CLERKIN, SINCLAIR & MAHONZi tO
ATTORNEYS AT LAW 2924 OCT - 7 PM I: 14
October 2, 2024 RECEIVED
CITY CLERK
VIA CERTIFIED MAIL ONLY
Rialto City Clerk's Office
150 S. Palm Avenue
| Rialto, CA 92376
Re: TORT CLAIM FOR DAMAGES
Date of Loss: 4/16/2024
Our File No.: 55-66D6-60J
Your Claim No.:
Our Client's Insured: Rafael Chavez
Tort Claim Amount: $23,126.73
Dear City of Rialto
This firm has been retained by State Farm Mutual Automobile Insurance Company to pursue a tort claim for damages arising from the negligence of Andrew Villasenor in a motor vehicle collision that occurred during the course and scope of their employment with City of Rialto. As of the date of this letter, State Farm Mutual Automobile Insurance Company has incurred damages in the amount of $23,126.73, and it intends to On behalf of State Farm Mutual Automobile Insurance Company, we are seeking repayment of $23,126.73, which includes any deductible paid by its policyholder Rafael Chavez. Payment should be made payable only to "CSM in trust for State Farm Mutual Automobile Insurance Company". Please mail all payments to our TX office at: 2929 North Central Expressway, Richardson, TX 75080. The firm's tax identification number is: 20-3335151.
All future correspondence on the referenced claim MUST come to this firm. Please do not communicate with my client concerning this matter without prior written authorization from our firm.
If you believe there are other responsible parties, or if you wish to discuss this tort claim, please contact Kristen Davis-Burns at [email protected] or (903) 218-0098.
Sincerely yours,
Clerkin, Sinclair, & Mahfouz, LLP
2929 NoRTH CENTRAL EXPRESSWAY
SUITE 320
RICHARDSON, TX 75080
619-308-6550
WWW.CLERKINLAW.COM
CITY CLERK'S DATE STAMP
CITY OF RIALTO
CENTYOOF RIALTO
LIABILITY
CLAIM FOR DAMAGES 2020200QCI→7 PM 1: 15
TO PERSON OR PROPERTY RERECEIVED
CITTY 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 §9112).
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:
State Farm Mutual Automobile Insurance Company ASO Rafael Chavez, Rafael Chavez Jr. N/A
FULL NAME DATE OF BIRTH
c/o CSM: 3333 Camino Del Rio South, Suite 120, San Diego, CA 92108 (619 ) 308-6550 -
HOME ADDRESS INCLUDING CITY, STATE & ZIP HOME TELEPHONE NO. 3333 Camino Del Rio South, Suite 120, San Diego, CA 92108 ( 619) 308-6550 -
BUSINESS ADDRESS INCLUDING CITY, STATE & ZIP BUSINESS TELEPHONE NO.
ADDRESS AT WHICH CLAIMANT DESIRES TO RECEIVE Clerkin, Sinclair & Mahfouz, LLP
NOTICES OR COMMUNICATIONS REGARDING THIS CLAIM
(if different from home address provided above): Address same as above.
TIME: 6:42 • AM X PM
1. WHEN DID DAMAGE OR INJURY OCCUR? DATE: 04/16/2024
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.
W Rialto Ave & N Cactus Ave, Rialto, CA
3. HOW DID DAMAGE OR INJURY OCCUR?
On April 16, 2024, at approximately 6:42 PM, State Far's insured vehicle (2022 Honda Accord, CA license plate number: was near W Rialto Ave & N Cactus Ave, in Rialto, CA when it was struck in the front by a City of Rialto Police Department vehicle (2020 Ford Explorer, license plate number:
driven by Andrew Villasenor, resulting in property damage.
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.
The City of Rialto Police Department employee (Andre Villasenor) failed to maintain proper lookout and made improper right turn and collided with State Farm's insured vehicle.
6. GIVE TOTAL AMOUNT OF CLAIM Include estimate of amount of any prospective injury or damage $ 23,126.73 HOW WAS THE ABOVE AMOUNT COMPUTED? Be specific, list doctor bills, repair estimates, etc. Please attach 2 estimates.
DAMAGES INCURRED TO DATE Total Loss payment $27,873.19 + Tow $476.40 + Item/Date: Deductible $1,000.00 - Net Salvage ($6.634.50) Amount: $_$21,715.09 Item/Date: Rental Amount: $_$411.64
2024 OCT - 7 PF.
RECEIVED
TOTAL AMOUNT CLAIMED AS OF PRESENTATION OF THIS CÉAIM: CLERK $ 23,126.73 ESTIMATED PROSPECTIVE DAMAGES, AS FAR AS KNOWN:
Item/Date: N/A Amount: $
Item/Date: N/A Amount: $_
TOTAL ESTIMATED AMOUNT PROSPECTIVE DAMAGES: $.
7. WITNESSES TO DAMAGE OR INJURY List all persons known to have information (attach additional pages, if necessary) NAME: _N/A NAME:
ADDRESS: ADDRESS:
TELEPHONE: |) TELEPHONE: |)
8. IF INJURED, PROVIDE NAME, CONTACT INFORMATION AND DATE/TIME DOCTORS) OR HOSPITALS) VISITED:
NAME: N/A NAME:
ADDRESS: ADDRESS:
TELEPHONE: L TELEPHONE: |)
DATE: TIME: • AM • PM DATE: TIME: •AM • PM
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.
If 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 vehicle when 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 the 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. *SEE ATTACHED POLICE REPORT FOR DIAGRAM**
CURB
PARKWAY
/ SIDEWALK
I HAVE READ THE FOREGOING CLAIM AND KNOW THE CONTENTS THEREOF; AND CERTIFY THAT THE SAME IS TRUE OF MY OWN KNOWLEDGE EXCEPT AS TO THOSE MATTERS WHICH ARE HEREIN STATED UPON MY INFORMATION AND BELIEF; AND AS TO THOSE MATTERS I BELIEVE THEM TO BE TRUE.
CERTIFY (OR DECLARE) UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT.
SIGNATURE OF CLAIMANT OR AGENT
Roxanna Robertson 10/02/2024
TYPE OR PRINT NAME DATE
on behalf of State Farm Mutual Automobile Insurance Company als/o Rafael Chavez, Rafael Chavez Jr.
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 ur wi
#1000146241
CITY OF RIALTO
LIMITED POWER OF ATTORNEY 2024 OCT - 7 PM 1: 15
RECEIVED
State Farm Mutual Automobile Insurance Company, on behalf of itself, its subsidiaries and affiliates ("State Farm") hereby appoints Clerkin, Sinclair & Mahfouz, LLP ("Law Fir") to act as its attomey-in-fact for the sole and limited purpose of executing a Settlement Release, in the name of and on behalf of State Farm, received from the responsible party or their insurer on subrogation claim files placed with Law Firm for collection and/or litigation.
This Limited Power of Attorney is executed in connection with the Attorney Subrogation Collection and Litigation Master Retainer Agreement #1000145200, entered into between State Farm and Law Firm. Except as expressly stated herein, no other rights, powers, duties, or authority is extended to Law Firm by the terms of this Limited Power of Attorney.
This Limited Power of Attorney will remain in effect until written revocation of the Limited Power of Attorney by State Farm, but in no event shall it remain in effect after written notification to terminate the Attorney Subrogation Collection and Litigation Master Retainer Agreement described above. This Limited Power of Attorney specifically revokes all prior Limited Powers of Attorney giving Law Firm, any individual employee, attorney, law firm, or partnership to which the members and employees of Law Firm previously practiced, authority to execute a settlement release in the name of and on behalf of State Farm.
Dated: 3/20/2015 STATE FARM MUTUAL AUTOMOBILE
INSURANCE COMPANY
BY: Haulyn m Watts
Asst Vice President- Claims
(Title)
Subscribed and sworn before me this 20. _day of March _20_15.
State of: Illinois
NANCY KAHLE County of: MeLean
OFFICIAL SEAL
Notary Public, State of Illinois Nancy Kakle
My Emiss Epire
2, 201
(Notary Public)
-I-
RBZ000HK
State Farm State Farm Mutual Automobile Insurance Companc/T Y OF RIALTO Auto Claim File Print
Financial Information 2024 OCT - 7 PM 1: 15
RECEIVED Route To:
CITY CLERA
BASIC CLAIM INFORMATION
Claim Number:
Date of Loss: 04-16-2024
Policy Number:
Named Insured: CHAVEZ, RAFAEL
FINANCIAL SUMMARY
Coverage in Force * = Forced Coverage
A 25/50/25,C 1,000D100, G1000,H,R1 50/1200, U 25/50,U1
Named Insured(s)
400 - Collision-Multiple Vehicle Tier: Tier Reason:
Status Reserve Amount Last Reserve Coverage Type
PD - 05-16-2024 7,920 Primary
Indemnity Paid Sub/Salvage Net Indemnity Expenses Paid
$31,573.09 $9,950.00 $21,623.09 $92.00
Assigned To Unit Location SOJ Matter:
TL B CA Team TL B CA Unit TL B Office CA Negotiation:
(0008371260083)
Attorney Rep:
Named Insured(s)
501 - Rental Reimbursement Tier: Tier Reason:
Status Reserve Amount Last Reserve Coverage Type
PD - 04-29-2024 550 Primary
Indemnity Paid Sub/Salvage Net Indemnity Expenses Paid
$411.64 $0.00 $411.64 $0.00
Assigned To Unit Location SOJ Matter:
TL B CA Team TL B CA Unit TL B Office CA Negotiation:
(0008371260083)
Attorney Rep:
RAFAEL CHAVEZ JR, Different Driver
600 - Medical Payment Tier: 1 Tier Reason:
Status Reserve Amount Last Reserve Coverage Type
CWP - 05-15-2024 1,000 Primary
Indemnity Paid Sub/Salvage Net Indemnity Expenses Paid
$0.00 $0.00 $0.00 $0.00
Assigned To Unit Location SOJ Matter:
Date: 10-01-2024 Page 1
STATE FARM CONFIDENTIAL INFORMATION
Distribution on a Business Need to Know Basis Only
AUTO Claim Number: 55-66D6-60J RBZOOOHK
PIPMPC B1 T1 Team PIPMPC B1 T1 Unit PIPMPC B1 Office CA Negotiation:
(0005899183743)
CITY OF RIALTO Attorney Rep: Yes
BRIANNA CERVANTEZ, Insured Passenger 2024 OCT - 7 PN I: 15 600 - Medical Payment Tier: 1 Tier Reason:
Status Reserve Amount RiLest Reserve Coverage Type
CWP - 05-15-2024 CITY CLE1:000 Primary
Indemnity Paid Sub/Salvage Net Indemnity Expenses Paid
$0.00 $0.00 $0.00 $0.00
Assigned To Unit Location SOJ Matter:
PIPMPC B1 T1 Team PIPMPC B1 T1 Unit PIPMPC B1 Office CA Negotiation:
(0005899183743)
Attorney Rep: Yes
ANDREW VILLASENOR, Claimant Driver
200 - Property Damage Liability Tier: Tier Reason:
Status Reserve Amount Last Reserve Coverage Type
CWP - 06-01-2024 6,390 Primary
Indemnity Paid Sub/Salvage Net Indemnity Expenses Paid
$0.00 $0.00 $0.00 $0.00
Assigned To Unit Location SOJ Matter:
Ruben Limon (YZFN) Inj B1 PHX T2/3 Unit 9W Inj B1 Office PHX CA Negotiation:
Attorney Rep:
CLAIM TOTALS
COL/Participant Indemnity Paid Ded Refund Sub/Salvage Net Indemnity Expenses Paid 200 / ANDREW VILLASENOR $0.00 $0.00 $0.00 $0.00 $0.00
400 / Named Insured(s) $31,573.09 $0.00 $9,950.00 $21,623.09 $92.00 501 / Named Insured(s) $411.64 $0.00 $0.00 $411.64 $0.00 600 / BRIANNA CERVANTEZ $0.00 $0.00 $0.00 $0.00 $0.00
600 / RAFAEL CHAVEZ JR $0.00 $0.00 $0.00 $0.00 $0.00
Totals: $31,984.73 $0.00 $9,950.00 $22,034.73 $92.00
PAYMENTS
C denotes consolidated payment
E denotes EFT payment
P previously converted payment from CAT/CMR
Payment Number Issued Date Pavee Status Amount Auth ID
112714866K 07-01-2024 INSURANCE AUTO AUCTIONS, ATTN: Paid $3,315.50 ECSAPY
SETTLEMENT
112686738K E 05-29-2024 CROSS COUNTRY MOTOR CLUB Paid $167.20 ECSAPY 112677141J 05-16-2024 AMERICAN HONDA FINANCE.CORP Paid $27,873.19 VAD68L 112673327J 05-13-2024 RAFAEL CHAVEZ Paid $130.00 WOFO
112671311K 05 09 2024 RAFAEL CHAVEZ Void $130.00 RUYK
112666691K 05-03-2024 CROSS COUNTRY MOTOR CLUB Paid $179.20 ECSAPY 112661762K 04-29-2024 ENTERPRISE RENT-A-CAR Paid $411.64 ECSAPY Date: 10-01-2024 Page 2
STATE FARM CONFIDENTIAL INFORMATION
Distribution on a Business Need to Know Basis Only
AUTO Claim Number: 55-66D6-60J RBZ000HK
Grand Total: $32,076.73
RECOVERIES
Check Number Status Entered Date Recovery Amount Expense Withheld Iype of Recovery Posted 06-29-2024 $9,950.00 $0.00 Salvage
Grand Total: $9,950.00 $0.00
Continued on Claim File Print - File History Information report CITY
OCT
OF
- 1 R!
M1:15 ALTO
Date: 10-01-2024 Page 3
STATE FARM CONFIDENTIAL INFORMATION
Distribution on a Business Need to Know Basis Only
AUTO Claim Number: 55-66D6-60J RBZOOOHK
BILL SUMMARY
Bill Information
Invoice Number: 32NBD42QXWM Claim Number:
Rental Vendor: ENTERPRISE RENT-A-CAR Date of Loss: 04-16-2024 Insured Name: CHAVEZ, RAFAEL Received From Renter: SỐ0O CIT Renter Name: CHAVEZ, RAFAEL Billed To Others: So00
Rental Start Date: 04-18-2024 Amount Due: € $411.64
Rental End Date: 04-26-2024 Amount Paid To Date: $Á11.64! Current Bill Status
Primary Status Primary Reason(s) pit ALTO
Reviewed
Secondary Status Secondary Reason(s) 15
Paid
Vehicle Information
Vehicle Rental Start Rental End Assnd Class Appr Class Make Model 01 04-18-2024 04-26-2024 SS NISN ROGU
Invoice Details
Rate Percent Extended
Vehicle Description Billed Party Quantity (%) ($) Covered Amount 01 Daily Rental Rate State Farm 9 40.75 100.000 $366.75 Sales Tax State Farm 366.75 7.750 0.000 $28.42
Veh Licensing/Registration Fee State Farm 9 1.83 100.000 $16.47 Subtotal Less Taxes : $366.75 Received From Renter: $0.00 Total Taxes : $44.89 ... Amount Due From State Farm : $411.64 Total Amount Due : $411.64
Date: 10-01-2024 Page 26
STATE FARM CONFIDENTIAL INFORMATION
Distribution on a Business Need to Know Basis Only
AUTO Claim Number: 55-66D6-60J RBZO0OHK
CITY
OF
10 RIALTO
1:15
TOTAL LOSS SETTLEMENT TOOL SUMMARY - INSURED VEHICLE - 01 Valuation Source: CCC Not Owner Retained
Ok to Pay: Yes Policy PD Limits: $0.00
Source Valuation: $26,652.00 Damage Estimate: $15,508.57 Total Additions: $0.00 Possible Supplements: $5,000.00
Total Deductions: $71.00 Additional Costs: $0.00
$71.00 Condition
ACV: $26,581.00 ACV vs Repair Cost: 77.15%
Tax Amount: $2,060.03 Confirmed Total Loss:
Fees: $232.16
Type of Fee: REG65 owed
Salvage: $7,579.00
Subtotal: $28,873.19
Comp/Negligence: $0.00(0.00%)
Deductible: $1,000.00
Post Settlement Ded: NULL
Total: $27,873.19
L/H Payoff: $31,861.10 L/H Name: AMERCN HONDA FIN CORP
Payoff good through: 04-19-2024 Per Diem: $4.86
Account Number: 464791943
Paid to L/H: $27,873.19
Paid to Owner: $0.00
Name as it is on title: CERVANTES BRIANNA GUADALUPE OR CHAVEZ RAFAEL JR Titling State: California
Branded Title State:
Title Brand: Salvage (STATE FARM MUTUAL)
Title Inst:
ACV vs Damage Estimate: 58.34%
Last Day Storage: 04-24-2024 Last Day Rental: 04-26-2024 Mileage: 27838 Actual Mileage: Yes
Vehicle Salvage Type: Car NMVTIS Qualification: Yes
Stock Number: 39255142
Comments: Title: U72221008 Issue Date: 10/07/2022 28.51% SV Date: 10-01-2024 Page 11
STATE FARM CONFIDENTIAL INFORMATION
Distribution on a Business Need to Know Basis Only
SEPARTMENT OF GALIFORIA HIGHWAY PATROL
TRAFFIC CRASH REPORT
CHP 555 Page 1 (Rev. 2-22) OPI 060 Page 1 of 7
SPECIAL CONDItIONS 0F140 CITY JUDICIAL DISTRICT LOCAL REPORT NUMBER aLON
OURTESY REPOR RIALTO SAN BERNARDINO SUPERIOR COURT FONTANA 9860-2024-01209
N-DUTY EMERGENCY VEHICL COURTHOLSE
NUMBER HIT & RUN COUNTY REPORTING DISTRICT BEAT DAY OF WEEK TOW AWAY
KILLED MISDEMEANOR
0 SAN BERNARDINO S MOW TFS O]YES EX NO
CRASH OCCURRED ON CRASH TIME (2400) NOTIF. TIME (2400)NCIC * OFFICER ID 04/16/2024 , CRASH DATE AR
CACTUS AVE. 1840 04/16/2024 1842
STATE HWY REL DIGITAL MEDIA
X AT INTERSECTION WITH
JOR RIALTO AVE •YES X) NO SINO
LOCATION GPS COORDINATES FOR LOCATION (LOC.) AND AREA(S) OF IMPACT (AOlI LONGE TLAT, POT LAT, ISSAME AS LOCATION LONG AOT LAT. CREFER TO HARRATIVE CIT LOC. 34.099579
34.099579 -117.383418 •117.383418
ADDL 401(6)0
LONG. LONG. LAT LONG.
AO1 LAT. 22 AT. 5.
STATE
PARTY DRIVER'S LICENSE NUMBER STATE CLASS AIR BAG SAFETY EQUIP VEH. YEAR MAKE/MODELICOLOR LICENSE NUMBER CA M G 2020 FORD EXPLORER BLK/WHI CAO
DRIVER NAME (FIRST MIDOLE LASTY ON-DUTY EMERGENCY VEHICLE X ANDREW VILLASENOR OWNER'S NAME • SAME AS DRIVER
STREET ADDRESS CITY OF RIALTO
TRIAN
OWNER'S ADDRESS SAME AS DRIVER
PARKED I CITY STATE/ZIP
NEHICLE
RIALTO CA 92376 DISPOSITION OF VEHICLE ON ORDERS OF: •OFFICER X DRIVER OTHER BiCY- SEX HAIR MEIGHT WEIGHT RACE DRIVEN AWAY
CUST
BRN BRN 160 H PRIOR MECKANICAL DEFECTS X NONE APPARENT TREFER TO NARRATIVE 6'0"
HOME PHONE BUSINESS PHONE VEHICLE IDENTIFICATION NUMBER:
NONE VEHICLE TYPE DESCRIBE VEHICLE DAMAGE
INSURANCE CARRIER POLICY NUMBER UNK •NONE X MINOR
ATOR 48
SELF INSURED SELF INSURED • MAJOR ROLL-OVER
DIR OF TON STREET OR HIGHWAY LANE THRU TOTAL SPEED
TRAVEL LANES LANES LIMIT
RIALTO AVE 40 CAL.T TOPPSC.
AIR BAO LICENSE NUMBER STATE
PARTY DRIVER'S LICENSE NUMBER STATE CLASS SAFETY EQUIP VEN. YEAR MAKE/MODELICOLOR CA L G 2022 HOND ACCORD BLU CA
DRIVER NAME (FIRST. MIDDLE. LASTI
RAFAEL. CHAVEZ JR. OWNER'S NAME X' SAME AS DRIVER
STREET ADDRESS
TRIAN
OWNER'S ADDRESS SAME AS DRIVER
(PARKED CITY/STATE/ZIP
VEHICLE
DISPOSITION OF VEHICLE ON ORDERS OF OFFICER XI ORIVER OTHER SEX THAIR TEYES HEIGHT WEIGHT BIRTHDATE Your RACE PRIVATE ASSISTANCE Me.
BLK BRN 6'1" 220 PRIOR MECHANICAL DEFECTS X NONE APPARENT REFER TO NARRATIVE HOME PHONE BUSINESS PHONE VEHICLE IDENTIFICATION NUMBER:
NONE VEHICLE TYPE DESCRIBE VEHICLE DAMAGE
INSURANCE CARRIER POLICY NUMBER UNK. • NONE X MINOR
ATOR
STATE FARM 01 MOD, •MAJOR • ROLL-OVER
DIR OF TON STREET OR HIGHWAY LANE THRU TOTAL SPEEO
LANES LANES UNIT DOt.
TRAVEL
RIALTO AVE 2 2 CAL-T TCP/PSC.
PARTY ORIVER S LICENSE NUMBER STATE CLASS AIR BAG SAFETY EQUIP VER. YEAR ¡MAKE/MODEUCOLOR LICENSE NUMBER STATE 3 DRIVER NAME (FIRST IDOLE LAST
OWNER'S NAME SAME AS DRIVER
PEDES: STREET AODRESS
TRIAN
OWNER'S ADDRESS •SAME AS DRIVER
PARKED CITYISTATE ZIP
VEMICLE
DISPOSITION OF VEHICLE ON ORDERS OF: OFFICER • DRIVER •OTHER BICY. SEX THAIR EYES THEIGHT WEIGHT NO BIRTHDATE VON RACE PRIOR MECHANICAL DEFECTS. NONE APPARENT REFER TO NARRATNE HOME PHONE BUSINESS PHONE VEHICLE IDENTIFICATION NUMBER.
VEHICLE TYPE DESCRIBE VEHICLE DAMAGE
POLICY NUMBER UNK. •NONE OMINOR
INSURANCE CARRIER
ATOR
• MOD. MAJOR ROLL-OVER
DIR OF TON STREET OR HIGHWAY DOT
TRAVEL
TCPPSC
PREPARER'S NAME DATE REVIEWEO
RAYMOND J GARCIA, 022630 X YES • NO İ • N/A
An Internationally Accredited Agency Destroy Previous Editions
STATE OF CALIFORNIA
DEPARTMENT OF CALIFORNIA HIGHWAY PATROL
TRAFFIC CRASH CODING or 7
CHP 555 Page 2 (Rev. 2-22) OPI 060 CITY OF RIALTO Page
CRASH DATE (MO. DAY YEAR) CRASH TIME (2400) NCIC # OFFICER IO NUMBER 04/16/2024 1840 • OCT - 7 PM 1: 15
2074
PROPERTY OWNER'S NAME OWNER'S ADDRESS
DAMAGE
PERSON NOTIFIED L SAME AS OWNER TELEPHONE NUMBER METHOD CANQTIFICATION (MARK ALL THAT APPLYI LOG / INCIDENT NUMBER INPERSON PHONE DISPATCH CHP 422
DESCRIPTION OF DAMAGE
SEATING POSITION SAFETY EQUIPMENT AIR BAG INATTENTION CODES
OCCUPANTS B- UNKNOWN
CHILD RESTRAINI A - CELLPHONE HANDHELD
A - NONE IN VEHICLE Q - IN VEHICLE USED L - AIR BAG DEPLOYED B - CELLPHONE HANDSFREE 1 TO 9 - STANDARD SEATING B - UNKNOWN R. IN VEHICLE NOT USED M - AIR BAG NOT DEPLOYED C- ELECTRONIC EQUIPMENT
POSITION C - LAP BELT USED N - OTHER
D - LAP BELT NOT USED S - IN VEHICLE USE UNKNOWN D. NOT REQUIRED O - RADIO /CD 10 - REAR OCC. TRK., VAN. E - SHOULDER HARNESS USED T - IN VEHICLE IMPROPER USE E - SMOKING 1 2 3 U - NONE IN VEHICLE EJECTED FROM VEHICLE F. EATING STATION WAGON, ETC.* F - SHOULDER HARNESS NOT USED
4 5 6 G - LAP/SHOULDER HARNESS USED 0 - NOT EJECTED 5 - CHILDREN MIC BICYCLE-HELMEI 1. FULLY EJECTEO H - ANIMALS
11 - POSITION UNKNOWN* H. LAPISHOULDER HARNESS NOT USED 7 8 9 DRIVER PASSENGER 2 - PARTIALLY EJECTED 1 - PERSONAL HYGIENE
J - PASSIVE RESTRAINT USED V - NO X - NO
K - PASSIVE RESTRAINT NOT USED 3 - UNKNOWN J- READING
10 0 - OTHER* W- YES y-YES
P • NOT REQUIRED K- OTHER
ITEMS MARKED BELOW FOLLOWED BY AN ASTERISK (*) SHOULD BE EXPLAINED IN THE NARRATIVE PRIMARY CRASH FACTOR TRAFFIC CONTROL DEVICES 3 VEHICLE AUTDMATION LEVEL 1 2 3 MOVEMENT PRECEDING CRASH LIST NUMBER (#) OF PARTY AT FAULT
CVC SECTION VIOLATEO CITED X A CONTROLS FUNCTIONING A SAE LEVEL • O A STOPPED A VC 22100(A) • YES B PROCEEDING STRAIGHT
B CONTROLS NOT FUNCTIONING' B SAE LEVEL • 1
B OTHER IMPROPER DRIVING: C CONTROLS OBSCURED C SAE LEVEL - 2 C RAN OFF ROAD D NO CONTROLS PRESENT / FACTOR- D SAE LEVEL - 3 MAKING RIGHT TURN C OTHER THAN DRIVER* TYPE OF CRASH E SAE LEVEL - 4 E MAKING LEFT TURN D UNKNOWN• A HEAD • ON F SAE LEVEL - 5 F MAKING U TURN
B SIDE SWIPE G UNKNOWN* G BACKING
C REAR END H SLOWING / STOPPING
2 VEHICLE AUTOMATION ENGAGED
WEATHER (MARK 1 TO 2 ITEMS) X D BROADSIDE PASSING OTHER VEHICLE
A CLEAR E HIT OBJECT X A NO AUTOMATION CHANGING LANES
B CLOUDY F OVERTURNED B DRIVER ASSISTANCE K PARKING MANEUVER
C RAINING G VEHICLE / PEDESTRIAN C PARTIAL AUTOMATION L ENTERING TRAFFIC D SNOWING H OTHER• D CONDITIONAL AUTOMATION M OTHER UNSAFE TURNING E FOG / VISIBILITY FT. MOTOR VEHICLE INVOLVED WITH E HIGH AUTOMATION IN XING INTO OPPOSING LANE F OTHER•• 'MARK I TO 2 ITEMS) F FULL AUTOMATION O PARKED G MND A NONCOLLISION G UNKNOWN* IP MERGING
LIGHTING B PEDESTRIAN Q TRAVELING WRONG WAY
A DAYLIGHT X C OTHER MOTOR VEHICLE HER ASSOCIATED FACTORI R OTHER•:
2 3
B DUSK - DAWN D MOTOR VEHICLE ON OTHER ROADWAY S LANE SPLITTING C DARK - STREET LIGHTS E PARKED MOTOR VEHICLE EVe S90754 VIDAMON SOBRIETY - DRUG - • PHYSICAL
D DARK - NO STREET LIGHTS § TRAIN (MARK ALL THAT APPLY)
E DARK - STREET LIGHTS NOT G BICYCLE CVC SECTION VIOLATION X X A HAD NOT BEEN DRINKING FUNCTIONING* H ANIMAL B HED - UNDER INFLUENCE
ROADWAY SURFACE FIXED OBJECT ENG SECTION VIOLATION CROCOYES C HBD - NOT UNDER INFLUENCE• A DRY • NO HBD - IMPAIRMENT UNKNOWN'
B WET J OTHER OBJECT UNDER DRUG INFLUENCE
C SNOWY - ICY E VISION OBSCUREMENT DRE EXAM. CONDUCTED
K ADDITIONAL OBJECTS) STRUCK F INATTENTION': STIMULANT
D SLIPPERY (MUDDY. OILY. ETC.)
ROADWAY CONDITION(S) PEDESTRIAN'S ACTIONS G STOP & GO TRAFFIC HALLUCINOGEN (MARK 1 TO 2 ITEMS) X A NO PEDESTRIANS INVOLVED H ENTERING / LEAVING RAMP DISSOCIATIVE ANESTHETICS A HOLES DEEP RUT* B CROSSING IN CROSSWALK PREVIOUS CRASH NARCOTIC ANALGE SIC B LOOSE MATERIAL ON ROADWAY• AT INTERSECTION J UNFAMILIAR WITH ROAD INHALANT C OBSTRUCTION ON ROADWAY• C AT INTERSECTIOSSWALK. NOT CANNABIS
D CONSTRUCTION - REPAIR ZONE DEPRESSANT
E REDUCED ROADWAY WOTH L UNINVOLVED VEHICLE IMPAIRMENT - PHYSIC IF FLOODED' M OTHER• IMPAIRMENT NOT KNO!
G OTHER*. F NOT IN ROAD N NONE APPARENT H NOT APPLICABLE
X H NO UNUSUAL CONDITIONS IG APPROACHING / LEAVING SCHOOL BUS TO RUNAWAY VEHICLE SLEEPY / FATIGUED'
SKETCH MISCELLANEOUS
12 SPECIAL INFORMATION
HEFER TO SKETCH PAGE(S) A HAZARDOUS MATERIAL
INDICATE MORTH B CELL PHONE HANDHELD IN USE
C CELL PHONE HANDSFREE IN
USE
ID CELL PHONE NOT IN USE
E CELL PHONE USE UNKNOWN
F SCHOOL BUS RELATED
1 2 3 BIKEWAY FACILITY
A SHARED ROADWAY
B CLASSI - BIKE PATH
C CLASS II - BIKE LANE*
D CLASS III - BIKE ROUTE
E CLASS IV - SEPARATED
•REFER TO NARRATIVE FOR ADDITIONAL INFORMATION IKEWAY
An Internationally Accredited Agency
STATE OF CALIFORNIA
DEPARTMENT OF CALIFORNIA HIGHWAY PATROL CITY OF RIALTO
INJURED / WITNESS / PASSENGERS Page 3 of 7
CHP 555 Page 3 (Rev. 2-22)_ OP| 060
CRASH DATE (MO OAY YEAR) CRASH TIME (2400) 2074 OCT OR 211 1: T NUMBER 04/16/2024 1840 9860-2024-01209
EXTENT OF INJURY ("X" ONE) GE INJURED WAS ("X" ONE) PARTY SEAT SAFETY EJECTED
PASSENGER
ONLY ONLY AGE SEX NUMBER POS. EQUIP.
FATAL SUSPECTED SERIOUS SUSPECTED MINOR POSSIBLE *PED. BICYCLIST, OTHER
INJURY INJURY INJURY INJURY E
23 F 2 3 L G 0
NAME /D. O. 8. I ADDRESS TELEPHONE
BRIANNA GUADALUPE CERVANTES (989) 440-7821/KONE
(INJURED ONLY, TRANSPORTED BY EMS RUN NUMBER TAKEN TO
RIALTO FIRE DEPARTMENT P201 ARROWHEAD REGIONAL MEDICAL CENTER
DESCRIBE INJURIES
COMPLAINT OF PAIN TO CHEST AND BACK
VICTIM OF VIOLENT CRIME NOTIFIED
NAME /D. O. B I ADDRESS TELEPHONE
(INJURED ONLY) TRANSPORTED BY• TAKEN TO:
DESCRIBE INJURIES
VICTIM OF VIOLENT CRIME NOTIFIED
NAME / D. O. 8. /ADDRESS TELEPHONE
(INJURED ONLY) TRANSPORTED BY. SUS RUN NUMEER
¡TAKEN TO
DESCRIBE INJURIES
VICTIM OF VIOLENT CRIME NOTIFIED
TELEPHONE
NAME / D. O. B. / ADDRESS
(INJURE ONLY) TRANSPORTED BY. EMS RUN NUMBER TAKEN TO
DESCRIBE INJURIES
VICTIM OF VIOLENT CRIME NOTIFIED
•* настенна
NAME / D O. B./ADDRESS TELEPHONE
(INJURED ONLY, TRANSPORTED BY EMS RuN NUMBER I TAKEN TO DESCRIBE iNJURIES
•* To lololoo
NAME: D. O. B / ADDRESS
(INJURED ONLY) TRANSPORTED BY EMS RUN NUMBER TAKEN TO
DESCRIBE INJURIES
• VICTIM OF VIOLENT CRIME NOTIFIEO
PREPARER'S NAME ID NUMBER TMO. DAY YEAR REVIEWER'S NAME RAYMOND J GARCIA 022630 04/16/2024
An Internationally Accredited Agency
CITY OF RIALTO
DEPARTMENT OF CALIFORNIA HIGHWAY PATROL
SKETCH DIAGRAM 2024 OCT - 7 PM I: 15
CHP 555 Page 4 (Rev. 2-20) OPI 060 Page 4 of 7
CRASH DATE (MO. DAY YEAR CRASH TIME (2400) NCIC & NUMBER
OFFICERTE CEIVED
04/16/2024 1840 CITY CLERA
DATE PREPARER CAPTURED IMAGE: 04/16/2024
PROPRIETOR OF IMAGE: Google Maps W E
COPYRIGHT YEAR OF IMAGE: 2024
TRAFFIC LIGHT
TRAFFIC LIGHT
•TRAFFIC LIGHT! TRAFFIC LIGHT 3D
18 17
Google
Imagery @2024 Google, Map data ®2024 United Siates Terms Piracy Send Produci Feedtack: 20 fL THIS OVERHEAD IMAGE IS PROVIDED TO DEPICT THE CRASH SCENE ENVIRONMENT ONLY. ANY VEHICLES,
PEDESTRIANS, OR OTHER ROAD USERS CAPTURED IN THE OVERHEAD IMAGE NOT DEPICTED IN THE SUMMARY/CAUSE WERE NOT ASSOCIATED WITH THIS CRASH.
ALL VEHICLE DIMENSIONS AND MEASUREMENTS ARE APPROXIMATE AND NOT TO SCALE UNLESS STATED.
PREPARED BY 10 NUMBER MO. DAY YEAR REVIEWER'S NAME MO. DAY YEAR RAYMOND J GARCIA 04/16/2024
An internationally Accredited Agency
.. CITY OF RIALTO
2024 OCT - 7 PM /: 15
STATE OF CALIFORNIA
NARRATIVE/SUPPLEMENTAL AGES OF
DATE OF INCIDENT TIME NCIC NUMBER LERK TE OFFICER I.D.
04/16/2024 1840
1 Alltimes, speeds, and measurements throughout this report are approximate. Meusurements were obtained 2 using visual estimation and GPS unless otherwise stated. All opinions and conclusions were hased on evidence and/or statements.
4 5 OTHER FACTUAL INFORMATION:
6 7 P-l showed me his bodycam footage of the incident on scene, utilizing his cellular device. Sergeant J. 8 Rodriguez, ID 21422, was provided a website link to an online database to observe the bodycam footage 9 worn by P-l. The bodycam was located near the abdomen of P-1; thus, 1 was unable to see P-I's point of 10 view. The bodycam footage revealed what seemed to be V-1 parked along the north curb of Rialto Ave., 11 east of Cactus Ave. P-1 was utilizing his mobile computer device. Suddenly, P-1 placed his vehicle in 12 drive, accelerated rapidly, and made a strong jerking movement 10 the left with the steering wheel towards 13 the left turn lane of Rialto Ave., at the intersection of Cactus Ave. I was able to observe the light was green 14 for westbound traffic. P-I did not slow down V-l, executed an aggressive turn to the right. causing his tires 15 to screech. Simultaneousiy, P-1 began to raise his right hand towards the control panel for the emergency 16 lights and siren, located near the rearview mirror of V-l. I continued to hear tires screech, and then heard 17 the traffic crash. After the impact, I heard V-l's audible siren. 18 19 After the crash, P-1 exited his vehicle and checked on the well-being of P-2 and V-2's passenger. As the 20 footage continued, I was able to hear P-2 and Passenger Cervantes tell P-I that he did not have his lights and 21 siren on. At no point did P-I contest their statements. 22 23 P-! advised me that he was not logged into his patrol vehicle's dashcam prior to the crash. 24 25 Due to the safety parameters of the website. I was unable to download a copy of the footage. No further 26 videos of the incident have been provided by the Rialto Police Department. 27 28 At the time of the crash, P-1 was on-duty as an Officer with the Rialto Police Department and was wearing a 29 departmentally approved black uniform while driving a fully marked black and white Rialto Police 30 Department patrol vehicle.
31 32
33 34
35 36
37 38
39 40
41 42
43 PREPARED BY I.D. NUMBER DATE REVIEWER'S NAME DATE
RAYMOND J GARCIA 022630 04/16/2024
CITY OF RIALTO
STATE OF CALIFORNIA
NARRATIVE SUPPLEMENTAL 2021 ACT PA 1: 15 PAGE 6 OF 7
DATE OF INCIDENT NCIC NUMBER OFFICER I.D. NUMBER
04/16/2024
RECEIVED
CITY CLERK
1 STATEMENTS:
2 3 Party #1 (P-1, Villasenor) was contacted at the scene where he related to me the following information:
4 P-1 was driving Vehicle #1 (V-1, Ford) within the westbound left turn lane of Rialto Ave., approaching the 5 intersection of Cactus Ave. at approximately 5 miles per hour. P-1 activated his emergency lights and siren 6 due to a pursuit occurring north of his location. P-I observed a vehicle stopped within the westbound #l 7 lane of Rialto Ave., west of the intersection of Cactus Ave. P-1 did not see V-2 prior to the crash. P-l's 8 light was green, so he accelerated to approximately 10 miles per hour, and proceeded to make a right turn to 9 head northbound onto Cactus Ave. from the left turn lane. Suddenly, P-1 felt an impact to the right side of 10 his vehicle. After the crash, P-1 stopped his vehicle to check on the wellbeing of P-2 and V-2's passenger. 11 P-1 relocated his vehicle to expedite traffic and awaited CHP arrival. 12 13 Party #2 (P-2, Chavez Jr.) was contacted at the scene where he related to me the following information:
14 P-2 was driving Vehicle #2 (V-2, Honda) within the westbound #2 lane of Rialto Ave., approaching the 15 intersection of Cactus Ave. at approximately 5 miles per hour. P-2 related prior to entering the intersection 16 he heard a siren coming from a separate patrol vehicle entering the intersection northbound on Cactus Ave.. 17 south of Rialto Ave. P-2 stopped his vehicle and allowed the patrol vehicle to travel through the 18 intersection. After the intersection was clear, P-2's light was green. so he began to proceed through the 19 intersection at approximately 5 miles per hour. P-2 related he did not see V-1 due to a vehicle to his left 20 within the westbound #1 lane of Rialto Ave., west of the intersection with Cactus Ave. P-2 did not hear an 21 audible siren, nor did he see V-I prior to the crash. Suddenly, V-I was directly ahead of him, and they 22 crashed. After the crash, P-2 put his vehicle in park, and was assisted by Rialto Police Department 23 personnel. Rialto Police Department personnel assisted P-2 in moving V-2 to the north curb of Rialto Ave., 24 west of Cactus Ave. P-2 remained on scene and awaited CHP arrival. 25 26
27 28
29 30
31 32
33 34
35 36
37 38
39 40
41 42
43 PREPARED BY I.D. NUMBER DATE REVIEWER'S NAME DATE
RAYMOND J GARCIA 022630 04/16/2024
STATE OF CALIFORNIA CITY OF RIALTO
NARRATIVE/SUPPLEMENTAL PAGE 7 OF 7
DATE OF INCIDENT TIME NOIC NUMBERCT - 7 OFFICER ID. NUMBER 04/16/2024 1840 п:15
RECEIVED
1 SUMMARY/CAUSE: CITY CLERK
2 3 Party #1 (P-1, Villasenor) was driving Vehicle #1 (V-1, Ford) within the westbound left turn lane of 4 Rialto Ave., approaching the intersection of Cactus Ave. at approximately 5 miles per hour. V-I was to the 5 left of V-2. Party #2 (P-2, Chavez Jr.) was driving Vehicle #2 (V-2, Honda) within the westbound #2 6 lane of Rialto Ave,, approaching the intersection of Cactus Ave. at approximately 5 miles per hour. 7 8 This crash was caused due to P-l's improper position for a right turn. A circular green light illuminated the 9 intersection allowing westhound traffic to proceed through the intersection. A separate Rialto Police 10 Department officer was involved in a pursuit north of the intersection. P-2 yielded for a Rialto Police 11 Department vehicle heading northbound through the intersection with emergency lights and siren activated. 12 P-l executed a right turn from the left turn lane (22100(a) VC- Improper Position for a Right Turn) and 13 entered the intersection. Simultaneously, P-2 entered the intersection. Due to P-l's improper position for a 14 right turn, as P-1 proceeded northbound through the intersection in front of V-2, the front left of V-2 crashed 15 into the right side of V-I (AOI #1).
16 17 After the crash, both parties stopped their vehicles within the intersection. P-l checked on the wellbeing of 18 P-2 and V-2's passenger. V-2 was moved by Rialto Police Department personnel to the north curb of Rialto 19 Ave., west of Cactus Ave. P-1 drove V-I to the east curb of Cactus Ave., north of Rialto Ave. Both parties 20 remained on scene and awaited CHP arrival.
PREPARED BY I.D. NUMBER DATE REVIEWER'S NAME DATE
RAYMOND J GARCIA 022630 04/16/2024
-
Agero Accident Management Invoice
Agero CITY OF RIALTO
2024 OCT -7 PH 1: 15
Bill To: Claim Number
State Farm RECEIYED
1 State Farm Plaza CITY CLERK Case Number CAS-5653285-Y7W9P7 Bloomington IL 61791
Transaction ID 3724493000000001
Product VRM
Date of Loss April 16, 2024
Closed Date April 19, 2024
Invoice Date May 28, 2024
Payment Terms NET 30
Billing Summary
Service Fee $167.20
Tow Charges $0.00
Release Charges $0.00
Total Amount $167.20
Case Details Release Charges Amount
Customer Rafael Chavez Jr Storage Fees (0 days @ $0.00) $0.00 Adjuster Maria Sahagun Primary Tow Charges $0.00
Policy Number Clean-Up Fees $0.00
Labor Charges $0.00
VIN Admin Fees $0.00
Vehicle 2022 Honda Accord Winching Fees $0.00
Vehicle Class Light Duty Impound Fees $0.00
License CAn/a Notification Fees $0.00
Preservation Fees $0.00
Pick Up Location Rafael Chavez Jr Sublet Fees $0.00
Tax $0.00
ROCK HONDA Tear Down Charges $0.00
Drop Off Location Gate Fees $0.00
16570 South Highland Avenue
FONTANA CA 92336 Miscellaneous Charges $0.00
Miles Towed 8 Total $0.00
Status CLOSED
Misc. Fee Information: 0
Contact: [email protected]
Please enter the Case Number in the remarks section of the payment
VOLTAGE TOWING
243 N. Meridian Ave.
San Bernardino CA 92410
DATE Ph: (909) 314-7075
LIC OY TIME REQUESTED BY P.O.M
A.M
NAME
P.M
ADDREKAFAEL CHAVEZ PHONE
CIT STATE ZIP
92376
YEAR, MAKE, MODEL Y YEHICLE KIALTO A
COLOR TAG # STATE
IVIN# t00n Accol ToLVE
[REGISTERED OWNER
MILEAGE SERVICE TIME EXTRA PERSON
FINISH FINISH
FINISH
START START.
START
TOTAL TOTAL TOTAL
EXTRA EQUIPMENT
REASON FOR SERVICE
AÇCIDENT ABANDONED FLAT TIRE SINGLE LINE
ARREST OUT OF GAS DUAL LINE
STOLEN
UNREGISTERED BREAK DOWN IMPOUNDED SNATCH BLOCKS
TOW ZONE LOCK OUT DOLLIE
SNOW REMOVAL NO START
TOWED PER ORDER OF VEHICLE TOWED TO
TYPE OF TOW
FIRST TOW
SLING/HOIST STATE POLICE
LOCAL POLICE
FLAT BED RAMP
*OWNER SECOND TOW
WHEEL LIFT
DEALER
STORAGE FROM TOWING CHARGE 30 u
TO DAYS AT $ MILEAGE CHARGE
PAID BY EXTRA PERSON
CASH I CHECK DEE
CAMEX SPECIAL EQUIP
• CREDIT CARD COMC EVISA
CV# LABOR CHARGE
CCE
DATE
OPERATORS NAME
TRUCK STORAGE
OPERATORS SIGNATURE
DATE ENVIRONMENTAL
AUTHORIZED SIGNATURE
DATE
VEHICLE RELEASED TG
SUB TOTAL
NAME
OL # TAX
SIGNATURE 14/24
I TOTAL 30
esponsible for any loss or damage to vehicle in case of fire theft or any cause beyond our control Agero Accident Management Invoice
Agero 1 CITY OF RIALTO
2024 OCT
Bill To: Claim Numbor
State Farm
1 State Farm Plaza CAS-5656366-F4J4N8
Bloomington IL 61791 4180593000000001
Transaction ID
Product VRM
Date of Loss April 16, 2024
Closed Date April 19, 2024
Invoice Date May 02, 2024
Payment Terms NET 30
Billing Summary
Service Fee $179.20
Tow Charges $0.00
Release Charges $0.00
Total Amount $179.20
Case Details Release Charges Amount
Customer Rafael Chavez Jr Storage Fees (0 days @ $0.00) $0.00 Adjuster Maria Sahagun Primary Tow Charges $0.00
Policy Number Clean-Up Fees $0.00
Labor Charges $0.00
VIN Admin Fees $0.00
Vehicle 2022 Honda Accord Winching Fees $0.00
Vehicle Class Light Duty Impound Fees $0.00
License Notification Fees $0.00
Preservation Fees $0.00
Pick Up Location Rock Honda (SERVICE ONLY) Sublet Fees $0.00 16570 South Highland Avenue Tax $0.00
Fontana CA 92336 Tear Down Charges $0.00
Drop Off Location Fast Track
24219 East 5th Street Gate Fees $0.00
San Bernardino CA 92410 Miscellaneous Charges $0.00
Miles Towed 12 Total $0.00
Status CLOSED
Misc. Fee Information: 0
Contact: [email protected]
Please enter the Case Number in the remarks section of the payment
COEONE MARKET VALUATION REPORT
Prepared for STATE FARM INSURANCE COMPANIES
REPORT SUMMARY 2024
The COC ONE Make Valuaton
DO CLAIM INFORMATION Report reflects CCIntelligent Solutions Inc's opinion as to the value of the loss
Owner Chavez, Rafael vehicle, based on information provided to CCC by STATE FARM INSURANCE
COMPANIES.
Loss Vehicle 2022 Honda Accord Sedan Sport w/
Continuously Variable Transmission Loss vehicle has 21% fewer than 04/16/2024 average mileage of 35,100.
Loss Incident Date
Claim Reported 04/18/2024
INSURANCE INFORMATION
Report Reference Number 118667741
Claim Reference 55-66D6-60J01
Claim Rep B1 Language Demand Pool As
Appraiser Navarrete, Ivania
Odometer 27,838
Last Updated 04/19/2024 11:54 AM
BASE VEHICLE VALUE
VALUATION SUMMARY This is derived per our Valuation
methodology described on the next
Base Vehicle Value $ 26,652.00 page.
Condition Adjustment - $ 71.00
ADJUSTED VEHICLE VALUE
Adjusted Vehicle Value $ 26,581.00
Vehicular Tax (7.75%) + $ 2,060.03 This is determined by adjusting the Base Vehicle Value to account for the
Tax reflects applicable state, county and municipal actual condition of the loss vehicle and taxes. certain other reported attributes, if any,
such as refurbishments and after factory
Value before Deductible $ 28,641.03 equipment.
Deductible* - $ 1,000.00
Total $ 27,641.03
Inside the Report
Adjustments indicated with an Asterisk (*) have been determined by STATE FARM INSURANCE COMPANIES and have been added here for convenience. Valuation Methodology. ...2 Vehicle Information.... ...3
The total may not represent the total of the settlement as other factors (e.g. license and Vehicle Condition...... ...6 fees) may need to be taken into account. Comparable Vehicles.... ..8 Valuation Notes.... 12
Supplemental Information. ..13
© Copyright 2021 CCC Intelligent Solutions Inc. All Rights Reserved. Page 1 of 16 Owner: Chavez, Rafael
COCEONE. MARKET VALUATION REPORT Claim:
VALUATION METHODOLOGY
How was the valuation determined?
CLAIM INSPECTION
STATE FARM INSURANCE COMPANIES has provided CCC with the zip code where the loss vehicle is garaged, loss vehicle VIN, mileage, equipment, as well as loss vehicle cangliton, which is 1, used to assist in determining the value of the loss vehicle.
DATABASE REVIEW
CCC maintains an extensive database of vehicles that currently are or recently were available for sale in the U.S. This database includes vehicles advertised for sale by dealerships or private parties. CCC also obtains vehicle sales prices from a database of California Department of Motor Vehicles vehicle registration sold transactions.
All of these sources are updated regularly.
SEARCH FOR COMPARABLES
When a valuation is created the database is searched and comparable vehicles in the area are selected. The zip code where the loss vehicle is garaged determines the starting point for the search. Comparable vehicles are similar to the loss vehicle based on relevant factors.
CALCULATE BASE VEHICLE VALUE
Adjustments to the price of the selected comparable vehicles are made to reflect differences in vehicle attributes, including mileage and options. Dollar adjustments are based upon market research.
Finally, the Base Vehicle Value is the straight average of the adjusted values of the comparable vehicles.
@ Copyright 2021 CCC Intelligent Solutions Inc. All Rights Reserved. Page 2 of 16 COSONE. MARKET VALUATION REPORT Owner: Chavez, Rafael
Claim:
VEHICLE INFORMATION
VEHICLE DETAILS
Vehicles sold in the United States
Location RIALTO, CA 92376-6623 are required to have a manufacturer assigned Vehicle Identification
VIN Number(VIN). This number provides
Year 2022 certain specifications of the vehicle.
Make Honda
Please review the information in the
Model Accord Sedan Vehicle Information Section to confirm Trim Sport the reported mileage and to verify that
w/Continuously Variable Transmission the information accurately reflects the Body Style
options, additional equipment or othe
Body Type Sedan aspects of the loss vehicle that may
Engine - impact the value.
Cylinders 4
Displacement 1.5L
Induction Turbocharged CITY OF RIALTO
Fuel Type Gasoline Hd
Carburation Gasoline Direct Injection
Transmission Automatic Transmission 1:16
Curb Weight 3223 Ibs
VEHICLE HISTORY SUMMARY
Experian AutoCheck No Title Problem Found
National Highway Traffic 2 Recalls
Safety Administration
© Copyright 2021 CCC Intelligent Solutions Inc. All Rights Reserved. Page 3 of 16 COSONE. MARKET VALUATION REPORT Owner: Chavez, Rafael
Claim:
VEHICLE INFORMATION
VEHICLE EQUIPMENT
To the left is the equipment of the
Odometer 27,838 loss vehicle that STATE FARM
INSURANCE COMPANIES provided to
Transmission Automatic Transmission CCC.
Power Power Steering
V Standard This equipment is
Power Brakes included in the base configuration of
the vehicle at time of purchase.
Power Windows
Power Locks E Additional Equipmentthat is pot
Standard but was noted lo be onithe
Power Mirrors
loss vehicle.
Power Driver Seat ) % OCT - 7
Eir
Decor/Convenience Air Conditioning
OF RIALTO
Climate Control Hd
CLERA
Tilt Wheel
1: 16
Cruise Control
Rear Defogger
Intermittent Wipers
Console/Storage
Overhead Console
Keyless Entry
Telescopic Wheel
Message Center
Seating Cloth Seats
Bucket Seats
Reclining/Lounge Seats
Radio AM Radio
FM Radio
Stereo
Search/Seek
Steering Wheel Touch Controls
Auxiliary Audio Connection V
Wheels Aluminum/Alloy Wheels
Safety/Brakes Air Bag (Driver Only)
Passenger Air Bag
Anti-lock Brakes (4) V
© Copyright 2021 CCC Intelligent Solutions Inc. All Rights Reserved. Page 4 of 16 COGSONE. MARKET VALUATION REPORT Owner have, R
Claim:
VEHICLE INFORMATION
VEHICLE EQUIPMENT
4-wheel Disc Brakes
Front Side Impact Air Bags
Head/Curtain Air Bags V
Backup Camera
Hands Free
Xenon Or L.E.D. Headlamps
Alarm
Traction Control
Stability Control CITY CLERK RECEIVED 2024 OCT - 7 PM 1: 16 CITY OF RIALTO Intelligent Cruise V
Lane Departure Warning
Exterior/Paint/Glass Dual Mirrors
Tinted Glass
Fog Lamps
Rear Spoiler
Clearcoat Paint
© Copyright 2021 CCC Intelligent Solutions Inc. All Rights Reserved Page 5 of 16 COLEONE MARKET VALUATION REPORT TA. com
CITY CLERK RECEIVED
VEHICLE CONDITION
COMPONENT CONDITION
STATE FARM INSURANCE
Condition Inspection Notes/Typical Vehicle Value Impact COMPANIES uses condition inspection Description guidelines to rate the condition of key
components of the loss vehicle on a
INTERIOR
three-point scale. A rating of average
Seats AVERAGE Typical Vehicle Desc: $0 condition results in a valuation of that Clean to very clean with no significant component that is consistent with typical tears, holes or burn marks. Light to no vehicles for that year, make and model wear. No bare spots. of vehicle. If a component is rated in exceptional condition, then a positive
Carpets AVERAGE Typical Vehicle Desc: $0 monetary adjustment is made to reflect Clean to very clean with no significant the impact of that condition level on the tears, holes or burn marks. Light to no value of the loss vehicle. Similarly, if a wear. No bare spots. component is rated in below average $0 condition, then a negative monetary
Dashboard AVERAGE Typical Vehicle Desc:
adjustment is made to reflect the impact
A few small and/or insignificant of that condition level on the value of the scratches or gouges. Minimal to no loss vehicle. Inspection Notes, if any, damage to firmly intact and functional reflect additional observations from the components. Light wear. appraiser regarding the loss vehicle's Headliner AVERAGE Typical Vehicle Desc $0 condition. Monetary adjustments are Clean to very clean with no significant based upon market research consisting of data gathered from dealerships in
holes or burn marks. Light to no
California.
significant scuffing.
CCC makes dollar adjustments that
EXTERIOR reflect the impact the reported condition
Sheet Metal AVERAGE Typical Vehicle Desc: $0 has on the value of the loss vehicle as Few to no dings. No dents. All panels compared to Average condition. These intact and properly aligned. dollar adjustments are based upon interviews with dealerships across the
Trim AVERAGE Typical Vehicle Desc: $0 United States.
No broken and/or missing components.
No dents. Few to no dings.
Paint AVERAGE Typical Vehicle Desc: $0
Minimal surface chipping and/or a few
small scratches. No peeling and/or
flaking. Minor to no swirl marks. Light to
no fading.
Glass BELOW Typical Vehicle Desc: - $ 71
AVERAGE Light to no surface scratches. Light to
no pitting.
MECHANICAL
Engine AVERAGE Typical Vehicle Desc:
Minor to no seepage. Belts and hoses
firm, and may show minimal wear.
Minimal to zero dirt and grease in
engine compartment.
@ Copyright 2021 CCC Intelligent Solutions Inc. All Rights Reserved. Page 6 of 16 COGSONE. MARKET VALUATION REPORT | Owner: Chavez, Rafael Claim:
2021, OCT -7
VEHICLE CONDITION
EFF CLERK
COMPONENT CONDITION CLERK
2024 OCT - 7
Condition Inspection Notes/Typical Vehicle Value Impact Description EGELY CITY OF RIALTO
Transmission AVERAGE Typical Vehicle Desc: $0
luid slightly discolored. A few areas t CLERK PH 1: 16
no seepage.
TIRES
Front Tires AVERAGE Typical Vehicle Desc $0
41% to 90% of new. Example: Typical
new car tires are 11/32, loss measures
at 5/32 = 46% (5/11)
Rear Tires AVERAGE Typical Vehicle Desc: $O
41% to 90% of new. Example: Typical
new car tires are 11/32, loss measures
at 5/32 = 46% (5/11)
Total Condition Adjustments - $ 71
© Copyright 2021 CCC Intelligent Solutions Inc. All Rights Reserved. Page 7 of 16 COSONE. MARKET VALUATION REPORT | Owner: Chavez, Rafael Claim:
COMPARABLE VEHICLES 2074
CITY
Options Loss Comp 1 Comp 2 Comp 3 Updafed Date: 01129/2024 Vehicle Comp 1
2022 Honda Accord Sedan Sport W/
27,838 25,265 32,482 28,786 continuously Variable Transmission 4? Odometer
1.5| Gasoline Turbocharged Gasoline
Automatic Transmission
Direct Injection
Power Steering VIN
Power Brakes >>> Dealership Penske Honda Ontario
Power Windows Telephone (909) 974-3800
Power Locks Source Verified Sold DMV
Stock # 9KTC264
Power Mirrors
Distance from Rialto, CA
Power Driver Seat 14 Miles - Ontario, CA
Power Trunk/Liftgate Comp 2 Updated Date: 02/16/2024
Air Conditioning V 2022 Honda Accord Sedan Sport W/
Climate Control continuously Variable Transmission 4
1.5l Gasoline Turbocharged Gasoline
Tilt Wheel
Direct Injection
Cruise Control VIN
Rear Defogger Dealership Moss Bros Honda
Intermittent Wipers Telephone (951) 486-9366
Source Verified Sold DV
Console/Storage
Stock # 9BDM360
Overhead Console
Distance from Rialto, CA
Keyless Entry 16 Miles - Moreno Valley, CA
Telescopic Wheel Comp 3 Updated Date: 04/02/2024
Message Center V 2022 Honda Accord Sedan Sport W/
Cloth Seats continuously Variable Transmission 4
1.5| Gasoline Turbocharged Gasoline
Bucket Seats
Direct Injection
Reclining/Lounge Seats V
VIN
AM Radio V Dealership Rock Honda
FM Radio Telephone (909) 330-7100
Stereo Source Autotrader
Search/Seek Stock # NA010737A
Distance from Rialto, CA
Steering Wheel Touch Controls 5 Miles - Fontana, CA
Auxiliary Audio Connection V
Aluminum/Alloy Wheels Comparable vehicles used in the
determination of the Base Vehicle Value
Drivers Side Air Bag
are not intended to be replacement
Passenger Air Bag vehicles but are reflective of the market Anti-lock Brakes (4) value, and may no longer be available 4-wheel Disc Brakes for sale.
Front Side Impact Air Bags List Price is the sticker price of an Head/Curtain Air Bags V inspected dealer vehicle and the Backup Camera advertised price for the advertised
Hands Free vehicle.
Xenon Or L.E.D. Headlamps
Alarm
© Copyright 2021 CCC Intelligent Solutions Inc. All Rights Reserved. Page 8 of 16 COEONE. MARKET VALUATION REPORT Owner: Chavez, Rafael
Claim:
COMPARABLE VEHICLES
Options Loss Comp 1 Comp 2 Comp 3
Vehicle Distance is based upon a straight line
between loss and comparable vehicle
locations.
Traction Control
> >
Stability Control
Intelligent Cruise
Lane Departure Warning
Dual Mirrors
Tinted Glass
Fog Lamps
2024 OCT - 7 CITY OF
Rear Spoiler
3,30
Clearcoat Paint
List Price $ 26,800 CLER RIALTO
ED
Sold Price $ 26,700 $ 25,100 1: 16
Adjustments:
Mileage - $ 334 + $ 650 + $ 127
Adjusted Comparable Value $ 26,366 $ 25,750 $ 26,927
Options Loss Comp 4 Comp 5 Comp 6
Vehicle Comp 4 Updated Date: 02/26/2024
2022 Honda Accord Sedan Sport W/
27,838 23,035 18,282 26,345 continuously Variable Transmission 4 Odometer
1.5l Gasoline Turbocharged Gasoline
Automatic Transmission
Direct Injection
Power Steering VIN
Power Brakes Dealership Rock Honda
Power Windows Telephone (909) 330-7100
Power Locks Source Autotrader
Stock # NA036362A
Power Mirrors
Distance from Rialto, CA
Power Driver Seat 5 Miles - Fontana, CA
Air Conditioning V Comp 5 Updated Date: 04/14/2024
Climate Control 2022 Honda Accord Sedan Sport W/
Tilt Wheel continuously Variable Transmission 4
1.5l Gasoline Turbocharged Gasoline
Cruise Control V V
Direct Injection
Rear Defogger V V VIN
Intermittent Wipers Dealership Riverside Honda
Console/Storage V Telephone (951) 509-2121
Overhead Console V V Source Autotrader
Keyless Entry Stock # 27976A
Distance from Rialto, CA
Telescopic Wheel
12 Miles - Riverside, CA
Message Center V Comp 6 Updated Date: 04/14/2024
Cloth Seats 2022 Honda Accord Sedan Sport W/
continuously Variable Transmission 4
© Copyright 2021 CCC Intelligent Solutions Inc. All Rights Reserved. Page 9 of 16 COSONE. MARKET VALUATION REPORT | Owner: Chavez, Rafael Claim:
COMPARABLE VEHICLES
Options Loss Comp 4 Comp 5 Comp 6 1.5l Gasoline Turbocharged Gasoline Vehicle Direct Injection
VIN
Bucket Seats Dealership Jeep Chrysler Dodge Ram
Reclining/Lounge Seats Fiat Of Ontario
Telephone (909) 390-9898
AM Radio
Source Autotrader
FM Radio
Stock # 24J287A
Stereo Distance from Rialto, CA
Search/Seek 14 Miles - Ontario, CA
Steering Wheel Touch Controls Comparable vehicles used in the Auxiliary Audio Connection determination of the Base Vehicle Value Aluminum/Alloy Wheels V are not intended to be replacement Drivers Side Air Bag vehicles but are reflective of the market value, and may no longer be available
Passenger Air Bag
for sale.
Anti-lock Brakes (4)
4-wheel Disc Brakes List Price is the sticker price of an Front Side Impact Air Bags inspected dealer vehicle and the advertised price for the advertised
Head/Curtain Air Bags
vehicle.
Backup Camera
Communications System Distance is based upon a straight line Hands Free between loss and comparable vehicle
locations. 2024
Xenon Or L.E.D. Headlamps V
CITY
Alarm V
Traction Control OCT - 7 OF
Stability Control
Intelligent Cruise CLERK ECEIVED RIALTO
Lane Departure Warning V PM 1: 16
Dual Mirrors
Tinted Glass
Fog Lamps
Rear Spoiler > >>
Clearcoat Paint
List Price $25,995 $ 28,881 $28,049
Adjustments:
Options - $ 100
Mileage - $ 609 - $ 1,153 - $ 196
Adjusted Comparable Value $ 25,386 $ 27,728 $ 27,753
© Copyright 2021 CCC Intelligent Solutions Inc. All Rights Reserved. Page 10 of 16 COGSONE. MARKET VALUATION REPORT Owner: Chavez, Rafael
Claim:
COMPARABLE VEHICLES
COMPARABLE VEHICLE SUMMARY The following comparable vehicles) were used to determine this Base
Source Comparable Vehicle Price Adjusted Comp Vehicle Value by computing the Value arithmetic average of the adjusted
$ 26,366 values of the comparable vehicles.
1 Verified Sold 2022 Honda Accord $ 26,700
Details on these comparable vehicles
DMV Sedan Sport W/ (Sold)
are in the Comparable Vehicles section.
continuously Variable
Transmission 4 1.5l
Gasoline Turbocharged
Gasoline Direct Injection
2 Verified Sold 2022 Honda Accord $ 25,100 $ 25,750
DMV Sedan Sport W/ (Sold)
continuously Variable
Transmission 41.5l
Gasoline Turbocharged
Gasoline Direct Injection
3 Dealer Vehicle 2022 Honda Accord $ 26,800 $ 26,927 PH 1:15 Sedan Sport WI (List)
continuously Variable
Transmission 4 1.5l
Gasoline Turbocharged
Gasoline Direct Injection
Dealer Vehicle 2022 Honda Accord $ 25,995 $ 25,386
Sedan Sport W/ (List)
continuously Variable
Transmission 4 1.5l
Gasoline Turbocharged
Gasoline Direct Injection
5 Dealer Vehicle 2022 Honda Accord $ 28,881 $ 27,728
Sedan Sport WI (List)
continuously Variable
Transmission 41.51
Gasoline Turbocharged
Gasoline Direct Injection
6 Dealer Vehicle 2022 Honda Accord $ 28,049 $ 27,753
Sedan Sport W/ (List)
continuously Variable
Transmission 41.5l
Gasoline Turbocharged
Gasoline Direct Injection
Base Vehicle Value $ 26,652.00
© Copyright 2021 CCC Intelligent Solutions Inc. All Rights Reserved. Page 11 of 16 COSONE. MARKET VALUATION REPORT Claim:
VALUATION NOTES
04/19/2024 11:54 - POADJ CHANGE REQUESTED BY: LEYVA,KACY Regulations concerning vehicle value
04/19/2024 11:54 - Condition Ratings changed after Valuation include California Code of Regulations This Market Valuation Report has been prepared exclusively for use by STATE FARM 10 CA ADC 2695.
INSURANCE COMPANIES, and no other person or entity is entitled to or should rely upon this Market Valuation Report and/or any of its contents. CCC is one source of vehicle valuations, and there are other valuation sources available.
OCT - 7 FA 1: 16 OF RIALTO
© Copyright 2021 CCC Intelligent Solutions Inc. All Rights Reserved Page 12 of 16 COGSONE. MARKET VALUATION REPORT Owner: Chavez, Rafael
Claim:
SUPPLEMENTAL INFORMATION
EXPERIAN® AUTOCHECK® VEHICLE HISTORY REPORT CCC provides STATE FARM INSURANCE COMPANIES information reported by
Experian regarding the 2022 Honda
TITLE CHECK RESULTS FOUND Accord Sedan
This data is provided for informational
Abandoned No Abandoned Record Found
purposes. Unless otherwise, noted in this
Damaged No Damaged Record Found Valuation Detail, CCC does not adjust the Fire Damage No Fire Damage Record Found
value of the loss vehicle based pon this Of
Grey Market information. 02
No Grey Market Record Found
Hail Damage No Hail Damage Record Found LEGEND :
Insurance Loss No Insurance Loss Record Found / No Event Found • Event Found
Junk No Junk Record Found
• Information Needed
Rebuilt No Rebuilt Record Found
TITLE CHECK
Salvage V No Salvage Record Found
THIS VEHICLE CHECKS OUT
EVENT CHECK RESULTS FOUND AutoCheck's result for this loss vehicle show no significant title events. When
NHTSA Crash Test Vehicle No NHTSA Crash Test Vehicle Record Found found, events often indicate automotive
Frame Damage No Frame Damage Record Found damage or warnings associated with the Major Damage Incident No Major Damage Incident Record Found vehicle.
Manufacturer Buyback/Lemon No Manufacturer Buyback/Lemon Record Found EVENT CHECK Odometer Problem No Odometer Problem Record Found THIS VEHICLE CHECKS OUT Recycled No Recycled Record Found AutoCheck's result for this loss vehicle Water Damage No Water Damage Record Found show no historical events that indicate a significant automotive problem. These
Salvage Auction V No Salvage Auction Record Found
problems can indicate past previous
RESULTS FOUND car damage, theft, or other significant
VEHICLE INFORMATION
problems.
Accident V No Accident Record Found
VEHICLE INFORMATION
Corrected Title V No Corrected Title Record Found
THIS VEHICLE CHECKS OUT
Driver Education No Driver Education Record Found AutoCheck's result for this loss vehicle Fire Damage Incident No Fire Damage Incident Record Found show no vehicle information that indicate Lease No Lease Record Found a significant automotive problem. These problems can indicate past previous
Lien No Lien Record Found
car damage, theft, or other significant
Livery Use No Livery Use Record Found problems.
Government Use No Government Use Record Found ODOMETER CHECK Police Use No Police Use Record Found THIS VEHICLE CHECKS OUT Fleet No Fleet Record Found AutoCheck's result for this loss vehicle Rental No Rental Record Found show no indication of odometer rollback Fleet and/or Rental or tampering was found. AutoCheck
V No Fleet and/or Rental Record Found
determines odometer rollbacks by
Repossessed No Repossessed Record Found searching for records that indicate Taxi use No Taxi use Record Found odometer readings less than a previously Theft No Theft Record Found reported value. Other odometer events Fleet and/or Lease can report events of tampering, or possible No Fleet and/or Lease Record Found
odometer breakage.
Emissions Safety Inspection No Emissions Safety Inspection Record Found Duplicate Title No Duplicate Title Record Found
© Copyright 2021 CCC Intelligent Solutions Inc. All Rights Reserved. Page 13 of 16 COGEONE. MARKET VALUATION REPORT Owner: Chavez, Rafael
Claim:
SUPPLEMENTAL INFORMATION
mist
130
FULL HISTORY REPORT RUN DATE: 04/19/2024
Below are the historical events for this vehicle listed in chronological order. RIALTO 310.
EVENT RESULTS ODOMETER DATA EVENT
DATE FOUND READING SOURCE DETAIL
09/25/2022 CA 235 Motor Vehicle Dept. Odometer Reading from DMV
10/07/2022 RIALTO, CA Motor Vehicle Dept. Title (Lien Reported) 10/07/2022 RIALTO, CA Motor Vehicle Dept. Registration Event Renewal
11/19/2022 FONTANA, CA 3677 Dealer Service Fuel System Serviced 11/19/2022 FONTANA, CA Dealer Service Multiple Point Vehicle Inspection
11/19/2022 FONTANA, CA Dealer Service Tires or Wheels Service Performed
11/19/2022 FONTANA, CA Dealer Service Lube, Oil And/Or Filter Changed
02/19/2023 FONTANA, CA 7768 Dealer Service Multiple Point Vehicle Inspection
02/19/2023 FONTANA, CA Dealer Service Tires or Wheels Service Performed
02/19/2023 FONTANA, CA Dealer Service Lube, Oil And/Or Filter Changed
05/08/2023 FONTANA, CA 11270 Dealer Service Lube, Oil And/Or Filter Changed
07/31/2023 FONTANA, CA 16204 Dealer Service Multiple Point Vehicle Inspection
07/31/2023 FONTANA, CA Dealer Service Tires or Wheels Service Performed
07/31/2023 FONTANA, CA Dealer Service Lube, Oil And/Or Filter - Changed
11/06/2023 FONTANA, CA 20609 Dealer Service Lube, Oil And/Or Filter Changed
03/12/2024 FONTANA, CA 26345 Dealer Service Multiple Point Vehicle Inspection
03/12/2024 FONTANA, CA Dealer Service Tires or Wheels Service Performed
03/12/2024 FONTANA, CA Dealer Service Lube, Oil And/Or Filter Changed
AUTOCHECK TERMS AND CONDITIONS:
Experian's Reports are compiled from multiple sources. It is not always possible for Experian to obtain complete discrepancy information on all vehicles; therefore, there may be other title brands, odometer readings or discrepancies that apply to a vehicle that are not reflected on that vehicle's Report. Experian searches data from additional sources where possible, but all discrepancies may not be reflected on the Report. @ Copyright 2021 CCC Intelligent Solutions Inc. All Rights Reserved. Page 14 of 16 COCHONE. MARKET VALUATION REPORT Owner: Chavez, Rafael
Claim:
SUPPLEMENTAL INFORMATION
These Reports are based on information supplied to Experian by external sources believed to be reliable, BUT NO RESPONSIBILITY IS ASSUMED BY EXPERIAN OR ITS AGENTS FOR ERRORS, INACCURACIES OR OMISSIONS. THE REPORTS ARE PROVIDED STRICTLY ON AN "AS IS WHERE IS" BASIS, AND EXPERIAN
FURTHER EXPRESSLY DISCLAIMS ALL WARRANTIES, EXPRESS OR IMPLIED, INCLUDING ANY IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE REGARDING THIS REPORT.
YOU AGREE TO INDEMNIFY EXPERIAN FOR ANY CLAIMS OR LOSSES, INCLUDING COSTS, EXPENSES AND ATTORNEYS FEES, INCURRED BY EXPERIAN ARISING DIRECTLY OR INDIRECTLY FROM YOUR IMPROPER OR UNAUTHORIZED USE OF AUTOCHECK VEHICLE HISTORY REPORTS.
Experian shall not be liable or any delay ar falure to provide an accurate report if and to the exten: which such delay or kailure is caused by events beyond the reasshable? control of Experian, including, without limitation, "acts of God", terrorism, or public enemies, labor disputes, equipment malfunctions, material or component shortages s supplier failures, embargoes, rationing, acts of local, state or national governments, or public agencies, utility or communication failures or delays, fire, earthquakes, toge epidemics, riots and strikes.
These terms and the relationship between you and Experian shall be governed by the laws of the State of Illinois (USA) without regard to its conflict of law provisions. You and Experian agree to submit to the personal and exclusive jurisdiction of the courts located within the county of Cook, Illinois. © Copyright 2021 CCC Intelligent Solutions Inc. All Rights Reserved Page 15 of 16 CCOSONE. MARKET VALUATION REPORT | Owner: Chavez, Rafael Claim:
SUPPLEMENTAL INFORMATION
The National Highway Traffic Safety
@ NHTSA VEHICLE RECALL Administration has issued 2 safety related recall notices that may apply to the above
valued vehicle.
NHTSA Campaign ID: 24V064000 ciT
Mfg's Report Date : JAN 31, 2024
Component : AIR BAGS:SENSOR: OCCUPANT CLASSIFICATION:FRONT 10
PASSENGER
Potential Number Of Units Affected : 750114 RIALT
Summary : Honda (American Honda Motor Co.) is recalling certain 2020-2022 Pilot, Accord, Civic sedan, HR-V, Odyssey, 2020 Civic coupe, Fit, 2021-2022 Civic hatchback, 2021 Civic Type R, Insight, 2020-2021 CR-V, CR-V Hybrid, Passport, Ridgeline, Accord Hybrid, 2020 Acura MDX, 2022 Acura MDX, 2020-2022 Acura RDX, and 2020-2021 Acura TLX vehicles. The front passenger seat weight sensor may crack and short circuit, failing to suppress the air bag as intended.
Consequence : An air bag that deploys unintentionally during a crash can increase the risk of injury.
Remedy: Dealers will replace the seat weight sensors, free of charge. Owner notification letters are expected to be mailed March 18, 2024. Owners may contact Honda customer service at 1-888-234-2138. Honda's numbers for these recalls are XHP and VHQ Manufacturer Recall No. : XHP, VHQ
NHTSA Campaign ID : 23V430000
Mfg's Report Date : JUN 14, 2023
Component : SERVICE BRAKES, HYDRAULIC:ANTILOCK/TRACTION CONTROL/ ELECTRONIC LIMITED SLIP:CONTROL UNIT/MODULE
Potential Number Of Units Affected : 386
Summary: Honda (America Honda Motor Co.) is recalling certain 2023 Civic, Acura RDX, Acura Integra, and 2022 Honda Accord vehicles. A ball valve in the vehicle stability assist (VSA) modulator may leak brake fluid, which can result in unintended vehicle movement when the brake hold feature is engaged or an unexpected increase in brake pedal travel.
Consequence : Unintended vehicle movement or an unexpected increase in brake pedal travel can increase the risk of a crash or injury.
Remedy : Dealers will replace the VSA modulator, free of charge. Owner notification letters were mailed July 24, 2023. Owners may contact Honda customer service at 1-888-234-2138. Honda's numbers for this recall are OEJ, XEK, AEY, XEX and OEW.
Manufacturer Recall No. : OEJ,XEK,AEY,XEX,OEW
© Copyright 2021 CCC Intelligent Solutions Inc. All Rights Reserved. Page 16 of 16 COGEONE. FEE INFORMATION - CARRIER RETAINED Owner: Chavez, Rafael Claim:
Company: STATE FARM INSURANCE
COMPANIES
CARRIER RETAINED VEHICLE FEES Fees listed have been identified to be applicable for reimbursement
Zip: 92376 by the STATE FARM INSURANCE
COMPANIES based on information
Zip+4: 6623 provided by STATE FARM INSURANCE
COMPANIES. Fees may include title,
Registration Expires: 09/26/2024 registration, license plate transfer and other related state/jurisdictional fees.
Plates are: Transferable
Insurance Carrier Fees are determined by venice a
Salvage retained by:
attributes, provided by the Insurance
Plate Type: Standard company, including, but not #mited to, Leased Vehicle: No
Third Party Vehicle: No Reference links are provided for informational purposes only. The links,.
Vehicle License Fee Paid: $ 226.00 and content contained in the links are not. produced, maintained or affiliated with
Title Fees CCC, and CCC bears no responsibility
for the content provided therein.
Title Transfer Fee - (Additional Reference 1) $ 15.00
*One or more inputs may be based on
Registration Fees the following preset values provided
by STATE FARM INSURANCE
Vehicle License Fee $ 94.17 COMPANIES. Any updates to these inputs are reflected both in the Valuation
Transportation Improvement Fee - (Additional Reference 1) $ 53.75 Notes section and under Vehicle Fees on this page.
California Highway Patrol Fee $ 13.33
Salvage retained by : Carrier
$ 29.58 Plates are : Transferable
Registration Fee - (Additional Reference 1)
Plate Type: Standard
Plate Fees Usage Type: Personal
Registration Term (in months) : 12
Reflectorized license plate - (Additional Reference 1) $ 0.42 Additional Fees
Alternative Fuel/Technology Smog Fee - (Additional Reference 1) - $ 3.33 (Additional Reference 2)
Smog transfer - (Additional Reference 1) - (Additional Reference 2) $ 8.00 Service Authority for Freeway Fee - (Additional Reference 1) $0.42 Air Quality Fee - (Additional Reference 1) - (Additional Reference 2) $2.92 Fingerprint ID Fee - (Additional Reference 1) $ 0.83
Smog abatement - (Additional Reference 1) - (Additional Reference 2) $ 8.33 Auto Theft/DUl Deterrent Fee - (Additional Reference 1) $ 0.83 © Copyright 2021 CCC Intelligent Solutions Inc. All Rights Reserved Page 1 of 2 COGSONE. FEE INFORMATION - CARRIER RETAINED Owner: Chavez, Rafael Claim:
Company: STATE FARM INSURANCE
COMPANIES
CARRIER RETAINED VEHICLE FEES
Alternative Fuel/Technology Registration - (Additional Reference 1) - $ 1.25 (Additional Reference 2)
Total Title, Registration and Other Fees $ 232.16
of
-1
pri RIALT
1: 16
© Copyright 2021 CCC Intelligent Solutions Inc. All Rights Reserved Page 2 of 2 COGSONE. ADDITIONAL REGISTRATION INFORMATION Owner: Chavez, Rafael Claim:
Company: STATE FARM INSURANCE
COMPANIES
VEHICLE DATA Personal information (including, but
not limited to: name, address, date of
Vehicle 2022 HOND Sedan 4 DR Gasoline birth, DL number) appearing on driver and vehicle records is protected by the
VIN Driver Privacy Protection Act (DPPA).
The use of personal information for
Registration Expires 09/26/2024 reasons not allowed by the DPPA will result in loss of information access
Date of Loss* 04/16/2024 privileges and may result in legal action.
Registration Issued 09/17/2023
Any person who knowingly discloses
any information in violation of the Driver
Tag
Privacy Protection Act (DPPA) may be
10/07/2022 subject to criminal sanctions and civil
Title Issued
liability specified in law for unauthorized
Use Regular Auto
*Date of Loss provided by Carrier
CONDITIONS
2024 OCT - 7 PM 1: 16 CITY OF RIALTO
REC STATUS:
CLERK CEIVED
10/08/22 SMOG DUE 09/26/30
LIENHOLDER PAPERLESS TITLE U72221008
NO MAILING ADDRESS
09/25/2022-ODOMETER: 235 MILES ACTUAL MILEAGE
VLF
Eligible Refund Amount $94.17
VEHICLE INTERESTS
Registered Owner CERVANTES BRIANNA GUADALUPE
OR CHAVEZ RAFAEL JR
Legal Owner(Lienholder) AMERCN HONDA FIN CORP
PO BX 997509
SACRAMENTO 95899
© Copyright 2021 CCC Intelligent Solutions Inc. All Rights Reserved. Page 1 of 1 3871
SPLIT REMITTANCE:
DATE: 06/28/2024
AA
Remittance Payable To:
Insurance Auto Auctions, Inc. State Farm Insurance - ACH Funnel Attn: Settlement Group Attn: Imaging - Total Loss
Two Westbrook Corporate Center Suite 500 400 E Rio Salado Pkwy Bld 2, Fir 8 Westchester, IL 60154 Tempe, AZ 85281
Phone: (708) 492-7000 Attn: Salvage Dept
Fax: (708) 492-7078
E-mail:
Salvage Information Account of Sale % ACV
IAA Stock #: 000-39255142
IAA Branch: 59,950.00% 0,37.43
Fed. Tax I.D.
Ruben Limon
Ruben Limon
Insured: RAFAEL CHAVEZ Payment Amount
CERVANTES BRIANNA GUADALUPE OR CHA F RIALTO
Claim #:
Policy#: 9n1:17
Vehicle: 2022 HONDA ACCORD
Damage: Front end/Right Side
VIN:
ACV: $26,581.00
NICB Date: 6/28/2024
BUYAGA MOTOR COMPANY LIC.
2626 AGILE CT
PERRIS, CA 92571
Resale Certificate # : N/A
Elapsed Days Analysis
Date of Event: Date Days
Loss 4/16/2024
Assigned 4/19/2024
Released 4/23/2024 5
Pickup 4/23/2024 1
Title Rec'd 6/10/2024 49
Sale Doc. Rec'd 6/12/2024 3
Auction Date 6/27/2024 16
Buyer Payment N/A
Remittance 6/28/2024 2
Elapsed Total Days: 74
IAA Doc. RP002i.rpt
3871 SPLIT DEFICIT INVOICE: S1243965818
/A. CITY OF RIALTO INVOICE DATE: 06/28/2024
2024 OCT - 7 PM |: 17 Payment Due Date : 7/13/2024
RECEIVEL
CITY CLERA
Insurance Auto Auctions, Inc. State Farm Insurance - ACH Funnel Attn: Settlement Group Attn: Imaging - Total Loss
Two Westbrook Corporate Center Suite 500 400 E Rio Salado Pkwy Bld 2, FIr Westchester, IL 60154
Phone: (708) 492-7000
Fax: (708) 492-7078
E-mail: IAA Charges % ACV
Salvage Information Consignment Flat Fee $65.00 0.24
IAA Stock #: 000-39255142
IAA Branch: State/Local Transfer Fee $27.00 0.10
Fontana
Fed. Tax I.D 953790111 Total of IAA Charges $92.00 0.35 Handler: Ruben Limon
Adjuster: Ruben Limon Outside Charges Advanced by lAA % ACV Insured: RAFAEL CHAVEZ Labor $289.50 1.09
Owner: CERVANTES BRIANNA GUADALUPE OF Lien Release $100.00 0.38 Claim #: Yard $125.00 0.47
Policy # Storage $1,560.00 5.87
Vehicle: 2022 HONDA ACCORD Advance Tow $695.00 2.61
Damage: Front end/Right Side Extra Equipment $325.50 1.22 VIN: Wait Time $128.50 0.48
ACV: $26,581.00
NICB Date: 6/28/2024 Total of Outside Charges $3,223.50 12.13 Amount Due to lAA $3,315.50 12.47 %
For proper credit, include invoice number: S1243965818 and stock number: 000-39255142 on your payment check.
Buyer Information
MGA MOTOR COMPANY LLC.
2626 AGILE CT
PERRIS, CA 92571
Resale Certificate # : N/A
Elapsed Days Analysis
Date of Event: Date Days
4/16/2024
Loss
Assigned 4/19/2024
Released 4/23/2024 5
Pickup 4/23/2024
Title Rec'd 6/10/2024
Sale Doc. Rec'd 6/12/2024
Sale Date 6/27/2024
Buyer Payment N/A
Invoice 6/28/2024
Elapsed Total Days:
IAA Doc. RP002j.гpt
1:11 4 ::: 49
* Messages
app.towbook.com
Fast Track Roadside INVOICE
1602L Forence Ave. Los Angeles CA 90001 / PHone: 214-183-2049 | INVOICE 24-110740 Invoice Photoc
Baslc Detoile Vehicle Summary
Purchase Order 69605891 VIN Number*
Number Model. 2027 Honda Accord (BiLe)
Call N 110740 Drivable: No
Account (No Account Specified)
Date/Thre 4/19/2024 ar 11:11 AM
Requestedi
Date/Tha 4/19/2024 ф 11:37 AM
Completed: CITY OF
Primary Reason: Sore MateR..
Customar: Rock Manda (service 0niy)L909-72g- 2024 OCT - 7 PM 8400)
Tow From: IGS70 South Highland Avenue, Fontana.
CA 92336, USA
Taw To: 21219 Lost Sth Street, Son Berndren, RIAL
CA 92410, USA CLEA
Charges Summary
-
service INwy Units/Qry Price Linstratal
Tow 1 $695.00 $695.00
Labor $289.50 $289.S0
Wait time $128.50 $128.50
Gate fee 1 $ 125.00 $$25.00
Equipment $325,50 **25.50
Storsge $195.00 $1,560.00
Llen fee 5100,00 ·100.00
Subtotal $3,223.50
Taxes: $0.00
Grand Total $3,223.50
Signature:
Upon signing this document I am freely admitting that 1 have the legal right to authorize FastTrack Roadside to recover and tow my vehicle. I also agree and understand that circumstances outside FastTrack Roadside control, with regard to the accident involving my vehicle, may make recovery and removal of my vehicle unusually difficult. And I unconditionally release, waive and discharge my right, whether by contract or under operation of law to file cause of action(s) or claims) which 1 may have against FastTrack Roadside now or in the future. I hereby assume any and all risk of loss, liability, damage or costs, and understand that any and all damages that may occur will be as a result of the accident not as a result of any negligence on the part of 1 fully understand the terms sec forth in this form, and t hereby waive my rights freely and voluntarily without any inducement, assurance, or guarantee being made to me to the fullest extent allowed by law. + 16
1:111
:.. 149
4 Messages
app.towbook.com 2024 OCT - 7
CITY OF RIALTO
Fast Track Roadside INVOICE
10a2 troPe
INVOICE # 24-110740
EFCELERK
Vehicle Summary
Purchase Order Vi Aumber
Humber Mandi:
110743
39255142-
Account
Oste/Time 4/19/1024 $ 11 11AM
Date/Time 419:2024 0 11.37 aM
Completed
Sto Notes.
Customer Rodr tanaa sonice Only l 909-720.
Tow Fram MED South Ahard Avenue, Fordamn.
Taw To: 24219 Eas: 5ch Stroel, San Barranimo,
CA 92410, USA
Charges Summary
Tow $595 00
Labor $289.50
Wait time $128.50
Gate fee 3125.00
Equipment $125.50
Storsge
Lien fee 3:00.00
Teres
Signature:
Upon gigning this document Tam freely admitting that I have the legal right to authorize FastTrack Roadside to recover and tow my vehicle. I also agree and understand that circumstancas outside FastTrack Roadside control, with regard to the accident involving my vehlcle, may make recovery and removal of my vehicle unusually difficult. And 1 unconditionally release, walve and discharge my right, 60112
16 STATE OF CALIFORNIA
SALVAGE CERTIFICATE
VEHICLE HISTORY
V61061224A3
AUTOMOBILE
VEHICLE ID NUMBER MODEL MAKE PLATE NUMBER
2022 HOND
LINLADEN -REGISTRATION"
BODY TYPE LODEL WEIGHT FUEL. TRANSFER DATE FEES PAID EXPIRATION DATE 4D G $27 09/26/2024
YA 1ST
SOLD CLASS MO BOUIPMTITRUST NOMBER ISSUE DATE
2022 KN FF 9255142 06/12/24
HOTORGYCLE SHINE NUMBER ОООМЕТЕЯ САТЕ DOOMETER READING
06/12/2024 27838 MI
ACTUAL MILEAGE
REGISTERED OWNERS)
STATE FARM MUTUAL
HOLD TO LIGHT TO VIEW AUTOMOBILE INS CO 110
C/0 IAA 132
11017 COBBLEROCK DR 150 OCT - 7
RNCHO CORDOVA CA 95670
CEIV
THE SALVAGE CERTIRCATE IS EVGENCE THAT TIFUNG
DOCUMENTS FOR THIS VEHICLE HAVE BEEN BARRENCERED
TO THE DEPARIMENT OF MOTOR VEHICLES
WARNING:
The vehicle described herein has been declared a total loss salvage vehicle per WA CVC 11515 and may not be registered without a vehicle identification number (VIN) inspection per CVC 5505 and a brake and light inspection. In addition a certification of compliance (smog) may be required.
To transfer ownership of this vehicle the seller and buyer must complete the NAVA reassignment on the back of this certificate.
VOID WITHOUT BEAR
OF
CVC 11515 requires the seller and any subsequent sellers SCAL that transfer ownership of a total loss vehicle pursuant to a properly endorsed salvage certificate to disclose to the purchaser at, or prior to, the time of sale that the vehicle has been declared a total loss salvage vehicle.
SALVAGE SALIFORNIA
000362 2981264
REG. 489 (REV.U/18)
KEEP IN A SAFE PLACE - VOID IF ALTERED
STATE FARM INSURANCE COMPANIES
CA
Take this initial estimate to the repair facility of your choice. If additional damage is found have the repair facility use the "Request Supplement" link at b2b.statefarm.com. **This is not an email address; it is the site to submit a Supplement**. All supplements must be approved by State Farm. 2C3c637e
Rate Table: Default
Estimate of Record
Written By: I VAFD4S, 4/18/2024 3:49:40 PM
Claim Rep: B1 Language Demand Pool As, (844) 292-8615 Business Insured: RAFAEL CHAVEZ Owner Policy #: Claim#: 55-66D6-60J01 Type of Loss: Collision Date of Loss: 04/16/2024 06:40 PM Days to Repair: 0 Point of Impact: 12 Front Deductible: 1000.00
Owner (Insured): Inspection Location: Repair Facility:
RAFAEL CHAVEZ. RESIDENCE - RAFAEL CHAVEZ RIALTO
Cellular Virtual
Other i Day
VEHICLE
2022 HOND Accord Sedan Sport w/Continuously Variable Transmission 4D SED 4-1.5L Turbocharged Gasoline Gasoline Direct Injection Blue VIN: Production Date: 08/2022 Interior Color:
License: Odometer: 27838 Exterior Color: Blue
State: CA Condition:
TRANSMISSION Air Conditioning FM Radio Bucket Seats
Automatic Transmission Intermittent Wipers Stereo Reclining/Lounge Seats POWER Tilt Wheel Search/Seek WHEELS
Power Steering Cruise Control Auxiliary Audio Connection Aluminum/Alloy Wheels Power Brakes Rear Defogger SAFETY PAINT
Power Windows Keyless Entry Drivers Side Air Bag Clear Coat Paint Power Locks Alarm Passenger Air Bag OTHER
Power Mirrors Message Center Anti-Lock Brakes (4) Fog Lamps Power Driver Seat Steering Wheel Touch Controls 4 Wheel Disc Brakes Traction Control DECOR Telescopic Wheel Front Side Impact Air Bags Stability Control Dual Mirrors Climate Control Head/Curtain Air Bags Rear Spoiler Tinted Glass Backup Camera Hands Free Device Xenon or L.E.D. Headlamps Console/Storage Intelligent Cruise Lane Departure Warning Overhead Console RADIO SEATS
CONVENIENCE AM Radio Cloth Seats
4/18/2024 3:49:40 PM 467561 | 1.9.06.12060 Page 1
Claim #:
Workfile ID: 2C3c637e
Estimate of Record
2022 HOND Accord Sedan Sport w/Continuously Variable Transmission 4D SED 4-1.5L Turbocharged Gasoline Gasoline Direct Injection Blue Line Oper Description Part Number Qty Extended Labor Paint Price $
1 FRONT BUMPER & GRILLE
2 O/H front bumper 4.6
**<> Repl Non OEM CAPA Bumper cover AM5343 1 349.03 Incl. 2.6 w/o prk sensor
4 Add for Clear Coat 1.0
5 ** Repl Non OEM LT Trim cover w/fog HO1038159 50.00 Inc. lamps
6 ** Repl Non OEM CAPA Lower grille black H01036139C 129.00 Ind. 7 HOOD
8 ** Repl Non OEM CAPA Hood (ALU) P152161 1 534.75 1.8 3.0 9 Overlap Major Non-Adj. Panel -0.2
10 Add for Clear Coat 0.6
Add for Underside(Complete) 9,5
12 Repl RT Hinge 60120TVAAOOZZ. 1 84.67 0.3
Add for Clear Coat C, 0.D
13 14 Repl LT Hinge 60170TVAA00ZZ 1 84.67
15 Add for Clear Coat
16 FENDER
17 # Repl Glass Installation 1
Kit-Windshield/Incl Glass Primer
18 ** Repl Non OEM CAPA RT Fender AM5017 1 210.00 1.9 1.8 19 Overlap Major Adj. Panel -0.4
20 Add for Clear Coat 0.3
21 Add for Edging 0.5
22 R&I RT Fender liner w/o hybrid 74100TVAA00 Ind.
23 ** Repl Non OEM CAPA LT Fender AM5018 1 210.03 1.9 1.8 24 Overlap Major Adj. Panel -0.4
25 Add for Clear Coat 0.3
26 Add for Edging 0.5
27 R&d LT Fender liner w/o hybrid - 74150TVAA00 Incl
28 WINDSHIELD
29 * Repl Windshield NAGS w/o head-up FWO4794GTY 1 604.36 3.2 dsply w/acoustic layer w/auto dim
-40%
30 Repl Upper molding 73150TVAA01 __1. _... 7.69 Ind.
1m INSTRUMENT PANEL
32 Repl USED console assy +25% 21791R 1 312.50 1.1
Repl Lower cover 1.5 liter turbo D 77345TVAA01ZA 1 18.89 sport, Sport SI
34 _ Repl Column cover 77302TVAA01ZA 1 _36.50
35 RESTRAINT SYSTEMS
36 Repl Driver air bag 77801TVAA10ZA 1 1,193.39 m Incl. M 37 Repl Psngr air bag 77820TVAA80 1 1,033.40 m 0.3 M
4/18/2024 3:49:40 PM 467561 | 1.9.06.12060 Page 2
Claim #:
Workfile ID: 2C3c637e
Estimate of Record
2022 HOND Accord Sedan Sport w/Continuously Variable Transmission 4D SED 4-1.5L Turbocharged Gasoline Gasoline Direct Injection Blue 38 Repl RT Knee air bag 78960TVAA81 1 860.37 m 0.4 M
39 Repl LT Knee air bag 78910TVAA81 1 861.44 m 0.4 M
40 Repl LT Head air bag wo sunroof 78875TVAA82 1 1,083.44 m 0.8 M 41 Repl Diagnostic unit w/o Hybrid 77960TVAL42 400.70 m 0.5 M 42 Repl RT Ft impact sensor 77930TVAA01 1 25.73 m 0.3 M 43 Repl LT Ft impact sensor 77930TVAA01 1 25.73 m 0.3 M 44 Repl Clockspring 77900TVAA12 135.87 m 1.2 M
45 Repl LT Side impact sens front 77970TVAC01 27.00 m 0.2 M 46 Repl LT Side impact sens rear 77970TVAC01 27.00 m 0.2 M 47 Repl LT Ft seat air bag 78055TVAA82 528.91 m 0.3 M CITY 48 Repl LT Belt & retractor ivory 04818TVAA00ZB 1 199.80 m 0.3 M 49 SEATS & TRACKS 03 OF
50 Repl Seat back cover Sport, TS-Tech 81121TVAA42ZD 1 618.04 black
R&I RT R&I front seat ALT
52 Rep! Seat back pad Tachi-s Sport 81127TVCA41 1 303.83 53 ROOF 17
54 Repl Headliner w/o sunroof gray 83201TVAA22ZB 1 561.52 55 FRONT DOOR
56 * BInd LT Outer panel (HSS) 67151TVA315ZZ 1.1
57 R&I LT Belt molding 72450TVAA01 0.3
58 R&I LT R&I mirror 76258TVAA02 0.3
59 R&J LT Handle, outside w/o smart 72181TVAA91ZC 0.4
entry sn marino red
60 R&I RT R&I trim panel 83503TVAA61ZA 0.5
61 MISCELLANEOUS OPERATIONS
62 # Rpr Pre-repair Scan 0.5 M
63 # Rpr Post-repair Scan 0.5 M
64 # R&I D&R Battery 0.2
65 # Repl Glass Installation 1 20.00
Kit-Windshield/Inc Glass Primer
66 OTHER CHARGES
67 E.P.C. 1 3.00
SUBTOTALS 10,541.26 28.8 14.8
4/18/2024 3:49:40 PM 467561 | 1.9.06.12060 Page 3
Claim #:
Workfile ID: 2c3c637e
Estimate of Record
2022 HOND Accord Sedan Sport w/Continuously Variable Transmission 4D SED 4-1.5L Turbocharged Gasoline Gasoline Direct Injection Blue
ESTIMATE TOTALS
Category Basis Rate Cost $
Parts 10,538.26
Body Labor 22.6 hrs @ $ 78.00 /hr 1,762.80
Paint Labor 14.8 hrs @ $78.00/hr 1,154.40
Mechanical Labor 6.2 hrs @ $205.00 /hr 1,271.00
Paint Supplies 14.8 hrs @ $56.00/hr 828.80c
Other Charges ·33300m
Subtotal 15,558.26
Sales Tax $ 11,367.06 _@ 7.7500 % CY 880.95
Total Cost of Repairs 16.439.211
Deductible 2.00000g
Total Adjustments 1,000.00
Net Cost of Repairs 15,439.21
For more information regarding State Farm's promise of satisfaction relating to new non-original equipment manufacturer (non-OEM) and recycled parts, please visit:
https://static1.st8fm.com/en US/downloads/sf/non-oem-recycled-parts-California-only.pdf or QR code.
Register online to check the status of your claim and stay connected with State Farm®. To register, go to http://www.statefarm.com/ and select Check the Status of a Claim. If you are already registered, thank you! 4/18/2024 3:49:40 PM 467561 | 1.9.06.12060 Page 4
Claim #:
Workfile ID: 2C3C637e
Estimate of Record
2022 HOND Accord Sedan Sport w/Continuously Variable Transmission 4D SED 4-1.5L Turbocharged Gasoline Gasoline Direct Injection Blue
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 CITY OF RIALTO Y OF RIALTO MISCELLANEOUS. CCC ONE: ADJ=ADJACENT, ALGN=ALIGN, OCT - 7 PM 1: 17 A/M=AFTERMARKET, BLND=BLEND, CAPA=CERTIFIED AUTOMOTIVE
PARTS ASSOCIATION, D&R=DISCONNECT AND RECONNECT, CLERK
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
WINDSHIELD CAN PROPERLY FUNCTION AS A SAFETY DEVICE PURSUANT
TO THE FEDERAL MOTOR VEHICLE SAFETY STANDARDS AND THE
VEHICLE MANUFACTURER'S SPECIFICATIONS.
THIS ESTIMATE HAS BEEN PREPARED BASED ON THE USE OF CRASH PARTS SUPPLIED BY A SOURCE OTHER THAN THE MANUFACTURER OF YOUR MOTOR VEHICLE. ANY WARRANTIES APPLICABLE TO THESE REPLACEMENT PARTS
ARE PROVIDED BY THE MANUFACTURER OR DISTRIBUTOR OF THE PARTS, RATHER THAN BY THE ORIGINAL MANUFACTURER OF YOUR VEHICLE.
4/18/2024 3:49:40 PM 467561 | 1.9.06.12060 Page 5
Claim #:
Workfile ID: 2c3c637e
Estimate of Record
2022 HOND Accord Sedan Sport w/Continuously Variable Transmission 4D SED 4-1.5L Turbocharged Gasoline Gasoline Direct Injection Blue 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 ARG4446, CCC Data Date 04/16/2024, 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/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 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! CITY
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: OF
SYMBOLS FOLLOWING PART PRICE:
m=MOTOR Mechanical component. s=MOTOR Structural component. T=Miscellaneous Taxed charge category. RIALTO 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. 4/18/2024 3:49:40 PM 467561 | 1.9.06.12060 Page 6
Claim #:
Workfile ID: 2C3с637e
Estimate of Record
2022 HOND Accord Sedan Sport w/Continuously Variable Transmission 4D SED 4-1.5L Turbocharged Gasoline Gasoline Direct Injection Blue *****INSURANCE COMPANY DISCLOSURES AND CUSTOMER NOTIFICATIONS***** "FOR YOUR PROTECTION CALIFORNIA LAW REQUIRES THE FOLLOWING TO APPEAR ON THIS FORM:
ANY PERSON WHO KNOWINGLY PRESENTS FALSE OR FRAUDULENT CLAIM FOR THE PAYMENT OF A LOSS IS GUILTY OF A CRIME AND MAY BE SUBJECT TO FINES AND CONFINEMENT IN STATE PRISON.
FALSE REPRESENTATIONS MADE ON A SIGNED AUTO THEFT CLAIM FORM SUBJECTS THE INSURED TO A PENALTY OF PERJURY."
THE FOLLOWING DISCLOSURE APPLIES TO THOSE PARTS IDENTIFIED AS NON-OEM ON THE ESTIMATE:
"THIS ESTIMATE HAS BEEN PREPARED BASED ON THE USE OF CRASH PARTS SUPPLIED BY A SOURCE OTHER THAN THE MANUFACTURER OF YOUR MOTOR VEHICLE. ANY WARRANTIES APPLICABLE TO
THESE REPLACEMENT PARTS ARE PROVIDED BY THE MANUFACTURER OR DISTRIBUTOR OF THE PARTS, RATHER THAN BY THE ORIGINAL MANUFACTURER OF YOUR VEHICLE.
PURSUANT TO CALIFORNIA CODE OF REGULATIONS, TITLE 10, CHAPTER 5, SUBCHAPTER 7.5, SECTION 2695.8 THE INSURER WARRANTS THAT ANY NON-ORIGINAL EQUIPMENT MANUFACTURER PARTS,
SPECIFIED IN THIS ESTIMATE ARE AT LEAST EQUAL TO THE ORIGINAL EQUIPMENT MANUFACTURER S PARTS IN TERMS OF KIND, QUALITY, SAFETY, FIT AND PERFORMANCE."
CLERA RIALTO
1:17
4/18/2024 3:49:40 PM 467561 | 1.9.06.12060 Page 7
Claim #:
Workfile ID: 2c3c637e
Estimate of Record
2022 HOND Accord Sedan Sport w/Continuously Variable Transmission 4D SED 4-1.5L Turbocharged Gasoline Gasoline Direct Injection Blue
ALTERNATE PARTS SUPPLIERS
Line Supplier Description Price
3 Ipart automotive inc #AM5343 $ 349.03
14975 hilton driver Non OEM CAPA Bumper cover w/o prk sensor Fontana CA 92335 Quote: 2146474149
(909) 587-6059 Expires: 04/24/24
5 Perfect Fit West #H01038159 $50.00
3383 Olive Ave Non OEM LT Trim cover w/fog lamps
Signal Hill CA 90755 Quote: 2146474149
(310) 956-4667 Expires: 04/24/24
6 KEYSTONE-FONTANA, CA #H01036139C $129.00
15895 VALLEY BLVD Non OEM CAPA Lower grille black
FONTANA CA 92335 Quote: 2471967927
(800) 421-7866 Expires: 06/01/24
8 Pacific Auto Company Ontario #P152161
John Perez Non OEM CAPA Hood (ALU)
1131 PHILADELPHIA STREET
ONTARIO CA 91761
(800) 722-8890 • RIALTO
18 Ipart automotive inc #AM5017
14975 hilton driver Non OEM CAPA RT Fender
Fontana CA 92335 Quote: 2146474149
(909) 587-6059 Expires: 04/24/24
23 Ipart automotive inc #AM5018 $210.03
14975 hilton driver Non OEM CAPA LT Fender
Fontana CA 92335 Quote: 2146474149
(909) 587-6059 Expires: 04/24/24
32 Benzeen Auto Parts PRP #21791R $250.00
Sales Number USED console assy +25%
3811 Recycle Road INSTRUMENT PANEL-CLUSTER - (CLUSTER), MPH, TURBO, 1.5L, ID 78100T
Rancho Cordova CA 95742
(916) 273-9395
4/18/2024 3:49:40 PM 467561 | 1.9.06.12060 Page 8
STATE FARM INSURANCE COMPANIES
CA
Take this initial estimate to the repair facility of your choice. If additional damage is found have the repair facility use the "Request Supplement" link at b2b.statefarm.com. **This is not an email address; it is the site to submit a Supplement**. All supplements must be approved by State Farm.
Claim #:
Workfile ID: 2c3с637e
Rate Table: Default
Supplement of Record 1 Summary
Written By: I VAFD4S, 4/19/2024 9:36:12 AM
Claim Rep: B1 Language Demand Pool As, (844) 292-8615 Business CITY
Insured: RAFAEL CHAVEZ Owner Policy #: Claim #: OCT
Type of Loss: Collision Date of Loss: 04/16/2024 06:40 PM Days to Repair: 0 Point of Impact: 12 Front Deductible: 1000.00
Owner (Insured): Inspection Location: Repair Facility:
RAFAEL CHAVEZ RESIDENCE - RAFAEL CHAVEZ
VEHICLE
2022 HOND Accord Sedan Sport w/Continuously Variable Transmission 4D SED 4-1.5L Turbocharged Gasoline Gasoline Direct Injection Blue VIN: Production Date: 08/2022 Interior Color:
License: Odometer: 27838 Exterior Color: Blue
State: CA Condition:
TRANSMISSION Air Conditioning FM Radio Bucket Seats
Automatic Transmission Intermittent Wipers Stereo Reclining/Lounge Seats POWER Tilt Wheel Search/Seek WHEELS
Power Steering Cruise Control Auxiliary Audio Connection Aluminum/Alloy Wheels Power Brakes Rear Defogger SAFETY PAINT
Power Windows Keyless Entry Drivers Side Air Bag Clear Coat Paint Power Locks Alarm Passenger Air Bag OTHER
Power Mirrors Message Center Anti-Lock Brakes (4) Fog Lamps Power Driver Seat Steering Wheel Touch Controls 4 Wheel Disc Brakes Traction Control DECOR Telescopic Wheel Front Side Impact Air Bags Stability Control Dual Mirrors Climate Control Head/Curtain Air Bags Rear Spoiler Tinted Glass Backup Camera Hands Free Device Xenon or L.E.D. Headlamps Console/Storage Intelligent Cruise Lane Departure Warning Overhead Console RADIO SEATS
CONVENIENCE AM Radio Cloth Seats
4/19/2024 9:36:12 AM 467561 | 1.9.06.12060 Page 1
Claim #:
Workfile ID: 203c637e
Supplement of Record 1 Summary
2022 HOND Accord Sedan Sport w/Continuously Variable Transmission 4D SED 4-1.5L Turbocharged Gasoline Gasoline Direct Injection Blue Line Oper Description Part Number Qty Extended Labor Paint Price $
1 FRONT BUMPER & GRILLE
2 O/H front bumper 4.6
**<> Repl Non OEM CAPA Bumper cover AM5343 1 349.03 Ind. 2.6 w/o prk sensor
4 Add for Clear Coat 1.0
** Repl Non OEM LT Trim cover w/fog HO1038159 1 50.00 Incl lamps
6 ** Repl Non OEM CAPA Lower grille black H01036139C 129.00 Ind. 7 HOOD
P152161 3.00
8 ** Repl Non OEM CAPA Hood (ALU) 1 534.75 1.8
9 Overlap Major Non-Adj. Panel OF
10 Add for Clear Coat
11 Add for Underside(Complete) RI
12 Repl RT Hinge 60120TVAAOOZZ 1 84.67 0.3 pil AL'
13 Add for Clear Coat
14 Repl LT Hinge 60170TVAAOOZZ 1 84.67 0.3 0.35
15 Add for Clear Coat 0.1
16 FENDER
17 # Repl Glass Installation 1
Kit-Windshield/Incl Glass Primer
18 * Repl Non OEM CAPA RT Fender AM5017 1 210.00 19 1.8 Overlap Major Adj. Panel -0.4
20 Add for Clear Coat 0.3
21 Add for Edging 0.5
22 R&I RT Fender liner w/o hybrid 74100TVAA00 Incl.
23 ** Repl Non OEM CAPA LT Fender AM5018 1 210.03 1.9 1.8 24 Overlap Major Adj. Panel -0.4
25 Add for Clear Coat 0.3
Add for Edging 0.5
R&t LT Fender liner w/o hybrid 74150TVAA00
28 INSTRUMENT PANEL
* Repl USED console assy +25% 21791R 1 312.50 1.1
30 Repl Lower cover 1.5 liter turbo LX, 77345TVAA01ZA 1 18.89 Sport, Sport SE
31 Repl Column cover 77302TVAA01ZA 1 36.50
32 RESTRAINT SYSTEMS
33 Repl Driver air bag 77801TVAA10ZA 1 1,193.39 m Incl. M 34 Repl Psngr air bag 77820TVAA80 1 1,033.40 m 0.3 M
35 Repl RT Knee air bag 78960TVAA81 1 860.37 m 0.4 M
36 Repl LT Knee air bag 78910TVAA81 1 861.44 m 0.4 M
Rep! LT Head air bag w/o sunroof 78875TVAA82 1 1,083.44 m 0.8 M 38 Repl Diagnostic unit w/o Hybrid 77960TVAL42 1 400.70 m 0.5 M 4/19/2024 9:36:12 AM 467561 | 1.9.06.12060 Page 2
Claim #:
Workfile ID: 2C3c637e
Supplement of Record 1 Summary
2022 HOND Accord Sedan Sport w/Continuously Variable Transmission 4D SED 4-1.5L Turbocharged Gasoline Gasoline Direct Injection Blue 39 Repl RT Ft impact sensor 77930TVAA01 1 25.73 m 0.3 M 40 Repl LT Ft impact sensor 77930TVAA01 1 25.73 m 0.3 M 41 Repl Clockspring 77900TVAA12 1 135.87 m 1.2 M
42 Repl LT Side impact sens front 77970TVAC01 1 27.00 m 0.2 M 43 Repl LT Side impact sens rear 77970TVAC01 1 27.00 m 0.2 M 44 Repl LT Ft seat air bag 78055TVAA82 1 528.91 m 0.3 M 45 Repl LT Belt & retractor ivory 04818TVAA00ZB 1 199.80 m 0.3 M 46 SEATS & TRACKS
47 Repl | Seat back cover Sport, TS-Tech 81121TVAA42ZD 1 618.04 1.1 black
48 R&I RT R&I front seat 0.5
49 Repl Seat back pad Tachi-S Sport 81127TVCA41 1 303.83 50 ROOF
51 Repl Headliner w/o sunroof gray 83201TVAA22ZB 1 561.52 4.2 52 FRONT DOOR
53 * Bind LT Outer panel (HSS) 67151TVA315ZZ
54 R&I LT Belt molding 72450TVAA01 0.3
55 R&T LT R&I mirror 76258TVAA02 0.327
56 R&T LT Handle, outside w/o smart 72181TVAA91ZC 0.4 2C) entry sn marino red
83503TVAA61ZA 0.5 RIALTO
57 R&I RT R&I trim panel
58 MISCELLANEOUS OPERATIONS
59 # Rpr Pre-repair Scan 0.5 M
60 # Rpr Post-repair Scan 0.5 M
61 # RaJ D&R Battery 0.2
62 OTHER CHARGES
63 # E.P.C. 1 3.00
SUBTOTALS 9,909.21 25.6 14.8
4/19/2024 9:36:12 AM 467561 | 1.9.06.12060 Page 3
Claim #:
Workfile ID: 2C3c637e
Supplement of Record 1 Summary
2022 HOND Accord Sedan Sport w/Continuously Variable Transmission 4D SED 4-1.5L Turbocharged Gasoline Gasoline Direct Injection Blue
ESTIMATE TOTALS
Category Basis Rate Cost $
Parts 9,906.21
Body Labor 19.4 hrs $ 78.00/hr 1,513.20
Paint Labor 14.8 hrs @ $ 78.00/hr 1,154.40
Mechanical Labor 6.2 hrs @ $ 205.00 /hr 1,271.00
Paint Supplies 14.8 hrs @ $ 56.00 /hr 828.80
Other Charges 3.00
Subtotal 14,676.61
Sales Tax $10,735.01 7.7500 % 831.96
Total Cost of Repairs 15,508.57
Deductible 1,900.00
Total Adjustments 1,000.00-1
Net Cost of Repairs 14,508,57
oF
• RIALTO
For more information regarding State Farm's promise of satisfaction relating to new non-original equipment manufacturer (non-OEM) and recycled parts, please visit:
https://static1.st8fm.com/en US/downloads/sf/non-oem-recycled-parts-California-only.pdf or QR code.
Register online to check the status of your claim and stay connected with State Farm®. To register, go to http://www.statefarm.com/ and select Check the Status of a Claim. If you are already registered, thank you! 4/19/2024 9:36:12 AM 467561 | 1.9.06.12060 Page 4
Claim #:
Workfile ID: 2c3c637e
Supplement of Record 1 Summary
2022 HOND Accord Sedan Sport w/Continuously Variable Transmission 4D SED 4-1.5L Turbocharged Gasoline Gasoline Direct Injection Blue
SUPPLEMENT SUMMARY
Line Oper Description Part Number Qty Extended Labor Paint Price $
Deleted Items
28 WINDSHIELD
29 * Repl Windshield NAGS w/o head-up FW04794GTY 1 -604.36 -3.2 dsply w/acoustic layer w/auto dim
-40%
30 Repl Upper molding 73150TVAA01 1 -7.69 Incl.
65 # Repl Glass Installation 1 -20.00
Kit-Windshield/Incl Glass Primer
SUBTOTALS -632.05 -3.2 0.0
TOTALS SUMMARY
Category Basis Rate Cost$
Parts -632.05
Body Labor -3.2 hrs $ 78.00 /hr 249.60
Subtotal -881.65,
Sales Tax $-632.05 @ 7,7500%7 2.48.984
Additional Supplement Taxes I -930.64", 1-0.00
Total Supplement Amount
NET COST OF SUPPLEMENT = -930:64 y
CUMULATIVE EFFECTS OF SUPPLEMENTS) 17
Estimate 16,439.21 I VAFD4S
Supplement S01 -930.64 I VAFD4S
Workfile Total: $ 15,508.57
TOTAL ADJUSTMENTS: $ 1,000.00
NET COST OF REPAIRS: $ 14,508.57
4/19/2024 9:36:12 AM 467561 | 1.9.06.12060 Page 5
Claim #:
Workfile ID: 2C3c637e
Supplement of Record 1 Summary
2022 HOND Accord Sedan Sport w/Continuously Variable Transmission 4D SED 4-1.5L Turbocharged Gasoline Gasoline Direct Injection Blue
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 CITY OF RIALTO PARTS ASSOCIATION, D&R=DISCONNECT AND RECONNECT, CITY CLERK RECEIVED 2024 OCT - 7 PM 1:18 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.
THIS ESTIMATE HAS BEEN PREPARED BASED ON THE USE OF CRASH PARTS SUPPLIED BY A SOURCE OTHER THAN THE MANUFACTURER OF YOUR MOTOR VEHICLE. ANY WARRANTIES APPLICABLE TO THESE REPLACEMENT PARTS
ARE PROVIDED BY THE MANUFACTURER OR DISTRIBUTOR OF THE PARTS, RATHER THAN BY THE ORIGINAL MANUFACTURER OF YOUR VEHICLE.
4/19/2024 9:36:12 AM 467561 | 1.9.06.12060 Page 6
Claim #:
Workfile ID: 2c3c637e
Supplement of Record 1 Summary
2022 HOND Accord Sedan Sport w/Continuously Variable Transmission 4D SED 4-1.5L Turbocharged Gasoline Gasoline Direct Injection Blue 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 ARG4446, CCC Data Date 04/16/2024, 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/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 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: 2024 CITY
m=MOTOR Mechanical component. s=MOTOR Structural component. T=Miscellaneous Taxed charge category.
X=Miscellaneous Non-Taxed charge category. OCT
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.* RIALTO OTHER SYMBOLS AND ABBREVIATIONS: 18
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. Refin=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. 4/19/2024 9:36:12 AM 467561 | 1.9.06.12060 Page 7
Claim #:
Workfile ID: 2c3c637e
Supplement of Record 1 Summary
2022 HOND Accord Sedan Sport w/Continuously Variable Transmission 4D SED 4-1.5L Turbocharged Gasoline Gasoline Direct Injection Blue *****INSURANCE COMPANY DISCLOSURES AND CUSTOMER NOTIFICATIONS***** "FOR YOUR PROTECTION CALIFORNIA LAW REQUIRES THE FOLLOWING TO APPEAR ON THIS FORM:
ANY PERSON WHO KNOWINGLY PRESENTS FALSE OR FRAUDULENT CLAIM FOR THE PAYMENT OF A LOSS IS GUILTY OF A CRIME AND MAY BE SUBJECT TO FINES AND CONFINEMENT IN STATE PRISON.
FALSE REPRESENTATIONS MADE ON A SIGNED AUTO THEFT CLAIM FORM SUBJECTS THE INSURED TO A PENALTY OF PERJURY."
THE FOLLOWING DISCLOSURE APPLIES TO THOSE PARTS IDENTIFIED AS NON-OEM ON THE ESTIMATE:
"THIS ESTIMATE HAS BEEN PREPARED BASED ON THE USE OF CRASH PARTS SUPPLIED BY A SOURCE OTHER THAN THE MANUFACTURER OF YOUR MOTOR VEHICLE. ANY WARRANTIES APPLICABLE TO
THESE REPLACEMENT PARTS ARE PROVIDED BY THE MANUFACTURER OR DISTRIBUTOR OF THE PARTS, RATHER THAN BY THE ORIGINAL MANUFACTURER OF YOUR VEHICLE. CIT PURSUANT TO CALIFORNIA CODE OF REGULATIONS, TITLE 10, CHAPTER 5, SUBCHAPTER 7.5, SECTION 2695.8 THE INSURER WARRANTS THAT ANY NON-ORIGINAL EQUIPMENT MANUFACTURER PARTS SPECIFIED IN THIS ESTIMATE ARE AT LEAST EQUAL TO THE ORIGINAL EQUIPMENT MANUFACTÜRER ! RIALTO PARTS IN TERMS OF KIND, QUALITY, SAFETY, FIT AND PERFORMANCE." 4/19/2024 9:36:12 AM 467561 | 1.9.06.12060 Page 8
Claim #:
Workfile ID: 2c3c637e
Supplement of Record 1 Summary
2022 HOND Accord Sedan Sport w/Continuously Variable Transmission 4D SED 4-1.5L Turbocharged Gasoline Gasoline Direct Injection Blue
ALTERNATE PARTS SUPPLIERS
Line Supplier Description Price
Ipart automotive inc #AM5343 $349.03
14975 hilton driver Non OEM CAPA Bumper cover w/o prk sensor Fontana CA 92335 Quote: 2146474149
(909) 587-6059 Expires: 04/24/24
5 Perfect Fit West #H01038159 $50.00
3383 Olive Ave Non OEM LT Trim cover w/fog lamps
Signal Hill CA 90755 Quote: 2146474149
(310) 956-4667 Expires: 04/24/24
KEYSTONE-FONTANA, CA #H01036139C $ 129.00
15895 VALLEY BLVD Non OEM CAPA Lower grille black
FONTANA CA 92335 Quote: 2471967927
(800) 421-7866 Expires: 06/01/24
8 Pacific Auto Company Ontario #P152161 $ 58475
John Perez Non OEM CAPA Hood (ALU)
y oF
1131 PHILADELPHIA STREET 27
ONTARIO CA 91761 10
(800) 722-8890
18 Ipart automotive inc #AM5017 7C$21000
14975 hilton driver Non OEM CAPA RT Fender
Fontana CA 92335 Quote: 2146474149
(909) 587-6059 Expires: 04/24/24
23 Ipart automotive inc #AM5018 $ 210.03
14975 hilton driver Non OEM CAPA LT Fender
Fontana CA 92335 Quote: 2146474149
(909) 587-6059 Expires: 04/24/24
29 Benzeen Auto Parts PRP #21791R $ 250.00
Sales Number USED console assy +25%
3811 Recycle Road 781 RUMENT PANEL-CLUSTER - (CLUSTER), MPH, TURBO, 15L, ID Rancho Cordova CA 95742
(916) 273-9395
4/19/2024 9:36:12 AM 467561 | 1.9.06.12060 Page 9
2024 OCT - 7 PM 1: 18 CITY OF RIALTO
RECEIY CLERK
CITY
CITY OF RIALTO
2024 OCT - 7 PH 1: 18
RECEIYLO CITY CLERK
RIAL
CITY 18
PH
7024 OCT
LIVE CLERI
CIT
MFD. BY HONDA DEVELOPMENT & 08/22
MANUFACTURING OF AMERICA, LLC
GVWR 2030KG (4475LBS]
GAWR F 1070KG (2358LBS]
GAWR R 960KG ( 2116LBS)
THIS VEHICLE CONFORMS TO ALL APPLICABLE
FEDERAL MOTOR VEHICLE SAFETY BUMPER,
AND THEFT PREVENTION STANDARDS IN EFFECT
ON THE DATE OF MANUFACTURE SHOWN ABOVE
VIN
TYPE PASSENGER CAR
475P
CITY OF RIALTO
OCT -7 PM I: 18
CITY CLERA RECEIRED
CITY OF RIALTO
2024 OCT - 7 PH I: 18
RECEIVED
CITY CLERA
CITY OF RIALTO
2024 OCT - 7 PH 1:18
RECEIVEU
CITY CLERK
CITY OF RIALTO
2024 OCT - 7 PM I: 18
CITY CLERK RECEIYED
CITY DF RIALTO
2071 OCT-7 PH : 18
Tal W
2024 OCT - 7 PM :
CITY CLERE
610949984641
CITY OF RIALTC
2024.0C - 7
1:19
EIVE
CIT 1 • CLERA
2024
ECEIV
CITY CLER
CITY OF RIALTO
2024 OCT - 7 PM 1:19
RECEIVED
CITY CLERA
CITY OF RIALTO
2024 OCT - 7 PM |: 19
WED BX HOKDY DE ОБИЕЙ 8
MFD. BY HONDA DEVELOPMENT &
ATION MANUFACTURING OF AMERICA, LLC
GVWR 2030KG (4475LBS) 08/22
REAR 3 GAWR F 1070KG (2358LBS)
or 850lbs. GAWR R 960KG (2116LBS)
VNER'S FEDERAL MOTOR VEHICLE SAFETY BUMPER, THIS VEHICLE CONFORMS TO ALL APPLICABLE
L FOR AND THEFT PREVENTION STANDARDS IN EFFECT
DNAL ON THE DATE OF MANUFACTURE SHOWN ABOVE.
V.I.N: 1UnA.-
ATION TYPE: PASSENGER CAR
TVA N AP5 B575P RECEIVED 2024 OCT - 7
CLERK PH 1813
CITY
202, 00:
CITY OF RIALTO
2024 OCT - 7 PM 1: 19
RECEIVC
CITY CLERT
CITY OF BIALTO
2021 OCT - 7, PM 1: 19
OF R
GISTI
027838 miles
160 Dismiss
86 F
140 20 Hood Open
el 120- 40 40
100 mph 60 x1000r/min
80 CITY OF RIALTO 2024 OCT - 7 PM RECEIV CITY CLE
CITY OF RIALIO
2024 OCT - 7
RECELY
CITI CL
CITY OF RIALIO
PH 1: 20
CITY OF RIALTO
2024 CCT - 7 FM 1: 14
CITY CLERA HECTIVEL
ORIGIN ID:MYFA FedEx®
SHIP DATE: 020CT24
ACTWGT: 1.00 LE
CLERKIN, SINCLAIR & MAHFOUZ, LLP CAD: 100256708/INET453 3333 CAMINO DEL RIO, STE. 120
08/09/24 16:02
SAN DIEGO, CA 92108 BILL SENDER
UNITED STATES US
TO RIALTO CITY CLERK'S OFFICE
Do not chini
150 S PALM AVE
RIALTO CA 92376
(909) 296-4249 REF:
INV:
limite aflishiliti
FedEx.
exoress
items securely. Need help? Go to fedex.com, You can help us get your package safely to This envelope is only for FedEx Exp.
FRI - 04 OCT 10:30A
TRK# MORNING 2DAY
[0201 7789 7809 0794
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CA-US SBD
/or packing tips. i by packing your