COLLISION REPAIR INFORMATION SHEET
1. Owner / Contact Information
2. Vehicle Identification & Equipment
| Year / Make / Model |
2013 Audi Q7 S Line Prestige Quattro 4D UTV |
| VIN |
WA1DGAFE3DD000122 |
| License Plate / State |
SZJ 6407 / VA |
| Engine |
3.0L Supercharged Gasoline Direct Injection (6-cylinder) |
| Drivetrain |
4-Wheel Drive (Quattro) |
| Transmission |
Automatic with Overdrive |
| Exterior Color |
Gray |
| Interior Color |
Black Leather |
| Production Date |
July 2012 |
| Odometer at Inspection |
106,691 miles |
Factory Installed Equipment (for Parts Matching & Labor Planning)
Power Features: Power steering, power brakes, power windows, power locks, power mirrors, power driver seat, power passenger seat
Comfort Features: Climate control, dual air conditioning, heated mirrors
Convenience Features: Keyless entry, alarm system, intermittent wipers, tilt & telescopic steering wheel, rear defogger, rear window wiper, steering wheel touch controls, message center
Audio / Infotainment: CD player, auxiliary audio connection, premium radio, satellite radio, navigation system, search/seek functionality
Seating: Leather seats, bucket seats, reclining/lounging seats, 3rd row seat, heated seats, ventilated seats
Safety Features: Driver air bag, passenger air bag, front side impact air bags, ABS (4-wheel), 4-wheel disc brakes, traction control, stability control
Wheels / Appearance: (4) 20" or larger wheels, clear-coat paint, fog lamps
Page 1 of 6
COLLISION REPAIR INFORMATION SHEET
3. Insurance / Claim Information
| Insurance Company |
Nationwide Mutual Insurance Company |
| Claim Type |
PD – Property Damage |
| Claim Number |
928360-GQ-1 |
| Workfile ID / Internal Ref |
ead0d0b8 |
| Adjuster Name |
Elsie Richmond-White |
| Adjuster Phone |
804-555-5555 (business) |
| Appraiser Name |
Elsie Retzel (License No. 028582) |
| Appraiser Phone |
757-286-3368 |
| Appraiser Email |
retzele@nationwide.com |
Special Insurance Notes from Estimate:
• "Call when sending supplements."
• "Prior payment approval needed for any parts changes or supplemental damages."
Insurer Mailing Address
Nationwide Insurance MARO Claims
P.O. Box 182068
Columbus, OH 43218
Phone: 757-286-3368
Fax: 866-380-2636
4. Loss Information
Page 2 of 6
COLLISION REPAIR INFORMATION SHEET
5. Vehicle History & Market / Recall Notes
(These notes are helpful for the shop and for any future valuation or supplement discussions.)
Market Valuation / Claim Notes (CCC Report Snippets)
Owner: Coates, Thomas
Claim: 928360-GQ-1 (CCC Market Valuation Report)
Sales tax rate updated from 4.10% to 4.15% as of 02/06/2026 (data modified after initial valuation).
Comparable Vehicle Example Used by CCC
| Comparable Vehicle |
2014 Audi Q7 S Line Prestige Quattro 3.0L |
| VIN |
WA1DGAFE1ED015722 |
| Mileage |
123,668 miles |
| List Price |
$9,668 |
| CCC Adjusted Comparable Value |
$8,007 |
| Dealer Location |
Elm City, NC |
NHTSA Recall Information
⚠ IMPORTANT: Shop should check open recalls by VIN before repair and advise customer.
| Campaign ID |
17V298000 |
| Component |
Fuel System, Gasoline |
| Issue |
Fuel pump flange may crack and leak fuel |
| Remedy |
Audi dealers replace flange if cracked or apply protective film if not; repairs free of charge |
| Campaign ID |
23V086000 |
| Component |
Equipment, Tires |
| Issue |
Incorrect rear GAWR (Gross Axle Weight Rating) on certification label |
| Remedy |
Overlay label with correct GAWR, free of charge |
Page 3 of 6
COLLISION REPAIR INFORMATION SHEET
6. Parts & Labor Planning – Front / Left-Front Structure
(Use this as a baseline for a complete estimate; shop to fill in quantities, labor hours, and prices.)
(Shop to continue with additional rows for structural/frame components, suspension/steering checks, alignment procedures, and any rear/side/interior damage identified during teardown.)
Page 4 of 6
COLLISION REPAIR INFORMATION SHEET
9. Owner Narrative of Loss & Detailed Situation Statement
Background & Context
This collision repair information sheet has been prepared by Thomas Coates, the owner of a 2013 Audi Q7 S Line Prestige Quattro (VIN: WA1DGAFE3DD000122), following a loss incident that occurred on January 24, 2026, at approximately 4:07 PM. The vehicle sustained damage primarily to the left front area (impact code 11 – Left Front), and this document is being provided to obtain a complete, thorough, and professional repair estimate from a qualified collision repair facility.
Initial Insurance Inspection Limitations
The initial insurance inspection conducted by Nationwide Mutual Insurance Company (Claim Number: 928360-GQ-1) was performed under less-than-ideal conditions. Specifically:
1. The vehicle interior was NOT fully examined during the initial inspection.
2. The vehicle's drivability and mechanical functioning were NOT tested or verified.
3. The underside, undercarriage, and subframe components were NOT inspected.
4. The vehicle was positioned tightly between other vehicles in a parking area, which significantly limited the appraiser's ability to conduct a complete visual inspection of all exterior panels, gaps, and alignment.
5. No teardown or disassembly was performed to identify hidden or secondary damage beneath exterior panels or within structural components.
Due to these limitations, the insurance company's initial estimate may not reflect the full scope of damage, and supplemental estimates will likely be necessary once the vehicle is properly evaluated by the repair shop.
Purpose of This Document
This document serves several critical purposes:
A. Complete Professional Assessment: To enable the collision repair facility to conduct a full, unrestricted inspection of the vehicle, including teardown as necessary, to identify all visible and hidden damage.
B. Accurate Repair Estimate: To obtain a comprehensive and accurate estimate that reflects the true cost of restoring the vehicle to its pre-loss condition using appropriate original equipment manufacturer (OEM) or certified aftermarket parts.
C. Supplement Foundation: To establish a documented baseline for any supplemental repair estimates that may be required once hidden damage is discovered during the repair process. Per the insurance company's instructions, all supplements must be called in and require prior payment approval.
D. Vehicle History & Recall Documentation: To ensure the repair facility is aware of all pertinent vehicle history, factory equipment, and open safety recalls that should be addressed during or in conjunction with the collision repair.
E. Insurance Coordination: To facilitate clear communication between the repair facility, the vehicle owner, and the insurance carrier (Nationwide Mutual Insurance Company) throughout the repair process.
Known Areas of Concern (to be verified by shop inspection)
Based on the owner's observation and the preliminary insurance inspection, the following areas are known or suspected to have sustained damage:
• Front bumper cover (left front impact zone)
• Left front fender and fender liner
• Left front headlamp assembly and mounting brackets
• Hood (potential alignment issues or direct damage)
• Front grille assemblies (center and lower)
• Left front fog lamp assembly, bezel, and wiring
• Bumper reinforcement bar and mounting brackets
• Radiator support and core support structures
• Cooling system components: radiator, condenser, intercooler(s)
• Front parking sensors and associated wiring harnesses
• Front undershields and splash guards
• Potential suspension and steering component damage (to be inspected on lift)
• Potential frame or subframe misalignment (requires measurement)
• ADAS (Advanced Driver Assistance Systems) sensor calibration requirements
• Paint and refinish requirements for all affected and blend panels
The repair facility is requested to conduct a thorough inspection, including placing the vehicle on a frame rack or alignment system to verify structural integrity, and to perform any necessary teardown to identify all collision-related damage.
Insurance & Payment Instructions
The vehicle owner and repair facility should be aware of the following insurance requirements:
1. All repair supplements MUST be called in to the appraiser (Elsie Retzel, 757-286-3368) before proceeding with additional work.
2. Prior payment approval is required for any parts changes (e.g., switching from aftermarket to OEM parts) or for any supplemental damage discovered during teardown.
3. The shop should coordinate directly with the insurance company for all approvals and should copy the vehicle owner on all communications.
4. Any delays in approval or payment disputes should be escalated immediately to the owner for resolution.
Owner's Repair Preferences & Expectations
The vehicle owner requests the following:
• Use of OEM (Original Equipment Manufacturer) parts wherever possible to ensure proper fit, finish, and long-term reliability.
• Complete restoration of all safety systems, including airbags (if deployed), ADAS sensors, and stability control systems.
• Post-repair calibration of all electronic safety and driver-assistance systems.
• Four-wheel alignment to be performed after all suspension and structural repairs are complete.
• Address any open NHTSA recalls during the repair process (see Page 3 for recall details).
• Provide detailed photographic documentation of all hidden or supplemental damage discovered during teardown.
• Maintain open communication with the owner throughout the repair process, especially if delays or complications arise.
Additional Notes for the Repair Facility
This vehicle is a high-value luxury SUV with advanced safety and comfort features. The owner expects that all repairs will be performed to manufacturer specifications and that the vehicle will be restored to safe, reliable, pre-loss condition. Any shortcuts, cost-cutting measures, or use of substandard parts will not be acceptable.
The owner is available for questions or clarifications at any time via phone (757-374-3539) or email (pdcoates@gmail.com). Please do not hesitate to reach out if additional information, documentation, or vehicle history is needed.
Thank you for your professionalism and attention to detail in evaluating and repairing this vehicle.
Document prepared by: Thomas Coates
Date prepared: March 14, 2026
Claim Reference: Nationwide Claim #928360-GQ-1
Page 6 of 6 – END OF DOCUMENT