The URL can be used to link to this page

Home My WebLink About13-0944 F:\F[LES\Clients\3050 DonegalU050 CurrentU050.695\3050 695 complaintl.wpd George B. Faller, Jr., Esquire ~; ~ =-_~ _ - ~;: MARTSON DEARDORFF WILLIAMS OTTO GILROY & FALLER ,-; ~-;~ -~ ;:-_`:! MARTSON LAW OFFICES • ~-~ r..~, -• LD. 49813 ~: `~. '~' 10 East High Street - '~'; _ _ . Carlisle, PA 17013 ''=' =~~~ (717) 243-3341 :.~ `= ` "' - Attorneys for Plaintiff HUY NGUYEN and IN THE COURT OF COMMON PLEAS OF JULIE NGUYEN CUMBERLAND COUNTY, PENNSYLVANIA Plaintiffs v. No. l3 - 4~ C~~-~Terw SCOTT A. NOSS, CIVIL ACTION-LAW Defendant NOTICE You have been sued in court. If you wish to defend against the claims set forth in the following pages, you must take action within twenty (20) days after this Complaint and Notice are served, by entering a written appearance personally or by attorney and filing in writing with the court your defenses or obj ections 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 Plaintiffs. You may lose money or property or other rights important to you. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW. THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER. IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAYBE ABLE TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCE FEE OR NO FEE: Cumberland County Bar Association 32 South Bedford Street Carlisle, PA 17013 (717) 249-3166 '~ ~ 103. ~5 PA ATT~ ~~ae~ ~s9 George B. Faller, Jr., Esquire MARTSON DEARDORFF WILLIAMS OTTO GILROY & FALLER MARTSON LAW OFFICES I.D. 49813 10 East High Street Carlisle, PA 17013 (717) 243-3341 Attorneys for Plaintiff HUY NGUYEN and IN THE COURT OF COMMON PLEAS OF JULIE NGUYEN CUMBERLAND COUNTY, PENNSYLVANIA Plaintiffs v. NO. SCOTT A. NOSS, CIVIL ACTION-LAW Defendant COMPLAINT 1. Plaintiffs, Huy Nguyen and Julie Nguyen are adult individuals with a last known address of 684 Frances Drive, Harrisburg, Pennsylvania 17109. 2. Defendant, Scott A. Noss("Defendant"), is an adult individual with a last known address of 35 2"d Street, York Haven, Pennsylvania 17370. 3. On or about August 2, 2012, Julie Nguyen was operating a 2006 Lexus ES330 at or near the intersection of Lower Allen Drive and the exit ramp of Route 15 South, in Camp Hill, Pennsylvania (the "Intersection"). She stopped her vehicle at the end of the exit ramp, at the traffic light for the Intersection. 4. Defendant was operating a 1998 Dodge Ram on the same exit ramp at the same time. Defendant failed to slow down when approaching the traffic light at the Intersection. 5. As a result of Defendant's failure to slow his vehicle, Defendant's vehicle struck the rear end of Julie Nguyen's vehicle. 6. Defendant's insurance company, Safe Auto Insurance Co., denied him coverage because the 1998 Dodge Ram was not listed as an insured vehicle on his insurance policy. Defendant purchased the 1998 Dodge Ram in May of 2012 as an additional vehicle, and failed to add the vehicle to his insurance policy prior to expiration of his policy's grace period. 7. The collision was caused as a result of the negligence, recklessness and carelessness of Defendant in that he: a. Failed to properly slow down as he approached the traffic light; b. Failed to operate his vehicle in a manner to avoid colliding with the rear-end of Julie Nguyen's vehicle; and Operated an uninsured vehicle. Pursuant to its insurance policy contract with Julie Nguyen and her husband, Huy Nguyen, Plaintiff is entitled to claim and pursue subrogation rights against third parties responsible for losses paid out under said contract. 9. As a result of the collision, Julie Nguyen's vehicle was damaged in the amount of $7,900.00. A copy of the repair estimate is attached hereto as Exhibit "A." 10. As a result of the collision, Julie Nguyen's vehicle became inoperable. Julie and Huy Nguyen were forced to incur the cost of renting a replacement vehicle in the amount of $440.95. 11. The outstanding balance owed by Defendant is $8,340.95, for which the claim is made by Plaintiffs. WHEREFORE, Plaintiffs demand judgment against Defendant in the amount of $8,340.95, plus costs, interest, and any other relief that the court deems appropriate. MARTS LA FI B ~ `~" ~; Y George .Faller, Esquire I.D. No. 49813 10 East High Street Carlisle, PA 17013 (717) 243-3341 Date: ~ J ~ ~~~ ~ Attorneys for Plaintiffs i J a ~~~,t~ PAP,R NICV(J ABLE I ' i d DONEGAL INSURANCE GROUP 1195 RIVER ROAD P.O. BOX 302 MARIETTA, PA 17547-0302 (717 426-1931 FAX: (717) 426-7023 "" SUPPLEMENT 1 "• 08/09/2012 01:13 PM ......................................................... ~wnwr .......................... Owner: HUY & JULIE NGUYEN Address: 684 FRANCES DR Cell: (717)343-3077 City State Zip: HARRISBURG, PA 17109 Home/Day: (717)343-4834 FAX: :................................................ ...................................................................................... Controllnformation ...................................................................................................... .............................................................................: Claim # : PAG-PA-Ot -1 2-0283 1 76 Insured Policy # : PAG-3106213 Loss Date/Time: 08/02/2012 08:00 AM Loss Type: Collision Deductible: $500.00 File # : Accounting # : 0005782 ins. Company: Donegal Insurance Group Agent: Debra Jones Address: Email: debrajones@donegalgroup.com Insured: HUY & JULIE NGUYEN Address: Work/Day: (800)877-0600x7435 Cell: (717)343-3077 Home/Day: (717)343-4834 Claim Rep: Debra Jones Address: Email: debrajones@donegalgroup.com Work/Day: (800)877-0600x7435 :............................................................................... ................................................................................... Inspection ................................ Inspection Date: 08/09/2012 01:15 PM Address: 684 FRANCES DR City State Zip: HARRISBURG, PA 17109 Primary Impact: Rear Driveable: No Assigned Date/Time: First Contact Date/Time: Company: Contact: JERRY FARABAUGH Address: 1195 RIVER ROAD P.O. BOX 302 City State Zip: Marietta, PA 17547 Email: jerryfarabaugh@donegalgroup.com Inspection Type: Field Cell: (717)343-3077 Home/Day: (717)343-4834 Secondary Impact: Rental Assisted: Received Date/Time: 08/09/2012 12:23 PM Appointment Date/Time: 08/10/2012 08:00 AM Appraiser License # : 131114 Work/Day: (717)838-9234 FAX: (717)838-9202 Cell: Orig Company: Contact: JERRY FARABAUGH Appraiser License # : 131114 Address: 1195 RIVER ROAD Work/Day: (717)838-9234 P.O. BOX 302 FAX: (717)838-9202 City State Zip: Marietta, PA 17547 Cell: Email: 'erryfarabau h@done algroup.com io;os;aofzosa~ ann Pape 1 of 8 Exhibit "A" 2006 Lexus ES330 ST[) 4 DR Sedan 08/09/201201:13 PM Claim >r :~PAG•PA-0 1-r2-0263176 5 BR 288 Door SheIl,Rear RT Blend Refinish S1 1.2 RF 0.8 Blend 0.4 Two-stage 6 RI 399 MIdg,Rear Door Scalp LT R & I Assembly S1 0.2 SM 7 RI 400 MIdg,Rear Door Scalp RT R & I Assembly S1 0.2 SM 8 RI 319 MIdg,Rear Door Belt LT R & I Assembly 0.3 SM 9 RI 320 MIdg,Rear Door Belt RT R & I Assembly S1 0.3 SM 10 E 323 01 MIdg,Rear Door Side LT 7574233190A0 $90.15 S1 0.4 SM 11 E 324 01 MIdg,Rear Door Side RT 7574133190A0 $90.15 S1 0.4 SM 12 RI 415 MIdg,Rear Door Lower LT R & I Assembly 0.3 SM 13 RI 416 MIdg,Rear Door Lower RT R & I Assembly S1 0.3 SM 14 E 304 Cover,RR Door Mandle RT 6922733050 $14.54 S1 1.0 SM 15 RI 321 Pnl,lnner Door Trim LT R & I Assembly INC SM 16 RI 305 Handie,RR Door Outer LT R & I Assembly 1.0 SM 17 RI 344 Supt,RR Door Handle LT R & I Assembly INC SM 18 RI 306 Handle,RR Door Outer RT R & I Assembly S1 INC SM 19 BR 43 13 Panel,Roof Side LT Blend Refinish 1.5 RF 0.6 Blend 0.6 Two-stage setup 0.3 Two-stage 20 BR 44 Panel,Roof Side RT Blend Refinish 0.8 RF 0.5 Blend 0.3 Two-stage 21 E 372 Mldg Assy,Back Glass 7557133080 $117.73 S1 3.4 SM 22 E 389 Panel,Ouarter LT 6160233161 $632.26 S1 12.7 SM 23 L 389 Panel,Quarter LT Refinish 3.8 RF 2.3 Surface 1.0 Edge 0.5 Two-stage 24 I 390 Panel,~uarter RT Repair S1 S1 4.0` 2 2 SM RF 25 L 390 Panel,Quarter RT Refinish . 2.2 Surface INC Two-stage 26 I 418 Extn,Quarter Panel LT Repair S1 0.1' SM 27 L 418 Extn,Quarter Panel LT Refinish S1 0.2 RF 0.2 Surface 28 E 424 Extn,Ouarter Panel LT 6106433010 $78.57 S1 INC SM 29 L 424 Extn,Gluarter Panel LT Refinish 0.5 RF 0.5 Surface INC Two-stage 30 L 419 Extn,Quarter Panel RT Refinish S1 0.2 RF 0.2 Surface 31 E 425 Extn,Quarter Panel RT 6106333010 $78.57 S1 1.9 SM 32 L 425 Extn,Quarter Panel RT Refinish 0.5 RF 0.5 Surface INC Two-stage 33 BR 397 Door,Fuel Filler LT Blend Refinish 0.2 RF 0.2 Blend INC Two-stage 34 RI 397 Door,Fuel Filler LT R & I Assembly INC SM 35 E 479 Lid,Rear Deck 6440133380 $594.03 S1 2.0 SM 36 L 479 Lid,Rear Deck Refinish 3.1 RF 2.1 Surface 1.0 Edge INC Two-stage 37 E 362 N/Plate,Deck Lid 7544733080 $30.40 S1 0.2 SM 38 E 365 N/Plate,Deck lid 7544233220 $30.40 S1 0.2 SM 39 E 485 Emblem,Deck Lid 9097502022 $37.14 S1 0.2 SM 40 E 487 Lock,Deck Lid 6460033110 $254.89 S1 INC SM 41 E 509 Panel,Rear Body 5830733120 $366.14 S1 8.1 SM 42 L 509 Panel,Rear Body Refinish 2.0 RF 1.5 Surface 0.5 Edge - - rays v v. e 1 0103/201 2 08:41 AM 2006 Lexus ES330 STn 4 DR Sedan Claim X .aAG-PA•01 •-2.0283176 08/09/2012 01:13 PM 43 E 607 Panel,Rear Body Trim 5838733080 $232.76 S1 INC SM 44 E 559 Lens,Taillamp LT 8 1 56 1 33430 ~ $171.14 S1 INC SM 45 E 560 Lens,Taillamp RT 8155133430 $171.14 S1 INC SM 46 E 528 Lens,Back Up Lamp LT 8159133100 $116.99 S1 INC SM 47 E 529 Lens,Back Up Lamp RT 8158133100 $116.99 S1 INC SM 48 E 565 Bumper,Rear 52171AA040 $199.48 S1 INC SM 49 L 565 Bumper,Rear Refinish 0.6 RF 0.6 Surface 50 E 566 Cover,Rear Bumper 5215933911 $432.71 S1 0.6 SM 51 L 566 Cover,Rear Bumper Refinish 3.1 RF 2.6 Surface 0.5 Two-stage 52 E 567 Absorber,Rear Bumper 5261533090 $55.07 S1 INC SM 53 E 592 Absorber,Rear Bumper 5261633011 $48.44 S1 INC SM 54 61 Brkt,Bumper Guard Mtg LT Replace OEM INC SM 55 62 Brkt,Bumper Guard Mtg RT Replace OEM INC SM 56 I SET UP AND MEASURE Repair 2.0' SM 57 EC CAR COVER Replace Economy $5.00' SM 58 EC FLEX Replace Economy $8.00' SM 59 EC CORROSION PROTECTION Replace Economy $8.00' SM 60 I PULL & SQUARE REAR Repair 3.0' SM 61 EC GLASS KIT Replace Economy $15.00' 51 SM 62 SB HAZARDOUS WASTE Sublet Repair $3.00` SM 63 EC CAULKlSEAM SEALER Replace Economy $10.00' SM 64 EC interior clips Replace Economy $5.64' S1 SM' 64 Items MC Message 01 CALL DEALER FOR EXACT PART # /PRICE 13 INCLUDES 0.6 HOURS FIRST PANEL TWO-STAGE ALLOWANCE Estimate Total & Entries Gross Parts $3,959.69 Other Parts $51.64 Paint Materials $485.30 Parts & Material Total $4,496.63 Tax on Parts & Material @ 6.000% $269.80 Labor Rate Replace Repair Mrs Total Hrs Mrs Sheet Metal (SM) $46.00 34.0 9.1 43.1 $1,982.60 Mach/Flat (ME) $47.00 Frame (FR) $46.00 Refinish (RF) $46.00 21.1 21.1 $970.60 Pafnt Materials $23.00 Labor Total 64.2 Hours $2,953.20 Tax on Labor ~ 6.000% $177.19 Sublet Repairs $3.00 Tax on Sublet @ 6.000% $0.18 Gross Total $7,900.00 Less: Deductible $500.00- Net Total $7,400.00 Actual Supplement Total $1,112.25 Less: Previous Net Total $6,287.75- Net Supplement Total $1,112.25 Alternate Parts Y/00/00/00/00/00 CUM 00/00/00/00/00 Zip Code: 17547 Default 10!03/2012 06:41 AM Papa a of 8 2006 Lexus ES330 STD 4 DR Sedan Claim ~ PAG•PA-01,12-0283176 Og/09/2012 01:13 PM Audatex Estimating 6.0.726 S1 10/03/2012 08:41 AM REL 6.0.726 DT 09/01/2012 DB 10/01/2012 Copyright (C) 2011 Audatex North America, Inc. 3.0 HRS WERE ADDED TO THIS ESTIMATE BASED ON AUDATEX'S TWO-STAGE REFINISH FORMULA. ESTIMATE CALCULATED USING THE 2.5 HOUR MAXIMUM ALLOWANCE FOR TWO-STAGE REFINISH OF NON-FLEX, EXTERIOR SURFACES. ABBREVIATION LEGEND: LKQ = LIKE KIND I'_V QUALITY, A/M = AFTERMARKET, RECOND = RECONDITION, 0/H= OVERHAUL, REPL = REPLACE, RPR = REPAIR, REFN = REFINISH, SECT = SECTION, R & I = REMOVE AND INSTALL, ALGN = ALIGN, SUBL = SUBLET, BLND = BLEND, ASSY= ASSEMBLY, FRNT/FRT = FRONT, HL/H/LAMP = HEADLAMP, INR = INNER, L = LEFT, MLD/MLDG = MOLDING, MTG = MOUNTING, OTR = OUTER, PNLS = PANELS, R/RT = RIGHT, REPL = REPLACEMENT, SUSP = SUSPENSION, W/0 MLD = WHEEL OPENING MOLDING, RIC = REMOTE CONTROL, BRKT = BRACKET, LIC = LICENSE, R/F = RIGHT FRONT, R/R = RIGHT REAR, L/F = LEFT FRONT, L/R = LEFT REAR, PNL = PANEL, FT = FRONT, PXN = PARTS EXCHANGE NEW, OEM = ORIGINAL EQUIPMENT MANUFACTURER, PRT = PART, NAGS = NATIONAL ASSOCIATION OF GLASS SUPPLIER, REMAN = REMANUFACTURED, PART = PARTIAL 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. WE WILL NOT BE RESPONSIBLE FOR ANY RELATED TOWING SERVICES OR STORAGE CHARGES, KNOWN AT THE TIME OF THE APPRAISAL, AND INCURRED AFTER THE FOLLOWING DATE: .......... CHARGES INCURRED AFTER THIS DATE WILL BE THE RESPONSIBILITY OF THE CONSUMER. COSTS THAT EXCEED THE APPRAISED AMOUNT MAY BE THE RESPONSIBILITY OF THE VEHICLE OWNER. IF YOU REQUEST, WE CAN PROVIDE YOU WITH THE NAMES OF REPAIR FACILITIES THAT WILL BE ABLE TO REPAIR THE VEHICLE FOR THE APPRAISED AMOUNT. THERE IS NO REQUIREMENT TO LSE ANY SPECIFIED REPAIR SHOP. THIS IS NOT AN AUTHORIZATION TO REPAIR. NO SUPPLEMENTS HONORED UNLESS INSPECTED ANC ACTHORIZED BY APPRAISER. IF THE APPRAISAL INCLUDES AFTERMARKET CRASH PARTS, THE AFTERMARKET CRASH PART SHALL HAVE A WARRANTY EQUAL TO OR BETTER THAN THE REMAINDER OF THE EXISTING WARRANTY ON THE PART BEING REPLACED. APPRAISER SIGNATURE: 10/03!2012 08:41 AM Pape 5 of 8 2006 Lexus ES330 STD a DR Sedan Claims PAG-PA-Oi•1~2.0283176 08/09/201201:13PM Op Codes ' =User-Entered Value EC =Replace Economy ET =Partial Replace Labor TE =Partial Replace Price L =Refinish TT =Two-Tone BR =Blend Refinish CG= Chipguard AA =Appearance Allowance E =Replace OEM OE = Replace PXN OE Srpls EP =Replace PXN PM= Replace PXN Reman/Reblt PC = Replace PXN Reconditioned SB =Sublet Repair I =Repair RI = R & I Assembly RP = Related Prior Damage NG = Replace NAGS UE =Replace OE Surplus EU =LIKE KIND & OUAL.PRT UM= Replace Reman/Rebuilt UC = Replace Reconditioned N =Additional Labor IT =Partial Repair P =Check This report contains proprietary information of Audatex and may not be disclosed to any third party (other than the insured, claimant and others on a need to know basis in order to effectuate the claims process) without ',;,,,. Audatex's prior written consent. ~r~d~~~x ~~ • ^••^^~ •Copyright (C) 2011 Audatex North America, Inc. Audatex Estimating is a trademark of Audatex North America, Inc. 10/03/2012 08:41 AM Page 6 of 8 2006 Lexus ES330 STD 4 DR Sedan Claim A rPAG•PA•01.72-0283176 08/09/2012 01:13 PM Estimate Summary Pa e Gross Total $7 900.00 Less: Deductible , $500.00- Net Total $7 400.00 Actual Supplement Total $1 112 25 , Less: Previous Net Total $1i 287 75- Net Supplement Total , . $1,112.25 Total Unrelated Prior Damage $239.20 Audatex Estimating 6.0.726 S1 10/03/2012 08:41 AM REL 6.0.726 DT 09/01/2012 DB 10/01/Z012 Copyright (C) 2011 Audatex North America, Inc. Pape 7 018 2006 Lexus E5330 STD 4 DR Sedan Giaim z ~• PAG-PA•Ot+12-0283176 08!09/201201:13 PM "' Unrelated Prior Damage Page ""' :Administrative Owner: HUY & JULIE NGUYEN Claim # : PAG-PA-01-12-0283176 Loss Date/Time: 08/02/2012 08:00 AM Inspection Date: 08/09/2012 01:15 PM Vehicle: 2006 Lexus ES330 STD 4 DR Sedan 6cyl Gasoline 3.3 5 Speed Automatic :Damages ....................................................................................................................................................................................... ;Estimate Total & Entries Paint Materials $64.40 Parts & Material Total $64.40 Replace Repair Total Hrs Hrs Hrs Labor Rate Sheet Metal (SM) $46.00 1.0 1.0 $46.00 MachlElec (ME) $47.00 Frame (FR) $46.00 Refinish (RF) $46.00 2.8 2.8 $128.80 Paint Materials $23.00 Labor Total 3.8 Hours $174.80 Unrelated Prior Damage Gross Total (excludes taxes) $239.20 These damages are unrelated to the stated loss incident. The stated costs are representative only and may differ based upon such factors as the involved incident facts, completion of the damages estimate and/or actual repair. ~i03/"L012 OB:41 AM -- Pape 8 of 8 "' SUPPLEMENT RECONCILIATION "' Supplement Si Claim # : PAG•PA-01-12-0283176 Insured Policy # : PAG-3106213 File # : CIaIm Rep: Debra Jones Insured: HUY & JULIE NGUYEN Inspection Date/Tlme: 08/09/2012 01:1 5 PM Owner Name: HUY & JULIE NGUYEN Company: Vehicle: 2006 Lexus ES330 STD 4 DR Sedan Deleted Lines < ~Llne .. ,..Guides ...Part'. » .................................. :.....Operatlon :..:.............. ................. ..............:.. -Price.... .....,ADJ%:....::.9% ...:: ...Labor.:: ...:..::: Rate . 1 323 MIdg,Rear Door Side LT R & I Assembly 0.4 SM ::Added Lines r ......... Line .............. Guide ............................................... Part ........................................ Operation ................. ................................................................ Price ADJ% B% ................. Labor ................: Rate 2 288 Door She1l,Rear RT Blend Refinish Si 1.2 RF 3 304 Cover,RR Door Handle RT Replace OEM Si $14.54 1.0 SM 4 306 Handle,RR Door Outer RT R & I Assembly Si INC SM 5 320 MIdg,Rear Door Belt RT R & I Assembly Si 0.3 SM 6 323 MIdg,Rear Door Side LT Replace OEM Si $90.15 0.4 SM 7 324 MIdg,Rear Door Side RT Replace OEM Si $90.15 0.4 SM 8 372 Mldg Assy,Back Glass Replace OEM S1 $117.73 3.4 SM 9 399 MIdg,Rear Door Scalp LT R 13< I Assembly S1 0.2 SM 10 400 MIdg,Rear Door Scalp RT R & 1 Assembly St 0.2 SM 11 416 MIdg,Rear Door Lower RT R & I Assembly S1 0.3 SM 12 418 Ex1n,Quarter Panel LT Repair S1 0.1' SM 13 418 Extn,Quarter Panel LT Refinish S1 0.2 RF 14 419 Extn,Quarter Panel RT Refinish S1 0.2 RF 15 487 Lock,Deck lid Replace OEM S1 $254.89 INC SM 16 GLASS KIT Replace Economy S1 $15.00' SM 17 interior clips Replace Economy Si $5.64` SM' ...................................................................... :Changed Lines :..................................................................... ......................................... ......................................... ................. ........ . .. ................................................................ . ................ ................. : Line Guide Part Operation . ... .. ............................................................... Price ADJ% B% ................ Labor ................ Rate 18 362 N/Plate,Deck Lid Replace OEM S1 $30.40 0.2 SM N/Plate,Deck lad $29.80 0.2 SM 19 365 N/Plate,Deck Lid Replace OEM S1 $30.40 0.2 SM N/Plate,Deck Lid $29.80 0.2 SM 20 389 Panel,Quarter LT Replace OEM S1 $632.26 12.7 SM Panel,Quarter LT $603.02 16.1 SM 21 390 Panel,Quarter RT Repair S1 4.0' SM Panel,Quarter R T 1.5` SM 22 424 Exin,Quarter Panel LT Replace OEM Si $78.57 INC SM Extn,Quarter Panel LT $77.00 INC SM 23 425 Extn,Quarter Panel RT Replace OEM Si $78.57 1.9 SM Extn,Quarter Panel RT $77.00 1.9 5M 24 479 Ud,Rear Deck Replace OEM Si $594.03 2.0 SM Lid,Rear Deck $594.06 2.0 SM 25 485 Emblem,Deck Lid Replace OEM S1 $37.14 0.2 SM Emblem,Deck Lid $36.40 0.2 SM 26 509 Panet,Rear Body Replace OEM Si $366.14 8.1 SM Panel,Rear Body $358.92 8.1 SM 27 528 Lens,Back Up Lamp LT Replace OEM S1 $116.99 INC SM Lens,Back Up Lamp LT $116.89 INC SM 28 529 Lens,Back Up Lamp RT Replace OEM S1 $116.99 INC SM Lens,Back Up lamp RT $116.89 INC SM 29 559 Lens,Taillamp LT Replace OEM S1 $171.14 INC SM Lens,Taillamp LT $171.26 INC SM 30 560 Lens,Taillamp RT Replace OEM S1 $171.14 INC SM Lens,Taillamp RT $171.26 INC SM 31 565 Bumper,Rear Replace OEM Si $199.48 INC SM Bumper,Rear $197.63 INC SM 32 566 Cover,Rear Bumper Replace OEM S1 $432.71 0.6 SM Cover,Rear Bumper $410.34 0.6 SM 33 567 Absorber,Rear Bumper Replace OEM Si $55.07 INC M S 10/03/20 12 08:41 AM _ _ Papa 1 of 2 2006 Lexus E5330 STD 4 DR Sedan Claim f r PA@S-PA-01.12.0283176 Absorber,Rear Bumper $54.01 INC SM 34 592 Absorber,Rear Bumper Replace OEM S1 $48.44 INC SM Absorber,Rear Bumper $47.50 INC SM 35 607 Panel,Rear Body Trim Replace OEM S1 $232.76 INC SM Panel,Rear Body Trim $228.15 INC SM Calculation Chances...... From To Dtfterence Gross Parts $3,319.93 $3,959.69 $639.76+ Other Parts $31.00 $51.64 $20.64+ Paint Materials $23.00 $400.00 $23.00 $485.30 $85.30+ Tax on Parts & Material 6.000% $225.06 6.000% $269.80 $44.74+ SM -Sheet Metal $46.00 $1,752.60 $46.00 $1,982.60 $230.00+ RF -Refinish $46.00 $897.00 $46.00 $970.60 $73.60+ Tax On Labor 6.000% $158.98 6.000% $177.19 $18.21+ Actual Supplement 1 Net Total x1,112.25+ Summary ............................. ............. Net Total Date Tlme Appraiser Original Estimate $6,287.75 08/09/2012 12:18 PM Supplement 1 $7,400.00 10/03/2012 06:18 AM This report contains proprietary information of Audatex and may not be disclosed to any third party (other than the insured, claimant and others on a need to know basis in order to effectuate the claims process) without Audatex's ~~ f ~~~~CX~ prior written consent. ~•-..M, Copyright (C) 2011 Audatex North America, Inc. Audatex Estimating is a trademark of Audatex North America, Inc. __ 10/03/2012 08:41 AM Pape 2 of 2 ' Notes and Comments Created Date Time: 2012-OS-09 17:26:53 Created By: Jerry Farabaugh , Type: LOSS_NOTE Subject: Untitled First Contact: 1PM 8-9-12 Inspection Location: listed on page one of estimate Owner Present: yes MRS Brief Description/Summary of Damages: REAR DAMAGE See point of impact, photos an d estimate for damage details. Alternative-LKQ Parts Search: listed on estimate if available at time of estimat e lkq no quot#2428449 Estimate handed to Owner Estimate written on site - yes. Payment issued: 8-9-12 ck#514397 $ Followed up with owner explained estimate and supplement process. ------------------------------------------------------------- Created Date Time: 2012-10-03 12:40:12 Created By: Jerry Farabaugh Type: LOSS_NOTE Subject: Untitled see photo of dop please pay supplement direct to the repair shop COPY OF SUPPLEMENT MAILED TO OWNER ------------------------------------------------------------- et ~ DONEGAL INSURANCE GROUP 1195 RIVER ROAD P.O. BOX 302 MARIETTA, PA 17547-0302 '17) 426-1931 FAX: (717) 426-7023 "•' ESTIMATE "" ... 08/09/2012 01:13 PM . ............................................................................................................................................................ Owner ........ Owner: HUY & JULIE NGUYEN Address: 684 FRANCES DR Cell: (717)343-3077 City State Zip: HARRISBURG, PA 17109 Home/Day: (717)343-4834 FAX: :................................................................................................. Controllnformation .................................................................................................... - ..... laim # : PAG-PA-01-12-0283176 Insured Policy # : PAG-3106213 Loss Date/Time: 08/02/2012 08:00 AM Lose T Deductibb• $500.00 YPe~ Collision File # : Accounting # : 0005782 Ins. Company: Donegal Insurance Group Agent: Debra Jones Address: Email: debrajones~donegalgroup.com Insured: HUY & JULIE NGUYEN Address: Claim Rep: Debra Jones Address: Email: debrajones@donegalgroup.com Work/Day: (800)877-0600x7435 Cell: (717)343-3077 Home/Day: (717)343-4834 Work/Day: (800)877-0600x7435 :........... ................................................................................................................................................................... :' Inspection ..................................... Inspection Date: 08/09/2012 01:15 PM Address: 684 FRANCES DR City State Zip: HARRISBURG, PA 17109 Primary Impact: Rear Driveable: No Inspection Type: Field Cell: (717)343-3077 Home/Day: (717)343-4834 Secondary Impact: Rental Assisted: Assigned Date/Tirr~: First Contact Date/Time: Company: Contact: JERRY FARABAUGH Address: 1195 RIVER ROAD P.O. BOX 302 City State Zip: Marietta, PA 17547 Email: jerryfarabaugh~donegalgroup.com Target Complete Date/Time: Received Date/Time: 08/09/2012 12:23 PM Appointment Date/Time: 08/10/2012 08:00 AM Appraiser License # : 131114 Work/Day: (717)838-9234 FAX: (717)838-9202 Ceil: Days To Repair: 10 08/0972012 01:31 PM Pape i of 7 1, v 2006 Lexue ES330 STD 4 OR Sedan Claim t : PAC-PA•Ot•12-0283176 Remarks *"`PLEASE PROVIDE A COPY OF THIS ESTIMATE TO THE REPAIR SHOP OF YOUR CHOICE"" "'ALL SUPPLEMENT MUST HAVE A DIRECTION OF PAY SIGNED BY THE VEHICLE OWNER"* **'DO NOT PROCEED WITH ANY SUPPLEMENTAL REPAIR WITHOUT APPRAISER'S APPROVAL**` "SUPPLEMENT MUST HAVE ALL PARTS INVOICES FOR THE ENTIRE JOB, NO EXCEPTIONS!`* *"COPY OF ESTIMATE GIVEN TO OWNER"" "'ANY SUPPLEMENT NOT APPROVED BY THE APPRAISER WILL NOT BE HONORED'*' 0808/201201:13 PM ehicle ............._ - ...--....._.._..._........... . ..................................................................................................................................: 2006 Lexus E5330 STD 4 DR Sedan 6cyl Gasoline 3.3 5 Speed Automatic Lic.Plate: HGK 8576 Lic State: PA Lic Expire: Prod Date: VIN: JTHBA30G465145976 Veh Inaptr` : Mileage: 103,304 Mileage Type: Actual Conditbn: Good Code: LX233A Ext. Color: SILVER Int. Color: Ext. Refinish: Two-Stage Int. Refinish: Options 17 Inch Ailoy Wheels Air Conditioning Alarm System Anti-Lock Brakes Automatic Dimming Mirror Bodyside Cladding Center Console Climate Cntrl Frnt Seats Compact Disc W/Tape Cruise Control Dual Airbags Dual Power Seats Dual Zone Auto A/C Fog Lights Garage Door Opener Head Airbags Heated Front Seats Heated Power Mirrors Intermittent Wipers Keyless Entry System Leather Seats Lighted Entry System Overhead Console Power Brakes Power Door Locks Power Moonroof Power Steering Power Windows Rem Trunk-UGate Release Rear Side Airbags Side Airbags Rear Window Defroster Tachometer Tilt Steering Wheel Strg Wheel Radio Control Tinted Glass Trip Computer Wood Interior Trim Wood Steering Wheel amages Line Op Guide MC Description MFR.Part No. Price ADJ°k B% Hours R 1 2 RI RI 205 274 Plate,Rear Sill LT MIdg,Rocker Panel LT R & I Assembly R & I Assembly INC SM 3 RI 275 MIdg,Rocker Panel RT R & I Assembly INC 0 3 SM SM 4 BR 287 Door SheIl,Rear LT Blend Refinish . 1.2 RF 0.8 Blend 5 RI 319 MIdg,Rear Door Belt LT 0.4 Two-stage R & I Assembly 6 RI 323 MIdg,Rear Door Side LT R & I Assembty 0.3 SM 7 RI 415 MIdg,Rear Door Lower LT R & I Assembly 0.4 SM 8 RI 321 Pnl,lnner Door Trim LT R & I Assembly 0.3 INC SM SM 9 RI 305 Handle,RR Door Outer LT R & I Assembty 1 0 SM 10 RI 344 Supt,RR Door Handle LT R & I Assembly . INC SM 11 BR 43 13 Panel,Roof Side LT Blend Refinish 1.5 RF 0.6 Blend 0.6 Two-stage setup 0.3 Two-stage 12 BR 44 Panel,Roof Side RT Blend Refinish 0.8 RF 08/09V201201:31 PM Pie 2 of 7 ,, , 2008 Lexus ES330 STD 4 DR Sedan . Gleim ar ~ PAGPA•01.12-0283178 08/09/201201:13 PM 0.5 Blend 13 E 389 Panel,Quarter LT 0.3 Two-stage 6160233161 $603 02 14 L 389 Panel,Ouarter LT Refinish . 16.1 SM 2.3 Surface 3.8 RF 1.0 Edge 15 I 390 Panel,Ouarter RT 0.5 Two-stage Repair 16 L 390 10 Panel,Quarter RT Reflnish 1.5' SM 1.8 Surface 2.2` RF 0.4 Two-stage » BLEND COLOR FULL CLEAR COAT 17 E 424 Extn,Quarter Panel LT 6106433010 $77 00 18 L 424 Extn,Quarter Panel LT Reflnish . INC SM 0.5 Surface 0.5 RF 19 E 425 Extn,Ouarter Panel RT INC Two-stage 6106333010 $77 00 20 L 425 Extn,Ouarter Panel RT Refinish . 1.9 SM 0.5 Surface 0.5 RF 21 BR 397 Door,Fuel Filler LT INC Two-stage Blend Reflnish 0.2 Blend 0.2 RF 22 RI 397 Door,Fuel Filler LT INC Two-stage R & I Assembly 23 E 479 Lid,Rear Deck 6440133380 $594 06 INC SM 24 L 479 Lid,Rear Deck Reflnish . 2.0 SM 2.1 Surface 3.1 RF 1.0 Edge 25 E 362 N/Plate, Deck Lid INC Two-stage 7544733080 $29 80 26 E 365 WPlate,Dedc Lid 7544233220 . $29 80 0.2 SM 27 E 485 Emblem,Deck Lid 9097502022 . $36 40 0.2 SM 28 E 509 Panel,Rear Body 5830733120 . $358 92 0.2 SM 29 L 509 Panel,Rear Body Refinish . 8.1 SM 1.5 Surtace 2.0 RF 30 E 607 Panel,Rear Body Trim 0.5 Edge 5838733080 $228 15 31 E 559 Lens,Tailtamp LT 8156133430 . $171 26 INC SM 32 E 560 Lens,Taillamp RT 8155133430 , $171 26 INC SM 33 E 528 Lens,Back Up Lamp LT 8159133100 ' $116 89 INC SM 34 E 529 Lens,Back Up Lamp RT 8158133100 . $116 89 INC SM 35 E 565 Bumper,Rear 52171AA040 . 63 $197 INC SM 36 L 565 Bumper,Rear Reflnish . INC SM 37 E 566 Cover,Rear Bumper 0.6 Surface 5215933911 $410 34 0.6 RF 38 L 566 Cover,Rear Bumper Refinish . 0.6 SM 2.6 Surtace 3.1 RF 39 E 567 Absorber,Rear Bumper 0.5 Two-stage 5261533090 $54 01 40 E 592 Absorber,Rear Bumper 5261633011 . $47 50 INC SM 41 61 Brkt,Bumper Guard Mtg LT Re lace OEM p . INC INC SM 42 62 Brkt,Bumper Guard Mtg RT Re lace OEM INC SM 43 I SET UP AND MEASURE Repair SM 44 EC CAR COVER Replace Economy $5 00' 2.0' SM 45 EC 46 EC FLEX CORROSION PROTECTION Replace Economy Replace Econom . $8.00 = SM SM 47 I PULL & SQUARE REAR y Repair $8.00 SM ~ SB HAZARDOUS WASTE Sublet Repair $3 00' 3.0` SM 49 EC CAULK/SEAM SEALER Replace Economy . $10 00 SM 49 Items . SM MC Message 08!08/2012 01:31 PM P~e3oi7 2008 Lexue E5330 STD 4 DR Sedan ' Claim ~ : PA(~PA-01-12-0283178 08!09/2012 01:13 PM 10 INCLUDES AUDATEX TIME TO CLEAR ENTIRE PANEL 13 INCLUDES 0.6 HOURS FIRST PANEL TWO-STAGE ALLOWANCE Estimate Total & Entries Gross Parts $3,319.93 Other Parts $31.00 Paint Materials $400.00" Parts & Material Total Tax on Parts & Material ~ 6.000% Labor Rate Replace Repair Hrs Total Hrs Hrs Sheet Metal (SM) $46.00 31.6 6.5 38.1 $1 752.60 Mech/Elec (ME) $47.00 , Frame (FR) $46.00 Refinish (RF) $46.00 19.5 19.5 $897 00 Paint Materials $23.00 . Labor Total 57.6 Hours Tax on Labor ~ 6.000~o $158 98 Sublet Repairs . $3 00 Tax on Sublet @- 6.0009'a . $0 18 Gross Total . Less: Deductible Net Total Alternate Parts Y/00/00/00/00/00 CUM 00/00/00/00/00 Zip Code: 17547 Default Audatex Estimating 6.0.726 ES 08/09/2012 01:31 PIN REL 6.0.726 DT 07/01/2012 DB 08/08/2012 Copyright (C) 2011 Audatex North America, Inc. $3, 750.93 $225.06 $2,649.60 $6,787.75 $500.00- $6,287.75 ** USER-ESTABLISHED THRESHOLD FOR PAINT MATERIALS HAS BEEN REACHED AND CALCULATED IN THIS ESTIMATE. ANY ADDITIONAL MATERIALS MAY REQUIRE FURTHER APPROVAL. ** 3.0 HRS WERE ADDED TO THIS ESTIMATE BASED ON AUDATEX'S TWO-STAGE REFlNISH FORMULA. ESTIMATE CALCULATED USING THE 2.5 HOUR MAXIMUM ALLOWANCE FOR TWO-STAGE REFlNISH OF NON-FLEX, EXTERIOR SURFACES. ABBREVIATION LEGEND: LKQ = LIKE KIND IN QUALITY, A/M = AFTERMARKET, RECOND = RECONDITION, 0/H= OVERHAUL, REPL = REPLACE, RPR = REPAIR, REFN =REFINISH, SECT = SECTION, R & I = REMOVE AND INSTALL, ALGN =ALIGN, SUBL = SUBLET, BLND = BLEND, ASSY= ASSEMBLY, FRNT/FRT = FRONT, HL/H/LAMP = HEADLAMP, INR = INNER, L = LEFT, MLD/MLDG = MOLDING, MTG = MOUNTING, OTR = OUTER, PNLS = PANELS, R/RT = RIGHT, REPL = REPLACEMENT, SUSP = SUSPENSION, W/O MLD = WHEEL OPENING MOLDING, RIC = REMOTE CONTROL, BRKT BRACKET, LIC = LICENSE, R/F - RIGHT FRONT, R/R = RIGHT REAR, L/F = LEFT FRONT, L/R = LEFT REAR, PNL = PANEL, FT = FRONT, PXN = PARTS EXCHANGE NEW, OEM = ORIGINAL EQUIPMENT MANUFACTURER, PRT = PART, NAGS = NATIONAL ASSOCIATION OF GLASS SUPPLIER, REMAN = REMANUFACTURED, PART = PARTIAL 08!09/201201:31 PM Pape 4 of 7 ,~~-, , 2006 Lexua ES330 STD 4 DR Sadan ' Claim f : PAG-PA-01.12-0283176 ~ 08K18/2012 01:13 PM 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. WE WILL NOT BE RESPONSIBLE FOR ANY RELATED TOWING SERVICES OR STORAGE CHARGES, KNOWN AT THE TIME OF THE APPRAISAL, AND INCURRED AFTER THE FOLLOWING DATE: CHARGES INCURRED AFTER THIS DATE WILL BE THE RESPONSIBILITY OF THE CONSUMER. COSTS THAT EXCEED THE APPRAISED AMOUNT MAY BE THE RESPONSIBILITY OF THE VEHICLE OWNER. IF YOU REQUEST, WE CAN PROVIDE YOU WITH THE NAMES OF REPAIR FACILITIES THAT WILL BE ABLE TO REPAIR THE VEHICLE FOR THE APPRAISED AMOUNT. THERE IS NO REQUIREMENT TO USE ANY SPECIFIED REPAIR SHOP. THIS IS NOT AN AUTHORIZATION TO REPAIR. NO SUPPLEMENTS HONORED UNLESS INSPECTED AND AUTHORIZED BY APPRAISER. IF THE APPRAISAL INCLUDES AFTERMARKET CRASH PARTS, THE AFTERMARKET CRASH PART SHALL HAVE A WARRANTY EQUAL TO OR BETTER THAN THE REMAINDER OF THE EXISTING WARRANTY ON THE PART BEING REPLACED. APPRAISER SIGNATURE: Op Codes ' =User-Entered Value EC =Replace Economy E =Replace OEM OE = Replace PXN OE Srpls NG = Replace NAGS ET =Partial Replace Labor TE =Partial Replace Price EP =Replace PXN UE =Replace OE Surplus EU =LIKE KIND & QUAL.PRT L =Refinish PM= Replace PXN Reman/Reblt PC =Replace PXN Recondition d UM= Replace Reman/Rebuilt TT =Two-Tone e SB =Sublet Repair UC = Replace Reconditioned N BR =Blend Refinish I =Repair =Additional Labor IT CG= Chipguard AA =Appearance Allowance RI = R & I Assembly RP =Related Prior Damage =Partial Repair P =Check This report contains proprietary information of Audatex and may not be disclosed to any third party (other than the insured, claimant and others on a need to know basis in order to effectuate the claims process) without ~~~~~~~ Audatex's prior written consent. a SsrEK"d L~7rir~d~ar Copyright (C) 20f1 Audatex North America, Inc. Audatex Estimatin is a trademark of Audatex North America, Inc. 08!0812012 01:31 PM Pape 5 of 7 2008 Lexua ES330 STD 4 DR Sedan Claim # : PAGPA-01.12-0283176 0&09/2012 01:13 PM ~ Estimate Summary Page Gross Total Leas: Deductible $6,787.75 Net Total $500.00- $6,287.75 Total Unrelated Prior Damage $239.20 Audatex Estimating 6.0.726 ES 08/09/2012 01:31 PM REL 6.0.726 DT 07/01/2012 DB 08/08/2012 Copyright (C) 2011 Audatex North America, Inc. 0&09/2012 01:31 PM Pape 6 of 7 '~ . 2008 Lexua ES330 STD 4 DR Sedan ' Claim a : PAG•PA-01.12-0283178 ' 08/09/201201:13 PM "" Unrelated Prior Damage Page "'" :Administrative Owner: HUY & JULIE NGUYEN Claim # : PAG-PA-01-12-0283176 Loss Date/Time: 08/02/201208:00 AM Inspection Date: 08/09/2012 01:15 PM Vehicle: 2006 Lexus ES330 STD 4 DR Sedan 6cyl Gasoline 3.3 5 Speed Automatic :Dams es ...,..._ ............._,.....:..:..,... ............................ Line Op Guide MC Description MFR.Part No. Price ADJ°k B% Hours R 1 i 83 Panel,Hood Repair 2 L 83 Panel,Hood Refinish 2 Items 1.0' SM 2.8 RF .................................. :Estimate Total & Entries ....................................................................................................................... Paint Materials Parts & Material Total $64.40 $64.40 Replace Repair Total Hrs Labor Hrs Hrs Rate Sheet Metal (SM) $46.00 Mach/Elec (ME) $47.00 1'0 1.0 $46.00 Frame (FR) $46.00 Refinish (RF) $46.00 2.8 2.8 $128.80 Paint Materials $23.00 Labor Total Unrelated Prior Damage Gross Total (excludes taxes) 3.8 Hours $174.80 $239.20 These damages are unrelated to the stated loss incident. The stated costs are representative only and may differ based upon such factors as the involved incident facts, completion of the damages estimate and/or actual repair. 0&'09/201201:31 PM Pape 7 of 7 ~~• , DTd~es and Comments Created Date Time: 2012-08-09 17:26:53 Created By: Jerry Farabaugh Type: LOSS_NOTE Subject: Untitled First Contact: 1PM 8-9-12 Inspection Location: listed on page one of estimate Owner Present: yes MRS Brief Description/Summary of Damages: REAR DAMAGE See point of impact, photos an d estimate for damage details. Alternative-LKQ Parts Search: listed on estimate if available at time of estimat e lkq no quot#2428449 Estimate handed to Owner Estimate written on site - yes. Payment issued: 8-9-12 ck#514397 $ Followed up with owner explained estimate and supplement process. ARMS®-Automated Rental Management System . .. ~® Sko naroahen - Donsgellnwroncs ~ createAUthen:atlen Flnecuataar Omce 123 MARIETTA PA Flle Owner JONES, DEBRA Invoicing. for NoUYEN, HUY Cldm Nwnbr.axsalTe INDIVIDUAL PAYMENT Page 1 of 1 Welcane DEBRAJONES 8422/12 ;dppQtd Atilondama ConpletNlACtbns RpoAs Admnlata0an HMp TramNr flk Make payment to: Togl Chayn: 5440.95 Len Aaneunt0.nelwdS280.85 ENTERPRISE RENTr1-CAR t47A1) TeglAnwntDw: St80.00 PO.BOX3106 BOSTON , MA 02241 Check Ntxnber foryotx payment t 1879701 ~ederallC 2 8-4 5 2 64 40 Please include on your check: Inwke Number. D290iA14i702 Neb b 5eM ^ PrintRentalHismryroo PringrfriendWPye use the'•Prrn" anion rrom.yolr warser arter d Icwrp the •Pnm statement txetorl RENTAL: Rentet Bnneh Leaatlen: ENTERPRISE RENT-A-CAR (5702) 2552 PAXTON ST HARRISBURG, PA 171111035 (717)584-8444 INVOICE: Invda Number D299534-5702 Invace Date 6116112 CLAIM: Renter: NGUYEN, HUY Claim Numbm. 0263176 Claim Type Insured Vehicle Condition: Non-Dnveade Dale a Loss: Insured Name. Addiacnal Driver AUTNORI2'/1TION DETAIL: Policy Daily Ratd Msxinxm Ddlars. 15.OOM50.00 Days 12 Raq: 15.00 Direct Bi/ Percent 100% Tegl Atdherlaed: g0O.00' •'Pdloy UmR RENTAL t)CTAIL: RlrRal Pldod BMn 2 to 8!15!12 (12 days) SIINd Perled.• flldM2 glMOMY (Y1 daya) PndusgandEwleee 12 DAYS ~ 1 FUEL Raq 30.74 1858 Aawnt 4388 88 518.58 Taaea and Surcharyea 12 PTA TAX 2.00 524.00 1 SALES TAX% 8.00% 529.51 Dlreet SN Peroene 100% Twl Charge: 4440.95 AeeuM RabelvM: 5260.85 TeglAmeuntOur. NlOAO VEHICLES RENTED: EMetlw Dan and Tlme Ynr Make MedN YIN SgrtlnB MWp lMbO Mllaye MIHye 8/4/12 I I a5 AM 2012 NISN ALTI 1N4AL2AP9CN544788 4587 5238 871 NOTE®OOK: ^ Extensions ^ Request Extension ^ Maintain Audttxiza[bn Date AtNter bMssap 9/18!12 713 AM SYSTEM,ARMS INVOICE RECEIVED. AMOUNTDUES180.00 9/15!12 5 52 PM RENTAL, BRANCH Ticket 299534 dosed bn 8/15/12 at 5:48 PM. 8!13112 3 31 PM RENTAL, BRANCH Repar Facagy set to PENDING SHOP. BI13112 3 28 PM RENTAL. BRANCH Ticket 299534 pened on BMI72 at 11:45 AM. 8ltOn 2 I0 12 AM RENTAL, BRANCH Authgrizatbn confrmed by Enterprise at 9:12 AM. Reservation nwttbr 393079. &10!12 t O. t 2 AM JONES, DEBR4 Auatrizatbn sent at 10:12 AM kr 20 days up ro S15.OOlday. Autharizatbn sent with 515.00lday! f450.00/max. Aulharized by JONES, DEBRA. Direct Bill Authonzadan set at 100 % BEmerpnse®Employee Note TO Sea i[] Note TNFrom Repair Facaay 7rme a daplayed fusee on yaw local am. mre: Ga17.04~00 ~p Ot aaca cbntactus rermsofuse PnvacyPOaryuK,lrelartd~NamAmenca U. S. Patanl No. 7,:?5038 corers the ANanMad Redd Mmagamanl SysUm (ARMSa and rehtad syanrtre and prognma. OtMr U.S and forego palaMe Dandng. https ://www. arnisweb. com/armsweb/actionitem s OCopynghl 2012 TM Cravford Group 8/22/2012 .~` VERIFICATION The foregoing Answers to Interrogatories aze based upon information which has been gathered by my counsel in the preparation of the lawsuit. The language of the document is that of counsel and not my own. I have read the document and to the extent that it is based upon information which I have given to my counsel, it is true and correct to the best of my knowledge, information and belief. To the extent that the content of the document is that of counsel, I have relied upon counsel in making this verification. This statement and verification are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities, which provides that if I make knowingly false averments, I may be subject to criminal penalties. Huy en e Julie N yen F \FILES\ClieatsU050 Donegal\3050 CuvmtU050.69511050 695 complainU.wpd SHERIFF'S OFFICE OF CUMBERLAND COUNTY Ronny R Anderson l- i; :`i -R Sheriff ff tia �t � ofClUrib"' 411 Jody S Smith Chief Deputy i�13 APR —4 AM 9: 0- Zrl Richard W Stewart Solicitor i,M3E LA � it;ij :,"Cj Huy &Julie Nguyen vs. Case Number Scott A Noss 2013-944 SHERIFF'S RETURN OF SERVICE 02/22/2013 Sheriff Ronny R Anderson, being duly sworn according to law, states he made diligent search and inquiry for the within named Defendant to wit: Scott A Noss, but was unable to locate the Defendant in the Sheriffs bailiwick.The Sheriff therefore deputizes the Sheriff of York, Pennsylvania to serve the within Complaint& Notice according to law. 03/13/2013 12:30 PM -The requested Complaint&Notice served by the Sheriff of York County upon Scott A Noss, personally, at York County Sheriffs Office at 45 North George Street, York, PA 17401. Richard Keuerleber, Sheriff, Return of Service attached to and made part of the within record. SHERIFF COST: $37.00 SO ANSWERS, f April 02, 2013 RbNW R ANDERSON, SHERIFF SHERIFF'S OFFICE OF YORK COUNTY Richard P Keuerleber PETER J. MANGAN, ESQ. Sheriff Solicitor Reuben B Zeager Richard E Rice, II Chief Deputy, Operations Chief Deputy,Administration HUY NGUYEN (et al.) vs. Case Number SCOTTA. NOSS 13-944 CIVIL SHERIFF'S RETURN OF SERVICE 03/13/2013 12:30 PM -SERVED THE REQUESTED COMPLAINT IN CIVIL ACTION (CICA) BY"PERSONALLY" HANDING A TRUE COPY TO A PERSON REPRESENTING THEMSELVES TO BE THE DEFENDANT, TO WIT: SCOTT A. NOSS AT THE YORK COUNTY SHERIFF'S OFFICE,45 NORTH GEORGE STREET,YORK, PA 17401. C CKAR , DEPUTY SHERIFF COST: $59.07 SO NSWERS, L 1),F-1�\A_k_ March 26, 2013 RICHARD P KE ERLEBER, SHERIFF CONIMON,WEALTH Q PENNSYLVANIA Shei E.�MaI Seat la mork,York MEMBER,PEIY►IMVAN7A f'6b.1,2017 AT1UW OF Mnrc arc NOTARY Affirmed and subscribed to before me this 26TH day of MARCH 2013 ._ ,ojw.Sude Sheriff TeleosoC -. FAFILEMClients13050 Donegal\3050 Current\3050.69513050.695.pral.wpd C= 7- George B. Faller, Jr., Esquire M C= I MARTSON DEARDORFF WILLIAMS OTTO GILROY & FALLER rT C3 6n MARTSON LAW OFFICES C, I.D. 49813 '= x Ir 10 East High Street -:7 --- Carlisle, PA 17013 (717) 243-3341 Attorneys for Plaintiff HUY NGUYEN and IN THE COURT OF COMMON PLEAS OF JULIE NGUYEN CUMBERLAND COUNTY, PENNSYLVANIA Plaintiffs V. NO. 13-944 SCOTT A. NOSS, CIVIL ACTION-LAW Defendant PRAECIPE TO THE CUMBERLAND PROTHONOTARY: Enter default judgment in the above-captioned action in favor of Plaintiffs and against Defendant in the amount of$8,340.95,plus interest and costs of suit as prayed for in the Complaint, for failure to file an Answer to Plaintiffs' Complaint. I do hereby certify that a written notice of intention to file this Praecipe,in the form attached hereto,was mailed to the Defendant at the address indicated thereon, on May 23, 2013,which date was subsequent to the date default occurred and at least ten (10) days prior to the date of the Praecipe. MARTSON LAW OFFICES B George"B. Faller, Jr., Es4uire' I.D. No. 49813 Ten East High Street Carlisle, PA 17013 (717) 243-3341 Dated: June 5, 2013 Attorneys for Plaintiffs r76S N,1 e y George B. Faller, Jr., Esquire MARTSON DEARDORFF WILLIAMS OTTO GILROY & FALLER MARTSON LAW OFFICES I.D. 49813 10 East High Street Carlisle, PA 17013 (717) 243-3341 Attorneys for Plaintiff HUY NGUYEN and IN THE COURT OF COMMON PLEAS OF JULIE NGUYEN CUMBERLAND COUNTY, PENNSYLVANIA Plaintiffs V. NO. 13-944 SCOTT A. NOSS, CIVIL ACTION-LAW Defendant AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA ) : SS COUNTY OF CUMBERLAND ) George B. Faller, Jr., Esquire, being duly sworn according to law, deposes and says that he is an employee of MARTSON DEARDORFF WILLIAMS OTTO GILROY&FALLER,attorneys for the Plaintiffs in the above captioned matter and that pursuant to the provisions of the Pennsylvania Rules of Civil Procedure, a notice of intention to enter default judgment against the Defendant was given to him by mail on May 23, 2013. ,al George B. Faller, Jr., Esqul0,re Sworn to and subscribed before me V this__5 day of , 2013. COMMONWEALTH OF PENNSYLVANIA Notarial Seal Shelly Taylor,Notary Public Carlisle Soro,Cumberland County Otary�U'11C My Commission Expires Aug.S.2013 MEMBER,PENNSYLVANIA ASSOCIATION OF NOTARIES George B. Faller, Jr., Esquire MARTSON DEARDORFF WILLIAMS OTTO GILROY & FALLER MARTSON LAW OFFICES I.D. 49813 10 East High Street Carlisle, PA 17013 (717) 243-3341 Attorneys for Plaintiff HUY NGUYEN and IN THE COURT OF COMMON PLEAS OF JULIE NGUYEN CUMBERLAND COUNTY, PENNSYLVANIA Plaintiffs V. NO. 13-944 SCOTT A. NOSS, CIVIL ACTION-LAW Defendant AFFIDAVIT AS TO MILITARY SERVICE COMMONWEALTH OF PENNSYLVANIA ) :SS. COUNTY OF CUMBERLAND ) George B. Faller, Jr., Esquire, being duly sworn according to law, deposes and says that he has authority to make this affidavit on behalf of his client, and to the best of his knowledge, information and belief,the Defendant above named is not in the military service of the United States of America, that he has knowledge that the said Defendant is now living at: 35 2nd Street, York Haven, PA 17370. Said Defendant's place of employment is unknown. 4,t�,_g lib, George B. Faller, Jr., Esq/ire Sworn to and subscribed before me this day o , 2013. COMMONWEALTH OF PENNSYLVANIA Notarial Seal Shelly Taylor,Notary Public Carlisle Boro,Cumberland County NOt PU 1C My Commission Expires Aug.S,2013 Y MEMBER,PENNSYLVANIA ASSOCIATION OF NOTARIES • F:\FILES\Clients\3050 Donegal\3050 Current\3050.695\3050.695.tendaynot I.wpd/ajt Created. 12/29/03 8 35AM • Revised: 5/9/13 9:43AM George B. Faller, Jr., Esquire MARTSON DEARDORFF WILLIAMS OTTO GILROY& FALLER MARTSON LAW OFFICES I.D. 49813 10 East High Street Carlisle, PA 17013 (717) 243-3341 Attorneys for Plaintiff HUY NGUYEN and IN THE COURT OF COMMON PLEAS OF JULIE NGUYEN CUMBERLAND COUNTY, PENNSYLVANIA Plaintiffs V. NO. 13-944 SCOTT A. NOSS, CIVIL ACTION-LAW Defendant IMPORTANT NOTICE TO: SCOTT A. NOSS DATE OF NOTICE: 5/2-3)1 YOU ARE IN DEFAULT BECAUSE YOU HAVE FAILED TO ENTER A WRITTEN APPEARANCE PERSONALLY OR BY ATTORNEY AND FILE IN WRITING WITH THE COURT ,- YOUR DEFENSES OR OBJECTIONS TO THE CLAIMS SET FORTH AGAINST YOU. UNLESS YOU ACT WITHIN TEN (10) DAYS FROM THE DATE OF THIS NOTICE,A JUDGMENT MAY BE ENTERED AGAINST YOU WITHOUT A HEARING AND YOU MAY LOSE YOUR PROPERTY OR OTHER IMPORTANT RIGHTS. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT '� HAVE A LAWYER,GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW. THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER. IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE. DAMAGES WILL BE ASSESSED AGAINST YOU IN THE AMOUNT OF THE REPAIR ESTIMATE UNLESS YOU FILE A WRITTEN PRAECIPE WITHIN TEN(10)DAYS REQUESTING A TRIAL ON DAMAGES. Cumberland County Lawyer Referral Service Cumberland County Bar Association 32 South Bedford Street Carlisle, PA 17013 Telephone:(717) 249-3166 MARTSON LAW OFFICES B M Y George B. Fa er, Jr., Esqui I. D. Number 49813 Ten East High Street Carlisle, PA 17013 (717) 243-3341 Attorneys for Plaintiffs RTILESTlients\3050 Donegall3050 Current\3050.69513050.695.afrl.wpd Revised: 519/13 10:04AM George B. Faller, Jr., Esquire MARTSON DEARDORFF WILLIAMS OTTO GILROY& FALLER MARTSON LAW OFFICES I.D. 49813 10 East High Street Carlisle, PA 17013 (717) 243-3341 Attorneys for Plaintiff HUY NGUYEN and IN THE COURT OF COMMON PLEAS OF JULIE NGUYEN CUMBERLAND COUNTY, PENNSYLVANIA Plaintiffs V. NO. 13-944 SCOTT A. NOSS, CIVIL ACTION-LAW Defendant AFFIDAVIT OF APPRAISER I do depose and state that I am a licensed appraiser;that the appraisal of$7,900.00 attached hereto is true and correct and accurately sets forth the damages to the value of the 2006 Lexus owned by Huy& Julie Nguyen and; that I have been engaged in the appraisal business for Q years and am qualified and capable to evaluate the appraisal as attached; and the repairs were necessary and the value indicated thereon was the amount by which the damages to this automobile would fairly and reasonably have been evaluated. This statement and appraisal are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities, which provides that if I make knowingly false averments, I may be subject to criminal penalties. Signature rr• ��r�btiHy� Print Name DONEGAL"INSURANCE GROUP 1195 RIVER ROAD P.O. BOX 302 717 426-1931 FAX: 717)426.7023 MARIETTA, PA 17547.0302 SUPPLEMENTI -- .......... .......................... .................................... Owner ...... ..................................................... 08/09/2012 01:13 PM . ........................................................................................... ...........11...................... ..............................................I................ ....................... ................................................................. Owner: HUY&JULIE NGUYEN ........................................ Address: 684 FRANCES DR City Stole Zip: HARRISBURG, PA 17109 Call: (717)343-3077 "o"IDSY: (717)343.4834 ... Control InfOrmo ........ .. . .... ......................................... .................................I............................. .... ................. .......................F...A..X Claim#: PAG-PA•01.12-02317, .y Lo as Do'*/"' ............................................ 012 08:00 AM Insured polio$500,00 ........... L File#: Lost Type: Collision Ins. Company: Donegal Insurance Group Accounting#: 0005782 Agent: Debra Jones Address: Email: debrajones@donegaigroup.com Work/DRY: (800)877.O6OOx7435 Insured: HUY&JULIE NGUYEN Address: Coll: (717)343-3077 Claim Re p: Debra Jones "O"WIDBY: (717)343-4834 Address: Email: debrajone$@donegalgroup.com Work/DRY: (800)877-0600x7435 .............. ........................................... Inspection Date: 08/09/2012 01:15 P...............................M................................................................................................... ....................................... ...... .. . ... ................. ... . . ...... ......... . .................. Address: 684 FRANCES DR Inspection Typo: Field ..... City State Zip: HARRISBURG, PA 17109 Call: (717)343-3077 Primary impact: Rear "On**/DSY: (717)343.4834 Driveable: No Secondary impact: Assigned Dat@/TImq: Rental Assisted: First Contact Dat@lTlffw: Received Dote/Time: Appointment Date/Tims: 08/09/2012 12:23 PM Company: 08/10/2012 08:00 AM Contact: JERRY FARABAUGH Appraiser License#: 131114 Address: 1195 RIVER ROAD P-0. BOX 302 Work/Day: (717)838-9234 City State ZIP: Marietta,PA 17547 FAX: (717)838-9202 Email: Jerryfarabaugh@donegaigroup,com Coll: Orig Company: Contact: JERRY FARABAUGH Appraiser License#: 131114 Address: 1195 RIVER ROAD P-0. BOX 302 Work/Day: (717)838-9234 ),03•202 081 city State ZIP: Marietta PA 17547 FAX: (717)838-9202 Exhibit "A" Page I of a , 2006+:XUS ES336 sm 4 DA srdtn C1tim t I VAC�.PA-0 1.12-0269176 06%/X12 0 t:WPM 5 BR 288 Door Shell,Rear RT Blend Refinish 0.8 Blend' S1 1.2 RF 6 RI 399 Mldg,Rear Door Scalp LT R 8 I Assembly 7 RI 400 MIdg,Rear Door Scalp RT R 8 I Assembly S1 0.2 SM 8 RI 319 Mldg,Rear Door Bet LT R 8 I Assembly $1 0.2 SM 9 RI 320 Midg,Rear Door Bet RT R b I Assembly 0.4 SM 10 E 323 01 Mldg,Rear Door Side LT 7574233190A0 S1 0.3 SM 11 E 324 01 MIdg,Rear Door Side RT 7574133190A0 $90.15 S1 0.4 SM 12 RI 415 Mldg,Rear Door Lower LT R 8 I Assembly $90.i5 S1 0.4 SM 13 RI 416 MIdg,Rear Door Lower RT R 8 I Assembly S1 SM 14 E 304 Cover,RR Door Handle RT 6922733050 S1 0.3 SM t 5 RI 321 Pnl,Inner Door Trim LT R 8 I Assembly x14.54 S1 t INC C SM 16 RI 305 Handle,RR Door Outer LT R 3 I Assembly SM 17 RI 344 Supt,RR Door Handle LT R 3 I Assembly 1 INC SM C 18 RI 306 Handle,RR Door Outer RT R 8 I Assembly S1 19 BR 43 13 Panel,Roof Side LT Blend Refinish S1 INC SM 0.6 Blend t.5 RF 0.6 Two-stage setup 20 BR 44 Panel,Roof Side RT 0.3 Two-stage Blend Refinish 0.8 RF 0.5 Blend 21 E 372 Mldg Assy,Back Glass 7557133 80 pelage 22 E 389 Panel,Ouarter LT 6160233161 $117.73 S1 3.4 SM 23 L 389 Panel,Ouarter LT Refinish $632.26 S1 12.7 SM 2.3 Surface 3.8 RF 1.0 Edge 24 I 390 Panel,Ouarter RT 0.5 Two-stage 25 L 390 Panel,Ouarter R 2 T Repair S1 .0' SM Refinish S1 2.2 RF 2.2 Surface 26 I 418 Extn,Ouarter Panel LT INC Two-stage 27 L 418 Extn,Ouarter Panel LT Repair S1 0.1• SM Refinish S1 0.2 RF 28 E 424 Extn,Ouarter Panel LT 0'2 Surface 29 L 424 Extn,Cluarter Panel LT Refinish s $78.57 S1 INC SM 0.5 Surface 0.5 RF 30 L 419 Extn,Ouarter Panel RT Refinish stage 0.2 Surface S1 0.2 RF 31 E 425 Extn,Ouarter Panel RT 6106333010 $78.57 32 L 425 Extn,Ouarter Panel RT Refinish S1 1.9 SM 0.5 Surface 0.5 RF 33 BR 397 Door,Fuei Filler LT INC Two-stage Refinish Blend Reffinish 0.2 Blend 0.2 RF INC Two-stage 34 Al 397 Door,Fuel Filler LT R 6 I Assembly 35 E 479 Lid,Rear Deck 6440133380 INC SM Refinish 36 L 479 Lid,Rear Deck $594.03 S1 2.0 SM 2.1 Surface 3.1 RF 1.0 Edge 37 E 362 N/Plate,Deck Lid 754 INC Two 38 E 365 N/Plate,Deck Lid 7544233220 $30.40 S1 0.2 SM 39 E 485 Emblem,Deck Lid $30.40 S1 0.2 SM 40 E 487 Lock,Deck Lid 9097502022 $37.14 S1 0.2 SM 41 E 509 Panel,Rear Body 6460033110 $254.89 S1 INC SM 42 L 509 Panel,Rear Body 5830733120 $366.14 Refinish S1 8.1 SM 1.5 Surface 2.0 RF 0.5 Edge 101OW2012 06 41 AM Pape Mfg m 2006 l.au.E3090 STp t ON S�om Cliim• ,vAG PA•01.12-0269.16 43 E 607 Panel,Rear Body Trim 06"1201.13 PM 44 E 559 Lens,Taillamp LT 5838733080 $232.76 45 E 560 Lens.Talllamp RT 8154133430 $171-14 S1 INC SM 46 E 528 Lens,Back U Lam LT 8155133430 $171-14 S1 INC SM 47 E 529 Lens,Back Up Lam 8159133100 S1 INC SM Up p 8158133100 116.99 S1 INC SM 49 L 565 Bumper,Rear $199.48 48 E 565 Bumper,Rear 52171AA040 $5116.99 S1 INC SM Refinish S1 INC SM Su 50 E 566 COver,Rear Bumper 5210593391 ace 0.6 RF 51 L 566 Cover,Rear Bumper Refinish $432.71 S1 0.6 SM 2.6 Surface 3.1 RF 52 E 567 Absorber,Rear Bumper 0.5 Two-stage 53 E 592 Absorber,Rear Bumper 52616 0 $55.07 54 61 Brkt,Bumper Guard M L7 $48.44 S1 INC SM 55 62 Brkt,Bumper Guard Mtg RT Replace OEM INC S1 INC SM 56 1 SET UP AND MEASURE INC SM 57 EC CAR COVER Repair SM 58 EC FLEX Repace Economy $5.00• 2.01 SM Replace 59 EC CORROSION PROTECTION Replace Economy $8'00, SM 60 1 PULL 3 SOUARE REAR $8.00 SM 61 EC GLASS KIT Repair SM 62 SB HAZARDOUS WASTE Replace Economy $15.00' 3.0' SM 63 EC CALILK/SEAM SEALER Sublet Repair 53 00. S1 SM 64 EC Interior clips Replace Econom y $10.00' SM 64 Items Replace Economy $5.64• SM S1 SM. MC Message 01 CALL DEALER FOR EXACT PART N/PRICE INCLUDES 0.6 HOURS FIRST PANEL TWO-STAGE Estimate Total i Entries ......... .V............~.. Y...............,............... ....,.,. . ....,....... ..... . ALLOWANCE ... ...,.,............ ................,...,..., ............................. . . Grose Parts ............................. ......................................... Other Part $3,959.69 Paint Materials $51.64 Part A Material Total $485.30 Tax on Parts A Material 6.000%9'. Labor $268.80 Rate Replace Repalr Hrs Total Hrs Hrs Sheet Metal(SM) $46.00 34.0 Mech/Elec(ME) $4100 9.1 43.1 $1,982.60 Frame(FR) $46.00 Refinish(RF) $46.00 21.1 Paint Materials $23.00 21.1 $970.60 Labor Total Tax on Labor 64.2 Hours Sublet Repairs ® 6.000% $177.19 $2,953.20 Tax on Sublet $3.00 Grose Total 6.000% $0.18 Less:Deductible $7,800.00 Net Total $500.00- Actual Supplement Total $7,400.00 Less:Previous Not Total $1,112.25 Net Supplement Total $6,287.75• $1,112.25 Alternate Parts Y/00/00'00/00/00 CUM 00/00/00/00/00 Zip 1 Code: 17547 Default M2012 06 t 1 AM Pop t o16 i 2006 L*%us f 5330 STO 4 OR So"" 0&09«2012 01:13 PM Qatm t PAC-PA-01.12-0263116 Audstex Estimating 6.0.726 S1 10/03/2012 08:41 AM REL 6.0.726 DT 09/01/2012 DB 10101/2017 Copyright(C)2011 Audstsx North America,Inc. 3.0 MRS WERE ADDED TO THIS ESTIMATE BASED ON AUDATEX'S TWO-STAGE REFINISH FORMULA. ESTIMATE CALCULATED USING THE 2.3 HOUR MAXIMUM ALLOWANCE FOR TWO-STAGE REFINISH OF NON-FLEX,EXTERIOR SURFACES. ABBRs'V:ATION LEGEND: LKQ - LIKE KIND IN QUALITY, A/M - AFTERMARKET, RECOND = RECONDITION, 0/H- OVERHAUL, REPL - REPLACE, RPR - REPAIR, REFN - REFINISH, SECT - SECTION, R & I • REMOVE AND INSTALL, ALGN - ALIGN, SUBL - SUBLET, BLND - BLEND, ASSY= ASSEMBLY, FRNT/FRT = FRONT, HL/H/LAMP - HEADLAMP, INR - INNER, L - LEFT, MLD/MLDG - MOLDING, MTG = MOUNTING, OTR - OUTER, ?NLS - PANELS, R/RT - RIGHT, REPL - REPLACEMENT, SUSP SUSPENSION, W/O MLD - WHEEL OPENING MOLDING, RIC - REMOTE CONTROL, BRKT - BRACKET, LIC - LICENSE, R/F - RIGHT FRONT, R/R - RIGHT REAR, L/F = LEFT FRONT, L/R - LEFT REAR, PNL - PANEL, FT - FRONT, PXN - PARTS EXCHANGE NEW, OEM - ORIGINAL -EQUIPMENT MANUFACTURER, PRT - PART, NAGS NATIONAL ASSOCIATION OF GLASS SUPPLIER, REMAN • R?MANUFACTURED, PART - PARTIAL 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 CR:ME AND SUBJECTS SUCH PERSON TO CRIMINAL AND CIVIL PENALTIES. WE WILL NOT BE RESPONSIBLE FOR ANY RELATED TOWING SERVICES OR STORAGE CHARGES, KNOWN AT THE TIME OF THE APPRAISAL, AND INCURRED AFTER THE FOLLOWING DATE: . . . . . . . . . . CHARGES :NCURRED AFTER THIS DATE WILL BE THE RESPONSIBILITY OF THE CONSUMER. COSTS THAT EXCEED THE APPRAISED AMOUNT MAY BE THE RESPONSIBILITY OF THE VEHICLE OWNER. IF YOU REQUEST, WE CAN PROVIDE YOU WITH THE NAMES OF REPAIR FACILITIES THAT WILL BE ABLE TO REPAIR THE VEHICLE FOR 7HE APPRAISED AMOUNT. THERE IS NO REQUIREMENT :0 USE ANY S?EC:F:ED RE?AIR SHOP. HIS :S NOT AN AUTHOR:ZAT:ON 70 REPAIR. NO S�?FLEMENTS HONORED UNLESS :NS?--CTED AND AUTHCRI"ZED BY APPRAISER. =F THE APPRA=SAL INCLUDES AF77RKARKET CRASH ?ARTS, THE AFTERMARKET CRASH ?ART SHALL HAVE A WARRANTY EQUAL TO OR BE,.?R THAN THE REMAINDER OF THE EXISTING WARRANTY ON THE PAR: BEING REPLACED. APPRAISER SIGNATURE: oiOW2012 06 41 AM Paps 6 of 6 9006 Leave 114330 570 4 0A Ssdsn 0646+2012 0f 13 PM Cleim s PAO-PA-01.12-0263116 Op Codes - User-Entered Value E - Replace OEM NG- Replace NAGS EC- Replace Economy OE- Replace PXN OE Srpls UE- Replace OE Surplus ET - Partial Replace Labor EP- Replace PXN EU- LIKE KIND&OUAL.PRT TIE - Partial Replace Price PM- Replace PXN Reman/Rsbtt UM- Replace Reman/Rebullt L - Refinish PC. Replace PXN RecondlWried UC- Replace Reconditioned TT - Two-Tone SS- Sublet Repair N - Additional Labor BR- Blend Refinish I - Repair IT - Partial Repair CG- Chipguard RI - R& I Assembly P = Chock AA- Appearance Allowance RP- Related Prior Damage This report contains proprietary information of Audatex and may not be disclosed to any third party(other than the insured,claimant and others on a need to know basis In order to effectuate the claims process)without s j� �`s Audatex's prior written consent. Copyright(C)2011 Audatex North America}Inc. Audatex Estimating is a trademark of Audatex North America,Inc, .03,2012 08 41 AM Peps 6 of 6 iM Le.ua E630 STO•DR Sedan Claim a •PA(}PA-01.12-02931176 OSVM 12 01.13 PM Estimate summary page Orose Total Less:Deductible $7,900,00 Not Total 5500.00- Actual Supplement Total $7,400.00 Lass:Previous Net Total $1,112.25 Net Supplement Total $6,287.75• Total Unrelated Prior Damage $239.20 $1,112.25 Audatex Estimating 6.0.726 S1 10/03/2012 08:41 AM REL 6.0.726 DT 09/01/2012 08 10/01/2012 Copyright(C)2011 Audatex North America,Inc. f 0/OW2012 06 41 AM Pop 7 01 =4 LeAus ES330 STp pp SgOU1 Claim f.PA(-PA-01'12-0293176 110 13 PM ................:.:.,:...........,. "'Unrelated Prior Damage Pape•~ :Administrative •... ....., Owner: HUY d JULIE NGUYEN Loss Date/f me: 0&02/2012 108 00 AM.12.0283176 Inspection Oats: 08/09/2012 01:15 PM Vehicle: 2006 Lexus ES330 STO 4 OR Sedan 6cyl Gasoline 3.3 5 Speed Automatic ................................. :Dame es ............. .......................... Line Op (iulds MC �••�••�•�••�•�• Descriptlon MFR.Part No. ......... Price ADJ% B% noun q 1 I 83 Panel,Hood Repair 2 L 83 Panel,Hood Refinish T Items 1.0' SM ................................... •8 RF ;Estimate Total 3 Entries .............................. Paint Materials _....... ..................,.......:..........:......:............... ..................... ................... Parts i Material Total $64.40 Rsplsce Repair Total Hn $64.40 Labor Rate Hrs Hrs Sheet Metal(SM) $46.00 Mech/Elec(ME) $47.00 1.0 1.0 $46.00 Frame(FR) $48.00 Refinish(RF) $46.00 2.8 Paint Materials $23.00 2.8 $128.80 Labor Total Unrelated Prior Damage Dross Total(excludes taxes) 3.8 Hours $174.80 These damages are,unrelated to the stated loss Incident.The stated costs are representative only and 239.20 may l rep based upon such factor as the involved incident facts,completion of the damapy estimate and/or actual repair. 10412012 09 41 AM Paps 9 of a SUPPLEMENT RECONCILIATION oupplement 31 Claim N: PAG•PA•01.12.0283178 FIN If: Insured Poiky N: PAG•3106213 Insured: HUY 3 JULIE NGUYEN Claim Rep: Debra Jones Owner Name: HUY d JULIE NGUYEN Inspection Det*/Time: 08/09/2012 01:15 PM Company: Vehicle: 2008 Lexus ES330 STD 4 DR Sedan Deleted Lines Line.. . Guide Put .........:...... Price ADJ%........8%.............:.............. . ...............: 1 323 MIdp,Rear Door Side LT Labor Rate R 6 I Assembly ....................................................................... .Added Line ....................................... ................................................ ..............; Line Guide Part ..............�................ Prta AOJ%.......8%.............bo ................... ..: 2 288 Door She�,Rear RT Labor Rate 3 304 Cover,RR Door Handle RT Replace OEM St 4 306 Handte,RR Door Outer RT S1 $1454 1.2 RF 5 320 Mldp,Rear Door Belt RT R i I ably Si t INC SM 8 323 Mkf9,Rear Door Side LT R 3 I Assembly S1 C SM Replace OEM S1 $9015 0.3 SM 7 324 Mldp,Rear Door Side RT Replace OEM 8 372 Mktg Asay,Back Glass $1 $90.15 0.4 SM 9 399 Mldg,Reu Door Scal p LT Replace OEM Si $117.73 0.4 SM 10 400 Mkip,Reu Door Scalp RT R t I ably S1 3.4 SM 11 418 MId9,Rear Door Lower RT R 8 I Assembly .2 SM 12 418 Exin,�rbr part$LT R i I Assembly S1 0.2 SM 13 418 Extn, Repay St 0.3 SM Quarter Panel LT S1 14 419 Extn,Q Refinish 0.1' SM uarter Panel RT Refinish 0.2 RF 15 487 Lock,Dack Lid Replace OEM S1 0.2 RF 18 GLASS KIT Replace OEM S1 $254.89 INC 17 interior dips $/5,00• SM Replace Economy Si $5.641 SM .............................................................................. ::Changed Linea ............................................................. .................................................... .......% Une Guide Put Operation..................... S�...................... Price................... ........................................ ADJ% 8% Labor ...Rate 18 382 N/Plate,Dedc Lid Replace OEM N/Plate,Dea Lid $30.40 0.2 SM 19 365 N/Plate,Deck Lid Replace OEM $29.80 0.2 SM N/Plate,Dm*Lid S1 $30.40 0.2 SM 20 389 Panel,Querter LT Replace OEM St 's 0.2 SM Panl,Quarter LT $632.28 12.7 SM 21 390 Panel,Quarter RT Repair S1 $803.02 SM 18.1 Panl,Quarter RT 4.1 SM 22 424 Extn,Quarler Panel LT Replace OEM 1 SM Exin,Quarter Panel LT S1 $78.57 INC SM 23 425 Extn,Quarw Panel RT Replace OEM $77.00 INC SM Extn,Ouarier Panel RT S1 $78.57 1.9 SM 24 479 Lid,Rau Deck Replace OEM S1 $77.00 1.9 SM Lid.Rau Deck $594.03 2.0 SM 25 485 Emblem,Deck Lid Replace OEM 5594.08 2.0 SM Emblem,Deck Lid S1 $37.14 0.2 SM 26 509 Psnel,Rsar Body Repave OEM 81 $38.40 0.2 SM Panel,Rear Body $388.14 8.1 SM 27 528 Lens,Back Up Lamp LT Replace OEM $358-92 SM Lens,Back Up Lamp LT S1 $118.99 INC SM 28 529 Lens,Back Up Lamp RT Replace OEM $116.89 INC SM Lens,Back Up Lamp RT S1 $118.99 INC SM 29 559 Lens,Talllamp LT Replace OEM $118.89 INC SM Lens,Taillamp LT S1 $171.14 INC SM 30 560 Lens,Taillamp RT Replace OEM $171.28 INC SM Lens,Tailiamp RT S1 $171.14 INC SM 31 585 Bumper,Rear Replace OEM $171.26 INC SM Bumper,Rear S1 5199.48 INC SM 32 566 Cover,Rear Bumper Replace OEM $197.83 INC SM Cover,Rear Bumper S1 $432.71 0.8 SM 7 A rR r Bumper q i 5410.31 10103=12 os:.i,un EM 1 . 7 0.6 SM Pao.1;2 zoos Low esaso sro 4 on swn Claim I•PA&PA-01.12.0247170 Absorber,Rear Bumper $54 St .01 34 592 Absorber,Rear Bumper Replace OEM $48 44 INC SM Absorber,Rear Bumper $47.50 INC SM 35 807 Panel,Rsar Body Trim Replace OEM St $232 78 INC SM Panel,Rear Body Trim INC SM ................................................................................................. $228.15 INC SM. ?Calculation Chan es ..................a..................... from .................................................... . To ................... DHference Gross Parts 319.93 Other Parts $3,$31.00 $3.959.89 $839.78+ Paint Materials $23.00 $51.84 $20.84+ �� Tax on Parts 8 Material $ 5485.30 SM -Sheet Metal 8.000% $225.08 8.000% $289.80 $85.30+ RF.Rohnish $46.00 48.00 $1,752.80 $48,00 $1.982.80 _$44.74+ Tax tar+labor $887.00 $48.00 $970.80 873.80+ $158.98 8.000% $177.19 $18.21+ Actual Supplement 1 Net Total .....................:.......................... $1,11128♦ . ...........:......................:....... Surma !Y................................................ ..... ................. ................ Net Total Date Time Appraiser Original Estimate $8,287,75 08/09/2012 12:18 PM Supplement 1 $7,400.00 10/03/2012 08:18 AM This report contains proprietary inforrnaWn of Audelex and may not be disclosed to an third insured,claimant and others on a need to know basis in order to effectuate the claims process)wife Audete q date prior written consent. �sarrra c•a:1;,,u:y Copyright(C)2011 Audatex North America,Inc. Audatex Estimatin is a trademark of Audatex North America,Inc. 4 I OlOY2012 08:41 AM Pmp 2 of 2 Notes and Comments Created Date Time: 2012-08-09 17:26: 53 Created By: Jerry Farabaugh Type: LOSS NOTE Subject:. Untitled First Contact: 1PM 8-9-12 Inspection Location: listed on page one of estimate Owner Present: yes MRS Brief Description/Summary of Damages : REAR DAMAGE See point of impact, photos an d estimate for damage details. Alternative-LKQ Parts Search: listed on estimate if available at time of estimat e lkq no quot#2428449 Estimate handed to Owner Estimate written on site - yes . Payment issued: 8-9-12 ck#514397 $ Followed up with owner explained estimate and supplement process. ------------------------------ Created Date Time: 2012-10-03 12:40: 12 Created By: Jerry Farabaugh Type: LOSS-NOTE Subject: Untitled see photo of dop please pay supplement direct to the repair shop COPY OF SUPPLEMENT MAILED TO OWNER ................... F7 DONEGAL INSURANCE GROUP 1195 RIVER ROAD P.O.BOX 302 T MARIETTA,PA 17547-0302 (71 r 426-1931 FAX:(717)426-7023 ESTIMATE .................................................... 08/09/2012 01:13 PM Owner ....I............................. ............................................................................................................................................................................................................................................. Ow"w: HUY&JULIE NGUYEN ............................................... Address: 684 FRANCES OR Call: (717)343-3077 City State ZIP: HARRISBURG, PA 17109 "On*/Day: (717)343.4834 ..........................................I......................................................... .Inforrnation ...... .... .........................................................–...................................................... FAX:........................................................I............................. Claim#: PAG-PA-01-12-0283176 ............. LOU DWO/Time: 08/02/2012 08:00 AM '"lured POIkY#: PAG-3 106213 Deductible: 5500.00 Love Type: Collision File#: I",Company: Donegal Insurance Group Accounting#: 0005782 Agent: Debra Jones Address: Email: debrajones"nggalgroup.00m Work/Day: (800877-06000435 kwursd: HUY It JULIE NGUYEN Addrees: Cell: (717)343-3077 Claim Rep: D�bra Jones Home/Day: (717)343-4834 Addran: ...............................................Email: debrajones4pdon9gaoroup.0orn Work/Day: (800)877-06000435 ................................................................ ......................................................................................11......................... lnsPfttWn Date: 08/091201201:lSpM Addr*813: 684 FRANCES DR InSpbelion TYPO: Field City State ZIP: HARRISBURG, PA 17109 "O"WO C1011: (717)343-3077 SY: (717)343.4&U Primary Impact: Rear Driveable: No Secondary Impact: Assigned DaWrInw: Rental Assisted: First Contact DateMme: Received DaWrk": 08/09/2012 12:23 PM Company: App*'ritme"'DOWTims: 08/110/201200:00AM Contact: JERRY FARABAUGH APPrIlSor Licanso#: 131114 Address: 1195 RIVER ROAD P.O. BOX 302 WO"Ry: (717)838-9234 City State ZIP: Marietta, PA 17547 FAX: (717)838-9202 Email: Jerrylarabaughodc,egialgroup-corn Coll: ................... ... ... !!!r...........................-- —............ ......... ...... ........... ................................................. ..... .. . ... Target Complete Dots/Tims: ............. .............. ................................. Days To Repair: 10 WW2012 013 1 Pm Page 1 of 7 2M Lejus PIES STO 4 DA Sabn 0S"M120Vt3PM PA& t!—,.*12- 74 *.•PLEASE PROVIDE A COPY OF THIS ESTIMATE TO THE REPAIR SHOP OF YOUR CHOICE*** `ALL SUPPLEMENT MUST HAVE A DIRECTION OF PAY SIGNED BY THE VEHICLE OWNER` ***DO NOT PROCEED WITH ANY SUPPLEMENTAL REPAIR WITHOUT APPRAISER'S APPROVAL*•* *SUPPLEMENT MUST HAVE ALL PARTS INVOICES FOR THE ENTIRE JOB,NO EXCEPTIONS(" COPY OF ESTIMATE GIVEN TO OWNER'" `ANY SUPPLEMENT NOT APPROVED BY THE APPRAISER WILL NOT BE HONORED*** .11,..................................................................... ...........I....... .........I.,...... ...................................... ................ ........ : Vehicle ... ..............................I......................................................................... ................................ .............I................. .......... 2006 LeXUS ES330 STD 4 DR Sedan 6cyl Gasoline 3.3 5 Speed Automatic Lic.Plate: HGK 8676 Lie State: PA Lic Expire: VIN: JTHBA30G465145976 Prod Dole: Milano: 103,304 Voh Inso: Milano Type: Actual Condition: Good Code: LX233A Ext.Color: SILVER Int.Color- Ext.Refinish: Two-Stage lint 11114finish: Options 17 Inch Alloy Wheels Air Cordtloning Alarm System Antl-Lock Brakes Automatic Dimming Mirror Body"Cladding Center Console Climate Cntd Fmt Seats Compact Disc WfT" Cruise Control Dual Alrbags Dual Power Seats Dual Zone Auto A/C Fog Lights Garage Door Opener Head Alrbags Heated Front Seats Heated Power Wrrore Intermittent Wipers Keyless Entry System Leather Seats Lighted Entry System Overhead Console Power Brakes Power Door Locks Power Moonroof Power Steering Power Windows Rear Side Altags Rear Window Defroster Rom Trunk-UGate Release Side Alrbogs Strg Wheel Radio Control T&dvmaW Tit Steering Wheel TwIted GIs" Trip Computer Wood Interior Trim Wood Steering Wheel .................... ..........I....,......",.....-.".....'............ ......... ......... .. ...... ..................... Line Op Guide MC Description MFR.Pwt No. price ADJ% 8% Hours R I RI 206 Plate,Roar Sill LT R&I Assembly INC SM 2 RI 274 MiftRocker Panel LT R&I Assembly INC SM 3 RI 275 MIdg,Aocker Panel FIT R& I Assembly 0.3 SM 4 13R 207 Door ShsII,Roar LT Blond Refinish 1.2 FIF 0.8 Blend 0.4 Two-step 5 Al 319 MIdg,Roar Door Set LT R&I Assembly 0.3 SM 6 RI 323 MIdg,Rear Door Skis LT A&I Assembly 0.4 SM 7 Al 415 MIdg,Raar Door Lower LT R&I Assembly 0.3 SM 8 RI 321 Pml,lnner Door Trim LT R&I Assembly INC SM 9 RI 305 Handie,RR Door Outer LT A&I Assembly 1.0 SM 10 RI 344 Supt,RR Door Handle LT R&I Assembly INC SM 11 BR 43 13 Panel,Roof Side LT Blond Refinish I'S AF 0.6 Blend 0.6 Two-stage setup 0.3 Two-stage 12 BR 44 Panel,Root Side FIT Blend Refinish 0.8 RF O&OW"12 0131 PM Pop 2 of 7 2000 LAaus'EWW Sm 4 OR Sedan CLim a PAPA-01.1 2-0209 1 71 OaiIWO12 01:13 PM 0.5 Blend 13 E 389 Panel,Ouarter LT 0.3 Two-stage 14 L 389 Panel,Quarter LT 61 sh $603.02 Refinish 16.1 SM 2.3 Surface 3.8 RF 1.0 Edge 0.5 15 1 390 Panel,Quarter RT Repair 16 L 390 10 Panel,Ouarter RT Reppair Refinish 1.5' SM 1.8 Surface 2.2' RF >>BLEND COLOR FULL CLEAR COAT Two-stage 17 E 424 Extn,Quarter Panel LT 6106433010 18 L 424 Extn,Quarter Panel LT Refinish $77'00 INC SM 0.5 Surface 0.5 RF 19 E 425 Extn,Quarter Panel RT INC Two-stage 20 L 425 Extn,Quarter Panel RT 81 10 $77.00 Refinish lydsh 1.9 SM 0.5 Surface 0.5 RF 21 SR 397 Door,Fuel Filler LT INC Two-stage Blend Refinish 0.2 Blend 0.2 RF' 22 RI 397 Door,Fuel Filler LT INC Two stage 23 E 479 LId,Reer Deck R d I Assembly 24 L 479 Lid,Rear Deck 64 80 $594. INC SM Refinish rtish 06 2.0 SM 21 Surface 3.1 RF 1.0 Edge 25 E 362 Ntftte,Deck Lid INC Two-stage 26 E 365 N/PI ,Deck Lid 7544733080 ta $29.80 27 E 485 Emblem,Deck Lid 7544233220 0.2 SM 9097502022 $29.80 0.2 SM 28 E 509 Panel.Row Body X30733120 �•� 0.2 SM 28 L 509 Panel,Rear Body Refinish 8.1 SM 1.5 Surface 2.0 RF 30 E 807 Panel,Roar 0.5 � 31 E 559 Lena,Taillamp LTl Trim 8156133430 583 $228.15 32 E 560 Lens,Taillamp RT 8156133430 $171.26 INC SM 33 E 528 Lens,Beck up Lamp LT 8159133100 $171.26 INC SM 34 E 529 Lens,Back Up Lamp RT 8156133100 $118.89 INC SM 35 E 565 Bumper,Rsar $116.89 INC SM 36 L 565 8umper,Rear 52171AA040 $197.63 INC SM Refinish INC SM 37 E 566 Cover,Rear Bu 0390.8 Surface 0.6 RF hr 52 CoverRear Bumper Refinish Cover. 38 L 566 roper Refinish $410.34 0.8 SM 2.6 Surface 3.1 RF 39 E 567 Absorber,Rear Bumper 0.5 Two•stage 40 E 592 Bumper 5 1 090 $54.01 Abaorber,Rear Bumper 5261633011 INC SM 41 61 Brkt,Bumper Guard Mtg LT Rte"OEM $47.50 INC INC SM 42 62 Srkt,Bumper Guard Mtg RT Replace OEM C SM 44 EC 43 I SET UP AND MEASURE RepaIr INC SM 45 EC CAR COVER Replace Economy 2.0' SM $5.00 46 EC CORROSION PROTECTION Rem SM Economy $8.00• SM 47 1 PULL 8 SQUARE REAR Repar Economy $8.00' SM 48 S8 HAZARDOUS WASTE Sublet Repair 3.0' SM 49 EC CAULK/SEAM SEALER Replace Economy $3.00' SM 49 Items $10.00' SM MC Message OW062012 01.31 PM Paps 3 of 7 2004 Maus E3330 STD 4 OR SadW CitMm t rAGPA•01.12-=176 ONOW2012 01.13 PM 10 INCLUDES AUDATEX TIME TO CLEAR ENTIRE PANEL 13 INCLUDES 0.6 HOURS FIRST PANEL TWO-STAGE ALLOWANCE ................. EstimateTotal S Entries Y.� .. .a.......,.... . .., . . . r .. .w..... . . .... .... - .Y ..........�.... ...,..............,....................... Gross Parts $3,319.93 Other Para $31.00 Paint Materials $400.00» Parts#Material Total $3,750.93 Tax on Parts i Material 6.000% $225.06 Labor Rate Replace Repair Mrs Total Hre Hrs Sheet Metal( $46.00 31.6 6.5 38.1 $1,752.60 MecWElec(ME) $47.00 Frama(FR) $46,00 Re tnish(RF) $46.00 19.5 19.5 $897.00 Pabst Materials $23.00 Labor Total 57.6 Hours $2,649.60 Tax an Labor (P 6.000% $158.98 Sublet"We $3.00 Tax an Sublet 6.000% $0.16 Gross Total $8,787.75 L m:Deductible $500.00- Not Total $8,28'7.75 Alternate Parts Y/00/0000/00/00 CUM 00/00/00100/00 Zip Code:17547 Default Audalex Estimating 8.I1798 ES ONW2012 01:31 PM REL 6.0.728 OT 07/01/21012 DO 08/06/2012 Copyright(C)2011 Audatex North America,Im USER-ESTABLISHED THRESHOLD FOR PAINT MATERIALS HAS BEEN REACHED AND CALCULATED IN THIS ESTIMATE.ANY ADDITIONAL MATERIALS MAY REQUIRE FURTHER APPROVAL ** 3.0 HRS WERE ADDED TO THIS ESTIMATE BASED ON AUDATEX'S TWO-STAGE REFINISH FORMULA. ESTMIATE CALCULATED USING THE 23 HOUR MAXIMUM ALLOWANCE FOR TWO-STAGE REFINISH OF NON-FLEX,EXTERIOR SURFACES. ABBR-VIA_ION LEGEND: LKO - LIKE KIND IN QUALITY, AIM = AFTERMARKET, RECOND - RECONDITION, O/H= OVERHAUL, REPL - REPLACE, RPR - REPAIR, REFN - REFINISH, SECT = SECTION, R & I - REMOVE AND INSTALL, ALGN - ALIGN, SUBL - SUBLET, BLVD = BLEND, ASSY- ASSEMBLY, FRNT/FRT - FRON:, HL/H/LAMP - HEADLAMP, 2NR - INNER, L = LEF=, MLD/MLDG - MOLDING, MTG MOUNTING, OTR - OUTER, ?NLS - PANELS, R/RT - RIGHT`, REPL - REPLACEMENT, SUS? SUSPENSION, W10 MLD - WHEEL OPENING MOLDING, RIC = REMOTE CONTROL, BRKT - BRACKET, LIC - LICENSE, R/F - RIGHT FRONT, R/R - RIGHT REAR, L/F - LEFT FRONT, L/R . LEFT REAR, PNL - PANEL, FT - FRONT, ?XN - PARTS EXCHANGE NEW, OEM - ORIGINAL EQUIPMENT MANUFACTURER, PRT = PART, NAGS = NATIONAL ASSOCIATION OF GLASS SUPPLIER, REMAN = REMANUFACTURED, PART = PARTIAL OS+M,2012 01.31 PM pot 4 of 7 200b LoxLf E6330 STO 4 0"SW4M 009M12 Ot:13 PM Cltim t. PA&PA-01-124263176 ANY PERSON WHO KNOWINGLY AND WITH INTENT TO DEFRAUD ANY INSURANCE COMPANY OR OTHER PERSON FILES AN APPLICATION FOR INSURANCE OR STATEMENT OF CLAM CONTAINING ANY MATERIALLY FALSE INFORMATION OR CONCEALS FOR THE PURPOSE OF MISLEAD:NG, INFORMATION CONCERN:NG ANY FACT MATERIAL :HERETO COMMITS A F.RAucULENT :NSURANCE ACT, WHICH IS A CREME AND SUBJECTS SUCH PERSON TO CRIMINAL AND CIVIL PENAL7:ES. WE W:LL NOT BE RESPONSIBLE FOR ANY RELATED TOWING SERVICES OR STORAGE CHARGES, KNOWN AT THE TIME OF THE APPRAISAL, AND INCURRED AFTER THE FOLLOWING DATE: . . . . . . . . . . CHARGES INCURRED AFTER THIS DATE WILL BE THE RESPCNS:B:L:-.Y OF THE CONSUMER. COSTS THAT EXCEED THE APPRAISED AMOUNT MAY BE THE RESPONSIBILITY OF THE VEHICLE OWNER. IF YOU REQUEST, WE CAN PROVIDE YOU WITH THE NAMES OF REPAIR FACILITIES THAT WILL BE ABLE TO REPAIR THE VEHICLE FOR THE APPRAISED AMOUNT, THERE IS NO REQUIREMENT TO USE ANY SPECIFIED REPAIR SHOP. THIS IS NOT AN AUTHORIZATION TO REPAIR. NO SUPPLEMENTS HONORED UNLESS INSPECTED AND AUTHORIZED BY APPRAISER. :F THE APPRAISAL INCLUDES AITERMARKET CRASH PARTS, THE AFTERMARKET CRASH PART SHALL HAVE A WARRANTY EQUAL TO OR BETTER THAN THE REMAINDER OF THE EXISTING WARRANTY ON THE PART BEING REPLACED. APPRAISER SIGNATURE: Op Cod" * • User-Entered Value E - Replace OEM NG- Replace NAGS EC- Replace Economy OE- Replace PXN OE Srpls LIE- Replace OE Surplus ET- Partial Replace Labor EP- Replace PXN ELI- LIKE KIND&OUAL.PRT TE - Partial Replace Price PM. Replace PXN Roman/Robit UM. Replace Reman/Rebulft L - Refinish PC• Replace PXN Reconditioned LIC= Replace Reconditioned TT - Two-Tons SO a Sublet Repair N - AddIdonal Labor OR• Blond Refinish I - Repair IT - Partial Repair CG. Chipguard RI a R&I Assembly P - Cheek AA . Appearance Allowance RP n Related Prior Damage This report contains proprietary Information of Audatex and may not be disclosed to any third party(other than the Insured,claimant and others on a need to know basis In order to effectuals the claims process)without u' datex Audatex's prior written consent. 1 SOA444 44xti**Av Copyright(C)2011 Audatex North America,Inc. Audatex Estimating Is a trademark of Audatex North America, Inc. 0&V6 2012 Ot.31 PM Pap*5 d 7 ��LejUl EWX S?4 t)R SM"n Od''O M1201:13 PM Estimate 3urtxn Page Gross Total Lena: Deductible Net Total $6,787.75 $500.00. Total Unrelated Prior Damage $239.20 $6,287.75 Audatex Estimating 6.0.726 E3 08/09/2012 01:31 PM REL 6.0.726 DT 07/01/2012 DO 0&09M12 Copyright(C)2011 Audatex North America,Inc. 06092012 01.31 PM PVO 0 o17 LOUS P -0M DIR 06"M1201 13 PM •••Unrelated Prior Damage Pogo'" ............... :Administrative.,r......... ....,..,,w.w r............. ,.Y... .,...., ......,.. ., .,.,,..., . .......,..... -.., .........,.... .............,............................,.................... Owner: HUY 8 JULIE NGUYEN Claim 6: PAG-PA-01.1 2-0283 1 76 Loss Date/Time: 08!02/2012 08:00 AM inspection Date: 08109/2012 01:15 PM Vehicle: 2006 Lexus ES330 STD 4 DR Sedan W Gasoline 3.3 5 Speed Automatic W!!T!apN........................................................................................................................................................................................................................ Line tap Guide MC Descriptbn lifFR-Part Na Price ADJ% B% Hours R 1 1 83 Panei,Hood Repair 1.0` SM 2 L 83 Panel,Hood Refinish 2.8 RF 2 items ............................................................................................................................................................................................................................................. :Estimate Total i Entries Paint Materials $64.40 Parts A Material Total $64.40 Replim Repair Total Mrs Mrs we Labor Rate Shoat Metal(SM) $46.00 1.0 1.0 $46.00 Moch/Eloc(ME) $47.00 Frans(FR) $48.00 RsfMMh(Rn $46.00 2.8 2.8 $128.80 Paint Materials $23.00 Labor Total 3.8 Hours $174.60 Unmated Prior Damage Oboes Total(exclude•taxes) $239.20 These damages are unrelated to the stated bas Incident.The stated costs are representative only and may difNr based upon such factors as the involved Incident facts,completion of the damages estimate and/or actual repair. )VA 1201.31 PM Ppo7of7 i 1 tTdtds and Comments Created Date Time: 2012-08-09 17:26:53 Created By: Jerry Farabaugh Type: LOSS_NOTE Subject: Untitled First Contact: IPM 8-9-12 Inspection Location: listed on page one of estimate Owner Present : yes MRS Brief Description/Summary of Damages: REAR DAMAGE See point of impact, photos an d estimate for damage details. Alternative-LKQ Parts Search: listed on estimate if available at time of estimat e lkq no quot#2428449 Estimate handed to Owner Estimate written on site - yes. Payment issued: 8-9-12 ck#514397 $ Followed up with owner explained estimate and supplement process. ------------------------------------------------------------------------ ARMS® - Automated Rental Management System Page 1 of 1 I .n A" DWWIW1noura10! 1MlcanfDEIRA�ONE9 VTLI] y1 CIMfaAMP.11lw.n PYM a IIfa.■W ACbn elflb CarlolMtIOACI tlriv RfaerSe AO171a166v1 H■0 'Nltf 173 MAP PA Py 0~ JONES,OE97A T M Invoicing: ror Nour�4 NUV a,l■N.■►aaaons, INDIVIDUAL PATItl NT n Meke OMmer4 to !NT"PRISE 1111117A-CAR ATAI) Tfrl Chvpr. $44006 P 0 BOk::OE Low A■.,w111aaaIV04210 M BOSTON MA C;241 row W. A■OMMICI h10 I:eaaoI C 23 326440 ClIeCkNumb/II6r Yov OaYlr+frlt I ISM 1 Phew nt:lyee on yeyr to$41 6� a1wM.Nw►r.OQifA4111Q1 Nate to f. 1 0 PMI RfnMI HI1■ry tee 1 PrN/N PA.n to►+e 1 Uft M—'11Yf--plpn "W wow 41114 CICkrM re'PI"SMORS 'Mall IMNTAI: _ 11Wfa1 balwh L.ae15.f1: A{IT11011MATMM4 ORAL: ENTERPRISERENT.A.CAR11702) Policy Rote 7362 PAX TON ST MO■naen 110046000 IHARIRS URG PA 171 it 103! D 17 Olive M Pbewe 1500 TOM Ae6lutf" t00% WVOKR: '40ty Lot "Woo, '"=Number 07115)d.3707 IbNTAL 01TAIL• In"■C7 0Me&16/17 %Mal Panty/Nll7 b 1111*12(12 aqa) MMA PaA.e:6MM6 w 6f16N2 Cu ar♦a) tillwt geivp NGJ1 EN HUY Prodooft will oervides 00M Number 0.031 l6 ■Ml 17 DA Mae Al■ d Y!0 im Tybe Inarrb0 >b 74 qw M 11411611 Conyers NOn.O"WeMe 1 FUEL Deft Of LPaf logo otl of Ina,na Name Too"m11 oMlivhllw 12 RA TAX AOObO+N Omer 1 SALES TAX% 700 !3100 111,0041 17161 OMaeerlenew 100% Te1g Chnlla: 1440 as Aa1SMAI Rwel old ; 1700 go VINMES MINTED: T4M11A■..ela Ow: 1/N,61 llllaokv one eM Tl■• Va.► 0W May! VM I14n2 1:45 AM 7017 NIlN AITI tIaAL2r►Mda6447go 4611 611111b/e lMby.ga Ygye 6231 71 NOTHODII: 6 ❑Emnao l ❑RED f EabnfMl ❑M W*MA Auflant:■len Owe ANow like" e &16n7 r 13 AM lYSMM.ARM1 INVOICE RECOV60,MI 413/17 552 PM RENT OLMTDUE1tgo00 K.BRANCH TICyt M6SN abae an 41&17 of 5 4o PM &13117 7 31 PM RENTAL BRANCH MOef FaUr Oat N P9004!HOP &13!17 i:c-M RENTAL BRANCH Trc1.t 7/MN WanaO on Wn7 R 11 46AM 410/17 10':IN RENTAL.B1iANCN AyeWWKIN ObnhmU RarrglW n b1'En■rprraa t 017 AM W0112 1On 7 0 r uMW 313071 AN JONES.OE9RA AuelOrgefpl 1111111118110 t 7 AM Air 20 dNM1 up to 115 OWa11y AuMtft■n er4".M 1 t!OWwY/6400 M#f W, AuAwgW bY JONES.DE&gA Oliva 911 AuelanZwo aet M too% �m:w0"te+Empnr.a �Nta•o Sff NOW TwFivre MPalrfetJ a.rr•u N».M a"yov mr bw.a,r. OMI.e4 00 N j CanMCt Ur 'SyvM Onvety P0ltyUK lltrnl NOM Mea1Ya V!PaNr4 W T:g A36 ca.an l..AMaroa1N ROW eIfn M1ivro lrpwn(4143'4 a.0 ro1f■a f/f■a.wa anlro..134.,U! B C4P1^f.t 3,12 TM_rwlM Crop .N h"r p046 e.n1.e https://www,annsweb.com/ar7nsweb/action items CERTIFICATE OF SERVICE I,Nichole L.Myers,an authorized agent of MARTSON DEARDORFF WILLIAMS OTTO GILROY & FALLER, hereby certify that a copy of the foregoing Praecipe was served this date by depositing same in the Post Office at Carlisle, PA, first class mail, postage prepaid, addressed as follows: Mr. Scott A. Noss 35 2nd Street York Haven, PA 17370 MARTSON LAW OFFICES By & flLw-j) Nichole L. Myers Ten East High Street Carlisle, PA 17013 (717) 243-3341 Dated: June 5, 2013 George B. Faller, Jr., Esquire MARTSON DEARDORFF WILLIAMS OTTO GILROY &FALLER MARTSON LAW OFFICES I.D. 49813 10 East High Street Carlisle, PA 17013 (717) 243-3341 Attorneys for Plaintiff HUY NGUYEN and IN THE COURT OF COMMON PLEAS OF JULIE NGUYEN CUMBERLAND COUNTY, PENNSYLVANIA Plaintiffs V. NO. 13-944 SCOTT A. NOSS, CIVIL ACTION-LAW Defendant TO: SCOTT A. NOSS, Defendant NOTICE OF ENTRY OF DEFAULT JUDGMENT You are hereby notified that on the 61* day of U 0(? , 2013, the following Judgment was entered against you in the above-captioned action: judgment in the amount of $8,340.95,plus interest and costs of suit as prayed for in the Complaint for failure to file an Answer to Plaintiffs' Complaint. Date: PrJth n ary I hereby certify that the name and address of the proper person to receive this notice under Pa. R. Civ. P. 236 is: Mr. Scott A. Noss 35 2"d Street York Haven, PA 17370 F:IFILESTIientO050 Donega113050 Current\3050,69513050,695.aff2.wpd Revised: 8120113 2 05M George B. Faller, Jr., Esquire MARTSON MARTSON LDAW OF`JFICES ILLIAMS OTTO GILROY & FALLER fi t � I.D. 49813 413 AUG 21 #�3 10 East High Street AN 4. 3t Carlisle, PA 17013 t"U'RLA {717} 243-3341 �'rwpa YLVAMA ' Attorneys for Plaintiffs HUY NGUYEN and IN THE COURT OF COMMON PLEAS OF JULIE NGUYEN : CUMBERLAND COUNTY, PENNSYLVANIA Plaintiffs V. NO. 13-944 SCOTT A. NOSS, : CIVIL ACTION-LAW Defendant AFFIDAVIT OF MOTOR VEHICLE ACCIDENT COMMONWEALTH OF PENNSYLVANIA } SS. COUNTY OF } On June 5, 2013, a Praecipe to enter default judgment in the above captioned action was entered in favor of Plaintiffs and against Defendant in the amount of $8,340.95, plus interest, attorney's fees and costs of suit and said judgment is the result of a motor vehicle accident which occurred on August 2, 2012. 1 make these statements pursuant to 18 Pa.Cons.Stat.§4904 relating to unsworn falsification to authorities and understand that false statements may subject me to criminal penalties under that statute. 6 DL. George B. aller, Jr., Esquire Sworn to and subscribed before me thiQ' l day oVbf 013. MONWEAITN OF PENNSYLVANIA Notarial Seal Margaret Ann Nash,Notary Public { Carlisle flora,Cumberland County My Commisslon Fxpires June 29,2815 MEMBER,PENNSYLVANIA ASSOCIATION OF NOTARIES a � CERTIFICATE OF SERVICE I, Nichole L. Myers, an authorized agent of Martson Deardorff Williams & Otto, hereby certify that a copy of the foregoing Affidavit was served this date by depositing same in the Post Office at Carlisle, PA, first class mail, postage prepaid, addressed as follows: Mr. Scott A. Noss 35 2"d Street York Haven, PA 17370 MARTSON LAW OFFICES By uic 4) 14- Nichole L. Myers Ten East High Street Carlisle, PA 17013 (717) 243-3341 Dated: 8/20/13