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HomeMy WebLinkAbout13-6569 v V �t Supreme Co ennsylvania C011 . b&C In O leas For Prothonotary Use Only. T C' ti. �► Docket No: ,k CU RLIfiNb County The information collected on this form is used solely for court administration purposes. This form does not supplement or replace the f ling and service of pleadings or other papers as required by law or rules of court. (' Commencement of Action: S I@ Complaint O Writ of Summons 13 Petition E [3 Transfer from Another Jurisdiction ® Declaration of Taking C Lead Plaintiff's Name: Lead Defendant's Name: T ATLANTIC STATES INSURANCE DANIEL SOBOTA Dollar Amount Requested: Elwithin arbitration limits Are money damages requested? Q Yes Q No (check one) 13outside arbitration limits 0 N Is this a Class Action Suit? ® Yes 0 No Is this an MDJAppeal? 13 Yes IM No A Name of Plaintiff /Appellant's Attorney: GEORGE A. MILLER, ESQ. ® Check here if you have no attorney (are a Self- Represented [Pro Sep 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 Plaintiff Administrative Agencies 13 Malicious Prosecution © Debt Collection: Credit Card © Board of Assessment ®x Motor Vehicle ® Debt Collection: Other 0 Board of Elections Nuisance ® Dept. of Transportation Premises Liability ® Statutory Appeal: Other S [3 Product Liability (does not include E mass tort) ®Employment Dispute: Slander/Libel/ Defamation Discrimination ® C ® Other: [3 Employment Dispute: Other [3 Zoning Board T © Other: I ® Other: O _ MASS TORT ® Asbestos N ® Tobacco ® Toxic Tort - DES ® Toxic Tort - Implant REA PROPERTY MISCELLANEOUS ® Toxic Waste ® Other: 0 Ejectment � Common Law /Statutory Arbitration B ® Eminent Domain /Condemnation ❑ Declaratory Judgment O Ground Rent Mandamus 13 Landlord/Tenant Dispute Non - Domestic Relations ® Mortgage Foreclosure: Residential Restraining Order PROFESSIONAL LIABLITY ® Mortgage Foreclosure: Commercial Q Quo Warranto ® Dental ® Partition O Replevin ® Legal ® Quiet Title 0 Other: Q Medical ® Other: 0 Other Professional: Updated 111/2011 Tt-L r [ 11€' f � r 4J1i3 r�^. 1�a. - 7 AN I I 1 5 CLIMI ERLANO COUNTY PEN't'SYI.,VA141A IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION ATLANTIC STATES INSURANCE CASE NO. COMPANY, as Subrogee for DAVID and ELIZABETH WAGNER, CODE NO. Plaintiff, TYPE OF PLEADING: VS. COMPLAINT IN CIVIL ACTION DANIEL SOBOTA, FILED ON BEHALF OF: Defendant. ATLANTIC STATES INSURANCE COMPANY, as Subrogee for DAVID and ELIZABETH WAGNER, Plaintiff COUNSEL OF RECORD FOR THIS PARTY: GEORGE A. MILLER, ESQUIRE Pa. I.D. No. 22525 BROMBERG & MILLER FIRM I.D. No. 937 1030 Fifth Avenue, Suite 102 PITTSBURGH, PA 15219 File 58522 (412) 232 -0440 . o�q�9 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION ATLANTIC STATES INSURANCE COMPANY, Case No. as Subrogee for DAVID and ELIZABETH WAGNER, Plaintiff, VS. DANIEL SOBOTA, Defendant. NOTICE TO DEFEND You have been sued in court. If you wish to defend against the claims set forth in the following pages, you must take action within twenty (20) days after this complaint and notice are served, by entering a written appearance personally or by attorney and filing in writing with the court your defense or objections to the claims set forth against you. You are warned that if you fail to do so the case may proceed without you and a judgment may be entered against you by the court without further notice for any money claimed in the Complaint or for any other claim or relief requested by the Plaintiff. You may lose money or property or other rights important to you. YOU SHOULD BRING THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. Lawyer Referral Service Cumberland County Bar Association 32 S. Bedford St. Carlisle, PA 17013 (717) 249 -3166 (800) 990 -9108 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ATLANTIC STATES INSURANCE COMPANY, CIVIL DIVISION as Subrogee for DAVID and ELIZABETH WAGNER Case No. Plaintiff, VS. DANIEL SOBOTA, Defendants. COMPLAINT IN CIVIL ACTION AND NOW come(s) ATLANTIC STATES INSURANCE COMPANY, as subrogee for DAVID and ELIZABETH WAGNER, 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: 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 Daniel Sobota, is an adult individual whose current address is 3120 Old Allegan Road, Fennville, MI 49408. 3. On or about August 14, 2012, Defendant was traveling Southbound on S. Hanover Street, Carlisle, Cumberland County, when he negligently ran a red light, striking the vehicle of Plaintiff's subrogees, being then and there operated by Orville C. Hardy, III, who had a green light and proceeded through intersection lawfully. 4. The negligence of Defendant Daniel Sobota consisted, inter alia, of the following: failure to have his vehicle under control; failure to maintain a proper lookout; failure to adhere to traffic signals; failure to prevent car from collision; and failure to have insurance. 5. As a direct and proximate result of the negligence of Defendant Daniel Sobota, Plaintiff's subrogors' motor vehicle sustained damages totaling Five Thousand Eighty -Seven Dollars and Thirty -Eight Cents ($5087.38). 6. Plaintiff expended such sum, less its insured's deductible, pursuant to a contract of insurance with its subrogors, and now seeks to recoup such expense, including said deductible, from the Defendants by means of its right of subrogation. 7. A copy of the Police Accident Report is attached hereto and marked as Plaintiff's Exhibit "A." 8. A copy of the Repair Estimate is attached hereto and marked as Plaintiff's Exhibit `B." 9. Plaintiff intends to offer the attached Exhibits into evidence pursuant to Pennsylvania Rules of Civil Procedure, Rule 1305. The vehicle was a total loss. 10. Plaintiff has demanded payment of its damages from both Defendants, which demand has been refused. WHEREFORE, the Plaintiff demands judgment against the Defendant, in the sum of $5,087.38, together with costs of suit. -2- Respectfully submitted, BROMBERG & MILLER BY: GEORGE A. MILLER, Esquire Atlantic States Insurance Company, as Subrogee for David & Elizabeth Wagner, Plaintiff -3- J VERIFICATION The undersigned, p f� • L does hereby v th at � y � at he/ she is the l of C /zA(L - Plaintiff herein, that he /she is authorized to make this verification on behalf of e Plaintiff, and that the factscontained 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 By: Title #.58522 INSURANCE AUTO AUCTIONS No. 80 4620905 To: Donegal Mutual Insurance Company Dale: 09!21/2012 Invoice No. Date Description Amount Discount Paid Amount 804620905 09/21/2012 CLM #PAG- PA -01- 12- 0284469/STK #10 $290,00 S290.00 - 7l TOTALS: $290.00 5290.00 INSURANCE AUfO 1fCTIONS f a, 'Bank otrAr rica, tJ4A._ r ?•, ' , j . No 646209054- Two Weslbrooft C pbratep g i teT Uite.N500 j •,: tle7 t otirgia; • Dal 9Ot R :AFTER d6bAYS ® Westche4�er. IC 80154 € '9d/ f, i08 492 -7000 ell :? iivt #AAC�PA of -1z 02l!4469 /STKfl o. , Ak=NT 5290.00 PAY Two Hundred Ninety Dollars. and 00 Cents TO THE :QRDER�' * po '6al Mutual lnsuranei Company bF .' x' : 1195 River Rd �s" r• Box 302 Marietta PA 75470302 tt'13 046 2090 Stt' 1:06 i 112 7$81: 3 299 12 r. S4 2tt' 0912412012 11:53 AM A7D79 2019 EXHIBIT "Ell Ij l a 9 FIEMITTANCE: 9867597 DATE: 09/21/2012 • : INSURAN.ClZ AMAtxrttONS Remittance Payable To: Insurance Auto Auctions, Inc. Donegal Mutual Insurance Company Attn: Settlement Group 1195 River Rd 5515 Susquehanna Trait Box 302 Manchester, PA 17345 Marietta, PA 17547 -0302 Phone (7171266 -8701 Attn: Salvage Dept . Fax: (7171266 -8705 E -mail IAA ASAP_ Harrisburg@iaai.com Tofai Salvage Information- Account of Sale Act vity % ACV IAA Stock #; 000-10103524 Sales $600.00 11.83 IAA Charges IAA Branch: Harrisburg Fed. Tax I.D. 954455113 Consignment Flat Fee $115.00 2.27 Adjuster: - Benjamin Smith Fuel Surcharge $0.00 0.00 Insured: David & Elizabeth Wagner Tow $0.00 0.00 Owner: David & Elizabeth Wagner Advance Chg Service Fee $0.00 0.00 Claim #: PAG- PA -01 -12 -0284469 Re-Run Fee $0.00 0.00 Policy #: Storage Fee $0.00 0.00 Vehicle: 1997 JEEP WRANGLER/f•J IAA - Title Processing Fee $5.00 0.10 ' Damage: Left Front/Mechanical Bundled Enhancement Fee $0.00 0.00 VIN: 1J4FY19S5VP494989 Car Start $0.00 0.00 ACV: $5,073.00 NICB Date: 9/21/2012 Less IAA Charges ($120.00) (2.37) Net IAA Return $490.00 9.46 Outside Charges Advanced by IAA Labor $15.00 0.30 Storage $80.00 1.58 Advance Tow $85.00 1.68 Clean Up $10.00 0.20 Buyer Information Less Outside Charges ($190.00) (3.75) CHATS USED AUTO PARTS & TOWING 6035 A Tanevtown Pike Payment Amount $290.00 5.72% Tanevtown. MD 21787 Resale Certificate #: x800008085900 (PA) Elapsed Dais Analysis Date of Event: Date Dave Loss . 8/14/2012 Assigned 8/15/2012 2 Released 8/1712012 3 Pickup 8/17/2012 1 Title Recd 813012012 14 Sale Doc. Recd • 9/5/2012 7 Auction Date 9/19/2012 15 Buyer Payment 9/20/2012 2 Remittance 9/21/2012 2 Elapsed Total Days: 39 IAA Da. RPWZro 09/241201211:53 AM A7D79 2019 .ASS OUJTE T01 LEBO'S GARAGE & TOWING; LLC Garage 301 lC. CbL1E6E S1pEE7 'barges Expense IAA CARUSIE, PA 17013 ' ("I) 249j2VI FAVO.17) 2 4 . cm wTE rw a vo,RO: BT! TP tocA TPMOF I o. IE CiTINE EkIftOERe0N P*.", r •1010352.4• FINISH FINISH VMS" ABS(SLUxE •Tov • START - !TART srART — a�• ''•r. • Garage . 1 T DrAL TbTAL hwrgesExpenSe.lAA - R roRi ersCULEDD�wurr 0 ABANDONED OMTTIRE OS NOIfINEWNCIUNO OMREST Ovwi# OOUTOFOAS OOWILIEWNCNIND O UNREGISTERED O BREAKDOTM OIMFwmo OsrATOHOtoOIs • OTOW IONS 4LogK OUT O oscopitLms O SNOW ROAMAt OBrAm i) OCOUr rrv6 oFTow TDNBDT+FAOROERoF "HICUTOM TOW O T v , , OtAi+E'E�isr' 0QWi49i• EEODNOTOw - O y •. ' ro n DArB�f • TOWNUCTTARUE I V wnEA►ECRNloE 1 O'CASN 00". ORNMLV.,NO: om'ARISCH s x1c1AA 10103524. 0CA96f7CARb QMC •OMA O"FX CO.gA LAWp An ,. CUSSIC BLUE • TO REONOEA: 146U $TORAOE rr y 0,1 ATURE ! twTOTAL Mfg TAX TOTAL Q Thank You • g191aV�IIIGgI�IGIVIIIqI11pIIIBqIIqq11Vq11911qIUI�G�ll�liql�ep ' 41AAI TOW 10412036#2616292.5 TOWOOCR> 5leOtil�46tf35244Heb MNiol I , 091241201211:53 AM A7D79 2019 ' Claim: PAG- PA- 01 -12- Autosource Valuation 1997 Jeep Wrangler Sport 4WD Utility AS Request: 31350400 0284469 "'Audatex Autosource Valuation Yvonne Davis :claimant; Donegal Insurance Group itlgllr$d Wagner, David & Elizabeth Marietta Branch i, C,lajm'PAG- PA -01 -12 -0284469 1195 River Road tAS3 /14/2012 Marietta PA 17547 Loss Type` Collision paticy' PAG - 3115389 t3[het y :o es r V1T3iJ4FY19S5VP494989 Decodes as1997 Jeep Wrangler Sport 4WD Utility AcM racy Decodes Correctly .Fllgpt3ty No activity was reported •s No Vehicles Advertised at (717) 776 -1096 s No Branded title history found for this VIN. Processed on 08/21/12 11:53 AM. Title History is powered by Experian AutoChedt. The Experian data contained in this report involves the conveyance of information provided to Experian byj )gtkx other sources. Accordingly, neither Experian nor Audatex can, or will, be an insurer or guarantor .., ;:, c:;cs.e•,. of the accuracy or reliability of the Experian data. IMEMENESENNEMMM .: a 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, imake 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. The market search originated from Zip Code 17241, as determined by the vehicle owner's principally garaged area. Autosource located 51, 1997 Jeep Wrangler 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]" field. The sum of the 51 comparable vehicles is $359,700 for an average price of $7,053. The asking or actual safe 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 1997 Jeep Wrangler, the difference between the asking price and selling price Is generally 6%. 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 0.75 cents per mile has been applied. Taking Into consideration the vehicle specifics, the fair market value is.$4,990. version: I Page: 1 08!21/1211:53 Claim: PACs -PA- 0112- Autosource Valuation 1997 Jeep Wrangler Sport 4WD Utility AS Request: 31350400 02$4469 See N.A.D.A See Valuation Autosource/ Value Section Detail Section N.A.D.A. N.A.O.A. Retail Autosource Average' 74 0 850 6630 6 BaBe i�TCe? 6 $ ?�fl n e. 9 :.::,•.:, .. Ys,�tn a5i0rtf -4 -44 7 0 -50 0 �0 0 tOdCt�et t. 5 3 eft1 Ad't1 ema e.. 350 6185 6 268 $6, 5 $ '#3Afae� 'dti9WoA t 268 A. C 6 8 6 5 : :................::::::::...... S $ a Gu •1 9 1 Ot '� 5 Total Co ndition Adjusted Mkt VJI' d) 55,073 a. "net "t$tieST 6.000% 8 Ge 3 aX. 17119 F80j . Trart5fer FBfi >� � etArcti .606bC led. SatyagP/Cther # ... ..:.....: ,. :: .�::.......:i .. The market area Identified has multiple tax Jurisdictions. Typical Vehicle Loss Vehicle Adjustment 1S(ate: Newvllle, PA Newville, PA 663 0 $6,630 Yt8r1997 1997 # Ril "'kit: Jeep Jeep a. P P A r lo'` "`f Wan ler de . Wrangler g B E�tio rC sport Sort 1 Po P 1�2 2D ' >Dtfv D '.< utility Utlli t i13oilj!'. Y 4WD Drve 4WD � e o Applicable of I�abi e x.. APP 6 Cylinder 4.0E in C 4 n gi ty Engine 6 Cy ride .0 Engi 0 [Trf9rsis8 {1111':5 Speed Manual 5 Speed Manual 0 < I Not A Ilcabl N it o e Specifi pp of pec ed s <; r: T I :<: < `C)ilomet8. 155 039 Ml I 21 55 Mi A to I -44 Lssti4r3tigti r3Qpili rq Air Conditioning Air Conditioning It Steering Ti Ste n Wheel Tilt n h ee t teen Wheel g Steering I <3: >(1tfim. fiat Egrfpnenf o ullg t Bar Roll/Light Bar • Re ar t e Step Bumper Rear Ste Bum P P Pe r Step n t Center Conso a er Cent Console so fe Version: t Page: 2 0821/1211:53 f y r Claim: PAO- PA -01 -12- Autosource Valuation 1997 Jeep Wrangler Sport 4WD Utility AS Request: 31350400 0284469 Typical Vehicle Loss Vehicle AdlustmenC Fog Lights _ 10 Skid Plates Skid Plates r Int WI s 0 Pe < Tachometer Tachometer : Dual Airbags Dual Airbags Trailer Hitch 25 Tinted Glass Tinted Glass Rear Spare Tire Carrier Rear Spare Tire Carrier PdW lit AC 6.6.. Power Steering Power Steering ;.Power Brakes Power Brakes RAdw/Phafre /:Alarm w. hCV . t{ohs AM/FM Stereo 15 f.RC�f t pOwmo, Soft Top Soft Top SeaC1pinis; V elour/Cloth Seats Velour /Cloth Seats 1 Rear Bench Seat Rear Bench Seat Bucket Seats Bucket Seats Y1/hestt3pUO.rts'.; AluminumfAlloy Wheels Steel Wheels 25 PACkites; Convenience Group Convenience Group Autns0urGe VIOd BetQtmCondRitsn ildjUStRtet!CS' 6,185 ff SOatS( Moderate Wear Moderate Wear "Moderate Wear Moderate Wear In[.7trjt Moderate Damage Needs Replacing 75 Good Good Moderate Damage Moderate Damage > .Wht Moderate Damage Needs Repaint 1,005 gxt Prim Moderate Damage Moderate Damage flpt?f= Moderate Damage Needs Replaced -50 0 Minor Work Minor Work transmisslaR: Minor Work Minor Work FtpnTires Good Good Bear fires Good Replace -65 Total Condition Adjustments NA - 1,195 e> FJit3t �]e(ttt� @; 0 Adju$titf8tit; 1.195 Net Condition Adjustment Total Condition Adjusted Market Value - 1,195 Noon e = "N.A.D -A. Vehicle Description: 1997 JEEP Wrangler Utility 2D Sport 4WD N.A.D.A- values are as of August, 2012 from the Official Older Used Car Guide, National Edition. Base V>flue $6,850 Version: I Page: 3 06/21112 11:53 Claim: PAG- PA- 01 -12- Autosource Valuation 1997 Jeep Wrangler Sport 4WD Utility AS Request: 31350400 0264469 +�qan $0 '�c�?amlasWn?� So Equipmer►l:,::.... Eautpn 0 t subt6 . 1 $0 Wltag8 „,5591�LE 5: $ •500 • • $6,350 These current N.A.D.A. values are furnished under license from NADASC. All values Copyright © 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. a • Adjustments of Special Note ° An adjustment of $25 was made for the reported aftermarket Trailer Hitch. The date of purchase was not provided. ° A mileage adjustment of 0.75 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 40% of the vehicle's starting value. • Information provided by Donegal Insurance Group • Loss vehicle description was provided by Donegal Insurance Group • 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 parry vehicles. • The originating search area for this valuation was Newville, Pennsylvania o Other Adjustments or Comments The market area Identified has multiple tax jurisdictions. Autosource was unable to Identify which county or city was applicable to the total loss vehicle. However, each of the counties have the Identical tax amount, therefore, the valuation was completed using this Identical amount o Conditioning Notes • INTERIOR ° int Trim: missing shifter surround, speakers; lower dash surround • EXTERIOR ° Roof: large cracks or toles. it dr vinyl glass,rt dr vinyl torn,top small tears • TIRES Front Tires: r 5,15 ° Rear Tires: r 6,1 1 Etrgire Qpttantr Trartniisslott OpYiotta • 6 Cylinder 4.0 Engine STD 5 Speed Manual STD 3 Speed Automatic $625 ;_ Olh�r 4�slional Equiptwrtt _ , Cont+�ntart�flntlotts Anti -Lock Brakes Condi tioning .... ......:.:..:..:::.....::.:..... .. ...............:... ,.:::..... $600 Air Conditioning $895 Roll/Light Bar STD Rear Window Defroster $165 Center Console TYP Trunk/Cargo Organizer $125 Dual Airbags STD Tilt Steering Wheel $195 Fog Lights $120atO)jt[onit Heavy u Electrical _ ......::..::.... ....._...:..............:,.:... ....... >. ;; kN ry $135 Bucket Seats STD Version: t Page: 4 06/21/12 1 1:53 Claim: PAG- PA- 01 -12- Autosource Valuation 1997 Jeep Wrangler Sport 4WD Utility AS Requesl: 31350400 0284469 Heavy Duty Suspension Rear Bench Seat STD Intermittent Wipers Velour /Cloth Seats $140 Locking Differential $285 PoliiarJlOeessories Leather Steering Wheel $50 Power Brakes STD Privacy Glass $240 Power Steering STD • Rear Step Bumper STD 0640phkti kiirm Oplfons Rear Window Wiper/Washer AM/FM Stereo Tape $180 Skid Plates STD AM/FM Stereo STD Sound Bar $245 Rab7 lions Rear Spare Tire Carrier STD Hardtop Roof $755 Sunscreen Glass $170 Soft Top STD Side Steps $75 W11A91 ilptt6rS3 Tachometer STD AluminumlAlloy Wheels $265 Tinted Glass STD Steel Wheels STD '' gptwtti Pacitfigea ... . Convenience Group $165 Includes Engine Compartment Light & Console. Dana 44 Rear Axle $595 includes Rear Trak -Lok Differential Axle. Hard Full Doors $125 Tire & Wheel Package $785 Includes Hd Suspension W /High Pressure Shock Absorbers, Conventional Spare Tire, Ail Terrain Tires & Aluminum Wheels. RaserataRj?rlce $17,665 Loss Vehicle manulacturer's suggested retail price as reported $19,180 Editions available for the same body style (In order of original cost, Increasing): SE, *Sport, Sahara • Indicates loss vehicle equipment a Plat'I. Highway Traffic Safety Admin (US) has Issued a total of 3 recall bulletins that may apply to this vehicle. � •• 96V060000 a)2fa:.iS sE19d 04/01/96 Sluarjtlty- AN0000 700 Manutactuteti,p.8ts January 1996 - February 1996 ; ,,.,.V..01i1Cie:Desct)ptlotlj{ Multi-purpose passenger vehicles. DeSgrfptlpl 0f D efect: The air bag electronic control module software contains an error which can delay the air bag deployment in certain crash situations. 1 cnsequertpe Qf iaefec2 Delayed deployment can cause Increased injury to from seat vehicle occupants in a collision. Co..rLectNe"i:1 ; Dealers will replace the air bag electronic control module on these vehicles. • 97V080 }ate fsspel; 05/01/97 ::: 731 ; tltacfufecl ; pates> July- September 1996 etteC3e gripilCtf Passenger vehicles, multi- purpose vehicles and light duty trucks. DesoClpifoTi CR D9Pet t`: The electrical circuit design allows the potential for an Inadvertent air bag deployment when the vehlGe's Ignition is turned off. gnSO uO CB Of : D9,f.9Ct Unexpected air bag deployment can result In occupant injury. CotcuetWg Ae13pn Dealers will replace the air bag electronic control module with a newly designed module. Version: i Page: 5 08/21/12 1153 Claim: PAG•PA -01.12- Autosource Valuation 1997 Jeep Wrangler Sport 4WD Utility AS Request: 31350400 0284469 98VO46 'ii¢titHf$sEj0t1; 02!01 /98 (ianti <Affe "d 1,600 z<::i1Uf2CU i't(:?9te ": January 1996 - Jury 1997 =: >YeniG@;pagciptian n/a a SAr pitgn(QtD feat. In manual steering Wrangler vehicles, the driver's side air bag 'clock spring" wiring harness can break when turned to the "full lock' turn position. Then, in the event of a vehicle crash, the air bag ` ::would not deploy, increasing the risk of serious in to the occupant. d ep Y, 9 Injury ant. P . Dealers will replace the clocks spring harness In these air bags. ed P P g 9s x 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. After your claim is settled, Autosource provides free assistance in locating your next vehicle. Your request can be submitted online 24hrs. per day at httpJ/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. IN r This report contains proprietary information of Audatex and shall not be disclosed to any third parry (other than the Insured of claimant) without Audatexs 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 VlNsource /NICB is provided solely to Identify potential duplicative claims activity. User agrees to use such information solely for lawful purposes. 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 791274082 US Pat. No 820051382 ® 2012 Audatex North America, Inc. All Rights Reserved. Version: t Page: 6 08/21!1211:53 wly awtu alp. ., rN vuvw rhn. tvvvrvvv-vvvu Target Complete Date/rime: Days To Repair: 0 09/21/2012 03:03 PM va0e 104 6 1997 Jeep Wrangler Sport 2 OR Utility 08212012 02:41 PM c.IW : PA &. 12.02644N ..,... ,.,,,- ,.,,... ,,,...,,....,. ,,.....�.. »,..,,. »., , .»»., »,.,.. ,, .,..,..,.,..,...........,,.,, », »,.....�. , ....,.... •" 1 E ., Vehicle ....._..,.. ,...._ .........,- .,... .. ... ........................._.._..,...... ._......_.._..,...,._........._ ... .._..._....- .._.,...M ........._.... ? 1997 Jeep Wrangler Sport 2 DR Utility 6cyl Gasoline 4.0 5 Speed Manual Lic Expire: VIN: 1J4FY19S5VP494989 Prod Date: Mileage: 213,559 Veh Insp# : Mileage Type: Actual Condition: Code: J7142B Ext. Refinish: Two -Stage Int. Refinish: Options Air Conditioning Bucket Seats Center Console Dual Airbags Fog Lights intermittent Wipers Power Brakes Power Steering Rear Bench Seat Rear Spare Tire Carrier Rear Step Bumper Roll/Light Bar Skid Plates Soft Top Steel Wheels Tachometer Tilt Steering Wheel Tinted Glass Trailer Hitch Velour /Cloth Seats ............................................................................................................................................................................................................. ............................... Damages Line Op Guide MC Description MFR.Part No. Price ADJ% B% Hours R 1 EU 5 49 Bumper Assembly,Front LIKE KIND & QUAL.PRT $150.00' +25.00 0.8 SM >> triple nickle 8009338627 2 L 5 Bumper,Front Refinish 0.8 RF 0.8 Surface 3 EU 8 Extn,Front Bumper Otr LT LIKE KIND & QUAL.PRT 0.2 SM 4 L 8 Extn,Front Bumper Otr LT Refinish 0.3 RF 0.3 Surface 5 EU 9 Extn,Front Bumper Otr RT LIKE KIND & QUAL.PRT 0.2 SM 6 L 9 Extn,Front Bumper Otr RT Refinish 0.3 RF 0.3 Surface 7 EU 28 Grille Assembly LIKE KIND & QUAL.PRT $135.00' +25.00 3.8 SM 8 L 28 13 Grille Assembly Refinish 3.5 RF 2.0 Surface 0.5 Edge 0.6 Two -stage setup 0.4 Two -stage 9 EU 43 Lamp Assembly,Fog LIKE KIND & QUAL.PRT $35.00' +25.00 0.2 SM 10 EU 83 Panel,Hood LIKE KIND & QUAL.PRT $175.00' +25.00 1.0 SM 11 L 83 Panel,Hood Refinish 4.5 RF 2.7 Surface 1.3 Edge 0.5 Two -stage 12 E 87 # Latch,Hood Panel 55074952AB $66.10 0.2 SM # =01,02 13 RI 88 Catch,Hood Safety LT R & I Assembly 0.2 SM 14 RI 89 Catch,Hood Safety RT R & I Assembly 0.2 SM 15 RI 79 Bracket,Hood Catch LT R & I Assembly 0.1 SM 16 Rl 80 Bracket,Hood Catch RT R & I Assembly 0.1 SM 17 E 84 Hinge,Hood Panel LT 55075559 $70,10 0.7 SM 18 L 84 Hinge,Hood Panel LT Refinish 0.3 RF 0.3 Surface 19 E 85 Hinge,Hood Panel RT 55075559 $70.10 0.2 SM 20 L 85 Hinge,Hood Panel RT Refinish 0.3 RF 0.3 Surface ;)j F irn 1 $,t a5 n i ctia 0&212012 03,03 PM Page 2 d 9 1997 Jeep WraPOIer sIM4 2 0R UM" 08121=202,41 PM Claim R: PAGFA' -01.12 -0264469 22 EU 118 Flare,Wheel Opening LT LIKE KIND & QUAL.PRT 0.5 SM 23 L 118 Flare,Wheel Opening LT Refinish 0.8 RF 0.8 Surface 24 E 670 Rod,Front Transverse 52088432 $240.00 0.2 ME 25 E 669 Bar,Front Stabilizer 52087824 $158.00 0.3 ME 26 E 659 Rod,Frt Stabilizer Bar LT 52087771 AB $65.50 0.1 ME 27 EU 836 Front Axle Assembly LIKE KIND & QUAL.PRT $900.00' +25.00 5.7 ME 28 1 UNIBODY SET -UP AND MEASURE Repair 2.0' SM 29 1 SQUARE UNIBODY Repair 4.0' FR' 29 Items MC Message 01 CALL DEALER FOR EXACT PART # / PRICE 02 PART NO. DISCONTINUED, CALL DEALER FOR EXACT PART NO. 13 INCLUDES 0.6 HOURS FIRST PANEL TWO -STAGE ALLOWANCE 49 UNPRINTED ALTERNATE PARTS COMPARE E Estimate Total & Entries ..................................................................................................................................................................................................... ............................... Gross Parts $675.15 Other Parts $1,395.00 Paint Materials $259.20 Line Item Markup $348.75 Parts & Material Total $2,678.10 Tax on Parts & Material @ 6.000% $160.69 Labor Rate Replace Repair Hrs Total Hrs Hrs Sheet Metal (SM) $46.00 8.5 2.0 10.5 $483.00 Mech/Elec (ME) $47.00 6.3 6.3 $296.10 Frame (FR) $46.00 4.0 4.0 $184.00 Refinish (RF) $46.00 10.8 10.8 $496.80 Paint Materials $24.00 Labor Total 31.6 Hours $1,459.90 Tax on Labor @ 6.000% $87.59 Gross Total $4,386.28 Less: Deductible $500.00 - Net Total $3,886.28 TOTAL LOSS Alternate Parts Y /01/00/00/01/00 CUM 01/00 /00 /01 /00 Zip Code: 17368 YORK Audatex Estimating 6.0.726 ES 08/21/2012 03:03 PM REL 6.0.726 DT 08/01/2012 Copyright (C) 2011 Audatex North America, Inc. 1.5 HRS WERE ADDED TO THIS ESTIMATE BASED ON AUDATEX'S TWO -STAGE REFINISH FORMULA. ABBREVIATION LEGEND: LKQ = LIKE KIND IN QUALITY, A/M = AFTERMARKET, RECOND = RECONDITION, O /H= OVERHAUL, REPL = REPLACE, RPR = REPAIR, REFN = REFINISH, SECT = SECTION, 08212012 03:03 PM Page 3 o16 Orpoof eft t'e Borough of Carlisle Carlisle Police /Accident Exchange of Information Form '°oadea t1b{ Incident 01 Z - Off ' �� $ - Date . /y- 17 - Location N — Office &4 -C DaA '/L Badge s— Time Occurred Primary Rd S- 14A'00"A Sr' Speed — TIC/D/ tZ - L # of Lanes 3 Intersecting Rd Speed Kt!5 T /C /D/ G L - # of Lanes '3 Unit # I Vehicle Registration R R 46�iD Y- State Vehicle Owner Llija LL.0 Address 2411 r. glim Arc-- Phone � IG�zs 93N Year 0 4 Make f Q KT Color W 4 VIN 1 F0;3 CGS V LM _77 Operator D kI 151 I&• SOA61'1 OLN Si.36 13.Sd144 l �013 Z - S - 63 State . 1 - �4 (3LO Alle a� YSY�B Address . 5 � ��'� °`� �� Phone /B A/B Insurance Co. 124 -1 - Amelz ° K � Policy #. PF)I 7 1l - 63 Co. Phon S/q - 7 Z 7 Z Occupant Unit # Name t �DQB� `' SIB A/B Address Phone Seat Position Witness(es) Unit # Z Vehicle Registration State E :vMfrVCQ. Pa r•7ztirr'• •., Vehicle Owner 41 Address .0 L J t' Z94 Rv,,e ;.YP - � Year `!' •• - Make Q Color R c— VIN J 5 q F V t JS 5 V e �54 1 Operator 01`1,111IL C. A" 01-N UY0 5611 DOB S - ZO-'M State tQ� Address 4¢rnG Phone A/B Insurance Co: A+6 r 5 ' s Policy # MG 311 9S Co. Phone 4416 ` Y!; Z2 Occupant Unit # Name 0013 l - >3- f3 A/B a tV rPon zys- P Address 17a Qru^ �� IA L Phone / — Seat Position F i Witness(es) ,!AI q; tov N 2� „ ter Additional Information tAL S7 US.floT ZCgZ7, VIP L/4 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) Reportable ❑ Non - Reportabie White Copy - Reporting Officer Canary Copy - Unit 1 Pink Copy - Unit 2 MC'1'RU THE: HARRISBQRG AREA POLICE INFORMATION RESOURCE SYSTEM (CRSIPINC) PAGE: 1 CRASH REPORT 08/14/12 MLB1 CARW CRASH NUMBER: F0013581 INCIDENT NUMBER: 20120800768 CAR CASE CLOSED: Y ------------------------------------------------------------------------------ AGENCY: 21402 CARLISLE DISP -TM: 1330 ARRV -TM: 1331 PATROL -ZN: 400 PRECINCT: 240 LINCOLN ST INV -DT: 08 -14 -2012 INVESTIGATOR: BREWBAKER, MARK L BADG: 0020 APP -DT: 00 -00 -0000 REVIEWER: BADG: 0000 COUNTY: 21 CUMBERLAND MUNICIPALITY: 402 CARLISLE CRS -DT: 08 -14 -2012 TM: 1328 #UNIT: 2 #PEOP: 3 #INJ: #KILL: REPORTABLE: Y NOTIF HIWY MAINT: N PENNDOT PROP: N SCH BUS RELATED: N SCH ZON RELATED: N FOLLOW UP: Y CITY PROP DAM: Z CRASH DESC: 4 REL TO RDWY: 1 ILLUM: 1 WEATHER: 1 RDWY SURF COND: 0 INTERS TYP: 01 SPEC LOC: 0 SPEC JURIS: RDWY SURF TYPE: PRINC RD - CNTY: 21 RT #: SEG: #LNS: 03 SPD LIM: 25 ORIENT: E STR NM: NOBLE BV BL HOUSE#: RT S INSEC RD - CNTY: 21 RT #: SEG: #LNS: 03 SPD LIM: 35 ORIENT: S STR NM: S HANOVER ST ST RT SIGN: 4 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: 2 FUNCTIONING: 3 WORK ZONE - TYP: LOC: SPEED LIM: WORKERS PRES: IN CLOS: RD CL /DETOUR: SHLD /MED WK: MOVING WK: FLAGGER: OTHER: LANE CLOSED DUE TO CRS: 1 DIRECT: 3 TRAF DETOUR: Y EST TM CLOSE: 1 FIRST HARMFUL EV: 02 UN #: 01 MOST HARMFUL EV: 02 UN #: 01 ENV /RDWY FACTORS: 00 PRIME FACTOR: D 09 UN #: O1 EMERGENCY TRANSPORT - EMS AGENCY: CARLISLE EMS MED FACILITY: WITNESS: DONALD SAGER PH: 6077942634 ADDR: HAS NO RESIDENCE. (HOMELESS) ON 08 -14 -12 AT 1331 I ARRIVED AT THE AREA OF HANOVER ST AND NOBLE BV WHERE AN ACCIDENT HAD OCCURED BETWEEN A BOB TAILED TRACTOR AND A JEEP. THE PASSENGER OF THE JEEP WAS A FEMALE WHO WAS CONCERNED FOR HER UNBORN CHILD REQUESTED TO BE CHECKED OUT BY EMS. THERE WERE NO OTHER REPORTED INJURIES FROM THE ACCIDENT. THE DRIVER OF UNIT #1 STATED THAT HE WAS SOUTH BOUND ON S HANOVER ST AND SAID THAT HE HAD BEEN BEHIND A CAR AND WHEN HE LAST LOOKED AT THE LIGHT IT WAS GREEN. HE FOLLOWED THE CAR THROUGH THE INTERSECTION AND CAME IN CONTACT WITH UNIT #2. THE DRIVER OF UNIT #2 STATED THAT HE WAS STOPPED AT THE INTERSECTION AND WHEN HIS LIGHT TURNED GREEN HE PROCEEDED WITH HIS LEFT TURN ONTO S HANOVER ST. AT THAT POINT HE WAS STRUCK BY UNIT #1 IN THE FRONT OF HIS CAR. THE WITNESS SAGER STATED THAT HE SAW THAT UNIT #2 HAD A GREEN LIGHT BEFORE IT PROCEEDED INTO THE INTERSECTION AND THAT THE TRACTOR HIT THE FRONT OF THE JEEP. HE STATED THAT HE DID NOT RECALL A CAR BEING IN FRONT OF THE TRACTOR. a• 1KV 't'l t!!flCatl StlUKti N YVL1l:C: 1N!'VKPItil'1VN K25SVU1Ct.C. SIS1Ll7 \L.1GO1C11V♦..J PAGE: 2 F � CRASH REPORT 08/14/12 MLBI CARW CRASH NUMBER: F0013582 INCIDENT NUMBER: 20120800768 CAR '------------------------------------------------------------------------------ BASED UPON THE ADMISSION OF THE DRIVER OF UNIT #1 THAT HE TOOK HIS EYES OFF THE LIGHT AND WAS WATCHING A CAR IN FRONT OF HIM INSTEAD OF THE TRAFFIC SIGNAL. ALONG WITH SAGER RELATING THAT UNIT #2 HAD A GREEN LIGHT WHEN IT PROCEEDED. I BELIEVE THAT UNIT #1 RAN THE RED LIGHT. THERE WERE NO INJURIES REPORTED AT THE SCENE OF THE ACCIDENT EVEN THOUGH BOTH THE DRIVER AND PASSENGER OF UNIT #2 WERE NOT SEATBELTED IN. UNIT #1 WAS TOWED FROM THE SCENE BY JOHNS MOBILE DUE TO A BROKEN AIR LINE AS WELL AS THE PASSENGER SIDE FRONT TIRE BEING DAMAGED. DAMAGE WAS LIGHT AND WAS IN THE AREA OF THE FRONT PASSENGER QUARTER PANEL AND TIRE. UNIT #2 SUFFERED SEVERE DAMAHE TO THE FRONT DRIVERS SIDE QUARTER OF THE CAR. UNIT #2 WAS TOWED FROM THE SCENE BY LEBO'S TOWING. THE DRIVER OF UNIT #1 WAS CITED FOR A RED LIGHT VIOLATION ON THE SCENE. ------------------------------------------------------------------------------ UNIT NUMBER: 01 TYPE: 01 COMMERCIAL VEH: Y OWNR NAME: ASLINESLLC TRUCKING CO 6162589311 OWNR ADDR: 2439 E COLLIER AVE SE GRAND RAPIDS MI 49546 VIN: 1FUJBBCG54LM72999 YR: 2004 MAKE: 82 LIC PLATE: RA46904 MI TRAV SPD: 999 INS CO,PO,PH: MAIN ST AMERICAN MGA YPI174301 8779187272 TOW TO,BY,PH: 1003 S HANOVER ST, CARLIS MULLENS GULF 243 -01 7172430130 # TRL UNITS: 0 TYP UNIT: TAG NO,YR,ST: TYP UNIT: TAG NO,YR,ST: VEHICLE COL: 03 TYP: 05 SPEC USAGE: 21 ROLE: •1 POSITION: 06 INIT IMP PT: 02 DAMAGE: 3 DIR TRAV: S MOVEMENT: 01 GRAD: 1 ALIGNM: 1 ALCOH DRG SUSP 1 TEST TYP 0 RESULT PHYSICAL COND: 0 E D-LO rti 09 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 POLfi #: DRIVER ACTION 4: VEH FAILURES: 00 PEDEST ACTION (45FI) DVR RESTRICTIONS COMPL: DVR ENDORSEMENT COMPL: DVR LICENSE COMPL: AVOIDANCE MANEUVER: UNDER RIDE INDICATOR: EMERGENCY USE: DRUG TEST TYPE: RESULTS: PRINCIPLE IMPACT PT: COMMERCIAL VEHICLE INFORMATION CARRIER PHONE: 6166086441 CARRIER NAME: DMR TRANSPORTATION GVWR: 008000 OVERSIZE LD: N ADDRESS: 2439 E COLLIER AVE SE GRAND RAPIDS MI 49546 USDOT #: 2042265 ICC #: 579038 PUC #: 4LM72999 CARGO BD TYP: 0 HAZARDOUS MAT: N CD,REL: N / / / VEH CONFIG: 07 mn:'KIKU 'EMS tL4KK1`.iIJURU AKZA YUL1CIS 1NFUKMNXION FtLrSUuxcm SY.`iTSM �t KS1Y1Nt ) PAGE: .3 CRASH REPORT 08/14/12 MLBI CARW CRASH NUMBER: P0013581 INCIDENT NUMBER: 20120800768 CAR '------------------------------------------------------------------------------ ------------------------------------------------------------------------------ UNIT NUMBER: 02 TYPE: 01 COMMERCIAL VEH: N OWNR NAME: HARDY ORVILLE C 7174486613 OWNR ADDR: 294 RUNNING PUMP RD NEWVILLE PA 17241 VIN: 1J4FY19SSVP494989 YR: 1997 MAKE: 02 LIC PLATE: GCS2363 PA TRAV SPD: 999 INS CO,PO,PH: ATLANTIC STATES PAG3115389 8664582242 TOW TO,BY,PH: 301 N COLLEGE ST, CARLISL LEBO'S GARAGE 249 -29 7172492977 # 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 POSITION: 06 INIT IMP PT: 11 DAMAGE: 3 DIR TRAV: E MOVEMENT: 12 GRAD: 1 ALIGNM: 1 ALCOH,DRG SUSP: 1 TEST TYP: 0 RESULT: PHYSICAL COND: 0 OWNER /DVR CD: 01 DVR PRESENCE: 1 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: AVOIDANCE MANEUVER: UNDER RIDE INDICATOR: EMERGENCY USE: DRUG TEST TYPE: RESULTS: PRINCIPLE IMPACT PT: MM: '1'AU TkIN KAKKlkibukli AKLSA ku"k;15 Lutu"la11UN Kri,UUKI -12. LZblmm PAGE: 4 CRASH REPORT 08/14/12 MLB1 CARW CRASH NUMBER: F0013581 INCIDENT NUMBER: 20120800768 CAR ' -=----------------------------------- -------------------- -- - - -- -- * * * * * * * * * * * * PEOPLE INFORMATION * * * PERSON TYPE: 1- DRIVER 2 =PASSENGER 7 =PEDESTRIAN 8 -OTHER 9= 1 UNKNOWN INJ SEVERITY: 0-NONE 1= KILLED 2-MAJOR INJ 3= MODERATE 4 =MINOR 9 =UNK UNIT NO: 01 PERSON NO: 01 TYP: 1 INJ SEVERITY: 0 DOB: 19630205 SEX: M NAME (L,F,M,S): SOBOTA DANIEL B ADDRESS: 3129 OLD ALLEGAN RD PHONE: 6162589311 FENNVILLE MI 49408 DRIVER LICENSE: MI S130135098096 SEAT POSN: 01 SAFE- EQ1,2: 03 00 EJECT: 1 EJ -PATH: 0 EXTRIC: 1 TRANSP: N UNIT NO: 02 PERSON NO: 01 TYP: 1 INJ SEVERITY: 0 DOB: 19820520 SEX: M NAME (L,F,M,S): HARDY ORVILLE C III ADDRESS: 294 RUNNING PUMP RD PHONE: 7174466613 NEWVILLE PA 17241 DRIVER LICENSE: PA 26460889 SEAT POSH: 01 SAFE- EQ1,2: 00 00 EJECT: 1 EJ -PATH: 0 EXTRIC: 1 TRANSP: N UNIT NO: 02 PERSON NO: 02 TYP: 2 INJ SEVERITY: 0 DOB: 19930113 SEX: F NAME (L,F,M,S): HARDY CHELSEA D ADDRESS: 1298 BRANDT RD PHONE: 7172459967 MECHANICSBURG PA 17055 SEAT POSN: 03 SAFE- EQ1,2: 00 00 EJECT: 0 EJ -PATH: 0 EXTRIC: 0' TRANSP: N coN.roNwEU.m ar rENNSrIw.m" C01-315 TRAFFIC CITATION - -M-•- 13 M -C3 N ❑1 N 20 v t. 1, M it ne�P is R.IaR O M✓w.w,•� luw O PI....ww... b n•w1 ❑ 6rwu aruty � / - psm.+t -. iw w. p. Mrrw �.SIIZ f an i�C O aN•I.r.,.L.,1... O,w....,w.e .r. ❑ aretn. r vr.d o.e1 �nw• r t 0— is Elti. Ip� f 1.11CA"E ,i.Nw.ra.... Oaa. and ❑" O Iwd,s— nns NtrN _ Nnl ❑ w ❑ we ❑ o... Ac ❑ o,.t+r.w....N. M•dn O a•..tt r.r.+t.r w u... 3,.4vJ"i 10.00 Ovrw.r lw C.1. w.ew . jor n Dff FMj-fa 7b ST2f C4 t- A StapV D - , L(ctT r4i%lr if ftpeca AtficD Ayy 4;s1.ItttlrM... 6 DM 'RiikLr i, qa7 Ouse.•... . iF • ri.,.......•w. a� O Nyir1 "itv on.. p ..e.. w.n rw K1 0Ca"C ati Q_ t1 >. Mn. 1•. M1. .` M rTrM • to N C L... bey.vwrb N✓tv rwt..,etdM Gfe . t CsMIl1AC.L 11100•y ±Ylrw��wes� C/NCIti SIGNATUi �JI /':/ : NiOfl- 27 - w " �o2.tt Sr c ILf ,1 l LV tl,,.d *•�e. o..... wee N...rtr.1 u.rm Tlr. tl i.a T•.r ,l L..1 tw. twM w. ter. tµ Te.et o.. twF Tom.. Ow 3= a .0- ❑Y9 12 •ewnr W II you 01.•d OviM a ° 'ire•IouM •. �' :'i.;NOTICE• . YuM: pdnl. 'mey 01 esmaea pnlmt vtnn tlri.e/1 mead. an,mmMldott d t.lne at•i mNt M thf.sulpemkn d ynoi dMFq pMltpn. N10. var ddVhlp pMigp % WILLOESUSPENDMNv uVZ a.nIo WOuGD/ Osowg ndinEImOn tMVehkbCade.IntlAng IM tm111,i11d la 75 VaCS.fS 17)1, 77/1, em 1 7715 77e1,1 U 3.77. 717/, 7'y741ab1.p.r. wnvsniot. d 75 V..LS.71801,aNd.dm d 75 oaes 7sieswMnamnrYp In,n .nl.. ta. m a ' d Mitts N IuaMM bi a. Ddiw, •nd a vlaYtlort d ib ftC' E 7781 wl.n OCMIbp M m s1M1 waA tom. Carlisle Police Department Crash Report Diagram Crash # _ 100 ! 5 I incident # Zo p - in $ - 7 6 8 (CAR) Agency Code. (21402) Date S - «- I.Z Arrival Time r' 3 3 ! Officer 112fc6J 8A k6? Badge 20 SoQTa 1 � _ NO 9 L WILVCI i r I 1 ! f I I t ' o o - - ---� -- = �- - -- -� - -- t,- White Copy - Penn DOT Canary Copy - Police Records In dceorgaoce'vrith Pcn"vinti.Rct 163, the following noUce Is being prdVlded: My pmsoh who knowingly and with idtebt to ddiand any insmoce eon fatty dr other prawn files app6edioa !br havnne ar stdement of Balm codislning any molcrisIly false hdbnnadon or conce for the purpose of mielcading (nfermation concerning avy fh4 mderisl U - eamniti ■ frauduleaf invaaitce ocf. which is a trine and snbiecfs such perm to aimfial and civil penaadcs. Page 2 of 4 DM-546 4/0912013 10:06 AM A60FA 4899, IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ATLANTIC STATES INSURANCE COMPANY SUBROGEE FOR DAVID AND ELIZABETH WAGNER, Plaintiff, VS. DANIEL SOBOTA, Defendant. CIVIL DIVISION ) ) Case No.: 13-6569 ) ) ) ) ) ) ) ) ) )' ) ) PRAECIPE TO REINSTATE COMPLAINT TO: PROTHONOTARY: Kindly reinstate the Complaint in Civ&Action in the above-captioned matter. Respectfully submitted, BROMBERG & MILLER BY:' EORGE A. MI LER, Esquire atut 11.7Si IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION ATLANTIC STATES INSURANCE CASE NO. 13 -6569 COMPANY SUBROGEE FOR DAVID AND ELIZABETH WAGNER, CODE NO. Plaintiff, TYPE OF PLEADING: vs. PRAECIPE TO REINSTATE COMPLAINT DANIEL SOBOTA, FILED ON BEHALF OF: Defendant. ATLANTIC STATES INSURANCE COMPANY SUBROGEE FOR DAVID AND ELIZABETH WAGNER, 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 (412) 232 -0440 State of MICHIGAN Case Number: 13-6569 AFFIDAVIT OF DUE DILIGENCE County of Court Plaintiff: ATLANTIC STATES INSURANCE COMPANY SUBROGEE FOR DAVID AND ELIZABETH WAGNER vs. Defendant: DANIEL SOBOTA For: BROMBER & MILLER ATTORNEYS AT LAW 1030 Fifth Avenue Ste 102 Pittsburg, PA 15219 • Received by Premier Process Serving, L.L.C. on the 14th day of March, 2014 at 2:31 pm to be served on DANIEL SOBOTA, 3120 OLD ALLEGAN RD, FENNVILLE, MI 49408. I, GARTH SEWERS COURT OFFICER, being duly sworn, depose and say that on the 30th day of March, 2014 at 2:57 pm, I: INDIVIDUALLY/PERSONALLY served by delivering a true copy of the Summons and Complaint with the date and hour of service endorsed thereon by me, to: DANIEL SOBOTA at the address of: 3120 OLD ALLEGAN RD, FENNVILLE, MI 49408, and informed said person of the contents therein, in compliance with state statutes. Additional Information pertaining to this Service: 3/30/2014 2:57 pm Sub served defendants brother Tim Sobota. 3/27/2014 11:53 am OFFICE NOTE SPOKE TO PAULINE ITS OK TO SUB SERVE. 3/19/2014 6:20 pm Daniel is an out of town trucker. Spoke to defendants brother who stated he is gone for extended periods of time. 3/15/2014 2:56 pm Given address is incorrect. Located the defendants correct address of 3129 Old Allegan Rd Fennville MI 49408 from skip trace will try here. Description of Person Served: Age: 65+, Sex: m, Race/Skin Color: white, Height: 5'11", Weight: 185, Hair: grey, Glasses: n I certify that I am over the age of 18, have no interest in the above action, and am a Process Server, in good standing, in the judicial circuit in which the process was served. Subscribed and Sw April, 2014 by t . • ._ . efore me • affi t ho is person ARY PUBUC-MICHIGAN MACOMB COUNTY M`(COMMINTHE WIRES OF MACOMB1 ACTING the 2nd day of Ily known to GARTH SEWERS COURT 0 Premier Process Serving, L.L.C. 43622 Elizabeth Rd Clinton Twp, MI 48036 (586) 783-1200 Our Job Serial Number: PJC -2014000826 yright © 1992-2011 Database Services, Inc. - Process Server's Toolbox V6.5n IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, , PENNSYLVANIA CIVIL DIVISION ATLANTIC STATES INSURANCE COMPANY SUBROGEE FOR DAVID AND ELIZABETH WAGNER Plaintiff, No. 13-6569 vs. DANIEL SOBOTA 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), DANIEL SOBOTA, in the amount of FIVE THOUSAND EIGHTY SEVEN DOLLARS AND THIRTY EIGHT CENTS ($5,087.38) 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. BY: Respectfusubmitted, G a RGE A. MILLER, Esquire ttorney for ATLANTIC STATES INSURANCE COMPANY SUBROGEE FOR DAVID AND ELIZABETH WAGNER aikm .% HI\ ejA=1 LAD (1/Oh � s tac:lP� IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION ATLANTIC STATES INSURANCE CASE NO. 13-6569 COMPANY SUBROGEE FOR DAVID AND ELIZABETH WAGNER CODE NO. Plaintiff, TYPE OF PLEADING: vs. DANIEL SOBOTA Defendant, File No. 58522 PRAECIPE TO ENTER DEFAULT JUDGMENT FILED ON BEHALF OF: ATLANTIC STATES INSURANCE COMPANY SUBROGEE FOR DAVID AND ELIZABETH WAGNER 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 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION ATLANTIC STATES INSURANCE COMPANY AS SUBROGEE FOR DAVID AND ELIZABETH WAGNER, vs. Plaintiff, NO. 13-6569 DANIEL SOBOTA Defendant. TO: DANIEL SOBOTA Date of Notice: APRIL 24, 2014 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 STREET CARLISLE, PA 17013 (717) 249-3166-800-990-9108 orge A. Miller, Esquire 1030 Fifth Avenue, Ste 102 Pittsburgh, PA 15219 13-6569 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION ATLANTIC STATES INSURANCE COMPANY AS SUBROGEE FOR DAVID AND ELIZABETH WAGNER, vs. DANIEL SOBOTA Plaintiff, Defendant. NO. 13-6569 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 24, 2014, 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. eo ge A. Mil er, Esquire IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION ATLANTIC STATES INSURANCE COMPANY SUBROGEE FOR DAVID AND ELIZABETH WAGNER Plaintiff, vs. DANIEL SOBOTA Defendant, CASE NO.: 13-6569 NOTICE OF JUDGMENT TO: DEFENDANT (S) ABOVE NAMED: DANIEL SOBOTA 3129 OLD ALLEGAN ROAD FENNVILLE, MI 49408 TAKE NOTICE, that on ,20E, JUDGMENT was entered against you and in favor of the Plaintiff (s) in the amount of FIVE THOUSAND EIGHTY SEVEN DOLLARS AND THIRTY EIGHT CENTS ($5,087.38) plus costs and interest from date of entry. PROTHONOTARY By: Deputy ROTHONO 2014 JUL 25 ptf 2' 22 ti" UNBERLAND COUNT �,, PENNSYLVANIA ENNS YL. VA NI �� ' i -. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION ATLANTIC STATES INSURANCE CASE NO.: 2013-6569 COMPANY, as Subrogee for DAVID AND ELIZABETH WAGNER CODE NO. Plaintiff, TYPE OF PLEADING: vs. DANIEL SOBOTA Defendant. File No. 57779 AFFIDAVIT IN SUPPORT OF CERTIFICATION OF MOTOR VEHICLE JUDGMENT FILED ON BEHALF OF: ATLANTIC STATES INSURANCE COMPANY, as Subrogee for DAVID AND ELIZABETH WAGNER, 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 anAi P (412) 232-0440 y_41-10 a� IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION ATLANTIC STATES INSURANCE COMPANY, as Subrogee for DAVID AND ELIZABETH WAGNER, Plaintiff, vs. DANIEL SOBOTA Defendant Case No. 2013-6569 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 Defendant, 3129 OLD ALLEGAN ROAD, FENNVILLE, MI 49408. 5. The judgment reflected at Docket No. 6569 of 2013 of the Court of Common Pleas of Cumberland County, PA is in the amount of $5087.38, is valid, enforceable and unsatisfied, and is the result of a motor vehicle accident upon which suspension of driver's operating privileges is authorized. GEORGE A. MILLE SWORN TO and subscribed before me this 2)---11 d day of 144- golz, 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 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY-i PENNSYLVANIA -:a ..�rJ P. .,..•.- • CIVIL DIVISION ATLANTIC STATES INSURANCE COMPANY SUBROGEE FOR DAVID AND ELIZABETH WAGNER, Plaintiff, vs. DANIEL SOBOTA, Defendant, File No. 58522 CASE NO. 13-6569 CODE NO. TYPE OF PLEADING: PRAECIPE TO SATISFY JUDGMENT FILED ON BEHALF OF: ATLANTIC STATES INSURANCE COMPANY SUBROGEE FOR DAVID AND ELIZABETH WAGNER, 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 (412) 232-0440 sgsapd affy CSL# X 357 Rif 3'2'91 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION ATLANTIC STATES INSURANCE COMPANY SUBROGEE FOR DAVID AND ELIZABETH WAGNER, Plaintiff, No. 13-6569 vs. DANIEL SOBOTA, Defendant. PRAECIPE TO SATISFY JUDGMENT TO: PROTHONOTARY KINDLY satisfy the JUDGMENT(S) entered MAY 13, 2014, against DANIEL SOBOTA. GEORGE A. MILLER, ESQUIRE I hereby certify that the foregoing is a true and correct statement of the above case. This statement is made subject to the penalties of 18 Pa. C.S. §4904 relating to unsworn falsifications to authorities. GEORGE A. MILLER, ESQUIRE