CC SR 20241015 D - Claim against the City Engberg
CITY COUNCIL MEETING DATE: 10/15/2024
AGENDA REPORT AGENDA HEADING: Consent Calendar
AGENDA TITLE:
Consideration and possible action regarding a claim against the City by Toni Engberg.
RECOMMENDED COUNCIL ACTION:
1) Reject the claim and direct Staff to notify the claimant, Toni Engberg
FISCAL IMPACT: None
Amount Budgeted: N/A
Additional Appropriation: N/A
Account Number(s): N/A
ORIGINATED BY: Enyssa Sisson, Deputy City Clerk
REVIEWED BY: Teresa Takaoka, City Clerk
APPROVED BY: Ara Mihranian, AICP, City Manager
ATTACHED SUPPORTING DOCUMENTS:
A. Toni Engberg 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 Clerk 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 September 26, 2024, the City received a claim for damages from Toni Engberg. The
claim was referred to Carl Warren for review and investigation. The claimant states that
her vehicle suffered damages on April 16, 2024. The claimant alleges that the City is
responsible for the damage to her vehicle due lack of warning signs of hazardous roadway
along Palos Verdes Drive South.
Deposition:
Carl Warren has reviewed the claim and advised the City to reject it due to the
determination that the City had adequate signage placed in numerous locations, inspects
the roadways daily, and addresses dangerous conditions to the best of their capability.
Carl Warren recommends denying the claim for damages.
2
A-1
Toni R Engberg RECEIVED September 24, 2024
CITY OF RANCHO PALOS VERDES
SEP 2 6 2024
CllY CLERK'S OFFICE
To Whom It May Concern:
This is in regard to the accident caused by the improperly maintained roadway on April 16,
2024.
Due to the ongoing damages being discovered on the vehicle we opted to sell the vehicle.
Due to said accident my insurance company deemed me at fault and canceled my
insurance.
I would be willing to settle for a refund of my $500.00 deductible and the city of Rancho
Palos Verdes to admit that they are at fault for the damages so I might get my insurance
reinstated. Please forward any legal documents to the address or email address above.
Please contact as soon as possible so we may either get this remedied, or if not I will have
to seek further legal action.
Thank you for your timely attention to this matter,
A-2
FILE WITH:
CITY CLERK'S OFFICE
City of Rancho Palos Verdes
30940 Hawthorne Blvd.
Rancho Palos Verdes, CA 90275
CLAIM FOR DAMAGES
TO PERSON OR PROPERTY
INSTRUCTIONS
1. Claims for death, injury to person or to personal property must be filed not
later than six months after the occurrence. (Gov. Code Sec. 911.2.)
2. Claims for damages to real property must be filed not later than 1 year after
the occurrence. (Gov. Code Sec. 911.2.)
3. Read entire claim form before filing.
4. See Page 2 for diagram upon which to locate place of accident.
5. THIS CLAIM FORM MUST BE SIGNED ON PAGE 2 AT BOTTOM.
6. Attach separate sheets, if necessary, to give full details. SIGN EACH SHEET.
TO: CITY OF RANCHO PALOS VERDES
Name of Claimant
Toni R Engberg
Home Address of Claimant
Business Address of Claimant
City and State
City and State
Give address and telephone number to which you desire notices or
communications to be sent regarding this claim:
RESERVE FOR FILING STAMP
CLAIM NO. l,0'2. i .-lot:\
RECEIVED
CITY OF RANCHO PALOS VERDES
SEP 2 6 2024
CITY CLERK'S OFFICE
Date of Birth of Claimant
laimant
Business Telephone Number
Claimant's Social Security No. -When did DAMAGE or INJURY occur? Names of any city employees involved in INJURY or DAMAGE
Date 04/16/2024 Time _s_:55....;p_m ____ _
If claim is for Equitable Indemnity, give date
claimant served with the complaint:
Date
Where did DAMAGE or INJURY occur? Describe fully, and locate on dia
street names and address and measurements from landmarks:
Copy of map attached.
While traveling west on I was traveling at the speed limit ascending uphill
and
Describe in detail how the D-· ccurred.
the roadway damage was no v1s1 e o rivers as is depicted in pictures, The crevice caused the vehicle tire to pop
causing the vehicle to bottom out on the roadway damaging the undercarriage, rendering the vehicle inoperable.
The impact transmission housing was cracked, the transmission sensor was broken, the alignment was thrown off,
motor mounts and transmission mounts were broken.
Why do you claim the city is responsible?
The city is responsible to maintenance of roadways and warning of hazards both of which the city neglected
doing at t his time and date resulting in severe damage to my vehicle and a cancelation of my insurance.
Describe in detail each INJURY or DAMAGE.
The poorly maintained roadway along with lack of warning for the crevice caused damage to my unde rcarriage , popping my tire, cracking the
transmission housing, destroying the sensors, breaking the motor mounts and transmission mounts. Due to this accident my insurance rates
have doubled and I can not afford insurance.
This Claim Must Be Signed on Page 2
A-3
The amount claimed, as of the date of presentation of this claim, is computed as follows:
Damages incurred to date (exact): Estimated prospective damages as far as known:
Damage to property .................... $ 41o2.oo Future expenses for medical and hospital care . $ ___ _
Expenses for medical and hospital care ... $____ Future loss of earnings ..................... $ ___ _
loss of earnings ...................... $____ Other prospective special damages .......... $ esoo.oo
Special damages for ................... $ 6500.00 Prospective general damages ............... $ ___ _
Total estimate prospective damages ....... $ ___ _
General damages ...................... $ ___ _
Total damages incurred to date ........ $ ___ _
Total amount claimed as of date of presentation of this claim: $ 16702.00
Was damage and/or injury investigated by police? no If so, what city? ________________ _
Were paramedics or ambulance called? no If so, name city or ambulance _______________ _
If injured, state date, time, name and address of doctor of your first visit ___________________ _
WITNESSES to DAMAGE or INJURY: list all persons and addresses of persons known to have information:
Name Graciela Quiroz Addressll■■■■■■■lll■ _______ Phon
Name Jackie Valenzuela Address Moved out of state Pilon
Name USAA Claims Address _________________ Phon
DOCTORS and HOSPITALS:
Hospital ____________ Address ______________ Date Hospitaiizecll _______ _
Doctor Address Date of Treatment ______ _
Doctor Address Date of Treatment ______ _
READ CAREFULLY
For all accident claims place on following diagram names
of streets, including North, East, South, and West; indicate
place of accident by "X" and by showing house numbers
or distances to street comers. If City Vehicle was
involved, designate by letter "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 accident 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 signed by the claimant.
See attached photos
smEWAU\
QX Palos Verde Drive S headed West
Signature of Claimant or person filing on
his behalf giving relationship to Claimant:
PARKWAY
SIDEWALK
Typed Name:
Toni R Engberg
Rotunda
Date:
September 23, 2024
NOTE: CLAIMS MUST BE FILED WITH CITY CLERK (Gov. Code Sec. 915a). Presentation of a false claim is a felony (Pen. Code Sec. 72.)
THIS DOCUMENT IS A PUBLIC RECORD AND MAY BE PROVIDED TO A REQUESTCIR UPON DEMAND.
A-4
~ Garrison Property and Casualty Insurance
Company RESERVATION OF
RIGHTS USAA®
DM-02276/21866424045150
TONI ENGBERG
Review Information About Insurance Claim
April 22, 2024
Dear Ms. Engberg,
I'm writing regarding the following claim.
USAA policyholder:
USAA member number:
Date of toss:
location of loss:
Toni Engberg
April 16, 2024
Palos Verdes, CALIF='ORNIA
Thank you for trusting USAA for your insurance needs. We're very sorry to learn that you have experienced a loss.
We're investigating your claim to confirm whether the loss is covered under your policy. Please see the attached
Reservation of Rights and Policy Provisions for information about your policy.
We understand that this is a difficult situation, and we will strive to investigate the claim and provide you with more
information in a timely manner.
How to Contact Us
Please send any correspondence or questions to us using one of the following options and include the
claim/reference number on each page mailed or faxed:
D usaa.com or our mobile app:
@ Email:
Address:
Fax:
Phone:
034043315 -DM-04664 -800 -06869 -01
Upload documents or post a secure message to your claim file
through the Claim Communication Center.
Send an email or attachments to your claim file at
3j5p4hgb5cw5w@claims.usaa.com. Do not send private
information using this channel.
USAA Claims Department
P.O. Box 33490
San Antonio, TX 78265
1-800-531-8669
1-800-531-8722
54509-0421
A-5
~ Garrison Property and Casualty Insurance
Company Reservation of Rights
USAA®
We are unable to confirm coverage at this time and are investigating due to the following provisions in the policy
contract:
PART E -GENERAL PROVISIONS
DUTIES AFTER AN ACCIDENT OR LOSS
We may not be required to provide coverage under this policy if there has not been full compliance with the
following duties:
A. We must be notified promptly of how, when, and where an accident or loss happened. Notice should also include
the names and addresses of any injured persons and of any witnesses.
E. A person seeking coverage under Part D -Physical Damage Coverage must also:
l. Take reasonable steps after loss to protect your covered auto and its equipment from further loss. We will pay
reasonable expenses incurred to do this.
3. Permit us to inspect and appraise the damaged property before its repair or disposal.
Nern-Waiver and Other Matters
USAA and its representatives will continue the process of investigating all matters related to the loss or incident
under a full and complete reservation of rights. Any actions taken by or for USAA shall not in any way impact any of
USAA's rights and defenses under this policy, including the right to deny coverage in whole or in part.
No actions on the part of USAA or its representatives shall in any way be construed as an admission of coverage for
the incident, claim or loss, and none of these actions will prejudice any rights or defenses we have under this policy
whether these rights or defenses have been specifically referred to in this reservation of rights.
USAA's investigation of this claim shall not be considered as a waiver, enlargement or change in any of the
provisions, terms, exclusions and conditions of this policy.
By expressly reserving our rights to deny coverage at some later date, USAA reserves its rights to supplement,
modify, or alter its coverage positions due to any new or additional information or for any other reason.
We will continue our work on this claim and be in contact with you as the investigation develops.
034043315 -DM-04664 -800 -06869 -01 54509-0421
Page 3 of 3
A-6
INVOICE
ENGBERG, TONI
Part Description / Number
TRANSMISSION FILTER AND
GASKET
Trans Filter/Gasket
SYNTHETIC TRANSMISSION FLUID
MAXLIFEATF
USED PAN
USEDGRADEA
VALVE BODY ASSEMBLY -NEW-
OEM
DLR-OEM
Qty
1.00
5.00
1.00
1.00
Org. Estimate 194.00 Revisions 1,766.33
[ Payments -Check -$524.75, Visa -$1,241.58]
Vehicle Received: 5/6/2024
Stu's AE Transmissions, Inc
5531 Cherry Avenue
INVOICE
19435
LONG BEACH, CA. 90805 Org. Est. # 023225
BAR#-EPA#
Phone: 562-428-4641 Fax: 562-428-3808
Sale
52.85
16.96
126.36
785.00
Printed Date: 05/16/2024 Work Completed: 05/16/2024
2016 Chevrolet -Sonic LT -1.8L, ln-Line4 (11 0CI) VIN(G)
Lie#: 7SMA364 Odometer In: 56774
Odometer Out : 56777
VIN#:
Ext labor Description
52.85 INSURANCE VEHICLE.-CUSTOMER HIT A POTHOLE
IN ROAD AND DAMAGED TRANSMISSION OIL PAN,
SECONDARY AIR CHECK VALVE, AND REPLACE R/F
84.80 MIRROR ASSY W/POWER. NEEDS AN ALIGNMENT
INSPECT AND ADVISE
126.36 VALVE BODY ASSEMBLY -Remove & Replace -
Complete Assembly -[Includes: Perform Relearn
procedure.]
Ext
n/c
472.50
785.00 Change automatic transmission filter and gasket 132.30
Road test and verify engine performance, transmission operation,
and shift patterns. Remove and replace automatic transmission filter
and gasket. Replenish transmission fluid. Inspect for leaks. Road
test vehicle.
Hazardous Materials 5.00
Taxes
Regular Rate 107.52
Current Estimate 1,960.33 labor: 604.80
1,049.01 Parts:
HazMat:
SubTotal:
Tax:
Total:
Bal Due:
5.00
1,658.81
107.52
1,766.33
$0.00
Customer Number: 10212
I authorize the repair work listed on this estimate to be completed with the required materials and using the necessary tools. I also grant you and/or your employees permission to
operate the described car or truck on streets, highways, or elsewhere for testing and inspection purposes. All parts used for the repair are new unless otherwise specified. I
acknowledge that an express mechanic's lien is placed on the car or truck to secure the cost of the repairs. [THE WARRANTY FOR NEW PARTS IS 12 MONTHS OR 12,000 MILES,
WHICHEVER COMES FIRST.] [ADDITIONALLY, THERE IS A 90-DAY WARRANTY ON ALL USED PARTS.] [PLEASE NOTE THAT THERE IS NO WARRANTY ON PARTS OR
LABOR FOR VEHICLES THAT ARE USED OR CONVERTED FOR COMMERCIAL PURPOSES.] I understand that the final amount due on this invoice may differ from the price
stated in the original estimate.
Signature __________________________ Date. _________________ _
Visit us on the web: www.STUSTRANSMISSION.COM Email Address: JAKE@STUSTRANSM/SS/ON.COM
Service Advisor: BRUCK, OTILIA, Tech : Page 1 of 1 Copyright (c) 2024 Mitchell Repair Information Company, LLC invhrs 5.12.21kr
A-7
BAR#299542/EPA#CAL000461001
5233 CLARK AVE
lAKEWOOD,CA 90712
.(562)531m7570
PAGE
Guest ID: 1721023011
Name: TONI ALEXIS ENGBERG
Year:
Make:
2016
CHEVROLET
SONIC
Date/Time:
Estimate#:
06/26/24 08:15:01
458601
Address: Model: Invoice#:
Address 2:
City,State,Zip:
Home Phone:
Lie No:
VIN:
Color: ---PO Number:
Unit Number:
Email Address:
Work Phone: Engine: L4-1.8L DOHC 16V MFI VIN G LWE Fleet/Wholesale: N
Other Phone: () -
Tax Exempt#:
Mileage In: 58167 Est Created On: 06/26/24 07:49: 17
Mileage Out: 0
Manager: Inspect Due:
Services Requested:
CUSTOMER CALLED, STATING OIL LEVEL WAS NO SHOWING UP ON DIP STICK. WE DID OIL CHANGE 6/1/24, IN WHICH OIL LEVEL EXTREMELY
LOW AS WELL. CK & ADVISE.,
Qty. Part#
Car
Loe Description Part labor Amount
Tire Pressure Spec: Not Available Wheel Torque: Not Available
INCLUDED WITH EVERY VISIT
1 Cl
1 TPC
SERVICE
COURTESY INSPECTION
TIRE PRESSURE CHECK & INFLATE
1 CODESCAN FREE CODE SCAN
1 COMMENT **COMMENT**
CHECK BRAKES -FEELS LOW AND NOT BRAKING QUICKLY: HESISTION WHEN ACCELERATION, POSSIBLE
BACKFIRING: BURNING OIL??:
TOTAL SERVICE:
NO CHARGE
NO CHARGE
NO CHARGE
NO CHARGE
0.00
THIS IS A PHONE QUOTE ESTIMATE, NOT AN INVOICE! DO NOT MAKE ANY PAYMENTS FROM THIS PAPERWORK!
TECH:
Authorization
SUB TOTAL
SALES TAX
GRAND TOTAL
1 hereby give the Company and its employees permission to operate my vchick for the purposc,s of testing and inspecting,
including pcrfomling the courtesy inspection outlined on the courtesy inspection thut was provided to tnc. I hereby authorize
the n.-pairs shown on the estimate to be made, along with any necessary parts.
O1101nol
eaumato:
Authorizod
.. '3-ll_'_
Additional
Cost:
Authoriz::ed
_By:
O~:scrjpUon:
i1 Revised
1 EsUmnto,:
lfi::: · ----1---·
. . . . .. J::::1t II::+:•~-•
I [" Dato: l r Tfmo,: -~·~-1··-, Cl B)' Phon.o
jPh<>n<>II: □ UV l°oQXt.
.. I Email:
CUSTOMER COPY
0.00
0.00
0.00
A-8
BAR#299542/EPA#CAl000461001
5233 CLARK AVE
lAKEWOOD,CA 90712
(562)531m7570
PAGE 1
Guest ID: 1721023011 Year:
Name: TONI / ALEXIS ENGBERG Make:
2016
CHEVROLET
SONIC
Date/Time:
Estimate#:
04/22/24 09:36:26
455650
Address: Model: Invoice#:
Address 2:
City,State ,Zip:
Home Phone:
Lie No:
VIN:
Color: ----PO Number:
Unit Number:
Email Address:
Work Phone: Engine: 1.8L GAS DOHC (VIN G) Fleet/Wholesale: N
Other Phone: () -
Tax Exempt #:
Mileage In: 56777 Est Created On: 04/17/24 15:49:37
Mileage Out: 0
Manager: DANIEL GOLLUB Inspect Due:
Services Requested:
CHECK FOR DAMAGE, HIT BUMP AND LOST ALL OIL AND RF TIRE, CHECK ENGINE LIGHT ON CHECK AND ADVISE
Car
Qty. Part # Loe Description Part
Tire Pressure Spec: FRONT: 35 REAR: 35 Wheel Torque: 100
Tire Pressure IN
.J!!L
.J!!L
INCLUDED WITH EVERY VISIT
1 Cl
1 TPC
SERVICE
1 OUTSE
1 OUTSEl
1 OUTSE2
7 881051
TIRE
2 166277008
2 RHW-MV
2 TR2
2 CATT
RF
RF
RF
RF
Tire Pressure OUT
.J!!L
.J!!L
COURTESY INSPECTION
TIRE PRESSURE CHECK & INFLATE
TRANSMISSION OIL PAN
TRANSMISSION OIL PAN GASKET
SECONDARY AIR CHECK VALVE
MAXLIFE TRANS FLUID
Tread Depth
TOTAL SERVICE:
COOPER ENDEAVOR
Tire Size: 195/65R15 Speed Rating: H Ply: 04
Load Range: B Sidewall: BLK Load Index: 91
Mileage Warranty: 65000
MV RDHAZARD COVERAGE
TIRE RECYCLING FEE
CP... TIRE FEE
I TOTAL TIRE:
HEEL ALIGNMENT
/32
/32
ackage Includes: Mounting, Balancing, Standard Valve Stem, TPMS
nspection & Reset if applicable Alignment Check, Wheel Torque PLUS:
ifetime Balancing, Lifetime Rotation. ·
TIRE SERVICE: ., ·i
SEE NEXT PAGE
207.75
77.46
519.11
8.00
139.99
22.40
4.40
1.75
0.00
0.00
Labor Amount
Brake Pads
/32 /32
_lg_ _jE_
NO CHARGE
NO CHARGE
324.00
0.00
54.00
0.00
0.00
0.00
0.00
0.00
129.99
30.99
531.75
77.46
573.11
56.00
1,238.32
279.98
44.80
8.80
3.50
337.08
129.99
61.98
191.97
IF YOU DO NOT RECEIVE AN INVOICE AFTER WORK IS COMPLETED AND !FINAL PAYMENT, PLEASE CALL 800-876-6676 x 3600.
CUSTOMER COPY
A-9
BAR#299542/EPA#CAL000461001
5233 CLARK AVE
lAKEWOOO,CA 90712
(562)531 a7570
PAGE 2
Guest ID: 1721023011 Year:
Name: TONI / ALEXIS ENGBERG Make:
2016
CHEVROLET
SONIC
Date/Time:
Estimate#:
04/22/24 09:30:05
455650
Address: Model: Invoice#:
Address 2:
City,State,Zip:
Home Phone:
Lie No:
VIN:
Color: ----PO Number:
Unit Number:
Email Address:
Work Phone: Engine: 1.8L GAS DOHC (VIN G) Fleet/Wholesale: N
Other Phone: () -
Tax Exempt#:
Mileage In: 56777 Est Created On: 04/17/24 15:49:37
Mileage Out: 0
Manager: DANIEL GOLLUB Inspect Due:
Services Requested:
CHECK FOR DAMAGE, HIT BUMP AND LOST ALL OIL AND RF TIRE, CHECK ENGINE LIGHT ON CHECK AND ADVISE
Car
Qty. Part# Loe Description Part labor Amount
IF YOU DO NOT RECEIVE AN INVOICE AFTER WORK IS COMPLETED AND FINJ\l PAYMENT, PLEASE CALL 800-876-6676 x 3500.
TECH:
Authorization
SUB TOTAL
SALES TAX
GRAND TOTAL
I hereby give the Company and its employees pe,-rmission to operate my vehicle for the purposes of testing and inspecting,
including pcrfom1ing the courtesy inspection outlined on the courtesy ihspcction that was p1·ovidcd to me. I hcrnby authorize
the rcpail's show11 011 the estim 1te to be made, along with any necesst1ry parts ..
Original
Esllmat,o:
Aii1horiz:od
. 8-¥.' ...
Addlllonal
C::osl:
1t:: '1 _l;;:r~:t
□ In Per~on
□ Bv Phooo
.. ~~---~¥. ... !.!~~--..
-~-.~X. e~~~~-i1_ .
\ Revised ,__ __ ....,..... _______ __, .. _ •--····-·-·--,· I rc>~to; r· CllnPenmn
I Entlmato: / Tlmo! /_.,..._____ 0 By Phono 1------~------~----~------·t-i -Ph_o_n_o_ll:-! □ av ro•t
Aulhorlz:ad t----+·--------+---'----l __ e_v,:_ ,,.. l Em;t:U: ! □ ev Ernt~U
Description:
CUSTOMER COPY
l
994.73
49.77
1,044.50
A-10
BAR#299542/EPA#CAL000461001
5233 CLARK AVE
LAKEWOOO,CA 90712
(562)531 ~7570
PAGE 1
Guest ID: 1721023011 Year:
Name: TONI/ ALEXIS ENGBERG Make:
2016
CHEVROLET
SONIC
Date/Time:
Estimate#:
04/22/24 09:30:05
455650
Address: Model: Invoice#:
Address 2:
City,State,Zip:
Home Phone:
Lie No:
VIN:
Color: ----PO Number:
Unit Number:
Email Address:
Work Phone: Engine: 1.8L GAS DOHC (VIN G) . Fleet/Wholesale: N
Other Phone: () -
Tax Exempt#:
Mileage In: 56777 Est Created On: 04/17/24 15:49:37
Mileage Out: 0
Manager: DANIEL GOLLUB Inspect Due:
Services Requested:
CHECK FOR DAMAGE, HIT BUMP AND LOST ALL OIL AND RF TIRE, CHECK ENGINE LIGHT ON CHECK AND ADVISE
Car
Qty. Part# Loe Description Part
Tire Pressure Spec: FRONT: 35 REAR: 35 Wheel Torque: 100
Tire Pressure IN
~
~ ~
INCLUDED WITH EVERY VISIT
1 Cl
1 TPC
SERVICE
1 0UTSE
1 0UTSEl
7 881051
TIRE
1 166277008
1 RHW-MV
1 TR2
1 CATT
TIRE SERVICE
1 ALIGNMENT
1 TIREINSTALL
RF
RF
RF
RF
Tire Pressure OUT
~ ~
COURTESY INSPECTION
TIRE PRESSURE CHECK & INFLATE
TRANSMISSION OIL PAN
TRANSMISSION OIL PAN GASKET
MAXLIFE TRANS FLUID
TOTAL SERVICE:
COOPER ENDEAVOR
Tire Size: 195/65R15 Speed Rating: H Ply: 04
Load Range: B Sidewall: BLK Load Index: 91
Mileage Warranty: 65000 ·•
MV RDHAZARD COVERAGE
TIRE RECYCLING FEE
CA TIRE FEE
TOTAL TIRE:
WHEEL ALIGNMENT
Tread Depth
Package Includes: Mounting, Balancing, Standar,9 Valve Stem, TPMS
Inspection & Reset if applicable Alignment Check Wheel Torque PLUS:
Lifetime Balancing, Lifetime Rotation. -. 'f
TAL TIRE SERVlqE: -~ ; .
SECONDARY AIR CHECK VALVE
: I
i
SEE NEXT PAGE . -.~. l
207.75
77.46
8.00
139.99
22.40
4.40
1.75
0.00
0.00
519.11
519.11
/32
/32
labor Amount
Brake Pads
/32
/32
NO CHARGE
NO CHARGE
324.00
0.00
0.00
0.00
0.00
0.00
0.00
129.99
30.99
54.00
54.00
531.75
77.46
56.00
665.21
139.99
22.40
4.40
1.75
168.54
129.99
30.99
160.98
573.11
573.11
IF YOU DO NOT RECEIVE AN INVOICE AFTER WORK IS COMPLETED AND FINAL PAYMENT, PLEASE CALL 800-876-6676 x 3500.
CUSTOMER COPY /
'\
A-11
Guest ID: 1721023011 Year:
Name: TONI/ ALEXIS ENGBERG Make:
Address: Model:
Address 2: Lie No:
City,State,Zip: VIN:
Home Phone: Color:
Work Phone: Engine:
Other Phone: Mileage In:
Tax Exempt#: Mileage Out:
BAR#299542/EPA#CAL000461001
5233 CLARK AVE
LAKEWOOD,CA 90712
(562)531~7570
2016
CHEVROLET
SONIC
111--
1 :BL GAS DOHC (VIN G)
56777
0
Date/Time:
Estimate#:
Invoice#:
PO Number:
Unit Number:
Email Address:
Fleet/Wholesale:
Est Created On:
PAGE 2
04/22/24 09:36:26
455650
N
04/17/24 15:49:37
Manager: DANIEL GOLLUB Inspect Due:
Services Requested:
CHECK FOR DAMAGE, HIT BUMP AND LOST ALL OIL AND RF TIRE, CHECK ENGINE LIGHT ON CHECK AND ADVISE
Car
Qty. Part# Loe Description Part Labor Amount
IF YOU DO NOT RECEIVE AN INVOICE AFTER WORK IS COMPLETED AND FINAL PAYMENT, PLEASE CALL 800-876-6676 x 3500.
TECH:
Authorization
SUB TOTAL
SALES TAX
GRAND TOTAL
I hereby give the Company and its employees pcm1issio11 to operate my vehicle for the purposes of testing and inspecting,
including pcrfom1ing the courtesy Inspection outlined on the courtesy inspection that was pt'ovidcd to me. I hereby authorize
the repairs shown on the estimate to be made, along with any necessary parts.
Original
, __ Estima.to:.~ .... ~ .. -·-
Aulhorlzod
__ By: ..
Addlllonal
Cast:
Authorized
. El.~_: ..
011-scription:
....... i
I R"vlHd ! 6$Um:tto: r
I Phono #;
1.1:.~'"~' ...
CUSTOMER COPY
1,767.37
117.78
1,885.15
A-12
BAR#299542/EPA#CAl000461001
5233 CLARK AVE
lAKEWOOD,CA 90712
(562)531 ~7570
PAGE 1
Guest ID: 1721023011 Year:
Name: TONI ALEXIS ENGBERG Make:
2016
CHEVROLET
Date/Time:
Estimate#:
07/01/24 15:43:04
458601
Address: Model: ---Invoice#: 441362
Address 2: Lie No: PO Number:
City,State,Zip: VIN: Unit Number:
Home Phone: Color: Email Address:
Work Phone: Fleet/Wholesale: N
Other Phone:
Engine: ·. L4-1.8L DOHC 16V MFI VIN G LWE
■ 58167 Est Created On: 06/26/24 08:24: 11
Tax Exempt#:
Manager: BRUCE SIMS
Services Requested:
Mileage Out: 58167
Inspect Due: 09/01/24
CUSTOMER CALLED, STATING OIL LEVEL WAS NO SHOWING UP ON DIP STICK. WE DID OIL CHANGE 6/1/24, IN WHICH OIL LEVEL EXTREMELY
LOW AS WELL. CK & ADVISE., .
Qty. Part#
Car
Loe Description
Tire Pressure Spec: Not Available Wheel Torque: Not Available
Tire Pressure IN Tire Pressure OUT
38 psi
INCLUDED WITH EVERY VISIT
1 Cl
1 TPC
SERVICE
38 psi
38 psi
COURTESY INSPECTION
TIRE PRESSURE CHECK & INFLATE
1 CODESCAN FREE CODE SCAN
1 COMMENT **COMMENT** · .,
Tread Depth
10 /32
9 /32
CHECK BRAKES -FEELS LOW AND NOT BRAKING QUICKLY: HESITATION WHEN ACCELERATION, POSSIBLE
BACKFIRING: BURNING OIL??:
OUTSE C5597 AUTO TRANS MOUNT
OUTSEl 3386 ENGINE MOUNT
COMMENT **COMMENT
ADVISED: TSB #01-06-01-0110 ENGINE OIL CONSUMP ION ISSUE. SEE DEALER. ENGINE CONSUMPTION
IS MORE THAN 1 QUART IN 2000 MILES, WHICH IS A OVE NORMAL.
COMMENT **COMME T**
ADVISED: TRANSMISSION BRACKET W/MOUNT IS ROKEN@ MOUNTING BOLT. ENGINE MOUNT BUSHING
COLLAPSED. LF CV AXLE SHAFT L
COMMENT
ADVISED: FRONT DISC BR
DRUM BRAKES OUT OF AD
12KBRAKE
NEW PADS WITl-)~g_t;:gij)IFACE ROTORS. REAR
T.
ty on Pads/Shoes 12 Month/12K Mile Labor
BRAKE
1 OUT
2 3
MKD1497 BRAKE PADS
RESURFACE/TURN ROTOR
$50 BRAKE SERVICE CR 1
OTAL FRONT BRAKES:
Part
254.74
250.95
25.99
(63.47)
169.99
0.00
(50.00)
CLEAN&ADJUST BRAKES 0.00
TOTAL REAR BRAKES:
NEXT PAGE
INVOICE INVOICE BAR#299542/EPA#CAL000461001 INVOICE
CUSTOMER COP~t
/32
/32
labor Amount
Brake Pads
NO CHARGE
NO CHARGE
NO CHARGE
NO CHARGE
180.00 434.74
90.00 340.95
NO CHARGE
NO CHARGE
NO CHARGE
NO CHARGE
3.00 28.99
0.00 (63.47)
741.21
80.00 249.99
50.00 100.00
0.00 (50.00)
299.99
65.00 65.00
65.00
A-13
BAR#299542/EPA#CAL000461001
5233 CLARK AVE
LAKEWOOD,CA 90712
(562)531-7570
PAGE 2
Guest ID: 1721023011 Year:
Name: TONI ALEXIS ENGBERG Make:
Address: Model:
Address 2: Lie No:
City,State,Zip: VIN:
Home Phone: Color:
Work Phone: Engine:
Other Phone: Mileage In:
Tax Exempt#: Mileage Out:
Manager: BRUCE SIMS Inspect Due:
Services Requested:
2016
CHEVROLET
SONIC ----L4-1.8L DOHC 16V MFI VIN G LWE
58167
58167
09/01/24
Date/Time:
Estimate#:
Invoice#:
PO Number:
Unit Number:
Email Address:
Fleet/Wholesale:
Est Created On:
07/01/24 15:43:04
458601
441362
N
06/26/24 08:24:11
CUSTOMER CALLED, STATING OIL LEVEL WAS NO SHOWING UP ON DIP STICK. WE DID OIL CHANGE 6/1/24, IN WHICH OIL LEVEL EXTREMELY
LOW AS WELL. CK & ADVISE.,
Qty.Part#
FRONT END
1 OUTCVS
Car
Loe
LF
Description
TOTAL BRAKES:
I
143 4N CV SHAFT
TOT FRONT END:
*** Customer Wishes To Discard Old Parts***
PAY TYPE: MASTERCARD 1657.03
CREDIT CARD#: XXXX-XXXX-XXX
TECH: 031484-0.00 D. FLORES
INVOICE INVOICE BAR#299542/EPA#CAL000461001 INVOICE
All parts are new unless otherwise specified. Please see reverse for warranty details.
Part Labor
232.69 234.00
SUB TOTAL
SALES TAX
GRAND TOTAL
Amount
364.99
466.69
466.69
1,572.89
84.14
1,657.03
I acknowledge that this invoice is for services rendered by [Monro Inc.] and now, in acceptance of such service, make payment in the amount set forth on
this invoice. If there was an increase in the original estimated price, I acknowledge notice an&oral approval of an increase in the original estimated price.
Caution: We may have removed your wheel(s) during this service. If so, for Important safety reasons, you should return after 25 miles to have your wheels
PAY
CREDIT
retorqued. Please return to any Monro-operated location (including this one) for c · ·
X
I certify that all repairs were properly completed. -·-----···-··----------
Did .1·ou haw ,i 5-star visit today'/ Let us know
AMT
1,657.03 7/1/2024
PAYMENT COLLECTED BY: B. SIMS
CUSTOMER COPY
_____ co_mp,wy ,\uthorizi.'d Represen!,1iivc
A-14
BAR#299542/E PA#CAL000461001
5233 CLARK AVE
LAKEWOOD,CA 90712
(562)531-7570
PAGE 2
Guest ID: 1721023011
Name: TONI / ALEXIS ENGBERG
Address:
Address 2:
City,State,Zip:
Horne Phone:
Work Phone:
Other Phone: () -
Tax Exempt#:
Manager: DANIEL GOLLUB
Services Requested:
Year:
Make:
Model:
Lie No:
VIN:
Color:
Engine:
Mileage In:
Mileage Out:
Inspect Due:
2016
CHEVROLET
SONIC ---WHITE
1.8L GAS DOHC (VIN G)
56777
56777
Date/Time:
Estimate#:
Invoice#:
PO Number:
Unit Number:
Email Address:
Fleet/Wholesale:
Est Created On:
CHECK FOR DAMAGE, HIT BUMP AND LOST ALL OIL AND RF TIRE, CHECK ENGINE LIGHT ON CHECK AND ADVISE
Car
04/29/24 12:12:57
455650
439840
N
04/17/24 15:49:37
Qty. Part# Loe Description Part labor Amount
INVOICE INVOICE BAR#299542/EPA#CAL000461001 INVOICE
TECH: 031487-0.00 R. PROM
SUB TOTAL
SALES TAX
GRAND TOTAL
PAY
CREDIT
All parts are new unless otherwise specified. Please see reverse for warranty details.
I acknowledge that this invoice is for services rendered by [Monro Inc.] and now, in acceptance of such service, make payment in the amount set forth on
this invoice. If there was an increase in the original estimated price, I acknowledge notice and oral approval of an increase in the original estimated price.
Caution: We may have removed your wheel(s} during this s_ervice. If so, for important safety rea"sons, you should return after 25 miles to have your wheels
retorqued. Please return to any Monro-operated location (including this one) for com
x_
I certify that all repairs were properly completed.
AMT
214.33 4/29/2024
Guest Signati.n·e
·r;J f;;,.-cM,ocJ..i
"'*"""'
PAYMENT COLLECTED BY: B. SIMS
CUSTOMER COPY
199.53
14.80
214.33
A-15
BAR#299542/EPA#CAL000461001
5233 CLARK AVE
LAKEWOOD,CA 90712
(562)531-7570
PAGE 1
Guest ID: 1721023011 Year:
Name: TONI / ALEXIS ENGBERG Make:
2016
CHEVROLET
SONIC
Date/Time:
Estimate#:
04 /29/24 12 :12:57
455650
Address: Mode l: Invoice#: 439840
Address 2:
City,State,Zip:
Home Phone:
Lie No:
VIN:
Color: ----PO Number:
Unit Number:
Email Address:
Work Phone: Engine: 1.8L GAS DOHC (VIN G) Fleet/Who lesale: N
Other Phone: () -
Tax Exempt #:
Mil eage In : 56777 Est Created On : 04/17/24 15 :49 :37
Mileage Out: 56777
Manager : DANIEL GOLLUB Inspect Due :
Services Requested :
CHECK FOR DAMAGE, HIT BUMP AND LOST ALL O IL AND RF TIRE, CHECK ENGINE LIGHT ON CHECK AND ADVISE
Car
Qty. Part# Loe Descrlption Part
Tire Pressure Spec: FRONT: 35 REAR : 35 Wheel Torque: 100
Tire Pressure IN
35 psi
36 psi
INCLUDED WITH EVERY VISIT
1 Cl
1 TPC
TIRE
1 166277008 RF
These parts were declined by the customer:
1 OUTSE
1 OUTSEl
1 OUTSE2
7 881051
1 ALIGNMENT RF
Subtotal of declined parts (tax not included):
Tire Pressure OUT
COURTESY I 'SPECTION
T IRE PRES RE CHECK & INFLATE
COOPE ENDEAVOR
Tire ize : 195/65R15 Speed Rating: H Ply: 04
Lo d Range : B Sidewcjll: BLK Load Index: 91
eage Warranty : 65000
g. Date : 2oth week of 2023
V RDHAZARD COVERAGE
IRE RECYCLING FEE
CA TIRE FEE
TOTAL TIRE:
Tread Depth
11 /3 2
6 /32
ackage Includes : Mounting, Balancing, Standard Valve Stem, TPMS
nspection & Reset if app licable A lignment Check, Wheel Torque PLUS:
Lifetime Balancing, Lifetirn,~ Rotation.
L TIRE SERVICE:
TRANSMISSION OIL PAN
TRANSMISSION OIL PAN GASKET
SECONDARY AIR CHECK VALVE
MAXLIFE TRANS FLUID
WHEEL ALIGNMENT
SEE N EXT PAGE
INVOICE INVOICE BAR#299542/EPA#CAL000461001 INVOICE
CUSTOMER COPY
139 .99
22.40
4.40
1.75
0 .00
207 .75
77.46
519.11
8.00
0.00
860 .32
Labor Amount
Brake Pads
/3 2
/32
NO CHARGE
NO CHARGE
0 .00
0.00
0 .00
0.00
30.99
324.00
0 .00
54.00
0 .00
129.99
507 .99
139.99
22.40
4.40
1.75
168 .54
30.99
30.99
531.75
77.46
573.11
56.00
129.99
1,368.31
A-16
Insured:
Type of Loss:
Point of I mp act:
Owner (Insured):
GARRISON PROPERTY & CASUALTY, A USAA SUBSIDIARY
USAA5163 -CA
Please Visit Us at USAA.com
P.O. Box 33490
San Antonio, TX 78265
Phone: (800) 531-8722
Supplement of Record 2 Summary
Claim#:
Workfile ID:
Written By: GEORGE LANGARICA, License Number: 726355, 6/29/2024 1 :56:52 PM
Toni Engberg
Comprehensive
28 Undercarriage
Owner Policy #:
Date of Loss:
Deductible:
Inspection Location:
04/16/2024 12:00 AM
500.00
Appraiser Information:
Claim#:
Days to Repair: 4
Repair Facility:
Toni Engberg MOUNTAIN VIEW TIRE &
AUTO SERVICE
George.Langarica@usaa.com
(562) 229-6307
MOUNTAIN VIEW TIRE & AUTO
SERVICE
5233 CLARK AVE
LAKEWOOD, CA 90712
Field
VEHICLE
2016 CHEV Sonic LT Automatic 4D H/B 4-1.BL Gasoline Electronic Fuel Injection White
VIN:
License:
State: CA
TRAN SM ISSI ON
Automatic Transmission
POWER
Power Steering
Power Brakes
Power Windows
Power Locks
Power Mirrors
Heated Mirrors
DECOR
6/29/2024 1 :56:54 PM
Production Date:
Odometer:
Condition:
Air Conditioning
Intermittent Wipers
Tilt Wheel
Cruise Control
Rear Defogger
Keyless Entry
Alarm
Message Center
Steering Wheel Touch Controls
Rear Window Wiper
Telescopic Wheel
09/2015
56774
FM Radio
Stereo
Search/Seek
Auxiliary Audio Connection
Satellite Radio
SAFETY
Drivers Side Air Bag
Passenger Air Bag
Anti-Lock Brakes ( 4)
Front Side Impact Air Bags
Head/Curtain Air Bags
Communications System
Hands Free Device
Rear Side Impact Air Bags
465993 I 1.9.02.05260
5233 CLARK AVE
LAKEWOOD, CA 90712
Interior Color:
Exterior Color: White
SEATS
Cloth Seats
Bucket Seats
Reclining/Lounge Seats
WHEELS
Aluminum/Alloy Wheels
PAINT
Clear Coat Paint
OTHER
Traction Control
Stability Control
Rear Spoiler
Page 1
A-17
Claim#:
Supplement of Record 2 Summary
2016 CHEV Sonic LT Automatic 4D H/B 4-1.8L Gasoline Electronic Fuel Injection White
Line Oper Description Part Number Qty Extended Labor Paint
Price 3
1 # *************************** 0.00 0.0 0.0
**************************
2 # •**Supplement Instructions*** 1 0.00 0.0 0.0
3 # For Supplements Use CCC 1 0.00 0.0 0.0
4 # Estimate Share -Questions 0.00 0.0 0.0
5 # Call CCC 800.637.8511 1 0.00 0.0 0.0
6 # Non CCC Users Contact i 0.00 0.0 0.0
7 # george.langarica@usaa.com or 0.00 0.0 0.0
562-229-6307
8 # *************************** 0.00 0.0 0.0
**************************
9 # S01 Subl Labor to install transmission oil 472.50 X 0.0 0.0
pan
NOTE: INCLUDES LABOR FOR AIR CHECK VALVE & MIRROR
10 S01 Repl A/M Tramsmission filter & gasket 52.85 0.0 0.0
11 # SOi Subl Labor to install filter & gasket 1 132.30 X 0.0 0.0
12 ** SOi Repl A/M Transmission fluid 5 84.80 0.0 0.0
13 # S01 Repl RCY Transmission oil pan 126.36 0.0 0.0
14 # S01 Repl Secondary air check valve i 785.00 0.0 0.0
15 # Subl Labor to install air check valve i 54.00 X 0.0 0.0
16 ENGINE/ TRAl\lSAXLE
17 S02 Repl Motor mount 95133816 134.18 m Q.Jl.. 0.0
18 # S02 Subl Labor to install motor mount 180.00 X 0.0 0.0
19 . S02 Repl Upr trans mount auto trans 95169684 1 83.30 m 0.0 0.0
20 # S02 Subl Labor to install upper trans 1 90.00 X 0.0 0.0
mount
21 . S02 Repl Lwr trans mount 95350019 56.22 m .!LQ 0.0
22 S02 Repl Trans mount brkt lower mount 96852643 95.20 m QJJ. 0.0
auto trans
23 # S02 Subl Labor to install Lower trans 180.00 X 0.0 0.0
brackets
24 WHEELS
25 # Sub! 4 Wheel Alignment 129.99 X 0.0 0.0
26 FRONT SUSPENSION
27 .. S02 Repl A/M LT Axle assy 1. 8 liter auto 143541\1 (GFHH) 1 111.05 m 0.0 0.0
trans
28 # S02 Subl Labor to install LT Axle 234.00 X 0.0 0.0
29 FRONT DOOR
30 S01 Rep! RGY RT Mirror assy w/power ~341590818 Efil)_ incl. M
+25%
31 Add for Clear Coat 0 0.00 0.0 0.1
32 0 0.00 0.4 0.0
33 MISCELLA
6/29/2024 1 :56:54 P 465993 I 1.s.02.05250 Page 2
A-18
Claim II:
Workfile ID:
Supplement of Record 2 Summary
2016 CHEV Sonic LT Automatic 4D H/B 4-1.8L Gasoline Electronic Fuel Injection White
34 # Refn Color Tint
35 OTHER CHARGES
36 # S01 E.P.C.
Estimate Notes:
Appraiser Repairable vehicle contact notes
Vehicle Owner Name: TONI ENGBERG
Phone Number(s) Contacted:
Contact Made or Voicemail Left? Contact made; Emailed estimate
Repair Process Review: YES
Explained Repair Process: YES
Explained STARS/SOC? YES
Reviewed Payment? YES
Reviewed Deductible? YES
Reviewed Supplement Process? YES
Follow Up Needed? NO
Prior Damage Notes:
Front
6/29/2024 1 :56:54 PM
ESTIMATE TOTALS
Category
Parts
Body Labor
Paint Labor
Paint Supplies
Miscellaneous
Other Charges
Subtotal
Sales Tax
Total Cost of Repairs
Deductible
Total Adjustments
Net Cost of Repairs
SUBTOTALS
NOTES
465993 I 1.9.02.05250
0 0.00
5.00
3,044.25
Basis
0.4 hrs @
1.0 hrs @
1.0hrs @
S 1,614.46 @
0.0
0.4
Rate
S 68.00 /hr
S 68.00 /hr
3 48.00 /hr
10.2500 %
0.5
1.0
Cost S
1,566.46
27.20
68.00
48.00
1,472.79
5.00
3,187.45
165.48
3,352.93
500.00
5 00.00
2,852.93
Page 3
A-19
Supplement of Record 2 Summary
2016 CHEV Sonic LT Automatic 4D H/B 4-1.8L Gasoline Electronic Fuel Injection White
SUPPLEMENT SUMMARY
Line Oper Description
Added Items
16 ENGINE/ TRANSAXLE
17 S02 Repl Motor mount
18 # S02 Subl Labor to install motor mount
19 S02 Repl Upr trans mount auto trans
20 # S02 Subl Labor to install upper trans
mount
21 . S02 Repl Lwr trans mount
22 * S02 Repl Trans mount brkt lower mount
auto trans
23 # S02 Subl Labor to install Lower trans
brackets
26 FRONT SUSPENSION
27 S02 Repl A/M LT Axle assy 1.8 liter auto
trans
28 # S02 Subl Labor to install LT Axle
Estimate Notes:
Appraiser Repairable vehicle contact notes
Vehicle Owner Name: TONI ENGBERG
Phone Number(s) Contacted:
Contact Made or Voice mail Left? Contact made; Emailed estimate
Repair Process Review: YES
Explained Repair Process: YES
Explained STARS/SOC? YES
Reviewed
Reviewed
Reviewed
Follow Up
Prior Dama
Front
6/29/2024 1 :56:54 PM
Part Number
95133816
95169684
95350019
96852643
14354N (CFHH)
SUBTOTALS
NOTES
465993 I 1.9.02.05250
Qty
Claim#:
Workfile ID:
Extended Labor Paint
Price S
134.18 m 0.0 0.0
180.00 X 0.0 0.0
83.30 m 0.0 0.0
1 90.00 X 0.0 0.0
1 56.22 m Q.,_Q 0.0
1 95.20 m Q.,_Q 0.0
180.00 X 0.0 0.0
111.05 m Q.,_Q 0.0
234.00 X 0.0 0.0
1,163.95 0.0 0.0
Page 4
A-20
Claim#:
Workfile ID:
Supplement of Record 2 Summary
2016 CHEV Sonic LT Automatic 40 H/B 4-i.8L Gasoline Electronic Fuel Injection White
TOTALS SUMMARY
Category
Parts
Miscellaneous
Subtotal
Sales Tax
Total Supplement Amount
NET COST OF SUPPLEMENT
Basis
8 479.95 @
CUMULATIVE EFFECTS OF SUPPLEMENT(S)
Estimate
Supplement S01
Supplement S02
Workfile Total:
TOTAL ADJUSTMENTS:
NET COST OF REPAIRS:
MyPricelink Estimate ID/ Quote !D:
s
s
3
1,615.04 GEORGE LANGARICA
524.75 GEORGE LANGARICA
1,213.14 GEORGE LANGARICA
3,352.93
500.00
2,852.93
AVOID DELAYS BY GETTING CLAIM AND PAYMENT INFORMATION IN JUST A FEW CLICKS!
VISIT: http://www.usaa.com/bodyshop
MEMBER NUMBER: Use Policy Number
LOSS NUMBER: Use digits 16, 17, & 18 of the claim number
LOSS DATE: Use Date of loss
Rate
10.2500 %
Cost S
479.95
684.00
1,163.95
49.19
1,213.14
1,213.14
If you choose to repair your vehicle at a STARS facility, please visit the following link for information regarding the
USAA STARS Limited Lifetime Warranty:
https: // content. usaa.com/ mco nte nt/static_assets/Media/ usaa-stars-li m ited-lif etim a-warranty. pdf
If you do not choose to repair your vehicle at a STARS facility, please note that USAA STARS Limited lifetime
Warranty will not apply to repairs to your vehicle.
Please Present A Copy Of This Estimate To A Repair Facility Of Your Choice
*USAA Subsidiaries include: United Services Automobile Association(USAA), USAA Casualty Insurance Company(CIC),
USAA General Indemnity Company(GIC) USAA County Mutual lnsurance(CMI} and Garrison Property Casualty
Insurance Company. Garrison Property and Casualty Insurance Company, a subsidiary of USAA Casualty Insurance
Company, Is authorized to use the USAA logo, a registered trademark of U,nited Services Automobile Association.
/
This is not an authorization to repair. Falling to present this estlma o the repairing garage before repair may result
in additional expenses to you. A USAA appraiser must authori ny supplement to this estimate. Repairs to this
ve t as recom ded by the manufacturer.
465993 I 1.0.02.05250 Page 5
A-21
Supplement of Record 2 Summary
2016 CHEV Sonic LT Automatic 4D H/B 4-1.SL Gasoline Electronic Fuel Injection White
FOR YOUR PROTECTION CALIFORNIA LAW REQUIRES THE FOLLOWING TO
APPEAR ON THIS FORM. ANY PERSON WHO KNOWINGLY PRESENTS FALSE
OR FRAUDULENT INFORMATION TO OBTAIN OR AMEND INSURANCE
COVERAGE OR TO MAKE A CLAIM FOR THE PAYMENT OF A LOSS IS
GUILTY 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=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, NAGS=NATIONAL AUTO GLASS
SPECIFICATIONS, NON-ADJ"'NON ADJACENT, 0/H=OVERHAUL,
OP=OPERATION, NO=LINE NUMBER, QTY=QUANTITY,
RECOND=RECONDITION, REFN=REFINISH, REPL=REPLACE, R&!;;: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 AFTERMARKET,
N=NOTES ATTACHED 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.
Claim#:
Workfile ID:
THIS ESTIMATE HAS BEEN PREPARED BASED ON THE USE OF CRASH p RTSSUPPLIED BY A SOURCE OTHER THAN
THE MANUFACTURER OF YOUR MOTOR VEHICLE. ANY WARRANT! APPLICABLE TO THESE REPLACEMENT PARTS
ARE PROVIDED BY THE MANUFACTURER OR DISTRIBUTOR OE E PARTS, RATHER THAN BY THE ORIGINAL
MANUFACTURER OF YOUR VEHICLE.
Page 6
A-22
Claim#:
Workfile ID:
Supplement of Record 2 Summary
2016 CHEV Sonic LT Automatic 40 H/B 4-1.BL Gasoline Electronic Fuel Injection White
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 DR1CJ12, CCC Data Date 06/17/2024, 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 OE/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/Mor 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 2024 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=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:;::Biend. BOR=Boron steel.
CAPA=Certified Automotive Parts Association. D&R=Disconnect and Reconnect. HSS=High Strength Steel.
HYD=Hydroformed Steel. lncl.=lncluded. 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. 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 Intelligent e'(~;ces Inc.
The following Is a 11st of abbreviations that may e used in CCC ONE Estimating that are not part of the MOTOR
CRASH ESTIMATING GUIDE:
BAR=Bureau of Automotive Repair. EPA= vlronmental Protection Agency. NHTSA= National Highway
Trans ortation and Safet Administration PDR=Paintless Dent Repair. VIN=Vehlcle Identification Number.
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Claim#:
Workfile ID:
Supplement of Record 2 Summary
2016 CHEV Sonic LT Automatic 4D H/B 4-1.SL Gasoline Electronic Fuel Injection White
USAAs Quality Replacement Parts Program
The following information summarizes USAAs Quality Replacement Parts program:
USAA utilizes a Quality Replacement Parts (QRP) program to help manage repair costs while maintaining a high
standard of quality and safety for vehicle repairs. USAAs QRP program includes parts that are required to be
equivalent in quality, safety, fit, and performance of the part(s) being replaced on your vehicle. The application of
USAAs QRP program will comply with all state/federal laws where applicable and may be superseded by
policy/endorsement language when applicable.
USAA provides a Limited Parts Warranty on Quality Replacement Parts that are authorized for use on USAA approved
repair estimates and installed during vehicle repairs. USAAs warranty on sheet metal, and plastic QRP body parts is
valid for the greater of the following time periods: (1) the remaining period of the Original Equipment Manufacturer
(OEM) vehicle factory warranty; or (2) three years from the date of the repair completion. USAAs warranty on
mechanical and electrical QRP parts is valid for the greater of the following time periods: (1) the remaining period of
the Original Equipment Manufacturer (OEM) vehicle factory warranty; or (2) the same warranty period that would be
provided by the Original Equipment Manufacturer (OEM) for an equivalent OEM replacement part.
Excluded from USAAs QRP warranty are the following conditions: (1) normal wear and tear; (2) damage caused by
accident and/or acts of nature; (3) intentional acts; (4) improper use or modification; (5) improper installation;
and/or (6) improper maintenance of the vehicle.
Any express warranty not provided herein is hereby excluded and disclaimed. Any implied warranties of
merchantability and fitness for any particular purpose which may exist are expressly limited to the QRP warranty
period(s) as cited above. The USAA QRP warranty period(s) will comply with and be superseded by state/federal law
where applicable.
USAA shall not be liable to any person for any special, incidental, or consequential damages, whether arising out of
breach of warranty, breach of contract or otherwise. Limitations or exclusions of liability may be superseded by
state/federal law where applicable.
The following questions and answers may help you understand more about USAAs QRP program:
Q. What types of parts are utilized in the QRP Program?
A. In addition to the use of OEM parts in certain instances, the following types of parts may be utilized in the QRP
Program:
New aftermarket parts: Parts provided by manufacturers and distributors other than the Original Equipment
Manufacturer.
Recycled parts: Parts from a vehicle of the same make and model.
Reconditioned, remanufactured, and rebuilt parts: Parts that are .rebuilt or repaired to OEM specifications.
Optional OEM parts: New OEM or OEM equivalent parts provi ,ed by distributors other than the Original Equipment
Man uf actu re r.
Q. What assurances do I have that QRP parts are of hig quality?
A. USAAs QRP program maintains high standards to ize parts that are equivalent In quality, safety, flt, and
performance of the part(s) being replaced on your ehicle. QRP parts carry an equal or better warranty when
compared to OEM parts and are backed by USA Limited Parts Warranty.
Q. Do I have a choice of which parts are use o repair my vehicle?
ht to choose the types of parts that are utilized in the repairs to your
465993 I 1.0.02.05250 Page 8
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Claim#:
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Supplement of Record 2 Summary
2016 CHEV Sonic LT Automatic 4D H/B 4-1.SL Gasoline Electronic Fuel Injection White
vehicle. If you choose to utilize parts that differ from USAAs approved estimate, you will be responsible for any
additional part costs and labor differences. As well, USAAs Limited Parts Warranty will not be applicable to parts that
deviate from USAAs approved estimate.
Q. Will using a non-OEM part void the warranty on my vehicle?
A. QRP parts utilized in your vehicles repair carry an equal or better warranty when compared to OEM parts.
Additionally, QRP parts are backed by USAAs Limited Parts Warranty, which includes the duration of the OEM
warranty period.
Q. If an issue arises with a QRP part utilized in the repair to my vehicle, what is the resolution process?
A. If you experience a problem, contact your repair shop to discuss the concern. The shop will assess the situation
and can work directly with the QRP supplier and/or USAA where necessary to resolve the issue.
a. What should I do if my repair shop refuses to use QRP parts?
A. You have the right to choose where, how, and by whom your vehicle will be repaired. Repair shops have the right
to conduct business in accordance with their own practices, including charging more than a competitive cost for
repairs. Should you choose a repair shop that refuses to utilize the QRP parts listed on the USAA approved estimate,
you will be responsible for any additional part costs and labor differences in the final repair bill. As well, the USAA
Limited Parts Warranty will not apply.
If you have questions about the program or warranty, log on to http://usaa.com or call 1-800-531-USAA (8722).
6/29/2024 1 :56:54 PM 465993 I 1.0.02.05250 Page 9
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Claim#:
Workfile ID:
Supplement of Record 2 Summary
2016 CHEV Sonic LT Automatic 40 H/B 4-1.8L Gasoline Electronic Fuel Injection White
Line Supplier
27 AUTOZONE #6394
3605 South St
30
Long Beach CA 90805
(562) 295-3680
LKQ of Southern California (Lakenor)
13642 Orden Dr.
Santa Fe Springs CA 90670
(800) 525-3667
6/29/2024 1 :56:54 PM
ALTERNATE PARTS SUPPLIERS
Description
#14354N (CFHH)
AIM LT Axle assy 1.8 liter auto trans
Quote: 2US24003F7TC1 L9
Expires: 07 /28/24
# ~341590818
RCY RT Mirror assy w/power +25%
Side View Mirror LT,4DR R, POWER; R.,S#SY2710 -POWER; R.
Quote: 2476971072
Expires: 06/06/24
465993 I 1.9.02.05260
Price
S 111.05
S 30.00
Page 1 O
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Supplement of Record 2 Summary
2016 CHEV Sonic LT Automatic 4D H/B 4-1.BL Gasoline Electronic Fuel Injection White
ALTERNATE PARTS USAGE
2016 CHEV Sonic LT Automatic 4D H/B 4-1.BL Gasoline Electronic Fuel Injection White
VIN:
License:
State: CA
Alternate Part Type
Aftermarket
Optional OEM
Reconditioned
Recycled
6/29/2024 1 :56:54 PM
Production Date:
Odometer:
Condition:
09/2015
56774
# Of Available Parts
23
0
1
9
465993 ! 1.9.02.05260
Claim#:
Workfile ID:
Interior Color:
Exterior Color: White
# Of Parts Selected
3
0
0
2
Page 11
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Supplement of Record 2 Summary
2016 CHEV Sonic LT Automatic 4D H/B 4-1.8L Gasoline Electronic Fuel Injection White
RECALL INFO
2016 CHEV Sonic LT Automatic 4D H/B 4-1.8L Gasoline Electronic Fuel Injection White
VIN:
License:
State: CA
Production Date:
Odometer:
Condition:
09/2015
56774
Claim#:
Workfile ID:
Interior Color:
Exterior Color: White
The National Highway Transportation and Safety Administration (NHTSA) has issued 2 safety-related recall notice(s) that may apply to the selected
vehicle.
NHTSA ID: 16V422000 Issued: Jun 6, 16 Number of Vehicles: 00018780
ELECTRICAL SYSTEM, EQUIPMENT General Motors LLC (GM) is recalling certain model year 2015-2016 Chevrolet Sonic and Trax, and 2013-2015
Spark vehicles equipped with a Bring Your Own Media radio. The affected radios may fail to provide an audible warning chime when the driver fails
to fasten their seatbelt or if the driver leaves the key in the ignition. As such, these vehicles fail to comply with the requirements of Federal Motor
Vehicle Safety Standard (FMVSS) numbers 208 "Occupant Crash Protection" and 114 "Theft Protection." Without audible indicators, the driver may
not fasten their seatbelt, increasing the risk of injury during a crash. GM will notify owners, and dealers will update the radio software, free of
charge. The recall began on July 22, 2016. Owners may contact Chevrolet customer service at 1-800-222-1020. GM"s number for this recall is
45340.
NHTSA ID: 16V257000 Issued: Apr 4, 16 Number of Vehicles: 00317572
ELECTRICAL SYSTEM, EQUIPMENT General Motors LLC (GM) is recalling certain model year 2013-2016 Chevrolet Sonic and Trax vehicles and
2013-2015 Chevrolet Spark vehicles equipped with a Bring Your Own Media radio. The affected radios may fail to provide an audible warning chime
when the driver, after turning off the ignition and leaving the key \n the cylinder, waits 10 minutes or longer to open the door. As such, these
vehicles fail to comply with the requirements of Federal Motor Ve,llicle Safety Standard (FMVSS) number 114 "Theft Protection." Without audible
indicators, the driver may leave the key in the ignition, increasifg the risk of theft. GM will notify owners, and dealers will update the radio
software, free of charge. The manufacturer has not yet provid d a notification schedule. Owners may contact Chevrolet customer service at
1-800-222-1020. GM"s number for this recall is 17130.
6/29/2024 1 :56:54 PM 465993 \ 1.9.02.05260 Page 12
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$1,115.04
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iss u e Date ! Scheduled To Pay On !
04/24/2024 04/23/2024
05/09/2024 05/09/2024
05/10/2024 05/10/2024
05/2.9/2024 05/22/2024
07/01/2024 07/01/2024
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More images available on request. This was not visible while approaching incline due to
sloughing of asphalt. Road was repaired by the following Saturday.