Plaintiff, which injuries and damages are strictly denied, were legally caused by the negligence of Plaintiff, and such conduct serves to reduce or bar Plaintiff s recovery pursuant to the terms of the Pennsylvania Comparative Negligence Act, 42 Pa. C.S.A. §7102. 16. Any act or omissions of Defendant was not substantial causes or factors or legal causes of the subject incident and/or did not result in the injuries, damages or losses alleged by Plaintiff. 17. Plaintiffs cause of action maybe barred by the Plaintiffs contributory negligence. 18. Any and all damages, injuries or losses allegedly sustained by Plaintiff may have been proximately caused by individuals and entities other than Defendant, including but not limited to, Plaintiff, or others for whose conduct Defendant is not liable or responsible. 19. The injuries, damages and losses alleged by Plaintiff may have been caused by events over which Defendant had no control and for which Defendant would not be responsible. 4 20. Plaintiffs alleged injuries, losses and damages may have been caused by superseding or intervening events or acts of third parties over which Defendant had no control. 21. As discovery may show, Plaintiffs claims maybe barred by the defenses of release, accord and satisfaction, waiver, estoppel, consent and/or waiver, the terms of a contract or agreement, an award at arbitration or the statute of limitations, as may be shown in discovery in this case. 22. Some or all of Plaintiff s damages, if any, are barred or reduced by Plaintiff s failure to mitigate said damages. 23. Defendant has no knowledge of any of its drivers operating a tractor trailer marked "SMX" on the date and location in question. 24. Plaintiff's cause of action and alleged damages may be barred or reduced by the terms of the MVFRL. Wherefore, Defendants request that judgment be entered in their favor and against all other parties, with costs. Date: June 18, 2012 By: Respectfully THOMASJPHOMAS & HAFER, LLP Steph duldig, Esquire PA orney ID No.: 43530 J son C. Giurintano, Esquire PA Attorney ID No.: 89177 305 North Front Street P.O. Box 999 Harrisburg, PA 17108-0999 (717) 237-7157 (t) (717) 237-7105 (fl Attorneys for Defendants 5 ATTORNEY VERIFICATION I, Jason C. Giurintano, of the law firm of THOMAS, THOMAS & HAFER, LLP, hereby verify that we are the attorneys of record for Western Express, Inc., in this case, that as such I am authorized to make this Verification, and that the information set forth in the foregoing is true and correct to the best of my knowledge, information, and belief. THOMAS, THOPWAS & HAFER, LLP BY: Jason C. G' ano Attorney for Defendant Dated: June 18, 2012 CERTIFICATE OF SERVICE I, Krista Fanus, legal secretary with the Firm of Thomas, Thomas & Hafer, LLP, hereby state that a true and correct copy of the attached document(s) was served upon all counsel of record on the date set forth below: George A. Miller, Esquire BROMBERG & MILLER 103o Fifth Avenue, Suite 102 Pittsburgh, Pennsylvania 15219 Date: June 18, 2012 -If Krista anus, Legal Secretary 7 U1= ? PROTHONOTARl 2012 JUL 18 AM 11: 34 CUMBERLAND COUNTY IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION ERIE INSURANCE GROUP, as CASE NO. 12-2414 Civil subrogee for LAURA LAY and KEVIN LAY, CODE NO. Plaintiff, TYPE OF PLEADING: VS. WESTERN EXPRESS, INC., by and through JOHN DOE, an unidentified individual, Defendant. File No: 58357 REPLY TO NEW MATTER FILED ON BEHALF OF: ERIE INSURANCE GROUP, as subrogee for LAURA LAY and KEVIN LAY, COUNSEL OF RECORD FOR THIS PARTY: GEORGE A. MILLER, ESQUIRE Pa. I.D. No. 22525 BROMBERG & MILLER FIRM I.D. No. 937 1030 Fifth Avenue, Suite 102 PITTSBURGH, PA 15219 (412) 232-0440 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION ERIE INSURANCE GROUP, as subrogee for LAURA LAY and KEVIN LAY, Plaintiff, VS. WESTERN EXPRESS, INC., by and through JOHN DOE, an unidentified individual., Defendant. No. 12-2414 Civil REPLY TO NEW MATTER AND NOW come(s) ERIE INSURANCE GROUP, as subrogee for LAURA and KEVIN LAY, Plaintiff, by and through their attorney, GEORGE A. MILLER, ESQ., BROMBERG & MILLER, Attorneys at Law, and file(s) the within REPLY TO NEW MA' as follows: 1. The averments contained in Paragraph 12 of Defendant's New Matter merely a recital of prior paragraphs to which no responsive pleading is required. 2. The averments contained in Paragraph 13 of Defendant's New Matter conclusions of law to which no responsive pleading is required. 3. The averments contained in Paragraph 14 of Defendant's New Matter conclusions of law to which no responsive pleading is required. 4. The averments contained in Paragraph 15 of Defendant's New Matter conclusions of law to which no responsive pleading is required. The averments contained in Paragraph 16 of Defendant's New Matter conclusions of law to which no responsive pleading is required. 6. The averments contained in Paragraph 17 of Defendant's New Matter conclusions of law to which no responsive pleading is required. 7. The averments contained in Paragraph 18 of Defendant's New Matter conclusions of law to which no responsive pleading is required. 8. The averments contained in Paragraph 19 of Defendant's New Matter conclusions of law to which no responsive pleading is required. 9. The averments contained in Paragraph 20 of Defendant's New Matter conclusions of law to which no responsive pleading is required. 10. The averments contained in Paragraph 21 of Defendant's New Matter conclusions of law to which no responsive pleading is required. 11. The averments contained in Paragraph 22 of Defendant's New Matter conclusions of law to which no responsive pleading is required. 12. After reasonable investigation, the Plaintiff is unable to ascertain the truth the averments contained in Paragraph 23 of Defendant's New Matter and the same are denied. By way of further response however, the Plaintiff believes and avers that a tractor marked "SMV was responsible for the loss more fully described in Plaintiff's Amended 13. The averments contained in Paragraph 24 of Defendant's New Matter conclusions of law to which no responsive pleading is required. WHEREFORE, the Plaintiff, Erie Insurance Group, demands judgment against Defendant in the sum of $7213.83, together with costs of suit. Respectfully submitted, BROMBERG & MILLER BY:? GEORGE A. MILLER, Esquire Erie Insurance Group, Plaintiff 4 VERIFICATION The undersigned, does hereby verify that h is the of 9 Pla hisein, that he/she is authorized to make this verification on behalf of the Plaintiff, and that the contained in the foregoing REPLY TO NEW MATTER are true and correct to the best of hi knowledge and belief. This statement is made subject to the penalties of 18 Pa.C.S. Section 4904 relating to falsification to authorities. ERIE INSURANCE GROUP By. Title File No. 58357