CITY OF RIALTO CITY CLERK'S DATE STAMP
LIABILITY CITY OF RIALTO
CLAIM FOR DAMAGES 2022 JUN 14 PM 3:51
TO PERSON OR PROPERTY RECEIVED
CITY CLERK
1. Claims for death, injury to person, or to personal property must be filed not later than six (6) months after the occurrence (Gov. Code $911.2).
2. Claims for damages to real property must be filed not later than one (1) year after the occurrence (Gov. Code §911.2). RETURN TO:
3.READ ENTIRE CLAIM FOR BEFORE FILING Rialto City Clerk's Office
4.ATTACH SEPARATE SHEETS, IF NECESSARY, TO GIVE FULL DETAILS Mail: 150 S. Palm Ave., Rialto, CA 92376 Address: 290 W. Rialto Ave., Rialto, CA 92376
CLAIMANT INFORMATION:
Automobile Club of Southern California
FULL NAME DATE OF BIRTH
HOME ADDRESS INCLUDING CITY, STATE & ZIP HOME TELEPHONE NO.
BUSINESS ADDRESS INCLUDING CITY, STATE & ZIP BUSINESS TELEPHONE NO.
ADDRESS AT WHICH CLAIMANT DESIRES TO RECEIVE
NOTICES OR COMMUNICATIONS REGARDING THIS CLAIM
(if different from home address provided above):
1. WHEN DID DAMAGE OR INJURY OCCUR? DATE:. 03/17/2022 TIME: 7:39 • AM PM
2. PLACE OF ACCIDENT (OCCURRENCE) BE SPECIFIC - Describe fully and (if applicable) locate on diagram on reverse side of this sheet.
Where appropriate, give street names and addresses, measurements and landmarks. 18912 San Bernardino Ave. Bloomington, CA 92316
3. HOW DID DAMAGE OR INJURY OCCUR?
The Rialto Police Officers pursued a suspect on a bicycle and apprehended the suspect which ensued a struggle to detain the suspect who resisted arrest and subsequently damaged our Insured's vehicle.
4. WERE POLICE AT THE SCENE? * YES • NO WERE PARAMEDICS AT THE SCENE? • YES • NO
5. WHAT PARTICULAR ACT OR OMISSION DO YOU CLAIM CAUSED THE INJURY OR DAMAGES? Give the name of the city/town employee causing the injury or damage, if known.
-Officer Guoto and Officer Stauffacher struggled with the suspect and fell onto our Insured's parked vehicle and was finally placed handcuffed. Damage to our Insured legally parked vehicle included minor hood, grill and driver's side fender damage.
6. GIVE TOTAL AMOUNT OF CLAIM Include estimate of amount of any prospective injury or damage $ $1,755.16 HOW WAS THE ABOVE AMOUNT COMPUTED? Be specific, list doctor bills, repair estimates, etc. Please attach 2 estimates.
DAMAGES INCURRED TO DATE:
Damages to Insured's vehicle
Item/Date: Amount:$ $1,505.16
Item/Date: Insured's out of pocket deductible Amount: $_ $250.00 TOTAL AMOUNT CLAIMED AS OF PRESENTATION OF THIS CLAIM: $ ESTIMATED PROSPECTIVE DAMAGES, AS FAR AS KNOWN:
Item/Date: Amount: $
Item/Date: Amount: $.
TOTAL ESTIMATED AMOUNT PROSPECTIVE DAMAGES: $ $1,755.16
7. WITNESSES TO DAMAGE OR INJURY List all persons known to have information (attach additional pages, if necessary) NAME: NAME:
ADDRESS: ADDRESS:
TELEPHONE: L TELEPHONE: | )
8. IF INJURED, PROVIDE NAME, CONTACT INFORMATION AND DATE/TIME DOCTORS) OR HOSPITAL(S) VISITED:
NAME: NAME:
ADDRESS: ADDRESS:
TELEPHONE: () TELEPHONE: |_)
DATE: TIME: • AM • PM DATE: _TIME:
9. PLEASE READ THE FOLLOWING CAREFULLY:
For all vehicle accident claims, place on the following diagram, the names of streets, including NORTH, EAST, SOUTH AND WEST directions. Indicate place of accident by "X" and by showing house numbers or distances to street corners. a city/town vehicle was involved, designate by letter "A" location of the City/Town vehicle when you first saw it, and by "B" location of yourself or your vehic hen you first saw City/Town vehicle; location of City/Town vehicle at time of accident by "A-1" and location of yourself or your vehicle at the time of t accident by "B-1" and the point of impact by "X".
→ NOTE: IF THE DIAGRAM BELOW DOES NOT FIT THE SITUATION, PLEASE ATTACH A PROPER DIAGRAM SIGNED BY THE CLAIMANT.
CURB
Parked Vehicle
PARKWAY
/ SIDEWALK IF CLERK JUN 14 PM CITY OF RIALT
сл.
LAVE READ THE FOREGOING CLAIM AND KNOW THE CONTENTS THEREOF; AND CERTIFY THAT THE SAME IS TRUE OF MY OWN KNOWLEDGE EXCEPT AS IOSE MATTERS WHICH ARE HEREIN STATED UPON MY INFORMATION AND BELIEF; AND AS TO THOSE MATTERS I BELIEVE THEM TO BE TRL R PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT.
SIGNATURE OF CLAIMANT OR AGENT
Laura A. Arias, AAA Claims Service Representative II! 06/08/2022
TYPE OR PRINT NAME DATE
Insurance Representative
RELATIONSHIP TO CLAIMANT
NOTE: PRESENTATION OF A FALSE CLAIM IS A FELONY (CA PENAL CODE 72) RETURN CLAIM TO: RIALTO CITY CLERK'S OFFICE - 150 S. PALM AVE., RIALTO, CA 92376 Interinsurance Exchange of the Automobile Club
1225 Freeport Pkwy, Coppell, TX 75019
SHEN CALEN
June 8, 2022
INITIAL REQUEST
HOUSE 999508
RE: Insured : Stephen Shea
Claim Number : 015138821
Date of Loss : 03/17/2022
Type of Loss : Auto
The Interinsurance Exchange of the Automobile Club has a claim against your insured as a result of the accident that has occurred on the above date. The claim consists of:
AUTO / PROPERTY 1,505.16
DEDUCTIBLE 250.00
RENTAL 0.00
TOTAL $ 1,755.16
Enclosed are the necessary documents to support our subrogation claim, as follows:
City of Rialto Claims Form, Estimate, Photos, Proof of Payment.
Please note our CLAIM NUMBER and DATE OF Loss on your payment, and forward same to:
Interinsurance Exchange of the Automobile Club
Corporate Cashiering, Mail Stop A118,
PO Box 25024
Santa Ana, CA 92799
Should you have any questions or need additional information regarding this matter, do not hesitate to contact the undersigned.
Sincerely,
ACE Subrogation Department
(888) 896-9962
CITY CLERK RECEIVEC 2022 JUN 14 PM 3:5! CITY OF RIALTO
Ltr No. CC0104
Rev Ed.: 02/16/2021
Sensitive Regulated Data
Claim: 015138821
Pol: CAA114267031 | Form: PPA | Ins: STEPHEN SHEA | DoL: 03/17/2022 | St: Closed | Adj: Lenora Patterson (Riverside ER9) | Claim: 015138821 | Years of Membership: 6 Financials (Total Incurred: $1,505.16): Checks
Check Number Pay To Net Amount Issue Date Scheduled Status Bulk Invoice Send Date
CALIBER COLLISION $1,505.16 05/16/2022 05/13/2022 Cleared
CENTER - ONTARIO
User: Laura Arias Page 1 06/08/2022 11:17 AM
CALIBER - ONTARIO Workfile ID: 7414a981
Federal ID: 33-0730794
RESTORING THE RHYTHM OF YOUR LIFE State ID: N/A
200 S. Wineville Ave., ONTARIO, CA 91761 Federal EPA: N/A Phone: (909) 937-0132 State EPA: CAL000326678
BAR: ARD299801
FAX: (909) 937-0230
Supplement of Record 1 with Summary
RO Number: 51022767
Written By: Derek Rodarte, 5/12/2022 4:49:28 PM
Adjuster: Patterson, Lenora, (951) 369-4526 Business
Insured: SHEA, STEPHEN Policy #: CAA114267031 Claim #: 015138821-1-4048 Type of Loss: Comprehensive Date of Loss: 3/17/2022 12:01 AM Days to Repair: 7 Point of Impact: 11 Left Front
Owner: Inspection Location: Insurance Company:
SHEA, STEPHEN CALIBER - ONTARIO AUTO CLUB ENTERPRISES
CA 92316-2051 200 S. Wineville Ave. AACAR
BLOOMINGTON, CA 92316 ONTARIO, CA 91761
Repair Facility
(909) 937-0132 Business
VEHICLE
2017 VW Jetta SE Automatic 4D SED 4-1.4L Turbocharged Gasoline Gasoline Direct Injection grey VIN: 3VWDB7AJ3HM413130 Interior Color: Mileage In: 33,894 Vehicle Out: 5/12/2022 License: 8RCK448 Exterior Color: grey Mileage Out: 33,895 State: CA Production Date: 6/2017 Condition: Job #:
TRANSMISSION Air Conditioning CD Player SEATS
Automatic Transmission Intermittent Wipers Auxiliary Audio Connection Bucket Seats POWER Tilt Wheel Satellite Radio Leather Seats
Power Steering Cruise Control SAFETY Heated Seats
Power Brakes Rear Defogger Drivers Side Air Bag WHEELS
Power Windows Keyless Entry Passenger Air Bag Aluminum/Alloy Wheels Power Locks Message Center Anti-Lock Brakes (4) PAINT
Power Mirrors Steering Wheel Touch Controls 4 Wheel Disc Brakes Clear Coat Paint Heated Mirrors Telescopic Wheel Front Side Impact Air Bags OTHER DECOR Backup Camera Head/Curtain Air Bags Traction Control Dual Mirrors RADIO Communications System Stability Control Tinted Glass AM Radio Hands Free Device Signal Integrated Mirrors Console/Storage FM Radio Blind Spot Detection
Overhead Console Stereo ROOF
CONVENIENCE Search/Seek Electric Glass Sunroof
5/12/2022 4:49:28 PM 029060 Page 1
Supplement of Record 1 with Summary
RO Number: 51022767
2017 VW Jetta SE Automatic 4D SED 4-1.4L Turbocharged Gasoline Gasoline Direct Injection grey Line Oper Description Part Number Qty Extended Labor Paint Price $
1 S01 Final for payment 1 0.00 0.0 0.0
2 FENDER
3 * S01 Rpr LT Fender 0 0.00
6.0 2.0
Note: Damage to panel on numerous body lines. Repair over replace and member in rental. 4 S01 Add for Clear Coat 0.00 0.0 0.8
5 R&I LT Fender liner w/o GLI w/o fog 0 0.00 0,4 0.0
lamps
6 # S01 Refn Basecoat Reduction 0 0.00
0.0 -0.3
7 # S01 Rpr Body pull 0.00
1.0 0.0
8 HOOD
* Rpr Hood 0 0.00 3.0 2.6
Note: Damage to LT side of panel near fender.
10 S01 Overlap Major Adj. Panel 0.00 0.0
-0.4
11 Add for Clear Coat 0.00 0.0 0.4
12 # Refn Basecoat Reduction 0.00 0.0 -0.3
13 FRONT BUMPER & GRILLE
14 S01 R&T R&I bumper cover 0.00 1.5 0.0
FRONT DOOR
16 * Rpr LT Outer panel 0.00
2.0 2.1
Note: Scratches to front middle portion of panel near fender.
Overlap Major Adj. Panel 0 0.00 0.0 -0.4
18 Add for Clear Coat 0.00 0.0 0.3
19 # Refn Basecoat Reduction 0.00 0.0 -0.3
20 R&I LT Belt molding black to 12/2017 0.00 0.3 0.0
21 R&I LT R&I mirror 0.00 0.3 0.0
22 R&I LT Handle, outside w/keyless 0 0.00 0.5 0.0
entry
23 R&I LT R&I trim panel 0.00 0.6 0.0
24 # 501 Subl Supply and install LF door edge 1 84.00 X 0.0 0.0 and pocket Mylar
25 FRONT LAMPS
26 S01 R&I LT R&I headlamp assy 0.00 0.3 0.0
27 VEHICLE DIAGNOSTICS
28 # S01 Pre-repair scan 1 40.00 x 0.5 0.0
29 # S01 Post-repair scan 1 80.00 X 0.5 0.0
30 # S01 Cover Car for Overspray 1 5.00 X 0.0 0.0
31 # 501 Mask Jambs, Opening, Entry 2.00 X 0.2 0.0
32 # S01 Rpr D&R Battery 0.00 0.2 M
0.0 33 # S01 DeNib and Polish 1 0.00 X 0.4
0.0 SUBTOTALS 211.00 17.7 6.5
5/12/2022 4:49:28 PM 029060 Page 2
Supplement of Record 1 with Summary
RO Number: 51022767
2017 VW Jetta SE Automatic 4D SED 4-1.4L Turbocharged Gasoline Gasoline Direct Injection grey
ESTIMATE TOTALS
Category Basis Rate Cost$
Parts 0.00
Body Labor 17.5 hrs @ $ 51.00 /hr 892.50
Paint Labor 6.5 hrs $ 51.00 /hr 331.50
Mechanical Labor 0.2 hrs $ 95.00 /hr 19.00
Paint Supplies 6.5 hrs $ 43.00 /hr •279.50
Miscellaneous 211.00
Subtotal 1,733.50
Sales Tax $279.50 @ 7.7500 % 21.66
Grand Total 1,755.16
Deductible 250.00
CUSTOMER PAY 250.00
INSURANCE PAY 1,505.16
5/12/2022 4:49:28 PM 029060
Supplement of Record 1 with Summary
RO Number: 51022767
2017 VW Jetta SE Automatic 4D SED 4-1.4L Turbocharged Gasoline Gasoline Direct Injection grey
SUPPLEMENT SUMMARY
Line Oper Description Part Number Qty Extended Labor Paint Price $
Changed Items
5 R&i LT Fender liner w/o GLI w/o fog 0 0.00 Incl
0.0 lamps
5 S01 R&I LT Fender liner w/o GLI w/o fog 0.00 0.4 0.0
lamps
Deleted Items
** Repl A/M CAPA LT Fender
5C6821105A 1 -119.84 -1.7 -2.0
Add for Clear Coat 0 0.00 0.0 -0.8
4 Add for Edging 0.00 0.0
-0.5
8 Overlap Major Adj. Panel 0.00 0.0
0.4 Added Items
1 # S01 Final for payment 1 0.00 0.0 0.0
* S01 Rpr LT Fender 0 0.00 6.0 2.0
NOTE: Damage to panel on numerous body lines. Repair over replace and member in rental. 4 501 Add for Clear Coat 0 0.00 0.0 0.8
# S01 Refn Basecoat Reduction 0.00 0.0 -0.3
# S01 Rpr Body pull 0.00 1.0 0.0
10 S01 Overlap Major Adj. Panel 0.00 0.0
-0.4
13 FRONT BUMPER & GRILLE
S01 R&T R&I bumper cover 0 0.00 1.5 0.0
24 # S01 Subl supply and install LF door edge 1 84.00 X 0.0 0.0 and pocket Mylar
25 FRONT LAMPS
26 501 R&I LT R&d headlamp assy 0.00 0.3 0.0
27 DIAGNOSTICS
28 # S01 Pre-repair scan 1 40.00 X 0.5 0.0
29 # 501 Post-repair scan 1 80.00 X 0.5
30 # S01 Cover Car for Overspray 1 5.00x 0.0
31 # 501 Mask Jambs, Opening, Entry 1 2.00 x 0.2
32 # S01 Rpr D&R Battery 0.00 0.2 M
33 # S01 DeNib and Polish 1 0.00 X 0.4
SUBTOTALS 91.16 9.3
5/12/2022 4:49:28 PM 029060
Supplement of Record 1 with Summary
RO Number: 51022767
2017 VW Jetta SE Automatic 4D SED 4-1.4L Turbocharged Gasoline Gasoline Direct Injection grey
TOTALS SUMMARY
Category Basis Rate Cost $
Parts -119.84
Body Labor 9.1 hrs $ 51.00/hr 464.10
Paint Labor -0.8 hrs $51.00/hr 40.80
Mechanical Labor 0.2 hrs $ 95.00 /hr 19.00
Paint Supplies -0.8 hrs @ $ 43.00/hr -34.40
Miscellaneous 211.00
Subtotal 499.06
Sales Tax $-154.24 @ 7.7500% -11.95
Total Supplement Amount 487.11
NET COST OF SUPPLEMENT 487.11
CUMULATIVE EFFECTS OF SUPPLEMENT(S)
Estimate 1,268.05 Derek Rodarte
Supplement S01 487.11 Derek Rodarte
Job Total: $ 1,755.16
CUSTOMER PAY: $ 250.00
INSURANCE PAY: $ 1,505.16
5/12/2022 4:49:28 PM 029060
Supplement of Record 1 with Summary
RO Number: 51022767
2017 VW Jetta SE Automatic 4D SED 4-1.4L Turbocharged Gasoline Gasoline Direct Injection grey ---- =============================================
Caliber Collision is the industry leader in quality collision repair. Since day one, our highest purpose has been to get people just like you back on the road as quickly as possible and fully restored to the rhythm of your life. You can be sure we do everything possible to ensure your complete satisfaction including:
Personalized, high quality service from the largest collision repair company in the U.S.
Consistently ranked among the highest customer satisfaction scores in the industry.
Approved by every major insurance company in the U.S.
Expedited car rental and towing services to get you back on the road again in no time.
Repair work backed by a written, lifetime warranty honored at every location. 24/7/365 customer service to answer questions and put your mind at ease.
This is a preliminary estimate based on visible damage. There may be additional repairs needed once the vehicle is taken apart by our I-CAR Gold Class technicians to identify any additional damage.
If an insurance company has written an estimate for you, please provide us with a copy. Properly endorsed insurance company checks are welcome as payment for the repair of your vehicle. Caliber Collision gladly accepts all major credit cards, debit cards, cashier's and traveler's checks. See your Caliber Collision center for details on acceptance of personal checks.
Before leaving your vehicle with us, please remove all important personal and valuable items from your vehicle.
Caliber Collision is not responsible for belongings left in your vehicle.
Please let us know how we can be of further assistance, and when we can schedule an appointment for your vehicle to be repaired.
Caliber Collision - Restoring The Rhythm Of Your Life
— — —————==∞======== ====≤==£===^===== ===
CUSTOMER HAS BEEN PROVIDED A COPY OF THE ESTIMATE AND THE AAA MEMBER PREFERRED REPAIRS BROCHURE.
5/12/2022 4:49:28 PM 029060 Page 6
Supplement of Record 1 with Summary
RO Number: 51022767
2017 VW Jetta SE Automatic 4D SED 4-1.4L Turbocharged Gasoline Gasoline Direct Injection grey FOR YOUR PROTECTION CALIFORNIA LAW REQUIRES THE FOLLOWING TO APPEAR ON THIS FORM: ANY PERSON
WHO KNOWINGLY PRESENTS FALSE OR FRAUDULENT INFORMAITON 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, O/H=OVERHAUL, OP=OPERATION, NO=LINE NUMBER, QTY=QUANTITY, RECOND=RECONDITION, REFN=REFINISH, REPL=REPLACE, R&I=REMOVE AND INSTALL, R&R=REMOVE AND REPLACE, RPR=REPAIR, RT=RIGHT, SECT=SECTION, SUBL-SUBLET, LT=LEFT, W/O=WITHOUT, W/_=WITH/_ 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. 5/12/2022 4:49:28 PM 029060 Page 7
Supplement of Record 1 with Summary
RO Number: 51022767
2017 VW Jetta SE Automatic 4D SED 4-1.4L Turbocharged Gasoline Gasoline Direct Injection grey 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 ERA9283, CCC Data Date 05/09/2022, 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/M or NAGS. Used parts are described as LKQ, RCY, or USED. Reconditioned parts are described as Recond. Recored parts are described as Recore. NAGS Part Numbers and Benchmark Prices are provided by National Auto Glass Specifications. Labor operation times listed on the line with the NAGS information are MOTOR suggested labor operation times. NAGS labor operation times are not included. Pound sign (#) items indicate manual entries.
Some 2022 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. BInd=Blend. BOR=Boron steel.
CAPA=Certified Automotive Parts Association. D&R=Disconnect and Reconnect. HSS=High Strength Steel.
HYD=Hydroformed Steel. Incl.=Included. LKQ=Like Kind and Quality. LT=Left. MAG=Magnesium. Non-Adj.=Non Adjacent. NSF=NSF International Certified Part. O/H=Overhaul. Qty=Quantity. Refn=Refinish. Repl=Replace.
R&I=Remove and Install. R&R=Remove and Replace. Rpr=Repair. RT=Right. SAS=Sandwiched Steel.
Sect=Section. Subl=Sublet. UHS=Ultra High Strength Steel. N=Note(s) associated with the estimate line.
CCC ONE Estimating - A product of CCC Intelligent 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. 5/12/2022 4:49:28 PM 029060 Page 8
(Page 1 of 7)
• LexisNexis®
Police Records Retrieval
RISK SOLUTIONS 800-934-9698
[email protected]
Accurint for Insurance
866-277-8407
[email protected]
PAGE COUNT: 7
CLIENT: 7126
DIVISION: CAA-RIVERSIDE
ADJUSTER: LENORA PATTERSO
CLAIM: 015138821
TRANSACTION #: 1695979661
DATE: 2022-05-20 10:28:32.0
DATE OF LOSS: 03/17/2022 TIME OF LOSS: 00:01
STREET:
CITY: BLOOMINGTON
COUNTY: SAN BERNARDINO
STATE: CA
INVESTIGATING AGENCY: RIALTO PD
REPORT NUMBER: 932203027
REPORT TYPE: VANDALISM
PARTY1: STEPHEN SHEA
PARTY2:
PARTY3:
CAR: NEW JETTA 1.4T MAKE: VLKS YEAR: 2017
TAG:
ADDITIONAL INFO:
NOTE: IN PARKED AND WAS DAMAGED..
THANK YOU FOR YOUR ORDER!
(Page 2 Of 7)
INCIDENT SUPPLEMENT REPORT
Agency Name: ORI#: Report Date/Time: OCA#:
RIALTO POLICE DEPARTMENT CA0360900 03/17/2022 19:39:25 932203027 Incident Start Date/Time: DOW: Leport Type Case Screening: Г СНР 180 SUPPLEMEN Total Loss
internal Incident Status: Serialized Property Hate Crime Incident End Date/Time:
Evidence Collected Г Gang Related
Г PC 293 Sex Crime | Domestic Viol.
Incident Location: Secondary Location:
Case Description: UCR Status: All Other Reporting Area:
ARREST Operation Method:
Penal Code: UCR Code: F/M: Penal Code Description: Counts: CompAnt:
Ш Structure TOD: Blas Motivation: Offense Location:
Weapon Used: Situation Code: Premise:
Penal Code: UCR Code: F/M: Penal Code Description: Counts: Comp/At LL
LL Structure TOD: Bias Motivation: Offense Location:
Weapon Used: Situation Code: Premise:
Г Person Name: Phone: Cell Phone:
Г Business
Address (Street, Apt., City, State, Zip): Pager:
Involvement Type (Person): Victim Type (Business): Domestic LEOKA Activity: LEOKA Assignment:
Violanca
Occupation: Employer: Employer Address: Employer Phone:
Relationship to Offender (Person): DOB: Age: Sex: Height: Weight:
Injury Type:
Minor Injuries Unconscious
Race: Ethnicity: SSN: License (#, Class, State): Related Offenses): Intemal Injuries Teeth injury Lacerations L Bone Injury
Other Injuries None
Suspect #1 Name: Phone: Cell Phone: Pager.
Address (Street, Apt., City, State, Zip): Occupation: Employer:
Suspect Forced Victim: Primary Action: Employer Address: Employer Phone:
Solicited/Offered: Suspact Farce: DOB: Age: Sex: Height: Weight: Build: Complexion: Eye Color:
Race: Ethnicity: SSN: License (#. Class, State): Related Offense(s): Hair Color: Hair Length: Hair Style:
Clothing Description: NCIC #: State ID: Facial Hair: Speech: Teeth:
Body Markings (Type, Location, Description):
Arrested: Suspacts: Persons:
COUTO, DORIAM 02055 03/20/2022 16:21:10
Reporting Officer ID # Date Reporting Officer Signature Assisting Officer Signature
Assisting Officer ID# Date CONTROLLED COPY
01760 CONFIDE REVIEWIS SACE
RICE, DWUAN 03/21/2022 MESFRICTED PC 19142919t443
Reviewing Officer 10# Date NOT FOR THIRD PARTY RELEASE
THE RIALTO POLICE DEPARTMENT Of B
RELTO: (EXIS NEXIS
SCANNED
BY S. MooNEr 0023
5-1722
(Page 3 of 7)
INCIDENT SUPPLEMENT REPORT - ADDITIONAL PERSONS
Agency Name: ORI#: Report Data/Time 932203027
RIALTO POLICE DEPARTMENT CA0360900 3/17/2022 19:39:2
Tv Person Name: Phone: Cell Phone:
Г Business STEPHEN MICHAEL SHEA
Address (Streat, Apt., City, State, Zip): Pager:
Involvement Type Victim Type (Business): Domestic 1 LEOKA Activity: LEOKA Assignment:
(Person): Violence
VICTIM PERSON / INDIVIDUAL (NOT A LAW
ENFORCEMENT OFFICERI
Occupation: Employer: Employer Address: Employer Phone:
10 UNKNOWN OR NOT
STATED
Relationship to Offender: DOB: Age: Height: Weight: Build: Complexion: Eye Color:
Stranger - Unknown 01/09/1970 52 510 210 MEDIUM LIGHT
Race: Ethnicity: SSN: 6718789, Class, St CA Reiated Offense(s): Hair Cofor: / Hair Length: Hair Style:
White NON-HISPANIC C6718789
Clothing Description: NCIC #: State ID#: Facial Hair. Speech: Teeth:
Body Markings (Type, Location, Description): Solicited/Offered: Injury Type:
Г Minor Injuries Unconscious
Suspect Forced Victim: Primary Action: Suspect Force: Intemal Injuries Teeth Injury C Lacerations Bone Injury
• Other Injuries # None
- Person Name: Phone: Cell Phone:
Г Business
Address (Street, Apt., City, State, ZIp): Pager:
Involvement Type (Person): Victim Type (Business): Domestic LEOKA Activity: LEOKA Assignment:
Violence
Occupation: Employer: Employer Address: Employer Phone:
Relationship to Offender: DOB: Age: Sex: Height: Weight: Build: Complexion: Eye Color:
Race: Ethnicity: SSN: License (#, Class, State): Related Offense(s): Hair Color: Hair Length: Hair Style:
Clothing Description: NGC # State ID # Facial Hair: Speech: Teeth:
Body Markings (Type, Location, Description): Solicited/Offered:
Г Minor Injuries Injury Type:
Unconscious
Suspect Forced Victim: Primary Action: Suspect Force: [Intemal Injuries Г Teeth Injury Г Lacerations I Bone injury
• Other Injuries Г None
Person Name: Phone: Cel Phone:
Business
Address (Street, Apt., City, Stato, Zip): Pager:
Involvement Type (Person): Victim Type (Business): Domestic r LEOKA Activity: LEOKA Assignment:
Violence
Occupation: Employer: Employer Address: Employer Phone:
Relationship to Offender: 7 DOB: Age: Sex: Height: Weight: Build: Complexion: Eye Color:
Race: Ethnicity: SSN: License (#, Class, State): Related Offense(s): Hair Color. Hair Length: Hair Style:
Clothing Description: NCIC # State ID#: Facial Hair. Speech: Teeth:
Body Markings (Type, Location, Description): Solicited/Offered Injury Type:
• Minor Injuries Unconscious
Suspect Forced Victim Primary Action: Suspect Force: [Internal injurtes Teeth injury [ Lacerations [Bone Injury
• Other Injuries Г None
Page? _of E
{Page 4 of 7)
INCIDENT SUPPLEMENT REPORT -
OFFENSES/PROPERTY/VEHICLES/DRUGS
Agency Name: ORI#: Report Date/Time: OCA#:
RIALTO POLICE DEPARTMENT CA0360900 03117/2022 19:39:25 932203027 Penal Code: UCR Code: FIM: Penal Code Description: Counts:
CompAtt:
Structure TOD: Bias Motivation: Offense Location:
Weapon Used: Situation Code: Premise:
Penal Code: UCR Code: F/M: Penal Code Description:
Counts: compati
Structure TOD: Bias Motivation: Offense Location:
Waapon Used: Situation Code: Premise:
Penal Code: UCR Code: F/M: Penal Code Description: Counts:
Fomp/AH:
Structure TOD: Blas Motivation: Offense Location:
Weapon Used: Situation Code: Premise:
Status: QTY: Make: Model: Color.
Type: | UOR: Description: Serial Number.
Value: Date Rec: Rec Value: Related To:
Status: QTY: Make: Model: Color.
Type: VOR: Description: Serial Number:
Value: Date Rec: Rec Value: Related To:
Status: QTY: Make: Model: Color:
Type: UOR: Description: Serial Number:
Value: Date Rec: Rec Value: Relaled To:
Total Property Loss:
Status: Year: UCR: Make: Model: Color: License/State:
VICTIM VEHICLE 2017 VOLK VOLK-JET GREY CA
Comments: VIN: Vakie: Rec Code: Date Rec: Rec Value:
ш
Status: Year: UCR: Make: Model: Color: License/State:
VICTIM VEHICLE 200B MERZ MERZ-320 SILVER CA
Comments: VIN: Value: Rec Code: Date Rec: Rec Value:
Status: Year: UCR: Make: Model: Color: Licanse/State:
VICTIM VEHICLE NISS NISS-PTH GREEN
Comments: VIN: Value: Rec Code: Date Rec: Roc Value CA
Total Vehicle Loss:
Code: Status: Qty: Measure: Susp. Type: Using Г Cultivating Distributing Exploting Children Operating Possessing Transporting
Code: Status: Qty: | Measure: Susp. Type: Using Cultivating Distributing Exploiding Chidren Operating Possessing Transporting
Code: Status: Qty: Measure: Susp. Type: Г Using Buy Cultivating I Distributing Г Exploiting Children Operating Possessing Transporting Page3 of 6
(Page 5 of 7)
•
INCIDENT SUPPLEMENT REPORT - NARRATIVE
Agency Name: ORI#: Roport Date/Time: OCA#:
RIALTO POLICE DEPARTMENT CA0360900 03/17/2022 19:39:25 932203027
NARRATIVE
ASSIGNMENT:
On 3/17/2022. I was assigned to uniformed DUl and traffic enforcement in the city of Rialto, County of San Bernardino.
At 1836 hours, Rialto PD dispatch received a call for service at 1157 S Vine St referencing a black or Hispanic male armed with a gun. The caller advised they left the location and last saw muitiple subjects in the middle of the street. The caller was unable to provide further information that was relayed to OBSERVATIONS:
I arrived to the scene at approximately 1841 hours driving my marked patrol unit north on Vine St. As l drove north, I could see Officer Staffacher was walking south on Vine St towards the call for service location. I saw a vehicle stopped in the middle of the roadway with multiple subjects standing around it.
The vehicle had the hood lifted up as if it had broken down or they were performing mechanic work. i saw a subject wearing a grey hooded sweatshirt with the hood up mounted on a bicycle talking to the subjects standing by the vehicle. I saw the subject on the bicycle tum his body north towards the direction of Officer Staffacher. The subject seemed startled by the Officers presence and peddled south on Vine St towards me. I suspected this subject was the armed male the reporting party called about and attempted to detain him to further investigate the call for service.
I activated my overhead front facing red light and siren to detain the bicyclist; however, he rode around my unit and refused to stop. As the rider went past my unit, he looked towards me with the activated lights and sirens leading me to believe he understood | was attempting to detain him. I made a U-turn to follow the rider south on Vine St and saw he made a eastbound tum onto Miramont St. and I suspected he was fleeing with a firearm.
The rider crossed Miramont St from the north curb through the front lawn of 1105 W Miramont St to turn south on Larch Ave. I paced along side the subject still with lights and sirens activated. The rider was riding towards an open tire shop located on the north east comer of Larch Ave and Randall Ave where I observed several employees working outside. I paced along side the rider and saw he collided with two parked vehicles at 18908 San Bernardino Ave as he was attempting to flee from me.
SUSPECT CONTACT:
exited my unit after seeing the suspect became trapped in between the parked vehicles. The suspect stood up and attempted to run east on San Bernardino. I hurdled the parked vehicles as I yelled at the suspect to get down on the ground. The subject stopped after being blocked by another parked vehicle and refused to comply with my orders, reaching his hands down towards his waistband area as he yelled out, "Fuck".
I was afraid if I allowed the subject to continue fleeing towards the inhabited business and residential area, he could potentially hold someone hostage and place the public in danger. Furthermore, it was still unknown if the suspect was armed with a firearm which he could retrieve if I gave him the opportunity.! Page of g
(Page 6 of 7)
INCIDENT SUPPLEMENT REPORT - NARRATIVE
Agency Name: ORI#. Report Date/Time: OCA#:
RIALTO POLICE DEPARTMENT CA0360900 03/17/2022 19:39:25 932203027
NARRATIVE
ran towards the suspect and tackled him to the ground. The suspect wrapped his arms around me and i could feel him reaching around my back towards my neck as if he was attempting to put me in a choke hold. I punched the suspect on the face twice as | yelled at him to place his hands behind his back and to stop fighting.
As 1 attempted to arrest the suspect under power, I heard Officer Staffacher arrive to the scene and also yell at the suspect to stop fighting. Officer Stauffacher and I were able to roll the suspect onto his right side: however, he began reaching his hand down towards his waistband again as if he was attempting to retrieve a weapon. Officer Stuffacher punched the suspect again and I saw he raised his hand to cover himself, revealing the hand from his waistline. I was able to control the suspect's left arm behind his back as Officer Staffacher controlled his right arm for handcuffing. The suspect was ultimately handcuffed under power as he forcefully resisted arrest.
ARREST:
Once the suspect was handcuffed, he was identified as Clarence Archie who I've had multiple previous contacts with. I previously arrested Archie for DUl drugs and possession of methamphetamine.
DAMAGED VEHICLES:
Archie collided with two parked vehicles being a green Nissan Pathfinder (CA Lic: 5NPU748) and Mercedes C320 (CA Lic: 6JYJ903) causing minor hood and from grill damage. Archie also fell onto a grey Volkswagen Jetta (CA Lic: 8RCK448) during his arrest causing minor driver side front fender damage.
NARCOTICS FOR SALES:
Officer Staffacher conducted a search incident to Archie's arrest and located a large amount of methamphetamine in a jar and zip loc bag.
I know based on my training and experience which I've acquired through formal and informal training from speaking with narcotic user, instructors, and patrol officers, a usable amount or dosage unit of methamphetamine is .2 grams which is enough for a user to intoxicate themselves. Officer Staffacher recovered 292 grams of methamphetamine which converted to ounces weighed 10.3 ounces. This amount of methamphetamine is equivalent to 1,460 dosage units. Archie did not state how often he used methamphetamine but claimed it was for personal use. Even if Archie used methamphetamine 3 times a day, this large amount of methamphetamine would take him over 1 year to ingest.
In addition to the methamphetamine, Archie was found to possess what he claimed was PCP (Phencyclidine) which is categorized as a dissociative anesthetic. PCP can be used by dipping a tobacco cigarette in the liquid and inhaling the lit cigarette to intoxicate themselves.
This amount of methamphetamine is not consistent with a personal use amount and per the current drug pricing, would be worth approximately $2,000-3,500. Based on the aforementioned investigation, / believe his amount of methamphetamine and possession of PCP is consistent with street level narcotic sales and distribution.
ADDITIONAL INFORMATION:
Archie was not found to possess a firearm at the conclusion of this investigation.
Pages of 6
(Page 7 of 7)
INCIDENT SUPPLEMENT REPORT - NARRATIVE
Agency Name: Report Date/Time: OCA#:
RIALTO POLICE DEPARTMENT CA0360900 03/17/2022 18:39:25 932203027
NARRATIVE
AXON:
My Axon body worn camera was switched to the off position at the intiation of this investigation. I didn't ealize the camera was off at the time and attempted to activate the camera with the double tap functior ue to the rapidly unfolding events, I was unable to turn the switch to the on position to record the arres of Archie.
DISPOSITION:
Supplemental report complete.
Attach this supplemental report to Office Stauffacher's original report.
RECOMMENDATION:
None.
Paged of 6
appeara
Body pull to LT fender
Claim Reference Id: 015138821-|-4048
File Name: PHOTO17
File Date: 05/10/2022
Label: Body pull to LT fender
Note: Owner:STEPHEN,SHEA/Style:2017,VW,Jetta SE
Automatic|Insured:STEPHEN,SHEA|LossDate:03/17/20
22|PolicyNumber:CAA114267031|ClaimRepresentative
Photo Location: CALIBER - ONTARIO
Photo Taken By: Derek Rodarte
Estimate Indicator: S01
Body pull to LT fender
Claim Reference Id: 015138821-|-4048
File Name: PHOTO15
File Date: 05/10/2022
Label: Body pull to LT fender
Note: Owner:STEPHEN,SHEA|Style:2017, VW,Jetta SE
Automatic Insured:STEPHEN,SHEA|LossDate:03/17/21
22|PolicyNumber:CAA114267031|ClaimRepresentativi
:P
Photo Location: CALIBER - ONTARIO
Photo Taken By: Derek Rodarte
Estimate Indicator: S01
0000
Body pull to LT fender
Claim Reference Id: 015138821-1-4048
File Name: PHOTO21
File Date: 05/10/2022
Label: Body pull to LT fender
Note: Owner:STEPHEN,SHEA|Style:2017,VW,Jetta SE
Automatic|Insured:STEPHEN,SHEA]LossDate:03/17/20
22|PolicyNumber:CAA114267031|ClaimRepresentative
:P
Photo Location: CALIBER - ONTARIO
Photo Taken By: Derek Rodarte
Estimate Indicator: S01
damage to hood
Claim Reference Id: 015138821-|-4048
File Name: PHOTO10
File Date: 04/04/2022
Label: damage to hood
Note: Owner:STEPHEN,SHEA|Style:2017,VW,Jetta SE
Automatic|Insured:STEPHEN.SHEA|LossDate:03/17/20
22|ClaimRepresentative:Patterson|ShopName: CALIBE
Photo Location: CALIBER - ONTARIO
Photo Taken By: Derek Rodarte
Estimate Indicator: E01
damage to hood
Claim Reference Id: 015138821-J-4048
File Name: PHOTO3
File Date: 04/04/2022
Label: damage to hood
Note: Owner:STEPHEN,SHEA|Style:2017, VW,Jetta SE
Automatic|Insured:STEPHEN,SHEÁ|LossDate:03/17/20
22|ClaimRepresentative:Patterson|ShopName:CALIBE
Photo Location: CALIBER - ONTARIO
Photo Taken By: Derek Rodarte
Estimate Indicator: E01
damage to LF door
Claim Reference Id: 015138821-1-4048
File Name: PHOTO7
File Date: 04/04/2022
Label: damage to LF door
Note: Owner:STEPHEN,SHEA/Style:2017, VW,Jetta SE
Automatic|Insured:STEPHEN,SHEA|LossDate:03/17/20
22/Claim Representative: Patterson/ShopName:CALIBE
Photo Location: CALIBER - ONTARIO
Photo Taken By: Derek Rodarte
Estimate Indicator: E01
damage to LT fender
Claim Reference Id: 015138821-1-4048
File Name: PHOTO14
File Date: 05/10/2022
Label: damage to LT fender
Note: Owner:STEPHEN,SHEA|Style:2017, VW, Jetta SE
Automatic Insured:STEPHEN,SHEA|LossDate:03/17/21
2 PolicyNumber:CAA114267031|ClaimRepresentative
:P
Photo Location: CALIBER - ONTARIO
Photo Taken By: Derek Rodarte
Estimate Indicator: S01
damage to LT fender
Claim Reference Id: 015138821-1-4048
File Name: PHOTO8
File Date: 04/04/2022
Label: damage to LT fender
Note: Owner:STEPHEN,SHEA|Style:2017,VW,Jetta SE
Automatlc|Insured:STEPHEN,SHEA|LossDate:03/17/20
22|ClaimRepresentative:Patterson|ShopName:CAL/BE
Photo Location: CALIBER - ONTARIO
Photo Taken By: Derek Rodarte
Estimate Indicator: E01
damage to LT side of hood
Claim Reference Id: 015138821-1-4048
File Name: PHOTO18
File Date: 05/10/2022
Label: damage to LT side of hood
Note: Owner:STEPHEN,SHEA|Style:2017,VW,Jetta SE
Photo Location: CALIBER - ONTARIO
Photo Taken By: Derek Rodarte
Estimate Indicator: S01
damage to LT side of hood
Claim Reference Id: 015138821-1-4048
File Name: PHOTO12
File Date: 05/10/2022
Label: damage to LT side of hood
Photo Location: CALIBER - ONTARIO
Photo Taken By: Derek Rodarte
Estimate Indicator: S01
in process photo
Claim Reference Id: 015138821-1-4048
File Name: PHOTO16
File Date: 05/11/2022
Label: in process photo
Note: Owner:STEPHEN,SHEA|Style:2017, VW,Jetta SE
Automatic/Insured:STEPHEN, SHEA|LossDate:03/17/2
2|PolicyNumber:CAA114267031|ClaimRepresentativ
Photo Location: CALIBER - ONTARIO
Photo Taken By: Derek Rodarte
Estimate Indicator: S01
in process photo
Claim Reference Id: 015138821-|-4048
File Name: PHOTO19
File Date: 05/11/2022
Label: in process photo
Note: Owner:STEPHEN,SHEA|Style:2017,VW Jetta SE
Automatic|Insured:STEPHEN,SHEA|LossDate:03/17/20
22|PolicyNumber:CAA114267031|ClaimRepresentative
:P
Photo Location: CALIBER - ONTARIO
Photo Taken By: Derek Rodarte
Estimate Indicator: S01
in process photo
Claim Reference Id: 015138821-1-4048
File Name: PHOTO20
File Date: 05/11/2022
Label: in process photo
Note: Owner:STEPHEN,SHEA|Style:2017, VW, Jetta SE
Automatic|Insured:STEPHEN, SHEA LossDate:03/17/21
22|PolicyNumber:CAA114267031|ClaimRepresentative
:P
Photo Location: CALIBER - ONTARIO
Photo Taken By: Derek Rodarte
Estimate Indicator: S01
ark
LF
Claim Reference Id: 015138821-J-4048
File Name: PHOTO6
File Date: 04/04/2022
Label: LF
Note: Owner:STEPHEN,SHEA|Style:2017,VW,Jetta SE
Automatic|Insured:STEPHEN,SHEA|LossDate:03/17/20
22 ClaimRepresentative:Patterson|ShopName:CALIBE
R
Photo Location: CALIBER - ONTARIO
Photo Taken By: Derek Rodarte
Estimate Indicator: E01
LR
Claim Reference Id: 015138821-J-4048
File Name: PHOTO2
File Date: 04/04/2022
Label: LR
Note: Owner:STEPHEN,SHEA Style:2017,VW,Jetta SE
Automatic Insured:STEPHEN,SHEA|LossDate:03/17/20
22|ClaimRepresentative:Patterson/ShopName: CALIBE
R
Photo Location: CALIBER - ONTARIO
Photo Taken By: Derek Rodarte
Estimate Indicator: E01
4:15
2 60 12030
20. mi
32956 trip
435.6
12 Odometer
Claim Reference Id: 015138821-|-4048
File Name: PHOTO5
File Date: 04/04/2022
Label: Odometer
Note: Owner:STEPHEN,SHEA|Style:2017,VW,Jetta SE
Automatic|Insured:STEPHEN,SHEA|LossDate:03/17/20
22|ClaimRepresentative:Patterson|ShopName:CALIBE
Photo Location: CALIBER - ONTARIO
Photo Taken By: Derek Rodarte
Estimate Indicator: E01
e9 ed CALIBER QUALITY CONTROL
COLLISION CHECKLIST
- 51022141 =m Auto cluba
C3R/CSt/DA Stephan Shea
Responsibilities 2011 VW JeHo
Jobr
5-9-22
Wakenato some
3922
TER Has Traces fema
STEP Mechincal Word es
5922
Operations Responsibilities To Caliber Standards SE Harm Completed 18yHody Technician
STEP 79: CUlM Vertied Meeury Calibe 151222
omments/Note
caterprise
33895
Photo 21
Claim Reference Id: 015138821-I-4048
File Name: PHOTO13
File Date: 05/12/2022
Label: Photo 21
Note: Owner:STEPHEN,SHEA/Style:2017,VW. Jetta SE
Automatic]Insured:STEPHÉN,SHEA| LossDate:03/17/20
22|PolicyNumber: CAA114267031|ClaimRepresentative
:P
Photo Location: CALIBER - ONTARIO
Photo Taken By: Derek Rodarte
Estimate Indicator: S01
ANG Caller?
8RCK448
JETTA SE
rear
Claim Reference Id: 015138821-1-4048
File Name: PHOTO1
File Date: 04/04/2022
Label: rear
Note: Owner:STEPHEN,SHEA|Style:2017,VW,Jetta SE
Automatic|Insured:STEPHÉN,SHEÁILossDate:03/17/20
22/Claim Representative: Patterson/ShopName: CALIBE
Photo Location: CALIBER - ONTARIO
Photo Taken By: Derek Rodarte
Estimate Indicator: E01
CALIBER
COLLISION
RF
Claim Reference Id: 015138821-1-4048
File Name: PHOTO11
File Date: 04/04/2022
Label: RF
Note: Owner:STEPHEN,SHEA/Style:2017, VW,Jetta SE
Automatic|Insured:STEPHEN,SHEA|LossDate:03/17/20
22|ClaimRepresentative:Patterson|ShopName:CALIBE
Photo Location: CALIBER - ONTARIO
Photo Taken By: Derek Rodarte
Estimate Indicator: E01
Claim Reference Id: 015138821-J-4048
File Name: PHOTO9
File Date: 04/04/2022
Label: RR
Note: Owner:STEPHEN,SHEA|Style:2017, VW, Jetta SE
Automatic|Insured:STEPHEN,SHEA|LossDate:03/17/20
22|ClaimRepresentative:Patterson|ShopName:CALIBE
Photo Location: CALIBER - ONTARIO
Photo Taken By: Derek Rodarte
Estimate Indicator: E01
MFD BY VOLKSWAGEN DE MEXICO S.A. DE C.V. =
MEXICO 06/17
GVWR 4189 GAWR FRONT 2138 / REAR 2161 LBS.
THIS VEHICLE CONFORMS TO ALL APPLICABLE U.S. 26167443156
FEDERAL MOTOR VEHICLE SAFETY, BUMPER AND
THEFT PREVENTION STANDARDS IN EFFECT ON THE DATE OF MANUFACTURE SHOWN ABOVE
PASSENGER CAR
3VWDB7AJ3HM413130
vin
Claim Reference Id: 015138821-1-4048
File Name: PHOTO4
File Date: 04/04/2022
Label: vin
Photo Location: CALIBER - ONTARIO
Photo Taken By: Derek Rodarte
Estimate Indicator: E01
DULALLS
AA Insurance
jation Dept. T2B20
Freeport Pkwy 109.36
opell TX 75019 CITY OF RIALTO
7020 3160 0001 3690 4659
2022 JUN 14 PM 3:52
RECEIVEL
CITY CLERP
Rialto City Clerk's Office
150 South Palm Ave
Rialto CA 92376