CC SR 20211221 F - Claim against the City Mercury-Villalvazo
RANCHO PALOS VERDES CITY COUNCIL MEETING DATE: 12/21/2021
AGENDA REPORT AGENDA HEADING: Consent Calendar
AGENDA TITLE:
Consideration and possible action regarding a claim against the City by Mercury
Insurance (insured Villalvazo).
RECOMMENDED COUNCIL ACTION:
1) Reject the claim and direct Staff to notify the claimant, Mercury Insurance.
FISCAL IMPACT: None
Amount Budgeted: N/A
Additional Appropriation: N/A
Account Number(s): N/A
ORIGINATED BY: Teresa Takaoka, City Clerk
REVIEWED BY: Karina Bañales, Deputy City Manager
APPROVED BY: Ara Mihranian, City Manager
ATTACHED SUPPORTING DOCUMENTS:
A. Mercury Insurance claim (page A-1)
BACKGROUND AND DISCUSSION:
The City of Rancho Palos Verdes (City) is a member of the California Joint Powers
Insurance Authority (Authority), which provides risk management services and handles
any liability claims received by the City. Under the current practice, claims presented to
the City Clerk are forwarded by the Authority to a third-party claims administrator, Carl
Warren and Company (Carl Warren) for adjusting.
Carl Warren’s staff reviews each claim on its merits and contacts the City with any
requested action pertaining to the disposition of the claim. The City Cle rk and the City
Attorney review each claim when received and work closely with Carl Warren throughout
the claims process.
1
CITYOF RANCHO PALOS VERDES
Claimant:
On December 6, 2021, the City received a claim for damages from Mercury Insurance as
Subrogee for Maria Villalvazo. The claim was referred to Carl Warren for review and
investigation. The claimant’s insurance representative states that on October 5, 2021, a
City tree branch fell and damaged the insured’s vehicle’s roof and interior lights. The claim
alleges the City is at fault due to a lack of maintenance of the tree.
Deposition:
Carl Warren has reviewed the claim and found that there is no liability for the City as the
tree is not within the City boundaries. Carl Warren recommends denying the claim for
damages.
2
A-1
A MERCURY ~~ INSURANCE
December 1, 2021
RE:
City of Rancho Palos Verdes
30940 Hawthorne B lvd
Rancho Palos Verdes .. CA 90275
OUR INSURED:
OUR CLAIM NUMBER:
DATE OF LOSS:
YOUR INSURED:
YOUR FILE NUMBER:
Dear City of Rancho Palos Verdes:
MARIA V ILLALVAZO
C O , 1
P.O . Box 10730
Santa Ana, CA 92711-0730
We have obtained information suggesting that the damages incurred from the above-referenced loss were caused by your
insu red's negligence.
Enclosed for your review, please find copies of our supporting documentation. The br eakdown of our payments is as foll ows:
Init ia l Repairs $5,457.68
Deductible $1,000.00
Suoolements
R en ta l Expense $848.41
Out of Pocket Expense
Other
Salvaoe
VLF, if annlicable
Total $7,306.09
Total Amount Due $7,306.09
Other:
Please review for payment.
If we receive a payment that is less than the amount shown above, it will be processed and applied as a partial payment only.
This will not indicate any acceptance of liability or agreement to compromise the claim amount. Note that "Full or final
selllement" or similar wording, whether on the payment itself or on accompanying correspondence, does not function as a
release.
Shou ld you have any questions or n eed additional information, please do not hesitate to contact me . Th ank you for your
cooperation .
Sincerely,
Mercury Insurance Company
Claims Department
888-263-7287
Encl.
C21 04/2021
A-2
A-3
FI LE W ITH:
CITY CLERK'S OFFI CE
City of Ranc ho Pa l os Verdes
30940 Hawthorne B lvd.
CLAIM FOR DAMAGES
TO PERSON OR PROPERTY
Rancho Pal os Verdes, CA 90275
INSTRUCTIONS
1. Cla i ms for death, injury to person or to personal property must be filed not
l ater than six months after the occurrence. (Gov. Code Sec. 911.2.)
2. Cl aims for damages to real property must be filed not late r than 1 year after
the occurrence. (Gov. Code Sec. 911.2.)
3. Read entire claim form befor e filing.
4. See Page 2 for diagram upon which to locate p l ace of accident.
5. TH IS CLAIM FORM MUST BE SIGNED ON PAGE 2 AT BOTTOM .
6. Attach separate sheets, if necessary, to give fu l l detail s. SIGN EACH SHEET.
TO: C ITY OF RANCHO PALOS VERDES
Name of Cl aimant
Mercury Insurance Company as subrogee to Maria Villalvazo
Home Address of C laimant City and State
Business Address of Cl aimant City and State
Give address and telephone number to which you desire notices or
communications to be sent regarding thi s claim:
RESERVE FOR FILING STAMP
CLAIM NO. _____ _
Date of Birth of Claimant -Occupation of Cl aimant
H om e Telephone Number
Business Tel ephone Number
Claimant's Social Security No.
When did DAMAGE or INJURY occur? Names of any city emp l oyees invol ved in INJURY or DAMAGE
Date 10/5/2021 Time 8 :00 am'----
lf claim is for Equitable Indemnity, give date
r.l aima nt served with the complaint:
Date
Where did DAMAGE or INJURY occur? D escribe fu ll y, and locate on d iagram on Page 2. Where appropr iate, give
street names and address and measurements f rom landm arks:
1 004 Via Mi rabe l St.
Palos Verdes E states, CA
Describe i n detail how the DAMAGE or I NJ URY occurred.
Tree bran ch fell on vehicle
Why do you c l aim the city is respons ib l e?
City owned tree
De s cribe In detail each INJURY or DAMAGE.
Roof, Interior lig hts not turning on, makes noises when driven.
Thi s Cl ai m Must Be Si gned on Page 2
A-4
The amount c l aimed, as of the date of presentation of this c l aim, is computed as follows:
Damages incurred to date (exact): Estimated prospective damages as far as known:
Damage to property .................... $____ Future expenses for medical and hospital care . $ ___ _
Expenses for med I ca l and hospital care ... $____ Future loss of earnings ..................... $ ___ _
Loss of earnings ...................... $____ Other prospective special damages .......... $ ___ _
Spec ial damages for ................... $____ Prospective general damages ............... $ ___ _
Total estimate prospective damages ....... $ ___ _
General damages ..................•... $=-,,=....,,...,....
Total damages incurred to date ........ $7,306.09
Total amount cl aimed as of date of presentation of this c l aim: $
Was damage and/or injury investigated by pol ice? _____ If so, what city? ________________ _
Were paramedics or ambulance called? _____ lf so, name city or ambul ance _______________ _
If injured, state date, time, name and address of doctor of your first v isit __________________ _
W ITNESSES to DAMAGE or INJURY: List all p erson s and addresses of persons known to have information: Name _____________ Address _________________ Phone ________ _
Name _____________ .Address _________________ Phone ________ _
Name _____________ .A ddress ________________ Phone ________ _
DOCTORS and HOSPITALS:
Hospital ____________ Address ______________ Date Hospital ized _______ _
Doctor Address Date of Treatment ______ _
Doctor Address Date of Treatment ______ _
READ CAREFULLY
For all accident cl aims place on following diag ram names
ot s treets, including North, East, South, and West; indicate
place of accident by "X" and by showing house numbers
or distances to street corners. If City Vehicle was
invol ved, designate by l etter "A" location of City Vehicle
when you first saw it, and by "B" location of yourself or
CURBJ
your vehicle when you first saw City vehicle; location of
City vehicle at time of accide n t by "A-1" and location of
yourself or your vehicle at the time of the accident by
"B-1" and the point of impact by "X." NOTE: If diagrams
below do not fit the situation, attach hereto a proper
diagram s igned by the claimant.
SIDEWALK
CURBT
PARKWAY
Signature of Cl aimant or person filing on
his behal f giving re l ationship to Cl aimant:
SIDEWALK
Typed Name: Date:
Chris Valenc ia 12/1/2021
NOTE: CLAIMS MUST BE FILED WITH CITY CLERK (Gov. Code Sec. 915a). Presentation of a falso claim is a felony (Pen. Code Sec. 72.)
THIS DOCUMENT IS A PUBLIC RECORD AND MAY BE PROVIDED TO A RE QUESTOR UPON DEMAND.
A-5
Financia ls (To t al Incurred: $6,306.09): Summary
Scheduled Send D Check Number !
< > Issue Date! < > Payment Channel • Payment Method • Check Type! PayTo ! Amount ... Status
11/05/2021 11/05/2021 Internal Electronic fu nds transfer Indemnity ENTERPR ISE RENT-A-CAR lliMI. Clea red
10/11/2021 10/11/2021 Internal Check Indemnity AUTO REPAIR SERVICE & MARIA ~ Clea red VILLALVAZO
10/27/2021 10/28/2021 Internal Ch(!ck lndelllnity AUTO REPAIR SERVICE ~ Cleared
A-6
®ARMS MERCURY INSURANCE SERVICES
Rental Company:
Invoice:
Enterprise Rent-A-Car
32D5D4MB5G0
BIii To: MER32CC
MERCURY I NSURANCE SERVICES
ATTN:UNIT .RENTAL
PO BOX 1 150
BREA, CA 928221 150
RENTER INFORMATION:
Renter: V IL LALVAZO.MARIA
Address:
Home Phone:
Office Phone :
RENTAL INFORMATION:
Rental Branch Location:
ENTERPRISE RENT-A-CAR(32D5)
15312 HAWTHORNE BLVD
LAWNDALE, CA 902602101
ADDITIONAL CLAIM INFORMATION:
Claim Number:
Claim Type: Insured
Vehicle Condition: Driveable
Date Of Loss: 10/05/2021
Insured Name:
Owner's Vehicle: 2013 O THERjNISSAN
Department Code:
Branch/ Unit#: 0032
Best Contact #:
Claimant# for Payment:
Application: GWCC
CARS Shop Type: No
Repair Faclllty:
AUTO REPAIR SERVICE
HAWTHORNE, CA 90250
(714) 206-3347
VEHICLES RENTED:
Effective Date Time Year
10/06/2021 11 :03 AM
Please Return This Portion with Remittance
Make Payment To:
ENTERPRISE RENT-A-CAR (32LB)
FILE 50727
LOS ANGELES, CA 900740727
Federal ID: 95-3475810
2021
Make
NISN
Alternate Invoice
Number:
RENTAL DETAIL:
4MB5G0
Rental Period: 10/06/2021 to 11/04/2021 (30 days)
BIiied Period: 10/06/2021 to 11/04/2021 (30 days)
Description Quantity Rate Amount
TIME & DISTANCE 30 $24.49 $734.70
VEHICLE LICENSE
RECOVERY FEE
SALES TAX
30
Total Charges:
Less Amount Received:
Total Amount Due:
Model VIN Mllea e
VERS 3N 1 CN8EV3ML838584 939
$1.28 $38.40
10.25% $75.31
$848.41
$0.00
$848.41
Rental Invoice
Total Charges:
Less Amount Received:
Total Amount Due .......... .
Please Include on you r Check:
Invoice:
$848.41
$0.00
$848.41
A-7
MERCURY INSURANCE COMPANY
555 W Imp er ial Hwy., Brea, CA 92821
Office: (714) 671-6700
Fax: (714) 671-4650
Ansanchez@Mercuryinsurance.com
EMAi LALL SUPPLEMEN T S T O MY A TT EN T ION -Ansanch ez@ Mercuryinsurance.com
Estimate ID
8446397
S1
Cl ai m Number
•••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••
NO SUPPLEMENTS WILL BE HONORED W ITHOUT PRIOR I NSPECT ION OR APPROVA L
******•••••••** CALL Fl LE ADJ UST ER TO CON Fl RM COVERAGE ................ ..
Anthony Sanchez
Cell 213-364-0049
Office-714-671-6700x 26819
Fax 714-6 71-4650
Owner
MARIA V ILLALVAZO
Supplemented By
Anthony Sanchez
ansanchez@mercuryinsurance.com
Class i f i cation
Fie ld
MERCURYINSURANCEGROUP
Insured
MARIA V ILLALVAZO
Loss Type
Comp rehens ive
Claim Number Pol icy Number
Deductible
1000.00 • Not Waived
c.om mittC!d On
10/26/2021
05:35 PM
Vetlloo
Mitchell Estlmating21.3
OEMOCT..21.V
Reported Date
10/05/2021
Loss Date
10/05/2021
Mitch ell Cloud Estimati ng™
Copyright 1994-2021 Mitche ll ln t<rn at lonal, Inc.
All Rights Re,erved
Appraiser
Anthony Sanchez
ansanchez@mercuryinsurance.com
Classification
Field
Prir<<d C>l
10/26/2021
OS:3SPM
Adjuster
Jerom e W illi ams
(800)827-1570+23422 (Wor
k)
Inspection Si te
AUTO REPA IR SERV ICE
14019 I NGLEWOOD AVE
HAWTHORNE, CA 90250-
6711
(3 10) 970-0055 (Work)
Prdile //11,odf/«I
MIC 102117
Pr'diJcVCf'Sicn
4.0
Page 1 of9
A-8
I nspection Date
10/26/202 1
Repair Fac il ity
AUTO REPA IR SERV I CE
14019 INGLEWOOD AVE
HAWTHORNE, CA 90250-
6711
(310) 970-0055 {Work)
2013 Nis san Pat hfinder SL 4 Door Utility 3.S L 6 Cy l Gas I njected 2WD
License VIN Interior Co lor
Bl ack
Trim Col or
WHITE -Condition
Fa ir
Mitchell Service Code
911550
Primary Point of I mpact
Non-Co llision (16)
Options
Air Lond1t 1oning
Automotic Headlight s
Driver Seat With Power
Lumba r Support
El ectronic Stability Control
Heated Mirror
Leather St eering Wheel
Power Doo r Locks
Powe r Windows
Rearview Camera
Steering Wheel Mounted
Audio Control
Traction ControVElectronic
Drivable
Yes
A lu m/Alloy Wheels
Auxiliary Input
Driver-Front Air Bag
Exterior Memory Mirrors
Heated Seats
Left-Curtain Ai r Bag
Power Driver Seat
Privacy Glass
Remote V ehicle Starter
System
Theft Deterrent Sy s.
Trip Computer
Odometer
124015
AM·FM Stereo
0luetooth Wireless
Connectivity
Dua l NC
Fi rst Row Bucket Seat
Interior Automatic
Day/Night Or
Electrochromatic Mirror
Memory Seats
Power Passenger Seat
Rear Bench Seat
Satellite Radio
Third Row Seat
Universal Garage Door
Opener
MAR IA VILLALVAZO 2013 Ni ssa n Pathfinder SL
Parts Profile
BREAAQRP
Line# Descri ption
A ir Bag System
1
2
CMimlt<dOn
10/26/2021
05:35 PM
100201
100200
Disal:fo & Enable A ir Bag
System ·M
Air Bag System Dia gnosis·
M
"""'°" Mitch•II Estimating z 1 .3
OEM OCT_21_V
Parts Profile Version
34.0
LABOR
Operation Type Total Uni ts
Re move/ Mechanical INC
Replace
Re move/ Mechanica l 0.5#
Replace
Mitchell Cloud Estimating™
Copyright 1994-2021 Mitch ell lnternatlonal,lnc.
All Rights Re<erved
Production D ate
02/2013
Anti-Lock Brake Sys. (ABS)
CD Player
Auto Air Condition
C1ub~ Cu11llul
Electric Defogger
Fog Lights
Keyl ess Entry System
MP3 Player
Power Remote Mirror
Rear Gate Wiper
El ectronic Parking Aid
Front Heated Seats
Leather Seats
Passenger-Front Air Bag
Power Steering
Rear Spoiler
Second Row Side Airbag With
Head Protection
Side A irbags
Tilt Steering Whee l
Type
Prirt<dO>
10/26/2021
05:35 PM
Tire Pressure Monitoring
System
PART
Number
Profile(Mallied
MIC 102117
Prolllc Vcr,k,r,
4 ,0
Qty Total Price
Page 2 of9
Tax
A-9
LABOR PART
Line# Description Operation Type Total Units Type Number Qty Total Price Tax
3 102023 R Air Bag Side Curtain Remove / Mechanical INCr# Existing
Module-M Ins tall
4 102024 L Air Bag Side Curt a in Remove/ Mechanical INCr# Existing
Module-M Install
Windshield
51 S 100 107 Windshield Rem ove/ Glass 0.4# Existing
Ins tall
6 100922 R W/Shield Pillar Garnish Remove / Body INCr# Existing
Install
7 100923 L W/Shleld Pillar Garnis h Remove / Body INCr# Existing
Install
Rocke r/ Pillars/ Floor
8 101303 R Door Opening Panel -5 Repair Body 2.0·# Exis ting
AUTO R Hinge Pilla r Refinish Refinish 1 .2 C Existing
Only
10 101304 L Door Opening Panel -5 Repair Body 1 .0 •# Existing
11 AUTO L Hinge Pillar Refinish Refinish 1.2 C Existing
Only
12 101362 R Upr Ctr Pillar Trim Panel Remove/ Body 0.8 r# Ex isting
Install
13 101363 L Upr Ct r Pillar Trim Panel Remove/ Body 0 .8r# Existing
Install
Seat Be lts
51 14 101J&5 R Fr l Seal Bell Re111uve / Buuy 0.3rll Ex is t ing
Install
51 15 101386 L Frt Seat Belt Remove / Body 0 .3r# Exist ing
Install
Sl 16 101236 R Ctr Seat Belt Remove / Body 0 .3r# Existing
Install
Sl 17 101237 L Ctr Seat Belt Remove / Body 0 .3r# Existing
Install
Roof
Sl 18 100599 Roof Pan el Remove/ Body 25.5# New 73112-3KA1A 1 $1,227.64 Yes
Replace
Sl 19 AUTO Roof Panel Outside Refinish Refinis h 3 .3 C
Only
51 20 AUTO Roof Edge Refinish Refinish 0 .5 C
Only
51 21 AUTO Add To R&I/R&R Side Remove / Mechanica l 2.0
Curtain Air Bags -M Replace
Sl 22 100604 Rear Roof Sunroof Reinf Remove/ Body 1.0 New G3140-3KAAA 1 $184.60 Yes
Replace
S1 23 100605 Rear Roof Header Panel Remove/ Body 1.5 New 73230-3KA0A 1 d$1,451.00 Yes
Replace
24 100663 R Roof Moulding Remove/ Body INC Exist ing
Install
25 100664 L Roof Moulding Remove/ Body INC Existing
Ins ta ll
26 100665 Combination Antenna Remov e/ Body INC# Existing
Install
27 102267 Roof Combination Antenna Remove / Body INC# New 28208-3JA0A 1 $150.28 Yes
Replace
28 100673 Roof Headliner Remove / Body INC# Existing
Install
29 100648 R Roof Luggage Rac k Side Remove / Body 0.4 Existing
Rail Insta ll
CanmlttedOn Vfflfon Mitchell Cloud Est ima ti ng™ Prfrt<dCln P,otlle/Modfi«t Page 3 of9
10/26/2021 Mitchell Est imating 21 .3 Copyright 1994-2021 Mitchell In ternational , Inc . 10/26/2021 MIC 102117
05:35 PM OEM OCT_2t_V All Rights Reserved 05 :35 PM ProfileV°"""'
4.0
A-10
LABOR PART
Line# Description Operation Type Tota l Units Type Number Qty Tota l Price T ax
30 100649 L Roof Luggage Rack Side Remove/ Body 0.4 Existing
Rail Install
Quarter Panel
3 1 100721 R Lwr Quarter Trim Panel Remove/ Body INCr# Existing
Install
32 AUTO Rear Seat Assy Remove/ Body INC
Install
33 AUTO Storage Compartment Remove I Body 0.4#
Install
34 100722 L Lwr Quarter Trim Panel Remove I Body IN Cr# Existing
Install
35 100729 R Frt Quarter Pilla r Tri m Remove/ Body INCr# Existing
Panel Install
36 100730 L Frt Quarter Pillar Trim Remove/ Body INCr# Existing
Panel Install
37 100735 R Rear Quarter Pillar Trim Remove I Body INCr# Existing
Panel Install
38 100736 L Rear Quarter Pillar Trim Remove I Body INCr# Existing
Pan el Ins ta ll
Liftgate
39 101879 Liftgate Assy Remove / Body I NC# Existing
Install
Ad..Jillu, Id I Cu, L, & Maler iab
40 AUTO Paint/Materials Additional $287.00 ' Yes
Cost
Additional Operations
41 AU TO Clear Coat Additional Refinish 2.0 $0.00
Operation
42 933018 MASK FOR OVERSPRAY Additional Body ' 0.0 $10.00'
Operation
43 933017 FINISH SAND AND BUFF Additiona l Refinish 1.0 $0.00
Operation
44 933003 TINT COLOR Additional Body' o.s• $0 .00
Operation
Specia l/ Manual Entry
45 900500 ROPE FRONT GLASS Additional Body' o.s• Existing 1
Labor
46 900500 SET BACK WIRING Additional Mechanical' 1.0 ' Existing 1
Labor
47 900500 VEHICLE NEEDS TO BE Remove / Body ' 0.0 ' Existing 1
TORN DOWN Install
48 900500 Post Scan Repair Mechanica l' o.s· Existing 1
49 900500 Pre Scan Repair Mechanical ' o.s• Existing 1
so 900500 HAZWASTE Remove/ Body' 0 ,0' New New 1 $3.50' Yes
Replace
51 900500 Battery Remove / Mechanical* 0.5 ' Existing 1
In stall
• Ju dgmen t Item C Included in Clear Coa t Calcu lati on
T Included In Two Tone Calculation A Included in Clear Coat and Two Tone Calculation
# Labor Note Ap pli es r CEG R&R Time Used for this Labor Operation
d Discontinued by Man ufacturer I] Verify the part number and pr ice before ordering
Estimate Totals
Lab or Units Rate Sublet Add'I Amount Totals
Mechanical Labor 5.0 $105.00 $525.00
Comm l1t ed0n Venloo Mitchell Cloud Estlmallng TM Pr/r(""C,, Ptol lie /,\bl/I«# Poge4of9
10/26/2021 Mitchell Estimating 21.3 Copyright 1994-2021 Mitchell International , In c. 10/26/202 1 MIC 102117
05 :35 PM OEMOCT_21_V Al l Rights Reserve d 0 5:35 PM P,ofjJc Vt o fon
4,0
A-11
Estimate Totals
Glass Labor 0 .4 $50.00
Body Labor 36.0 $50.00 $10.00
Refinish labor 9.2 $50.00
Total Labor 50.6
Taxabl e
Tax 0.0000%
Non-Taxable
Labor Tota l
Parts Amount
Taxable Parts $3,017 .02
Parts Adjustments
Tax 10.2500%
Non-T axable
Parts Total
Costs Amount
Other Additional Cos t s $0.00
Pain t Mate ria ls $287.00
Taxable
Paint Materials Rate: $ 3 5.00 Ta x 10.2500%
Rate Max: 99 .9 uni ts Non• Ta xab le
Ad ditiona l Rale : $0 .00 Los ts I ota l
Gross Tota ls Amou nt
Gross Tota l $6,457.68
Taxable
Ta x
Non-Taxable
Gross Tota l
Adjustments Amoun t
Deduct ible -$1,000.00
Total Customer
Responsibility
Net Estimate Total
Less Origina l Net Total
Net Suppl ement Amount
S 1: Anthony Sanchez
***PURSUANT TO CALIFORNIA CODE OF REGULATIONS, TITLE 10, CHAPTER 5,
SUBCHAPTER 7.5,SECTION 2695.STHEINSURER WARRANTS THAT ANY
NON-ORIGINAL EQUIPMENT MANUFACTURER PARTS SPECIFIED IN THIS ESTIMATE
ARE AT LEAST EQUAL TOTHEORIGINAL EQUIPMENT MANUFACTURER PARTS IN
TERMS OF KIND, QUALITY, SAFETY, FIT AND PERFORMANCE ."'"'"'
THIS IS NOT AN AUTHORIZATION TO REPAIR. THE UNDERSIGNED REPAIR
FAC I UTY AGREES TO REPAIR TH IS VEHICLE USING IN DUST RY ACCEPTED
EQUIPMENT AND METH ODS, AND TO COMPLETE AND GUARANTEE SAFER EPAI RS AT
A PRICE OF$ ___ _, INCLUDING ALL CHARGES. NO SUPPLEMENTS
CommlU,ed 01
10/26/2021
OS:3S PM
V"1lon
Mitchell Est imating 21.3
OEM OCT.21.V
Mitchell Cloud Estimating TM
Copyright 1994-2021 Mitchell International, Inc.
All Ri ghts Reserved
Prf,todOn
10/26/2021
05 :35 PM
Pn:tlle (Motlfl«f
MIC 102117
Profile Vc,,swn
4.0
$20.00
$1,810.00
$460.00
$2,815.00
$0.00
$0.00
$2 ,815 .00
$2,815.00
$3,017.02
$0.00
$309.24
$0.00
$3,326.26
$0.00
$287.00
$287.00
$29.42
$0 .00
$316.42
$6,457.68
$3,304.02
$338 .66
$2 ,815 .00
$6,457.68
-$1,000.00
-$1,000.00
$5,457.68
$1 ,853 .95
$3,603 .73
$3,603.73
Page 5 of 9
A-12
WILL BE HONORED WITHOUT PRIOR APPROVAL.
SIGNED: ______________ _
IN THE EVENT THAT REPAIRS ARE COMMENCED,AND DURING SUCH REPAIRS IT
IS DETERMINED BYMERCURYTHATTHEVEHICLEISATOTALLOSS, THE
UNDERSIGNED SHOP AGREES NOTTO CHARGE STORAGE FEES FROMTHETIMETHE
VEHICLEARRIVESATTHESHOPUNTIL THETIMETHATREPAIRSARESTOPPED
DUE TO MERCURY'S TOTAL LOSS DETERMINATION.
SIGNED: _______________ _
Disclaimer: For your protection California law requires the following statement to appear on this form. Any person who
knowingly presents false or fraudulent claim for the payment of a loss is guilty of a crime and may be subject to fines and
confinement in state prison.
Estimate Event Log
Job Created 10/6/202104:15 PM
Supplement 1 Started 10/7/202103:3 0 PM
Supplement 1 Printed 10/26/202105:35 PM
Supplement 1 Committed 10/26/202105:35 rM
Estimate Version 1
Com mlltt<!On
10126/2021
05 :35 PM
Ver,ion
Mitche ll Est imating 21.3
OEM OCT .21. V
Mitc hell Cloud Estimating™
Copyright 1994-2021 Mltchell International, Inc .
All Rights Reserved
Pri,.edOn
10/26/2021
05 :3 5 PM
i'l'olOe {Modf/e<1
MIC 102117
ProtileVersfon
4.0
Page 6 of9
A-13
Date:
Estimate ID:
Supplement:
Profile ID:
Supplement Delta Report
Comparison of Estimate 8446397 Supplement O and Supplement 1
Damage Assessed By: Anthony Sanchez
Supplemented By: Anthony Sanchez
Insured: MARIA VILLALVAZO
Owner: MARIA VILLALVAZO
Vehicle : 2013 Nissan Pathfinder SL
Date of Loss: 10/05/2021
Line Labor
Item Type Operation
Changed Entries
3 Mechanical REMOVE/INSTALL
3 Mechanical REMOVE/INSTALL
4 Mechanical REMOVE/INSTALL
4 Mechanical REMOVE/INSTALL
9 Body REMOVE/INST ALL
12< Body REMOVE/INSTALL
10 Body REMOVE/INSTALL
13< Body REMOVE/INSTALL
11 Body REPAIR
Line Item
Description
R Air Bag Side Curtain
Module -M
R Air Bag Side Curtain
Module -M
L Air Bag Side Curtain
Module -M
L Air Bag Side Curtain
Module -M
R Upr Ctr Pillar Trim
Panel
R Upr Ctr Pillar Trim
Panel
L Upr Ctr Pillar Trim
Panel
L Upr Ctr Pillar Trim
Panel
Roof Panel
18< Body REMOVE/REPLACE< Roof Panel
13 Body REMOVE/INSTALL R Roof Moulding
24< Body REMOVE/INSTALL R Roof Moulding
CO'nm ltt ec:I On Vonlon Mitchell Cloud Estimating™
10/26/2021 Mitchell Est imating 21 .3 Copyright 1994-2021 Mitchell International, Inc .
05:35 PM OEM OCT_21_V All Rights Reserved
10/26/2021 5 :35:46 PM
8446397
1 -10/26/20215:35:45 PM
MIC 102117
Part Dollar Labor C EG
T ype/Num Amount Units Unit
Existing 0.00 1.0 1.0 Existing
Existing 0.00 INC 1.0 Existing
Existing 0.00 1.0 1.0 Existing
Existing 0 .00 INC 1.0 Existing
Existing 0.00 INC 0 .8 Existing
Existing 0.00 0 .8< 0.8 Existing
Existing 0.00 INC 0.8 Existing
Existing 0.00 0.8< 0.8 Existing
Existing 0.00 16.0* 0.0 Existing
New< 1227.64< 25 .5< 25 .5T < 73112-3KA1A
Existing 0.00 0.4 0.4 Existing
Existing 0 .00 INC 0.4 Existing
Prlrtl!!dQi P,ololc/MOd/i«I Page 7 of9
10/26/2021 MIC 102117
05:35 PM Prdik! Version
4.0
A-14
14 Body REMOVE/INSTALL L Roof Moulding Existing 0.00 0.4 0.4
Existing
25< Body REMOVE/INST ALL L Roof Moulding Existing 0.00 INC 0.4 Existing
16 Body REMOVE/REPLACE Roof Combination New 150.28 0.3 0.3T Antenna 28208-3JA0A
27< Body REMOVE/REPLACE Roof Combination New 150.28 INC 0.3T Antenna 28208-3JA0A
17 Body REMOVE/INSTALL Roof Headliner Existing 0.00 6.4 6.4 Existing
28< Body REMOVE/INSTALL Roof Headliner Existing 0.00 INC 6.4 Existing
28 ADD'LCOST Paint/Materials 262.50 * T
40< ADD'LCOST Paint/Materials 287.00*< T
29 Refinish ADD'L QPR Clear Coat 0.00 1.8 0.0
41< Refinish ADD'LOPR Clear Coat 0.00 2.0< 0.0
Added Entries
5 Glass REMOVE/INSTALL Windshield Existing 0 .00 0.4 4.0 Existing
6 Body REMOVE/INSTAI I R W/Shield Pillar Existing 0.00 INC 0.3 Garnish Existing
7 Body REMOVE/INSTALL L W/Shield Pillar Existing 0.00 INC 0.3 Garnish Existing
14 Body REMOVE/INSTALL R Frt Seat Belt Existing 0.00 0 .3 0.3 Existing
15 Body REM OVE/1 NSTALL L Frt Seat Belt Existing 0.00 0.3 0.3 Existing
16 Body REM OVE/1 NST ALL R Ctr Seat Belt Existing 0.00 0.3 0.3 Existing
17 Body REMOVE/INSTALL L Ctr Seat Belt Existing 0.00 0.3 0.3 Existing
20 Refinish REFINISH Roof Edge 0 .5 0.5
21 Mechanical REMOVE/REPLACE Add To R&I/R&R Side 2.0 2.0 Curtain Air Bags -M
22 Body REMOVE/REPLACE Rear Roof Sunroof New 184.60 1.0 1.0T Reinf G3140-3KAAA
23 Body REMOVE/REPLACE Rear Roof Header New 1,451.00 1.5 1.ST
Panel 73230-3KA0A
39 Body REMOVE/INSTALL Liftgate Assy Existing 0.00 INC 1.8 Existing
Global Changes
No Deductible, Deductible Reduction Credit, Customer Responsibility, Labor Rate, or Part Adjustment changes
were made.
C-orrlmltted()l
10/26/2021
0 5:35 PM
Vtnloo
Mi tch ell Est imati ng 2 1.3
OE M OCT_2 1_V
Mi tchell Cloud Estimati ng™
Copyright 1994-202 1 Mi tch ell International, Inc.
All Rights Reserved
Printed 0,
1012 6/2021
05 :35 PM
Prolllefl,,kxlllec,
MIC 102 117
Prd'llcVcnlon
4 .0
Page 8 of9
A-15
Software
Version:
Ccnl rn ltt edOn
10/26/2021
05:35 PM
21.3
Ven/on
Mitchell Estimating 21.3
OEM OCT_21_V
Orig i nal
Estimate
Supplement 3,603.73 1
Orig Tot al 42.67 T ax
Supp 1 338.66 Total Tax
Net
Suppl e ment
Amount
Net Total
Program Cale
Version
Supp0
Supp 1
Copyright (C) 1994 -2021 Mitchell International
All Rights Reserved
Mitchell Clo ud Est imating™
Copyright 1994-2021 Mitchell International, Inc .
All Rights Reserved
P~rtedOI
10/26/2021
05 :35 PM
5
5
Prol lle /Medf/,d
MIC 102117
ProtileV«sion
4 ,0
Amount
1,853.95
3 ,603.73
5,457.68
Data Versions
OCT_21_V
OCT_21_V
Page 9 of9
A-16
Claim: Page I of 6
20211007 _092645.jpg 20211007 _092651.j pg
https:/ /www.mymitchell.com/Claim /Clairnf ile Viewer/Photo Print.aspx ?CID=66992348&C... 12 / l /2021
A-17
Claim:
Claim:
20211007 _092938.jpg
RT SIDE SAI L PANEL DAMAGE
20211007 _092934.jpg
ROOF DAMAGE
20211007 _092946.jpg
LT SIDE SAIL PANEL DAMAGE
Page 2 of 6
https://www.mymitchell.com/Claim/ClaimFileViewer/PhotoPrint.aspx?CID=66992348&C... 12/1/2021
A-18
Claim: Page 3 of 6
MARIA VILLALVAZO
2021 1007 _092952.jpg 20211007 _092957 .jpg
2021 1007 _093001.jpg 202 11 007 _093006 .jp9
https://www .mymitchell.com/Claim/C laimFi le Viewer/Pho toPrint.aspx?CID=66992348&C... 12 / I /2021
A-19
Cla im:
20211007 _093245 .jpg 202 11 007 _ 093352. jpg
ROOF DAM AGE
Page 4 of 6
https://www.mymitchelI.com/Claim/Claim File Viewer/PhotoPrint.aspx ?CID =66992348&C ... I 2/1/2021
A-20
Claim:
202 11021_1 10331 .jpg
REINFORCME NT DAMAGE
Page 5 of 6
202 11021_ 110354 .jpg
ROOF REI NFO RCMENT DAMAGES
https://www.mymitchell .com/Claim/C laimFile Yiewer/PhotoPrint.aspx?CID=66992348&C... J 2/l /2021
A-21
Claim:
202 11 021_ 11 0421.jpg
ROOF AIR BAGS
Page 6 of 6
20211021_ 1 10509.jpg
https://www.mymitchell.com/Claim/ClaimFi le Viewer/Phot oPrint.aspx?C I D=66992348&C... l 2/ l /202 1