American Family Mutual Insurance Company, S.I. vs Cabdullahi Cusman, 27-CV-23-16837, 31102023_Other Document_0 (Minnesota State, Hennepin County, District Court Oct. 31, 2023) (2024)

`

`27-CV-23-16837
`
`Filed in District Court
`State of Minnesota
`10/31/2023 2:03 PM
`
`06/29/202310:42AM
`
`Page2
`
`User:HeatherTripp
`
`SOLUTIONS
`RISK,
`LEXISNEXIS
`
`PartIal-FAIRVIEW
`Supplement-
`
`CARE
`EXPRESS
`
`Pamai-FAIR\/|EI/V
`
`CARE
`EXPRESS
`
`Submitted
`
`Loss"Cost
`
`Submitted
`
`Other
`Expensej
`
`Submitted
`
`LossCost
`
`HOSPITAL
`RIDGES
`FAIRVIEw
`
`HOSPITAL
`FAIRVIEW
`CENTER}
`SURGERY
`AND
`CLINICS
`HEALTH'
`MINNESOTA
`OF,
`UNIVERSITY
`
`Partial
`
`Submitted
`
`LessCost
`
`Partial
`
`Submitted
`
`Loss005':
`
`.
`
`Partial
`
`supmitted
`
`LossCost
`
`Partial-VFAIRMIEW
`
`ROGERS
`CLINICS
`
`Subrnitted
`
`LossCost
`
`/
`
`Medical
`PIP-
`
`Collision
`Person
`ExpensePer
`Medical
`PIP-
`Person
`ExpensePer
`Medical
`PIP'~
`Person
`ExpensePer
`Medical
`Pia-
`
`Person
`ExpensePer
`Medical
`PIP-.'7'
`Person
`ExpensePer
`Medical
`PIP-
`Person
`ExpensePier
`
`"
`
`2
`
`2
`
`2
`
`$224.00
`
`03/I8/2022
`
`03/18/2022
`
`133.85
`
`03/16/2022
`
`03/15/2022
`
`$212:00
`
`03/01/2022
`
`03/01/2022
`
`$619.00
`
`02/09/2022
`
`02/0/2022
`
`$552.00
`
`02/09/2022
`
`02/07/2022
`
`$483.00
`
`01/13/2022
`
`01/12/2022
`
`($256.00
`
`01/12/2022
`
`01/10/2022
`
`Number
`'Ch'eck
`
`PmtType
`
`CostType
`
`Coverage
`
`Exposure
`
`Amount
`
`IssueDate
`
`SendDate
`Scheduled
`
`|
`
`A.— mummmv7
`
`|
`
`|
`
`|
`
`Claim:01-004-187405
`
`XLUSBLQNilhefl
`
`PayTo
`
`Sta
`Pol'
`
`|Clm:01-004-187405MN|Ins:CHERYLERICKSONIDoL:12/15/2021|
`
`

`

`27-CV-23-16837
`
`Filed in District Court
`State of Minnesota
`10/31/2023 2:03 PM
`
`06/29/202310:42AM
`
`Page3
`
`User:HeatherTripp
`
`Person
`Expense5er
`
`PayTo
`
`Number
`Check
`
`PmtType
`
`a
`
`Sta
`Pnl'
`
`IClm:01-004-187405MNIIns:CHERYLERICKSONIDOL:12/15/2021I
`
`II
`
`I
`
`'
`
`CostType
`
`Coverage
`
`Exposure
`newmm:7
`
`I
`
`"
`
`Amount
`
`IssueDate
`
`I
`
`I
`
`SendDate
`Scheduled
`
`Claim:01-004-187405
`
`

`

`COPART AUTO AUCTIONS
`10588 CENTRAL AVE NE
`BLAINE, MN 55434
`(763) 781—1025
`PHONE
`
`TAX ID# -
`
`27-CV-23-16837
`
`EXHIBIT
`
`01
`
`FINAL INVOICE
`
`Filed in District Court
`State of Minnesota
`10/31/2023 2:03 PM
`
`Date
`1/11/22
`Visit us at www.copart.com
`All Amounts are in USD
`
`Copart Lot#
`Loss Date
`Called In
`P/U Cleared
`Pickup Date
`Original Title
`Trans Title
`Sale Document
`Loss Type
`Description
`Vehicle ID#
`License#/ST
`Mileage
`Pickup From
`
`37 MW
`
`- MINNEAPOLIS
`
`69988481
`12/15/21
`12/17/21
`12/20/21
`12/21/21
`12/21/21
`12/22/21
`12/22/21
`COLLISION
`13 SUBA OUTBACK
`4S4BRCJCOD3295593
`MMZ 633
`MN
`92,001
`LAMETRYS COLLISION- LAKEVILLE
`21023 CEDAR AVE
`LAKEVILLE, MN 55044 7217
`(952) 985-5855
`
`SILVR
`
`ADVANCE CHARGES PAID BY COPART
`TOW SERVICE
`TAX
`
`TOTAL ADVANCE CHARGES
`
`COPART SERVICE CHARGES
`PIP FEE/SERVICE FEE
`
`TOTAL COPART SERVICE CHARGES.
`
`PIP249A
`AF22
`JOAN PETERSON
`AFMIC-AM FAM MUTUAL INS CO, SI
`302 NORTH WALBRIDGE AVENUE
`MADISON, WI 53714 1958
`
`Claim# 01-004-187405
`Policy#
`Loss Code C
`Reference#
`Insured CHERYL ERICKSON
`Owner CHERYL ERICKSON
`
`356.24
`25.38
`
`381.62
`
`69.00
`
`69.00
`
`450.62
`3350.00CR
`2899.38
`
`.00
`
`*Bid Raised By Internet*
`
`TOTAL DUE COPART
`PROCEEDS FROM SALE
`CHECK PAYMENT FROM COPART.
`
`.
`
`NET DUE COPART
`
`COPART PAYMENTS DETAIL
`COPART CHECK# 62360584
`
`69988481
`Lot#
`Sale Date
`1/06/22
`Sale Amount
`3350.00
`14759.00
`ACV
`Repair E512716.23
`Return
`22.6%
`
`1/07/22
`Payment From Buyer
`Reported To NICB 1/07/22
`
`01/10/22
`
`2,899.38
`
`SALE INFORMATION
`
`Sold To
`
`Item#
`
`130
`
`1495 BROADWAY ST W
`ROCKVILLE, MN 56369
`(320) 685-7214
`Invoice Date
`Invoice Amount
`
`REMIT TO: COPART
`4610 WESTAMERICA DRIVE
`FAIRFIELD, CA 94534
`
`46155 AUTOMOTIVE PARTS SOLUTIONS
`
`1/10/22
`.00
`
`USD
`
`

`

`27-CV-23-16837
`
`EXHIBIT3
`
`Filed in District Court
`State of Minnesota
`10/31/2023 2:03 PM
`
`Prepared for AMERICAN FAMILY MUTUAL INSURANCE COMPANY, S. I.
`
`E" REPORT SUMMARY
`Mbi CLAIM INFORMATION
`
`Owner
`
`Loss Vehicle
`
`Loss Incident Date
`Claim Reported
`
`Erickson. Cheryl
`5836 Abbott Ave S
`Edina, MN 55410-2810
`2013 Subaru Outback Limited
`Automatic
`12/15/2021
`12/15/2021
`
`(9—0)
`.'-'-_".
`
`INSURANCE INFORMATION
`
`Report Reference Number
`Claim Reference
`
`Adjuster
`Appraiser
`Odometer
`Last Updated
`
`105058229
`01004187405-1
`Sokol, Scott
`Hilde, Kenneth
`92,001
`12/15/2021 04:02 PM
`
`VALUATION SUMMARY
`Base Vehicle Value
`Condition Adjustment
`Adjusted Vehicle Value
`$ 13,616.00
`Total
`$ 13,6163!)
`The total may not represent the total Of the settlement as other factors (e.g. license and
`fees) may need to be taken into account.
`
`$ 13,334.00
`+ $ 282.00
`
`Thé5CCC'ONE® Market ValuatIon
`summary-reflects ccc Intelligent
`SdlutionsInc '5 00mm as to th
`0f theIlOs's'ivehEéIe, based on Information
`pr'Ovidedjtdgccc by AMERICAN FAMILY:
`MUIUALj-IVNSURANCE COMPANY, s I
`
`Loss vehicle has 14"A) fewer than
`average'rrni'l'eage Of 107,200
`
`BASE VEHICLE VALUE
`This-is deriVed per our Valuation
`fiwthbdélogy described on the next
`bade:
`
`ADJUSTED VEHICLE VALUE
`This isdetermxned by adjusting the
`Ba'sefVahiCle Value to account for the
`actual'oondition'Of the loss vehIcle and
`oertaihiothel reported attributes, If any,
`ch'asirefurbIshments and aft
`equipment,
`
`'Iirii'slidethe Report
`
`valuationzMethodology
`MehiCle;lhfofrnation
`
`EVehide1COndItion .
`
`ComparahIeVehfIcles
`
`2}
`
`3'
`6
`
`'7'"
`
`© Copyright 2021 000 Intelligent Solutions Inc. All Rights Reserved.
`
`Page 1 Of 7
`
`

`

`27-CV-23-16837
`
`Filed in District Court
`State of Minnesota
`10/31/2023 2:03 PM
`
`CfJJEON E. MARKET VALUATION SUMMARY
`
`Sgfif'ofiggii224EZ?P'
`
`VALUATION METHODOLOGY
`How was the valuation determined?
`
`CLAIM INSPECTION
`AMERICAN FAMILY MUTUAL INSURANCE COMPANY, SJ. 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.
`
`f I
`
`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 that CCC employees have physically inspected, as well as
`vehicles advertised for sale by dealerships or private parties. All of
`these sources are updated regularly.
`
`SEARCH FOR COMPARABLES
`When a valuation is created the database is searched and
`comparable vehicles in the area are selected. The zip code
`where the loss vehicle is garaged determines the starting point '
`for the search. Comparable vehicles are similar to the loss
`vehicle based on relevant factors.
`
`CALCULATE BASE VEHICLE VALUE
`Adjustments to the price of the selected comparable vehicles are made to reflect
`differences in vehicle attributes, including mileage and options. Dollar adjustments are
`based upon market research.
`Finally, the Base Vehicle Value is the weighted average of the adjusted values of the
`comparable vehicles based on the following factors:
`~ Source of the data (such as inspected versus advertised)
`- Similarity (such as equipment, mileage, and year)
`o Proximity to the loss vehicle's primary garage location
`- Recency of information
`
`© Copyright 2021 CCC Intelligent Solutions Inc. All Rights Reserved.
`
`Page 2 0f 7
`
`

`

`27-CV-23-16837
`
`Filed in District Court
`State of Minnesota
`10/31/2023 2:03 PM
`
`CILDSONE. MARKET VALUATION SUMMARY
`
`Owner: Erickson, Cheryl
`Claim: 01004187405-1
`
`9 VEHICLE INFORMATION
`
`VEHICLE DETAILS
`
`Location
`VIN
`Year
`Make
`Model
`Trim
`Body Style
`Body Type
`Engine -
`Cylinders
`Displacement
`Fuel Type
`Carburation
`Transmission
`Curb Weight
`
`MINNEAPOLIS, MN 55410-2810
`4S4BRCJCOD3295593
`2013
`Subaru
`Outback
`Limited
`Automatic
`Station Wagon
`
`4
`2.5L
`Gasoline
`Electronic Fuel Injection
`Automatic Transmission 4 Wheel Drive
`3538 lbs
`
`3Vehicles=soldin theUnitéd'St'atéS
`:arerrequired;to have a rnanufaCturer
`-ass:gned,VehncletldentIficatIon
`-Number(VIN).,This number prevudes
`:oertarnspecrficatlons otthe vehicle.
`
`Eélease'revi'ew theinformationin the_
`E[Vehicle"Information Sectionio confifin
`the reamed. mileage and conditions
`:and :to'verify that-the information
`samurateIyEmfleds the options:
`:additionalequipment. refurbishments
`or other. aspects of the loss.vehicle that
`mayumpact the-value.
`
`'
`
`© Copyright 2021 C00 Intelligent Solutions Inc. All Rights Reserved.
`
`Page 3 of 7
`
`

`

`.
`
`,
`
`,
`
`.
`
`>V Standard Thls~equlpment'»ls
`includedzin the-base: oonfiQUration;ot;
`theivehicle'atltime.of purchase.
`
`.EITiA'd'dluonal'Equipmént'tliatiisnot
`Standard butewas;nOted3to'5eEOn=flie
`.. ..
`loss.vehlcle.»
`
`;
`
`27-CV-23-16837
`
`Filed in District Court
`State of Minnesota
`10/31/2023 2:03 PM
`
`CffifiONE. MARKET VALUATION SUMMARY
`B VEHICLE INFORMATION
`
`VEHICLE EQUIPMENT
`
`Owner: Erickson Cheryl
`Claim: 01004187405-1
`
`the efl is the equipment-of the
`iloss vehicle thatiAMERlCANzl-TAMILY
`MUTUAL INSURANCE COMPANY, 34,
`Eipr<_2_\_/iéled;_to CCQ.V
`
`Odometer
`
`Transmission
`
`Power
`
`Decor/Convenience
`
`Seating
`
`Radio
`
`92,001
`
`Automatic Transmission
`4Wheel Drive
`Power Steering
`Power Brakes
`
`Power Windows
`
`Power Locks
`
`Power Mirrors
`Power Driver Seat
`Power Passenger Seat
`Air Conditioning
`Climate Control
`
`Tilt Wheel
`
`Cruise Control
`Rear Defogger
`lnterrnittent Vlfipers
`
`Console/Storage
`Overhead Console
`
`Keyless Entry
`Telescopic Wheel
`Message Center
`Wood Interior Trim
`Bucket Seats
`Leather Seats
`Heated Seats
`
`AM Radio
`
`FM Radio
`
`Stereo
`
`Search/Seek
`CD Player
`Steering Wheel Touch Controls
`Auxiliary Audio Connection
`
`(9 Copyright 2021 ccc intelligent Solutions Inc. All Rights Reserved.
`
`Page 4 of 7
`
`

`

`27-CV-23-16837
`
`Filed in District Court
`State of Minnesota
`10/31/2023 2:03 PM
`
`C/'LSONE. MARKET VALUATION SUMMARY
`B VEHICLE INFORMATION
`
`VEHICLE EQUIPMENT
`
`3;:{3E33'gj'34'ggfir'
`
`Wheels
`Roof
`
`Safety/Brakes
`
`Exterior/Painthlass
`
`Premium Radio
`
`Satellite Radio
`Aluminum/Alloy Wheels
`Luggage/Roof Rack
`Air Bag (Driver Only)
`Passenger Air Bag
`Anti-lock Brakes (4)
`4—wheel Disc Brakes
`Front Side Impact Air Bags
`Head/Curtain Air Bags
`Hands Free
`
`Alarm
`
`Traction Control
`
`Stability Control
`Dual Mirrors
`
`Heated Mirrors
`Privacy Glass
`Fog Lamps
`Rear Spoiler
`Rear Window Wiper
`Clearcoat Paint
`
`Metallic Paint
`
`© Copyright 2021 CCC Intelligent Solutions Inc. All Rights Reserved.
`
`Page 5 of 7
`
`

`

`27-CV-23-16837
`
`Filed in District Court
`State of Minnesota
`10/31/2023 2:03 PM
`
`Cf'JQSONE- MARKET VALUATION SUMMARY
`
`3;?;{=0E2;:i';";4%';?{"
`
`B VEHICLE CONDITION
`
`COMPONENT CONDITION
`
`Mechanical
`Tires
`
`Paint
`
`Body
`
`Glass
`
`Interior
`
`Condition
`GOOD
`EXCELLENT
`GOOD
`GOOD
`
`GOOD
`GOOD
`
`'
`Total CODdItIO" AdJUStm9I'i5
`
`'
`
`Inspection Notes
`no supporting photos
`just purchased last week
`No significant peeling and/or flaking.
`No significant surface rust. Trim:
`Minimal damage to components.
`Light surface scratches
`seats Lightly soiled carpets No
`significant bare spots. dashboard Light
`wear door pael. headliner No significant
`scuffing.
`
`Value Impact
`$ 0
`
`$ 282
`
`$ 0
`
`5 0
`
`$ 0
`
`5 0
`
`.$. 282
`
`AMERICAN-FAMILY MUTUAL
`|NSURANCE.CQMP\ANY.' S.Ii;uses
`
`commonInSpewon'gyfééllnesv
`to detennlnethefioondltlon of key
`companent§10f the' loss yehiCleEpnor"
`10' méé'oss' Th'evguidellnes descnbe
`physrcal. Characteristics for msse key
`components,_fg_r,_the';qg_mlltiqn_selected;
`based updn'_age. Inspection Notes
`"meet
`e appraiser
`bservatlon 5' 3291',
`.0
`regardlngttheloss yehlcle s condltlon.
`C99 ma_kes dollar adjustments that
`reflect-the impact-the'reported condition»
`has on the valueofjhe loss vehicle as
`compared to=Gpod condition. These
`dollar adjustmentsare'based 'upon
`interviews with dealerships-across the
`United states.
`
`© Copyright 2021 ccc intelligent Solutions Inc. All Rights Reserved.
`
`Page 6 of 7
`
`

`

`27-CV-23-16837
`
`Filed in District Court
`State of Minnesota
`10/31/2023 2:03 PM
`
`CTJJfiONE. MARKET VALUATION SUMMARY
`
`Owner Erickson, Cheryl
`Claim 01004187405-1
`
`COMPARABLE VEHICLES
`$5 COMPARABLE VEHICLES
`
`Adjusted
`Comparable
`Value
`
`Price
`
`$ 13,500
`(List)
`
`$ 12,163
`
`$ 11,698
`(List)
`
`$ 13,070
`
`$ 10,998
`(List)
`
`$ 12.664
`
`Source
`
`Vehicle
`
`Comp 1
`Source: Dealer Ad
`Prospect Auto Sales
`Osseo. MN
`(763) 425-0646
`14 Miles From Minneapolis,
`MN
`
`2013 Subaru Outback
`Premium Automatic 4 2.5l
`Gasoline Electronic Fuel
`Injection
`Odometer: 86,800
`VIN: 4S4BRBCC7D3252344
`Stock #: 252344
`Updated Date: 12/09/2021
`
`Comp 2
`2013 Subaru Outback
`Source: Dealer Ad
`Premium Automatic 4 2.5l
`Richfield Bloomington Hon
`Gasoline Electronic Fuel
`Minneapolis, MN
`(612) 866-8832
`Injection
`3 Miles From Minneapolis, MN Odometer: 136,396
`VIN: 4S48RBCC4D3296592
`Stock #: 19306P
`Updated Date: 12/09/2021
`
`Comp 3
`Source: Dealer Ad
`Richfield Bloomington Hon
`Minneapolis, MN
`(612) 866-8832
`3 Miles From Minneapolis, MN
`
`2013 Subaru Outback
`Premium Automatic 4 2.5l
`Gasoline Electronic Fuel
`Injection
`Odometer: 148,924
`VIN: 4S4BRBCC4D3313455
`Stock #: 19280P
`Updated Date: 12l02/2021
`
`Comparable vehicles used In the
`deterrmnatlon of the Base Vehicle Value
`arernot intended to bereplacement
`vehicles but are reflective of the market:
`value, and may no longer be avallable
`for sale
`
`List'Prlce Is the shaker pnce of an
`inSpected dealer vehlcle and the
`advertised price for the advertised
`Vehiélé
`
`Take'fPrice is the amount that the
`dealership Wlll accept to sell the
`inspected vehicle, though a lower pnoe
`maybe obtainable through negotiation:
`
`Distance IS based upon a straight line
`between loss and comparable vehlcle
`locations
`
`Adjusted Comparable Value
`represents the price 01 the comparable
`yehiéle wrth adjustmentsfor options,
`mileage, condition, and yearlmodel/tnrn7
`as compared to the Io'ssveh'lcle
`
`A condltlon adjustment Is also made
`to setéthe comparable'vehlcle to Good
`Condmon, WhlCh the loss vehlc
`compared to In the VehicIeCondltion
`section
`
`© Copyright 2021 CCC Intelligent Solutions Inc. All Rights Reserved.
`
`Page 7 of 7
`
`

`

`27-CV-23-16837
`
`'
`
`'
`
`and More
`
`'
`LaMettry s
`
`eVI e
`ColIl-Ias|I(on,-"GIass
`"Every Customer Leaves Wim A Smile..
`21023 Cedar Ave, Lakeville, MN 55044
`Phone: (952) 985-5855
`FAX: (952) 985-8883
`Preliminary Estimate
`
`Filed in District Court
`State of Minnesota
`10/31/2023 2:03 PM
`
`658d7e84
`6M6]
`
`Workfile ID:
`PansShare:
`
`Federal ID: -
`EXHIBITf
`
`®
`
`Collision, Gloss and More!
`
`R0 Number: 534545
`
`Erickson, Cheryl
`
`15 Total Loss
`
`Insured:
`Type of Loss:
`Point of Impact:
`
`Owner:
`Erickson, Cheryl
`
`(763) 331-1066 Cell
`
`Written By: En'n Parsley
`
`Policy #z
`Date of Loss:
`
`(Jaim #z
`Days to Repair:
`
`NEED
`0
`
`Insurance Company:
`AMERIUN FAMILY INSURANCE
`
`Inspection Location:
`LaMettry's Collision, Glass and More
`Lakeville
`21023 Cedar Ave
`Lakeville, MN 55044
`Repair Facility
`(952) 985-5855 Business
`
`VEHICLE
`
`2013 SUBA Outback Limited Automatic 4D WGN 4-2.5L Gasoline Electronic Fuel Injection Silver
`
`4S43RCJC003295593
`VIN:
`License: MM2633
`State:
`MN
`
`Interior Color:
`Exterior Color:
`Producfion Date:
`
`Silver
`3/2013
`
`Mileage In:
`Mileage Out:
`Condition:
`
`92,100
`
`Vehide Out:
`
`Job #:
`
`TRANSMISSION
`Automatic Transmission
`4 Wheel Drive
`POWER
`Power Steering
`Power Brakes
`Power Vlfindows
`Power Locks
`Power Mirrors
`Heated Mirrors
`Power Driver Seat
`Power Passenger Seat
`DECOR
`Dual Mirrors
`Privacy Glass
`Console/Storage
`
`Overhead Console
`Wood Interior Trim
`CONVENIENCE
`Air Conditioning
`Intermittent Wipers
`Tilt Wheel
`Cruise Control
`Rear Defogger
`Keyless Entry
`Alarm
`Message Center
`Steering Wheel Touch Conh'ols
`Rear Window \Mper
`Telescopic Wheel
`Climate Control
`RADIO
`
`AM Radio
`FM Radio
`Stereo
`Search/Seek
`CD Player
`Auxiliary Audio Connection
`Premium Radio
`Satellite Radio
`SAFETY
`Drivers Side Air Bag
`Passenger Air Bag
`Anti-Lock Brakes (4)
`4 Wheel Disc Brakes
`Front Side Impact Air Bags
`Head/Curtain Air Bags
`Hands Free Device
`
`ROOF
`Luggage/Roof Rack
`SEATS
`Bucket Seats
`Leather Seats
`Heated Seats
`WHEELS
`Aluminum/Alloy Wheels
`PAINT
`Clear Coat Paint
`OTHER
`Fog Lamps
`Traction Control
`smbility Control
`Rear Spoiler
`
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`
`095934
`
`Page 1
`
`

`

`27-CV-23-16837
`
`Filed in District Court
`State of Minnesota
`10/31/2023 2:03 PM
`
`R0 Number: 534545
`2013 SUBA Oumack Limited Automatic 4D WGN 4-2.5L Gasoline Electronic Fuel Injection Silver
`
`Preliminary Estimate
`
`Line
`
`Oper
`
`Description
`
`Part Number
`
`Qty
`
`Extended
`Price s
`
`Labor
`
`Paint
`
`1
`
`2
`
`3
`4
`
`5
`
`6
`7
`
`8
`9
`10
`11
`
`#
`Rpr
`#
`Rpr
`FRONT BUMPER
`
`Set up and Measure Unibody
`Sheet Meal Pull per application
`
`< >
`
`*
`**
`GRILLE
`**
`
`FRONT LAMPS
`*
`
`*
`**
`
`0/H front bumper
`Repl Bumper cover
`Add for Gear Coat
`Add for fog lamps
`Spoiler accessory
`A/M NSF Energy absorber
`
`Repl
`Repl
`
`Repl AIM Grille outback
`Repl Grille bracket
`
`LKQ RT Headlamp assy +30%
`Repl
`LKQ LT Headlamp assy +30%
`Repl
`Repl A/M CAPA RT Fog lamp assy
`Aim fog lamps
`LKQ LT Fog lamp assy +30%
`
`3.0
`1.2
`
`M
`
`1.5
`3.0
`
`1.6
`Incl.
`
`0.4
`0.3
`Incl.
`
`Incl.
`Incl.
`
`Q;
`Q3
`Incl.
`0.3
`DJ
`
`259.95
`
`97.75
`62.00
`
`193.00
`30.83
`
`227.50
`214.50
`81.05
`
`65.00
`
`195.00 s
`
`1_Q._Q
`
`57704A112A
`
`E5515AJ310
`57705A111A
`
`91121AJl4A
`91165A100A
`
`84001AJZOB
`84001A1218
`84501AJO9A
`
`84501A110A
`
`53029A116B9P
`
`1
`
`1
`
`1
`
`1
`
`1
`
`1
`
`1
`
`1
`
`1
`
`1
`
`12
`13
`14
`15
`16
`17
`18
`19
`20
`21
`22
`23
`24
`25
`26
`27
`28
`29
`30
`31
`32
`33
`34
`35
`36
`37
`38
`39
`40
`41
`42
`43
`
`LKQ Radiator support +30%
`
`*
`Repl
`RADIATOR SUPPORT
`*
`Rep
`COOLING
`LKQ Fan & motor +30%
`*
`Rep
`**
`AIM Radiator assy manaul trans
`Rep
`AIR CONDITIONER a HEATER
`LKQ Condenser assy +30%
`*
`Rep
`Deduct for Overlap
`LKQ Fan & motor +30%
`
`*
`
`Rep
`
`HOOD
`**
`
`*
`
`*
`
`*
`FENDER
`**
`
`Rep
`
`Rep
`Rep
`
`Rep
`
`Rep
`Rep
`
`Rep
`
`A/M ('APA Hood all
`Overlap Major Non-Adj. Panel
`Add for dear Coat
`Add for Underside(Comp|ete)
`Insulator w/o turbo
`LKQ RT Hinge +30%
`Add for Gear Coat
`LKQ LT Hinge +30%
`Add for Clear Coat
`Striker
`LKQ Latch +30%
`
`A/M GPA RT Fender Outback
`Overlap Major Adj. Panel
`Add for Gear Coat
`
`45121AGOZA
`45111A101A
`
`73210A100A
`
`73310AGO4A
`
`57229A100A9P
`
`90819A100A
`57260A100A9P
`
`57260A101A9P
`
`57311AGOlO
`57310A1001
`
`57120A106A9P
`
`1
`
`l
`
`1
`
`1
`
`1
`
`1
`
`1
`
`1
`
`1
`
`1
`
`1
`
`65.00 m
`170.00 m
`
`71.50 m
`
`58.50 m
`
`367.00
`
`126.37
`41.60
`
`41.60
`
`26.25
`58.50
`
`198.00
`
`M
`
`0.2
`1.5
`
`L1
`-0.2
`9.2
`
`1.3
`
`Incl.
`9.3
`
`9L3
`
`Incl.
`9.3
`
`2.1
`
`1L5
`
`2.8
`-0.2
`0.5
`1.4
`
`0.3
`0.1
`0.3
`0.1
`
`2.0
`-0.4
`0.3
`
`12/15/2021 3:30:35 PM
`
`095934
`
`Page 2
`
`

`

`27-CV-23-16837
`
`Filed in District Court
`State of Minnesota
`10/31/2023 2:03 PM
`
`R0 Number: 534545
`2013 SUBA Outback Limited Automatic 4D WGN 4-2.5L Gasoline Electronic Fuel Injecfion Silver
`
`Preliminary Estimate
`
`open
`"62 WiivnsuIELo
`63
`
`44
`45
`46
`47
`48
`
`49
`
`50
`51
`52
`53
`54
`55
`56
`
`open
`58
`59
`60
`
`64
`65
`66
`67
`68
`69
`70
`71
`
`72
`
`73
`74
`75
`76
`77
`78
`79
`80
`81
`82
`83
`84
`
`Repl
`
`Repl
`
`Repl
`
`Add for Edging
`LKQ LT fender assy +30%
`Overlap Major Adj. Panel
`Add for Gear Coat
`LKQ RT Fender liner Ouflaack
`+30%
`LKQ LT Fender liner Outback
`+30%
`Repl RT Lower rail assy (HSS)
`Overlap Major Non-Adj. Panel
`Deduct for Overlap
`LT Lower rail assy (HSS)
`Overlap Major Non-Adj. Panel
`Deduct for Overlap
`
`Repl
`
`*
`
`*
`
`*
`
`ELECTRICAL
`
`Battery
`Repl
`Tray
`Repl
`Battery cover
`Repl
`ENGINE / TRANSAXLE
`R&I engine/trans assy
`Repl
`
`Vifindshield Subam w/o EyeSight
`system, w/heated
`RESTRAINT SYSTEMS
`Repl Driver air bag
`Air bag system diagnosis
`Repl RT Seat belt assy black
`LT Seat belt assy black
`Repl
`Repl RT Buckle black
`LT Buckle bladr
`Repl
`Repl RT Head air bag Outback w/o
`sunroof
`LT Head air bag Oumack w/o
`sunroof
`
`R&I
`
`Repl
`
`ROOF
`
`R&I headliner
`R&I
`Repl Headliner w/o sunroof
`PILLARS, ROCKER & FLOOR
`RT Hinge pillar
`*
`Rpr
`Overlap Major Non-Adj. Panel
`
`FRONT noon
`
`Blnd RT Door shell Cuback
`LT Door shell Outback
`Blnd
`RT Belt w'slrip
`R&I
`LT Belt w'sln'p
`R&I
`RT Lower molding Outback
`R&I
`
`57120AJO7A9P
`
`59120A102C
`
`59120AJO3C
`
`51620AJ38A9P
`
`51620AJ39A9P
`
`SEE FOOTNOTE
`82122A110A
`82123AGIOB
`
`NONE
`
`98211AJO4CVH
`
`64621A106AVH
`64621AJO7AVH
`64631AJO0AVH
`64631A101AVH
`98251A124A
`
`98251AJ25A
`
`94416A100BME
`
`1
`
`1
`
`1
`
`1
`
`1
`
`1
`
`1
`
`1
`
`1
`
`1
`
`l
`1
`
`1
`
`l
`
`1
`
`1
`
`1
`
`0.5
`2.0
`-0.4
`0.3
`
`1.2
`-O.2
`
`1.2
`-0.2
`
`1.5
`-0.2
`
`1.0
`1.0
`
`221.00
`
`58.50
`
`65.00
`
`222.65 s
`
`227.07 s
`
`3.60
`24.18
`
`m
`
`m
`
`741.82 m
`m
`
`181.05
`190.07
`72.15
`47.88
`515.23 m
`
`1.9
`
`Qfi
`
`Dfi
`
`8.5
`
`-1.0
`8.5
`
`-1.0
`
`0.3
`0.2
`
`10.5
`
`M
`
`2.8
`
`0.4
`0.5
`0.3
`0.3
`0.2
`0.2
`0.8
`
`M
`
`M
`
`515.23 m
`
`0.8
`
`M
`
`318.60
`
`s
`
`Incl.
`4.4
`
`Lg
`
`0.3
`0.3
`0.2
`
`12/15/2021 3:30:35 PM
`
`095934
`
`Page 3
`
`

`

`27-CV-23-16837
`
`Filed in District Court
`State of Minnesota
`10/31/2023 2:03 PM
`
`R0 Number: 534545
`2013 SUBA Outback Limited Automatic 4D WGN 4-2.5L Gasoline Electronic Fuel Injection Silver
`
`Preliminary Estimate
`
`LT Lower molding Outback
`R&I
`RT R&I mirror
`R&I
`LT R&I mirror
`R&I
`R&I RT Handle, outside w/o smart key
`LT Handle, oubide w/o smart key
`R&I
`RT R&I trim panel
`R&I
`LT R&I trim panel
`R&I
`
`85
`86
`87
`88
`89
`90
`91
`
`92
`93
`
`#
`
`ESTIMATE TOTALS
`Category
`Parts
`Body Labor
`Paint Labor
`Mechanical Labor
`Flame Labor
`Paint Supplies
`Body Supplies
`Other Olarges
`Subtotal
`Sales Tax
`Grand Total
`Deductible
`CUSTOMER PAY
`INSURANCE PAY
`
`0.2
`0.3
`0.3
`0.4
`0.4
`0.3
`0.3
`
`OTHER CHARGES
`Towing
`SUBTOTALS
`
`1
`
`356.24
`6,411.17
`
`68.5
`
`20.6
`
`Basis
`
`49.7 hrs
`20.6 hrs
`15.8 hrs
`3.0 hrs
`20.6 hrs
`5.5 hrs
`
`@
`@
`@
`@
`@
`@
`
`Rate
`
`$ 64.00 /hr
`$ 64.00 /hr
`$ 155.00 /hr
`$ 95.00 /hr
`$ 44.00 /hr
`$ 6.00 /hr
`
`$ 7,350.57
`
`@
`
`7.1250 %
`
`Cost s
`6,054.93
`3,180.80
`1,318.40
`2,449.00
`285.00
`906.40
`33.00
`356.24
`14,583.77
`523.73
`15,107.50
`0.00
`0.00
`15,107.50
`
`12/15/2021 3:30:35 PM
`
`095934
`
`Page 4
`
`

`

`27-CV-23-16837
`
`Agency
`Richfield Police Dept
`Day Of Week
`Date
`1211512021 WEDNESDAY
`
`Local Case Number
`21004204
`ACN
`213490223
`Road of Occunerrce XERXES AVE 5
`
`Tillie
`10 42 AM
`:
`
`Vehicles
`2
`
`injuries
`1
`
`Fatalities
`0
`
`Courlty
`HENNEPIN
`City
`'
`R'
`Ichfle
`
`id
`
`Filed in District Court
`State of Minnesota
`10/31/2023 2:03 PM
`
`EXHIBIT5
`
`D
`Report Amended?D
`ye?D
`Private Proputy
`Public Property Damage?I]
`Longitude -93.31SBO458.
`where
`LYNN
`
`"N" 1 "WE"
`.Maie DFWE
`any
`EDINA
`Phone
`
`First
`Last Name
`CABDULLAHI
`CUSMAN
`A
`6300" $058K AVESAPT-llil
`State
`MN
`
`cmmty
`
`Email
`
`Middle
`AXMED
`
`21;:
`554352217
`
`Latitude: 4438717327
`Last Name
`First
`"WT 2 "M
`CHERYL
`ERICKSON
`Duran .Fm'e sassAeaorTAVE,s
`Address
`City
`EDINA
`Phone
`
`SIate
`MN
`
`County
`
`Zip
`554102310
`
`Emil
`
`Status
`Valid
`
`A99 m "ma"
`
`DOB
`11111982
`Class
`D The Normal (Nm'Commerdai) Driver Lioanee
`DL State
`Endorsem*nt
`More
`MN
`
`Jurisdiction
`State
`
`Recommendations?
`None
`
`Physical Conditions
`Appmenli Norml (including No Drugs/Alcohol
`y
`
`)
`
`Age
`
`Driver's Llcense' No
`
`008
`11/8/1957
`Class
`D The Normal (Not Cornmerciai) DriVer License
`DL State
`Endorsem*nt
`None
`MN
`
`_
`
`Restriction
`Corrective Lenses
`
`Jurisdictlorr
`State
`
`Recommendations?
`None
`
`Physical Conditions
`"
`-, Nor-Ind 1'
`'
`-'.—r
`
`v No Drugs/Alcohol)
`
`mm Correctl
`[Imam
`
`HONDA
`
`[jaw Vehicle Year VetItcIe Malia
`2011
`Vehicle Model
`FILOT
`# 01' Passengers Tag a
`mvpw
`
`Plate c'ounry
`
`Dew Vehicle Year Venue";
`
`SUBARU
`
`2013
`Vehiele Model
`OUTBACK
`.II of Passengers Tag a'
`mm
`
`Status
`Valid
`
`Restridion
`Corrective Lenses
`
`E Address Correct
`
`[jInoIaIIom
`
`VIN
`434m
`Venicb Color
`SILVER
`Year Registered
`2m
`P [icy No
`
`Plate Counry-
`
`VIN
`smvm'nm
`Vehicle Color
`GRAY
`Year Registered
`2022
`Policy No
`
`sum
`MfllNESOTA
`insurance Go.
`GEIOO
`
`Not Towed
`
`Towing Company
`
`Famed status
`Dyehicle Fire, Tm
`[jpumng Unit
`Point of Initial Contact Most Harmful EVeett
`MOTOR VEHICLE IN TRANSPORT
`FRONT RIGHT
`PASSENGER CABIN
`SequenceotEm;
`Vehicle Maneuver
`MOTOR VEHICLE IN 'IRANSIJORI
`
`Stet:
`MINNESOTA
`insurance 00.
`AMERICAN FAMILY
`Twins Company
`CHEiFS TOWING
`
`_
`
`_
`
`_
`
`Parked Stews
`UVehicIeI-"ue Tam
`Towed Due to Disabling
`UPulilng Uni't Dame
`Point of Initial Contact Most Harmtui Event
`MOTOR VEHICLE IN TRANSPORT
`FRONT
`Sequence of Events 7
`Vehicle Maneuver
`MOTOR VEHICLE' IN TWORT
`"mun-W
`VehiCie Type
`SPORT UTILITY VEHICLE'
`Vehldeu"
`NORMAL
`Emergency Use
`
`Vehicle Type
`SPORT UTILITY VEHICLE
`Vehicle use
`NORMAL
`Emergency Use
`
`Contributing Faaors
`FAILURE To VIELO RiGHTOF-WAY
`
`Ped Maneuver
`
`Tested
`Np, Test Not Given
`
`,
`
`Tested
`No, Test Not Given
`
`"'99
`
`Type
`
`Vehiclei Factors
`NO CLEAR CONTRIBUTING FACTOR
`
`'
`
`Vehicle Fedora
`NOOLEAROONTRIBUTTNG FACTOR
`
`Distracted Driving
`NOT D'STRACTED.
`
`Speeding
`NOT SPEEDING
`
`Contributing Factors
`N0 CLEAR CONTRIBUTNG ACTION
`
`Distracted DrMng
`NOT DISTRACTED
`
`Speeding
`NOT SPEEDiNG
`
`DAicohol Suspected
`DOM Suspected
`Results
`
`Results
`
`PM Maneuver
`
`795394
`No. Test Not Given
`Tested
`No, Test Not Given
`
`_
`
`TYPE
`
`Type
`
`EINCOhol Suspected
`DDwg Suspected
`Resuls
`
`Result:
`
`Direction of Travel
`EASTBOUND
`Tramc Design
`TWO-WAY. nor DMDED
`
`Roadway Grade
`Alignment
`LEVEL
`STRAIGHT
`MIC Ctri stem Ti'aflit; 0111
`STOP SIGN
`OPERATIONAL
`
`30
`
`2
`
`Posted Direction 0! Wavei
`NORTHBOUND
`Speed
`Number Tunic Design
`or Lanes firm-WW"
`
`Alignment
`STRAIGHT
`Tramcrcrrr status
`
`Way Grade
`LEVEL
`flame Cti'l
`NO CONTROLS
`
`Posted
`Speed
`Number
`of Lanes
`
`Report By
`Officer Giilord, Andrew
`
`Badge it Department
`Richfieki Police
`157
`
`Created Date
`
`1211612021'
`
`Submitted By
`0
`
`Checked By
`
`Date Checked
`
`Pegeiol4
`
`

`

`27-CV-23-16837
`
`Filed in District Court
`State of Minnesota
`10/31/2023 2:03 PM
`
`Unit 1
`
`Unit 2
`
`11a"
`
`12
`
`—.
`
`.-
`
`| Z|T°P
`LI Undercm in
`[:]All Arm,
`n Unknown
`
`Extent ()1 Damage
`Moderale — Fur-ch31
`
`[3m
`[-IU'nderca'nlage
`ll IAII Am:
`L] Unknown
`W 01' "firm-
`
`Modemte - Disabino
`
`Pagezot4
`
`

`

`in.
`
`27-CV-23-16837
`
`Filed in District Court
`State of Minnesota
`10/31/2023 2:03 PM
`
`Crash Ty'pe
`Motor Vehiclein
`Transport
`
`Weather-
`Clear
`
`Light Court
`Daylight
`
`$10009 in Damage Bus lnv.
`Yes
`No
`
`Road Sin-fade
`Dry
`
`Road Circ*msmee
`Hone
`
`Mantler of collision
`Angie (ex. Frorit to Side)
`
`Photos Taken
`No
`
`On Bridge
`No
`
`Ownership 01 Land
`Public Property
`
`'
`
`Roadway Direction
`North
`
`OnIOt'f Tramway
`Trafficway, On Road
`
`Location Relative toTraflicway
`On Roadway (imlmiing aliey,.driveway,
`#90»)
`
`Location Relative to Intersection
`Four-Way intersection
`
`Merlin Wot-ii Zone
`No
`
`Type ofWorir Zone
`NOT'APPU'CABLE
`
`Location Relatlvo to Work Zone Workers Present
`
`LE. Present
`
`VEH it
`
`1
`
`Last Nam, First. Middle
`CUSMAN. CABDULLAHI
`AXMED
`
`Person Type
`Driver
`
`Position
`
`DOB
`
`Driver (include Motorcycle Driver)
`
`11111982
`
`Sex
`
`M
`
`injury
`No Apparent injury
`
`Transporter!
`
`Amhrgiance Service
`
`Rant
`
`Restrairrt Type And Use
`Lap and Shouider Belt Used
`
`Ejeet
`NntEjected or Trapped
`
`Airbag uae
`Deployed Combinatbn
`
`VEH #
`
`2
`
`Lest Nam. Fist. Middle
`ERICKSON, CHERYL LYNN
`
`Person Type
`Driver
`
`Position
`
`DOB
`
`Driver (Include Mdorcyde Driver)
`
`11.16I1957
`
`Sex
`F
`
`Injury
`Possible Injury (C)
`
`Transported
`Not Transporter!
`
`Eject
`Not Ejeded or Trapped
`
`Airbag Use
`Deployed Combination
`
`Amtinhnce Service
`
`Rrmt
`
`Restraint Type All! Use
`Lap and Shoulder Bait Used
`
`VEH #
`
`1
`
`Last Name, First; Middle
`CUSMAN. CABDULLAHI
`AXMED
`
`Address
`6300 YORK AVE 5 AP'i' 101
`
`'
`
`Person type
`OWNER
`
`DSame" as Driver
`
`Phone No.
`Prinaie Data
`
`VEH I
`2
`
`Lastflame. First, Middle
`ERICKSON. CHERYL LYNN
`
`Address
`5836 ABBOTT AVE 5
`
`Person Type
`ownen
`
`DSame as Driver
`
`Phone No.
`
`VEl-l #
`
`2
`
`Last Name. First; Middle
`ENSINGER. DEBORAH ANNE
`
`Address
`5836 A380" AVE 5
`
`we
`
`Person 1'
`OWNER
`
`Esme as Driver
`
`Phone No.
`
`City
`EDiNA
`
`{:in
`EDINA
`
`City
`EDINA
`
`.State
`
`MN
`
`State
`
`MN
`
`State
`
`MN
`
`County
`
`County
`
`2h
`m
`
`Zip
`""7""
`
`County
`
`Zip
`rams»
`
`Witness Name-
`
`DOB
`
`Sex
`
`Phone
`
`Email
`
`Pege3ot4
`
`

`

`27-CV-23-16837
`
`Filed in District Court
`State of Minnesota
`10/31/2023 2:03 PM
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`V2 NB Xerxes Ave Sin RT traffic lane. approaching 64th St. DZ stated-she was liraveling approximately 30 mph. V1 was EB
`64th St, attempting to cross'Xerxes Ave S and continue EB on 64m St. EB and WB traffic on 64th St have a stop Sign. D1
`stated he did not see V2. V2 struck V1 ,
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