Supplement 1 - State Farm Insurance Companies Itemized supplement requests photos and any applicable invoices should be emailed to

Supplement 1 - State Farm Insurance Companies Itemized...

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State Farm Insurance Companies Itemized supplement requests, photos and any applicable invoices should be emailed to [email protected]Farm.com and must be approved by State Farm. A Supplement Request form may be found on b2b.statefarm.com. If email is unavailable, you may fax to 866-566-6595. *** SUPPLEMENT 1 *** 10/11/2017 S1 10/25/2017 10:46 AM Owner Owner: SCOTT PACHECO Address: 1203 N SWEETZER AVE APT 102 Home/Day: (323)656-5546 Cell: (310)625-5546 City State Zip: W HOLLYWOOD, CA 90069-3028 Home/Evening: (310)625-5546 Control Information Claim # : 75-1622-L6901 Insured Policy # : Loss Date/Time: 09/01/2017 05:00 AM Loss Type: Collision Deductible: $500.00 Ins. Company: State Farm Insured: SCOTT PACHECO Address: Home/Day: (323)656-5546 Cell: (310)625-5546 City State Zip: Home/Evening: (310)625-5546 Claim Rep: Express Team B Address: Work/Day: (855)341-8184 Inspection Inspection Date: 10/11/2017 06:23 PM Inspection Type: Field Inspection Location: BEVERLY HILLS AUTO BODY Contact: Address: 200 North La Cienega Boulevard Home/Day: (310)657-5696 City State Zip: Beverly Hills, CA 90211 Primary Impact: Right Side Secondary Impact: Driveable: No Rental Assisted: Assigned Date/Time: Received Date/Time: 10/10/2017 05:53 PM First Contact Date/Time: Appointment Date/Time: 10/11/2017 02:53 PM Appraiser Name: Benny (WW6K) Appraiser License # : Orig Appraiser Name: RICK PMHZ Appraiser License # : Repairer Repairer: BEVERLY HILLS AUTO BODY Contact: Address: 200 North La Cienega Boulevard Home/Day: (310)657-5696 City State Zip: Beverly Hills, CA 90211 Remarks 10/25/2017 02:34 PM Page 1 of 6
UPD FRONT BUMPER SECOND CLAIM PENDING UPD REAR BUMPER Vehicle 2012 Infiniti G37 STD 2 DR Convertible 6cyl Gasoline 3.7 7-Speed Automatic Lic.Plate: 6WFK373 Lic State: CA Lic Expire: VIN: JN1CV6FE4CM203283 Prod Date: Mileage: 34,674 Veh Insp# : Mileage Type: Actual Condition: Code: IN453A Ext. Color: MALBEC BLACK MET Int. Color: Graphite Ext. Refinish: Two-Stage Int. Refinish: Two-Stage Ext. Paint Code: GAC Int. Trim Code: G Options - AudaVIN Information Received 19 Inch Alloy Wheels AM/FM CD Player Air Conditioning Alarm System Anti-Lock Brakes Auto Headlamp Control Auto-Leveling Headlamps Automatic Dimming Mirror Bose Sound System Bucket Seats Center Console Chrome Grille Climate Cntrl Frnt Seats Cruise Control Driver Seat Memory Dual Airbags Dual Power Seats Dual Zone Auto A/C Floor Mats Fog Lights Garage Door Opener Head Airbags Heated Power Mirrors High Intensity Headlamps Illuminated Visor Mirror Intermittent Wipers Keyless Entry System LED Brakelights Leather Seats Leather Steering Wheel Lighted Entry System MP3 Decoder Mirror(s) Memory Navigation System Overhead Console Power Brakes Power Door Locks Power Steering Power Windows Pwr Driver Lumbar Supp Pwr Retractable Hardtop Pwr Tilt/Tele. Str Wheel Rear Bench Seat Rear View Camera Rear Window Defroster Rem Trunk-L/Gate Release Reverse Sensing System Roll Over Prot. System Side Airbags Stability Cntrl Suspensn Strg Wheel Radio Control Tachometer Tilt & Telescopic Steer Tinted Glass Tire Pressure Monitor Traction Control System Trip Computer USB Audio Input(s) Wood Interior Trim XM Satellite Radio AudaVIN options are listed in bold-italic fonts Damages Line Op Guide MC Description MFR.Part No. Price ADJ% B%

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