LIBERTY MUTUAL PERSONAL INSURANCE COMPANY

LMIC
***Supplement Instructions***
ALL SUPPLEMENTS REQUIRE PRIOR APPROVAL BY LIBERTY MUTUAL/SAFECO INSURANCE COMPANY
Please Submit Supplement to appraiser listed below in APPRAISER INFORMATION
***Body Shop Instructions***
Body Shops Can Check Claim Status, Payments, Obtain Appraisal Info & More
Visit Our Claims Information Portal: https://claiminfoportal.libertymutual.com
ALL OTHER QUESTIONS CALL:
800-251-7447
P.O. Box 5014
Scranton, PA 18505 Claim #: 056691915-0001
Phone: (800) 215-2467 Workfile ID: 1c4c09c6

Estimate of Record

Written By: JAY BERARD, License Number: 7522335, 5/1/2024 12:01:55 PM

Adjuster: COMER, MATTHEW

Insured: ALI NASER Owner Policy #: MARI Claim #: 056691915-0001

Type of Loss: COMP - Date of Loss: 04/26/2024 12:00 AM Days to Repair: 0
Comprehensive
Coverage
Point of Impact: 02 Right Front Pillar Deductible: 1000.00
(Right Side)

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

ALI NASER NASER, ALI jay.berard@libertymutual.com
65 W SILVER ST 65 W SILVER ST (413) 244-8963
WESTFIELD, MA 01085-3628 WESTFIELD, MA 01085-3628
(413) 557-9257 Cellular Field
alinaser029@gmail.com (413) 557-9257 Day

VEHICLE

2015 CADI CTS Sedan Luxury AWD 4D SED 4-2.0L Turbocharged Gasoline SIDI Black

VIN: 1G6AX5SX4F0130771 Production Date: 03/2015 Interior Color: Jet Black/Jet Black
Accen
License: 2ZZM17 Odometer: UNK Exterior Color: Black
State: MA Condition:

TRANSMISSION CONVENIENCE AM Radio ROOF

Automatic Transmission Air Conditioning FM Radio Electric Glass Sunroof
4 Wheel Drive Intermittent Wipers Stereo Skyview Roof
POWER Tilt Wheel Search/Seek SEATS
Power Steering Cruise Control Auxiliary Audio Connection Bucket Seats
Power Brakes Rear Defogger Premium Radio Leather Seats
Power Windows Keyless Entry Satellite Radio Heated Seats
Power Locks Alarm SAFETY Ventilated Seats
Power Mirrors Message Center Drivers Side Air Bag WHEELS

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 Claim #: 056691915-0001
Workfile ID: 1c4c09c6
Estimate of Record

2015 CADI CTS Sedan Luxury AWD 4D SED 4-2.0L Turbocharged Gasoline SIDI Black

Heated Mirrors Steering Wheel Touch Controls Passenger Air Bag Aluminum/Alloy Wheels
Power Driver Seat Telescopic Wheel Anti-Lock Brakes (4) PAINT
Power Passenger Seat Heated Steering Wheel 4 Wheel Disc Brakes Clear Coat Paint
Memory Package Climate Control Front Side Impact Air Bags OTHER
DECOR Navigation System Head/Curtain Air Bags Traction Control
Dual Mirrors Remote Starter Communications System Stability Control
Tinted Glass Backup Camera Hands Free Device Signal Integrated Mirrors
Console/Storage Parking Sensors Rear Side Impact Air Bags Xenon or L.E.D. Headlamps
Overhead Console Home Link Blind Spot Detection Power Trunk/Liftgate
Wood Interior Trim RADIO Lane Departure Warning

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 Claim #: 056691915-0001
Workfile ID: 1c4c09c6
Estimate of Record

2015 CADI CTS Sedan Luxury AWD 4D SED 4-2.0L Turbocharged Gasoline SIDI Black

Line Oper Description Part Number Qty Extended Labor Paint

Price $
1 FRONT BUMPER
2 R&I R&I bumper assy 84033411 2.3
3 FRONT LAMPS
4 R&I RT Headlamp assy w/o CTS V 84319716 0.4
w/HID
NOTE: Time is after bumper cover is removed. This part is eligible for a Core Charge. Part Price does not include
the Core Charge.
5 FENDER
6 * Rpr RT Fender 84054145 6.0 2.0
7 Add for Clear Coat 0.8
8 # Refn Partial Refinish Adjustment -0.5
9 WINDSHIELD
10 R&I RT Side molding 23179298 0.2
11 * Rpr RT Side molding 23179298 0.5 0.5
12 Add for Clear Coat 0.1
13 PILLARS, ROCKER & FLOOR
14 * Rpr RT Windshield pillar 84307907 s 4.0 1.5
15 Overlap Major Non-Adj. Panel -0.2
16 Add for Clear Coat 0.3
17 FRONT DOOR
18 R&I RT Mirror assy w/side object 84348266 0.4
detect, w/o surround view
19 * Rpr RT Mirror assy w/side object 84348266 0.5 0.6
detect, w/o surround view
20 Overlap Minor Panel -0.2
21 Add for Clear Coat 0.1
22 Repl RT Mirror cover 23105595 1 90.08 0.4 0.4
23 Overlap Minor Panel -0.2
24 Add for Clear Coat 0.1
25 VEHICLE DIAGNOSTICS
26 * Rpr Pre-repair scan m 0.5
27 * Rpr Post-repair scan m 0.5
28 MISCELLANEOUS OPERATIONS
29 # Repl Corrosion Protection 1 8.00 0.2
30 # Subl Hazardous waste removal 1 3.50
31 # Repl Car Cover 1 5.00 0.3
SUBTOTALS 106.58 16.2 5.3

NOTES

Prior Damage Notes:

FRONT BUMPER SCRATCHED. GRILLE PEELING PAINT. RT HEADLAMP AND RT DAYTIME RUNNING LAMP ARE SCUFFED. HOOD STONE CHIPPED.
WINDSHIELD STONE CHIPPED. RT 1/4 PANEL DENTED. REAR BUMPER SCUFFED ON THE RT SIDE. LT 1/4 PANEL DENT. ALL 4 WHEELS HAVE

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 Claim #: 056691915-0001
Workfile ID: 1c4c09c6
Estimate of Record

2015 CADI CTS Sedan Luxury AWD 4D SED 4-2.0L Turbocharged Gasoline SIDI Black

CURB DAMAGE.

ESTIMATE TOTALS
Category Basis Rate Cost $
Parts 106.58
Body Labor 16.2 hrs @ $ 45.00 /hr 729.00
Paint Labor 5.3 hrs @ $ 45.00 /hr 238.50
Paint Supplies 5.3 hrs @ $ 21.00 /hr 111.30
Subtotal 1,185.38
Sales Tax $ 217.88 @ 6.2500 % 13.62
Total Cost of Repairs 1,199.00
Deductible 1,000.00
Total Adjustments 1,000.00
Net Cost of Repairs 199.00

MyPriceLink Estimate ID:

1214955956413145088

-- THIS IS NOT AN AUTHORIZATION TO REPAIR

-- ALL SUPPLEMENTS REQUIRE PRIOR APPROVAL BY LIBERTY MUTUAL/SAFECO INSURANCE
Submit all Supplement Requests to Jay Berard
email: jay.berard@libertymutual.com or call 413-244-8963
Please present this Appraisal to the repair facility before repairs begin. Liberty Mutual/Safeco reserves the right to
inspect any additional damage.
My supervisor is Zach Allyn and he can be reached at zachary.allyn@libertymutual.com

"PER MASSACHUSETTS REG. TITLE 212 CHAPTER 2.02(5), "THIS ESTIMATE HAS BEEN PREPARED AND SWORN TO
UNDER THE PENALTIES OF PERJURY."

PER MASSACHUSETTS REG. TITLE 212 CHAPTER 2.02(5), "THIS ESTIMATE HAS BEEN PREPARED AND SWORN TO
UNDER THE PENALTIES OF PERJURY."

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 Claim #: 056691915-0001
Workfile ID: 1c4c09c6
Estimate of Record

2015 CADI CTS Sedan Luxury AWD 4D SED 4-2.0L Turbocharged Gasoline SIDI Black

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 DR1BK14, CCC Data Date 04/09/2024, 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 2024 vehicles contain minor changes from the previous year. For those vehicles, prior to receiving updated
data from the vehicle manufacturer, labor and parts data from the previous year may be used. The 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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 Claim #: 056691915-0001
Workfile ID: 1c4c09c6
Estimate of Record

2015 CADI CTS Sedan Luxury AWD 4D SED 4-2.0L Turbocharged Gasoline SIDI Black

THIS IS NOT AN AUTHORIZATION TO REPAIR. ALL SUPPLEMENTS REQUIRE PRIOR APPROVAL

Please present this Appraisal to the repair facility before repairs begin.
We reserve the right to inspect any additional damage.
** For supplement requests, please follow the instructions below:
**** If the ORIGINAL APPRAISAL was completed by a LIBERTY MUTUAL/SAFECO STAFF APPRAISER or a
GUARANTEED REPAIR NETWORK SHOP, please submit your supplement request at
HTTPS://SUPPLEMENTS.LIBERTYMUTUAL.COM/
****If the ORIGINAL APPRAISAL was completed by an INDEPENDENT APPRAISER, please contact the appraiser
directly; their email address and phone number can be located in the header of the appraisal or in the "APPRAISER
INFORMATION" section at the top of the appraisal.
******************************************************************************
If you have RENTAL COVERAGE or are entitled to a Rental due to this loss, Rental will be allowed for the reasonable
period necessary to repair your vehicle, subject to any applicable policy provisions, laws or regulations.
If a rental vehicle has not been pre-authorized or you have any questions regarding your rental coverage or eligibility,
please contact your adjuster prior to securing a rental vehicle.
Additional rental costs offered through the rental agency are not covered.
******************************************************************************
Liberty Mutual offers body shops fast and convenient service online through our Claim Information Portal. You can
check claim status, obtain payment details, view liability status, and much more.
Visit HTTPS://CIPAUTOBODY.LIBERTYMUTUAL.COM to register and login.
Customers and body shops may also contact a claims representative at the phone numbers below:
Liberty Mutual Insurance 1-800-225-2467
Safeco Insurance 1-800-332-3226
******************************************************************************
THE INSURER GUARANTEES THAT IT WILL REPLACE ANY PART IDENTIFIED IN THIS ESTIMATE WHICH IS NOT A
NEW ORIGINAL EQUIPMENT MANUFACTURER PART, INCLUDING RECYCLED PARTS MANUFACTURED BY THE
ORIGINAL EQUIPMENT MANUFACTURER OR NEW PARTS NOT MANUFACTURED BY THE ORIGINAL EQUIPMENT
MANUFACTURER, IF A DEFECT IS DISCOVERED.
THIS GUARANTEE WILL BE IN EFFECT FOR AS LONG AS YOU OWN THE VEHICLE DESCRIBED IN THIS ESTIMATE,
BUT IT IS NOT TRANSFERABLE TO ANY OTHER PARTY AT ANY TIME. THIS GUARANTEE COVERS THE COST OF THE
PART, LABOR TO INSTALL, AND PAINT AND MATERIALS, IF REQUIRED. THIS GUARANTEE DOES NOT COVER
CONSEQUENTIAL DAMAGES.
IF A DEFECT IS DISCOVERED IN ANY RECYCLED PARTS MANUFACTURED BY THE ORIGINAL EQUIPMENT
MANUFACTURER OR NEW PARTS NOT MANUFACTURED BY THE ORIGINAL EQUIPMENT MANUFACTURER THAT ARE
USED IN REPAIR OF YOUR VEHICLE, CONTACT YOUR ADJUSTER OR AGENT IMMEDIATELY, AND WE WILL REPLACE
THE PART WITH A NEW ORIGINAL EQUIPMENT MANUFACTURER PART.
******************************************************************************
You have the right to choose any repair facility to complete the repairs to your vehicle. If you choose to use one of
our Liberty Mutual Superior Service Program (SSP) shops or Safeco Superior Service Program shops, Liberty
Mutual/Safeco Insurance will guarantee the repairs for as long as you own the vehicle; in addition, we offer our
Referral Shop Program. For more information and to find a complete list of our Superior Service Program (SSP)
shops, Referral Program Shops and registered repair facilities in Massachusetts, please visit:

Liberty Mutual Insurance: https://www.libertymutual.com/ma-referral-shop-list

Safeco Insurance: https://www.safeco.com/ma-auto-repair-referral-list

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 Claim #: 056691915-0001
Workfile ID: 1c4c09c6
Estimate of Record

2015 CADI CTS Sedan Luxury AWD 4D SED 4-2.0L Turbocharged Gasoline SIDI Black

******************************************************************************
Repair Certification Form: Please complete and mail this section back to the address below if you are an insured and
your claim was repaired through Liberty Mutual/Safeco. This does not apply if you are not our insured

Completion Information

Insured _____________________________________________________________________________

Claim Number ________________________________________________________________________

Date of Accident ____________________________________________________________________

Policyholder Information

I. Explanation of Your Rights and Duties for Repairing Damaged Vehicle

1. It is your right to shop around and to obtain repairs at the repair shop of your choice.
2. It is your right to be given a list of geographically convenient repair shops which will provide quality repairs for the
amount of the payment made to you plus any applicable deductible plus any increase in value due to the repairs. We
guarantee the quality of the materials and workmanship used in making the repairs at any shop on our list.
3. It is your duty to notify us, by phone or in writing, prior to or in the course of repairs, if the cost of repairs is
expected to exceed our payment plus any applicable deductible and increase in value and you wish us to pay any
part of that excess cost. We have the right to inspect the vehicle within three (3) business days of your notification
and we have the duty to authorize or deny any supplemental payments within one (1) business day after inspection.
4. It is your right to pursue resolution of any differences in repair cost through contact with us and the procedure
established in General Provision Section 11 of the policy.
5. It is your duty to complete and to return this Repair Certification Form when the vehicle is repaired. If the
completed Repair Certification Form is not returned to us, the actual cash value of the insured vehicle will be reduced
by the amount of the claim payment plus any applicable deductible.
6. It is your duty to allow us, upon request, to reinspect the repaired vehicle after receipt of the Repair Certification
Form. If the repaired vehicle is not made available for reinspection within a reasonable amount of time, the actual
cash value of the insured vehicle will be reduced by the amount of the claims payment plus any applicable deductible.

II. Certification of Repair

I certify that my damaged vehicle has been repaired by:

Repair Shop Name ________________________________________________________________

Address _________________________________________________________________________

Telephone _______________________________________________________________________

Policyholder Signature ______________________________________________________________

Date _____________________________________________________________________________

Address ___________________________________________________________________________

Telephone _________________________________________________________________________
After the repairs are complete, please return this completed form to;

Liberty Mutual Insurance

P.O. Box 5014

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 Claim #: 056691915-0001
Workfile ID: 1c4c09c6
Estimate of Record

2015 CADI CTS Sedan Luxury AWD 4D SED 4-2.0L Turbocharged Gasoline SIDI Black

Scranton, PA 18505-5014

Safeco Insurance
P.O. Box 5014
Scranton, PA 18505-5014

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 Claim #: 056691915-0001
Workfile ID: 1c4c09c6
Estimate of Record

2015 CADI CTS Sedan Luxury AWD 4D SED 4-2.0L Turbocharged Gasoline SIDI Black

ALTERNATE PARTS USAGE

2015 CADI CTS Sedan Luxury AWD 4D SED 4-2.0L Turbocharged Gasoline SIDI Black

VIN: 1G6AX5SX4F0130771 Production Date: 03/2015 Interior Color: Jet Black/Jet Black
Accen
License: 2ZZM17 Odometer: UNK Exterior Color: Black
State: MA Condition:

Alternate Part Type # Of Available Parts # Of Parts Selected

Aftermarket 0 0
Optional OEM 0 0
Reconditioned 0 0
Recycled 70 0

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