Progressive Direct Insurance Company vs Mandela A. Ibrahim, 73-CV-22-2012, 11042022_Other Document_0 (Minnesota State, Stearns County, District Court Apr. 11, 2022) (2024)

`

`Claim Payment Detail,
`
`73-CV-22-2012
`
`Filed in District Court
`Page l of l
`State of Minnesota
`4/11/2022 1:26 PM
`
`Claim Payment Detail ( 19-1848217 )
`
`~Paymant Information
`Disbursem*nt Number: 357178990
`Draft Number:
`2779227856
`MICHAEL CHASE AND ANNE CHASE
`Pay to the Order of:
`2814 RHODE lSLAND AVE S
`Malling Address:
`SAINT LOUIS PARK. MN 55426-3050 USA
`Progressive Invoice Number: 62191999
`
`In Payment Of:
`
`Total Amount:
`$950.00
`Invoice Number: 62191999
`
`-RevIewed Summary
`A113195
`Issuing Rep:
`Issue Date:
`08-15-19
`Last Updated Rep: A113195
`
`—Bank Information
`
`Type:
`Stop Reason:
`Stop Date:
`
`Loss
`
`~Exposure Detail: UMIUIM
`Party Name:
`Paymentrype:
`
`Approved By:
`Review Date:
`Reviewed By:
`
`—
`
`Cleared:
`
`08-26-19
`
`CHASE. MICHAEL
`FINAL PAYMENT
`
`Amount Paid:
`Deduct'b'e Taken:
`
`$950.00
`50-00
`
`http://claimspayments/AIpha/C IaimsPaymentsWeb/defauIt.aspx?page=C IaimPaymentDet...
`
`IO/ I 9/2020
`
`

`

`73-CV-22-2012
`
`Filed in District Court
`State of Minnesota
`4/11/2022 1:26 PM
`
`9I26I2019 04:32 PM
`Date:
`EstImate ID:
`19-1848217-01
`Estimate Version:
`2
`2 (F F) 9/26/2019 04:26:16 PM
`Supplement:
`Profile ID: Metro All Pats'l 125
`Quote '3:
`51594726
`
`Progresswe Dlrect Insurance Co
`J Ditnnoesco 440-910-5808
`JENNIE POLZN
`Field
`
`SANDY CHANG
`(952) 562.6920
`
`Damage Assessed By:
`
`'ClaIm Rep:
`
`Supplemented By:
`Classification:
`' PmductType Auto
`' Dae of Loss:
`7/1712019
`‘ Deductible:
`500 00
`' Claim Number:
`19-1848217-01
`Insured: MICHAEL CHASE
`Owner: MICHAEL CHASE
`2814 RHODE ISLAND AVE S, SAINT LOUIS PARK, MN 55425
`Address:
`Telephone:
`Ce" Phone:
`(99) 485-1864
`
`Contact Phone:
`
`(952) 486-2864
`
`.-
`
`Description:
`
`2015 GMC TerraIn SLE
`
`Mitchell Service:
`
`911265
`
`IIIIT!
`IIleage:
`OEMIALT: A
`Search Code: ARDENHILU
`Color: BLACK
`Options: PASSENGER AIRBAG, POWER DRIVER SEAT, POWER LOCK, POWER WINDOW, POWER STEERING
`REAR WINDOW DEFOGGER, AIR CONDITION. CRUISE CONTROL, TILT STEERING COLUMN
`AMIFM STEREO, DRIVER AIRBAG, HEATED EXTERIOR MIRROR
`FRONT SIDE AIRBAG WITH HEAD PROTECTION, PREMMM SOUMJ SYSTEM
`ANTI-LOCK BRAKE SYS , TRACTION CONTROL, FOG LIGHTS, ALWIALLOY WHEELS
`REARVIEW CAM ERA, TIRE iNFLATIONIPRESSURE M ONITOR, AUXILIARY INPUT
`BLUETOOTH WIRELESS CONNECTIVITY, LEATHER STEERING WHEEL, SATELLITE RADIO
`CD PLAYER, POWER ADJUSTABLE EXTERIOR MIRROR, 4WD OR AWD, PRIVACY GLASS
`AUTO AIR CONDITION, TRIP COMPUTER, FIRST ROW BUCKET SEAT, TELEMATIC SYSTEMS
`CLOTH SEAT, ALL WHEEL DRNE, SIDE AIRBAGS
`SECOND ROW SIDE AIRBAG WITH HEAD PROTECTION
`INTERIOR AUTOMATIC DAY/NIGHT OR ELECTROCHROMATIC MRROR, MP3 PLAYER
`DAYTIME RUNNING LIGHTS, DRIVER SEAT WITH POWER LUMBAR SLPPORT
`ELECTRONIC STABILITY CONTROL, KEYLESS ENTRY SYSTEM, REAR BENCH SEAT
`STEERING WHEEL AUDIO CONTROLS
`
`Une Item
`Description
`sze The/Wheel
`Exhaust Muffler
`
`-M
`
`.mm.
`W
`Id 8
`R Quarter Trlm Panel
`L Quarter Trlm Panel
`R Upr Quafler Trlm Panel
`L Upr Quarter Trlm Panel
`_|-ittu.ate_
`
`Llne
`Labor
`Entry
`Item Number Type
`
`Operalion
`
`S1 1
`
`S2 2
`
`S1 3
`S1 4
`52 5
`SZ 6
`
`100780 BDY
`
`REMOVEIINSTALL
`
`100422 MCH
`
`REMOVEIREPLACE
`
`BDY
`100941
`100942 BDY
`100950 BDY
`100952 BDY
`
`REMOVEIINSTALL
`REMOVEIINSTALL
`REMOVEIINSTALL
`REMOVEIINSTALL
`
`7
`8
`9
`10
`11
`12
`13
`
`100964 BDY
`REF
`101225 BDY
`BDY
`101119 BDY
`BDY
`101121
`101124 BDY
`
`S1 14
`
`101161
`
`BDY
`
`RE PAIR
`REFINISH
`REMOVEIINSTALL
`REMOVEIINSTALL
`REMOVEIREPLACE
`REMOVE/REPLACE
`REMOVEIINSTALL
`
`REPAIR
`
`Llftgate Shell
`Liltgate Outside
`Lwr LIftgaIe Applique
`Lwr Littgate Trim Panel
`Liftgate Adhesive Nameplate
`Liftgate Adhesive Nameplate
`Upr Liftgale Trim Panel
`Rgz find!
`Rea Body Panel
`ESTIMATE RECALL WMBER: 07I2ZI2019 13:03:01 19-1048217-01
`OEM: JUL 19 vmo
`Mitchell Data Version:
`MAPP:JUL_19_V0906
`11217
`
`Softwae VersIon:
`
`Copyright (C) 1994 - 2019 Mitchell Internationd
`All Rights Reserved
`
`Part Type]
`Part Number
`
`Dolls
`Amount
`
`Labor
`Unit:
`
`“ AIM
`
`Existing
`Existlng
`Existing
`Existing
`
`Existing
`
`23255005
`23255004
`
`Existing
`
`381 88 '
`
`0 2
`
`1 1
`
`0 4
`0 4
`0 3
`0 3
`
`r
`r
`r
`r
`
`6 0' fl
`C 2 4
`0 5 I!
`0 3
`0 2
`0 2
`0 2
`
`8 0' #
`
`28 85
`40 M
`
`Page
`
`1 015
`
`

`

`73-CV-22-2012
`
`Filed in District Court
`State of Minnesota
`4/11/2022 1:26 PM
`
`15
`S1 16
`17
`s1 18
`19
`20
`21
`S1 22
`$1 23
`
`24
`25
`26
`27
`
`28
`s2 29
`30
`$2 31
`32
`82 33
`34
`s2 35
`82 30
`37
`82 38
`s1 39
`
`40
`
`41
`42
`
`43
`44
`S1 45
`s1 48
`S1 47
`s1 48
`S1 49
`s1 50
`S1 51
`S1 52
`$2 53
`
`REF
`
`REFINISHIREPAIR
`
`101115 BDY
`
`REPAIR
`
`REF
`101212 BDY
`BDY
`102419
`
`BDY
`101229
`BDY
`101230
`BDY
`101231
`101232 BDY
`
`BDY
`101693 BDY
`REF
`101697 BDY
`BDY
`101698 BDY
`
`101700 BDY
`BDY
`101701
`101702 BDY
`BDY
`101707
`BDY
`101708
`
`REFINISHIREPAIR
`REM OVEIINSTALL
`REMOVEIINSTALL
`
`REMOVEIINSTALL
`REMOVEIINSTALL
`REMOVE/INSTALL
`REMOVEIINSTALL
`
`OVERHAUL
`REMOVEIREPLACE
`REFINISH
`REMOVE/REPLACE
`REMOVE/INSTALL
`REMOVE/REPLACE
`
`REMOVE/REPLACE
`REMOVE/REPLACE
`REM OVEIINSTALL
`REMOVEIREPLACE
`REMOVEIINSTALL
`
`REF
`
`ADD'L OPR
`
`ADD'L COST
`ADD'L COST
`
`ADD'L LABOR OP
`
`REMOVEIREPLACE
`REMOVEIREPLACE
`REMOVEIREPLACE
`ADD'L LABOR OP
`ADD'L LABOR OP
`REMOVEIREPLACE
`REMOVEIREPLACE
`ADD'L LABOR OP
`REMOVEIREPLACE
`
`900500 BDY '
`900500 REF ‘
`BDY "
`900500
`900500 BDY "
`900500 MCH‘
`900500 BDY ‘
`900500 MCH'
`900500 BDY '
`900500 REF ‘
`900500 BDY '
`
`Repalr Time After Pull
`Rear Body Panel
`MODIFIED REFINISH WITH FULL CLEAR COAT
`Rear Body Floor Pan
`SPOT REFINISH
`Repalr Tlme After Pull
`Rear Body Floor Pan
`Rear Body Scuff Plate
`Rear Body Spare Wheel Well Cover
`REN LEEE
`R Rear Combination Lamp
`L Rear Comblnatlon Lamp
`R License Lamp
`L License Lamp
`m
`Rear Bumper Cover Assy
`Rear Bumper Cover
`Rear Bumper Cover
`Rear Lwr Bumper Cover
`Rear Bumper Cover
`Rear Bumper Access Hole Cover
`missing
`Rear Upr Bumper Pad
`R Rear Bumper Reflector
`L Rear Bumper Reflector
`Rear Bumper Energy Absorber
`Rear Bumper Impact Bar
`Additional Operations
`
`Clear Coat
`Additional Costs & Materiglg
`Paint/M aterials
`Hazardous Waste Disposal
`
`TIE-DOWN & PULL
`PULL REAR BODY, FLOOR PAN
`FLEX ADDITIVE
`COVER CAR FOR OVERSPRAY
`CORROSION PROTECTION
`Pre Repair Scan
`Post Repair Scan
`SOUND DEADENER ($4 00 PER12' X 12" PAD)
`SEAM SEALER - PANEL REPAIR
`mask liftgate opening
`Clamp
`
`*-Judgmentflem
`# - Labor Note Applies
`C - Included in Clear Coat Calc
`r - CEG R&R Time Used For This Labor Operation
`
`Date:
`9I26I2019 04:32 PM
`Estlmate ID:
`19-1848217-01
`Estimate Version:
`2
`2 (F F) 9/26I2019 04:26:16 PM
`Supplement:
`Profile ID: Metro All PaltsT 125
`51594728
`Quote ID:
`
`Exlstlng
`
`Exlstlng
`Exlstlng
`
`Remanufactured
`
`25798310
`
`22950586
`Existing
`
`Existing
`
`Existing
`
`Sublet
`Sublet
`Sublet
`Sublet
`Sublet
`Sublet
`Sublet
`Existing
`New
`
`c 1 0‘
`
`4 0'
`
`o 5"
`0 2
`0 2
`
`r
`r
`
`0 3 #
`0 3 #
`INC #
`INC #
`
`2 4
`510 00 '
`INC
`C 2 2
`388 00 ‘
`INC #
`INC
`INC II
`
`24 73
`
`58 70 "
`37 27
`
`175 46 ‘
`
`INC
`
`INC #
`INC #
`INC #r
`INC #
`0 3 #
`
`1 7
`
`307 80 '
`3 50 '
`
`2 0'
`5 00 ‘ 00"
`7 50 "
`0 2'
`7 50 ' 0 3"
`0 5‘
`0 5"
`8 00 "
`INC'
`10 00 ' 0 3"
`0 3"
`5 52 ‘ 00'
`
`A11 manufacturers requirements regarding seat belt and supplemental
`restraint
`If additional parts
`system replacement must be adhered to.
`or operations are necessary to properly accomplish this, please
`the estimating claims rep.
`contact
`
`ESTIMATE RECALL NUMBER: 07I22I2019 13:03:01 19-1848217-01
`Mitchell Data Version: OEM: JUL_19_V0910
`Copyright (C) 1994 - 2019 Mitchell Inhmational
`MAPP:JUL_19_V0908
`Software Version:
`All Rights Reserved
`7 1 237
`
`Pagozors
`
`

`

`73-CV-22-2012
`
`Estimate Totals
`
`Filed in District Court
`State of Minnesota
`4/11/2022 1:26 PM
`
`9/26/2019 04: 32 PM
`Date:
`Estimate ID:
`19-1 848217-01
`Estimate Verdun:
`2
`2 (F F) SIZE/2019 04:26:18 PM
`Supplement:
`Profile lD: M etro All P3157 125
`Quote '3:
`51594726
`
`Add'l
`Labor
`Amount
`0 00
`0 00
`0 00
`
`Sublet
`Amount
`0 00
`0 00
`0 00
`
`|
`
`Labor Subtotals
`Body
`Refinish
`Mechanical
`
`Unis
`27 5
`81
`21
`
`Rate
`58 00
`58 00
`85 00
`
`Non-Taxable Labor
`
`Labor summary
`
`37 7
`
`iii
`
`Additional Costs
`Taxable Costs
`
`Sales Tax
`
`@
`
`7 525%
`
`Non-Taxahle Costs
`
`Total Additional Costs
`
`Paint M aterlal Method: Rates
`hit Rate I 38 00
`
`Totals
`1,595 00
`469 80
`178 50
`
`2.243 30
`
`2,243 30
`
`Amount
`307 80
`23 16
`
`3 50
`
`334 48
`
`II
`
`Part Replacement Summary
`Taxable Parts
`Sales Tax
`
`@
`
`7 525%
`
`Total Replacement Parts Amount
`
`IV
`
`Adjustments
`Insurance Deductible
`
`Customer Responsibility
`
`1
`II
`Ill
`
`IV
`
`Total Labor:
`Total Replacement Parts:
`Total Additional Costs:
`Gross Total:
`
`Total Adjustments:
`Net Total:
`Less Original Net Totd:
`Net Supplement Amount:
`JENNE POLZN
`JENNE POLZN
`
`S1:
`52:
`
`Amount
`1,740 41
`131 57
`
`1.879 98
`
`Amount
`500 00-
`
`500 00-
`
`2.243 30
`1,879 98
`334 45
`4,457 74
`
`500 00.
`3.957 74
`2,113 31
`1,844 43
`
`738 95
`1,105 48
`
`Polnfls) of impact
`6 Rear Center (P)
`
`Alt Location: PROGRESSWE
`
`Inspection Date:
`
`7I22I2019
`
`ESTIMATE RECALL WMBER: 07I2212019 13:03:01 19-1848217-01
`Mitchell Data Version: DEM: JUL 19 V0910
`MAPP:JUL_19_V0908
`Sofiwae Version:
`7 1 237
`
`Copyright (C) 1994- 2019 Mitchell Internationa
`All Rights Reserved
`
`Page 3 of
`
`5
`
`

`

`73-CV-22-2012
`
`Filed in District Court
`State of Minnesota
`4/11/2022 1:26 PM
`
`Date:
`9/26I2019 04:32 PM
`Estimate ID:
`19-1848217-01
`Estimate Verslon:
`2
`2 (F F) 9/26I2019 04:26:16 PM
`Supplement:
`Profile ID: Metro All PartsT 125
`51594726
`Quote ID:
`
`This is a damage assessment only - Not an authorization to repair-
`based on damage visible
`or certain at
`the time it was written.
`frame or unibody repair is included on this estimate,
`If
`the amount
`shown includes time or allowance for measuring before, during and
`after
`those repairs.
`The owner of the vehicle may select
`choice.
`To ensure proper and prompt payment for additional
`damage discovered
`of repairs, contact Progressive for supplement
`during the course
`handling procedures.
`Progressive honors the prevailing labor market rate in your area
`for
`If you choose a shop that charges in excess
`of the
`your property.
`prevailing labor market rates, you will be responsible for the
`difference.
`Lifetime guarantee for sheet metal and plastic body parts
`
`the repair facility of his/her
`
`The replacement parts written on the estimate are
`intended to return
`your vehicle to its pre-loss condition with proper installation.
`After repair,
`if any sheet metal or plastic body part included in the
`estimate fails
`to return your vehicle to its pre-loss condition
`(assuming proper installation),
`form, fit,
`finish,
`in terms of
`durability or
`functionality, Progressive will
`arrange and pay for the
`replacement of the part,
`to the extent not covered by a
`manufacturer's or other warranty. This service will be performed at
`no cost
`to you (including associated repair and rental
`car costs). To
`obtain service under this Guarantee, call Progressive at
`1-800-274-4641. This Guarantee applies as
`lease
`long as you own or
`the vehicle.
`This Guarantee is not transferable and terminates if you
`sell or otherwise transfer your vehicle.
`This guarantee does not cover
`normal wear and tear or damage caused
`by improper maintenance, neglect, abuse or subsequent accident. This
`guarantee is limited to arranging for the selection of repair parts
`return your vehicle to its pre-loss condition. Accordingly,
`that will
`Progressive will not be liable for any indirect,
`incidental
`or
`consequential damages that result
`from the installation
`or use of
`these parts.
`
`Part Type Terms and Abbreviations
`NEW and OEM or part number displayed - These refer to a new, original
`equipment manufacturer part.
`A/M Certified:
`This refers to a new, certified non-original equipment
`manufacturer replacement part.
`This refers to a new, non—original equipment manufacturer
`A/M:
`replacement part.
`Recycled: This refers to a used OEM part.
`Remanufactured and Recond. and Recore: These refer
`ESTIMATE RECALL NUMBER: 07/22I2019 13:03:01 19-1848217-01
`Mitchell Data Version: DEM: JUL_19_V0910
`Copyright (C) 1994 - 2019 Mitchell International
`MAPP:JUL_19_V0908
`Ali Rights Reserved
`Sofiware Version:
`T 1 237
`
`to recycled OEM
`
`Page 4 of
`
`5
`
`

`

`73-CV-22-2012
`
`Filed in District Court
`State of Minnesota
`4/11/2022 1:26 PM
`
`Date:
`9I26I2019 04:32 PM
`Estimate ID:
`19-1848217-01
`Estimate Version:
`2
`2 (F F) 9I26I2019 04:26:16 PM
`Supplement:
`Profile lD: Metro All PartsT 125
`Quote ID:
`51594726
`
`parts that have been rebuilt
`or refurbished.
`This refers to new OEM parts,
`DEM Surplus Part:
`that are
`excess
`inventory from the Original Equipment Manufacturer.
`Recovered OE - This refers to parts removed from a new vehicle for
`various reasons.
`Repair shop's authorized representative's signature indicating
`to return the vehicle to pre—loss condition
`agreement on cost
`including tow/storage charges:
`
`Shop Signature:
`Est.
`completion Date:
`a claim with intent
`A person who files
`to defraud or helps commit a
`fraud against an insurer is guilty of a crime.
`
`Event Log
`
`File Created:
`Estimate Started:
`Estimate Printed:
`Estimate Committed:
`Estimate Uploaded:
`
`07/22/2019 09:32:49 AM
`09I20I2019 04:16:24 PM
`09l26l2019 04:30:04 PM
`09l26l2019 04:29:10 PM
`09/2612019 04:32:16 PM
`
`ESTIMATE RECALL NUMBER: 07/22/2019 13:03:01 19-1848217-01
`Mitchell Date Version: OEM:
`JUL_19_V0910
`Copyright (C) 1994 - 2019 Mitchell lnlemational
`MAPP:JUL_19_V0908
`All Rights Reserved
`7 1 237
`
`Software Version:
`
`Page 5 of
`
`5
`
`

`

`73-CV-22-2012
`
`Filed in District Court
`State of Minnesota
`4/11/2022 1:26 PM
`
`Date:
`9I2W2019 04:32 PM
`Estimate ID:
`19-1848217-01
`Estimate Version:
`2
`2 (F F) 9/26/2019 04:26:16 PM
`Supplement:
`Profile ID: Metro All Pa'ts'l 125
`
`Progresswe Direct Insurance Co
`
`Supplement Delta Report
`Comparison of Estimate 19-1848217-01 Supplement 1 and Supplement 2
`J Dltrancesco 440-910-5808
`Damage Assessed By:
`JEMIE POLZIN
`Supplemented By:
`Insured: MICHAEL CHASE
`Owner: MICHAEL CHASE
`2015 GM C Terrain SLE
`Vehicle Description:
`' Date of Loss:
`7/17/2019
`
`Line
`Item
`
`Labor
`Type
`
`Changed Entries
`MCH
`2
`52 2
`MCI-I
`BDY
`27
`52 29< BDY
`BDY
`32
`52 31< BDY
`BDY
`51 34
`52 33< BDY
`BDY
`36
`82 35< BDY
`BDY
`37
`52 36< BDY
`BDY
`39
`52 38< BDY
`
`Deleted Entries
`29
`30
`31
`
`Added Entries
`52 5
`BDY
`52 6
`BDY
`S2 53
`BDY
`
`Operaion
`
`Line Item
`Description
`
`REMOVE/REPLACE
`REMOVE/REPLACE
`REMOVE/REPLACE
`REMOVE/REPLACE
`REMOVE/REPLACE
`REMOVE/REPLACE
`REMOVE/REPLACE
`REMOVE/REPLACE
`REMOVE/REPLACE
`REMOVE/REPLACE
`REMOVE/REPLACE
`REMOVE/REPLACE
`REMOVE/REPLACE
`REMOVE/REPLACE
`
`Exhaust MquIer
`-M
`Exhaust Muffler
`-M
`Rear Bumper Cover
`Rear Bumper Cover
`Rear Lwr Bumper Cover
`Rear Lwr Bumper Cover
`Rear Bumper Accsss Hole Cover
`Rear Bumper Access Hole Cover
`Rear Upr Bumper Pad
`Rear Upr Bumper Pad
`R Rear Bumper Reflector
`R Rear Bumper Refledor
`Rear Bumper Energy Absorber
`Rear Bumper Energy Absorber
`
`Part Type
`" AIM
`“Qual Repl Part<
`Recycled
`Remmufactured<
`Recycled
`“Qual Repl Part<
`Recycled
`25798816<
`Recycled
`“Qual Repl Park
`Recycled
`2350588<
`Recycled
`"Dual Repl Park
`
`BUMPER ASSEM BLY [INCLUDES MARKUP
`LKQ VIKING I 6511363359
`STOCK it SW21910-540 l APU #1415 6368 2873 048
`
`Dollar
`Amount
`
`Labor
`Units
`
`CEG
`Unlt
`
`52 08
`38188 '<
`593 75 '
`570 00 '<
`INC '
`388 00 '<
`INC '
`24 73
`INC '
`58 70 '<
`INC '
`INC‘
`37 27
`175 48 '<
`
`<
`
`<
`
`1 1T
`1 1T
`2 4T
`2 4T
`0 6T
`0 6T
`0 2T
`0 2T
`0 2T
`0 2T
`0 2T
`0 2T
`0 2T
`0 2T
`
`1 1
`1 1
`INC
`INC
`INC
`INC
`INC
`INC
`INC
`INc
`INC
`INC
`INC
`INC
`
`O 0
`0 0
`0 0
`
`REMOVE/INSTALL
`REMOVE/INSTALL
`REMOVEIREPLACE
`
`R Upr Quarter Trim Patel
`L Upr Quarter Trlm Panel
`Clamp
`
`Existing
`Existing
`New
`
`552 '
`
`0 3
`0 3
`00‘
`
`0 3
`0 3
`T
`
`Global changes
`No Deductible, Customer Responsibility, Labor Rate, or Part Adjustment changes were made
`
`Original Estimate:
`Supplement 1
`Supplement 2
`
`Supp 1 Total Tax
`Supp 2 Total Tax
`Net Supplement Amount
`Net Tobi
`
`738 95
`1,105 48
`
`79 80
`154 73
`
`ANOHM
`2,113 31
`
`1,844 43
`
`337-174
`
`Supp 1
`Supp 2
`
`Program Calc Versions
`Data Versions
`7 1 236 MAY 7197V0708
`1 1 237
`JUL_19_V0910
`
`ESTIMATE RECALL NlM BER: 7/22/201913:03:01 194848217411
`Copyright (C) 1994 - 2019 Mltdmll International
`All Rights Rsserved
`
`Soflwa'e Version:
`
`7 1 237
`
`Page
`
`1
`
`of
`
`1
`
`

`

`73-CV-22-2012
`ARMS® - Automated Rental Management System
`
`Filed in District Court
`Page l of 2
`State of Minnesota
`4/11/2022 1:26 PM
`
`®ARMS PROGRESSIVE
`
`Bill To: PRO1901
`PROGRESSIVE
`ATTN: SANDY CHANG
`10220 GOLDENROD ST NW STE 150
`COON RAPIDS. MN 55448
`RENTER INFORMATION:
`Renter: CHASE. MICHAEL
`
`RENTAL INFORMATION:
`Rental Branch Location:
`ENTERPRISE RENT-A-CAR (1909)
`10841 EXCELSIOR BLVD
`HOPKINS. MN 553433431
`(952) 938-8825
`
`ADDITIONAL CLAIM INFORMATION:
`Claim Number :19-1848217
`Claim Type: Insured
`Vehicle Condition: Driveable
`Date Of Loss:
`Insured Name:
`Owner‘s Vehicle: 2015 GMC TERRAIN
`Additional Driver:
`
`Repalr Facility:
`HOPKINS AUTO BODY
`HOPKINS, MN 553433431
`(952) 935-7556
`
`VEHICLES RENTED:
`Effective
`
`Year Make Model VIN
`
`giantizand
`
`9:47
`
`234/19
`
`8125/19
`12:00 AM
`
`Rental Company:
`Invoice:
`Alternate lnvolce
`Number.
`
`ENTERPRISE RENT-A-
`CAR
`D630042-1909
`6VH4SZ
`
`RENTAL DETAIL:
`Rental Period: 8/24/19 to 8/31/19(8 days)
`Billed Period: 8124/19 to 8/31/19(8 days)
`
`E
`
`Products and
`Services
`TIME &
`DISTANCE
`TIME &
`DISTANCE
`REFUELING
`CHARGE
`YOUNG RENTER
`FEE
`
`Taxes and
`Surcharges
`MN RENTAL CAR
`TAX
`MN
`REGISTRATION
`FEE
`SALES TAX
`
`‘Quantity: Rate
`
`Amount
`
`7
`
`1
`
`0
`
`8
`
`1
`
`1
`
`29.99
`
`$209.93
`
`31.99
`
`$31.99
`
`0.00
`
`0.00
`
`$0.00
`
`$0.00
`
`9.20%
`
`$22.26
`
`5.00%
`
`$12.10
`
`1
`
`7.53%
`Total Charges:
`Less Amount Received:
`Total Amount Due:
`
`$18.20
`$294.48
`$0.00
`$294.48
`
`Starting
`Mileage
`
`Ending
`Mileage
`
`Rate
`Mileage Charged
`
`2019 CHEV S1LD ZGCRCPEC7K1125062 23463
`
`23502
`
`2018 NISN ALTI
`
`1N4AL3APOJC110738
`
`43450
`
`43531
`
`39
`
`81
`
`$31.99
`
`$29.99
`
`Rental Invoice
`
`Please Return This Portion with Remittance
`
`Make Payment To:
`ENTERPRISE RENT-A-CAR
`
`Total Charges:
`Less Amount Received:
`
`$294.48
`$0.00
`
`https://www.axmsweb.com/armsweb/closedcustomerfile.do
`
`10/ l 9/2020
`
`

`

`73-CV-22-2012
`ARMS® - Automated Rental Management System
`
`Filed in District Court
`Page 2 of 2
`State of Minnesota
`4/11/2022 1:26 PM
`
`P.O. BOX B40086
`KANSAS CITY, MO 64184-0086
`Federal ID: 43-0724835
`
`Total Amount Due
`
`$294.48
`
`Please include on your check:
`Invoice: 0630042-1 909
`
`https://www.armsweb.com/armsweb/closedcustomerfile.do
`
`l 0/19/2020
`
`

`

`Claim Payment Detail
`
`73-CV-22-2012
`
`Filed in District Court
`Page l of l
`State of Minnesota
`4/11/2022 1:26 PM
`
`Claim Payment Detail ( 19-1848217 )
`
`—Payment Information
`Disbursem*nt Number: 777978366
`EFT Trace Number:
`713725271
`HOPKINS AUTO BODY AND GLASS
`Pay to the Order of:
`10889 EXCELSIOR BLVD
`Malling Address:
`HOPKINS. MN 55343-3431 USA
`Progressive Invoice Number: 63684902
`
`In Payment Of:
`
`—Revlewed Summary
`A095169
`Issuing Rep:
`Issue Date:
`09-27-19
`Last Updated Rep: A095169
`
`rBank Information
`Type:
`Stop Reason:
`Stop Date:
`
`Loss
`
`-Exposure Detail: COLL
`CHASE. MICHAEL
`Party Name:
`Property Description: 15 GMC TERRAIN
`SUPPLEMENTAL PAYMENT
`Payment Type:
`
`Total Amount:
`$1,105.48
`Invoice Number: 63684902
`
`Approved By:
`Review Date:
`Reviewed By:
`
`Cleared:
`
`09-30-19
`
`Amount Paid:
`$1,105.48
`Deductible Taken: $0.00
`Property Damage: $0.00
`Rental:
`$0.00
`
`http://ciaimspayments/AIpha/ClaimsPaymentsWeb/default.aspx?page=CIaimPaymentDet...
`
`IO/ 19/2020
`
`

`

`Claim Payment Detail
`
`73-CV-22-2012
`
`Filed in District Court
`Page l of l
`State of Minnesota
`4/11/2022 1:26 PM
`
`Claim Payment Detail( 19-1848217 )
`
`—Payment Information
`Disbursem*nt Number: 777818557
`EFT Trace N umber:
`713720863
`ENTERPRISE RENT A CAR CO
`Pay to the Order of:
`Mailing Address:
`PO BOX 795110
`SAINT LOUIS, MO 63179 USA
`Progressive Invoice Number: 62767454
`
`In Payment Of:
`
`Total Amount:
`$294.48
`Invoice Number: 62767454
`
`-Revlewed Summary
`VJJ0003
`Issuing Rep:
`Issue Date:
`09-25-19
`Last Updated Rep: VJJ0003
`
`—Bank Information
`
`Type:
`Stop Reason:
`Stop Date:
`
`Loss
`
`—Exposure Detail: RENTAL
`CHASE. MICHAEL
`Party Name:
`Property Description: 15 GMC TERRAIN
`FINAL PAYMENT
`Payment Type:
`
`Approved By:
`Review Date:
`Reviewed By:
`
`_
`
`Cleared:
`
`09-27-19
`
`Amount Paid:
`$294.48
`Deductible Taken: $0.00
`Property Damage: $0.00
`Rental:
`$294.48
`
`http://claimspayments/Alpha/CiaimsPaymentsWeb/default.aspx?page=CiaimPaymentDet...
`
`10/ i 9/2020
`
`

`

`Claim Payment Detail
`
`73-CV-22-2012
`
`Filed in District Court
`Page l of l
`State of Minnesota
`4/11/2022 1:26 PM
`
`Claim Payment Detai|( 19-1848217 )
`
`— Payment Information
`Disbursem*nt Number: 777742885
`EFT Trace Number:
`713675697
`HOPKINS AUTO BODY AND GLASS
`Pay to the Order of:
`10889 EXCELSiOR BLVD
`Mailing Address:
`HOPKINS. MN 55343-3431 USA
`Progressive Invoice Number: 62438430
`
`In Payment Of:
`
`Total Amount:
`$2,852.26
`lnvolce Number: 62438430
`
`—Reviewed Summary
`A095169
`Issuing Rep:
`Issue Date:
`08-23-19
`Last Updated Rep: A095169
`
`—Bank Information
`
`Type:
`Stop Reason:
`Stop Date:
`
`Loss
`
`Approved By:
`Review Date:
`Reviewed By:
`
`_
`
`Cleared:
`
`08-26-19
`
`—Exposure Detail: COLL
`CHASE, MICHAEL
`Party Name:
`Property Description: 15 GMC TERRAIN
`SUPPLEMENTAL PAYMENT
`Payment Type:
`
`Amount Pald:
`$2,852.26
`Deductible Taken: $500.00
`Property Damage: $0.00
`Rental:
`$0.00
`
`http:l/claimspayments/Alpha/CiaimsPaymcntsWeb/default.aspx?page=CIaimPaymentDet...
`
`10/ 19/2020
`
`

`

`Claim Payment Detail
`
`73-CV-22-2012
`
`Filed in District Court
`Page 1 of l
`State of Minnesota
`4/11/2022 1:26 PM
`
`Claim Payment Detail ( 19-1848217 )
`
`—Payment Information
`Disbursem*nt Number: 357348973
`Draft Number:
`2779250428
`ANNE CHASE AND MICHAEL CHASE
`Pay to the Order of:
`2814 RHODE ISLAND AVE S
`Malling Address:
`SAINT LOUIS PARK, MN 55426-3050 USA
`Progressive Invoice Number: 62393224
`
`In Payment Of:
`
`Total Amount:
`$800.00
`Involce Number: 62393224
`
`—Revlewed Summary
`A113195
`Issuing Rep:
`Issue Date:
`08-21-19
`Last Updated Rep: A113195
`
`rBank lnfonnation
`
`Type:
`Stop Reason:
`Stop Date:
`
`Loss
`
`-Exposure Detail: UMIUIM
`Party Name:
`Payment Type:
`
`Approved By:
`Review Date:
`Reviewed By:
`
`—
`
`Cleared:
`
`08-28-19
`
`CHASE, ANNE
`FINAL PAYMENT
`
`Amount Paid:
`Deductible Taken:
`
`$800.00
`$0.00
`
`httpJ/claimspayments/Alpha/ClaimsPaymentsWeb/default.aspx?page=C laimPaymentDet...
`
`10/ l 9/2020
`
`

`

`73-CV-22-2012
`
`RELEASE 0F UNINSURED MOTORIST CLAIM
`
`Filed in District Court
`State of Minnesota
`4/11/2022 1:26 PM
`
`FOR THE SOLE CONSIDERATION OF Eight Hundred and 00/100 Dollars ($800.00), Anne Chase and Michael Chase,
`individually and as husband and wife, only, hereby fully and forever release(s) and discharge(s) Progressive Direct Insurance
`Company (hereinafier “Company"). and any and all heirs. administrators, executors, successors and assigns, from all claims for unin-
`sured motorist benefits under policy number-or all damages which l sustained as the result of an accident which occurred
`on or about July 17, 2019 on/at Wilson Avenue and Highway 23 in the City of St Cloud, County of Stearus. State of Minnesota.
`l.
`
`By executing this Release. l agree that:
`
`a.
`
`b.
`
`"claims" includes demands, actions and rights of action and also includes all claims which l now or hereafter may
`have arising out of, in consequence of, or on account of said accident;
`
`"damages" includes damages for personal injury; bodily injury, sickness, or disease; death resulting from such inju-
`ry, sickness or disease; injury to or destruction of property; damages for care and loss of services arising front such
`injury, sickness or disease; loss of consortium; damages for loss of use of property because of its injury or destruc-
`tion; punitive damages; medical expenses: wage loss; loss or impairment ofcarning capacity; criminal restitution;
`and all other damages of whatever kind or nature.
`
`c.
`
`“uninsured motorist benefits" as used in this agreement refers to any amount recoverable under the uninsured motor-
`ist coverage of the Company's, policy number
`md refers to that amount which the Releasing Party is
`legally entitled to recover as damages for bodily injury ut which are uncompensated because the owner/operator of
`a motor vehicle was “uninsured" for bodily liability coverage.
`l ex resslv intend and agree that this Release applies to all of my claims for uninsured motorist benefits under policy number
`l*arising from said accident, including, but not limited to, claims for known, unknown, latent, developed and unde-
`veloped injuries; anticipated and unanticipated consequences, and known and unknown developments of any of such injuries;
`and claims as respects the nature, extent and pemianency of any of such injuries.
`
`l0
`
`l expressly reserve my claims for No-Fault Benefits and this Release shall have no effect on my claims for such benefits.
`
`ln executing this Release, l am relying on my judgment, belief and knowledge as to all phases of my claims and that l am not
`relying on representations or statements made by any of the parties herein released, anyone representing them, or anyone em-
`ployed by them or the Company.
`
`l acknowledge that said sum is paid in compromise and settlement of disputed claims, that payment thereof shall not be con-
`stmed as an admission of any liability whatsoever by any of the parties herein released by whom liability is expressly denied.
`Releasing Party further agrees to perform and comply fully with all of the terms and conditions of the policy or policies of
`insurance under which this payment is being made. including without limitation the uninsured motorist coverage trust agree-
`‘
`ment which is incorporated herein by reference.
`
`By payment to Releasing Party under this coverage, the Company is entitled to all the rights of recovery it has against anoth-
`l agree to sign and deliver to the “Company" any legal paper relating to that recovery and do whatever else is necessary to
`er.
`help the Company exercise its rights.
`
`l agree that l have not received any recovery from anyone for my injuries and a release has not been signed for my claims
`i agree to do nothing to prejudice the Company‘s rights.
`l agree to hold in trust for the benefit of the Com-
`against anyone.
`pany all rights of recovery, which l may have against any person or entity, and reimburse the Company to the extent of its
`l further agree and hereby do assign to the Company all rights or claims l may have against any person or
`payment to me.
`entity for my injuries or damages.
`
`R MN 300F l2/2011
`
`lnitialsUfl%
`
`Page l of 2
`
`

`

`73-CV-22-2012
`
`RELEASE 0F UNINSURED MOTORIST CLAIM
`
`Filed in District Court
`State of Minnesota
`4/11/2022 1:26 PM
`
`9.
`
`10.
`
`l l.
`
`If more than one person has executed this Release, the consideration paid shall apply jointly to all such persons. All other
`provisions shall apply separately to each such person. The word "person" as used in this paragraph includes natural persons,
`firms, associations, organizations and corporations.
`
`I expressly agree that any and all medical or other liens will be resolved by the Releasing Party and I hereby agree to defend,
`indemnify and hold harmless the Company from any and all claims, demands, or causes of action, of any and every nature
`whatsoever made by any person, firms, or corporations in connection with any medical or other liens arising out of or in any
`way connected with the July 17, 2019 accident and the injuries to Anne Chase.
`
`l expressly agree to hold the Company hamtless and agree to defend and indemnify the Company from any claims, demands
`or causes of action by any person or entity, for contribution or indemnity or otherwise, whether such is alleged to arise by
`reason ofjudgment, settlement, reallocation of fault in the event of insolvency or uncollectability of an award, or otherwise
`arising out of or any way connected with the July l7, 2019 accident and the injuries toAnne Chase.
`
`A PERSON WHO FILES A CLAIM WITH INTENT T0 DEFRAUD OR HELPS COMMIT A FRAUD AGAINST AN IN-
`SURER IS GUILTY OF A CRIME.
`
`Q/m W .3-23—:~tq
`
`Signature
`
`Date
`
`\
`
`Witness Signature
`
`Date
`
`\.
`
`Date
`
`tgnature
`
`g/Xé/im
`Daté
`
`Subscribed afi
`
`to be
`
`e me this
`
`day of
`
`Witnesssyme
`
`Notary Publj
`
`R
`
`{‘é’URNsW
`3'4!)
`
`R MN 3001: 12/2011
`
`initiatsM’
`
`Page 2 or2
`
`

`

`73-CV-22-2012
`
`RELEASE 0F UNINSURED MOTORIST CLAIM
`
`Filed in District Court
`State of Minnesota
`4/11/2022 1:26 PM
`
`M
`‘1 '8 W U7
`
`FOR THE SOLE CONSIDERATION 0F Nine Hundred Fifty and 00/100 Dollars ($950.00), Michael Chase and Anne Chase,
`individually and as husband and wife, only hereby fully and forever release(s) and discharge(s) Progressive Direct Insurance
`Company (hereinafier “Company“). and any and all heirs, administrators, executors, successors and assigns, from all claims for unin—
`sured motorist benefits under policy number-
`for all damages which I sustained as the result of an accident which occurred
`on or about July I7, 2019 on/at Wilson Avenue and Highway 23 in the City of St Cloud, County of Stearns, State of Minnesota.
`
`By executing this Release, l agree that:
`
`a.
`
`b.
`
`c.
`
`"claims" includes demands. actions and rights of action and also includes aII claims which I now or hereafter may
`have arising out of. in consequence of, or on account of said accident;
`
`"damages" includes damages for personal injury; bodily injury, sickness, or disease; death resulting from such inju-
`ry, sickness or disease; injury to or destruction of property; damages for care and loss of services arising from such
`injury, sickness or disease; loss of consortium; damages for loss of use of property because of its injury or destruc-
`tion; punitive damages; medical expenses; wage loss; loss or impainnent of earning capacity; criminal restitution;
`and all other damages of whatever kind or nature.
`
`“uninsured motorist benefits" as used in this agreement refers to any amount recoverable under the uninsured motor-
`ist coverage of the Company‘s, policy numbc
`and refers to that amount which the Releasing Party is
`legally entitled to recover as damages for bodily injury but which are uncompensated because the owner/operator of
`a motor vehicle was “uninsured" for bodily liability coverage.
`
`2.
`
`“new and agree that this Release applies to all of my claims for uninsured motorist benefits under policy number
`
`arising from said accident, including, but not limited to, claims for known, unknown, latent. developed and un-
`developed injuries; anticipated and unanticipated consequences, and known and unknown developments of any of such inju-
`ries; and claims as respects the nature, extent and permanency of any of such injuries.
`
`I expressly reserve my claims for No-Fault Benefits and this Release shall have no effect on my claims for such benefits.
`
`In executing this Release, I am relying on my judgment, belief and knowledge as to all phases of my claims and that I am not
`relying on representations or statements made by any of the parties herein released, anyone representing them, or anyone em-
`ployed by them or the Company.
`
`I acknowledge that said sum is paid in compromise and settlement of disputed claims, that payment thereof shall not be con-
`strued as an admission of any liability whatsoever by any of the parties herein released by whom liability is expressly denied.
`
`Releasing Party further agrees to perfonn and comply fully with all of the terms and conditions of the policy or policies of
`insurance under which this payment is being made, including without limitation the uninsured motorist coverage trust agree-
`ment which is incorporated herein by reference.
`
`By payment to Releasing Party under this coverage, the Company is entitled to all the rights of recovery it has against anoth-
`I agree to sign and deliver to the “Company“ any legal paper relating to that recovery and do whatever else is necessary to
`er.
`help the Company exercise its rights.
`
`I agree that I have not received any recovery from anyone I'or my injuries and a release has not been signed for my claims
`I agree to hold in trust for the benefit of the Com-
`I agree to do nothing to prejudice the Company's rights.
`against anyone.
`pany all rights of recovery, which l may have against any person or entity, and reimburse the Company to the extent of its
`l further agree and hereby do assign to the Company all rights or claims I may have against any person or
`payment to me.
`entity for my injuries or damages.
`
`n MN 300E 12/201 t
`
`Initiatsflflfl
`
`Page 1 of2
`
`

`

`73-CV-22-2012
`
`Filed in District Court
`State of Minnesota
`4/11/2022 1:26 PM
`
`RELEASE OF UNINSURED MOTORIST CLAIM
`
`9.
`
`10.
`
`1 l.
`
`If more than one person has executed this Release, the consideration paid shall apply jointly to all such persons. All other
`provisions shall apply separately to each such person. The word "person" as used in this paragraph includes natural persons,
`firms, associations, organizations and corporations.
`
`I expressly agree that any and all medical or other liens will be resolved by the Releasing Party and I hereby agree to defend,
`indemnify and hold hamiless the Company from any and all claims, demands, or causes of action, of any and every nature
`whatsoever made by any person, firms, or corporations in connection with any medical or other liens arising out of or in any
`way connected with the July 17, 2019 accident and the injuries to Michael Chase.
`I expressly agree to hold the Company harmless and agree to defend and indemnify the Company from any claims, demands
`or causes of action by any person or entity, for contribution or indemnity or otherwise, whether such is alleged to arise by
`reason ofjudgnient, settlement, reallocation of fault in the event of insolvency or uncollectability of an award, or otherwise
`arising out of or any way c