CC SR 20200505 D - Claim Against the City Dao-Pickard
RANCHO PALOS VERDES CITY COUNCIL MEETING DATE: 05/05/2020
AGENDA REPORT AGENDA HEADING: Consent Calendar
AGENDA DESCRIPTION:
Consideration and possible action regarding a claim against the City by Sara Dao-
Pickard.
RECOMMENDED COUNCIL ACTION:
1) Reject the claim and direct Staff to notify the claimant.
FISCAL IMPACT: None
Amount Budgeted: N/A
Additional Appropriation: N/A
Account Number(s): N/A
ORIGINATED BY: Emily Colborn, City Clerk
REVIEWED BY: Megan Barnes, Senior Administrative Analyst
APPROVED BY: Ara Mihranian, AICP, City Manager
ATTACHED SUPPORTING DOCUMENTS:
A. Sara Dao-Pickard claim (page A-1)
BACKGROUND AND DISCUSSION:
The claimant alleges that her vehicle sustained damaged from a falling tree limb while
parked on Deep Valley Drive. The alleged incident occurred on December 15, 2019.
The City’s Claims Administrator, Carl Warren and Company, has reviewed the claim
and advised the City to reject it due to the determination that tree standards for trimming
were met and the records established proved the tree to be in good health.
1
(Page 1 of 2)
D ~ ~j ~ W!f(jl ~EB 2 8 2020 IU:dJ
For Official Use Only
POSTMARK DATE IF MAILED
CITY OF ROLLiNG H!LLS ESTATES
CITY OF ROLLING HILLS ESTATES
GOVERNMENT CLAIM (Per Government Sec. 910 . .4)
Sara Dao-Pickard
Name of Claimant Age
Mailing Address
E-Mail Address
City
CLAIMANT
Home Telephone Work Telephone
State Zip Code
Send notices r egarding this claim to
(If different than name ;~nd address above)
CLAIM INFORMATION
Date· of Incident (Month/Day/Year): _1_21_1_51_1_9 ____ _ Time of Incident: 3:48pm
Location: In front of Promenade Ice Chalet-550 Deep Valley Dr #107, Rolling Hills, CA 90274
Describe injury, damage or loss that occurred as a result of this incident: After I parked the car ,
a de ad tree branch fell on the back of my car, which b ro ke the back glass, the speaker, and damages around the area.
--------------~--------------------------------------
State the circumstances that gave rise to this claim. (State facts that support your claim and
what particular action by the City or its employees, caused the alleged injury, damage loss.
Include names of employees, if known). Please attach additional pages, if needed.
Due to the dead/broken branch falling on the car causing the damages, the damages
needed to be repai red .
Amount of damage to date: 500
Estimated amount of future damages : -------
TOTAL amount claimed: 500
1
A-1
· (Page 2 of 2)
NAMEoFciAIMANTSara Dao-Pickard
••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••
State how the amount of the claim was computed {Include copies of supporting
documentation such as estimates, Invoices, billing statements and receipts):
My deductible, which was paid, was $500. Please see invoice from repair shop and
receipts for the payments totaling to $500.
List the names of all witnesses to this incident, including address and phone numbers:
Jonathan Pickard, Spouse. Same address.
Provide any additional information that might be helpful in considering this claim:
See pictures of the damages with the dead/broken branch. The car was parked on the
street, on city property. There were no restrictions on the parking spot.
REPRESENTATIVE INFORMATION
(Complete only if claim is presented by someone acting on claimant's behalf}
Name of Authorized Representative Telephone
City State Zip Code
Representative
;/>a,b-e;
Date
-----------------------------------------------------Please note, a claim must be filed within 180 days after the incident or occurrence. It Is a criminal
offense to file a false claim: {PENAL CODE SECTION 72; INSURANCE CODE SECfiON 556.1).
DELIVER OR MAIL ClAIM TO:
City of Rolling Hills Estates
Attention: Risk Manager
4045 Palos Verdes Drive North
Rolling Hills Estates, CA. 90274
2.
A-2
o l HJ :
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· .. -C""'rt"'!. ' ~-~. :. ,,.,. ~::1 ·.\.J ti"t ·~
A-3
01/28/2020
CALIBER COLLISION 1067
1634 W ANAHEIM ST
HARBOR CITY, CA 90710
CREDIT CARD
AMEX SALE
15:58:20
Card#
Chip Card: AMERICAN EXPRESS
AlD:
SEQ#:
Batch#:
INVOICE
Approval Code:
Entry Method:
Mode:
SALE AMOUNT
: · .. -··: .
..... ' .. : : ·, ...
. • ... ·. • ... ·.·.·· ... ·:1067003386 · ..
. . · ~ U §§~Qi~·
··••·· .. ··.:ChiP .•:•Read·
.. · · .·:·rssuer
:-' ' : . . . ~ ' . : . . : . _· ' . -'
Restoring The Rhythm Of Your Life
CUSTOMER COPY 2-I 2-
A-4
Clty of Rolllng Hllls Est 310-377-4468 p.1
For Official Use Only
POSTMARK DATE IF MAILED
CITY OF ROlLING HlllS ESTATES
GOVERNMENT ClAIM {Per Government Sec. 910.4)
ClAIMANT
GEICO A/S/0 Sara Pickard N/A 858-513-5433
Name of Claimant Age Home Telephone Work Telephone
PO BOX: 509119 San Diego CA 92150
Mailing Address CitY State Zip Code
FAX: 619-819-1004 with attention to claim number: 0477368030101040
.E-Mail Address Send notices regarding this claim to
(If different than name and address above)
ClAIM INFORMATION
Date of Incident {Month/Day/Year): _12_1 1_s_12_o1_9~-----Time of Incident: 3:4 aPM
lot:ation; _ln_f_ro_n_t o_f_P_ro_m_e_na_d_e_lc_e_C_h_al_et_. s_s_o_o_e_ep_V_a_ue_y_D_r_. #-1-07_,_R_ol-11n_g_H-il-ls_, c_A_9_0-27_4 _____ _
Describe injurv~ damage or loss that occurred as a result of this incident: After our Insured parked
their vehicle a dead tree branch fell on the back of the vehicle. There was damage to the window and around the area.
-··--·----------~-----------------------~------------
State the circumstances that gave rise to this claim. (~tate facts that support your claim and
what particular action by the City or its employees, caused the alleged injury, damage loss.
Include names of employees, if krsown}. Please attach additional pages1 if needed.
Amount of damage to date: $3,485.33
Estimated amount of future damages: -------
TOTAL amount claimed: $3,485.33
Claim #0477368030101040
1
A-5
C ity of Rolling Hills Est 31 0-3 77-4468
NAME OF CLAIMANT GEICO AIS/0 Sara Pickard
State how the amount of the claim was computed (include copies of supporting
documentation such as estimates, invoices, billing statements and receipts):
Please see attached estimate and photos.
List the names of all w itnesses to th is incident, including address and phone numbers:
Jonathan Pickard , Insured's spouse.-
Provide any additional information that might be helpful in considering this claim;
REPRESENTATIVE INFORMATION
(Complete only if claim is presented by someone acting on claimant's behalf)
Subrogation Adjuste r: Weston Andrew , Ph 858-513-5433
Claim Number: 0477368030101040 --------------------------------Name of Author ized Representative Telephone
PO BOX: 509119 San Diego CA 92150
Mailing Address City State Zip Code
p.2
dh~/o-od-0
7 Date Signature of Claimant or Authorized Representative
---------~-------------------------------------------
Please note, a claim must be filed within 180 days after the incident or occurrence, It is a criminal
offense to file a false claim: (PENAL CODE SECTION 7Z; INSURANCE CODE SECTION 556.1).
DELIVER OR MAIL CI.AIM TO:
City of Rolling Hills Estates
Attention: Risk Manager
4045 Palos Verdes Drive North
Rolling Hills Estates, CA. 90274
2
Cla im #0477368030101040
A-6
II Government Employees Insurance Company
II GEICO Indemnity Company
II GEICO General Insurance Company
II GEICO Casualty Company
Regional Office: GEICO • Box 509119 • San Diego, CA 92150-9119
February 25, 2020
PAYMENT RECOVERY NOTICE
City of Rolling Hills Estates
Attention: Risk Manager
4045 Palos Verdes Drive North
Rolling Hills Estates, CA 90274
Date of Loss:
Our Insured:
Our Claim#:
12/15/2019
Sara Dao Pickard
0477368030101040
Company: Government Employees Insurance Company
Our investigation reveals The City of Rolling Hills Estates to be 100% responsible for our insured's
damages. Repairs, total loss settlement or supplemental damages have been paid. Our itemization of
damages is as follows:
Repairs:
Rental:
Deductible:
Tow:
Supplement:
Salvage:
TOTAL:
$2,436.20
$1,049.13
( )
$3,485.33
Insured's out of pocket expense:
Please handle OOP directly with our· insured.
Please mail the check to: Government Employees Insurance Company
PO Box 509119
San Diego, CA 92150
Please reference our claim number on your check. If we fail to receive your payment or response to
this demand within 45 days we will file in Arb Forums or make a referral to counsel for possible
litigation.
Sincerely,
Weston Andrew
Payment Recovery Unit
858-513-5433
A-7
A-8
A-9
(Page 1 o£ 4l
Claim Number :0477368030101040-01
Version :S02
Image FileName :PHOT037
Image Label :Photo 27
Insured :Pickard, Sara
Policy Number····
Claimant :Pickard, Sara
Year :2009
Make :Honda
Model :Accord Sedan EX-L Automatic PZEV
VIN
Loss Date :12/15/2019
Appraiser :CALIBER-LOMITA
Photo Added Date :01/08/2020
A-10
(Page 2 of 4)
Claim Number :0477368030101040-01
Version :S02
Image FileName :PHOT038
Image Label :Photo 25
Insured :Pickard, Sara
Policy Number······
Claimant :Pickard, Sara
Year :2009
Make :Honda
Model :A=rd Sedan EX-L Automatic PZEV
VIN·····
Loss Date :12115/2019
Appraiser :CALIBER· LOMITA
Photo Added Date :12/30/2019
A-11
(Page 3 of 4)
Claim Number :0477368030101040-01
Version :802
Image FileName :PHOT039
Image Label :Photo 26
Insured :Pickard, Sara
Policy Number-
Claimant :Pickard, Sara
Year :2009
Make :Honda
Model :A=rd Sedan EX-L Automatic PZEV VIN········ Loss Date : 12/15/2019
Appraiser :CALIBER-LOMITA
Photo Added Date :01/08/2020
A-12
(Page 4 of 4)
Claim Number :0477368030101040-01
Version :S02
Image FileName :PHOT040
Image Label :Photo 24
Insured :Pickard, Sara
Policy Number·····
Claimant :Pickard, Sara
Year:2009
Make :Honda
Model :Accord Sedan EX-L Automatic PZEV
VIN····-
Loss Date :12/15/2019
Appraiser :CALIBER-LOMITA
Photo Added Date :12/30/2019
A-13
(Page 1 of 9)
RO Number: 1067003386
Insured: Pickard, Sara
Type of Loss: Comprehensive
Point of Impact: 06 Rear
Owner:
Pickard, Sara
CALIBER-LOMITA
RESTORING THE RHYTHM OF YOUR UFE
1634 W Anaheim St, Harbor City, CA 90710
Phone: (310) 326-0568
FAX: (310) 539-2989
Supplement of Record 2 with Summary
Written By: John Roumdikian, l/28/2020 1:42:20 PM
Adjuster: CMAW
Workfile ID:
Federal ID:
State EPA:
512989cc
33-0728858
CAL000471020
Pol'lcy#: -Cla'1m #: 0477368030101040-01
Date of Loss: 12/15/2019 4:00 PM
Inspection Location:
CALIBER -LOMITA
1634 W Anaheim St
Harbor City, CA 90710
Repair Facility
(310) 326-0568 Business
VEHICLE
Days to Repair: 8
Insurance Company:
GEICO
04
SAN DIEGO
2009 HOND Accord Sedan EX-L Automatic PZEV 4D SED 6-3.5L Gasoline MPFI Black
VIN: Interior Color: Black Mileage In: 125,387 Vehicle Out: 1/14/2020
License: Exterior Color: Black Mileage Out:
State: CA Production Date: 9/2008 Condition: Good Job#:
TRANSMISSION TELESCOPIC WHEEL CD CHANGER/STACKER POWER BRAKES
ALJTOMATIC TRANSMISSION STEERING WHEEL TOUCH AUXILIARY AUDIO CONNECTION ANTI-LOCK BRAKES (4)
CONTROLS
OVERDRIVE CONSOLE/STORAGE SATELLITE RADIO GLASS & MIRRORS
DRIVER CONVENIENCE INSTRUMENT PANEL ROOF DUAL MIRRORS
KEYLESS ENTRY TRACTION CONTROL ELECTRIC GLASS ROOF SEATS
MESSAGE CENTER STABILITY CONTROL SAFETY LEATHER SEATS
POWER DRIVER SEAT ALARM DRIVERS SIDE AIR BAG BUCKET SEATS
POWER WINDOWS AIR CONDmONING PASSENGER AIR BAG POWER PASSENGER SEAT
POWER LOCKS CLIMATE CONTROL FRONT SIDE IMPACT AIR BAGS HEATED SEATS
POWER MIRRORS REAR DEFOGGER HEAD/CURTAIN AIR BAGS WHEELS
HEATED MIRRORS RADIO PAINT 4-WHEEL DISC BRAKES
POWER TRUNK/GATE RELEASE AM RADIO CLEARCOAT PAINT ALUMINUM/ALLOY WHEELS
CRUISE CONTROL FM RADIO FRONT END
INTERMmENT WIPERS STEREO FOG LAMPS
TILT WHEEL SEARCH/SEEK POWER STEERING
1/28/2020 1:42:20 PM 315271 Page 1
A-14
(Page 2 of 9)
Supplement of Record 2 with Summary
RO Number: 1067003386
2009 HOND Accord Sedan EX-L Automatic PZEV 4D SED 6-3.5L Gasoline MPFI Black
line Oper Description Part Number Qty Extended Labor Paint
Price$
1 CONSOLE
2 R&I R&I console assy 0.7
Note: For access to clean
3 SEATS & TRACKS
4 R&I R&I rear seat as an assy 0.4
Note: For access to dean glass underside
5 Rep I RT Headrest, outer EX-L, SE black 82140TA5A71ZA 220.37 0.1
6 Rep I LT Headrest, outer EX-L, SE black 82140TA5A71ZA 1 220.37 0.1
7 R&I RT R&I front seat 0.4
Note: For access to clean glass underside
8 R&I L T R&I front seat 0.4
Note: For access to clean underside
9 ROOF
10 R&I L T Roof molding 0.4
11 # SOl Blend L Roof Rail 0.3
12 R&I R&I headliner 2.5
Note: For access to clean glass inside headliner
13 R&I RT Roof molding 0.4
14 # SOl Blend L Roof Rail 1 0.3
15 502 Rep I RT Roof molding retainer #3 73156TAOA01 3 10.35
16 S02 Rep I RT Roof molding retainer #2 73155TAOA01 6 19.62
17 S02 Repl RT Roof molding retainer #1 73154TAOA01 6 19.62
18 S02 Rep I RT Roof molding retainer #4 73157TAOA01 3 10.35
19 S02 Repl RT Roof molding clip #3 91570TA5A01 1 0.75
20 S02 Repl LT Roof molding clip #3 91570TA5A01 1 0.75
21 502 Rep I RT Roof molding clip #2 91571TA5A01 3 3.54
22 502 Rep I LT Roof moldinQ clip #2 91571TA5A01 3 3.54
23 PILLARS, ROCKER & FLOOR
24 R&I RT Upr ctr plr trim gray 0.3
25 R&I L T Upr ctr plr trim gray 0.3
26 R&l RT Lwr ctr plr trim black 0.3
27 R&l LT Lwr ctr plr trim black 0.3
28 R&I RT Rear sill plate black 0.2
29 R&I LT Rear sill plate black 0.2
30 R&I RT Front sill plate black 0.2
31 R&I LT Front sill plate black 0.2
32 R&I RT Wndshld plr trim gray 0.2
33 R&I LT Wnds~ldplrtrirl1 gray 0.2
34 BACK GLASS
35 502 Rep I Dam upper 73225TAOAOO 1 4.68
36 Rep! Dam lower 73227TAOAOO 1 22.12
37 502 Rep I RT Dam side 73226TAOAOO 1 4.25
38 502 Rep I LT Dam side 73226TAOAOO 1 4.25
1/28/2020 1:42:20 PM 315271 Page 2
A-15
(Page 3 of 9)
Supplement of Record 2 with Summary
RO Number: 1067003386
2009 HOND Accord Sedan EX-L Automatic PZEV 40 SED 6-3.5L Gasoline MPFI Black
39 # S02 Rep I Urethane Kit
40 ----~~ ~~~IJI .~~~.9.~~~ NA,~?
41 QUARTER PANEL
42 * SOl Rpr LT Quarter panel
43 Add for Clear Coat
44 # Base coat reduction
45 R&I Fuel door
46 Bind Fu el door
47 Repl RT Qtr pillar trim gray
48 * Rpr RT Quarter panel
49 Overlap Major Adj. Panel
50 Add for Clear Coat
51 # Base coat reduction
.. -····--··-"····-···~---
52 TRUNK LID
53 * Rpr Trunk lid
54 Overlap Major Adj . Panel
55 Add for Clear Coat
56 # Base coat reduction
57 R&I Ucense pocket US built beige
58 502 Rep I Emblem
59 R&I Camera
• ·-·-••"'Y'w·-····~-·-·-•-·• .. --~-~----------·--··---·-··· -··-··-·--.-..
60 REAR LAMPS
61 R&I High mount lamp package tray
trim
62 REAR BODY & FLOOR
63 Repl RT Speake r grille black
64 Repl Pkg tray trim EX-L, 3.5L gray
-~~--_____ -· _______ _ . R_~~-_L_! Speak~-~!:!11~£1ack
66 REAR BUMPER
67 ... _ .. R&J . R&I bUmP.~!. ~()yer.
68 MISCELLANEOUS OPERATIONS
69 *
70 #
71 #
Repl Cover car/bag
Repl Corrosion Protection Primer
S01 Broken Glass Cleanup
FB23512GTN
84131TASA01ZA
75701TAOOOO
84507TAOA01ZA
84505TA1A51ZA
84557TAOA01ZA
2 36.00
1 281.75
1
1
1
1
1
1
1
1
1
36.75
60.58
9.43
191.23
9.43
10.00 T
Note: deanup for rear deckid, rear and front seat, carpet, headliner, R quarter inner.
72 # SOl
73
74 #
Prior Damage Notes:
Agreement Reached with Shop 1
OTHER CHARGES
E.P.C.
SUBTOTALS
NOTES
1
RT RR and FRT door, Frt Bumper, Hood, RT QTR Pnl, LT Pillar, LT RR and FRT doors
l/28/2020 1:42:20 PM 315271
3.00
1,182.73
2.7
0.3
0.2
0.8
0.4
0.2
0.2
0.2
0.9
0.9
0.0
0.2
2.0
19.8
2.6
1.0
-0.6
0.2
2.6
-0.4
0.4
-0 .8
2.3
-0.4
0.4
-0.5
7.6
Page 3
A-16
(Page 4 of 9)
Supplement of Record 2 with Summary
RO Number: 1067003386
2009 HOND Accord Sedan EX-L Automatic PZEV 4D SED 6-3.5L Gasoline MPFI Black
1/28/2020 1:42:20 PM
ESTIMATE TOTALS
category
Parts
Body Labor
Paint Labor
Paint Supplies
Miscellaneous
Other Charges
Subtotal
Sales Tax
Grand Total
Deductible
CUSTOMER PAY
INSURANCE PAY
315271
Basis
19.8 hrs @
7.6 hrs @
7.6 hrs @
$ 1,407.73 @
Rate
$ 44.00 /hr
$44.00 /hr
$ 30.00 /hr
9.5000%
Cost$
1,169.73
871.20
334.40
228.00
10.00
3.00
2,616.33
133.73
2,750.06
500.00
500.00
2,250.06
Page4
A-17
(Page 5 of 9)
Supplement of Record 2 with Summary
RO Number: 1067003386
2009 HOND Accord Sedan EX-L Automatic PZEV 4D SED 6-3.5L Gasoline MPFI Black
SUPPLEMENT SUMMARY
Line Oper Description Part Number Qty Extended Labor Paint
Price
27 * Rep I LKQ Back glass Honda +20% 73211TASA01 1 -96.00 :1,]_
46 * R&l Emblem :Q1.
15 502 Rep I RT Roof molding retainer #3 73156TAOA01 3 10.35
16 502 Repl RT Roof molding retainer #2 731SSTAOA01 6 19.62
17 502 Repl RT Roof molding retainer #1 73154TAOA01 6 19.62
18 502 Rep I RT Roof molding retainer #4 73157TAOA01 3 10.35
19 502 Rep I RT Roof molding clip #3 91570TA5A01 1 0.75
20 502 Repl LT Roof molding clip #3 91570TA5A01 1 0.75
21 502 Rep I RT Roof molding clip #2 91571TA5A01 3 3.54
22 502 Rep I LT Roof molding clip #2 91571TASA01 3 3.54
35 502 Rep I Dam upper 7322STAOAOO 1 4.68
37 502 Rep! RT Dam side 73226TAOAOO 1 4.25
38 502 Rep I LTDam side 73226TAOAOO 1 4.25
39 # 502 Rep! Urethane Kit 2 36.00
40 502 Rep! Back glass NAGS FB23512GTN 1 281.75 2.7
58 502 Rep! Emblem 75701TAOOOO 1 60.58 0.2
SUBTOTALS 364.03 0.0 0.0
TOTALS SUMMARY
Category Basis Rate Cost$
Parts 364.03
Body Labor 0.00
Subtotal 364.03
5alesTax $364.03 @ 9.5000% 34.58
Total Supplement Amount 398,61
NET COST OF SUPPLEMENT 398.61
1/28/2020 1:42:20 PM 315271 Page 5
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(Page 6 of 9)
Supplement of Record 2 with Summary
RO Number: 1067003386
2009 HOND Accord Sedan EX-L Automatic PZEV 4D SED 6-3.5L Gasoline MPFI Black
CUMULATIVE EFFECTS OF SUPPLEMENT(S)
Estimate 2,553.67 John Roumdikian
Supplement SOl -202.22 John Roumdikian
Supplement S02 398.61 John Roumdikian
Job Total: $ 2,750.06
CUSTOMER PAY: $ 500.00
INSURANCE PAY: $ 2,250.06
==============~~~~~~~;~~~~~~~=~~=======================================
Caliber Collision is the industry leader in quality collision repair. Since day one, our highest purpose has been to get
people just like you back on the road as quickly as possible and fully restored to the rhythm of your life. You can be
sure we do everything possible to ensure your complete satisfaction including:
DPersonalized, high quality service from the largest collision repair company in the U.S.
DConsistently ranked among the highest customer satisfaction scores in the industry.
DApproved by every major insurance company in the U.S.
DExpedited car rental and towing services to get you back on the road again in no time.
DRepair work backed by a written, lifetime warranty honored at every location.
024/7/365 customer service to answer questions and put your mind at ease.
This is a preliminary estimate based on visible damage. There may be additional repairs needed once the
vehicle is taken apart by our I-CAR Gold Class technicians to identify any additional damage.
If an insurance company has written an estimate for you, please provide us with a copy. Properly endorsed
insurance company checks are welcome as payment for the repair of your vehicle. Caliber Collision gladly accepts all
major credit cards, debit cards, cashier's and traveler's checks. See your Caliber Collision center for details on
acceptance of personal checks.
Before leaving your vehicle with us, please remove all important personal and valuable items from your vehicle.
Caliber Collision is not responsible for belongings left in your vehicle.
Please let us know how we can be of further assistance, and when we can schedule an appointment for your vehicle
to be repaired.
Caliber Collision -Restoring The Rhythm Of Your Life®
=====================================================================;;
1/28/2020 1:42:20 PM 315271 Page 6
A-19
(Page 7 of 9)
Supplement of Record 2 with Summary
RO Number: 1067003386
2009 HOND Accord Sedan EX-L Automat ic PZEV 40 SED 6-3.5L Gasoline MPFI Black
No Supplement will be honored unless authorized by GEICO.
NOTICE: Vehicles constructed of special metals may require the use of specialized welding and bonding equipment.
Proper measuring and structural repair systems are required on today's vehicle to accurately accomplish vehicle
repairs. Make sure your shop has the proper equipment to repair your vehicle.
ALTERNATE PARTS DISCLAIMER:
IF A QUALITY REPLACEMENT PART (A/M, LKQ, RECOND OR OPT OEM) APPEARS ON THIS ESTIMATE, IT INDICATES
THAT THIS ESTIMATE HAS BEEN PREPARED BASED ON THE USE OF ONE OR MORE CRASH PARTS SUPPLIED BY A
SOURCE OTHER THAN THE MANUFACTURER OF YOUR MOTOR VEHICLE. GUARANTEES, IF ANY, APPLICABLE TO
THESE REPLACEMENT CRASH PARTS ARE PROVIDED BY THE PART MANUFACTURER OR DISTRIBUTOR RATHER
THAN BY THE MANUFACTURER OF YOUR VEHICLE.
***IN ADDffiON TO ANY SUCH GUARANTEES, GEICO PROVIDES THE FOLLOWING:
****OWNER LIMITED GUARANTEE**** WE GUARANTEE THAT ALL QUALITY REPLACEMENT BODY PARTS (PARTS
NOT MANUFACTURED BY THE MANUFACTURER) IDENTIFIED ON YOUR ESTIMATE, ARE FREE OF DEFECTS IN
MATERIAL AND WORKMANSHIP AND MEET GENERALLY ACCEPTED INDUSTRY STANDARDS. THIS PARTS AND
LABOR GUARANTEE WILL BE IN EFFECT FOR AS LONG AS YOU OWN THE VEHICLE DESCRIBED I N THE ESTIMATE.
THIS GUARANTEE COVERS THE COST OF THE PART, LABOR TO INSTALL, AND INCIDENTALS SUCH AS PAINT AND
MATERIALS AND IS SPECIACALL Y LIMITED TO THOSE ITEMS. THIS GUARANTEE DOES NOT COVER LOSS OR
DAMAGE THAT IS UNRELATED TO DEFECTS IN THE QUALITY REPLACEMENT PARTS. THIS IS NOT TRANSFERABLE.
IF ANY QUALITY REPLACEMENT PARTS ARE DEFECTIVE IN EITHER MATERIAL OR WORKMANSHIP, CONTACT YOUR
LOCAL GEICO REPRESENTATIVE.
FOR YOUR PROTECTION CALIFORNIA LAW REQUIRES THE FOLLOWING TO APPEAR ON THIS FORM: ANY PERSON
WHO KNOWINGLY PRESENTS FALSE OR FRAUDULENT CLAIM FOR THE PAYMENT OF A LOSS IS GUlL TY OF A CRIME
AND MAY BE SUBJECT TO FINES AND CONFINEMENT IN STATE PRISON.
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:
MOTOR ABBREVIATIONS/SYMBOLS: D=DISCONTINUED PART, A=APPROXIMATE PRICE. LABOR TYPES: 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. CCC ONE: ADJ=ADJACENT,
ALGN=ALIGN, A/M=AFfERMARKET, BLND""BLEND, CAPA=CERTIFIED AUTOMOTIVE PARTS ASSOCIATION 1
D&R=DISCONNECT AND RECONNECT, EST=ESTIMATE, EXT. PRICE= UNIT PRICE MULTIPLIED BY THE QUANTITY,
INCL=INCLUDED, MISC=MISCELLANEOUS, NAGS=NATIONAL AUTO GLASS SPECIFICATIONS, NON-ADJ=NON
ADJACENT, 0/H=OVERHAUL, OP=OPERATION, NO=LINE NUMBER, QTY=QUANTITY, RECOND=RECONDmON,
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/_ SYMBOLS : #::MANUAL LINE
ENTRY, *=OTHER [IE .. MOTORS DATABASE INFORMATION WAS CHANGED], **=DATABASE LINE WITH
AffiRMARKET1 N=NOTES ATTAC HED TO LINE. OPT OEM=ORIGINAL EQUIPMENT MANUFACTURER PARTS EITHER
OPTIONALLY SOURCED OR OTHERWISE PROVIDED WITH SOME UNIQUE PRICING OR DISCOUNT.
"CURE TIME" MEANS THE LENGTH OF TIME THAT, PER THE ADHESIVE MANUFACTURER, THE WINDSHIELD
ADHESIVE NEEDS TO CURE UNTIL THE WINDSHIELD CAN PROPERLY FUNCTION AS A SAFETY DEVICE PURSUANT
TO THE FEDERAL MOTOR VEHICLE SAFETY STANDARDS AND THE VEHICLE MANUFACTURER 'S SPECIFICATIONS.
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Supplement of Record 2 with Summary
RO Number: 1067003386
2009 HOND Accord Sedan EX-L Automatic PZEV 4D SED 6-3.5L Gasoline MPFI Black
Estimate based on MOTOR CRASH ESTIMATING GUIDE and potentially other third party sources of data. Unless
otherwise noted, (a) all items are derived from the Guide ARG4443, CCC Data Date 01/17/2020, and potentially other
third party sources of data; and (b) the parts presented are OEM-parts. OEM parts are manufactured by or for the
vehicle's Original Equipment Manufacturer (OEM) according to OEM's specifications for U.S. distribution. OEM parts
are available at DE/Vehicle dealerships or the specified supplier. 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 with discounted pricing. Asterisk (*) or Double Asterisk (**) indicates that the parts and/or labor data
provided by third party sources of data 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 Non OEM, A/M or NAGS. 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 2020 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 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=Eiectrical labor category. F=Frame labor category. G=Glass labor category.
M=Mechanical labor category. S"'Structurallabor category. (numbers) 1 through 4"'User Defined Labor Categories.
OTHER SYMBOLS AND ABBREVIATIONS:
Adj."'Adjacent. Algn."'Aiign. ALU=Aiuminum. A/M=Aftermarket part. Blnd=Biend. BOR"'Boron steel.
CAPA=Certified Automotive Parts Association. D&R=Disconnect and Reconnect. HSS=High Strength Steel.
HYD"'Hydroformed Steel. Inci.=Included. LKQ=Like Kind and Quality. LT"'Left. MAG=Magnesium. Non-Adj.=Non
Adjacent. NSF=NSF International Certified Part. 0/H=Overhaul. Qty=Quantity. Refn=Refinish. Repi=Replace.
R&I=Remove and Install. R&R=Remove and Replace. Rpr=Repair. RT=Right. SAS=Sandwiched Steel.
Sect=Section. Subi=Sublet. UHS=Uitra 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.
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(Page 9 of 9)
Supplement of Record 2 with Summary
RO Number: 1067003386
2009 HOND Accord Sedan EX-L Automatic PZEV 4D SED 6-3.5L Gasoline MPFI Black
WE WARRANT THAT ALL PARTS USED IN THE REPAIR OF THIS VEHICLE ARE EQUAL TO THE ORIGINAL EQUIPMENT
MANUFACTURER PARTS IN TERMS OF KIND, QUALilY, SAFETY, FIT AND PERFORMANCE. THIS PARTS AND LABOR
WARRANTY WILL BE IN EFFECT FOR AS LONG AS YOU OWN THE VEHICLE DESCRIBED IN THE ESTIMATE. THIS
WARRANTY COVERS THE COST ASSOCIATED WITH RETURNING THE PART AND THE COST TO REMOVE AND
REPLACE THE NON-ORIGINAL EQUIPMENT MANUFACTURER PART WITH A COMPLIANT NON-ORIGINAL EQUIPMENT
PART OR AN ORIGINAL EQUIPMENT MANUFACTURER PART. THIS WARRANTY DOES NOT COVER LOSS OR
DAMAGE THAT IS UNRELATED TO DEFECTS IN THE QUALilY REPLACEMENT PARTS. THIS WARRANTY IS NOT
TRANSFERABLE. IF ANY QUALilY REPLACEMENT PARTS ARE DEFECTIVE IN EITHER MATERIAL OR WORKMANSHIP,
YOU MUST CONTACT YOUR LOCAL GEICO REPRESENTATIVE.
If a customer subsequently chooses a repair shop, GEICO shall prepare a supplement using the prevailing rate in the
Geographic Area of the customer's chosen shop.
This is not an authorization to repair. The undersigned repair facility is in agreement to the estimate prepared by
GEICO in the amount of$ . No supplements will be honored by GEICO without prior approval.
Signed: ________ _
Print Name: _______ _
Date:----------
We are required under sect 2695.7(b) of the Unfair Claims Settlement Practices Regulations to provide the following
notice: If you believe that your claim has been wrongfully denied or rejected, you also have the right to have the
California Department of Insurance review this matter. The Department of Insurance is located at 300 South Spring
Street, Los Angeles, CA 90013, telephone number (800) 927-4357.
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(Page 1 of 2)
Bill To: GEI3284
GEICO
'GEICO
ATIN:NANCY CMAW-DO
PO BOX 509090
SAN DIEGO, CA 921509090
RENTER INFORMATION:
Renter: DAOPICKARD,SARA
Address:
Home Phone:
Office Phone:
RENTAL INFORMATION:
Rental Branch Location:
ENTERPRISE RENT -A-CAR(32D2)
2230 PACIFIC COAST HWY
LOMITA, CA 907172505
ADDITIONAL CLAIM INFORMATION:
Claim Number: 047736803010104001
Claim Type: Insured
Vehicle Condition: Driveable
Date Of Loss: 12/15/2019
Insured Name: PICKARD,SARA
Owner's Vehicle: 2009 HONDA
Assign type: Xpress Driveable
ClaimNumber: 0477368030101040
IPNumber: 01
Internet Self Serve: No
Days To Repair: 29
RenterName: SARADAOPJCKARD
NumberofDaysAuthorized: 0
Invoice Target: ATLAS
Source: PD
Shop Code: MLX
Automated Extension :
Line of Business: APV
Class Segment:
CatActive: False
Catlndicator: False
CatCode: NULL
Repair Facility:
CALIBER #1067 LOMITA
HARBOR CITY , CA 907103214
(310) 326-0568
VEHICLES RENTED:
Effective Date Time
12/16/2019 8:33AM
Rental Company:
Invoice:
Alternate Invoice
Number:
RENTAL DETAIL:
Enterprise Rent-A-Car
32D2D7ZXYZK
7ZXYZK
Rental Period: 12/16/2019 to 01/14/2020 (30 days)
Billed Period: 12116/2019 to 01/1412020 (30 days)
Description Quantity Rate Amount
TIME & DISTANCE 30 $30.43 $912 .90
REFUELING CHARGE $0 .00 $0 .00
VEHICLE LICENSE
RECOVERY FEE
SALES TAX
30
Total Charges:
Less Amount Received:
Total Amount Due:
KNMA T2MV1 KP511286
$1.65 $49.50
9.50% $86 .73
$1049.13
$0.00
$1049.13
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(Page 2 of 2)
Please Return This Portion with Remittance
Make Payment To:
ENTERPRJSE RENT -A-CAR
P.O. BOX 840086
KANSAS CITY, MO 641840086
FederaiiD: 43-0724835
Rental Invoice
Total Charges:
Less Amount Received:
Total Amount Due .......... .
Please Include on your Check :
lnvoice:32D2D7ZXYZK
$1049 .13
$0.00
$1049.13
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Claim Number :0477368030101040-01
Year :2009
Category :Estimate
Make :HONDA
Sub Category :
Model :ACCORD EX
Image FileName :cc132076837·1576515281000.Jpg
VlN
Image Label :image
Loss Date :12/15/2019
Insured :Sara Pickard
Adjuster:
Policy Number
Photo Taken Date :2019-12-16T08:54:41
Vehicle Owner :Sara Pickard
Supplement Number :00
Picture From External .Source
2019-12-16TOB:54:41
0
Hl
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View order details
Order date
Order#
Ordertotat
Cancel items
Dec 16,2019
114-7651848-1196257
$186.14 (1 item)
Shipment details
Change shipping speed
Not yet shipped
Oetivery Estimate
Tuesday, December 17, 2019 by 8pm
Gra~9 Nautilus 65 LX 3
in 1 Harness Bqoster
Car Seat, Matrix
Qty: 1
Sold By: Amazon.:om Scrvic~5. inc
Track shipment
Payment information
Payment Method
Americal'lExpress ending in-
>
)
$169.99
>
>
Shipping address -Picture Frpm EKternal Source
2.019-12-16Tt2:2.8:21
Claim Number :04 773680301 01 040-01
Year :2009
Category :Estimate
Make:HONDA
Sub Category :
Model :ACCORD EX
Image FileName :cc132076837-1576528101000.jpg VIN~~~---·
Image Label :image
Loss Date :12/15/2019
Insured :Sara Pickard
Adjuster :Nancy Do
Policy Number •••••
Photo Taken Date :2019-12·16T12:28:21
Vehicle Owner :Sara Pickard
Supplement Number :oo
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