KEMPER Policy underwritten by
RECEIVED Infinity Insurance Company
MAR 18 2026 Named insured: Jackeling Mendoza
Kemper Valle
123 Town Square Place
CITY CLERK DEPARTMENT
PMB 785 000068 1/32
Claim number: 25123754413
Jersey City, NJ 07310
Date of loss: December 2, 2025
SP 06 000068 01065 E 1 BSNGLP Date of mailing: March 10, 2026 City Of Vernon
4305 S Santa Fe Ave
Vernon, CA 90058-1714
Dear City Of Vernon:
Please review enclosed claim form and related documents, Thank you for your prompt response and attention.
Sincerely,
Andres Pinzon
Claims Team
T 800-353-6737, ext.5883711
F 888-976-2123
[email protected]
CLAIM FOR DAMAGES RESERVE FOR FILING STAMP
TO PERSON OR PROPERTY CLAIM No. _
000068 2/32
INSTRUCTIONS
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 Sec. 9112)
2. Claims for damages to real property must be filed not later than one (1) year after the occurrence. (Gov. Code Sec.911.2)
3. Read entire claim before filing.
See page 2 for diagram upon which to locate place of accident This claim form must be signed on page 2 at bottom.
Attach separate sheets, if necessary, to give full details. SIGN EACH SHEET
7. Claim must be filed with City Clerk. (Gov.Code Sec. 915a) TO: CITY OF VERNON CITY COUNCIL
Name of Claimant Age of Claimant (If natural person)
Kemper Insurance as subrogee of Jackeling Mendoza
Home Address of Claimant City and State Home Telephone Number Business Address of Claimant City and State Business Telephone Number 800-353-6737
Give address to which you desire notices or communications to be sent regarding this claim:
How did DAMAGE or INJURY occur? Give full particulars.
Our insured vehicle was traveling on 26th street, had turn signal to turn left onto Minerva St, our insured was turing left when city vehicle rear ended our insured.
When did DAMAGE or INJURY occur? Give full particulars, date, time of day, etc.:
12/02/2025 4:00 PM
Where did DAMAGE or INJURY occur? Describe fully, and locate on diagram on reverse side of this sheet, where approximate, give street names and address and measurements from landmarks:
26th Street and Minerva Street, Huntington Park, CA
What particular ACT or OMISSION do you claim causedthe injury or damage? Give names of City employees, if any, causing the injury or damage, if known:
City employee rear ended our insured's vehicle. City Employee is Rudy Hernandez What DAMAGE or INJURIES do you claim resulted? Give full extent of injuries or damages claimed:
Damages to the rear of our insured's vehicle.
What AMOUNT do you claim of each item of injury or damage as of date of presentation of this claim, giving basis of computation:
$8,804.81 for the damages to the 2019 Toyota Camry, please see enclosed demand Give ESTIMATED AMOUNT as faras knownyou claim on account of each item of prospective injury or damage, giving basis of computation:
$8,804.81
P
Were you insured at the time of the incident? If so, provide name of insurance company, policy numbers and amount of insurance payments received:
Kemper insurance claim 25123754413, insurance pad 7,804.81 Expenditures made on account of accident or Injury: (Date - Item) (Amount) Name and address of Witnesses, Doctors and Hospitals:
na
READCAREFULLY
For all accident claims place on following diagram names of streets, including North, East. South, and West: indicate place of accident by "X" and by showing house numbers or distances to street corners.
If City Vehicle was Involved, desianate bv letter "A" location of City vehicle when vou first saw it, and by "B" location of vourself or your vehicle when you first saw City vehicle; location of City vehicle at time of accident by "A-1"and location of yourself or your vehicle at the time of accident by "8 1" and the point of Impact by "X." NOTE: if diagrams do not fit the situation, attach hereto a proper diagram signed by claimant.
FOR AUTOMOBILE ACCIDENTS
14L
FOR OTHER ACCIDENTS
//LL
CURB/
CURB)
PARKWAY
SIDEWALK
I declare, under penalty of perjury, that the foregoing, including any attachments, is true and correct.
Typed/Printed Name: Signature of Claimant or person filing on his/her behalf, giving Date:
Kemper insurance relationship to Claimant: 03/10/26
Andres Pinzon
NOTE: ALL CLAIMANTS MAY BE REQUESTED TO BE EXAMINED AS TO THEIR CLAIM UNDER OATH. PRESENTATION OF A FALSE CLAIM IS A FELONY (CAL PEN. CODE SEC. 12). CLAIMS MUST BE FILED WITH CITY CLERK (GOV.CODE SEC. 915a). STATE LAW PROVIDES THAT IF YOU ARE NOT NOTIFIED OF ANY ACTION BY THE CITY OF THIS CLAIM WITHIN 45 DAYS OF FILING THEN THE CLAIM IS DEEMED DENIED (SEE GOV. CODE SEC. 911.6 & 912.4) Rev. 8/4/16
KEMPER 000068 3/32
Subrogation
123 Town Square Place PMB 785
Jersey City, NJ 07310
March 10, 2026
CITY OF VERNON
4305 South Santa Fe Ave
Vernon, CA 90058
RE: Your Claim Number: NA
Your Insured: CITY OF VERNON
Date of Loss: 12/02/25
Our Insured: JACKELING MENDOZA VALLE
Our Claim Number: 25123754413
Our investigation indicates liability rests with your insured. We come to you now for recovery under our policy rights of subrogation for damages paid in the amount of S8,804.81, which includes our insured's deductible.
The breakdown of our demand is below:
Collision 7,804.81
Deductible: 1,000.00
Total: 8,804.81
X We seek 100% of our damages.
Please make your check in the amount of $8,804.81 payable to the company listed above as Subrogee of Jackeling Mendoza Valle. Please include our claim number on your payment and mail the payment to our address listed above. If you have any questions, I can be reached at 1-800-353-6737 × 5883711.
Please be advised that any payment in an amount less than that is set forth in this letter to Infinity without prior authorization will not constitute a full & final settlement and will be accepted as partial payment only.
Although such payments may be demarked as "payment in full" or have other words of similar meaning noted, by processing this will not constitute an accord and satisfaction, as Infinity has not agreed to the acceptance of such payment. Only an authorized Subrogation Specialist may communicate, orally or in writing, Infinity's specific agreement to accept an amount less than that demanded in this letter.
In order to assist you in evaluating and processing our subrogation claim we are presenting; we may provide nonpublic personal information about our customers. We are sharing this information to effect, administer, or enforce a transaction authorized by the consumer. However, you are neither authorized nor permitted to:
(1) use the customer information we provide for any purpose other than to evaluate and process our subrogation claim, or (2) disclose or share the customer information we provide for any purpose other than to evaluate and process the subrogation claim.
KEMPER
Subrogation
Jersey City, NJ 07310
Sincerely,
Andres Pinzon
Subrogation Specialist
[email protected]
Infinity Insurance Company
* If you do not provide coverage for this loss, please send us your written coverage denial so we may pursue accordingly
KEMPER SERVICES GROUP
KEMPER CLAIMS OFFICE
For Supplement Requests See
Instructions at End of Estimate 68/7 890000
Ciaim # : 2512375441301
Jersey City, NJ 07310 Worktile ID: 839aca9e
Supplement of Record 2 Summary
Written By: ALBERT RODRIGUEZ, License Number: 147403, 12/31/2025 3:02:18 PM Insured: Jackeling Mendoza Owner Policy #: Claim #: 2512375441301 Valle
Type of Loss: Collision Date of Loss: 12/01/2025.04:00 PM Days to Repair: 5 Point of Impact: 06 Rear Deductible: 1000.00
Owner (Insured): Inspection Location: Repair Facility:
- Jackeling Mendoza Valle Desk NEW SMILE AUTO BODY
4153 VENICE BLVD
LOS ANGELES, CA 90019
(323) 735-5800 Evening
371868019 Federal ID
VEHICLE
2019 TOYO Camry LE Automatic 4D SED 4-2.5L Gasoline Port/Direct Injection Gray VIN: Production Date: 05/2019 Interior Color: Ash
License: Odometer: 36886 Exterior Color: Gray
State: Condition: Good
TRANSMISSION CONVENIENCE FM Radio SEATS
Automatic Transmission Air Conditioning Stereo Coth Seats POWER Intermittent Wipers Search/Seek Bucket Seats
Power Steering Tilt Wheel Auxiliary Audio Connection Reclining/Lounge Seats Power Brakes Guise Control SAFETY WHEELS
Power Windows Rear Defogger Drivers Side Air Bag Aluminum/ Alloy Wheels Power Locks Keyless Entry Passenger Air Bag PAINT
Power Mirrors Alarm Anti-Lock Brakes (4) Gear Coat Paint Message Center 4 Wheel Disc Brakes OTHER
Power Driver Seat
DECOR Steering Wheel Touch Controls Front Side Impact Air Bags Traction Control Dual Mirrors Telescopic Wheel Head/ Curtain Air Bags Stability Control Tinted Glass Backup Camera Communications System Xenon or L.E.D. Headlamps Intelligent Culse Hands Free Device California Emissions Console/ Storage
Overhead Console RADIO Rear Side Impact Air Bags
Wood Interior Trim AM Radio Lane Departure Warning
147403 | 1.9.09,09160 Page 1
12/31/2025 3:02:18 PM
P
Claim #: 2512375441301
Workfile ID: 839acase
Supplement of Record 2 Summary
2019 TOYO Camry LE Automatic 4D SED 4-2.5L Gasoline Port/Direct Injection Gray Line Oper Description Part Number Qty Extended Labor Paint PriceS
1 EXHAUST SYSTEM
S02 R&l Muffler L, LE to 12/2018 17430F0010 m 0.6 M
ROOF
S02 R&I RT Drip molding w/o two-tone 7555506090 0.4
roof
S02 Bind RT Outer rail 6121306220 0.9
:
S02 Bind LT Outer rail 6121406190 09
S02 R&/ LT Drip molding w/o two-tone 7555606090 0.4
roof
S02 Repl RT Drip molding clip 7556108040 2 3.96
9 S02 Repl LT Drip molding clip 7556108040 2 3.96
10 PILLARS, ROCKER & FLOOR
11 S02 P&/ RT Rocker molding L, LE, XLE 7585106941 0.9
12 S02 R&I LT Rocker molding L, LE, XLE 7585206941 0.9
13 S02 Repl RT Rocker molding clip #1 75867AA010 30.56
14 S02 Repl LT Rocker molding clip #1 75867AA010 30.56
15 S02 Repl RT Rocker molding retainer 9046722014 9.28
16 S02 Repl LT Rocker molding retainer 9046722014 9.28
17 BACK GLASS
18 S02 R&I Back glass Toyota w/o L model 6480106221 3.6 19 S02 Repl Dam 135mm 6481306440 2 3.64
NOTE: Part included with back glass. Part cannot be reused/reinstalled. 2 of these are required 20 S02 Repl Dam 573mm 6481306230 7.30
21 S02 Repl Dam 630mm 6481306220 7.47
22 S02 Repl Dam 1183mm 6481306180 11.47
23 QUARTER PANEL
24 S02 Por LT Quarter panel w/o blind spot 6160206320 4.5 2.9 25 S02 Add for Cear Coat 1.2
26 S02 Ren Partial Basecoat refinish -0.5
27 S02 Rpr RT Quarter panel w/o blind spot 6160106320 2.9
6.0 28 S02 Overlap Major Adj. Panel
-0.4
29 S02 Add for Clear Coat
0.5 30 S02 Repl RT Quarter panel protector 5874706130 18.61 0.1 31 S02 Repl LT Quarter panel protector 5874806130 18.61 0.1 32 S02 R&I Fuel door 7735006180 0.4
33 S02 Bind Fuel door 7735006180
0.2 34 S02 R&I LT Pressure vent 62940AQ020 0.1
35 S02 R&I RT Wheelhouse liner L, LE, XLE 6563706250 0.3 36 S02 Repl Fuel door rivet 90269A0005 2 6.28
37 S02 R&I LT Wheelhouse liner L, LE, XLE 6563806250 0.3 38 REAR BODY & FLOOR
39 Repl Rear body panel (HSS) 5830706221 1 478.37
8.3 1.6
12/31/20253:02:18 PM 147403 | 1.9.09.09160 Page 2
Claim # : 2512375441301
Worktile ID: 839aca9e
Supplement of Record 2 Summary
2019 TOYO Camry LE Automatic 4D SED 4-2.5L Gasoline Port/Direct Injection Gray 000068 5/32 40 S02 Overlap Major Adj. Panel -0.4
41 Add for Clear Coat 0.2
Add for Inside 0.8
42 43 Por Rear floor pan 5830106909 1.0 1.8
44 S02 R&I Floor cover fixed rear seat 6477006330C1 0.1 45 S02 Repl Rear panel trim 583870621000 1 246.99 0.2
46 TRUNK LID
47 • S01 Repl RCY trunk Hid assy + 20% 245164 636.00 1.1 2.3 48 Overlap Major Adj. Panel -0.4
Add for Clear Coat 0.4
49 Repl License molding chrome 7680106E1080 1 123.91 0.2 0.8 50 nameplate gray
Overlap Minor Panel -0.2
51 S02
52 Add for Clear Coat 0.1
Non OEM Nameplate "LE 7544306180-AT 14.00 0.1
53 Pepl
7543102080-AT 14.00 0.1
54 Repl Non OEM Emblem
RCY RT Hinge + 20% -445724105 1 63.60 0.4 0.3
55 S02 Repl
0.1 56 S02 Add for Clear Coat
Repl RCY LT Hinge + 20% - 445724104 1 63.60 0.4 0.3
57 S02
S02 Add for Clear Coat 0.1
58 Weatherstrip 6446106220 114.26 0.3
59 S02 Repl
S02 Lock assy 6460006070 248.33 0.4
60 Repl
Striker 6462106030 12.45 0.2
61 S02 Repl
Repl Lower trim w/o passive entry 7681306030 110.59
62 S02
S02 Repl RCY Rear camera w/o blind spot WJK051 102.00 m 0.1 63 + 20%
64 REAR LAMPS
Non OEM LT Backup lamp assy 15114 1 73.30 0.2
65 Repl
w/o smoked tint
S02 Repl Non OEM RT Tail lamp assy w/o 11-9031-00B 1 93.94 0.3 66 smoked tint
8149706010 21.28
67 S02 Repl RT Access cover
Non OEM RT Tail lamp assy TO1143144 2 70.00 0.1
68 S02 Repl
retainer
Repl RT Tail lamp assy grommet 9018906242 2 2.64
69 S02
70 REAR BUMPER
- 1.6
71 S02 O/H rear bumper
AM3549 1 325.00 Incl. 3.2
72 •• S02 Repl Non OEM CAPA Bumper cover
w/o prk sensor
NOTE: |PART QUote #312899
9095876059|08
Overlap Major Non-Adj. Panel -0.2
73 S02
• 0.6
74 S02 Add for Clear Coat
T9125 106.66 Incl.
75 Repl Non OEM Lower cover
Repl Non OEM CAPA Absorber TO1170168C Incl Incl
76 S02
NOTE: Incl with bumper cover
12/31/2025 3:02:18 PM 147403 | 1.9.09.09160 Page 3
P
Claim # : 2512375441301
Worktile ID: 839aca9e
Supplement of Record 2 Summary
2019 TOYO Camry LE Automatic 4D SED 4-2.5L Gasoline Port/Direct Injection Gray 77 S02 Repl Bumper cover pad 5246206180 2 21.26
NOTE: Part cannot be reused/reinstalled. 2 of these are required. 78 S02 Repl Bumper cover retainer 5216102020 3.64
79 S02 R&/ RT Side retainer 5257506160 0.1
80 S02 R&/ LT Side retainer 5257606160 0.1
81 S02 Repl Non OEM Impact bar (ALU) 5217106170 1 Incl Incl. 82 VEHICLE DI AGNOSTICS
83 S02 Subi Pre-repair scan 1 65.00 Xm
84 • S02 Subi Post-repair scan 1
65.00 m
85 MISCELLANEOUS OPERATIONS
86 Non OEM Hazardous Waste 1 3.50
Disposal
87 S02 Repl Cover car/bag 8.00 0.2
88 Repl Non OEM Corrosion Protection 10.00
89 S02 Repl Non OEM Flex 10.00
90 # S02 Ror Setup & measure 2.0 F
91 S02 Repl Seam sealer 1 25.00
92 S02 Por Denib & polish 1.0
SUBTOTALS 3,293.30 37.1 20.0
NOTES
Prior Damage Notes:
minor rt front
Largest Odometer Reading Date Read
29864 mil 05/28/2024
ESTIMATE TOTALS
Category Basis Rate Cost $
Parts
3,163.30
Body Labor 34.5 hrs @ $ 70.00 /hr 2,415.00
Paint Labor 20.0 hrs @ $ 70.00 /hr 1,400.00
Mechanical Labor 0.6 hrs $ 185.00 /hr 111.00
Frame Labor 2.0 hrs @ $ 95.00 /hr 190.00
Paint Supplies 20.0 hrs @ $ 50.00 /hr 1,000.00
Miscellaneous 130.00
Subtotal
8,409.30
Sales Tax $ 4.163.30 @ 9.5000%
395.51
Total Cost of Repairs 8,804.81
Deductible
1,000.00
Total Adjustments 1,000.00
Net Cost of Repairs 7,804.81
12/31/20253:02:18 PM 147403 | 1.9.09.09160
Claim # : 2512375441301
Workfile ID: 839aca9e
Supplement of Record 2 Summary
2019 TOYO Camry LE Automatic 4D SED 4-2.5L Gasoline Port/Direct Injection Gray 000068 6/32
SUPPLEMENT SUMMARY
Line Oper Description Part Number Qty Extended Labor Paint Price S
Changed Items
3 Add for Clear Coat -0.6
41 S02 Add for Clear Coat 0.2
23 Repl Non OEM CAPA Absorber TO1170168C -32.98 Inci.
:
76 S02 Repl Non OEM CAPA Absorber TO1170168C Incl Inci.
NOTE: Incl with bumper cover
27 Repl Cover car/bag -0.2
87 • 502 Repl Cover car/bag 8.00 0.2
Repl Non OEM Flex -8.00 -
29 89 S02 Repl Non OEM Flex 10.00
Deleted Items
Overlap Minor Panel 0.2
11 18 O/H rear bumper -1.6
19 <> Repl Non OEM CAPA Bumper cover 24KV09 1 -111.00 Incl. -3.2 w/o prk sensor
Overlap Major Non-Ad]. Panel 0.2
20 Add for Clear Coat -0.6
21 24 S01 Repl RCY Impact bar (ALU) + 20% P25211 1 =156,00 -0.4 Added Items
EXHAUST SYSTEM
2 S02 R&/ Muffler L, LE to 12/2018 17430F0010 m 26 M
ROOF
S02 R&I RT Drip molding w/o two-tone 7555506090 0.4
roof
S02 Bind RT Outer rail 6121306220 0.9
S02 Bind LT Outer rail 6121406190 0.9
S02 R&/ LT Drip molding w/o two-tone 7555606090 0.4
roof
8 S02 Repl RT Drip molding clip 7556108040 2 3.96
S02 Repl LT Drip molding clip 7556108040 2 3.96
10 PILLARS, ROCKER & FLOOR
-
11 S02 A&/ RT Rocker molding L, LE, XLE 7585106941 0.9
12 S02 R&I LT Rocker molding L, LE, XLE 7585206941 0.9
S02 Repl RT Rocker molding clip # 1 75867AA010 30.56
13 14 S02 Repl LT Rocker molding clip #1 75867A4010 30.56 15 S02 Repl RT Rocker molding retainer 9046722014 9.28
16 S02 Repl LT Rocker molding retainer 9046722014 9.28
17 BACK GLASS
18 S02 R&/ Back glass Toyota w/o L model 6480106221 3.6 19 S02 Repl Dam 135mm 6481306440 2 3.64
12/31/20253:02:18PM 147403 | 1.9.09.09160 Page 5
Claim # : 2512375441301
Worktile ID 839aca9e
Supplement of Record 2 Summary
2019 TOYO Camry LE Automatic 4D SED 4-2.5L Gasoline Port/Direct Injection Gray NOTE: Part included with back glass. Part cannot be reused/reinstalled. 2 of these are required. 20 S02 Repl Dam 573mm 6481306230 1 7.30
21 S02 Repl Dam 630mm 6481306220 7.47
22 S02 Repl Dam 1183mm 6481306180 11.47
23 QUARTER PANEL
24 S02 Rpr LT Quarter panel w/o blind spot 6160206320 4.5 2.9 25 S02 Add for Clear Coat 1.2
26 # S02 Refn Partial Basecoat refinish -0.5
27 S02 Rpr RT Quarter panel w/o blind spot 6160106320 5.0 2.9 28 S02 Overlap Major Adj. Panel -0.4
29 S02 Add for Clear Coat 0.5
30 S02 Repl AT Quarter panel protector 5874706130 18.61 0.1 31 S02 Repl LT Quarter panel protector 5874806130 1 18.61 0.1 32 S02 R&l Fuel door 7735006180 0.4
33 S02 Bind Fuel door 7735006180 0.2
34 S02 R&1 LT Pressure vent 62940AQ020 0.1
35 S02 R&I RT Wheelhouse liner L, LE, XLE 6563706250 0,3 36 S02 Repl Fuel door rivet 90269A0005 2 6.28
37 S02 R&I LT Wheelhouse liner L, LE, XLE 6563806250 0.3 40 S02 Overlap Major Adj. Panel -0.4
44 S02 R&I Floor cover fixed rear seat 6477006330C1 0.1 45 S02 Repl Rear panel trim 5838706210C0 246.99
0.2 51 S02 Overlap Minor Panel -0.2
55 S02 Repl RCY RT Hinge + 20% -445724105 63,60
2.4 23
56 S02 Add for Gear Coat 0.1
57 S02 Repl RCY LT Hinge + 20% -445724104 0.3
63.60 04
58 S02 Add for Clear Coat 0.1
59 S02 Rep Weatherstrip 6446106220 1 114.26 0.3
60 S02 Repl Lock assy 6460006070 1 248.33 0.4
61 S02 Rep Striker 6462106030 12.45 0.2
62 S02 Rep! Lower trim w/o passive entry 7681306030 1 110.59 63 S02 Repl RCY Rear camera w/o blind spot WJK051 1
102.00 m 2.1
+ 20%
66 S02 Repl Non OEM RT Tail lamp assy w/o 11-9031-00B 1 93,94 0.3 smoked tint
67 S02 Repl RT Access cover 8149706010 21.28
68 S02 Repl Non OEM RT Tail lamp assy TO1143144 70.00
0.1 retainer
69 S02 Repl RT Tail lamp assy grommet 9018906242 2 2.64 71 S02 O/H rear bumper
1.6 72 <> S02 Repl Non OEM CAPA Bumper cover AM3549 1 325.00 Incl. 3.2 w/o prk sensor
NOTE: I PART QUote #312899
9095876059(oe
73 S02 Overlap Major Non-Adj. Panel -0.2
12/31/20253:02:18 PM 147403 | 1.9.09.09160
Claim #: 2512375441301
Worktile ID: 839aca9e
Supplement of Record 2 Summary
2019 TOYO Camry LE Automatic 4D SED 4-2.5L Gasoline Port/Direct Injection Gray • Add for Clear Coat 0.6
74 S02
77 S02 Repl Bumper cover pad 5246206180 2 21.26
NOTE: Part cannot be reused/reinstalled. 2 of these are required. 78 S02 Repl Bumper cover retainer 5216102020 1 3.64
S02 R&I RT Side retainer 5257506160 0.1
79 S02 R&I LT Side retainer 5257606160 0.1
80 S02 Repl Non OEM Impact bar (ALU) 5217106170 1 IncL. Inci. 81 82 VEHICLE DI AGNOSTICS
83 S02 Subl Pre-repair scan 65.00 Xm
84 • S02 Subl Post-repair scan 65.00 Xm
90 # S02 Ppr Setup & measure 2.0 F
91 # S02 Repl Seam sealer 25.00
92 # S02 Por Denib & polish 1.0
SUBTOTALS 1,525.58 23.9 8.6
NOTES
Prior Damage Notes:
minor rt front
Largest Odometer Reading Date Read
29864 ml 05/28/2024
RATE CHANGES
$ 23.00 /hr 47.00 to 70.00) = 303.60
Body Labor (Est) 13.2 hrs @
Paint Labor (Est) 11.4 hrs $ 23.00 /hi 47.00 to 70.00) = 262.20
11.4 hrs @ $ 16.00 /ht 34.00 to 50.00) = 182.40
Paint Supplies (Est)
147403 | 1.9.09.09160 Page 7
12/31/2025 3:02:18 PM
IP Y
Claim #: 2512375441301
Worktile ID: 839aca9e
Supplement of Record 2 Summary
2019 TOYO Camry LE Automatic 4D SED 4-2.5L Gasoline Port/Direct Injection Gray
TOTALS SUMMARY
Category Basis Rate Cost $
Parts 1,395.58
Body Labor 21.3 hrs @ $ 70.00 /hr 1,491.00
Paint Labor 8.6 hrs $ 70.00 /hr 602.00
Mechanical Labor 0.6 hrs $ 185.00 /hr 111.00
Frame Labor 2.0 hrs $95.00 /hr 190.00
Additional Supplement Labor 565.80
Paint Supples 8.6 hrs @ $ 50.00 /hr 430.00
Additional Supplement Materials/ Supplies 182.40
Miscellaneous 130.00
Subtotal 5,097.78
Sales Tax $ 2,007.98 @ 9.5000 % 190.76
Additional Supplement Taxes -0.01
Total Supplement Amount 5,288.53
NET COST OF SUPPLEMENT 5,288.53
CUMULATIVE EFFECTS OF SUPPLEMENTS)
Estimate 3,931.96 Edvin Ohanyan
Supplement S01 -415.68 ALBERT RODRIGUEZ
Supplement S02 5,288.53 ALBERT RODRIGUEZ
Workfile Total: $ 8,804.81
TOTAL ADJUSTMENTS: $ 1,000.00
NET COST OF REPAIRS: 7,804.81
12/31/2025 3:02:18 PM 147403 | 1.9.09.09160
680
Claim # : 2512375441301
Workfile ID: 839aca9e
Supplement of Record 2 Summary
2019 TOYO Camry LE Automatic 4D SED 4-2.5L Gasoline Port/Direct Injection Gray 000068 8/32 ***** KEMPER REPAIR NETWORK (KRN) PARTNER SHOPS, PLEASE USE ESTIMATE SHARE ********* You can download a copy of this appraisal with COC One Import Workfile Copy and upload supplements and additional images.
NON-KRN SUPPLEMENT REQUEST INSTRUCTIONS * ***
NOTICE: Any supplement requests submitted, including part changes, must have prior approval.
Please send a copy of your estimate, and all photos/ supporting documents, to:
******** For ADAS-related work, the vehicle must be fully torn down. All required pre-scan printouts, including DCs, must be submitted with the first supplement. Any ADAS calibrations must receive prior approval for payment. ********
* SUPPLEMENTS@KEMPER COM"
Phone number for the supplement request voicemail box: 877-757-4680 (Please provide the claim number/vehicle info and your contact information in the message.) Tips for A Successful Supplement Request to Ensure Quicker Responses:
1. Vehicle should be torn down prior to supplement inspection so additional damage is verifiable by our appraiser.
2. If listed on estimate/prior supplement, floor pulls and/or set up & measure must be completed prior to our inspection.
3. Provide copies of all invoices for parts and sublet operations listed on the original estimate and/or previous supplement.
4. Provide copies of the repair authorization and direction of payment (DOP) forms signed by the vehicle's owner.
5. Provide an itemized list of additional operations or items requested prior to supplement inspection.
6. All photos, estimate, and supporting documents are included in one single email.
This is not an authorization to repair. Any authorization should be obtained directly from the vehicle owner. This is not a guarantee of payment. For questions regarding coverages, liability, checks, or car rental please contact the adjuster listed at the top of the estimate.
In order for the vehicle owner to avoid unnecessary out of pocket expenses, the owner should provide a copy of this estimate to the repair facility prior to authorizing repairs. 12/31/20253:02:18 PM 147403 | 1.9.09.09160 Page 9
Claim # : 2512375441301
Workfile ID: 839aca9e
Supplement of Record 2 Summary
2019 TOYO Camry LE Automatic 4D SED 4-2.5L Gasoline Port/Direct Injection Gray 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.
THIS ESTIMATE IS FOR REPAIRS TO MEET VEHICLE MANUFACTURER AND INDUSTRY STANDARDS. AS THE
CUSTOMER, IT IS YOUR RESPONSIBILITY TO CONTACT THE THIRD-PARTY PAYOR FOR PAYMENT OF THE REPAIRS YOU HAVE AUTHORIZED.
THE FOLLOWING IS A LIST OF ATIONS OR SYMBOLS THAT MAY
BE USED TO DESCRI BE 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. COC 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, INC= INCLUDED, MI SC= 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&/ = 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 [I E.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 DI SOOUNT.
''CURE TIME' MEANS THE LENGTH OF TIME THAT, PER THE ADHESI VE
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.
12/31/20253:02:18 PM 147403 | 1.9.09.09160 Page 10
Claim #: 2512375441301
Workfile ID: 839aca9e
Supplement of Record 2 Summary
2019 TOYO Camry LE Automatic 4D SED 4-2.5L Gasoline Port/Direct Injection Gray ZE/6 890000 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 ARM8527, COC Data Date 12/15/2025, 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 EMs 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 COC 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. Ind.= Included. LKQ= Like Kind and Quality. LT= Left. MAG= Magnesium. Non-Adj. = Non Adjacent. NSF= NSF International Certified Part.
O/H= Overhaul. Oty= Quantity. Refn= Refinish. Repl= Replace. R&|= Remove and Install. P&R= Remove and Replace. Ppr= 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.
COC ONE Estimating - A product of COC Intelligent Solutions Inc.
The following is a list of abbreviations that may be used in COC 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. 147403 | 1.9.09.09160 Page 11
12/31/20253:02:18 PM
Caim #: 2512375441301
Workfile ID: 839aca9e
Supplement of Record 2 Summary
2019 TOYO Camry LE Automatic 4D SED 4-2.5L Gasoline Port/Direct Injection Gray
THE INSURANCE COMPANY THIS ESTIMATE WAS PREPARED BY OR FOR WARRANTS THAT ANY NON-ORIGINAL
EQUIPMENT MANUFACTURER REPLACEMENT CRASH PART INCLUDED IN YOUR ESTIMATE ARE AT LEAST EQUAL TO
THE ORIGINAL EQUIPMENT MANUFACTURER PARTS IN TERMS OF KIND, QUALITY, SAFETY, FIT, AND
PERFORMANCE
12/31/20253:02:18 PM 147403 | 1.9.09.09160
Gaim #: 2512375441301
Workfile ID: 839aca9e
Supplement of Record 2 Summary
2019 TOYO Camry LE Automatic 4D SED 4-2.5L Gasoline Port/Direct Injection Gray 000068 10/32
ALTERNATE PARTS SUPPLIERS
Line Supplier Description Price
47 CHERRY AUTO PARTS #245164 $ 530.00
SALES REPRESENTATIVE RCY trunk lid assy + 20%
11911 SHELDON ST Tallgate TAI LGATE-LIFTGATE-TRUNK LID-6440106F50INSURANCE QUALITY SHELL $, S# 245164
SUN VALLEY CA 91352
(818) 767-0047
53 Adhesive Templates (Adhesive Only) #7544306180-AT $ 14.00 10418 SHAVER RD Non OEM Nameplate "LE
- PORTAGE MI 49024 -
(888) 249-3350
54 Adhesive Templates (Adhesive Only) #7543102080-AT $ 14.00 10418 SHAVER RD Non OEM Emblem
PORTAGE MI 49024
(888) 249-3350
55 LKQ of Southern California (Lakenor) #~445724105 $ 53.00 13642 Orden Dr. RCY RT Hinge + 20%
Santa Fe Springs CA 90670 Trunk Lid Hinge LE,4DR R, RH., S# $Y5210 (800) 525-3667 Quote: 3281626078
Expires: 02/13/26
57 LKQ of Southern California (Lakenor) #~445724104 $ 53.00 13642 Orden Dr. RCY LT Hinge + 20%
Santa Fe Springs CA 90670 Trunk Lid Hinge LE, 4DR L, LH., S#$Y5210 (800) 525-3667 Quote: 3281626078
Expires: 02/13/26
63 Bells Auto Parts- Fenix Parts #WJK051 $ 85.00
8777 San Fernando Rd RCY Pear camera w/o blind spot + 20% Sun Valley CA 91352 CHECK ID, REAR 4DR SED - camera, rear (decklid mounted), ID 867 (818) 983-1135 Quote: CCC-420005506
Expires: 01/09/26
65 San Jose Trading Company, Inc. #15114 $ 73.30
1945 LUNDY AVENUE Non OEM LT Backup lamp assy w/o smoked tint SAN JOSE CA 95131
(408) 434-9222
#11-9031-00B $ 93.94
66 Pro-A Motors
6363 Corsair St Non OEM RT Tail lamp assy w/o smoked tint Commerce CA 90040 Quote: 19188456422
12/31/2025 3:02:18 PM 147403 | 1.9.09.09160 Page 13
Claim #: 2512375441301
Workfile ID: 839aca9e
Supplement of Record 2 Summary
2019 TOYO Camry LE Automatic 4D SED 4-2.5L Gasoline Port/Direct Injection Gray (323) 617-5214 Expires: 01/06/26
68 KEYSTONE-LOS ANGELES, CA #TO1143144 $ 35.00
13642 ORDEN DRIVE Non OEM RT Tail lamp assy retainer
SANTA FE SPRINGS CA 90670 Quote: 3281626078
(562) 944-6422 Expires: 02/13/26
72 Ipart automotive inc # AM3549 $ 325.00
14975 Hilton Drive Non OEM CAPA Bumper cover w/o prk sensor Fontana CA 92335 Quote: 19183556832
(909) 587-6059 Expires: 01/06/26
75 Quality Plus San Diego # T9125 $ 106.66
1333 30TH ST STE C Non OEM Lower cover
SAN DI EGO CA 92154
(619) 424-9991
76 Express Body Parts Inc. # TO1170168C $ 32.98
7295 COLDWATER CANYON AVE. Non OEM CAPA Absorber
NORTH HOLLYWOOD CA 91605
(818) 764-0707
12/31/20253:02:18 PM 147403 | 1.9.09.09160 Page 14
000068 11/32
Left Front
Claim Reference Id: 2512375441301
File Name: Left Front 129490273
File Date: 12/09/2025
Label: Left Front
Note:
Photo Location:
Photo Taken By: SCA - WEST
Estimate Indicator: E01
CO P
Left Rear
Claim Reference Id: 2512375441301
Flle Name: Left Rear 129490280
File Date: 12/09/2025
Label: Left Rear
Note:
Photo Location:
Photo Taken By: SCA - WEST
Estimate Indicator: E01
28/L 890000
12/09/2025
License Plate
Claim Reference Id: 2512375441301
File Name: License Plate 129490281
File Date: 12/09/2025
Label: License Plate
Note:
Photo Location:
Photo Taken By: SCA - WEST
Estimate Indicator: E01
12/092
Measurement
Claim Reference Id: 2512375441301
File Name: Measurement 129490285
File Date: 12/09/2025
Label: Measurement
Note:
Photo Location:
Photo Taken By: SCA - WEST
Estimate Indicator: E01
000068 13/32
09/2025
Point of impact
Claim Reference Id: 2512375441301
File Name: Point of impact 129490295
File Date: 12/09/2025
Label: Point of Impact
Note:
Photo Location:
Photo Taken By: SCA - WEST
Estimate Indicator: E01
OP Y
12/09/2025
Point of Impact
Claim Reference Id: 2512375441301
File Name: Point of Impact 129490294
File Date: 12/09/2025
Label: Point of Impact
Note:
Photo Location:
Photo Taken By: SCA - WEST
Estimate Indicator: E01
000068 14/32
09/2025
Point of Impact
Claim Reference Id: 2512375441301
File Name: Point of Impact 129490292
File Date: 12/09/2025
Label: Point of Impact
Note:
Photo Location:
Photo Taken By: SCA - WEST
Estimate Indicator: E01
Point of Impact
Claim Reference Id: 2512375441301
File Name: Point of impact 129490290
File Date: 12/09/2025
Label: Point of Impact
Note:
Photo Location:
Photo Taken By: SCA - WEST
Estimate Indicator: E01
Point of Impact
Claim Reference Id: 2512375441301
Flle Name: Point of Impact 129490291
File Date: 12/09/2025
Label: Point of Impact
Note:
Photo Location:
Photo Taken By: SCA - WEST
Estimate Indicator: E01
COPY
Point of impact
Claim Reference Id: 2512375441301
Flle Name: Point of impact 129490289
File Date: 12/09/2025
Label: Point of Impact
Note:
Photo Location:
Photo Taken By: SCA - WEST
Estimate Indicator: E01
000068 16/32
12/09/2025
Point of Impact
Claim Reference Id: 2512375441301
File Name: Point of Impact 129490288
File Date: 12/09/2025
Label: Point of Impact
Note:
Photo Location:
Photo Taken By: SCA - WEST
Estimate Indicator: E01
COP Y
Point of Impact
Claim Reference Id: 2512375441301
File Name: Point of Impact 129490287
File Date: 12/09/2025
Label: Point of impact
Note:
Photo Location:
Photo Taken By: SCA - WEST
Estimate Indicator: E01
000068 17/32
12/09/2025
Point of Impact
Claim Reference Id: 2512375441301
File Name: Point of Impact 129490283
File Date: 12/09/2025
Label: Point of Impact
Note:
Photo Location:
Photo Taken By: SCA - WEST
Estimate Indicator: E01
o PY
12/09/2025
Right Front
Claim Reference Id: 2512375441301
File Name: Right Front 129490272
File Date: 12/09/2025
Label: Right Front
Note:
Photo Location:
Photo Taken By: SCA - WEST
Estimate Indicator: E01
000068 18/32
12/09/2021
Right Rear
2512375441301
Right Rear 129490282
File Date: 12/09/2025
Label: Right Rear
Note:
Photo Location:
Photo Taken By: SCA - WEST
Estimate Indicator: E01
COPY
No Label
2512375441301
Photo 07.jpg
File Date: 12/29/2025
Label: 00006819/32
Note:
586
• O
No Label
2512375441301
Ph oto 08.jpg
12/29/2025
Label: 000068 20/32
Note:
cops
Claim Reference Id: 2512375441301
File Name: Photo 09.jpg
File Date: 12/29/2025
Label: 000068 21/32
Note:
Photo Location:
Photo Taken By:
Estimate Indicator:
copY
No Label
2512375441301
Photo 10.jpg
12/29/2025
Label: 000068 22/32
Note:
No Label
Claim Reference Id: 2512375441301
File Name: Photo 11.jpg
File Date: 12/29/2025
Label:
Note:
!!!
000068 23/32
No Label
2512375441301
Photo 12.jpg
File Date: 12/29/2025
Label:
Note:
000068 24/32
No Label
COPY
Claim Reference Id: 2512375441301
File Name: Photo 13.jpg
File Date: 12/29/2025
Label:
Note:
000068 25/32
No Label
COPY
Claim Reference Id: 2512375441301
File Name: Photo 14.jpg
File Date: 12/29/2025
Label:
Note:
Photo Location:
Photo Taken By:
Estimate Indicator:
28/92 890000
No Label
•O P
Claim Reference Id: 2512375441301
Flle Name: Photo 15.JPg
File Date: 12/29/2025
Label:
Note:
Photo Location:
Photo Taken By:
Estimate Indicator:
000068 27/32
No Label
• O P
Claim Reference Id: 2512375441301
File Name: Photo 16.jpg
File Date: 12/29/2025
Label:
Note:
Photo Location:
Photo Taken By:
Estimate Indicator:
Bepoct ID: MAXM20251229085241
Shop Name: - TestTime 2025-12-79-08.52:41
Te
AUTEL
Email:
2019 Toyota Pre-scan Report
Vehicle Information
oilc/Tavala /Gamiv/A25A.EKS odometer Re
Cleense Plate
Customer Information
Name lackeling Merdoza Tet rs
Device information
Scanner Maxisys: MSQ06 AT Serial Number: VB8GK4C01836
Version V11.60 Reoair Order Kumber: 1538A
-
• System Scanned (26)
Calbration Statio/OTC
Svstem
Engine
Transmission
8 ABS/VSC/TRC/EPB
0 SRS airbag
Combination meter
Tire pressure monitor
Main body
Driver dodr motor
6 Right rear doar motor
Left rear door motar
0 Passenger doar mator
Air conditioner
Wiper
:0
Cocupant detection
Master switch
Navigation system
Telematics
Central gateway
Pre-Collision 2
Steering angie sensot (S49)
No Label
-O P
Claim Reference Id: 2512375441301
File Name: Photo 22.jPg
File Date: 12/29/2025
Label:
Note:
Photo Location:
Photo Taken By:
Estimate Indicator:
000068 29/32
ite/Camry/425A.FKS Report ID: MAX(A20231229765141
2025-12-19085241
6 -keeping assist (LKA)/Lane departure alert (DA)
ont recognition camera
EMPS
0 Aadar cruise 2
Redar cruise 1
Immabilizer
• Pre-scan DTC (6)
Engine (1 DTC)
Status
ĐTC Description
Engine coolant bypass valve circuit short to battery or Confirmed P268115
open
ABS/VSC/TRC/EPB (1 DTC)
Status
DTC Description
Vehicle driven with steering angle sensor (SAS) not History G1445
initialized
Combination meter (1 DTC)
Status
DTC Description
Last communication with crulse control front distance Confirmed U023587
range sensor missing message
Main body (2 DTCa)
Status
ĐTC Description
Power window(e/s) master switch electronic.conso History B1205 unit(ECU) communication. stop
Driver door motor electronic control chit(ECt) History
B2321
communication stop
Lane keeping assist (LKA)/Lane departure alert (LDA) (I DTO) States
DTC. Descriptian
Lost commonication with cruse contol fide listance Histery U0235 range sensor
Pre-scan Technician Notes
No Label
CoPY
2512375441301
e: Photo 23.jpg
File Date: 12/29/2025
Label:
Note:
Photo Location:
Photo Taken By:
Estimate Indicator:
000068 30/32
-
No Label
75441301
24.jpg
(2025
Label:
Note:
_PY
No Label
Claim Reference Id: 2512375441301
File Name: Photo 25.jpg
File Date: 12/29/2025
Label:
Note:
Photo Location:
Photo Taken By:
Estimate Indicator:
000068 31/32
яативо иО
No Label
2512375441301
Photo 26.JPg
File Date: 12/29/2025
Label:
Note:
COPY
No Label
Claim Reference Id: 2512375441301
File Name: Photo 27.jpg
File Date: 12/29/2025
Label:
Note:
Photo Location:
Photo Taken By:
Estimate Indicator:
692
ZE/LE 890000
No Label
2512375441301
Photo 28.jpg
File Date: 12/29/2025
Label:
Note:
•o P
3/10/26, 11:00 AM Guidewire ClaimCenter (Andres Pinzon) Claim 25123754413 Desktop • Claim (25123754413) Search Address Book y Vat Po Ins: Jackeling Mendoza Valle DoL: 12/02/2025
Adj: Tatiana Bibbins (KAWTeam 321) Loss State CA Policy State CA UnderWriting Groun Infinity A Contact
Financials: Checks
AL
Check Number * Pay To ÷ Gross Amount Issue Date Scheduled Send Date: Status
JACKELING
615-3084346 MENDOZA $2,516.28 12/17/2025 12/17/2025 Geared
SI VALLE
NEWSMILE
Tr
AUTO
615-3103451 BODY&
$5,257.64 01/02/2026 01/02/2026 Cleared
Ch JACKELING
MENDOZA
VALLE
NEWSMILE
615-3111022 AUTO $30.89 01/08/2026 01/08/2026 Cleared
BODY
:
*%
LP
TS
https://claims.kemperi.com/cc/ClaimCenter.do
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