Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
13-1498
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION ATLANTIC STATES INSURANCE COMPANY, as Subrogee for DAVID VANDERLYKE, Plaintiff, ud VS. ROBERT L. CARRASQUILLO, JR. and JESSICA LONG, Defendants. 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 S. Bedford St. Carlisle, PA 17013 (717) 249 -3166 (800) 990 -9108 ask � 00 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ATLANTIC STATES INSURANCE COMPANY, as Subrogee for DAVID VANDERLYKE, Case No. Plaintiff, VS. ROBERT L. CARRASQUILLO, JR. and JESSICA LONG Defendants. COMPLAINT IN CIVIL ACTION AND NOW come(s) ATLANTIC STATES INSURANCE COMPANY, as Subrogee for DAVID VANDERLYKE, 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: COUNTI (NEGLIGENCE AGAINST DRIVER 1. The Plaintiff is Atlantic States Insurance Company, a licensed insurance company in a pooling arrangement with Donegal Mutual Insurance Co. whose offices are located at 1195 River Road, Marietta, PA 17547. 2. Defendant Robert L. Carrasquillo, Jr., (hereafter referred to as "Carrasquillo" ), is an adult individual whose current address is 113 Courtyard Drive, Carlisle, PA 17013. 3. Defendant Jessica Long, (hereafter referred to as "Long "), is an adult individual whose current address is 113 Courtyard Drive, Carlisle,PA 17013. 4. On or about April 30, 2010, Defendant Carasquillo was operating the motor vehicle of Defendant Long northbound on Franklin when he failed to stop at a stop sign at the intersection of Courtyard Drive, struck and damaged the stop sign, proceeded through the intersection and struck the lawfully parked motor vehicle of Plaintiff's insured. 5. Defendant Carrasquillo's operation of the Long motor vehicle was negligent in the following particulars: a. In failing to stop at a stop sign upon entering a controlled intersection; b. In failing to exercise due care; C. In being inattentive; d. In failing to fulfill the requirements of the Pennsylvania Motor Vehicle Financial Responsibility Law; e. In failing to maintain control of motor vehicle; and f. In operating a motor vehicle at an excessive rate of speed, with a reckless disregard for the safety of others. 6. As a direct and proximate result of the negligence of Defendant Carrasquillo, the Vanderlyke motor vehicle sustained damages totaling Eight Thousand Five Hundred Sixty -nine Dollars and Four Cents ($8,569.04), plus the insured's deductible. COUNT II (NEGLIGENCE ENTRUSTMENT AGAINST OWNER) 7. Plaintiff incorporates by reference the allegations of paragraphs 1 through 6 of this Complaint as if set forth in their entirety. 8. The vehicle being operated by Defendant Carrasquillo at the time that he struck the Plaintiff s subrogor's vehicle, and caused the said damages, was registered to and owned by Defendant Long. -2- 9. At the time of the accident that caused the damages alleged above, Defendant Carrasquillo was using the motor vehicle with the knowledge and consent of Defendant Long. 10. Defendant Long was aware that Defendant Carrasquillo was not licensed to operate a motor vehicle in Pennsylvania. H. Defendant Long negligently entrusted her motor vehicle to Defendant Carrasquillo, and is liable for the damages caused by him. COUNT III (SUBROGATION) 12 Plaintiff incorporates by reference the allegations of paragraphs 1 through 11 of this Complaint as if set forth in their entirety. 13. Plaintiff expended the sum of Eight Thousand Five Hundred Sixty -nine Dollars and Four Cents ($8,569.04), plus its insured's deductible, pursuant to a contract of insurance with its subrogors, and now seeks to recoup such expense, not including said deductible, from the Defendants by means of its right of subrogation. 14. A copy of the Police Accident Report is attached hereto and marked as Plaintiffs Exhibit "A." 15. A copy of the Repair Estimate is attached hereto and marked as Plaintiffs Exhibit ` °B." 16. Plaintiff intends to offer the attached Exhibits into evidence pursuant to Pennsylvania Rules of Civil Procedure, Rule 1305. The repairs have not been performed. The vehicle was a total loss. VERIFICATION The tuidersigned, Tamara L Richardson does heroby verilf— that he, /she isthe Subrogation Claims Rep. of Atlantic States Insurance Co., Plaintiff herein, 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 unsworn falsification to authorities. ATLANTIC STATES INSURANCE COMPANY B�, �� }_ y : z� Subrogation Claims Represent Title File No. 58463 F- 0 O 1 331 � V ve Borough of Carlisle Carlisle Police /Accident Exchange of Information Form A°QOdei1�g1 Incident � �1n7 y- pate I Locatio / ra u Officer A, E- ifh % f� Date ` Badge -1 Time Occurred _ n I R Primary Rd oyq=z i}op ap, Speed T /C /D/ s # of Lanes - �2 I Intersecting Rd Speed T /C /D/ 5 # of Lanes Unit # Vehicle Registration _j 1S State Vehicle Owner Address Cc �A P'iZ Phone01 q+ a"{6 Year _8_CtT. Make _QR0 Color W' ' VIN Operator �Ob CAl�lZ,� 7 p (.d L 0 L FDOB _1 State Address Phone S/B A/B Insurance Co. Polio # Y Co. Phone t Occupant Unit # Name DOB `` _ SSA A/ B �r .' Address Phone Seat Position i Witness(es) M i lie &4 Cft4eL9AP_P X, I Unit # Vehicle Registration �s r8 �� 3 �"- State � Vehicle Owner _ ` &I dress CC) ^� ' �g � iR Phone(� Year 2b of", _ Make _ _ �_ Color _Q _ VIN _q T 1 Operator _� Ae OLN .-OSS 1 °DOB � O r estate - - - --?—A _ Address Phone S/B A/B Insurance Co. ftRyT)C_ °iX1Tf5 policy # P 34$(0{0 0 Co. Phone Bbb y Occupant Unit Name __-- DOB SIB A/B Address Phone Seat Position _ Witness(es) Additional Informatio UNi 0 : : _ O o<<<cCK LL N 1 1T pt NOTICE: Copies of accident reports are available by mail only unless emergency circumstances prevail. EXHIBIT Enclose a check or money order in the amount of $15.00 and send to: Carlisle Police Department, 240 Lincoln Street, Carlisle, PA 17013, (717) 243 -5252 Ai (Please allow seven (7) days for processing and return of accident form) 9 05/02/2012 11:01 AM A7D79_0062 A Reportable ( on- Reportable White Coov - Reoortina Officer Canary Copy - Unit 1 Pink Copy - Jnit 2 Borough of Carlisle Carlisle Police /Accident Exchange of Information Form A°4 0ed 1't°� Incident Date Location A2k Office 0-4 - Date 2 - , Badge "� • Time Occurred 0 �— Primary Rd C atU2r�,�jZf1 . Speed T /C /D/ S s # of Lanes -- Intersecting Rd F320xi.rf� �T Speed T /C/D/ s S # of Lanes — � — Unit # 3 Vehicle Registration State Vehicle Own --I hT rtv� Address 5� t`�`�J fl - loci Phone Year -4X!Qq_ Make _ Color IWO VIN E 6 LQ H LS S S� tn � 49-4 Operato OLN DOB State ----- Address Phone S/B A/B Insurance Co. Policy # Co. Phone Occupant Unit # A Name -- DOB _ S/B A/B i Address Phone Seat Position _ Witness(es) Unit # Vehicle Registration State Vehicle Owner Address Phone Year Make Color VIN Operator OLN DOB State �---- Address Phone SIB A/B Insurance Co. Policy # Co. Phone Occupant Unit # Name DOB S/B A/B Address Phone Seat Position — Witness(es) Additional Information NOTICE: Copies of accident reports are available by mail only, unless emergency circumstances prevail. Enclose a check or money order in the amount of $15.00 and send to: Carlisle Police Department, 240 Lincoln Street, Carlisle, PA 17013, (717) 243 -5252 (Please allow seven (7) days for processing and return of accident form) 05/02/2012 11:01 AM A7D79_0062 ❑ Reportable ❑ No n- Reportable White Coov - Reoortina Officer Canary Copy - Unit 1 Pink Copy - Unit 2 M.r;'1Y.0 THE HARRISBURG AREA PULIUE 1.i4yoKMA'1'lUN KESUUR(:r: SY5'1 M �c x51r1�v( PAGE: 1 CRASH REPORT 04/30/12 CJD1 CARU CRASH' NUMBER: F0013316 INCIDENT NUMBER: 20120401586 CAR CASE CLOSED: Y --------------------- ------------- - -- AGENCY: 21402 CARLISLE DISP —TM: 0640 ARRV —TM: 0642 PATROL —ZN: PRECINCT: 240 LINCOLN ST INV —DT: 04 -30 -2012 INVESTIGATOR: DARHOWER, CHRISTOPHER J BADG: 0006 APP —DT: 00 -00 -0000 REVIEWER: BADG: 0000 COUNTY: 21 CUMBERLAND MUNICIPALITY: 402 CARLISLE CRS —DT: 04 -30 -2012 TM: 0640 #UNIT: 3 #PEOP: 1 #INJ: #KILL: REPORTABLE: Y NOTIF HIWY MAINT: Y PENNDOT PROP: N SCH BUS RELATED: N SCH ZON RELATED: N �. FOLLOW UP: Y CITY PROP DAM: S CRASH DESC: 7 REL TO RDWY: 5 ILLUM: 1 WEATHER: 1 RDWY SURF COND: 0 INTERS TYP: 00 SPEC LOC: 0 SPEC JURIS: RDWY SURF TYPE: PRINC RD — CNTY: 21 RT #: SEG: #LNS: 02 SPD LIM: 25 ORIENT: E STR NM: COURTYARD DR DR HOUSE #: 00109 RT S INSEC RD — CNTY: RT #: SEG: ##LNS: SPD LIM: ORIENT: STR NM: RT SIGN: LANDMARKI — RT #: MILEPOST: 0000 SEG MARKER: ORIENT: STR NM: DIST FR CRASH — FT: MI: •0 ' LANDMARK2 — RT##: MILEPOST: 0000 SEG MARKER: ORIENT: STR NM: TRAF CONTROL DEVICE TYPE: 3 FUNCTIONING; 3 WORK ZONE — TYP: LOC: SPEED LIM: LN CLOS: RD CL /DETOUR: SHLD /MED WK: MOVING WK: FLAGGER: OTHER: LANE CLOSED DUE TO CRS: 0 DIRECT: TRAF DETOUR: EST TM CLOSE: FIRST HARMFUL EV: 31 UN #: 01 MOST HARMFUL EV: 31 UN #: Ol ENV /RDWY FACTORS: 00 PRIME FACTOR: D 08 UN##: 01 EMERGENCY TRANSPORT — EMS AGENCY: NONE MED FACILITY: WITNESS: ROSSALYN VANDERLYKE PH: 7176097883 ADDR: 109 COURTYARD DR CARLISLE PA 17013 WITNESS: MICHAEL SNYDER PH: 9999999999 ADDR: 84 COURTYARD DR CARLISLE PA 17013 UNIT 1: 1995 BLUE /WHITE FORD BRONCO REGISTRATION: HKW8218 (PA) OWNER: JESSICA LONG DRIVER: ROBERTO CARRASQUILLO JR UNIT 2: 2006 RED TOYOTA SEDAN REGISTRATION: GSB2937 (PA) OWNER: DAVID VANDERLYKE DRIVER: PARKED UNIT 3: 2004 TAN JEEP REGISTRATION: GLR4579 (PA) OWNER: DAVID VANDERLYKE DRIVER: PARKED i i 05/02/2012 11:01 AM A7D79 0062 Mr;'1'Kv' AREA YUL.LUt 1N r'UH1vj&j Kr;SUVKI:� bYb "1'U"1.1 ��lCJ 1t11Y 1-) PAGE: 2 CRASH REPORT 04/30/12 CJDl CARU •CRAS14 NUMBER: F0013316 INCIDENT NUMBER: 20120401586 CAR dt --------------------------------------- --------------------- - - - - -- - - - - -- ON 4/30/2012 I WAS DISPATCHED TO REPORTS OF A HIT AND RUN AUTO CRASH INTO A BUILDING WITH A WHITE /BLUE FORD BRONCO FLEEING THE SCENE OF THE CRASH. A :. PENNYSLVANIA REGISTRATION OF "HKW -8218 WAS PROVIDED WHICH CAME BACK TO A 113 COURTYARD DR IN CARLISLE. I ARRIVED IN THE AREA AND FOUND A WHITE /BLUE FORD BROCO PARKED ON THE SOUTH SIDE OF COURTYARD DRIVE FACING EAST BOUND WITH HEAVY DAMAGE TO THE 10 /11 O'CLOCK POSITION. I CONTINUED WEST BOUND TO THE RESIDENCE WHICH HAD BEEN STRUCK AT 109 COURTYARD.''.,;.;. DRIVE AND SENT OTHER RESPONDING UNITS TO THE FORD BRONCO AND TO SEARCH THE AREA FOR A DRIVER OF SUCH. .` AT THE CRASH SCENE I NOTICED SKID MARKS WHICH BEGAN ON FRANKLIN STREET, CONTINUED OVER THE CURB, INTO THE GRASS, OVER A STOP SIGN, INTO A PARKED VEHICLE, AND INTO A RESIDENCE. A TRAIL OF DEBRIS WAS SCATTERED DOWN THE ROADWAY TOWARDS WHERE THE WHITE AND BLUE FORD BRONCO WAS NOW PARKED. FROM THE EVIDENCE AS VIEWED, IT APPEARED THAT THE FORD BRONCO HAD BEEN TRAVELING NORTH BOUND, FAILED TO STOP AT THE STOP SIGN OR NEGOTIATE THS RIGHT TURN ONTO COURTYARD DRIVE, AND STRUCK THE RESIDENCE AND PARKED CARS IN THE DRIVEWAY. I TOOK SEVERAL PHOTOS OF THE CRASH SCENE WHICH WERE PRINTED AND ATTACHED TO THE REPORT. UNIT 1 WAS TOWED FROM THE SCENE BY LEBOS TOWING. UNIT 2 WAS TOWED FROM THE SCENE BY THE HOMEOWNER AND HAD MAJOR DAMAGE AT THE 10 /11 O'CLOCK POSITION. UNIT 3 SUSTAINED MINOR DAMAGE AT THE 12 O'CLOCK POSITION WHEN UNIT 2 WAS _�...' PUSHED AT AN ANGLE INTO IT. THE DRIVER OF THE BRONCO, LATER IDENTIFIED AS ROBERTO CARRASQUILLO JR BY WITNESSES, FLED THE SCENE AND A WARRANT HAS BEEN REQUESTED FOR HIS ARREST. DAVID VANDERLYKE, OWNER OF 109 COURTYARD, ALSO SUSTAINED MODERATE DAMAGES TO HIS HOME INCLUDING SHRUBBERY, GRASS, SIDING, ELECTRICAL, WALL, AND GARA,E DOOR DAMAGES. A STOP SIGN OWNED BY CARLISLE BOROUGH WAS ALSO RUN OVER DURING THE INCLDENT AND ROAD CREWS HAD TO BE CALLED OUT TO PLACE A TEMPORARY STOP SIGN IN =TS PLACE. A DRIVER'S SIDE MIRROR WAS ALSO COLLECTED AT THE CRASH SCENE WHICH MATCHES THE TYPE FOUND ON THE BRONCO. z' CARRASQUILLO FACES SEVERAL CHARGES INCLUDING HIT AND RUN, FAILURE TO S'L'OP AND RENDER AID, DRIVING ON A SUSPENDED LICENSE, A STOP SIGN VIOLATION POND SEVERAL OTHER OFFENSES. 05/02/2012 11:01 AM A7D79_0062 mr.IRu 'l tl r, riE'llC1�17 t�UttV tucrc -s YVL1l.L 11Vr VrJ•uyi lVly [�r.�v vi��„i.; ti+tviJ:,.•. PAGE: 3 CRASH ASH REPORT 04/30/12 CJD1 CARU CRASH NUMBER: F0013316 INCIDENT NUMBER: 20120401586 CAR y ----------------- - - - - -- _ JESSICA LONG, THE OWNER OF UNIT 1, FACES CHARGES OF PERMITTING VIOLATION OF TITLE AND FALSE SWEARING TO A LAW ENFORCEMENT OFFICER AFTER SHE MADE CLAIMS OF DRIVING THE VEHICLE DURING THE CRASH. 'x A CURRENT INSURANCE CARD COULD NOT BE FOUND FOR THE BRONCO, HOWEVER LONG REPORTS THAT SHE DOES HAVE INSURANCE THROUGH MEMBERS 1ST. NO INJURIES WERE REPORTED. END OF REPORT: 4/30/2012 @ 1309 ------------------------------ - - - - -- ----- --- _ UNIT NUMBER: 01 TYPE: 01 COMMERCIAL VEH: N - - - OWNR NAME: LONG JESSICA 7174489611 OWNR ADDR: 113 COURTYARD DR CARLISLE PA 17013 VIN: 1 FMEU15H2SLC08814 YR: 1995 MAKE: 12 LIC PLATE: HKW8218 PA TRAV SPD: 999 INS CO , PO , PH : i. TOW TO,BY,PH: LEBOS EBS # TRL UNITS: 0 TYP UNIT: TAG NOLYROST: 7172492977 TYP UNIT: TAG NO,YR,ST: VEHICLE COL: 03 TYP: 01 SPEC USAGE: 00 ROLE: 1 POSITION: 98 INIT IMP PT: 11 DAMAGE: 3 DIR TRAY: N MOVEMENT: 10 GRAD. 3. ALIGNM: 1 ALCOH,DRG SUSP: 1 TEST TYP: 0 RESULT: PHYSICAL COND: 9 OWNER /DVR CD: 02 DVR PRESENCE: 3 PEDESTRIAN SIGNAL: PED LOC: VIOLATION CD: CHARGED: HARM EVENT 1: 31 L /R: L MHE: Y UTIL POLE #: DRIVER ACTION 1: 08 HARM EVENT 2: L /R: MHE: UTIL POLE #: DRIVER ACTION 2: 05 HARM EVENT 3: L /R: MHE: UTIL POLE #: DRIVER ACTION 3: 23 HARM EVENT 4: L /R: MHE: UTIL POLE #: DRIVER ACTION 4: VEH FAILURES: 01 PEDEST ACTION (45F1) DVR RESTRICTIONS COMPL: DVR ENDORSEMENT COMPL: DVR LICENSE COMPL: AVOIDANCE MANEUVER: UNDER RILE INDICATOR: EMERGENCY USE: -- - - - - -- -DRUG - TEST TYPE: RESULTS: PRINCIPLE IMPACT PT: ---- --- - - - - -- ------------------ -- UNIT NUMBER: 02 TYPE: 02 COMMERCIAL VEH: N ------------------_------ OWNR NAME: VANDERLYKE DAVID R 7176097883 OWNR ADDR: 109 COURTYARD DR CARLISLE PA 1701:3 VIN: 4 T 1 BE30KX6U120866 YR: 2006 MAKE: 49 LIC PLATE: GSB2937 PA TRAV SPD: 000 INS CO,PO,PH: ATLANTIC STATES PAG3086680 8664582242 TOW TO,BY,PH: BY OWNER BY OWNER # TRL UNITS: 0 TYP UNIT: TAG NO,YR,ST: TYP UNIT: TAG NO,YR,ST: VEHICLE COL: 02 TYP: 01 SPEC USAGE: 00 ROLE: 2 POSIT ION: 98 INIT IMP PT: 10 DAMAGE: 3 DIR TRAV: U MOVEMENT: 06 GRAD: 1 ALLGNM : 1 -• .�•- : ; `' ALCOH,DRG SUSP: 1 TEST TYP: 0 RESULT: PHYSICAL COND: 9 OWNER /DVR CD: 01 DVR PRESENCE: 2 PEDESTRIAN SIGNAL: PED LOC: VIOLATION CD: CHARGED: HARM EVENT 1: 11 L /R: MHE: Y UTIL POLE #: DRIVER ACTION 1: 00 HARM EVENT 2: L /R: MHE: UTIL POLE #: DRIVER ACTION 2: HARM EVENT 3: L /R: MHE: UTIL POLE #: DRIVER ACTION 3: HARM EVENT 4: L /R: MHE: UTIL POLE #: DRIVER ACTION 4: VEH FAILURES: 00 PEDEST ACTION (45F1) DVR RESTRICTIONS COMPL: DVR ENDORSEMENT COMPL: DVR LICENSE COMPL: r AVOIDANCE MANEUVER: UNDER RIDE INDICATOR: EMERGENCY USE: DRUG TEST TYPE: RESULTS: PRINCIPLE IMPACT PT: n. 05/02/2012 11:01 AM A7D79 0062 •�.•�'� '1':ir; �1.KttJ.J13UKli Htcr:Ei YVLlI.r, 11VrVtC1•ltilyVly s�.rraVVn�,r, ut.7si:u•a �,....+..�i••••; AGE: 4 CRASH REPORT 04/30/12 CJD1 CARU -( 'f?- .SR F0013316 INCIDENT NUMBER: 20120401586 CAR INIT NUMBER: 03 TYPE: 02 COMMERCIAL VEH: N OWNR NAME: VANDERLYKE DAVID R 7176097:883 ':;, OW`dR ADDR: 109 COURTYARD DR CARLISLE PA 17013 VIN: 1 J4GW48S54C238497 YR: 2004 MAKE: 02 LIC PLATE: GLR4579 PA TRAV SPD: 000 INS CO,PO,PH: ATLANTIC STATES PAG3086680 8664582242 TOW TO,BY,PH: # TRL UNITS: 0 TYP UNIT: TAG NO,YR,ST: TYP UNIT: TAG NO,YR,ST: VEHICLE COL: 09 TYP: 01 SPEC USAGE: 00 ROLE: 2 POSITION: 98 INIT IMP PT: 12 DAMAGE: 1 DIR TRAV: U MOVEMENT: 06 GRAD: 1 ALIGNM: 1 a. ALCOH,DRG SUSP: 1 TEST TYP: 0 RESULT: PHYSICAL COND: 9 OWNER/DVR VIOLATION CD: O1 DVR PRESENCE: 2 PEDESTRIAN SIGNAL: PED LOC: VIOLATION CD: CHARGED: HARM EVENT 1: 12 L /R: MHE: Y UTIL POLE #: DRIVER ACTION 1: 00 HARM EVENT 2: L /R: MHE: UTIL POLE#: DRIVER ACTION 2: HARM EVENT 3: L /R: MHE: UTIL POLE #: DRIVER .ACTION 3 HARM EVENT 4 :. L /R: MHE: UTIL POLE #: DRIVER ACTION 4: ' VEH FAILURES: 00 PEDEST ACTION (45F1) DVR RESTRICTIONS COMPL: DVR ENDORSEMENT COMPL: DVR LICENSE COMPL: AVOIDANCE MANEUVER: UNDER RIDE INDICATOR: EMERGENCY USE: DRUG TEST TYPE: RESULTS: • PRINCIPLE IMPACT PT: i 05/02/2012 11:01 AM A7D79_0062 ...,..' .. I;'�" t HK't,E► t'VLll.l; 11vrv1C1•u- Ll.lvly L�s uiuiLa•, -- - - �',C�li : 5 CRASH REPORT 04/30/12 CJD1 CARU ( ` 1) S }4NUNl1ER: F0013316 INCIDENT NUMBER: 20120401586 CAR ------ - - - - -- _'ERcON TYPE: 1= DRIVER 2= PASSENGER I 7FPEDESTRIAN 8 *OTHER 9= UNKNOWN 1' >'J _SEVERITY: O =NONE 1= KILLED 2 =MAJOR INJ 3= MODERATE 4 =MINOR 9 =UNK CSIT NO: 01 PERSON NO: 01 TYP: 1 INJ SEVERITY: 0 DOB: 19801228 SEX:_M'.. NAME (L, F, M, S) : CARRAS UI Q LLO ADDRESS: 113 COURTYARD DR ROBERTO JR PHONE: 7174489611 CARLISLE PA 17013 DRIVER LICENSE: PA 29325363 SEAT POSN: 01 SAFE— EQ1,2: 99 99 EJECT: 1 EJ —PATH: 0 EXTRIC: 1 TRANSP: N a is 05102/2012 11:01 AM A7D79 0062 , Carlisle. Police:Department ;Crash Report Diagram Crash . # 1 I . incident # (CAR) Agency Code: (21402) , 4 30 ' 1 Z Arrival Time l Office 01d E'�2 Badge ! f _ � r i t 1 � 1 J f V 05/02/201 11 OT M ,4 D79 006 : DONEGAL INSURANCE GROUP 1195 RIVER ROAD P.O. BOX 302 MARIETTA, PA 17547 -0302 (717) 426 -1931 FAX: (717) 426-7023 ••' ESTIMATE'•' 05102/2012 09:32 AM ................................................................................ Owner .................................................................................................................................................. ..............................> Owner: D REED & ROSSALYN VANDERLYKE Address: 109 COURTYARD DR Cell: (717)609 -7883 City State Zip: CARLISLE, PA 17013 FAX: .................................................................................................................... ............................... Control Information ............................................................................................................................. ............................... . .............. Claim * : PAG- PA- 01 -12- 0262404 Insured Policy Ik : PAG - 3086680 Loss Date/Time: 04/30 /2012 08:00 AM Loss Type: Collision Deductible: $1,000.00 File 9: Accounting * : 0004338 Ins. Company. Donegal Insurance Group Company Contact: JACK CHIARA Address: Work/Day: (717)737 -5757 FAX: (717)737 -7501 City State Zip: PA FAX: Agent: Jennifer Fugate Address: Work/Day: (800)877 - 0600x7486 Email: Jenniferfugate®donegaigroup.com Insured: D REED & ROSSALYN VANDERLYKE Address: Cell: (717)609 -7883 Claim Rep: Jennifer Fugate Address: Work/Day: (800)877- 06000488 Email: Jenniferfugate @donegalgroup.com Loss Payee: PSECU ............................................... ............................... E Inspection ......................................... ............................... Inspection Date: 05/0212012 Inspection T Inspection Location: SUBWAY Type: Feld Contact: Address: 109 COURTYARD DR Cell: (717)609.7883 City State Zip: CARLISLE, PA 17013 Primary Impact: Left Front Corner Secondary Impact: Left Front Side Driveable: Yes Rental Assisted: Assigned Date/Time: Received Date/Time: 04/3012012 12:01 PM First Contact Date/Time: Appointment Data/Time: 05 /01 12012 08:00 AM Company: DONEGAL INSURANCE GROUP Appraiser License # : 416512 Contact: JACK CHIARA Address: Work/Day: (717)737 -5757 City State Zip: PA FAX: (717)737 -7501 FAX: Repairer ....... ... ... ...... osf02/4012 09.56 AM r`nnfart• . -... ........ . Pepe 1 of 6 EXHIBIT 2006 Toyota Ca-y LE 4 DR Sedan Claim Y: PAG- PA -01 - 12 -026 05M220f209,32 AM SUBWAY AUTO BODY COLLISION CE Address: 1231 RITNER HWY Work/Day: (717)243 -9978 City State Zip: CARLISLE, PA 17013 FAX: (717)243 -7370 License #: Regulation ID: 251854056 Target Complete Date/Time: Days To Repair: 7 .......................... ........ ......... . _...._. ........ . Remarks ...... .... .... . .... ..... _.....,. .. ALL SUPPLEMENTAL DAMAGE MUST BE APPROVED BY THE APPRAISER COPY OF APPRAISAL SENT TO OWNER Vehicle -- ..................................................................................................................................... ...._..........._.............. 2006 Toyota Camry LE 4 DR Sedan 4cyl Gasoline 2.4 5 Speed Automatic Lic.Plate: GSB -2937 Lic State: PA Llc Expire: VIN: 4 T1BE30KX6U120866 Prod Date: Mileage: 114,173 Veh Insp# : Mileage Type: Actual Condition: Good Code: Y17438 Ext. Color: RED Int. Color. Ext. Refinish: Two -Stage Int. Refinish: Options AM /FM CD Player Air Conditioning Alarm System Anti -lock Brakes Bucket Seats Center Console Cruise Control Dual Airbags Intermittent Wipers Keyless Entry System Lighted Entry System Overhead Console Power Brakes Power Door Locks Power Drivers Seat Power Mirrors Power Steering Power Windows Pwr Driver Lumbar Supp Rear Window Defroster Rem Trunk -UGate Release Split Folding Rear Seat Strg Wheel Radio Control Tachometer Tilt Steering Wheel Tinted Glass Velour /Cloth Seats Damages :........ :..._ -._ ::.. .. :....................... Line Op Guide MC Description MFR.Part No. Price ADJ% B% Hours R 1 N 4 Frt Bumper Cvr Overhau Additional Labor 2.0 2 U NC I C 6 Cover,Front Bumper Replace Reconditioned $225.00' NC SM >> PARTS LOCATED AT LKO 250 1- 877.391.2727 EXT 4, OT #82013 SM 3 L 6 13 Cover,Front Bumper Refinish 2.6 Surface 3.7 RF 0.6 Two -stage setup Bumper U r 0 5 Two -stage 4 E 13 Reinf,Frt Bum P P 52029AA030 $30.41 04 SM 5 E 561 Relnf,Frt Bumper Upr LT 52126AA020 $30.92 6 L 561 Reinf,Frt Bumper U r LT INC SM P P Relinish 0.3 RF 7 E 0.3 Surface 69 Ret,Frt Bumper Cover LT 5211633050 8 L 359 Pre Raw Frt Bm Cvr $19.42 INC SM P Pr Refinish 0.5 RF 9 E 28 Grille Assembl 0 . 6 Surface 10 UC 41 Headlamp Assy,Halogen LT Re Reconditioned $169.55 0.3 SM I $237.00' INC SM 05/02l1D12 09:56 AM Page 2 of 6 2006 Torola Camry LE 4 O Sedan Claim R: PAG -0 02 624 0 4 05'02/201209:32 AM >> PARTS LOCATED AT LKQ 250 1- 877- 391 -2727 EXT 4, OT #82013 11 N 973 Headlamps Aim Additional Labor 0.4 SM 12 1 83 Panel,Hood Repair 1.5' SM 13 L 83 Panel,Hood Refinish 3.6 RF 3.0 Surface 0.6 Two -stage 14 RI 1030 Nozzle,W /S Washer LT R & I Assembly 0.1 SM 15 RI 1031 Nozzle,W /S Washer FIT R & I Assembly 0.1 SM 16 1 73 07 Panel Assembly,Rad Sup Repair 1.5' SM 17 L 73 Panel Assembly,Rad Sup Refinish 0.5' RF 0.5 Surface 18 E 126 Tray,Battery LT 7443133011 $45.28 0.3 SM 19 E 34 # Box,Fuse 8970117010 $10.12 0.1' ME # =01,02 20 E 67 Shield,Relay Box 8977121020 $14.65 ME 21 1 105 07 Pnl Assembly,inr Fndr LT Repair 2.0' SM 22 L 105 Pnl Assembly,lnr Fndr LT Relinish 1.0 RF 1.0 Surface 23 E 103 Fender,Front LT 53802AA020 $260.37 t 6 SM 24 L 103 Fender,Front LT Refinish 2.7 RF 1.8 Surface 0.5 Edge 0.4 Two -stage 25 E 152 Skirt,Inner Fender LT 53E176AA011 $73.47 INC SM 26 E 131 Brace,Front Fender LT 53846AA020 $7.04 INC SM 27 EU 728 Air Cleaner Assembly LIKE KIND & OUAL.PRT $125.00' +25.00 0.1 ME >> PARTS LOCATED AT LKQ 250 1- 877' - 391.2727 EXT 4, OT #82013 28 E 653 Arm,Lower Control OF 4806906070 $181.69 7.8 ME 29 E 659 Absorber,Strut OF 4852039565 $145.77 0.9 ME Betterment 20 30 E 685 Mount,Strut LT 4860906090 $90.65 INC ME 31 E 693 Rod,Frt Stabilizer Bar LT 4882006040 $74.88 3.1 ME 32 RI 274 Mldg Rocker Panel LT R & I Assembly INC SM 33 E 1361 Clip,Rocker Panel Midg LT MULTI -PART $48.30 SM 34 BR 209 Pnl,Front Door Outer LT Blend Refinish 1.2 RF 0.8 Blend 0.4 Two -stage 35 RI 231 Pn1,Inner Door Trim LT R & I Assembly 114C SM 36 RI 258 Mldg,Front Door Belt LT R & I Assembly 37 RI 254 Mldg,Front Door Side LT R 0.3 SM 81 I Assembly 38 RI 229 Mirror,Outer R/C LT R & I Assembly 0.4 SM 39 RI 227 Handle,Front Door Otr LT R & I Assembly 0.3 SM 40 1 SET UP AND MEASURE Repair ().8 SM 41 N FRONT END ALIGNMENT Additional Labor 2.0' SM 42 EC CAR COVER $49.95' SM 43 EC FLEX Replace Economy $5.00' SM 44 EC CORROSION PROTECTION Replace Economy $8.00' SM I 45 SB HAZARDOUS WASTE y $8.00' SM CAULK/SEAM SEALER Replace Economy 46 EC Sublet Repair $3.00' SM 47 1 CLEAN AND RETAPE $10.00' MOLDINGS Repair SM 48 1 COLLISION PULL Repair 0.3' SM 48 Items 2.0' FR' MC Message 01 CALL DEALER FOR EXACT PART # / PRICE 02 PART NO. DISCONTINUED, CALL DEALER FOR EXACT PART NO. 07 STRUCTURAL PART AS IDENTIFIED BY [-CAR 13 INCLUDES 0.6 HOURS FIRST PANEL TWO -STAGE ALLOWANCE .. .............. Estimate Total & Entries •...... •••° • - --• -• •••• - -................. ............ .........................._.... _... _................ . Gross Parts 0502/2012 09:56 AM $1,202.52 Page 3 of 6 2006 Toyota Camry LE 4 DR Sedan 0$/02/2012 09:32 AM Claime: PAG -PA -01.12 -0262404 Other Parts $667.95 Paint Materials $310.50 Line Item Markup $31.25 Parts & Material Total $2,212.22 Tax on Parts & Material @ 6.000% $132.73 Labor Rate Replace Repalr Hrs Total Hrs Mrs Sheet Metal (SM) $46.00 4.6 9.7 14.3 $657.80 Mech /Elec (ME) $47.00 9.0 9.0 $423.00 Frame (FR) $48.00 2.0 2.0 $96.00 Refinish (RF) $46.00 13.5 13.5 $621.00 Paint Materials $23.00 Labor Total 38.8 Hours $1,797.80 Tax on Labor @ 6.000 % $107.87 Sublet Repairs $3.00 Towing Gross Total $150.00 Less: Deductible $4.403.62 Less: Betterment & Tax $1,000.00 - Nat Total $39.87- $3363.75 Alternate Parts Y /00 /00 /00 /00 /00 CUM 00 /00 100 /00 /00 Zip Code: 17547 Default Audatex Estimating 6.0.726 ES 05/02/2012 09:56 AM REL 6.0.726 DT 04/01/2012 DB 01/01/2012 Copyright (C) 2011 Audatex North America, Inc. 2.5 MRS WERE ADDED TO THIS ESTIMATE BASED ON AUDAT'EX'S TWO -STAGE REFINISH FORMULA. ABBREVIATION LEGEND: LKQ = LIKE KIND IN QUALITY, A/M = AFTERMARKET, RECOND = RECONDITION, 0 /H= OVERHAUL, REPL = REPLACE, RPR = REPAIR, REFN = REFINISH, SECT = SECTION, R 5 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 = LICIENSE, 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. 05/02!2012 09'.56 AM Page 4 o16 2006 Toyota Camry LE t DR Sedan Claim a: pA.PA- 01-12 -026 DSi02201209'.32 AM 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 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 T A OU & EU =LIKE KIND L.PR TE = Partial Replace Price PM= Replace PXN Reman/Reblt UM= Replace D & OU L.PR L =Refinish PC = Replace PXN Reconditioned UC = Replace Reconditioned TT = Two -Tone SB = Sublet Repair =Additional Labor BR= Blend Refinish I = Repair N N = Partial Repair IT CG= Chipguard RI = R & I Assembly P =Cheek 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 Audatex Audatex's prior written consent. So!eY's .OKffidNl Copyright (C) 2011 Audatex North America, Inc. Audatex Esdmatin is a trademark of Audatex North America, Inc. 05!022012 09:$6 qM Page 5 of 2006 Toyota Camry LE 4 OR Sedan C181mt: PAGPA -01.12 -0262404 05/02M1209:32AM Estimate Summary Page DONEGAL INSURANCE GROUP Gross Total Less: Deductible $4,403.62 Less: Betterment & Tax $1,000.00 - Net Total $39.87- $3,363.75 Audatex Estimating 6.0.726 ES 05/02/2012 09:56 AM REL 6.0.726 DT 04/01/2012 DB 01/01/2012 Copyright (C) 2011 Audatex North America, Inc. 05/022012 09:66 AM Page 6 016 .Notes and Comments Created Date Time: 2012 -05 -02 13:55:54 Created By: Jack Chiara Type: LOSS—NOTE Subject: Untitled NO CHECK ISSUED. ONLY LKQ AVAILABLE IS ON ESTIMATE. CALLED 250, TRIPLE NICKLE AN D CHUCKS. POSSIBLE ADDITIONAL FT SUSP AND APRON DAMAGE. POSSIBLE REINF /ABSORBER DAMAGE. FT GLASS IS DAMAGED. LM WITH CUSTOMER TO SEE IF GLASS DAMAGE IS RELATED. NO RETURN CALL BY THE TIME ESTIMATE WAS COMPLETED. First Contact:04 /30 Owner Present:N Inspection Location: See Estimate Description Of Damage: Documented By Estimate & Photos Alt /LKQ Parts Search: See Above Notes /Estimate Estimate To Owner:Y LEFT AT SHOP Payment Issued: See Above: ----------------------- ------------------------ ------------------ reated Date Time: 2012 -05-01 12:06:55 Created By: Jennifer Fugate Type: GENERAL_ COMMENT Subject: Untitled insured had vehicle towed to Subway ,auto in Carlisle. 717 - 243 -9978 DONEGAL INSURANCE GROUP 1195 RIVER ROAD P.O. BOX 302 MARIETTA, PA 17547 -0302 717 426 -1931 FAX: (717) 426-7023 — SUPPLEMENT 1 — 05/02/2012 09:32 AM ..................................................................................................................................................................... ............................... Owner ........................................................................................................................................................................................................... ............................... Owner: D REED & ROSSALYN VANDERLYKE Address: 109 COURTYARD DR Cell: (717)609 -7883 City State Zip: CARLISLE, PA 17013 FAX: ..................................................................................................................................................................................... ............................... Control Information .............................................................................................................................................................................................................. ............................... Claim #: PAG- PA- 01 -12- 0262404 Insured Policy # : PAG - 3086680 Loss Date/Time: 04 130/2012 08:00 AM Loss Type: Collision Deductible: $1,000.00 File # : Accounting #: 0004338 Ins. Company: Donegal Insurance Group Company Contact: JACK CHIARA Address: Work/Day: (717)737 -5757 FAX: (717)737 -7501 City State Zip: PA FAX: Agent: Jennifer Fugate Address: Work/Day: (800)877- 0600x748£1 Email: Jenniferfugate @donegalgroup.com Insured: D REED & ROSSALYN VANDERLYKE Address: Cell: (717)609.7883 Claim Rep: Jennifer Fugate Address: Work/Day: (800)877 - 0600x7488 Email: Jenniferfugate @donegaigroup.com Loss Payee: PSECU ....................................................................................................................................................... ............................... Inspection Inspection Date: 05/02/2012 Inspection Type: Feld Inspection Location: SUBWAY Contact: Address: 109 COURTYARD DR Cell: (717)609 -7883 City State Zip: CARLISLE, PA 17013 Primary Impact: Left Front Corner Secondary Impact: Left Front Side Driveable: Yes Rental Assisted: Assigned Date/Time: Received Date/Time: 04/3012012 12:01 PM First Contact Date/Time: Appointment Date/Time: 05/01/2012 08:00 AWI Company: DONEGAL INSURANCE GROUP Appraiser License # • 416512 Contact: JACK CHIARA Address: Work/Day: (717)737 -5757 FAX: (717)737 -7501 City State Zip: PA FAX: Orig Company: DONEGAL INSURANCE GROUP Appraiser License # : 416512 Contact: JACK CHIARA Address: Work/Day: (717)737.5757 05/19@012 09'.30 AM Pepe 1 0 7 20CC Toyota Camry LE 4 DR Sedan OSU22012 0932 AM Claim a: P PA-01 - 12 -0282 FAX: (717)737 -7501 City State Zip: PA FAX: Repairer .. _... ......: -.... ........... . .......... . i Repairer- SUBWAY AUTO BODY P COLLISION CE Contact. Address: 1231 RITNER HWY Work/Day: (717)243 -9978 City State Zip: CARLISLE, PA 17013 FAX: (717)243 -7370 License #r : Regulation ID: 251854056 Target Complete Date/Time: Days To Repair: 7 ................. ------------- - -, _ .............._.._.. ......... _.:. Remarks ALL SUPPLEMENTAL DAMAGE MUST BE APPROVED BY THE APPRAISER COPY OF APPRAISAL SENT TO OWNER _...._ ...._ _... ................................ ............................... Vehicle 2006 Toyota Camry LE 4 DR Sedan 4cyl Gasoline 2.4 5 Speed Automatic Lic.Plate: GSB -2937 Lic State: PA Lic Expire: VIN: 4 T1BE30KX6U120866 Prod Date: Mileage: 114,173 Veh Insp#t : Mileage Type: Actual Condition: Good Code: Y1743B Ext. Color: RED Int. Color: Ext. Refinish: Two -Stage Int. Refinish: Options Air Conditioning Alarm System Anti -lock Brakes Automatic Trans Bucket Seats Center Console Cruise Control Dual Airbags In -Dash CD Changer &Tape Intermittent Wipers Keyless Entry System Lighted Entry System Overhead Console Power Brakes Power Door Locks Power Drivers Seat Power Mirrors Power Moonroof Power Steering Power Windows Pwr Driver Lumbar Supp Rear Window Defroster Rem Trunk -UGate Release Split Folding Rear Seat Strg Wheel Radio Control Tachometer Tilt Steering Wheel Tinted Glass U.S.A. Built Vehicle Velour /Cloth Seats Dama ............................ ............................... i Line Op Guide MC Description MFR.Part No. Price ADJ% B% Hours R 1 N 4 Frt Bumper Cvr Overhau Additional Labor Si I.8 SM 2 UC 6 Cover,Front Bumper Replace Reconditioned $225.00' INC SM >> PARTS LOCATED AT LKO 250 1- 877.391.2727 EXT 4, OTp82013 3 L 6 13 Cover,Front Bumper Refinish 3.7 RF 2.6 Surface 0.6 Two -stage setup Bumper Upr 0,5 Two -stage 4 E 13 Reinf,Frt Bum P P 52029AA030 $30.41 0.4 SM 5 E 561 Reinf,Frt Bumper Upr LT 52126AA020 $30.92 INC SM 6 L 561 Reinf,Frt Bumper Upr LT Refinish 0.3 Surface 0.3 RF 05/152012 09.30 AM Pape 2 of 7 2006 Toyota Camry LE 4 OR Sedan 05/02/2012 09.32 AM Clam 9: PAG PA -0 61 1.12 - 02624 7 E 69 Ret,Frt Bumper Cover LT 52116AA020 $19.42 INC SM 8 L 359 Prep Raw Fri Bmpr Cvr - Refinish 0.5 RF 0.5 Surface 9 E 28 Grille Assembly 5310106050 $200.76 S1 INC SM 10 UC 41 Headlamp Assy,Halogen LT Replace Reconditioned $237.00' INC SM >> PARTS LOCATED AT LKO 250 1- 877.391 -2727 EXT 4, OT #82013 11 N 973 Headlamps Aim Afttlonai Labor 0.4 SM 12 E 83 Panel,Hood 53301AA060 $513.82 S1 1.5 SM 13 L 83 Panel,Hood Refinish S1 4.6 RF 2.8 Surface 1.2 Edge 0.6 Two -stage 14 RI 1030 Nozzie,W /S Washer LT R & I Assembly S1 INC SM 15 RI 1031 Nozzle,W /S Washer AT R & I Assembly S1 INC SM 16 E 84 Hinge,Hood Panel LT 53420AA030 $35.51 S 1 0.3 SM 17 L 84 Hinge,Hood Panel LT Refinish S1 0.3 RF 0.3 Surface 18 E 85 Hinge,Hood Panel AT 53410AA030 $35.51 S1 1.5 SM 19 L 85 Hinge,Hood Panel AT Refinish St 0.3 RF 0.3 Surface 20 1 73 07 Panel Assembly,Rad Sup Repair 1.5' SM 21 L 73 Panel Assembly,Rad Sup Refinish 0.5' RF 0.5 Surface 22 E 126 Tray,Battery LT 7443108010 $59.19 Si INC SM 23 E 34 # Box,Fuse 8970117010 $10,12 # =01,02 0.1' ME 24 E 67 Shield,Relay Box 8977121020 $14.65 25 E 105 07 Pnl Assembly,lnr Fndr LT 5370206060 ME 26 L 105 Pnl Assembly, Inr Fndr LT Refinish $355.19 S1 9.4 SM i.0 RF 1,0 Surface 27 E 103 Fender,Front LT 53802AA020 $260.37 S1 1.3 SM 28 L 103 Fender,Front LT Refinish 1.8 Surface 2 . 7 RF 0.5 Edge 0.4 Two -stage 29 1 104 Fender,Front AT Repair 30 L 104 Fender,Front RT S1 3.5' SM Refinish S1 2.2 RF 1.8 Surface 0.4 Two -stage 31 E 152 Skirt,lnner Fender LT 53876AA011 $73,47 32 E 131 Brace,Front Fender LT 53846AA020 IIVC SM 33 N 972 Engine & Transaxle R &I $7'04 g Additional Labor INC SM Si 2.4 ME 34 EU 728 Air Cleaner Assembly LIKE: KIND & QUAL.PRT $125.00' +25.00 0.1 ME >> PARTS LOCATED AT LKO 250 1- 877.391 -2727 EXT 4, OT #82013 35 E 653 Arm,Lower Control L/F 4806906070 $181.69 S1 7.4 ME 36 E 659 Absorber,Strut L/F 48520A9250 $145,77 S1 0.7 ME 37 E 685 MountStrut LT Betterment 20 38 E 693 Rod,Frt Stabilizer Bar LT 4860906090 $90.65 INC ME 39 RI 143 Windshield R& I 4882006040 $74.88 S1 INC ME Assembly 40 E 145 Arm,Wiper Blade LT R 8 I Assem sem S 1 . 8 SM 85221A 41 RI 146 Arm,Wiper Blade AT 8 2 I Assembly $69.74 S1 0.1 SM 42 E 1023 Panel,Cowl Top 6570006130 $682.54 em y Si INC SM 43 L 1023 Pa Top Refinish S1 ,,.5 SM 0.8 Surface Si G.8 RF 44 1 163 07 Pillar,Hinge LT Repair 45 L 163 Pillar,Hinge LT Refinish S1 2.0' SM 2.0 Surface S1 2.2 RF 46 RI 274 Mid ,Rocker Panel LT 0.2 Two-stage 47 E 1361 CIip,Rocker Panel Mid g LT R & I Assembly INC SM 48 1 208 Door Shell,Front AT MULTIPART $48.30 SM 49 L 208 Door Shell,Front AT Repair S1 2.0' SM Refinish U5/1912012 oa 30 AM St 2.0 RF Papa 3 .17 2006 Toyota Camay LE 4 DR Sedan Claim e P -0142- 026 21 0 4 05 AM 2.0 Surface INC Two -stage 50 BR 209 Pnl,Front Door Outer LT Blend Refinish S1 1.0 RF 1.0 Blend INC Two -stage 51 RI 231 Pnl,lnner Door Trim LT R & I Assembly INC SM 52 RI 232 Pnl,lnner Door Trim RT R & I Assembly S1 INC SM 53 RI 258 MIdg,Front Door Belt LT R 8 I Assembly 0.3 SM 54 RI 259 MIdg,Front Door Belt FIT R 8 I Assembly S1 0.3 SM 55 RI 254 MIdg,Front Door Side LT R & I Assembly 0.4 SM 56 RI 255 MIdg,Front Door Side FIT R & I Assembly S1 0.4 SM 57 RI 229 Mirror,Outer R/C LT R & I Assembly 0.3 SM 58 RI 230 Mirror,Outer R/C FIT R 8 I Assembly Si 0.3 SM 59 RI 227 Handle,Front Door Otr LT R & I Assembly 0.8 SM 60 RI 228 Handle,Front Door Otr FIT R 8 I Assembly S1 0.8 SM 61 BR 43 Panel,Roof Side LT Blend Refinish St 0.9 RF 0.6 Blend 0.3 Two -stage 62 RI 256 MIdg,Roof Drip LT R & I Assembly S1 0.3 SM 63 1 SET UP AND MEASURE Repair 2.0' SM 64 N FRONT END ALIGNMENT Additional Labor $49.95' 65 EC CAR COVER Replace Economy $,.,5.00• SM 66 EC FLEX Replace Economy $8.00* SM 67 EC CORROSION PROTECTION Replace Economy $8.00* SM 68 SB HAZARDOUS WASTE Sublet Repair $3.00* SM 69 EC CAULWSEAM SEALER Replace Economy $10.00' SM 70 1 CLEAN AND RETAPE MOLDINGS Repair SM 71 1 COLLISION PULL Repair 0.3' SM 71 Items S1 6.0' FR' MC Message 01 CALL DEALER FOR EXACT PART # / PRICE 02 PART NO. DISCONTINUED, CALL DEALER FOR EXACT PART NO. 0 STRUCTURAL PART AS IDENTIFIED BY I-CAR 13 INCLUDES 0.6 HOURS FIRST PANEL TWO -STAGE ALLOWANCE ......... Estimate Total &Entries " """' ° ° •°• °•••° •° � -•� ............. ............................... Gross Parts Other Parts $2,939.95 Paint Materials $667.95 Line Item Markup $529.00 Parts & Material Total $31.25 Tax on Parts & Material $4,168.15 @ 6.CIOCI % $250.09 Labor Rate Replace Repair Hrs Total Hrs Hrs Sheet Metal (SM) $46.00 24.7 13.5 38.2 $1,757.20 Mech /Elec (ME) $47.00 8.3 2.4 10.7 $502.90 Frame (FR) $48.00 6.0 6.0 $288.00 Refinish (RF) $46.00 23.0 23.0 $1,058.00 Paint Materials $23.00 Labor Total Tax on Labor 77.9 Hours $3,606.10 Sublet Repairs @ 6.000% $216.37 Towing $3.00 Storage $150.00 Gross Total $30.00 Less: Deductible $8,423.71 Less: Betterment & Tax $1,000.00- 05/182012 0930 AM $37.88 - Page 4 01 7 2006 Toyota Camry LE 4 DR Sedan Claim a : PA -01 -12 -0262104 05022012 08:32 AM Net Total $7,385.83 TOTAL LOSS Actual Supplement Total $4,022.08 Less: Previous Net Total $3,363.75• Net Supplement Total $4,022.08 Alternate Parts Y /00100 /00 /00 /00 CUM 00/00/00 /00100 Zip Code: 17547 Default Audatex Estimating 6.0.726 St 05/18/2012 09:30 AM REL 6.0.726 DT 09/0112011 DB 01/01/2012 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 IN QUALITY, A/M = AFTERMARKET, RECOND = RECONDITION, O /H= OVERHAUL, REPL = REPLACE, RPR = REPAIR, R:EFN = 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 = LIC:ENSE, 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 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 05/182012 0930 AM Page 5 017 2006 Toyota Camry LE s DR Seda. C181 -a: PAGPA -01- 12.0262404 05/02/20 t209:32 AM BETTER THAN THE REMAINDER OF THE EXISTING WARRANTY ON THE PART BEING REPLACED. APPRAISER SIGNATURE: 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 & CUAL.PRT TE = Partial Replace Price PM= Replace PXN Reman/Reblt UM= Replace Reman /Rebuilt L = Refinish PC= Replace PXN Reconditioned UC = Replace Reconditioned TT =Two Tone SB - Sublet Repair N - Additional Labor BR= Blend Refinish I = Repair IT = Partial Repair CG= Chipguard RI = R & I Assembly P =Check 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 Audatex Audatex's prior written consent. s sacs.tFflha:;v Copyright (C) 2011 Audatex North America, Inc. Audatex Estimatin is a trademark of Audatex North America, Inc. 05118/2012 09:30 AM Pape 6 d7 2006 ToyoMe Camry LE 4 DR Sedan [5'022012 09:92 AM C4ian Y: PAG-PA-0612 -028 Estimate Summary Page DONEGAL INSURANCE GROUP Gross Total $8,423.71 Less: Deductible $1,000.00 - Less: Betterment & Tax $37.88 - Net Total $7,385.83 Actual Supplement Total $4,022.08 Less: Previous Net Total $3,363.75- Net Supplement Total $4,022.08 Audatex Estimating 6.0.726 S1 05/18/2012 09:30 AM REL 6.0.726 DT 09101/2011 DB 01/01/2012 Copyright (C) 2011 Audatex North America, Inc. 05/1812012 09.30 AM Page 7 W 7 •'• SUPPLEMENT RECONCILIATION Supplement S1 Claim # : PAG- PA- 01 -12- 0262404 Insured Policy # : PAG - 3066660 File # : Claim Rep: Jennifer Fugate Insured: D REED & ROSSALYN VANDERLYKE Inspection Date/Time: 05(02/2012 Owner Name: D REED & ROSSALYN VANDERLYKE Company: DONEGAL INSURANCE GROUP Vehicle: 2006 Toyota Camry LE 4 DR Sedan ......... ... .... ......... ... .................. 'Deleted Linea ..._, ...,_. .,. _.. -._. ., , ....,....,_...... . ..,,_...,._......_,.,._,�..,.., i Line Guke Part _.,.,,, -.,..,_.,,,,._ __,.- .,.. .................:.... . .....:__._,._::.,..,..w.,..:.: Operation � .....::..,., �,__.._._.,..,,_..,.,,,...., ,,,,,,,:.,.,...,_.::.,,...,,,., Price AW% B% Labor Rate i 83 Panel,Hood Repair 1.5' 2 105 Pnl Assembly,inr Fndr LT Repair SM 2.0' SM .............. _... .............. ................................................................ .................................. ............................... :Added Lines ......... ............................... ............................................... ............................... LineGuide Part ... ........................ ......................................... ....... Operation P ..... rice ADJ% ............B... % .... ........ L...a.bor .. .. ...........'Rate'" 3 43 Panel,Roof Side LT Blend Refinish $1 0.9 RF 4 83 Panel,Hood Replace OEM S1 $513.82 5 84 Hinge,Hood Panel LT Replace OEM S1 1.5 SM $35.51 0.3 SM 6 84 Hinge,Hood Panel LT Refinish 7 85 Hinge,Hood Panel RT Replace OEM S1 0.3 RF S1 $35.51 1,5 SM 8 85 Hinge,Hood Panel RT Refinish S1 0.3 RF 9 104 Fender,Front RT Repair Si 3.5' S 10 104 Fender,Front RT Refinish Si 11 105 Pnl Assembly,lnr Fndr LT Replace OEM S1 2.2 RF 12 143 Windshield R & I R & I Assembly S7 $355.19 9.4 SM 13 145 Arm,Wiper Blade LT Replace OEM Si 2.8 SM 14 146 Arm,Wiper Blade RT R & I Assembly S1 $69.74 01 SM 15 163 Pillar,Hinge LT Repair INC SM 16 163 Pillar,Hinge LT Refinish S1 2.0' SM 17 208 Door Shefi,Front RT Repair S7 2.2 RF 18 208 Door Shell,Front R Refinish T St 2.0' SM Si 19 228 Handle,Front Dos Otr RT R 8 I Assembly S1 2.0 RF 20 230 Mirror,Outer RIC RT R & I Assembly S1 0.8 SM 21 232 Pnl,Inner Door Trim RT R & I Assembly S1 0.3 SM 22 255 MIdg,Front Door Side RT R 8 I Assembly St INC SM 23 256 Mldg,Roof Drip LT R & I Assembly S1 0.4 SM 24 259 Mldg,Front Door Belt RT R & I Assembly S1 0.3 SM 25 972 Engine & Transaxle R &I Additional Labor S1 0.3 SM 26 1023 Panel, Cowl Top Replace OEM S1 2.4 ME 27 1023 Panel, Cowl Top Refinish $682.54 3.5 SM S7 08 RF ChangedLines ............................................. ............................... .. _ ........................... _.......... ............................... Line Guide Part "- " " " " """ ° ° ° -° Price ADJ% B% Labor Rate 28 4 Fri Bumper Cvr Overhau Additional Labor S1 Fri Bumper Cvr Overhau 1.8 SM 29 28 Grille Assembly Replace OEM S7 2.0 SM Grille Assembly $200.76 INC SM 30 83 Panel,Hood Refinish $169.55 0.3 SM Panel,Hood S1 4.6 RF 31 103 Fender,Front LT Replace OEM St 3.6 RF Fender,Fronl LT $260.37 11 SM 32 126 Tray, Battery LT Replace OEM S1 $$59 $5919 .37 1.6 SM Tray,Battery LT INC SM 33 209 Pnl,Front Door Outer LT $45.28 0.3 SM Blend Refinish St Pnl,Froni Door Outer LT 1.0 RF 34 653 Arm,Lower Control OF Replace OEM S1 1.2 RF rm A,LOwer Control L/F $161'69 7.4 ME 35 659 Absorber,Strut OF Replace OEM $181.69 7.8 ME Absorber,Slrul OF S $145.77 20 01 ME 36 693 Rod,Fn Stabilizer Bar LT Replace OEM S1 $145.77 20 0.9 ME Rod, Fri Stabilizer Bar LT $74.88 INC ME 37 1030 Nozzle,WIS Washer LT R & I Assembly Si $74.68 0.1 ME N- zte,W(S Washer LT INC SM 38 1031 Nozzle Wls Washer RT R & I Assembly $ 1 0.1 SM 05 /taWt209.90 AM INC SM Pape I of 2 C� r PA3-PA -01-12 - 0262404 Nozzle,W /S Washer FIT 39 COLLISION PULL Repair g 0.1 SM COLLISION PULL 6.C' FR' 2.0' FR' calculation ChanQea 1111 ..... .. . .........,......,. From ....... ............................... . ............ ..............................: Dlllaronce Gross Pans $1 Paint Materials $23.00 $310.50 $2,939.95 $1,737.43+ Tax on Pans 8 Material $23.00 $529.00 $218.50+ 6 -000% $132.73 6.000% $250.09 SM - Sheet Metal $46.00 $65J.8o $46.00 $117.36+ FR • Frame $47.00 $423.00 Eleclrcal $1,757.20 $1,099.40+ FR -Frame $47.00 $502.90 $79.90+ $48.00 RF Refinish $96.00 $48.00 $288.00 Tax On Labor $46.00 $621.00 $46.00 $1,058.170 $192.0(1+ 6.000% $107.87 6.000% $437.0(x+ Storage $216.37 $108.50+ Betterment 8 Tax $'0'00 $30.00 $30.00+ Actual Supplement 1 Net Total $39.87 $37.86 $1.95, __._........_.. .....,..........._......_...... Summar $4,022.08+ y _._. ___ ......... .. .............1...1..11........ . Net Total ........... ser Date ............ Time A ..................... ............................... PPral .. ........: Original Estimate $3,363.75 04130/2012 12:01 PM DONEGAL INSURANCE GROUP Supplement 1 $7,385.83 05/1812'012 08:45 AM DONEGAL INSURANCE GROUP This report contains proprietary information of Audatex and may not be disclosed 10 any third party (other than the '�"' insured, claimant and others on a need to know basis in order to effectuate the claims process) without �u at prior written consent. Audatex's Copyrlght (C) 2011 Audatex North America, Inc. K Audatex Estimating is a trademark of Audatex North America, Inc. os/18/2012 09:30 AM gaga 2 012 Notes and Comments Created Date Time: 2012 - 05 -02 13:55:54 Created By: Jack Chiara Type: LOSS_NOTE Subject: Untitled NO CHECK ISSUED. ONLY LKQ AVAILABLE IS ON ESTIMATE. CALLED 250, TRIPLE NICKLE AN D CHUCKS. POSSIBLE ADDITIONAL FT SUSI? AND APRON DAMAGE. POSSIBLE REINF /ABSORBER DAMAGE. FT GLASS IS DAMAGED. LM WITH CUSTOMER TO SEE IF GLASS DAMAGE IS RELATED. NO RETURN CALL BY THE TIME ESTIMATE WAS COMPLETED. First Contact:04 /30 Owner Present:N Inspection Location: See Estimate Description Of Damage: Documented By Estimate 6 Photos Alt /LKQ Parts Search: See Above Notes /Estimate Estimate To Owner:Y LEFT AT SHOP Payment Issued: See Above: --------------------- --------------------------------------------- Created Date Time: 2012 -05 -18 13:29:52 Created By: Jack Chiara Type: LOSS_NOTE Subject: Untitled REINSPECTED VEHICLE 05/18. VEHICLE IS A TOTAL LOSS. STORAGE IS $30.00 PER DAY ST ARTING 05/18. SHOP IS ASKING FOR 2.0 ($92.00) IN TEARDOWN. PROBABLE STEERING /RAC K DAMAGE. LEFT MESSAGE TO CUSTOMER CONCERNING TOTAL LOSS, DID NOT GET AN OK TO M OVE FROM SHOP. ----------------------------- ----------------------------------- Created Date Time: 2012 -05 -01 12:06:55 Created By: Jennifer Fugate Type: GENERAL_ COMMENT Subject: Untitled insured had vehicle towed to Subway auto in Carlisle. 717- 243 -9978 ----------------------------- - - - - -- ...fit. .. .. �-r- rte._ -.,-� • .., 1 ? .,�YY 6 �� � i' f �a Y. . 9Y r •r` 4 X�a ' b 1' At- i , /�^ y . � . \ ƒ \/ . / k � /\ �/ � f , � �� \ . � /ƒ \ � » � �._ \ � . � � / � � . � , .. } /: « � � . � � \\ � / . � � . /© � / � {\ . . �� /^ » . . � � \ � § � ,y/ �f� <f � � . � »r � -� < \ , /` : . � . � 11 1 y . .«� \ , \� � ��� yf � y / , , r . ����� � . \ �� � / � � s 1 + :� �� \ /� / . � � .��� � � � / .� :Z r f �. � � � ^� « ,.. . � � M �� ^��� e \ \� / , . \ .: . . ,. .�.. J �,. .p,. �. ( � _. } r �:: -�. ». .. � .. _ � � � a I, :,,- , t �'. o, Y h �� �. '� � .,���� 1,\ „� nn„ n .,� �, ,` �. , .� . , ,,r �. f , :. '.�,:: �.�.�� � . '�. . i j :� �� ,,� ��.���� -��� � . �' '`�. SHERIFF'S OFFICE OF CUMBERLAND COUNTY Ronny RAnderson F IILED-OFFICL Sheriff of Climb, ` ttfl ONO Ti':. Jody S Smith Chief Deputy 2013 MAR 28 AM (0: S3 Richard W Stewart Solicitor �'CE F'"� CU LAND COUNTY ��"��'r` PENNSYLVANIA Atlantic States Insurance Company Subrogee for David Vanderlyke Case Number vs. Robert L Carrasquillo, Jr. (et al.) 2013-1498 SHERIFF'S RETURN OF SERVICE 03/25/2013 04:20 PM - Deputy Valerie Weary, being duly sworn according to law, served the requested Complaint& Notice by handing a true copy to a person representing themselves to be Sheila Rodriguez. sister,who accepted as"Adult Person in Charge"for Robert L Carrasquillo, Jr. at 113 Courtyard Drive, Carlisle Borough, Carlisle, PA 17013. 41111� VALERIE WEARY, DEPUTY 03/25/2013 04:20 PM-Deputy Valerie Weary, being duly sworn according to law, served the requested Complaint& Notice by handing a true copy to a person representing themselves to be Sheila Rodriguez, sister in law, who accepted as"Adult Person in Charge"for Jessica Long at 113 Courtyard Drive, Carlisle ough, Carlisle, PA 17013. VALERIE WEARY, DEPUTY SHERIFF COST: $50.00 SO ANSWERS, March 26, 2013 RbNIV R ANDERSON, SHERIFF ,c)CountySuite Sheriff,Teleosori Inc. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION ATLANTIC STATES INSURANCE COMPANY,AS SUBROGEE FORDAVID CASE NO. 13-1498 VANDERLYKE CODE NO. c2? (5 >c:: Plaintiff, TYPE OF PLEADING: VS. PRAECIPE TO ENTER DEFAULT ROBERT L.CARRASQUILLO,JR.AND JUDGMENT JESSICA LONG FILED ON BEHALF OF: Defendant, ATLANTIC STATES INSURANCE COMPANY,AS SUBROGEE FOR DAVID VANDERLYKE, PLANTIFF 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, Ste 102 PITTSBURGH,PA 15219 (412)232-0440 File No. 58463 �11,50 po ATr4 &v� P's aqo3l q led IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION ATLANTIC STATES INSURANCE COMPANY,AS SUBROGEE FOR DAVID VANDERLYKE Plaintiff, No. 13-1498 VS. ROBERT L. CARRASQUILLO,4111. AND JESSICA LONG Defendant, PRAECIPE TO ENTER DEFAULT JUDGMENT TO: PROTHONOTARY,COURT OF COMMON PLEAS OF CUMBERLAND COUNTY KINDLY ENTER DEFAULT JUDGMENT IN THE ABOVE CASE AGAINST THE DEFENDANT(S),ROBERT L.CARRASQUILLO,JR.AND JESSICA LONG, in the amount of EIGHT THOUSAND FIVE HUNDRED SIXTY-NINE DOLLARS AND FOUR CENTS ($8,569.04)plus costs and interest from the date of entry,the Defendant(s)having failed to file an Answer to the Complaint. More than ten (10) days have elapsed since serving the Defendant(s) with a copy of the "IMPORTANT NOTICE," a copy of said Notice with the PROOF OF SERVICE being attached hereto as Exhibit"A. Respectfully submitted, BY: G RGE A. MILLER, Esquire ttorney for ATLANTIC STATES INSURANCE COMPANY, AS SUBROGEE FOR DAVID VANDERLYKE, PLANTIFF 2 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,PENNSYLVANIA CIVIL DIVISION ATLANTIC STATES INSURANCE COMPANY SUBROGEE FOR DAVID VANDERLYKE, Plaintiff, VS. NO. 13-1498 ROBERT L. CARRASQUILLO,JR AND JESSICA LONG Defendant. TO: ROBERT L. CARRASOUILLO, JR Date of Notice: APRIL 23,2013 IMPORTANT NOTICE 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 NOTICE TO A LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE FOLLOWING OFFICE TO FIND OUT WHERE YOU CAN GET LEGAL HELP. LAWYER REFERRAL SERVICE CUMBERLAND COUNTY BAR ASSOCIATION 32 S. BEDFORD ST. CARLISLE,PA 17013 (727) 249-3166, 800-990-9108 Ge rge A. Miller, Esquire 1030 Fifth Avenue, Ste 102 Pittsburgh,PA 15219 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,PENNSYLVANIA CIVIL DIVISION ATLANTIC STATES INSURANCE COMPANY SUBROGEE FOR DAVID VANDERLYKE, Plaintiff, VS. NO. 13-1498 ROBERT L. CARRASQUILLO,JR AND JESSICA LONG Defendant. TO: Jessica Loni Date of Notice: APRIL 23.2013 IMPORTANT NOTICE 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 NOTICE TO A LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE,GO TO OR TELEPHONE THE FOLLOWING OFFICE TO FIND OUT WHERE YOU CAN GET LEGAL HELP. LAWYER REFERRAL SERVICE CUMBERLAND COUNTY BAR ASSOCIATION 32 S. BEDFORD ST. CARLISLE,PA 17013 (727) 249-3166, 800-990-9108 Ge ge A.Miller, Esquire 30 Fifth Avenue, Ste 102 Pittsburgh, PA 15219 13-1498 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,PENNSYLVANIA CIVIL DIVISION ATLANTIC STATES INSURANCE COMPANY SUBROGEE FOR DAVID VANDERLYKE, Plaintiff, VS. NO. 13-1498 ROBERT L. CARRASQUILLO,JR AND JESSICA LONG Defendant. PROOF OF SERVICE THE UNDERSIGNED,George A.Miller,Attorney for Plaintiff herein,does hereby verify that the IMPORTANT NOTICE, a copy of which is attached hereto, was mailed to the Defendant(s) herein on APRIL 23, 2013, by U.S. Mail, First Class, Postage Paid. This statement is made subject to the penalties of 18 Pa. C.S., Section 4904,relating to unsworn falsifications to authorities. Geo e A. Miller, Esquire 13-1498 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,PENNSYLVANIA CIVIL DIVISION ATLANTIC STATES INSURANCE COMPANY SUBROGEE FOR DAVID VANDERLYKE, Plaintiff, VS. NO. 13-1498 ROBERT L. CARRASQUILLO,JR AND JESSICA LONG Defendant. PROOF OF SERVICE THE UNDERSIGNED,George A.Miller,Attorney for Plaintiff herein,does hereby verify that the IMPORTANT NOTICE, a copy of which is attached hereto, was mailed to the Defendant(s) herein on APRIL 23, 2013,by U.S. Mail, First Class, Postage Paid. This statement is made subject to the penalties of 18 Pa. C.S., Section 4904,relating to unworn falsifications to authorities. Ge ge A. Miller, Esquire IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION ATLANTIC STATES INSURANCE COMPANY,AS SUBROGEE FORDAVID VANDERLYKE Plaintiff, CASE NO.: 13-1498 VS. ROBERT L.CARRASQUILLO,JR.AND JESSICA LONG Defendant, NOTICE OF JUDGMENT TO: DEFENDANT (S)ABOVE NAMED: ROBERT L. CARRASQUILLO,JR. 113 COURTYARD DRIVE CARLISLE, PA 17013 ck)5 TAKE NOTICE,that on MCLU JUDGMENT was entered G against you and in favor of the Plaintiff(s)in the amount of EIGHT THOUSAND FIVE HUNDRED SIXTY-NINE D L UR CENTS 8,569.04 plus costs and interest from date of entry. PROTHON:)Y By: Deputy IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION ATLANTIC STATES INSURANCE ) COMPANY,AS SUBROGEE FOR DAVID ) VANDERLYKE ) Plaintiff, ) CASE NO.: 13-1498 VS. ) ROBERT L. CARRASQUILLO,JR.AND ) JESSICA LONG ) Defendant, NOTICE OF JUDGMENT TO: DEFENDANT (S)ABOVE NAMED: JESSICA LONG 113 COURTYARD DRIVE CARLISLE, PA 17013 TAKE NOTICE, that on , 0013 JUDGMENT was entered against you and in favor of the Plaintiff(s)in the amount of EIGHT THOUSAND FIVE HUNDRED SIXTY-NINE DOL S CENTS 569.04 plus costs and interest from date of entry. PROTHONOTARY By: Deputy _Lf3 AUG PH I: 1, r, PENNSYLVANIA IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION ATLANTIC STATES INSURANCE CASE NO.: 13-1498 COMPANY, as Subrogee for DAVID VANDERLYKE CODE NO. Plaintiff, TYPE OF PLEADING: vs. ROBERT L. CARRASQUILLO, JR. AFFIDAVIT IN SUPPORT OF AND JESSICA LONG CERTIFICATION OF MOTOR VEHICLE JUDGMENT Defendants. FILED ON BEHALF OF: ATLANTIC STATES INSURANCE COMPANY, as Subrogee for DAVID VANDERLYKE,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 943-. 7 S,P0. "' ' ^i File No. 57779 (412) 232-0440 C KU SS n,\ 1 R 316294/AU IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION ATLANTIC STATES INSURANCE COMPANY, Case No. 2010-2569 as Subrogee for DAVID VANDERLYKE Plaintiff, vs. ROBERT L. CARRASQUILLO,JR and JESSICA LONG, Defendants. AFFIDAVIT IN SUPPORT OF CERTIFICATION OF MOTOR VEHICLE JUDGMENT COMMONWEALTH OF PENNSYLVANIA, SS: COUNTY OF ALLEGHENY, I,GEORGE A.MILLER,ESQUIRE,being duly sworn according to law,depose and state: 1. I am an attorney in good standing, admitted to practice in the courts of this Commonwealth, and am counsel of record for the Plaintiff-judgment creditor, Atlantic States Insurance Company, in the above-captioned matter. 2. I am authorized to make this Affidavit on behalf of the Plaintiff. 3. The address of the Plaintiff is 1195 River Road, Marietta, PA 17547. 4. The last-known address of the Defendants, 113 Courtyard Dr., Carlisle,PA 17013. 5. The judgment reflected at Docket No. 1498 of 2013 of the Court of Common Pleas of Cumberland County,PA is in the amount of$8,569.04,is valid,enforceable and unsatisfied, and is the result of a motor vehicle accident upon which suspension of driver's operating privileges is authorized. v GEORGE A. MILLER, ESQUIRE SWORN TO and subscribed before e this 1/ day of , 2013. cm-44w_ C.9/ )1)12-a-e—k-- otary Public COMMONWEALTH OF PENNSYLVANIA Notarial Seal Laura D.Miller,Notary Public Ross Twp.,Allegheny County My Commission Expires March 28,2016 MEMBER,PENNSYLVANIA ASSOCIATION OF NOTARIES