Owner	Thomas Coates
Phone	757-374-3539
Email	tdcoates@gmail.com
Inspection	Supplement / Full Repair Review

Owner, Vehicle, Claim, and Inspection Intake

Owner Name	Address	Preferred Contact	Vehicle Year / Make / Model	VIN	Mileage / Plate / State
Thomas Coates	Virginia Beach, Virginia	Email and phone	2013 Audi Q7 S Line Prestige Quattro	WA1DGAFE3DD000122	106,691 miles SZJ 6407 / VA
Exterior Color	Interior	Engine	Transmission	Drivetrain	Point of Impact
Gray		3.0L Supercharged Gasoline Direct Injection	Automatic with overdrive	4-wheel drive	11 - Left Front

Narrative of Loss and Inspection Context

Owner Narrative of Loss	Inspection Notes / Limitation Notes
Provide a full description of what happened, direction of travel, speeds, road conditions, and how the impact occurred. Include any secondary impacts, movement after impact, and any contact with another vehicle, fixed object, road debris, or barrier.	Initial insurance inspection was conducted without full vehicle access. Vehicle interior, drivability, underside, and all hidden conditions may not have been fully examined. This estimate form is designed to support a more complete repair review and supplement process.

Photo Documentation - Paste Images Directly into the Boxes

Front Overall

Click inside this box and paste a picture. The frame will expand automatically as images are added.

Left Front Close-Up

Use for bumper, fender, headlamp, grille, hood, and support damage photographs.

ESTIMATE GRID

Mitchell / CCC Style Estimate Grid - Main Damage Line Items

Ln	Area	Operation	Part Description	OEM Part No.	Repair	Replace	Qty	Unit $	Labor $	Total
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Use the Repair and Replace columns as a shop-style estimate toggle. Totals calculate from Qty × Unit Price + Labor.

Damage Description and Hidden Damage Concerns

Primary Visible Damage
Describe all visible left-front damage, including bumper cover, lamps, grille, fender, hood, and any wheel, tire, or alignment concern.

Secondary / Hidden Damage Concerns
Note possible impact to suspension, steering, subframe, radiator support, sensors, wiring, ADAS functions, underbody shields, cooling components, and drivability-related conditions.

ADDITIONAL ITEMS

Secondary Estimate Grid - Refinish, Calibration, Alignment, and Supplement Items

Ln	Area	Operation	Part Description	OEM Part No.	Repair	Replace	Qty	Unit $	Labor $	Total
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Repair Method and Safety Notes

Driveability / Safety Notes	Supplement / Approval Notes
Summarize whether the vehicle was driven after loss, any pulling, vibration, warning lights, fluid leaks, noises, alignment concerns, or structural safety issues observed.	Use this section for insurer approvals, supplement requests, parts changes, and any note that prior payment approval may be required before proceeding with additional line items.

TOTALS / PHOTOS

Estimate Totals, Refinish, Sublet, Tax, and Completion Planning

Parts Subtotal	0.00
Labor Subtotal	0.00
Paint Materials
Sublet / Calibration
Misc. Fees
Tax Rate %
Estimated Tax	0.00
Estimated Grand Total	0.00

Appraiser	Elsie Richmond-White
Insurer Address	Nationwide Insurance MARO Claims P.O. Box 182068 Columbus, OH 43218
Insurer Phone / Fax	757-286-3368 866-380-2636
Target Completion

Additional Image / Document Drop Zones

Supplement Damage

Paste close-up supplement photos, underside shots, cooling stack pictures, wheel or suspension images, or insurer correspondence screenshots.

Repair Order / Parts / Correspondence

Paste parts quotes, dealership pricing screenshots, estimate pages, or claim communication exhibits.

Claim Communication Notes

Insurer / Adjuster Notes
Call when sending supplements. Prior payment approval may be required for parts changes, hidden damage, or additional repair items. Use this section to document contact attempts, estimate revisions, approvals, and disputed scope issues.

CUSTOMER COPY

Customer Repair Summary

Work Summary
Summarize major replaced parts, repaired panels, refinish work, calibration procedures, alignment services, and any insurer-approved supplement items completed or still pending review.

Customer Acknowledgment

Owner Authorization

SignatureDate

Shop Representative

SignatureDate

SHOP COPY

Internal Shop Notes

Parts Status / Supplement Status / QC Notes / Delivery Notes
Use this area for internal administrative notes, insurer callback history, supplement timing, parts ordering status, teardown findings, calibration completion, QC checks, and delivery readiness.

Additional Shop Image Drop Zone

Final QC / Parts / Delivery Photos

Paste internal completion photos, parts labels, scan tool screenshots, invoice exhibits, or final quality-control images.

Any Auto Body & Paint

BAR Registration No. ARD123456
EPA Identification No. CAL6764321
1234 Example Blvd.
Anytown, CA 90000
Phone: (555) 555-1234
Fax: (555) 555-5678
Email: sample@sample.com

ESTIMATE

Est. No.: 000021
Date: January 3, 2019

Customer Information:
John Doe
1000 Place Road
Anytown, CA 90000
(555) 555-1234

Vehicle Information:
2012 Example Wagon
VIN: 1ABCD23EF45678901
License: 4XYZ123
Odometer: 45,124
Color: White
Engine: 4 Cyl.

LINE	OPERATION	DESCRIPTION	PART NUMBER	QTY	PARTS	LABOR HOURS	PAINT HOURS
1	Replace / Refinish	Front Bumper Cover (New Non-OEM Aftermarket Part)	23302980P	1	$280.00	2.8	2.0
2	Replace	Head Assembly (OEM Part)	20971-868	1	$630.00	2.5	—
3	Replace / Refinish	Front Right Fender (OEM Part) NOTE: This part is purchased and warrantied through a third‑party vendor and may not be manufactured by the original vehicle manufacturer.	2271-640P	1	$360.00	2.0	2.0
4	Replace	Right Headlamp Assembly (Used Part)	2530-3491	1	$260.00	1.0	—
5	Replace	Right Fender Moulding	—	1	$90.00	1.0	—

*NOTE: Although not required, it is best practice to disclose when the customer is authorizing non OEM (Aftermarket) parts. These parts might be warrantied by the vendor and not the vehicle manufacturer.

Body Labor 7.3 Hours @ $100.00 / Hour	$730.00
Paint Labor 4.0 Hours @ $110.00 / Hour	$440.00
Parts	$1,620.00
Materials	$356.31
SUBTOTAL	$3,146.31
Sales Tax	$1,000.00
TOTAL	$4,146.31

AUTHORIZATION
Original Estimate: $4,146.31	Date: 1/3/2019	In Person ☐	By Phone ☐
I hereby authorize the repair work hereinafter set forth to be done along with the necessary materials and agree that you are not responsible for loss or damage to vehicle or articles left in vehicle in case of fire, theft, accident or any other cause beyond your control.
Customer Signature:

Makes of vehicles displayed are Any Auto Body & Paint. Payment is expected upon completion of all work. All repairs are covered by our 1‑year/12,000 mile warranty unless otherwise noted in writing.

RO / File
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Estimator