Claim by Amanda Reynolds0
CLAIM AGAINST THE CITY OF DUBUQUE, IOWA
This written report constitutes your claim against the City of Dubuque, Iowa. You should
complete this form in full and attach any additional information that supports your claim.
The Claim must be filed with the City Clerk at City Hall, 50 W. 13th St., Dubuque, IA 52001. It
will then be referred by the City Council to the appropriate department for investigation.
Once that investigation is completed, a report and recommendation will be submitted to the
City Council. You will be provided with a copy of that report and recommendation.
THE FINAL DECISION ON ALL CLAIMS IS MADE BY THE CITY COUNCIL. NO EMPLOYEE OF
THE CITY OF DUBUQUE HAS THE AUTHORITY TO MAKE ANY REPRESENTATION TO YOU
AS TO WHETHER YOUR CLAIM WILL OR WILL NOT BE PAID.
1 ~ ~ L
1. Name of Claimant: VJC~'Y\.t).~:1C~ 1~t,c ~ 4~~
2. Address: ~ ~"~
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3. Telephone Number: c7~~.- ?~, ~ '~'~ ~ 1 CL; C ~r ~~ ~ ~ ~ ~~ ~`~ "~j
4. Date of Incident: ~ ` ~ ~ ~-- ~ `'~
5. Time of Incident: 1 ~ ~~ ~~ v..,,-~,
6. Location of Incident (Be specific): l .c ; , r~_t _ c,-~~' \ ~, ~~~-'~~ G~-~ ~-~- ~c~~~ \
~~ ~
7. DESCRIBE ACCIDENT OR OCCURRENCE THAT CAUSED INJURY OR DAMAGE. (Give
full details upon which you base your claim. If a City employee was involved, give the
employee's name.)
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8. What were weather conditions like? Lim ~
9. Give name and address of any witnesses: ~,~ ~ -~ <-~ ~~ r ~ u ~ ~~ ~~` `"`~`" '~` ~`-,~
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10. Did police investigate? (If so, give names of officers.)
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11. Was anyone injured? (If so, give names, addresses, and extent of inj~ies). ~ .7
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~12. Was any damage done to property? (If so, describe property and the extent of damages.
Attach estimates of damages or describe basis for ascertaining extent of damage.)
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13. What other damages do you claim, if any.
14. Have you been compensated for any part or all of your claim by any insurance
company? (If so, give name and address of insurance company and amount paid.)
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15. What amount do you claim from the City of Dubuque?
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16. Why do you claim the City of Dubuque is responsible?
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17. Have you made any claim against anyone else for damages as a result of this incident?
(If yes, give name and address.)
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18. If the answer to Question 17 is yes, have you received any payment from that source,
and if so, in what amount?
Dated at Dubuque, Iowa this ~ day of N ~^v-c~-'~ 20 ~~
gnature)
~+rmC~~ ~.-c-~~`~~~~~ (Print Name)
(Rev. 1100 8~ 7101)
Date: 11/12/2008 02:57 PM
Estimate ID: 2460
` Estimate Version: 0
Prelxninary
Profile ID: Mitchell
HANLEY AUTO BODY
1030 Century Circle, Dubuque, IA 52002
(563) 583-7220
Fax: (563) 583-8355
Damage Assessed By: Robert Hanley
Deductible: UNKNOWN
Owner: Amanda Reynolds
Address: 424 Lowell Street, Dubuque, IA 52003
Telephone: Home Phone: (56S) 513-0483
Mitchell Service: 914495
Description: 1997 Chevrolet Cavalier
Body Style: 2D Cpe Drive Train: 2.2L Inj 4 Cy13A FWD
VIN: 1G1JC1249VM150750 License: 876 TBG IA
Mileage: 150,255
Cobr: Black
Options: AIR CONDITIONING, AUTOMATIC TRANSMISSK)N
Line
Item Entry Labor
Number Type
Operation Line Item
Description Part Type!
Part Number Dollar Labor
Amount Units
1 402277 BDY REPAIR L DOOR OPENING FRAME S Existing 3.0'#
2 AUTO REF REFINISH L DOOR OPENING PANEL COMPLETE C 2.8
3 400966 BDY REMOVE/REPLACE L FRT DOOR SHELL Qual Recycled Part 125.00 * 4.8 #
4 AUTO REF REFINISH L FRT DOOR OUTSIDE C 2.2
5 AUTO REF REFINISH L FRT ADD FOR JAMBS 8 INTERIOR C 1.0
6 AUTO REF ADD'L OPR CLEAR COAT 1.8
7 AUTO ADD'L COST PAINT/MATERIALS 234.00
8 AUTO ADD'L COST HAZARDOUS WASTE DISPOSAL 5.00 *
" -Judgment Item
# -Labor Note Applies
C -Included in Clear Coat Calc
ESTIMATE RECALL NUMBER: 11/12/2008 14:57:08 2460
Mitchell Data Version: OCT_08 A UltraMate is a Trademark of MitcheN International
Copyright (C) 1994 -2008 Mitchell International Page 1 of 2
UltraMate Versiar. 6.7.016 Ail Rights Reserved
Date: 11/1212008 02:57 PM
Estimate ID: 2460
Estimate Version: 0
Preliminary
Profile ID: Mitchell
Estimate Totals
Add'I
Labor Sublet
I. Labor Subtotals Units Rate Amount Amount Totals II. Part Replacement Summary Amount
Body 7.8 48.00 0.00 0.00 374.40 T Taxable Parts 125.00
Refinish 7.8 48.00 0.00 0.00 374.40 T Sales Tax ~ 7.000% 8.75
Taxable Labor 748.80 Total Replacement Parts Amount 133.75
Labor Tax ~ 7.000 % 52.42
Labor Summary 15.6 801.22
III. Additional Costs Amount N. Adjustments Amount
Non-Taxable Costs 238.00 Customer Responsibility 0.00
Total Additional Costs 239.00
1. Total Labor: 801.22
II. Total Replacement Parts: 133.75
III. Total Additional Costs: 238.00
Gross Total: 1,173.97
N. Total Adjustments: 0.00
Net Total: 1,173.87
This is a areliminary estimate.
Additional chances to the estimate may be required for the actual reaair.
ESTIMATE RECALL NUMBER: 11/12/2008 14:57:08 2460
Mitchell Data Version: OCT_08_A URraMate is a Trademark of MRchell International
Copyright (C} 1984 - 2008 MRchell International
URraMate Version: 6.7.016 All Rights Reserved
Page 2 of 2
-~uf,~5
11y12/2~008 at 02:37 PM
24443
Job Number:
ABRA - DUBUQUE
Federal ID #:420782245
DBA: ANDERSON-WEBER INC
3400 CENTER GROVE DR
DUBUQUE, IA 52003
(563)556-0696 Fax: (563)556-1899
PRELIMINARY ESTIMATE
Written By: RICK KELLY
Adjuster:
Insured: AMANDA REYNOLDS
Owner: AMANDA REYNOLDS
Address: 424 LOWELL
DUBUQUE, IA 52001
Evening: (563)513-4483
Inspect ABRA - DUBUQUE
Location: 3400 CENTER GROVE DR
DUBUQUE, IA 52003
Insurance
Company:
1997 CHEV CAVALIER 4-2.2L-FI 2D CPE BLACK Int:
Business: (563)556-0696
Days to Repair
VIN: 1G1JC1249VM150750 Lic: Prod Date: Odometer:
Intermitte nt Wipers Dual Mirrors Console/S torage
Clear Coat Paint Power Steering Power Bra kes
Anti-Lock Brakes (4) Driver Air Bag Passenger Air Bag
Cloth Seat s Bucket Seats 5 Speed T ransmissi on
Overdrive Full Wheel Covers
--------
----
-----------
---------
-------
----------
N0. ------
OP.
- ------------------------
DESCRIPTION
-------------------------------- QTY
---- EXT. PRICE
----------- LABOR P
--------- AINT
-------
----------
1 ----- DOOR
N 2* Repl Qual Recy Parts LT door assy; 1 125.00 1.6 3.3
2 door models +25~
3 Add for Clear Coat 0 0.00 0.0 1.3
4 R&I molding belt 0 0.00 0.3 0.0
5 R&I outside handle 0 0.00 0.3 0.0
6 R&I weatherstrip 0 0.00 0.7 0.0
7 LT R&I mirror standard 0 0.00 0.3 0.0
8 R&I lock 0 0.00 0.4 0.0
9 R&I trim panel 0 0.00 0.4 0.0
10 PILLARS, ROCKER & FLOOR
11* Rpr LT Uniside assy, REPAIR LOWER 0 0.00 s 2.5 1.8 ~~, ~#
ROCKER
12 Overlap Major Adj. Panel 0 0.00 0.0 -0.4
13 Add for Clear Coat 0 0.00 0.0 0.3
14# Subl HAZARDOUS WASTE DISPOSAL 1 4.00 T 0.0 0.0
15# Subl BAG / COVER CAR 1 10.00 0.0 0.0
Claim #
Policy #
Deductible:
Date of Loss:
Type Of Loss:
Point of Impact:
1
•11'/I2/2008 at 02:37 PM
24443
Job Number:
PRELIMINARY ESTIMATE
1997 CHEV CAVALIER 4-2.2L-FI 2D CPE BLACK Int:
----------------------------------------------
NO. OP. DESCRIPTION -----------------
QTY EXT. PRICE
-- -------
LABOR
------- ---------
PAINT
---------
----------------------------------------------
16# Subl CORRISON PROTECTION ---------------
1 10.00 T 0.0 0.0
-
------
----------------------------------------------
Subtotals =_> -----------------
149.00 -------
6.5 -
-
6.3
Line 2 HANLEY
Parts 135.00
Body Labor 6.5 hrs @ $ 52.00/hr 338.00
Paint Labor 6.3 hrs @ $ 52.00/hr 327.60
Paint Supplies 6.3 hrs @ $ 33.00/hr 207.90
Sublet/Misc. 14.00
-
------------------
SUBTOTAL -------- --------- ----------
$ ------
1022.50
Sales Tax $ 814.60 @ 7.0000 57.02
GRAND TOTAL $ 1079.52
ADJUSTMENTS:
Deductible 0.00
----------------------------------------------------
CUSTOMER PAY $ 0.00
INSURANCE PAY $ 1079.52
WARRANTY VALID ONLY WITH ORIGIONAL COPY OF YOUR RECEIPT PARTS SUBJECT TO
INVOICE NO GUARANTEE ON RUST ALL PARTS NEW, UNLESS OTHERWISE NOTED
WARRANTY VALID ONLY WITH ORIGIONAL COPY OF RECEIPT. PARTS SUBJECT TO INVOICE.
NO GUARANTEES ON RUST. ALL PARTS NEW, UNLESS OTHERWISE SPECIFIED.
2
•11'/12/2008 at 02:37 PM
24443
Job Number:
PRELIMINARY ESTIMATE
1997 CHEV CAVALIER 4-2.2L-FI 2D CPE BLACK Int:
Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived
from the Guide DR1CL95, CCC Data Date 10/01/2008, and the parts selected 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
information provided by MOTOR may have been modified or may have come from an alternate data
source. Tilde sign (~) items indicate MOTOR Not-Included Labor operations. Non-Original
Equipment Manufacturer aftermarket parts are described as AM, Qual Repl Parts or Comp Repl Parts
which stands for Competitive Replacement Parts. Used parts are described as LKQ, Qual Recy
Parts, 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 2009 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 Pathways estimator has a complete list of
applicable vehicles. Parts numbers and prices should be confirmed with the local dealership.
CCC Pathways - A product of CCC Information Services Inc.
3