Filetype Excel XLSX | Posted on 08 Aug 2022 | 3 years ago
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203x Filetype XLSX File size 0.20 MB Source: www.bar.ca.gov
Sheet 1: Repair 1
| SECTION 1 - STATION & CONSUMER INFORMATION | 0 | ||||||||||||||||||
| CAP ID # | Consumer Last Name | 0 | 1 | ||||||||||||||||
| Lic Plate # | Vehicle Year | Remaining CAP Funds | $500.00 | Calculations use specific approval amount. | 0 | 0 | |||||||||||||
| ARD # | 0 | Station Name | 0 | PR instructs ARD to imput specific $ amount | |||||||||||||||
| Tech Lic # | RO Ref # | Labor Guide | for any funds approved over $500. (H12) | ||||||||||||||||
| Labor Rate | $0.00 | Tax Rate | 0.000% | ARD Phone # | (000) 000-0000 | ||||||||||||||
| Print Name | Title | Date | |||||||||||||||||
| Signature | Station Fax # or E-Mail Address | ||||||||||||||||||
| 0 | |||||||||||||||||||
| SECTION 2 - ADDITIONAL FUNDS APPROVAL | |||||||||||||||||||
| Pre-Approval Request |
Additional CAP Funds Approved By | Additional CAP Funds Approval Amount | 400 | ||||||||||||||||
| SECTION 3 - REPAIR INFORMATION | |||||||||||||||||||
| Repair Notification #1 | Labor Units | Labor Total | Parts Quantity | Parts Price | Parts Total | I3 for Formulas | |||||||||||||
| $0.00 | $500.00 | 0 | |||||||||||||||||
| $0.00 | 0 | ||||||||||||||||||
| $0.00 | Previously Used Funds | 0 | |||||||||||||||||
| $0.00 | $0.00 | 0 | |||||||||||||||||
| $0.00 | 0 | ||||||||||||||||||
| $0.00 | CAP ID Total | 0 | |||||||||||||||||
| $0.00 | $0.00 | 0 | |||||||||||||||||
| $0.00 | 0 | ||||||||||||||||||
| $0.00 | RN #1 Subtotals | 0 | |||||||||||||||||
| $0.00 | Labor | Parts | 0 | ||||||||||||||||
| $0.00 | $0.00 | $0.00 | 0 | ||||||||||||||||
| $0.00 | 0 | ||||||||||||||||||
| Calculation 1 (BAR Use Only) |
Calculation 2 (BAR Use Only) |
Funds approved over $500 | CAP Funds (up to $500) | Tax | Notification #1 Total | Consumer Co-Pay (20% of total) | Consumer Paid Over CAP amount | Additionally approved CAP funds | CAP Funds (up to $500) | Tax | RN #1 Total | ||||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||||
| Repair Notification #2 | Labor Units | Labor Total | Parts Quantity | Parts Price | Parts Total | CAP ID Total | |||||||||||||
| $0.00 | $0.00 | 0 | |||||||||||||||||
| $0.00 | 0 | ||||||||||||||||||
| $0.00 | RN #2 Subtotals | 0 | |||||||||||||||||
| $0.00 | Labor | Parts | Max CAP A Formula | CAP A Formula 2 | H12 Verification | 0 | |||||||||||||
| $0.00 | $0.00 | $0.00 | -$500.00 | $0.00 | 0 | 0 | |||||||||||||
| $0.00 | 0 | ||||||||||||||||||
| Calculation 1 (BAR Use Only) |
Calculation 2/CAP A (BAR Use Only) |
Funds approved over $500 | CAP Funds (up to $500) | Tax | Notification #2 Total | Consumer Co-Pay (20% of total) | Consumer Paid Over CAP amount | Additionally approved CAP funds | CAP Funds (up to $500) | Tax | RN #2 Total | ||||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||||
| SECTION 4 - SUMMARY DETAIL | |||||||||||||||||||
| Labor Total | Parts Total | Tax | Repair Summary | Calculation 1 & 2 | Consumer Cost Share | Funds approved over $500 | CAP Total | Grand Total | Consumer Grand Total | CAP Grand Total | |||||||||
| BAR Use Only | Labor | Parts | Total Tax | Grand Total | |||||||||||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| SECTION 1 - STATION & CONSUMER INFORMATION | 0 | ||||||||||||||||||
| CAP ID # | Consumer Last Name | 0 | 1 | ||||||||||||||||
| Lic Plate # | Vehicle Year | Remaining CAP Funds | $500.00 | Calculations use specific approval amount. | 0 | 0 | |||||||||||||
| ARD # | 0 | Station Name | 0 | PR instructs ARD to imput specific $ amount | |||||||||||||||
| Tech Lic # | RO Ref # | Labor Guide | for any funds approved over $500. (H12) | ||||||||||||||||
| Labor Rate | $0.00 | Tax Rate | 0.000% | ARD Phone # | (000) 000-0000 | ||||||||||||||
| Print Name | Title | Date | |||||||||||||||||
| Signature | Station Fax # or E-Mail Address | ||||||||||||||||||
| 0 | |||||||||||||||||||
| SECTION 2 - ADDITIONAL FUNDS APPROVAL | |||||||||||||||||||
| Pre-Approval Request |
Additional CAP Funds Approved By | Additional CAP Funds Approval Amount | 400 | ||||||||||||||||
| SECTION 3 - REPAIR INFORMATION | |||||||||||||||||||
| Repair Notification #1 | Labor Units | Labor Total | Parts Quantity | Parts Price | Parts Total | I3 for Formulas | |||||||||||||
| $0.00 | $500.00 | 0 | |||||||||||||||||
| $0.00 | 0 | ||||||||||||||||||
| $0.00 | Previously Used Funds | 0 | |||||||||||||||||
| $0.00 | $0.00 | 0 | |||||||||||||||||
| $0.00 | 0 | ||||||||||||||||||
| $0.00 | CAP ID Total | 0 | |||||||||||||||||
| $0.00 | $0.00 | 0 | |||||||||||||||||
| $0.00 | 0 | ||||||||||||||||||
| $0.00 | RN #1 Subtotals | 0 | |||||||||||||||||
| $0.00 | Labor | Parts | 0 | ||||||||||||||||
| $0.00 | $0.00 | $0.00 | 0 | ||||||||||||||||
| $0.00 | 0 | ||||||||||||||||||
| Calculation 1 (BAR Use Only) |
Calculation 2 (BAR Use Only) |
Funds approved over $500 | CAP Funds (up to $500) | Tax | Notification #1 Total | Consumer Co-Pay (20% of total) | Consumer Paid Over CAP amount | Additionally approved CAP funds | CAP Funds (up to $500) | Tax | RN #1 Total | ||||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||||
| Repair Notification #2 | Labor Units | Labor Total | Parts Quantity | Parts Price | Parts Total | CAP ID Total | |||||||||||||
| $0.00 | $0.00 | 0 | |||||||||||||||||
| $0.00 | 0 | ||||||||||||||||||
| $0.00 | RN #2 Subtotals | 0 | |||||||||||||||||
| $0.00 | Labor | Parts | Max CAP A Formula | CAP A Formula 2 | H12 Verification | 0 | |||||||||||||
| $0.00 | $0.00 | $0.00 | -$500.00 | $0.00 | 0 | 0 | |||||||||||||
| $0.00 | 0 | ||||||||||||||||||
| Calculation 1 (BAR Use Only) |
Calculation 2/CAP A (BAR Use Only) |
Funds approved over $500 | CAP Funds (up to $500) | Tax | Notification #2 Total | Consumer Co-Pay (20% of total) | Consumer Paid Over CAP amount | Additionally approved CAP funds | CAP Funds (up to $500) | Tax | RN #2 Total | ||||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||||
| SECTION 4 - SUMMARY DETAIL | |||||||||||||||||||
| Labor Total | Parts Total | Tax | Repair Summary | Calculation 1 & 2 | Consumer Cost Share | Funds approved over $500 | CAP Total | Grand Total | Consumer Grand Total | CAP Grand Total | |||||||||
| BAR Use Only | Labor | Parts | Total Tax | Grand Total | |||||||||||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
| SECTION 1 - STATION & CONSUMER INFORMATION | 0 | ||||||||||||||||||
| CAP ID # | Consumer Last Name | 0 | 1 | ||||||||||||||||
| Lic Plate # | Vehicle Year | Remaining CAP Funds | $500.00 | Calculations use specific approval amount. | 0 | 0 | |||||||||||||
| ARD # | 0 | Station Name | 0 | PR instructs ARD to imput specific $ amount | |||||||||||||||
| Tech Lic # | RO Ref # | Labor Guide | for any funds approved over $500. (H12) | ||||||||||||||||
| Labor Rate | $0.00 | Tax Rate | 0.000% | ARD Phone # | (000) 000-0000 | ||||||||||||||
| Print Name | Title | Date | |||||||||||||||||
| Signature | Station Fax # or E-Mail Address | ||||||||||||||||||
| 0 | |||||||||||||||||||
| SECTION 2 - ADDITIONAL FUNDS APPROVAL | |||||||||||||||||||
| Pre-Approval Request |
Additional CAP Funds Approved By | Additional CAP Funds Approval Amount | 400 | ||||||||||||||||
| SECTION 3 - REPAIR INFORMATION | |||||||||||||||||||
| Repair Notification #1 | Labor Units | Labor Total | Parts Quantity | Parts Price | Parts Total | I3 for Formulas | |||||||||||||
| $0.00 | $500.00 | 0 | |||||||||||||||||
| $0.00 | 0 | ||||||||||||||||||
| $0.00 | Previously Used Funds | 0 | |||||||||||||||||
| $0.00 | $0.00 | 0 | |||||||||||||||||
| $0.00 | 0 | ||||||||||||||||||
| $0.00 | CAP ID Total | 0 | |||||||||||||||||
| $0.00 | $0.00 | 0 | |||||||||||||||||
| $0.00 | 0 | ||||||||||||||||||
| $0.00 | RN #1 Subtotals | 0 | |||||||||||||||||
| $0.00 | Labor | Parts | 0 | ||||||||||||||||
| $0.00 | $0.00 | $0.00 | 0 | ||||||||||||||||
| $0.00 | 0 | ||||||||||||||||||
| Calculation 1 (BAR Use Only) |
Calculation 2 (BAR Use Only) |
Funds approved over $500 | CAP Funds (up to $500) | Tax | Notification #1 Total | Consumer Co-Pay (20% of total) | Consumer Paid Over CAP amount | Additionally approved CAP funds | CAP Funds (up to $500) | Tax | RN #1 Total | ||||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||||
| Repair Notification #2 | Labor Units | Labor Total | Parts Quantity | Parts Price | Parts Total | CAP ID Total | |||||||||||||
| $0.00 | $0.00 | 0 | |||||||||||||||||
| $0.00 | 0 | ||||||||||||||||||
| $0.00 | RN #2 Subtotals | 0 | |||||||||||||||||
| $0.00 | Labor | Parts | Max CAP A Formula | CAP A Formula 2 | H12 Verification | 0 | |||||||||||||
| $0.00 | $0.00 | $0.00 | -$500.00 | $0.00 | 0 | 0 | |||||||||||||
| $0.00 | 0 | ||||||||||||||||||
| Calculation 1 (BAR Use Only) |
Calculation 2/CAP A (BAR Use Only) |
Funds approved over $500 | CAP Funds (up to $500) | Tax | Notification #2 Total | Consumer Co-Pay (20% of total) | Consumer Paid Over CAP amount | Additionally approved CAP funds | CAP Funds (up to $500) | Tax | RN #2 Total | ||||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||||
| SECTION 4 - SUMMARY DETAIL | |||||||||||||||||||
| Labor Total | Parts Total | Tax | Repair Summary | Calculation 1 & 2 | Consumer Cost Share | Funds approved over $500 | CAP Total | Grand Total | Consumer Grand Total | CAP Grand Total | |||||||||
| BAR Use Only | Labor | Parts | Total Tax | Grand Total | |||||||||||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||
