CertiMotive© Appraiser Scope Sheet
CertiMotive© ID#
*
ID# must be Input to use this Form
Date/Time
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
1
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12
:
Hour
00
01
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46
47
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49
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51
52
53
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55
56
57
58
59
Minutes
AM
PM
AM/PM Option
File #
IA Company or Other File #
Email - Gary Rowley
Appraiser First Name
*
Appraiser Last Name
*
Cell Phone Number
*
E-mail
*
Insurance Company
AAA
AARP
21st Century Insurance
ACE Limited
Acuity
Aetna
Affirmative Insurance
Aflac
Alleghany Corporation
Allied Insurance
Allstate
American Automobile Association
American Family Insurance
American Income Life Insurance Company
American International Group (AIG)
American National Insurance Company
Ameriprise
Ameritas Life Insurance Company
Amica Mutual Insurance
Applied Underwriters
Arbella Insurance Group
Assurant
Assurity Life Insurance Company
Auto Club
Auto-Owners Insurance
AXA Equitable Life Insurance Company
Bankers Life and Casualty Company
Berkshire Hathaway
Chubb Corp.
Cincinnati Insurance Company
CNA Financial
Colonial Life & Accident Insurance Company
Combined Insurance
Commerce Insurance Group
Conseco
Country Financial
Elephant.com
Encompass Insurance Company
Erie Insurance Group
Esurance
Evergreen USA RRG
Farmers Insurance Group
Federated Mutual Insurance Company
First Insurance Company of Hawaii
FM Global
GAINSCO
GEICO
General Re
Genworth Financial
Gerber Life Insurance Company
GMAC Insurance
Gracy Title Company
Grange Mutual Casualty Company
Guardian Life Insurance Company of America
GuideOne Mutual Insurance
Hanover Insurance
The Hartford
HCC Insurance Holdings
Hiscox Small Business Insurance
Horace Mann
Infinity Property & Casualty Corporation
IntelliQuote Insurance Services
Ironshore
Jackson National Life
John Hancock Insurance
K&K Insurance
Kansas City Life Insurance Company
Kentucky Farm Bureau
Knights of Columbus
Liberty Mutual
Lincoln National Corporation
Manhattan Life Insurance Company
Markel Corporation
MassMutual
Merchants Insurance Group
Mercury Insurance Group
MetLife
Modern Woodmen of America
Mutual of Omaha
National Life
Nationwide Mutual Insurance Company
New Jersey Manufacturers Insurance Company
New York Life Insurance Company
The Norfolk & Dedham Group
Northwestern Mutual
Omega
OneBeacon
Oxford Health Plans
Pacific Life
Pacificare
PEMCO
Penn Mutual
Philadelphia Contributionship for the Insurance of Houses from Loss by Fire
Philadelphia Insurance Companies
Physicians Mutual
Primerica
Principal Financial Group
Progressive
Protective Life
Prudential Financial
QBE
The Regence Group
Reliance Insurance Company
RLI Corp.
Safe Auto Insurance Company
Safeco
Safeway Insurance Group
Selective Insurance
Sentry Insurance
Shelter Insurance
Southern Aid and Insurance Company
Standard Insurance Company
State Farm Insurance
Sun Life Financial
Symetra
TIAA-CREF
Transamerica Corporation
The Travelers Companies
Trupanion
Unum
USAA
West Bend[disambiguation needed]
West Coast Life
Western & Southern Financial Group
Western Mutual Insurance Group
Westfield Insurance
Westminster American Insurance Company
White Mountains Insurance Group
Other Insurance
If Other Ins Co
Insurance
*
Insured
Claimant
Claim #
*
Vehicle Year
*
Year
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
Vehicle Make
*
Make
Acura
Alfa Romeo
AM General
American Motors
Aston Martin
Audi
Austin/Austin Healey
Avanti
Auto-Union-DKW
Bentley
Bertone
Bluebird
BMW
Bricklin
Brockway
BSA
Buick
Cadillac
Carpenter
Checker
Chevrolet
Chrysler
Citroen
Collins Bus
Daewoo
Daihatsu
Datsun
DeLorean
Desoto
Desta
Diamond Reo or Reo
DINA
Divco
Dodge
Ducati
Eagle
Eagle Coach
Excaliber
Ferrari
Fiat
Ford
Freightliner
FWD
Gazelle
Gillig
GMC
Grumman
HarleyDavidson
Hillman
Hino
Honda
Hudson
Hyundai
Imperial
Infiniti
International Harvester
Isuzu
Iveco/Magirus
Jaguar
Jensen
Jeep
Kaiser-Jeep
Kawasaki
Kenworth
Kia
Koenigsegg
Lada
Lamborghini
Lancia
Land Rover
Lexus
Lincoln
Lotus
Mack
Mahinda
Maserati
Maybach
Mazda
MCI
Mercedes-Benz
Mercury
Merkur
Mid Bus
Mini-Cooper
MG
Mitsubishi
Morgan
Morris
Moto-Guzzi
Navistar
Neoplan
Nissan
Norton
Oldsmobile
Opel
Orion
Oshkosh
Packard
Panoz
Peterbilt
Peugeot
Plymouth
Pontiac
Porsche
Reliant
Renault
Rolls Royce
Saab
Saleen
Saturn
Scania
Scion
Simca
Singer
Smart
Spyker
Sterling
Sterling
Studabaker
Stutz
Subaru
Sunbeam
Suzuki
Tesla
Thomas Built
Toyota
Triumph
TVR
UD
Van Hool
Victory
Volkswagen
Volvo
Western Star
White/Autocar
White/GMC
Willys-Jeep
Yamaha
Yes
Yugo
Vehicle Model
*
VIN Scan
VIN
*
VIN - Input Manually
Prod Date
*
Vehicle Type
2 DR
4 DR
Hatchback
Convertible
Truck
SUV Sm
SUV Lg
Wagon
Van
RV
Heavy Truck
Semi
Other - Put in Notes
Transmission
Auto
Overdrive
S6
S5
S4
S3
4W
Cylinders
3
4
5
6
8
10
12
Turbo
Diesel
If Truck
Shortbed
Longbed
1/2 ton
3/4 ton
1 ton
Utility
Cab & Chassis
Other
Odometer (mileage)
*
License Plate #
License Plate Exp Date
License Plate State
AL
AK
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Interior Color
Black
Tan
White
Blue
Grey
Silver
Other
Interior Type
Leather
Cloth
Exterior Color
Black
White
Blue
Grey
Silver
Red
Green
Biege
Other
Damage Type
Repairable
Borderline Total Loss
Total Loss
Power Options
PS POWER STEERING
PB POWER BRAKES
PW POWER WINDOWS
PL POWER LOCKS
PM POWER MIRRORS
POWER ANTENNA
POWER DRIVER SEAT
POWER PASS SEAT
POWER TRUNK/GATE RELEASE
POWER ADJUSTABLE PEDALS
POWER SLIDING DOOR
DUAL POWER SLIDING DOORS
Other
Convenience
AC AIR CONDITIONING
CLIMATE CONTROL
DUAL AIR COND
TILT WHEEL
CRUISE CONTROL
INTERMITTENT WIPERS
CONSOLE/STORAGE
OVERHEAD CONSOLE
MEMORY PACKAGE
NAV SYSTEM
ENT CENTER
DUAL ENT CENTER
TELESCOPIC WHEEL
MESSAGE CENTER
HOME LINK
REAR DEFOGGER
REMOTE STARTER
WOOD INTERIOR TRIM
KEYLESS ENTRY
REAR POWER SUNSHADE
Other
Seating
CLOTH SEATS
BUCKET SEATS
RECLINING/LOUNGE SEATS
LEATHER SEATS
HEATED SEATS
REAR HEATED SEATS
VENTILATED SEATS
3RD ROW SEAT
POWER 3RD SEAT
RETRACTABLE SEATS
12 PASS SEATING
15 PASS SEATING
CAPTAIN CHAIRS 2
CAPTAIN CHAIRS 4
CAPTAIN CHAIRS 6
Other
Radio
AM RADIO
FM RADIO
STEREO
SEARCH/SEEK
CD
CASS
STEERING WHEEL TOUCH CONTROLS
AUX AUDIO CONNECTION
PREMIUM RADIO
CD CHANGER/STACKER
SATELLITE RADIO
EQUALIZER
Other
Wheels
STYLED STEEL WHEELS
FULL WHEEL COVERS
CLAD WHEELS
ALUMINUM/ALLOY WHEELS
CHROME WHEELS
OR LARGER WHEELS
20
WIRE WHEELS
WIRE WHEEL COVERS
LOCKING WHEELS
Other
Roof
ELEC GLASS ROOF
ELEC STEEL ROOF
SKYVIEW ROOF
DUAL PWR SUNROOF
MAN STEEL ROOF
MAN GLASS ROOF
FLIP ROOF
T-TOP/PANEL
PWR CONVERTIBLE ROOF
DETACHABLE ROOF
VINYL COVERED ROOF
HARD TOP
Other
Safety/Brakes
DRIVERS SIDE AIR BAGS
PASSENGER AIR BAGS
FRONT SIDE IMPACT AIR BAGS
REAR SIDE IMPACT AIR BAGS
HEAD/CURTAIN AIR BAGS
4 WHL DISC BRAKES
ANTI LOCK BRAKES 4
ANTI LOCK BRAKES 2
TRACTION CONTROL
STABILITY CONTROL
POSITRACTION
COMMUNICATIONS SYSTEM
PARKING SENSORS
BACKUP CAMERA W/SENSORS
ALARM
HANDS FREE DEVICE
XENON HEADLAMPS
HEADS UP DISPLAY
INTELLIGENT CRUISE
BLIND SPOT DETECTION
LANE DEPARTURE WARNING
NIGHT VISION
ROLL BAR
Other
Ext/Paint/Glass
DUAL MIRRORS
HEATED MIRRORS
BODY SIDE MLDGS
TINTED GLASS
AM FILM TINT
PRIVACY GLASS
REAR WINDOW WIPER
FOG LAMPS
LUGGAGE/ROOF RACK
REAR SPOILER
HEADLAMP WASHERS
SIGNAL INTEGRATED MIRRORS
WOOD GRAIN
CLEAR COAT PAINT
METALLIC PAINT
TWO TONE PAINT
THREE STAGE PAINT
Other
Other
REAR STEP BUMPER
TRAILER HITCH
TRAILERING PACKAGE
REAR SLIDING WINDOW
POWER REAR WINDOW
RUNNING BOARDS/SIDE STEPS
XENON HEADLAMPS
PWR RETRACTABLE RUNNING BOARDS
BED LINER
BED LINER (SPRAY ON)
SOFT TONNEAU COVER
HARD TONNEAU COVER
DELUXE TRUCK CAP
BED RAILS
GRILLE GUARD
TOOL BOX (PERM)
DUAL REAR WHEELS
AUX FUEL TANK
CAL EMISSIONS
STONE GUARD
WINCH
Other
Engine Condition Rating
0
1
2
3
0=Rough 1=Fair 2=Clean 3=Extra Clean
Trans Cond Rating
0
1
2
3
0=Rough 1=Fair 2=Clean 3=Extra Clean
Paint Cond Rating
0
1
2
3
0=Rough 1=Fair 2=Clean 3=Extra Clean
Front Tires
0
1
2
3
0=Rough 1=Fair 2=Clean 3=Extra Clean
Rear Tires
0
1
2
3
0=Rough 1=Fair 2=Clean 3=Extra Clean
Body/Glass
0
1
2
3
0=Rough 1=Fair 2=Clean 3=Extra Clean
Interior
0
1
2
3
0=Rough 1=Fair 2=Clean 3=Extra Clean
CCC Eval #
Repair
0/5000
Replace
0/5000
Refinish
0/5000
Blend
FT BUMPER
RR BUMPER
HOOD
ROOF
RT FENDER
LT FENDER
RT FT DOOR
LT FT DOOR
RT RR DOOR
LT RR DOOR
RT QUARTER
LT QUARTER
DECKLID/LIFTGATE
OTHER
Hold Down "ctrl" button to select multiple
R&I
FT BUMPER
FT DEFLECTOR
LT H/LMP
RT H/LMP
LT MARKER LMP
RT MARKER LMP
LT REFLECTOR
RT REFLECTOR
GRILLE
HOOD EMBLEM
HOOD SEAL
HOOD NOZZLES
COWL PANEL
WIPERS
WINDSHIELD
LT FENDER LINER
LT FENDER EMBLEMS
LT FENDER MLDG
LT FENDER SPLASH SHIELD
LT FENDER W/O MLDG
RT FENDER LINER
RT FENDER EMBLEMS
RT FENDER MLDG
RT FENDER SPLASH SHIELD
RT FENDER W/O MLDG
LT MIRROR
RT MIRROR
LT FT DR INNER PANEL
LT FT DR HANDLE
LT FT DR LOCK CYL
LT FT DR BELT MLDG
LT FT DR MLDG
RT FT DR INNER PANEL
RT FT DR HANDLE
RT FT DR LOCK CYL
RT FT DOOR BELT MLDG
RT FT DR MLDG
LT RR DR INNER PANEL
LT RR DR HANDLE
LT RR DR BELT MLDG
LT RR DR MLDG
RT RR DR INNER PANEL
RT RR DR HANDLE
RT RR DOOR BELT MLDG
RT RR DR MLDG
LT QTR GLASS
LT QTR GLASS MLDG
LT QTR MLDG
LT QTR W/O MLDG
LT QTR SPLASH SHIELD
LT QTR INNER LINER
LT QTR GLASS
RT QTR GLASS MLDG
RT QTR MLDG
RT QTR W/O MLDG
RT QTR SPLASH SHIELD
RT QTR INNER LINER
DECKLID MLDG
DECKLID EMBLEMS
DECKLID LOCK CYL
DECKLID RACK
DECKLID SPOILER
RR GLASS
ROOF RACK
ROOF MLDGS
LT T/LMP
RT T/LMP
LT RR REFLECTOR
RT RR REFLECTOR
RR BUMPER
RR BUMPER MLDG
RR LOWER SPOILER
LT RUNNING BOARD
RT RUNNING BOARD
LT BEDSIDE UPPER MLDG
RT BEDSIDE UPPER MLDG
BEDLINER
LT FT SUSPENSION R&I
RT FT SUSPENSION R&I
ENGINE R&I
HEADLINER
LT FT SEAT
RT FRONT SEAT
REAR SEAT
DASHBOARD
Hold Down "ctrl" button to select multiple
Add
Haz Waste
Cover Car Exterior
Flex Additive
FT Susp Alignment
Bleed Brakes
Setup & Measure
Sheet Metal Pull
Frame Pull
AC Recharge
AC EVAC & RECHARGE
FT COVER O/H
AIM H/LAMPS
AIM FOG LAMPS
LOOSEN WIRING
ANTI FREEZE - COOLANT
BATTERY
CAULK
CLEANINTERIOR
CODE LOCK CYLINDER
COLOR SAND & BUFF
COLOR TINT
CORROSION PROTECTION
COVER CAR INTERIOR
DISABLE AIR BAG
DOOR EDGE MLDGS
DRILL TIME
FACTORY HARDWARE
FLUSH & FILL CRANKCASE
FLUSH & FILL TRANSMISSION
FT FRAME BUCKLE
RR FRAME BUCKLE
FRAME DIAMOND
FT FRAME MASH
RR FRAME MASH
FT FRAME SAG
RR FRAME SAG
FT FRAME SIDESWAY
RR FRAME SIDESWAY
FRAME TWIST
GLASS CLEAN UP
GLASS INSTALLATION KIT
PISTRIPES - PAINTED
PINSTRIPES - TAPE
POLISH PAINT
PULL & SQUARE UNIBODY
PULL LT STRUT TOWER
PULL RT STRUT TOWER
REFINISH SETUP
REFRIGERANT
RESET ELECTRICAL COMPONENTS
RUSTPROOFING
SETUP FOR REALIGNMENT
STEAM CLEAN ENGINE
STONEGUARD
TIRE - LT FT BAL
TIRE - LT RR BAL
TIRE - RT FT BAL
TIRE - RT RR BAL
TIRE - SPARE
TWO TONE PAINT
UNDERCOATING
URETHANE ADHESIVE REMOVAL
VALVE STEM
WASH & DRY CARPETING
WHEEL BALANCE
WHEEL OPENING MLDGS
Hold Down "ctrl" button to select multiple
Notes
0/5000
Click YES to Verify All Info is Correct
*
YES
Submit
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