Progressive Northern Insurance Company v. Dennis Schroeder

IN THE DISTRICT COURT OF WOODS COUNTY, WOODS COUNTY, OKLAHOMA STATE OF OKLAHOMA PROGRESSIVE NORTHERN INSURANCE COMPANY Plaintiff, vs. DENNIS SCHROEDER Defendant. Case No. CJ-2024-12 PETITION FOR MONEY DUE IN SUBROGATION COMES NOW the Plaintiff and for its cause of action against the Defendant states as follows: FACTS COMMON TO ALL ACCOUNTS 1. That Plaintiff is a CORPORATION organized and existing under the laws of OHIO. 2. The cause of action herein accrued under the laws of the State of Oklahoma; the Defendant resides in or may be found in WOODS County, Oklahoma and within the venue of this court. In the alternative, the facts giving rise to the cause of action as stated herein occurred in WOODS County, Oklahoma and within the venue of this Court. 3. That at all times mentioned, SHAWN ADAMS, hereinafter referred to as 'Insured' was a covered person under the policy and/or was the owner of an automobile insured by Plaintiff. 4. That on or about 04/24/2022, Defendant’s cows was running unrestrained and at large and entered the roadway at or near US-64 Highway and NS Highway 212 in Woods County, Oklahoma. 5. That at the same time Defendant’s cows were running unrestrained and at large, Insured was operating his/her/their vehicle on US-64 Highway when Defendant’s cows entered the roadway and were struck by the Insured, resulting in damages to Insured in the amount of $39,654.02. 6. That prior to the loss set forth above, Plaintiff had issued to Insured a policy of insurance in which Plaintiff agreed to indemnify Insured against loss or damage to the described property. 7. That by reason of the legal liability imposed on Plaintiff by the policy, Plaintiff was obligated to pay, and did pay to or for the benefit of Insured, the amount of $39,654.02, for damages arising from Defendant’s negligence, as evidenced by the documents attached hereto. 8. That Insured, pursuant to the subrogation provisions of his or her policy, assigned to plaintiff all rights of Insured to recover the amount of loss so paid under the policy and caused by the negligence of Defendant. 9. Pursuant to the SCRA §201(b)(4), Plaintiff declares under penalty of perjury that Defendant DENNIS SCHROEDER is/are not in the Armed Forces for the United States, verified on 02/09/2024 via the U.S. Department of Defense website. COUNT I-NEGLIGENCE 10. Plaintiff re-alleges and incorporates herein by this reference each and every allegation contained in Paragraph 1 through 9 of this Complaint as though fully set forth herein. 11. That Defendants owed a duty of reasonable care to ensure that that his/her/their cow was effectively restrained and was not permitted to run at large. 12. That Defendants breached his duty of care by failing to effectively secure his/her/their cow and by allowing or permitting said cow to run at large. 13. That the acts of negligence which were the direct and proximate cause of the injury to Insured may include but are not limited to: a. Violation of Oklahoma State code § 98 b. Failure to properly supervise cattle. c. Failure to ensure cow was in a fenced in area. d. Failure to inspect fencing on property and ensure the fencing was functioning properly. e. Failure to prevent cattle from entering the roadway. 14. That Defendants negligence was the legal and proximate cause of the damages sustained by Insured. COUNT II-NEGLICENCE PER SE 15. Plaintiff re-alleges and incorporates herein by this reference each and every allegation contained in Paragraph 1 through 9 of this Complaint as though fully set forth herein. 16. That Defendants violated one or more of the following statutes/ordinances: a. Violation of Oklahoma State code § 98. 17. That the aforementioned are safety statutes. 18. That the Defendants acts caused the type of harm that the statutes were intended to prevent. 19. That Insured, and by extension Plaintiff, was a member of the class that the statutes intended to protect. 20. That due to Defendants violations, the Insured, and by extension Plaintiff, incurred damages in the sum of $39,654.02. WHEREFORE, Plaintiff prays that it be subrogated to the rights of Insured as against Defendant, to the extent of all amounts paid under its policy with Insured and for Judgment against Defendant, and for each of them, in the amount of: Amount claimed: $39,654.02; Interest: at the rate of 10.50% per annum from the date of Judgment until paid; All costs herein expended, including but not limited to court costs, sheriff’s fees, and any costs for service of the summons(es). Respectfully submitted, FABER AND BRAND L.L.C. BY: ___/s/ Michael L. Foster___ Michael L. Foster OK #20701 Jason P. Gubbins OK #22576 P.O. Box 10110 Columbia, Missouri 65205-4000 (888) 233-3141 (573) 442-1072 FAX [email protected] ATTORNEY FOR PLAINTIFF THIS IS A COMMUNICATION FROM A DEBT COLLECTOR IN AN ATTEMPT TO COLLECT A DEBT. ANY INFORMATION OBTAINED WILL BE USED FOR THAT PURPOSE. F&B Acct. No: 509564 AFFIDAVIT OF ACCOUNT & VERIFICATION OF BUSINESS RECORDS STATE OF Ohio COUNTY OF CUYAHOGA Before me, the undersigned authority, personally appeared Megan Marie McCullough, who, being by me duly sworn deposes and states: I am of sound mind, capable of making this affidavit and personally acquainted with the facts herein stated: I am in charge of the records for PROGRESSIVE NORTHERN INSURANCE COMPANY a CORPORATION organized and existing under the laws of the State of OHIO. In such capacity I am the custodian of the business records of such company and attached hereto are the pages of records which are kept and maintained under my control and supervision in the regular course of business by employees or representatives of the company with knowledge of the act, event, condition, opinion, or diagnosis recorded to make the record or transmit information thereof to be included in such record; and the record was made at or near the time of the act, event, condition, opinion or diagnosis. The attached statement of account and supporting documentation are business records of such company so kept, and such statement as well as the various items thereof are within my personal knowledge just, true and correct, and the originals or exact duplicates of the originals and the balance of $39,654.02 shown thereon is due and owing over and above all payments, credits and set offs, plus interest at the Judgment rate, per annum from the date of Judgment until paid in full, by DENNIS SCHROEDER to such company. Charges for the above referenced services are reasonable, and the services were necessary. To the best of my knowledge and belief, the Defendant(s), DENNIS SCHROEDER, is/are not on active duty in the Armed Forces for the United States nor any branch thereof. Defendant(s) is/are not an infant or incompetent person. Megan Marie McCullough In witness whereof I have hereunto subscribed my name and affixed my official seal the 12th day of March, 2024. DAWN J MITCHELL Notary Public My commission Expires: 06/26/2027 *Q509564SAFF1-* OFFICIAL OKLAHOMA TRAFFIC COLLISION REPORT (1) Reporting Agency: OKLAHOMA HIGHWAY PATROL Case Number (Agency Use): 22-008088 Motor Vehicles Involved: 01 Number Injured: 00 Number Killed: 00 (2) Date of Collision (mm/dd/yyyy): 04/24/2022 Time: 1830 County Number and Name: 76 WOODS Nearest City or Town Number and Name: 00 FREEDOM (3) Distance from Nearest City or Town Limits: 0040 Mi. N Control #: MI X W E Int ID: 02 Location: 00 East Grid: 27 North Grid: 062 Administrative: PARIS Distance from: NS 212 (23) (4) Street, Road or Highway: US-64 (5) Unit: 01 Occupants Type: D Last Name: ADAMS First: SHAWN Middle: HOWARD (6) Address: City: State: Zip: Telephone: Driver License Number: State: OK Class: Type of Injury: Drv/Ped Cond: 01 OP Use: 04 Ejected Extricated Test (% BAC): Air Bag: 1 1 1 5 Transported by: To Medical Facility: License Plate Number: Vehicle Year: 2003 Color: WHI 2nd Color: BLK Make: PTRB Model: 379 Veh. Conf.: 10 Extent of Damage: 3 Insurance Company Name: PROGRESSIVE NORTHERN Policy Number: Insurance Telephone (Use Area Code): (800)444-4487 (11) Vehicle Removed by: WATERS WRECKER Driver License Number: State: OK Class: Type of Injury: Drv/Ped Cond: 00 OP Use: 00 Driver License Number: State: Class: Type of Injury: Drv/Ped Cond: 00 OP Use: 00 Insurance Company Name: Policy Number: Insurance Telephone (Use Area Code): Owner's Last Name: SCHROEDER First: DENNIS Middle: D Suffix: (14) Unit: 02 Occupants Type: A Last Name: 3 COWS Driver License Number: State: Class: Type of Injury: Drv/Ped Cond: 00 OP Use: 00 Driver License Number: State: Class: Type of Injury: Drv/Ped Cond: 00 OP Use: 00 Insurance Company Name: Policy Number: Insurance Telephone (Use Area Code): Owner's Last Name: First: Middle: Suffix: Citation Number: Statute/Ordinance Number: Citation Number: Statute/Ordinance Number: Unit Type: Injury Severity: Type of Injury: Driver/Pedestrian Condition: Chemical Test: Extent of Damage: Insurance Verification: Oversized Load: 00 Rolled: Burned: Phone present: Phone in use: (23) Investigating Officer: Randal McCullough Badge Number: 672 Trp/Div Assigned: J Trp/Div Location: BM Reviewer (Int.): 184 Date of Report (mm/dd/yyyy): 04/24/2022 (24) Unit Injured [ ] Passenger [ ] Pos in Veh. Last Name First [ ] Middle [ ] Suffix [ ] DOB(mm/dd/yyyy) Sex [ ] Witness [ ] Prop. Owner [ ] Address [ ] City [ ] State [ ] Zip [ ] Telephone (Use Area Code) (25) Same as Driver [ ] Address [ ] City [ ] State [ ] Zip [ ] Telephone (Use Area Code) (26) Injury Severity / Type OP Use Air Bag Ejected Extricated Transported by [ ] To Medical Facility Property Type [ ] (27) Unit Injured [ ] Passenger [ ] Pos in Veh. Last Name First [ ] Middle [ ] Suffix [ ] DOB(mm/dd/yyyy) Sex [ ] Witness [ ] Prop. Owner [ ] Address [ ] City [ ] State [ ] Zip [ ] Telephone (Use Area Code) (28) Same as Driver [ ] Address [ ] City [ ] State [ ] Zip [ ] Telephone (Use Area Code) (29) Injury Severity / Type OP Use Air Bag Ejected Extricated Transported by [ ] To Medical Facility Property Type [ ] (30) Unit Injured [ ] Passenger [ ] Pos in Veh. Last Name First [ ] Middle [ ] Suffix [ ] DOB(mm/dd/yyyy) Sex [ ] Witness [ ] Prop. Owner [ ] Address [ ] City [ ] State [ ] Zip [ ] Telephone (Use Area Code) (31) Same as Driver [ ] Address [ ] City [ ] State [ ] Zip [ ] Telephone (Use Area Code) (32) Injury Severity / Type OP Use Air Bag Ejected Extricated Transported by [ ] To Medical Facility Property Type [ ] (33) Unit Injured [ ] Passenger [ ] Pos in Veh. Last Name First [ ] Middle [ ] Suffix [ ] DOB(mm/dd/yyyy) Sex [ ] Witness [ ] Prop. Owner [ ] Address [ ] City [ ] State [ ] Zip [ ] Telephone (Use Area Code) (34) Same as Driver [ ] Address [ ] City [ ] State [ ] Zip [ ] Telephone (Use Area Code) (35) Injury Severity / Type OP Use Air Bag Ejected Extricated Transported by [ ] To Medical Facility Property Type [ ] Complete information below if this vehicle is being used for COMMERCE/BUSINESS and has a GVWR/GCWR IN EXCESS OF 10,000 LBS., or has a HAZMAT PLACARD, or is a BUS WITH SEATING FOR NINE OR MORE INCLUDING THE DRIVER (36) Unit Carrier Name Address [ ] (37) City [ ] State [ ] Zip [ ] GVWR [ ] 0-10K lbs. Axle Qty [ ] Cargo Body [ ] Vehicle Use [ ] GVWR [ ] 10,001-25K lbs. Axle Qty [ ] Cargo Body [ ] Vehicle Use [ ] GVWR [ ] 26K+ lbs. Axle Qty [ ] Cargo Body [ ] Vehicle Use [ ] [ ] Interstate Commerce [ ] Intrastate Commerce [ ] Other Non-Commercial [ ] Government Haz. Mat. Class [ ] Haz. Mat. Involved [ ] Haz. Mat. Release [ ] Yes [ ] Yes [ ] Yes [ ] No [ ] No [ ] No [ ] (38) U.S. DOT Number NASI Report Number Placard Number [ ] Haz. Mat. Class [ ] Haz. Mat. Involved [ ] Haz. Mat. Release [ ] Yes [ ] Yes [ ] Yes [ ] No [ ] No [ ] No [ ] (39) Unit Carrier Name Address [ ] (40) City [ ] State [ ] Zip [ ] GVWR [ ] 0-10K lbs. Axle Qty [ ] Cargo Body [ ] Vehicle Use [ ] GVWR [ ] 10,001-25K lbs. Axle Qty [ ] Cargo Body [ ] Vehicle Use [ ] GVWR [ ] 26K+ lbs. Axle Qty [ ] Cargo Body [ ] Vehicle Use [ ] [ ] Interstate Commerce [ ] Intrastate Commerce [ ] Other Non-Commercial [ ] Government Haz. Mat. Class [ ] Haz. Mat. Involved [ ] Haz. Mat. Release [ ] Yes [ ] Yes [ ] Yes [ ] No [ ] No [ ] No [ ] (41) U.S. DOT Number NASI Report Number Placard Number [ ] Haz. Mat. Class [ ] Haz. Mat. Involved [ ] Haz. Mat. Release [ ] Yes [ ] Yes [ ] Yes [ ] No [ ] No [ ] No [ ] Position in Vehicle 00 Not Applicable 18 Front Row - Other 28 Second Row - Other 38 Third Row - Other 48 Fourth Row - Other 50 Sleeper Section of Truck Cab See manual for additional seating examples Vehicle Configuration 00 N/A 01 Passenger Veh.-2 Dr 02 Passenger Veh.-4 Dr 03 Passenger Veh.Conv 04 Pickup 05 Single Unit Truck, 2 axles 06 Single Unit Truck, 3+ axles 07 School Bus 08 Truck/Trailer 09 Truck-Tractor (Bobtail) 10 Truck-Tractor/Semi-Trailer 11 Truck-Tractor/Double 12 Truck-Tractor/Triple 13 Bus/Large Van 9-15 occupants including driver 14 Bus 16+ occupants including driver 15 Motorcycle 16 Motor Scooter/Moped 17 Motor Home 18 Farm Machinery 19 ATV 20 SUV 21 Passenger Van 22 Truck more than 10,000 lbs. Cannot Classify 23 Van 10,000 lbs or Less 24 Other 25 Unknown Cargo Body Type 00 N/A 01 Bus 9-15 seats 02 Bus 16+ seats 03 Van / Enclosed Box / Stock Trailer 04 Cargo Tank 05 Flatbed 06 Intermodal 07 Dump Truck/Trailer 08 Concrete Mixer 09 Auto Transporter 10 Garbage/Refuse 11 Hopper (grain/chips/gravel) 12 Pole Trailer 13 Log Trailer 14 Vehicle Towing Vehicle 15 Other 99 Unknown OFFICIAL OKLAHOMA TRAFFIC COLLISION REPORT Case Number 22-008088 Pg 3 of 4 Unit 01 02 65 Total Lanes in Roadway Legal Speed Actions Prior to Collision Location at Time of Collision Safety Equip Unit Number Vehicle Striking Pedestrian / Pedalcyclist Only Was the collision in or near a construction, maintenance or utility work zone? (If yes, complete this section) Yes ☒ No ☐ Type of Work Zone Lane Closure Lane Shift/Crossover Work on Shoulder or Median Intermittent or Moving Work Unknown Location of the Work Zone Before the First Work Zone Warning Sign Advance Warning Area Transition Area Activity Area Termination Area Unknown Workers Present Yes ☐ No ☒ Unknown ☐ Unit 1 Unit 2 Trafficway 2 0 Not Applicable One Way Two-Way - Not Divided Two-Way - Divided Two-Way - Divided - Positive Median Barrier Turn Lane Ramp / Loop Driveway Alley / Parking Lot Unknown Unit 1 Unit 2 Vehicle Removal 1 0 Not Applicable Towed Due To Vehicle Damage Towed For Reasons Other Than Damage Remained at Scene Driven from Scene Unknown Unit 1 Unit 2 Failed To Yield 98 91 01 From Stop Sign 02 From Yield Sign 03 Private Drive 04 County Road at Through Highway 05 From Signal Light 06 From Alley 07 To Pedestrian 08 To Vehicle on Right 09 To Vehicle in Intersection 10 To Emergency Vehicles 12 Other FOLLOWED TOO CLOSELY 13 Human Element 14 Traffic Condition 15 Weather Condition UNSAFE SPEED 16 Driver's Ability (Aged) 17 Inexperienced Driver - Young 18 Exceeding Legal Limit 19 For Traffic Conditions 20 For Type of Roadway (Gravel, Dirt, etc.) 21 For Ice or Snow on Roadway 22 Rain or Wet Roadway 23 Wind 24 Other Weather Conditions 25 Vehicle Condition 26 View Obstruction 27 On Curve/Turn 28 Impeding Traffic 29 Other WRONG WAY 30 From Wrong Lane 31 From Direct Course 32 Right 33 Left 34 Turn About/U-Turn 35 To Enter Private Drive 36 In Front Of Oncoming Traffic 37 Other IMPLIED OR IMPLICIT ACT/MOVEMENT 38 CHANGED LANES UNSAFELY 39 STOPPED IN TRAFFIC LANE FAILED TO STOP 40 For Stop Sign 41 For Traffic Signal 42 For School Bus Gates/Signal 44 For Officer/Flagman 45 At Sidewalk/Stopline 46 Other UNSAFE VEHICLE 47 Brakes 48 Steering Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 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Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit 2 Unit 1 Unit <table> <tr> <th colspan="6">COLLISION EVENTS</th> <th>Most Harmful Event</th> <th>First Harmful Event for the Entire Collision</th> </tr> <tr> <th>Unit</th> <th>First Event</th> <th>Second Event</th> <th>Third Event</th> <th>Fourth Event</th> <th>Most Harmful Event</th> <th>First Harmful Event for the Entire Collision</th> </tr> <tr> <td>01</td> <td>33</td> <td>00</td> <td>00</td> <td>00</td> <td>33</td> <td>33</td> </tr> <tr> <td>02</td> <td>00</td> <td>00</td> <td>00</td> <td>00</td> <td>00</td> <td></td> </tr> <tr> <td colspan="7"> <table> <tr> <th>Unit</th> <th>Event</th> <th>Description</th> </tr> <tr><td>00</td><td>Not Applicable</td><td></td></tr> <tr><td>10</td><td>Overturn/Rollover</td><td></td></tr> <tr><td>11</td><td>Fire/Explosion</td><td></td></tr> <tr><td>12</td><td>Immersion</td><td></td></tr> <tr><td>13</td><td>Jackknife</td><td></td></tr> <tr><td>14</td><td>Cargo/Equipment Loss or Shift</td><td></td></tr> <tr><td>15</td><td>Equipment Failure (Blown Tire, Brake Failure, etc.)</td><td></td></tr> <tr><td>16</td><td>Separation of Units</td><td></td></tr> <tr><td>17</td><td>Departed Road Right</td><td></td></tr> <tr><td>18</td><td>Departed Road Left</td><td></td></tr> <tr><td>19</td><td>Cross Median/Centerline</td><td></td></tr> <tr><td>20</td><td>Downhill Runaway</td><td></td></tr> <tr><td>21</td><td>Fell/Jumped From Motor Vehicle</td><td></td></tr> <tr><td>22</td><td>Thrown Or Falling Object</td><td></td></tr> <tr><td>23</td><td>Other Non-Collision PERSON, MOTOR VEHICLE, OR NON-FIXED OBJECT.</td><td></td></tr> <tr><td>30</td><td>Pedestrian</td><td></td></tr> <tr><td>31</td><td>Animal</td><td></td></tr> <tr><td>32</td><td>Railway Vehicle (train, engine)</td><td></td></tr> <tr><td>33</td><td>Motor Vehicle in Transport</td><td></td></tr> <tr><td>35</td><td>Parked Motor Vehicle</td><td></td></tr> <tr><td>36</td><td>Struck by Falling, Shifting Cargo or Anything Set in Motion by Motor Vehicle</td><td></td></tr> <tr><td>37</td><td>Work Zone/Maintenance Equipment</td><td></td></tr> <tr><td>38</td><td>Other Non-Fixed Object</td><td></td></tr> <tr><td>40</td><td>Barrier (Cable)</td><td></td></tr> <tr><td>41</td><td>Barrier (Concrete)</td><td></td></tr> <tr><td>42</td><td>Barrier (Other)</td><td></td></tr> <tr><td>43</td><td>Fence Pole</td><td></td></tr> <tr><td>44</td><td>Fence</td><td></td></tr> <tr><td>45</td><td>Traffic Signal Support</td><td></td></tr> <tr><td>46</td><td>Traffic Sign Support</td><td></td></tr> <tr><td>47</td><td>Utility Pole/Light Support</td><td></td></tr> <tr><td>48</td><td>Other Post/Pole/Support</td><td></td></tr> <tr><td>49</td><td>Guardrail/Guardrail Face</td><td></td></tr> <tr><td>50</td><td>Guardrail End</td><td></td></tr> <tr><td>51</td><td>Culvert</td><td></td></tr> <tr><td>52</td><td>Curb</td><td></td></tr> <tr><td>53</td><td>Island</td><td></td></tr> <tr><td>54</td><td>Sand Barrels</td><td></td></tr> <tr><td>55</td><td>Impact Attenuator/ Crash Cushion</td><td></td></tr> <tr><td>56</td><td>Pavement Drop-Off</td><td></td></tr> <tr><td>57</td><td>Ditch</td><td></td></tr> <tr><td>58</td><td>Embankment</td><td></td></tr> <tr><td>59</td><td>Tree (Standing)</td><td></td></tr> <tr><td>60</td><td>Dividing Strip</td><td></td></tr> <tr><td>61</td><td>Retaining Wall</td><td></td></tr> <tr><td>62</td><td>Bridge Abutment</td><td></td></tr> <tr><td>63</td><td>Bridge Pier or Support</td><td></td></tr> <tr><td>64</td><td>Bridge Rail</td><td></td></tr> <tr><td>65</td><td>Bridge Post</td><td></td></tr> <tr><td>66</td><td>Bridge Curb</td><td></td></tr> <tr><td>67</td><td>Bridge Super Structure (Beams)</td><td></td></tr> <tr><td>68</td><td>Bridge Overhead Structure</td><td></td></tr> <tr><td>69</td><td>Delimiter</td><td></td></tr> <tr><td>70</td><td>Mailbox</td><td></td></tr> <tr><td>71</td><td>Other Fixed Object</td><td></td></tr> <tr><td>72</td><td>Other Highway Structure</td><td></td></tr> <tr><td>73</td><td>Ground</td><td></td></tr> <tr><td>99</td><td>Unknown</td><td></td></tr> </table> </td> </tr> </table> Remarks THE OWNER OF THE CATTLE HAD RECEIVED A REPORT OF THE CATTLE BEING OUT AND WAS ATTEMPTING TO DRIVE THE CATTLE BACK TO THE SOUTH FROM THE HIGHWAY. AT THE SAME TIME UNIT 1 WAS EAST BOUND AND HAD JUST CRESTED A HILL AND WAS UNABLE TO STOP, STRIKING AT LEAST 3 OF THE COWS. P.O.I. WAS APPROXIMATELY THE CENTER OF LINE OF US HIGHWAY 64 AND 55 FEET WEST OF COUNTY ROAD 120 SOUTH. P.O.R. FOR UNIT 1 WAS UNDETERMIND, DUE TO THE TRUCK CONTINUING TO A SAFE LOCATION TO PULL OFF. P.O.R. FOR 2 OF THE COWS WAS APPROXIMATELY 230 FEET EAST AND 46 FEET SOUTH OF P.O.I. P.O.R. FOR THE THIRD COW WAS APPROXIMATELY 175 FEET EAST AND 48 FEET NORTH OF P.O.I. This report is based on the officer's investigation of this collision. This report may contain the opinion of the officer. Progressive Northern Insurance Co Owner SHAWN ADAMS Supplemented By SHAWN ALLEN (405) 318-5750 (Work) [email protected] OK License [REDACTED] Classification None Insured SHAWN ADAMS Appraiser SHAWN ALLEN (405) 318-5750 (Work) [email protected] Classification None Underwriter Progressive Northern Insurance Co Progressive Northern Insurance Co Claim Number 23-7969615-01 Adjuster Stephanie Jones (440) 697-7781 (Work) [email protected] Deductible 1000.00 - Not Waived Reported Date 08/15/2023 Loss Date 04/24/2022 Inspection Site BEATTY BODY SHOP 5325 SW 11th St Oklahoma City, OK 73128 (999) 999-9999 (Mobile) 2003 Peterbilt 379 Exterior Color White VIN [REDACTED] 7399 Drivable No Odometer 430779 Mitchell Service Code 912307 Primary Point of Impact Front (12) SHAWN ADAMS | 2003 Peterbilt 379 Parts Profile CL OK ALL PART TYPES Parts Profile Version 2.0 Line # Description LABOR PART Operation Type Total Units Type Number Qty Total Price Tax Front Bumper 1 Custom Front Bumper Remove / Replace Body* 3.0* New 1 $2,100.00* Yes 2 Custom Front Bumper Refinish Labor Refinish 6.0* Grille S1 3 Grille Assembly Remove / Replace Body 3.0**# Aftermarket New 1 $1,600.00* Yes S1 4 Line Markup 25.0% Remove / Replace Body 3.0**# Aftermarket New 1 $400.00 5 Truck Shrouds Alum Grille Refinish Labor Refinish 6.0* $400.00 S1 6 Grille Assembly Refinish Labor Refinish 6.0* Front Lamps 7 R Headlamp Assembly Remove / Replace Body 0.7 Aftermarket New 1 $400.04* Yes 8 Line Markup 25.0% Remove / Replace Body 0.7 Aftermarket New 1 $100.01 9 4 states Check / Adjust Body 0.5 Hood S2 11 Hood Assy Remove / Replace Body 7.5* New N.A. 1 $20,388.56* Yes S2 12 Hood Assy Complete Refinish Only Refinish 8.6* Existing S2 13 Add For Hood Underside Refinish Only Refinish 4.3 S2 14 Hood Two Tone Additional Labor Body* 5.2* Existing Charge Air Cooler 16 Charge Air Cooler Assembly -M Remove / Replace Mechanical 1.0# Aftermarket New 1 $794.68* Yes 17 Line Markup 25.0% Remove / Replace Mechanical 1.0# Aftermarket New 1 $198.67 18 4 states Remove / Install Mechanical INC Cooling 20 Evacuate & Recharge A/C -M Remove / Replace Mechanical 1.4 A/C / Heater / Ventilation 21 A/C Refrigerant Recovery -M Remove / Replace Mechanical 0.3 22 A/C Condenser -M Remove / Replace Mechanical 1.3 Aftermarket New 1 $190.11* Yes 23 Line Markup 25.0% Remove / Replace Mechanical 1.3 Aftermarket New 1 $47.53 24 4 states, (855) 220-8608 Remove / Replace Mechanical 1.3 25 Receiver/Drier -M Remove / Replace Mechanical 0.7 Aftermarket New 1 $51.98* Yes 26 Line Markup 25.0% Remove / Replace Mechanical 0.7 Aftermarket New 1 $13.00 Driveshaft S1 28 Drive Shaft -M Remove / Install Mechanical 1.7 Existing Line # Description OPERATION TYPE TOTAL UNITS PART Additional Costs & Materials 29 AUTO Paint/Materials Additional Cost 30 936004 Shipping Additional Cost 31 900501 OE Parts Additional Cost 32 936004 Shipping Additional Cost 33 900501 4 states 34 936007 Shop Materials Additional Cost S2 45 936004 Shipping Additional Cost 36 900501 Truck Shrouds Additional Cost Additional Operations 37 AUTO Clear Coat Additional Operation Refinish 4.0* Special / Manual Entry 38 900500 Hood Vinyl Remove / Replace Body* 0.0* New 1 $650.00* Yes 39 900501 Stacy Custom Stripe Remove / Replace Body* 1.0* New 1 $116.00* Yes 40 900500 Beta Brace Kit Remove / Replace Body* 0.0* New 1 $406.35* Yes 41 900500 Specialty Fasteners Remove / Replace Body* 0.0* New 1 42 900510 Line Markup 25.0% 43 900501 4 states * Judgment Item T Included in Two Tone Calculation # Labor Note Applies d Discontinued by Manufacturer C Included in Clear Coat Calculation A Included in Clear Coat and Two Tone Calculation r CEG R&R Time Used for this Labor Operation [ ] Verify the part number and price before ordering Parts Vendors BEST FIT TRUCK PARTS 4579 Highway 43 Joplin MO 64804 (855) 220-8608 (Work) Line Part # Total Price 25 29-070018 $51.98 Disclaimer: This estimate has been prepared based on the use of crash parts supplied by a source other than the manufacturer of your motor vehicle. Warranties applicable to these replacement parts are provided by the manufacturer or distributor of these parts rather than the manufacturer of your vehicle. Estimate Totals <table> <tr> <th>Labor</th> <th>Units</th> <th>Rate</th> <th>Sublet Add'l Amount</th> <th>Totals</th> </tr> <tr> <td>Body Labor</td> <td>20.9</td> <td>$125.00</td> <td></td> <td>$2,612.50</td> </tr> <tr> <td>Refinish Labor</td> <td>28.9</td> <td>$125.00</td> <td></td> <td>$3,612.50</td> </tr> </table> Estimate Totals Mechanical Labor 6.4 $140.00 Total Labor 56.2 $896.00 $7,121.00 Taxable $0.00 Tax 0.0000% $0.00 Non-Taxable $7,121.00 Labor Total $7,121.00 <table> <tr><th>Parts</th><th>Amount</th></tr> <tr><td>Taxable Parts</td><td>$26,697.72</td></tr> </table> <table> <tr><th>Costs</th><th>Amount</th></tr> <tr><td>Other Additional Costs</td><td>$1,182.97</td></tr> <tr><td>Paint Materials</td><td>$1,200.00</td></tr> <tr><td></td><td></td></tr> <tr><td>Paint Materials Rate: $90.00</td><td></td></tr> <tr><td>Rate Max: 99.9 units</td><td></td></tr> <tr><td>Additional Rate: $0.00</td><td></td></tr> <tr><td>Gross Totals</td><td></td></tr> <tr><td>Gross Total</td><td>$39,553.43</td></tr> </table> <table> <tr><th>Adjustments</th><th>Amount</th></tr> <tr><td>Deductible</td><td>-$1,000.00</td></tr> <tr><td>Related Prior Damage</td><td>-$3,992.83</td></tr> <tr><td>Total Customer Responsibility</td><td>-$4,992.83</td></tr> </table> <table> <tr><th></th><th>Amount</th></tr> <tr><td>Taxable</td><td>$1,182.97</td></tr> <tr><td>Parts Adjustments</td><td>$860.80</td></tr> <tr><td>Tax 8.6300%</td><td>$2,378.30</td></tr> <tr><td>Non-Taxable</td><td>$0.00</td></tr> <tr><td>Parts Total</td><td>$29,936.82</td></tr> <tr><td>Costs Total</td><td>$2,495.61</td></tr> </table> <table> <tr><th></th><th>Amount</th></tr> <tr><td>Taxable</td><td>$1,305.26</td></tr> <tr><td>Tax 8.6300%</td><td>$112.64</td></tr> <tr><td>Non-Taxable</td><td>$1,077.71</td></tr> <tr><td>Gross Total</td><td>$39,553.43</td></tr> <tr><td>Taxable</td><td>$28,863.78</td></tr> <tr><td>Tax</td><td>$2,490.94</td></tr> <tr><td>Non-Taxable</td><td>$8,198.71</td></tr> <tr><td>Gross Total</td><td>$39,553.43</td></tr> </table> Net Estimate Total $34,560.60 Less Original Net Total $31,289.64 Net Supplement Amount $3,270.96 S1: SHAWN ALLEN $3,904.51 S2: SHAWN ALLEN -$633.55 "All manufacturers requirements regarding seat belt and supplemental restraint system replacement must be adhered to. If additional parts or operations are necessary to properly accomplish this, please contact the estimating claims rep." THIS IS A DAMAGE ASSESSMENT ONLY - NOT AN AUTHORIZATION TO REPAIR - BASED ON DAMAGE VISIBLE OR CERTAIN AT THE TIME IT WAS WRITTEN. IF FRAME OR UNIBODY REPAIR IS INCLUDED ON THIS ESTIMATE, THE AMOUNT SHOWN INCLUDES TIME OR ALLOWANCE FOR MEASURING BEFORE, DURING AND AFTER THOSE REPAIRS. THE OWNER OF THE VEHICLE MAY SELECT THE REPAIR FACILITY OF HIS/HER CHOICE. TO ENSURE PROPER AND PROMPT PAYMENT FOR ADDITIONAL DAMAGE DISCOVERED DURING THE COURSE OF REPAIRS, CONTACT PROGRESSIVE FOR SUPPLEMENT HANDLING PROCEDURES. PROGRESSIVE HONORS THE PREVAILING LABOR MARKET RATE IN YOUR AREA FOR YOUR PROPERTY. IF YOU CHOOSE A SHOP THAT CHARGES IN EXCESS OF PREVAILING LABOR MARKET RATES, YOU WILL BE RESPONSIBLE FOR THE DIFFERENCE. LIFETIME GUARANTEE FOR SHEET METAL AND PLASTIC BODY PARTS 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), in terms of form, fit, finish, 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 long as you own or lease 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 THAT WILL RETURN YOUR VEHICLE TO ITS PRE-LOSS CONDITION. ACCORDINGLY, 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. NON-OEM and A/M and Qual REPL - These refer to an after-market part, which is a new, non-original equipment manufacturer part. USED/RECYCLED and LKQ - These refer to a used OEM part. REMANUFACTURED and RECOND. and RECORE - These refer to used/recycled OEM parts that have been refurbished. REPAIR SHOP'S AUTHORIZED REPRESENTATIVE'S SIGNATURE INDICATING AGREEMENT ON COST TO RETURN THE VEHICLE TO PRE-LOSS CONDITION, INCLUDING TOW/STORAGE CHARGES: SHOP SIGNATURE: ____________________ EST. COMPLETION DATE:_____ WARNING: Any person who knowingly, and with the intent to injure, defraud or deceive any insurer, makes any claim for the proceeds of an insurance policy containing any false, incomplete or misleading information is guilty of a felony. Part Type Terms and Abbreviations NEW and OEM or part number displayed - These refer to a new, original equipment manufacturer part. NON-OEM and A/M and QUAL REPL - These refer to an after-market part, which is a new, non-original equipment manufacturer part. USED/RECYCLED and LKQ - These refer to a used OEM part. REMANUFACTURED and RECOND. and RECORE - These refer to used/recycled OEM parts that have been refurbished. Progressive’s Lifetime Guarantee does not cover repairs you request the shop to make that are not related to this accident, including but not exclusive to unrelated prior damage and pre-existing damage. Disclaimer: WARNING: Any person who knowingly, and with intent to injure, defraud or deceive any insurer, makes any claim for the proceeds of an insurance policy containing any false, incomplete or misleading information is guilty of a felony. Cycle Time Information Due In 8/17/2023 Estimate Event Log Job Created 8/16/2023 09:18 AM Supplement 2 Started 8/17/2023 08:36 AM Supplement 2 Printed 8/30/2023 10:57 AM Supplement 2 Committed 8/30/2023 10:57 AM Estimate Version 2 Progressive Northern Insurance Co Related Prior Damage Estimate Owner SHAWN ADAMS Insured SHAWN ADAMS Appraiser SHAWN ALLEN (405) 318-5750 (Work) [email protected] Classification None Supplemented By SHAWN ALLEN (405) 318-5750 (Work) [email protected] OK License 3000262377 Classification None Underwriter Progressive Northern Insurance Co Progressive Northern Insurance Co Claim Number 23-7969615-01 Adjuster Stephanie Jones (440) 697-7781 (Work) [email protected] Deductible 1000.00 - Not Waived Reported Date 08/15/2023 Loss Date 04/24/2022 Inspection Site BEATTY BODY SHOP 5325 SW 11th St Oklahoma City, OK 73128 (999) 999-9999 (Mobile) 2003 Peterbilt 379 Exterior Color White VIN 1XP5DB9X33N587399 Drivable No Odometer 430779 Mitchell Service Code 912307 Primary Point of Impact Front (12) SHAWN ADAMS | 2003 Peterbilt 379 Parts Profile CL OK ALL PART TYPES Line # Description Operation Type Total Units Type Number Qty Total Price Tax Additional Costs & Materials 1 AUTO Paint/Materials Additional Cost $540.00* Yes Special / Manual Entry S1 2 900500 Custom Front Bumper Remove / Replace Body* 3.0* New 1 $2,100.00* Yes S1 3 935000 Custom Front Bumper Refinish Labor Refinish Labor 6.0* ] * Judgment Item T Included in Two Tone Calculation # Labor Note Applies d Discontinued by Manufacturer C Included in Clear Coat Calculation A Included in Clear Coat and Two Tone Calculation r CEG R&R Time Used for this Labor Operation [ ] Verify the part number and price before ordering Disclaimer: This estimate has been prepared based on the use of crash parts supplied by a source other than the manufacturer of your motor vehicle. Warranties applicable to these replacement parts are provided by the manufacturer or distributor of these parts rather than the manufacturer of your vehicle. Estimate Totals <table> <tr> <th>Labor</th> <th>Units</th> <th>Rate</th> <th>Sublet Add'l Amount</th> <th>Totals</th> </tr> <tr> <td>Body Labor</td> <td>3.0</td> <td>$125.00</td> <td></td> <td>$375.00</td> </tr> <tr> <td>Refinish Labor</td> <td>6.0</td> <td>$125.00</td> <td></td> <td>$750.00</td> </tr> <tr> <td>Total Labor</td> <td>9.0</td> <td></td> <td></td> <td>$1,125.00</td> </tr> </table> <table> <tr> <th>Parts</th> <th>Amount</th> </tr> <tr> <td>Taxable Parts</td> <td>$2,100.00</td> </tr> <tr> <td>Parts Adjustments</td> <td>$0.00</td> </tr> <tr> <td>Tax 8.6300%</td> <td>$181.23</td> </tr> <tr> <td>Non-Taxable</td> <td>$0.00</td> </tr> <tr> <td><b>Parts Total</b></td> <td><b>$2,281.23</b></td> </tr> </table> <table> <tr> <th>Costs</th> <th>Amount</th> </tr> <tr> <td>Other Additional Costs</td> <td>$0.00</td> </tr> <tr> <td>Paint Materials</td> <td>$540.00</td> </tr> <tr> <td>Paint Materials Rate: $90.00<br>Rate Max: 99.9 units<br>Additional Rate: $0.00</td> <td></td> </tr> <tr> <td>Gross Totals</td> <td></td> </tr> <tr> <td><b>Gross Total</b></td> <td><b>$3,992.83</b></td> </tr> </table> <table> <tr> <th>Adjustments</th> <th>Amount</th> </tr> <tr> <td>Taxable</td> <td>$2,640.00</td> </tr> <tr> <td>Tax</td> <td>$227.83</td> </tr> <tr> <td>Non-Taxable</td> <td>$1,125.00</td> </tr> <tr> <td><b>Gross Total</b></td> <td><b>$3,992.83</b></td> </tr> </table> Estimate Totals Total Customer Responsibility $0.00 Net Estimate Total $3,992.83 "All manufacturers requirements regarding seat belt and supplemental restraint system replacement must be adhered to. If additional parts or operations are necessary to properly accomplish this, please contact the estimating claims rep." THIS IS A DAMAGE ASSESSMENT ONLY - NOT AN AUTHORIZATION TO REPAIR - BASED ON DAMAGE VISIBLE OR CERTAIN AT THE TIME IT WAS WRITTEN. IF FRAME OR UNIBODY REPAIR IS INCLUDED ON THIS ESTIMATE, THE AMOUNT SHOWN INCLUDES TIME OR ALLOWANCE FOR MEASURING BEFORE, DURING AND AFTER THOSE REPAIRS. THE OWNER OF THE VEHICLE MAY SELECT THE REPAIR FACILITY OF HIS/HER CHOICE. TO ENSURE PROPER AND PROMPT PAYMENT FOR ADDITIONAL DAMAGE DISCOVERED DURING THE COURSE OF REPAIRS, CONTACT PROGRESSIVE FOR SUPPLEMENT HANDLING PROCEDURES. PROGRESSIVE HONORS THE PREVAILING LABOR MARKET RATE IN YOUR AREA FOR YOUR PROPERTY. IF YOU CHOOSE A SHOP THAT CHARGES IN EXCESS OF PREVAILING LABOR MARKET RATES, YOU WILL BE RESPONSIBLE FOR THE DIFFERENCE. LIFETIME GUARANTEE FOR SHEET METAL AND PLASTIC BODY PARTS 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), in terms of form, fit, finish, 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 long as you own or lease 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 THAT WILL RETURN YOUR VEHICLE TO ITS PRE-LOSS CONDITION. ACCORDINGLY, 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. NON-OEM and A/M and Qual REPL - These refer to an after-market part, which is a new, non-original equipment manufacturer part. USED/RECYCLED and LKQ - These refer to a used OEM part. REMANUFACTURED and RECOND. and RECORE - These refer to used/recycled OEM parts that have been refurbished. REPAIR SHOP'S AUTHORIZED REPRESENTATIVE'S SIGNATURE INDICATING AGREEMENT ON COST TO RETURN THE VEHICLE TO PRE-LOSS CONDITION, INCLUDING TOW/STORAGE CHARGES: SHOP SIGNATURE: ____________ EST. COMPLETION DATE:______ WARNING: Any person who knowingly, and with the intent to injure, defraud or deceive any insurer, makes any claim for the proceeds of an insurance policy containing any false, incomplete or misleading information is guilty of a felony. Part Type Terms and Abbreviations NEW and OEM or part number displayed - These refer to a new, original equipment manufacturer part. NON-OEM and A/M and QUAL REPL - These refer to an after-market part, which is a new, non-original equipment manufacturer part. USED/RECYCLED and LKQ - These refer to a used OEM part. REMANUFACTURED and RECOND. and RECORE - These refer to used/recycled OEM parts that have been refurbished. Progressive’s Lifetime Guarantee does not cover repairs you request the shop to make that are not related to this accident, including but not exclusive to unrelated prior damage and pre-existing damage. Disclaimer: WARNING: Any person who knowingly, and with intent to injure, defraud or deceive any insurer, makes any claim for the proceeds of an insurance policy containing any false, incomplete or misleading information is guilty of a felony. Cycle Time Information Due In 8/17/2023 Estimate Event Log <table> <tr> <th>Job Created</th> <td>8/16/2023 09:18 AM</td> </tr> <tr> <th>Supplement 2 Started</th> <td>8/17/2023 08:36 AM</td> </tr> <tr> <th>Supplement 2 Printed</th> <td>8/30/2023 10:57 AM</td> </tr> <tr> <th>Supplement 2 Committed</th> <td>8/30/2023 10:57 AM</td> </tr> <tr> <th>Estimate Version</th> <td>2</td> </tr> </table> Progressive Northern Insurance Co Unrelated Prior Damage Estimate Owner SHAWN ADAMS Insured SHAWN ADAMS Appraiser SHAWN ALLEN (405) 318-5750 (Work) [email protected] Classification None Supplemented By SHAWN ALLEN (405) 318-5750 (Work) [email protected] Underwriter Progressive Northern Insurance Co OK License 3000262377 Classification None Progressive Northern Insurance Co Claim Number 23-7969615-01 Adjuster Stephanie Jones (440) 697-7781 (Work) [email protected] Deductible 1000.00 - Not Waived Reported Date 08/15/2023 Loss Date 04/24/2022 Inspection Site BEATTY BODY SHOP 5325 SW 11th St Oklahoma City, OK 73128 (999) 999-9999 (Mobile) 2003 Peterbilt 379 Exterior Color White VIN 1XP5DB9X33N587399 Mitchell Service Code 912307 Primary Point of Impact Front (12) Drivable No Odometer 430779 Parts Profile CLOK ALL PART TYPES Parts Profile Version 2.0 <table> <tr> <th>Line #</th> <th>Description</th> <th>Operation</th> <th>Type</th> <th>Total Units</th> <th colspan="5">LABOR</th> <th colspan="4">PART</th> </tr> <tr> <td></td> <td></td> <td></td> <td></td> <td></td> <td></td> <td></td> <td></td> <td></td> <td></td> <td></td> <td></td> <td>Qty</td> <td>Total Price</td> <td>Tax</td> </tr> <tr> <td>Front Bumper<br>1 200208<br>2 900501</td> <td>Frt Bumper<br>custom bumper</td> <td>Remove / Replace</td> <td>Body</td> <td>1.0</td> <td></td> <td></td> <td></td> <td></td> <td></td> <td></td> <td></td> <td>1</td> <td>$2,100.00*</td> <td>Yes</td> </tr> <tr> <td>Windshield<br>3 200563</td> <td>L W/Shield Glass</td> <td>Remove / Replace</td> <td>Glass</td> <td>1.5#</td> <td>New</td> <td>N.A.</td> <td></td> <td></td> <td></td> <td></td> <td></td> <td>1</td> <td>$91.00*</td> <td>Yes</td> </tr> <tr> <td>Pete-36",48",63" Unibilt Sleeper<br>4 846601<br>5 900510<br>6 900501</td> <td>R Sleeper Side Panel<br>Line Markup 25.0%<br>truck shrouds</td> <td>Remove / Replace</td> <td>Body</td> <td>6.5</td> <td>New</td> <td></td> <td></td> <td></td> <td></td> <td></td> <td></td> <td>1</td> <td>$495.00*</td> <td>Yes</td> </tr> <tr> <td></td> <td></td> <td></td> <td></td> <td></td> <td></td> <td></td> <td></td> <td></td> <td></td> <td></td> <td></td> <td></td> <td>$123.75</td> <td></td> </tr> <tr> <td>Quarter Fender<br>7 200185<br>8 900510<br>9 900501<br>10 200027<br>11 900510<br>12 900501</td> <td>R Qtr Fender<br>Line Markup 25.0%<br>4 states<br>L Qtr Fender<br>Line Markup 25.0%<br>4 states</td> <td>Remove / Replace</td> <td>Body</td> <td>0.6#</td> <td>Aftermarket New</td> <td></td> <td></td> <td></td> <td></td> <td></td> <td></td> <td>1</td> <td>$379.32*</td> <td>Yes</td> </tr> <tr> <td></td> <td></td> <td></td> <td></td> <td></td> <td></td> <td></td> <td></td> <td></td> <td></td> <td></td> <td></td> <td></td> <td>$94.83</td> <td></td> </tr> <tr> <td></td> <td></td> <td></td> <td></td> <td></td> <td></td> <td></td> <td></td> <td></td> <td></td> <td></td> <td></td> <td>1</td> <td>$379.32*</td> <td>Yes</td> </tr> <tr> <td></td> <td></td> <td></td> <td></td> <td></td> <td></td> <td></td> <td></td> <td></td> <td></td> <td></td> <td></td> <td></td> <td>$94.83</td> <td></td> </tr> </table> * Judgment Item T Included in Two Tone Calculation # Labor Note Applies d Discontinued by Manufacturer C Included in Clear Coat Calculation A Included in Clear Coat and Two Tone Calculation r CEG R&R Time Used for this Labor Operation [ ] Verify the part number and price before ordering Disclaimer: This estimate has been prepared based on the use of crash parts supplied by a source other than the manufacturer of your motor vehicle. Warranties applicable to these replacement parts are provided by the manufacturer or distributor of these parts rather than the manufacturer of your vehicle. Estimate Totals <table> <tr> <th>Labor</th> <th>Units</th> <th>Rate</th> <th>Sublet Add'l Amount</th> <th>Totals</th> </tr> <tr> <td>Body Labor</td> <td>8.7</td> <td>$125.00</td> <td></td> <td>$1,087.50</td> </tr> <tr> <td>Glass Labor</td> <td>1.5</td> <td>$125.00</td> <td></td> <td>$187.50</td> </tr> <tr> <td>Total Labor</td> <td>10.2</td> <td></td> <td></td> <td>$1,275.00</td> </tr> <tr> <td>Taxable</td> <td></td> <td></td> <td></td> <td>$0.00</td> </tr> <tr> <td>Tax 0.0000%</td> <td></td> <td></td> <td></td> <td>$0.00</td> </tr> <tr> <td>Non-Taxable</td> <td></td> <td></td> <td></td> <td>$1,275.00</td> </tr> <tr> <td>Labor Total</td> <td></td> <td></td> <td></td> <td>$1,275.00</td> </tr> <tr> <th>Parts</th> <th>Amount</th> <th></th> <th></th> <th></th> </tr> <tr> <td>Taxable Parts</td> <td>$3,444.64</td> <td></td> <td></td> <td></td> </tr> <tr> <td>Parts Adjustments</td> <td>$313.41</td> <td></td> <td></td> <td></td> </tr> <tr> <td>Tax 8.6300%</td> <td>$324.32</td> <td></td> <td></td> <td></td> </tr> <tr> <td>Non-Taxable</td> <td>$0.00</td> <td></td> <td></td> <td></td> </tr> <tr> <td>Parts Total</td> <td>$4,082.37</td> <td></td> <td></td> <td></td> </tr> <tr> <th>Costs Other Additional Costs</th> <th>Amount</th> <th></th> <th></th> <th>$0.00</th> </tr> </table> Estimate Totals Paint Materials $0.00 <table> <tr> <th></th> <th>Amount</th> <th></th> </tr> <tr> <td>Taxable</td> <td>$0.00</td> <td></td> </tr> <tr> <td>Tax 8.6300%</td> <td>$0.00</td> <td></td> </tr> <tr> <td>Non-Taxable</td> <td>$0.00</td> <td></td> </tr> <tr> <td><b>Costs Total</b></td> <td><b>$0.00</b></td> <td></td> </tr> </table> Gross Totals Amount Gross Total $5,357.37 <table> <tr> <th></th> <th>Amount</th> <th></th> </tr> <tr> <td>Gross Total</td> <td>$5,357.37</td> <td></td> </tr> <tr> <td>Taxable</td> <td>$3,758.05</td> <td></td> </tr> <tr> <td>Tax</td> <td>$324.32</td> <td></td> </tr> <tr> <td>Non-Taxable</td> <td>$1,275.00</td> <td></td> </tr> <tr> <td><b>Gross Total</b></td> <td><b>$5,357.37</b></td> <td></td> </tr> </table> Adjustments Amount Total Customer Responsibility $0.00 Net Estimate Total $5,357.37 "All manufacturers requirements regarding seat belt and supplemental restraint system replacement must be adhered to. If additional parts or operations are necessary to properly accomplish this, please contact the estimating claims rep." THIS IS A DAMAGE ASSESSMENT ONLY - NOT AN AUTHORIZATION TO REPAIR - BASED ON DAMAGE VISIBLE OR CERTAIN AT THE TIME IT WAS WRITTEN. IF FRAME OR UNIBODY REPAIR IS INCLUDED ON THIS ESTIMATE, THE AMOUNT SHOWN INCLUDES TIME OR ALLOWANCE FOR MEASURING BEFORE, DURING AND AFTER THOSE REPAIRS. THE OWNER OF THE VEHICLE MAY SELECT THE REPAIR FACILITY OF HIS/HER CHOICE. TO ENSURE PROPER AND PROMPT PAYMENT FOR ADDITIONAL DAMAGE DISCOVERED DURING THE COURSE OF REPAIRS, CONTACT PROGRESSIVE FOR SUPPLEMENT HANDLING PROCEDURES. PROGRESSIVE HONORS THE PREVAILING LABOR MARKET RATE IN YOUR AREA FOR YOUR PROPERTY. IF YOU CHOOSE A SHOP THAT CHARGES IN EXCESS OF PREVAILING LABOR MARKET RATES, YOU WILL BE RESPONSIBLE FOR THE DIFFERENCE. LIFETIME GUARANTEE FOR SHEET METAL AND PLASTIC BODY PARTS 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), in terms of form, fit, finish, 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 long as you own or lease 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 THAT WILL RETURN YOUR VEHICLE TO ITS PRE-LOSS CONDITION. ACCORDINGLY, 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. NON-OEM and A/M and Qual REPL - These refer to an after-market part, which is a new, non-original equipment manufacturer part. USED/RECYCLED and LKQ - These refer to a used OEM part. REMANUFACTURED and RECOND. and RECORE - These refer to used/recycled OEM parts that have been refurbished. REPAIR SHOP'S AUTHORIZED REPRESENTATIVE'S SIGNATURE INDICATING AGREEMENT ON COST TO RETURN THE VEHICLE TO PRE-LOSS CONDITION, INCLUDING TOW/STORAGE CHARGES: SHOP SIGNATURE: ____________________ EST. COMPLETION DATE:_____ WARNING: Any person who knowingly, and with the intent to injure, defraud or deceive any insurer, makes any claim for the proceeds of an insurance policy containing any false, incomplete or misleading information is guilty of a felony. Part Type Terms and Abbreviations NEW and OEM or part number displayed - These refer to a new, original equipment manufacturer part. NON-OEM and A/M and QUAL REPL - These refer to an after-market part, which is a new, non-original equipment manufacturer part. USED/RECYCLED and LKQ - These refer to a used OEM part. REMANUFACTURED and RECOND. and RECORE - These refer to used/recycled OEM parts that have been refurbished. Progressive’s Lifetime Guarantee does not cover repairs you request the shop to make that are not related to this accident, including but not exclusive to unrelated prior damage and pre-existing damage. Disclaimer: WARNING: Any person who knowingly, and with intent to injure, defraud or deceive any insurer, makes any claim for the proceeds of an insurance policy containing any false, incomplete or misleading information is guilty of a felony. Cycle Time Information Due In 8/17/2023 Estimate Event Log <table> <tr> <th>Event</th> <th>Date</th> </tr> <tr> <td>Job Created</td> <td>8/16/2023 09:18 AM</td> </tr> <tr> <td>Supplement 2 Started</td> <td>8/17/2023 08:36 AM</td> </tr> <tr> <td>Supplement 2 Printed</td> <td>8/30/2023 10:57 AM</td> </tr> <tr> <td>Supplement 2 Committed</td> <td>8/30/2023 10:57 AM</td> </tr> <tr> <td>Estimate Version</td> <td>2</td> </tr> </table> Date: 8/30/2023 10:57:32 AM Estimate ID: 13335866 Supplement: 2 - 8/30/2023 10:57:31 AM Profile ID: CL Oklahoma Supplement Delta Report Comparison of Estimate 13335866 Supplement 1 and Supplement 2 Damage Assessed By: SHAWN ALLEN Supplemented By: SHAWN ALLEN Insured: SHAWN ADAMS Owner: SHAWN ADAMS Vehicle: 2003 Peterbilt 379 Date of Loss: 04/24/2022 <table> <tr> <th>Line Item</th> <th>Labor Type</th> <th>Operation</th> <th>Line Item Description</th> <th>Part Type/Num</th> <th>Dollar Amount</th> <th>Labor Units</th> <th>CEG Unit</th> </tr> <tr><th colspan="8">Changed Entries</th></tr> <tr> <td>S1 14</td> <td>Body</td> <td>REMOVE/REPLACE</td> <td>Hood Assy</td> <td>New<br>N.A.</td> <td>20,388.56*</td> <td>12.7*</td> <td>7.50T</td> </tr> <tr> <td>11<</td> <td>Body</td> <td>REMOVE/REPLACE</td> <td>Hood Assy</td> <td>New<br>N.A.</td> <td>20,388.56*</td> <td>7.50*</td> <td>7.50T</td> </tr> <tr> <td>S1 36</td> <td></td> <td>ADD'L COST</td> <td>Shop Materials</td> <td></td> <td>107.88*</td> <td>T</td> <td></td> </tr> <tr> <td>34<</td> <td></td> <td>ADD'L COST</td> <td>Shop Materials</td> <td></td> <td>105.26*<</td> <td>T</td> <td></td> </tr> <tr><th colspan="8">Deleted Entries</th></tr> <tr> <td>11</td> <td>Body</td> <td>REMOVE/REPLACE</td> <td>L Headlamp Assembly</td> <td>Aftermarket New<br>Aftermarket New</td> <td>400.04*</td> <td>0.70</td> <td>0.70T</td> </tr> <tr> <td>12</td> <td></td> <td>LINE MARKUP</td> <td>Line Markup 25.0%</td> <td></td> <td>100.01</td> <td></td> <td></td> </tr> <tr> <td>13</td> <td></td> <td></td> <td>4 states</td> <td></td> <td></td> <td></td> <td></td> </tr> <tr> <td>15</td> <td></td> <td></td> <td>includes 5.2 for two tone fenders</td> <td></td> <td></td> <td></td> <td></td> </tr> <tr><th colspan="8">Added Entries</th></tr> <tr> <td>14</td> <td>Body</td> <td>ADD'L LABOR</td> <td>Hood Two Tone</td> <td>Existing</td> <td>0.00*</td> <td>5.2*</td> <td>0.00</td> </tr> <tr> <td>15</td> <td></td> <td></td> <td>5.2 for two tone</td> <td></td> <td></td> <td></td> <td></td> </tr> </table> Related Prior Damage Line Item Labor Type Operation Line Item Description Part Type/Num Dollar Amount Labor Units CEG Unit No changes to Repair Lines. Global Changes No Deductible, Deductible Reduction Credit, Customer Responsibility, Labor Rate, or Part Adjustment changes were made. Amount Original Estimate 31,289.64 Supplement 1 3,904.51 Supplement 2 -633.55 Supp 1 Total Tax 2534.32 Supp 2 Total Tax 2490.94 Net Supplement Amount 3,270.96 Net Total 34,560.60 Program Calc Version Data Versions Supp 1 3 AUG_23_V Supp 2 3 AUG_23_V Claim Payment Detail Payment Information Disbursement Number: [REDACTED] Draft Number: Pay to the Order of: SNB BANK NA Mailing Address: PO BOX 39 SHATTUCK, OK 73858 USA In Payment Of: Progressive Invoice Number: [REDACTED] Total Amount: $31,085.90 Invoice Number: [REDACTED] Reviewed Summary Issuing Rep: [REDACTED] Issue Date: 08-31-23 Last Updated Rep: [REDACTED] Approved By: Review Date: Reviewed By: Bank Information Type: Loss Stop Reason: Stop Date: Bank Code: [REDACTED] Cleared: 09-14-23 Exposure Detail: COMP Party Name: ADAMS, SHAWN Property Description: 03 PTRB 379 Payment Type: FINAL PAYMENT Amount Paid: $31,085.90 Deductible Taken: $1,000.00 Property Damage: $0.00 Rental: $0.00 Claim Payment Detail ( 23-7969615 ) Payment Information Disbursement Number: [REDACTED] Digital Payment #: Pay to the Order of: SHAWN ADAMS Digital Payment Notification Method: Email: [REDACTED] Phone Number: [REDACTED] In Payment Of: Progressive Invoice Number: [REDACTED] Total Amount: $5,854.05 Invoice Number: [REDACTED] Reviewed Summary Issuing Rep: [REDACTED] Issue Date: 08-31-23 Last Updated Rep: [REDACTED] Approved By: Review Date: Reviewed By: Bank Information Type: Loss Stop Reason: Stop Date: Bank Code: [REDACTED] Cleared: 09-06-23 Exposure Detail: COMP Party Name: ADAMS, SHAWN Property Description: 03 PTRB 379 Payment Type: SUPPLEMENTAL PAYMENT Amount Paid: $5,854.05 Deductible Taken: $0.00 Property Damage: $0.00 Rental: $0.00 10/5/23, 8:38 AM Claim Payment Detail Claim Payment Detail ( 23-7969615 ) Payment Information Disbursement Number: [REDACTED] Draft Number: [REDACTED] Pay to the Order of: BEATTY BODY WORKS Mailing Address: 5325 SW 11TH ST OKLAHOMA CITY, OK 73128 USA In Payment Of: Progressive Invoice Number: [REDACTED] Total Amount: $1,714.07 Invoice Number: [REDACTED] Reviewed Summary Issuing Rep: [REDACTED] Issue Date: 08-31-23 Last Updated Rep: [REDACTED] Approved By: Review Date: Reviewed By: Bank Information Type: Loss Stop Reason: Stop Date: Bank Code: [REDACTED] Cleared: 09-13-23 Exposure Detail: COMP Party Name: ADAMS, SHAWN Property Description: 03 PTRB 379 Payment Type: PARTIAL PAYMENT Amount Paid: $1,714.07 Deductible Taken: $0.00 Property Damage: $0.00 Rental: $0.00