START-223511880 ST-White

Policy underwritten by
Infinity Insurance Company
Named insured: Jesus Bazan
Kemper
P.O. Box 2843 Claimant: ANTHONY MORALES
Clinton, IA 52733 Claim number: 23123562951
Date of loss: March 13, 2023
ANTHONY MORALES Date of mailing: May 19, 2023
6948 Laurel Ave
Highland, CA 92346

Dear MARJORIE MORALES:

We are writing to you regarding your automobile material damage total loss claim and to
explain how the total loss and sale of the salvage are processed. Please read the entire letter.
It is important you understand the process in order to resolve your claim quickly.
The value of your vehicle was determined based on similar vehicles for sale in your local
market, considering pre-accident condition, accessories, options and mileage. Please review
the following offer:
COMPANY RETAINED
Actual Cash Value (ACV) = $4,126.00
Total Sales Tax (7.75%) = 319.77
Registration Fees = 51.00
Settlement Calculation = $4,496.77
OWNER RETAINED
Actual Cash Value (ACV) = $4,126.00
Total Sales Tax (7.75%) = 257.77
Salvage Certificate Fee = 25.00
Salvage = (800.00)
Settlement Calculation = $3,608.77
You requested to have this matter reviewed prior to payment being issued. You must advise
your decision to proceed with vehicle payment as we will not issue payment until you provide
a decision.
Please contact your agent to discuss removal of the vehicle from your policy. Your agent is the
best resource for policy issues and can answer questions about how the claim may affect your
policy.
We were advised no rental vehicle was used during this matter. We are offering loss of use for
the vehicle at 23 days worth ( April27th - May 19th) for $575.00. This will be issued once you
advise how you wish to proceed with your matter.
If you have any questions, please contact us and have the claim number available so we can
assist you as quickly as possible.

Sincerely,
Sean Keller
Claims Team
T 800-353-6737, ext.1351296
F 888-976-2123
skeller@kemper.com

California - 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.
C O P Y
 INFINITY INSURANCE COMPANY
Supplement Request Options:
FOR SUPPLEMENTS PLEASE CONTACT THE APPRAISER VIA PHONE OR EMAIL
Kemper Repair Network Shops:Estshare
PO Box 2855
CLINTON, IA 52733 Claim #: 2312356295102
Phone: (909) 222-0946 Workfile ID: f062f4e8

Supplement of Record 1 Summary

Written By: HEATHER FLOREA, License Number: 149043, 5/17/2023 11:43:45 AM

Adjuster: Jimenez, Lorraine, (800) 353-6737 x1453837 Evening

Insured: Jesus Bazan Owner Policy #: Claim #: 2312356295102

Type of Loss: Liability Date of Loss: 03/13/2023 12:00 AM Days to Repair: 0
Point of Impact: 15 Total Loss Deductible:

Owner (Claimant): Inspection Location: Appraiser Information: Repair Facility:

ANTHONY MORALES MORALES, ANTHONY heather.florea@kemper.com
6948 Laurel Ave 6948 Laurel Ave (909) 222-0946
Highland, CA 92346 Highland, CA 92346
(909) 649-7171 Evening Field
(909) 289-2228 Cellular (909) 289-2228 Day

VEHICLE

1987 NISS SE 4WD w/Short Bed 2D P/U 6-3.0L Gasoline FI bronze

VIN: JN6HD11Y5HW001197 Production Date: 04/1987 Interior Color: grey

License: 3p48585 Odometer: 216178 Exterior Color: bronze
State: CA Condition: Fair

TRANSMISSION Dual Mirrors FM Radio WHEELS

Overdrive Tinted Glass Stereo Styled Steel Wheels
5 Speed Transmission Console/Storage Search/Seek PAINT
4 Wheel Drive CONVENIENCE CD Player Clear Coat Paint
POWER Air Conditioning Auxiliary Audio Connection TRUCK
Power Steering Tilt Wheel SEATS Trailer Hitch
Power Brakes RADIO Cloth Seats
DECOR AM Radio Bucket Seats

5/17/2023 11:43:45 AM 149043 | 1.9.01.09190 Page 1

C O P Y
 Claim #: 2312356295102
Workfile ID: f062f4e8
Supplement of Record 1 Summary

1987 NISS SE 4WD w/Short Bed 2D P/U 6-3.0L Gasoline FI bronze

Line Oper Description Part Number Qty Extended Labor Paint

Price $
1 WHEELS
2 * Repl RT/Rear Wheel, steel 4WD 4030036G00 1 198.65 m 0.3 0.0
15x5.5 (STL)
3 # Repl Milestar Patagonia M/T 1 138.07
31x10/50r15 B40%
NOTE: Price per Walmart.com. Betterment applied based on current measurement of 15/32. OE measures 19/32
4 CAB
5 * Rpr Back panel 4WD 7910092G31 8.0 2.5
6 # Partial basecoat refinish 1 -0.6
NOTE: Applied Basecoat Adjustment for partial basecoat refinish with full clear coat
Right side damage only
7 PICK UP BOX
8 Repl RT Side panel w/o tie down 9330092G30 1 1,407.44 10.5 2.8
9 Overlap Major Non-Adj. Panel -0.2
10 Add for Inside 1.5
11 * Rpr Fuel door 9387092G00 0.5 0.5
12 * Rpr Floor pan assy 9350092G30 6.0 1.7
13 Overlap Major Adj. Panel -0.4
14 # Partial basecoat refinish 1 -0.4
NOTE: Applied Basecoat Adjustment for partial basecoat refinish with full clear coat
Rt rear panel damage
15 Repl Rear sill 9369001G00 1 243.95 3.5 0.5
16 Overlap Minor Panel -0.2
17 * Repl LKQ tailgate assy +20% 03721 1 120.00 0.7 3.3
18 Overlap Major Adj. Panel -0.4
19 Clear Coat 2.5
20 REAR SUSPENSION
21 Repl Axle housing 4WD 4301032G99 1 576.66 m 5.5 M
22 Repl RT Spring 4WD 5502031G00 1 502.22 m 1.9 M
23 Deduct for Overlap -0.5 M
24 REAR LAMPS
25 * Repl LKQ RT Tail lamp assy +20% B65503B300 1 90.00 Incl.
NOTE: Brother's Auto Wrecking, Rialto, CA 92377, 909-574-1212, Stock# 1478, Delivery: 1 Day, Grade A - 000
cc, 1995 - Nissan Truck RH,(quarter panel mounted), $75.00 Actual Price
26 REAR BUMPER
27 ** Repl A/M Bumper assy black- pending H5011S4328 1 0.8
invoice
NOTE: Price pending invoice - unable to locate comparable style bumper
28 Deduct for Rear Bumper R&I -0.5
SUBTOTALS 3,276.99 36.7 13.1

5/17/2023 11:43:45 AM 149043 | 1.9.01.09190 Page 2

 Claim #: 2312356295102
Workfile ID: f062f4e8
Supplement of Record 1 Summary

1987 NISS SE 4WD w/Short Bed 2D P/U 6-3.0L Gasoline FI bronze

ESTIMATE TOTALS
Category Basis Rate Cost $
Parts 3,276.99
Body Labor 29.8 hrs @ $ 40.00 /hr 1,192.00
Paint Labor 13.1 hrs @ $ 40.00 /hr 524.00
Mechanical Labor 6.9 hrs @ $ 54.00 /hr 372.60
Paint Supplies 13.1 hrs @ $ 29.00 /hr 379.90
Subtotal 5,745.49
Sales Tax $ 3,656.89 @ 7.7500 % 283.41
Total Cost of Repairs 6,028.90
Milestar Patagonia M/T 31x10/50r15 B40% 60.06
Total Adjustments 60.06
Net Cost of Repairs 5,968.84

5/17/2023 11:43:45 AM 149043 | 1.9.01.09190 Page 3

C O P Y
 Claim #: 2312356295102
Workfile ID: f062f4e8
Supplement of Record 1 Summary

1987 NISS SE 4WD w/Short Bed 2D P/U 6-3.0L Gasoline FI bronze

RATE CHANGES

Sales Tax $ 3656.89 -1.0000 % ( 8.7500 % to 7.7500 %) = -36.57

TOTALS SUMMARY
Category Basis Rate Cost $
Parts 0.00
Subtotal 0.00
Additional Supplement Taxes -36.57
Total Supplement Amount -36.57
NET COST OF SUPPLEMENT -36.57

CUMULATIVE EFFECTS OF SUPPLEMENT(S)

Estimate 6,065.47 HEATHER FLOREA

Supplement S01 -36.57 HEATHER FLOREA

Workfile Total: $ 6,028.90

TOTAL ADJUSTMENTS: $ 60.06
NET COST OF REPAIRS: $ 5,968.84

5/17/2023 11:43:45 AM 149043 | 1.9.01.09190 Page 4

 Claim #: 2312356295102
Workfile ID: f062f4e8
Supplement of Record 1 Summary

1987 NISS SE 4WD w/Short Bed 2D P/U 6-3.0L Gasoline FI bronze

********* KEMPER REPAIR NETWORK (KRN) PARTNER SHOPS, PLEASE USE ESTIMATE SHARE *********

You can download a copy of this appraisal with CCC 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 SUPPLEMENTS PLEASE CONTACT APPRAISER DIRECT. CONTACT INFORMATION ON FRONT PAGE ***

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.
***************************************************************************************

5/17/2023 11:43:45 AM 149043 | 1.9.01.09190 Page 5

C O P Y
 Claim #: 2312356295102
Workfile ID: f062f4e8
Supplement of Record 1 Summary

1987 NISS SE 4WD w/Short Bed 2D P/U 6-3.0L Gasoline FI bronze

FOR YOUR PROTECTION CALIFORNIA LAW REQUIRES THE FOLLOWING TO

APPEAR ON THIS FORM. ANY PERSON WHO KNOWINGLY PRESENTS FALSE
OR FRAUDULENT INFORMATION TO OBTAIN OR AMEND INSURANCE
COVERAGE OR TO MAKE A CLAIM FOR THE PAYMENT OF A LOSS IS
GUILTY OF A CRIME AND MAY BE SUBJECT TO FINES AND CONFINEMENT
IN STATE PRISON.

THE FOLLOWING IS A LIST OF ABBREVIATIONS OR SYMBOLS THAT MAY

BE USED TO DESCRIBE WORK TO BE DONE OR PARTS TO BE REPAIRED OR
REPLACED:

MOTOR ABBREVIATIONS/SYMBOLS: D=DISCONTINUED PART,

A=APPROXIMATE PRICE. LABOR TYPES: B=BODY LABOR, D=DIAGNOSTIC,
E=ELECTRICAL, F=FRAME, G=GLASS, M=MECHANICAL, P=PAINT LABOR,
S=STRUCTURAL, T=TAXED MISCELLANEOUS, X=NON TAXED
MISCELLANEOUS. CCC ONE: ADJ=ADJACENT, ALGN=ALIGN,
A/M=AFTERMARKET, BLND=BLEND, CAPA=CERTIFIED AUTOMOTIVE
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
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.

5/17/2023 11:43:45 AM 149043 | 1.9.01.09190 Page 6

 Claim #: 2312356295102
Workfile ID: f062f4e8
Supplement of Record 1 Summary

1987 NISS SE 4WD w/Short Bed 2D P/U 6-3.0L Gasoline FI bronze

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 AEF3613, CCC Data Date 05/01/2023, 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 2023 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. Blnd=Blend. BOR=Boron steel.
CAPA=Certified Automotive Parts Association. D&R=Disconnect and Reconnect. HSS=High Strength Steel.
HYD=Hydroformed Steel. Incl.=Included. LKQ=Like Kind and Quality. LT=Left. MAG=Magnesium. Non-Adj.=Non
Adjacent. NSF=NSF International Certified Part. O/H=Overhaul. Qty=Quantity. Refn=Refinish. Repl=Replace.
R&I=Remove and Install. R&R=Remove and Replace. Rpr=Repair. RT=Right. SAS=Sandwiched Steel.
Sect=Section. Subl=Sublet. UHS=Ultra High Strength Steel. N=Note(s) associated with the estimate line.

CCC ONE Estimating - A product of CCC Intelligent Services Inc.

The following is a list of abbreviations that may be used in CCC ONE Estimating that are not part of the MOTOR
CRASH ESTIMATING GUIDE:
BAR=Bureau of Automotive Repair. EPA=Environmental Protection Agency. NHTSA= National Highway
Transportation and Safety Administration. PDR=Paintless Dent Repair. VIN=Vehicle Identification Number.

5/17/2023 11:43:45 AM 149043 | 1.9.01.09190 Page 7

C O P Y
 Claim #: 2312356295102
Workfile ID: f062f4e8
Supplement of Record 1 Summary

1987 NISS SE 4WD w/Short Bed 2D P/U 6-3.0L Gasoline FI bronze

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.

5/17/2023 11:43:45 AM 149043 | 1.9.01.09190 Page 8

 Claim #: 2312356295102
Workfile ID: f062f4e8
Supplement of Record 1 Summary

1987 NISS SE 4WD w/Short Bed 2D P/U 6-3.0L Gasoline FI bronze

ALTERNATE PARTS SUPPLIERS

Line Supplier Description Price

17 Qwikparts Auto Salvage #03721 $ 100.00
Sales Number LKQ tailgate assy +20%
330 E. 6th St. TAILGATE-LIFTGATE-TRUNK LID-BLACK EXT
San Bernadino CA 92410
(909) 889-0206

5/17/2023 11:43:45 AM 149043 | 1.9.01.09190 Page 9

C O P Y
 Claim #: 2312356295102
Workfile ID: f062f4e8
Supplement of Record 1 Summary

1987 NISS SE 4WD w/Short Bed 2D P/U 6-3.0L Gasoline FI bronze

RECALL INFO

1987 NISS SE 4WD w/Short Bed 2D P/U 6-3.0L Gasoline FI bronze

VIN: JN6HD11Y5HW001197 Production Date: 04/1987 Interior Color: grey

License: 3p48585 Odometer: 216178 Exterior Color: bronze
State: CA Condition: Fair

The National Highway Transportation and Safety Administration (NHTSA) has issued 1 safety-related recall notice(s) that may apply to the selected
vehicle.

NHTSA ID: 95V103002 Issued: May 5, 95 Number of Vehicles: 02730462

The front safety belt buckle release buttons can break. These red plastic release buttons are marked "press." if a button breaks, pieces can fall
into the buckle assembly causing the buckle to operate improperly. The safety belts would not provide adequate protectionto an occupant in a
Vehicle crash. Owners should promptly check the condition and operation of both front safety belt buckles and carefully inspect the red release
button for any breaks or cracks. They should ensure that both buckles are operating properly by inserting each latch plate into its buckle, tugging
on the belt to make sure the latch is securely locked, and then pressing the release button. The latch plate should pop out of the buckle when the
button is pressed. If either release button shows a sign of breaking or cracking or if either buckle fails to operate properly, owners should
promptly contact their authorized Dealer to schedule an appointment to have the buckle replaced or repaired free of charge. System: Interior; seat
belts; belt buckles. Vehicle Description: Passenger, multi-purpose Vehicles and light duty trucksequipped with safety belts made by takata
corporation. Note: If your Vehicle is presented to an authorized Dealer on an agreed uponservice date and the remedy is not provided free of
charge within a reasonabletime, please contact Nissan at 1-800-647-7261. Also contact the nationalhighway traffic safety administration''s auto
safety hotline at 1-800-424-9393.

5/17/2023 11:43:45 AM 149043 | 1.9.01.09190 Page 10

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C O P Y
 Prepared for INFINITY INSURANCE COMPANY

REPORT SUMMARY
The CCC ONE® Market Valuation
CLAIM INFORMATION Report reflects CCC Intelligent Solutions
Inc.’s opinion as to the value of the loss
Owner Morales, Anthony
vehicle, based on information provided
6948 Laurel Ave to CCC by INFINITY INSURANCE
Highland, CA 92346-3356 COMPANY.
Loss Vehicle 1987 Nissan SE 4WD w/Short Bed
Loss vehicle has 5% fewer than average
Loss Incident Date 03/13/2023
mileage of 227,500.
Claim Reported 05/17/2023

INSURANCE INFORMATION
Report Reference Number 113127654
Claim Reference 2312356295102
Adjuster Jimenez, Lorraine
Appraiser Florea, Heather
Odometer 216,178
Last Updated 05/17/2023 02:13 PM

BASE VEHICLE VALUE

VALUATION SUMMARY This is derived per our Valuation
methodology described on the next
Base Vehicle Value $ 4,400.00 page.
Condition Adjustment - $ 274.00
ADJUSTED VEHICLE VALUE
Adjusted Vehicle Value $ 4,126.00
This is determined by adjusting the
Vehicular Tax (7.75%) + $ 319.77
Base Vehicle Value to account for the
Tax reflects applicable state, county and municipal
actual condition of the loss vehicle and
taxes.
certain other reported attributes, if any,
such as refurbishments and after factory
Total $ 4,445.77 equipment.

The total may not represent the total of the settlement as other factors (e.g. license and
Inside the Report
fees) may need to be taken into account.
Valuation Methodology............................. 2
Vehicle Information...................................3
Vehicle Condition......................................5
Comparable Vehicles............................... 7
Valuation Notes........................................ 9
Supplemental Information.......................10

© Copyright 2021 CCC Intelligent Solutions Inc. All Rights Reserved. Page 1 of 13
 Owner: Morales, Anthony
Claim: 2312356295102

VALUATION METHODOLOGY
How was the valuation determined?

CLAIM INSPECTION
INFINITY 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

Adjustments to the price of the selected comparable vehicles are made to reflect
differences in vehicle attributes, including mileage and options. Dollar adjustments are
based upon market research.
Finally, the Base Vehicle Value is the straight average of the adjusted values of the
comparable vehicles.

© Copyright 2021 CCC Intelligent Solutions Inc. All Rights Reserved. Page 2 of 13

C O P Y
 Owner: Morales, Anthony
Claim: 2312356295102

VEHICLE INFORMATION
VEHICLE DETAILS
Vehicles sold in the United States
Location HIGHLAND, CA 92346-3356 are required to have a manufacturer
assigned Vehicle Identification
VIN JN6HD11Y5HW001197
Number(VIN). This number provides
Year 1987 certain specifications of the vehicle.
Make Nissan
Please review the information in the
Model SE 4WD Vehicle Information Section to confirm
Body Style w/Short Bed the reported mileage and to verify that
the information accurately reflects the
Body Type Pickup
options, additional equipment or other
Engine - aspects of the loss vehicle that may
Cylinders 6 impact the value.

Displacement 3.0L
Fuel Type Gasoline
Carburation FI
Transmission 5 Speed Transmission Overdrive 4 Wheel Drive

VEHICLE HISTORY SUMMARY

Experian AutoCheck No Title Problem Found

National Highway Traffic 1 Recall

Safety Administration

© Copyright 2021 CCC Intelligent Solutions Inc. All Rights Reserved. Page 3 of 13
 Owner: Morales, Anthony
Claim: 2312356295102

VEHICLE INFORMATION
VEHICLE EQUIPMENT
To the left is the equipment of the loss
Odometer 216,178 vehicle that INFINITY INSURANCE
COMPANY provided to CCC.
Transmission 5 Speed Transmission
Standard This equipment is
Overdrive
included in the base configuration of
4 Wheel Drive the vehicle at time of purchase.

Power Power Steering

Additional Equipment that is not
Power Brakes Standard but was noted to be on the
loss vehicle.
Decor/Convenience Air Conditioning

Tilt Wheel

Console/Storage

Seating Cloth Seats

Bucket Seats

Radio AM Radio

FM Radio

Stereo

Search/Seek

CD Player

Auxiliary Audio Connection

Wheels Styled Steel Wheels

Exterior/Paint/Glass Dual Mirrors

Tinted Glass

Clearcoat Paint

Other - Trucks Trailer Hitch

© Copyright 2021 CCC Intelligent Solutions Inc. All Rights Reserved. Page 4 of 13

C O P Y
 Owner: Morales, Anthony
Claim: 2312356295102

VEHICLE CONDITION
COMPONENT CONDITION
INFINITY INSURANCE COMPANY
Condition Inspection Notes/Typical Vehicle Value Impact uses condition inspection guidelines to
Description rate the condition of key components of
the loss vehicle on a three-point scale.
INTERIOR
A rating of average condition results
Seats BELOW Notes: Tears/holes and stains, worn - $ 57 in a valuation of that component that
AVERAGE Typical Vehicle Desc: is consistent with typical vehicles for
Lightly soiled to clean,faded and/or that year, make and model of vehicle.
discolored. A few small to insignificant If a component is rated in exceptional
tears, holes and/or burn marks. None or condition, then a positive monetary
adjustment is made to reflect the impact
no significant bare spots.
of that condition level on the value of the
Carpets BELOW Notes: stains/wear, holes - $ 38 loss vehicle. Similarly, if a component
AVERAGE Typical Vehicle Desc: is rated in below average condition,
Lightly soiled to clean and/or stained. A then a negative monetary adjustment
few small to no tears, holes and/ or burn is made to reflect the impact of that
marks. No significant bare spots. condition level on the value of the
loss vehicle. Inspection Notes, if any,
Dashboard BELOW Notes: gouges/scratches, broken - $ 36 reflect additional observations from the
AVERAGE pieces. Trim panels worn/torn appraiser regarding the loss vehicle's
Typical Vehicle Desc: condition. Monetary adjustments are
Significant to a few small scratches based upon market research consisting
and/or gouges. Components may be of data gathered from dealerships in
damaged and/or cracked. Significant to California.
light wear. CCC makes dollar adjustments that
Headliner BELOW Notes: stains/fuzzing - $ 23 reflect the impact the reported condition
has on the value of the loss vehicle as
AVERAGE Typical Vehicle Desc:
compared to Average condition. These
A few small to no significant holes and/
dollar adjustments are based upon
or burn marks. Light to no significant
interviews with dealerships across the
scuffing. United States.
EXTERIOR

Body BELOW Notes: UPD to ft bumper, rt front lights, - $ 52

AVERAGE lt/rt fenders, rt door has prior repair work
Typical Vehicle Desc:
Sheet Metal: A few to no dents.
Numerous to a few dings. No significant
surface rust.
Trim: Minimal to no damage to
components. No broken and/or
missing components. Few to no dents.
Numerous to a few dings.

Glass BELOW Notes: pits - $ 17

AVERAGE Typical Vehicle Desc:
Light surface scratches and/or pitting.
Few to no chips.

© Copyright 2021 CCC Intelligent Solutions Inc. All Rights Reserved. Page 5 of 13
 Owner: Morales, Anthony
Claim: 2312356295102

VEHICLE CONDITION
COMPONENT CONDITION

Condition Inspection Notes/Typical Vehicle Value Impact

Description

Paint BELOW Notes: faded, primer on some panels - $ 51

AVERAGE Typical Vehicle Desc:
Few small deep to minimal surface
chips and/or scratches. No significant
peeling and/or flaking. Minor swirl
marks. Slight to no Fading.

MECHANICAL
Engine AVERAGE Notes: no visible leaks $0
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: No visible leaks $0

Typical Vehicle Desc:
Fluid slightly discolored. None to a few
areas of seepage.

TIRES

Front Tires AVERAGE Notes: all avg 15/32 $0

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: all avg 15/32 $0

Typical Vehicle Desc:
41% to 90% of new. Example: Typical
new car tires are 11/32, loss measures
at 5/32 = 46% (5/11)

Total Condition Adjustments - $ 274

© Copyright 2021 CCC Intelligent Solutions Inc. All Rights Reserved. Page 6 of 13

C O P Y
 Owner: Morales, Anthony
Claim: 2312356295102

COMPARABLE VEHICLES
Options Loss Comp 1 Comp 2
Comp 1 Updated Date: 03/16/2023
Vehicle
1987 Nissan E 4wd 4 2.4l Gasoline Fi
Odometer 216,178 284,000 160,850 VIN UNKNOWN
5 Speed Transmission Telephone (860) 936-8377
Source Private Ad
Overdrive
Distance from Highland, CA
4 Wheel Drive 2454 Miles - Hartford, CT
Power Steering Comp 2 Updated Date: 03/08/2023
Power Brakes 1988 Nissan Se King Cab 6 3.0l
Air Conditioning Gasoline Fi
VIN 1N6HD16SXJC395436
Tilt Wheel
Dealership Gateway Ford Nissan
Intermittent Wipers Telephone (423) 639-5151
Console/Storage Source Autotrader
Cloth Seats Stock # T15412M
Bucket Seats Distance from Highland, CA
1937 Miles - Greeneville, TN
Reclining/Lounge Seats
AM Radio Comparable vehicles used in the
FM Radio determination of the Base Vehicle Value
are not intended to be replacement
Stereo
vehicles but are reflective of the market
Search/Seek value, and may no longer be available
CD Player for sale.
Auxiliary Audio Connection
List Price is the sticker price of an
Styled Steel Wheels
inspected dealer vehicle and the
Dual Mirrors advertised price for the advertised
Tinted Glass vehicle.
Clearcoat Paint
Distance is based upon a straight line
Rear Step Bumper between loss and comparable vehicle
Trailer Hitch locations.
Rear Sliding Window

List Price $ 3,300 $ 4,200

Adjustments:
Make/Model/Trim + $ 575
Options + $ 322 + $ 187
Mileage + $ 1,120 - $ 904

Adjusted Comparable Value $ 4,742 $ 4,058

© Copyright 2021 CCC Intelligent Solutions Inc. All Rights Reserved. Page 7 of 13
 Owner: Morales, Anthony
Claim: 2312356295102

COMPARABLE VEHICLES
COMPARABLE VEHICLE SUMMARY The following comparable vehicle(s)
were used to determine this Base
Source Comparable Vehicle Price Adjusted Comp
Vehicle Value by computing the
Value arithmetic average of the adjusted
values of the comparable vehicles.
1 Verified 1987 Nissan E 4wd 4 2.4l $ 3,300 $ 4,742
Details on these comparable vehicles
Gasoline Fi (List)
are in the Comparable Vehicles section.
2 Verified 1988 Nissan Se King Cab $ 4,200 $ 4,058
6 3.0l Gasoline Fi (List)

Base Vehicle Value $ 4,400.00

© Copyright 2021 CCC Intelligent Solutions Inc. All Rights Reserved. Page 8 of 13

C O P Y
 Owner: Morales, Anthony
Claim: 2312356295102

VALUATION NOTES
05/17/2023 14:13 - 575 adjustment for drive type on comparables
Regulations concerning vehicle value
This Market Valuation Report has been prepared exclusively for use by INFINITY include California Code of Regulations
INSURANCE COMPANY, and no other person or entity is entitled to or should rely upon 10 CA ADC 2695.
this Market Valuation Report and/or any of its contents. CCC is one source of vehicle
valuations, and there are other valuation sources available.

© Copyright 2021 CCC Intelligent Solutions Inc. All Rights Reserved. Page 9 of 13
 Owner: Morales, Anthony
Claim: 2312356295102

SUPPLEMENTAL INFORMATION
CCC provides INFINITY INSURANCE
EXPERIAN® AUTOCHECK® VEHICLE HISTORY REPORT
COMPANY information reported by
Experian regarding the 1987 Nissan SE
TITLE CHECK RESULTS FOUND 4WD (JN6HD11Y5HW001197). This data is
provided for informational purposes. Unless
Abandoned No Abandoned Record Found
otherwise noted in this Valuation Detail,
Damaged No Damaged Record Found CCC does not adjust the value of the loss
Fire Damage No Fire Damage Record Found vehicle based upon this information.
Grey Market No Grey Market Record Found LEGEND :
Hail Damage No Hail Damage Record Found No Event Found
Insurance Loss No Insurance Loss Record Found Event Found

Junk Information Needed

No Junk Record Found
Rebuilt No Rebuilt Record Found TITLE CHECK
Salvage No Salvage Record Found THIS VEHICLE CHECKS OUT
AutoCheck's result for this loss vehicle
EVENT CHECK RESULTS FOUND show no significant title events. When

NHTSA Crash Test Vehicle found, events often indicate automotive

No NHTSA Crash Test Vehicle Record Found
Frame Damage No Frame Damage Record Found
Major Damage Incident No Major Damage Incident Record Found
Manufacturer Buyback/Lemon No Manufacturer Buyback/Lemon Record Found
Odometer Problem No Odometer Problem Record Found
Recycled No Recycled Record Found
Water Damage
No Water Damage Record Found
Salvage Auction No Salvage Auction Record Found
damage or warnings associated with the
vehicle.
EVENT CHECK
THIS VEHICLE CHECKS OUT
AutoCheck's result for this loss vehicle
show no historical events that indicate
a significant automotive problem. These
problems can indicate past previous
car damage, theft, or other significant

VEHICLE INFORMATION RESULTS FOUND problems.

VEHICLE INFORMATION
Accident No Accident Record Found
THIS VEHICLE CHECKS OUT
Corrected Title No Corrected Title Record Found
AutoCheck's result for this loss vehicle
Driver Education No Driver Education Record Found show no vehicle information that indicate
Fire Damage Incident No Fire Damage Incident Record Found a significant automotive problem. These
Lease No Lease Record Found problems can indicate past previous
car damage, theft, or other significant
Lien No Lien Record Found
problems.
Livery Use No Livery Use Record Found
ODOMETER CHECK
Government Use No Government Use Record Found
THIS VEHICLE CHECKS OUT
Police Use No Police Use Record Found
AutoCheck's result for this loss vehicle
Fleet No Fleet Record Found show no indication of odometer rollback
Rental No Rental Record Found or tampering was found. AutoCheck
Fleet and/or Rental determines odometer rollbacks by
No Fleet and/or Rental Record Found
searching for records that indicate
Repossessed No Repossessed Record Found
odometer readings less than a previously
Taxi use No Taxi use Record Found reported value. Other odometer events
Theft No Theft Record Found can report events of tampering, or possible
Fleet and/or Lease odometer breakage.
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 10 of 13

C O P Y
 Owner: Morales, Anthony
Claim: 2312356295102

SUPPLEMENTAL INFORMATION
FULL HISTORY REPORT RUN DATE: 05/17/2023

Below are the historical events for this vehicle listed in chronological order.

EVENT RESULTS ODOMETER DATA EVENT

DATE FOUND READING SOURCE DETAIL

06/07/1988 CA Independent Source Vehicle Manufactured and

Shipped to Dealer
07/02/1988 LONG BEACH, CA Motor Vehicle Dept. Title (Lien Reported)
04/23/1997 CA 105006 State Agency Passed Emission
Inspection
05/21/1999 SEAL BEACH, CA 127891 State Agency Passed Emission
Inspection
06/05/2001 CA 134702 State Agency Passed Emission
Inspection
05/07/2005 CA 142236 State Agency Passed Emission
Inspection
05/25/2007 CA 144692 State Agency Passed Emission
Inspection
07/26/2007 HUNTINGTON Motor Vehicle Dept. Registration Event/
BEACH, CA Renewal
08/05/2007 HUNTINGTON Motor Vehicle Dept. Title
BEACH, CA
08/06/2009 CYPRESS, CA Motor Vehicle Dept. Registration Event/
Renewal
09/05/2009 CA 153243 State Agency Passed Emission
Inspection
07/30/2011 CA 159199 State Agency Failed Emission Inspection
08/08/2011 CA 159235 State Agency Failed Emission Inspection
08/09/2011 CA 159306 State Agency Passed Emission
Inspection
06/22/2013 CA 164707 State Agency Passed Emission
Inspection
06/22/2015 CA 167406 Motor Vehicle Dept. Odometer Reading from
DMV
06/23/2015 CA Motor Vehicle Dept. Title
06/23/2015 CA Motor Vehicle Dept. Registration Event/
Renewal
06/23/2015 CA Motor Vehicle Dept. Pro-Rated Registration
04/05/2016 CERRITOS, CA Motor Vehicle Dept. Registration Event/
Renewal
06/16/2017 FULLERTON, CA 174493 State Agency Passed Emission
Inspection
05/02/2019 COMPTON, CA Motor Vehicle Dept. Title
05/02/2019 COMPTON, CA Motor Vehicle Dept. Registration Event/
Renewal

© Copyright 2021 CCC Intelligent Solutions Inc. All Rights Reserved. Page 11 of 13
 Owner: Morales, Anthony
Claim: 2312356295102

SUPPLEMENTAL INFORMATION
EVENT RESULTS ODOMETER DATA EVENT
DATE FOUND READING SOURCE DETAIL

05/02/2019 COMPTON, CA Motor Vehicle Dept. Pro-Rated Registration

05/02/2019 SOUTH GATE, CA 181147 State Agency Passed Emission
Inspection
01/25/2020 LYNWOOD, CA 189162 Independent Repair Center Steering System Serviced
01/25/2020 LYNWOOD, CA Independent Repair Center Tires or Wheels Service
Performed
08/10/2021 COMPTON, CA 181888 State Agency Passed Emission
Inspection
07/13/2022 WALNUT, CA 208415 State Agency Failed Emission Inspection
07/25/2022 POMONA, CA 208660 State Agency Failed Emission Inspection
07/26/2022 COVINA, CA Motor Vehicle Dept. Title
07/26/2022 COVINA, CA Motor Vehicle Dept. Registration Event/
Renewal
07/26/2022 COVINA, CA Motor Vehicle Dept. Pro-Rated Registration
07/26/2022 POMONA, CA 208661 State Agency Passed Emission
Inspection
08/26/2022 HIGHLAND, CA Motor Vehicle Dept. Title
08/26/2022 HIGHLAND, CA Motor Vehicle Dept. Registration Event/
Renewal
08/26/2022 HIGHLAND, CA Motor Vehicle Dept. Pro-Rated Registration

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.

These terms and the relationship between you and Experian shall be governed by the laws of the State of Illinois (USA) without regard to its conflict of law provisions. You and
Experian agree to submit to the personal and exclusive jurisdiction of the courts located within the county of Cook, Illinois.

© Copyright 2021 CCC Intelligent Solutions Inc. All Rights Reserved. Page 12 of 13

C O P Y
 Owner: Morales, Anthony
Claim: 2312356295102

SUPPLEMENTAL INFORMATION
The National Highway Traffic Safety
NHTSA VEHICLE RECALL Administration has issued 1 safety related
recall notices that may apply to the above
valued vehicle.
NHTSA Campaign ID : 95V103002
Mfg's Report Date : 05/12/1995
Potential Number Of Units Affected : 02730462
Summary : The front safety belt buckle release buttons can break. These red plastic
release buttons are marked "press." if a button breaks, pieces can fall into the buckle
assembly causing the buckle to operate improperly. The safety belts would not provide
adequate protectionto an occupant in a Vehicle crash. Owners should promptly check
the condition and operation of both front safety belt buckles and carefully inspect the
red release button for any breaks or cracks. They should ensure that both buckles are
operating properly by inserting each latch plate into its buckle, tugging on the belt to make
sure the latch is securely locked, and then pressing the release button. The latch plate
should pop out of the buckle when the button is pressed. If either release button shows
a sign of breaking or cracking or if either buckle fails to operate properly, owners should
promptly contact their authorized Dealer to schedule an appointment to have the buckle
replaced or repaired free of charge. System: Interior; seat belts; belt buckles. Vehicle
Description: Passenger, multi-purpose Vehicles and light duty trucksequipped with safety
belts made by takata corporation. Note: If your Vehicle is presented to an authorized
Dealer on an agreed uponservice date and the remedy is not provided free of charge
within a reasonabletime, please contact Nissan at 1-800-647-7261. Also contact the
nationalhighway traffic safety administration's auto safety hotline at 1-800-424-9393.
Dates Of Manufacture : AUGUST 1986 - JULY 1991

© Copyright 2021 CCC Intelligent Solutions Inc. All Rights Reserved. Page 13 of 13