184x 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 | |||||
no reviews yet
Please Login to review.