STATE FARM INSURANCE COMPANIES

ALL
Take this initial estimate to the repair facility of your choice. If additional
damage is found have the repair facility use the "Request Supplement" link at
b2b.statefarm.com. **This is not an email address; it is the site to submit a
Supplement**. All supplements must be approved by State Farm.
Claim #: 41-30D4-81R01
Workfile ID: 79471324
Rate Table: Default

Estimate of Record

Written By: CARL NELSON, 2/14/2022 8:58:23 AM

Claim Rep: Elliott, Peyton, (855) 341-8184 Business

Insured: PAIGE CHILARSKI Owner Policy #: Claim #: 41-30D4-81R01

Type of Loss: Collision Date of Loss: 02/03/2022 12:00 AM Days to Repair: 0
Point of Impact: 12 Front Deductible: 1000.00

Owner (Insured): Inspection Location: Repair Facility:

PAIGE CHILARSKI IAA Sioux Falls
840 N SPRUCE ST LOT 191 47028 276th St.
RAPID CITY, SD 57701-1357 Lennox, SD 57039
(605) 202-0391 Evening Salvage
(605) 389-5530 Cellular (605) 271-8855 Day

VEHICLE

2012 FORD Fusion SEL FWD 4D SED 4-2.5L Gasoline Electronic Fuel Injection Red Candy (2) TC

VIN: 3FAHP0JA7CR412190 Production Date: 06/2012 Interior Color: Charcoal Black

Interior
License: . Odometer: 124790 Exterior Color: Red Candy (2) TC
State: SD Condition:

TRANSMISSION Air Conditioning FM Radio ROOF

Automatic Transmission Intermittent Wipers Stereo Electric Glass Sunroof
POWER Tilt Wheel Search/Seek SEATS
Power Steering Cruise Control CD Player Bucket Seats
Power Brakes Rear Defogger Auxiliary Audio Connection Reclining/Lounge Seats
Power Windows Keyless Entry Satellite Radio Leather Seats
Power Locks Alarm SAFETY Heated Seats
Power Mirrors Message Center Drivers Side Air Bag WHEELS
Heated Mirrors Steering Wheel Touch Controls Passenger Air Bag Aluminum/Alloy Wheels
Power Driver Seat Telescopic Wheel Anti-Lock Brakes (4) PAINT
Power Passenger Seat Climate Control 4 Wheel Disc Brakes Clear Coat Paint
DECOR Backup Camera Front Side Impact Air Bags OTHER
Dual Mirrors Parking Sensors Head/Curtain Air Bags Fog Lamps
Tinted Glass Home Link Hands Free Device Traction Control
Console/Storage RADIO Rear Side Impact Air Bags Stability Control
CONVENIENCE AM Radio Blind Spot Detection Power Trunk/Liftgate

2/14/2022 8:58:25 AM 443642 | 1.8.07.10200 Page 1

 Claim #: 41-30D4-81R01
Workfile ID: 79471324
Estimate of Record

2012 FORD Fusion SEL FWD 4D SED 4-2.5L Gasoline Electronic Fuel Injection Red Candy (2) TC

Line Oper Description Part Number Qty Extended Labor Paint

Price $
1 FRONT BUMPER
2 ** Repl Non OEM CAPA Absorber FO1070177DSC 1 80.00 0.1
3 * Repl RCY Impact bar (UHS) +25% FIB1017 1 83.75 0.4
4 O/H front bumper 2.7
5 R&I RT Bezel w/SEL model AE5Z17E810F Incl.
6 * Repl RCY Grille surround w/o sport AE5Z17K945A 1 50.00 Incl.
model
NOTE: McChesney Auto USA-IA(Somers) Request_Quote 515-467-5546
7 R&I LT Bezel w/SEL model AE5Z17E811F Incl.
8 ** <> Repl RECOND Bumper cover FO1000650R 1 377.00 Incl. 2.6
9 Add for Clear Coat 1.0
10 Add for fog lamps 0.4
11 * Repl RCY Bumper grille w/o sport AE5Z8200DA 1 60.00 Incl.
model
NOTE: McChesney Auto USA-IA(Somers) Request_Quote 515-467-5546
12 ** Repl Non OEM License bracket FO1068129 1 16.00 0.2
13 GRILLE
14 * Repl RCY Mount panel AE5Z8A284AC 1 Incl. 0.6
15 * Repl RCY Upper grille chrome w/o AE5Z8200C 1 187.50 Incl.
SPORT - ASSY +25%
NOTE: ASSEMBLY WITH ALL MOLDINGS & MOUNT PANEL
McChesney Auto USA-IA(Somers) Request_Quote 515-467-5546
16 FRONT LAMPS
17 R&I RT Fog lamp assy 6E5Z15200A Incl.
18 R&I LT Fog lamp assy 6E5Z15200A Incl.
19 * Repl RCY RT Headlamp assy +25% 9E5Z13008A 1 250.00 Incl.
NOTE: McChesney Auto USA-IA(Somers) Request_Quote 515-467-5546
20 * Repl RCY LT Headlamp assy +25% 9E5Z13008B 1 250.00 Incl.
NOTE: McChesney Auto USA-IA(Somers) Request_Quote 515-467-5546
21 RADIATOR SUPPORT
22 * Repl RCY Radiator support w/2.5, 3.0 7LNYE1 1 187.50 4.0
Liter +25%
23 Aim headlamps 0.5
24 AC Service refrigerant recovery m 0.4 M
25 AC Service evacuate & recharge m 1.4 M
26 COOLING
27 * Repl RCY Radiator auto trans +25% BB0251 1 106.25 m 2.9 M
28 Deduct for Overlap -1.2 M
29 ** Repl Non OEM Upper hose NBH16371 1 26.93 m 0.4 M
30 Deduct for Overlap -0.2 M
31 * Repl RCY Fan assy +25% 00026665 1 100.00 m Incl. M
32 AIR CONDITIONER & HEATER

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 Claim #: 41-30D4-81R01
Workfile ID: 79471324
Estimate of Record

2012 FORD Fusion SEL FWD 4D SED 4-2.5L Gasoline Electronic Fuel Injection Red Candy (2) TC

33 * Repl RCY Condenser +25% ~305310401 1 75.00 m 0.6 M

34 ** Repl Non OEM Hose & tube assy TEM282189 1 85.15 m 1.1 M
35 Deduct for Overlap -0.3 M
36 ** Repl Non OEM Pressure line TEM282187 1 37.83 m 0.5 M
37 Deduct for Overlap -0.2 M
38 ** Repl Non OEM Dehydrator TEM218202 1 17.51 m 0.2 M
39 HOOD
40 * Repl RCY hood +25% 00026556 1 906.25 0.6 2.8
NOTE: McChesney Auto USA-IA(Somers) Request_Quote 515-467-554
41 Overlap Major Non-Adj. Panel -0.2
42 Add for Clear Coat 0.5
43 ** Repl Non OEM Latch NOE87600021 1 42.68 Incl.
44 FENDER
45 * Rpr RT Fender AE5Z16005A 0.7 2.0
46 Overlap Major Adj. Panel -0.4
47 Add for Clear Coat 0.3
48 # Refn Basecoat Reduction -0.3
49 # Rpr Feather Prime and Block 0.3 3
50 * Rpr LT Fender AE5Z16006A 0.7 2.0
51 Overlap Major Adj. Panel -0.4
52 Add for Clear Coat 0.3
53 # Refn Basecoat Reduction -0.3
54 # Rpr Feather Prime and Block 0.3 3
55 MISCELLANEOUS OPERATIONS
56 # Repl Antifreeze Coolant 1 25.00
57 # Refn Corrosion Protection 0.3
58 # Rpr Pre-repair Scan 0.5 M
59 # Rpr Post-repair Scan 0.5 M
60 OTHER CHARGES
61 # E.P.C. 1 5.00
SUBTOTALS 2,969.35 18.1 10.2

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 Claim #: 41-30D4-81R01
Workfile ID: 79471324
Estimate of Record

2012 FORD Fusion SEL FWD 4D SED 4-2.5L Gasoline Electronic Fuel Injection Red Candy (2) TC

ESTIMATE TOTALS
Category Basis Rate Cost $
Parts 2,964.35
Body Labor 10.9 hrs @ $ 65.00 /hr 708.50
Paint Labor 10.2 hrs @ $ 65.00 /hr 663.00
Mechanical Labor 6.6 hrs @ $ 65.00 /hr 429.00
Feather Prime and Block 0.6 hrs @ $ 65.00 /hr 39.00
Paint Supplies 10.2 hrs @ $ 45.00 /hr 459.00
Other Charges 5.00
Subtotal 5,267.85
Sales Tax $ 5,267.85 @ 6.5000 % 342.41
Total Cost of Repairs 5,610.26
Deductible 1,000.00
Total Adjustments 1,000.00
Net Cost of Repairs 4,610.26

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

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

MyPriceLink Estimate ID / Quote ID:

922520398141071360 / 100747430

THIS ESTIMATE MAY BE BASED IN WHOLE OR IN PART UPON THE PAINTLESS DENT REPAIR METHOD. EACH ITEM
OF DAMAGE ADJUSTED USING THAT METHOD IS IDENTIFIED ON THE ESTIMATE. THE PAINTLESS DENT REPAIR
METHOD MAY NOT BE THE APPROPRIATE REPAIR METHOD FOR ALL TYPES OF DAMAGE. IF AN INSURER IS LIABLE
FOR THE DAMAGE LISTED ON THE ESTIMATE, THE INSURER SHALL PROVIDE SUFFICIENT COMPENSATION TO
RESTORE THE VEHICLE TO SUBSTANTIALLY THE SAME PHYSICAL CONDITION. FOR ANY DAMAGE WHERE IT IS
APPROPRIATE TO REPAIR THE VEHICLE USING THE PAINTLESS DENT REPAIR METHOD, THE INSURED MAY
CHOOSE NOT TO REPAIR THE VEHICLE OR CHOOSE TO HAVE THE VEHICLE REPAIRED USING A DIFFERENT
METHOD OF REPAIR. IF THE INSURED CHOOSES EITHER OF THESE OPTIONS, THE INSURER IS LIABLE ONLY FOR
THE COST OF THE PAINTLESS DENT REPAIR METHOD.

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.

2/14/2022 8:58:25 AM 443642 | 1.8.07.10200 Page 4

 Claim #: 41-30D4-81R01
Workfile ID: 79471324
Estimate of Record

2012 FORD Fusion SEL FWD 4D SED 4-2.5L Gasoline Electronic Fuel Injection Red Candy (2) TC

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 DE2JP10, CCC Data Date 01/17/2022, and potentially other
third party sources of data; and (b) the parts presented are OEM-parts. OEM parts are manufactured by or for the
vehicle's Original Equipment Manufacturer (OEM) according to OEM's specifications for U.S. distribution. OEM parts
are available at OE/Vehicle dealerships or the specified supplier. OPT OEM (Optional OEM) or ALT OEM (Alternative
OEM) parts are OEM parts that may be provided by or through alternate sources other than the OEM vehicle
dealerships with discounted pricing. Asterisk (*) or Double Asterisk (**) indicates that the parts and/or labor data
provided by third party sources of data may have been modified or may have come from an alternate data source.
Tilde sign (~) items indicate MOTOR Not-Included Labor operations. The symbol (<>) indicates the refinish
operation WILL NOT be performed as a separate procedure from the other panels in the estimate. Non-Original
Equipment Manufacturer aftermarket parts are described as Non OEM, A/M or NAGS. Used parts are described as
LKQ, RCY, or USED. Reconditioned parts are described as Recond. Recored parts are described as Recore. NAGS
Part Numbers and Benchmark Prices are provided by National Auto Glass Specifications. Labor operation times listed
on the line with the NAGS information are MOTOR suggested labor operation times. NAGS labor operation times are
not included. Pound sign (#) items indicate manual entries.

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

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

SYMBOLS FOLLOWING PART PRICE:

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

SYMBOLS FOLLOWING LABOR:

D=Diagnostic labor category. E=Electrical labor category. F=Frame labor category. G=Glass labor category.
M=Mechanical labor category. S=Structural labor category. (numbers) 1 through 4=User Defined Labor Categories.

OTHER SYMBOLS AND ABBREVIATIONS:

Adj.=Adjacent. Algn.=Align. ALU=Aluminum. A/M=Aftermarket part. Blnd=Blend. BOR=Boron steel.
CAPA=Certified Automotive Parts Association. D&R=Disconnect and Reconnect. HSS=High Strength Steel.
HYD=Hydroformed Steel. Incl.=Included. LKQ=Like Kind and Quality. LT=Left. MAG=Magnesium. Non-Adj.=Non
Adjacent. NSF=NSF International Certified Part. O/H=Overhaul. Qty=Quantity. Refn=Refinish. Repl=Replace.
R&I=Remove and Install. R&R=Remove and Replace. Rpr=Repair. RT=Right. SAS=Sandwiched Steel.
Sect=Section. Subl=Sublet. UHS=Ultra High Strength Steel. N=Note(s) associated with the estimate line.

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

The following is a list of abbreviations that may be used in CCC ONE Estimating that are not part of the MOTOR
CRASH ESTIMATING GUIDE:
BAR=Bureau of Automotive Repair. EPA=Environmental Protection Agency. NHTSA= National Highway
Transportation and Safety Administration. PDR=Paintless Dent Repair. VIN=Vehicle Identification Number.

2/14/2022 8:58:25 AM 443642 | 1.8.07.10200 Page 5

 Claim #: 41-30D4-81R01
Workfile ID: 79471324
Estimate of Record

2012 FORD Fusion SEL FWD 4D SED 4-2.5L Gasoline Electronic Fuel Injection Red Candy (2) TC

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

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

ESTIMATE:

THIS ESTIMATE HAS BEEN PREPARED BASED ON THE USE OF CRASH PARTS SUPPLIED BY A SOURCE
OTHER THAN THE MANUFACTURER OF YOUR MOTOR VEHICLE. WARRANTIES APPLICABLE TO THESE
REPLACEMENT PARTS ARE PROVIDED BY THE MANUFACTURER OR DISTRIBUTOR OF THESE PARTS
RATHER THAN THE MANUFACTURER OF YOUR VEHICLE.

2/14/2022 8:58:25 AM 443642 | 1.8.07.10200 Page 6

 Claim #: 41-30D4-81R01
Workfile ID: 79471324
Estimate of Record

2012 FORD Fusion SEL FWD 4D SED 4-2.5L Gasoline Electronic Fuel Injection Red Candy (2) TC

ALTERNATE PARTS SUPPLIERS

Line Supplier Description Price

2 Auto Body Specialties, Inc. #FO1070177DSC $ 80.00
4710 N. Westport Ave. Non OEM CAPA Absorber
Sioux Falls SD 57107 Quote: 1139647223
(605) 336-1606 Expires: 02/20/22

3 Original One Parts #FIB1017 $ 67.00

4201 Spring Valley Rd. RCY Impact bar (UHS) +25%
Dallas TX 75244 AE5Z17757A,FIB1017-C,FRONT BUMPER IMPACT BAR FIB1017
(877) 441-0001 Quote: CCC-102524561
Expires: 02/23/22

8 KEYSTONE-MINNEAPOLIS, MN(UPS) #FO1000650R $ 377.00

60 51ST WAY NE RECOND Bumper cover
FRIDLEY MN 55421 Quote: 1172727420
(612) 789-1919 Expires: 03/30/22

12 Fargo Bumper #FO1068129 $ 16.00

1002 6th Ave.N. Non OEM License bracket
Fargo ND 58102 Quote: 1139667382
(701) 237-5661 Expires: 02/20/22

22 Nordstrom's Automotive Inc #7LNYE1 $ 150.00

Craig Halverson RCY Radiator support w/2.5, 3.0 Liter +25%
25513 480th Ave RADIATOR SUPPORT-LH RAIL
W-APRON,6-12,2.5L,AT6,FWD,SE,S#FK0272 - 2.5L, VIN A (8TH
DIGIT)
Garretson SD 57030
(605) 594-4185

27 Pam's Auto Inc - Rcy #BB0251 $ 85.00

Pat Huesers RCY Radiator auto trans +25%
7505 Ridgewood Road RADIATOR-ASSY,AT,TESTED GD,LIFETIME WARRANTY - 2.5L, VIN 3
(8TH DIGIT, HYBRID), GASOL
St Cloud MN 56303
(320) 363-0000

29 NAPA #NBH16371 $ 26.93

Preston Keanum Non OEM Upper hose
2999 CIRCLE 75 PARKWAY
ATLANTA GA 30339
(800) 538-6272

31 HANSER SALVAGE CO. PRP #00026665 $ 80.00

430 S BILLINGS BLVD RCY Fan assy +25%

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 Claim #: 41-30D4-81R01
Workfile ID: 79471324
Estimate of Record

2012 FORD Fusion SEL FWD 4D SED 4-2.5L Gasoline Electronic Fuel Injection Red Candy (2) TC

BILLINGS MT 59101 COOLING FAN - FAN ASSEMBLY; 2.5L

(406) 248-7795 Quote: CCC-102536332
Expires: 02/23/22

33 LKQ Smart Parts #~305310401 $ 60.00

N4079 Highway E RCY Condenser +25%
Hustisford WI 53034 Condenser SEL,4DR EXC. 3.5L,S#$Y0373 - 2.5L, VIN 3 (8TH DIGIT,
HYBRID)
(920) 349-3236 Quote: 1172690113
Expires: 03/30/22

34 NAPA #TEM282189 $ 85.15

Preston Keanum Non OEM Hose & tube assy
2999 CIRCLE 75 PARKWAY
ATLANTA GA 30339
(800) 538-6272

36 NAPA #TEM282187 $ 37.83

Preston Keanum Non OEM Pressure line
2999 CIRCLE 75 PARKWAY
ATLANTA GA 30339
(800) 538-6272

38 NAPA #TEM218202 $ 17.51

Preston Keanum Non OEM Dehydrator
2999 CIRCLE 75 PARKWAY
ATLANTA GA 30339
(800) 538-6272

40 HANSER SALVAGE CO. PRP #00026556 $ 725.00

430 S BILLINGS BLVD RCY hood +25%
BILLINGS MT 59101 000 UL
(406) 248-7795 Quote: CCC-102536332
Expires: 02/23/22

43 NAPA #NOE87600021 $ 42.68

Preston Keanum Non OEM Latch
2999 CIRCLE 75 PARKWAY
ATLANTA GA 30339
(800) 538-6272

2/14/2022 8:58:25 AM 443642 | 1.8.07.10200 Page 8

 Claim #: 41-30D4-81R01
Workfile ID: 79471324
Estimate of Record

2012 FORD Fusion SEL FWD 4D SED 4-2.5L Gasoline Electronic Fuel Injection Red Candy (2) TC

ALTERNATE PARTS USAGE

2012 FORD Fusion SEL FWD 4D SED 4-2.5L Gasoline Electronic Fuel Injection Red Candy (2) TC

VIN: 3FAHP0JA7CR412190 Production Date: 06/2012 Interior Color: Charcoal Black

Interior
License: . Odometer: 124790 Exterior Color: Red Candy (2) TC
State: SD Condition:

Alternate Part Type # Of Available Parts # Of Parts Selected

Aftermarket 43 7
Optional OEM 1 0
Reconditioned 4 1
Recycled 60 12

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