<p>Fire / Ambulance / Tow / Catering / Cold / Hot Dog Cart / Hot / Motion Picture / Utility Truck (PDA) Call in: 800-351-3133, menu option 3</p><p>Audatex Request # Audatex ID # (Required) </p><p>Total Loss Point of Impact: Claim Rep Name Claim Rep Phone # Loss Date Gross Estimate Amount $: Claim # Policy # Owner Name (1st) Owner Phone # Loss Type</p><p>Market Area (City/Zip/Postal Code) Inspection (City & State) Insured (2nd) Owner Phone # Claimant 10th digit-model year J=88 K=89 L=90 M=91 N=92 P=93 R=94 S=95 T=96 V=97 W=98 X=99 Y=2000 1=01 2=02 3=03 4=04 5=05 6=06 7=07 8=08 9=09 A=10 Ext Color: VIN: </p><p>Year Make Model Body Style Conventional CabType Standard Cab Drive Type COE Forward Cab Ext. Cab Crew Cab 2wd 4wd Trim Body Type Fire Truck Ambulance Mileage Engine Make/Model Horsepower Transmission Tow Hot Dog/Vending Auto Manual Catering/Cold Utility Hot/Motion Picture Truck Cart Transmission Make # of Gears GVW Wheel Base Suspension Type # of Rear Axles Spring Air Hendrickson Other # of Driven Axles Rear Axle Rating Front Axle Rating Drop Axle(s) Dual Rear Wheels Yes EQUIPMENT CAB EQUIPMENT Hose & Reels Light Bar Push Bumper Up to Code Oven UTILITY BODY Power Steering Generator: Battery Booster System Open Top Burners Body Year: Body Manufacture: Power Windows Scene Lights # of Winches: Grill/Griddle Top Body Length: Power Locks # of Fuel Tanks: PTO Deep Fryers Total Fuel Cap # gal: Body Material Cruise Control # of Fuel Tanks: Warming Oven Steam Table AMBULANCE Total Fuel Cap # gal: Aluminum Steel Tilt/Telescoping Wheel Refrigerator Body Year: CATERING TRUCK Ladder/Pipe Rack Air Conditioning Body Manufacture: COLD TRUCK Cold Sandwich Box Air Compressor: Radio Type Body Model: Body Year: Ice Chest Coffee Urns Welder: AM/FM Stereo Body Type Body Manufacture: Fountain Pop Machine Generator: AM/FM Cass Type-I Type-II Body Material Generator: Crane Year: AM/FM CD Type-III Aluminum Roof Type Crane Make: Crane Model: CB Radio Light Bar Stainless Steel Standard Translucent Crane Capacity: # of Fuel Tanks: Refurbished Box Jake Brake S.S Storage Shelving Max Extension: Air Ride Seats: Total Fuel Cap # gal: Warming Oven 3 Compartment Sink Work Bench Bumper Driver Passenger TOW Pizza Oven Grill Hand Washing Sink Body Year: Mounted Vice FIRE TRUCK Steam Table Fresh Water Tank Body Year: Body Manufacture: # of Fuel Tanks: Coffee Urns Waste Water Tank Body Manufacture: Body Type Total Fuel Cap # of gal: # of LPG tanks: Body Material Wrecker Rollback Cold Sandwich Box Body Model: Salad Bar # of Fuel Tanks: Man Lift Equipment Steel Aluminum Total Fuel Cap # gal: Body Length/Line Display Rack Ice Chest Man Lift Year: Stainless Steel HOT DOG/VENDING CART Man Lift Make: 19 Foot 21 Foot Body Type Stainless Steel Storage Cart Material Man Lift Model: # of LPG tanks: Aerial Pumper Single Line Dual Line Aluminum Stainless Man Lift Capacity: # of Fuel Tanks: Quint Tanker Repo/Wheel Lift Steel Max Lift Height: Body Material Total Fuel Cap # gal: # of Man Buckets Brush HOT/MOTION PICTURE Steam Table Steel Aluminum Tank Cap: TRUCK Rolling Hot Dog Grill 1 Man 2 Man Pump Manufacture: Light Bar Tunnel Body Body Year: Ice Chest Outriggers Pump Cap: # of Tool Boxes: Body Manufacture: Stainless Steel Storage Foam System Wheel Lift Body Material: Aluminum Hand Washing Sink Aerial Ladder (# of ft): Tow Dollies Stainless Steel Fresh Water Tank Attic & Roof Ladders Updated Kitchen: Waste Water Tank # of LPG tanks: CONDITIONING: INTERIOR ABOVE AVERAGE AVERAGE BELOW AVERAGE Prior Damage Cost: $ EXTERIOR ABOVE AVERAGE AVERAGE BELOW AVERAGE Prior Damage Cost: $ MECHANICAL ABOVE AVERAGE AVERAGE BELOW AVERAGE ENGINE Rebuilt Engine Yes No Miles on Rebuilt: Cost: $ TRANS Rebuilt Trans Yes No Miles on Rebuilt: Cost: $ OTHER MECHANICAL Desc/$: Date work done/Part(s): RECEIPTS FRONT TIRES ABOVE AVERAGE AVERAGE BELOW AVERAGE REAR TIRES 1st AXLE ABOVE AVERAGE AVERAGE BELOW AVERAGE REAR TIRES 2nd AXLE ABOVE AVERAGE AVERAGE BELOW AVERAGE GEN’L COMMENTS: </p><p>PDA = Pre-Damage Appraisal (c) 2010 Audatex North America, Inc.</p>