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HomeMy WebLinkAbout13-4547 20164717 C Y Jer JIH Supreme Court-of-Pennsylvania « ° «rRa Cou of Common` Pleas For Use Onh': r Civi�C ©verr�heet' f C UMBERLAND: '01 F 1 County- Docket No: �+ The information collected on this form is used solely for court administration purposes. 777is form does not supplement or replace the filing and sen -ice ofpleadings or other papers as required by lain or rules of court. Commencement of Action: S M Complaint ❑ Writ of Summons ❑ Petition E ❑ Transfer from Another Jurisdiction ❑ Declaration of Takin C Lead Pitt %m Mutual Automob a Lead Defendant's Name: T Insuratice company ERIC P KELLER I 0 Are money damages requested? ® Yes ❑ No Dollar Amount Requested: ® within arbitration limits N (check one) E3 outside arbitration limits Is this a Class Action Suit? ❑ Yes Q No Is this an MDJ Appeal? ❑ Yes 10 No A Name of Plaintiff /Appellant's Attorney: Michael J. Dougherty,76046 ❑ Check here if you have no attorney (are a Self - Represented [Pro Sel Litigant) Nature of the Case: Place an "X" to the left of the ONE case category that most accurately describes your PRIMARY CASE. If you are making more than one type of claim, check the one that you consider most important. TORT (do not include Mass Tort) CONTRACT (do not include Judgments) CIVIL APPEALS ❑ Intentional ❑ Buyer Protection Administrative Agencies ❑ Malicious Prosecution ❑ Debt Collection: Credit Card ❑ Board of Assessment ❑ Motor Vehicle ❑ Debt Collection: Other ❑ Board of Elections ❑ Nuisance ❑ Dept. of Transportation S ❑ Premises Liability ❑ Statutory Appeal: Other E E3 Product Liability (does not include [3 Employment Dispute Mass tort) Discrimination C ❑ Slander/Libel/Defamation ❑ Employment Dispute: Other ❑ Zoning Board T Other: ❑ Other: O 13 Other: N MASS TORT ❑ Asbestos B ❑ Tobacco REAL PROPERTY MISCELLANEOUS ❑ Toxic Tort - DES ❑ Ejectment ❑ Common Law /Statutory Arbitration ❑ Toxic Tort — Implant ❑ Eminent Domain /Condemnation ❑ Declaratory Judgment ❑ Toxic Waste ❑ Ground Rent ❑ Mandamus ❑ Other: ❑ Landlord/Tenant Dispute ❑ Non - Domestic Relations ❑ Mortgage Foreclosure: Residential Retraining Order ❑ Mortgage Foreclosure: Commercial ❑ Quo Waranto ❑ Partition ❑ Replevin PROFESSIONAL LIABILITY ❑ Quiet Title ❑ Other: ❑ Dental ❑ Other: ❑ Legal ❑ Medical ❑ Other Professional: Updated 1/1/2011. , Fil ED 0 THE FT0THO N0 TAR%`t 20 11 AUG -? N] I I: 10 CUMBERLAND COUNTY PENNSYLVANIA IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION State Farm Mutual Automobile' Insurance Company CrJ � Plaintiff No: vr 1 �- �J7 VS. COMPLAINT IN CIVIL ACTION ERIC P KELLER Defendant FILED ON BEHALF OF Plaintiff COUNSEL OF RECORD OF THIS PARTY: Michael J. Dougherty,76046 WELTMAN, WEINBERG & REIS CO., L.P.A. 325 CHESTNUT STREET SUITE 501 PHILADELPHIA, PA 19106 -2614 215- 599 -1500 FAX:-'215-599-1505 20164717 C Y Jer JIH ow 4+ aa3 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION State Farm Mutual Automobile Insntance Company Plaintiff VS. Civil Action No ERIC P KELLER Defendant COMPLAINT AND NOTICE TO DEFEND You have been sued in court. If you wish to defend against the claims set forth-in.the following pages, you must take action within twenty (20) days after this complaint and notice are served, by entering a written appearance personally or by an attorney and filing in writing with the court your defenses or objections to the claims set forth against you. You are warned that if you fail to do so the case may proceed without you and a judgment may be entered against you by the court without further notice for any money claimed in-the complaint or for any other claim or relief requested by the plaintiff. You may lose money or property or other rights important to you. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. 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. LAWYER REFERRAL SERVICE CUMBERLAND COUNTY BAR ASSOCIATION 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 (717) 249 -3166 WELTMAN, WEINBERG & REIS CO., L.P.A. BY: Benjamin W. Lawrence, Esquire Attorney for Plaintiff(s) Pa. Identification No.209032 325 Chestnut Street, Suite 501 Philadelphia, PA 19106 Phone: 215.599.1500 Fax: 215.599.1505 File #20164717 } STATE FARM MUTUAL AUTOMOBILE } INSURANCE COMPANY } Court of Common Pleas } CUMBERLAND County } } vs. } } ERIC KELLER } NO. CIVIL ACTION — COMPLAINT 1. Plaintiff is a business organization licensed and authorized to conduct business in the State of Illinois with a place of business located at P.O. Box 2371, Bloomingtion, IL 61702. 2. Defendant is an adult individual who at all time pertinent hereto resided at 644 HOLLY PIKE, MT HOLLY SPGS, PA 17065. 3. State Farm issued a policy of motor vehicle insurance whereby State Farm agreed to insure the motor vehicle involved in this incident ( "Insured, Vehicle "), owned by Plaintiff's insured. 4. On or about July 14, 2012 Defendant was the operator of a motor vehicle which vehicle did negligently, recklessly and /or carelessly collide with the Plaintiff Insured's vehicle at or near Hanover and Ridge Streets, Carlisle, Pennsylvania. 5. The negligence and /or carelessness of the Defendant consisted of the following: 1 a. Failing to have his motor vehicle under such control as the situation warranted; b. Operating his motor vehicle in complete disregard of the point and position of Plaintiff's vehicle; c. Failing to keep a proper lookout; d. Traveling too fast for conditions; e. Disregarding traffic control devices; f. Failing to abide by the Rules of the Road and the Motor Vehicle Code of Pennsylvania; g. Being otherwise negligent under the circumstances; and, h. Being negligent as a matter of law as may be relevant through discovery and /or at the time of trial. 6. As a direct and proximate result of Defendant's negligence, the State Farm Insured's vehicle sustained property damage and /or incurred rental charges in the total amount of $13299.76. See attached as Exhibit 1" a copy of the damage documentation which documents Plaintiff further intends to introduce at the arbitration in this matter. 7. Pursuant to the insurance policy issued by State Farm and as a result of the aforesaid payment, State Farm became subrogated to the claim of its Insured against Defendant. WHEREFORE, Plaintiff demands Judgment against Defendant in the amount of $13299.76 plus interest and costs. WELTMAN, WEINBERG & REIS, CO., L.P.A. Benjamin W. a rence, Esquire PA 1. D. # 209 325 Chestnut reet Suite 501 Philadelphia, PA 19106 (215) 599 -1500 WWR #20164717 EXIMIT 1 STATE FARM INSURANCE COMPANIES LIKE A GOOD NEIGHBOR, STATE FARM IS THERE 1 STATE FARM DRIVE CONCORDVILLE, PA 19339 PHONE (800) 839 -8050 -- FAX ALL SUPPLEMENT REQUESTS TO (800) 916 -0342 * ** ESTIMATE * ** 07/20/2012 09:19 AM Owner Owner: AVDO DEDIC Address: 162 N PITT ST City State Zip: CARLISLE, PA 17013 -2330 Home /Day: (717)243 -0524 Control Information Claim # : 38 -1H18 -48201 Loss Date /Time: 07/14/2012 Loss Type: Collision Deductible: $500.00 Ins. Company: State Farm Company Contact: Ray Bond Insured: AVDO DEDIC Home /Day: (717)243 -0524 Claim Rep: Team CR Unit Cl ACC COC Work /Day: (888)713 -4694 Inspection Inspection Date: 07/20/2012 09:13 AM Inspection Type: Field Inspection Location: LEBOS GARAGE AND TOWING Address: 301 N College St City State Zip: Carlisle, PA 17013 Primary Impact: Left Rear Side Secondary Impact: Right Rear Side Driveable: No Received Date /Time: 07/19/2012 04:33 PM Appointment Date /Time: 07/20/2012 12 :57 PM Appraiser License # 131866 Contact: Ray BOND Remarks ESTIMATE PREPARED BY RAY BOND {ELECTRONIC SIGNATURE) SUPPLEMENTAL REQUEST MUST BE FAXED TO 1- 800 -916 -0342 PRIOR TO STARTING THOSE REPAIRS. IF NO FAX CALL 1- 800 - 839 -8050 ANY SUPPLEMENT TO THIS ESTIMATE REQUIRES THE APPROVAL OF A STATE FARM REPRESENTATIVE PRIOR TO THE PERFORMANCE OF THAT REQUEST. RECYCLED PARTS LOCATED @250 AUTO HARRISVILLE,OH 1- 800 - 334 -9811 Note vehicle has hail damage that occured after veh was a non drive at tow facility. Quote # for recycled parts Quote # 1948332 ask for Sarah Vehicle 2010 Nissan Versa 1.8SL 4 DR Hatchback 4cyl Gasoline 1.8 Continuously Variable Tr Lic.Plate: HMK -8643 Lic State: PA Lic Expire: VIN: 3N1BC1CP4AL433763 2010 Nissan Versa 1.8SL 4 DR Hatchback 07/20/2012 10:28 AM Page 1 of 5 • Claim # : 38 -1H18 -48201 07/20/2012 Prod Date: Mileage: 7,632 Veh Insp# Mileage Type: Actual Condition: Code: Z0204B Ext. Refinish: Two -Stage Ext. Color: red Int. Refinish: Two -Stage Options AM /FM CD Player Air Conditioning Alarm System Aluminum /Alloy Wheels Anti -Lock Brakes Automatic Trans Bucket Seats Center Console Cruise Control Dual Airbags Floor Mats Fog Lights Halogen Headlights Head Airbags Intermittent Wipers Keyless Entry System Lighted Entry System MP3 Player Navigation System Overhead Console Power Brakes Power Door Locks Power Mirrors Power Steering Power Windows Rear Spoiler Rear Window Defroster Rear Window Wiper /Washer Satellite Receiver Systm Side Airbags Split Folding Rear Seat Stability Cntrl Suspensn Tachometer Theft Deterrent System Tilt Steering Wheel Tinted Glass Tonneau /Cargo Cover Traction Control System Velour /Cloth Seats XM Satellite Radio Damages Ln# Op GDE Description MFR.Part No. Price An B% HRS R - -- -- - - -- -------------- - - - - -- - - - - - -- - - - - -- -- - - - - -- -- - - - - -- - - -- -- 1 N 6 Front Bumper Cover R ADDITIONAL OPERA 1.0* SM >> Partial R &I 2 RI 41 Headlamp Assy,Hal IT R & I Assembly 0.2 SM 3 PC 907 Wheel,Rear LT RECOND PART 178.25 0.3 SM 4 PC 908 Wheel,Rear RT RECOND PART 178.25 0.3 SM 5 N 970 Susp Align,4 Wheel ADDITIONAL OPERA 75.00* INC* ME 6 RI 430 Frt Vent Gls Assy LT R & I Assembly 0.6 SM 7 BR 165 Panel,Bodyside Ot IT Blend Refinish 1.4 RF MC 13 0.5 Blend 0.6 Two -stage setup 0.3 Two -stage 8 BR 166 Panel,Bodyside Ot RT Blend Refinish 0.7 RF 0.5 Blend 0.2 Two -stage 9 E 821 Module,Airbag Contro 98820EM69A 356.57 0.3 ME 10 E 355 Airbag & Seat Bac LT 87651ZWBOA 1329.00 1.2 SM MC O1 11 E 356 Airbag & Seat Bac RT 87601ZW80A 2246.46 1.1 SM MC O1 12 E 877 Airbag,Roof LT 985PIZWSSA 619.22 4.6 ME MC O1 13 E 878 Airbag,Roof RT 985POZW88A 615.94 1.0 ME MC O1 14 E 1683 Buckle,Frt Seatbe LT 86842EM38B 129.97 INC SM MC O1 15 E 1685 Seatbelt,Front IT 86885EM37B 184.47 INC SM MC O1 16 I 200 Panel,Rocker RT Repair 3.0* SM MC 07 17 L 200 Panel,Rocker RT Refinish 1.4* RF MC 10 1.2 * Surface 2010 Nissan Versa 1.8SL 4 DR Hatchback 07/20/2012 10:28 AM Page 2 of 5 Claim # 38 -1H18 -48201 07/20/2012 0.2 Two -stage >> REFINISH WITHIN PANEL BOUNDARIES 18 E 209 M1dg,Rocker Panel LT 76851EM40A 267.97 0.4 SM 19 L 209 M1dg,Rocker Panel LT Refinish 1.2 RF 1.0 Surface 0.2 Two -stage 20 E 210 M1dg,Rocker Panel RT 76850EM40A 267.97 0.4 SM 21 L 210 M1dg,Rocker Panel RT Refinish 1.2 RF 1.0 Surface 0.2 Two -stage 22 EU 207 Door Assembly,Fro LT RECYCLED PART 490.00* +33.00 3.3 SM 23 L 207 Door Shell,Front LT Refinish 3.7 RF 2.1 Surface 1.0 Edge 0.6 Two -stage 24 I 208 Door Shell,Front RT Repair 1.5* SM 25 L 208 Door Shell,Front RT Refinish 1.9* RF MC 10 1.5 * Surface 0.4 Two -stage >> REFINISH WITHIN PANEL BOUNDARIES 26 RI 231 Pnl,Inner Door Tr LT R & I Assembly INC SM 27 RI 232 Pnl,Inner Door Tr RT R & I Assembly 0.4 SM 28 RI 271 M1dg,Front Door B LT R & I Assembly INC SM 29 RI 272 M1dg,Front Door B RT R & I Assembly 0.3 SM 30 RI 273 Mirror,Outer R/C LT R & I Assembly INC SM 31 RI 274 Mirror,Outer R/C RT R & I Assembly 0.5 SM 32 RI 227 Handle,Front Door LT R & I Assembly INC SM 33 RI 228 Handle,Front Door RT R & I Assembly 0.4 SM 34 RI 1136 Striker,Front Loc LT R & I Assembly 0.1 SM 35 E 651 Airbag Sensor,Sid LT K8830CNO25 248.53 1.4 ME 36 E 652 Airbag Sensor,Sid RT K8830CNO25 248.53 1.4 ME 37 EU 287 Door Assembly,Rea LT RECYCLED PART 430.00* +33.00 2.4 SM 38 L 287 Door Shell,Rear LT Refinish 2.9 RF 1.7 Surface 1.0 Edge 0.2 Two -stage 39 EU 288 Door Assembly,Rea RT RECYCLED PART 430.00* +33.00 2.4 SM 40 L 288 Door Shell,Rear RT Refinish 2.8 RF 1.6 Surface 1.0 Edge 0.2 Two -stage 41 RI 334 M1dg,Rear Door Be LT R & I Assembly INC SM 42 RI 335 M1dg,Rear Door Be RT R & I Assembly INC SM 43 RI 307 Pnl,Inner Door Tr LT R & I Assembly INC SM 44 RI 308 Pnl,Inner Door Tr RT R & I Assembly INC SM 45 RI 305 Handle,RR Door Ou LT R & I Assembly INC SM 46 RI 306 Handle,RR Door Ou RT R & I Assembly INC SM 47 E 883 Headliner,Roof 739BOZWBOA 2533.33 INC SM 48 BR 390 Panel,Quarter RT Blend Refinish 1.0 RF 1.0 Blend INC Two -stage 49 RI 537 Lens & Hsg,Tailla LT R & I Assembly INC SM 50 RI 538 Lens & Hsg,Tailla RT R & I Assembly INC SM 51 N 566 Rear Bumper Cover R& ADDITIONAL OPERA 1.6 SM 52 EU 703 Beam,Rear Axle RECYCLED PART 350.00* +33.00 4.3 ME 52 Items MC Message O1 CALL DEALER FOR EXACT PART # / PRICE 07 STRUCTURAL PART AS IDENTIFIED BY I -CAR 2010 Nissan Versa 1.8SL 4 DR Hatchback 07/20/2012 10:28 AM Page 3 of 5 Claim # : 38 -1H18 -48201 07/20/2012 10 INCLUDES AUDATEX TIME TO CLEAR ENTIRE PANEL 13 INCLUDES 0.6 HOURS FIRST PANEL TWO -STAGE ALLOWANCE Estimate Total & Entries Gross Parts $9,047.96 Other Parts $2,131.50 Paint Materials $473.20 Line Item Markup $561.00 Parts & Material Total $12,213.66 Tax on Parts & Material @ 6.000 $732.82 Labor Rate Replace Hrs Repair Hrs Total Hrs Sheet Metal (SM) $48.00 14.3 7.1 21.4 $1,027.20 Mech /Elec (ME) $48.00 13.0 13.0 $624.00 Frame (FR) $50.00 Refinish (RF) $48.00 18.2 18.2 $873.60 Paint Materials $26.00 Labor Total 52.6 Hours $2,524.80 Tax on Labor @ 6.000% $151.49 Towing $115.00 Gross Total $15,737.77 Less: Deductible $500.00 - Net Total $15,237.77 Alternate Parts Y/02/02/00/00/00 CUM 02/02/00/00/00 Zip Code: 17070 HARRISBURG Audatex Estimating 6.0.726 ES 07/20/2012 10:28 AM REL 6.0.726 DT 07/01/2012 DB 07/15/2012 Copyright (C) 2011 Audatex North America, Inc. 3.1 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. Op Codes * = User - Entered Value E = NEW PART NG = Replace NAGS EC = ** NON -OEM PART ET = Partial Replace Labo EP = ** NON -OEM PART EU = RECYCLED PART TE = Partial Replace Pric PM = REMAN /REBUILT PART UM = REMAN /REBUILT PART L = Refinish PC = RECOND PART UC = RECOND PART TT = Two -Tone SB = Sublet Repair N = ADDITIONAL OPERATION BR = Blend Refinish I = Repair IT = Partial Repair CG = Chipguard RI = R & I Assembly P = Check RP = RP- RELATED PRIOR 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. Copyright (C) 2011 Audatex North America, Inc. 2010 Nissan Versa 1.8SL 4 DR Hatchback 07/20/2012 10:28 AM Page 4 of 5 Claim ## : 38 -1H18 -48201 07/20/2012 Estimate Summary Page Gross Total $15,737.77 Less: Deductible $500.00 - Net Total .$15,237.77 Audatex Estimating 6.0.726 ES 07/20/2012 10:28 AM REL 6.0.726 DT 07/01/2012 DB 07/15/2012 Copyright (C) 2011 Audatex North America, Inc. SM -SHEET METAL ME- MECH /ELEC FR -FRAME RE- REFINISH SY- SYSTEM THIS IS AN ESTIMATE. REPAIR FACILITIES MUST INSPECT THE VEHICLE TO DETERMINE IF ANY REPAIRS NOT LISTED ARE REQUIRED, AND TO CONTACT STATE FARM BEFORE MAKING SUCH REPAIRS. REPAIRER ALSO IS RESPONSIBLE FOR CONDUCTING ANY NECESSARY INSPECTION AND SAFETY CHECKS PRIOR TO AND AFTER COMPLETING REPAIRS. IF THIS APPRAISAL HAS BEEN PREPARED BASED ON THE USE OF AFTERMARKET CRASH PARTS, AND IF THE USE OF ANY AFTERMARKET CRASH PART VOIDS THE EXISTING WARRANTY ON THE PART BEING REPLACED OR ANY OTHER PART, THE AFTERMARKET CRASH PART SHALL HAVE A WARRANTY EQUAL TO OR BETTER THAN THE REMAINDER OF THE EXISTING WARRANTY, 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. ANY PERSON WHO KNOWINGLY AND WITH INTENT TO INJURE OR DEFRAUD ANY INSURER FILES AN APPLICATION OR CLAIM CONTAINING ANY FALSE, INCOMPLETE OR MISLEADING INFORMATION SHALL, UPON CONVICTION, BE SUBJECT TO IMPRISONMENT FOR UP TO. SEVEN YEARS AND PAYMENT OF A FINE OF UP TO $15,000. YOU ARE UNDER NO REQUIREMENT TO USE ANY SPECIFIC REPAIR FACILITY TO PERFORM REPAIRS TO YOUR VEHICLE. COSTS ABOVE THE APPRAISED AMOUNT MAY BE THE RESPONSIBILITY OF THE VEHICLE OWNER. INFORMATION REGARDING REPAIR FACILITIES WHICH WILL BE ABLE TO REPAIR THE VEHICLE FOR THE APPRAISED AMOUNT IS AVAILABLE FROM YOUR CLAIM HANDLER OR ONLINE AT WWW.STATEFARM.COM THIS APPRAISAL INCLUDES ONLY THOSE INCIDENTAL CHARGES, KNOWN AND AGREED UPON BY THE APPRAISER AT THE TIME OF APPRAISAL, INCLUDING TOWING, PROTECTIVE CARE, CUSTODY STORAGE, DEPRECIATION, BATTERY AND TIRE REPLACEMENT. ANY TOWING, STORAGE, OR OTHER INCIDENTAL CHARGES KNOWN BUT NOT LISTED ON THE ESTIMATE ARE FORWARDED TO THE CLAIM HANDLER FOR DISPOSITION. FAILING TO PRESENT THIS ESTIMATE TO THE REPAIRING FACILITY BEFORE A REPAIR MAY RESULT IN ADDITIONAL EXPENSE TO YOU. COPY OF THE FORM(S) WAS SENT /GIVEN TO THE CONSUMER ON 2010 Nissan Versa 1.8SL 4 DR Hatchback 07/20/2012 10:28 AM Page 5 of 5 QUALITY REPLACEMENT PARTS REPORT Vehicle 2010 Nissan Versa 1.8SL 4 DR Hatchback 4cyl Gasoline 1.8 Continuously Variable Tr Options AM /FM CD Player Air Conditioning Alarm System Aluminum /Alloy Wheels Anti -Lock Brakes Automatic Trans Bucket Seats Center Console Cruise Control Dual Airbags Floor Mats Fog Lights Halogen Headlights Head Airbags Intermittent Wipers Keyless Entry System Lighted Entry System MP3 Player Navigation System Overhead Console Power Brakes Power Door Locks Power Mirrors Power Steering Power Windows Rear Spoiler Rear Window Defroster Rear Window Wiper /Washer Satellite Receiver Systm Side Airbags Split Folding Rear Seat Stability Cntrl Suspensn Tachometer Theft Deterrent System Tilt Steering Wheel Tinted Glass Tonneau /Cargo Cover Traction Control System Velour /Cloth Seats XM Satellite Radio Ln# Part Description Supplier Part Number Sub OEM Part Supp C S code - -- -------------- - - - - -- -------------- - - - - -- -------------- - - - - -- - - -- - - 3 Wheel,Rear LT 62508 D0300EN11B > 1 R 3 62508XXSI D0300EN11B 3 R 3 ALY6250SU20 D0300EN11B 2 R 3 ALY62508U20 D0300EN11B 4 R 3 4 Wheel,Rear RT 62508 D0300EN11B > 1 R 3 62508XXSI D0300EN11B 3 R 3 ALY6250SU20 D0300EN11B 2 R 3 ALY6250BU20 D0300EN11B 4 R 3 > = ESTIMATE TOTAL IS BASED ON PRICE QUOTED BY THIS SUPPLIER Key to Classification / Source Codes CLS = Classification Code C - CAPA CERTIFIED PART QUOTED BY LISTED SUPPLIER M - REMANUFACTURED / REBUILT PART R - RECONDITIONED PART S - OEM SURPLUS PART SRC = Source Code 1 - NON ORIGINAL EQUIPMENT MANUFACTURER PART 3 - ORIGINAL EQUIPMENT MANUFACTURER (OEM) PART Detailed Distributor List 1 PXN3588 WHEELS TO WORLD RCND (800)334 -9433 680 AMERICANA DR #57 ANNAPOLIS, MD 21403 2 PXN5025 KEYSTONE AUTO RCND (800)524 -4349 275 CROSS FARM LANE (717)843 -8927 YORK, PA 17406 3 PXN6196 WHEEL COLLISION RCND (800)292 -7467 7286 PENN DRIVE (610)837 -8792 BATH, PA 18014 4 PXN6349 TRANSWHEEL RCND (800)892 -3733 10417 FERGUSSON LANE #2000 (301)223 -4855 07/20/2012 10:28 AM Page 1 of 2 2010 Nissan Versa 1.8SL 4 DR Hatchback WILLIAMSPORT, MD 21795 Audatex Estimating 6.0.726 ES 07/20/2012 10:28 AM REL 6.0.726 DT 07/01/2012 DB 07/15/2012 Zip Code: 17070 Search Area: HARRISBURG Copyright (C) 2011 Audatex North America, Inc. 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. Copyright (C) 2011 Audatex North America, Inc. Audatex Estimating is a trademark of Audatex North America, Inc. 07/20/2012 10:28 AM Page 2 of 2 VINSOURCE ANALYSIS (continued) 2010 NISSAN VERSA 1.8SL 4D VIN: 3N1BC1CP4AL433763 Decodes as: 2010 Nissan Versa 1.8SL 4D Hatchback Accuracy: Decodes Correctly History: No activity was reported REPORTED PHONE NUMBER ANALYSIS 2010 NISSAN VERSA 1.8SL 4D HATCHBACK No Vehicles Advertised at (717) 243 -0524 N.A_D.A. VALUE ** 2010 NISSAN VERSA 1.8SL 4D HATCHBACK * *N.A.D.A. Vehicle Description: 2010 NISSAN Versa -4 Cyl. Hatchback 5D SL N.A.D.A. values are as of July, 2012 from the Eastern Edition. ---- - - - - -- - Base Value----- - - - - -- $14,075 ----------- Mechanical----- - - - - -- Engine: $0 Transmission: $0 ----------- Equipment------ - - - - -- Aluminum /Alloy Wheels Included Cruise Control: Included Navigation System 500 Power Door Locks: Included Power Windows: Included - - - - - -- Equipment Subtotal- - - - - -- $500 - - - - - -- Mileage: 7,632 Mi-- - - - - -- $1,650 -------- - - - - -- -------------- Adjusted Total $16,225 These current N.A.D.A. values are furnished under license from NADASC. All values Copyright (C) NADASC 2012. The values in the N.A.D.A. guide assume a vehicle in clean condition. Appropriate deductions should be made to put a vehicle in salable condition. SPECIAL NOTE ON OLDER VEHICLES: N.A.D.A.'s editors believe that most optional equipment has little or no value on older vehicles. This is especially true of options that cost relatively little to begin with and which deteriorate with age or use. LOSS VEHICLE VALUATION 2010 NISSAN VERSA 1.8SL 4D HATCHBACK The Autosource database contains inspected dealer inventories, dealer advertisements, phone verified vehicles, and private party advertisements from thousands of sources including automotive publications, newspapers and Web sites. Autosource uses vehicles comparable in year, make and model within the specified market area, expanding as necessary, to determine the loss vehicle's local market value. This valuation includes a representative sample of the vehicles used to calculate the typical starting price. 07/20/12 07:42 AUTOSOURCE VALUATION Page 3 Via: Direct AS Request: 31194457 Version: 1 LOSS VEHICLE VALUATION (continued) 2010 NISSAN VERSA 1.8SL 4D The market search originated from Zip Code 170132330, as determined by the vehicle owners principally garaged area. Autosource located 53, 2010 Nissan Versa vehicles which were used to determine the typical vehicle price. Adjustments have been made to the comparable vehicles for value differences in vehicle description as indicated in the "Veh Ad.j" field. The sum of the 53 comparable vehicles is $709,104 for an average price of $13,379. The asking or actual sale price is displayed for each vehicle. If a vehicle has been sold, the sold price is displayed with an (S) indicator. The selling price may be substantially less than the asking price. In the case of this 2010 Nissan Versa, the difference between the asking price and selling price is generally 60. This selling price adjustment has been applied to the typical price. Additional adjustments have been made to the typical vehicle price taking into consideration the loss vehicle's mileage, equipment and condition. All adjustments are vehicle specific and reflect driving habits and condition for the vehicle's market. A mileage adjustment of 5.50 cents per mile has been applied. Taking into consideration the vehicle specifics, the fair market value is 515,396. VEHICLE VALUATION DETAIL 2010 NISSAN VERSA 1.8SL 4D HATCHBACK Typical Vehicle Loss Vehicle Adjustment ---------------- - - - - -- -------------- - - - - -- ---- - - - - -- City/State:Carlisle, PA Carlisle, PA Price:$12,577 $12,577 ---- Description ----- Year:2010 2010 Make:Nissan Nissan Model:Versa Versa Edition:1.8SL 1.8SL Door:4D 4D Body:Hatchback Hatchback Drive:2WD 2WD Engine:4 Cylinder 1.8 Engine 4 Cylinder 1.8 Engine 0 Transmission:Continuously Variable Continuously Variable 0 Color:Not Applicable Red Odometer:33,633 Mi(Typical) 7,632 Mi(Actual) 1,430 ----- Equipment - - - - -- Convenience Options:Air Conditioning Air Conditioning Tilt Steering Wheel Tilt Steering Wheel Cruise Control Cruise Control Floor Mats Floor Mats Rear Window Defroster Rear Window Defroster Other Optional:Tinted Glass Tinted Glass 07/20/12 07:42 AUTOSOURCE VALUATION Page 4 Via: Direct AS Request: 31194457 Version: 1 VEHICLE VALUATION DETAIL (continued) 2010 NISSAN VERSA 1.8SL 4D Typical Vehicle Loss Vehicle Adjustment ---------------- - - - - -- -------------- - - - - -- ---- - - - - -- Anti -Lock Brakes Anti -Lock Brakes Center Console Center Console Fog Lights Fog Lights Rear Spoiler Rear Spoiler Head Airbags Head Airbags Halogen Headlights Halogen Headlights Intermittent Wipers Intermittent Wipers Keyless Entry System Keyless Entry System Lighted Entry System Lighted Entry System Navigation System 0 Traction Control System Traction Control Tachometer Tachometer Overhead Console Overhead Console Stability Cntrl Stability Cntrl Side Airbags Side Airbags Rear Window Rear Window Dual Airbags Dual Airbags Tonneau /Cargo Cover Tonneau /Cargo Cover Power Accessories:Power Steering Power Steering Power Door Locks Power Door Locks Power Brakes Power Brakes Power Windows Power Windows Power Mirrors Power Mirrors Radio /Phone /Alarm:Alarm System Alarm System MP3 Player MP3 Player Theft Deterrent System Theft Deterrent Satellite Receiver Satellite Receiver XM Satellite Radio 0 AM /FM CD Player AM /FM CD Player Seat Options:Bucket Seats Bucket Seats Velour /Cloth Seats Velour /Cloth Seats Split Folding Rear Seat Split Folding Rear Wheel Options:Aluminum /Alloy Wheels Aluminum /Alloy Wheels Packages: Aluminum Kick Plate 70 Navigation & Audio 330 Autosource Value Before Condition Adjustments: 14,407 ------ Interior ------ Seats:Good Good Carpets:Good Good Int Trim:Good Good Glass:Good Good Headliner:Good Good ------ Exterior ------ Body:Good Good Paint:Good Good Ext Trim:Good Good ----- Mechanical - - - -- 07/20/12 07:42 AUTOSOURCE VALUATION Page 5 Via: Direct AS Request: 31194457 Version: 1 VEHICLE VALUATION DETAIL (continued) 2010 NISSAN VERSA 1.8SL 4D Typical Vehicle Loss Vehicle Adjustment ---------------- - - - - -- -------------- - - - - -- ---- - - - - -- Engine:Well Maintained Well Maintained Transmission:Well Maintained Well Maintained ------- Tires-- - - - - -- Front Tires:Good New 40 Rear Tires:Good New 40 Total Condition Adjustments: 80 Prior Damage: 0 Condition Adjustment: 80 Net Condition Adjustment: 80 Total Condition Adjusted Market Value: $14,487 VALUATION NOTES 2010 NISSAN VERSA 1.8SL 4D HATCHBACK • Adjustments of Special Note - A mileage adjustment of 5.50 cents per mile /kilometer has been applied. This adjustment is based on the vehicle year, vehicle category and market area. Mileage adjustments are capped at 40a of the vehicle's starting value. - No special adjustments were made for this vehicle. • Information provided by State Farm Insurance - Loss vehicle description was provided by State Farm Insurance - All values are in U.S. dollars. • Autosource Valuation Process - Over 3,800,000 vehicles are entered weekly into the database used for researching this value. This database includes dealer inspected, dealer inventory, dealer advertised, phone verified and advertised private party vehicles. - The originating search area for this valuation was Carlisle, Pennsylvania. • Other Adjustments or Comments - Note vehicle has hail damage from a storm that came through area after vehicle was a non -drive T/L at tow facility. 07/20/12 07:42 AUTOSOURCE VALUATION Page 6 Via: Direct AS Request: 31194457 Version: 1 VALUATION NOTES (continued) 2010 NISSAN VERSA 1.8SL 4D - The tax was calculated based on a date of loss of 07/14/2012 using zip 17013, in CARLISLE, Cumberland County, Pennsylvania. The city may vary from search area to reflect correct tax location. o Conditioning Notes TIRES * FRONT TIRES: RF 9/32, LF 9/32 * REAR TIRES: LR 9/32,RR 9/32 ORIGINAL EQUIPMENT GUIDE 2010 NISSAN VERSA 1.8SL 4D HATCHBACK ---- - - - - -- Engine Options----- - - - - -- - - - - - -- Transmission Options-------- * 4 Cylinder 1.8 Engine STD * Continuously Variable Tr STD - - -- -Other Optional Equipment - - - - -- -- - - - - -- Convenience Options-------- * Anti -Lock Brakes STD * Air Conditioning STD • Center Console STD Automatic Dimming Mirror $125 • Dual Airbags STD Cargo /Trunk Mat • Fog Lights STD * Cruise Control STD • Head Airbags STD * Rear Window Defroster STD • Halogen Headlights STD * Floor Mats TYP • Intermittent Wipers STD Strg Wheel Radio Control • Keyless Entry System STD Trunk /Cargo Organizer $160 • Lighted Entry System STD * Tilt Steering Wheel STD Leather Steering Wheel - - - -- Radio /Phone /Alarm Options - - - -- * Navigation System * Alarm System STD • Overhead Console STD * AM /FM CD Player STD • Rear Window Wiper /Washer STD * MP3 Player STD • Side Airbags STD * Satellite Receiver Systm STD • Stability Cntrl Suspensn STD * Theft Deterrent System STD • Rear Spoiler STD * XM Satellite Radio • Tachometer STD -- - - - - -- - Power Accessories---- - - - -- * Traction Control System STD * Power Brakes STD • Tonneau /Cargo Cover STD * Power Door Locks STD • Tinted Glass STD * Power Mirrors STD ---- - - - - -- -Seat Options------ - - - - -- * Power Steering STD • Bucket Seats STD * Power Windows STD • Split Folding Rear Seat STD ---- - - - - -- - Wheel Options-------- - -- * Velour /Cloth Seats STD 16 Inch Alloy Wheels - -- -Roof Options - - - -- * Aluminum /Alloy Wheels STD Power Moonroof $600 ------------------------ - - - - -- Option Packages------------------------------- Accent Package $240 Includes Interior Accent Lighting * Aluminum Kick Plate $130 Cargo Mat Set $155 Includes Cargo /Trunk Mat, Floor Mats 07/20/12 07:42 AUTOSOURCE VALUATION Page 7 Via: Direct AS Request: 31194457 Version: 1 ORIGINAL EQUIPMENT GUIDE (continued) 2010 NISSAN VERSA 1.8SL 4D * Navigation & Audio Pkg. $610 Includes Navigation System, XM Satellite Radio, Touch Screen Display Monitor Premium Package $980 Includes 16 Inch Alloy Wheels, Leather Steering Wheel, Strg Wheel Radio Control, Intelligent Key, Bluetooth Hands -Free System Base retail price: $17,250 Loss Vehicle manufacturer's suggested retail price as reported: $17,990 Editions available for the same body style (in order of original cost, increasing): 1.8S, *1.8SL * Indicates loss vehicle equipment. VEHICLE LOCATOR SERVICE 2010 NISSAN VERSA 1.8SL 41) HATCHBACK After your claim is settled, Autosou rce provides free assistance in locating your next vehicle. Your request can be submitted online 24hrs. per day at http: / /www_support.audatex.us. Under Additional Services click the Autosource Vehicle Locator Service Form link to complete the VLS form. Or you can call us Monday through Friday, between 8:00 AM and 5:00 PM, Pacific time at (800)351 -3133, ext 7428. Our specialists will work with you to find a new or used vehicle in your area. PENNSYLVANIA REGULATORY STATEMENT 2010 NISSAN VERSA 1.8SL 4D HATCHBACK 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. Any person who knowingly and with intent to injure or defraud any insurer files an application or claim containing any false, incomplete or misleading information shall, upon conviction, be subject to imprisonment for up to seven years and the payment of a fine of up to $15,000. ABOUT YOUR VALUATION 2010 NISSAN VERSA 1.8SL 4D HATCHBACK This report contains proprietary information of Audatex and shall not be disclosed to any third party (other than the insured or claimant) without Audatex's prior written consent. If you are the insured or claimant and have questions regarding the description of your vehicle, please contact the insurance company that is handling your claim. Information within VINsource /NICB is provided solely to identify potential duplicative claims activity. User agrees to use such information solely for lawful purposes. 07/20/12 07:42 AUTOSOURCE VALUATION Page 8 Via: Direct AS Request: 31194457 Version: 1 ABOUT YOUR VALUATION (continued) 2010 NISSAN VERSA 1.8SL 4D Tax rates contained herein are based on general sales tax data provided by Vertex Inc. Excise, use, registration, licensing and other taxes and fees that may be applicable are not included. Audatex makes no representations or warranties concerning the applicability or accuracy of such tax data. Report Generated by Audatex, a Solera Company US Pat. No 7912740B2 (C) 2012 Audatex North America, Inc. All Rights Reserved. VERIFICATION I, Benjamin W. Lawrence, Esquire, attorney for the Plaintiff(s) do hereby swear and affirm that the averments in the attached Complaint are true and correct to the best of my knowledge, information and /or belief. These averments are made subject to the penalties of 18 Pa.C.S.A. §4904 relating to unsworn falsification to authorities. Benja in .Lawrence Date `1 �-c. \� SHERIFF'S OFFICE OF CUMBERLAND COUNTY Ronny R Anderson = C� Sheriff t ",- Jody S Smith lull = Chief Deputy ,' co Richard W Stewart "+' '"` Solicitor s= OF Tai:: y, ^ C-) i C0 State Farm Mutual Automobile Ins. Co. Case Number vs. Eric P Keller 2013-4547 SHERIFF'S RETURN OF SERVICE 08/05/2013 08:51 PM - Deputy Jamie DiMartle, being duly sworn according to law, served the requested Complaint& Notice by"personally" handing a true copy to a person representing themselves to be the Defendant, to wit: Eric P Keller at 644 Holly Pike, South Middleon, Mt. Holly Spring, PA 17065. JA IE DIMA , DEPUTY SHERIFF COST: $35.91 SO ANSWERS, 6Z August 06, 2013 RONNY R ANDERSON, SHERIFF cj CountySuite Sheriff,Tole osoft,Gic,