IN THE MUNICIPAL COURT OF FRANKLIN COUNTY, OHIO Three

IN THE MUNICIPAL COURT OF FRANKLIN COUNTY, OHIO
Three-C Body Shop, Inc.
2300 Briggs Road
Columbus, Ohio 43223
20m NOV 2 6
PH2:l4?
Case No.
Plaintiff,
Judge.
vs.
Caleb P. Brickey
161 Iberia Street
Mount Gilead, Ohio 43338-1260
Defendant.
COMPLAINT
NOW COMES Plaintiff, Three-C Body Shop, Inc. ("Three-C"), by and through its
counsel, and for its Complaint against Defendant, Caleb P. Brickey, hereby states as follows:
PARTIES
1.
Plaintiff Three-C Body Shop, Inc. is a collision repair facility located at 2300
Briggs Road, Columbus, Franklin County, Ohio.
2.
Upon information and belief, Defendant Caleb P. Brickey ("Defendant"), is an
individual residing at 161 Iberia Street, Mount Gilead, Morrow County, Ohio.
JURISDICTION AND VENUE
3.
Jurisdiction is conferred in this Court by Ohio Rev. Code § 1901.017.
4.
Venue is proper under Ohio Civil Rules 3(B) (6).
FACTS COMMON TO ALL CLAIMS
4.
On or about June 3, 2014, Defendant failed to yield to oncoming traffic while
turning and as a result, struck a 2005 Jeep Liberty owned by Andrew Kirk.
5.
The impact caused damages to Andrew Kirk's vehicle requiring repairs to restore
the vehicle to pre-accident condition.
6.
Andrew Kirk took his vehicle to Three-C and signed an agreement authorizing
repairs. See, "Agreement and Repair Authorization" attached hereto as Exhibit A.
7.
An initial estimate of the work was prepared but as work progressed, additional
repairs were required to restore the vehicle to pre-accident condition. The final cost for all
repairs totaled $5,687.83.
See, Supplement of Record 4 with Summary attached hereto as
Exhibit B.
8.
Defendant was insured at the time of the accident and Defendant's insurance
company tendered payment in the amount of $3,585.43 but refused to pay for all necessary
repairs to return Andrew Kirk's vehicle to pre-accident condition.
9.
Paragraph 32 of the Agreement and Repair Authorization assigns the customer's
damage claim for repairs and other services rendered under the agreement to Three-C.
10.
Andrew Kirk further provided Three-C with a Power of Attorney to collect for the
services not paid under the Agreement and Repair Authorization. See Exhibit C attached hereto.
11.
A balance of $2,102.40 remains unpaid for the work performed by Three-C.
NEGLIGENCE
10.
Three-C adopts and incorporates its previous allegations in the Complaint the
same as if fully rewritten herein.
11.
Defendant was operating his motor vehicle on Eakin Road in Franklin County,
Ohio, when he failed to yield to oncoming traffic and struck the 2005 Jeep Liberty owned by
Andrew Kirk.
12.
Defendant owed a duty to avoid damaging property owned by Andrew Kirk.
13.
Defendant breached that duty by failing to yield thereby proximately causing
damages to property owned by Andrew Kirk.
14.
Andrew Kirk assigned his rights to collect for the remaining damages to his
vehicle arising from Defendant's negligence to Three-C by virtue of the Agreement and
Authorization for Repairs and by executing a Power of Attorney.
15.
Three-C suffered damages as a direct and proximate result of Defendant's action
in the amount of $2,102.40 plus costs, expenses, and attorney's fees, pre-judgment and postjudgment interest.
WHEREFORE, Plaintiff Three-C Body Shop, Inc. demands judgment against
Defendant for damages in the amount of $2,102.40 plus costs, interest at the statutory rate,
attorneys' fees and any other relief deemed necessary and/or appropriate by this Court.
Respectfully submitted,
I lO'Wesj Broad Street
^ColumbW, OH 43215
(614) 464-1211
(614) 464-1737 FAX
i [email protected]
Attorneys for Plaintiff,
Three-C Body Shop, Inc.
073d35fl
'31-1313581
Workfile ID:
Federal ID:
Three-C Body Shops, Inc.
"The Rnest In Collision Repair."
2300 Briggs Rd, Columbus, OH 43223
Phone: (614) 274-8245
FAX: (614) 701-9965
Supplement of Record 4 with Summary
RO Number: 16164
Written By: Kevin Bates, 7/31/2014 1:55:22 PM
Adjuster: BOARD, GARY, (614) 561-7526 Business
Insured:
Type of Losg:' -
Collision
Point of Impact:
01 Right Front
Policy #:
1762871305
Claim #:
00855071507-0
Date of Loss:
6/3/2014 12:00:00 PM
Days to Repair:
0
Owner;
Inspection Location:
Insurance Company:
Kirk, Andrew
Three-C Body Shops, Inc.
AMERICAN FAMILY INSURANCE
94 SOUTH ST
2300 Briggs Rd
GROVEPORT, OH 43125
Columbus, OH 43223 .
(614) 565-2430 Ceil
Repair Facility
(614) 567-6307 Cell
(614) 274-8245 Business
VEHICLE
Body Style:
4D UTV
VIN:
D4GL38K35W579013
Mileage In:
Engine:
6-3.7L-FI
License:
PH413IL
Mileage Out:
Year;
2005
Make:
JEEP
Model:
LIBERTY 4X4 RENEGADE
Production Date:
State:
Colon
Champaign Inh
Condition:
Job#:
•
7/31/2014
Vehide Out:
16164
TRANSMISSION
Dual Mirrors
Rear Window Wiper
ROOF
Overdrive
Body Side Moldings
RADIO
Luggage/Roof Rack
6 Speed Transmission
Privacy Glass
AM Radio
SEATS
4 Wheel Drive
Console/Storage
FM Radio
doth Seats
Bucket Seals
.
POWER
CONVENIENCE
Stereo
Power Steering
Air Conditioning
Search/Seek
WHEELS
Power Brakes
Intermittent Wipers
CD Player
Afuminum/Alloy Wheels
Power Windows
Tilt Wheel
SAFETY
PAINT
Power Locks
Cruise Control
Drivers Side Air Bag
dear Coat Paint
Power Mirrors
Rear Defogger
Passenger Air Bag
OTHER
DECOR
Keyless Entry
4 Wheel Disc Brakes
Fog Lamps
'
73
fix a)
Le^
j)cud
l5J.A,a.
&iH
(>ij
cU
SlSl.
"35^ S.
(I N L
*TTo3>~
Exhibit
7/31/2014 1:56:01 PM
003313
Page 1
Supplement of Record 4 with Summary
RO Number: 16164
Vehide: 2005 JEEP LIBERTY 4X4 RENEGADE 40 UTV 6-3.7L-FI Champaign
Uhe
Description
Oper
#
Part Number •
FRONT BUMPER
2
S02
4
SQ3
5
*
S03
Extended
Price $
labor
Paint
<r-
DELETED INT EST TO INPUT INS
EST
S01
3
Qty
R&I
i
0.5
License bracket package
2.4
O/H bumper assy
Repl
Bumper cover all accent
190.00
Ind.
55156758AF
130.00
Ind.
55156887AA
23.45
. 5JG91CD7AD
ILfl
Note: INS HAD WRONG BUMPER FIGURED ON EST
0.3
Add for fog lamps
6
S03
7
S03
Repl
8 .
502
R&I
Air ddlectcr
9
503
Repl
License bracket plate mounting
21
S02
R&I
Grille Renegade
12
S02
Rpr
Grille Renegade
Absorber
•
0.2
GRILLE
10
Ind.
•
13
S02
14
S02
Refh
DEDUCT FOR PARTIAL REFN
15
502
R&I
Insert
1,0
503
Repl
17
#
S03
Repl
18
FRONT LAMPS
1.8
0.7
Add for dear Coat
#-
16
Ind.
•
•0.9
02
52.75
RT FOG GRILLE
PART#55157448AA
Ind.
Note: SELF DESTRUCT ON REMOVAL
LT FOG GRILLE PART
#55157443AA
.1
52.75
Note: SELF DESTRUCT ON REMOVAL
S02
19
20
21
SQ2
Repl
RT Side marker lamp
55156882AB
RT Fog lamp assy w/Renegade
•
55156923AE
AIM FOG LAMPS
1
37.85
Ind.
1
150.00
Ind.
0.3
1
#
S03
S04
R&I
RT Headlamp assy from 10-6-02
*
S04
- Rpr
RT Headlamp assy from 10-6-02
22
23
Repl
0.3
.
Note: OTHER THAN REPLACING
24
*
•
S04
Rpr
S03
Repl
Support panel w/Renegade
•
ID
"
Note: OTHER THAN REPLACEING AND HAVING CUST PAY BETTERMENT
25
RT Park & side lamp
26
RADIATOR SUPPORT
27
*
S03
Rpr
Radiator support
28
*
SIM
Rpr
Front dmember
29
COOLING
55156766AE
1
60.75
Ind.
ZD
ZD.
.
LLC
1.0
Note: OTHER THAN REPLACING
30
*
31
STEERING GEAR & LINKAGE
32
33
34
S03
SG3
R&I
R&I
JLfi
Cooler
1.0 M
P/S cooler
AIR CONDITIONER & HEATER
S03
7/31/2014 1:56:01 PM
R&I
0.6 M
Condenser
003313
Page 2
Supplement of Record 4 with Summary
RO Number: 16164
Vehlde: 2005 JEEP LIBERTY 4X4 RENEGADE 4D UTV 6-3.7L-FI Champaign
Note: FOR ACCESS
35
SQ3
3637
Repl1
m
1.4 M
1
.m
0.4 M
1
25.00 T
M
AC Service evacuate & recharge
1
S03 - -Repl
AC Sevice refrigerant recovery
SQ3
Rep!
Freon & Oil
SQ3
R&l
Cow! grille
S04
Rpr
COWL
38
39
40
FENDER
41
»-
0.8
RT Fender
.
2i5
2.0
Note: USED WAS POOR CONDITION.
42
504
Overlap Major Non-AdJ. Pane!
43
504
Add for dear Coat
-0.2
0.4
44
*
S03
Rep!. FT Wheel flare a!! code (KBE)
45
#
S02
Repl
AM PINSTRIPES TAPE
46
#
502
Rpr
REMOVE PINSTRIPES
47
*
5JR68QMAH
Note: INS HAD WRONG FLAR FIGURED ON EST
48
49
*
50
51
165.00
1
15,00
0.6
•
0.5
0.2
503
Rpr
RT Side rail
S02
Repl
FT Wheel flare rivet
502
Rpr
RT Inner panel reinforcement
504
1
'
6506007AA
S
s
2*0
LZ
s
2J '
0.7
8.50
Overlap Minor Panel
-0.2
ELECTRICAL
52
#
503
R&I
FUSE BOX
0.4 M
53
*
S02
RSI
Cover
QJ
S03
R&I
Mast
0.1
54
55
#
S02
R&I
WIRING
0.4
56
#
503
Rpr
WIRING PROTECTIVE COVERING
as M
57
#
S03
Rep!
RESTORE CORROSION
PROTECTION
.•
4
58
#
S02
Rep!
CAR COVER
1
5.00 -
59
#
1
5.00
1
2.30
•
60
502
Rep!
SEAM SEALER
S03
R&I
Battery
Repl
ROCKER MLDG CUP
-
.
0.6
20.00
•
0.2
m
0.3 M
61
#
502
62
#
503
DENIB AND POLISH
63
#
502
Rpr
SETUP & MEASURE
502
A!gn
PULL REBAR AND APRON
3.0 F
S03
Algn
ADDmOANL FULLTO SQAURE
HOOD APPETURE
4.0 F
503
Rpr
WELD ON TABS FOR
STRAIGHTENING PULLS TO
APRON
1.0
S03
R&I
TRIAL FIT PARTS AND SET GAPS
1.5
S03
R&I
RT/Front R&I wheel
64
65
#
66
67
68
#
'
1
'
- 2.50
.0.6
2.0
.WHEELS
69
m
0,1 M
m
0.5 M
Note: FOR ACCESS
70
71
72
ENGINE
503
R&I
Air deaner assy
WINDSHIELD
7/31/2014 1:56:01 PM
003313
Page 3
Supplement of Record 4 with Summary
RO Number: 16164
Vehlde: 2005 JEEP UBERTY 4X4 RENEGADE 40UTV 6-3.7L-FI Champaign
73
S04
*
74
R8J
Rpr
S04
.
Reservoir
.
0.8
-
Reservoir
1M
Note: NON OE RESERVOIRS LEAK
PILLARS, ROCKER ft FLOOR
75
'76
S02
R&T
RT Step assy
0.2
77
•S02
R&I
LT Step assy
0.2
S02
Rpr
PINCH WELDS AFTER PULL
1.6 '
79
S02
R&I
KT Rocker molding front
80
S02 • R&I
LT Rocker molding front
0.4
81
S02
FBI
RT Rocker molding rear
0.4
82
S02
R&I
LT Rocker molding rear
0.4
83
FRONTDOOR
Bind
RT Outer panel-
S02
R&I
KT Body ddemldgalJ code (Kll)
sn
S02
R&I
RT Mirror power heated w/o
memory
0.3
S02
R&I
RT Run channel
02
S02
R&I. RT Handle, outside w/o lock
cylinder
502
R&I
R&I
#
78
502
84
85
*
86
87 '
*
88
89
.
.
502
#
SQ2
Tint Color
92
#
S03
Hazardous Waste
93
#
S03
Repl
RETAINERS PART#55157069AB
94
#
S03
Rep!
RETAINERS PART#55157070AC
95
#
S03
Repl
96
#
503
Repl
97
#
S03
Rpr
FRONT WHEEL ALIGNMENT
98
#
S03
MASK FOR PRIMER
99
#
S03
MASK HOOD AND DOOR JAMB
100
#
S03
FREE UP TIME FOR RUSTED
BOLTS
#
103
VENT SHADE
0.5
1
10.00 T
28.80
15
100.50
BODY MATERIALS
1
90.00
WASHER FLUID
1
4.00
1
0.8
i
0.6
0.5
1
-
0.4 M
'
S03 . Rep)
1.3 HOURS OVERLAP MATERIAL
ADD BACK@$30 HR.
39.00
"#
S03
.
NirTS,BOLTS,BULBS,OR
FASTWER,VWRE TIES
17.95
104
#
S03
Undercoating
11.89 T
105
#
S04
TOTAL AMOUNT OF SUPP
$1912.23
Rep!
0.2
1.4 M
-
TEST DRIVE FOR SAFETY AND
NOISES
.
*
•S03
0-5
0.2
#
102
0.4
RT R&I trim panel
SO
#
. 0.4
1.2
91
101
1.0
SUBTOTALS
1,248,00
0.3
583
10.6
NOTES
Prior Damage Notes:
LF Door
7/31/2014 1:56:01PM
003313
Page 4
Supplement of Record 4 with Summary
RO Number: 16164
Vehide: 2005 JEEP LIBERTY 4X4 RENEGADE 4D UTV 6-3.7L-FI Champaign
RF Door
RR Door
.
.
,
•
ESTIMATE TOTALS
Basis
Category
Rate
Body Labor
44.3 hrs
Paint Labor
10.6 hrs
Mahanfcaf Labor
@
@
7.0 hrs
Frame Labor
Paint Supplies
$ 50.00 /hr
2,215.00
$ 50,00/hr
530.00
$ 85.00 /hr
595.00
7.0 hrs
@
$ 55.00/hr
3B5.00
10.6 hrs
@
$ 30.00/hr
-318.00
46.89
Miscellaneous
5,291.00
Subtotal
Sales Tax
$ 5,291.00
@ •
7.5000%
396.-83
5,687.83
Grand Total
0.00
CUSTOMER PAY
5,687.83
INSURANCE PAY
7/31/2014 1:56:01 PM
Cost $
1,201.11
Parts
003313
Page 5
Supplement of Record 4 with Summary:
RO Number: 16164
Vehlde: 2005 JEEP LIBERTY 4X4 RENEGADE 4D UTV 6-3.71-F1 Champaign
SUPPLEMENT SUMMARY
Oper
Una
Description
Part Number
Qty
Extended
Price $
Labor
1
-171.25
Ind.
Paint
Deleted Items
22
S02
*
23
502
24
503
Repl
LKQ RT Headlamp assy from
10-6-02 +25%
' 55157140AA
.
-0.5
Aim headlamps
Repl
Support panel w/Renegade
.
S51S6968AE
1
-294.00
-1.3
NOTE: INS HAS CU5T TO PAY 50% OF COST AND LABOR DUE TO PRIOR DAMAGE
27
*
41
S02
Repl
Front Cmember
55360190AN
1
' -245.00 s
-3.5
-1.0
S02
Repl
LKQ RT fender assy+25%
55360598AB
1
-169.99
-0.6
-2.0
42
S02
Overlap Major Non-Adj. Panel
43
S02
Add for dear Coat
S02
.44
48
*
S03
0.2
-0.4
-0.5
Refn edges
Rpr
LT Side rail
.
.
.
s
AS
-JA
NOTE:. WELD ZONE
52
Overlap Minor Panel
S02
74
WINDSHIELD
75
**
S02
Repl
S04
R&I-
RT Headlamp assy from 10-6-02
S04
Rpr
RT Headlamp assy from 10-6-02
0.2
'
A/M Reservoir
-27.00
5I6132QAA-
-0.8
Added Items
22
23
*
0.3
-
2*5
NOTE: OTHER THAN REPLACING
24
S04
Rpr
Support panel w/Renegade
iQ
NOTE: OTHER THAN REPLACEING AND HAVING CUST PAY BETTERMENT
28
S04
Rpr . Front Cmember
NOTE: OTHER THAN REPLACING
41
S04
Rpr
42
S04
Overlap Major Non-AdJ. Panel
43
S04
Add for Clear Coat
50
S04
Overlap Minor Panel
72
WINDSHIELD
73
S04
R&I
S04
Rpr
IA
1.0
i5
2.0
'
RT Fender
NOTE: USED WAS POOR CONDITION.
74
*
-0.2
0.4
-0.2
Reservoir
0.8
Reservoir
1A
NOTE: NON OE RESERVOIRS LEAK
105
#
S04
TOTAL AMOUNT OF SUPP
$1912.23
SUBTOTALS
7/31/2014 1:56:01 PM
003313
-907.24
10.9
-1.5
Page 6
Supplement of Record 4 with Summary
R.0 Number: 16164
Vehide: 2005 JEEP LIBERTY 4X4 RENEGADE 40 UTV 6-3.7L-FI Champaign
TOTALS SUMMARY
Category
Rate
Basts
Parts
Cost $
-907.24
,
Body Labor
•
•
10.9 hrs
PaJnt Labor
-1.5 hrs
Paint Supplies
-1.5 hrs
@
@
$ 50.00 /hr
545.00
$ 50.00 /hr
-75.00
-45.00
$ 30.00 /hr
-482.24
Subtotal
Sate Tax
$ -482.24
-36.17
7.5000%
0.01
Additional Supplement Taxes
Total Supplement Amount
-51&40
-
-518*40
NET COST OF SUPPLEMENT
CUMULATIVE EFFECTS OF SUPPLEMENT(S)
Estimate
7,869.03
Pamela Smoot
Supplement SOI
-7,869.03
Kevin Bate
Supplement S02
3,775.60
Kevin Bate
Supplement S03
2,430.63
Kevin Bate
Supplement S04
-518.40
Kevin Bates
Job Total:
$
5,687.83
INSURANCE PAY:
$
5,687.83
This is a preliminary estimate only,- Additional changes to the estimate may be required for the actual repair.
After the repair worfc has been started, worn, damaged or previously repaired parts that were not evident upon our
first Inspection may be discovered. Naturally, this estimate cannot cover such contingencies and the final repair may
require additional parts and/or labor. Also, the repair may change from this estimate if, in our opinion, a change in
the repair process would benefit the vehicle and the vehide owner.
ALL REPAIRS AND REFINISHING WORK PERFORMED BY THREE-C BODY SHOPS, INC. HAS A LIMITED LIFETIME
WARRANTY FOR AS LONG AS YOU OWN YOUR CAR. PLEASE KEEP THIS DOCUMENT IN A SAFE PLACE AS XT MUST
BE PRESENTED TO RECEIVE WARRANTY SERVICE.
THREE-C BODY SHORS, INC. DOES NOT PROVIDE TRANSPORTATION FOR WARRANTY RELATED ITEMS.
•
Any person who, with intent to defraud or knowing that he is facilitating a fraud against an insurer, submits an
application or fifes a claim containfng a fafse or deceptive statement fs guilty of Insurance fraud.
.
7/31/2014 1:56:01 PM
003313
Page 7
Supplement of Record 4 with Summary
RO Number: 16164
Vetilde: 200S JEEP LIBERTY 4X4 RENEGADE 4D UTV 6-3.7L-FI Champaign
Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from the Guide
DR3WD02, CCC Data Date -7/17/2014, and the parts selected are OEM-parts manufactured by the vehides Original
Equipment Manufacturer. OEM parts are available at OE/Vehide dealerships. OPT OEM (Optional OEM) or AIT OEM
(Alternative OEM) parts are OEM parts that may be provided by or through alternate sources other than the OEM
vehide dealerships. OPT OEM or ALT OEM parts may reflect some spedflc, spedal, or unique pricing or discount.
.
OPT OEM or ALT OEM parts may Include "Blemished" parts provided by OEM's through OEM vehicle"dealershlps.
Asterisk (*) or Double Asterisk (**) indicates that the parts and/or labor Information provided"by MOTOR 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
OEMorA/M. Used parts are described as LKQ, RCY, or USED. Reconditioned parts are described as Record.
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 2015 vehides contain minor changes from the previous year. For those vehides, 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 complete list of applicable vehides. 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=Diagnostlc labor category. E=Elecbical labor category. F=Frame labor category. G=Glass labor category.
M=Mechanica! labor category. S=Structural labor category. * (numbers) 1 through 4=User Defined Labor Categories.
OTHER SYMBOLS AND ABBREVIATIONS: •
Adj.=Adjacent Algn.=Allgn. ALU=Aluminum. A/M=Aftermarket part Blnd=Blend. BOR=Boron steel,
G\PA=Certified Automotive Parts Association. D&R=Disconnect and Reconnect HSS=High Strength Steel.,
HYD=Hydroformed Steel. Ind.=I(iduded. LKQ=LIke Kind and Quality. LT=Left MAG=Magneslum. Non-Adj.=Non
Adjacent. NSF=NSF International Certified Part. 0/H=Overhaul. Qty=Quantity. Refn=Refinish. RepI=Replace.
R8d=Remove and Install. R&R=Remove and Replace. Rpr=Repalr. RT=Right SAS=Sandwiched Steel.
,
SectsSection. Subl=Sublet. UHS=Ultra High Strength Steel. N=Note(s) assodated with the estimate line.
CCC ONE Estimating - A product of CCC Information 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=PalntIess Dent Repair. VIN=Vehide Identification Number.
7/31/2014 1:56:01 PM
003313
Page8
Three-C Rep
This Agreement and
Al Kender
Andrew Kirk
Repair Authorization
("Agreement") is
entered into between
Three-C Body Shops,
inc. {"Three-C") and
("Customer")
for the repair of a
2005
Make
Jeep
Model
Submodel
Color
VIN
Liberty
4x4 Renegade
Champaigne
1J4GL38K35W579013
Phone Number
(614) 565-2430
Email Address
ANDREWKIRK4@AOL,COM
Address
94 SOUTH ST
GROVEPORT, OH 43125
Current Date & Time
Jun 09, 2014 06:00 PM
Insurer Involvement
AK
AGREEMENT AND REPAIR AUTHORIZATION
This Agreement and Repair Authorization ("Agreement") is entered into between
Three-C Body Shops, Inc. ("Three-C") and "Customer") for the repair of a the listed
vehicle on the date and time of this contract
Three-C agrees to repair Customer's Vehicle and Customer agrees to hire ThreeExhibit
C to repair Customer's Vehicle upon the foilowing terms and conditions. The
charges in this Agreement apply to both a repaired Vehicle and when Customer
declares the Vehicle to be a total loss or sells the Vehicle to any third party in lieu
of obtaining a full repair.
In consideration of the mutual promises herein, and other valuable consideration,
the parties agree as follows:
1. Authorization to Repair. Customer requests and authorizes Three-C to make all
repairs that Three-C, in its sole discretion, believes are necessary or proper to
make Customer's Vehicle safe and roadworthy. Customer expressly represents to
Three-C that Customer has the lawful right to authorize repairs to be made to the
Vehicle, whether by right of ownership, leasehold interest, or direct authorization
from the owner of the Vehicle. Customer also acknowledges that any data,
documentation and information pertaining to the damage analysis or repair belong
to Three-C and that Three-C may use that data, documentation and information in
any way Three-C chooses, including but not limited to disclosing it to third parties.
Customer authorizes Three-C to continue working on and making repairs to
Customer's Vehicle until such time as Three-C, in its sole discretion, believes that
all repairs have been completed, or Customer executes an Acknowledgment
Terminating Repair Contract and Releasing Motor Vehicle.
2. Completion. The estimated completion dates are approximate, not binding upon
Three-C, and may be exceeded because of a variety of reasons, including but not
limited to unforeseen circumstances.
3. Estimate. Before performing any repair work on Customer's Vehicle, Three-C
shall provide to Customer, upon Customer's request, an estimate. Three-C shall
make every reasonable effort to perform all repair work pursuant to the items and
limitations of any such estimate. However, Customer authorizes Three-C to repair
or replace any parts on the Vehicle which Three-C determines, in its sole
professional judgment, are necessary or proper to repair Customer's Vehicle.
Customer grants Three-C, in its sole discretion, the sole and exclusive right to
determine whether parts should be repaired or replaced, regardless of any
insurance company's directive or preference. Customer expressly grants Three-C
the right to repair or replace such parts as it determines, in its sole discretion, to be
necessary or proper and adjust the cost accordingly. The parties agree that the
actual repair or replacement cost shall not exceed the estimated repair costs by
more than ten percent (10%), unless Three-C receives prior approval from
Customer or an agent from the responsible insurance company. Customer agrees
that the prices for all parts are estimated and subject to change upon receipt of the
invoice. Customer acknowledges that Three-C's average estimated cost for ThreeC's labor, charges, costs, fees, and expenses for totaled vehicles averages
approximately $1,750.00, and Three-C's average estimated cost for Three-C's
labor, charges, costs, fees, and expenses for repairable vehicles is $3,000.00.
Customer acknowledges that these average estimates do not include rental fees,
towing charges, storage costs, taxes, extraordinary costs, fees, and expenses,
extraordinary labor charges, or other costs, fees, or expenses not related to ThreeC's average labor, charges, costs, fees, and expenses. Customer further
acknowledges that the final balance due regarding Customer's Vehicle may be
greater than or less than the average amounts identified above. Customer agrees
and accepts that the amounts discussed above and as otherwise identified in this
Agreement serve as an estimate to Customer, in addition to an Agreement and
Repair Authorization.
4. Authorization to Operate and Release. Customer-authorizes Three-C to move,
test drive, and otherwise operate the Vehicle on all public and private streets,
roads, highways, and other thoroughfares for the purpose of transporting, moving,
testing, or inspecting the Vehicle as Three-C, in its sole discretion, deems
necessary or proper. Customer forever waives, discharges, and releases Three-C
from all liability and damages caused to the Vehicle as a result of, or caused by or
during, the operation.
5. Independent Third-Parties. Three-C may in its sole discretion retain and utilize
independent third-parties to perform repairs and services to the Vehicle. Customer
authorizes Three-C to transport, drive, move, tow, and/or send the Vehicle to
another location for the independent third-party to repair, examine, test, or
otherwise work on the Vehicle. Customer forever waives, discharges, and releases
Three-C from all liability and damages caused to the Vehicle as a result of, or
caused by or during, any independent third-party's actions, inactions, omissions,
negligence, or intentional acts.
6. Limitation of Liability. Customer agrees that Three-C will not be held liable for
any loss, damages, or destruction caused to the Vehicle by fire, theft, acts of God,
unlawful conduct by third parties, and/or anything not within Three-C's full control,
and any cost or expense resulting therefrom. Customer further agrees that ThreeC is not responsible for dead batteries, window tint, squeaks, rattles, buff-throughs,
car phones, alarms, custom electronics, or any personal property. Customer
forever waives, discharges, acquits, releases and agrees to indemnify Three-C
from, against, and for any and all liability regarding the aforementioned, and any
and all losses, damages, costs, fees, including but not limited to attorney's fees
and expert witness fees, charges, and expenses associated therewith.
7. Storage. If Three-C notifies Customer that the Vehicle is ready for pick-up and
Customer does not pick-up the Vehicle within three (3) calendar days from ThreeC's notification, Customer agrees to be charged a storage charge of $30.00 per
day for the first thirty (30) calendar days, and $125.00 per day for every calendar
day thereafter, beginning with tie fourth (4th) calendar day after the Three-C
notified Customer that the Vehicle was ready for pick-up and continuing each day
until the final balance due is paid in full and the Vehicle is physically removed from
Three-C's property. Further, if at any point the responsible insurance company
deems the Vehicle a total loss, Customer will be charged a storage charge of
$30.00 per day for the first thirty (30) calendar days, and $125.00 per calendar day
for each day thereafter, beginning with the date the Vehicle was delivered to
Three-C until the date that the final balance due is paid in full and the Vehicle is
physically removed from Three-C's property. Customer agrees to be responsible
for all of the aforementioned charges at all times. Further, Customer authorizes
Three-C to hold Customer's Vehicle until such time as Customer pays all of ThreeC's charges, costs, fees, and expenses that are due under this Agreement.
Customer authorizes Three-C to add all storage charges, costs, and fees to
Customer's final balance due. Further, Customer authorizes Three-C to store the
Vehicle at any location Three-C chooses, in its sole discretion, regardless of where
the location is located and whether Three-C or a third party owns the location.
Customer further authorizes Three-C to tow or otherwise transport the Vehicle to
and from any location where Three-C chooses to store the Vehicle. Customer
forever releases and waives any and all claims Customer has or may have, if any,
against Three-C for towing or transporting the Vehicle to and from storage
locations.
8. Hazardous Waste Charge. Customer agrees to be charged a minimum
hazardous waste charge of $10.00 as a standard fee to compensate Three-C for
the expense of complying with the laws governing the disposal of hazardous waste
material. If Three-C, in its sole discretion, believes that Customer's Vehicle has
leaked excessive amounts of fluids during the repair process or Three-C's storage
of the Vehicle, Customer agrees to pay a maximum hazardous waste charge of
$50.00 to Three-C.
9. Cover. Customer agrees to pay $10.00 per occasion for Three-C's use of a car
cover to protect Customer's Vehicle from paint overspray, dust, and other matters
while the Vehicle is in Three-C's shop areas. Customer authorizes Three-C to
utilize a car cover on as many occasions as Three-C, in its sole discretion, deems
necessary or proper.
10. Administrative Fee. If the responsible insurance company ever deems the
Vehicle a total loss, or Customer sells the Vehicle to any third party in lieu of
obtaining a full repair, Customer will pay Three-C an administrative fee of between
$25.00 and $400.00 for various administrative functions performed by Three-C, in
addition to the other charges, costs, fees, and other charges discussed in this
Agreement. Three-C will provide Customer v/ith a list of such functions and its
associated cost upon Customer's request.
11. Towing. Customer will pay for all towing charges, including towing charges by
Three-C and/or any other vendor. Any unpaid towing charges will be added to
Customer's invoice(s) or final balance ov/ed. In addition, if the Vehicle was towed
by Three-C and/or any other vendor at Customer's request and Three-C is
required by the towing company to pay the towing charges and fees in order to
obtain possession of the Vehicle, Customer will reimburse Three-C for those
towing charges. Further, Customer agrees that if the Vehicle is disabled and/or
Three-C believes towing the Vehicle in connection with its repair or storage is
necessary or proper, Customer will pay Three-C for said towing charges and fees.
For each towing charge, Customer will pay Three-C a mark-up fee of between
10% and 30% beyond each actual towing charge, regardless of whether the towing
company is the Three-C or another vendor. Customer grants Three-C the right to
determine the mark-up fee.
12. Disassembly/Reassembly. If the Vehicle is disassembled at any time by ThreeC to determine the extent of the damage, the cost of repairs, or for any other
purpose associated with repairing Customer's Vehicle and Three-C does not
complete all related repairs that Three-C, in its sole discretion, deems necessary
or proper, Customer will pay a disassembly and reassembly fee in accordance with
the Three-C's standard hourly rates that apply when such work took place. ThreeC will provide Customer with a list of such rates upon Customer's request. Further,
Customer acknowledges that reassembly may not be possible once the Vehicle
has been disassembled. Customer releases and waives any claims Customer may
have against Three-C for not reassembling the Vehicle.
13. Insurance Company Payment Checks. Customer acknowledges that: (a) If
Customer is issued a check or draft from an insurance company for payment of the
costs of Three-C's repairs or any other cost, fee, charge or expense discussed in
this Agreement, and the check or draft requires a bank or lending institution's
endorsement, Three-C shall have possession of the check or draft for a minimum
of forty-eight (48) hours before submitting the check or draft to the endorsing
institution; (b) Three-C will not present checks or drafts, nor wiil a representative of
Three-C accompany Customer to the endorsing institution to have the check or
draft endorsed; (c) If the endorsing institution is located outside of Columbus, Ohio
or a contiguous city, Customer must personally make arrangements with the
endorsing institution to have the check or draft properly endorsed; (d) Payment
must be made to Three-C at the time Customer receives delivery of the Vehicle.
THREE-C DOES NOT ACCEPT PERSONAL CHECKS, BUT DOES ACCEPT
BANK CERTIFIED CHECKS AND MONEY ORDERS, OR MASTERCARD, VISA,
AND DISCOVER CREDIT CARD PAYMENTS UP TO $1,000.00. IN ADDITION
TO THE PAYMENT AMOUNT, CUSTOMER AGREES TO PAY THREE-C A
CONVENIENCE FEE OF 3.00% OF THE AMOUNT OF THE PAYMENT MADE IF
CUSTOMER'S CREDIT CARD PAYMENT EXCEEDS $1,000.00.
14. Durable Limited Power of Attorney. Customer grants Three-C a Durable
Limited Power of Attorney and appoints Three-C as Customer's lawful attorney-infact for Customer, and in Customer's name, place, and stead, for the following
specific and limited purposes only: to institute, prosecute, file suit, hire legal
representation, defend, negotiate, compromise, settle, appeal, or terminate any
administrative proceedings, civil claims, litigation, or other proceedings, for or
against Customer with regard to any and all claims Customer has or may have in
the future against all responsible insurance company(ies), and/or any of its
subsidiaries, related companies, and/or agents regarding any monies Three-C is
owed relating to the goods and services described in this Agreement; and to
endorse all checks or drafts in Customer's name which are received in payment of
the goods and services provided to Customer under this Agreement for the
duration of the claim(s). Customer hereby waives, releases, and discharges ThreeC from any and all claims, losses, and/or causes of action with Customer, or
anyone claiming by or through Customer, regarding this Durable Limited Power of
Attorney, or any actions or omissions hereunder. This Durable Limited Power of
Attorney shall not be affected by Customer's disability or the lapse of time.
Customer agrees to reimburse and indemnify Three-C for any costs, fees,
including but not limited to attorney's fees, and expenses Three-C incurs in
exercising the powers granted herein. No bond shall be required of the Three-C at
any time. Customer agrees to indemnify any injured person or entity who acts in
good faith and in reliance upon this durable limited power of attorney.
15. Lien. Customer grants to Three-C a valid, enforceable lien in the Vehicle,
which shall be valued at all total amount(s) owed by Customer to Three-C.
Customer acknowledges that the total amount(s) owed include, but are not limited
to any and all costs, fees, including reasonable attorney's fees, charges,
expenses, rental car fees, labor charges, towing charges, storage charges, and all
other charges, costs, fees and expenses identified in this Agreement. Customer
agrees that Three-C's lien shall only be released upon Customer's payment of the
final balance owed to Three-C. Customer agrees that the lien granted herein
entitles Three-C to sole possessory rights and interest in the Vehicle until said lien
is released as described above. Customer further agrees that said lien shall be
superior to any other lien attached to or associated with the Vehicle, as well as any
other rights of assignment and/or possessory rights and interests in the Vehicle.
16. Rental Charges. Customer is solely responsible for all rental car charges,
costs, fees, and expenses. Three-C will not be responsible for Vehicle rental costs,
or any other costs, fees, or expenses incurred by Customer. Customer releases
Three-C from any such costs, fees, and expenses. Customer agrees to pay all
charges, costs, fees, and expenses associated with Customer's rental car before
requiring Three-C to release the Vehicle to Customer or any third party. Customer
further authorizes Three-C to retain the Vehicle in Three-C's possession until such
time as the rental car charges, costs, fees, and expenses are paid in full. Customer
further authorizes Three-C to add any rental car charges, costs, fees and
expenses due to Customer's invoice(s) or final balance due.
17. Payment. Customer agrees to pay Three-C for all actions undertaken on
Customer's behalf, including the cost of parts, labor, taxes, fees, services,
diagnostic testing, administrative charges, hazardous waste charges, restocking
fees, rental car fees, and all other charges that may involve costs for towing,
parking, and/or storage. Three-C will provide Customer with an invoice or request
for payment reflecting charges for activities relating to Customer's Vehicle, any
proceeds or payments received, and any outstanding balance which must be paid
by Customer prior to the release of the Vehicle. Customer acknowledges that all
invoice(s) and requests for payment are due and owing immediately upon receipt.
If payment in full is not made upon Three-C's request, Three-C may charge
interest to Customer or Customer's account at the maximum rate allowed by law.
In addition, Customer agrees to reimburse Three-C for all of its charges, costs,
fees, and expenses associated with Three-C collecting any amounts due under
this Agreement, including, but not limited to, all of Three-C's attorney's fees, thirdparty fees, court costs, expert witness costs, other fees, and expenses, travel fees,
Three-C's hourly rate for additional lime spent collecting, and all other charges,
costs, fees, and expenses incurred by Three-C. Customer authorizes Three-C to
accept and apply any and all payments received by Three-C, whether paid by the
Customer or any third-party or insurance company, that are less than Customer's
invoice(s) or final balance due. Customer agrees that any payments so applied
shall not be considered or construed as a compromise or settlement of Customer's
invoice(s) or final balance due, but rather a partial payment toward the invoice(s)
or final balance due.
18. Repair Process.
A. Damage Analysis. Customer will pay for repairs to the Vehicle specified by
Three-C's analysis of damage, expected repair cost, and repair plan ("Damage
Analysis). Customer agrees that Three-C has provided Customer with a copy of
the Damage Analysis (if Customer requested the same), which is incorporated
herein by reference, and the same may have been discussed with and approved
by Customer prior to the performance of the repairs. Customer acknowledges that
any estimate prepared by or for an insurance company is solely for the insurer's
internal cost-estimating purposes and has no impact on decisions Three-C will
make to properly and safely repair Customer's Vehicle.
B. Additional Damage. Additional damage may be discovered and the need for
additional repairs not included on the Damage Analysis may become necessary
during the course of repair. In that event, Three-C will promptly notify Customer of
the additional repairs necessary to be made to the Vehicle and the expected cost.
Three-C may provide a supplemental Damage Analysis or may incorporate the
additional repairs into a revised version of the original Damage Analysis if
Customer formaiiy requests the same.
.
19. Insurer Involvement. Three-C is the sole professional determiner of the
necessary and proper method for repairing Customer's Vehicle. Customer is the
only person/entity with whom Three-C has any obligation to communicate and has
the right to make decisions concerning the Vehicle's repair. Customer
acknowledges that Three-C has no obligation to communicate with any insurer and
that Three-C does not accept any insurer's estimate as the cost of repair or
method of repair. Three-C may elect to interface with an insurer to streamline the
payment process for Customer, but Customer agrees any interface is solely
performed as a courtesy to Customer and understands Three-C is not acting as an
agent of Customer.
(Customer initial) I understand that Three-C, in the exercise of professional
judgment, v/ill repair my Vehicle safely and properly, which may involve using
better parts or safer repair techniques than those for which my insurer or a
responsible third party may reimburse me. My insurer or a responsible third party
might deny payment for repairs that Three-C deems necessary or proper in the
exercise of professional judgment. I understand and agree that i will be financially
responsible for all repair services provided to me, which may include charges for
labor, parts, car rental, towing, parking, and storage, as they are listed on the
invoice(s) and/or final balance due, even if payment is denied by my insurer or a
responsible third party, i UNDERSTAND THAT 1 AM FINANCIALLY
RESPONSIBLE FOR ALL CHARGES, COSTS, FEES, AND EXPENSES
DISCUSSED IN THIS AGREEMENT.
20. Possession and Replevin. Three-C shall have a lien against the Vehicle for any
and all amounts identified in this Agreement until those amounts are paid in full.
Customer agrees that Three-C shall have the right to retain the Vehicle until ThreeC is paid in full. Customer releases and waives all replevin claims against Three-C
regarding the Vehicle until Customer pays the final balance owed to Three-C.
Further, Customer warrants that Customer will not pursue any replevin action
against the Three-C until Customer has paid the entire final balance due.
Customer agrees to consent to any motion or request to dismiss any such action
based on Customer's warrant, release and waiver herein.
21. Right to Expectancy Damages. By undertaking this Agreement to repair the
Vehicle, Three-C will have lost the opportunity to accept other repair contracts and
perform other repairs by designating personnel and dedicating resources to the
preparation for and engagement of the repair of the Vehicle. In the event Customer
breaches this Agreement, even if persuaded to breach by a third party privileged to
interfere with a contract between Customer and Three-C, Three-C shall be entitled
to the full measure of all of the cost of repairs, labor, parts, fees, taxes, services,
and charges, including charges for towing, parking and/or storage, expected to be
paid in the performance of this Agreement, together with interest accruing at the
maximum statutory rate authorized by state law from the date of the breach.
22. Parts. Three-C prefers to utilize new original equipment manufactured ("OEM")
parts when performing repairs. IfThree-C determines that the use of other than
new OEM parts will not affect the safety or performance of the Vehicle and
Customer elects to utilize other parts, Customer acknowledges that use of such
parts may decrease the value of the Vehicle, may place Customer In violation of a
Vehicle lease or finance contract, and may impact the Vehicle's manufacturer's
warranties. Customer authorizes Three-C to discard all old parts unless Customer
instructs Three-C otherwise in writing below. Customer would like the following
parts returned to Customer (Customer acknowledges that if Customer does not fill
in the line below, it is Customer's request that Three-C dispose of all parts
removed from Customer's Vehicle):
Customer will be responsible for the disposal of the following parts (Customer
acknowledges that if Customer does not fill in the line below, it is Customer's
request that Three-C dispose of ail parts removed from Customer's Vehicle):
Further, in the event the responsible insurer does not pay Three-C in full for the
entire balance(s) due upon receipt of Three-C's invoice(s) or request for pay.
Customer authorizes Three-C to remove and keep as its own property all parts
installed on the Vehicle.
23. Workmanship Warranty. Customer acknowledges that only upon payment of
the entire balance due of Three-C's invoice(s), Three-C warrants to Customer that
the workmanship of the repairs to the Vehicle will be free of defects for as long as
the customer owns the vehicle from the date Vehicle is released to Customer. At
no charge to Customer, Three-C will correct any defects in workmanship within
that timeframe. For Three-C to remedy any workmanship defect, Customer must
notify Three-C in writing and provide Three-C with a reasonable opportunity to cure
the defect. This warranty applies to workmanship only. Further, Customer agrees
that Three-C is the only Three-C that may make repairs under the warranty
provisions herein. This warranty shall become null and void if Customer or any
third-party authorizes any other Three-C, entity, or individual to make repairs, or
attempt to make repairs, to the alleged defects.
24. Binding Effect. This agreement shall be binding upon the parties, their heirs,
estates, agents, representatives, transferees, successors, insurers, third-parties,
and assigns, including a new or different owner and/or change in title ownership of
the Vehicle.
25. Entire Agreement / Amendments. This Agreement constitutes the entire terms
of the parties' agreement. This Agreement cannot be amended, modified, or
altered orally and may only be amended, modified, or altered in writing by a
document signed by both parties.
26. Severability. The provisions of this Agreement are severable. If one or more of
its provisions are determined to be illegal, invalid, or unenforceable, in whole or in
part, then the remaining provisions, and any partially enforceable provision to the
extent it is enforceable, shall nevertheless be binding and enforceable upon the
parties.
•
27. Waiver. The failure by one party to require performance of any provision herein
shall not affect that party's right to require performance at any time thereafter, nor
shall a waiver of any breach or default of this Agreement constitute a waiver of any
subsequent breach or default or a waiver of the provision itself. The rights granted
to the partes herein are cumulative and the waiver by a party of any single remedy
shall not constitute a waiver of such party's right to assert all other legal remedies
available to it under the circumstances.
28. Governing Law / Forum. This Agreement shall be governed by and interpreted
in accordance with the laws of the State of Ohio without reference to conflicts of
law. Any litigation arising under this Agreement or relating to its subject matter
shall be commenced and resolved in a court of competent jurisdiction in Franklin
County, Ohio.
29. Captions. The various captions and section headings contained in this
Agreement are inserted only as a matter of convenience and in no way define,
limit, or extend the scope or intent of any of the provisions of this Agreement
30. Copy. A copy of this signed Agreement shall carry the same weight, power,
and authority and shall have the same binding effect as the original signed
Agreement.
31. Effective Date. This Agreement shall become effective upon Customer signing
this Agreement and providing it to Three-C.
32. Assignment. Customer hereby assigns and transfers to Three-C all property
loss claims, good faith claims, and all benefits and proceeds resulting therefrom as
an insured party under Customer's automobile insurance policy with Customer's
insurance company, or as a third-party claimant under the automobile insurance
policy of the at-fault party, whichever may be the case. Customer's assignment
includes, but is not limited to, all property loss rights, benefits, and claims held by
Customer, together with any accrued or due interest that has or will have accrued
on such claims. Customer grants to Three-C the authority to collect such claims, to
receive payment, to maintain actions and causes of action, and to do all things in
relation to such claims that Customer could have done had this assignment not
been granted. Customer asserts that all insurance premiums are current and, if
applicable, all payments on the Vehicle are current. Customer grants Three-C the
right and authority to settle or compromise on terms that are acceptable to Three-C
and apply the proceeds received to Customer's balance owed. Customer agrees
that Three-C may accept any amount from any person or entity owing under this
Agreement and may enforce the payment of proceeds, prosecute any action
and/or cause of action, and defend any legal claim or proceeding with respect to
any and all proceeds, and enforce all other rights of Customer with respect to
securing payment of the proceeds. This assignment applies to all payments,
including but not limited to all initial fees, supplemental fees, charges, costs, and
expenses related to the loss. Customer grants Three-C the right to notify any
person or entity of this authority and the rights and benefits received hereunder. I
UNDERSTAND THAT I AM ASSIGNING MY RIGHT TO INDEMNIFICATION FOR
ALL COSTS RELATED TO PROPERTY LOSS TO THREE-C. Customer warrants
to Three-C that Customer has the legal right, capacity and ability to make the
assignment(s) herein discussed.
33. Estoppel. Customer is estopped from assigning, delegating, and/or transferring
any right, title and/or interest in the Vehicle, or any part thereof, to any person or
entity other than Three-C until Three-C's final balance due is paid in full and the
Three-C acknowledges the same. If Customer transfers any right, title and/or
interest in the Vehicle, in whole or in part, to any person or entity other than ThreeC before Three-C's final balance due is paid In fulf and Three-C acknowledges the
same, then Customer agrees that Customer has breached this Agreement and
hereby expressly declares such assignment, delegation, and/or transfer to be null
and void and hereby consents to any court of competent jurisdiction entering
judgment in favor of the Three-C and declaring such assignment, delegation,
and/or transfer to be null and void immediately upon motion or request by Three-C.
Further, Customer agrees to indemnify and be liable to Three-C for any and all
costs, including but not limited to court costs, fees, including but not limited to
attorney's fees, and expenses incurred by Three-C to enforce the provisions herein
and/or obtain such declaration or judgment.
34. Event of Default. The occurrence of any one or more of the following events
shall constitute an event of default hereunder: (a) Customer's failure to
immediately tender full payment of Three-C's invoice(s) and/or final balance due
upon receipt of Three-C's invoice(s) or request of the final balance due; (b) If under
the United States Bankruptcy Code or any other federal or state law relating to
insolvency or relief of debts, Customer (i) commences a voluntary case or
proceeding, (ii) consents to the entry of an order for relief against it in an
involuntary case, (iii) consents to the appointment of a trustee, receiver, assignee,
liquidator, or similar official, (iv) makes an assignment for the benefit of its
creditors, or (v) admits in writing its inability to pay its debts as they become due;
(c) Customer transfers any right, title, or interest in, or any claims relating to, the
Vehicle to any person or entity other than Three-C without Three-C's prior express
written consent; (d) Customer executes an Acknowledgment Terminating
Agreement and Repair Authorization and Releasing Motor Vehic!e;.or (e)
Customer breaches of any term of this Agreement or any obligation specified
herein.
35. Remedies. Upon the occurrence of any event of default, Three-C may declare
any or all of Customer's indebtedness hereunder to be immediately due and
payable. In addition, the defaulting Customer shall be liable to Three-C for all
amounts due and ov/ing under this Agreement, plus pre-judgment and postjudgment interest thereon, plus reimbursement of all costs, including but not limited
to court costs, expenses, fees, including reasonable attorney's fees, expert witness
fees, and other fees, and other charges incurred as a result of the default and any
collection and/or enforcement efforts relating to this Agreement or any matter
hereto, plus any and all other rights and remedies granted to Three-C in this
Agreement, and any other remedies available to Three-C under law or equity or
granted to it by any court of competent jurisdiction. Customer further agrees to
reimburse and indemnify Three-C for any and all costs, including but not limited to
court costs, expenses, and fees, including but not limited to filing fees, attorney
fees, expert witness fees, and other fees that Three-C incurs relating to any action
that any insurer brings against Three-C relating to the Vehicle or Customer.
36. Counsel. Customer acknowledges Customer's right to consult with and be
advised by legal counsel before executing this Agreement. After making such
acknowledgment, Customer voluntarily waives Customer's right to consult with and
be advised by legal counsel regarding the matters herein.
37. Communication. Customer authorizes Three-C to communicate, receive,
disclose, and freely share with any third-parties, including but not limited to
responsible insurance company(ies), expert witnesses, legal counsel, tax
professionals, and other individuals or entities, any and all information Three-C
desires to communicate, receive, disclose, and freely share with such individuals
or entities regarding Customer's Vehicle, estimate(s), balance(s) due, and any
other matters discussed in this Agreement. Upon Three-C's request, Customer will
contact Three-C and notify it of the date, time, and substance of all communication
any insurance company has with Customer regarding the Vehicle and will
immediately provide Three-C with a copy of any and all communication,
documents, instruments, and things any insurance company provides Customer
with respect to the Vehicle. Customer will sign any and all waivers, releases,
documents, and things and perform any act necessary for any insurance company
to release to Three-C any and all files, policies, recordings, interviews,
communications, information, materials, letters, notes, documents, records and
things requested by Three-C upon Three-C's request regarding the Vehicle, any
collision, any insurance policy relating thereto, and/or the Customer. Customer
waives any privileges that may have otherwise previously protected the same.
38. Prep-Pack. If the insurer desires the Vehicles parts, Customer agrees to pay
Three-C a prep-pack fee of $50.00.
39. Non-Returnable Parts. Customer acknowledges that some parts may be nonreturnable. Customer agrees to pay the full price of all parts that are designated by
Three-C as non-returnable parts.
40. Miscellaneous. Customer warrants to Three-C that Customer has the full legal
capacity, right, and ability to enter into this Agreement and make the promises
herein; that Customer is not subject to any undue influence or duress upon
entering this Agreement; that Customer has read this entire Agreement,
understands its terms, and voluntarily enters into the same as Customer's own free
act and deed; that Customer did not rely upon any promise, statement,
advertisement, warrant, guarantee, or anything else not contained in this
Agreement to entice or persuade Customer into entering this Agreement; and that
Customer agrees to be bound by the terms of this Agreement, regardless of any
action or inaction by any insurance company or third-party. Customer agrees that
although the Three-C prepared this Agreement, this Agreement should be
interpreted fairly and not for or against either party. Accordingly, Customer agrees
that the rule of ambiguities being determined against the drafter shall not be
applied to any term in this Agreement.
I UNDERSTAND THAT THE VEHICLE WILL NOT BE RELEASED UNTIL THREEC HAS RECEIVED PAYMENT IN FULL OF THE TOTAL BALANCE DUE THE
THREE-C. BY MY SIGNATURE, I STATE UNEQUIVOCALLY THAT I HAVE
THOROUGHLY READ THIS AGREEMENT AND ALL OF THE INFORMATION
PROVIDED HEREIN AND FULLY UNDERSTAND AND AGREE TO THE TERMS
AND CONDITIONS SET FORTH HEREIN AND AM AWARE OF MY RIGHTS AND
OBLIGATIONS.
(CUSTOMER'S INITIALS)
YOU HAVE THE RIGHT TO HAVE AN ESTIMATE OF THE COST OF REPAIRS
OR SERVICE YOU ARE REQUESTING. YOUR BILL WILL NOT BE HIGHER
THAN THE ESTIMATE BY MORE THAN TEN PERCENT (10%) UNLESS YOU
APPROVE A LARGER AMOUNT BEFORE THE REPAIRS ARE FINISHED. IF
ADDITIONS MUST BE MADE TO AN ESTIMATE, PLEASE SELECT HOW YOU
WISH TO BE NOTIFIED FOR YOUR APPROVAL BY PLACING YOUR INTIALS
ON ONE OF THE BLANKS PROVIDED BELOW:
Written
Verbal
None
Customer Signature Date
State of Ohio}
County of
} ss:
Before me, a Notary Public in and for said state, personally appeared
who acknowledged that he / she did sign the
foregoing instrument and that the same is his / her free act and deed, on this
day of
, 20
Notary Public
Vehicle Release
Verba! Estimate
AK
^^
Requested
Authorization for
Repairs
(3 KB)
f
(6 KB)
.
STATE OF OHIO
POWER OF ATTORNEY
I, Andrew Kirk ("Principal"), appoint Three-C Body Shop, Inc. located at 2300 Briggs Road,
Columbus, Ohio 43223 as the Company Agent ("Agent") to act in any lawful way with respect
to the following subject:
To commence, prosecute, discontinue, or defend all actions or other legal proceedings related
to the damage to my 2005 Jeep Liberty 4X4 Renegade, YIN # 1J4GL38K35W570913 by
Caleb Brickley on or about June 3, 2014 ("Loss"). To defend, settle, adjust, make allowances,
compound, submit to arbitration, and compromise all accounts, reckonings, claims, and demands
whatsoever that are not, or hereafter shall be, pending between me and Caleb Brickley/Allstate
Insurance Co., related to the Loss, in such manner and all respects as my Attorney-in-Fact deems
proper pursuant to Ohio Revised Code 1337.53.
Choice of Law. THIS POWER OF ATTORNEY WILL BE GOVERNED BY THE LAWS OF
THE STATE OF OHIO WITHOTU REGARD FOR CONFLICTS OF LAWS PRINCIPLES.
IT IS INTENDED TO BE VALID IN ALL JURISDICTIONS OF THE UNITED STATES OF
AMERICA.
This power of attorney is effective immediately unless I have stated otherwise in the Special
Instructions.
I am fully informed as to all the contents of this form and understand the full import of this grant
of powers to my Agent.
Any person, including my agent, may rely upon the validity of this power of attorney or a copy
of it unless that person knows it has been terminated or is invalid.
Signed this
day of October, 2014.
Exhibit
Andrew Kirk
94 South Street
Groveport, Ohio 43125
STATE OF OHIO
COUNTY OF FRANKLIN
This document was acknowledged before me on fyAilL
[Notary Seal, if any]:
Notary Public
My
' '
Juana lleana Ruiz
Notary Public. State of Ohio
My Commission Expires 12/18/2010
2014 by Andrew Kirk.