Claim by Jessica M.SchickTHE CITY OF
DUB E MEMORANDUM
Masterpiece on the Mississippi
TRACEY STECKLEIN
PARALEGAL
To: Mayor Roy D. Buol and
Members of the City Council
DATE:
RE:
Claimant
March 30, 2009
Claim Against the City of Dubuque by the Jessica M. Schick
Date of Claim
Jessica M. Schick
03/26/09
Date of Loss
03/23/09
Nature of Claim
Vehicle Damage
This is a claim in which claimant alleges that as a City of Dubuque fire truck was
responding to an emergency call at 710 Hennepin Street, the truck sideswiped that back
quarter panel of claimant's vehicle which was parked in front of 706 Hennepin Street.
This claim has been referred to Public Entity Risk Services of Iowa, the agent for the Iowa
Communities Assurance Pool.
BAL:tIs
cc: Michael C. Van Milligen, City Manager
Dan Brown, Fire Chief
Jessica M. Schick
OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA
SUITE 330, HARBOR VIEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001-6944
TELEPHONE (563) 583-4113 / FAx (563) 583-1040 / EAnAIL tsteckle@cityofdubuque.org
CLAIM AGAINST THE CITY OFD BUQUE, IOWA ~\ ~-~ ~-;i2~~~~'~2~
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 West 13th St.,
Dubuque, IA 52001. It will then be referred to the appropriate department for
investigation and to the City Attorney's Office. 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. Name of Claimant: ,~l'SSIC-C~ ~~ ~ 5C~'~ll~.k
2. Address: 4 ?j~ ~,~; it l(~~. If~"1Gt1 i ~ ~U~ ~Xll"1~t711'1
3. Telephone Number (5~~1 J~jLP~'~Icf ~ r~(.P3~ a-51-`~C~U<~
4. Date of Incident: ~~~ 3~~~
5. Time of Incident: I ~ J ~~'Y1
6. Location of Incident LBe specific):
8. What were weather conditions like?
~ ~~~rrt -~n~~r . l_~rW
9. Give name and address of any witnesses:
~ ~'i~n - ~~r .~(' h ~ r' K ~ ~~~y ' I a
10. Did police_investigate? (If so, give names of officers.
7. Describe the 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 emplovee's name.)
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
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.)
N~
1 ~ What amo nt do you claim from the City of Dubuque?
v S~
~~~~ v~ ~ ~'TD
16. Why do you claim the City of Dubuq/ue is respons^ib~l+e~? .}~~~ ~`J M`' (~/~~
~ (`~/} 1VY) -i'1f1PS i~ r~~1~/7'101 ~n~ T71~ rt~P C ~~ )1 Ili 1 I /~ ~ 1 ly l-t-'Ur
17. Have you made any claim against anyone else for damages as a result of
this incident? (If yes, give name and address.)
~~
18. If the answer to Question 17 is yes, have you received any payment from that
source, and if so, in what amount?
Nf~
T
Dated this ~ a day of ~(/t~~G~ , 20~• n
' ~ ~' `~ ~.
ignature) Y C~:
t:
~ ~
"'
-~
~ `:~
(Print Name)
~' =~
C`
"' ~
;
o
CD ~
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
Driver Information Exchange Report
Dubuque Police Department
563-589-4410
T
001
Drivers Name - Last
BRADLEY
First
DENNIS
Middle
RICHARD
Suffix
Address
9945 LAUDEVILLE ROAD
Gender jogs Number
Male
Owner Company Name
CITY OF DUBUQUE
City
DUBUQUE
Stale
IA
52003
Class
D
State
IA
Endorsements
2
Restrictions
B
Owners Name - Last
Address
50 WEST 13TH STREET
VIN No
1 HTMKADN25H685900
First
Insurance Co Name
CITY OF DUBUQUE
Insurance Policy *
Middle
Suffix
Phone
(563) 556-8726 a
Insurance Co Phone p
(563) 589-4100 x
City
DUBUQUE
State
IA
Zip
62001-
Year
2005
License Plate # i State
88792 IA
Make
INTL
Model
4400
Style
SBA 4X2
Year
Most Damaged Area
04 - Right Rear
i Vehicle Configuration
05
Approximate Cost to Repair or Replace
$100.00
u
002
Driver's Name - Last
Address
Gender
First
Middle
Suffix
Date of Birth
City
State
Zip
Driver's License Number
Class
State
Endorsements
NONE
Restrictions
NONE
Owner Company Name
Insurance Co Name
ALLSTATE
Insurance Policy #
921676522
Owner's Name - Last
SCHICK
Address
439 WINONA STREET
VIN No.
First
JESSICA
Middle
MARIE
Suffix
Phone
(563) 556-8019 x
Insurance Co Phone
(563) 582-2424 x
City
DUBUQUE
State Zip
IA 52001-
1 G221f548854124129
License Plate #
523PAL
Year
2005
Make
PONT
Model
G6
Style
GT
State Year Most Damaged Area
IA 200009 06 - Left Rear
Vehicle Configuration
01
Approximate Cost to Repair or Replace
$300.00
County
Dubuque -31
Literal Description
BRECHT LN
Accident occurred within corporate ttmils of (city)
Dubuque - 2100
X-Coordinate
00691506
If accident occurred outside of city
limits show general vacinity "N/A"
On Road, Street, or Highway'
706 HENNEPIN STREET
Y-Coordinate
04710409
Direction
"NIA" of
Nearest City
NIA"
Route (Cardinal)
Travel Direction "N/A"
Distance
150 Ft
Direction !Distance
3-E and 20 Ft
Definable intersection, bridge, or railroad crossing
WINDSOR AVE.
Officer
At intersection with
"N/A"
Direction ' Milepost Number
5-S of "NIA" Or
�HARDEN,ANDREW
Badge No
59A
Printed At: Dubuque Police Department 03123l2009 09:46 PM
Law Enforcement Case Number
01-1tlFu8 Oi-rv''1--I) iC
Date of Accident
03/23/2009
Time of Accident
19:55 Hrs.
Page 1 Form *: 01-12408
03/24/2009 at 11:02 AM
2443
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: JESSICA SCHICK
Owner: JESSICA SCHICK
Address: 706 HENNEPIN
DUBUQUE, IA 52001
Evening: (563)556-8019
Inspect ABRA - DUBUQUE
Location: 3400 CENTER GROVE DR
DUBUQUE, IA 52003
Insurance
Company:
Claim #
Policy #
Deductible:
Date of LosB:
Type of Loss:
Point of Fact:
Job Number:
7. Left Rear
Business: (563)556-0696
Days to Repair
2005 PONT G6 GT 6-3.5L-FI 4D SED BLUE Int:GREY
VIN: 1G2ZH548854124129 Lic: 523PAL IA Prod Date: 10/2004 Odometer: 32000
Air Conditioning Rear Defogger Tilt Wheel
Cruise Control Intermittent Wipers Keyless Entry
Message Center Body Side Moldings Dual Mirrors
Console/Storage Traction Control Fog Lamps
Rear Spoiler Clear Coat Paint Power Steering
Power Brakes Power Windows Power Locks
Power Driver Seat Power Mirrors Power Trunk/Tailgate
Power Adjustable Pedals AM Radio FM Radio
Stereo Search/Seek CD Player
Premium Radio Anti-Lock Brakes (4) Driver Air Bag
Passenger Air Bag 4 Wheel Disc Brakes Communications System
Cloth Seats Bucket Seats Recline/Lounge Seats
Automatic Transmission
------------------------ Overdrive
-------- Aluminum/Alloy Wheels
NO. OP.
------------------ ----------------
DESCRIPTION ----
QTY ----------------
EXT. PRICE LABOR -----------
PAINT
------
1 REAR ------------------------
BUMPER ---- ---------------- -----------
2* Rpr Bumper cover 0 0.00 1.5 2.6
3 Add for Clear Coat 0 0.00 0.0 1.0
4 O/H bumper assy 0 0.00 2.4 0.0
5# Rpr BUFF LR QTR SCUFF 0 0.00 0.5 0.0
6# Subl HAZARDOUS WASTE DISPOSAL
---------------------------------- 1 4.00 T 0.0 0.0
--------------
Subtotals =_> ---- -----------------
4.00 4.4 ----------
3.6
1
03/24/2009 at 11:02 AM
24443
Job Number:
PRELIMINARY ESTIMATE
2005 PONT G6 GT 6-3.5L-FI 4D SED BLUE Int:GREY
Parts 0.00
Body Labor 4.4 hrs @ $ 55.00/hr 242.00
Paint Labor 3.6 hrs @ $ 55.00/hr 198.00
Paint Supplies 3.6 hrs @ $ 35.00/hr 126.00
Sublet/Misc.
------------------
- 4.00
SUBTOTAL -------- ------ - -----------
$ -------
570.00
Sales Tax
-------------- $ 444.00 @ 7.0000 31.08
----
GRAND TOTAL --------- ------ - -----------
$ -------
601.08
ADJUSTMENTS:
Deductible
--------------- 0.00
----
CUSTOMER PAY -------- ------ - -----------
$ -------
0.00
INSURANCE PAY $ 601.08
WARRANTY VALID ONLY WITH ORIGIONAL COPY OF YOUR RECEIPT PARTS SUBJECT TO
INVOICE NO GUARANTEE ON RUST ALL PARTS NEW, UNLESS OTHERWISE NOTED
Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived
from the Guide DR1FQ05, CCC Data Date 03/02/2009, 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.
2