Claim by McKenzie Kline Copyrighted
August 21, 2023
City of Dubuque Consent Items # 02.
City Council Meeting
ITEM TITLE: Notice of Claims and Suits
SUM MARY: Clayton and Nicole Ketchum for property damage; McKenzie Kline for
vehicle damage
SUGGESTED Suggested Disposition: Receive and File; Referto CityAttorney
DISPOSITION:
ATTACHMENTS:
Description Type
Claim by Clayton and Nicole Ketchum Supporting Documentation
Claim by McKenzie Kline Supporting Documentation
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CLAIM AGAINST THE CITY OF DUBUQUE, IOWA i�r�n �Chuc��L,
This written report constitufies your claim against the City of Dubuque, lowa. You should
complete this form in fuil and attach any addifional informafion that supports your claim.
The Claim must be filed with the City Clerk at City Hall, 50 W. 13t" St., Dubuque, IA 52001. It
will then be referred by the City Council to the appropriate departrnent 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 REPRESEIVTATION TO YOU
AS TO WHETHER YOUR CLAlM WiLL OR WILL NOT BE PAlD,
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1. Name of Claimant: ��`��' ��G��;;r f� ( L,����c�1,�_
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2. Address: __� �� ���(,��, ��
City: l� � ��.� State: 1 f�� Zi '
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3. Telephone Number: >��� " c�-�l " �;��/��
4. Date of Incident: �r _j rv���.� ��� a�-,� � ��r�vn-ti,; 1�,���ti��'
5. Time of Incident: �L�i�� ���� v�`—
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6. Location of Incident(Be specific): --��'�-�'�� ���'��'-� ��''�l°"�C.L%�� ���-�����?
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7. DESCRIBE ACCIDENT OR OCCURRENCE THAT CAUSED INJURY OR DAMAGE. (Give
full details upon which you base your claim. If a Citjt emplayee was involved, give the
employee's name.)
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8. What were weather conditions like? ��,i,���1�,5�'�1���' � ��-ti�-.��- �,�f�,��►���� i�'��� 6��c�-��
9. Give name and address of any witnesses: �f�'.�zr! v;�r�,��,�;`r9�f-.z c� �';�-�. �=.�,r-��
10. Did police investigate? {tf so, give names of officers.j
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11. Was anyone injured? (If so, give nam+es, addresses, and e�ctaent of injuries).
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12. Was any damage done to property? (If so, describe properly and the extent of
damages. Attach estimates of damages or describe basis for ascertaining e�ctent of
damage.)
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13. What other damages do you claim, if any? 1�✓(Itt`r' '� �-�`<���` �:'�`'Y'
14. Have you been compensated for any part or al! 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 etse for damages as a result of this incident?
(If yes, give name and address.)
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18. If the answer to Quesiion 17 is yes, have y4u received any payment from that source,
and if so, in what amount?
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Dated at Dubuque, lowa this�day of�.%-�� ;v' r - , 20,�.
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�'�'��;�-.��t�i � ��ir G�-�.. (Print Name)
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(Rev. 5/18) "_ ` '
Confidential
This communication and any attachments may contain information which is confidential
and privileged by law and is for the use of the designated recipient if you are not the
intended recipient, you are hereby notified that you have received this communication in
error, and that any review, disclosure, dissemination, distribution or copying of its contents
is prohibited. Please no#ify City of Dubuque immediately by telephone at (563)-589-�4�120 of
your receipt of these it�eems and destroy the communication and any attachments
immediately. Further disclosure of this informafion may violate state and federal
restrictions.
Confidentia! informafion may in�lut�e the following:
1) Social Security Number(s)
2) MedicaUHealth Information
3) Personnel/Disciplinary Information
4) Bank Account Information
5) Financiallnformation
6) Credit Card Numbers
If any documentatian you desire #o submit to the City of Dubuqu� contains any of the items above
this cover sheet must be attached directly to the confidential information and indicate the type of
informatian that is included.
I, �� �° l t::��'�iZ��' Y1��(Ui,�( , hereby certify that the attached documents
include the following protected information.
Social Security Number(s) Bank Accoun# Information
Medical/Health Information Financial Information
PersonneVDisciplinary Information Credit Card Number(s)
I understand that this information may be distributed within the City organization or to agents of the
City for processing and I hereby authorize the City to act accordingly taking all precautions to
protect my information from unnecessary distribution.
"Ir'��b�,�(���'�'�� ��`-G-��� C/1 ( l ���en��
Signature Date
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S'�
� '�r C ' � TERRY FORTMA.�TN
_ Jee� ; _ �vSb��.Nattu�;rr
�NRYSLER
9IIKFc�enrRn •n�A�._NF.�:�s��N�' DODGE CHRYSLER 7EEP Workfile ID: 88469fid
_ ---�•�-� `DUBU�UE,IA PartsShare: 7rP35Q
www.turpindoclge.com �M
tfortmannQturpindudgr.com Federal ID: 20-2360000
(5G3) 5K3-5781 :mann@turpindodge.com
�r�;,�i (800) 7�7-=�221
, =NNEDY RD., DUBUQUE, IA 52002
� ��; hone: (563) 583-5781
�:- FAX: (563) 556-6928
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, �� �Np�"6� �reliminary Estimate
Customer: Kline, Mckenkie ]ob Number:
Written By:Terry
Insured: Kline,Mckenkie Policy#: Claim #:
Type of Loss: Date of Loss: Days to Repair: 0
Point of Impact:
Owner: Inspection Location: Insurance Company:
Kline, Mckenkie TURPIN DODGE CHRYSLER JEEP RAM
(563)451-6849 Cell 90 JOHN F. KENNEDY RD.
DUBUQUE,IA 52002
Repair Facility
(563) 583-5781 Day
VEHICLE
2017 JEEP Grand Cherokee Limited 4WD 4D UN 6-3.6L Flex Fuel Sequentiai MPI
VIN: iC4RJFBG3HC613726 Interior Color: Mileage In: Vehicle Out:
License: E�erior Color: Mileage Out:
State: IA Production Date: Condition: Job#:
TRANSMISSION CONVENIENCE AM Radio SEATS
Automatic Transmission Air Conditioning FM Radio Bucket Seats
4 Wheel Drive Intermittent Wipers Stereo Reclining/Lounge Seats
POWER Tilt Wheel Search/Seek Leather Seats
Power Steering Cruise Control Auxiliary Audio Connection Heated Seats
Power Brakes Rear Defogger Sateliite Radio Rear Heated Seats
Power Wi�dows Keyless Entry Equalizer WHEELS
Power Locks Alarm SAFETY Aluminum/Alioy Wheels
Power Mirrors Message Center Drivers Side Air Bag PAINT
Heated Mirrors Steering Wheel Touch Controls Passenger Air Bag Ciear Coat Paint
Power Driver Seat Rear Window Wiper Anti-Lock Brakes(4) OTHER
Power Passenger Seat Telescopic Wheel 4 Wheel Disc Brakes Fog Lamps
Memory Package Heated Steering Wheel Traction Control Rear Spoiler
DECOR Climate Control Stability Control Signal Integrated Mirrors
Dual Mirrors Backup Camera Front Side Impact Air Bags California Emissions
Privacy Glass Parking Sensors Head/Curtain Air Bags TRUCK
Console/Storage Remote Starter Hands Free Device Rear Step Bumper
Overhead Console Home Link ROOF Power Trunk/Liftgate
7/10/2023 4:40:51 PM 094524 Page 1
r
Preliminary Estimate
Customer: Kiine, Mckenkie Job Number:
2017 JEEP Grand Cherokee Limited 4WD 4D UN 6-3.6L Flex Fuel Sequential MPI
Wood Interior Trim RADIO Luggage/Roof Rack
7/10/2023 4:40:51 PM 094524 Page 2
�
Preliminary Estimate
Customer: Kline, Mckenkie
Job Number:
2017 JEEP Grand Cherokee Limited 4WD 4D UN 6-3.6L Flex Fuel Sequential MPI
Line Oper Description Part Number
Qty E�e�ded Labor Paint
1 FRONT BUMPER Price$
Z R&I R&I bumper cover
3 * 1.4
Rpr Bumper cover w/tow hooks,
w/prk snsr,w/auto park w/lamp 3--5 2•6
wash
4 Add for Clear Coat
5 Repi Lower grille center w/o tow hooks 1.0
68258566AA 1 46.40 Incl.
6 Repl Lowercover 6CK19TZZAA
� 1 329.00 0.6 1.8
Add for Clear Coat
$ Repl RT Applique outer platinum �'�
5ZT56SZ7AA 1 44.40 0.1
9 Repl Applique center platinum 5ZT53SZ7AA 7
10 146.00 Incl.
Repi License bracket 68277142AA 1
11 34.00 p,Z
Repl RT Bezei piatinum 6AH10SZ7A6 1 82.00
12 GRILLE 0.1
13 Repl Grille surround 5XL23TZZAA
1 319.00 1.2 OJ
14 Add for Clear Coat
15 Repl Support 0.1
68258419AC 1 164.00 p,z
16 Rep� Grille satin 6NZ02SZ7AA 1
1� 415.00 Incl,
Repi Trim ring satin 6ML10SZ7AA 1 250.00
18 FRONT LAMPS Incl.
19 Repl RT Headlamp assy w/adaptive, 68266660AI 1
w/lamp washer 1,600.00 0.3
20 Aim headlamps
21 HOOD 0.5
22 R&I R&I hood assy
23 * Rpr Hood w/o air vent(ALU) ���
24 2_5 2,8
Overiap Minor Panel
25 Add for Clear Coat -��Z
Zb Repl Nameplate"Jeep"bronze 1'Q
682b8156A6 1 68.60 0.3
27 FENDER
Z$ * Rpr RT Fender
29 2-0 2.2
Overlap Major Adj. Panel
30 Add for Clear Coat -0.4
31 R&I RT Fender liner w/o SRT 0.4
32 R&I RT Wheel flare w/body color code 0.4
MRY 0.4
33 R&I LT Wheel flare w/body color code
MRY 0.4
34 * Rpr RT Wheei flare w/body color code
MRY 1-� 1.1
35 Overlap Major Non-Adj. Panel
36 Add for Clear Coat -0�2
37 Repl Wheel flare rivet 0�2
6500911 6 61.80
38 # HAZARDOUS WASTE
� 5.00 T
7/10/2023 4:40:51 PM 094524
Page 3
�
Preliminary Estimate
Customer: Kline, Mckenkie .7ob Number:
2017 JEEP Grand Cherokee Limited 4WD 4D UN 6-3.6L Flex Fuel Sequential MPI
39 # CAR COVER 1 5.00 T
SUBTOTALS 3,570.20 16.3 13.8
ESTIMATE TOTALS
Category Basis Rate Cost$
Parts
3,560.20
Body Labor 16.3 hrs @ $68.00/hr 1,108.40
Paint Labor 13.8 hrs @ $68.00/hr 938.40
Paint Supplies 13.8 hrs @ $45.00/hr 621.00
Miscelianeous
Subtotal 10.00
Sales Tax 6,238.00
Grand Total $6,238.00 @ 7.0000% 436.66
6,674.66
Deductible
0.00
CUSTOMER PAY
0.00
INSURANCE PAY
6,674.66
7/10/2023 4:40:51 PM 09452�}
Page 4
�-
Preliminary Estimate
Customer: Kline, Mckenkie 7ob Number:
2017 JEEP Grand Cherokee Limited 4WD 4D UN 6-3.6L Flex Fuei Sequential MPI
Estimate based on MOTOR CRASH ESTIMATING GUIDE and potentially other third party sources of data. Unless
otherwise noted, (a) all items are derived from the Guide DR3WA14, CCC Data Date 07/03/2023, and potentiaily
other third party sources of data; and (b) the parts presented are OEM-parts. OEM parts are manufactured by or for
the vehicle's Original Equipment Manufacturer (�EM) according to OEM's specifications for U.S. distribution. OEM
parts are available at OE/Vehicle dealerships or the specified supplier. 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 with discounted pricing. Asterisk (*) or pouble Asterisk (**) indicates that the parts and/or
labor data provided by third party sources of data may have been modified or may have come from an alternate data
source. Tilde sign (�) items indicate MOTOR Not-Included Labor operations. The symbol (<>) indicates the refinish
operation WILL NOT be performed as a separate procedure from the other panels in the estimate. Non-Original
Equipment Manufacturer aftermarket parts are described as Non OEM, A/M or NAGS. Used parts are described as
LKQ, 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 2023 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 CCC ONE
estimator has a list of applicable vehicles. Parts numbers and prices should be confirmed with the local dealership.
The following is a list of additional abbreviations or symbols that may be used to describe work to be done or parts to
be repaired or replaced:
SYMBOLS FOLLOWING PART PRICE:
m=MOTOR Mechanical component. s=MOTOR Structural component. T=Miscellaneous Taxed charge category.
X=Miscellaneous Non-Taxed charge category.
SYMBOLS FOLLOWING LABOR:
D=Diagnostic labor category. E=Electrical labar category. F=Frame labor category. G=Glass labor category.
M=Mechanical labor category. S=Structural labor category. (numbers) 1 through 4=User Defined Labor Categories.
OTHER SYMBOLS AND ABBREVIATIONS:
Adj.=Adjacent. Algn.=Align. ALU=Aluminum. A/M=Aftermarket part. BInd=Blend. BOR=Boron steel.
CAPA=Certified Automotive Parts Association. D&R=Disconnect and Reconnect. HSS=High Strength Steel.
HYD=Hydroformed Steel. Inc1.=Included. LKQ=Like Kind and Quality. LT=Left. MAG=Magnesium. Non-Adj.=Non
Adjacent. NSF=NSF International Certified Part. 0/H=Overhaul. Qty=Quantity. Refn=Refinish. Repl=Replace.
R&I=Remove and Install. R&R=Remove and Replace. Rpr=Repair. RT=Right. SAS=Sandwiched Steel.
Sect=Section. Subl=Sublet. UHS=UItra High Strength Steel. N=Note(s) associated with the estimate line.
CCC ONE Estimating - A product of CCC Intelligent Services Inc.
The following is a list of abbreviations that may be used in CCC ONE Estimating that are not part of the MOTOR
CRASH ESTIMATING GUIDE:
BAR=Bureau of Automotive Repair. EPA=Environmental Protection Agency. NHTSA= National Highway
Transportation and Safety Administration. PDR=Paintless Dent Repair. VIN=Vehicle Identification Number.
7/10/2023 4:40:51 PM 094524 Page 5
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Copyrighted
August 21, 2023
City of Dubuque Consent Items # 03.
City Council Meeting
ITEM TITLE: Disposition of Claims
SUMMARY: CityAttorneyadvising thatthe following claims have been referred to
Public Entity Risk Services of lowa, the agent for the lowa Communities
Assurance Pool:
SUGGESTED Suggested Disposition: Receive and File; Concur
DISPOSITION:
ATTACHMENTS:
Description Type
Clayton and Nicole Ketchum Property Damage Supporting Documentation
McKenzie Kline for Vehicle Damage Supporting Documentation
THE CTTY OF
DUB E MEMORANDUM
MasterpTece on the Mississippi
� ONI MEDINGER
LEGAL ADMINISTRATIVE ASSISTANT
To: Mayor Brad M. Cavanagh and
Members of the City Council
DATE: 8/17/2023
RE: Claim Against the City of Dubuque by McKenzie Kline
Claimant Date of Claim Date of Incident Nature of Claim
McKenzie Kline 8/11/2023 Ongoing Vehicle Damage
This is a claim in which claimant alleges Claimant's vehicle has been damaged due to
salt and water dripping from the ceiling above a parking spot in a City parking ramp where
Claimant's vehicle parks.
This claim has been referred to Public Entity Risk Services of lowa, the agent for the lowa
Communities Assurance Pool.
cc: Michael C. Van Milligen, City Manager
Ryan Knuckey, Director of Transportation Services
McKenzie Kline
OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA
SUITE 330, HARBOR VIEW PLACE, 3OO MAIN STREET DUBUQUE, IA 52001-6944
TE�EPHONE (563)589-4113/Fax (563)583-1040/EMai� jmedinge@cityofdubuque.org