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HomeMy WebLinkAbout14-2557 f 20447610 C Y Jer HOH Supreme Coin t of Pennsy1vama # Cou cif Common Pleas 0 v pifG oVer`Sheet ForProlhorwtan UseOnb': C D',K l; COUnh' Docket UMBERLAN The information collected on this form is used solely p for court administration purposes. This form does not supplement or replace the filing and service of pleadings or other papers as rewired b law or rules of court. Commencement of Action: S 13 Complaint ❑ Writ of Summons ❑ Petition E - Declaration of Takin C State Farm Mutual Automobile Lead Defendant's Name: I Insurance Company NAJIB BOURASSI I - _ Plaintiff -_- C Are money damages requested? ® Yes ❑ No Dollar Amount Requested: ® within arbitration limits N (check one) c3 outside arbitration limits Is this a Class Action Suit? ❑ Yes Q No Is this an MDJ Appeal? ❑ Yes W No A Benjamin W. Lawrence,209032 Name of Plaintiff /Appellant's Attorney: ❑ 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. i 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 ❑ Product Liability (does not include ❑ Employment Dispute Mass tort) Discrimination C ❑ Slander /Libel /Defamation ❑Employment Dispute: Other ❑ Zoning Board 'I' Other: pu ❑ Other: 1 Sal � t, a ny C 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 1 FILED - OFFICE 2014 APR 25 PM t2.0 8 CUMBERLAND COUNTY PENNSYLVANIA IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION State Farm Mutual Automobile Insurance Company Plaintiff 5 U — 7 No: VS. COMPLAINT IN CIVIL ACTION NAJIB BOURASSI Defendant FILED ON BEHALF OF Plaintiff COUNSEL OF RECORD OF THIS PARTY: Benjamin W. Lawrence,209032 WELTMAN, WEINBERG & REIS CO., L.P.A. 325 CHESTNUT STREET SUITE 501 PHILADELPHIA, PA 19106 -2614 215- 599 -1500 FAX: 215- 599 -1505 20447610 C Y Jer HOH 9'l61 3 - 7 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION State Farm Mutual Automobile ` Insurance Company Plaintiff VS . Civil Action No / [J ���S' c v; / +er& NAJIB BOURASSI 17 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 #20447610 STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY Court of Common Pleas CUMBERLAND County vs. NAJIB BOURASSI NO. Cam! CIVIL ACTION — COMPLAINT 1. Plaintiff is a business organization licensed and authorized to conduct business in the State of Illionois with a place of business located at P.O. BOX 2371, BLOOMINTON, IL 61702. 2. Defendant is an adult individual who at all time pertinent hereto resided at 407 BEAVER AVE, APT B, ENOLA, PA 17025. 3. Plaintiff issued a policy of motor vehicle insurance whereby Plaintiff agreed to insure the motor vehicle involved in this incident ( "Insured Vehicle "), owned by Plaintiff's insured. 4. On or about May 26, 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 Carlisle Pike, Silver Spring, Pennsylvania. 5. , The negligence and /or carelessness of the Defendant consisted of the following: a 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 Plaintiff Insured's vehicle sustained property damage and /or incurred rental charges in the total amount of $14,929.71. 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 Plaintiff and as a result of the aforesaid payment, 'Plaintiff became subrogated to the claim of its Insured against Defendant. WHEREFORE, Plaintiff demands Judgment against Defendant in the amount of $14,929.71 plus interest and costs. WELTMAN, WEINBERG & REIS, CO., L.P.A. Benjamin W. awrence, Esquire PA L D. # 209 32 Ch 325 estnut treet Suite 501 Philadelphia, PA 19106 (215) 599 -1500 WW R #20447610 EXHIBIT 1 THOMAS E. BROWN INC. Workfile ID: 45542445 Federal ID: 25- 1772980 "Auto Body Werks" State ID: 21- 566370 5030 ARTHUR AVENUE, MECHANICSBURG, PA 17050 Phone: (717) 691 -3679 FAX: (717) 691 -5544 Supplement of Record Customer: PETERS, ALBERT C Written By: Lance Bonsall, 150538, 7/27/2012 4:49:35 PM Adjuster: Team CP Unit C3 ACC COC Insured: PETERS, ALBERT C Policy #: Claim #: 38 -iB80 -96101 Type of Loss: COLL - Collision Date of Loss: 5/26/2012 12:00:00 AM Days to Repair: 25 Point of Impact: 06 Rear Owner: Inspection Location: Insurance Company: PETERS, ALBERT C THOMAS E. BROWN INC. STATE FARM INSURANCE COMPANIES 6204 CHARING CROSS 5030 ARTHUR AVENUE COC ESTIMATICS SERVICE CENTER MECHANICSBURG, PA 17050 -5205 MECHANICSBURG, PA 17050 CONCORDVILLE (717) 796 -2290 Evening Repair Facility (717) 920 -7315 Day (717) 691 -3679 Business Vehicle Drop Off Date: 06/01/2012 Promise Date: 07/17/2012 Repair Start Date: 06/20/2012 Repair Completion Date: 07/27/2012 Vehicle Pick Up /Return 07/27/2012 Date: VEHICLE Year: 2010 Body Style: 4D SED VIN: 1HGCP2F39AA147369 Mileage In: 45510 Make: HOND Engine: 4- 2.4L -FI License: ewm5360 Mileage Out: Model: ACCORD LX Production Date: 5/2010 State: PA Vehicle Out: 7/17/2012 Color: BLUE PRL Int: Condition: Job #: 7105 TRANSMISSION BRAKES Stereo Console /Storage Automatic Transmission Power Brakes Search /Seek Intermittent Wipers Traction Control Anti-Lock Brakes (4) CD Player EXTERIOR SEATS GLASS INTERIOR Power Mirrors Bucket Seats Rear Defogger Power Locks Dual Mirrors Cloth Seats Power Windows Power Trunk/Tailgate Keyless Entry STEERING WHEELS Air Conditioning PAINT Power Steering Full Wheel Covers Cruise Control Clear Coat Paint Tilt Wheel RADIO Driver Air Bag Telescopic Wheel AM Radio Passenger Air Bag Steering Wheel Controls FM Radio Front Side Impact Air Bags 7/27/2012 4:49:37 PM 031557 Page 1 i N Supplement of Record Customer: PETERS, ALBERT C Vehicle: 2010 HOND ACCORD LX 4D SED 4-2.4L-Fl BLUE PRL Line Oper Description Part Number Qty Extended Labor Paint Price $ 1 # UNIBODY SETUP & MEASURE 1 2.0 F 2 # FRONT & REAR UNIBODY 1 6.0 F CORRECTIONS NOTE: PULL REAR RIGHT & LEFT RAILS, PULL RIGHT & LEFT FRONT RAILS. PULLER REAR UPPER BODY, PULL FRONT UPPER BODY. REPAIR TIME INCLUDES TO REALIGN FRONT SHEET METAL AND RIGHT SIDE DOORS. 3 REAR BUMPER 4 S03 O/H rear bumper 5 <> S03 Repl Bumper cover 2.4L 0471STAOA90ZZ 1 342.98 Incl. 3.2 6 S03 Add for Clear Coat 1.3 7 S03 Deduct for Rear Bumper R &I -0.9 8 Repl Reinf beam (UHS) 71530TA5AOOZZ 1 169.73 0.4 0.7 9 Repl Energy absorber 71570TAOAOO 1 48.00 Incl. 10 Repl RT Side support 71593TAOAOO 1 6.15 0.1 11 Repl LT Side support 71598TAOAOO 1 6.15 0.1 12 Repl RT Bumper cover grommet 90682SB0003 1 0.22 Incl. 13 Repl RT Bumper cover bracket US built 71505S5AOOO 1 7.62 Incl. 14 Repl LT Bumper cover bracket US built 71555S5A000 1 7.42 Incl. 15 Rep[ RT Hole cover all 71503S5A000 1 3.18 Ind. 0.2 16 Add for Clear Coat 0.1 17 Repl LT Hole cover all 71503S5A000 1 3.18 Incl. 0.2 18 Add for Clear Coat 0.1 19 Repl Bumper cover clip 91505S9AO03 4 8.92 Incl. 20 EXHAUST SYSTEM 21 Repl Muffler & pipe US built LX 18307TA5AO1 1 451.38 m Incl. 22 Repl Finish pipe 04183TA1305 1 93.08 0.1 23 Repl Heat shield rear 74654TAIAOO 1 20.43 0.2 24 Repl Converter gasket 18302SP0003 1 8.33 25 Repl Muffler & pipe mount cushion 18215TAOA21 1 4.50 _.._, type 2 26 REAR LAMPS 27 Rep) RT Tail lamp assy 33500TAOA01 1 164.07 Ind. 28 S03 Repl LT Tail lamp assy 33550TAOAOI 1 164.07 Incl. NOTE: COLLISION WRAP MELTED AND CRACKED LT TAILAMP LENS 29 TRUNK LID 30 * S02 Rep) LKQ trunk lid assy +25% 68500TAOA90ZZ 1 825.00 0.7 2.1 NOTE: RECYCLED PARTS SEARCHED AT : LKQ 250 152 SR250 PO BOX 250 HARRISVILLE OH 43974 800 - 334 -9811 S / W KEN QOUTE# 776724. TRUNK NO LONGER AVAIL. RECYCLED PARTS SEARCHED AT: CHUCK'S AUTO SALVAGE 877 - 877 -6699 S/W JIM ETA 6 -13 -12 CAME IN DAMAGED 250 AUTO LOCATED TRUNK LID 6 -15 -12 3 -4 DAYS OUT 31 S03 Overlap Major Non -Adj. Panel -0.2 32 Add for Clear Coat 0.4 33 Repi Weatherstrip 74865TAOA01 1 42.67 0.4 34 R&I Trunklock 74851TAOA01 0.3 7127/2012 4:49:37 PM 031557 Page 2 Supplement of Record Customer: PETERS, ALBERT C Vehicle: 2010 HOND ACCORD LX 4D SED 4- 2.4L -FI BLUE PRL 35 R&I Striker 74862TA0003 Incl. 36 Rpl both hinges 1.0 37 * Repl LKQ RT Hinge US built 68610TASAOOZZ 1 Ind. Ind, 0_3 38 Add for Clear Coat 0.1 39 * Repl LKQ LT Hinge US built 68660TA5AOOZZ 1 Incl. Ind, Q.3 40 Add for Clear Coat 0.1 41 * Repl LKQ License pocket US built blue 74895TASAOlZA 1 Ind. 0_4 1_3 42 Add for Clear Coat 0.3 43 Repl Nameplate "Accord" 75722TAOA01 - 1 42.95 0.2 44 Repl Emblem 75701TA0000 1 37.97 0.2 45 R&I Trunk lid trim 84630TAOAOOZA 0.3 46 REAR BODY & FLOOR 47 Repl Rear body panel US built 66100TA5AOOZZ 1 125.92 7.5 13 48 Overlap Major Adj. Panel -0.4 49 * Add for Clear Coat 0.2 50 Add for Inside 0.8 51 Repl RT Floor extn (HSS) 65630TAOAOOZZ 1 84.78 2.0 0.5 52 Overlap Minor Panel -0.2 53 * Rpr RT Rail extn (HSS) 65613TAOAOOZZ S 2_0 0.7 54 Overlap Minor Panel -0.2 55 * Rpr Spare fire panel 2.4L 65550TAOAOOZZ 4_0 1.4 56 * Add for Clear Coat 0.3 57 Repl RT Rail end (HSS) 65618TAOAOOZZ 1 12.25 0.5 58 R&I Pkg tray trim LX, LX -P, SE gray 84505TAOAO1ZB Ind. 59 * Rpr Pkg tray trim LX, LX -P, SE gray 84505TAOAOIZB 0_5 NOTE: HEAT AND RESHAPE, TRIM PANEL MAY NEED REPLACED 60 Repl Rear panel trim 84640TAOA0IZA 1 20.35 Incl. 61 R&I LT Trunk side trim 84651TAIA0lZA Ind. 62 R&I Spare cover 84521TAOAOOZA 0.1 63 * Rpr Package tray US built w/o woofer 66500TAOAOOZZ 0 0_8 NOTE: TIME TO REPAIR WELD LOCATIONS OF INNER QRT PANEL 64 Overlap Minor Panel -0.2 65 REAR SUSPENSION 66 * Repl LKQ Susp crossmember +25% 50300TAOA50 1 543.75 m 4_0 M NOTE: RECYCLED PARTS SEARCHED AT: LKQ 250 152 SR250 PO BOX 250 HARRISVILLE OH 43974 800 - 334 -9811 S / W KEN QOUTE # 777488 67 Repl RT Stabilizer bar bushing 2.41- 52306TAOA02 1 2.92 68 Rep) RT Stabilizer bar bracket 52308TAOA00 1 12.13 _ 69 R&I R&I rear susp ension both sides m 4.5 M 70 QUARTER PANEL 71 Repl RT Quarter panel US built 04636TA5A90ZZ 1 637.85 18.0 3.4 72 Overlap Major Adj. Panel -0.4 73 * Add for Clear Coat 0.6 74 Deduct for Overlap -1.5 75 Repl RT Gutter 63320TAOAOOZZ 1 128.16 2.0 0.5 7/27/2012 4:49 :37 PM 031557 Page 3 Supplement of Record Customer: PETERS, ALBERT C Vehicle: 2010 HOND ACCORD LX 4D SED 4- 2.4L -FI BLUE PRL 76 Overlap Minor Panel -0.2 77 * Rpr LT Quarter panel US built 04646TA5A90ZZ 1_0 2.6 78 Overlap Major Adj. Panel -0.4 79 * Add for Clear Coat 0.4 80 # partial refinish deduction 1 -0.1 81 Repl RT Stone guard 74401TA5A00 1 2.27 Incl. 82 Repl LT Stone guard 74405TA5A00 1 2.27 0.2 83 Repl RT Splash shield 74551TAOAOO 1 2.73 Incl. 84 R &I Pressure vent US built 7545OSDAA01 0.2 85 R&I Fueldoor 63910TAOAOOZZ 0.3 86 Bind Fuel door 63910TAOAOOZZ 0.2 87 Repi RT Inner panel assy US built 64300TA5315ZZ 1 442.63 s 8.5 1.6 88 * Add for Clear Coat 0.3 89 BACK GLASS 90 R&I Back glass Honda 73211TA5AO1 Incl. 91 Repl Dam lower 73227TAOAOO 1 16.05 92 Repi RT Dam side 73226TAOAOO 1 2.77 93 Repl LT Dam side 73226TAOAOO 1 2.77 94 Repl Dam upper 73225TAOAOO 1 3.17 95 # urathane kit 1 22.00 M.. ,.... __... .•.. ....... .... _...,.__. _ _ ... __. .. • . ,.,.m.,,.,.._.. M,. ._... . _. ...,.,.,, _ .. _.._._ .,,.. 96 PILLARS, ROCKER & FLOOR 97 * Rpr RT Outer rocker pnl US built 04631TA5AOOZZ s 1_0 1.5 98 Overlap Major Adj. Panel -0.4 99 * Add for Clear Coat 0.2 100 # chip guard coating 1 0.7 101 Bind RT Aperture panel US built 04635TA5AOOZZ s 2.0 102 R &I RT Opening trim rear, US built 72815TA5AOSZA 0.3 black 103 R &I RT Opening trim front, US built 7231STA5A01ZA 0.3 black 104 R &I RT Rear sill plate gray 84211TAOA01ZB Incl. 105 R&I RT Front sill plate gray 84201TAOA01ZB 0.2 106 S03 Bind LT Outer rocker pnl US built 04641TA5AOOZZ s 0.8 _................ _ ....... , .._ -.. �. m. ... - ....... _.,_..... -. .............._.. ......w....... .- 107 REAR DOOR 108 R&I RT R&I door assy 67510TAOA90ZZ 1.0 109 * Rpr RT Outer panel (HSS) 67611TAOAOOZZ 0_5 2.0 110 Overlap Major Adj. Panel -0.4 111 * Add for Clear Coat 0.3 112 R &I RT Belt molding 72910TAOA01 0.3 113 R&I RT Upper molding 72921TAOA01 0.3 114 R&I RT Handle, outside painted, US 72141TA5AOlZA 0.4 built royal blue 115 R&I RT Striker 72135SDAA01 Incl. 116 R&I RT R&I trim panel 83702TASA04ZA 0.3 117 R &I RT Water deflector 72821TAOAOO 0.1 118 S03 Repl LT Upper molding 72961TAOAOI 1 47.37 0.3 7/27/2012 4:49:37 PM 031557 Page 4 i Supplement of Record Customer: PETERS, ALBERT C Vehicle: 2010 HOND ACCORD LX 41) SED 4- 2.4L -FI BLUE PRL NOTE: ONE TIME USE MLDG 119 FRONT DOOR 120 Blnd RT Outer panel (HSS) 67111TAOAOOZZ 1.0 121 R &I RT Belt molding 72410TAOAOI 0.3 122 R&I RT R&I mirror 76208TASA01 0.3 123 R &I RT Handle, outside painted, US 72141TASAOlZA 0.4 built royal blue 124 R&I RT R&I trim panel 83502TA5AO3ZA 0.3 .......... .........__. ....,,,..,..,.,. _ .�...... ........, ,._.,._.µ ..........._ ... _..... ....,,,,...,_....,. .. _ ,..., 125 FRONT LAMPS 126 R&I RT Headlamp assy 33100TAOA01 0.5 127 R&I LT Headiamp assy 33150TAOA01 0.5 _........ _.._., ... _.... .. .. . ..._. 128 GRILLE 129 S03 O/H front bumper 1.7 130 Repl Grille 71121TAOAOO 1 90.23 Incl. 131 Repi Grille surround US built 71126TA5AOO 1 136.52 Incl. 132 * Rpr Emblem 75700TAOAOO 0_I NOTE: CLEAN MARKS FROM EMBLEM 133 R&I Emblem 75700TAOAOO Incl. 134 R&I Sight shield US built 2.41- 71123TA5A00 Incl. 135 Repi Grille clip 91501SO4003 4 5.60 136 * S03 Rep) Sight shield clip #2 91506S9AO03 2 3.04 _... _... __._ _- ._.W_� -. ._. ._.. _..... . __. 137 FRONT BUMPER 138 * <> S03 Repl Bumper cover 2.41L 04711TAOA90ZZ 1 292.00 Incl. 2.8 139 S03 Overlap Major Non -Adj. Panel -0.2 140 * S03 Add for Clear Coat 0.5 141 Rep) RT Upper support 71140TAOAOO 1 13.90 Incl. 142 Repi LT Upper support 71190TAOAOO 1 13.90 Incl. 143 Rep] Energy absorber 71172TAOKOO 1 30.57 Incl. 144_ * Repl Impact bar US built (UHS) 71130 1 173.62 Incl. 1_0 . ,.,.,,..._ .... .. ...._..._.�......_._.._..,..... _. _ .._ ... _.. ........___ .,_ 145 AIR CO NDITIONER & HEATER 146 ** Rep] A/M Condenser 80110TAOA01 1 173.00 m 1.2 147 Evacuate & recharge m 1.4 148 Refrigerant recovery m 0.4 149 RADIATOR SUPPORT 150 * Rpr RT Side panel 04601TAOAOOZZ s 0_5 0 151 Overlap Minor Panel - 0.2 152 * Rpr LT Side panel 04611TAOAOOZZ s 0_5 0_2 153 Overlap Minor Panel - 0.2 154 * Rpr Upper tie bar US built D4602TASAOOZZ s 1_0 0_5 155 Overlap Major Non -Adj. Panel -0.2 _ ., ...._ ......_..... _...- ..,.,.,..__ __.. s ___ ._.......... .......... ... 156 HOOD 157 R&I Lock assy w/o anti -theft 74120TAOA01 0.3 ..... -,... ....... ....... ................... 158 ELECTRICAL 159 R&I Horn low note 38100STKA02 m 0.2 160 R&I Horn high note 38150TAOA01 m 0.2 7/27/2012 4:49:37 PM 031557 Page 5 Supplement of Record Customer: PETERS, ALBERT C Vehicle: 2010 HOND ACCORD LX 4D SED 4-2.4L-Fl BLUE PRL 161 * Rpr Horn low note 38100STKA02 m 0.3 NOTE: STRAIGHTEN BRACKET 162 # corrosion protection 1 0.5 163 # mask off interior 1 0.5 NOTE: PROTECT INTERIOR FROM WELDING AND BODY REPAIR OPERATIONS 164 # seam sealers 1 45.00 165 # flex agent 1 6.00 166 # sound deadening pad for quarter 1 15.00 replacement 167 # denib & polish refinished panels 1 1.2 168 # Subl hazard waste removal 1 3.00 169 # 4 wheel alignment 1 69.95 170 # mechanical rate adjustment 1 212.50 8.5hrs X 25.00 per hour 171 # Sol CHANGED START AND PROMISE 1 DATE 172 # S02 SUPP 2 CHANGE START AND 1 PROMISE DATE DUE TO PARTS DELAY 173 # S03 BLEND LT ROOF RAIL 1 0.8 174 # S03 FINAL BILL 1 SUBTOTALS 5,853.97 82.5 38.8 NOTES Estimate Notes: RECYCLED PARTS SEARCHED AT: CHUCK'S AUTO SALVAGE 877 - 877 -6699 S/W JAMES QOUTE# 216285 NO PARTS AVAIL RECYCLED PARTS SEARCHED AT: LKQ 250 152 SR250 PO BOX 250 HARRISVILLE OH 43974 800 - 334 -9811 S / W KEN QOUTE3 776724 TRUNK ONLY / 777488 REAR CRADLE ONLY. NO OTHER PARTS AVAIL RECYCLED PARTS SEARCHED AT: NEW CUMB. AUTO PARTS OLD YORK RD NEW CUMBERLAND PA 17070 717 - 774 -1190 53112 NO PARTS AVAIL 7/27/2012 4:49:37 PM 031557 Page 6 Supplement of Record Customer: PETERS, ALBERT C Vehicle: 2010 HOND ACCORD LX 4D SED 4-2.4L-Fl BLUE PRL ESTIMATE TOTALS Category Basis Rate Cost Parts 5,853.97 Body Labor 66.0 hrs @ $ 46.00 /hr 3,036.00 Paint Labor 38.8 hrs @ $ 46.00 /hr 1,784.80 Mechanical Labor 8.5 hrs @ $ 45.00 /hr 382.50 Frame Labor 8.0 hrs @ $ 50.00 /hr 400.00 Paint Supplies 1,000.00 Subtotal 12,457.27 Sales Tax $ 12,457.27 @ 6.0000% 747.44 Grand Total 13,204.71 Deductible 100.00 CUSTOMER PAY 100.00 INSURANCE PAY 13,104.71 7/27/2012 4:49:37 PM 031557 Page 7 Supplement of Record Customer: PETERS, ALBERT C Vehicle: 2010 HOND ACCORD LX 41) SED 4-2.4L-Fl BLUE PRL SUPPLEMENT SUMMARY Line Oper Description Part Number Qty Extended Labor Paint Price $ Changed Items 29 Add for Clear Coat -0.8 32 S03 Add for Clear Coat 0.4 132 Repl Sight shield clip #2 91506S9A003 2 -4.46 136 * S03 Repi Sight shield clip #2 9150699A003 2 304 'Deleted Items 4 O/H rear bumper 1.1 5 •* S02 Repl RECOND Bumper cover 2.4L 04715TAOA90ZZ 1 - 342.98 Incl. -3.2 6 Add for Clear Coat -1.3 27 R &I LT Tail lamp assy 33550TAOA01 Incl. 73 Deduct for Rear Bumper R&I 0.9 126 O/H front bumper -1.7 135 ** Repl RECOND Bumper cover 2.4L 04711TAOA90ZZ 1 - 292.00 Incl. -2.8 1 36 Add for Clear Coat -1.1 !Added Items 4 S03 O/H rear bumper 1.1 5 <> S03 Repl Bumper cover 2.4L 04715TAOA90ZZ 1 342.98 Incl. 3.2 6 S03 Add for Clear Coat 1.3 7 S03 Deduct for Rear Bumper R&I -0.9 28 S03 Repl LT Tail lamp assy 33550TAOA0I 1 164.07 Ind. NOTE: COLLISION WRAP MELTED AND CRACKED LT TAILAMP LENS 31 S03 Overlap Major Non -Adj. Panel -0.2 106 S03 Bind LT Outer rocker pnl US built 04641TA5AOOZZ s 0.8 118 S03 Repl LT Upper molding 72961TAOA01 1 47.37 0.3 NOTE: ONE TIME USE MLDG 129 S03 O/H front bumper 1.7 138 * <> S03 Repl Bumper cover 2.4L 04711TAOA90ZZ 1 292.00 Incl. 2.8 139 S03 Overlap Major Non -Adj. Panel -0.2 140 * S03 Add for Clear Coat 0.5 173 # S03 BLEND LT ROOF RAIL 1 0.8 174 # S03 FINAL BILL 1 SUBTOTALS 210.02 0.3 0.2 7/27/2012 4:49:37 PM 031557 Page 8 Supplement of Record Customer: PETERS, ALBERT C Vehicle: 2010 HOND ACCORD LX 4D SED 4- 2.4L -FI BLUE PRL TOTALS SUMMARY Category Basis Rate Cost $ Parts 210.02 Body Labor 0.3 hrs @ $ 46.00 /hr 13.80 Paint Labor 0.2 hrs @ $ 46.00 /hr 9.20 Paint Supplies 0.2 hrs @ $ 26.00 /hr 5.20 Additional Supplement Materials /Supplies -5.20 Subtotal 233.02 Sales Tax $ 233.02 @ 6.0000% 13.98 Total Supplement Amount 247.00 NET COST OF SUPPLEMENT 247.00 CUMULATIVE EFFECTS OF SUPPLEMENT(S) Estimate 12,890.42 Lance Bonsall Supplement S01 0.00 Lance Bonsall Supplement S02 67.29 Lance Bonsall Supplement S03 247.00 Lance Bonsall Job Total: $ 13,204.71 CUSTOMER PAY: $ 100.00 INSURANCE PAY: $ 13,104.71 7/27/2012 4:49:37 PM 031557 Page 9 Supplement of Record 1. Customer: PETERS, ALBERT C Vehicle: 2010 HOND ACCORD LX 4D SED 4-2.4L-Fl BLUE PRL IF THE RESPONSIBLE PAYING PARTY IS NOT A DIRECT PAYING PARTY THROUGH OUR BUSINESS; YOU MUST PRESENT A COPY OF THEIR APPRAISAL AT THE TIME OF SCHEDULING YOUR REPAIRS,THIS INSURES US THAT PAYMENT IS AVAILABLE. IT ALSO RELIEVES YOU FROM PAYING OUT OF POCKET SUPPLEMENTAL CHARGES. (EXCLUDING DEDUCTIBLES AND /OR BETTERMENTS) WHEN LEAVING YOUR VEHICLE HERE FOR REPAIRS, WE AT THOMAS E. BROWN INC. ASK THAT YOU REMOVE ALL PERSONAL BELONGINGS FROM YOUR VEHICLE. WE ALSO NEED THE TRUNK/HATCH AREA TO BE FREE OF PERSONAL BELONGINGS AS WELL. WE ARE NOT RESPONSIBLE FOR ANY ITEMS LEFT BEHIND IN YOUR CAR. TOWED IN VEHICLES OR VEHICLES LEFT HERE THAT ARE DECLARED UNDRIVABLE MAY BE SUBJECT TO A $45.00 A DAY STORAGE FEE.STORAGE WILL APPLY TO ALL VEHICLES THAT ARE DECLARED A TOTAL LOSS. IF WE PERFORM THE REPAIRS, THIS CHARGE IS NOT APPLIED. TOWING FEE CHARGED ALSO WHEN APPLICABLE. MY SCHEDULED APPOINTMENT IS: I AM IN AGREEMENT WITH THE PRELIMINARY ESTIMATE THAT I HAVE RECEIVED FROM " THOMAS E. BROWN INC. ". I UNDERSTAND THAT IF I FAIL TO SHOW UP /CANCEL AN APPOINTMENT WHEN PARTS HAVE BEEN ORDERED FOR MY VEHICLE THIS INCLUDES TOTAL LOSSES AFTER REPAIRS HAVE BEGAN, I WILL BE RESPONSIBLE FOR ALL ASSOCIATED FEES AND RESTOCKING FEES OF ALL PARTS RETURNED. IF OTHER ARRANGEMENTS FOR AFTER HOUR PICK -UP ARE NEEDED; PAYMENT IS REQUIRED WHEN THE VEHICLE IS DROPPED OFF FOR REPAIRS. (BE SURE TO HAVE A SPARE KEY) WE REQUIRE PAYMENT IN FULL UPON DEPARTURE OF THE VEHICLE. THE ONLY EXCEPTION IS THE DIRECT REPAIR PROGRAM. (LESS THE DEDUCTIBLE & AUTHORIZATION SIGNATURE) LIMITED LIFETIME WARRANTY AS PER ALL ORIGINAL MANUFACTURES WRITTEN WARRANTIES ALL PAYMENTS MADE OTHER THAN INSURANCE CHECKS, PERSONAL CHECKS, CASH OR MONEY ORDERS WILL BE BILLED OUT AT THE CURRENT LABOR RATES POSTED ON THE WALL IN WAITING AREA. ANY NON DIRECT INSURANCE REPAIRS WILL BE BILLED OUT AT POSTED LABORS RATE IN WAITING AREA. Responsible Party: Print ,Signature LIMITED LIFETIME WARRANTY 7/27/2012 4:49:37 PM 031557 Page 10 Supplement of Record Customer: PETERS, ALBERT C Vehicle: 2010 HOND ACCORD LX 4D SED 4-2.4L-Fl BLUE PRL 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 THE PERSON TO CRIMINAL AND CIVIL PENALTIES. THE FOLLOWING IS A LIST OF ABBREVIATIONS OR SYMBOLS THAT MAY BE USED TO DESCRIBE WORK TO BE DONE OR PARTS TO BE REPAIRED OR REPLACED: D= DISCONTINUED PART A= APPROXIMATE PRICE B =BODY LABOR D= DIAGNOSTIC E= ELECTRICAL F =FRAME G =GLASS M= MECHANICAL P =PAINT LABOR S= STRUCTURAL T =TAXED MISCELLANEOUS X =NON TAXED MISCELLANEOUS ADJ= ADJACENT ALGN =ALIGN A/M= AFTERMARKET BLND =BLEND CAPA= CERTIFIED AUTOMOTIVE PARTS ASSOCIATION D &R= DISCONNECT AND RECONNECT EST = ESTIMATE EXT. PRICE =UNIT PRICE MULTIPLIED BY THE QUANTITY INCL= INCLUDED MISC = MISCELLANEOUS NON -ADJ =NON ADJACENT O /H= OVERHAUL OP= OPERATION NO =LINE NUMBER QTY = QUANTITY RECOND= RECONDITION REFN= REFINISH REPL = REPLACE R&I= REMOVE AND INSTALL R&R= REMOVE AND REPLACE RPR= REPAIR RT =RIGHT SECT = SECTION SUBL = SUBLET LT =LEFT W /O= WITHOUT W/_ WITH/_ #= MANUAL LINE ENTRY * =OTHER [IE..MOTORS DATABASE INFORMATION WAS CHANGED]. * *= DATABASE LINE WITH AFTERMARKET N =NOTES ATTACHED TO LINE NAGS= NATIONAL AUTO GLASS SPECIFICATIONS. MQVP = MANUFACTURER'S QUALITY AND VALIDATION PROGRAM.OPT OEM = ORIGINAL EQUIPMENT MANUFACTURER PARTS EITHER OPTIONALLY SOURCED OR OTHERWISE PROVIDED WITH SOME UNIQUE PRICING OR DISCOUNT. THE ATTACHED ESTIMATE REPRESENTS AN APPRAISAL OF THE COST OF REPAIR FOR THE VISIBLE DAMAGE TO THE VEHICLE NOTED AT THE TIME OF INSPECTION NECESSARY TO RETURN THE VEHICLE TO ITS PREDAMAGED CONDITION. COSTS ABOVE THE APPRAISED AMOUNT MAY BE THE RESPONSIBILITY OF THE VEHICLE OWNER. THERE IS NO REQUIREMENT THAT THE VEHICLE OWNER USE ANY SPECIFIED REPAIR SHOP. INFORMATION REGARDING REPAIR FACILITIES WHICH WILL BE ABLE TO REPAIR THE VEHICLE FOR THE APPRAISED AMOUNT IS AVAILABLE FROM THE INSURANCE COMPANY. IF USED PARTS ARE SPECIFIED, THEY ARE REQUIRED TO BE OF LIKE KIND AND QUALITY TO THOSE BEING REPLACED. INCIDENTAL CHARGES SUCH AS TOWING, PROTECTIVE CARE, CUSTODY, STORAGE, DEPRECIATION, BATTERY AND TIRE REPLACEMENT ARE NOTED WHEN APPLICABLE. Estimate calculated using a preset user threshold amount for the paint and material cost. 7/27/2012 4:49:37 PM 031557 Page 11 Supplement of Record Customer: PETERS, ALBERT C Vehicle: 2010 HOND ACCORD LX 4D SED 4- 2.4L -FI BLUE PRL Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from the Guide ARG4443, CCC Data Date 7/17/2012, and the parts selected are OEM -parts manufactured by the vehicles Original Equipment Manufacturer. OEM parts are available at OE /Vehicle dealerships. OPT OEM (Optional OEM) or ALT OEM (Alternative OEM) parts are OEM parts that may be provided by or through alternate sources other than the OEM vehicle dealerships. OPT OEM or ALT OEM parts may reflect some specific, special, or unique pricing or discount. OPT OEM or ALT OEM parts may include "Blemished" parts provided by OEM's through OEM vehicle dealerships. Asterisk ( *) or Double Asterisk ( * *) indicates that the parts and /or labor information provided by MOTOR may have been modified or may have come from an alternate data source. Tilde sign ( —) items indicate MOTOR Not - Included Labor operations. The symbol ( < >) indicates the refinish operation WILL NOT be performed as a separate procedure from the other panels in the estimate. Non - Original Equipment Manufacturer aftermarket parts are described as AM. Used parts are described as LKQ, RCY, or USED. Reconditioned parts are described as Recond. Recored parts are described as Recore. NAGS Part Numbers and Benchmark Prices are provided by National Auto Glass Specifications. Labor operation times listed on the line with the NAGS information are MOTOR suggested labor operation times. NAGS labor operation times are not included. Pound sign ( #) items indicate manual entries. Some 2012 vehicles contain minor changes from the previous year. For those vehicles, prior to receiving updated data from the vehicle manufacturer, labor and parts data from the previous year may be used. The CCC ONE estimator has a complete list of applicable vehicles. Parts numbers and prices should be confirmed with the local dealership. The following is a list of additional abbreviations or symbols that may be used to describe work to be done or parts to be repaired or replaced: SYMBOLS FOLLOWING PART PRICE: m =MOTOR Mechanical component. s =MOTOR Structural component. T= Miscellaneous Taxed charge category. X= Miscellaneous Non -Taxed charge category. SYMBOLS FOLLOWING LABOR: D= Diagnostic labor category. E= Electrical labor category. F =Frame labor category. G =Glass labor category. M= Mechanical labor category. S= Structural labor category. (numbers) 1 through 4 =User Defined Labor Categories. OTHER SYMBOLS AND ABBREVIATIONS: Adj.= Adjacent. Algn.= Align. ALU= Aluminum. A /M= Aftermarket part. Blnd= Blend. BOR =Boron steel. CAPA= Certified Automotive Parts Association. D &R= Disconnect and Reconnect. HSS =High Strength Steel. HYD= Hydroformed Steel. Incl. = Included. LKQ =Like Kind and Quality. LT =Left. MAG= Magnesium. Non -Adj. =Non Adjacent. NSF =NSF International Certified Part. O /H= Overhaul. Qty= Quantity. Refn = Refinish. Repl= Replace. R &I= Remove and Install. R&R= Remove and Replace. Rpr= Repair. RT= Right. SAS = Sandwiched Steel. Sect = Section. Subl= Sublet. UHS =Ultra High Strength Steel. N= Note(s) associated with the estimate line. CCC ONE Estimating - A product of CCC Information Services Inc. The following is a list of abbreviations that may be used in CCC ONE Estimating that are not part of the MOTOR CRASH ESTIMATING GUIDE: BAR = Bureau of Automotive Repair. EPA= Environmental Protection Agency. NHTSA= National Highway Transportation and Safety Administration. PDR= Paintless Dent Repair. VIN = Vehicle Identification Number. 7/27/2012 4:49:37 PM 031557 Page 12 Supplement of Recor Customer: PETERS, ALBERT C Vehicle: 2010 HOND ACCORD LX 4D SED 4- 2.4L -FI BLUE PRL ALTERNATE PARTS SUPPLIERS Supplier: Performance Radiator -PA2 Location(s): 4322 BERMUDA ST., PHILADELPHIA PA 19124 (877) 723 -4286 (215) 333 -1610 Line Description Item # Price 146 A/M Condenser 3538 $ 173.00 7/27/2012 4:49:37 PM 031557 Page 13 " THOMAS E. BROWN INC. Workfile ID: 45542445 Federal ID: 25- 1772980 "Auto Body Werks" State ID: 21- 566370 5030 ARTHUR AVENUE, MECHANICSBURG, PA 17050 Phone: (717) 691 -3679 FAX: (717) 691 -5544 Supplement of Record Customer. PETERS, ALBERT C Written By: Lance Bonsall, 150538, 6/15/2012 3:14:26 PM Adjuster: Team CP Unit C3 ACC COC Insured: PETERS, ALBERT C Policy #: Claim #: 38 -1B80 -96101 Type of Loss: COLL - Collision Date of Loss: 5/26/2012 12:00:00 AM Days to Repair: 25 Point of Impact: 06 Rear Owner: Inspection Location: Insurance Company: PETERS, ALBERT C THOMAS E. BROWN INC. STATE FARM INSURANCE COMPANIES 6204 CHARING CROSS 5030 ARTHUR AVENUE COC ESTIMATICS SERVICE CENTER MECHANICSBURG, PA 17050 -5205 MECHANICSBURG, PA 17050 CONCORDVILLE (717) 796 -2290 Evening Repair Facility (717) 920 -7315 Day (717) 691 -3679 Business Vehicle Drop Off Date: 06/01/2012 Promise Date: 07/17/2012 Repair Start Date: 06/20/2012 VEHICLE Year: 2010 Body Style: 4D SED VIN: 1HGCP2F39AA147369 Mileage In: 45510 Make: HOND Engine: 4- 2.4L -FI License: ewm5360 Mileage Out: Model: ACCORD LX Production Date: 5/2010 State: PA Vehicle Out: 7/17/2012 Color: BLUE PRL Int: Condition: Job #: 7105 Air Conditioning Console /Storage Keyless Entry Rear Defogger AM Radio Cruise Control Passenger Air Bag Search /Seek Anti -Lock Brakes (4) Driver Air Bag Power Brakes Steering Wheel Controls Automatic Transmission Dual Mirrors Power Locks Stereo Bucket Seats FM Radio Power Mirrors Telescopic Wheel CD Player Front Side Impact Air Bags Power Steering Tilt Wheel Clear Coat Paint Full Wheel Covers Power Trunk/Tailgate Traction Control Cloth Seats Intermittent Wipers Power Windows 6115/2012 3:14:29 PM 031557 Page 1 { Supplement of Recor Customer: PETERS, ALBERT C Vehicle: 2010 HOND ACCORD LX 4D SED 4- 2.4L -FI BLUE PRL Line Operation Description Qty Extended Labor Paint Price $ 1 # UNIBODY SETUP & MEASURE 1 2.0 F N 2 # FRONT & REAR UNIBODY CORRECTIONS 1 6.0 F 3 REAR BUMPER 4 O/H rear bumper 1.1 5 ** S02 Repl RECOND Bumper cover 2.41- 1 342.98 Incl. 3.2 6 Add for Clear Coat 1.3 7 Rep] Reinf beam (UHS) 1 169.73 0.4 0.7 8 Repl Energy absorber 1 48.00 Incl. 9 Repl RT Side support 1 6.15 0.1 10 Repi LT Side support 1 6.15 0.1 it Repl RT Bumper cover grommet 1 0.22 Incl. 12 Rep] RT Bumper cover bracket US built 1 7.62 Incl. 13 Repi LT Bumper cover bracket US built 1 7.42 Incl. 14 Rep] RT Hole cover all 1 3.18 Incl. 0.2 15 Add for Clear Coat 0.1 16 Repl LT Hole cover all 1 3.18 Incl. 0.2 17 Add for Clear Coat 0.1 18 Repl Bumper cover clip 4 8.92 Ind. 19 EXHAUST SYSTEM 20 Repi Muffler & pipe US built LX 1 451.38 m Incl. 21 Repl Finish pipe 1 93.08 0.1 22 Repl Heat shield rear 1 20.43 0.2 23 Repl Converter gasket 1 8.33 24 Repl Muffler & pipe mount cushion type 2 1 4.50 25 REAR LAMPS 26 Rep[ RT Tail lamp assy 1 164.07 Incl. 27 R&I LT Tail lamp assy Incl. 28 TRUNK LID N 29 * S02 Rep) LKQ trunk lid assy +25% 1 825.00 0.7 2.1 30 Add for Clear Coat 0.8 31 Repi Weatherstrip 1 42.67 0.4 32 R &I Trunk lock 0.3 33 R&I Striker Incl. 34 Rpl both hinges 1.0 35 * Repl LKQ RT Hinge US built 1 Incl. Incl. 0_3 36 Add for Clear Coat 0.1 37 * Repl LKQ LT Hinge US built 1 Incl. Ind. 0_3 38 Add for Clear Coat 0.1 39 * Repl LKQ License pocket US built blue 1 Incl. 0_4 1_3 40 Add for Clear Coat 0.3 41 Repl Nameplate "Accord" 1 42.95 0.2 42 Repl Emblem 1 37.97 0.2 43 R&I Trunk lid trim 0.3 6/15/2012 3:14:29 PM 031557 Page 2 Supplement of Record Customer: PETERS, ALBERT C Vehicle: 2010 HOND ACCORD LX 4D SED 4- 2.4L -FI BLUE PRL 44 REAR BODY & FLOOR 45 Rep[ Rear body panel US built 1 125.92 7.5 1.5 46 Overlap Major Adj. Panel -0.4 47 Add for Clear Coat 0.2 48 Add for Inside 0.8 49 Rep[ RT Floor extn (HSS) 1 84.78 2.0 0.5 50 Overlap Minor Panel -0.2 51 * Rpr RT Rail extn (HSS) s 2_0 0.7 52 Overlap Minor Panel -0.2 53 * Rpr Spare fire panel 2.41- 4_0 1.4 54 Add for Clear Coat 0.3 55 Repl kT Rail end (HSS) 1 12.25 0.5 56 R&I Pkg tray trim LX, LX -P, SE gray Incl. N 57 * Rpr Pkg tray trim LX, LX -P, SE gray 0_5 58 Repl Rear panel trim 1 20.35 Incl. 59 R &I LT Trunk side trim Incl. 60 R&I Spare cover 0.1 N 61 * Rpr Package tray US built w/o woofer 0_5 0_8 62 Overlap Minor Panel -0.2 63 REAR SUSPENSION N 64 * Repl LKQ Susp crossmember +25% 1 543.75 m 4 M 65 Repl RT Stabilizer bar bushing 2.41- 1 2.92 66 Repl RT Stabilizer bar bracket 1 12.13 67 R&I R&I rear suspension both sides m 4.5 M 68 QUARTER PANEL 69 Rep[ RT Quarter panel US built 1 637.85 18.0 3.4 70 Overlap Major Adj. Panel -0.4 71 * Add for Clear Coat 0.6 72 Deduct for Overlap -1.5 73 Deduct for Rear Bumper R&I -0.9 74 Repl RT Gutter 1 128.16 2.0 0.5 75 Overlap Minor Panel -0.2 76 * Rpr LT Quarter panel US built 1_0 2.6 77 Overlap Major Adj. Panel -0.4 78 * Add for Clear Coat 0.4 79 # partial refinish deduction 1 -0.1 80 Repl RT Stone guard 1 2.27 Incl. 81 Repl LT Stone guard 1 2.27 0.2 82 Repl RT Splash shield 1 2.73 Incl. 83 R &I Pressure vent US built 0.2 84 R &I Fuel door 0.3 85 Blnd Fuel door 0.2 86 Repl RT Inner panel assy US built 1 442.63 s 8.5 1.6 87 * Add for Clear Coat 0.3 88 BACK GLASS 6/15/2012 3:14:29 PM 031557 Page 3 Supplement of Reco Customer: PETERS, ALBERT C Vehicle: 2010 HOND ACCORD LX 4D SED 4- 2.4L -FI BLUE PRL 89 R&I Back glass Honda Incl. 90 Repl Dam lower 1 16.05 91 Repl RT Dam side 1 2.77 92 Repl LT Dam side 1 2.77 93 Repl Dam upper 1 3.17 94 # urathane kit 1 22.00 95 PILLARS, ROCKER & FLOOR 96 * Rpr RT Outer rocker pnl US built s 1_0 1.5 97 Overlap Major Adj. Panel -0.4 98 * Add for Clear Coat 0.2 99 # chip guard coating 1 0.7 100 Blnd RT Aperture panel US built s 2.0 101 R&I RT Opening trim rear, US built black 0.3 102 R &I RT Opening trim front, US built black 0.3 103 R&I RT Rear sill plate gray Incl. 104 R &I RT Front sill plate gray 0.2 105 REAR DOOR 106 R &I RT R&I door assy 1.0 107 * Rpr RT Outer panel (HSS) 0 2.0 108 Overlap Major Adj. Panel -0.4 109 * Add for Clear Coat 0.3 110 R&I RT Belt molding 0.3 111 R&I RT Upper molding 0.3 112 R&I RT Handle, outside painted, US built royal blue 0.4 113 R&I RT Striker Incl. 114 R&I RT R &I trim panel 0.3 115 R&I RT Water deflector 0.1 116 FRONT DOOR 117 Blnd RT Outer panel (HSS) 1.0 118 R&I RT Belt molding 0.3 119 R&I RT R&I mirror 0.3 120 R&I RT Handle, outside painted, US built royal blue 0.4 121 R &I RT R&I trim panel 0.3 122 FRONT LAMPS 123 R &I RT Headlamp assy 0.5 124 R&I LT Headlamp assy 0.5 125 GRILLE 126 O/H front bumper 1.7 127 Repl Grille 1 90.23 Incl. 128 Repl Grille surround US built 1 136.52 Incl. N 129 * Rpr Emblem 0_1 130 R &I Emblem Incl. 131 R&I Sight shield US built 2.41- Incl. 132 Repl Grille clip 4 5.60 133 Rep) Sight shield clip #2 2 4.46 6/15/2012 3:14:29 PM 031557 Page 4 ' Supplement of Record Customer: PETERS, ALBERT C Vehicle: 2010 HOND ACCORD LX 4D SED 4- 2.4L -FI BLUE PRL 134 FRONT BUMPER 135 ** Repl RECOND Bumper cover 2.4L 1 292.00 Incl. 2.8 136 Add for Gear Coat 1.1 137 Repl RT Upper support 1 13.90 Incl. 138 Repl LT Upper support 1 13.90 Incl. 139 Rep[ Energy absorber 1 30.57 Ind. 140 * Repl Impact bar US built (UHS) 1 173.62 Incl. 1.0 141 AIR CONDITIONER & HEATER 142 ** Repl A/M Condenser 1 173.00 m 1.2 143 Evacuate & recharge m 1.4 144 Refrigerant recovery m 0.4 145 RADIATOR SUPPORT 146 * Rpr RT Side panel s 05 147 Overlap Minor Panel -0 148 * Rpr LT Side panel s 0_5 0-2 149 Overlap Minor Panel -0.2 150 * Rpr Upper tie bar US built s 1_0 0_5 151 Overlap Major Non -Adj. Panel -0 152 HOOD 153 R&I Lock assy w/o anti -theft 0.3 154 ELECTRICAL 155 R&I Hom low note m 0.2 156 R&I Hom high note m 0.2 N 157 * Rpr Hom low note m 0.3 158 # corrosion protection 1 0.5 N 159 # mask off interior 1 0.5 160 # seam sealers 1 45.00 161 # flex agent 1 6.00 162 # sound deadening pad for quarter replacement 1 15.00 163 # denib & polish refinished panels 1 1.2 164 # Subi hazard waste removal 1 3.00 165 # 4 wheel alignment 1 69.95 166 # mechanical rate adjustment 8.5hrs X 25.00 per 1 212.50 hour 167 # Sol CHANGED START AND PROMISE DATE 1 168 # S02 SUPP 2 CHANGE START AND PROMISE DATE 1 DUE TO PARTS DELAY SUBTOTALS 5,643.95 82.2 38.6 NOTES Line 2: PULL REAR RIGHT & LEFT RAILS, PULL RIGHT & LEFT FRONT RAILS. PULLER REAR UPPER BODY, PULL FRONT UPPER BODY. REPAIR TIME INCLUDES TO REALIGN FRONT SHEET METAL AND RIGHT SIDE DOORS. Line 29: RECYCLED PARTS SEARCHED AT: LKQ 250 152 SR250 PO BOX 250 HARRISVILLE OH 43974 800 - 334 -9811 S / W KEN QOUTE# 776724. TRUNK NO LONGER AVAIL. RECYCLED PARTS SEARCHED AT: CHUCICS AUTO SALVAGE 877 - 877 -6699 S/W JIM ETA 6 -13 -12 CAME IN DAMAGED 250 AUTO LOCATED TRUNK LID 6 -15 -12 3-4 DAYS OUT 6/15/2012 3:14:29 PM 031557 Page 5 Supplement of Record Customer: PETERS, ALBERT C Vehicle: 2010 HOND ACCORD LX 4D SED 4-2.4L-Fl BLUE PRL Line 57: HEAT AND RESHAPE, TRIM PANEL MAY NEED REPLACED Line 61: TIME TO REPAIR WELD LOCATIONS OF INNER QRT PANEL Line 64: RECYCLED PARTS SEARCHED AT: LKQ 250 152 SR250 PO BOX 250 HARRISVILLE OH 43974 800- 334 -9811 S J W KEN QOUTE # 777488 Line 129: CLEAN MARKS FROM EMBLEM Line 157: STRAIGHTEN BRACKET Line 159: PROTECT INTERIOR FROM WELDING AND BODY REPAIR OPERATIONS Estimate Notes: RECYCLED PARTS SEARCHED AT: CHUCK'S AUTO SALVAGE 877 - 877 -6699 S/W JAMES QOUTE# 216285 NO PARTS AVAIL RECYCLED PARTS SEARCHED AT: LKQ 250 152 SR250 PO BOX 250 HARRISVILLE OH 43974 800 - 334 -9811 S / W KEN QOUTE3 776724 TRUNK ONLY / 777488 REAR CRADLE ONLY. NO OTHER PARTS AVAIL RECYCLED PARTS SEARCHED AT: NEW COMB. AUTO PARTS OLD YORK RD NEW CUMBERLAND PA 17070 717 - 774 -1190 53112 NO PARTS AVAIL ESTIMATE TOTALS Category Basis Rate Cost $ Parts 5,643.95 Body Labor 65.7 hrs @ $ 46.00 /hr 3,022.20 Paint Labor 38.6 hrs @ $ 46.00 /hr 1,775.60 Mechanical Labor 8.5 hrs @ $ 45.00 /hr 382.50 Frame Labor 8.0 hrs @ $ 50.00 /hr 400.00 Paint Supplies 1,000.00 Subtotal 12,224.25 Sales Tax $ 12,224.25 @ 6.0000% 733.46 Grand Total 12,957.71 Deductible 100.00 CUSTOMER PAY 100.00 INSURANCE PAY 12,857.71 6/15/2012 3:14:29 PM 031557 Page 6 Supplement of Record Customer: PETERS, ALBERT C Vehicle: 2010 HOND ACCORD LX 4D SED 4-2.4L-Fl BLUE PRL SUPPLEMENT SUMMARY Line Operation Description Qty Extended Labor Paint Price $ Changed Items 4 * Rep[ RECOND Bumper cover 2AL 1 - 292.00 Incl. -3.2 5 ** S02 Rep[ RECOND Bumper cover 2AL 1 342.98 Incl. 3.2 N 28 * Repl LKQ trunk lid assy +25% 1 - 812.50 -0.7 -2.1 N 29 * S02 Repl LKQ trunk lid assy +25% 1 825.00 0.7 2.1 Added Items 168 # S02 SUPP 2 CHANGE START AND PROMISE DATE 1 DUE TO PARTS DELAY SUBTOTALS 63.48 0.0 0.0 TOTALS SUMMARY Category Basis Rate Cost $ Parts 63.48 Subtotal 63.48 Sales Tax $ 63.48 @ 6.0000% 3.81 Total Supplement Amount 67.29 NET COST OF SUPPLEMENT 67.29 CUMULATIVE EFFECTS OF SUPPLEMENT(S) Estimate 12,890.42 Lance Bonsall Supplement S01 0.00 Lance Bonsall Supplement S02 67.29 Lance Bonsai[ Job Total: $ 12,957.71 CUSTOMER PAY: $ 100.00 INSURANCE PAY: $ 12,857.71 6/15/2012 3:14:29 PM 031557 Page 7 Supplement of Record Customer: PETERS, ALBERT C Vehicle: 2010 HOND ACCORD LX 40 SED 4- 2.4L -FI BLUE PRL IF THE RESPONSIBLE PAYING PARTY IS NOT A DIRECT PAYING PARTY THROUGH OUR BUSINESS; YOU MUST PRESENT A COPY OF THEIR APPRAISAL AT THE TIME OF SCHEDULING YOUR REPAIRS,THIS INSURES US THAT PAYMENT IS AVAILABLE. IT ALSO RELIEVES YOU FROM PAYING OUT OF POCKET SUPPLEMENTAL CHARGES. (EXCLUDING DEDUCTIBLES AND /OR BETTERMENTS) WHEN LEAVING YOUR VEHICLE HERE FOR REPAIRS, WE AT THOMAS E. BROWN INC. ASK THAT YOU REMOVE ALL PERSONAL BELONGINGS FROM YOUR VEHICLE. WE ALSO NEED THE TRUNK/HATCH AREA TO BE FREE OF PERSONAL BELONGINGS AS WELL. WE ARE NOT RESPONSIBLE FOR ANY ITEMS LEFT BEHIND IN YOUR CAR. TOWED IN VEHICLES OR VEHICLES LEFT HERE THAT ARE DECLARED UNDRIVABLE MAY BE SUBJECT TO A $45.00 A DAY STORAGE FEE.STORAGE WILL APPLY TO ALL VEHICLES THAT ARE DECLARED A TOTAL LOSS. IF WE PERFORM THE REPAIRS, THIS CHARGE IS NOT APPLIED. TOWING FEE CHARGED ALSO WHEN APPLICABLE. MY SCHEDULED APPOINTMENT IS: I AM IN AGREEMENT WITH THE PRELIMINARY ESTIMATE THAT I HAVE RECEIVED FROM " THOMAS E. BROWN INC. ". I UNDERSTAND THAT IF I FAIL TO SHOW UP /CANCEL AN APPOINTMENT WHEN PARTS HAVE BEEN ORDERED FOR MY VEHICLE THIS INCLUDES TOTAL LOSSES AFTER REPAIRS HAVE BEGAN, I WILL BE RESPONSIBLE FOR ALL ASSOCIATED FEES AND RESTOCKING FEES OF ALL PARTS RETURNED. IF OTHER ARRANGEMENTS FOR AFTER HOUR PICK -UP ARE NEEDED; PAYMENT IS REQUIRED WHEN THE VEHICLE IS DROPPED OFF FOR REPAIRS. (BE SURE TO HAVE A SPARE KEY) WE REQUIRE PAYMENT IN FULL UPON DEPARTURE OF THE VEHICLE. THE ONLY EXCEPTION IS THE DIRECT REPAIR PROGRAM. (LESS THE DEDUCTIBLE & AUTHORIZATION SIGNATURE) LIMITED LIFETIME WARRANTY AS PER ALL ORIGINAL MANUFACTURES WRITTEN WARRANTIES ALL PAYMENTS MADE OTHER THAN INSURANCE CHECKS, PERSONAL CHECKS, CASH OR MONEY ORDERS WILL BE BILLED OUT AT THE CURRENT LABOR RATES POSTED ON THE WALL IN WAITING AREA. ANY NON DIRECT INSURANCE REPAIRS WILL BE BILLED OUT AT POSTED LABORS RATE IN WAITING AREA. Responsible Party: Print Signature LIMITED LIFETIME WARRANTY 5/15/2012 3:14:29 PM 031557 Page 8 R Supplement of Record Customer: PETERS, ALBERT C Vehicle: 2010 HOND ACCORD LX 4D SED 4- 2.4L -FI BLUE PRL 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 THE PERSON TO CRIMINAL AND CIVIL PENALTIES. THE FOLLOWING IS A LIST OF ABBREVIATIONS OR SYMBOLS THAT MAY BE USED TO DESCRIBE WORK TO BE DONE OR PARTS TO BE REPAIRED OR REPLACED:D= DISCONTINUED PART A= APPROXIMATE PRICE B =BODY LABOR D= DIAGNOSTIC E= ELECTRICAL F =FRAME G =GLASS M= MECHANICAL P =PAINT LABOR S= STRUCTURAL T =TAXED MISCELLANEOUS X =NON TAXED MISCELLANEOUS ADJ= ADJACENT ALGN =ALIGN A/M= AFTERMARKET BLND =BLEND CAPA= CERTIFIED AUTOMOTIVE PARTS ASSOCIATION D &R= DISCONNECT AND RECONNECT EST = ESTIMATE EXT. PRICE =UNIT PRICE MULTIPLIED BY THE QUANTITY INCL = INCLUDED MISC = MISCELLANEOUS NON- ADJ =NON ADJACENT O /H= OVERHAUL OP= OPERATION NO =LINE NUMBER QTY = QUANTITY RECOND= RECONDITION REFN= REFINISH REPL= REPLACE R&I= REMOVE AND INSTALL R &R= REMOVE AND REPLACE RPR= REPAIR RT =RIGHT SECT = SECTION SUBL = SUBLET LT =LEFT W /O= WITHOUT W /_= WITH /_ #= MANUAL LINE ENTRY * =OTHER [IE..MOTORS DATABASE INFORMATION WAS CHANGED]. * *= DATABASE LINE WITH AFTERMARKET N =NOTES ATTACHED TO LINE NAGS = NATIONAL AUTO GLASS SPECIFICATIONS. MQVP = MANUFACTURER'S QUALITY AND VALIDATION PROGRAM.OPT OEM = ORIGINAL EQUIPMENT MANUFACTURER PARTS EITHER OPTIONALLY SOURCED OR OTHERWISE PROVIDED WITH SOME UNIQUE PRICING OR DISCOUNT. THE ATTACHED ESTIMATE REPRESENTS AN APPRAISAL OF THE COST OF REPAIR FOR THE VISIBLE DAMAGE TO THE VEHICLE NOTED AT THE TIME OF INSPECTION NECESSARY TO RETURN THE VEHICLE TO ITS PREDAMAGED CONDITION. COSTS ABOVE THE APPRAISED AMOUNT MAY BE THE RESPONSIBILITY OF THE VEHICLE OWNER. THERE IS NO REQUIREMENT THAT THE VEHICLE OWNER USE ANY SPECIFIED REPAIR SHOP. INFORMATION REGARDING REPAIR FACILITIES WHICH WILL BE ABLE TO REPAIR THE VEHICLE FOR THE APPRAISED AMOUNT IS AVAILABLE FROM THE INSURANCE COMPANY. IF USED PARTS ARE SPECIFIED, THEY ARE REQUIRED TO BE OF LIKE KIND AND QUALITY TO THOSE BEING REPLACED. INCIDENTAL CHARGES SUCH AS TOWING, PROTECTIVE CARE, CUSTODY, STORAGE, DEPRECIATION, BATTERY AND TIRE REPLACEMENT ARE NOTED WHEN APPLICABLE. Estimate calculated using a preset user threshold amount for the paint and material cost. 6/15/2012 3:14:29 PM 031557 Page 9 Supplement of Record Customer: PETERS, ALBERT C Vehicle: 2010 HOND ACCORD LX 4D SED 4- 2.4L -FI BLUE PRL Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from the Guide ARG4443, CCC Data Date 6/8/2012, and the parts selected are OEM -parts manufactured by the vehicles Original Equipment Manufacturer. OEM parts are available at OE /Vehicle dealerships. OPT OEM (Optional OEM) or ALT OEM (Alternative OEM) parts are OEM parts that may be provided by or through alternate sources other than the OEM vehicle dealerships. OPT OEM or ALT OEM parts may reflect some specific, special, or unique pricing or discount. OPT OEM or ALT OEM parts may include "Blemished" parts provided by OEM's through OEM vehicle dealerships. Asterisk ( *) or Double Asterisk ( * *) indicates that the parts and /or labor information provided by MOTOR may have been modified or may have come from an alternate data source. Tilde sign ( —) items indicate MOTOR Not - Included Labor operations. The symbol ( < >) indicates the refinish operation WILL NOT be performed as a separate procedure from the other panels in the estimate. Non - Original Equipment Manufacturer aftermarket parts are described as AM. Used parts are described as LKQ, RCY, or USED. Reconditioned parts are described as Recond. Recored parts are described as Recore. NAGS Part Numbers and Benchmark Prices are provided by National Auto Glass Specifications. Labor operation times listed on the line with the NAGS information are MOTOR suggested labor operation times. NAGS labor operation times are not included. Pound sign ( #) items indicate manual entries. Some 2012 vehicles contain minor changes from the previous year. For those vehicles, prior to receiving updated data from the vehicle manufacturer, labor and parts data from the previous year may be used. The CCC ONE estimator has a complete list of applicable vehicles. Parts numbers and prices should be confirmed with the local dealership. The following is a list of additional abbreviations or symbols that may be used to describe work to be done or parts to be repaired or replaced: SYMBOLS FOLLOWING PART PRICE: m =MOTOR Mechanical component. s =MOTOR Structural component. T= Miscellaneous Taxed charge category. X= Miscellaneous Non -Taxed charge category. SYMBOLS FOLLOWING LABOR: D= Diagnostic labor category. E= Electrical labor category. F =Frame labor category. G =Glass labor category. M= Mechanical labor category. S= Structural labor category. (numbers) i through 4 =User Defined Labor Categories. OTHER SYMBOLS AND ABBREVIATIONS: Adj.= Adjacent. Algn.= Align. ALU= Aluminum. A/M= Aftermarket part. Bind= Blend. BOR =Boron steel. CAPA= Certified Automotive Parts Association. D &R= Disconnect and Reconnect. HSS =High Strength Steel. HYD= Hydroformed Steel. Incl. = Included. LKQ =Like Kind and Quality. LT =Left. MAG= Magnesium. Non -Adj. =Non Adjacent. NSF =NSF International Certified Part. O /H= Overhaul. Qty= Quantity. Refn = Refinish. Repl= Replace. R&I= Remove and Install. R &R= Remove and Replace. Rpr= Repair. RT= Right. SAS= Sandwiched Steel. Sect= Section. Subl = Sublet. UHS =Ultra High Strength Steel. N= Note(s) associated with the estimate line. CCC ONE Estimating - A product of CCC Information Services Inc. The following is a list of abbreviations that may be used in CCC ONE Estimating that are not part of the MOTOR CRASH ESTIMATING GUIDE: BAR = Bureau of Automotive Repair. EPA= Environmental Protection Agency. NHTSA= National Highway Transportation and Safety Administration. PDR= Paintless Dent Repair. VIN = Vehicle Identification Number. 6/15/2012 3:14:29 PM 031557 Page 10 k Supplement of Record Customer: PETERS, ALBERT C Vehicle: 2010 HOND ACCORD LX 4D SED 4- 2.4L -FI BLUE PRL ALTERNATE PARTS SUPPLIERS Supplier: Keystone - Complete - Windber Location(s): 320 DOBSON STREET, WINDBER PA 15963 (800) 438 -2510 (814) 467 -5531 1709 7TH STREET, PARKERSBURG WV 26101 (800) 696 -3064 3658 ROUTE 378, BETHLEHEM PA 18015 (800) 441 -4200 (610) 866 -0313 275 CROSS FARM LANE, YORK PA 17406 (800) 524 -4349 (717) 843 -8927 433 LAWRENCE STREET, OLD FORGE PA 18518 (800) 446 -7066 (570) 457 -6464 1435 TRIPLETT BLVD, AKRON OH 44306 (800) 822 -5555 (216) 398 -7788 615 ALPHA DRIVE REAR, PITTSBURGH PA 15238 (800) 445 -5215 (724) 339 -1800 901 W. 12TH STREET, ERIE PA 16501 (814) 459 -1300 (888) 566 -7844 Line Description Item # Price 5 RECOND Bumper cover 2.41 HO1100246R $ 342.98 135 RECOND Bumper cover 2.41- HO1000254R $ 292.00 Supplier: Performance Radiator -PA2 Location(s): 4322 BERMUDA ST., PHILADELPHIA PA 19124 (877) 723 -4286 (215) 333 -1610 Line Description Item # Price 142 AIM Condenser 3538 $ 173.00 6/15/2012 3:14:29 PM 031557 Page 11 THOMAS E. BROWN INC. Workfile ID: 45542445 Federal ID: 25- 1772980 "Auto Body Werks" State ID: 21- 566370 5030 ARTHUR AVENUE, MECHANICSBURG, PA 17050 Phone: (717) 691 -3679 FAX: (717) 691 -5544 Supplement of Record Customer: PETERS, ALBERT C Written By: Lance Bonsall, 150538, 6/1/2012 2:45:37 PM Adjuster: Team CP Unit C3 ACC COC Insured: PETERS, ALBERT C Policy #: Claim #: 38 -iB80 -96101 Type of Loss: COLL- Collision Date of Loss: 5/26/2012 12 :00:00 AM Days to Repair: 25 Point of Impact: 06 Rear Owner: Inspection Location: Insurance Company: PETERS, ALBERT C THOMAS E. BROWN INC. STATE FARM INSURANCE COMPANIES 6204 CHARING CROSS 5030 ARTHUR AVENUE COC ESTIMATICS SERVICE CENTER MECHANICSBURG, PA 17050 -5205 MECHANICSBURG, PA 17050 CONCORDVILLE (717) 796 -2290 Evening Repair Facility (717) 920 -7315 Day (717) 691 -3679 Business Vehicle Drop Off Date: 06/01/2012 Promise Date: 07/10/2012 Repair Start Date: 06/06/2012 VEHICLE Year: 2010 Body Style: 4D SED VIN: 1HGCP2F39AA147369 Mileage In: 45510 Make: HOND Engine: 4-2.4L -FI License: ewm5360 Mileage Out: Model: ACCORD LX Production Date: S/2010 State: PA Vehicle Out: 7/1712012 Color: BLUE PRL Int: Condition: Job #: 7105 Air Conditioning Console /Storage Keyless Entry Rear Defogger AM Radio Cruise Control Passenger Air Bag Search /Seek Anti -Lock Brakes (4) Driver Air Bag Power Brakes Steering Wheel Controls Automatic Transmission Dual Mirrors Power Locks Stereo Bucket Seats FM Radio Power Mirrors Telescopic Wheel CD Player Front Side Impact Air Bags Power Steering Tilt Wheel Clear Coat Paint Full Wheel Covers Power Trunk/Tailgate Traction Control Cloth Seats Intermittent Wipers Power Windows 6/1/2012 2:45:38 PM 031557 Page 1 A 4 Supplement of Record Customer: PETERS, ALBERT C Vehicle: 2010 HOND ACCORD LX 4D SED 4- 2.4L -FI BLUE PRL Line Operation Description Qty Extended Labor Paint Price $ 1 # UNIBODY SETUP & MEASURE 1 2.0 F N 2 # FRONT & REAR UNIBODY CORRECTIONS 1 6.0 F 3 REAR BUMPER 4 O/H rear bumper 1.1 5 ** Repl RECOND Bumper cover 2.41- 1 292.00 Incl. 3.2 6 Add for Clear Coat 1.3 7 Repl Reinf beam (UHS) 1 169.73 0.4 0.7 8 Repl Energy absorber 1 48.00 Incl. 9 Repl RT Side support 1 6.15 0.1 10 Repl LT Side support 1 6.15 0.1 11 Repl RT Bumper cover grommet 1 0.22 Incl. 12 Repl RT Bumper cover bracket US built 1 7.62 Ind. 13 Repl LT Bumper cover bracket US built 1 7.42 Incl. 14 Repl RT Hale cover all 1 3.18 Ind. 0.2 15 Add for Clear Coat 0.1 16 Repl LT Hole cover all 1 3.18 Incl. 0.2 17 Add for Clear Coat 0.1 18 Repl Bumper cover clip 4 8.92 Ind. 19 EXHAUST SYSTEM 20 Repl Muffler & pipe US built LX 1 451.38 m Incl. 21 Rep[ Finish pipe 1 93.08 0.1 22 Repl Heat shield rear 1 20.43 0.2 23 Repl Converter gasket 1 8.33 24 Repl Muffler & pipe mount cushion type 2 1 4.50 25 REAR LAMPS 26 Rep[ RT Tail lamp assy 1 164.07 Incl. 27 R&I LT Tail lamp asst' Incl. 28 TRUNK LID N 29 * Repl LKQ trunk lid assy +25% 1 812.50 0.7 2.1 30 Add for Clear Coat 0 31 Rep[ Weatherstrip 1 42.67 0.4 32 R &I Trunk lock 0.3 33 R&I Striker Incl. 34 Rpl both hinges 1.0 35 * Repl LKQ RT Hinge US built 1 Ind. Incl. 0 36 Add for Clear Coat 0.1 37 * Repl LKQ LT Hinge US built 1 Incl. Incl. 0_3 38 Add for Clear Coat 0.1 39 * Rep[ LKQ License pocket US built blue 1 Ind. 0 = 4 1_3 40 Add for Clear Coat 0.3 41 Repi Nameplate "Accord" 1 42.95 0.2 42 Rep[ Emblem 1 37.97 0.2 43 R&I Trunk lid trim 0.3 6/112012 2:45:38 PM 031557 Page 2 Supplement of Record a Customer: PETERS, ALBERT C Vehicle: 2010 HOND ACCORD LX 4D SED 4-2.4L-Fl BLUE PRL 44 REAR BODY & FLOOR 45 Repl Rear body panel US built 1 125.92 7.5 1.5 46 Overlap Major Adj. Panel -0.4 47 Add for Clear Coat 0.2 48 Add for Inside 0.8 49 Repl RT Floor extn (HSS) 1 84.78 2.0 0.5 50 Overlap Minor Panel -0.2 51 * Rpr RT Rail extn (HSS) s 2. 0.7 52 Overlap Minor Panel -0 53 * Rpr Spare tire panel 2.41- 4 ` 0 1.4 54 Add for Clear Coat 0.3 55 Rep[ RT Rail end (HSS) 1 12.25 0.5 56 R&I Pkg tray trim LX, LX -P, SE gray Incl. N 57 * Rpr Pkg tray trim LX, LX -P, SE gray 0.5 58 Rep) Rear panel trim 1 20.35 Incl. 59 R&I LT Trunk side trim Inc. 60 R&I Spare cover 0.1 N 61 * Rpr Package tray US built w/o woofer D..5 0 62 Overlap Minor Panel -0.2 63 REAR SUSPENSION N 64 * Repl LKQ Susp crossmember +25% 1 543.75 m 4.0 M 65 Repl RT Stabilizer bar bushing 2.41- 1 2.92 66 Repl RT Stabilizer bar bracket 1 12.13 67 R&I R&I rear suspension both sides m 4.5 M 68 QUARTER PANEL 69 Repl RT Quarter panel US built 1 637.85 1810 3.4 70 Overlap Major Adj. Panel -0.4 71 * Add for Clear Coat 0.6 72 Deduct for Overlap -1.5 73 Deduct for Rear Bumper R&I -0.9 74 Repl RT Gutter 1 128.16 2.0 0.5 75 Overlap Minor Panel -0.2 76 * Rpr LT Quarter panel US built 2.6 77 Overlap Major Adj. Panel -0.4 78 * Add for Clear Coat 0.4 79 # partial refinish deduction 1 -0.1 80 Repi RT Stone guard 1 2.27 Incl. 81 Repl LT Stone guard 1 2.27 0.2 82 Rep[ RT Splash shield 1 2.73 Ind. 83 R &I Pressure vent US built 0.2 84 R&I Fuel door 0.3 85 Bind Fuel door 0 86 Repl RT Inner panel assy US built 1 442.63 s 8.5 1.6 87 * Add for Clear Coat 0.3 88 BACK GLASS 611/2012 2:45:38 PM 031557 Page 3 Supplement of Record Customer: PETERS, ALBERT C Vehicle: 2010 HOND ACCORD LX 4D SED 4-2.4L-Fl BLUE PRL 89 R&I Back glass Honda Incl 90 Repl Dam lower 1 16.05 91 Rep) RT Dam side 1 2.77 92 Rep[ LT Dam side 1 2.77 93 Repi Dam upper 1 3.17 94 # urathane kit 1 22.00 95 PILLARS, ROCKER & FLOOR 96 * Rpr RT Outer rocker pnl US built s 1_0 1.5 97 Overlap Major Adj. Panel -0.4 98 * Add for Clear Coat 0.2 99 # chip guard coating 1 0.7 100 Bind RT Aperture panel US built s 2.0 101 R&I RT Opening trim rear, US built black 0.3 102 R &I RT Opening trim front, US built black 0.3 103 R&I RT Rear sill plate gray Incl. 104 R &I RT Front sill plate gray 0 105 REAR DOOR 106 R &I RT R&I door assy 1.0 107 * Rpr RT Outer panel {HSS} 0.5 2.0 108 Overlap Major Adj. Panel -0.4 109 * Add for Clear Coat 0.3 110 R&I RT Belt molding 0 ill R&I RT Upper molding 0.3 112 R&I RT Handle, outside painted, US built royal blue 0.4 113 R&I RT Striker Incl. 114 R&I RT R&I trim panel 0 115 R&I RT Water deflector 0.1 116 FRONT DOOR 117 Bind RT Outer panel {HSS} 1.0 118 PI&I RT Belt molding 0.3 119 R&I RT R&I mirror 0 120 R&I RT Handle, outside painted, US built royal blue 0.4 121 R &I RT R&I trim panel 0.3 122 FRONT LAMPS 123 R &I RT Headlamp assy 0.5 124 R&I LT Headlamp asst' 0.5 125 GRILLE 126 O/H front bumper 1.7 127 Repi Grille 1 90.23 Incl. 128 Repi Grille surround US built 1 136.52 Incl. N 129 * Rpr Emblem 0.1 130 R &I Emblem Incl. 131 R&I Sight shield US built 2.41- Incl. 132 Repi Grille clip 4 5.60 133 Repl Sight shield clip #2 2 4.46 6/1/2012 2:45 :38 PM 031557 Page 4 Supplement of Record Customer: PETERS, ALBERT C Vehicle: 2010 HOND ACCORD LX 4D SED 4-2.4L-Fl BLUE PRL 134 FRONT BUMPER 135 ** Repl RECOND Bumper cover 2.41- 1 292.00 Incl. 2.8 136 Add for Clear Coat 1.1 137 Repl RT Upper support 1 13.90 Incl. 138 Repl LT Upper support 1 13.90 Incl. 139 Repl Energy absorber 1 30.57 Incl. 140 * Repl Impact bar US built (UHS) 1 173.62 Incl. 1.0 141 AIR CONDITIONER & HEATER 142 ** Repl A/M Condenser 1 173.00 m 1.2 143 Evacuate & recharge m 1.4 144 Refrigerant recovery m 0.4 145 RADIATOR SUPPORT 146 * Rpr RT Side panel s 0_5 0_2 147 Overlap Minor Panel -0.2 148 * Rpr LT Side panel s 0 0 149 Overlap Minor Panel -0 150 * Rpr Upper tie bar US built s 1 0.5 151 Overlap Major Non -Adj. Panel -0 152 HOOD 153 R&I Lock assy w/o anti -theft 0.3 154 ELECTRICAL 155 R&I Horn low note m 0.2 156 R&I Horn high note m 0.2 N 157 * Rpr Horn low note m 0.3 158 # corrosion protection 1 0.5 N 159 # mask off interior 1 0.5 160 # seam sealers 1 45.00 161 # flex agent 1 6.00 162 # sound deadening pad for quarter replacement 1 15.00 163 # denib & polish refinished panels 1 1.2 164 # Sub] hazard waste removal 1 3.00 165 # 4 wheel alignment 1 69.95 166 # mechanical rate adjustment 8.5hrs X 25.00 per 1 212.50 hour 167 # SO1 CHANGED START AND PROMISE DATE 1 SUBTOTALS 5,580.47 82.2 38.6 NOTES Line 2: PULL REAR RIGHT & LEFT RAILS, PULL RIGHT & LEFT FRONT RAILS. PULLER REAR UPPER BODY, PULL FRONT UPPER BODY. REPAIR TIME INCLUDES TO REALIGN FRONT SHEET METAL AND RIGHT SIDE DOORS. Line 29: RECYCLED PARTS SEARCHED AT: LKQ 250 152 SR250 PO BOX 250 HARRISVILLE OH 43974 800- 334 -9811 S / W KEN QOUTE# 776724 Line 57: HEAT AND RESHAPE, TRIM PANEL MAY NEED REPLACED Line 61: TIME TO REPAIR WELD LOCATIONS OF INNER QRT PANEL Line 64: RECYCLED PARTS SEARCHED AT: LKQ 250 152 SR250 PO BOX 250 HARRISVILLE OH 43974 800- 334 -9811 S / W KEN QOUTE # 777488 Line 129: CLEAN MARKS FROM EMBLEM Line 157: STRAIGHTEN BRACKET 6/1/2012 2:45:38 PM 031557 Page 5 Supplement of Record Customer: PETERS, ALBERT C Vehicle: 2010 HOND ACCORD LX 4D SED 4- 2.4L -FI BLUE PRL Line 159: PROTECT INTERIOR FROM WELDING AND BODY REPAIR OPERATIONS Estimate Notes: RECYCLED PARTS SEARCHED AT: CHUCK'S AUTO SALVAGE 877 - 877 -6699 S/W JAMES QOUTE# 216285 NO PARTS AVAIL RECYCLED PARTS SEARCHED AT: LKQ 250 152 SR250 PO BOX 250 HARRISVILLE OH 43974 800 -334 -9811 S / W KEN QOUTE3 776724 TRUNK ONLY / 777488 REAR CRADLE ONLY. NO OTHER PARTS AVAIL RECYCLED PARTS SEARCHED AT: NEW CUMB. AUTO PARTS OLD YORK RD NEW CUMBERLAND PA 17070 717 - 774 -1190 53112 NO PARTS AVAIL ESTIMATE TOTALS Category Basis Rate Cost $ Parts 5,580.47 Body Labor 65.7 hrs @ $ 46.00 /hr 3,022.20 Paint Labor 38.6 hrs @ $ 46.00 /hr 1,775.60 Mechanical Labor .8.5 hrs @ $ 45.00 /hr 382.50 Frame Labor 8.0 hrs @ $ 50.00 /hr 400.00 Paint Supplies 1,000.00 Subtotal 12,160.77 Sales Tax $ 12,160.77 @ 6.0000% 729.65 Grand Total 12,890.42 Deductible 100.00 CUSTOMER PAY 100.00 INSURANCE PAY 12,790.42 6/1/2012 2:45:38 PM 031557 Page 6 Supplement of Record Customer: PETERS, ALBERT C Vehicle: 2010 HOND ACCORD LX 4D SED 4- 2.4L -FI BLUE PRL SUPPLEMENT SUMMARY Line Operation Description Qty Extended Labor Paint Price $ Added Items 167 # Sol CHANGED START AND PROMISE DATE 1 SUBTOTALS 0.00 0.0 0.0 TOTALS SUMMARY Category Basis Rate cost $ P arts 0.00 Subtotal 0.00 CUMULATIVE EFFECTS OF SUPPLEMENT(S) Estimate 12,890.42 Lance Bonsall Supplement S01 0.00 Lance Bonsall Job Total: $ 12,890.42 CUSTOMER PAY: $ 100.00 INSURANCE PAY: $ 12,790.42 6/1/2012 2:45:38 PM 031557 Page 7 Supplement of Record Customer: PETERS, ALBERT C Vehicle: 2010 HOND ACCORD LX 4D SED 4- 2.4L -FI BLUE PRL IF THE RESPONSIBLE PAYING PARTY IS NOT A DIRECT PAYING PARTY THROUGH OUR BUSINESS; YOU MUST PRESENT A COPY OF THEIR APPRAISAL AT THE TIME OF SCHEDULING YOUR REPAIRS,THIS INSURES US THAT PAYMENT IS AVAILABLE. IT ALSO RELIEVES YOU FROM PAYING OUT OF POCKET SUPPLEMENTAL CHARGES. (EXCLUDING DEDUCTIBLES AND /OR BETTERMENTS) WHEN LEAVING YOUR VEHICLE HERE FOR REPAIRS, WE AT THOMAS E. BROWN INC. ASK THAT YOU REMOVE ALL PERSONAL BELONGINGS FROM YOUR VEHICLE. WE ALSO NEED THE TRUNK/HATCH AREA TO BE FREE OF PERSONAL BELONGINGS AS WELL. WE ARE NOT RESPONSIBLE FOR ANY ITEMS LEFT BEHIND IN YOUR CAR. TOWED IN VEHICLES OR VEHICLES LEFT HERE THAT ARE DECLARED UNDRIVABLE MAY BE SUBJECT TO A $45.00 A DAY STORAGE FEE.STORAGE WILL APPLY TO ALL VEHICLES THAT ARE DECLARED A TOTAL LOSS. IF WE PERFORM THE REPAIRS, THIS CHARGE IS NOT APPLIED. TOWING FEE CHARGED ALSO WHEN APPLICABLE. MY SCHEDULED APPOINTMENT IS: I AM IN AGREEMENT WITH THE PRELIMINARY ESTIMATE THAT I HAVE RECEIVED FROM " THOMAS E. BROWN INC. ". I UNDERSTAND THAT IF I FAIL TO SHOW UP /CANCEL AN APPOINTMENT WHEN PARTS HAVE BEEN ORDERED FOR MY VEHICLE THIS INCLUDES TOTAL LOSSES AFTER REPAIRS HAVE BEGAN, I WILL BE RESPONSIBLE FOR ALL ASSOCIATED FEES AND RESTOCKING FEES OF ALL PARTS RETURNED. IF OTHER ARRANGEMENTS FOR AFTER HOUR PICK -UP ARE NEEDED; PAYMENT IS REQUIRED WHEN THE VEHICLE IS DROPPED OFF FOR REPAIRS. (BE SURE TO HAVE A SPARE KEY) WE REQUIRE PAYMENT IN FULL UPON DEPARTURE OF THE VEHICLE. THE ONLY EXCEPTION IS THE DIRECT REPAIR PROGRAM. (LESS THE DEDUCTIBLE & AUTHORIZATION SIGNATURE) LIMITED LIFETIME WARRANTY AS PER ALL ORIGINAL MANUFACTURES WRITTEN WARRANTIES ALL PAYMENTS MADE OTHER THAN INSURANCE CHECKS, PERSONAL CHECKS, CASH OR MONEY ORDERS WILL BE BILLED OUT AT THE CURRENT LABOR RATES POSTED ON THE WALL IN WAITING AREA. ANY NON DIRECT INSURANCE REPAIRS WILL BE BILLED OUT AT POSTED LABORS RATE IN WAITING AREA. Responsible Party: Print Signature LIMITED LIFETIME WARRANTY 6/1/2012 2:45:38 PM 031557 Page 8 Supplement of Record Customer: PETERS, ALBERT C Vehide: 2010 HOND ACCORD LX 4D SED 4- 2.4L -FI BLUE PRL 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 THE PERSON TO CRIMINAL AND CIVIL PENALTIES. THE FOLLOWING IS A LIST OF ABBREVIATIONS OR SYMBOLS THAT MAY BE USED TO DESCRIBE WORK TO BE DONE OR PARTS TO BE REPAIRED OR REPLACED: D= DISCONTINUED PART A= APPROXIMATE PRICE B =BODY LABOR D= DIAGNOSTIC E= ELECTRICAL F =FRAME G =GLASS M= MECHANICAL P =PAINT LABOR S= STRUCTURAL T =TAXED MISCELLANEOUS X =NON TAXED MISCELLANEOUS ADJ= ADJACENT ALGN =ALIGN A/M= AFTERMARKET BLVD =BLEND CAPA= CERTIFIED AUTOMOTIVE PARTS ASSOCIATION D &R= DISCONNECT AND RECONNECT EST = ESTIMATE EXT. PRICE =UNIT PRICE MULTIPLIED BY THE QUANTITY INCL = INCLUDED MISC = MISCELLANEOUS NON -ADJ =NON ADJACENT O /H= OVERHAUL OP= OPERATION NO =LINE NUMBER QTY = QUANTITY RECON D= RECONDITION REFN = REFINISH REPL= REPLACE R&I= REMOVE AND INSTALL R&R= REMOVE AND REPLACE RPR= REPAIR RT=RIGHT SECT = SECTION SUBL = SUBLET LT =LEFT W /O= WITHOUT W/_ WITH /_ #= MANUAL LINE ENTRY * =OTHER [IE..MOTORS DATABASE INFORMATION WAS CHANGED]. * *= DATABASE LINE WITH AFTERMARKET N =NOTES ATTACHED TO LINE NAGS= NATIONAL AUTO GLASS SPECIFICATIONS. MQVP= MANUFACTURER'S QUALITY AND VALIDATION PROGRAM.OPT OEM = ORIGINAL EQUIPMENT MANUFACTURER PARTS EITHER OPTIONALLY SOURCED OR OTHERWISE PROVIDED WITH SOME UNIQUE PRICING OR DISCOUNT. THE ATTACHED ESTIMATE REPRESENTS AN APPRAISAL OF THE COST OF REPAIR FOR THE VISIBLE DAMAGE TO THE VEHICLE NOTED AT THE TIME OF INSPECTION NECESSARY TO RETURN THE VEHICLE TO ITS PREDAMAGED CONDITION. COSTS ABOVE THE APPRAISED AMOUNT MAY BE THE RESPONSIBILITY OF THE VEHICLE OWNER. THERE IS NO REQUIREMENT THAT THE VEHICLE OWNER USE ANY SPECIFIED REPAIR SHOP. INFORMATION REGARDING REPAIR FACILITIES WHICH WILL BE ABLE TO REPAIR THE VEHICLE FOR THE APPRAISED AMOUNT IS AVAILABLE FROM THE INSURANCE COMPANY. IF USED PARTS ARE SPECIFIED, THEY ARE REQUIRED TO BE OF LIKE KIND AND QUALITY TO THOSE BEING REPLACED. INCIDENTAL CHARGES SUCH AS TOWING, PROTECTIVE CARE, CUSTODY, STORAGE, DEPRECIATION, BATTERY AND TIRE REPLACEMENT ARE NOTED WHEN APPLICABLE. Estimate calculated using a preset user threshold amount for the paint and material cost. 6/1/2012 2:45:38 PM 031557 Page 9 " Supplement of Record Customer: PETERS, ALBERT C Vehicle: 2010 HOND ACCORD LX 4D SED 4- 2.4L -FI BLUE PRL Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from the Guide ARG4443, CCC Data Date 5/16/2012, and the parts selected are OEM -parts manufactured by the vehicles Original Equipment Manufacturer. OEM parts are available at OE /Vehide dealerships. OPT OEM (Optional OEM) or ALT OEM (Alternative OEM) parts are OEM parts that may be provided by or through alternate sources other than the OEM vehicle dealerships. OPT OEM or ALT OEM parts may reflect some specific, special, or unique pricing or discount. OPT OEM or ALT OEM parts may include "Blemished" parts provided by OEM's through OEM vehicle dealerships. Asterisk ( *) or Double Asterisk ( * *) indicates that the parts and /or labor information provided by MOTOR may have been modified or may have come from an alternate data source. Tilde sign ( —) items indicate MOTOR Not - Included Labor operations. The symbol ( < >) indicates the refinish operation WILL NOT be performed as a separate procedure from the other panels in the estimate. Non - Original Equipment Manufacturer aftermarket parts are described as AM. Used parts are described as LKQ, RCY, or USED. Reconditioned parts are described as Recond. Recored parts are described as Recore. NAGS Part Numbers and Benchmark Prices are provided by National Auto Glass Specifications. Labor operation times listed on the line with the NAGS information are MOTOR suggested labor operation times. NAGS labor operation times are not included. Pound sign ( #) items indicate manual entries. Some 2012 vehicles contain minor changes from the previous year. For those vehicles, prior to receiving updated data from the vehicle manufacturer, labor and parts data from the previous year may be used. The CCC ONE estimator has a complete list of applicable vehicles. Parts numbers and prices should be confirmed with the local dealership. The following is a list of additional abbreviations or symbols that may be used to describe work to be done or parts to be repaired or replaced: SYMBOLS FOLLOWING PART PRICE: m =MOTOR Mechanical component. s =MOTOR Structural component. T= Miscellaneous Taxed charge category. X= Miscellaneous Non -Taxed charge category. SYMBOLS FOLLOWING LABOR: D= Diagnostic labor category. E= Electrical labor category. F =Frame labor category. G =Glass labor category. M= Mechanical labor category. S= Structural labor category. (numbers) 1 through 4 =User Defined Labor Categories. OTHER SYMBOLS AND ABBREVIATIONS: Adj.= Adjacent. Algn.= Align. ALU= Aluminum. A /M= Aftermarket part. Bind= Blend. BOR =Boron steel. CAPA= Certified Automotive Parts Association. D &R= Disconnect and Reconnect. HSS =High Strength Steel. HYD= Hydroformed Steel. Ind. = Included. LKQ =Like Kind and Quality. LT =Left. MAG= Magnesium. Non -Adj. =Non Adjacent. NSF =NSF International Certified Part. O /H= Overhaul. Qty = Quantity. Refn = Refinish. Repl= Replace. R&I= Remove and Install. R &R= Remove and Replace. Rpr= Repair. RT= Right. SAS = Sandwiched Steel. Sect = Section. Subl= Sublet. UHS =Ultra High Strength Steel. N= Note(s) associated with the estimate line. CCC ONE Estimating - A product of CCC Information Services Inc. The following is a list of abbreviations that may be used in CCC ONE Estimating that are not part of the MOTOR CRASH ESTIMATING GUIDE: BAR = Bureau of Automotive Repair. EPA= Environmental Protection Agency. NHTSA= National Highway Transportation and Safety Administration. PDR= Paintless Dent Repair. VIN = Vehicle Identification Number. 6/1/2012 2:45:38 PM 031557 Page 10 Supplement of Record Customer: PETERS, ALBERT C Vehicle: 2010 HOND ACCORD LX 4D SED 4- 2.4L -FI BLUE PRL ALTERNATE PARTS SUPPLIERS Supplier: Keystone - Complete - Windber Location(s): 320 DOBSON STREET, WINDBER PA 15963 (800) 438 -2510 (814) 467 -5531 1709 7TH STREET, PARKERSBURG WV 26101 (800) 696 -3064 3658 ROUTE 378, BETHLEHEM PA 18015 (800) 441 -4200 (610) 866 -0313 275 CROSS FARM LANE, YORK PA 17406 (800) 524 -4349 (717) 843 -8927 433 LAWRENCE STREET, OLD FORGE PA 18518 (800) 446 -7066 (570) 457 -6464 1435 TRIPLETT BLVD, AKRON OH 44306 (800) 822 -5555 (216) 398 -7788 615 ALPHA DRIVE REAR, PITTSBURGH PA 15238 (800) 445 -5215 (724) 339 -1800 901 W. 12TH STREET, ERIE PA 16501 (814) 459 -1300 (888) 566 -7844 Line Description Item # Price 5 RECOND Bumper cover 2.41 H01100246R $ 292.00 135 RECOND Bumper cover 2.41- H01000254R $ 292.00 Supplier: Performance Radiator -PA2 Location(s): 4322 BERMUDA STREET, PHILADELPHIA PA 19124 (877) 723 -4286 (215) 333 -1610 Line Description Item # Price 142 AIM Condenser 3538 $ 173.00 6/112012 2:45:38 PM 031557 Page 11 THOMAS E. BROWN INC. Workfile ID: 45542445 Federal ID: 25- 1772980 "Auto Body Werks" State ID: 21- 566370 5030 ARTHUR AVENUE, MECHANICSBURG, PA 17050 Phone: (717) 691 -3679 FAX: (717) 691 -5544 Estimate of Record Customer: PETERS, ALBERT C Written By: Lance Bonsall, 150538, 6/1/2012 12:11:43 PM Adjuster: Team CP Unit C3 ACC COC Insured: PETERS, ALBERT C Policy #: Claim #: 38 -1B80 -96101 Type of Loss: COLL- Collision Date of Loss: 5/26/2012 12:00:00 AM Days to Repair: 25 Point of Impact: 06 Rear Owner: Inspection Location: Insurance Company: PETERS, ALBERT C THOMAS E. BROWN INC. STATE FARM INSURANCE COMPANIES 6204 CHARING CROSS 5030 ARTHUR AVENUE COC ESTIMATICS SERVICE CENTER MECHANICSBURG, PA 17050 -5205 MECHANICSBURG, PA 17050 CONCORDVILLE (717) 796 -2290 Evening Repair Facility (717) 920 -7315 Day (717) 691 -3679 Business Vehicle Drop Off Date: 06/01/2012 Promise Date: 07/17/2012 Repair Start Date: 06113/2012 VEHICLE Year: 2010 Body Style: 4D SED VIN: 1HGCP2F39AA147369 Mileage In: 45510 Make: HOND Engine: 4-2.4L-Fl License: ewm5360 Mileage Out: Model: ACCORD LX Production Date: 5/2010 State: PA Vehicle Out: 7/17/2012 Color: BLUE PRL Int: Condition: Job #: 7105 Air Conditioning Console /Storage Keyless Entry Rear Defogger AM Radio Cruise Control Passenger Air Bag Search /Seek Anti -Lock Brakes (4) Driver Air Bag Power Brakes Steering Wheel Controls Automatic Transmission Dual Mirrors Power Locks Stereo Bucket Seats FM Radio Power Mirrors Telescopic Wheel CD Player Front Side Impact Air Bags Power Steering Tilt Wheel Clear Coat Paint Full Wheel Covers Power Trunk/Tailgate Traction Control Cloth Seats Intermittent Wipers Power Windows 6/1/2012 12:11 :43 PM 031557 Page 1 c Estimate of Record Customer: PETERS, ALBERT C Vehicle: 2010 HOND ACCORD LX 4D SED 4- 2.4L -FI BLUE PRL Line Operation Description Qty Extended Labor Paint Price $ 1 # UNIBODY SETUP & MEASURE 1 2.0 F N 2 # FRONT & REAR UNIBODY CORRECTIONS 1 6.0 F 3 REAR BUMPER 4 O/H rear bumper 1.1 5 ** Repl RECOND Bumper cover 2.41- 1 292.00 Incl. 3.2 6 Add for Clear Coat 1.3 7 Repl Reinf beam (UHS) 1 169.73 0.4 0.7 8 Rep] Energy absorber 1 48.00 Incl. 9 Rep] RT Side support 1 6.15 0.1 10 Repl LT Side support 1 6.15 0.1 11 Rep] RT Bumper cover grommet 1 0.22 Incl. 12 Rep] RT Bumper cover bracket US built 1 7.62 Inc]. 13 Repl LT Bumper cover bracket US built 1 7.42 Incl. 14 Repl RT Hole cover all 1 3.18 Incl. 0.2 15 Add for Clear Coat 0.1 16 Repl LT Hole cover all 1 3.18 Incl. 0.2 17 Add for Clear Coat 0.1 18 Repl Bumper cover clip 4 8.92 Incl. 19 EXHAUST SYSTEM 20 Repl Muffler & pipe US built LX 1 451.38 m Incl. 21 Repl Finish pipe 1 93.08 0.1 22 Repl Heat shield rear 1 20.43 0.2 23 Repl Converter gasket 1 8.33 24 Repl Muffler & pipe mount cushion type 2 1 4.50 25 REAR LAMPS 26 Repl RT Tail lamp assy 1 164.07 Incl. 27 R&I LT Tail lamp assy Incl. 28 TRUNK LID N 29 * Repl LKQ trunk lid assy +25% 1 812.50 0.7 2.1 30 Add for Clear Coat 0.8 31 Repl Weatherstrip 1 42.67 0.4 32 R &I Trunk lock 0.3 33 R&I Striker Incl. 34 Rpl both hinges 1.0 35 * Repl LKQ RT Hinge US built 1 Incl. Ind, 0_3 36 Add for Clear Coat 0.1 37 * Repl LKQ LT Hinge US built 1 Incl. Incl. 0_3 38 Add for Clear Coat 0.1 39 * Repl LKQ License pocket US built blue 1 Incl. 0_4 1_3 40 Add for Clear Coat 0.3 41 Repl Nameplate "Accord" 1 42.95 0.2 42 Repl Emblem 1 37.97 0.2 43 R&I Trunk lid trim 0.3 6/1/2012 12:11:43 PM 031557 Page 2 Estimate o Record Customer: PETERS, ALBERT C Vehicle: 2010 HOND ACCORD LX 4D SED 4- 2.4L -FI BLUE PRL 44 REAR BODY & FLOOR 45 Repl Rear body panel US built 1 125.92 7.5 1.5 46 Overlap Major Adj. Panel -0.4 47 Add for Clear Coat 0.2 48 Add for Inside 0.8 49 Repl RT Floor extn (HSS) 1 84.78 2.0 0.5 50 Overlap Minor Panel -0.2 51 * Rpr RT Rail extn (HSS) s 2_0 0.7 52 Overlap Minor Panel -0.2 53 * Rpr Spare tire panel 2.41- 4_0 1.4 54 Add for Clear Coat 0.3 55 Repl RT Rail end (HSS) 1 12.25 0.5 56 R&I Pkg tray trim LX, LX -P, SE gray Incl. N 57 * Rpr Pkg tray trim LX, LX -P, SE gray 0 58 Repl Rear panel trim 1 20.35 Incl. 59 R&I LT Trunk side trim Incl. 60 R&I Spare cover 0.1 N 61 * Rpr Package tray US built w/o woofer 0 5 0_8 62 Overlap Minor Panel -0.2 63 REAR SUSPENSION N 64 * Repl LKQ Susp crossmember +25% 1 543.75 m 4_0 M 65 Repl RT Stabilizer bar bushing 2.41- 1 2.92 66 Rep[ RT Stabilizer bar bracket 1 12.13 67 R &I R&I rear suspension both sides m 4.5 M 68 QUARTER PANEL 69 Repl RT Quarter panel US built 1 637.85 18.0 3.4 70 Overlap Major Adj. Panel -0.4 71 * Add for Clear Coat 0.6 72 Deduct for Overlap -1.5 73 Deduct for Rear Bumper R&I -0.9 74 Rep[ RT Gutter 1 128.16 2.0 0.5 75 Overlap Minor Panel -0.2 76 * Rpr LT Quarter panel US built 1_0 2.6 77 Overlap Major Adj. Panel -0.4 78 * Add for Clear Coat 0.4 79 # partial refinish deduction 1 -0.1 80 Repl RT Stone guard 1 2.27 Incl. 81 Repl LT Stone guard 1 2.27 0.2 82 Repl RT Splash shield 1 2.73 Incl. 83 R &I Pressure vent US built 0.2 84 R&I Fuel door 0.3 85 Blnd Fuel door 0.2 86 Rep[ RT Inner panel assy US built 1 442.63 s 8.5 1.6 87 * Add for Clear Coat 0.3 88 BACK GLASS 6/1/2012 12:11:43 PM 031557 Page 3 A l Estimate of Record Customer: PETERS, ALBERT C Vehicle: 2010 HOND ACCORD LX 4D SED 4- 2.4L -FI BLUE PRL 89 R&I Back glass Honda Incl. 90 Repi Dam lower 1 16.05 91 Repi RT Dam side 1 2.77 92 Repi LT Dam side 1 2.77 93 Repl Dam upper 1 3.17 94 # urathane kit 1 2100 95 PILLARS, ROCKER & FLOOR 96 * Rpr RT Outer rocker pn] US built s 1_0 1.5 97 Overlap Major Adj. Panel -0.4 98 * Add for Clear Coat 0.2 99 # chip guard coating 1 0.7 100 Bind RT Aperture panel US built s 2.0 101 R&I RT Opening trim rear, US built black 0.3 102 R &I RT Opening trim front, US built black 0.3 103 R&I RT Rear sill plate gray Incl. 104 R&I RT Front sill plate gray 0.2 105 REAR DOOR 106 R&I RT R&I door assy 1.0 107 * Rpr RT Outer panel (HSS) 0 2.0 108 Overlap Major Adj. Panel -0.4 109 * Add for Clear Coat 0.3 110 R&I RT Belt molding 0.3 111 R&I RT Upper molding 0.3 112 R&I RT Handle, outside painted, US built royal blue 0.4 113 R&I RT Striker Incl. 114 R &I RT R&I trim panel 0.3 115 R&I RT Water deflector 0.1 116 FRONT DOOR 117 Bind RT Outer panel (HSS) 1.0 118 R&I RT Belt molding 0.3 119 R&I RT R &I mirror 0.3 120 R&I RT Handle, outside painted, US built royal blue 0.4 121 R &I RT R&I trim panel 0.3 122 FRONT LAMPS 123 R &I RT Headlamp assy 0.5 124 R&I LT Headlamp assy 0.5 125 GRILLE 126 O/H front bumper 1.7 127 Repi Grille 1 90.23 Incl. 128 Repl Grille surround US built 1 136.52 Incl. N 129 * Rpr Emblem 0_1 130 R &I Emblem Incl. 131 R&I Sight shield US built 2.41- Incl. 132 Repl Grille clip 4 5.60 133 Rep] Sight shield clip #2 2 4.46 6/1/2012 12:11:43 PM 031557 Page 4 Estimate of Re cord Customer: PETERS, ALBERT C Vehicle: 2010 HOND ACCORD LX 4D SED 4- 2.4L -FI BLUE PRL 134 FRONT BUMPER 135 ** Repl RECOND Bumper cover 2.4L 1 292.00 Incl. 2.8 136 Add for Clear Coat 1.1 137 Repl RT Upper support 1 13.90 Incl. 138 Repl LT Upper support 1 13.90 Incl. 139 Repl Energy absorber 1 30.57 Incl. 140 * Repl Impact bar US built (UHS) 1 173.62 Incl. 1 141 AIR CONDITIONER & HEATER 142 ** Repl A/M Condenser 1 173.00 m 1.2 143 Evacuate & recharge m 1.4 144 Refrigerant recovery m 0.4 145 RADIATOR SUPPORT 146 * Rpr RT Side panel s 0_5 0_2 147 Overlap Minor Panel -0.2 148 * Rpr LT Side panel s 0 0.2 149 Overlap Minor Panel -0.2 150 * Rpr Upper tie bar US built s 1 0_.55 151 Overlap Major Non -Adj. Panel -0.2 152 HOOD 153 R&I Lock assy w/o anti -theft 0.3 154 ELECTRICAL 155 R&I Horn low note m 0.2 156 R&I Horn high note m 0.2 N 157 * Rpr Horn low note m 0_3 158 # corrosion protection 1 0.5 N 159 # mask off interior 1 0.5 160 # seam sealers 1 45.00 161 # flex agent 1 6.00 162 # sound deadening pad for quarter replacement 1 15.00 163 # denib & polish refinished panels 1 1.2 164 # Subl hazard waste removal 1 3.00 165 # 4 wheel alignment 1 69.95 166 # mechanical rate adjustment 8.5hrs X 25.00 per 1 212.50 hour SUBTOTALS 5,580.47 82.2 38.6 NOTES Line 2: PULL REAR RIGHT & LEFT RAILS, PULL RIGHT & LEFT FRONT RAILS. PULLER REAR UPPER BODY, PULL FRONT UPPER BODY. REPAIR TIME INCLUDES TO REALIGN FRONT SHEET METAL AND RIGHT SIDE DOORS. Line 29: RECYCLED PARTS SEARCHED AT: LKQ 250 152 SR250 PO BOX 250 HARRISVILLE OH 43974 800 -334 -9811 S / W KEN QOUTE# 776724 Line 57: HEAT AND RESHAPE, TRIM PANEL MAY NEED REPLACED Line 61: TIME TO REPAIR WELD LOCATIONS OF INNER QRT PANEL Line 64: RECYCLED PARTS SEARCHED AT: LKQ 250 152 SR250 PO BOX 250 HARRISVILLE OH 43974 800 - 334 -9811 S / W KEN QOUTE # 777488 Line 129: CLEAN MARKS FROM EMBLEM Line 157: STRAIGHTEN BRACKET Line 159: PROTECT INTERIOR FROM WELDING AND BODY REPAIR OPERATIONS 6/1/2012 12:11:43 PM 031557 Page 5 Estimate of Record Customer: PETERS, ALBERT C Vehicle: 2010 HOND ACCORD LX 4D SED 4- 2.4L -FI BLUE PRL Estimate Notes: RECYCLED PARTS SEARCHED AT: CHUCK'S AUTO SALVAGE 877- 877 -6699 S/W JAMES QOUTE# 216285 NO PARTS AVAIL RECYCLED PARTS SEARCHED AT : LKQ 250 152 SR250 PO BOX 250 HARRISVILLE OH 43974 800- 334 -9811 S / W KEN QOUTE3 776724 TRUNK ONLY / 777488 REAR CRADLE ONLY. NO OTHER PARTS AVAIL RECYCLED PARTS SEARCHED AT: NEW CLIMB. AUTO PARTS OLD YORK RD NEW CUMBERLAND PA 17070 717 - 774 -1190 53112 NO PARTS AVAIL ESTIMATE TOTALS Category Basis Rate Cost $ Parts 5,580.47 Body Labor 65.7 hrs @ $ 46.00 /hr 3,022.20 Paint Labor 38.6 hrs @ $ 46.00 /hr 1,775.60 Mechanical Labor 8.5 hrs @ $ 45.00 /hr 382.50 Frame Labor 8.0 hrs @ $ 50.00 /hr 400.00 Paint Supplies 1,000.00 Subtotal 12,160.77 Sales Tax $ 12,160.77 @ 6.0000% 729.65 Grand Total 12,890.42 Deductible 100.00 CUSTOMER PAY 100.00 INSURANCE PAY 12,790,42 611/2012 12:11:43 PM 031557 Page 6 n a Estimate of Record Customer: PETERS, ALBERT C Vehicle: 2010 HOND ACCORD LX 4D SED 4- 2.4L -FI BLUE PRL IF THE RESPONSIBLE PAYING PARTY IS NOT A DIRECT PAYING PARTY THROUGH OUR BUSINESS; YOU MUST PRESENT A COPY OF THEIR APPRAISAL AT THE TIME OF SCHEDULING YOUR REPAIRS,THIS INSURES US THAT PAYMENT IS AVAILABLE. IT ALSO RELIEVES YOU FROM PAYING OUT OF POCKET SUPPLEMENTAL CHARGES. (EXCLUDING DEDUCTIBLES AND /OR BETTERMENTS) WHEN LEAVING YOUR VEHICLE HERE FOR REPAIRS, WE AT THOMAS E. BROWN INC. ASK THAT YOU REMOVE ALL PERSONAL BELONGINGS FROM YOUR VEHICLE. WE ALSO NEED THE TRUNK/HATCH AREA TO BE FREE OF PERSONAL BELONGINGS AS WELL. WE ARE NOT RESPONSIBLE FOR ANY ITEMS LEFT BEHIND IN YOUR CAR. TOWED IN VEHICLES OR VEHICLES LEFT HERE THAT ARE DECLARED UNDRIVABLE MAY BE SUBJECT TO A $45.00 A DAY STORAGE FEE.STORAGE WILL APPLY TO ALL VEHICLES THAT ARE DECLARED A TOTAL LOSS. IF WE PERFORM THE REPAIRS, THIS CHARGE IS NOT APPLIED. TOWING FEE CHARGED ALSO WHEN APPLICABLE. MY SCHEDULED APPOINTMENT IS: I AM IN AGREEMENT WITH THE PRELIMINARY ESTIMATE THAT I HAVE RECEIVED FROM " THOMAS E. BROWN INC. ". I UNDERSTAND THAT IF I FAIL TO SHOW UP /CANCEL AN APPOINTMENT WHEN PARTS HAVE BEEN ORDERED FOR MY VEHICLE THIS INCLUDES TOTAL LOSSES AFTER REPAIRS HAVE BEGAN, I WILL BE RESPONSIBLE FOR ALL ASSOCIATED FEES AND RESTOCKING FEES OF ALL PARTS RETURNED. IF OTHER ARRANGEMENTS FOR AFTER HOUR PICK -UP ARE NEEDED; PAYMENT IS REQUIRED WHEN THE VEHICLE IS DROPPED OFF FOR REPAIRS. (BE SURE TO HAVE A SPARE KEY) WE REQUIRE PAYMENT IN FULL UPON DEPARTURE OF THE VEHICLE. THE ONLY EXCEPTION IS THE DIRECT REPAIR PROGRAM. (LESS THE DEDUCTIBLE & AUTHORIZATION SIGNATURE) LIMITED LIFETIME WARRANTY AS PER ALL ORIGINAL MANUFACTURES WRITTEN WARRANTIES ALL PAYMENTS MADE OTHER THAN INSURANCE CHECKS, PERSONAL CHECKS, CASH OR MONEY ORDERS WILL BE BILLED OUT AT THE CURRENT LABOR RATES POSTED ON THE WALL IN WAITING AREA. ANY NON DIRECT INSURANCE REPAIRS WILL BE BILLED OUT AT POSTED LABORS RATE IN WAITING AREA. Responsible Party: Print Signature LIMITED LIFETIME WARRANTY 6/1/2012 12:11:43 PM 031557 Page 7 Estimate of Record Customer: PETERS, ALBERT C Vehicle: 2010 HOND ACCORD LX 4D SED 4- 2.4L -FI BLUE PRL 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 THE PERSON TO CRIMINAL AND CIVIL PENALTIES. THE FOLLOWING IS A LIST OF ABBREVIATIONS OR SYMBOLS THAT MAY BE USED TO DESCRIBE WORK TO BE DONE OR PARTS TO BE REPAIRED OR REPLACED: D= DISCONTINUED PART A= APPROXIMATE PRICE B =BODY LABOR D= DIAGNOSTIC E= ELECTRICAL F =FRAME G =GLASS M= MECHANICAL P =PAINT LABOR S= STRUCTURAL T =TAXED MISCELLANEOUS X =NON TAXED MISCELLANEOUS ADJ= ADJACENT ALGN =ALIGN A/M= AFTERMARKET BLND =BLEND CAPA= CERTIFIED AUTOMOTIVE PARTS ASSOCIATION D &R= DISCONNECT AND RECONNECT EST = ESTIMATE EXT. PRICE =UNIT PRICE MULTIPLIED BY THE QUANTITY INCL= INCLUDED MISC= MISCELLANEOUS NON -ADJ =NON ADJACENT O /H= OVERHAUL OP= OPERATION NO =LINE NUMBER QTY = QUANTITY RECON D= RECONDITION REFN = REFINISH REPL= REPLACE R&I= REMOVE AND INSTALL R &R= REMOVE AND REPLACE RPR= REPAIR RT =RIGHT SECT = SECTION SUBL= SUBLET LT =LEFT W /O= WITHOUT W /_= WITH/_ #= MANUAL LINE ENTRY * =OTHER [IE..MOTORS DATABASE INFORMATION WAS CHANGED]. * *= DATABASE LINE WITH AFTERMARKET N =NOTES ATTACHED TO LINE NAGS = NATIONAL AUTO GLASS SPECIFICATIONS. MQVP= MANUFACTURER'S QUALITY AND VALIDATION PROGRAM.OPT OEM = ORIGINAL EQUIPMENT MANUFACTURER PARTS EITHER OPTIONALLY SOURCED OR OTHERWISE PROVIDED WITH SOME UNIQUE PRICING OR DISCOUNT. THE ATTACHED ESTIMATE REPRESENTS AN APPRAISAL OF THE COST OF REPAIR FOR THE VISIBLE DAMAGE TO THE VEHICLE NOTED AT THE TIME OF INSPECTION NECESSARY TO RETURN THE VEHICLE TO ITS PREDAMAGED CONDITION. COSTS ABOVE THE APPRAISED AMOUNT MAY BE THE RESPONSIBILITY OF THE VEHICLE OWNER. THERE IS NO REQUIREMENT THAT THE VEHICLE OWNER USE ANY SPECIFIED REPAIR SHOP. INFORMATION REGARDING REPAIR FACILITIES WHICH WILL BE ABLE TO REPAIR THE VEHICLE FOR THE APPRAISED AMOUNT IS AVAILABLE FROM THE INSURANCE COMPANY. IF USED PARTS ARE SPECIFIED, THEY ARE REQUIRED TO BE OF LIKE KIND AND QUALITY TO THOSE BEING REPLACED. INCIDENTAL CHARGES SUCH AS TOWING, PROTECTIVE CARE, CUSTODY, STORAGE, DEPRECIATION, BATTERY AND TIRE REPLACEMENT ARE NOTED WHEN APPLICABLE. Estimate calculated using a preset user threshold amount for the paint and material cost. 6/112012 12:11:43 PM 031557 Page 8 • A Estim of Record Customer: PETERS, ALBERT C Vehicle: 2010 HOND ACCORD LX 4D SED 4- 2.4L -FI BLUE PRL Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from the Guide ARG4443, CCC Data Date 5/16/2012, and the parts selected are OEM -parts manufactured by the vehicles Original Equipment Manufacturer. OEM parts are available at OE /Vehicle dealerships. OPT OEM (Optional OEM) or ALT OEM (Alternative OEM) parts are OEM parts that may be provided by or through alternate sources other than the OEM vehicle dealerships. OPT OEM or ALT OEM parts may reflect some specific, special, or unique pricing or discount. OPT OEM or ALT OEM parts may include "Blemished" parts provided by OEM's through OEM vehicle dealerships. Asterisk ( *) or Double Asterisk ( * *) indicates that the parts and /or labor information provided by MOTOR may have been modified or may have come from an alternate data source. Tilde sign ( —) items indicate MOTOR Not - Included Labor operations. The symbol (< >) indicates the refinish operation WILL NOT be performed as a separate procedure from the other panels in the estimate: Non - Original Equipment Manufacturer aftermarket parts are described as AM. Used parts are described as LKQ, RCY, or USED. Reconditioned parts are described as Recond. Recored parts are described as Recore. NAGS Part Numbers and Benchmark Prices are provided by National Auto Glass Specifications. Labor operation times listed on the line with the NAGS information are MOTOR suggested labor operation times. NAGS labor operation times are not included. Pound sign ( #) items indicate manual entries. Some 2012 vehicles contain minor changes from the previous year. For those vehicles, prior to receiving updated data from the vehicle manufacturer, labor and parts data from the previous year may be used. The CCC ONE estimator has a complete list of applicable vehicles. Parts numbers and prices should be confirmed with the local dealership. The following is a list of additional abbreviations or symbols that may be used to describe work to be done or parts to be repaired or replaced: SYMBOLS FOLLOWING PART PRICE: m =MOTOR Mechanical component. s =MOTOR Structural component. T= Miscellaneous Taxed charge category. X= Miscellaneous Non -Taxed charge category. SYMBOLS FOLLOWING LABOR: D= Diagnostic labor category. E= Electrical labor category. F =Frame labor category. G =Glass labor category. M= Mechanical labor category. S= Structural labor category. (numbers) 1 through 4 =User Defined Labor Categories. OTHER SYMBOLS AND ABBREVIATIONS: Adj.= Adjacent. Algn.= Align. ALU= Aluminum. A/M= Aftermarket part. Blnd= Blend. BOR =Boron steel. CAPA= Certified Automotive Parts Association. D &R= Disconnect and Reconnect. HSS =High Strength Steel. HYD= Hydroformed Steel. Incl.= Included. LKQ =Like Kind and Quality. LT =Left. MAG= Magnesium. Non -Adj. =Non Adjacent. NSF =NSF International Certified Part. O /H= Overhaul. Qty= Quantity. Refn= Refinish. Repl= Replace. R&I= Remove and Install. R &R= Remove and Replace. Rpr= Repair. RT= Right. SAS = Sandwiched Steel. Sect= Section. Subl= Sublet. UHS =Ultra High Strength Steel. N= Note(s) associated with the estimate line. CCC ONE Estimating - A product of CCC Information Services Inc. The following is a list of abbreviations that may be used in CCC ONE Estimating that are not part of the MOTOR CRASH ESTIMATING GUIDE: BAR = Bureau of Automotive Repair. EPA= Environmental Protection Agency. NHTSA= National Highway Transportation and Safety Administration. PDR= Paintless Dent Repair. VIN = Vehicle Identification Number. 6/1/2012 12:11:43 PM 031557 Page 9 Estimate of Record Customer: PETERS, ALBERT C Vehicle: 2010 HOND ACCORD LX 4D SED 4- 2.4L -FI BLUE PRL ALTERNATE PARTS SUPPLIERS Supplier: Keystone - Complete - Windber Location(s): 320 DOBSON STREET, WINDBER PA 15963 (800) 438 -2510 (814) 467 -5531 1709 7TH STREET, PARKERSBURG WV 26101 (800) 696 -3064 3658 ROUTE 378, BETHLEHEM PA 18015 (800) 441 -4200 (610) 866 -0313 275 CROSS FARM LANE, YORK PA 17406 (800) 524 -4349 (717) 843 -8927 433 LAWRENCE STREET, OLD FORGE PA 18518 (800) 446 -7066 (570) 457 -6464 1435 TRIPLETT BLVD, AKRON OH 44306 (800) 822 -5555 (216) 398 -7788 615 ALPHA DRIVE REAR, PITTSBURGH PA 15238 (800) 445 -5215 (724) 339 -1800 901 W. 12TH STREET, ERIE PA 16501 (814) 459 -1300 (888) 566 -7844 Line Description Item # Price 5 RECOND Bumper cover 2.41- HO1100246R $ 292.00 135 RECOND Bumper cover 2.41- HO1000254R $ 292.00 Supplier: Performance Radiator -PA2 Location(s): 4322 BERMUDA STREET, PHILADELPHIA PA 19124 (877) 723 -4286 (215) 333 -1610 Line Description Item # Price 142 A/M Condenser 3538 $ 173.00 6/1/2012 12:11:43 PM 031557 Page 10 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. Benjami .Lawrence Date ���� `�`� SHERIFF'S OFFICE OF CUMBERLAND COUNTY Ronny R Anderson ] �� i j� Sheriff i F,` PRO P-1 .'i , xsxtt u� 'a �tai�frrrt �J Jody S Smith Chief Deputy }� ~ 20 Richard W Stewart CUMBERLAND COUNTY Solicitor PENNSYLVANIA State Farm Mutual Auto Insurance vs. Case Number Najib Bourassi 2014-2557 SHERIFF'S RETURN OF SERVICE 04/28/2014 06:56 PM- Deputy Jason Kinsler, being duly sworn according to law, served the requested Complaint& Notice by handing a true copy to a person representing themselves to be Hajer Bouakka,Wife,who accepted as"Adult Person in Charge"for Najib Bourassi at 407 Beaver Avenue,Apt. B, East Pennsboro, Enola, PA 17025. JASON IN9CE-yR, DEPUTY SHERIFF COST: $45.44 SO ANSWERS, April 29, 2014 RONR ANDERSON, SHERIFF Joseph R. D'Annunzio, Esquire I.D. No. 23384 4309 Linglestown Road, Suite 211, Harrisburg, PA 17112 (717) 901-5002 Fax: (717) 901-5012 Attorney for Defendant, Najib Bourassi vim, y• ��� ECJ •�-+•C�. -4 yip+ IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA State Farm Mutual Insurance Company Plaintiff v. Najib Bourassi, NO. 14-2557 CIVIL ACTION - LAW JURY TRIAL DEMANDED Defendant PRAECIPE TO ENTER APPEARANCE TO THE PROTHONOTARY: Kindly enter my appearance on behalf of Defendant, Najib Bourassi, in the above -captioned matter. y C Date: $c/ Lt, j,/4 LAW OFFICE OF JOSEPH R. D'ANNUNZIO BY:, 1 2' V Joseph R. D'Annunzio, Esquire Attorney for Defendant CERTIFICATE OF SERVICE I hereby certify that I am this day serving a copy of the foregoing document upon the person(s) and in the manner indicated below, which service satisfies the requirements of the Pennsylvania Rules of Civil Procedure, by depositing a copy of same in the United States Mail, first-class postage prepaid, addressed as follows: Benjamin Lawrence, Esq. Weltman, Weinberg & Reis, Co., L.P.A. 325 Chestnut Street Suite 501 Philadelphia, PA 19106 Date: `5/aI)1L1 Krly Stielper BY: Joseph R. D'Annunzio Law Office of Joseph R. D'Annunzio Identification No. 23384 4309 Linglestown Road, Suite 211 Harrisburg, PA 17112 (717) 901-5002 (717) 901-5012 (Fax) jdannunzio@geico.com Attorney for Defendant, Najib Bourassi IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA STATE FARM MUTUAL INSURANCE COMPANY, Plaintiff NO. 14-2557 v. CIVIL ACTION - LAW NAJIB BOURASSI, JURY TRIAL DEMANDED Defendant NOTICE TO PLEAD TO: State Farm Mutual Auto Ins Company c/o Benjamin Lawrence, Esquire Weltman, Weinberg & Reis, Co., L.P.A. 325 Chestnut Street Suite 501 Philadelphia, PA 19106 You are hereby notified to file a written response to the enclosed Answer and New Matter of Defendant to Plaintiff s Complaint within twenty (20) days from service hereof or a default judgment may be entered against you. Date: A/4y 2Aict LAW OFFICE OF JOSEPH R. D'ANNUNZIO By: Joseph R. D'Annunzio, Esquire Attorney for Defendant, Najib Bourassi BY: Joseph R. D'Annunzio Law Office of Joseph R. D'Annunzio Identification No. 23384 4309 Linglestown Road, Suite 211 Harrisburg, PA 17112 (717) 901-5002 (717) 901-5012 (Fax) jdannunzio@geico.com Attorney for Defendant, Najib Bourassi IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA STATE FARM MUTUAL INSURANCE COMPANY, Plaintiff NO. 14-2557 v. CIVIL ACTION - LAW NAJIB BOURASSI, JURY TRIAL DEMANDED Defendant ANSWER AND NEW MATTER OF DEFENDANT, NAJIB BOURASSI, TO PLAINTIFF'S COMPLAINT 1. Admitted only upon information and belief. 2. Admitted. 3. After reasonable investigation, the answering Defendant is without knowledge or information sufficient to form a belief as to the truth of the averments set forth in this paragraph. Accordingly, the averments are deemed denied and strict proof is demanded. 4. Admitted only that on or about May 26, 2012 the Defendant was involved in a motor vehicle collision with a vehicle that was located on Carlisle Pike in Silver Spring, Pennsylvania. The remaining averments are deemed denied as conclusions of law. 5. Denied as conclusions of law to which no responsive pleading is required. 6. Denied that the Defendant was negligent or that his conduct in any way caused or contributed to any injuries or damages allegedly sustained by the Plaintiff. To the contrary, the Defendant exercised due and reasonable care. After reasonable investigation, the answering Defendant is without knowledge or information sufficient to form a belief as to the truth of the averments set forth in this paragraph regarding injuries and damages. Accordingly, the averments are deemed denied and strict proof is demanded. 7. Denied as a conclusion of law to which no responsive pleading is required. By way of further answer, after reasonable investigation, the answering Defendant is without knowledge or information sufficient to form a belief as to the truth of the averments set forth in this paragraph. Accordingly, the averments are deemed denied and strict proof is demanded. WHEREFORE, Defendant, Najib Bourassi demands that judgment be entered in his favor. NEW MATTER 8. The answers to paragraphs 1 through 7 of Plaintiffs Complaint are incorporated by reference as if fully set forth herein. 9. On or about May 26, 2012, Defendant Najib Bourassi was operating a motor vehicle and traveling on Carlisle Pike in Silver Spring Township, Cumberland County, Pennsylvania. 10. As the Defendant approached a traffic control signal, he saw that traffic was blocked in front of him waiting for the signal to change. 11. The Defendant applied his brakes in order to stop his vehicle but his brakes failed and locked up, causing the vehicle operated by the Defendant to strike a vehicle in front of it. It is believed that the vehicle struck by the Defendant's vehicle was the vehicle insured by State Farm Mutual Insurance Company. 12. The proximate cause of the collision and the damages allegedly sustained by the State Farm's insured was the conduct of third parties over whom the Defendant had no control or ability to control. 13. The Plaintiff has failed to state a claim for which relief can be granted, in that the Plaintiff has never identified its insured in the pleadings. 14. The Plaintiff's Complaint failed to state a cause of action. WHEREFORE, Defendant, Najib Bourassi, demands that judgment be entered in his favor and against the Plaintiff. Date: MPJ -/ )^1“t1 Respectfully submitted, By: Joseph R. D'Annunzio, Esquire Attorney for Defendant, Najib Bourassi VERIFICATION I, Najib Bourassi, hereby state that I am the Defendant in this action, and verify that the statements made in the foregoing document are true and correct to the best of my knowledge, information and belief. The undersigned understands that the statements therein are made subject to the penalties of 18 Pa. C.S.A. Section 4904 relating to unsworn falsification to authorities. Date: -,20. 1J- NAJIB BOURASSI BY: Joseph R. D'Annunzio Law Office of Joseph R. D'Annunzio Identification No. 23384 4309 Linglestown Road, Suite 211 Harrisburg, PA 17112 (717) 901-5002 (717) 901-5012 (Fax) jdannunzio@geico.com Attorney for Defendant, Najib Bourassi IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA STATE FARM MUTUAL INSURANCE COMPANY, Plaintiff NO. 14-2557 v. : CIVIL ACTION - LAW NAJIB BOURASSI, JURY TRIAL DEMANDED Defendant CERTIFICATE OF SERVICE I, Kimberly Stielper, do hereby certify that on this c) -l` day of , 2014, I caused a true and correct copy of Defendant, Najib Bourassi's, Answer and New Matter Addressed to Plaintiff, State Farm Mutual Auto Ins Company, to be served upon the following person listed below via first class United States mail, postage prepaid: Benjamin Lawrence, Esquire Weltman, Weinberg & Reis, Co., L.P.A. 325 Chestnut Street Suite 501 Philadelphia, PA 19106 LAW OFFICE OF JOSEPH R. D'ANNUNZIO BY: Kimberly Stieljser, Legal Secretary WELTMAN, WEINBERG & REIS CO., L.P.A. BY: Benjamin W. Lawrence, Esquire I.D. No. 209032 325 Chestnut Street, Suite 501 Philadelphia, PA 19106 Phone: 215.599.1500 Fax: 215.599.1505 File # 20447610 478/4y Attorney for Plaintiff JO/ / STATE FARM MUTUAL AUTOMOBILE INS. CO., Plaintiff vs. NAJIB BOURASSI Defendants Cumberland County Court of Common Pleas Civil Division No. 14-2557 PLAINTIFF'S REPLY TO DEFENDANT'S NEW MATTER 8-14. Denied. Defendant's averment is a conclusion of law to which no responsive pleading is required. As way of further response, after reasonable investigation Plaintiff is without sufficient information to form a belief as to the truth or falsity of Defendant's averments. Strict proof is therefore required at time of trial. WHEREFORE, Plaintiff demands that judgment be entered in its favor and against Defendant. WELTMAN, WEINBERG & REIS CO., L.P.A. By Benjamin W. Lawrence, Esquire Attorney for Plaintiff VERIFICATION I, Benjamin W. Lawrence, Esquire, attorney for the Plaintiff(s) do hereby swear and affirm that the averments in the attached Reply to New Matter 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. Benjamin W. Lawrence, Esq. Date �� Pd IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA State Farm Mutual Automobile Insurance Company . Plaintiff VS Najib Bourassi : No. 14 2557 CIVIL TERM Lr -T' G1 _- T ... Defendant c., -,~ • RULE 1312-1 The Petition for Appointment of Arbitrators shall be substantially in t1.19-4.).7,-.7. --1 -- following form: M.. _G THE PETITION FOR APPOINTMENT OF ARBITRATORSt; A r C 7:::, .--i -g ..0 TO THE HONORABLE, THE JUDGES OF SAID COURT: -4. Benjamin W Lawrence , counsel for the plaintiff/defendant in the above action (or actions), respectfully represents that: 1. The above -captioned action (or actions) is (are) at issue. 2. The claim of plaintiff in the action is $14,929.71 The counterclaim of the defendant in the action is The following attorneys are interested in the case(s) as counsel or are otherwise disqualified to sit as arbitrators: WHEREFORE, your petitioner prays your Honorable Court to appoint three (3) arbitrators to whom the case shall be submitted. Respectfully submitted, ORDER OF COURT AND NOW, , 20 , in consideration of the foregoing petition, Esq., and Esq., and .Esq., are appointed arbitrators in the above captioned action (or actions) as prayed for. 'By the Court, KEVIN A. HESS, P.J. cuu.k sD9.`°Pa 3ugi IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA State Farm Mutual Automobile Insurance Company . Plaintiff VS Najib Bourassi Defendant RULE 1312-1 following form: N0.14 2557 CIVIL TERM The Petition for Appointment of Arbitrators shall be substantially in the, THE PETITION FOR APPOINTMENT OF ARBITRATORS TO THE HONORABLE, THE JUDGES OF SAID COURT: Benjamin W Lawrence , counsel for the plaintiff/defendant in the above action (or actions), respectfully represents that: 1. The above -captioned action (or actions) is (are) at issue. 2. The claim of plaintiff in the action is $ 14,929.71 The counterclaim of the defendant in the action is The following attorneys are interested in the case(s) as counsel or are otherwise disqualified to sit as arbitrators: (-) �a P WHEREFORE, your petitioner prays your Honorable Court to appoint three (3) arbitratomrtf . cp whom the case shall be submitted. z x (1) N D © /17 D r> o ➢ � 9? -- < <x> Respectfully submitted, ORDER OF COURT AND NOW, %,yP_ATIA.PAI 026 , 20/1(, in consideration of the foregoing �. • Esq., and 9-1//t Esq., are appointed arbitrators in the above captioned action (or actions) as prayed for. Wei) ee,' ToseAX ,T. (� ��hui ZIO 4© ma ./e/ ,' By the Court KEVIN A. SS, P.J. 41:4,44, c s ao.So pa Clc 'Wit3Cs4 �k 31 SLi 1