Assignment Details Claim Ref:

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Assignment Details

Claim Ref:

0010294220-001

Loss & Adjuster

Company Name: UTICA NATIONAL INSURANCE GROUP Claim Reference Id: 0010294220-001

Claim Type: Vehicle

Claim Type Detail: Utility Vehicle Assignment Type: Assignment

Date of Loss: 10/21/2021 Time of Loss: 10:45 a.m.

Date Reported: 10/28/2021 Loss Ref. Id: 0010294220-001

Catastrophe Code:

Injuries: Unknown

From Company: UTICA NATIONAL INSURANCE GROUP

Office: MATERIAL DAMAGE UNIT

Theft: Unknown

Place of Loss:

Address 1: ATLANTA

Address 2:

City: ATLANTA

State / Province: GA

Postal Code: 30340

Country: USA

Facts Of Loss: INSURED BACKING UP LOANER VEHICLE HIT CONCRETE BALUSTER DENTING DRIVER FRONT DOOR.

Adjuster Code: 0P13 Other:

Name: LYNCH, MARY Other:

Phone: 315-235-6745 Claim Unit:

Extn:

Party & Claim

Party

Party: MERCEDES BENZ OF BUCKHEAD Owner/Company

Title:

Address Type: Home

Address 1: 2799 PIEDMONT RD NE

ATLANTA, GA 30305 USA

Phone: 800-697-7204 (Day)

PIN/Pager:

Email:

Driver's License Number:

License State / Province: OT Expiration Date:

Social Security Number:

Injuries: Unknown

Statement:

Claim

Date Reported: 10/28/2021 Rental In Use: Unknown

Coverage: Daily Cost:

Type Of Loss: Collision Ok To Pay: Unknown

3rd Party Claim Ref. ID:

Vehicle Details

VIN / Identification Number: WDC0G8DB7LF688497

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Vehicle Type: Utility Vehicle Year: 2020

Make: Mercedes-Benz Model: GLC 300

Body Style: Engine:

Interior Color: Exterior Color: GREY

Odometer / Hours: Vehicle Production Date:

License Plate / Registration #: State of Registration:

License Plate / Registration # Expiration Date:

Vehicle Location

Vehicle Location Indicator:

Repair Facility

Name: BUCKHEAD COLLISION

Address 1: 1900 PIEDMONT CIR

Address 2:

City: ATLANTA

State / Province: Georgia

Postal Code: 30324

Country: UNITED STATES

Phone: 404-873-4071 Extn.

Vehicle Damage

Primary Impact Area:

10. Left Front Pillar

Secondary Impact Area:

Tertiary Impact Area:

Driveable: Not Driveable

Prior Damage Notes:

Impact Notes:

Total Loss: Unknown

Postal Code Where Vehicle Principally Garaged:

Condition:

Appointment & Recipient

Appointment Date: Appointment Time:

Inspection Type: Demand Estimate Inspection Location: Repair Facility

Type: Physical

Inspection Requirements:

Recipient

Recipient: Recipient Type: RF

Recipient Address: 1900 PIEDMONT CIR ATLANTA Georgia 30324 Recipient Phone: 404-873-4071

Recipient Drive-In: Demand Estimate Recipient Company: BUCKHEAD COLLISION

Assigned By: Date Assigned: 11/18/2021

Instructions to Estimator:

Our mutual customer has noted that they intend to use your shop for an estimate or repairs. Please be advised if you have questions about Open Shop you should contact CCC or your CCC representative. If you have not already spoken with the customer please contact them and schedule them for an estimate. We have noted below our guidelines for estimating. Please complete an estimate and upload your estimate and photos to the CCC portal. Repairs are not authorized and should not begin until an agreed price has been reached with Utica National. If the vehicle is a possible total loss please advise Utica National and fill out a Basic Claim Information Form. We will review and make a determination. Guidelines: Â# OEM parts for current model year or current model year plus one. Â# AM radiators and condensers can be used on current model year plus one. Â# LKQ and AM parts can be utilized on vehicles less than current model year plus one. Â# AM parts need to be CAPA certified and LKQ need to be from same year or newer vehicle with same mileage or less. Â# All parts need to be compliant with state regulations. Â# NO LKQ SRS

COMPONENTS OR SUSPENSION. New AM suspension parts are authorized. Â# Please provide photos of the vehicle including 4 corners, mileage, license plate number and VIN number. Â# Please provide far away and close up of

damaged panels. Â# If the vehicle is a possible total loss please include photos of unrelated prior damage and options. Â#

No more than three AM or LKQ suppliers on an estimate. (NY Only) Please make sure to list your vendors. Thank you

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and if you should have any questions please contact the adjuster MARY LYNCH 315-235-6745

Policy & Agent

Insurance Carrier: UTICA NATIONAL INSURANCE GROUP Subsidiary Insurance Carrier:

Policy Number: 005457792

Policy Effective Date: Policy Expiration Date:

Deductible: $0 Deductible Type: Dollar Amount

Underwriting Company:

NO COV

Policy Notes:

Endorsement Notes:

Agent Details

Agent Last Name: Agent ID:

Agent First Name: Agent Type:

License:

Address 1:

Address 2:

City:

State / Province:

Postal Code:

Country:

Phone: Extn.

Agent Email:

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Buckhead Collision

Workfile ID:

PartsShare:

Federal ID:

e924a73f

582517962

"An Atlanta Tradition Since 1962"

1900 Piedmont Circle, Atlanta, GA 30324 Phone: (404) 873-4071

FAX: (404) 873-4074 Estimate of Record

Customer: MERCEDES BENZ OF BUCKHEAD Job Number: 10211121

Written By: GEORGE BERRONG, 11/18/2021 2:59:07 PM Adjuster: LYNCH, MARY, (315) 235-6745 Business

Insured: Policy #: Claim #: 0010294220-001

Type of Loss: Collision Date of Loss: 10/21/2021 10:45 AM Days to Repair: 0 Point of Impact: 10 Left Front Pillar (Left

Side)

Owner: Inspection Location: Insurance Company:

MERCEDES BENZ OF BUCKHEAD Buckhead Collision UTICA NATIONAL INSURANCE GROUP

2799 PIEDMONT RD NE 1900 Piedmont Circle NO COV

ATLANTA, GA 30305 Atlanta, GA 30324 MATERIAL DAMAGE UNIT

(800) 697-7204 Day Repair Facility RED CREEK

(404) 873-4071 Day

VEHICLE

2020 BENZ GLC 300 4D UTV 4-2.0L Turbocharged Gasoline Gasoline Direct Injection GREY

VIN: WDC0G8DB7LF688497 Interior Color: Mileage In: 17,867 Vehicle Out:

License: RHJ9252 Exterior Color: GREY Mileage Out:

State: GA Production Date: Condition: Job #: 10211121

TRANSMISSION CONVENIENCE AM Radio Blind Spot Detection

Automatic Transmission Air Conditioning FM Radio ROOF

POWER Intermittent Wipers Stereo Luggage/Roof Rack

Power Steering Tilt Wheel Search/Seek SEATS

Power Brakes Cruise Control Auxiliary Audio Connection Bucket Seats

Power Windows Rear Defogger SAFETY Reclining/Lounge Seats

Power Locks Keyless Entry Drivers Side Air Bag Leather Seats

Power Mirrors Alarm Passenger Air Bag Heated Seats

Heated Mirrors Message Center Anti-Lock Brakes (4) WHEELS

Power Driver Seat Steering Wheel Touch Controls 4 Wheel Disc Brakes Aluminum/Alloy Wheels

Power Passenger Seat Rear Window Wiper Traction Control PAINT

Memory Package Telescopic Wheel Stability Control Clear Coat Paint

DECOR Climate Control Front Side Impact Air Bags OTHER

Dual Mirrors Backup Camera Head/Curtain Air Bags Rear Spoiler

Privacy Glass Remote Starter Communications System Signal Integrated Mirrors

Console/Storage Home Link Hands Free Device TRUCK

Overhead Console RADIO Xenon or L.E.D. Headlamps Power Trunk/Liftgate

11/18/2021 2:59:08 PM 306944 Page 1

6wH6bm 6wH6bm

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Estimate of Record

Customer: MERCEDES BENZ OF BUCKHEAD Job Number: 10211121

Line Oper Description Part Number Qty Extended

Price $

Labor Paint

1 FRONT BUMPER & GRILLE

2 R&I R&I bumper cover 2.2

3 FRONT LAMPS

4 R&I LT R&I headlamp assy 0.5

5 FENDER

6 Repl LT Flare GLC300 w/o AMG line 2538850522 1 132.00 0.3

7 Blnd LT Fender 1.0

8 R&I LT Ft fender liner w/o AMG GLC63

0.2

9 R&I LT Rr fender liner 0.2

10 PILLARS, ROCKER & FLOOR

11 Repl LT Rocker molding w/o GLC63 2536980800 1 306.00 1.1

12 FRONT DOOR

13 Repl LT Door shell 2537200305 1 1,640.00 7.5 3.0

14 Add for Clear Coat 1.2

15 Repl LT Door w'strip 2047271187 1 208.00 0.8

16 R&I LT R&I trim panel Incl.

17 Repl LT Trim molding chrome 2537250182 1 115.00 0.2

18 REAR DOOR

19 Blnd LT Door shell 1.0

20 R&I LT Trim molding black 21 R&I LT Handle, outside w/o

keyless-go black

Incl.

22 R&I LT R&I trim panel 0.6

23 Repl LT Water shield 253737010064 1 52.00

24 R&I LT Regulator module 1.5

25 # Repl l/f door sound deadner 1 12.00 0.2

26 # Repl Corrosion protection primer 1 0.4

27 # Repl Cover Car 1 8.00 0.2

28 # Repl SEAL SEAM OEM DOOR 1 57.00 1.0

29 # Repl DE NIB & POLISH 1 16.00 2.0

30 # Rpr POST SCAN 1.0 M

31 # Rpr PRE SCAN 1.0 M

32 # Repl VIRUS MITIGATION 1 25.00 1.0

33 # Repl MASK JAMBS 1 6.00 0.3

SUBTOTALS 2,577.00 21.8 6.6

11/18/2021 2:59:08 PM 306944 Page 2

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Estimate of Record

Customer: MERCEDES BENZ OF BUCKHEAD Job Number: 10211121

ESTIMATE TOTALS

Category Basis Rate Cost $

Parts 2,577.00

Body Labor 19.8 hrs @ $ 46.00 /hr 910.80

Paint Labor 6.6 hrs @ $ 46.00 /hr 303.60

Mechanical Labor 2.0 hrs @ $ 110.00 /hr 220.00

Paint Supplies 6.6 hrs @ $ 32.00 /hr 211.20

Subtotal 4,222.60

Sales Tax $ 2,788.20 @ 8.0000 % 223.06

Grand Total 4,445.66

CUSTOMER PAY 0.00

INSURANCE PAY 4,445.66

Note***** possible additional damages maybe found once the actual repairs are started. All part prices subject to invoices.

NOTICE TO THIRD PARTY CLAIMANTS: Failure to use the insurance proceeds in accordance with a security agreement between you and a lienholder, if any, may be a violation of Code Section 16-8-4 of the O.C.G.A. If you have any questions, contact your lending institution.

11/18/2021 2:59:08 PM 306944 Page 3

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Estimate of Record

Customer: MERCEDES BENZ OF BUCKHEAD Job Number: 10211121

Estimate based on MOTOR CRASH ESTIMATING GUIDE and potentially other third party sources of data. Unless otherwise noted, (a) all items are derived from the Guide ERI5901, CCC Data Date 11/15/2021, and potentially other third party sources of data; and (b) the parts presented are OEM-parts. OEM parts are manufactured by or for the vehicle's Original Equipment Manufacturer (OEM) according to OEM's specifications for U.S. distribution. OEM parts are available at OE/Vehicle dealerships or the specified supplier. OPT OEM (Optional OEM) or ALT OEM (Alternative OEM) parts are OEM parts that may be provided by or through alternate sources other than the OEM vehicle dealerships with discounted pricing. Asterisk (*) or Double Asterisk (**) indicates that the parts and/or labor data provided by third party sources of data may have been modified or may have come from an alternate data source.

Tilde sign (~) items indicate MOTOR Not-Included Labor operations. The symbol (<>) indicates the refinish operation WILL NOT be performed as a separate procedure from the other panels in the estimate. Non-Original Equipment Manufacturer aftermarket parts are described as Non OEM, A/M or NAGS. Used parts are described as LKQ, RCY, or USED. Reconditioned parts are described as Recond. Recored parts are described as Recore. NAGS Part Numbers and Benchmark Prices are provided by National Auto Glass Specifications. Labor operation times listed on the line with the NAGS information are MOTOR suggested labor operation times. NAGS labor operation times are not included. Pound sign (#) items indicate manual entries.

Some 2022 vehicles contain minor changes from the previous year. For those vehicles, prior to receiving updated data from the vehicle manufacturer, labor and parts data from the previous year may be used. The CCC ONE estimator has a list of applicable vehicles. Parts numbers and prices should be confirmed with the local dealership.

The following is a list of additional abbreviations or symbols that may be used to describe work to be done or parts to be repaired or replaced:

SYMBOLS FOLLOWING PART PRICE:

m=MOTOR Mechanical component. s=MOTOR Structural component. T=Miscellaneous Taxed charge category.

X=Miscellaneous Non-Taxed charge category.

SYMBOLS FOLLOWING LABOR:

D=Diagnostic labor category. E=Electrical labor category. F=Frame labor category. G=Glass labor category.

M=Mechanical labor category. S=Structural labor category. (numbers) 1 through 4=User Defined Labor Categories.

OTHER SYMBOLS AND ABBREVIATIONS:

Adj.=Adjacent. Algn.=Align. ALU=Aluminum. A/M=Aftermarket part. Blnd=Blend. BOR=Boron steel.

CAPA=Certified Automotive Parts Association. D&R=Disconnect and Reconnect. HSS=High Strength Steel.

HYD=Hydroformed Steel. Incl.=Included. LKQ=Like Kind and Quality. LT=Left. MAG=Magnesium. Non-Adj.=Non Adjacent. NSF=NSF International Certified Part. O/H=Overhaul. Qty=Quantity. Refn=Refinish. Repl=Replace.

R&I=Remove and Install. R&R=Remove and Replace. Rpr=Repair. RT=Right. SAS=Sandwiched Steel.

Sect=Section. Subl=Sublet. UHS=Ultra High Strength Steel. N=Note(s) associated with the estimate line.

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

The following is a list of abbreviations that may be used in CCC ONE Estimating that are not part of the MOTOR CRASH ESTIMATING GUIDE:

BAR=Bureau of Automotive Repair. EPA=Environmental Protection Agency. NHTSA= National Highway Transportation and Safety Administration. PDR=Paintless Dent Repair. VIN=Vehicle Identification Number.

11/18/2021 2:59:08 PM 306944 Page 4

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UTICA NATIONAL INSURANCE GROUP

MATERIAL DAMAGE UNIT

RED CREEK,,

Written By : GEORGE BERRONG Appraisal Totals : Claim # : 0010294220-001

Daytime Contact : Last Appraised : $0.00 Policy # :

Adjuster : MARY LYNCH Total Appraised : $4,445.66 Date of Loss : 10/21/2021

Daytime Contact : (404)873-4071 Total Score : 435 Type of Loss : Collision

Total Labor Hours : 28.4 TL Threshold Amount : $28,560.35 Total Variance : 49.40 TL Threshold % : 65.00%

Audit Results

Rule Description Line Number Actual Rule Variance Score

Paint Materials Rate Exceeds $30 32.00 30.00 150

Estimate Contains more than 5 Manual Entries 9.00 5.00 50

Manual Line Exceeds $100 31 $110.00 $100.00 $10.00 50

Mechanical Labor Rate Exceeds $65 110.00 65.00 15

Corrosion Protection Cost exceeds $25 26 $31.20 $25.00 $6.20 10

The Car Cover Cost Exceeds $5.00 27 $17.20 $5.00 $12.20 10

* indicates rules with parts detail information

# Rule uses median part price and includes parts detail information

Appraisal Information

Appraisal Source : Buckhead Collision Address1 : 1900 Piedmont Circle Address2 :

City/State/Zip : Atlanta, GA 30324 Daytime Contact : (404)873-4071 Evening Contact :

Appraisal Platform : CCC ONE Vehicle Owner :

Address1 : 2799 PIEDMONT RD NE Address2 :

City/State/Zip : ATLANTA GA 30305 Daytime Contact : (800)697-7204 Evening Contact :

Inspection Location :

Address1 : 1900 Piedmont Circle Address2 :

City/State/Zip : Atlanta, GA 30324 Daytime Contact : (404)873-4071 Evening Contact :

Inspection Type : REPAIRSHOP Vehicle Information : 2020 BENZ GLC 300

VIN : WDC0G8DB7LF688497 License : RHJ9252

Odometer : 17867 Days to Repair :

Driveable : YES Production Date :

Point of Impact : 10. Left Front Pillar (Left Side) 11/18/2021 at 20:08

CCC

^®

Audit Report

Page 1 of 1

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Photo 01

Claim Reference Id: 0010294220-001 File Name: PHOTO7

File Date: 11/18/2021 Label: Photo 01

Note: Style:2020,BENZ,GLC

300|LossDate:10/21/2021|ClaimRepresentative:LYNCH

|ShopName:Buckhead

Collision|VIN:WDC0G8DB7LF688497|InsuranceCompa ny:UTI

Photo Location: Buckhead Collision Photo Taken By: GEORGE BERRONG Estimate Indicator: E01

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Photo 02

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Photo 03

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Photo 05

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Photo 06

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Photo 07

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Photo 09

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Photo 10

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Photo 12