Workfile ID: 0e3d26ca

AutoNation Chevrolet Collision PartsShare: 6vPrvP

Center West Colonia Federal ID: 59-1553076
3707 W COLONIAL DR, ORLANDO, FL 32808 State ID: 58-8012001186-0
Phone: (407) 521-4141
FAX: (407) 292-0287

Supplement of Record 1 with Summary

Customer: THOMPSON, BARBARA Job Number: 231251

Written By: John Achtabowski, 2/3/2022 5:23:35 PM
Adjuster: Team L, Express, (855) 341-8184 Business

Insured: THOMPSON, BARBARA Policy #: Claim #: 59-26W3-64N01

Type of Loss: Collision Date of Loss: 11/5/2021 12:00 PM Days to Repair: 18
Point of Impact: 06 Rear

Owner: Inspection Location: Insurance Company:

THOMPSON, BARBARA AutoNation Chevrolet Collision Center STATE FARM INSURANCE COMPANIES
West Colonia
1601 PINE BLUFF AVE 3707 W COLONIAL DR STATE FARM - FL
ORLANDO, FL 32806 ORLANDO, FL 32808 Orlando
(407) 765-5430 Cell Repair Facility (407) 327-8624 Business
(407) 896-0368 Evening (407) 521-4141 Business

Vehicle Drop Off Date: 11/09/2021 Promise Date: 12/07/2021 Repair Start Date: 11/12/2021

VEHICLE

2016 FORD Escape SE FWD 4D UTV 4-2.0L Turbocharged Gasoline Gasoline Direct Injection black met

VIN: 1FMCU0G94GUB25085 Interior Color: Mileage In: 42,018 Vehicle Out: 12/7/2021
License: 046QGZ Exterior Color: black met Mileage Out:
State: FL Production Date: 10/2015 Condition: Job #: 231251

TRANSMISSION CONVENIENCE FM Radio Head/Curtain Air Bags

Automatic Transmission Air Conditioning Stereo Hands Free Device
POWER Intermittent Wipers Search/Seek SEATS
Power Steering Tilt Wheel CD Player Cloth Seats
Power Brakes Cruise Control Auxiliary Audio Connection Bucket Seats
Power Windows Rear Defogger Satellite Radio Reclining/Lounge Seats
Power Locks Keyless Entry SAFETY WHEELS
Power Mirrors Message Center Drivers Side Air Bag Aluminum/Alloy Wheels
Power Driver Seat Steering Wheel Touch Controls Passenger Air Bag PAINT
DECOR Rear Window Wiper Anti-Lock Brakes (4) Clear Coat Paint
Dual Mirrors Telescopic Wheel 4 Wheel Disc Brakes OTHER
Privacy Glass Backup Camera Traction Control Fog Lamps
Console/Storage RADIO Stability Control
Overhead Console AM Radio Front Side Impact Air Bags

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 Supplement of Record 1 with Summary

Customer: THOMPSON, BARBARA Job Number: 231251

2016 FORD Escape SE FWD 4D UTV 4-2.0L Turbocharged Gasoline Gasoline Direct Injection black met

Line Oper Description Part Number Qty Extended Labor Paint

Price $
1 # Rpr SETUP & MEASURE BENCH 2.0
SETUP
2 # Rpr SIDE SWAY 2.0
3 # S01 Rpr Damage from unibody clamps 0.5 0.5
4 REAR BUMPER
5 O/H rear bumper 2.7
6 * Repl Bumper cover w/o park sensors CJ5Z17K835ABCP 1 180.00 Incl.
Note: LABOR: Time is after outer tail lamp assemblies are removed. Time includes R&I/R&R side extensions,
lower cover, shield and reflectors.
7 * R&I LT Side extn Incl.
8 Repl Lower cover "SE", "SEL" CJ5Z17K835BA 1 136.48 Incl.
9 Repl RT Reflector CJ5Z15A449A 1 33.73 Incl.
10 <> Repl RT Side extn CJ5Z17810APTM 1 222.85 Incl. 1.8
11 Repl Absorber CJ5Z17754B 1 73.37 0.2
12 * Repl Reinforcement CJ5Z17906ACP 1 120.00 0.3
13 PILLARS, ROCKER & FLOOR
14 * Repl LKQ RT Rocker molding +25% CJ5Z7810176AB 1 87.50 0.5
15 S01 R&I LT Rocker molding 0.5
16 S01 Blnd LT Aperture panel s 2.1
17 S01 R&I RT Upr ctr plr trim to 11/16/2015 Incl.
18 S01 R&I LT Upr ctr plr trim to 11/16/2015 Incl.
19 S01 R&I RT W/S pillar trim Incl.
20 S01 R&I LT W/S pillar trim Incl.
21 S01 R&I RT Scuff plate rear Incl.
22 S01 R&I LT Scuff plate rear Incl.
23 S01 R&I RT Lwr ctr plr trim to 12/09/2016 0.4
24 S01 R&I LT Lwr ctr plr trim to 12/09/2016 0.4
25 S01 R&I RT Scuff plate front Incl.
26 S01 R&I LT Scuff plate front Incl.
27 S01 R&I RT Cowl trim 0.2
28 S01 R&I LT Cowl trim 0.2
29 EXHAUST SYSTEM
30 Repl Center muffler CV6Z5230CJ 1 158.21 m 0.8
31 * Repl Muffler w/tpipe CV6Z5A289D 1 401.38 m 0.6
32 Repl RT Muffler w/tpipe mount bracket CV6Z5K291K 1 17.91
33 R&I Heat shield rear muffler 0.3
34 LIFT GATE
35 Repl Nameplate "ESCAPE" CJ5Z1642528A 1 26.92 0.2
36 * Repl LKQ Lower trim CJ5Z78423A42APTM 1 Incl. Incl. 1.0
37 * Repl LKQ Decklid Tailgate Privacy tint 00211326:l00001 1 862.50 4.9 3.1
glass, ma +25%
Note: Cocoa Auto Salvage - black per partstrader
38 Overlap Major Non-Adj. Panel -0.2

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 Supplement of Record 1 with Summary

Customer: THOMPSON, BARBARA Job Number: 231251

2016 FORD Escape SE FWD 4D UTV 4-2.0L Turbocharged Gasoline Gasoline Direct Injection black met

39 REAR LAMPS
40 * Repl LKQ LT Tail lamp assy +25% CJ5Z13405E 1 37.50 0.3
41 * Repl LKQ RT Tail lamp assy +25% CJ5Z13404E 1 43.75 0.3
42 QUARTER PANEL
43 R&I RT Rear trim 0.2 G
44 Blnd RT Trough 0.4
45 * Rpr RT Quarter panel 1.0 2.2
46 Overlap Major Adj. Panel -0.4
47 R&I RT Wheel opng mldg 0.3
48 R&I Fuel door 0.1
49 R&I RT Qtr glass Ford, w/black 1.6 G
molding green tint
50 # Repl urethane kit 1 20.00
51 # Blnd rt upper rail 0.7
52 # S01 Repl Weld-through primer 1 8.00
53 * Repl LKQ LT quarter panel +25% GJ5Z7827841A 1 318.75 17.0 3.5
54 Overlap Major Adj. Panel -0.4
55 Deduct for Rear Bumper R&I -1.5
56 Refn inner pnl & edge 1.0
57 # Rpr Cut and trim lkq 3.0
58 S01 Repl LT Trough CJ5Z7845115C 1 183.67 3.5 0.7
59 R&I LT Qtr trim panel w/o subwoofer Incl.
to 09/05/2018
60 R&I LT Rear trim to 09/06/2016 0.2
61 R&I RT Qtr trim panel Incl.
62 R&I RT Rear trim 0.2
63 Repl LT Wheel opng mldg CJ5Z78290A61AA 1 63.55 0.3
64 S01 Repl LT Inner panel assy GJ5Z7810129A 1 1,083.97 7.0 1.5
65 S01 R&I RT Front trim 0.2
66 S01 R&I LT Front trim 0.2
67 FRONT DOOR
68 * Repl LKQ RT Mirror glass w/o blind CJ5Z17K707A 1 50.00 0.2
spot monitor +25%
69 * S01 Rpr LT Outer panel to 07/13/2017 0.5 1.9
(HSS)
70 Overlap Major Adj. Panel -0.4
71 R&I LT Belt molding black 0.3
72 * R&I LT Side molding 0.4
73 R&I LT R&I mirror 0.3
74 FUEL SYSTEM
75 S01 R&I R&I fuel tank m 1.9 M
76 # S01 Rpr Drain Fuel tank 1.0
77 WHEELS
78 S01 R&I LT/Rear R&I wheel m 0.1
79 S01 R&I RT/Rear R&I wheel m 0.1
80 REAR SUSPENSION

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 Supplement of Record 1 with Summary

Customer: THOMPSON, BARBARA Job Number: 231251

2016 FORD Escape SE FWD 4D UTV 4-2.0L Turbocharged Gasoline Gasoline Direct Injection black met

81 # Subl FOUR WHHEL ALIGN 1 69.95

82 * Repl LKQ RT Lower cntrl arm +25% CV6Z5500P 1 43.75 m 1.4 M
83 * S01 Repl RT Knuckle CV6Z5A968F 1 156.25 m 2.1 M
84 Deduct for Overlap -0.3 M
85 S01 R&I RT R&I susp crossmember as an m 3.5 M
assy
86 S01 R&I LT R&I susp crossmember as an m 3.5 M
assy
87 S01 Repl Bleed brake system 1 m 0.5 M
88 # S01 Repl brake fluid 1 8.00
89 REAR BODY & FLOOR
90 Repl Rear body panel AM5Z5840320B 1 139.87 6.0 2.0
91 Overlap Major Adj. Panel -0.4
92 Deduct for Overlap -1.0
93 Repl Inner panel CJ5Z7840320A 1 172.57 7.5 1.0
94 R&I Sill plate Incl.
95 R&I Luggage cover 0.1
96 R&I Lower insulator 0.1
97 R&I LT Insulator w/compact spare 0.2
98 R&I RT Insulator w/compact spare 0.2
99 R&I Liner 0.1
100 * R&I Holder 0.2
101 S01 Repl Floor pan assy CV6Z7811215A 1 362.03 22.5 2.1
Note: LABOR: Time is after rear body panel and inner panel are removed.
102 S01 Overlap Minor Panel -0.2
103 S01 Repl LT Floor side rail CV6Z7810125A 1 240.65 s 7.5 1.3
104 S01 Overlap Major Non-Adj. Panel -0.2
105 REAR DOOR
106 * Rpr LT Door shell (HSS) 3.0 2.2
107 Overlap Major Adj. Panel -0.4
108 Clear Coat 2.5
109 R&I LT W'strip on body 0.4
110 R&I LT Door w'strip 0.6
111 R&I LT Handle, outside w/o keyless 0.4
entry/start black
112 R&I LT Latch 0.4
113 R&I LT R&I trim panel Incl.
114 * Rpr LT Outer panel (HSS) 0.5 Incl.
115 R&I LT Side molding 0.4
116 R&I LT Belt molding black 0.3
117 # Subl HAZARDOUS WASTE REMOVAL 1 3.00
118 # Repl COVER CAR WITH PLASTIC 1 5.00
119 SEATS & TRACKS
120 S01 R&I LT R&I rear seat 0.4
121 S01 R&I RT R&I rear seat 0.4
122 S01 R&I LT R&I front seat 0.5

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 Supplement of Record 1 with Summary

Customer: THOMPSON, BARBARA Job Number: 231251

2016 FORD Escape SE FWD 4D UTV 4-2.0L Turbocharged Gasoline Gasoline Direct Injection black met

123 S01 R&I RT R&I front seat 0.5

124 CONSOLE
125 S01 R&I R&I console assy 1.6
126 ROOF
127 S01 R&I R&I headliner 3.1
128 # S01 R&I Carpet 1.5
129 # S01 Repl FLEX/ PER BUMPER COVER 1 5.00
130 # S01 Rpr MASK DOOR JAMBS 1.5
131 # S01 Repl SEAMSEALER PER TUBE 4 32.00 2.0
132 # S01 Repl Sound deadening pads 10 80.00
133 VEHICLE DIAGNOSTICS
134 * S01 Subl Post-repair scan 1 50.00 X m
135 * S01 Rpr Post-repair scan m 0.5
136 # S01 Rpr tpms reset 0.4
137 # S01 R&I wiring as necessary 2.0

138 OTHER CHARGES

139 # Towing 1 287.65
SUBTOTALS 5,785.76 129.9 28.9

ESTIMATE TOTALS
Category Basis Rate Cost $
Parts 5,448.11
Parts Discount $ 3,773.41 -9.0 % -339.61
Body Labor 115.5 hrs @ $ 44.00 /hr 5,082.00
Paint Labor 28.9 hrs @ $ 44.00 /hr 1,271.60
Mechanical Labor 12.6 hrs @ $ 65.50 /hr 825.30
Glass Labor 1.8 hrs @ $ 44.00 /hr 79.20
Paint Supplies 400.00
Miscellaneous 50.00
Other Charges 287.65
Pre-Tax Discount -1.0 % -131.04
Subtotal 12,973.21
Sales Tax $ 12,638.94 @ 6.0000 % 758.34
County Tax Tier 1 $ 5,000.00 @ 0.5000 % 25.00
Grand Total 13,756.55
Deductible 250.00
CUSTOMER PAY 250.00
INSURANCE PAY 13,506.55

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 Supplement of Record 1 with Summary

Customer: THOMPSON, BARBARA Job Number: 231251

2016 FORD Escape SE FWD 4D UTV 4-2.0L Turbocharged Gasoline Gasoline Direct Injection black met

For more information regarding State Farm’s promise of satisfaction relating to new non-original equipment
manufacturer (non-OEM) and recycled parts, please visit: http://st8.fm/7X4 or QR code.

Register online to check the status of your claim and stay connected with State Farm®. To register, go to http://www.statefarm.com/
and select Check the Status of a Claim. If you are already registered, thank you!

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 Supplement of Record 1 with Summary

Customer: THOMPSON, BARBARA Job Number: 231251

2016 FORD Escape SE FWD 4D UTV 4-2.0L Turbocharged Gasoline Gasoline Direct Injection black met

SUPPLEMENT SUMMARY

Line Oper Description Part Number Qty Extended Labor Paint

Price $
Changed Items
43 R&I LT Qtr trim panel w/o subwoofer -0.5
to 09/05/2018
59 S01 R&I LT Qtr trim panel w/o subwoofer Incl.
to 09/05/2018
45 R&I RT Qtr trim panel -0.5
61 S01 R&I RT Qtr trim panel Incl.
50 * Rpr LT Outer panel to 07/13/2017 -0.5 -2.2
(HSS)
69 * S01 Rpr LT Outer panel to 07/13/2017 0.5 1.9
(HSS)
58 * Repl RT Knuckle CV6Z5A968F 1 -156.25 m -2.1
83 * S01 Repl RT Knuckle CV6Z5A968F 1 156.25 m 2.1 M
59 Deduct for Overlap 0.3
84 S01 Deduct for Overlap -0.3 M
Deleted Items
42 * Repl LKQ LT Trough CJ5Z7845115C 1 Incl. -3.5 -0.7
Added Items
3 # S01 Rpr Damage from unibody clamps 0.5 0.5
15 S01 R&I LT Rocker molding 0.5
16 S01 Blnd LT Aperture panel s 2.1
17 S01 R&I RT Upr ctr plr trim to 11/16/2015 Incl.
18 S01 R&I LT Upr ctr plr trim to 11/16/2015 Incl.
19 S01 R&I RT W/S pillar trim Incl.
20 S01 R&I LT W/S pillar trim Incl.
21 S01 R&I RT Scuff plate rear Incl.
22 S01 R&I LT Scuff plate rear Incl.
23 S01 R&I RT Lwr ctr plr trim to 12/09/2016 0.4
24 S01 R&I LT Lwr ctr plr trim to 12/09/2016 0.4
25 S01 R&I RT Scuff plate front Incl.
26 S01 R&I LT Scuff plate front Incl.
27 S01 R&I RT Cowl trim 0.2
28 S01 R&I LT Cowl trim 0.2
52 # S01 Repl Weld-through primer 1 8.00
58 S01 Repl LT Trough CJ5Z7845115C 1 183.67 3.5 0.7
64 S01 Repl LT Inner panel assy GJ5Z7810129A 1 1,083.97 7.0 1.5
65 S01 R&I RT Front trim 0.2
66 S01 R&I LT Front trim 0.2
74 FUEL SYSTEM
75 S01 R&I R&I fuel tank m 1.9 M
76 # S01 Rpr Drain Fuel tank 1.0

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 Supplement of Record 1 with Summary

Customer: THOMPSON, BARBARA Job Number: 231251

2016 FORD Escape SE FWD 4D UTV 4-2.0L Turbocharged Gasoline Gasoline Direct Injection black met

77 WHEELS
78 S01 R&I LT/Rear R&I wheel m 0.1
79 S01 R&I RT/Rear R&I wheel m 0.1
85 S01 R&I RT R&I susp crossmember as an m 3.5 M
assy
86 S01 R&I LT R&I susp crossmember as an m 3.5 M
assy
87 S01 Repl Bleed brake system 1 m 0.5 M
88 # S01 Repl brake fluid 1 8.00
101 S01 Repl Floor pan assy CV6Z7811215A 1 362.03 22.5 2.1
NOTE: LABOR: Time is after rear body panel and inner panel are removed.
102 S01 Overlap Minor Panel -0.2
103 S01 Repl LT Floor side rail CV6Z7810125A 1 240.65 s 7.5 1.3
104 S01 Overlap Major Non-Adj. Panel -0.2
119 SEATS & TRACKS
120 S01 R&I LT R&I rear seat 0.4
121 S01 R&I RT R&I rear seat 0.4
122 S01 R&I LT R&I front seat 0.5
123 S01 R&I RT R&I front seat 0.5
124 CONSOLE
125 S01 R&I R&I console assy 1.6
126 ROOF
127 S01 R&I R&I headliner 3.1
128 # S01 R&I Carpet 1.5
129 # S01 Repl FLEX/ PER BUMPER COVER 1 5.00
130 # S01 Rpr MASK DOOR JAMBS 1.5
131 # S01 Repl SEAMSEALER PER TUBE 4 32.00 2.0
132 # S01 Repl Sound deadening pads 10 80.00
133 VEHICLE DIAGNOSTICS
134 * S01 Subl Post-repair scan 1 50.00 Xm
135 * S01 Rpr Post-repair scan m 0.5
136 # S01 Rpr tpms reset 0.4
137 # S01 R&I wiring as necessary 2.0
SUBTOTALS 2,053.32 63.6 6.8

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 Supplement of Record 1 with Summary

Customer: THOMPSON, BARBARA Job Number: 231251

2016 FORD Escape SE FWD 4D UTV 4-2.0L Turbocharged Gasoline Gasoline Direct Injection black met

TOTALS SUMMARY
Category Basis Rate Cost $
Parts 2,003.32
Parts Discount $ 1,870.32 -9.0 % -168.33
Body Labor 52.4 hrs @ $ 44.00 /hr 2,305.60
Paint Labor 6.8 hrs @ $ 44.00 /hr 299.20
Mechanical Labor 11.2 hrs @ $ 65.50 /hr 733.60
Paint Supplies 6.8 hrs @ $ 26.00 /hr 176.80
Additional Supplement Materials/Supplies -176.80
Miscellaneous 50.00
Pre-Tax Discount -1.0 % -52.23
Subtotal 5,171.16
Sales Tax $ 5,121.66 @ 6.0000 % 307.30
Total Supplement Amount 5,478.46
NET COST OF SUPPLEMENT 5,478.46

CUMULATIVE EFFECTS OF SUPPLEMENT(S)

Estimate 8,278.09 John Achtabowski

Supplement S01 5,478.46 John Achtabowski

Job Total: $ 13,756.55

CUSTOMER PAY: $ 250.00
INSURANCE PAY: $ 13,506.55

This estimate was prepared by a visual inspection of the damages to your vehicle. It is likely that additional hidden
damage could be identified by the collision repair facility once the vehicle is disassembled. This estimate may need to
be adjusted, and additional parts, materials and labor may be required, to properly repair your vehicle. The amount
of this estimate may not accurately reflect the full amount required to settle your loss. Due to damages incurred in a
collision loss, disassembly or tear-down of the vehicle WILL negate the ability to reassemble the vehicle without
performing repairs.

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 Supplement of Record 1 with Summary

Customer: THOMPSON, BARBARA Job Number: 231251

2016 FORD Escape SE FWD 4D UTV 4-2.0L Turbocharged Gasoline Gasoline Direct Injection black met

ANY PERSON WHO KNOWINGLY AND WITH INTENT TO INJURE, DEFRAUD, OR DECEIVE ANY INSURER FILES A
STATEMENT OF CLAIM OR AN APPLICATION CONTAINING ANY FALSE, INCOMPLETE, OR MISLEADING
INFORMATION IS GUILTY OF A FELONY OF THE THIRD DEGREE(FLORIDA STATUTES TITLE XLVI, CHAPTER
817.234). FAILURE TO USE THE INSURANCE PROCEEDS IN ACCORDANCE WITH THE SECURITY AGREEMENT,IF
ANY, COULD BE A VIOLATION OF S. 812.014, FLORIDA STATUTES. IF YOU HAVE ANY QUESTIONS, CONTACT YOUR
LENDING INSTITUTION. IF A CHARGE FOR SHOP SUPPLIES OR HAZARDOUS OR OTHER WASTE REMOVAL IS
INCLUDED ON THIS ESTIMATE, PLEASE NOTE THE FOLLOWING: "THIS CHARGE REPRESENTS COSTS AND PROFITS
TO THE MOTOR VEHICLE REPAIR FACILITY FOR MISCELLANEOUS SHOP SUPPLIES OR WASTE DISPOSAL." IF A
CHARGE FOR NEW TIRES OR A NEW OR REMANUFACTURED LEAD-ACID BATTERY IS INCLUDED ON THIS
ESTIMATE, PLEASE NOTE THE FOLLOWING: A $1.00 FEE FOR EACH NEW MOTOR VEHICLE TIRE SOLD AT RETAIL IS
IMPOSED ON ANY PERSON ENGAGING IN THE BUSINESS OF MAKING RETAIL SALES OF NEW MOTOR VEHICLE
TIRES WITHIN THE STATE OF FLORIDA. FLORIDA STATUTES TITLE XXIX CHAPTER 403.718. A $1.50 FEE FOR EACH
NEW OR REMANUFACTURED LEAD-ACID BATTERY SOLD AT RETAIL IS IMPOSED ON ANY PERSON ENGAGING IN
THE BUSINESS OF MAKING RETAIL SALES OF NEW OR REMANUFACTURED LEAD-ACID BATTERIES WITHIN THE
STATE OF FLORIDA. FLORIDA STATUTES TITLE XXIX 403.7185.

Estimate calculated using a preset user threshold amount for the paint and material cost.

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 Supplement of Record 1 with Summary

Customer: THOMPSON, BARBARA Job Number: 231251

2016 FORD Escape SE FWD 4D UTV 4-2.0L Turbocharged Gasoline Gasoline Direct Injection black met

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 DR2MK13, CCC Data Date 01/17/2022, 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 2022 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.

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 Supplement of Record 1 with Summary

Customer: THOMPSON, BARBARA Job Number: 231251

2016 FORD Escape SE FWD 4D UTV 4-2.0L Turbocharged Gasoline Gasoline Direct Injection black met

*****STATE FARM DISCLOSURES AND CUSTOMER NOTIFICATIONS*****

ANY PERSON WHO KNOWINGLY AND WITH INTENT TO INJURE, DEFRAUD, OR DECEIVE ANY INSURER
FILES A STATEMENT OF CLAIM OR AN APPLICATION CONTAINING ANY FALSE, INCOMPLETE, OR
MISLEADING INFORMATION IS GUILTY OF A FELONY OF THE THIRD DEGREE.

THE FOLLOWING DISCLOSURE APPLIES TO THOSE PARTS IDENTIFIED AS NON-OEM ON THE

ESTIMATE:

THIS ESTIMATE HAS BEEN PREPARED BASED ON THE USE OF CRASH PARTS SUPPLIED BY A SOURCE
OTHER THAN THE MANUFACTURER OF YOUR MOTOR VEHICLE. THE AFTERMARKET CRASH PARTS USED
IN THE PREPARATION OF THIS ESTIMATE ARE WARRANTED BY THE MANUFACTURER OR
DISTRIBUTOR OF SUCH PARTS RATHER THAN THE MANUFACTURER OF YOUR VEHICLE.

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 Supplement of Record 1 with Summary

Customer: THOMPSON, BARBARA Job Number: 231251

2016 FORD Escape SE FWD 4D UTV 4-2.0L Turbocharged Gasoline Gasoline Direct Injection black met

PARTS SUPPLIER LIST

Line Supplier Description Price

6 AutoNation Clearwater #CJ5Z17K835ABCP $ 180.00
15005 US Highway 19 North Bumper cover w/o park sensors
Clearwater FL 33764 Quote: 1054287960
Expires: 12/08/21

6 AutoNation Parts Center Clearwater #CJ5Z17K835ABCP $ 180.00

15005 US Highway 19 North Bumper cover w/o park sensors
Clearwater FL 33764
(800) 888-2292

8 Peacock Ford #CJ5Z17K835BA $ 136.48

1875 S Orlando Ave Lower cover "SE", "SEL"
Maitland FL 32751 Quote: 1054296022
Expires: 12/08/21

12 AutoNation Parts Center Clearwater #CJ5Z17906ACP $ 120.00

15005 US Highway 19 North Reinforcement
Clearwater FL 33764
(800) 888-2292

14 LKQ Corp #~273065170 $ 70.00

4950 West Norvell Bryant Highway LKQ RT Rocker molding +25%
Crystal River FL 34429 Rocker Panel Moulding TITANIUM,4DR RH, R.,S#$B2313
(800) 541-3011 Quote: 1063765700
Expires: 12/23/21

37 Cocoa Auto Salvage #00211326:l00001 $ 862.50

810 Industry S Rd LKQ Decklid Tailgate Privacy tint glass, ma +25%
Cocoa FL 32926
(321) 636-7130

40 Headlights 101 #AP485 $ 30.00

150 Tober Trail LKQ LT Tail lamp assy +25%
FAYETTEVILLE GA 30214 LH,COMP,LID
(770) 461-5974 Quote: CCC-88940295
Expires: 11/18/21

41 Elite Auto Lights #00000166 $ 35.00

100 Tabor Road Extension LKQ RT Tail lamp assy +25%
Flat Rock NC 28731 INS QUALITY GATE MOUNTED
(828) 696-2060 Quote: CCC-88940765
Expires: 11/18/21

53 LKQ Corp #~290998661 $ 255.00

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 Supplement of Record 1 with Summary

Customer: THOMPSON, BARBARA Job Number: 231251

2016 FORD Escape SE FWD 4D UTV 4-2.0L Turbocharged Gasoline Gasoline Direct Injection black met

4950 West Norvell Bryant Highway LKQ LT quarter panel +25%

Crystal River FL 34429 Quarter Panel Assembly ESCAPE,4DR,W/OSUN L, MAIN (FORWARD),
L.,S#$CF480
(800) 541-3011 Quote: 1066643385
Expires: 12/25/21

68 LKQ Corp #~268302354 $ 40.00

4950 West Norvell Bryant Highway LKQ RT Mirror glass w/o blind spot monitor +25%
Crystal River FL 34429 Side View Mirror POWER, W/O BLIND SPOT ALERT; W/O HEATED;
CHROME COVER,S#$CE645
(800) 541-3011 Quote: 1064957941
Expires: 12/24/21

82 LKQ Corp #~250323169 $ 35.00

4950 West Norvell Bryant Highway LKQ RT Lower cntrl arm +25%
Crystal River FL 34429 Lower Control Arm, Rear SE,1.6,FWD R, LOCATING ARMS; TOE LINK
(FRONT) ,S#$W3019
(800) 541-3011 Quote: 1066645611
Expires: 12/25/21

101 Peacock Ford #CV6Z7811215A $ 362.03

1875 S Orlando Ave Floor pan assy
Maitland FL 32751 Quote: 1130831332
Expires: 03/05/22

2/3/2022 5:23:35 PM 024662 Page 14