Claim - Mid-Century Ins Co ASO Gilbert Ortiz_Redacted.pdf

CITY CLERK'S DATE STAMP

CITY OF RIALTO

LIABILITY CITY OF RIALTO
CLAIM FOR DAMAGES 2005 MAY -8 PM 1: 59

TO PERSON OR PROPERTY

NECELYLU

CITY CLERN

1. Claims for death, injury to person, orto personal property must be filed not later than six (6) months after the occurrence (Gov. Code §911.2).

2. Claims for damages to real property must be filed not later than one (1) year after the occurrence (Gov. Code §911.2). RETURN TO:

3.READ ENTIRE CLAIM FOR BEFORE FILING Rialto City Clerk's Office

4. ATTACH SEPARATE SHEETS, IF NECESSARY, TO GIVE FULL DETAILS Mail: 150 S. Palm Ave., Rialto, CA 9237 ddress: 290 W. Rialto Ave., Rialto, CA 9237
CLAIMANT INFORMATION:

Mid-Century Insurance Company A/S/O Gilbert Ortiz N/A

FULL NAME DATE OF BIRTH
HOME ADDRESS INCLUDING CITY, STATE & ZIP HOME TELEPHONE NO.

PO BOX 268992 Oklahoma City, OK 73126 (616)803-7653
BUSINESS ADDRESS INCLUDING CITY, STATE & ZIP BUSINESS TELEPHONE NO.

ADDRESS AT WHICH CLAIMANT DESIRES TO RECEIVE Mid-Century Insurance Company A/S/O Gilbert Ortiz

NOTICES OR COMMUNICATIONS REGARDING THIS CLAIM
(if different from home address provided above): PO BOX 268992 Oklahoma City. OK 73126

1. WHEN DID DAMAGE OR INJURY OCCUR? DATE: 11/29/2024 TIME: 10:56 •AM 2 PM

2. PLACE OF ACCIDENT (OCCURRENCE) BE SPECIFIC - Describe fully and (if applicable) locate on diagram on reverse side of this sheet.

Where appropriate, give street names and addresses, measurements and landmarks.

The incident occured near 1155 W Renaissance Parkway in Rialto, CA

3. HOW DID DAMAGE OR INJURY OCCUR?
The Rialto PD were following Andrew with no lights or sirens activated. Andrew did not stop as he had had not been given any directive to do so. Andrew attempted a left turn onto Renaissance when the _officer struck Andrew's vehicle.

4. WERE POLICE AT THE SCENE? * YES • NO WERE PARAMEDICS AT THE SCENE? • YES * NO

5. WHAT PARTICULAR ACT OR OMISSION DO YOU CLAIM CAUSED THE INJURY OR DAMAGES? Give the name of the city/town employee causing the injury or damage, if known.

The Rialto PD struck the Mid-Century insured's vehicle without due cause or notifying them that they were conducting a traffic stop.

6. GIVE TOTAL AMOUNT OF CLAIM Include estimate of amount of any prospective injury or damage $9.141.59 HOW WAS THE ABOVE AMOUNT COMPUTED? Be specific, list doctor bills, repair estimates, etc. Please attach 2 estimates.

DAMAGES INCURRED TO DATE:

Item/Date: Damage to 2010 BMW 328l (totaled) (includes tow/storage) Amount: $9,689.59 Item/Date: Deductible Amount: $1.000.00
TOTAL AMOUNT CLAIMED AS OF PRESENTATION OF THIS CLAIM: $ 9,141.59 ESTIMATED PROSPECTIVE DAMAGES, AS FAR AS KNOWN:

Item/Date: Amount: $
Item/Date: 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: L TELEPHONE: | )

8. IF INJURED, PROVIDE NAME, CONTACT INFORMATION AND DATE/TIME DOCTORS) OR HOSPITAL(S) VISITED: JO NAME: N/A NAME:

ADDRESS: ADDRESS:

TELEPHONE: L TELEPHONE: |)
DATE: TIME: DAM 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 hen you first saw City/Town vehicle; location of City/Town vehicle at time of accident by "A-1" and location of yourself or your vehicle at the time of the ccident by "B-1" and the point of impact by "X"
→ NOTE: IF THE DIAGRAM BELOW DOES NOT FIT THE SITUATION, PLEASE ATTACH A PROPER DIAGRAM SIGNED BY THE CLAIMANT.

CURB
PARKWAY 1155 W Renaissance Pky. Rial CA 92376
7/F 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.

I CERTIFY (OR DECLARE) UNDERgIN syner by Britary Shine FOREGOING IS TRUE AND CORRECT.

Brittany Shine Date: 2025.05.07 11:52:06-04'00'

SIGNATURE OF CLAIMANT OR AGENT
Brittany Shine 05/07/2025

TYPE OR PRINT NAME DATE
Litigation Claim Representative

RELATIONSHIP TO CLAIMANT
NOTE: PRESENTATION OF A FALSE CLAIM IS A FELONY (CA PENAL CODE 72) RETURN CLAIM TO: RIALTO CITY CLERK'S OFFICE - 150 S. PALM AVE., RIALTO, CA 92376

CITY OF RIALTO
2025 MAY -8 PM 2:00

RECEIV- CITY CLERA
thinli
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Ma Calfmania 9DTJ125
INVOICE #7.740.

MONT 5053
12: 07
19/13/2024

TRANS/DRIVE
BMW 3281 SULEV LICENSEISTATE
Batch MAKE/MODEL MILES IN/MILES OUT 121454/121454
VIN

CHERT I CARD ENGINE

CHACTEESS
Entry GILBERT TITROMFROGMAIL COM

TREAD DEPTH
BASE ANT: AIR PRESSURE OUT
PSt. 32" -132"
Non- Cash PSI. PSL.

PsI. 132'
PSI

TOMER STATES IT OVERHEATED VING IT ALSO STALLED ON HIM
1005180,00

FOVERHEATED -WHEN DRIVING IT ALSO STALLED ON HIM
Total for CUSTOMER STATES IT
VEHICLE ISSUE WATER PUMP LEAKING 1 8 3565 98 NEW
PART CPURNS PORT OIRECT WATER PUMPS ENGINE WATER PUMP 20 510.95 NEw

COOLANT
PRESCHANT 2.5 40 3180.00 8400 00 LABOR
WATER PUMP, RAR, 3 SERIES, 320 0.1 @т 5180.00 LABOR.,
DISPOSAL FEE WATER PUMP LEARNE" 3: DOM EN

LABOR ADD
VERICLE ISSUE 3 COOLANT HOSES REC
REIN RADIATOR COOLANT HOSE + 4R S55.90 NEW
PART REIN RADIATOR COOLANT MOSE Total TO COOLANT HOSES REC. "5102 5R VEHICLE ISSUE IM: OIL CHANGE
SW30
POURITE 8:9 @ 36:05 S47:00
SWSO FULL SYNTHETIC ENGINE OIL 10 S8.95 SB.0s New

0.1053.40 $100.00 san 00 CABO

REPLACE OIL AND FILTER
5 6.
s000
whichever
5: 151.200
BANTE 568 7 4

51.224 10
S:22410
30 00
Toll Free: (800) 435-7764

FARMERS

INSURANCE
Oklahoma City, OK. 73126-899
ax: (877) 217-138
Email Delivery:

From: [email protected]
Date: Wed, May 7, 2025 @ 12:06 PM
Subject: Mid-Century Insurance Company 5034306369-1-0 Self Insured To: [email protected]
05/07/2025

CITY OF
Rialto City Clerk's Office
150 S Palm Avenue
Rialto, CA 92376
LTO
Our Insured: Gilbert Ortiz. 2: 00
ur Claim # 099 SUB 5034306369-1
ate of Loss 11/29/2024
Your Insured: Responsible Party Unknown
Your Claim #:

Deductible Amount: $1,000.00
Total Amount Owed: $9,141.59
Dear Rialto City Clerk's Office:

Our investigation has established that the above loss was caused by your negligence or someone employed by you. It has been determined that you are responsible for all or part of the material damage, bodily injury, property damage, medical, and/or related expense payments paid on our insured's behalf. The current amount we have paid on our insured's behalf may increase or decrease due to additional bodily injury, property damage, medical and/or other related expense payments. The amount for which we are seeking reimbursement for property damage is $9,141.59.

Our theory of liability is as follows:

You have the right to dispute any or all of our claim. If you do not dispute it within seven (7) days of receiving this letter, Farmers Insurance Exchange will assume that it is valid. Be advised that no partial payment, which is less than the full amount, will be considered in any way an acceptance of benefits, a novation or an accord and satisfaction of this claim without the express written release of our claim executed by an individual who identifies himself/herself as a member of our subrogation department. Therefore, our legal rights to enforce collection on the remaining amount of the claim shall not be waived or estopped due to a partial payment by you.

If you need additional support for our claim or require further information, please contact me. Please 76QFS7BP3
send payment to:

National Document Center
PO Box 268992
Oklahoma City, Ok 73126
Thank you,
Brittany Shine
Litigation Claims Representative
Mid-Century Insurance Company
616-803-7653 (Call/Text)
2005 MAY - 3 PH 2: 00 CITY OF RIALTO
76QFS7BP3

CITY OF RIALTO CITY CLERKS DATE STAMP

RATIO, CA OF
LIABILITY 202 •RIALTO
CLAIM FOR DAMAGES PR 2:00

TO PERSON OR PROPERTY OFFENDA

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 5911.2).

2. Claims for damages to real property must be filed not later than one (1) year after the occurrence (Gov. Code $911.2).

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:

Mid-Century Insurance Company A/S/O Gilbert Ortiz N/A

FULL NAME DATE OF BIRTH
HOME ADDRESS INCLUDING CITY, STATE & ZIP HOME TELEPHONE NO.

PO BOX 268992 Oklahoma City, OK 73126 (616)803-7653
BUSINESS ADDRESS INCLUDING CITY, STATE & ZIP BUSINESS TELEPHONE NO.

ADDRESS AT WHICH CLAIMANT DESIRES TO RECEIVE Mid-Century Insurance Company A/S/O Gilbert Ortiz

NOTICES OR COMMUNICATIONS REGARDING THIS CLAIM
(if different from home address provided above): PO BOX 268992 Oklahoma City. OK 73126

1. WHEN DID DAMAGE OR INJURY OCCUR? DATE: 11/29/2024 TIME: 10:56 • AM X PM

2. PLACE OF ACCIDENT (OCCURRENCE) BE SPECIFIC - Describe fully and (if applicable) locate on diagram on reverse side of this sheet.

Where appropriate, give street names and addresses, measurements and landmarks.

The incident occured near 1155 W Renaissance Parkway in Rialto, CA

4. WERE POLICE AT THE SCENE? XI YES • NO WERE PARAMEDICS AT THE SCENE? • YES *I 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 Rialto PD struck the Mid-Century insured's vehicle without due cause or notifying them that they were conducting a traffic stop.

DAMAGES INCURRED TO DATE:

Item/Date: Damage to 2010 BMW 3281 (totaled) (includes tow/storage) Amount: $9.689.59 Item/Date: Deductible Amount: $1,000.00
76QFS7BP3
TOTAL AMOUNT CLAIMED AS OF PRESENTATION OF THIS CLAIM: $9,141.59 ESTIMATED PROSPECTIVE DAMAGES, AS FAR AS KNOWN:

Item/Date: Amount: $
Item/Date: 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 HOSPITAL(S) VISITED:

NAME: N/A NAME:

ADDRESS: ADDRESS:

TELEPHONE: L TELEPHONE: |)
DATE: TIME: • AM • PM DATE: TIME: • AM •PM

9. PLEASE READ THE FOLLOWING CAREFULLY:
-or all vehicle accident claims, place on the following diagram, the names of streets, including NORTH, EAST, SOUTH AND WEST directions. Indicate plac f 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 → NOTE: IF THE DIAGRAM BELOW DOES NOT FIT THE SITUATION, PLEASE ATTACH A PROPER DIAGRAM SIGNED BY THE CLAIMANT.

CURB
PARKWAY 1155 W Renaissance Pkuy: Rialid CA 92376
7/t 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.

I CERTIFY (OR DECLARE) UND Engitaly signed by Briany Shine FOREGOING IS TRUE AND CORRECT.

Brittany Shine Date: 2025.05.07 11:52:06 -04'00'

SIGNATURE OF CLAIMANT OR AGENT
Brittany Shine 05/07/2025

TYPE OR PRINT NAME DATE
Litigation Claim Representative

RELATIONSHIP TO CLAIMANT
NOTE: PRESENTATION OF A FALSE CLAIM IS A FELONY (CA PENAL CODE 72) 76QFS7BP3 RETURN CLAIM TO: RIALTO CITY CLERK'S OFFICE - 150 S. PALM AVE., RIALTO, CA 92376

MID-CENTURY INSURANCE COMPANY
OKC APD Specialist (TL-CA)
For CCC Supplements: Import by Workfile ID
Build Supplement on top of existing file
Lock to submit for review
Non-CCC supplements:

Phone: (405) 782-6667 Claim #: 5034306369-1_A5056803
Fax: (877) 217-1389 Workfile ID:

Estimate of Record
Written By: CORY CANNON, 1/7/2025 8:52:43 AM
Adjuster: CANNON, CORY
Insured: GILBERT ORTIZ Owner Policy#: 0169980504 Claim #: 5034306369-1_A5056803 Type of Loss: COLL1 - MD Date of Loss: 11/29/2024 10:56 PM Days to Repair: 0 Point of Impact: 09 Left T-Bone (Left Deductible: 1000.00 Owner (Insured): Inspection Location: Appraiser Information: Repair Facility:

GILBERT ORTIZ Desk [email protected]
(405) 782-6667

VEHICLE
2010 BMW 3 Series 328i RWD SULEV 4D SED 6-3.0L Gasoline MPI VIN: Production Date: Interior Color:

License: Odometer: 122378 Exterior Color:

State: Condition:

TRANSMISSION Aftermarket Film Tint RADIO Hands Free Device Automatic Transmission Console/Storage AM Radio ROOF
Overdrive Wood Interior Trim FM Radio Electric Glass Sunroof POWER CONVENIENCE Stereo SEATS
Power Steering Air Conditioning Search/Seek Bucket Seats Power Brakes Intermittent Wipers CD Player Leather Seats Power Windows Tilt Wheel Auxiliary Audio Connection WHEELS Power Locks Cruise Control SAFETY Aluminum/Alloy Wheels Power Mirrors Rear Defogger Drivers Side Air Bag PAINT
Heated Mirrors Keyless Entry Passenger Air Bag Clear Coat Paint Power Driver Seat Message Center Anti-Lock Brakes (4) OTHER Power Passenger Seat Steering Wheel Touch Controls 4 Wheel Disc Brakes Fog Lamps Memory Package Telescopic Wheel Front Side Impact Air Bags Traction Control DECOR Climate Control Head/Curtain Air Bags Stability Control Dual Mirrors Home Link Communications System Power Trunk/Liftgate 1/7/2025 8:52:43 AM 114541 | 1.9.07.03270 Page 1

Page 5 of 51 ends

Claim #: 5034306369-1_A5056803
Workfile ID: 1d3d9eb7
Estimate of Record
2010 BMW 3 Series 328i RWD SULEV 4D SED 6-3.0L Gasoline MPI Line Oper Description Part Number Qty Extended Labor Paint Price $
1 # Color Tint 0.5
2 WHEELS
** ALY59582U2ON 2 403.88 m 0.3 CIT
3 Repl A/M Wheel, alloy style 159
4 PILLARS, ROCKER & FLOOR
5 Repl LT Rocker molding w/o Sport 51777202653 1 316.14 1.5 % pack

FRONT DOOR
7 * Bind RT Door shell 41515A2A386 I.O
8 R&T LT R&I door assy 41515A2A385 1.1
9 R&I RT Belt w'strip 51337060234 0.3
10 R& LT Belt w'strip 51337060233 0.3
11 R&I RT R&J mirror as an assy 51167282528 0.3 :;
12 R&U LT R&I mirror as an assy 51167282527 0.3
13 R&J RT Handle, outside w/keyless 51217207564 0.4
entr from 1-08
14 R&I LT Handle, outside w/keyless entr 51217207565 0.4 from 1-08
15 R&I RT R&I trim panel 51419154172 0.6
16 R&I LT R&I trim panel 51419167805 0.6

REAR DOOR
18 * Repl LKQ RT door assy +20% EM918 1 150.00 2.0 2.9
19 Overlap Major Non-Adj. Panel -0.2
20 * Repl LKQ LT door assy +20% 22168P 1 210.00 2.0 2.9 21 Overlap Major Non-Adj. Panel -0.2
22 QUARTER PANEL
23 * Repl LKQ RT quarter panel +20% EM918 1 240.00 18.0 3.5 24 Overlap Major Adj. Panel -0.4
25 * Rpr LT Quarter panel 41217145095 6.0 2.2
26 Overlap Major Adj. Panel -0.4
27 Repl RT Splash shield 51717059382 1 126.90 0.3
28 R&t LT Splash shield 51717059381 0.3
29 R&I Fuel door 51177060692 0.3
30 * Bind Fuel door 51177060692 0.2
31 # Bind RT Roof Rail 1.0
32 # Bind LT Roof Rail 1.0
33 REAR SUSPENSION
34 O/H rr susp rt m 4.5 M
35 ** Repl AIM RT Ft upr cott arm OGGS101002 1 63.89 m Inci. M 36 * Repl LKQ RT Knuckle sedan 328i 242614B 1 198.00 m Incl. M +20%
* Repl LKQ RT Lower cntrl arm +20% EM918 1 54.00 m Incl. M 38 REAR LAMPS
1/7/2025 8:52:43 AM 114541 | 1.9.07.03270 Page 2

Page 6 of 51 ends

Claim #: 5034306369-1_A5056803
Workfile ID: 1d3d9eb7
Estimate of Record
2010 BMW 3 Series 328i RWD SULEV 4D SED 6-3.0L Gasoline MPI 39 R&I RT Tail lamp 63217289430 0.4
40 R&T LT Tail lamp 63217289429 0.4
CiT

REAR BUMPER
42 R&I R&I bumper cover 51127202706 1.4
43 Bumper cover w/o park sensor, 51127202706 1.0 2.80
w/o turbo sedan
44 Overlap Major Non-Adj. Panel -0-2
45 2:5
46 MISCELLANEOUS OPERATIONS
47 Subl 4 Wheel Alignment 1 89,99 X
48 Flex Additive 1 12.00 X
49 Hazardous Waste 1 5000X
50 Post Repair Scan 0.5 M
51 Pre Repair Scan 1 0.5 M
SUBTOTALS 1,869.80 43.1 20.1

ESTIMATE TOTALS
Category Basis Rate Costs
Parts 1,762.81
Body Labor 37.6 hrs @ $53.82/hr 2,023.63
Paint Labor 20.1 hrs $ 53.82/hr 1,081.78
Mechanical Labor 5.5 hrs $ 92.64 /hr 509.52
Paint Supplies 20.1 hrs $ 38.00 /hr 763.80
Miscellaneous 106.99
Subtotal 6,248.53
Sales Tax $ 2,526.61 6.0000 % 151.60
Municipal Tax $2,526.61 @ 1.2500% 31.58
County Tax $2,526.61 @ 1.2500% 31.58
Other Tax 1 $2,526.61 @ 0.5000% 12.63
Total Cost of Repairs 6,475.92
Deductible 1,000.00
Total Adjustments 1,000.00
Net Cost of Repairs 5,475.92
1/7/2025 8:52:43 AM 114541 | 1.9.07.03270 Page 3

Page 7 of 51 ends

Claim #: 5034306369-1_A5056803
Workfile ID: 1d3d9eb7
Estimate of Record
2010 BMW 3 Series 328i RWD SULEV 4D SED 6-3.0L Gasoline MPI THIS IS NOT AN AUTHORIZATION TO REPAIR. TO ENSURE REPAIRS WILL BE COMPLETED BASED ON THIS ESTIMATE; PLEASE PROVIDE A COPY TO THE REPAIR FACILITY PRIOR TO AUTHORIZING REPAIRS. FAILURE TO DO SO MAY RESULT IN YOU BECOMING RESPONSIBLE FOR PAYING UNAPPROVED EXPENSES. ***SUPPLEMENTAL REQUESTS*** NO PAYMENT FOR A SUPPLEMENT WILL BE APPROVED OR ISSUED UNLESS THE REPAIRS WERE AUTHORIZED PRIOR TO COMPLETING THE SUPPLEMENTAL REPAIRS. POTENTIALLY, A REINSPECTION MAY BE CONDUCTED. ALL SUPPLEMENTS MUST BE APPROVED BY A CLAIMS REPRESENTATIVE BEFORE REPAIRS ARE COMPLETED.
*** RENTAL COVERAGE*** BASED ON OUR ESTIMATE WE HAVE CALCULATED THE DAYS TO REPAIR YOUR VEHICLE AND THIS INFORMATION IS LOCATED ON THE FRONT PAGE OF YOUR ESTIMATE. THIS APPLIES IF YOU :

HAVE RENTAL COVERAGE AVAILABLE OR HAVE BEEN APPROVED FOR A RENTAL VEHICLE. REQUESTS FOR A RENTAL EXTENSION MUST BE REVIEWED PRIOR TO AUTHORIZATION. IF YOUR VEHICLE IS SAFELY DRIVABLE, IT:

SHOULD NOT BE LEFT FOR REPAIRS UNTIL THE NECESSARY PARTS ARE AVAILABLE AND YOUR REPAIR FACILITY IS READY TO COMMENCE REPAIRS. IF YOU LEAVE YOUR SAFELY DRIVABLE VEHICLE WITH THE REPAIR FACILITY

BEFORE PARTS ARE AVAILABLE, YOU WILL BE RESPONSIBLE FOR ANY UNNECESSARY RENTAL EXPENSES INCURRED DURING REPAIRS.
1/7/2025 8:52:43 AM 114541 | 1.9.07.03270 Page 4

Page 8 of 51 ends

Claim #: 5034306369-1_A5056803
Workfile ID: 1d3d9eb7
Estimate of Record
2010 BMW 3 Series 328i RWD SULEV 4D SED 6-3.0L Gasoline MPI CCC OPEN SHOP SUPPLEMENTS: SUBMIT USING ESTIMATE SHARE (AWE) RETRIEVAL PROCESS OR CONTACT CCC AT (800) 637-8511 FOR ASSISTANCE.

NON-CCC REPAIR FACILITIES: CONTACT US AT THE NUMBER LISTED ON THE HEADER.

ALL SUPPLEMENTS MUST BE APPROVED BY A CLAIMS REPRESENTATIVE BEFORE REPAIRS ARE COMPLETED.

IF YOU HAVE COVERAGE FOR DAMAGE TO YOUR VEHICLE UNDER THIS POLICY IT IS OUR OBLIGATION TO INFORM YOU THAT UNDER CALIFORNIA CODE OF REGULATIONS, TITLE 10, CHAPTER 5, SECTION 2695.8(E) YOU> HAVE THE RIGHT TO SELECT THE VEHICLE REPAIR FACILITY OF YOUR CHOICE. 02 WE ARE PROHIBITED BY LAW FROM REQUIRING THAT REPAIRS BE DONE AT A SPECIFIC AUTOMOTIVE REPAIR:

DEALER. YOU ARE ENTITLED TO SELECT THE AUTO BODY REPAIR SHOP TO REPAIR DAMAGE COVERED BY US. WE HAVE RECOMMENDED AN AUTOMOTIVE REPAIR DEALER THAT WILL REPAIR YOUR DAMAGED VEHICLE. IF YOU

AGREE TO USE OUR RECOMMENDED AUTOMOTIVE REPAIR DEALER, WE WILL CAUSE THE DAMAGED VEHICLE TO

BE RESTORED TO ITS CONDITION PRIOR TO THE LOSS AT NO ADDITIONAL COST TO YOU OTHER THAN AS STATED IN THE INSURANCE POLICY OR AS OTHERWISE ALLOWED BY LAW. IF YOU EXPERIENCE A PROBLEM WITH THE REPAIR OF YOUR VEHICLE, PLEASE CONTACT US IMMEDIATELY FOR ASSISTANCE.

AUTO BODY REPAIR CONSUMER BILL OF RIGHTS
A CONSUMER IS ENTITLED TO:

1. SELECT THE AUTO BODY REPAIR SHOP TO REPAIR AUTO BODY DAMAGE COVERED BY THE INSURANCE COMPANY. AN INSURANCE COMPANY SHALL NOT REQUIRE THE REPAIRS TO BE DONE AT A SPECIFIC AUTO BODY REPAIR SHOP.

2. AN ITEMIZED WRITTEN ESTIMATE FOR AUTO BODY REPAIRS AND, UPON COMPLETION OF REPAIRS, A DETAILED INVOICE. THE ESTIMATE AND THE INVOICE MUST INCLUDE AN ITEMIZED LIST OF PARTS AND LABOR ALONG WITH THE TOTAL PRICE FOR THE WORK PERFORMED. THE ESTIMATE AND INVOICE MUST ALSO IDENTIFY ALL PARTS AS NEW, USED, AFTERMARKET, RECONDITIONED, OR REBUILT.

3. BE INFORMED ABOUT COVERAGE FOR TOWING AND STORAGE SERVICES.

4. BE INFORMED ABOUT THE EXTENT OF COVERAGE, IF ANY, FOR A REPLACEMENT RENTAL VEHICLE WHILE A DAMAGED VEHICLE IS BEING REPAIRED.

5. BE INFORMED OF WHERE TO REPORT SUSPECTED FRAUD OR OTHER COMPLAINTS AND CONCERNS ABOUT AUTO BODY REPAIRS.

6. SEEK AND OBTAIN AN INDEPENDENT REPAIR ESTIMATE DIRECTLY FROM A REGISTERED AUTO BODY REPAIR

SHOP FOR REPAIR OF A DAMAGED VEHICLE, EVEN WHEN PURSUING AN INSURANCE CLAIM FOR REPAIR OF THE VEHICLE.

COMPLAINTS WITHIN THE JURISDICTION OF THE BUREAU OF AUTOMOTIVE REPAIR

COMPLAINTS CONCERNING THE REPAIR OF A VEHICLE BY AN AUTO BODY REPAIR SHOP SHOULD BE DIRECTED TO:

TOLL FREE (866) 799-3811

CALIFORNIA DEPARTMENT OF CONSUMER AFFAIRS

BUREAU OF AUTOMOTIVE REPAIR
10949 NORTH MATHER BOULEVARD
RANCHO CORDOVA, CA 95670
THE BUREAU OF AUTOMOTIVE REPAIR CAN ALSO ACCEPT COMPLAINTS OVER ITS WEB SITE AT:
1/7/2025 8:52:43 AM 114541 | 1.9.07.03270 Page 5

Page 9 of 51 ends

Claim #: 5034306369-1_A5056803
Workfile ID: 1d3d9eb7
Estimate of Record
2010 BMW 3 Series 328i RWD SULEV 4D SED 6-3.0L Gasoline MPI WWW.AUTOREPAIR.CA.GOV

COMPLAINTS WITHIN THE JURISDICTION OF THE CALIFORNIA INSURANCE COMMISSIONER

ANY CONCERNS REGARDING HOW AN AUTO INSURANCE CLAIM IS BEING HANDLED SHOULD BE SUBMITTED TO THE CALIFORNIA DEPARTMENT OF INSURANCE AT:
(800) 927-HELP OR (213) 897-8921

CALIFORNIA DEPARTMENT OF INSURANCE

CONSUMER SERVICES DIVISION
- 17
300 SOUTH SPRING STREET SOUTH TOWER
LOS ANGELES, CA 90013
THE CALIFORNIA DEPARTMENT OF INSURANCE CAN ALSO ACCEPT COMPLAINTS OVER ITS WEB SITE AT: LTO WWW.INSURANCE.CA.GOV 2:00

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:

S=STRUCTURAL, T=TAXED MISCELLANEOUS, X=NON TAXED
MISCELLANEOUS. CCC ONE: ADJ=ADJACENT, ALGN=ALIGN,
A/M=AFTERMARKET, BLND-BLEND, CAPA=CERTIFIED AUTOMOTIVE
PARTS ASSOCIATION, D&R=DISCONNECT AND RECONNECT,
EST=ESTIMATE, EXT. PRICE=UNIT PRICE MULTIPLIED BY THE QUANTITY, INCL=INCLUDED, MISC=MISCELLANEOUS, NAGS=NATIONAL AUTO GLASS SPECIFICATIONS, NON-ADJ=NON ADJACENT, O/H=OVERHAUL,
OP=OPERATION, NO-LINE NUMBER, QTY=QUANTITY,
RECOND=RECONDITION, REFN=REFINISH, REPL=REPLACE, R&I=REMOVE AND INSTALL, R&R=REMOVE AND REPLACE, RPR=REPAIR, RT=RIGHT, SECT=SECTION, SUBL=SUBLET, LT=LEFT, W/O=WITHOUT, W/_=WITH/_ SYMBOLS: #=MANUAL LINE ENTRY, *=OTHER [IE. MOTORS DATABASE INFORMATION WAS CHANGED], **=DATABASE LINE WITH AFTERMARKET, N= NOTES ATTACHED TO LINE. OPT OEM= ORIGINAL EQUIPMENT

MANUFACTURER PARTS EITHER OPTIONALLY SOURCED OR OTHERWISE PROVIDED WITH SOME UNIQUE PRICING OR DISCOUNT.
''''CURE TIME'' MEANS THE LENGTH OF TIME THAT, PER THE ADHESIVE 1/7/2025 8:52:43 AM 114541 | 1.9.07.03270 Page 6

Page 10 of 51 ends

Claim #: 5034306369-1_A5056803
Workfile ID: 1d3d9eb7
Estimate of Record
2010 BMW 3 Series 328i RWD SULEV 4D SED 6-3.0L Gasoline MPI

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. CITY
-3 P: 2: 00 RIALTO
1/7/2025 8:52:43 AM 114541 | 1.9.07.03270 Page 7

Page 11 of 51 ends

Claim #: 5034306369-1_A5056803
Workfile ID: 1d3d9eb7
Estimate of Record
2010 BMW 3 Series 328i RWD SULEV 4D SED 6-3.0L Gasoline MPI 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 ERE1942, CCC Data Date 01/02/2025, 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:
m=MOTOR Mechanical component. s=MOTOR Structural component. T=Miscellaneous Taxed charge category.

X=Miscellaneous Non-Taxed charge category.

SYMBOLS FOLLOWING LABOR:

D=Diagnostic labor category. E=Electrical labor category. F=Frame labor category. G=Glass labor category.

M=Mechanical labor category. S=Structural labor category. (numbers) 1 through 4=User Defined Labor Categories.

OTHER SYMBOLS AND ABBREVIATIONS:

Adj.=Adjacent. Algn.=Align. ALU=Aluminum. A/M=Aftermarket part. BInd=Blend. BOR=Boron steel.

CAPA=Certified Automotive Parts Association. CFC=Carbon Fiber.

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. STS=Stainless Steel. Subl=Sublet.

UHS=Ultra High Strength Steel. N=Note(s) associated with the estimate line.

CCC ONE Estimating - A product of CCC Intelligent Solutions 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. 1/7/2025 8:52:43 AM 114541 | 1.9.07.03270 Page 8

Page 12 of 51 ends

Claim#: 5034306369-1_A5056803
Workfile ID: 1d3d9eb7
Estimate of Record
2010 BMW 3 Series 328i RWD SULEV 4D SED 6-3.0L Gasoline MPI Fraud Language: For your protection California law requires the following to appear on this form: Any person who knowingly presents ralse or traudulent 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 THIS REPAIR ESTIMATE MAY SPECIFY THE USE OF QUALITY REPLACEMENT PARTS. QUALITY REPLACEMENT PARTS ARE PARTS NOT MANUFACTURED BY OR FOR THE ORIGINAL EQUIPMENT MANUFACTURER. YOUR INSURANCE

COMPANY WILL STAND BEHIND THE QUALITY REPLACEMENT PARTS SPECIFIED ON THIS ESTIMATE AND USED IN THE REPAIR OF YOUR VEHICLE, FOR AS LONG AS YOU OWN/LEASE THE VEHICLE. YOUR INSURANCE COMPANY

WARRANTS THESE PARTS ARE OF LIKE KIND, QUALITY, FIT AND PERFORMANCE TO PARTS MANUFACTURED BY OR FOR THE ORIGINAL EQUIPMENT MANUFACTURER.

THIS WARRANTY EXCLUSIVELY COVERS LOSS OR DAMAGE THAT IS RELATED TO DEFECTS IN THE QUALITY REPLACEMENT PART. THIS WARRANTY DOES NOT COVER DAMAGE OR PART FAILURE DUE TO IMPROPER

INSTALLATION, MISUSE, NEGLECT, ABUSE, IMPROPER MAINTENANCE, ABNORMAL OPERATION, OR NORMAL WEAR

SHOULD A SUPPLIER OF A PART SPECIFIED IN THE REPAIR ESTIMATE, OR THE REPAIR FACILITY THAT PERFORMS

THE REPAIR ON YOUR VEHICLE, BE UNABLE TO RESOLVE A LEGITIMATE COMPLAINT ABOUT THE QUALITY

REPLACEMENT PART USED IN THE REPAIR, YOUR INSURANCE COMPANY WILL MAKE EVERY EFFORT TO SEE THAT THE PROBLEM IS CORRECTED.

THIS QUALITY REPLACEMENT PARTS WARRANTY AND ANY REPRESENTATIONS MADE HEREIN ARE

NON-TRANSFERABLE AND EXTEND ONLY TO THE PARTY OWNING/LEASING THE VEHICLE AT THE TIME OF THE REPAIR. FOR ASSISTANCE, PLEASE CONTACT YOUR INSURANCE COMPANY'S NEAREST CLAIM DEPARTMENT:* OFFICE.

As the vehicle owner, the final choice as to which parts will actually be used in the repairs is yours. If you prefer:
parts other than those included on the estimate, you should notify your repair facility. Should the use of those other TO parts increase the repair cost, you will be expected to pay the difference. 1/7/2025 8:52:43 AM 114541 | 1.9.07.03270 Page 9

Page 13 of 51 ends

Claim #: 5034306369-1_A5056803
Workfile ID: 1d3d9eb7
Estimate of Record
2010 BMW 3 Series 328i RWD SULEV 4D SED 6-3.0L Gasoline MPI

ALTERNATE PARTS SUPPLIERS
Line Supplier Description Price
3 WheelerShip #ALY59582U20N $201.94
850 Washington Ave A/M Wheel, alloy style 159
Carlstadt NJ 07072 Quote: 3255870199
(551) 340-3350 Expires: 01/13/25
18 Empire Auto Dismantling #EM918 $125.00
Sales Number LKQ RT door assy +20%
8569 Beech Avenue Unit #C RT SIDE DOOR-RH BLUE COMPLETE, HAS DENT IN BOTTOM 2HRS,S#EM918 - (SDN), R.

Fontana CA 92335
(909) 357-9500
20 Benzeen Auto Parts Prp #22168P $175.00
Sales Number LKQ LT door assy +20%
3811 Recycle Road LT SIDE DOOR-LH, WHT,S#22168P - (SDN, CANADA MARKET), L.

Rancho Cordova CA 95742
(916) 273-9395
23 Empire Auto Dismantling #EM918 $200.001
Sales Number LKQ RT quarter panel +20%
8569 Beech Avenue Unit #C RT QTR PANEL-RH BLUE-INS QUALITY,S#EM918 - W/O FOLDING REAR SEATS; SDN, R.

Fontana CA 92335
(909) 357-9500
35 National Autobody Parts Whse - DFW #OGGS101002 $63.89 2000 E Main St A/M RT Ft upr cotl arm
Grand Prairie TX 75050 Quote: 250107-092921-003a7075
(972) 263-1111 Expires: 01/07/25
36 Allied Auto Salvage - Team Prp #242614B $165.00
Sales Number LKQ RT Knuckle sedan 328i +20%
1926 Spruce Street SPINDLE/KNUCKLE RR RT-NONE, S#242614B - (SDN, CANADA MARKET), R.

Riverside CA 92507
(951) 784-0057
37 Empire Auto Dismantling #EM918 $45.00
Sales Number LKQ RT Lower entrl arm +20%
8569 Beech Avenue Unit #C CONTROL ARM LOWER RR RT-LH SPRING ARM,S#EM918 - SPRING PERCH
Fontana CA 92335
(909) 357-9500
1/7/2025 8:52:43 AM 114541 | 1.9.07.03270 Page 10

Page 14 of 51 ends

FARMERS INSURANCE GROUP (F182) - Wed Jan 08 2025 14:36:36 PST (Yard - 97) TLE-360 Document Id cc5aa41a-f83f-4b0e-8b84-607fa86e6271 User Id GBCARRILLO
User Name Gabriel Carrillo
Address 12167 ARROW ROUTE RANCHO CUCAMONGA, CA 91739 USA Lot Number 87730245
Claim Number 5034306369-1-1
Year 2010
Make BMW
Model 328 I SULE
VIN Sticker
VEHICLE TYPE: PASSENGER CAR
BAYERISCHE MOTORENWERKE 09/09
1486 Ibs 2035 kg
RONT 2127 Ibs 965 kg REAR 2524 Ibs 1145 kg

IS VEHICLE CONFORMS TO ALL APPLICABLE US

FEDERAL MOTOR VEHICLE SAFETY, BUMPER AND THEFT

PREVENTION STANDARDS IN EFFECT ON THE DATE OF

MANUFACTURE SHOWN AROVE
CITY CLiNK 235MPY - 3 PM 2: 01 CITY OF RIALTO
License Plate /
Registration Sticker
Engine Compartment

Page 15 of 51 ends

Driver Entry
CITY CLERK RECEIVLO 2025 MAY - 8 PH 2: 01 CITY OF RIALTO Driver Front Floor Board
Keys / Key Fob

Page 16 of 51 ends

Oil Change Sticker
XCAS
OREa
2075 MAY - ? P 2: 01 CITY OF RIALTO
Is vehicle an SUV/Van? No
Odometer/Instrument
Cluster
6-
-140-
Driver Rear Floor Board

Page 17 of 51 ends

Cockpit View
CHIT CLLRK RECEIP: U 2215 MAY -3 P: 2: 01 CITY OF RIALTO Trunk/Cargo/Truck Bed
Passenger Side Front
Angle

Page 18 of 51 ends

Direct Front
CITY CLLRY RECEIVED 2025 MAY - 3 P 2: 01 CITY OF RIALTO Driver Side Front Angle
Is there Windshield
No
Damage?
Driver Front Tire

Page 19 of 51 ends

Driver Front Tire Tread
5/32
Depth Value
Driver Rear Tire
Cili CLEA RECEIVED 2 LAY - 3 PM 2: 01 CITY OF RIALTO
Driver Rear Tire Tread
5/32
Depth Value
Driver Side Rear Angle

Page 20 of 51 ends

Direct Rear
Passenger Side Rear
Angle
Passenger Rear Tire
CITY CLLRA RECEIVED 2025 MAY - 8 PM 2:01 CITY OF RIALTO Passenger Rear Tire 5/32
Tread Depth Value
Rear Seat from
Passenger Side

Page 21 of 51 ends

Passenger Rear Floor
Board
Passenger Front Floor
Board
CITY CALMA RECEIVED 2025 MAY - 3 PM 2: 01 CITY OF RIALTO Passenger Front Tire

Page 22 of 51 ends

Passenger Front Tire 5/32
Tread Depth Value
Roof
Is there Hail Damage? No
Prior damage? No
CITEYER 2025 MAY - 3 PH 2: 01 CITY OF RIALTO

Page 23 of 51 ends

Send all correspondence to:
2 Email: [email protected]
FARMERS Please include your claim# on any correspondence INSURANCE Farmers Insurance Total Loss COE
P.O. Box 108815
Oklahoma City, OK 73101-8815
January 13, 2025 Fax: (877) 217-1389
Gilbert Ortiz
9552 PRADERA AVE
Montclair CA 91763
RE: Claim Number: 5034306369-1-1
Loss Date: 11-29-2024
VIN:

Vehicle: 2010 BMW 328 I 4D SULEV
Loss Covered by: Collision
Dear Gilbert Ortiz:

Thank you for choosing us to provide for your insurance needs. I know being involved in a claim can be a difficult experience. I wanted to take a moment to thank you for allowing us to assist you with this process.

It is truly our pleasure to serve you.

Per our previous discussion, the damage to your vehicle has resulted in a total loss. I have issued the ettlement payment based on the Actual Cash Value. As I explained, the amount of the payment wa letermined as follow
Actual Cash Value: $8,114.00
Sales Tax: + $730.26
License / Transfer Fees: + $77.32
Less Deductible: - $1,000.00
Total Amount: $7,921.58
As your 2010 BMW 328 1 4D SULEV is a total loss, we urge you to contact your agent, if you have not already done so, to make further arrangements for your coverage needs. Please consult your policy for the exact terms and conditions of coverage.
much we value your relationship with us. We strive to provide the best possible customer experience. CITY OF As a valued customer, your comments and opinions are important to us. You may receive a text message of survey in your email. We would appreciate your time in letting us know how we did.

RIALTO
Thank you once again for your business.

I am committed to earning your satisfaction with the claims process. If you have any questions or concerns, please feel free to contact me at 405-782-6667.

Page 24 of 51 ends

Sincerely,
Cory Cannon
Claims Representative
Mid-Century Insurance Company
CITY CLEA RECEIVED 205 MAY -3 FN 2: 01 CITY OF RIALTO

Page 25 of 51 ends

COGSONE. MARKET VALUATION REPORT
Prepared for MID-CENTURY INSURANCE COMPANY

REPORT SUMMARY
The CCC ONE® Market Valuation
POT CLAIM INFORMATION Report reflects CCC Intelligent Solutions Inc's opinion as to the value of the loss
Owner Ortiz, Gilbert vehicle, based on information provided to CCC by MID-CENTURY INSURANCE

COMPANY
Loss Vehicle 2010 BMW 3 Series 328i RWD
SULEV Loss vehicle has 11% fewer than
average mileage of 137,200
Loss Incident Date 11/29/2024
Claim Reported 01/07/2025

INSURANCE INFORMATION
Report Reference Number 123220833
Claim Reference 5034306369-1_A5056803
Adjuster Cannon, Cory
Odometer 122,378
Last Updated 01/10/2025 11:43 AM

BASE VEHICLE VALUE
VALUATION SUMMARY This is derived per our Valuation
methodology described on the next
Base Vehicle Value $7,901.00 page.

Refurbishments + $ 213.00

ADJUSTED VEHICLE VALUE
Adjusted Vehicle Value $8,114.00
Vehicular Tax (9%) + $ 730.27 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 52 taxes. certain other reported attributes, any, 77
Title, Registration and Other Fees* + $ 77.32 such as refurbishments and after factory equipment.

Value before Deductible $ 8,921.59
Deductible* - $ 1,000.00
RIALTO
Total $ 7,921.59 Inside the Report
Valuation Methodology.. ...2
Adjustments indicated with an Asterisk (*) have been determined by MID-CENTURY INSURANCE COMPANY and have been added here for convenience. Vehicle Information. .3 Vehicle Condition... ..6
The total may not represent the total of the settlement as other factors (i.e. other Taxes and Fees..... ..8 applicable fees) may need to be taken into account. Comparable Vehicles... • 10
in the event additional fees are incurred please contact MID-CENTURY INSURANCE Valuation Note....... .. 13 COMPANY to determine if they qualify for reimbursement. Supplemental Informatio....... ....14 © Copyright 2021 CCC Intelligent Solutions Inc. All Rights Reserved. Page 1 of 22

Page 26 of 51 ends

COEONE MARKET VALUATION REPORT Claim: 5034306369-1_A5056803

VALUATION METHODOLOGY
How was the valuation determined?

CLAIM INSPECTION
MID-CENTURY INSURANCE COMPANY has provided CCC with the zip code where the loss vehicle is garaged, loss vehicle VIN, mileage, equipment, as well as loss vehicle condition, which is 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 CITY OU RECEI
Adjustments to the price of the selected comparable vehicles are made to reflect 2075 MAY -S PI 2: 01 CITY OF RIALTO 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 22

Page 27 of 51 ends

Owner: Ortiz, Gilbert
COGSONE MARKET VALUATION REPORT Claim: 5034306369-1_A5056803

VEHICLE INFORMATION

VEHICLE DETAILS
Vehicles sold in the United States
Location MONTCLAIR, CA 91763-0000 are required to have a manufacturer assigned Vehicle Identification
VIN Number(VIN). This number provides
Year 2010 certain specifications of the vehicle.

Make BMW Please review the information in the
Model 3 Series Vehicle Information Section to confirm
328i the reported mileage and to verify that
Trim
the information accurately reflects the
Body Style RWD SULEV options, additional equipment or other Body Type Sedan aspects of the loss vehicle that may
impact the value.

Engine -
Cylinders 6
Displacement 3.OL
Fuel Type Gasoline
Carburation MPI
Transmission Automatic Transmission Overdrive
Curb Weight 3362 Ibs
CITY CLERA RECENTO 2925 MAY - B PM 2:01 CITY OF RIALTO
© Copyright 2021 CCC Intelligent Solutions Inc. All Rights Reserved Page 3 of 22

Page 28 of 51 ends

COGSONE MARKET VALUATION REPORT Owner: Ortiz, Gilbert
Claim: 5034306369-1_A5056803

VEHICLE INFORMATION

VEHICLE EQUIPMENT
To the left is the equipment of the
Package 1: Premium loss vehicle that MID-CENTURY
INSURANCE COMPANY provided to
Odometer 122,378 CCC.

Transmission Automatic Transmission / Standard This equipment is Overdrive included in the base configuration of
the vehicle at time of purchase.

Power Power Steering
Power Brakes V • Additional Equipment that is not
Standard but was noted to be on the
Power Windows loss vehicle.

Power Locks
Power Mirrors
Power Driver Seat V
Power Passenger Seat
Power Trunk/Liftgate
Decor/Convenience Air Conditioning
Climate Control
Tilt Wheel
Cruise Control
Rear Defogger
Intermittent Wipers
Console/Storage
Memory Package V
Keyless Entry
Telescopic Wheel
Message Center
Home Link
Wood Interior Trim
Seating Bucket Seats
Leather Seats CITY CLERA
RECEIVED 2025 MAY - 8 PM 2: 01 CITY OF RIALTO
Radio AM Radio
FM Radio
Stereo
Search/Seek
CD Player
@ Copyright 2021 CCC Intelligent Solutions Inc. All Rights Reserved Page 4 of 22

Page 29 of 51 ends

COOSONE MARKET VALUATION REPORT
Claim: 5034306369-1_A5056803
@ VEHICLE INFORMATION

VEHICLE EQUIPMENT
Steering Wheel Touch Controls
Auxiliary Audio Connection
Wheels Aluminum/Alloy Wheels
Roof Electric Glass Roof
Safety/Brakes Air Bag (Driver Only)
Passenger Air Bag
Anti-lock Brakes (4)
4-wheel Disc Brakes
Front Side Impact Air Bags
Head/Curtain Air Bags
Communications System
Hands Free
Traction Control
Stability Control
Exterior/Paint/Glass Dual Mirrors
Heated Mirrors
Aftermarket Film Tint
Fog Lamps
Clearcoat Paint
CITY CLERA RECEITED 2075 MAY -S PM 2: 01 CITY OF RIALTO © Copyright 2021 CCC Intelligent Solutions Inc. All Rights Reserved Page 5 of 22

Page 30 of 51 ends

COCONE MARKET VALUATION REPORT Owner: Ortiz, Gilbert
Claim: 5034306369-1_A5056803

VEHICLE CONDITION/REFURBISHMENTS

COMPONENT CONDITION

MID-CENTURY INSURANCE
Condition Value Impact COMPANY uses condition inspection Descripin NotesTypical Vehicle guidelines to rate the condition of key components of the loss vehicle on a
INTERIOR three-point scale. A rating of average
Seats AVERAGE Notes: Light wear. No significant tears condition results in a valuation of that or holes. component that is consistent with typical
Typical Vehicle Desc: vehicles for that year, make and model Lightly soiled to clean, faded and/or of vehicle. If a component is rated in discolored. A few small to insignificant exceptional condition, then a positive tears, holes and/or burn marks. None or monetary adjustment is made to reflect the impact of that condition level on the
no significant bare spots. value of the loss vehicle. Similarly, it a Carpets AVERAGE Notes: Light soiling. No bare spots. $0 component is rated in below average Typical Vehicle Desc: condition, then a negative monetary Lightly soiled to clean and/or stained. A adjustment is made to reflect the impact few small to no tears, holes and/ or burn of that condition level on the value of the marks. No significant bare spots. ioss vehicle. Inspection Notes, if any, reflect additional observations from the
Dashboard AVERAGE Notes: Minor wear. No significant $0 appraiser regarding the loss vehicle's cracks. condition. Monetary adjustments are
Typical Vehicle Desc: based upon market research consisting Significant to a few small scratches of data gathered from dealerships in and/or gouges. Components may be California.
damaged and/or cracked. Significant to CCC makes dollar adjustments that light wear. reflect the impact the reported condition
Notes: No significant tears or holes. $0 has on the value of the loss vehicle as Headliner AVERAGE compared to Average condition. These
Typical Vehicle Desc: dollar adjustments are based upon A few small to no significant holes and/ interviews with dealerships across the or burn marks. Light to no significant United States.
scuffing.

MID-CENTURY INSURANCE
EXTERIOR COMPANY also identifies the after
Sheet Metal AVERAGE Notes: Minor dents/dings. No rust. $0 factory options and upkeep dollars Typical Vehicle Desc: invested into the loss vehicle that were A few to no dents. Numerous to a few brought to its attention. CCC makes dings. No significant surface rust. dollar adjustments that reflect the impact, if any, these items have of the
Trim AVERAGE Notes: Some scuffs on wheels and trim. $0 value of the vehicle. The total of these o No missing trim. adjustments is shown-in the Valuation → Typical Vehicle Desc: Summary as Refurbishments
Minimal to no damage to components.

No broken and/or missing components.

Few to no dents. Numerous to a few
dings. 2:01 RIALTO
© Copyright 2021 CCC Intelligent Solutions Inc. All Rights Reserved. Page 6 of 22

Page 31 of 51 ends

COOSONE MARKET VALUATION REPORT 1 Claim: 034, Gilbert, Claim: 5034306369-1_A5056803

VEHICLE CONDITION/REFURBISHMENTS

COMPONENT CONDITION
Condition Inspection Notes/Typical Vehicle Value Impact Description
Paint AVERAGE $0
Glass AVERAGE Notes: Normal for age. No cracks. $0
Typical Vehicle Desc
Light surface scratches and/or pitting.

Few to no chips.

MECHANICAL
Engine AVERAGE Notes: Minimal dirt and grease in $0
engine compartment.

Typical Vehicle Desc:

Few small leaks to minor seepage.

Belts and hoses show minimal wear.

Significant to minimal dirt and grease in
engine compartment.

Transmission AVERAGE Notes: Inaccessible. $0
Typical Vehicle Desc:

Fluid slightly discolored. None to a few
areas of seepage.

TIRES
Front Tires AVERAGE Notes: Remaining tread appears to be in the normal range.

Typical Vehicle Desc:
41% to 90% of new. Example: Typical
new car tires are 11/32, loss measures
at 5/32 = 46% (5/11)
Rear Tires AVERAGE Notes: Remaining tread appears to be in the normal range.

Typical Vehicle Desc:
41% to 90% of new. Example: Typical
new car tires are 11/32, loss measures CITY CLERA RECEIVED 2075 MAY -3 PM 2:01 CITY OF RIALTO at 5/32 = 46% (5/11)
Maintenance Purchase Price : $ 1,149.00 $213
Item
Total Condition Adjustments $0
@ Copyright 2021 CCC Intelligent Solutions Inc. All Rights Reserved. Page 7 of 22

Page 32 of 51 ends

COGSONE MARKET VALUATION REPORT
Claim: 5034306369-1_A5056803

TITLE, REGISTRATION AND OTHER FEES
VEHICLE FEES Fees listed have been identified to
be applicable for reimbursement by
Zip: 91763 the MID-CENTURY INSURANCE
COMPANY based on information
Zip+4: 0000 rovided by MID-CENTUR
INSURANCE COMPANY. Fees ma
Registration Expires: 01/02/2025 include title, registration, license plate transfer and other related state
Plates are: Non-Transferable
Salvage retained by: Insurance Carrier
Fees are determined by vehicle
Plate Type: Standard attributes, provided by the Insurance company, including, but not limited to,
Plate Numbering: Standard vehicle type, size, weight, primary usage, vehicle salvaged, or owner retained.

Third Party Vehicle: No
Reference links are provided for
Vehicle License Fee Paid: $ 3.50 informational purposes only. The links and content contained in the links are not
Title Fees produced, maintained or affiliated with
$ 15.00 CCC, and CCC bears no responsibility
Title Transfer Fee - (Additional Reference 1) for the content provided therein.

Registration Fees
Vehicle License Fee $ 3.50
California Highway Patrol Fee $5.33
Transportation Improvement Fee - (Additional Reference 1) $ 10.83 Registration Fee - (Additional Reference 1) $ 11.83
Plate Fees
Replacement/Substitute Plate Fee - (Additional Reference 1) $27.00 Additional Fees
Fingerprint ID Fee - (Additional Reference 1) $ 0.33
Air Quality Fee - (Additional Reference 1) - (Additional Reference 2) $ 1.17 2025 MAY - 3 Auto Theft/DUl Deterrent Fee - (Additional Reference 1) $ 0.33 CITY OF RIALTO EIVED
Alternative Fuel/Technology Smog Fee - (Additional Reference 1) - $ 1.33 (Additional Reference 2) PM 2:01
Service Authority for Freeway Fee - (Additional Reference 1) $0.17 Alternative Fuel/Technology Registration - (Additional Reference 1) - $ 0.50 (Additional Reference 2)
@ Copyright 2021 CCC Intelligent Solutions Inc. All Rights Reserved. Page 8 of 22

Page 33 of 51 ends

CCOSONE MARKET VALUATION REPORT Owner: Ortiz, Gilbert
Claim: 5034306369-1_A5056803

TITLE, REGISTRATION AND OTHER FEES

VEHICLE FEES
Total Title, Registration and Other Fees $ 77
CITY CLEAR RECEITED 2025 МАУ - З РМ 2: 01 CITY OF RIALTO © Copyright 2021 CCC Intelligent Solutions Inc. All Rights Reserved. Page 9 of 22

Page 34 of 51 ends

COSONE MARKET VALUATION REPORT | Owner: Ortiz, Gilbert
Claim: 5034306369-1_A5056803

COMPARABLE VEHICLES
Options Loss Comp 1 Comp 2
Vehicle Comp 1 Updated Date: 12/29/2024
2010 Bmw 3 Series 328i Rwd Sulev
(south Africa) 6 3.01 Gasoline Mpi
Premium
102,396 140,964 VIN
Odometer 122,378 Dealership Ochoa Auto Sales
Automatic Transmission Telephone (323) 263-2448
Overdrive Source Autotrader
Power Steering Distance from Montclair, CA
Power Brakes 28 Miles - Los Angeles, CA
comp 2 Updated Date: 12/23/2024
Power Windows
2010 Bmw 3 Series 328i Rwd Sulev
Power Locks (south Africa) 6 3.01 Gasoline Mpi
Power Mirrors VIN
Power Driver Seat Dealership Delsol Auto Sales
Power Passenger Seat Telephone (310) 955-6032
Source Dealer Ad
Power Trunk/Liftgate
Distance from Montclair, CA
Air Conditioning 37 Miles - Wilmington, CA
Climate Control
Tilt Wheel Comparable vehicles used in the
determination of the Base Vehicle Value
Cruise Control
are not intended to be replacement
Rear Defogger vehicles but are reflective of the market Intermittent Wipers value, and may no longer be available Console/Storage for sale.

Memory Package List Price is the sticker price of an
Navigation System inspected dealer vehicle and the
Keyless Entry advertised price for the advertised
Telescopic Wheel vehicle.

Message Center Distance is based upon a straight line
Home Link between loss and comparable vehicle
Wood Interior Trim locations.

Bucket Seats
Leather Seats
Heated Seats
AM Radio
FM Radio CITY CLIMA RECEIVED 2025 MAY -8 PM 2: 01 CITY OF RIALTO Stereo
Search/Seek
CD Player
Steering Wheel Touch Controls
Auxiliary Audio Connection
Premium Radio
Satellite Radio x
Aluminum/Alloy Wheels
Electric Glass Roof
© Copyright 2021 CCC Intelligent Solutions Inc. All Rights Reserved. Page 10 of 22

Page 35 of 51 ends

COEONE MARKET VALUATION REPORT Owner: Ortiz, Gilbert
Claim: 5034306369-1_A5056803

COMPARABLE VEHICLES
Options Loss Comp 1 Comp 2
Vehicle
Drivers Side Air Bag
Passenger Air Bag
Anti-lock Brakes (4)
4-wheel Disc Brakes
Front Side Impact Air Bags
Head/Curtain Air Bags V
Parking Sensors x
Communications System
Hands Free
Xenon Or L.E.D. Headlamps
Alarm
Traction Control
Stability Control
Dual Mirrors
Heated Mirrors
Tinted Glass
Aftermarket Film Tint
Fog Lamps
Clearcoat Paint
List Price $ 7,990 $ 7,500
Adjustments:

Package + $ 260 + $ 260
Options +$ 96 - $ 447
Mileage - $ 399 + $ 541
Adjusted Comparable Value $ 7,947 $ 7,854
CITY CLERE. RECRIVED 2025 MAY -3 PM 2: 02 CITY OF RIALTO © Copyright 2021 CCC Intelligent Solutions Inc. All Rights Reserved. Page 11 of 22

Page 36 of 51 ends

COCSONE MARKET VALUATION REPORT Owner: Ortiz, Gilbert
Claim: 5034306369-1_A5056803
› COMPARABLE VEHICLES
® COMPARABLE VEHICLE SUMMARY The following comparable vehicles) vere used to determine this Bast
Source Comparable Vehicle Price Adjusted Comp Vehicle Value by computing the Value arithmetic average of the adjusted
$7,947 values of the comparable vehicles.
1 Dealer Vehicle 2010 Bmw 3 Series 328i $ 7,990
Details on these comparable vehicles
Rwd Sulev (south Africa) (List) are in the Comparable Vehicles section. 6 3.01 Gasoline Mpi
2 Dealer Vehicle 2010 Bmw 3 Series 328i $ 7,500 $ 7,854 Rwd Sulev (south Africa) (List)
6 3.01 Gasoline Mpi
Base Vehicle Value $ 7,901.00
CITY CLERA RECEIVED 2025 MAY - B PH 2:02 CITY OF RIALTO © Copyright 2021 CCC Intelligent Solutions Inc. All Rights Reserved.

Page 37 of 51 ends

Owner: Ortiz, Gilbert
COGEONE MARKET VALUATION REPORT Claim: 5034306369-1_A5056803

VALUATION NOTES
01/10/2025 11:43 - POADJ CHANGE REQUESTED BY: CANNON, CORY Regulations concerning vehicle value
01/10/2025 11:43 - Refurbishments changed after request Disposed include California Code of Regulations 01/10/2025 11:43 - Refurbishment Maintenance Item Changed: Purchase Price Old: NIL 10 CA ADC 2695.

Purchase Price New: $1,149.00 Mileage Old: NIL Mileage New: 0 Date Old: NIL Date Any person who knowingly presents a
New: 11/01/2024 Type Old: NIL Type New: Standard false or fraudulent insurance claim for 01/10/2025 11:43 - Pre/Post Tax data modified after Valuation the payment of a loss may be guilty of a crime and may be subject to fines and
This Market Valuation Report has been prepared exclusively for use by MID-CENTURY confinement in state prison INSURANCE COMPANY, 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.

Page 38 of 51 ends

COO-ONE MARKET VALUATION REPORT Claim: 5034306369-1_A5056803

SUPPLEMENTAL INFORMATION

BO VEHICLE HISTORY INFORMATION
VINguard®
VINguard® Message: VINguard has decoded this VIN without any errors ISO Vehicle History:

Number of times reported to ISO: 3
ISO's file number: H0382131025
Loss date: 11/29/2024
Phone: 7084305685
Claim ref:

Mileage:

Loss date: 11/29/2024
Phone: 8004357764
Claim ref: 50343063691
Mileage:

Loss date: 05/21/2019
Phone: 7148852621
Claim ref: 013777293
Mileage:

Vehicle Market History Information:

This vehicle was reported to CCC on 08/19/2024 Mileage: 116290 Location: in RIVERSIDE, CA
CITY CLERA 2025 MAY - 3 PM 2: 02 CITY OF RIALTO
© Copyright 2021 CCC Intelligent Solutions Inc. All Rights Reserved Page 14 of 22

Page 39 of 51 ends

COOSONE MARKET VALUATION REPORT | Owner: Ortiz, Gilbert Claim: 5034306369-1_A5056803

SUPPLEMENTAL INFORMATION
CCC provides MID-CENTURY
EXPERIAN® AUTOCHECK® VEHICLE HISTORY REPORT INSURANCE COMPANY information reported by Experian regarding the 2010
TITLE CHECK RESULTS FOUND BMW 3 Series
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 upon this information.

Grey Market No Grey Market Record Found
Hail Damage No Hail Damage Record Found LEGEND:
/ No Event Found
Insurance Loss No Insurance Loss Record Found
© Event Found
Junk No Junk Record Found
• Information Needed
Rebuilt No Rebuilt Record Found

TITLE CHECK
Salvage No Salvage Record Found

THIS VEHICLE CHECKS OUT
EVENT CHECK RESULTS FOUND lutoCheck's result for this loss vehicl how no significant title events. Wher
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 No Salvage Auction Record Found
problems can indicate past previous
car damage, theft, or other significant

VEHICLE INFORMATION RESULTS FOUND
problems.

Accident No Accident Record Found

VEHICLE INFORMATION
Corrected Title Corrected Title Record Found INFORMATION FOUND Driver Education No Driver Education Record Found AutoCheck found additional information Fire Damage Incident No Fire Damage Incident Record Found on this vehicle. These records will provide Lease No Lease Record Found more history for this loss vehicle Lien No Lien Record Found ODOMETER CHECK
Livery Use No Livery Use Record Found THIS VEHICLE CHECKS OUT Government Use No Government Use Record Found AutoCheck's result for this loss vehicle show no indication of odometer rollback
Police Use No Police Use Record Found or tampering was found. AutoCheck Fleet No Fleet Record Found determines odometer polbacks by 3 Rental No Rental Record Found searching for records trat indicate odometer readings lass than a previously
Fleet and/or Rental No Fleet and/or Rental Record Found reported value. Otherddometervents"
Repossessed No Repossessed Record Found can report events of tampering, or possible Taxi use No Taxi use Record Found odometer breakage?*
Theft No Theft Record Found
Fleet and/or Lease No Fleet and/or Lease Record Found
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 15 of 22

Page 40 of 51 ends

COSONE MARKET VALUATION REPORT | Owner Oriz, Gilbert
Claim: 5034306369-1_A5056803

SUPPLEMENTAL INFORMATION
BE FULL HISTORY REPORT RUN DATE: 01/10/2025
Below are the historical events for this vehicle listed in chronological order.

EVENT RESULTS ODOMETER DATA EVENT

DATE FOUND READING SOURCE DETAIL
12/30/2009 CA 15 Motor Vehicle Dept. Odometer Reading from DMV
01/11/2010 SAN DIEGO, CA Motor Vehicle Dept. Registration Event/ Renewal
01/20/2010 SAN DIEGO, CA Motor Vehicle Dept. Title (Lien Reported) 10/13/2010 SAN DIEGO, CA Motor Vehicle Dept. Registration Event/ Renewal
10/19/2010 SAN DIEGO, CA Motor Vehicle Dept. Registration Event/ Renewal
11/04/2010 SAN DIEGO, CA Motor Vehicle Dept. Registration Event/ Renewal
06/12/2012 SAN DIEGO, CA Motor Vehicle Dept. Registration Event/ Renewal
06/24/2012 SAN DIEGO, CA Motor Vehicle Dept. Title
10/09/2012 SAN DIEGO, CA Motor Vehicle Dept. Registration Event/ Renewal
10/26/2012 CA 46473 Motor Vehicle Dept. Odometer Reading from DMV
10/26/2012 SAN DIEGO, CA Motor Vehicle Dept. Registration Event/ Renewal
11/09/2012 SAN DIEGO, CA Motor Vehicle Dept. Title
11/18/2015 CA 66542 Motor Vehicle Dept. Passed Emission Inspection
12/21/2016 SAN DIEGO, CA 71294 Service Record Vehicle Interior Serviced 12/21/2016 SAN DIEGO, CA Service Record Multiple Point Vehicle Inspection
12/21/2016 SAN DIEGO, CA Service Record Electrical System Serviced 12/21/2016 SAN DIEGO, CA Service Record Lights or Signals Serviced 12/21/2016 SAN DIEGO, CA Service Record Tires or Wheels Service Performed
12/22/2017 CA 76161 Motor Vehicle Dept. Passed Emission Inspection
11/02/2019 CA 86802 Motor Vehicle Dept. Passed Emission Inspection 223
08/19/2021 ESCONDIDO, CA Motor Vehicle Dept. Registration Event/ HAY -3 Renewal
Motor Vehicle Dept. Registration Event/ CITY OF RIALTO
10/13/2021 ESCONDIDO, CA
Renewal r1i 2:
11/06/2021 CA 100684 Motor Vehicle Dept. Passed Emission Inspection
© Copyright 2021 CCC Intelligent Solutions Inc. All Rights Reserved. Page 16 of 22

Page 41 of 51 ends

COOSONE MARKET VALUATION REPORT Owner: Ortiz, Gilbert
Claim: 5034306369-1_A5056803

SUPPLEMENTAL INFORMATION

EVENT RESULTS ODOMETER DATA EVENT

DATE FOUND READING SOURCE DETAIL
03/02/2022 Manufacturer Manufacturer Recall
02/07/2023 ESCONDIDO, CA Motor Vehicle Dept. Title (Lien Reported) 02/07/2023 ESCONDIDO, CA Motor Vehicle Dept. Corrected Title (Lien Reported)
02/07/2023 ESCONDIDO, CA Motor Vehicle Dept. Registration Event/ Renewal
12/12/2023 CA 114767 Motor Vehicle Dept. Passed Emission Inspection
03/22/2024 PACIFIC SW 116290 Auto Auction Reported at Auto Auction

REGION,
03/25/2024 CA 116290 Auto Auction Reported at Auto Auction as Manufacturer Vehicle
03/29/2024 CA 116325 Motor Vehicle Dept. Passed Emission Inspection
07/03/2024 Manufacturer Manufacturer Recall
09/13/2024 MONTCLAIR, CA Motor Vehicle Dept. Title
09/13/2024 MONTCLAIR, CA Motor Vehicle Dept. Registration Event/ Renewal
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.

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 for any delay or failure to provide an accurate report if and to the extent which such delay or failure is caused by events beyond the reasonable control of Experian, including, without limitation, "acts of God", terrorism, or public enemies, labor disputes, equipment malfunctions, material or component shortages, supplier failures, embargoes, rationing, acts of local, state or national governments, or public agencies, utility or communication failures or delays, fire, earthquakes, flood, epidemics, riots and strikes.

Those forms end tie rolationtil simen you and Expia sal te overedy the an of the sites li 4s1, withou regard to is confide lay prime fay and Experian agree to submit to the personal and exclusive jurisdiction of the courts located within the county of Cook, linois.

Page 42 of 51 ends

| Owner: Ortiz, Gilbert
COGSONE MARKET VALUATION REPORT Claim: 5034306369-1_A5056803

SUPPLEMENTAL INFORMATION
The National Highway Traffic Safety
NHTSA VEHICLE RECALL Administration has issued 10 safety related recall notices that may apply to the
above valued vehicle.

NHTSA Campaign ID: 13V044000
Mfg's Report Date: FEB 07, 2013
Component : ELECTRICAL SYSTEM
Potential Number Of Units Affected : 504,545
Summary: BMW is recalling certain model year 2008-2012 1-Series coupes and convertibles manufactured December 2007 through July 2011; and 2007-2011 3-Series coupes and convertibles manufactured March 2007 through July 2011; 2007-2011 3- Series sedans manufactured March 2007 through October 2011; 2007-2011 3-Series sports wagons manufactured March 2007 through June 2011; and 2009-2011 Z4 vehicles manufactured March 2009 through June 2011. The connector for the positive battery cable connector and the corresponding terminal on the fuse box may degrade over time. Over time, the high current flow and heat from electrical resistance may lead to a breakage of the connection, and a loss of electrical power to the vehicle.

Consequence: If there is a loss of electrical power to the vehicle, the vehicle may unexpectedly stall, increasing the risk of a crash.

Remedy: BMW will notify owners, and dealers will replace the positive battery cable connector and secure it with an improved method, free of charge. The recall began on March 13, 2013. Owners may call BMW at 1-800-525-7417 or email BMW at [email protected].

Notes: Owners may also contact the National Highway Traffic Safety Administration Vehicle Safety Hotline at 1-888-327-4236 (TTY 1-800-424-9153), or go to www.safercar.gov
NHTSA Campaign ID: 14V176000
Mfg's Report Date : APR 10, 2014
Potential Number Of Units Affected : 156,137
Summary : BMW of North America, LLC (BMW) is recalling certain model year 2010-2011 128i Coupe, 128i Convertible, 328i Sedan, 328i Drive Sedan, 328i Coupe, 328i Convertible, 328i Sports Wagon and Z4 sDrive 30i, 2011-2012 135i Coupe, 135i Convertible, 335i Sedan, X5 Drive 35i, and X6 Drive 35i, 2011 335i xDrive Sedan, 335i Coupe, 335i Convertible, 528i Sedan, 535i Sedan, 535i Drive Sedan, X3 Drive 28i, and X3 xDrive 35i, 2010 X3 xDrive 30i, and X5 Drive 30i, 2012 640i Coupe, and 640i Convertible and 2010-2012 535i Gran Turismo vehicles. In the affected vehicles, the bolts that secure the housing for the variable camshaft timing adjustment (VANOS) unit can 2025 MAY - 8 oosen over time and may possibly break.

Consequence: If the bolts loosen or break the engine may have reduced power or stall. CITY OF RIALTO An engine stall increases the risk of a crash.

Page 43 of 51 ends

OCO-ONE MARKET VALUATION REPORT Claim: 5034306369-1_A5056803

SUPPLEMENTAL INFORMATION
Remedy: BMW will notify owners, and dealers will replace the four VANOS housing bolts for both VANOS units (intake and exhaust), free of charge. The recall is expected to begin in May 2014. In addition, owners of approximately 170,172 model year 2010-2012 3MW vehicles equipped with inline 6 cylinder engines not covered by this recall, wil eceive an extended warranty to address this condition. Owners may contact BMW al 1-800-525-7417.

Notes : Owners may also contact the National Highway Traffic Safety Administration Vehicle Safety Hotline at 1-888-327-4236 (TTY 1-800-424-9153), or go to www.safercar.gov.

NTSA Campaign ID : 16V071000
Mfg's Report Date : FEB 05, 2016
Component : AIR BAGS
Potential Number Of Units Affected : 840,000
Summary : BMW of North America, LLC (BMW) is recalling certain model year 2008-2013 128i and 135i coupes and convertibles and 1 Series M coupes, 2006-2011 325i, 325xi, 328i, 328xi, 328i Drive, 330i, 330xi, 335i, 335xi, 335i Drive Sedans, 2009-2011 335d sedans, 2006-2012 325xiT, 328i and 328xi sports wagons, 2007-2013 328i, 328xi, 328i Drive, 335i, 335xi, 335i Drive, 335is and M3 Coupes and Convertibles, 2013-2015 X1 sDrive28i, X1 xDrive28i and X1 xDrive35i SAVs, 2007-2010 X3 xDrive30i SAVs, 2007-2013 X5 xDrive30i, X5 xDrive35i, X5 xDrive48i, X5 xDrive50i and X5 M SAVs, 2009-2013 BMW X5 xDrive35d SAVs, 2008-2014 X6 xDrive35i, X6 xDrive50i, and X6 M SACs, 2010-2011 BMW X6 xDrive50i SACs and 2008-2011 M3 Sedan vehicles.

Upon deployment of the driver's frontal air bag, excessive internal pressure may cause the inflator to rupture.

Consequence : In the event of a crash necessitating deployment of the driver's frontal air bag, the inflator could rupture with metal fragments striking the driver or other occupants resulting in serious injury or death.

Remedy: BMW will notify owners, and dealers will replace the driver's frontal air bag module or inflator depending on the vehicle model, free of charge. Parts are not currently available. Owners will be mailed an interim notification beginning March 31, 2016. A second notice will be mailed when remedy parts are available. Owners may contact BMW customer service at 1-800-525-7417.

NHTSA Campaign ID : 17V683000
Mfg's Report Date : October 30, 2017
Component : ENGINE AND ENGINE COOLING
Potential Number Of Units Affected : 740,561
2025 MAY -3 PM 2:

Summary : BMW of North America, LLC (BMW) is recalling certain 2008-2011 128i and CITY OF RIALTO 2007-2011 328i, 328xi, 328i Drive, 525i, 525xi, 528i, 528xi, 530i, 530xi, X3 3.0si, X3 xDrive30i, X5 xDrive30i, Z4 3.0i, Z4 3.Osi and Z4 sDrive30i vehicles. The heater for the positive crankcase ventilation (PCV) valve may short circuit. © Copyright 2021 CCC Intelligent Solutions Inc. All Rights Reserved. Page 19 of 22

Page 44 of 51 ends

COGSONE MARKET VALUATION REPORT | Owner Ortiz, Gilbert
Claim: 5034306369-1_A5056803

SUPPLEMENTAL INFORMATION
Consequence : An electrical short can cause the parts within the PCV valve to melt, increasing the risk of a fire, even when the vehicle is not in use Remedy: BMW will notify owners, and dealers will replace the PCV valve heater, free of charge. The recall is expected to begin December 18, 2017. Owners may contact BMW customer service at 1-800-525-7417.

NHTSA Campaign ID: 17V676000
Mfg's Report Date : October 25, 2017
Potential Number Of Units Affected : 672,775
Summary : BMW of North America, LLC (BMW) is recalling certain 2006-2011 323i, 325i, 325xi, 328i, 328xi, 330i, 330xi, 335i, 335xi and M3, 2007-2011 328i Drive, 335i Drive and 335is and 2009-2011 335d vehicles. The wiring and electrical connectors for the system that controls air flow for the heating and air conditioning system may overheat.

Consequence: Wiring that overheats could cause the electrical connectors to melt, and increase the risk of a fire, even when the vehicle is unattended.

Remedy: BMW will notify owners, and dealers will replace the wiring and electrical connectors, free of charge. The recall is expected to begin December 18, 2017. Owners may contact BMW customer service at 1-800-525-7417.

NHTSA Campaign ID : 20V017000
Mfg's Report Date : January 15, 2020
Potential Number Of Units Affected : 59,965
Summary : BMW of North America, LLC (BMW) is recalling certain 2008-2013 128i and 135i Convertibles, 128i, 135i, and M Coupes, 2007-2010 X3 30si and X3 xDrive30i, 2013-2015 X1 sDrive28i, X1 xDrive28i and X1 xDrive35i, 2007-2013 328i, 328i xDrive, 335i, 335is, 335i Drive and M3 Coupes, 2006-2011 328i, 328xi, 328i Drive, 325i, 325xi, 330i, 330xi, 335i, 335xi, 335i Drive and M3, 2009-2011 335D, 2006-2012 325xi, 328i, 328xi and 328i Drive, 2010-2011 X6 ActiveHybrid, 2007-2013 328i, 335i, 335is, M3 Coupes, X5 30si, X5 xDrive30i, X5 xDrive35i, X5 48i, X5 xDrive48i, X5 xDrive50i and X5 M, 2009-2013 X5 xDrive35d and 2008-2014 X6 xDrive35i, X6 xDrive50i and X6M vehicles equipped with non-desiccated driver frontal air bag inflators containing phase stabilized ammonium nitrate (PSAN) that were used as interim remedy parts for previous Takata recalls. These inflators may explode due to propellant degradation occurring after long- term exposure to high absolute humidity, high temperatures, and high te...

Consequence: An inflator explosion may result in sharp metal fragments striking the driver or other occupants resulting in serious injury or death. 2025 MAY - 8 - D:

Remedy: BMW will notify owners, and dealers will replace the driver air bag. On X5 and X6 vehicles, only the inflator will be replaced. All repairs will be performed free of charge. CITY OF RIALTO The recall is expected to begin March 6, 2020. Owners may contact BMW customer service at 1-800-525-7417.

Page 45 of 51 ends

COSONE MARKET VALUATION REPORT Claim: 5034306369-1_A5056803

SUPPLEMENTAL INFORMATION
NHTSA Campaign ID : 22V119000
Mfg's Report Date: March 2, 2022
Potential Number Of Units Affected: 917,106
Summary: BMW of North America, LLC (BMW) is recalling certain 2008-2013 1 Series Coupe (128i); 2007-2013 3 Series Coupe (328i, 328xi, 328i xDrive); 2007-2010 X3 SAV (X3 3.Osi, X3 xDrive30i); 2008-2013 1 Series Convertible (128i); 2006-2011 3 Series Sedan (325i, 325xi, 328i, 328xi, 328i Drive, 330i, 330xi); 2006-2012 3 Series Wagon (328i, 328i Drive); 2007-2013 3 Series Convertible (328i); 2006-2010 5 Series Sedan (525i, 525xi, 528i, 528xi, 530i, 530xi); 2006-2007 5 Series Wagon (530xi); 2007-2010 X5 SAV (X5 3.0si, X5 xDrive30i); 2006-2008 Z4 Coupe (Z4 3.0si); and 2006-2011 Z4 Roadster (Z4 3.0i, Z4 3.0si, Z4 sDrive30i) vehicles. The heater for the positive crankcase ventilation (PCV) valve may short circuit.

Consequence: An electrical short can cause the PCV valve heater to overheat, increasing the risk of a fire while driving or, soon after driving when parked.

Remedy : This recall supersedes and expands previous NHTSA recalls 17V-683 and 19V-273. Vehicles previously repaired under the prior recalls will need to come back for the new recall remedy. The remedy is currently being developed. Owner notification letters are expected to be mailed April 25, 2022. Owners may contact BMW customer service at 1-800-525-7417.

Notes: Owners may also contact the National Highway Traffic Safety Administration Vehicle Safety Hotline at 1-888-327-4236 (TTY 1-800-424-9153), or go to www.nhtsa.gov.

NHTSA Campaign ID: 12E029000
Mfg's Report Date : AUG 09, 2012
Component : ENGINE AND ENGINE COOLING:COOLING SYSTEM:FAN Potential Number Of Units Affected : 585
Summary: Valeo is recalling certain engine cooling fans, part numbers 696121, 696273, and 696275, used as service replacement parts for model year 2008-2011 BMW 1-Series, 2006-2011 BMW 3-Series, 2000-2009 BMW 5-Series, 2004-2005 BMW 6-Series, and 2006-2007 BMW 7-Series vehicles. A metal-oxide semiconductor may overheat due to insufficient screwing of the semiconductor on the aluminum heat sink. This primary failure could cause adjacent components on the fan assembly motor circuit board to overheat and short.

Consequence: This condition could cause the fan motor to become inoperative, or cause the motor circuit board in the assembly to overheat, potentially leading to a fire in the Cx:
engine compartment. - 7T
Remedy: Valeo will notify owners and replace the fans free of charge. The safety recall is expected to begin during August 2012. This recall is being conducted by Valeo, not by CITY OF RIALTO BMW. For further information, owners may contact Valeo at 1-888-718-2536. PH 02 NHTSA Campaign ID: 23V707000
Mfg's Report Date : October 20, 2023
© Copyright 2021 CCC Intelligent Solutions Inc. All Rights Reserved. Page 21 of 22

Page 46 of 51 ends

CO-ONE MARKET VALUATION REPORT Claim: 5034306369-1_A5056803

SUPPLEMENTAL INFORMATION
Potential Number Of Units Affected : 155,627
Summary: BMW of North America, LLC (BMW) is recalling certain 2010-2012 1 Series Coupe, 1 Series Convertible, 3 Series Sedan, 3 Series Convertible, 2010-2011 3 Series Sportswagon, 3 Series Coupe, 5 Series Sedan, X3 Drive 28i, X3 Drive 30i, X5 xDrive30i, and Z4 sDrive30i vehicles. The aluminum bolts that secure the housing for the variable camshaft timing adjustment (VANOS) unit can loosen over time and possibly break.

Consequence : Loose or broken VANOS unit bolts can result in an engine stall, increasing the risk of a crash.

Remedy: Dealers will replace the four VANOS bolts, free of charge. Interim letters notifying owners of the safety risk are expected to be mailed December 12, 2023. Second letters will be mailed once the remedy is available. Owners may contact BMW customer service at 1-800-525-7417.

NHTSA Campaign ID: 24V513000
Mfg's Report Date : July 3, 2024
Potential Number Of Units Affected : 394,029
Summary: BMW of North America, LLC (BMW) is recalling certain 2006-2011 3 Series Sedan (324i, 325i, 325xi, 328i, 328xi, 330i, 330xi, 335i, 335xi), 2006-2012 3 Series Sportswagon (325xi, 328i, 328xi), and 2009-2011 3 Series Sedan (335d) vehicles. The original steering wheel may have been replaced with a sport or M-sport steering wheel equipped with an inflator that can explode during deployment.

Consequence: An inflator explosion may result in sharp metal fragments striking the driver or other occupants, resulting in serious injury or death.

Remedy : Dealers will inspect and replace the driver's air bag module as necessary, free of charge. Owner notification letters are expected to be mailed August 23, 2024. Owners may contact BMW customer service at 1-800-525-7417.

Page 47 of 51 ends

COPART AUTO AUCTIONS Date 2/11/25
12167 ARROW ROUTE
RANCHO CUCAMONGA, CA 91739 Visit us at www.copart.com
PHONE (909) 581-3595 All Amounts are in USD
TAX ID# 942867490

FINAL INVOICE
97 CA - RANCHO CUCAMONGA
F182 PIP969A

CASH RECEIPTS

FARMERS INSURANCE GROUP
7340 W. MEMORIAL RD
OKLAHOMA CITY, OK 73142
328 I SULE RED
Claim# 5034306369-1-1
Policy# UNKNOWN
Loss Code C
Pickup From Reference#
Insured GILBERT ORTIZ
Owner GILBERT ORTIZ

ADVANCE CHARGES PAID BY COPART
TOTAL ADVANCE CHARGES • .00

COPART SERVICE CHARGES
FARMERS TOTAL LOSS EXP2 20.00
:::::: 70.00 APPL DUP TITLE/SAL CERT
TITLE PROCESSING.

PIP FEE/SERVICE FEE • • • • 62.00
• .

TOTAL COPART SERVICE CHARGES. . . . . . 152.00
TOTAL DUE COPART ... • . ••.• 152.00
PROCEEDS FROM SALE 1700.00CR *Sold Via Internet Bid*
... •...

CHECK PAYMENT FROM COPART. . . . . . . . . • 1548.00
-----
NET DUE COPART . . . . .. • • .. ... • 00

COPART PAYMENTS DETAIL
COPART CHECK# 22835658 02/10/25 1,548.00
CIT

SALE INFORMATION MA
-Г:

Lot# 87730245 sold To 716192 CASTANEDA'S CARS LIC
Sale Date 2/07/25 2130 N ARROWHEAD AVE STE 102
Sale Amount 1700.00 SAN BERNARDINO, CA 92405
ACV 7901.00 LTO
Repair Est6475.92
Return 21.5% Item# 1 Invoice Date 2/10/25
Cert# 3141878 Invoice Amount .00 USD
Payment From Buyer REMIT TO: COPART
Reported To NICB 2/07/25 4610 WESTAMERICA DRIVE
CA 94534

Page 48 of 51 ends

STATE OF CALIFORNIA

SALVAGE CERTIFICATE VEHICLE HISTORY
V1901312505

AUTOMOBILE
YR

MODEL MAKE

VEHICLE ID NUMBER
2010

REGISTRATION

UNLADEN EXPIATION DATE

AX FUEL TRANSFER DATE
BODY IYPE MODEL 954 01/02/2029
YR 1ST EQUIPMT/TRUST NUMBER
SOLD CLASS *YA GẢO 08/31/25
2009 BN 2024 8773024
VOID

DOOMETER READING
ODOMETER DATE |16290
MOTORCYCLE ENGINE NUMBER 08/28/2024

ACTUAL MILEAGE

MRDSTREWORY INSURANCE

COMPANY
8687 WEYAND AVE
SACRAMENTO CA 95828

THIS SALVAGE CERTIFICATE IS EVIDENCE THAT TITLING

DOCUMENTS FOR THIS VEHICLE HAVE BEEN SURRENDERED

TO THE DEPMATMENT OF MOTOR VEHICLES
WARNING: ITHOUT BEAR WATERMARK. HOLD TO LIGHT TO VIEW.

The vehicle described herein has been declared a lolai loss salvage vehicle per 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 vehicie the seller and buyer must complete the reassignment on the back of this certificate.

SEAL THE
CVC 11515 requires the seller and any subsequent sellers EUREKA that transfer ownership of a total loss vehicle pursuant to a LEAT 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.
87730245 VAGE CALIFORNIA
87730245
10 BMW SDOC
328 I SULE 438883 3141878
PH: 97 - PR: 750 FRM 000040 REG. 489 (REV.1/16)

SONNESE

KEEP IN A SAFE PLACE - VOID IF ALTERED
CITY CLER* RECEIVLL 2025 MAY -8 PM 2: 02 CITY OF RIALTO

Page 49 of 51 ends

FIRST REASSIGNMENT
The undesigned here confes that the relace described on tas Savane Gertficate has been transferred to the lotoving bayerts), and the ltle is iree and clear of all liens.

TRUE FURT MARTS) OF BUYERS! DRIVER LICENSE 2
DRIVER LICENSE 7

ADDRESS

STATE ZIP CODE
( certity (or declate) under penalty of pertury under the laws of the State of Caliornia that the toreyoing is irue and correct.

PRINTED NAME DEALER MUMBER R'S HUMBER

SELLING PRICE

SIGHATURE OF SELLET DATE PHONE NUMBER
The bogaler reading is intens which, to the bead of may kowledge. is the achal mileage unless one of the toliowing stalements is checked.

WARNING - MILEAGE iS no) the actial meane •exceeds odometer mechanical limits I certily (or declare) wader penally at perjury under the laws of the State of Calitornia that the foregoing is tree and correct.

FEDERAL AND STATE LAW REQUIRES that you state the milcage upon transfer of pomership. Failure te complete or making a taise statement may result in lines and/or imprisonment SIGNATUPE OF SELLER PRINTER NAME|
DATE

SARATISE OF BESEE TACHION EDGES DIMATEP RLASTIGI PRINTED NAME DATE

SECOND REASSIGNMENT
The Linder?
THUE FULL NASTERS) OF BIVER ST le fies icel tallerted to the fole ong buyers! and the atle is free and clear o'at hens DRIVER LICENSE 7

DRIVER LICENSE T

ADDRESS

STATE ZIP CODE
I certily (or declare) ubder penalte of perjory under the laws of the State of Califorata thai the foregoing is true and correct.

PRINTED RABIE DEALES NUMBER TAS NUMBER

SENG RICE

SIGNATURE DE SETTED
D4TE PHONE NUMBER
The odomler some is ., LL (oleno; which, in the best of my knowledge. is the aclazi mileage unless one of the foiloving stalements is checked.

WARNING - MILEAGE • is an ase actual muleage excueds demeter ine chanical imits i certity (or declars) under ponaily of perjury under the laws of the State of California that the foregping is true and correct SEAR ARE LAW REQUIRES hat you state the mileage aran transfes of owneston. Failure to complete or making a false staterent may resullin fines andfor impreonment.

SIGNATURE DE LOSER AGENT EDES DOCKETER READIAGN

PRENTED HASE
DATE,
87730245 87730245
10 BMW BDOC
328 I SULE 438883
PH: 97 - PR: 750 FRM
CITY CLERP RECLIVEL 2025 MAY - 8 PM 2: 02 CITY OF RIALTO

Page 50 of 51 ends

Email: [email protected]
FARMERS Please include your claim # on any correspondence

INSURANCE
P.O. Box 268994
May 7, 2025 Oklahoma City, OK 73126-8994
www.farmers.com/claimstatus
Payment Log
Account Number: JJJ309244
Date of Loss: 11/29/2024
Insured's Name GILBERT ORTIZ
Claim Number: 5034306369-1
Unit Type Claim Unit Date Issued Payee Check Number Payment Amount
Vehicle 01/14/2025 GILBERT ORTIZ 1641479322 $232.18
Vehicle 02/19/2025 HORSEMEN INVESTIGATIONS 1641809947 $389.60 Vehicle 01/08/2025 GILBERT ORTIZ 1641428909 $1,768.00
Vehicle 01/09/2025 GILBERT ORTIZ 1641443320 $7,689.41
Vehicle 05/02/2025 HORSEMEN INVESTIGATIONS 1642460581 $200.00 Vehicle Total: $10,279.19
Payment Total: $10,279.19
Collections Total : $0.00
Deductible: $0.00
Grand Total : $10,279.19
CITY CLERK RECCIVEN 2025 MAY -8 PM 2: 02 CITY OF RIALTO 76QFS7BP3 Page 51 of 51
0: 253712
A CITY OK 73142

BILL SENDER

TO RIALTO CITY CLERK'S OFFICE
150 S PALM AVE
009000966539
RIALTO CA 92376
(405) 782-6128 REF: 640SJA3010
INV:

PO:

DEPT:

FedEx®
Express
THU - 08 MAY 5:00P
TRK# STANDARD OVERNIGHT
[0201 2884 1489 3240
92376

XW RIVA
SBD
CA-US
500/00 mil 400. CHES
8608-L18 12.600000.1/0:6:001
2 4B
Chit China 2075 MAY -8 PM 1: 59 CITY OF RIALTO

Rialto City CouncilMay 27, 2025

Rialto City Council
May 27, 2025