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Home My WebLink About20162091.tiffAMERICAN FAMILY INSURANCE Scanning Center 16000 American Pkwy I Madison WI 53783-0001 I 1-800-MYAMFAM (692-6326) I amfam.com June 17, 2016 16-IABOO1 WELD COUNTY COMMISSIONERS PO BOX 758 GREELEY CO 80632-0758 RE: Our Claim Number: Our Policy Number: Our Insured: Date of Loss: 00-175-055297-1912 41000843-11 Joshua A Raun March 8, 2016 Certified Mail Return Receipt Requested Dear Weld County Commissioners: Please accept this correspondence as notice of a claim for damages. Name and address of the claimant: American Family Insurance as subrogee of Joshua Raun Claim 175 055297 PO Box 3328 Englewood CO 80155 RECEIVEL JUN Z 3 20 WELD COUNT' COMM±°SiONF- Factual basis of the claim: On 3/8/16, the American Family insured, Joshua Raun was southbound on 8th Avenue in Greeley in the right lane. A Weld County dump truck was in the left lane. When the vehicles crossed the railroad tracks, rocks fells from the Weld County vehicle into Joshua Raun's vehicle. The hood and windshield were scratched/dented. Joshua called police. Please see the call log. We also have photos of the dump truck. Time and Location: 3/8/16, around 1 pm Name and address of involved public employee: Weld County P.O. Box 758 Greeley, CO 80632 (1imtJ Y l i Gt + i J n S R 1/11 /5 2016-2091 Extent of damages claimed: Repairs needed to the American Family insured's vehicle, 2015 Subaru Legacy Monetary damages claimed: $1428.39 Our supporting documentation is attached. Sincerely, Anna A Berry Subrogation Senior Adjuster American Family Insurance Company 1-800-MYAMFAM (1-800-692-6326) X 52209 aberr2@amfam.com Fax: 866-855-0147 www.amfam.com/claims Enc: It is unlawful to knowingly provide false, incomplete, or misleading facts or information to an insurance company for the purpose of defrauding or attempting to defraud the company. Penalties may include imprisonment, fines, denial of insurance, and civil damages. Any insurance company or agent of an insurance company who knowingly provides false, incomplete, or misleading facts or information to a policyholder or claimant for the purpose of defrauding or attempting to defraud the policyholder or claimant with regard to a settlement or award payable from insurance proceeds shall be reported to the Colorado Division of Insurance within the Department of Regulatory Agencies. 'JD nn ,J o r s Co/act/l Co Page 1 of 1 http : //ics.amfam.com/ics/claim/viewImage.do?print=true&doc_id= { A806CD64-03 F0 -40A... 6/ 17/2016 Page 1of1 /fyt,�yI�+•ti" tttt(tttrrrrtt,ttt,: i � � t�'iEi1, ,; vas ,;4 ! �f f7l It' t i aI, , I II I a i .;.' k:c`: � ( '' t•._ ♦ ii t . i f Rat 1 Yh `•M 11•.1 ` ��,.� . Edit .I• to i 1 r r i 1 y ♦ tti . ') , t f F',IS'L v http : //ics. amfam. com/ics/claim/viewImage. do?print=true&doc_id= { B 8 5 72143 -4F69 -44C... 6/17/2016 S.A.T.R.N. Subro Potential Page 1 of 1 SATRN Insured: RAUN. JOSHUA A Claim: 00-175-055297 Policy: Loss Date: 41000-8431 I 03-08-2016 Go Back Save and Go Back Subrogation Potential Select/Deselect Claimant ID 00 Peril COMPREHENSIVE - MISC. NON - COLLISION AND FIRE THEFT WIND (FTW)COVERAGE (059) Sub -Peril FALLING OBJECT/MISSILE Coverage Comprehensive Transaction Sub -Class Draft Key 0100180407 Pymt Type 01 Payment Date 06-10-2016 Select Draft Deductible Applied 0.00 Amount Paid $ 1,428.39 Payee Name ABRA AUTO BODY https://satrn.amfam.com/satrn/SubroActivity?subrold=00175055297 6/16/2016 ABRA AUTO BODY & GLASS - GREELEY 2835 S 31ST AVE GREELEY, COLORADO 80631 PHONE 970-352-1316 FAX 970-352-2054 *** ESTIMATE *** 04/04/2016 11:29 AM WASOAINNW Owner Owner: JOSHUA A RAUN Address: 48153 COUNTY ROAD 31 City State Zip: NUNN, CO 80648-9724 (970)590-8468 Control Information r - - Inspection Claim # : 00175055297-0C Loss Date/Time: 03/08/2016 06:00 AM Deductible: Unknown ins. Company: Company Contact: Address: City State Zip: Email: American Family Insurance Toni Call 2835 S 31ST AVE. Greeley, CO 80631 greeley@ABRAAUTO.COM Insured: JOSHUA A RAUN Address: Insured Policy # : 4100084311 Loss Type: Other Comp Work/Day: (970)352-1316 FAX: (970)352-2054 (970)590-8468 Inspection Date: 04/04/2016 11:28 AM Inspection Location: INS advd CRP will contact w/in 2 business days to schedule e Address: 48153 COUNTY ROAD 31 City State Zip: NUNN, CO 80648-9724 Primary Impact: Front Driveable: Yes Assigned Date/Time: First Contact Date/Time: Appraiser Name: TOM CALL Inspection Type: Direct Repair Program Contact: (970)590-8468 Secondary Impact: Rental Assisted: Received Date/Time: 03/17/2016 07:35 AM Appointment Date/Time: 03/17/2016 06:00 AM Appraiser License # : Repairer Repairer: ABRA Auto Body & Glass Address: 2835 S 31st Ave City State Zip: Greeley, CO 80631 Email: greeley@abraauto.com Repair Start Date/Time: 05/17/2016 Repair Complete Date/Time: 05/20/2016 Target Complete Date/Time: 05/20/2016 Contact: Work/Day: (970)352-1316 FAX: (970)352-2054 Work/Day: Vehicle Drop Off Date/Time: 05/16/2016 Vehicle Pick Up Date/Time: 05/23/2016 Days To Repair: Vehicle 06/01/2016 11 54 AM Page 1 of 4 2015 Subaru Legacy 2.5i Limited 4 DR Sedan Claim # 00175055297-0C 04/04/2016 11 29 AM 2015 Subaru Legacy 2.5i Limited 4 DR Sedan 4cyl Gasoline 2.5 PZEV Continuously Variable Tr Lic.Plate: QYQ-793 Lic Expire: Prod Date: Veh Insp# : Condition: Ext. Color: Carbide Gray Metallic Ext. Refinish: Two -Stage Ext. Paint Code: GG3 Options - AudaVIN Information Received Lic State: CO VIN: 4S3BNBJ61 F3064306 Mileage: 10,724 Mileage Type: Actual Code: F2304A Int. Color: Black Int. Refinish: Int. Trim Code: BLC 1st Row LCD Monitor(s) Air Conditioning Aluminum/Alloy Wheels Auto Headlamp Control Blind Spot Sensor Center Console Daytime Running Lights Dual Power Seats Electronic Compass Garage Door Opener Head Airbags Heated W/S Wiper Washers Illuminated Visor Mirror Keyless Entry System Leather Shift Knob MP3 Decoder Pelvic Airbags Power Windows Rear View Camera Side Airbags Stability Cntrl Suspensn Theft Deterrent System Tire Pressure Monitor Trip Computer Wireless Phone Connect 2nd Row Head Airbags Alarm System Amplifier Automatic Dimming Mirror Bucket Seats Chrome Grille Digital Signal Processor Dual Zone Auto NC Ext Mirror Turn Signals Halogen Headlights Heated Frnt & Rear Seats High Definition Radio Interior Cargo Tray LED Brakelights Leather Steering Wheel Mud/Splash Guards Power Brakes Pwr Driver Lumbar Supp Rear Window Defroster SiriusXM Satellite Radio Strg Wheel Radio Control Tilt & Telescopic Steer Touch Screen Display USB Audio Input(s) AM/FM CD Player All -Weather Mats (Floor) Anti -Lock Brakes Auxiliary Audio Input Cargo/Trunk Net Cruise Control Dual Airbags Electric Steering Fog Lights Harman Kardon Sound Sys Heated Power Mirrors IPOD Control Intermittent Wipers Leather Seats Lighted Entry System Overhead Console Power Door Locks Rear Collisn Mitigation Rem Trunk-L/Gate Release Split Folding Rear Seat Tachometer Tinted Glass Traction Control System Wireless Audio Streaming AudaVIN options are listed in bold -italic fonts Damages Line Op Guide MC Description MFR.Part No. Price ADJ% B% Hours R 1 RI 8 Frt Bumper Cvr Overhau 2 I 6 Cover,Front Bumper 3 L 6 # Cover,Front Bumper # = 10, 13 » BASECOAT REDUCTION TAKEN 4 RI 15 5 RI 126 6 RI 127 7 RI 7 8 RI 28 9 RI 1065 10 I 83 11 L 83 12 E 143 Grille,Frt Bumper Lwr Filler,Front Bumper LT Filler,Front Bumper RT Absorber,Front Bumper Grille Assembly Brkt,Grille Mounting Panel,Hood 10 Panel,Hood R & I Assembly Repair Refinish R & I Assembly R & I Assembly R & I Assembly R & I Assembly R & I Assembly R & I Assembly Repair Refinish » BASECOAT REDUCTION TAKEN Windshield,Tinted 65009AL17C INC 0.2 INC 0.8 INC 0.3 2.0* 3.1* $369.96 2.8 SM SM RF SM SM SM SM SM SM SM RF SM 06/01/2016 11 54 AM Page 2 of 4 I 2015 Subaru Legacy 2 5i Limited 4 DR Sedan Claim # 00175055297-0C 04/04/2016 11 29 AM 13 E 14 EC 15 EC 15 150 M60 Items MIdg,W/S Reveal Upper Hazardous Waste Removal Restore corrosion MC Message 65058AL01 A Replace Economy Replace Economy $79.95 $3.00* $8.00* -2.50 INC SM SM SM 10 INCLUDES AUDATEX TIME TO CLEAR ENTIRE PANEL 13 INCLUDES 0.6 HOURS FIRST PANEL TWO -STAGE ALLOWANCE Estimate Total & Entries Gross Parts Other Parts Paint & Materials Line Item Discount Parts & Material Total Tax on Parts & Material 6.2 Hours @ $32.00 @ 7.010% Labor Rate Replace Repair Hrs Total Hrs Hrs $449.91 $11.00 $198.40 $2.00 - Sheet Metal (SM) Mech/Elec (ME) Frame (FR) Refinish (RF) $50.00 $89.00 $75.00 $50.00 5.3 3.0 8.3 $415.00 6.2 6.2 $310.00 Labor Total Gross Total Less: Deductible Net Total (Final Bill) 14.5 Hours Alternate Parts C/00/00/00/00/00 CUM 00/00/00/00/00 Zip Code: 80631 Geo 80631 Recycled Parts Y/0/0 Zip Code: 80631 Rate Name Default Audatex Estimating 7.0.813 ES 06/01/2016 11:54 AM REL 7.0.813 DT 03/01/2016 DB 05/15/2016 Copyright (C) 2016 Audatex North America, Inc. $657.31 $46.08 $725.00 $1,428.39 Unknown - $1,428.39 1.7 HRS WERE ADDED TO THIS ESTIMATE BASED ON AUDATEX'S TWO -STAGE REFINISH FORMULA. THIS ESTIMATE HAS BEEN PREPARED BASED ON THE USE OF ONE OR MORE CRASH PARTS SUPPLIED BY A SOURCE OTHER THAN THE MANUFACTURER OF YOUR MOTOR VEHICLE. WARRANTIES, IF ANY, APPLICABLE TO THESE REPLACEMENT CRASH PARTS ARE PROVIDED BY THE PARTS MANUFACTURER OR DISTRIBUTOR RATHER THAN BY THE MANUFACTURER OF YOUR VEHICLE. IT IS UNLAWFUL TO KNOWINGLY PROVIDE FALSE, INCOMPLETE, OR MISLEADING FACTS OR INFORMATION TO AN INSURANCE COMPANY FOR THE PURPOSE OF DEFRAUDING OR ATTEMPTING TO DEFRAUD THE COMPANY. PENALTIES MAY INCLUDE IMPRISONMENT, FINES, DENIAL OF INSURANCE AND CIVIL DAMAGES. ANY INSURANCE COMPANY OR AGENT OF AN INSURANCE COMPANY WHO KNOWINGLY PROVIDES FALSE, INCOMPLETE, OR MISLEADING 06/01/2016 11 54 AM Page 3 of 4 2015 Subaru Legacy 2 5i Limited 4 DR Sedan Claim # 00175055297-0C 04/04/2016 11:29 AM FACTS OR INFORMATION TO A POLICYHOLDER OR CLAIMANT FOR THE PURPOSE OF DEFRAUDING OR ATTEMPTING TO DEFRAUD THE POLICYHOLDER OR CLAIMING WITH REGARD TO A SETTLEMENT OR AWARD PAYABLE FOR INSURANCE PROCEEDS SHALL BE REPORTED TO THE COLORADO DIVISION OF INSURANCE WITHIN THE DEPARTMENT OF REGULATORY AGENCIES. Op Codes * = User -Entered Value EC = Replace Economy ET = Partial Replace Labor TE = Partial Replace Price L = Refinish TT = Two -Tone BR = Blend Refinish CG= Chipguard AA = Appearance Allowance E = Replace OEM OE= Replace PXN OE Srpls EP = Replace PXN PM = Replace PXN Reman/Reblt PC = Replace PXN Reconditioned SB = Sublet Repair I = Repair RI = R & I Assembly RP = Related Prior Damage NG = Replace NAGS UE = Replace OE Surplus EU = RECYCLED PART UM= Replace Reman/Rebuilt UC = Replace Reconditioned N = Additional Labor IT = Partial Repair P = Check This report contains proprietary information of Audatex and may not be disclosed to any third party (other than the insured, claimant and others on a need to know basis in order to effectuate the claims process) without Ciludatex Audatex's prior written consent. a Solna company Copyright (C) 2016 Audatex North America, Inc. Audatex Estimating is a trademark of Audatex North America, Inc. 06/01/2016 11:54 AM Page44 of 4 GREELEY/WELD CRIMINAL JUSTICE RECORDS COPY RELEASED TO: LinS AOC DATE: 0441 Co 04/13/16 12:34 Call Number: Nature: Reported: Rcvd By: Occ Btwn: Type: Priority: Address: City: Alarm: GREELEY POLICE DEPARTMENT CALL DETAIL REPORT 1538013 VANDC 13:14:18 03/08/16 PRICHARD A 13:13:29 03/08/16 1 4 BY: How Rcvd: T and 13:13:29 03/08/16 5TH ST @ 8TH AVE ;JUST NORTH ;SB GREELEY COMPLAINANT/CONTACT Complainant: , Race: Sex: Address: , Home Phone: DOB: **/**/** Contact: JOSHUA RAUN Address: Phone: RADIO LOG Dispatcher Time/Date Unit Work Phone: 1473 ISE OF TITS INFORMATIN IS REGULATED BY LAW 'fl NOT DISSEMINATE. Name#: Code Zone Agnc Description 1 PRICHARD A STUDER A STUDER A STUDER A WHIPPLE SWANSON SWANSON SWANSON WHIPPLE WHIPPLE WHIPPLE WHIPPLE SWANSON COMMENTS J T T T J J 13:16:15 03/08/16 13:21:11 03/08/16 G291 13:30:03 03/08/16 G291 13:30:04 03/08/16 G291 13:38:27 03/08/16 G291 13:58:55 03/08/16 G291 14:05:21 03/08/16 G291 14:31:17 14:43:43 14:43:44 J 14:44:18 J 14:44:19 T 14:50:27 03/08/16 03/08/16 03/08/16 03/08/16 03/08/16 03/08/16 G291 G291 G291 G291 G291 G291 RCVD GPA GPD OSPH GPA GPD LOCT GPA GPD ER GPA GPD OS GPA GPD LOCT GPA OS GPA OK GPA NMIN GPA DLIN GPA VHIN VHRE TCIT GPA GPA GPA GPD GPD GPD GPD GPD GPD GPD GPD Call 4581 changed from INPUT to RCVD incid#=16G018885 ON SCENE BY PHONE call=4581 Unit Location: 924 11TH ST incid#=16G018885 ENROUTE call=4581 (MDC) Arrived on scene incid#=16G018885 call=4581 Unit Location: 1111 H ST incid#=16G018885 ON SCENE call=4581 incid#=16G018885 CODE 4 call=4581 MDC: name=FILLINGER, CHRISTOPHER MDC: name=FILLINGER, CHRISTOPHER MDC: p1=512A34 st=CO MDC: p1=512A34 st=CO incid#=16G018885 CLEAR TS WITH CITATION clr:T call=4581 GRAVEL FELL OUT OF GREELEY DUMP TRUCK AND HIT RP'S CAR 04/13/16 12:34 GREELEY POLICE DEPARTMENT CALL DETAIL REPORT Page: 1473 2 13:17:48 03/08/2016 - PRICHARD A SUSP VEH WELD DUMP TRUCK FLEET NUMBER 15460024 .DOT NUMBER POSS 9927276CO .WHT WELD COUNTY DUMP TRUCK. 13:18:51 03/08/2016 - PRICHARD A RP'S CAR IS A GREY 2015 SUBARU LEGACY LIC QYQ793 COLORADO PLATE. 13:19:07 03/08/2016 -- PRICHARD A GRAVEL DAMAGED RP'S WINDSHIELD AND HOOD OF THE CAR. 13:19:16 03/08/2016 - PRICHARD A CONT BY PHN UNIT HISTORY Unit Time/Date Code G291 G291 G291 G291 G291 G291 G291 G291 G291 G291 G291 G291 13:16:15 13:21:11 13:30:03 13:30:04 13:38:27 13:58:55 14:05:21 14:31:17 14:43:43 14:43:44 14:44:18 14:44:19 14:50:27 03/08/16 03/08/16 03/08/16 03/08/16 03/08/16 03/08/16 03/08/16 03/08/16 03/08/16 03/08/16 03/08/16 03/08/16 03/08/16 RESPONDING OFFICERS Unit Officer G291 WHIPPLE J INVOLVEMENTS Type Record# Date RCVD OS PH LOCT ER OS LOCT OS OK NMIN DLIN VHIN VHRE TCIT Description Relationship LW 16G018885 03/08/16 VANDC 16G018885 5TH ST @ 8TH Initiating Call copy USE of THIS INFORMATION IS REGULATED BY LAW no NOT DISSEMINATE. Photos for Claim Number Page 1 of 1 1 Attached: 04/04/16 11:32am WINDSHIELD Attached: 04/04/16 11:32am RR O, https://www.audatexso[utions.com/searchview/DispPhoto.asp?wa pk=372003071 &claim_... 6/16/2016 Hello