CITIZENS INSURANCE CO OF AMERICA THE HANOVER INSURANCE GROUP For Supplements Call 413-977-4951 PO BOX 15052, WORCESTER, MA 01615 Phone: (800) 628-0250 Fax: (508) 926-4977
Claim #: Workfile ID:
14-00-929703-1-1 0e1a89c0
Supplement of Record 1 with Summary Written By: BRIAN VREELAND, License Number: 013123, 9/17/2012 10:18:18 AM Adjuster: PROCTOR, SARAH, (800) 628-0250 Business Insured:
David Ewen
Policy #:
APN3755616
Claim #:
14-00-929703-1-1
Type of Loss:
Collision
Date of Loss:
09/11/2012 12:00 AM
Days to Repair:
15
Point of Impact:
07 Left Rear
Deductible:
500.00
Owner:
Inspection Location:
Appraiser Information:
Repair Facility:
David Ewen 88 APPLETON ST SPRINGFIELD, MA 01108 (413) 237-0809 Evening
BALISE COLLISION REPAIR CENTER 292 MAIN ST. SPRINGFIELD, MA 01105 Repair Facility (413) 732-8702 Business
Email: bvreeland@hanover.com Phone: (413) 977-4951
BALISE COLLISION REPAIR CENTER 292 MAIN ST. SPRINGFIELD, MA 01105 (413) 732-8702 Business (413) 747-0509 Fax 55-0811490
VEHICLE Year:
2012
Color:
GRAY Int: gray
License:
953DL3
Make:
HOND
Body Style:
4D SED
State:
MA
Odometer:
Model:
CIVIC LX
Engine:
4-1.8L-FI
VIN:
2HGFB2E57CH556344
Condition:
TRANSMISSION
Production Date:
Console/Storage
AM Radio
Cloth Seats Bucket Seats
5 Speed Transmission
CONVENIENCE
FM Radio
Overdrive
Air Conditioning
Stereo
Recline/Lounge Seats
POWER
Rear Defogger
Search/Seek
WHEELS
Power Steering
Tilt Wheel
CD Player
Full Wheel Covers
Power Brakes
Cruise Control
Auxiliary Audio Connection
PAINT
Power Windows
Telescopic Wheel
SAFETY
Clear Coat Paint
Power Locks
Intermittent Wipers
Anti-Lock Brakes (4)
Metallic Paint
Power Mirrors
Keyless Entry
Driver Air Bag
OTHER
Power Trunk/Tailgate
Alarm
Passenger Air Bag
Traction Control
DECOR
Steering Wheel Controls
Head/Curtain Air Bags
Stability Control
Tinted Glass
Message Center
Front Side Impact Air Bags
Dual Mirrors
RADIO
SEATS
9/17/2012 10:18:43 AM
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5876
Page 1
Claim #:
14-00-929703-1-1
Workfile ID:
0e1a89c0
Supplement of Record 1 with Summary 2012 HOND CIVIC LX 4D SED 4-1.8L-FI GRAY
Line 1
Oper
Repl
4
Labor
Bumper cover w/o Si US built
1.4 04715TR3A90ZZ
1
303.38
Incl.
Repl
LT Spacer US built
71598TR0A01
1
12.27
0.1
R&I
LT Tail lamp assy
33550TR0A01
Incl. 0.8
TRUNK LID
9
R&I
R&I trunk lid
68500TR0A90ZZ
Blnd
Trunk lid LX, EX, EX-L
68500TR0A90ZZ
11
R&I
License molding US built, w/o DX cool mist
74890TR3A01ZF
R&I
License plate
13
Repl
Nameplate "CIVIC"
14
R&I
Trunk lid trim
84620TR3A01ZA
#
LT Quarter panel
04646TR0A90ZZ
1.2 0.3 0.1
75722TR0A01
1
26.73
0.2 0.3
QUARTER PANEL
16
Repl
17
Add for Clear Coat
18
Deduct for Rear Bumper R&I
19
R&I
20 21
1
735.12
17.5
1.2 63910TR0A00ZZ
Blnd
Fuel door
63910TR0A00ZZ
Repl
LT Air outlet vent
75450TR0A00
1
17.70
Incl.
22
Repl
LT Splash shield
74591TR0A00
1
3.82
0.2
23
Repl
LT Stone guard US built
74485SNAA00
1
24
Repl
LT Inner panel US built (HSS)
64700TR3415ZZ
1
25
Incl. 0.2
10.70 570.70 s
0.2 6.5
Add for Clear Coat R&I
LT Upper qtr trim US built beige
84180TR0A01ZC
Incl.
27
R&I
RT Upper qtr trim US built beige
84130TR0A01ZC
0.3
Rpr
Fabricate 1/4 sleeves
Repl
LT Gutter extn US built
# S01
30
S01
Add for Clear Coat
31
S01
Deduct for Overlap
2.0 63720TR3305ZZ
1
40.13
2.5
0.2 -1.0
R&I
LT Roof molding
74316TR0A01
0.4
35
R&I
Back glass Honda, US built w/o navigation
73211TR3A01
Incl.
36
Repl
Dam
73525SYY000
1
7.32
37
Repl
Lower seal
73227TR0A00
1
8.65
38
1.0
ROOF
33 34
1.5 0.3
26
29
3.1
-1.0
Fuel door
32
3.0 1.2
10
28
Paint
REAR LAMPS
7
15
Extended Price $
Add for Clear Coat
5
12
Qty
O/H rear bumper
3
8
Part Number
REAR BUMPER
2
6
Description
BACK GLASS
Incl.
REAR BODY & FLOOR
39
9/17/2012 10:18:43 AM
R&I
Pkg tray trim DX, LX, EX, HF beige
84505TR0A01ZC
107572
Incl.
Page 2
Claim #:
14-00-929703-1-1
Workfile ID:
0e1a89c0
Supplement of Record 1 with Summary 2012 HOND CIVIC LX 4D SED 4-1.8L-FI GRAY 40 41 42
*
43
*
S01
R&I
LT Trunk side trim US built DX, LX, EX, HF
R&I R&I Rpr
84651TR3A01ZA
Incl.
Rear panel trim
84640TR0A01ZA
Incl.
Spare cover US built
84521TR3A00ZA
Incl.
Rear body panel
66100TR0A00ZZ
1.5
0.5
NOTE: spot repair spot refinish LT side of panel 44
Overlap Major Adj. Panel
45
-0.4
Add for Clear Coat
46
*
S01
Rpr
47
REAR SUSPENSION
48
Repl
Rear floor pan US built
0.1 04655TR3A00ZZ
1.5
0.5
NOTE: spot repair spot refinish LT side of floor panel
49
Align four wheels
1
m
O/H rr susp lt
1.6
m
2.9
50
Repl
LT Trailing arm w/o Si
52371TR0A03
1
187.32 m
Incl.
51
Repl
LT Upper cntrl arm
52510TR0A01
1
67.52 m
Incl.
52
Repl
LT Knuckle sedan, US built DX, LX, HF
52215TR3A00
1
132.62 m
Incl.
42200TR0901
1
101.05 m
67550TR0A90ZZ
1
628.07
53
Deduct for Overlap
54 55
Repl
LT Hub & bearing sedan
Incl. Incl.
REAR DOOR
56
Repl
LT Door shell
57
Overlap Major Adj. Panel
58
Add for Clear Coat
59
Add for power units
4.0
0.5 0.2
60
R&I
LT Door w'strip US built
72850TR3A01
61
R&I
LT Water shield
72861TR0A00
0.1
62
R&I
LT Belt molding
72950TR0A01
Incl.
63
Repl
LT Black out tape US built
67865TR3A01
64
R&I
LT Moveable glass Honda US built
73450TR3A00
65
*
66 67
0.5
1
3.80
0.3 Incl.
R&I
LT Run channel
72775TR0A01
Incl.
R&I
LT Fixed glass Honda, w/o Si US built
73455TR3L00
Incl.
R&I
LT Weatherstrip US built
73491TR3A01
Incl.
68
*
R&I
LT Handle, outside painted
72181TR0A11ZH
Incl.
69
*
Refn
LT Handle, outside painted
72181TR0A11ZH
70
Overlap Minor Panel
71
Add for Clear Coat
72
2.9 -0.4
0.5 -0.2 0.1
FRONT DOOR
73
Blnd
LT Outer panel
74
R&I
LT Water shield
72361TR0A01
0.1
75
R&I
LT Belt molding
72450TR0A01
0.3
76
R&I
LT R&I mirror
76258TR3A01
0.4
77
R&I
LT Handle, outside painted alabaster slv
72181TR0A11ZC
0.4
78
R&I
LT R&I trim panel
83550TR0A11ZB
0.4
9/17/2012 10:18:43 AM
67151TR0305ZZ
107572
1.0
Page 3
Claim #:
14-00-929703-1-1
Workfile ID:
0e1a89c0
Supplement of Record 1 with Summary 2012 HOND CIVIC LX 4D SED 4-1.8L-FI GRAY 79
SEATS & TRACKS
80
S01
81
WHEELS
82
*
83
Repl
Seat cushion pad clip
82138TR0003
2
3.24
Repl
LT/Rear Wheel, steel 15"
42700TR0A02
1
78.60 m
Repl
LT/Rear Wheel cover 15" US built
44733TR0A00
1
20.88
Refn
TINT AND TEST
84
TIRES
85
#
86
#
87
#
DETAIL MASK
1
88
#
ADD FOR FLEX
1
12.00 T
89
#
RUSTPROOFING
1
10.00 T
90
#
DENIB AND POLISH
1
91
#
Blnd
92
#
Repl
93
#
94
#
95
#
96
COVER CAR FOR OVERSPRAY
1
3.00 X
0.3
0.2 0.5 0.6 0.2 2.5
BLEND WELD ZONES
0.5
SEAM SEAL
1
RESET ELECTRONICS
1
0.3
SETUP AND MEASURE
1
2.0
#
DIAGNOSE SUSPENSION
1
0.5
97
#
REPAIR CLAMP DAMAGE
1
0.5
98
#
PULL UNIBODY
1
4.0 F
99
#
D&R BATTERY
1
0.2
100
#
RESEAL VAPOR BARRIOR
1
101
#
PANEL BONDING KIT
1
102
#
BALANCE WHEEL
1
103
#
S01
Repl
Paint/materials
1
396.00
104
*
S01
Repl
FIRE 195/65R15 AFFINITY TOURING S4 89S
1
101.15
Refn
T
0.5
ANTI CORROSION PRIMER
0.3
FI07602
1.25
0.5
0.2
39.56 T 0.2 0.3
NOTE: Town fair Tire Co 1127 Riverdale st Wspringfield MA (413)787-0701 105
#
S01
Additional P/M per mitchell $643.90 less $396.00 allowed
1
247.90 T
NOTE: Code NH737M 12.9hrs refinish 2.9hrs blend =643.90 less 396.00 allowed = 247.90 SUBTOTALS
9/17/2012 10:18:43 AM
107572
3,770.48
57.5
19.8
Page 4
Claim #:
14-00-929703-1-1
Workfile ID:
0e1a89c0
Supplement of Record 1 with Summary 2012 HOND CIVIC LX 4D SED 4-1.8L-FI GRAY
ESTIMATE TOTALS Category
Basis
Rate
Parts Body Labor
53.5 hrs
@
$ 36.00 /hr
Paint Labor
19.8 hrs
@
$ 36.00 /hr
712.80
Frame Labor
4.0 hrs
@
$ 40.00 /hr
160.00
Miscellaneous
1,926.00
312.46
Subtotal
6,569.28
Sales Tax
$ 3,767.48
Total Cost of Repairs
@
6.2500 %
235.47 6,804.75
Deductible
500.00
Total Adjustments
500.00
Net Cost of Repairs
9/17/2012 10:18:43 AM
Cost $ 3,458.02
6,304.75
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Page 5
Claim #:
14-00-929703-1-1
Workfile ID:
0e1a89c0
Supplement of Record 1 with Summary 2012 HOND CIVIC LX 4D SED 4-1.8L-FI GRAY
SUPPLEMENT SUMMARY Line
Oper
Description
Part Number
Qty
Extended Price $
Labor
Paint
Changed Items 39
*
43
*
Rpr S01
Rpr
Rear body panel
66100TR0A00ZZ
-3.0
-1.0
Rear body panel
66100TR0A00ZZ
1.5
0.5
NOTE: spot repair spot refinish LT side of panel 42
*
46
*
Rpr S01
Rpr
Rear floor pan US built
04655TR3A00ZZ
-2.0
-0.5
Rear floor pan US built
04655TR3A00ZZ
1.5
0.5
NOTE: spot repair spot refinish LT side of floor panel 98
#
103
#
S01
Repl
Paint/materials
1
-382.00
Repl
Paint/materials
1
396.00
Repl
FIRE P195/65R15 AFFINITY TOURING S4
FI01808
1
-117.99
-0.3
Repl
LT Gutter extn US built
63720TR3305ZZ
1
40.13
2.5
Deleted Items 80
*
Added Items 29
S01
30
S01
Add for Clear Coat
31
S01
Deduct for Overlap
79
0.2 -1.0
SEATS & TRACKS
80 104
1.0
*
S01
Repl
Seat cushion pad clip
S01
Repl
FIRE 195/65R15 AFFINITY TOURING S4 89S
82138TR0003
2
3.24
FI07602
1
101.15
0.3
NOTE: Town fair Tire Co 1127 Riverdale st Wspringfield MA (413)787-0701 105
#
S01
Additional P/M per mitchell $643.90 less $396.00 allowed
1
247.90 T
NOTE: Code NH737M 12.9hrs refinish 2.9hrs blend =643.90 less 396.00 allowed = 247.90 SUBTOTALS
9/17/2012 10:18:43 AM
107572
288.43
-0.5
0.7
Page 6
Claim #:
14-00-929703-1-1
Workfile ID:
0e1a89c0
Supplement of Record 1 with Summary 2012 HOND CIVIC LX 4D SED 4-1.8L-FI GRAY
TOTALS SUMMARY Category
Basis
Rate
Cost $
Parts
40.53
Body Labor
-0.5 hrs
@
$ 36.00 /hr
-18.00
Paint Labor
0.7 hrs
@
$ 36.00 /hr
25.20
Paint Supplies
0.7 hrs
@
$ 20.00 /hr
14.00
Additional Supplement Materials/Supplies
-14.00
Miscellaneous
247.90
Subtotal
295.63
Sales Tax
$ 288.43
@
6.2500 %
18.03
Total Supplement Amount
313.66
NET COST OF SUPPLEMENT
313.66
CUMULATIVE EFFECTS OF SUPPLEMENT(S) Estimate
6,491.09
Supplement S01
313.66
Workfile Total:
$
6,804.75
TOTAL ADJUSTMENTS:
$
500.00
NET COST OF REPAIRS:
$
6,304.75
Ted Lolos BRIAN VREELAND
BRIAN VREELAND MA LIC #013123 PER MASSACHUSETTS REG. TITLE 212 CHAPTER 2.02(5), "THIS ESTIMATE HAS BEEN PREPARED AND SWORN TO UNDER THE PENALTIES OF PERJURY." Estimate calculated using a preset user threshold amount for the paint and material cost.
9/17/2012 10:18:43 AM
107572
Page 7
Claim #:
14-00-929703-1-1
Workfile ID:
0e1a89c0
Supplement of Record 1 with Summary 2012 HOND CIVIC LX 4D SED 4-1.8L-FI GRAY
Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from the Guide ARG4449, CCC Data Date 8/17/2012, and the parts selected are OEM-parts manufactured by the vehicles Original Equipment Manufacturer. OEM parts are available at OE/Vehicle dealerships. OPT OEM (Optional OEM) or ALT OEM (Alternative OEM) parts are OEM parts that may be provided by or through alternate sources other than the OEM vehicle dealerships. OPT OEM or ALT OEM parts may reflect some specific, special, or unique pricing or discount. OPT OEM or ALT OEM parts may include "Blemished" parts provided by OEM's through OEM vehicle dealerships. Asterisk (*) or Double Asterisk (**) indicates that the parts and/or labor information provided by MOTOR may have been modified or may have come from an alternate data source. Tilde sign (~) items indicate MOTOR Not-Included Labor operations. The symbol (<>) indicates the refinish operation WILL NOT be performed as a separate procedure from the other panels in the estimate. Non-Original Equipment Manufacturer aftermarket parts are described as AM. Used parts are described as LKQ, RCY, or USED. Reconditioned parts are described as Recond. Recored parts are described as Recore. NAGS Part Numbers and Benchmark Prices are provided by National Auto Glass Specifications. Labor operation times listed on the line with the NAGS information are MOTOR suggested labor operation times. NAGS labor operation times are not included. Pound sign (#) items indicate manual entries. Some 2012 vehicles contain minor changes from the previous year. For those vehicles, prior to receiving updated data from the vehicle manufacturer, labor and parts data from the previous year may be used. The CCC ONE estimator has a complete list of applicable vehicles. Parts numbers and prices should be confirmed with the local dealership. The following is a list of additional abbreviations or symbols that may be used to describe work to be done or parts to be repaired or replaced: SYMBOLS FOLLOWING PART PRICE: m=MOTOR Mechanical component. s=MOTOR Structural component. T=Miscellaneous Taxed charge category. X=Miscellaneous Non-Taxed charge category. SYMBOLS FOLLOWING LABOR: D=Diagnostic labor category. E=Electrical labor category. F=Frame labor category. G=Glass labor category. M=Mechanical labor category. S=Structural labor category. (numbers) 1 through 4=User Defined Labor Categories. OTHER SYMBOLS AND ABBREVIATIONS: Adj.=Adjacent. Algn.=Align. ALU=Aluminum. A/M=Aftermarket part. Blnd=Blend. BOR=Boron steel. CAPA=Certified Automotive Parts Association. D&R=Disconnect and Reconnect. HSS=High Strength Steel. HYD=Hydroformed Steel. Incl.=Included. LKQ=Like Kind and Quality. LT=Left. MAG=Magnesium. Non-Adj.=Non Adjacent. NSF=NSF International Certified Part. O/H=Overhaul. Qty=Quantity. Refn=Refinish. Repl=Replace. R&I=Remove and Install. R&R=Remove and Replace. Rpr=Repair. RT=Right. SAS=Sandwiched Steel. Sect=Section. Subl=Sublet. UHS=Ultra High Strength Steel. N=Note(s) associated with the estimate line. CCC ONE Estimating - A product of CCC Information Services Inc. The following is a list of abbreviations that may be used in CCC ONE Estimating that are not part of the MOTOR CRASH ESTIMATING GUIDE: BAR=Bureau of Automotive Repair. EPA=Environmental Protection Agency. NHTSA= National Highway Transportation and Safety Administration. PDR=Paintless Dent Repair. VIN=Vehicle Identification Number.
9/17/2012 10:18:43 AM
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Page 8
Claim #:
14-00-929703-1-1
Workfile ID:
0e1a89c0
Supplement of Record 1 with Summary 2012 HOND CIVIC LX 4D SED 4-1.8L-FI GRAY
TIRE PARTS SUPPLIERS Line
Description
Supplier
104
FIRE 195/65R15 AFFINITY TOURING S4 89S
Town Fair Tire Co
Price
1127 Riverdale Street, W. Springfield MA 01089-0
9/17/2012 10:18:43 AM
$ 101.15 (413) 787-0701
107572
Page 9