i ,1 - Shawnee County

Transcription

BOARD OF COUNTY COMMISSIONERS AGENDA
MONDAY, AUGUST 22, 2016, 9:00 AM
COMMISSION CHAMBERS, ROOM B-11
I.
II.
PROCLAMATIONS/PRESENTATIONS
UNFINISHED BUSINESS
1.
III.
IV.
Consider approval of request to solicit bids from contractors for repairs to the Lake Shawnee
spillway-Parks + Recreation.
CONSENT AGENDA
1.
Acknowledge receipt of Go Topeka's 2nd quarter financial report.
2.
Consider approval ofrequest to pay invoices from the Diversion Fund account in a total amount of
$3,052.54-District Attorney.
3.
Acknowledge receipt of out-of-state travel report from Joe Rucker regarding the Control
Defensive Tactics, Ground Defense and Handgun/Long Gun Retention Training at the National
Law Enforcement Training Center (NLETC) in Kansas City, Missouri-Corrections.
NEW BUSINESS
A. COUNTY CLERK-Cynthia Beck
1.
Consider all voucher payments.
2.
Consider correction orders.
B. PUBLIC WORKS/SOLID WASTE-Tom Vlach
1.
Consider awarding bid for the purchase of four rear-load solid waste trucks to Armor Equipment
in an amount of$488,l 18.40, including trade-in, and to Elliot Equipment for a roll-off truck in the
amount of$166,477.00 including trade-in.
2.
Consider awarding the bid for the purchase of glass beads for retro-reflective enhancement of
roadway paint striping to Ennis Paint in an amount of$13,200.00.
C. APPRAISER - Steve Bauman
1.
Consider approval ofrequest for out-of-state travel for an employee to attend the New World
Public Safety User Group Meeting at a cost of $500.00.
D. COUNSELOR - Rich Eckert
1.
Consider approval of claim of Allied Property & Casualty Insurance Company a/s/o Stacia Kolbek
in an amount of$1 l,OOO.OO for damage to a vehicle, car rental charges, and medical expenses.
E. CORRECTIONS-Brian Cole
1.
V.
VI.
Consider approval ofrequest to solicit bids for concrete replacement in multiple areas of the
County Detention Center at an estimated cost of$24,785.00.
ADMINISTRATIVE COMMUNICATIONS
EXECUTIVE SESSIONS
-
~
recreation
August 8, 2016
TO:
FROM:
Board of Commissioners
Shawnee County
John E. Knight, Director
Parks + Recreation
RE:
J
.
"-,j
Solicit Bids - Lake Shawnee Spillway Improvements
Asset Management Division
Board of Commissioners approval is requested to solicit bids from contractors to complete the
improvements necessary for the Lake Shawnee spillway.
On August 6, 2015, the Board of Commissioners approved a contract with Professional Engineering
Consultants to provide design services for the repairs to the Lake Shawnee spillway. The plans and
permits to move forward with the work are complete.
The work includes excavation of the soil behind the spillway structures, installing a filter fabric
throughout the excavated area, backfilling with excavated materials or with an alternate aggregate fill
and capping the excavated area with three foot of riprap. The goal of the work is to improve the
function of weep holes located at the base of the spillway structures. The purpose of the weep holes is
to reduce hydraulic pressure on the back side of the structures. Some of the weep holes are plugged
and are not functioning as designed. Further, an outcome of the project is the reduction of the
subsidence of the aggregate material behind the spillway structures reducing the possibility that the
weep holes will plug again.
The engineers estimate for the project is $178,000 to $202,000 depending on whether an alternate is
accepted or not.
In addition to the approval to solicit bids the department requests approval to amend contract C3002015 with Professional Engineering Consultants to provide construction inspection services during
the project. In a letter dated April 26, 2016, Ambrose J. Ketter, Water Structures Engineer of the
Kansas Department of Agriculture, the regulating agency for improvements or modifications of a darn
structures, stated "It should also be noted that, per K.A.R. 5-40-71, the darn shall be inspected by an
engineer competent in the design of dams, or that engineers authorized representative, at all times
during any construction activity."
The estimated amount for the amendment to the contract is $35,350. Professional Engineering Services
is very familiar with the spillway and dam structures having designed this project and performed
multiple Dam Safety Inspection Reports for Shawnee County.
Funding for this project was identified in the Certificates of Participation issued in early spring 2015.
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GROWTH ORGANIZATION OF TOPEKA/
SHAWNEE COUNTY, INC. - PUBLIC
Financial Statements & Accountant's
Compilation Report
April 30, 2016
Accountant's Compilation Repo11
•
MIZE,,.., J-IOUSER
~~~/()1.\A.
Growth Organization of Topeka/ Shawnee County, Inc.
120 S.E. 6111 Ave. - Suite 110
Topeka, Kansas 66603
Management is responsible for the accompanying financial statements of Growth Organization of Topeka /
Shawnee County, lnc.-Public (a division of Growth Organization of Topeka/Shawnee County, Inc., consisting
p1imarily of activities related to the City of Topeka and Shawnee County Joint Economic Development
Organization grant), (Go Topeka), which comprise the statements of assets, liabilities and change in fundsmodified cash basis as of April 30, 2016, and the related statement of income and expense-modified cash basis for
the one month and four month periods then ended, and for determining that the modified cash basis of accounting
is an acceptable financial reporting framework. We have performed a compilation engagement in accordance with
Statements on Standards for Accounting and Review Services promulgated by the Accounting and Review
Services Committee of the A!CPA. We did not audit or review the financial statements nor were we required to
perform any procedures to verify the accuracy or completeness of the information provided by management.
Accordingly, we do not express an opinion, a conclusion, nor provide any form of assurance on these financial
statements.
The financial statements are prepared in accordance with the modified cash basis of accounting, which is a basis
of accounting other than accot1nting principles generally accepted in the United States of America.
Management has elected to omit substantially all of the disclosures ordinarily included in financial statements
prepared on the modified cash basis of accounting. If the omitted disclosures were included in the financial
statements, they might influence the user's conclusions about the Company's assets, liabilities, equity, revenues,
and expenses. Accordingly, these financial statements are not designed for those who are not informed about such
matters.
The supplementary information listed below is presented for purposes of additional analysis and is not a required
part of the basic financial statements. The supplementary info1mation is the representation of management. This
supplementary information was not subject to our compilation engagement. We do not express an opinion, a
conclusion, nor provide any form of assurance on such supplementary infonnation.
Supplemental information (presented only for supplementary analysis purposes):
Schedule of committed/pending incentive offers and site expenditures as of April 30, 2016.
We are not independent with respect to Growth Organization of Topeka/ Shawnee County, lnc.-Public.
Mize Houser & Company P.A.
Ce11ified Public Accountants
August 12, 2016
Topeka, Kansas
BNO:rb:sc
Enclosures
V>J\Y\."'=t.rni2Hhows0r.t'.oin a mhco@mizehouser.corn
534 S Kans,,s Ave, Suite 700 • Topeka, KS 66603-3465 • 785.233.0536 p • 785.233.1078 f
534 S Kansas Ave, Suite 400 • Topeka, KS 66603-3454 •785.234.5573 pa 785.234.1037 f
7101 College Blvd, Suite 900• Overland Park, KS 66210-'1984 •913.451.1882 p•913.451.22·1 I f
211 E E,ghth St, Suite A• Lawrence, KS 66044-2771 • 78.5.842.8844 p • 785.842.9049 f
Go Topeka, Inc.
Statement of Assets. Liabilities, &
Change In FLmds-Public - Modified Cash Basis
April 30, 2016
Assets
Current Assets
Cash-Sales Tax (A)
Investments-Sales Tax (Al
Other Current Assets
Total Current Assets
Other Assets
Land Held for Development
6,455,128
5,877,999
20,010
12,353,137
7,645,194
Total Other Assets
7,645,194
19,998,331
Total Assets
Liabilities and Fund Balance
Current Liabilities
EMBD Carryover
Due to/(from) Chamber
KF Park & Fire House Fund
Other Payables
850,436
763
203,159
1,994
1,056,352
Total Current Liabilities
Fund Balances
Opening Fund Balance
Excess-Current Year
17,867,963
1,074,016
18,941,979
Total Liabilities and Fund Balance
(A) - Subject to commitments. See supplemental schedule.
See Accountant's Compilation Report
19,998,331
Go Topeka, Inc.
Statement of Income and Expense - Public
Modified Cash Basis
April 30, 2016
Actual
Current Period
Budget
Variance
Actual
Year to Date
Budget
Variance
Revenue
Sales Tax
Net Investment Income (Fees)
Other Program Revenue
Total Revenues
416,667
605
7,533
416,666
100
3,000
1
505
4,533
1,666,667
4,859
21,263
1,666,664
400
5,000
3
4,459
16,263
424,805
419,766
5,039
1,692,788
1,672,064
20,724
9,888
13,233
52,415
1,500
5,891
25,794
795
4,090
990
12,066
34,657
4,641
1,625
8,775
44,101
975
5,155
990
2,178
21,424
(47,774)
125
2,884
18,307
180
1,065
41,410
125,422
74,439
6,070
42,137
170,982
3,135
7,958
3,190
53,214
259,827
83,764
6,250
51,800
236,904
41,400
20,620
3,190
11,804
134,404
9,325
180
9,663
65,923
38,265
12,662
114,596
112,985
(1,611)
474.743
756,969
282,226
8,051
13,460
5,409
37,216
53,840
16,624
122,647
126,445
3,798
511,959
810,809
298,850
0
41,525
0
42,000
0
475
60,000
46,814
60,000
48,000
0
1,186
260,633
251,321
9,312
1,074,016
753,255
320,761
Expenses
Program Expenses
•
Business Retention
New Business Attraction
Workforce Development
Government Relations Consultant
Research & Governmt'I Relations
Entrepreneurial & Minority Bus Dev
Small Business Innovation Center
Site/Prospect Support
Incentives & Site Expend - Direct
Less: Site Expenditures Capitalized
Total Program Expenses
General & Administrative Expenses
Total Operating Expenses
Transfer to Visioning
Small Business Incentive Program
Revenues over (under) Expenses
Page 2
SUPPLEMENTAL INFORMATION
Go Topeka, Inc.
Committed/Pending Incentive Offers and Site Expenditures
April 30, 2016
2016
Cash:
Committed - Performance Based:
Alorica
Big Heart Pet 2
Big Heart Pet 2
FHLB
Koch & Co
PTMW
Yantra
Terminex
Mars Escrow - Employment Incentive
Total Committed - Performance Based
Expected:
Site Improvements
Dev. & Maintenance
Total Expected
Total Committed and Expected
Under Consideration:
Pending Cash Incentives
Total Under Consideration
Total before EMBD
2017
2018
THEREAFTER
Totals
80,000
63,000
150,000
840,000
20,000
70,000
16,000
27.600
40,000
40,000
227,000
20,000
60,000
2,000
122,000
40,000
10,000
3.600
260,000
10,000
1,800
60,000
1,266,600
560,600
113,800
222,000
2,163,000
50,000
45,000
95,000
45,000
45,000
45,000
45,000
0
50,000
135,000
185,000
1,361,600
605,600
158,800
222,000
2,348,000
40,000
40,000
323,600
323,600
372,800
372,800
1,197,600
1,197,600
1,934,000
1,934,000
1,401,600
929,200
531,600
1,419,600
4,282,000
160,000
63,000
150,000
1,249,000
82,000
70,000
96,000
33,000
260,000
850,436
203,159
5,335,595
EMBD Carryover
KF Park and Fire House Fund
Total
GROWTH ORGANIZATION OF TOPEKA/
Compilation Report
May 31, 2016
Accountant's Compilation Report
120 S.E. 6'11 Ave. - Suite 110
primarily of activities related to the City of Topeka and Shawnee County Joint Economic Development
Organization grant), (Go Topeka), which comprise the statements of assets, liabilities and change in fundsmodified cash basis as of May 31, 2016, and the related statement of income and expense-modified cash basis for
the one month and five month periods then ended, and for determining that the modified cash basis of accounting
is an acceptable financial repo1ting framework. We have perfom1ed a compilation engagement in accordance with
Services Committee of the AICPA. We did not audit or review the financial statements nor were we required to
perfonn any procedures to verify the accuracy or completeness of the information provided by management.
Accordingly, we do not express an opinion, a conclusion, nor provide any fonn of assurance on these financial
statements.
of accounting other than accounting p1inciples generally accepted in the United States of America.
and expenses. Accordingly, these financial statements are not designed for those who are not informed about such
matters.
The supplementary info1111ation listed below is presented for purposes of additional analysis and is not a required
part of the basic financial statements. The supplementary info1111ation is the representation of management. This
supplementary infonnation was not subject to our compilation engagement. We do not express an opinion, a
conclusion, nor provide any fom1 of assurance on such supplementary infonnation.
Supplemental info1mation (presented only for supplementary analysis purposes):
Schedule of committed/pending incentive offers and site expenditures as of May 3 J, 2016.
We are not independent with respect to Growth Organization of Topeka/ Shawnee County, Inc.-Public.
Certified Public Accountants
August 12, 2016
Topeka. Kansas
BNO:rb:sc
Enclosures
534 S Kans,1s Ave. Suite 700 •Topeka, KS 66603,3465 •785 23.10536 p • 785.233.1078 f
534 S Kansas Ave. S,,ile 400 •Topeka, KS 66603-3454 • 785.234.5573 p • 785.234.1037 f
7101 College Bivd, SLiitt, 900• Overland Park, KS 66210-1984 •913.451. 1882 p • 913.451.2211 f
211 E Eighth St, Suite A• Lavm,nce, KS 66044-2771 • 785.842.8844 p • 785.81t2.9049 f
Go Topeka, Inc.
Statement of Assets, Liabilities, &
Change In Funds-Public - Modified Cash Basis
May 31, 2016
Assets
Current Assets
Cash-Sales Tax (A)
Investments-Sales Tax (A)
Other Assets
6,759,134
5,879,878
17,392
12,656,404
7,645,194
Total Other Assets
7,645,194
Total Assets
20,301,598
Current Liabilities
EMBD Carryover
Other Payables
850,436
724
203,159
0
Fund Balances
Excess-Current Year
1,054,319
17,867,963
1,379,316
19,247,279
20,301,598
Go Topeka, Inc.
Modified Cash Basis
May 31, 2016
Actual
Current Period
Budget
Variance
Actual
Year to Date
Budget
Variance
Revenue
Sales Tax
416,667
1,938
2,223
416,666
100
8,300
1
1,838
(6,077)
2,083,333
6,797
23,486
2,083,330
500
13,300
3
6,297
10,186
420,828
425,066
(4,238)
2,113,616
2,097,130
16,486
Business Retention
11,874
36,375
6,848
1,500
6,562
22,706
795
4,529
(990)
14,666
34,157
29,641
1,500
8,775
49,601
38,475
5,155
(990)
2,792
(2,219)
22,793
53,284
161,798
81,287
7,570
48,700
193,687
3,930
12,487
2,200
67,880
293,983
113,405
7,750
60,575
286,505
79,875
25,775
2,200
14,596
132,186
32,118
180
11,875
92,818
75,945
13,288
90,200
180,980
90,780
564,943
937,949
373,006
15,328
13,460
(1,868)
52,544
67,300
14,756
105,528
194,440
88,912
617,487
1,005,248
387,762
0
10,000
0
10,000
0
0
60,000
56,814
60,000
58,000
0
1,186
305,300
220,626
84,673
1,379,316
973,882
405,434
Total Revenues
Expenses
Program Expenses
*
*
2,213
26,896
37,680
626
Page 2
Go Topeka, Inc.
May 31, 2016
2016
Cash:
Alorica
Big Heart Pet 2
Big Heart Pet 2
FHLB
Koch & Co
PTMW
Yantra
Terminex
Futamura USA
se2
Expected:
Site Improvements
Dev. & Maintenance
Total Expected
Total before EMBD
60,000
63,000
150,000
840,000
20,000
70,000
16,000
27,600
2017
2018
THEREAFTER
Totals
60,000
40,000
227,000
20,000
60,000
2,000
122,000
40,000
10,000
3,600
260,000
49,600
80,0QO
10,000
1,800
60,000
48,800
160,000
107,600
760,000
160,000
63,000
150,000
1,249,000
82,000
70,000
96,000
33,000
260,000
206,000
1,000,000
1,246,600
710,200
322,600
1,089,600
3,369,000
50,000
45,000
95,000
45,000
45,000
45,000
45,000
0
50,000
135,000
185,000
1,341,600
755,200
367,600
1,089,600
3,554,000
40,000
40,000
194,000
194,000
164,000
164,000
330,000
330,000
728,000
728,000
1,381,600
949,200
531,600
1,419,600
4,282,000
EMBD Carryover
Total
850,436
203,159
5,335,595
GROWTH ORGANIZATION OF TOPEKA I
Compilation Report
June 30, 2016
Accountant's Compilation Report
120 S.E. 6th Ave. - Suite 110
primarily of activities related to the City of Topeka and Shawnee County Joint Economic Development
Organization grant), (Go Topeka), which comprise the statements of assets, liabilities and change in fundsmodified cash basis as of June 30, 2016, and the related statement of income and expense-modified cash basis for
the one month and six month periods then ended, and for determining that the modified cash basis of accounting
is an acceptable financial reporting framework. We have perfo1med a compilation engagement in accordance with
Services Committee of the AICPA. We did not audit or review the financial statements nor were we required to
perfonn any procedures to verify the accuracy or completeness of the information provided by management.
Accordingly, we do not express an opinion, a conclusion, nor provide any form of assurance on these financial
statements.
of accounting other than accounting principles generally accepted in the United States of America.
and expenses. Accordingly, these financial statements are not designed for those who are not infon11ed about such
matters.
The supplementary infonnation listed below is presented for purposes of additional analysis and is not a required
part of the basic financial statements. The supplementaiy information is the representation of management. This
supplementary information was not subject to our compilation engagement. We do not express an opinion, a
conclusion, nor provide any form of assurance on such supplementary info1111ation.
Supplemental information (presented only for supplementary analysis purposes):
Schedule of committed/pending incentive offers and site expenditures as of June 30, 2016.
We are not independent with respect to Growth Organization of Topeka/ Shawnee County, lnc.-Public.
Certified Public Accountants
August 12, 2016
Topeka, Kansas
BNO:rb:sc
Enclosures
534 S Ka,1sas Ave, Suite 700 • Topeka, l<S 6(,603-.3465 •785.233.0536 p •785.23.11078 i
534 S Kansas Ave, SL1ite 400 •Topeka, KS 6660.3-3454 •785.234.5573 p • 785.234 1037 f
7101 College Blvd. Suite 900• Overland Park, KS 66210.. 1984 •9'13.451.1882 p• 913.451.221'! f
211 E Eighth St, Suite A• Lawrence, KS 66044-2771 • 785 842.8844 p • 78S.842. 9049 f
Go Topeka, Inc.
Statement of Assets, Liabilities, &
Change In Funds-Public · Modified Cash Basis
June 30, 2016
Assets
Current Assets
Cash-Sales Tax (AJ
Investments-Sales Tax (A)
Other Assets
6,983,114
5,880,178
17,820
12,881,112
7,645,194
7,645,194
Total Other Assets
20,526,306
Total Assets
Current Liabilities
EMBD Carryover
Other Payables
850,436
1,092
203,159
446
1,055,133
Fund Balances
Excess-Current Year
17,867,963
1,603,210
19,471,173
20,526,306
Go Topeka, Inc.
Modified Cash Basis
June 30, 2016
Actual
Current Period
Budget
Variance
Actual
Year to Date
Budget
Variance
Revenue
Sales Tax
416,667
359
1,381
416,666
100
1,300
1
259
81
2,500,000
7,156
24,867
2,499,996
600
14,600
4
6,556
10,267
418,407
418,066
341
2,532,023
2,515,196
16,827
Business Retention
11,844
58,751
3,241
1,500
7,097
35,799
1,590
8,703
(27,176)
14,566
38,507
4,641
26,625
8,775
46,501
975
5,155
(27,176)
2,722
(20,245)
1,400
25,125
1,678
10,703
(615)
(3,548)
65,128
220,549
84,528
9,070
55,797
229,486
5,520
21,190
(24,976)
82,446
332,490
118,046
34,375
69,350
333,006
80,850
30,930
(24,976)
17,318
111,941
33,518
25,305
13,553
103,521
75,330
9,740
101,348
118,568
17,220
666,291
1,056,517
390,226
11,287
13,460
2,173
63,831
80,760
16,928
112,635
132,028
19,393
730,122
1,137,277
407,154
0
81,878
0
82,000
0
122
60,000
138,691
60,000
140,000
0
1,309
223,894
204,038
19,856
1,603,210
1,177,919
425,290
Total Revenues
Expenses
Program Expenses
*
*
Page 2
Go Topeka, Inc.
June 30, 2016
2016
Cash:
Alorica
Big Heart Pet 2
Big Heart Pet 2
FHLB
Koch & Co
PTMW
Yantra
Terminex
Futamura USA
se2
Expected:
Site Improvements
Dev. & Maintenance
Total Expected
Total before EMBD
60,000
63,000
150,000
840,000
20,000
70,000
16,000
27,600
2017
2018
THEREAFTER
Totals
60,000
40,000
227,000
20,000
60,000
2,000
122,000
40,000
10,000
3,600
260,000
49,600
80,000
10,000
1,800
60,000
48,800
160,000
107,600
760,000
160,000
63,000
150,000
1,249,000
82,000
70,000
96,000
33,000
260,000
206,000
1,000,000
1,246,600
710,200
322,600
1,089,600
3,369,000
50,000
45,000
95,000
45,000
45,000
45,000
45,000
0
50,000
135,000
185,000
1,341,600
755,200
367,600
1,089,600
3,554,000
40,000
40,000
194,000
194,000
164,000
164,000
330,000
330,000
728,000
728,000
1,381,600
949,200
531,600
1,419,600
4,282,000
EMBD Carryover
Total
850,436
203,159
5,335,595
:i ,1;
OFFICE OF THE DISTRICT ATTORNEY
THIRD JUDICIAL DISTRICT
OF KANSAS
Chadwick J. Taylor, District Attorney
MEMORANDUM
TO:
Board of County Commissioners
FROM:
Chadwick J. Taylor, District A t t o ~
DATE:
August 17, 2016
RE:
Request for Diversion Fund Payments
/
The District Attorney's Office wishes to pay the following invoices from their Diversion Fund account:
1)
Flory, Marci for transcript fees
a)
Invoice dated August 12, 2016 in the amount of $63.00
2)
Independent Stationers for office supplies
a)
Invoice No. 173594 dated August 9, 2016 in the amount of $25.10
b)
c)
3)
Verizon Wireless for telephone and data charges for July 2016 [Approved by the BCC on 10/9/14
- Contract #C361-2014]
a)
Invoice No. 9769601736 dated August 1, 2016 in the amount of $1,603.36
The District Attorney's Office hereby requests placement on the consent agenda for consideration of the
above itemized invoices, in the total amount of $3,052.54, to be paid from the Diversion Fund account.
Shawnee County Courthouse
200 SE 7th Street, Suite 214 • Topeka, Kansas 66603 • (785) 251-4330
~
SALES INVOICE
Local Delivery Provided By:
OFFICE PLUS OF KANSAS
8iindependent
. . ,,~.\sll9~r:1!
.... ······ .
SaleslnvolceNiiiiioer: ·s 10011359'4
Sales Invoice Date:
Remit Independent Stationers, Inc.
To:
5600 N River Road, Suite 700
Invoice Questions: 847-261-0052
Rosemont, IL 60018
Contract No.: R141701
800-231-9848
Sold
,To:
08/09/16
Page: 1
Ordered By: Kathy Beach
Ship
To:
SHAWNEE COUNTY
200 SE 7TH ST
TOPEKA, KS 66603
DISTRICT ATTORNEY
Kathy Beach
200 SE 7TH RM 214
DISTRICT ATTORNEY
TOPEKA, KS 66603
Ship-to Code: SHP0040259
IACCT. NO.
I_
Sales Order No.
CUSTOMER PO
PNW117552
PNWltem
Customer ID:
VER96806
000000
Description
DRIVE,USB,32GB,RED
DUE DATE
DEPARTMENT
,
09/08/16
Ord Qty
Ship Qty
3 EA
EA
2 DZ
DZ
1 PK
PK
2 PK
2 PK
Unit Price
Total Price
12.55
25.10
Contract Item PerTCPN Contract# R141701
UNV10630
PAD,LGLRULED,PERF,LTR,CA
UNV79000VP
STAPLES,CHSEL PT,25TH/PK
Contract Item Per TCPN Contract# R141701
RAC90558
Amount Subject to
Sales Tax
0.00
(End of Report)
WIPES,D1SINF,3PACK
Amount Exempt
from Sales Tax
25.10
Subtotal:
25.10
Total Sales Tax:
0.00
Total:
25.10
SALES INVOICE
8lndependent
··
.steuorie.rS.
Sales lnvoiee Number: S100173617
Sales Invoice Date: 08/09/16
To:
Rosemont, IL 60018
800-231-9848
Sold
To:
Page: 1
Ship
To:
SHAWNEE COUNTY
200 SE 7TH ST
DISTRICT ATTORNEY
Kathy Beach
· 200 SE 7TH RM 214
TOPEKA, KS 66603
DISTRICT ATTORNEY
TOPEKA, KS 66603
IACCT. NO.
Sales Order No.
I
-.
PNWltem
Customer ID:
ACM90015
PNW118259
DUE DATE
DEPARTMENT
CUSTOMER PO
09/08/16
0000000
Description
ASPIRIN,IBUPROFEN,ST.VINC
Ord Qty
Ship Qty
Unit Price
Total Price
1 BX
1BX
14.97
14.97
1 EA
1 EA
106.39
106.39
3 PK
3 PK
7.43
22.29
1 CT
1 CT
19.14
19.14
2 EA
2 EA
· 103.20
206.40
3 EA
3 EA
2.71
8.13
4 BX
4 BX
5.35
21.40
5 CT
5 CT
36.97
184.85
ELl75400
CRTDG,HEWCC364A, 1OK
PAP5032315
CORRECTION,DRYLINE,5/CD
DXEPTM21
SPOON,TEA,PLS,MDWT, 1MCT
IVR83042X
TONER,HPLJ4250/4350,BK
OFX00020
CREAMER,CNSTR, 1202
UNV12113
FOLDER,MLA, 1/3CT,LTR, 100
UNV20030
PAPER,RECY,20LB,8.5X11,WE
4 DA Adult - 1 JV Side
Transferre.d to page 2.................................
583.57
·.·.·
,.
8 independent
·
SALES INVOICE
· ste110t1Eirs
Sales Invoice Number: $100173617
To:
Rosemont, IL 60018
800-231-9848
Sold
To:
Page: 2
SHAWNEE COUNTY
Ship
To:
200 SE 7TH ST
TOPEKA, KS 66603
DISTRICT ATTORNEY
Kathy Beach
200 SE 7TH RM 214
DISTRICT ATTORNEY
TOPEKA, KS 66603
JACCT. NO.
Sales Order No.
L
CUSTOMER PO
PNW118259
PNWltem
Customer ID:
DEPARTMENT
DUE DATE
0000000
Description
Transferred from page 1. ............................
UNV35662
NOTE,STICK-IT, 1.5X2YW12PD
09/08/16
Ord Qty
Ship Qty
Unit Price
4 PK
4 PK
1.17
583.57
4.68
3 DZ
3 DZ
2.88
8.64
2 EA
2 EA
4.11
8.22
2 CT
2 CT
63.44
126.88
Total Price -
UNV39510
PEN,GEL,R-BALL,MED,BK
USSIR62
REFILL,INKBOTTLE,RED
OFX00020CT
FOOD.NONDAIRY CREAMR, 12
Amount Subject to
Sales Tax
0.00
(End of Report)
.
Amount Exempt
from Sales Tax
731.99
Subtotal:
731.99
-Total Sales Tax:
0.00
Total:
731.99
Local Delivery Provided
SALES INVOICE
By:
Sales lrivoice Number: SI00174476
Rosemont, IL 60018
800-231-9848
To:
Sold
To:
Page: 1
Ordered Bv: K,ithv Ria:ar.h
Ship
To:
SHAWNEE COUNTY
200 SE 7TH ST
DISTRICT ATTORNEY
Kathy Beach
200 SE 7TH RM 214
TOPEKA, KS 66603
DISTRICT ATTORNEY
TOPEKA, KS 66603
/ACCT. NO.
Sales Order No.
I
PNW119382
PNWltem
Customer ID:
MAX648200
DUE DATE
DEPARTMENT
CUSTOMER PO
0000000
Description
CDR, 700MB,80"-1 OOSPNDL
09/11/16
Ord Qty
Ship Qty
Unit Price
Total Price
.1 PK
1 PK
23.39
23.39
6 PK
6 PK
3.93
23.58
2 PK
2 PK
7.43
14.86
2 EA
2 EA
106.39
212.78
4 EA
4 EA
2.36
9.44
6 EA
6 EA
5.59
33.54
3 EA
3 EA
1.32
3.96
5 CT
5 CT
36.97
184.85
MMM684SH
FLAGS,POSTIT"SIGNHERE"MI
PAP5032315
CORRECTION,DRYLINE,5/CD
IVRC364A
TONER,HPLJ4015,BK
OFX00019
SUGAR,CNSTR,200Z
RED51114
BOOK,FOLLOWUPVOICEML,W
UNV10700
REMOVER,STAPLE,WAND,BK
UNV20030
PAPER,RECY,20LB,8.5X11,WE
3 DA Adult 2 JV Side
Transferred to page 2 ................................
506.40
·8 independent
-
.s.t~ociners.
Sales Invoice Number: SI00174476
To:
Rosemont, IL 60018
800-231-9848
Sold
To:
SALES INVOICE
Page: 2
Ordered Bv: Kathv Beach
us
Ship
To:
SHAWNEE COUNTY
200 SE 7TH ST
DISTRICT ATTORNEY
Kathy Beach
200 SE 7TH RM 214
TOPEKA, KS 66603
DISTRICT ATTORNEY
TOPEKA, KS 66603
IACCT. NO.
Sales Order No.
DUE DATE
DEPARTMENT
CUSTOMER PO
I
PNW119382
PNWltem
Customer ID:
09/11/16
0000000
Description
Transferred from page 1... ..........................
UNV31312
PUSHPIN,PLAS, 100,ASTDGEM
Total Price
Ord Qty
Ship Qty
Unit Price
1 PK
1 PK
0.78
0.78
4 DZ
4 DZ
5.61
22.44
1 PK
1 PK
3.66
3.66
6 EA
6 EA
0.99
5.94
1 PK
1 PK
2.29
2.29
2 BX
2 BX
32.99
65.98
2 EA
2 EA
10.80
21.60
506.40
UNV39913
PEN,GEL,CLRBARL,0.7MM.BE
UNV83410
TAPE,. 75X10006ROL/PK, CR
UNV96920
BOOK,STENO,GREGG,80SH,W
UNV00700VP
REMOVER,STAPLE,JAWST,3,8
PFX62714
FOLDER.ET MCRBGD 2FA,ML
FOL20421EA
COFFEE,FG,30.50Z,CLS RST
Local Delivery Provided
8tndep:·.·endertt
$li)floners
SALES INVOICE
By:
Sales Invoice Number: 5100174476
To:
Rosemont, IL 60018
800-231-9848
Sold
To:
Page:· 3
Ship
To:
SHAWNEE COUNTY
200 SE 7TH ST
TOPEKA, KS 66603
DISTRICT ATTORNEY
Kathy Beach
200 SE 7TH RM 214
DISTRICT ATTORNEY
TOPEKA, KS 66603
!ACCT. NO.
I
Sales Order No.
PNW119382
CUSTOMER PO
'DEPARTMENT
DUE DATE
0000000
09/11/16
I
Amount Subject to
Sales Tax
Amount Exempt
from Sales Tax
Subtotal:
629.09
0.00
629.09
Total Sales Tax:
0.00
Total:
629.09
(End of Report)
. . w
.ver1zon
Account Number
P.O. BOX 4002
ACWORTH, GA30101
Change your address at
htl:p://sso.verizonenterprise.com
Iinvoice Number I~769601736
Quick Bill Summary .
OO_D.1625 07 MB 2.007 **AUTO T9 0 6401 66603-393364
•1 1111'111•ll••1'111•l•1''l11••'l•••l•'•11•1'1l11l'l·''•ll•'•IIII
SHAWNEE COUNTY DISTRIGT
ATTORNEY
200 S.E.iTH ST STE 214
TOPEKA, KS 6.6.603-3933
· Previous Balance (see back for details)
No Payment Received
$1,603.36
$.00
. Balance Forw.ard Due Immediately
$1,603.36
Monthly Charges
Usage and Purchase Charges
Voice
Messaging
Data
Surcharges
and Other Charges & Credits
TaJCes, Governmental Surcharges & Fees
Total Current Charges Due by August 27, 2016
$1,521.99
~
_...,.,,_•.._•..s.,_,. ____ o..·- __ .._.,,_• .,. •...,s.,.•a.•... •..::,...,.._•.z.•..,....,:.-:. .:.""' o..•.:,..•..:. _
;- _ _ _ _ _ _ _ _ _ .:. _ _ _
verizon"
SHAWNEE COUNTY DISTRICT
• AnoRNEY
··
:ioo SE 7TH ST STE.214
TOPEKA,KS 66603-3933
L
.._ •
..,.,_,.s........., __
.
.
$59.77
$21.60
$1,603.36
.<."..s""" _ _ _ _ _ - · - _ _ _ _ ..,....,,......_,..,_,,;; _ _ _ _ -·-·...-...:- .e:.•..s•..=c..•.:..•·u:•• . . . . . . . . ••••••• · - ·
Sill Date
Account Number
Invoice Number
.
$.00
$.00
$.00
$3,206.72
Total Amount Due
- - - - - ---· •··-···-w·"•·•-...,,,_._._ - ;.. -
Jul 02 - Aug 01
-C24-P01626-11
AUQUSt 01. 2016
9769601736
.
.
Total Amount Due
Make check payable to Verizon Wireless.
Please return this remit slip with payment.
$3,206.72
· $0,DDD.DD
P.O. BOX 25505
LEHIGH VALLEY, PA 18002-5505
IhII 1l I It •I I'It In 1l 1ll11l 11•1111ll 1h 1111• •mI' I 1l1I In 1l l1 •1•
•
·u--.,
Shawnee County
:oz-.·
Department of Corrections
501 S.E. 81h Street- Topeka, Kansas 66607
Brian W. Cole, Director
Adult Detention Facility- 501 SE 8th - Topeka, Kansas 66607 - (785) 291-5000- FAX (785) 291-4924
Youth Detention Facility-401 SE 8th - Topeka, Kansas 66607 - (785) 233-6459- FAX (785) 291-4963
Corrections Annex- 818 SE Adams - Topeka, Kansas 66607 - (785) 291-5000 - FAX (785 291-4930
MEMORANDUM
To:
From:
Date:
August 12, 2016
Subject:
NLETC Out-of-State Training Report - Consent Agenda
V--
On July 11, 2016 through July 16, 2016, Division Manager Joe Rucker was approved to
attend Control Defensive Tactics, Ground Defense and Handgun/Long Gun
Retention Training at the National Law Enforcement Training Center (NLETC), in
Kansas City, Missouri.
The NLETC is dedicated to providing safe, effective and legally defensible tactics,
training and certification to law enforcement, corrections, military and security
organizations around the world.
Overall, the training sessions provided valuable training and insight to the challenges of
de-escalating challenging and combative inmates.
At the conclusion of the week long training session, Captain Joe Rucker was awarded a
three (3) year Trainer Certification. To receive this honor, trainers must show proficiency
in technique application as well as instructing the principles. Prior to certification,
Captain Joe Rucker successfully completed a written test and a practical test, which
included student teaching. This training has proved to be very helpful and will allow our
agency to meet legal obligations and maintain safety.
I will be happy to go into more detail if requested and will be happy to answer any
questions you may have.
BWC:rjr
3
I
Shawnee County
Solid Waste Department
1515 N.W. SALINE STREET, SUITE 150
TOPEKA, KANSAS 66618-2868
785-233-4 77 4
785-291-4929 (FAX)
THOMAS C. VLACH, P.E., Director
solidwaste@snco.us
www.snco.us
MEMORANDUM
DATE: August 16, 2016
TO:
FROM: Thomas C. Vlach, P.E. ~
Director of Solid Waste
RE:
Recommendation of Award
Quotation 034-16: Rear-load Solid Waste Truck
Quotation 035-16: Front-load Solid Waste Truck
The Shawnee County Solid Waste Department (SCSWD) issued separate Requests for Quotation (RFQ)
for the purchase of four rear-load solid waste trucks and one front-load solid waste truck.
Four vendors submitted bids, with some providing multiple bids, for the trucks. The Tabulations of Bids
are attached for your information.
After reviewing the bids, it is SCSWD's opinion that the best, most responsive bid meeting the
specifications for the rear-load trucks was submitted by Armor Equipment (Bid #2) for the amount of
$488,118.40, including trade-in. As it turned out, Armor Equipment actually submitted the low bid for
each manufacturer of truck that was proposed, so no matter which bid is awarded, Armor Equipment
would be the winning bidder.
Furthermore, it is SCSWD's opinion that the best, most responsive bid meeting the specifications for the
roll-off truck was submitted by Elliot Equipment (Bid #2) for the amount of $166,477.00, including
trade-in.
The total of the five vehicles is $654,595.40.
August 16, 2016
Page2
In summary, the SCSWD recommends the following:
(1) It is recommended that the bid for the four rear-load trucks be awarded to Armor Equipment for
the amount of $488,118.40.
(2) It is recommended that the front-load truck be awarded to Elliot Equipment for the amount of
$166,477.00.
SCSWD customers will benefit by the approval of this request in that SCSWD will be able to continue
providing reliable, efficient service by having reliable vehicles.
Funding for these requests will come from the Solid Waste Fund (Account No. 25SW3 l O 59500). No
tax funds will be used for the purchase of these vehicles.
Your consideration of these requests is appreciated.
Attachments
TABULATION OF BIDS
AL'./3 1t?
DEPARTMENT
QUOTATION NUMBER
Solid Waste
PEOPLE PRESENT
Michele Hanshaw, Cassey Duer
NAMES OF BIDDERS
Truck w/
compaction unit
Amercian Equipment
Down ing Sales bid # 1
Trade In on
SW 3107
/- = '--'_)O ."-"-"
Zp .000.00
"'-0
, ~·~
v_,
_c../ ('t'
~-1 "'- A.• rf'
.,.,.- .J
O
· () ._lAuJ
l (),<7,/)..1• ?i D
76 . nr.,() . en ·2c..
. ·.,;
').r.:::-,']
, _._. -··_LI __
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('-f'-r".l'V",
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or--n or'<)
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"
~WE'
7 lJ,D44 .m
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_16 ,tcO ij '" ~-1. ·' -?/?A
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a -- ,,,, D
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411,CCD, (X)
I ,,-.:z.. ~, -·,,.-. !Y1
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4~ ,ooo. Ut)
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LJS JflO , (AJ
\oS , 000 .0() J lc6, ()(; t) J.x)
t h _ (,-:_
.,'{"'
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(1!
- -'l 'J>...A"-...J .. \..J ~
..,..I\.i,l.;.,/'{\,,4
,-,,•-, ' s< lf I
~ 1..,/
f rJ:::.,J-/)n.
J' V~_....,\J " tlt)·
,_,, \_
\.;f'
~
.1
0
T
t· \
_,1{
I '1-· +, -:/-{p I . oo
A
5' . . -
'
-
JJY-·
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Elliott Equipment bid #1
T rade in on
SW 3106
----··· -- ·-· ····---1-·-···--·-·--·--------······---1-------·--------·--- -1 ---· - '
fl :.,,.., '#-
An'nor E guipmenC#2
Trade In on
SW 31 05
1"'4 2 Jo lvD . CO
,.1;
Armor Equipment #1
Date 08-04-16
I B5 1 lvlo 6. 00
,
11l p'~
Truck Component Services #2
Subtotal
Extended price
1~D t)\ G
Downing Sales bid # 2
034-16 Rear Loader Truck
PH 2 ~
Ell iott Equipment bid #2
/ /J/
_./1-)
1
·
1L~, on I + tt>O.tlf5lt;,a)
4 ()).. r::=, J
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ir
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,rvt1
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TABULATION OF BIOS
DEPARTMENT
QUOTATION NUMBER
Solid Waste
PEOPLE PRESENT
Amercian Equipment
DowningSalesbid# l
D owning Sales bid # 2
Truck Component Services # 1
A@orEqutpmeirt#2
Date 08-04-16
Trade In on
SW 311 O
NAMES OF BIDDERS
Armor Equipment # 1
034-16 Rear LoaderTruc,k
.
Extended
Warranty
,......, .
J\JO b id
26 , cw.o()
cco; 0()
L{{ ?1, OO'J ' DO
.
{_f1JX1) ,0{)
! ~
i O,r;CC();-eQ-
. ,...-
ll?JX)O,C:0
,.C:-
~
_ 7,
-----------------------------
_ _ . f',,,
l'i
.
,
,
:::t.t 6\ci Htitntilt:V-16
_
I
.
.!,er:
..
f;;/1?\Mi1.01\t, Js.
/J....,
:'10, l_tCt.).00
..7 ") ;
... .
.
-:_:x:i,l/J00,00
.
. , ,
1n-C
.tbH!icr
.
/
.
.
ivrt Wied
<") .,..,
,..,
OU
!4 , 140, CO
'
t
_
sis . ooB. co
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,,,
_ ,,..
,..-
oi)
2()(::/ n dart+u,\Q,virf'Df'>
._j
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.
/f ~ ..,.
.,....
;
-
t
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E.HL22.8t.-
2f i)CleMo·t
tr l =l
'
i2HC.U3L
rkt-?H1ft
_
r:,
,
l~k? u .:dwio.5r,ry-
,,...
l:::XCd . :._;
_,
·
/ 1.--~ J'Jij,"(;(?~'1 -"J400 2.0)v UJl(t1pW(f;'{,_; EY.. Ce. _-._,
7~ 1-:f . _
. .
, . -;---, --.
vrerttf1+t LK£.V' /06:f:i:> Hf_,{ I UJ/-8i00 2/)I&-:;
Z.brJ
c'J.u { 7)1-<-1060 D
..
,,.,.
New VJflu !Lrr.t:f u!iJrt,_
_
~YlvJorft'1 t 4 1-t)
.
_
·
_
0 .
DD4 ,Cv w-e1c;ir1+-rn tLt I02tA)
0
~
·
11
~ ·.- i,-);
_
l'tA!l::-t}/H'e
4 2.J. gc,4,41)
_ n . , ,·.
(J
.
~
4 _t35-'-;:.l P:;: , ~fD ke:vlW;l tt-'r {L/10
5CD ,lff"vW-00
_
r
.
!j.), .
Make & Model of
compaction unit
.J .
•
4BB ,3fr"i, l.D ]J)FJ f1'"t'1C1h-Hiv!Gt j bt'.'.i~;t)
C. c A
:.0/JC(..JfCO
(JS,CJ:;D.
~
/JJ4Z, lJ;i.iO. oo k'..wwcq~·\t2+0D)enes
T-1- 6 3L~,oo ;:_,(:: ::ri ' ~
lvl1:X).ou
Make & Model of T ruck
---- --·
1-5,oCO, oO
4w
Total Bid
4 i3. I rn.co lr11-k-<t10tlT6t'1cl/ 74DO
•
. ,
.
1
.
-! .
/j
_.
1
IJ\lh;JlV11Ll llt.tvi tJJ.Pr,
·
, . _'
J
/\
f\JtuJ UJJL/ Vrrt ! .!JkJ
I
J
,
ii'(
;;i._
~UG 4
TABULATION OF BIDS
DEPARTMENT
QUOTATION NUMBER
Solid Waste
PEOPLE PRESENT
Frontloader
chassis
& Refuse body
Freightliner Truck Center
Company
Amercian Equipment
t,,Jr, p,;·~,,,f
f_i\ i O t. . ',·
~ _\t \
J! _,:t
;
' )
Date 08-04-16
035-16 Front Loader Truck
Ai
Trade in
allowance
Subtotal
.•
.- 1 - - - - - -·-
f'JD
B ;ci --
.L- {~~"'~
1 c,c.,
~t,· no
,,, .....
./':,
?
~
n·.~ . .... ~ •. ,.,_,.
---··1- - · -- - -- - ----l - - - - · · - - - -- --
-1.Ac.
(_
"Q_
L
'--t;J., ,P-:-2,f
}(./, . _
V
:..._,.,,,,";
Make & Model of
Chassis
Total Bid Price
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,
Shawnee County
Department of Public Works
1515 N.W. SALINE STREET• SUITE 200 • TOPEKA, KANSAS 66618-2867
785-251-6101
FAX 785-251-4920
THOMAS C. VLACH, P.E.
DIRECTOR OF PUBLIC WORKS
COUNTY ENGINEER
August 15, 2016
TO:
FROM:
Thomas C. Vlach, Director of Public Works·~
SUBJECT:
GLASS BEADS-QUOTE #039-16- PRIOR APPROVAL BY THE BOARD
OF COUNTY COMMISSIONERS-FEBRUARY 1, 2016.
DISCUSSION:
Bids were advertised and solicited for the purchase of 44,000 pounds of glass beads to be used
for retro-reflective enhancement of roadway paint striping. The following bids were received.
COMPANY
PRICE PER POUND
TOTAL PRICE
ENNIS PAINT
$0.300
$13,200.00
APEX UNIVERSAL
$0.309
$13,596.00
POTTERS INDUSTRIES
$0.309
$13,596.00
SWARCO REFLEX
$0.330
$14,520.00
PAYING MAINTENANCE SUPPLY
$0.332
$14,608.00
Shawnee County residents will benefit by the approval of this request in that the SCDPW will be
able to provide retro-reflective roadway striping which enhances nighttime driving capabilities,
thus providing a safer roadway network.
The financial impact of this request will be an expenditure of $13,200.00. No detrimental effects
to the Public Works operating budget are anticipated as a result of the approval of this
recommendation.
RECOMMENDATION:
Award the bid to Potters Industries, the lowest responsive bidder meeting the minimum
specifications.
Funding for this request will be from the following fund: 2016 Public Works Road Maintenance
Fund (Account No. 10PW126 50355)
AUG 112016 F'K 2:(t3
TABULATION OF BIDS
DEPARTMENT
Public Works
QUOTATION NUMBER
PEOPLE PRESENT
Michele Hanshaw, Cassy Duer
NAMES OF BIDDERS
Glass Spheres
Per pound
Ennis Paint
.30
f3.200,00
•
.30Cf
Potters Industries
Paving Maintenance Supply
133
,332_
~
.
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Swarco Reflex
Delivery
Total for
44,000 pounds
Apex Universal
039-16 Glass beads
I
I
(j)D8 ,CO
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t4'W
J
<'P
I
Date 08-11-16
Shawnee County
OFFICE OF COUNTY APPRAISER
Steve J Bauman, RMA
Memorandrnn
To:
Board of Shawnee County Commissioners
From: Steve Bauman, Shawnee County Appraiser
n\
iv
Date:
August 17, 2016
Re:
Agenda Request - Out of State Travel, Norman Ok.
I am requesting approval to send one staff member out of state to attend the New World Public Safety
Kansas-Arkansas-Missouri-Oklahoma User Group Meeting. The two-day event will take place in
Norman, OK on August 31st - September 1si_ The event will allow the GIS Coordinator to learn more
about the New World Systems and network with other local New World customers for additional support
of the Sheriffs Office. The newest version of New World software is GIS-centric and requires in depth
knowledge of the system. There is no cost to attend the meeting. There are sufficient funds available in
the Appraiser's Office budget for all mileage, lodging, and per diem costs estimated to be $500. Travel
will be by personal vehicle.
1515 NW Saline, Suite 100-Topeka, Kansas 66618-2838-Phone (785) 233-2882-Fax (785) 251-4903
New World Public Safety
KAMOUG User Group Agenda
Wednesday, August 31 - Thursday, September 1, 2016
Embassy Suites Hotel
2501 Conference Drive
Norman, OK 73069
(405} 364-8040
Wednesday. August 31st
8:30 am - 9:15 am
Registration- (Breakfast on your own)
9:30 am -10:00 am
Welcome, Introductions & User Group Business
10:00 am -11:00 am
Work Group Breakout Sessions: CAD- LERMS- Fire- Corrections-1/T
11:00 am -12:00 pm
State User Groups: Kansas- Missouri- Arkansas- Oklahoma
12:00 pm -1:00 pm
Lunch- (Provided by Tyler Technologies)
1:00 pm -2:00 pm
Enterprise CAD & Vll.x presentation by Norman, OK
(Topics to be covered include Mapping. Response Plans, & Managing Dispatch)
2:00 pm- 2:45 pm
"Answering your Questions with Decision Support: CAD, LERMS and Corrections".
·.i··:·:::?::.::ii(/("·
. : >~>~\"
6:00 pm - 9:00 pm
: ,.... ;
··.· ..·t
. :!:\
:,,:i;i~,,oJt~:~~l}~,;~~:~ilt~(,a~~Jivis ~~~orting
Networking Event provided by Tyler Technologies
Hollywood Corners
4712 North Porter Street, Norman, OK. (405) 701-4990
http://www.hollywoodcornersstation.com/
(Dinner will start at 6:30 pm)
•••••••
•···®·
Empowering people who serve the public~
~--------------------------------------------------,
New World Public Safety
KAMOUG User Group Agenda
Wednesday, August 31 - Thursday, September 1, 2016
Embassy Suites Hotel
2501 Conference Drive
Norman, OK 73069
(405) 364-8040
Thursday. September 1st
8:00 am - 8:30 am
Registration (Coffee/ Pastries provided by Tyler Technologies)
8:30 am - 9:15 am
Tyler Product Integration Roadmap- (Paul Case On-site)
Tyler Alliance, Evergreen, Everguide
9:15 am -10:00 am
"How Enterprise Records will be different from MSP" (Joe Olson or Eric Ponce Remote)
Examine how Enterprise Records, (Currently in Development), will differ from Current Releases.
10:00 am -10:45 am
"Predictive Analytics-The Future of Decision Support"- (Steve Lett - Remote)
See how DSS is evolving into the next phase of Public Safety Statistical Analysis
10:45 am -11:00 am
BREAK
11:00 am -12:00 pm
Breakout Sessions
"ASAP to PSAP Interface" Earl Karcher Onsite
E-Citations with Brazos? (Kimberly Germer On-site)
Fire-, "NEMSIS V3"? Connie Warner Remote Schooley/Hemphill On-site
12:00 pm -12:45 pm
Lunch- (Provided by Tyler Technologies)
12:45 pm -1:30 pm
"Unraveling a Major Crime in LERMS"- (John Devane On-site)
Examine clues of a major crime that show how to use all the parts of the New World software.
1:30 pm - 2:00 pm
User Group Business- (Next Meeting? Location?)
Wrap Up & Adjourn
2
Shawnee County
Office of County Counselor
RICHARD V. ECKERT
County Counselor
200 SE 7th St., Ste. 100
Topeka, Kansas 66603-3932
(785) 233-8200 Ext. 4042
Fax (785) 291-4902
MEMORANDUM
TO:
Board of Shawnee County Commissioners
FROM:
Richard V. Eckert, Shawnee County Counselor jff
DATE:
August 16, 2016
RE:
Claim of Allied Property & Casualty Insurance Company a/s/o Stacia Kolbek
11,1/L_/
-
Please place the following item on the Monday, August 22, 2016 agenda.
Our office seeks authority from the Board to pay Allied Property & Casualty Insurance Company
the amount of $11,000.00 for settlement in full for its claim against the Shawnee County Parks &
Recreation Department.
Factual Background:
Allied Property & Casualty Insurance Company, on behalf of its insured, Ms. Stacia Kolbek, has
submitted a claim for damage to Ms. Kolbek's 2012 Ford Fusion. According to the claim and a
report from the Topeka Police Department, on April 13, 2016, Ms. Kolbek was traveling
southbound on SW Gage Blvd at SW 10th Avenue when she struck a Toro Riding Lawn Mower
owned by Shawnee County Parks and Recreation as it was turning westbound onto SW 10th
Avenue from northbound SW Gage Blvd. · Allied Property & Casualty Insurance Company seeks
a total of $12,949.13 for the resulting damage to Ms. Kolbeck's vehicle, rental car charges and
medical expenses incurred. A copy of the claim, the Topeka Police report and photos of the
damage are attached for your review. (See Claim Documents, attached as "A".)
Mr. John Boyd, Superintendent, Greenspaces/Parkland Division for Shawnee County Parks and
Recreation investigated the matter and wrote the attached memorandum explaining his findings.
Mr. Boyd reports that our employee was attempting to clear the intersection and felt he had
sufficient time to do so. The lawn mower is quite large and has flashing hazard lights so it is
visible to traffic. (See memorandum from John Boyd, attached as "B".)
Responsibility of County to Pay Claim:
Regarding the issue of Shawnee County's responsibility to pay the claim, in this case, there is no
dispute that Ms. Kolbek's vehicle was damaged when it struck a Shawnee County-owned lawn
mower in the intersection of SW Gage Blvd and SW 10th Ave. The Topeka Police Report does
not indicate that Ms. Kolbek was speeding or that she had a red light at the time of this incident.
While it has been suggested that Ms. Kolbek may have been distracted or inattentive while she
was driving, there is also nothing referenced in the police report in this regard.
Our office has negotiated this matter with DeAnthony Zanders, Legal Subrogation, Allied
Property & Casualty Insurance Company, who has agreed to accept the sum of $11,000.00 in
exchange for a complete release, with prejudice, of all claims against the County arising out of or
related to this incident.
·
Consequently, it is the recommendation of our office that the claim be paid in the amount of
$11,000.00 conditioned upon a full release of liability signed by Allied Property & Casualty
Insurance Company.
Allied Property & Casualty Insurance Company has been advised of the hearing date and their
right to present evidence in support of their claim. If you have any questions, please feel free to
contact our office.
RVE
Attachments
c:
Mr. John Knight, Director, Shawnee County Parks & Recreation
Mr. John Boyd, Superintendent, Greenspaces/Parkland Division, Parks & Recreation
Allied Property & Casualty Insurance Company, c/o DeAnthony Za:iders, Legal
Subrogation, 1100 Locust St., Dept. 2019, Des Moines, IA 50391-2019
Shawnee County
Office of County Clerk
CYNTHIA A. BECK
785-251-4155
Fax 785-251-4912
200 SE J'h Street Room 107
www.snco.us
Topeka, Kansa~ 66603-3963
Memorandum
DATE:
May 23, 2016
TO:
Richard Ecke~~ Counselor
FROM:
Cynthia A. fa.eek, County Clerk
RE:
Insurance Claim
Attached is a claim filed by Allied Property & Casualty Insurance Company a/s/o Stacia Kolbek which
was received in the Shawnee County Clerk's Office.
As per Resolution No. 86-16, I am forwarding this claim to you for further investigation.
Attachments
A
CLAIM AGAINST THE BOARD OF COUNTY COivltvllSSIONERS
OF THE COUNTY OF SHAWNEE, KANSAS
Received Via:
IE
US Mail
Inter-Office Mail
Over the Counter
g \W ~
IIAY 23
,fm
a111 ·~
Fax
Internet
SHAWNEE COUNTY CLERK
Completed claim fotms must be s1.1bmi1ted to the Shawnee County Clerks Of ice,
Shawnee County Courthouse, 200 TI'., 7q1, Rnnm 107, Topeka, Kansas 66603. Where
space is insufficient, please use ndditional paper.
WARNING: It is n criminal
{.1:'ffn!ie
lt•
lt!e
i
f:1L~e
claim. (K.S ..A ••H-6004)
The undersigned respectfully r;nl::rnit:·i the r'ollc·wing claim mid information relative to
damage to persons and/or prop0rly:
I. N arnc ofcIa iman t: Allied Pmportr t, Cmm:.lty 11 ,rnranc1, Company a/s/o Stacia Kolbek
·--,----------,a. Address ofCh:inrnn!:: _11ooi.ao:,,:8! C•c";t._ZC19,_
(Street adore.%)
Q{;s 1\110::1:.J:,,
IA
50391
-------
(St ate)
(City)
b. Phone Number:
(Zip)
Home ·-·-·-·-·. ---··-------Work
s1%oa-3014
Cell
2. Namt:, telephone and :iddres,; to which ciaimunt desires notices to be sent if
different than above:
DeAnthony Zanders: Nationwide Claims Specialist: 015-508-3074
--------------
3. Occun"ence or event from which the claim arises:
a.
Date: o4 / 13 /20 1s
·
b. Time:----;;;;-· AM(/ PM lcircle one}
c. Location: 10th St, Guage St., Topeka, KS 66603
d. Specify the circmhstmices ofthe occurrence; event, act or omission that
you claim caused the injury, damage or loss. (Use additional paper if
necessary)
Alfied's Insured Stacia Kolbek was driving south on Gauge St in TopeRa, KS. A Shawnee Countr employee, John Shea,
,vas driving a
riding lawn mower north on Gauge. SI. As both drivecs approached-the intersectfon wilh 10lh, John Shea auempted.a left turn on 10th
in Irani ofARled lnsuced Stacia Kolbek, causing Iha collls!on. Both drivers-had a solid green light but John Shea failed lo yield Iha right·ofway,
AS a ,esufl al Iha collislon our lnsureo·s vehlda sustained property damage and our Insured Incurred rental ax1141nse and received PIP.
e. State how or in what manner Shawnee County or its employees were at
rau1t:
John Shea railed to yield the.right of way when attempting a leff tum. (See attached police reportj.
f.
State the names of any county employee(s) causing the injury, damage or
·
loss (if known):
John Shea
4. Give. a description of the injury, pl"opel'ty damage or loss: incurred as. far as is.
known at the tirnc of this claim. (if your claim f1ivolves a veliicle, include. make,
model, year and license number.)
2012 Ford Fusion,was repaired by Allied P&C. lnsurance,Company. The damage was to the front of the.vehicle. The
impact of the accident caused Injury and.Allied paid J;>IP to Ms, Kolbek.pursuant to,her policy. Ms. l<olbek Incurred rental
while her vehicle was being repaired. (See estimate, photos; and lnvalces).
5. Damages Claimed:
a. Amount claimed as of this date:
$ 12.eos.so
b. Estimated amount ofa11y future costs:
$_a_ _ _ __
c. Total amount claimed:
$ 12;s.os,so
ATTACH ALL AVAILABLE DOCUMENTATION EVIDENCING
AMOUNTS CLAIMED (1nclude copies of all bills, invoices, e1>timates, ect.)
6. Names and addresses of all witnesses to the incident
Name:
Address:
---------'-----Name:
Address:
-----------------------Name:
----------- Address:
Namc:
----------- Address:·
Address: -------------_ _ _ _ _ _ _ _ _ _ __
Name:
-----------~-~
-----------
7. 1fthis claim relates to damage to your vehicl.e or other property and you have
insurance coverage on the property, please answer the foflowing:
a. Name of insunmce carrier: Allied P&C Insurance Company
b. Address, of i11sm·ai:ice cmTier: 1100 Locust St., Dept. 201.9, Des Mofnes, rA 50391
c. Insurance pol icy number:_P_P_C_M_0_05_8_5_6_61_3_8____________
d. Tnsurance agent's name:_A_H_IG_·_ro_u~p_ _ _ _ _ _ _ _ _ _ _ _ _ __
e. Agent's telephone:_9_13_-_83_9_-1_4_7_8_____________
f. Do you have collisfon insurance? Yes...Y'.'.'._
No
g. Have you reported this damage to your insurance carrier: Yes_L_ No_
h. Have you been paid anything by your insurance company related to this
No
claim: Yes_y_(ifyes, state the amount$ 349.16 )
i. Amount of your insurance deductible:$ 500 ..QQ___
8. Please provide or uttaeb any additional infom1ation that might be helpful in
considering your claim:
The claimants insured carries collision, rental,. and PIP benefits coverage. and this accident was reported to the claimants
Insurance carrier. Pursuant to the terms of the insured's policy, the claimant carrier paid fer the repairs to Ms. Kolbek's vehicle
and for rental while vehicle was under repair and PIP benefits. This claim is for relmburserrienl for the amount paid for repair,
rental, and PIP benefits. The total amount gaid:to oron behalf of Ms. Kolbekwas
12,aos;ao which does include the insured's
ileducUble.
,)
9.. Please attach copies of the following documents if avaifable:
• Ttemized statem~dts ·of estimates of damages. Three repair estimates are
preferred.
•
Itemized paid bills, cancelled checks, etc. as proof of payment for the repair of
•
the datnage.
·
Photographs of tire damage done to the property,. if available.
Please be advised, Kansas Statutes Almotated 12-105b provides that a claim shall be deemed denied
if the County fails to approve in its entirety within one hundred t\venty (120) days of the tiling
rt
date.
NOTICE: W-9 Form Requirement - if the event this claim is approved in whole or in
part, the County will require Claimant h> submit an I.R.S. Form W-9 certifying their
Tax ID prior to any payment.
WARNING: It is a cdminal offense to file a false claim. (K.S.A. 21-6004)
I have rend the statements made in the above claim and I know the same to be true ai1d
con·ect. r certify under penafty of pe1jury that the foregoing is trne and correct.
Signed this \ ~
(l
day of f)1~
20lli
1
OIIIIIIH
Account No. 055 7SI
NAT-OH
VM
Attention: Rafael Dominguez
NATIONWIDE INSURANCE COMPANY
Customer Service:
Metro Reporting Customer Support l-800-245-6686 or help@metroreportirrg.com
Metropolitan Reporting Bureau
BOX 926, WiIIiam Penn Annex
Philadelphia, PA 19105-0926
FAX (80Q) 343~9047
Type of Report:
INSURED
STACIA KOLBEK
CLAIM ,..NUMBER:
967715GC
POLICY NUM.
PPCMOOS8566138
:
DATE OF LOSS:
04/13/16
LOSS STREET
10TH ST GUAGE ST
LOSS CITY
TOPEKA KS
AUTO ACCIDENT
POLICE DEPT. :
REPORT NUM.
INS. DRIVER
KOLBEK STACIA
OTHER DRIVER;
PCT. /DIST.
DESC'..OF OTHER~
THANK YOU FOR THE ORDER!
Any questions or problems please feel free to contact mi.
PH. (800) 245-6686 or Hclp@metroreporiing.com
rJIIIIJIWrJl~ll~,111m1~1~11r1~11·
L
*5036824539*
_J
Kansas Motor Vehicle
Accident Report
KDOT FOITll 850A Rev f-2009
Mii,po,1·
Fro;n m11
II
Rl:''illl°Cdb)'
fc.
TOPEKA POLICE DEPT
003
17771-16
rn•~d~ting Oflh.,:r N.an1':'
B•d~'I: Number
J. HARRISON
ISW I10TH
OlockN•
le;:/:;;~
04/13/2016
35
lt~a<lTypo
TkkNotitkd (ma,'<l<V)m)
ll~Sl'.t . SpdfJtll
BLVD
... SW GAGE
04{13/2016
40
Norn.ti\"<: 1)<1cr,bc: cech iraOio uni rs pn:~h mo1·e11,1n1 At>d dlrtction ort1,vc1
flue AITIVM (~tnWd/);');')
04/13/2016
01 SOUTHBOUND ON SW GAGE BLVD AT SW 10TH AVE. 02
TURINGING WESTBOUND ON TO SW 10TH FROM NORTHBOUND
SW 1orH. 01 STRUCK 02.
First a111c
M:~rik:.Namc
SHAWNEE c<lUNTY
xrxrrif Ob;rct 1' D,rn,iw .l: N.,lul\;orDam,~·1: (>lt!JI'' in 1li•f.llltn)
,RA:..,·s.mc ···-··-- 'iilnTllame ····-····
WE
l"imc Motlr.
I1ly
1.1:57
WE
lunc.~niv~
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WE
PDO>= n,ooo
PDO<Sl,000
D Privutc; l'rup1:rty
-·· 01 Construction
n.,..,.,. __ ,..,_,, _
6~JI
TOPEKA
KS 66606 (786) 251-2668
Woil(PIIMe
-·
LJ
-1.0CATIO!llN WORK7.0l'l"F.(A01)
01 Beforo ftr.;t warning sign
02 Advance warning area
03 Transition area
rcrm2I rhnric
Mlddl[NAme --·- City·-~·--·---··-·-~ St.to 7Jp ···-·-·won:Pitor~ - - · - · -
04 Acllvl(y are.a
99 Unkncwn
05 Termination orea
IJ!J
Ll<lllTCO:'iOITJO:',S
01 Daylight
04 Dark: street llghts on
02 Dawn
05 Dark: no strealltijhls
03 Dusk
98Unknown
~ - ,10111::KSi,: wi;snrnR
l
ON ROADWAY- {within ir.'°'11,nn)
12 Intersection +
coxomoxs
15 On Crossover
02 Sleet, hall
17Toll Plaza
03.Snow
OFF ROAfW,/AY:
04Fog
20 Shoulder
21 Roadside (not shoul<!er)
22 Median
05Smoka
06 Sicong wind
,..•. 23 Palldn9 lot or Rest area
07 BloWlng dust. sand, etc.
OB Freezing raln, mist, drizzle
880lhet:
1<1 Rain &reg
99 Unkr.own
16 Rain & wind
24 Sleet & fog
36 Snow & wind
01 Four-way lntarsacUan
99 Unknown
SURJIACF. n'rr.
AT~
01 Concte[e
03 Gravel
03 T •intersecillln
oe Roundabout
88 OUm:
(S-n Manual
07 Traffic Circle for Oefirl~oM)
99 Unknalll"I
06 Part of en lnlerchange
99Unknown
l_.21._ TlO.lh srf.CTAf, J!RATilRF.S
~ . SlJRF.\CEGClNDITr()ll'S
ON
AT
01 Dry
88 Other:
02Wel
03Snow
OO·Nona
01 Bridge
99 Unknc.'ln
04 Ice
os MudldirVsano
(upto3) .
OODD
02 Bi1d119 Dverhead
03 Ralfroad: Bridge
04RRXING
02 Lane shift / crossover
03 Work on shoulder/ median
99 Unknown
•COLIJSIC>N, WITH YEUICU
tnn,lt" I l»x per side lhl1Jlfi<.1bli)
pt--
·-
L
01 Bridge sllucture
02 Bridgo rail
03 Ct~sh eushJ!mpaet attem,ator
04 Divider,. median llarTler
05 Overhead slg, support
06 Utility devices: pole,me.ter,etc
07 Other PQS.I or
00 Building
09 Gusrdrall
10 Sign post
11 Culvtll1
03 Angle - side inpact
04 Sidesmpe: opposite directiOn
05 Sklesmpe: Same direction
06 Backed fnlO
BB Ollar:
99 Unkna'lln
TRAJl!llC C:ONTROL'i
(llll/,\t l/1.ld) Ill,\
.[. TYl'01'1<tu.i OICll\'1'
'
001'.'om,
Ot Officar, flagger
02 Ttaffic sign81
03Slop sign
04l'fa9her
05 Yield sign
14 Hydr,nl
07 RR CJOSsfug signs
20T,ea
·-
M•" ll•cntt'ul Ei:fDC
02Reer end
12 Curb
13 fonce/Gafe
15 Barricade
16Mallbox
17Dftch
18 Embankment
.19WsD
L.
01 Head on.
bls:u than16t1 frtrtt
polo
05 L • lnlernctlon
04 Dirt
05 Bilek
02 Five-way 01 more
04 Y • lntersectJon
02 llUlcl<top (Asphalt)
ut11ltF.n 011jF.CTTYN:
[n,., k I l,ox ~" si<!• ir ,pplic.,~~l
~ +11\'TT.RSRC:TION n'PF.
68 Oiher:
Ot Lane closure
LJ
99 Unknown
1,1 "··-··· ~""'
-WORK ZONE C!ATEC:ORY
04 fnlerm:11ent or moving vehicle
06 Fixed obj~"
08 Other obfeci: RIDING MOWER
_J
__j
as Other:
·-
02 Pede9trlan
03 tt.otor vehicle ln·llllnsport'
04 Lege Uy Parked Vehlc!e
OS Railway train
06 Pedal cyc!lst
07 Animal Type:
14 AcceS9 to Parking loUDrvwy
15 Interchange Area t
(lnurlc l lxapcrl'id•)
,l1iel U1tm[ul" £'1·,ot
st nacm!al Ertnl
COLLISION WITH:
13 lnl81'!18cUon,re/atad t
01 Rain, ml&t, driule
~
ACCTDJ:lffCI.ASS
00 Other non•col'is!on
o1 Overtumod/RoUovor
11 Non-lntersecUon
00 No adverse conditfon,
~ON
~
ACC,.LOC,\'flO:t
£0[1<1H@m1r111 f-r••O.
·0
_.... - -..,... , ........1.., - , . , , , ,.......
03 Ulifity Zena •
99Unknown
.,...,_. •,,. • ·'=.·•-•·; · ,.-;.7··-.·,,.1,•:,C,1 Ofll.Y,CIICOS.i011P COOE'..1;,JiR"<!!.\~RY UlnP.>-SS1'£C!fl ·O..On!•=II~''-"=· c;: ,,;_·:-;,-;';fl, 0 :a{== ,..-, ·,,
L£:!_j
AT~
Zone-·{§5 ·
OZ Malnlenanc:e Zone •
Cly
1"'1>:r S11t1:t A•~
Ful.ol
Injury
oo None Apply
rCNd:ul. rhnnc
7Jp
~Acclacnt Severity
W!lRKZONEiYPE
__Q!JOl'i
t;J~ TO~O RIDING ~AWN MOWER···---··- 41400 SW CONSERVATORY DR··---·---0
""" .Mt Name
Day
1f:55
11:57.
Luni,>it1i.k (AOI)
Owner Stta:t Adlln.s,
0DUI
D Hil&.Run
Loli111<le (,\O!)
Ph~:os by
KllO"lif <ll>jl!l:t I o,ni,gw It No!W\! of Dom,g,., (>huw In ,Ji,!lf..n}
i1 / 7
llirSlx Spdl,~I llflf( of Aui~c11r (mm'U')m, T,mco.cur.
AVE
F!/1111 Front DI.Dir.Pl'<terlreoco-a<AIRoad Nan•
'.•
147
l!Md Typo
Di< Pf.< 01t RC<rl Nam<
D. Amended Rtport
:.:;Uoiial,GawRa..=;-.;l pagc of
lnvesUsn1u1g Tlep<Vtmen1
'a
~o
...
1
y
1
02 0K
2
09 ~OK
'JA '02 10K
iA 4 09 10K
l
•
)
06 RR gates I &Jgml
08 No passing 2one
09 Canter/Edge fines
10 Warning signs
11 Sthooltone signs
12 Perfdng Ines
06 Oebr1s {off. etc.)
05 Interchange-
21 RRXING flxlures
07 Standing/ moving water
OGRamp
88 Other.
8801her.
OB Slush
99 Unknovm
99 Unknown
99Unknown
-
SPECJAt KVt:NT
Accident Diagram
85M continued
llO.~IIWA'I'
04
04.
OH
SPF.CJAl; DATA
llOADCIIARAC'Jl:11
01 00 SP.ECW.JilJUSDlCfJOS
AT'---+-'--~·
NUMBER OF L.\k\£8 '--~--'O~
.\'I'
00 Noimal Jlirisdiclion (Not Spe.:ial)
01 Straight & Level
01 One
02 Straight on grade/slope
03 snalght en hlllcrest
0.4 cuived & lover
05 Curved on grade/slope
02Two
03Thnie
04 Fourta, Six
05 Seven or more
_________
8801her:
99 UnkJIOwn
06 Curved on hillcresl
_.__ as Other~----90 Unknown
01 Na!iQn&I Park SeNice
·02Mllitary
03 Indian Roservation
1)1
nn.1a
Abaslodiag,am "'·required tar an~tale reportable .
acadents shawlng mOYement», dlcecifoo,.lllld·posilion,
o/ a!I traffic unlls in lllillionslllp io the llafflcway.
Identify (label}. the stroct(~) and traffic unH(s). alo.'lQ
v.iln· Ille area or Impact (1101) where po$Slb1e. Reier
to venides arid peo'esllfans bY. unlqvo. numbers
assfgned In lhls teport
· ®
College / Unfversily Campus
05 Other Federal properly
88 Olher:
)1ldlcate North DlreclJon
---------
99\Jnknown
o+o
0
0
O
O 0
t
\(>
~AGE BLVD
l
r
--$
f
~
----
SW10THST
AOI
')I~
·~)
~'
AOI
12 FT SOUTH OF NORTH C/L OF SW 10TH AVE
16 FT EAST OF WEST C/L OF SW GAGE BLVD
JLH/1.47 04-14-16
I
Occupants & Vehicles
1~Yf!tl1,,,cin;Olli«r/Rodi;cNo.
DRIVER & PASSENGER INFORMATION
~.m,~ of
l:c?,1.ocalGase'Nfi,.
(reco1d pedestrians on supplemental fonn 854)
J. HARRISON 147
7771-16
j3 / 7
n)&.:",; ··~"Y.10UT10!'lS"CllARllr.nlb_ ~-, .ci... : ,·':'.'! ti ,;,:;_cn'.ITIQY.(,:· , "¥ 'Tl.'I ,,· ;,·;;YTQ(;,\ TIO'NS·CIJit.nor.n;.-ol.lo;a.v!Clid(a:,,,:Wli•li!'.fiQ'~ k ,Cr?ATTONI '; ·.·.,
KDOT Fann 8508 Rev. 1-2009
I
I
I
I
I
I
I
I
I
01
99
P2 f 99
I
)
I
j
I
I
I
J
I
J
I
j
I
Uiiiu.,;: ow.v1,itus,n1;r.o· -~ •.•·:;: rtkttcl<!uar,.,;,;;~_ '" :1?.~Y~1<:ll.\?!l.~~J.1!.~!!ls~.r;J~.~~!!1$:,·J::r-~ ~~1!\i~~~-:i ~~~\w.~'.... rM~!!!t 1,~J!#.t
scu·r- ·Ul!tVliK }lrii:r1.in:~,_ ·• , .: .., 'lJa!ooruGii:: '" Citw;.-=··. .,,., ~, '!'.. ,•;..,..,st.l:, ·-~:.:Zlo,:f:.; -WciilPbilrii!Numba' ,, ;.,. n\w. 1t:;..:i1r,;,'i,:- 1!i&i:1.,i,. ~,i,-.tloo?.
11
'01
sr 01
KOLBEK
~~;~~~-- ..·---- · • --
i'l
535 SW WATSON AVE
i~~o;;;;;- -T~·;·~; ·--
~
I
OL~101, 1)1i\ing fo,
FJ11ployrt1
RESTRIC:T l:CJMP!. Y
GOMPL\'
00 NolfceMed
Restrictions?
[BJ
a 1 Valld License
02 Suspt!nded
03 Revoked
04 Expfled
I
CUI,?
O 0
!.1lM~ll!R(;(AL !NOORSE.\!El>TS
I
07 Resbicted
99 Unknown
OTO· l::'lidanuaryTest gl'len
Tesh: HGN1 -...11r.and.1t.:m, cno !e,g: ~l.!l'ld, t~
_o.__
tot:"ts ;1,;o:,o1~0111 itr.ats """'"'I
05 Obselved
(Odor. S"'JQttfrg, !/1,m,d sp<«J\ l!C)
O 06 OU1ar (e.g. $8fiva lasll
0 . O BIOOO (BAC)
0.
D
Drug screen rnuil
D DODD
Z -None
D
20 D
30 D
40 D
P • Passenger Vehicle
N • Tar\lc Vehicle
H• Placarded Hai. Material
X • Combination TanlcJHazMat
S - &hoot &Js
U- Vnkno'MI
,o
07 Resir.~led
suusr.utci: l!SI!
0 M> - ~ho! Ingested (n111t.. oll 1hl1 opoly) 0 DC - !Regal drugs.conlrlbuted
0 AC-Alcohol con!ribufed
0 MP- Mecfrcation.!ngeSled
D DP· l!agat dntgS lngasted
0 MC· MedlcaUon contributed
l~ll'AIRM!Nl' 1E~1'
,\lf;l'IJOD Ill' DP.TER1'11N.\Tlll.'i
rn,i,~ all d•,,upply)
[rmsl ,11~,at ;Pt'ly)
0 NG • No Test gtven
0
D OTR. Tesl Re(ililed (Ncc,~ol/Orug)
O 01 Evidential Test (Brealh,B1ood,e1e) 0 DPT. Frellm Positive Test (PBT)
O 02 P"nmlna,y Breall'I Test PBT
O TG. Evidenli8cy T.usl given
AWll.illl.
00 N'o avfdanceolfmpainncnl
0
D Evidanli3ry Bre31h D Eye Fluid
O 0~ Passive Alcohol Sensor
03 Behavioral
QJl.lllili.
TOIL\ HGN, \V~-i1~-lu1n, orie l&Q ,1anc1. t'L
D O RP • Resulls pending
D cl/idw~ary Brtath D Eve F1uf9
t'\l«;Ohal Se R!Or
_o.__ 0 04 Pas.Iva
(ftlacllolcdldl:o.,idtl',-anmcu;h)
Omner
_o.__
I I
CU.\lr.lIRC:tAL ENDOR.~E-'IE.,1'11
T -·Double/Triple Tmller
(nll>l lll lbll G~')lly)
O O RP· Resulfs penoing
C'Pl.7·
03 Rcvokad
04Explred
l~ll'A[RMLYf"T~~T
[81 oo No evldencaol lmpalnnenl
IBJ D TR. Tesl Relused (Alcoholitlrug)
O 01 Evlden\ral Tes\ (Brealh,Bl<lod;elc) 0 DPT. Prelllll Pos!Uve Test (PST}
RE:l'TRl!:T t:OMPL \'
I
O D
Driver, Lie Comp•ad•
~ L1!.
99Unknallll
.llllliGll. IB}NG•NoTC$\gr,~
DU.'lll< llrivi119 ror
RestricUons?
06 DlsqunGrted
S\'IISl,\.'iCE usi,;
ME'TIIUD orolTtlOH:-ATl(JN
(n•illk 31! l~~I Appl)-)
D
ao Nor foenscd
01 Valid llcernie
02 Suspended
05 Cancld or Denied
D AP • AIC!lhol lnoestod ,..,,, All ll•,119ply) D DC· Tilagal druos convibutod
O AC - Alcohol conlributed
0 MP • Med!cadon li1Qesled
D DP - IUegal drugs Ingested
0 MC - Medl~lion cooilibuted
0
s,.,. , Dri«(1 li«n«: Mum!itr
Cl~\\PI.Y'
U-Unk110M1
D 02 PrellmlnacyBreath Test PST
N
N ------· -··c:T~.
....
j_j DR tJ(:EN~E
ranx
O 03 Behavforal
s
'F.mployctl
DODD
Z • Nor.e
05 Candd or Denied
06 DisQUallffed
I
DL
T • Doubfe/Triple TMilet
P • Ps~ngcr Vohlde
N.
Vehl:le
H. Placaroed Haz. Material
X • Combination Tank/Hazt.lel
S • Sthool Bus
MmlillL
2;· -
.
K03173741
I ni I DR LIC:&XSlt
F
~:·KS f66;~-·· w~~ -·-·- ·-··
·---- ------- .. ____ . . ·-·---· -·- . ... -- \l'IIR ----·----·--·- - ----- -----
---··- . -....-----·-·-- OOR
KS
APTf'1 0 (785) 506-6863
Q05 Ob5erved
(Ofor,.,""»'tt-vi.wn-ed 1peuh.01:>)
D 06 Other (e.g. saliva lest)
.Q..__
_o_.- -
D . 0 81coo (BACJ
O OUter
D
I I.
_o.__
0.
Drug setee11 resull
.!li.!!!l.:.:.~ 'Pi\SSl!NGJ!ll Lh1Nimc:.: ..::,-_,
MlddJ,i'/lm, ,7;' PA~~9!!1S.W,!!E!~J~~;~!!).~~~~c.!~E ~o:wll'oo...Niiiit\u' "'~J!. ~)£.~~r. lii~1i!trir.,."",'fl'Y!!!
Stllt'l°'m: i•t.SSl!NGHR:l'•>I Nanio .. · :.-, : :0u1.i oC lfmb ·,.• , £:~l- · · · ,. 1.• ·.. :' , ,:. , i·Shllc,: ·• Zto . :~ Work l!hui, Numtici.•' ;; ~ ; .:Ji•o• • l:'ll!IVl'n,n Uil:i:t.l'wf.b'·~ l!iimcAtlun'!,
(\JO 1
KOLBEK
M!I
ST' 05
MATTHEW
~~,11/2015
·---··-· --··---··---"-·---·---
- -·--..
APf"'t D (765) 506'6863
---. ·--------···........- ...--------- -·------·---TOPEKA
I KS 168606
535 SW WATSON AVE
\VOit
M
88
·-~--- - ..._
I
N
N
__ .... -----· __ . _..
ru
,
~
.
0
,
D
TIJ
- - - - · - - - - · · - · · - - - · .. _ _ _ _ ..... I,..;.,..--·- . ··---·-·-... - .... _
ST
1,011
ITU
IM:'-1
~-· -·-·---··-··-----··-·-·- OOH----··
l"r.an.."-PQr•
ltM:. JIJ'lr: Nooueg
IIJURd t,1..(CR h~:
\lull
F.~1S Ani,N ,F.\iS T1D114iH01p luJU((J lzlcn io;
.. , .. ___________ ...... - ....- - - -..- -
I
I
- - - - - - · - - - · - - ___ ,.... -
-------~----
\VOit
~....~111?
- ···--··--------------;-~----··- \\'o,l·--··-·------ ~- -··· ----·- -··---T!"WII\IIUrt
Ualt
D
D ftr.,<lilcl
IC."'• I line. N'1l1Um I lnJ~Cu Ull\,e.,1 uy
D ..
Occupants & Vehicles •.,,,,
I~~:~:t
8508 Continued
~;~~K Nunc
I
·- 01
('.Stm<" lfUtim)
,~dJ~N:im,
Nim<
(785) 506-6863
cm·
Worx.P~:ie
I I
&T
KS
C."OLOR
I
MAKI(
MODEL
BOOHTYll!
FORD
FUS
40
Y£AR
2012
7.IP
66606
LIC£N~£ PLA TB t
O,,Jill)'
8127953
SN
I
~
F.xp Yll
l1l$\1r.inct C~1p.i.ny
11
ALLIED
[
;or~·lf
r
l
I
MAKE
ST
3 Slolen
6 Dliverless
Worlc·Yhllllt
7JP
·--·-· __ ,,,-.......""'....... ...--........ --·-·. ---·
IMCCC1
1/Jl,.ofTmycJ ,- 0CC'Jl'""li
Pollcy1'1um!>tr.
t
I'
2 Non,Contacl
5 Pursued by LE
Legaly Parked
Odo:'llrltt
3 Stolen
t 'ti'
1 Towed away
due lo.damage
6 Drivertess:
•LNWJ:/ill!,\YY. V~IUCLl!LOCYWJlovOI' f~~bll
10 Singfa heavy lfl.<ck.>10,000 Iba
01 Aulomobijs
10 Sin11Ja heavy vuck >10,000 lbs
02 Molorcycle
11 Truck & 1rsner(s)
02 Motorcycle
11Truck &traRer(s)
03 Moto1 scoot~r 01 Moped
12 TraclOl'-l!P_He,ts).
03 Mrxor scoote101 Moped
12 Tracto1-ltalle1(s)
ICalrubJtd
ctimpact spc,d ",
J
04 Van
Cl5 Pickup lruc.k <10,001 lbs
13 , - =m,y "''
f4 Schoof bu~
. llui Sot
05 SPotl utility veh. SW
16 Transit(cityJbus
07 Camper or RV
18...Other
b\Js
........ --..--.-..
25 Train
09 All-lei!ain yqhfclt: ·ATV
88 Other:
~
\'liJHCl,F.USr.
02 taxi /limo
oa Police
06 MiHtaiy
Power Source
99 Unknown
\'F.JIICJ;F. ll"AfACR
04 Destroyed
Dt Carnage (mlnor)
88 Other:
02 Functional
03 Disabling
99 Unknown
1.oc.mo~ ,\Rt.A
~ Y£H. ~wm. DE.FOR!: 11,\"liT,IB, lllT.
1! Slopped
fir.,\ JmpJcl ..23._ Majur Jmp.icl _g_ 01 Stralghl/
11,oucr,
following road
02 Left Turn
x,21J.,i,tm ""'
-1
B(1~~'f~
~~» 1,)C~: H lu6.J
0
ft 00 __i\Jc:::;;;~ '"-)( j 10 I ~R ~A ! &
6,1;
'°
7
1&01her wlmlo.._~ Q89Unknown
o· H l:nlfre whlde damage<!
rr·------· -.··
---···==·---·-·
Tralfer. Present/ Damaged
\'t:IIICLt: 51::QUtNC!s 0J>'£\'J:::-frS
04 UTum
14 Disabled in
roadway
OS Passing
D f4 t}fl(/arcarrlage O is \'tlndshlcld
osaothcr:
03 Right Turn
awaiHng turn
12 Stopped In ti-ar
13 IHegally parked
06 Chanijfng lane!
07 Avoidance man.
t5 Sfov,ingor
sloppl11g
ts Nagotlating a
CUNe
06Mergin9
09 Par'xlng
880!her:
10Backlng
ggunknowo
(Lil( up to~ fMtuall fn 1Bt onlt1·o(occuron1e}
OODDD
0 The eiact ~uence Is nnknO'Nn
XON-COT.TJ.stQH
(!IILUSION l\1TII
OB Farm machlneiy
25Traln.
88,other.
os·Pollca
07 Ambulance
03 Schwl bus
OBF11a
04 oµ,e, bus
09 Mail/Parcel
05 Military
99Unknown
llAMAOF.J.OCATIONARf,A
;;o
2
l
aoNone
JD
I:
~
.3: JU, ,=:.:\ 2=~U -II ; JO l9R[~,l.[1
03 Disabling
u
99 Unknown
YEJ! •.lt.\SU, BEFORE l!S~i,\B..m;
s
01 StralghV"
(ollowlng road
02 leff Tum
11 Slopped
awaiting tum
12 Slopped In traf
03 Righi Turn
1:lc Illegally palkea
68
04UTum
14. l)tsabled In
7
06 Pessin9
Ot4 Umle,carriage D 1a Wlndslieid
QtaOlherwlnoows 08DUhli/lGWI\
D 17 l:ilt!ie vehlde damaged
0 &Bother.
... ---·=·- ---.. - --
~
04 Destr4yeo'
02 Functional
J.Mor lrnpac1 _
J,\
99 Unknown.
vr.mcr,r.·nAAIAGF.
Ot Damage (minor} BllOther:
~~lnE -'"
I
' PcWor Sou~
_J
nmrJ,F. usi::
J.
--J
..._1s.OU,er bus....
09 AIMiurain vehicfe.-A.1V
Fir,;! trorii:1 __
nus 5'ar
• · c~cn,
Tr.1iler: PtsSent I Damaged
Vl'.IJICL£ Sl!QU~CI! 01' J:Vl!Nt9
~y
15 S1o11.ing at
06 Changing lanes
stopplna
07A~oldence man. 16 Negotiating a
CUN8.
08Merging
ae.·othei:.
09 Parldng
to Backing
99 Unknown
(t.lM u1110 4 per •nltl<> 1hr or>l11 oloccur111ct)
r:=cJDD
D Toe exacl iequenco 1, unl<nO'MI
cuu,sms.wrrn
liON,C01,l,1SfO:'i
10 D~hlll runaway
2t Ptdil,trian
02 Ran off road left
11 Trailer sv.ing
22.Mo1or,veh·1n-1ransport·
03 Crossed ce ntel1[ne
12 Separation ofunits
23 legally Parked Vehlda
04 Overtum/Rollo.v8f
l3Jackknlle
24
25 Pedar cycle (bike;.elc)
05 Cro5sed median
HFllll
25 Pedal ,yde (~ike, e.!q)
02 Ran. o!f road left
1f Trailer swing
03 Crossed' ~entelf n!!I
.12 Separadoo of units
23 Legally Parked Vehlc.'e
04 Oilertu.rn/RO!lover
13 Jac~knile
05 C:rossed l!tedlan
14 Are
06 Fa!I/JUmped lrom veh
15 E:lpfosion
10 DQWnhlll runaway
School
I
j).1 Ranoltroad rlgh!
2t Pedeslr1Dn
22 Moler veh ln,transpor1 ·
OI Ran off.road rlghl
""""'''""""
J· .
14
bus
15 TranslL(cily)bus
01 No speclalu!e·
02 Ta1i I Lfmo
0
nt.lmpKI
06 Sport utility v~h • SUV
u
~
ttculol(J,p<Od
05 P"rdrup truck <10,001 lbs
01 Camper or RV
OD None
07 Ambulanc11
06 fire
09 MalUf'arcet
99 Un~nown
03 Schoo/ bus
04 Olherbus
--J
.,_,,,,.- ,
.08 Farm machinery
!.E:!J
Dl No speclal use
. · Ca()lti1y
MVan
.
ST
I
1 Ha&Run
~
I
BODY ~,YLB
MOD.El
I
Fi/r? "'£PiUAt.L'0.'<1lJ1t<l.\S10~;!'
:~~; ~ r}11iAlllf1(i\~t~f~:-~i· .J,· f,
7Towedaway
due to damage
-
P,1'Moll ~hono
Vl!lllC'lh Wll.'i!JNC.\11011 NUhWllll
ID
IO®nl<llt
D
County R•p vn !lrmo,·rdu)':
L1C:BNS1!rU7Ecf
lAROli/ 111:,\VY VhlUCUHGCVWRo,er 10.00011:i,) __J\'.t:W(Ll:; UODY l'Yf.t:
01 Automobile
0
Yl?,\R
i1u>!m1:1r
Ti•surance Cosntwt)'
5 Pursued by LE
vi,:mcu:uouvnPir
!Ale cc,
;;r~~ri~-8566138
2 Non-Conlaci
1 Hfl&Run
4 legally Parl<ed
~
I'
f
, COLOR·
r;orTrof,I I
3FAHPOCG5CR156682
; .:.~_·t.JcAJ,'f"IC
~,rru1, co~tTJO.'•!Jf
:]' .
:"l_n;:1::- ....f'.,;., 7
I ~.
....,,wb>~
\'l:JUC'Lli IUIJ'HWIC,\'fl01i IIUMUl:.I\
14 / 7
I
CITY
KS
KITCH TOWING
2016
''. ; -1.o121 Case'N0:1\r. .l~~ ~,
SPF.CIAI .. DAT.\
llll'NHR AODR ESS !Nund>.T, :illl.>:tl
535 SW WATSON AVE APT 1
.TQPeKA
I
7771-16
(02, 04, N2, X4, elcll
.
OWNl!lt L>.!1 rtlunt l'SM!t"'IU>iiverl, OWJ,lliRJoi1m'fu110
rliddl<Namt
:;1~>l.lrt,,rQ Ps-r,.,,nol Phnn:
0\1/NER ADDRESS (Number, S~<cl)
BLU
1111
SPF.CT..\f.DATA:
f(llt, 03,Nl, XJ, efc)I
.24 T1ain
Train
26.Animal
.08 FeWJumped from veil 1S Expfos!on
28 Animal
07 Thrown or t.ilHng object 16 lmmer$ion In waler
'}.7 FIX~ Ob!ec:t
07ThrOWTJ or (allfng Objccl 16 lmme~il In water·
2Tfllroo Obie«
Oa Cargo loss.or shi~
B8 Olher event:
28 Olfler.111Q'lea~le oblecf
08. CargQ.loss or shill
88 Other event:
28 Olt(er moveabfa objcel
93 Unknovin non-coll.
99 Unknown object
09 Equlpment raaura
(Ure. brakes, etc.}
98.Unknowil r:on~I.
99 Unknown obied
09 Equipment fatture
(lire, brakes, •le.)
RIDING MOWER
Passengers & Pedestrians
KDOT form 654 Rev. 1-200.9
---
I
J. HARRISON
TRAFFIC UNIT
• · - - - - · -
lJOU
·-··--·--------·
s
· - · - - -. . -
I
lU
-·-·---·
....-..-......__ ,.__ ,___ ,.,..,_,,. DUB
_.......
~T
ST
•
- --·-"'"'
•. DOB
_,,,_
I
_,,_, ····--··.. -
- · - · · - .... _
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_04/13t1945 TOPEKA
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03 In lnter.;ectlon without a
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13111 aroawlthouu. crosswalk or
bikeway
03 In Intersection Without a
ctosswalk orbikeway
12 NOTin crosswalk or bikeway
13 In area, Wllhoul a CJ'OSG.Walk Cf'
bfkeway·
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880!!1er:
99 UnknoWt'I
02 NOT In croS3walk orblkeway
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09 Dedlc:ated bike fllno
03: On Island
10.Shared-u~epalh or Irall4
04 Road shoulder (not ditch or mcdl.in)
05 Roadside (not on slloolder)
11 Inside building
12 In iegally parxed vehicle
06SJdewalk
07 Ouls!dG !raffii:way
99 Unknown
01 Wilhin a wort. zone
t f Inside bu~rig
12Jn legal!~ parkl,d vehicle
88 Olher: _ _ _ _ _ __
99 Unknown
03 On Island
07 Ou!sidil lraftli:Way
02Jn median (not shoulder)
08 Driveway accosnrosswalk
09 Dedicated bike lime
10 Shared-use path or 1/ais
04 Road shoulo'er (not dllcl1 or median)
05 Roadside (nol on shouldet}
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OTKF.R P&DE!ITRlr\11 LOC.ATIO:O.:(Nalin OrMnc Lmi)
~
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PJ::llCS'l1UAN ACJ10.~ JJ£l'ORE CIUSU _
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07 Standlng,_silling, o, lying
02 Approaching or leaving bus
08 Playing, running, walking
02 Approaching or leaving bus
00 Playing,· running, walking
03 A~proachlng or leavifl9 vehicle
09 Cycling
03 Appr<iadlfng or leavinq_ vehlcle
09 Cycling
04 Working (not on vehicle)
IO Ertlering or crossing
04Worklng {nol on veh!de)
to Entering or crossing
05 Working on vehicle
88 Olhor.
05 Working on vehich?
88 Other:
06 Pushln9 mo!orvehlcle
99 Unknown
06 Pushing molar veh!clo
99 Unknown
LJ
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00 No podestrian signal
Of Obeyed p.!desllian signal
02 [llsobeyed pedestrians/gnat
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99 Unknown
1m.ukalrth:i1 -.p;ily)
O AC -Alcohol contributed
0
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O O TR. Test Relu5ed (AA:oho'lDrl.llJ) 18) 00 No emlence of lmpafrmenl _ 181 DTR, 'test Refused (Alcohol/Drug)
D DPT_ Preim Posilive Tett(PBT) DO t Evlden11a1Test(B1esth,Blood;D1G) 0 DPT. Ptelin\ P0$1tlve Ttlsl (P81)
D 04 Passive Ncohol Sensor
0
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D 03 Gehavlotal
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M&THOD OF DETERMIN,\llll:-1
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D 02 PreOmlllllry Brealh T6$l PBT
D TG· Evidenlla,yTesl given
0 03 Beh~ral
_
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D 05 Ob&ervect
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QMP - Medlc;ition Ingested
O DP - Illegal drugs r119esled
(m.11t ,u 1h,upp1y)
llRU!ji
O 00 No evidence orlmpalrmenl
03 Ped sfgnat malfunclion
04 Nohppir:able
99 Unknown
O AC • Al~ol contlibuted
OMP • Me<fcatlon rn90sted
MC -1.!edlcallon contnbuled
IMPAIR,\1£.,Tn:sT
DP - lllegafdrugs Ji>gesled
o!lll.l!QL.
PfiDESTRIANOBEDlt:Xf..E TQ. Tll.U'FI(: sm:uL
00 No pedesi!lan signal
01 Obeyed pedestrian sll,l'lal
02 Disobeyed pedestrian signal
03Ped signal ma!Jmcilon
04 Nol applicable
Sll8STAXCE usr.:
RIDING MOWER
0 D BIOo(I !BACl
.Q,___
0
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octile,
.9.,__
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Accident Narrative
KDOT Form 851 Rev. 1,2009
I
Officer Observatrons
Description of events
Wllnoss statamen. Is
Addition al Information
,.rnv~!li;,ll~g0ffic..-11lulg~ll'o.
J. HARRISON
147
l;;..?J;oi!alillil.iiiHilii;'::'~i l'<~·oC
I 7771·16
01 ADVISED SHEWAS SOUTHBOUND ON: SW GAGE IN THE MIDOLflHROUGHLANE At SW 10TH WITH A GREEN
SIGNAL LIGHT. 01 ENTERED THE INTERSECTION, THEN C0ll1DE0WITH 02, RIDING A LAWN MOWER IN THE
MIDDLE OF THE INTERSECTION.
02 ADVISED HE WAS RIDING THE RED TORO GROUNDSMASTER 5900 RIDING LAWN MOWER, SERIAL NUMBER
313000306 NORTHBOUND ON.SW GAGE, TURNING WESTBOUND ON SW 10TH WITH A GREEN SIGNAL LIGHT TO
TURN. WHILE MAKING HIS TURN IN THE INTERSECTION, HE WAS.STRUCK BY 01. THERE WAS DAMAGE TO THE
REAR, RIGHTS IDE TIRE AND AREASURROUNDlNG THE TIRE AS A RESULT OF THE ACCIDENT.
JLH/147 04·14·16
-17 t 7
Claim: 967715-GC
~
I•
Pol: PPCM0058566138 I Ins: Stacia Kolbek I Dol: 04/13/2016 I St Open I Adj: Katie Zavacki (CPCZ Casualty Group
1 Team 2 Unit 3) I
Financials (Total Incurred: $12,306.70): Checks
Check Number
I
Pay To
I
Gross Amou-nt
I's~ue Date IScti'edu!~ctlI
Statl,1$
Send Date
1-
Bulk Invoice
41245686
EAN Services, LLC
$629.26 05/09/2016 05/07/2016 Cleared
6779007
Stacia Kolbek
$204.00 05/12/2016 05/1212016 Requestec I <none>
6798299
ST FRANCIS HEALTH
CENTER INC
01280226
Stacia Kolbek
01280230
DOUG RICHERT
$4,500.00 05/16/2016 05/16/2016 Requested
24743
I
Payment
Method
EFT
<none>
Check
Cleared
<none>
Manuc1I check
$6,704.42 04/19/2016
Cle!'lred
<none>
Manual check
$123.86 05/03/2016
Cleared
<none>
Mc1nual check
$145.1(:5 04/15/2016
PONTIAC CADILLAC &
StaCii'! Kolbek
01505478
DOUG RICHERT
PONTIAC CAOILLA.C &
Stacia Kolbek
User: DeAnthonyZanders
Pager
05/16/2016 04:17 PM
,)j,../l.RMS
Rental Company:
Invoice#:
Alternate Invoice
Number:
NATIONWIDE
ENTERPRISE RENT-A-CAR
097 4106-0561
44V5VD
RENTAL DETAIL:
Bill To: NAT77CP
NATIONWIDE CLAIMCENTER (GUIDEWIRE CLAIMS ONLY)
ATTN: JERRY BERROTH
3820 109th St
Rate
Des Moines, IA 50391
Amount
26.60
S558,60
RENTER INFORMATION:
Renter: KOLB.EK, STACIA
$19.55
1 SALES TAX
RENTAL INFORMATION;
Renlal Branch Location:
$51.11
$629.20
ENTERPRISE RENT-A-CAR(0561)
Leas Amount Received:
$0.00
Total Amount Due:
$629.26
333 SW TOPEKA BlVD
TOPEKA, KS 666033061
(785) 233-0200
ADDITIONAL CLAIM INFORMATION:
Claim Number 967715-GC
Claim Type: Insured
Vehicle Condition: Non-Driveabie
Date Of Loss:. 4/13/16
Insured Name: STACIA KOLBEK
Ovmer's Vehicle: 2012 FORD
AddiUonal Driver:
Repair Facility:
POSSIBLE TOTAL LOSS
sr. LOUIS, MO 63105
(999) 999-9999
VEHICLES RENTED:
Tlmo·
Elfoctlva Date and
Yoar
Make
Modal
VIN
Starting
4/14/16 5:27PM
2016
HYUN
SONA
5NPE24AF9GH335510
Mlloago
Ending Mllea11e MIieage
Rate Charged
11982
14667
$26.90
2685
Rental Invoice
Please Return This Portion wifh Remittance·
Make Payment To:
Total Charges:
ENTERPRISE RENT-A-CAR
Lass Amount Received:
P.O. BOX 840086
Total Amotint·Due....."'"'"'"""
KANSAS CITY, MO 64184-0086
Please fnclude on your check:
Federal ID:43-0724835
Invoice#: 0974106-0561
$629.26
~0:00
$629.26
ALLIED PROPERTY & CASUALTY INS
Central Plains Claim Zone/ Kansas
"ON YOUR SIDE"
One Nationwide Gateway
Email.: berrotj@nationwide.com
Phone: (785) 658-5543
Fax: (888) 669-6917
9677l5-GC0 3
b8d0d113
Claim II:
Workfile ID:·
Supplement of Record 1 Summary
Written By: JERRY BERROTH, 5/3/2016 1:22:24 PM
Adjuster: Berri:ltll, Jerry
Insured:
Stacia Kolbek
OWner Policy 11:
PPCM0058566138
Claim II:
967715-GC-3
Type. of Loss:
Collision
Date ofloss:
04/13/2016 12:00 PM
Days to Repair~
O
Point of Impact:
12 Front
Deductible:
500.00
Owner (Insured):
Inspection Location:
Appraiser Information:
Repair Facility:
Stacia Kolbek
535 5 W Watson Ave
Topeka, KS 66606
(785) 506-6863 Evening
(785} S06a6863 Cellular
10th St
Guage St
Topeka, KS66603"
Non Drive-in
BERROTJ@NATIONWiDE.COM
(785) 658-5543
KITCH TOWING
VEHICLE
Year:
2012'
Color:
BLUE Int: TAN
License:
TEMP
·Production bate:
08/2011
Make:
FORD
Body Style:.
4DSED
State:
KS
Odometer:
71562
Model:
FUSION SEL
AWD
Engine:
6-3.0L·A
VIN:
3FAHPOCGSCR156682
Condition:
TRANSMISSION
Overhead Console
AM Radio
Cloth Seats
Automatic Transmission
Wood InteriorTrim
FM.Radio
Bucket Seats
4 Wheel Drive
CONVENIENCE
Stereo
Reclining/lounge Seats
POWER
Air Conditioning.
Search/Seek
Heated Seats
Power Steering
Intermittent Wipers
CD Player
WHEELS
Po\ver Brakes
Tilt Wheel
Auxlllary Audio Connection
Alumlnum/AlloyWheers
Power Windows
Cruise Control
Satellite Radio
PAINTc
Power Locks
Rear Defogger
SAFETY
Clear Coat Paint
Power Mirrors
Keyless Entry
Drivers Side Air Bag
OTHER
Fog.Lamps
Heated Mirrors
Alarm
•Passenger Air Bag
Power Driver Seat
Message Center
Anti-Lock Brakes (4)
Traction Control
Power Passenger Seat
Steering Wheel Touch. Controls
4 Wheel Disc- Brakes
Stability Con(rol
DECOR
Telescopic Wheel
Front Side Impact Air Bags
Power Trunk/Gate Release
Duar Mirrors
Climate Control
Head/Curtain Afr Bags
Tinted Glass
Home.Link
Hands Free Device
Console/Storage
RADIO
SEATS
5/3/2016 1:22:25 PM
093878
Pager
Claim#:
967715-GC'3
WorkfileID:
b8d0dl13
2012 FORD FUSION SEL AWD 40 SEO 6-3.0L-A BLUE
Oper
Line
Description
Part Number
Extended
Qty
Labor
Paint
2.2
2.0
u
2d
2.2
2.0
Price$
Subl
#
OEN
2
#
CALL JERRY FOR SUPPLEMENT
APPROVAL 785°658-5543
3
#
ALL SUP PAYMENTS ARE MADE
TO BOTH SHOP AND OWNER
4
FENDER
5
*
501
Repl
RCY RT fender assy +25%
AE5216005A
1
NOTE: LKQ#8894794 Fender
SHOP PRICE MATCH WITH OE PART
Add for Cfear Coat
6
7
Rpr
*
0.8
RT Apron/rail assy (HSS)
s
NOTE: REPAIR THE OUTER EDGE WHERE DAMAGE JS LOCATED
8
501
*
Repl
RCY LT fender assy +25%
Nl27278665
181.25
NOTE: LKQ# 8894794 FENDER
9
Overlap Major Adj. Panel
10
Add for Clear Coat
11
INFORMATION LABELS
t2
#
-0.4
0.3
Rep!. EMISSION LABEL
1
15.00
1
5.22
NOTE: NOLLERS
13
#
Repl
AC LABEL
NOTE: NOLLERS
14
15
Repl
16
17
Fan label
XW4Z8653BA
5.22
0.2
F01000650R
~
Incl.
FRONT BUMPER
0/H fronUiumper
......
<>
501
Repl
2.7
Opt OEM. Bumper cover +25%
26
NOTE:. MIDWAY OE SURPLUS 816-241"2100/ SPOKE TO WHAN
18
Overlap Major Non-Adj. Panel
19
Add for Clear Coat
20
Add for fog lamps
21
**
501
Repl
·0.2
0.5
0.4
A/M CAPA Grille surround w/o
sport model
F01037l01C
1
99.00
Incl.
F01006256N
279.00
0.4
F01070177DS
89,00
NOTE:. SHOP PRICE MATCH WITH OE PART
22
**
23
""
501
Repl
A/M NSFlmpact bar (UHS)
Repl
A/M Absorber
R&I
RT Bezel w/SEL model
Repl
A/M LT Bezel w/Sa model
1.Q.
N<m:: SHOP PRICE MATCH WITH OE PART
24
25
"*
501
0.1
Incl.
F01038139
1
99.00
Incl.
9.00
0.1
NOTE: SHOP PRICE MATCH WITH OE PART
26
"*
501
Repl A/M RT Side retainer
F0t027113
NOTE: SHOP PRICEMATCH WITH OE PART
5/3/2016 1:22:25 PM
093878
Page 2
Claim.#:
967715°GC0 3
WorkfileID:
b8d0dli3
Suppleinent of Record 1 Summary
2012 FORD FUSION SEL AWD 40 SE06-3.0L·FI BLUE
27
501
**
Repl
A/M. LT Side retainer
F01026113
9.00
0.1
63.00
rncf.
76.00
0,6
92.00
Incl,
AS4Z8213A
39.37
Incl.
F01217103PP
171.00
Incl.
85;00
lncl,
1
28
"'*
29
GRILLE
30
**
501
Repl
A/M CAPA Bumper grille w/o
sport moder
F01036127PP
NOTE:.. SHOP PRICE MATCH WITH OE PART
501
Repl
A/M CAPA Mount panel
F01223114C
1
NOTE: SH.OP PRICE MATCH.WITH OEPART
31
**
501
Repl
A/M CAPA,Center grille. chrome
w/o SPORT
Repl
Emblem
F01210106PP
NOTE::SHOP PRICE MATCH WITH OE PART
32
33
*"
501
Repl
A/M- CAPA Upper grille chrome
w/b SPORT
34
**
501
Repl
A/M CAPA Lower grille chrome
w/oSPORT
35
ENGINE/ TRANSAXLE
36
*
F01216104PP
1
~126864170
1
501
Rep!
RCY Air cleaner +25%
~m
Incl;
286.00
Incl;
286,00
Incl.
NOTE: [ewfs salvage Topeka
37
FRONT LAMP.S
38
"*
501
Rep!
A/M CAPA RT Headlamp
assy
F02503273C
39
40
Alm headlamps
**"
501
0.5
Repl
A/M CAPA LT Head la mp assy
41
R&I
RT Side. marker lamp
Incl.
42.
R&I
LT Side marker lamp
Incl.
43
R&i
RT Fog lamp assy
Ind.
44
R&I
LT Fog lamp assy
Incl.
RepJ
A/M Radiator
F02502273C
1
45
COOLING
46
**
501
CSF-3533
1
150,33 m
2.9
.ill:.99. m
Ind.
47
*
Si)l
Rep!
RC:Y Fan assy +25%
~117139264
NOTE: lKQ#8894794
48'
HOOD
49
"
501
Repl
RCY'hood +25%
BESZ16612A
NOTE: LKQ#8894794
Overlap Major Adj; Panel
51
Add for Clear Coat
53
5/3/20161:22:25 PM
~·
0.6
2'.8
SHOP PRICE MATCl:lWifH OE PART
so
52
1
Repl
RTHlnge
·M
0.5
6E5216796A
Add for Clear Coat
24.38
0.3
OA
0;1
093878
Page 1
Claim#:
967715-GC~l
WorkfileID:
b8d0d113
2012 FORD FUSION SEL AWD 4D SED 6-3;0L·R BLUE
6E5Z16797A
1
24.'17
0.3
AE5Z16700A
1
59.95
rnct.
9ESZ168990A
1
58,28
0.2
6ESZ16826A
32.72
Inct
F01225201PP
183.00
4.0
LT Hinge
Repl
54
Add for Clear Coat
55
56
R&I
Insulator w/3.0 Liter
57
Repl
Latch
58
Repl
Front w'strip
59
R&l
Front seal
60
Repl
Stay rod
61
RADIATOR SUPPORT
62
**
S01
Rep[
0.4
0.1
0.3
0.2
A/M CAPA Radtator support w/2.5
3.0 Liter
NOTE: PR1CE MATCHED WITH OE PART
63
Evacuate & recharge
m
1.4 M
64
Refrigerant recovery
m
0.4 M
65
Deduct for Overlap
66
AIR CONDITIONER &. HEATER
67
**
68
WINDSHIELD
·L2
REA·31·3786P
1
8ESZ17603A
1.
120,82 m
0.6 M
Repl
A/M Condenser
Repl
LT Washer nozzle
71.
Bind
RT Door shellw/keyless lock pad
72
73:
Bind
LT Door shell w/keyless lock pad
R&I
RT Seit. \I/Strip black
74
R&I
LT Belt w'strip black
0.3
75
*
R&I
RT Mirror assy w/o .heat
~
76
*
69
S01
70
FRONT DOOR
77
6.83
0.2
1.2
1.2
0.3
R&I
LT Mirror assy w/o heat
M
R&I
RT Handle, outside
OA
78
R&I
LT Handle, outsfde
0..4
79
R&l
LT Keyless lock pad It. Ice blue
0,2
80
II
Subl
COVER CAR
10.00 T
81
#
Rep!
CORROSION PROTEcnON
10.00 T
82
II
Subl
R134AFREON
40.00 T
83
#
Refn
STONE GUARD/ RT AND LEFT
FENDERS
84
**
Subl
A/M COOLANT +25%
S01
0.3
0.6
24,94
NOTE: RICHERTS USED OE COOLANT
II
86
OTHER CHARGES
87
II
Towing
88
#
E.P.C.
S01
Subl
l
CLIPS
85
10.86 T
236.00
3;00
SUBTOTALS
4,232;14
24.6
16.0
NOTES
Prior Damage Notes:
NONE
5/3/2016 1:22:25 PM
093878
Page 4
Claim#:
967715sGC-3
Workfile ID:
b8d0dl13
2012 FORD FUSION SEL AWO 40 SED 6-3:0L-A BLUE.
ESTIMATE TOTALS
Category
Rate
Basis
Body Laboe
22.2 hrs
@
$ 48;00/hr
1,065.50
Paint Labor
16.0 hrs
@
$ 48.00/hr
768:00
2.4 hrs
@
$ 55;00 /hr
156,00
16.6 hrs
@-
$ 32;00 /hr
512.00
Mechanical Labor
Paint Supplies
Mlscellane_ous
70.86
Other Charges
239,00
6,733.74
Subtotal
$ 5,497 ..24.
Sales Tax
5/3/2016 1:22:25PM
Cost$
3;922.28
f'arts
@
9..1500 %.
594.54
Total Cost of Repairs
Deductible
Total Adjustments
7,328.28
Net Cost.of Repairs
6,828.28
500.00
500;00
093878
Page 5
Oahn #:
96Z715·GC·3
Workfile ID:
b8d0d113
2012 FORD FUSION. SEL AWD 40 SED 6·3.0L-FI BLUE
SUPPLEMENT SUMMARY
Description
Oper
Line
Part.Number
Qty
Extended
Pr.lee$,
Labor
Pain.t
·changed Items
21
22
**
"*
S0l
Repl
A/M NSF Impact bar (UHS)
F01006256N
-279.00
·0.4
Repl
F01006256N
279,00
0,4
35
Repl
*
RCY Air cleaner
+25%
Nl26864170
·125.00 m
filg,_
Nl2686417Q
.ill.25. m
lnci..
NOTE: LKQ#8894794
36
SOl
*
Repl
RCY Air cleaner
+25%
NOTE: lewis salvage Topeka
46
Repl
*
RCY Fan assy + 25%
"'117139264
1
-162.50 m
Incl.
"'117139264
1
ill:..QQ. m
lnci..
8E5Zl7603A
1
6,83
0.2
1
24.94
NOTE: LKQ#8894794
47
SO.I
*
Repl
RCY Fan assy + 25%
NOTE: LKQ#8894794
Added Items
68
WINDSHIELD
S01
Repl
Lt Washer nozzle
**·
SOl
Sllbl
A/M COOLANT +25%
II
S01
Subl
CLIPS
69
84
NOTE: RICHER.TS USED OE COOLANT
85
10.86 T
23,88
SUBTOTALS
0.2
1.0
Rate
Cost$·
NOTES
Prior Damage Notes:
NONE
TOTALS SUMMARY
Category
Basis
Parts
13.02
Body Labor
0.2 hrs
@
$48.00/hr
9.60
Paint Labor
1.0 hrs
@
$ 48.00 /hr
48.00
Paint Supplies
1.0 hrs
@
$ 32.00 /hr
32.00
Miscellaneous
10.86
Subtotal
113.48
Sales Tax.
5/3/2016 1:22:25 PM
$ 113.48
@
9.1500 %
10.38
Total Supplement Amount
123.86
NET COST OF SUPPLEMENT
123.86
093878
Page 6
Claim#-:
967715-GC0 3
Workfile ID:
b8d0dl.13
2012 FORD FUSION SEl
AWD 40 SED 6-3.0L-ffBLUE
CUMULATIVE EFFECTS Of SUPPLEMENT(S)
Estimate
Supplement 501
7,201:f.42
JERRY BERROTH
123.86
JERRY BERROTH
Workfile Totak
$
TOTAL ADJUSTMENTS:
$
500,00
NET COST OF REPAIRS:
$
ti,828.28
7,328.28
The limit of your coverage Is the actual cash value of your auto or its damaged parts at the time of loss. Fair market
value, age and condition of your damaged vehicle will be considered when determinfng the actual cash value of a:
loss. Certain parts lose value or depreciate because of age, condition 1 andt'or wear and tear. Betterment is the
increase in value of a vehicle or any of its parts as a result of replacing certain parts damaged in a less. If the
replacement of certain parts results in an rncrec1se in value to your vehicle or any of its parts, a deduction for
betterment may be made. to your loss payment to reflect the actual cash value you are owed under your policy.
CAPA=Certified Automotive Parts Association
NSF=NSF InternatiorialCertified Part
AQRP = Assured Quality Replacement Parts
***NATIONWIDE INSURANCE GUARANTEE***
THE VEHICLE OWNER IS GUARANTEED THAT THE NATIONWIDE APPRAISAL~
-IS FA1RLY PRICED AND INCLUDES ALL DAMAGE RELATED TO THE ACCIDENT THAT WAS EVIDENT WHEN THE
VEHICLE WAS APPRAISED; AND
-WlLL ALSO INCLUDE II\I THE REPAIRS AND THE SITTLEMENT ANY HIDDEN OR MISSED DAMAGE CAUSED BY THE
ACCIDENT.
IN ADDITTON, YOUR ASSIGNED NATIONWIDE CLAIM REPRESENTATIVE WILL BE AVAILABLE TO ASSISf IN
RESOLVING ANY CONCERNS YOU, THE VEHICLE OWNER, MAY HAVE ABOUT THE QUALITY Of REPAIRS
IMPORTANT! ALL SERVICE PROVIDERS MUST COMPLY WITH SfATE AND FEDERALPRIVACY LAWS, INCLUDING
THE PRIVACY PROVISIONS OF THE GRAMM-LEACH-BULEY ACT AND WITf:, NATIONWIDE1S PRIVACY STATEMENT
AND PROCEDURES. ACCORDINGLY, YOU ARE HEREBY NOTIFIED THAT CUSTOMER INFORMATION SHARED WITH
OR OBTAINED BY SERVICE PROVIDERS SHALL BE USED SOLELY FOR THE PURPOSE FOR WHICH IT WAS PROVIDED AND FOR NO PURPOSE WHATSOEVER.
***********************************************************************************************
"'************************************************
THIS ESfIMATE HAS BEEN PREPARED BASED ON THE USE OF AFTERMARKET CRASH PARTS SUPPLIED BY A
SOURCE OTHER TrfAN THE MANUFACTURER OF YOUR MOTOR VEHICLE. ANY WARRANTIES APPLICABLE TO
THESE REPLACEMENT PARTS ARE PROVIDED BY THE MANUFACTURER OR DISfRIBUTOR OF THESE PARTS RATHER
THAN THE MANUFACTURER OF YOLIRVEHICLE.
5/3/2016 l:22:25°PM
093878
Page 7
Claim#:
967715-GC-3
Workflle ID:
b8d0di13
2012 FORD FUSION SEL AWD 'ID SED 6-3.0L-R BLUE
***********************************************************************************************
**************************************************
This is an estimate only and not an authorization to repair. Additional payments will be made only with the approval
priorto repair.
Nationwide will replace any defective like and kind quallty(used), reconditioned, recyclable, and,any quality
replacement aftermarket {non-oem) parts as specified on the appraisal for as long as you own or lease the vehicle.
THIS ESTIMATE HAS BEEN PREPARED BASED ON THE USE OF ONE OR MOREAFTER MARKET PARTS SUPPLIED BY
A SOURCE OTHER THAN THE MANUFACTURER OF YOUR MOTOR VEHICLE. WARRANTIES APPLICABLE TO THESE
PARTS ARE PROVIDED BY THE PARTS MANUFACTURER OR DISTRIBUTOR RATHER THAN BY THE MANUFACTURER
OF YOUR VEHICLE.
Nationwide will replace any defective like Kind and Quality (Used), Reconditioned, and any Aftermarket (non-OEM)
parts for as long as you own the vehicle.
5/3/2016 1:22:25PM
093878
Claim#:
967715-GC-3
Workfile ID:
b8d0d113
Supplement.of Recordl Summary
2012 FORD FUSION: SEL AWD 40 SED 6~3,0L-ABl.:.UE
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 DR2JP10, CCC Data Date 1/15/2016, and potentially other
third party sources of data; and (b) the parts presented are OEM-parts manufactured by the vehicles Original
Equipment Manufacturer. OEM parts are available at OE/Vehicle dealerships. 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. OPT OEM or ALT OEM parts may reflect some specific, special, or unique pricing or discount.
OPT OEM or ALT OEM parts may include "Blemished". parts provided by OEM's through OEM vehicle dealerships.
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 'NILL NOT be performed as a
separate procedure from the other panels ih 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 fncluded. Pound sign (#) items
indicate manual entries.
Some 2016 vehicles contain minor changes from tlieprevious 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 ofapplicable vehfcles. Parts humbers and prices should be confirmed with the tocaJ 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=Miscellarieous Taxed charge category.
X=Miscellaneous Non~Taxed charge category.
SYMBOLS FOLLOWING LABOR:
D=Diagriostlc 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.=Adjatent. Algn.=Align. ALU=Aluminum. NM=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. Nor\-Adj.=Non
Adjacent. NSF=NSF International Certffied Part. 0/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 nne~
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 RepaiL EPA=EnvlronmentaLProtection Agency. NHTSA= National Highway
Transportation and Safety Administration. PDR=Paintless Dent Repair. VIN=Vehide Identification Number ..
5/3/2016 1:22:25 PM
093878
Page 9
Claim#:
967715-.GC,3
Work.fife ID:
b8d0d113
2012 FORD FUSION SELAWD 4D SED 6°3.0l·FT BLUE
ALTERNATE PARTS SUPPLIERS
Line
8
Supplier
Description
LKQ Mid-America
#-127278665
Price
$ 150.00
5725 SW Topeka Blvd
Topeka KS 66619
Fender 4DR,SE L., w/o Sport pkg,S#$M0788
(785) 862-0000
Qucite:: 60888338
Explres~ 06/02/16
17
$ 272.50
Midway Auto Parts
#F01000650R
Aimee Studna
Opt OEM 8umper cover + 25%
950 Century Ave
Kansas City MO 64120
(816) 241-2100
21
Midway Auto Parts
#F01037101C
Aimee Studna
A/M CAPAGrille surround w/o sport. model
$ 99.00
950 Century Ave
Kansas.City MO !54120
(816) 241-2100
22
23
25
KEYSTONE · TOPEKA, KS
#F01006256N
5725 STOPEKABLVD
TOPEKA KS 66619
Quote: 60485641
(800) 530-5497
Expires: 05/29/16
KEYSTONE • TOPEKA, KS
#F01070177DS
5725 S TOPEKA BLVD
A/M Absorber
TOPEKA KS 66619
Quote: 60485641
(800) 530· 5497
Expires: 05/29/16
$ 279.00
$ 89.00
$ 99.00
#F01038139
PHILLIP CODY
5725 SW TOPEKA BLVD
TOPEKA KS 66619
(800) 530-5497
26
#F01027113
PHILLIP CODY
NM RT Side retainer
$9.00
5725 SW TOPEKA BLVD
TOPEKA.KS 66619
(800) 530-5497
27
$ 9.00
KEYSTONE • TOPEKA,, KS
#f01026H3.
PHILLIP CODY
A/M LTSide retainer
5725 SW TOPEKA BLVD
5/3/2016 1:22:25 PM
093878
Page 10
Claim#:
967715-GC-3
Workfile ID:
b8d0d113
2012 FORD FUSION SEL AWD 40 SED 6~3.0l!.·FI BLUE
TOPEKAKS 66619
(800) 530-5497
28
30
31
33
34
36
$ 63;00
KEYSTONE· TOPEKA, KS
#F01036127PP
5725 STOPEKA BLVD
AlM CAPA Bumper grillew/o sport model
TOPEKA KS 66619
Quote: 60906457
(800) 530-5497
Expires: 06/02/16
#F01223114C
5725 S TOPEKA BLVD
$ 76.00
TOPEKA KS 66619
Quote: 60485641
(800) 530-5497
Expires: 05/29/16
KEYSTONE • TOPEKA,. KS
IIF01210.106PP
5725 S TOPEKA BLVD
A/M CAPA Center grille chrome w/ocSPORT
$ 92.00
TOPEKA KS 66619
Quote: 60485641
(800) 530-5497
Expires: 05/29/16
# F01217103PI?
5-725 STOPEKA BLVD
A/M CAPA Upper grille chrome w/o SPORT
$ 171.0Q
TOPEKA KS 66619
Quote: 60894599
(800) 530°5497
Expires: 06/02/ l 6
$ 85.00
KEYSTONE - TOPEKA, KS
#F0121610<lPP
5725 STOPEKA BLVD
A/M' CAPA Lower grille chrome w/o SPORT
TOPEKA KS 66619
Q4ote: 60894599
(800} 530-5497
Expires:· 06/02/16
LKQ Mid-America
#"'126864170
5725 SW Topeka Blvd
$ 1!5.00
Topeka KS 66619
Air Cleaner 3.0,AUTO,FWD 3,0L,S#$K1207
(785.) 862°0000
Quote: 60485641
Expires: 05/29/ 16
38
40
46
#F02503273C
5725 STOPEKABLVO
A/M CAPA RT Headlamp assy
TOPEKA KS 66619
Quote: 60899882
(800) 530-5497
Expires: 06/02/ l 6
$ 286.00
$286.00
KEYSTONE -TOPEKA, KS
#F02502273C
5725 S TOPEKA BLVD
A/M CAPA LT Headlamp assy
TOP© KS 66619
Quote: 60899882
(800} 530°5497
EXplres: 06/02/16
Radiators Plus A/C • Shipping
#:C5~3533
Kenneth Hancock
A/M Radiator
$15033
1120 Elin HIii Pike,,Sulte 125
5/3/2016 1:22:'25 PM
093878
Page 11
Claim#:
967715-GC-3
Worklile ID:
b8d0dl13
2012 FORD FUS10N.SEL AWD 40 SEO 6-3.0L·f'l BLUE
Nashville TN 37210
47
(888) 564· 2300
LKQ Mld,America
5725 SW Topeka Blvd
Topeka KS 66619
(785) 862-0000
, ... 117139264
$130.00
RCY Fan assy +25%
Radiator or Condenser Fan Motor·(ASSM), 3.0L,S#$K0899
Quote: 60485641
Expires: 05/29/16
62
67
$ 183.00
#F0122520lPP
5725 s·TOPEKA BLVD
A/M CAPA Radiator support w/2.5 3.0 Liter
TOPEKA KS 66619
Quote: 60485641
(800) 530-5497
Expires: 05/29/16
Radiators Plus A/C • Shipping
# REA-3F3786P
Kenneth Hancock
A/M Condenser
$ 120.82
1120 Elm Hill Pike, Suite 125
Nashville TN 37210
(ll88J 564- 2300
5/3/2016 1:22:25 PM
093878
Page 12'
AUT~; INJURY
.
s o L u T , o N s PIP and Medical Payments Log
Exp,;<tl!<, • T,:,;;h11ology • Rtl-$U!CS
Carrier Name:
ALLll;D P&C INSURANCE
COIVIPANY
Expe11se Summary
Total Charges
·Tota.I Paid
Medical
Wages
$ $4aa.o!1
$ 204.00
$ 4500.00
$'l104.00
4500.QO
$ O.QQ
o:oo
$ 0.00
$.0,00
$ 0.00
$
AJipcated to PIP
$
Allocated to MP
Interest PiJlp ·
A,pplie~f to D~uctible
$ 0.00
Applied to Copay
$
oocro Received
Date
NFOSOS4n 2016·05·10
NM2630013
Paid
Date
wages
967715-GC
Date <>f loss:
Services
04/1$/2016
Funeral
Patient Name:
Other
ST.FRANCIS HEALTH
CENTER IN\:
Wage Loss
Reimbur$em~~t
Kolbek, Staci~
Totals
$ 6692.09
$ 4704.00
$ 4500,0Q
$ 0.00
:$ 0.00
$ 0,00
o:oo
Exper!se·Type Sentic::e Provider/
Payee
2016·05°16 l\1edlo,I
2016•05·12
Oaim Numben
$
Billing Provider
Dates of
Service
ST FRANCIS HEALTl1
CENTER INC
04/l~/2016·
04/13/2016
04/13/2016·
04/15/2016
Charges
$ 6488,09.
Reim Amt
$
o.oo
Oe(!uctible
copay
Paid Amount
4500.00
$
o,oo
$0.00
$ 4500.00
s a.ob
~
o,oo
$ 0,00
$ 204.00
Printed on S/1E!/20i6 3:00;Jl9 PM
PMelofl
Check
Number
6779007
.·
~-·
l
.~
.· ~!ii
•.
•
!'I
__
,
--~
~
.
~·
.....-
.: .
Nationwide®
is on your side
May 18, 2016
Shawnee County Clerks Office
200 E. Jib, Room 107, Topeka, KS 66603
Re:
My claim no.:
Date ofloss:
My Insureds:
967715-GC
04/13/2016
Stacia Kolbek
To Whom It May Concern:
Enclosed please find your completed claim form and supporting documentation. After
reviewing the enclosed documents please forward payment of$12,806.60 to:
Allied Property & Casualty Insurance Company
Attn: Trust Department, Claim #967715-GC
1100 Locust St, Dept 2019
Des Moines, IA 50391-2019
Please include my claim number on any payment or correspondence. Please let me know if
you need further documentation.
J
DeAnt 1: y-Zander
Legal Subrogation
Depositors Insurance Company
(515) 508-3074
(855) 847-0213 [fax]
Zanded3@nationwide.com
Enclosures: (1) Claim Form (2) Police Report; (3) Nationwide Check Listing; (4) Rental
Invoice; (5) Vehicle Damage Estimate; (6) PIP Log; and (7)Vehicle Damage Photos
Nationwide®
is on your side
July 1, 2016
Shawnee County
200 SE 7th. Street, Room 100
Topeka, KS 66603-3922
Re:
My claim no.:
Date of loss:
My Insureds:
967715-GC
4/13/2016
Stacia Kolbek
To Whom It May Concern:
Enclosed please find an updated balance and supporting documentation. After reviewing the
enclosed documents please forward payment of$12,849.13 to:
Attn: Trust Department, Claim #967715-GC
Please include my claim number on any payment or correspondence. Please let me know if
you need further documentation.
Sincerely,
.
~C;;:)"3cwcU
DeAnthony ~ders
Legal Subrogation
(515) 508-3074
(855) 847-0213 [fax]
zanded3@nationwide.com.
Enclosures: (1) Nationwide Check Listing; (2) Vehicle Damage Estimate
Claim: 967715-GC
I) I 4iliilJr, Pol: PPCM0058566138 I Ins: Stacia Kolbek I Dol: 04/13/20161 St: Open I Adj: DeAnthony Zanders (Claims
Recovery Services Group 2 Unit 5)
I
Financials {Total Incurred: $12,349.13): Checks
Check Number
I
Pay To
Gross Amount
I Issue Date I Scheduled I Status
Send Date
I
Bulk Invoice
I Payment Method
41245686
EAN Services, LLC
$629.26 05/09/2016 05/07/2016 Cleared
24743
EFT
6779007
Stacia Kblbek
$204.00 05/12/2016 05/12/2016 Cleared
<none>
Check
6798299
ST FRANCIS HEALTH
CENTER INC
$4,500.00 05/16/2016 05/16/2016 Cleared
<none>
Check
01280226
Stacia Kolbek
01280230
$145.16 04/15/2016
Cleared
<none>
Manual check
DOUG RICHERT
PONTIAC CADILLAC &
Stacia Kolbek
$6,704.42 04/19/2016
Cleared
<none>
Manual check
01505478
DOUG RICHERT
PONTIAC CADILLAC &
Stacia Kolbek
$123.86 05/03/2016
Cleared
<none>
Manual check
01589816
DOUG RICHERT
PONTIAC CADILLAC
Issued
<none>
Manual check
User: DeAnthony Zanders
$42.43 07/01/2016
Page 1
07/01/201611:34AM
ALLIED PROPERTY & CASUALTY INS
Central Plains Claim Zone/ Kansas
"ON YOUR SIDE''
One Nationwide Gateway
Email: berrotj@nationwide.com
Phone: (785) 658-5543
Fax: (888) 669-6917
967715-GC-3
b8d0d113
Claim#:
Workfile ID:
Written By: JERRY BERROTI-i, 7/1/2016 10:01:22 AM
Adjuster: Berreth, Jerry
Insured:
Stacia Kolbek
Owner Policy #:
PPCM0058566138
Claim #:
967715-GC-3
Type of Loss:
Collision
Date of Loss:
04/13/2016 12:00 PM
Days to Repair:
0
Point of Impact:
12 Front
Deductible:
500.00
Owner (Insured):
Inspection Location:
Appraiser Information:
Repair Facility:
Stacia Kolbek
535 S W Watson Ave
Topeka, KS 66606
(785) 506-6863 Evening
(785) 506-6863 Cellular
10th St
Guage St
Topeka,· KS 66603
Non Drive-in
BERROTJ@NATIONWIDE.COM
(785) 658-5543
KITCH TOWING
VEHICLE
2012 FORD FUSION SEL AWD 4D SED 6-3.0L-FI BLUE
Production Date:
08/2011
Interior Color:
TAN
TEMP
Odometer:
71562
Exterior Color:
BLUE
KS
Condition:
VIN:
3FAHPOCG5CR156682
License:
State:
Cloth Seats
TRANSMISSION
Overhead Console
AM Radio
Automatic Transmission
Wood Interior Trim
FM Radio
Bucket Seats
4Wheel Drive
CONVENIENCE
Stereo
Reclining/Lounge Seats
POWER
Air Conditioning
Search/Seek
Heated Seats
Power Steering
Intermittent Wipers
CD Player
WHEELS
Power Brakes
Tilt Wheel
Auxiliary Audio Connection
Aluminum/Alloy Wheels
Power Windows
Cruise Control
Satellite Radio
PAINT
Clear Coat Paint
Power Locks
Rear Defogger
SAFETY
Power Mirrors
Keyless Entry
Drivers Side Air Bag
OTHER
Heated Mirrors
Alarm
Passenger Air Bag
Fog Lamps
Power Driver Seat
Message Center
Anti-Lock Brakes (4)
Traction Control
Power Passenger Seat
Steering Wheel Touch Controls
4 Wheel Disc Brakes
Stability Control
Power Trunk/Gate Release
DECOR
Telescopic Wheel
Front Side Impact Air Bags
Dual Mirrors
Climate Control
Head/Curtain Air Bags
1inted Glass
Home Link
Hands Free Device
Console/Storage
RADIO
SEATS
7/1/2016 10:01:22 AM
093878 I 1.6.06.04210
Page 1
Claim#:
967715-GC0 3
Workfile ID:
b8d0dll3
2012 FORD FUSION sa AWD 4D SED 6-3.0L-FI BLUE
Line
Oper
Subl
Description
Part Number
Qty
1
#
2
#
CALL JERRY FOR SUPPLEMENT
APPROVAL 785-658-5543
1
3
#
ALL SUP PAYMENTS ARE MADE
TO BOTH SHOP AND OWNER
1
4
FENDER
5
*
501
Repl
Extended
Price$
Labor
Paint
181.25
2.2
2.0
OEN
-·. ·----····-······-·-··--- ...
RCY RT fender assy +25%
AE5Z16005A
1
NOTE: LKQ#8894794 Fender
Add for Clear Coat
6
7
*
8
*
Rpr
RT Apron/rail assy (HSS)
Repl
0.8
s
~
NOTE: REPAIR THE OUTER EDGE WHERE DAMAGE IS LOCATED
501
Nl27278665
2.2
2.0
NOTE: LKQ# 8894794 FENDER
9
10
Add for Clear Coat
11
INFORMATION LABELS
12
#
Repl
EMISSION LABEL
13
#
Repl
AC LABa
-0.4
0.3
1
15.00
NOTE: NOLLERS
5.22
NOTE: NOLLERS
14
15
Repl
XW4Z8653BA
1
F01000650R
1
5.22
0.2
FRONT BUMPER
16
17
Fan label
0/H front bumper
**
<>
501
Repl
2.7
Opt OEM Bumper cover +25%
Incl.
2.6
NOTE: MIDWAY OE SURPLUS 816-241-2100/ SPOKE TO WHAN
18
Overlap Major Non-Adj. Panel
19
Add for Clear Coat
20
Add for fog lamps
21
**
501
Repl
A/M CAPA Grille surround w/o
sport model
22
**
501
Repl
-0.2
0.5
0.4
F01037101C
1
99.00
Incl.
F01006256N
1
279.00
0.4
F01070177DS
1
89.00
23
**
24
25
**
501
Repl
A/M Absorber '
R&I
RT Bezel w/SEL model
Rep!
0.1
Incl.
F01038139
1
99.00
Incl.
F01027113
1
9.00
0.1
26
**
501
Repl
A/M RT Side retainer
7/1/2016 10:01:22 AM
093878
I 1.6.06.04210
Page 2
Claim#:
967715-GC-3
Workfile ID:
b8d0d113
2012 FORD FUSION SEL AWD 4D SED 6-3.0L-FI BLUE
27
**
SOl
Repl
A/M LT Side retainer
F01026113
1
9.00
0.1
63.00
Incl.
28
**
29
GRILLE
30
**
SOl
Repl
A/M CAPA Bumper grille w/o
sport model
NOTE: SHOP PRICE MATCH
SOl
Repl
F01036127PP
WITH OE PART
F01223114C
1
76.00
0.6
F01210106PP
1
92.00
Incl.
31
**
501
Repl
A/M CAPA Center grille chrome
w/oSPORT
32
Repl
Emblem
33
**
S01
Repl
A/M CAPA Upper grille chrome
w/o SPORT
34
**
501
Repl
A/M CAPA Lower grille chrome
w/o SPORT
35
ENGINE/ TRANSAXLE
36
*
37
FRONT LAMPS
38
**
AS4Z8213A
39.37
Incl.
F01217103PP
171.00
Incl.
85.00
Incl.
F01216104PP
1
501
Repl
-126864170
143.75 m
F02503273C
286.00
Incl.
286.00
Incl.
NOTE_:_lewts saly~~eTope~
501
Repl
A/M CAPA RT Headlamp assy
39
40
0.5
Alm headlamps
**
501
Repl
F02502273C
41
R&I
RT Side marker lamp
Incl.
42
R&I
LT Side markt;lr lamp
Incl.
43
R&I
RT Fog lamp assy
Incl.
44
R&I
LT Fog lamp assy
Incl.
45
COOLING
46
**
501
Repl
A/M Radiator
CSF-3533
150.33 m
-117139264
125.00 m
2.9
47
*
48
HOOD
49
*
501
Rep!
RCY Fan assy +25%
_NOTE: L~9#8~~~?~~ --
501
Repl
RCY hood +25%
0.6
BE5Z16612A
2.8
NOTE: LKQ#8894794
50
51
Add for Clear Coat
52
53
7/1/2016 10:01:22 AM
Repl
RT Hinge
-0.4
0.5
6E5Z16796A
24.38
0.3
0.4
0.1
Add for Clear Coat
093878 I 1.6.06.04210
Page 3
Claim#:
967715-GC-3
Workfile ID:
b8d0d113
2012 FORD FUSION SEL AWD 40 SED 6-3.0L-A BLUE
54
Repl
LT Hinge
55
6E5216797A
24.47
0.3
Add for Clear Coat
56
R&I
Insulator w/3.0 Liter
57
Rep!
Latch
58
Repl
Front w'strip
59
R&I
Front seal
60
Rep!
Stay rod
61
RADIATOR SUPPORT
62
**
501
Repl
0.4
0.1
0.3
AE5216700A
1
59.95.
Incl.
9E5216B990A
1
58.28
0.2
6E5216826A
.....
1
32.72
Incl,
F01225201PP
1
183.00
4.0
0.2
A/M CAPA Radiator support w/2.5
3.0 Liter
NOTE: PRICE MATCHED WITH OE PART
63
Evacuate & recharge
m
1.4 M
64
Refrigerant recovery
m
0.4 M
65
66
67
**
68
WINDSHIELD
69
501 Repl .. LT Washer nozzle
FRONT DOOR
70
-1.2
De_~uct for Overlap_
AIR CONDITIONER & HEATER
Repl
A/M Condenser
REA-31-3786P
1
8E5217603A
120.82 m
6.83
0.6 M
0.2
71
Bind
RT Door shell w/keyless lock pad
1.2
72
Bind
LT Door shell w{keytess lock pad
1.2
73
R&I
RT Belt w'strip black
0.3
74
R&I
LT Belt w'strip black
0.3
R&I
RT Mirror assy w/o heat
M
R&I
LT Mirror assy w/o heat·
0.5
77
R&I
RT Handle, outside
0.4
78
R&I
LT Handle, outside
0.4
75
76
*
*
R&I
LT Keyless lock pad It. ice blue
80
79
#
Subl
COVER CAR
0.2
10.00 T
81
#
Repl
CORROSION PROTECT10N
10.00 T
82
#
Subl
Rl34A FREON
40.00 T
83
#
Refn
STONE GUARD/ RT AND LEFT
FENDERS
84
**
Subl
A/M COOLANT +25%
501
0.3
0.6
24.94
NOTE: RICHERTS USED OE COOLANT
85
#
501
Subl
CLIPS
1
10.86 T
86
#
502
Subl
trans check
1
38.87 T
87
OTHER CHARGES
88
#
Towing
1
89
#
E.P.C.
1
SUBTOTALS
236.00
3.00
4,271.01
24.6
16.0
NOTES
Prior Damage Notes:
7/1/2016 10:01:22 AM
093878
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Page 4
Claim#:
967715-GC-3
Workfile ID:
b8d0d113
2012 FORD FUSION SB. AWD 4D SED 6-3.0L-A BLUE
NONE
ESTIMATE TOTALS
Category
Rate
Basis
Parts
Body Labor
22.2 hrs
@
Paint Labor
16.0 hrs
@
Mechanical Labor
Paint Supplies
2.4 hrs
@
16.0 hrs
@
$ 48.00 /hr
$ 48.00 /hr
$ 65.00 /hr
$ 32.. 00 /hr
1,065.60
768.00
156.00
512.00
Miscellaneous
109.73
Other Charges
239.00
Subtotal
6,772.61
.Sales Tax
$6,536.61
@
9.1500 %
598.10
7,370.71
Total Cost of Repairs
Deductible
500.00
Total Adjustments
500.00
Net Cost of Repairs
7/1/2016 10:01:22 AM
Cost$
3,922.28
6,870.71
093878
I 1.6.06.04210
Page 5
Claim#:
967715-GC-3
Workfile ID:
b8d0d113
2012 FORD FUSION SEL AWD 4D SED 6-3.0L-A BLUE
SUPPLEMENT SUMMARY
Line
Oper
Description
Part Number
Qty
Extended
Price$
Labor
Paint
0.0
o.o
Rate
Cost$
Added Items
86
#
502
Subl
trans check
38.87 T
38.87
SUBTOTALS
NOTES
Prior Damage Notes:
NONE
TOTALS SUMMARY
Category
Basis
Parts
0.00
Miscellaneous
38.87
Subtotal
38.87
$ 38.87
Sales Tax
@
9.1500 %
3.56
Total Supplement Amount
42.43
NET COST OF SUPPLEMENT
42.43
CUMULATIVE EFFECTS OF SUPPLEMENT(S)
7,204.42
JERRY BERROTH
Supplement SO 1
Estimate
123.86
JERRY BERROTH
Supplement 502
42.43
JERRY BERROTH
Workfile Total:
TOTAL ADJUSTMENTS:
NET COST OF REPAIRS:
$
$
$
7,370.71
500.00
6,870.71
The limit of your coverage is the actual cash value of your auto or its damaged parts at the time of loss. Fair market
value, age and condition of your damaged vehicle will be considered when determining the actual cash value of a
loss. Certain parts lose value or depreciate because of age, condition, and/or wear and tear. Betterment is the
increase in value of a vehicle or any of its parts as a result of replacing certain parts damaged in a loss. If the
replacement of certain parts results in an increase in value to your vehicle or any of its parts, a deduction for
betterment may be made to your loss payment to reflect the actual cash value you are owed under your policy.
CAPA=Certified Automotive Parts Association
NSF=NSF International Certified Part
AQRP = Assured Quality Replacement Parts
7/1/2016 10:01:22 AM
093878
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1.6.06.04210
Page 6
Claim#:
967715-GC-3
Workfile ID:
bSd0d113
2012 FORD RJSION SEL AWD 4D SED 6-3.0L-A BLUE
***NATIONWIDE INSURANCE GUARANTEE***
THE VEHICLE OWNER IS GUARANTEED THAT THE NATIONWIDE APPRAISAL:
-IS FAIRLY PRICED AND INCLUDES ALL DAMAGE RELATED TO THE ACCIDENT THAT WAS EVIDENT WHEN THE
VEHICLE WAS APPRAISED; AND
-WILL ALSO INCLUDE IN THE REPAIRS AND THE smLEMENT ANY HIDDEN OR MISSED DAMAGE CAUSED BY THE
ACCIDENT.
IN ADDITION, YOUR ASSIGNED NATIONWIDE CLAIM REPRESENTATIVE WILL BE AVAILABLE TO ASSIST IN
RESOLVING ANY CONCERNS YOU, THE VEHICLE OWNER, MAY HAVE ABOUT THE QUALITY OF REPAIRS
IMPORTANT! ALL SERVICE PROVIDERS MUST COMPLY WITH STATE AND FEDERAL PRIVACY LAWS, INCLUDING
THE PRIVACY PROVISIONS OF THE GRAMM-LEACH-BLILEY ACT AND WITH NATIONWIDE'S PRIVACY STATEMENT
AND PROCEDURES. ACCORDINGLY, YOU ARE HEREBY NOTIFIED THAT CUSTOMER INFORMATION SHARED WITH
OR OBTAINED BY SERVICE PROVIDERS SHALL BE USED SOLELY FOR THE PURPOSE FOR WHICH IT WAS PROVIDED
AND FOR NO PURPOSE WHATSOEVER.
***********************************************************************************************
*************************************************
THIS ESTIMATE HAS BEEN PREPARED BASED ON THE USE OF AFTERMARKET CRASH PARTS SUPPLIED BY A
SOURCE OTHER THAN THE MANUFACTURER OF YOUR MOTOR VEHICLE. ANY WARRANTIES APPLICABLE TO
THESE REPLACEMENT PARTS ARE PROVIDED BY THE MANUFACTURER OR DISTRIBUTOR OF THESE PARTS RATHER
THAN THE MANUFACTURER OF YOUR VEHICLE.
***********************************************************************************************
**************************************************
This is an estimate only and not an authorization to repair. Additional payments will be made only with the approval
prior to repair.
Nationwide will replace any defective like and kind quality (used), reconditioned, recyclable, and any quality
replacement aftermarket (non-oem) parts as specified on the appraisal for as long as you own or lease the vehicle.
THIS ESTIMATE HAS BEEN PREPARED BASED ON THE USE OF ONE OR MORE AFTER MARKET PARTS SUPPLIED BY
A SOURCE OTHER THAN THE MANUFACTURER OF YOUR MOTOR VEHICLE. WARRANTIES APPLICABLE TO THESE
PARTS ARE PROVIDED BY THE PARTS MANUFACTURER OR DISTRIBUTOR RATHER THAN BY THE MANUFACTURER
OF YOUR VEHICLE.
Nationwide will replace any defective Like Kind and Quality (Used), Reconditioned, and any Aftermarket (non-OEM)
parts for as long as you own the vehicle.
7/1/2016 10:01:22 AM
093878
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1.6.06.04210
Page 7
Claim#:
967715-GC-3
Workfile ID:
b8d0d113
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 DR2JP10, CCC Data Date 6/16/2016, and potentially other
third party sources of data; and (b) the parts presented are OEM-parts manufactured by the vehicles Original
Equipment Manufacturer. OEM parts are available at OE/Vehicle dealerships. 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. OPT OEM or ALT OEM parts may reflect some specific, special, or unique pricing or discount.
OPT OEM or ALT OEM parts may include "Blemished" parts provided by OEM's through OEM vehicle dealerships.
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/Mor 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 2017 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 dqne or parts to
1
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. 0/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 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=Paintless Dent Repair. VIN=Vehicle Identification Number.
7/1/2016 10:01:22 AM
093878
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Page 8
Claim#:
967715-GC-3
Workfile ID:
b8d0d113
2012 FORD FUSION SEL AWD 4D SEO 6-3.0L-A BLUE
ALTERNATE PARTS SUPPLIERS
Line
8
Supplier
Description
LKQ Mid-America
~"'127278665
Price
$ 150.00
5725 SW Topeka Blvd
Topeka KS 66619
Fender 4DR,SE L., w/o Sport pkg,S#$M0788
(785) 862-0000
Quote: 60888338
Expires: 06/02/16
17
$ 272.50
Midway Auto Parts
#F01000650R
Aimee Studna
Opt OEM Bumper cover +25%
950 Century Ave
(816) 241-2100
21
$ 99.00
Midway Auto Parts
#F01037101C
Aimee Studna
A/M CAPA Grille surround w/o sport model
950 Century Ave
(816) 241-2100
22
23
25
$ 279.00
#F01006256N
5725 S TOPEKA BLVD
TOPEKA KS 66619
Quote: 60485641
(800) 530-5497
Expires: 05/29/16
#F01070177DS
5725 S TOPEKA BLVD
A/M Absorber
TOPEKA KS 66619
Quote: 60485641
(800) 530-5497
Expires: 05/29/16
$ 89.00
$ 99.00
#F01038139
PHILLIP CODY
A/M LT Bezel w/SEL model
5725 SW TOPEKA BLVD
TOPEKA KS 66619
(800) 530-5497
26
$ 9.00
#F01027113
PHILLIP CODY
A/M RT Side retainer
5725 SW TOPEKA BLVD
TOPEKA KS 66619
(800) 530-5497
27
$ 9.00
#F01026113
PHILLIP CODY
A/M LT Side retainer
5725 SW TOPEKA BLVD
7/1/2016 10:01:22 AM
093878
I 1.6.06.04210
Page 9
Claim#:
967715-GC-3
Workfile ID:
b8d0d113
2012 FORD RJSION SEL AWD 4D SEO 6-3.0L·A BLUE
TOPEKA KS 66619
(800) 530-5497
28
30
31
33
34
36
$ 63.00
#F01036127PP
5725 S TOPEKA BLVD
A/M CAPA Bumper grille w/o sport model
TOPEKA KS 66619
Quote: 60906457
(800) 530-5497
Expires: 06/02/16
#F01223114C
5725 S TOPEKA BLVD
NM CAPA Mount panel
TOPEKA KS 66619
Quote: 60485641
(800) 530-5497
Expires: 05/29/16
$ 76.00
#F01210106PP
5725 S TOPEKA BLVD
A/M CAPA Center grille chrome w/o SPORT
TOPEKA KS 66619
Quote: 60485641
(800) 530-5497
Expires: 05/29/16
$ 92.00
$ 171.00
#F01217103PP
5725 S TOPEKA BLVD
NM CAPA Upper grille chrome w/o SPORT
TOPEKA KS 66619
Quote: 60894599
(800) 530-5497
Expires: 06/02/16
$ 85.00
#F01216104PP
5725 S TOPEKA BLVD
A/M CAPA Lower grille chrome w/o SPORT
TOPEKA KS 66619
Quote: 60894599
(800) 530-5497
Expires: 06/02/16
$ 115.00
LKQ Mid-America
#"'126864170
5725 SW Topeka Blvd
Topeka KS 66619
Air Cleaner 3.0,AUTO,FWD 3.0L,S#$K1207
(785) 862-0000
Quote: 60485641
Expires: 05/29/16
38
40
46
$ 286.00
#F02503273C
5725 S TOPEKA BLVD
NM CAPA RT Headlamp assy
TOPEKA KS 66619
Quote: 60899882
(800) 530-5497
Expires: 06/02/16
$ 286.00
#F02502273C
5725 S TOPEKA BLVD
TOPEKA KS 66619
Quote: 60899882
(800) 530-5497
Expires: 06/02/16
Radiators Plus A/C - Shipping
#CSF-3533
Kenneth Hancock
A/M Radiator
$ 150.33
7/1/2016 10:01:22 AM
093878
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Page 10
Claim#:
967715-GC-3
Workfile ID:
b8d0d113
Nashville TN 37210
(888) 564-2300
47
LKQ Mid-America
#"'117139264
5725 SW Topeka Blvd
RCY Fan assy +25%
Topeka KS 66619
Radiator or Condenser Fan Motor (ASSM), 3.0L,S#$K0899
(785) 862-0000
Quote: 60485641
$ 130.00
Expires: 05/29/16
62
67
#F01225201PP
5725 S TOPEKA BLVD
A/M CAPA Radiator support w/2.5 3.0 Liter
TOPEKA KS 66619
Quote: 60485641
(800) 530-5497
Expires: 05/29/16
Radiators Plus A/C - Shipping
#REA-31-3786P
Kenneth Hancock
A/M Condenser
$ 183.00
$ 120.82
Nashville TN 37210
(888) 564-2300
7/1/2016 10:01:22 AM
093878 I 1.6.06.04210
Page 11
Shawnee
I~aunty ' ' , rt,
P.arKs+ ~
recreation
June 24, 2016
TO:
Richard V. Eckert
Shawnee County Counselor
FROM:
Parks+ Recreation
RE:
Claim of Allied Property and Casualty Insurance Co. (Stacia Kolbek)
1
On June 3, 2016, I received your memorandum requesting an investigation of the claim filed by Allied
Property and Casualty Insurance Co. (Stacia Kolbek).
John Boyd, Superintendent of
Greenspaces/Parkland investigated this incident and his findings are attached.
Please let me know if you have any additional questions or concerns.
JEK/lrk
.Attachment(s)
parks.snco.us
? :._
',
•
'
.'
•
.(_
.
•
.> .
... ' .. .· ' ..
'
. '~:: :: . ';
B
Shawnee
I ~aunty " ' , r! ,
P.arKs+ ~
recreation
June 24, 2016
TO:
Parks + Recreation
FROM:
John Boyd, Superintendent
Greenspaces/Parkland Division
RE:
Claim of Allied Property and Casualty Insurance Co. (Stacia Kolbek)
Please find attached copies of accident reports from the day of the incident. John O'Shea was
attempting to clear the intersection and felt he had sufficient time to do so. The fact that the claimant
impacted the rear of the machine as he was clearing the intersection leads me to believe she was
inattentive and or distracted. The machine is quite large and has flashing hazard lights so it is visible to
traffic.
John O'Shea was a participant in the accident, but in no way completely responsible for the results.
JEB/lrk
Attachment( s)
parks.snco.us
INCIDENT REPORT
DATE:7-/3-/I.:, TIME: __!l_;_StJ /fh?
FACILITY: __J}JpuerPERSON(S) INVOLVED:
Name:
Name:
5&A 1-,
Osl..e~
S'hic.,'e. /(ol~ek..
Address:
.s~s- ~.W,(dt:t-f
J'c111...
di
IF MINOR, PARENT/GUARDIAN'S NAlvffi: _ _
Address & phone if different: _ _
HOW WAS TIIlS INCIDENT BROUGHT TO YOUR ATTENTION?
_.- I
'1eJ/L)L
/15' Ji effi.. odlt•cl
v
DESCRIBE T~ INCID~NT IN DET~IL (Use ~dditionarpaper if necessary):
.l..t!'-l'f- f'i'lft, /17-t She(..+ ./l'dh\. 11), fi,v.,.d G,,,.;.e., lAe.. i/eh,'c/t.
- - 71'tJ.vi/,·,.; ~ov+!.. e,.M( li.i'f flt{. ie',;J..f ;eea.r Y-r di f~! /'>')'4,::/,,',ie_
_ _ '7vr111.11.J
/kt!. !/ufley
(_r11rretl)
fr1
'f
.:/-
+~Ii /..,
I)
117
.,.
(de
WITNESSES:
Name:
Address:
Phone:
Name:
Address:
Phone:
DEPARTMENTPERSONELNOTIFIED?_)'lz/fe
//1,1fley1 J"A>i. BIJ!y~
/am
SIGNATURE OF REPORTING E M P L O Y E E : ~ / ~ ,
I
...J
/Jt9t>il"1e
DATE:
'7-/ :J'-/t, .
I
SIGNATURE OF WITNESS:
----------------SIGNATURE OF WITNESS:
----------------SIGNATUREOFPERSONINVOLVED:
~
DATE: - - - - DATE: _ _ _ __
DATE: _ _ _ __
SIGNATURE OF PERSON INVOLVED:c;'c:::~.~-;;i;~·'ff!'--;;~,.::::::..·
~~=,___.;;:~------------
FOLLOW-UP INFORMATION BY SUPERVISOR:
------------------DATE: - - - - -
SHAWNEE COUNTY VEHICLE/PROPERTY ACCIDENT REPORT FORM
(To be completed by department & submitted immediately to the County Clerk)
County Clerk contact: John Morgan 785-251-4161
FAX: 785-291-4912
Date of Accident //-/J-/C,
· Department Contact Person:
1)
3)
4)
5)
7)
8)
9)
/Juc/,.aJ //vfley
d"KJ:
DEPARTMENT:
Phone: 7g-.5-_-q?.....'Si-=1=--'-e?~C'-/-9_ _ _ __
EMPLOYEE INFORMATION
::S:,A'
Narne :
A
tJ~le t:1,
Work Phone No.
'7%S: 2,;?.J- 7"17'i
2) Horne Phone No.
Home Add.ress: .f/7/t, ..SlJ Cede/' Cresl ifd
(O/Je.k(). 16 t.,!,tOG
Date of Birth:
f--11- z1s- 6) Drivers License No. /(0,2. -1'tJ -CJ(/1
Was this employee the driver? _K yes_ no ·
Was this employee injured in the accident?
yes .X.. no,
If yes, was medical attention provided?
yes
no
Location of accident (Be specific) TAf-eruc.f/1),',.. -;;;- /tJ+)._slrec:I o:1-- ~ jz;,l e
10)
un
10) Were the authorities contacted?~ yes
no
If yes, please indicate Sheriff or([o);l~ (Circle one)
Case No. 7 ?7 /- / (,. J- J, 7 ::SS-1-i.S11) Were there passengers in this vehicle?
yes _,K no
If yes, please list their name, address, & phone no.
COUNTY VEHICLE INFORMATION
1) Make and year of vehicle:
Vehicle ID No. (VIN) :
3) Was this vehicle damaged?
County ID No.
2)
lfta.r
7/re_ t,,.1u A
Jt.
o
yes_ no
/cc.£ c,-f-
If so, describe damage.
/!, ii,,. 4111 l"J,t!d
;-
. Was this vehicle towed lrom the scene? _ yes .f2.. no
Current location of vehicle:
~tPh/f'Cquif t!t.f c'.hi0e
5)
WV
OTHER l?'ARTY INFORMATION
1)
2)
3)
5)
8)
10)
11)
12)
14)
17
)'1'1 owu
l!Jc•e.K
tf:,rk
Name: .,,,<;fac/e l!l-6ek
·
Address:
5::3.S- , £ tv Wo..rto1::t;:!:/
4) Alternate phone
Daytime Phone No.: 78'S·f~6 -{, €':l. J
Insurance Provider: ___A-.._,__.!/~1~',=d....___ ___________----,;,-,---------6) Phone No.:
7) Policy No.:
f/JC..;n-eOrf:c!,S-t.CIJ,f
Was this person's vehicle damaged? Jlyes _ no
9) If so, describe damage _ft~~=~-t._.,~.,_,_fl~·~ll~1~(e,-a=d~'-a~t=~r--~----~---~
Make and year of vehicle:
~
Tag No.
Was this person injured? ~ yes J( no
Were there other passengers in this vehicle? _j_ yes_ no How many? / IA~n-113) Were any· passengers injured _· yes
no
no
14) If yes, was medical attention provided?
yes
Was this person's property damaged? _ y e s _ no
15) If so, describe damage.
_x
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STEP 3: Collector affixes bottle seal{s) to bottle(s). Ccillectci(dateis__se~f(s). qo~'.0r.'irii;,ais:seal(s): Op~o~·cornpletes STEP. '5 pri Copy'·2 (MAO
STEP. 4: CHAIN OF CUSTODY• INfTIATED BY CO!-LECTQR,AND CQl'l/lPLETE;Q _BY LABO!=IATOR.Y. : . . .-... ·, . · ..
..: .. . : . . ,
, , · '·:· .: . · · .. · ·
I certify th.~~~ $pe~imen ~~ 'V me fY the donor ideQtified in_ tMc:ert(ffcation ~e:t/0~·011 Co .~ of thi~ •.torni was qo(lecte.d)abel9:<f{5.eale,d and'releasecf_to the,Delivery_Sei'vicif/1o_teq)n: <·,
. accordanc6.,·"."'th'ap~hcable~qumyie/J!~ .,....__
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. I certify iM:it" !_provided urin~ specimen to th~ col/ecidr; 'ihafl.tiaVe .d~t: 'aeft.jl~~rp.ted jt i; any rhJmner;' eapti ${}~c(ifien. ,h<!We used ~ii~fJii.~eq with' <I·. ta.n!f)~,._~~~i<j~ni .', .:
sea/ '.'Jft'tit~e.24:e; ~Efrt!J9,t the,,ir:,Jqr_aJ/J1provided 0~ this _for':1. arj~~ tpe _!a.be/ af(i~rrfJo.._s~~-h ~:ecl(rle~ ·o~ttl~/s _cor~ft·: . : .: ·: . ' .·/'. . . ·. -~: ......... :: :: ~
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. STEP 6: COMPl.:.ETED,BY.MEDICAL REVIEW·ci'FFICER·-.PRIMA,RY'SP.ECIMEN ·
lri. accordarice-",with}1pplica1?J~:requir~ments; nJy" d~t.erminatibn~rificatib_n,.fs.:. :_ . · ... ,·... .".'
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: REMARKS'-.----~-,-,---.--'---:-::·_
. ......-.c...,--,----,-~..,:---.------
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Signature of-Medli;!!I flBViBY! Officer..
;
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[] NEGATIVE .. Q POSrflVE ··.. 'OTEST CANCELLE.P:.: ·: D·QllUTE '.:·.. .-.: : ..
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(PRINT) Mecllcal Review O.itlc;e;.~ Name (Fjrst),fr, Last) . '
·.:.
·1n accordance with ~ppJ{qJbie requirements; f!IY det~rmi~ationlve~fi.cat(oh· · : :
.D RECONF;IRMED O FAl!:.ED TO .RECONFIRM - RE;ASON
"X
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Signature .of Medical R~viev; Officer.
: :: ·{P.RINll M~i:tical Revj~v; Offlc;~rs NElmEi° (Fjrs~ t,,11, Last) · .
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. ·oate (M"o)oa··r<r:) . ' .
ear Citizen,
he Topeka Police Department desires to strengthen our
ll1:nership with the community by working with the
tiz~ns and providing quality service. Feedback from you,
Jr partner, is essential in providing the best possible ,
:rvice. Please take a moment to complete the
uestionnaire and let us know how we are doing. Just fill
1is out, detach it and drop it in the mail. Thank you.
/as the police response timely?
YES
NO
las your request or problem handled effectively?
YES
NO
YES
NO
~ere you treated with courtesy and respect by the
fflcer?
lescribe your contact with the
olice.
Vlctlmof Reporting Traffic
a crime
a crime Accident
Other
reason
Vhat Is your opinion of the level
,f service provided by the
opeka Police Department?
Very
satisfied
Somewhat
satisfied
Not
satlsfied
low do you rate the s_afety of
our neighborhood? (Topeka
esidents only)
Excellent
Good
Average
Poor
low do you rate the safety of
opeka
Excellent
Good
Average
Poor
Satisfied
i, Comments and/or suggestions on improving service:
'Jptional:
,fame:------------------~,ddress: - - - - - - - - - - - - - - - - ~hone N u m b e r : - - - - - - - - - - - - - - - -
Cas_e N"umber:
Offi~~r:
L..,
:17J ~{-LC
hamna ~·
Badge#:
c>Z3
Please keep this pamphlet. The following information has
been prepared to address questions you may have about
the law enforcement process and questions you may have
as a victim of crime. If you have reason to be fearful or are
receiving threats about your involvement in your case, or
if you are in a situation of immediate threat or need of
emergency medical care, dial 911.
The Crime Victims' Assistance Unit of the Topeka
Police Department will answer questions relating to your
police report, your rights as a crime victim, the filing of
charges, status of property, disposition of cases, process of
restitution and service you may need. Contact the Crime
Victims' Assistance Unit Monday- Friday, between 8 a.m.
- 5 p.m. at 368-9064. After hours and on weekends, please
leave a message. The Crime Victims' Assistance Unit is
funded through the Governor's Grants Office, by award of
a federal Victims' of Crime Act grant. Kansas law allows
for compensation to some crime victims through the Crime
Victims' Compensation Board, Kansas Attorney General's
Office, 296-2359, 120 SW 10th Ave, Topeka, KS 66612.
Stolen Property: If your case involves stolen property
that has a specific identifier, such as a serial number, a
description of your stolen items will be compared to ·all
property recovered by the Police Department. Local pawn
shops are monitored and cooperate in the recovery of
stolen items. Stolen property with known serial nunibers
will be entered into the FBI's National Crime Information
Computer. You are responsible for notifying any credit
corporations and/or banks if credit cards or checks
were stolen. If·you discover losses, locate serial numbers
for stolen items or recover your own property, compile a
detailed written list of those items and mail them as soon
as possible to Records, Topeka Police Department, 320 S.
Kansas Ave., Topeka, KS 66603. Include the case number,
your name, address and phone number.
Domestic Violence Law: Kansas Law requires an arrest
under _certaip: circumstances. The prosecution of these
charges is
.of the District Attorney's Office
. the decision
., ,. ,}
and noqhe victim:... · ·· \~ ./ .
YourRi.ght~ as·awj~Lirit'.. ·;
K.S.A. 74-7333 and 7~-1335.states:
1. Vict4I1{ should· be treated\']:;iith courtesy, compassion and with
respeC[ for their dignity
privacy and should suffer the minimum
of necessary inconvenience.. from their involvement with the
criminal justice system,
·
·
2. Victims sh~uld ~ecelve,'tlirough formal and informal procedures,
prompt and fair ~edress for the harm which they have suffered.
3. Informatfon regarding the availability of criminal restitution,
d!!Jilages in a civil cause of action, the crime victims
recovery
compt:nsatjon fund and other remedies and the mechanisms to
obtain such remedies should be made available to victims.
4. Information .should be made available to victims about their
Follow-up Investigations and Criminal Cha:nit~=,)~ven
participation. in criminal proceedings and the scheduling, progress
though your case will be given as much considi::r.~\t/'.811:,~.
and ultimate disposition of the proceedings.
p~ss~ble,. it ~ll take time to b~- processed-;,th.r~fi~)~~&>. , · 5. The views and concerns of victims should be ascertained and the
appropriate assistance provided throughout the criminal process.
crumnal Justice system. If solvab1hty f!:!-clors are PJf,SJ.)ij.:1£,(}
6. When the per~onal interests of victims are affected, the views or
your criminal case, a detective will be assign~fidfJf.i'9;.ol,lr'. ·;
concerns oftiie victim should, when appropriate and consistent with
have specific facts which might aid in the irht~stigat,Io~;/
criminal law. BJ].d procedure, be brought to the attention of the court.
7. Measures· nj'ay be taken when necessary to provide for the safety of
please contact or leave a message for .the ·Detective
victims encl tn~ir families and to protect them from intimidation and
Supervisor, Monday - Friday, 8 a;m. - lO'p,.m .. at 368retaliation.
9400. For Accident Investigations, please call 368-9450
8. Enhanced training should be made available to sensitize criminal
. between 8 a.m. - 5 p.m., Monday - Friday.
justice personnel to the needs and concerns of victims and
guidelines should be developed for this purpose.
After investigating the crime, the Police Department
9. Victims should be informed of the availability of health and social
services and other relevant assistance that they might continue to
presents its evidence to the City Attorney's Offj:ce· or the
receive the necessary medical, psychological and social assistance
District Attorney's Office. These offices detern_1ine what,
through existing programs and services.
if any, charges should be filed against the suspect. _City of
10. Victims should report the crime and cooperate with law
Topeka Attorney's Office - 368-3883, 215 SE 7t1(~t-, 4th
enforcement authorities.
11. The victim or victim's family shall be notified of the right to be
Floor, Topeka, KS 66603. Shawnee County'-'Dzstrict
present at any public hearing where .the accused or the convicted
Attorney's Office - 233-8200 ext. 4330, 200 SE 7th St.,
person has the right to appear and be heard.
2nd floor, Topeka, KS 66603.
·
12. Notification shall be made to any victim or victim's family whose
address is known to the District Attorney.
and
or
CRIME PREVENTION TIPS
en
b
,,
DateandTime:t)L}•\3· \
Location:
\Qj- (:JBGE..
OTHER VEHICLE INFO:
Make: ~OD
Year: '\ 2.
.J
J
r"°
Model:=-'-'v~:5~:µ..J~--=---License No.: P,\g,:B"'S:}
OWNESRINFORMATION (if different from driver):
Name: ~
Phone:' - - - - - Address:
Driver's L i c e n s e : - - - - - - - - - - - - DRIVER INFORMATION:
.
Name: 51'~\t. $.o,be..\l Phone: $ob-(;,gf,3
Address: 5 :> S ~ W~-,~$ ~ ~ \
Driver's License: l<.03 l'T~7
INSURANCE INFO:!f::TION:
L\'
Company: P. \ \ ,
Policy Number: ~~(. rnDl>':;>zs
The Topeka Police Department pledges to work with you
to solve your case. Hopefully, this situation will not
happen again. Here are some helpful crime prevention
tips:
• Observe and report suspicious activity, persons and
vehicles to 91 l.
• Cooperate with officers investigating a crime in
your neighborhood and be willing to testify if
necessary.
• Keep doors and windows of your home locked and
exterior lights on at night.
• Mark your property - with your driver's license
number. Note: Ifyour driver's license is your social
security number, do not use and seek to change it at
your earliest convenience.
• Be observant, travel with friends and keep your car
doors locked.
• Always lock your car, take the keys and remove
valuables from sight in your car.
• Know your neighbors and look out for one another.
._
? b [. ., \ 3 9:,
REPORTS
Public Information: Some information about a reported_
crime is public record and the Police Department cannot
de!).y access. We have no control over the public
information used by the news media.
To obtain a copy of your police report: The open records
portions of reports are available five business days after the
initial report is made. The Records Division counter hours
are 8 a.m. - 5 p.m., Monday - Friday, and closed on
holidays and weekends. The cost for the open records
portions of an offense report is $2 up to five pages, plus $1
for each additional page over five. The cost for an accident
report is $5, or online at topekaks.policereports.us. For
additional questions, contact Records at 368-9474.
To obtain a copy of your report by mail: send a check or
money order (no cash, please) for the exact amount, payable
to the City of Topeka. Mail your request with a return selfaddressed, stamped, business-size envelope. Include: report
date, case number, type of report, location of incident,
person or company named in the report and check or mon'.ey
order.
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Emergency Assistance (Police/Fire/Medical) .............. 911
TPD's Victims Assistance Unit ................. 785-368-9064
TPD Crime Prevention ................................ 785-368-9497
Detective Division~.: ....: ............................... 785-368-9400
Accident Investigation ................................. 785-368-9450
YWCA Center for Safety and Empowerment
Business Hours ..................................... 785-354-7927
After Hours/Weekends ........................ , 888-822-2983
Health Care:
St. Francis Health Center............................. 785-295-8000
Stormont Vail Health Care ......................... 785-354-6000
Legal:
.
City Attorney's Office ................................. 785-368-3910
Shawnee County District Attorney's Office ..................... .
.............................................. 78~-233-8200 ext. 4330
Other Assistance:
Kansas Crime Victims' Compensation Board ................. .
........................................:..................... 785-296-2359
Kansas Domestic Violence and Sexual Assault Hotline
.......................................................... 1-888-363-2287
Kansas Children's Service League Parent Help Hotline
........................................................... 1-800-332-6378
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HELPFUL NUMBERS
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Boyd,John
From:
Sent:
To:
Cc:
Subject:
Damme, Pam
Monday, April 18, 2016 2:25 PM
Hutley, Mike
Boyd, John
drug test - John O'Shea
John O'Shea passed his post accident drug test.
1
Shawnee
I ~ounty "-1' ~ r!'~
P.arKs+ ~
recreation
June 3, 2016
TO:
John Boyd, Superintendent
Greenspaces/Parkland
FROM:
Parks + Recreation
RE:
Claim of Allied Property & Casualty Insurance Co. (Stacia Kolbek)
Please find attached a copy of the request for information from Richard V. Eckert, Shawnee County
Counselor. Mr. Eckert is requesting information you have relating to same and also provide your
recommendation regarding approval or denial of the claim filed by Allied Property & Casualty
Insurance Co. a/s/o Stacia Kolbek.
Allied Property & Casualty Insurance Co filed a claim for the occurrence that occurred on April 13,
2016. Please investigate this incident and provide me with your account, investigation and any
appropriate documents from your staff or other divisions of the department.
John O'Shea is supervised by Lyle Bausch
JEK
Attachments
parks.snco.us
Shawnee County
Department of Corrections
501 S.E. 8th Street - Topeka, Kansas 66607
Adult Detention Facility- 501 SE 8th- Topeka, Kansas 66607 -(785) 291-5000- FAX (785) 291-4924
Youth Detention Facility- 401 SE 8th- Topeka, Kansas 66607 - (785) 233-6459- FAX (785) 291-4963
Corrections Annex - 818 SE Adams - Topeka, Kansas 66607 - (785) 291-5000 - FAX (785) 291-4930
\
TO:
FROM:
Brian Cole, Director
DATE:
August 15, 2016
SUBJECT:
Request to Solicit Bids for Concrete Replacement
&<--
I am requesting your approval to solicit bids for necessary concrete replacement on the
Department of Corrections grounds.
The current concrete has multiple areas where the surface has deteriorated creating holes and
uneven surfaces which present a safety hazards. The concrete needing replaced is the sidewalk
and front entrance to the Adult Detention Center which is a high traffic area. We have discussed
the project with Facilities Director Bill Kroll and he agrees with our assessment.
The estimated cost for the project is $24,785.00. I have met with Ms. Greiner concerning this
project and the remaining funds from a project funded by the Certificate of Participation can be
used. Thank you for your consideration of this request, and I will be happy to answer any
questions you may have.
BWC:ek
cc:
Betty Greiner, Director of Administrative Services
Eve Kendall, Deputy Director
File

i ,1 - Shawnee County

Transcription

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