Claim by Jill Boge Copyrighted
October 2, 2023
City of Dubuque Consent Items # 02.
City Council Meeting
ITEM TITLE: Notice of Claims and Suits
SUM MARY: Jill Boge for vehicle damage; John Eby for vehicle damage; David
Weydert for property damage
SUGGESTED Suggested Disposition: Receive and File; Referto CityAttorney
DISPOSITION:
ATTACHMENTS:
Description Type
Claim by Jill Boge Supporting Documentation
Claim by John Eby Supporting Documentation
Claim by David Weydert Supporting Documentation
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CLAIM AGAINST THE CITY OF DUBUQUE, IDWA �
This written report constitutes your claim against fhe City of Dubuque, lowa. You should
complete this form in full anc[ attach any additional information t�at supports your claim.
The C[aim must be filed with the City C[erk at City Hall, 50 W. 13t" St., Dubuque, IA 52001. It
will then be referred by the City Council to the appropriate de�artment for in�es#igation.
Once that in�estigation is campleted, a report and recommendation will be submitted to the
City Council. You wil[ be pra�ided with a copy of�hat report and recommer�dation.
THE FfNAL DEC1510N ON ALL CLAIMS IS MADE BY THE CITY COl]NCIL. NO EMPLOYEE OF
TH� CITY �F DUBUQUE HAS THE AUTHORITY TO MAKE ANY REPRESENTATI�N T� Y�U
AS TO WHETHER YOLJR CLAIM WILL OR WILL NOT BE PAID.
1. Name of Claimant: !� � U
2. Address: � �� �V�1`��' ��'�, 4�'1�
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City: State• I � Zip•
3. Te[ephone Number: �� � � � ��o�
4. Date of Inciden�: 'U � 2
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5. Time of Incident: , � �
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6. Location of Incident (Be specific}: ��� � ��� �`� Y ,� � !�� � 2�
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7. DESCRIBE ACC[DENT OR OCCURRENCE THAT CAUSED INJIJRY OR DAMAGE. (Give
full details upon wh�ch you base your claim. If a City employee was �nvol�ed, gi�e the
employee's name.)
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8. What were weather cor�ditions like7 �/1� � _
9. Give name and address of any witnesses:
10. Did police investigate? �If so, gi�e names of officers.}
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1'I. Was anyone injured? (If so, give r�ames, addresses, and extent of injuries).
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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? l�bs 1 '1 U V �C,�J 1�!u l✓t.
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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?�^ p�y �/�/ipp�� .I n1��,�pr
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16. Why do you claim the Cit,y�o jD��u�gue is responsible?k��� r��� ��� J
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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.) �/1
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18. If the answer to Question 17 is yes, have you received any payment from that source, I
and if so, in what amount? ��
Dated at Dubuque, lowa this � l day of �� ��, 20�. I
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(Signature)
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(Rev. 5l18) ._ r`
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BRIMEYERAUTOBOD°! Worl<fIeID; a84a6f11
PartsShare: 7yz8yt
10709 Collision Dr, Dubuque, IA 52001
Phone: (563) 583-4456 FederallD: 421438480
FAX: (563) 583-1838
Preliminary Estimate
Customer: BOGE, JELL ]ob Number:
Written By:AUSTIN BRIMEY[R
Insured: BOGE,JILL Policy#: Claim 8:
Type of Loss: Date of Loss: Days Co Repalr: D
Point oF Impact:
Owner: Inspectlon Location: %nsurance Company:
BOGE,JILL BRIMEYER AUTO BODY - �
(563)513-5055 Business � 10709 Collision Dr
Dubuque, IA 52001
Repalr Facility
(563)583-4456 Buslness
VEHICLE
2021 TOYO 4Runner SRS 4WD 4D UN 6-4.OL Gasoline Sequential MPI ��I
VIN: 7TEMUSlR8M5940213 Interior Color: Mileage In: Vehicle Out: I
License; Exterlor Color: Mileage Out:
SCate: Production Date: Condition: lob 4f:
� TRANSMISSION Air Conditloning Auxiliary Audio Connection Cloth Seats
� Automatic Transmission Intermittent Wipers Satellite Radio Bucket Seats
Overdrive Tilt Wheel SAFETY � WHEELS
�; 4 Wheel Drlve Cruise Control Drivers Side Alr Bag Aluminum/Alloy Wheels
POWER Rear Defogger Passenger Air Bag PAINT
I Power Steering Keyless EnCry Anti-Lock Brakes(4) Clear Coat Paint
Power Brakes Alarm 4 Wheel Disc 6rakes OTHER
� Power Windows Message Cenler Traction Control Fog Lamps
� Power Locks Steering Wheel Touch Controls Stability Control Rear Spoiler
Power Mirrors Rear Window Wiper Front Side ImpacC Air 8ags California Emissions
�'� Heated Mirrors Telescopic Wheel Head/Curtaln Air Bags TRUCK
Power Driver Seat Backup Camera Communications System Rear Step Bumper
� DECOR Intelligent Cruise Hands Free Device Power Rear Window
Dual Mirrors RADIO Xenon or L.E.�. Headlamps Trailer Hitch
� Privacy Glass AM Radlo Lane Departure Warning Trailering Package
IConsole/Storage FM Radlo ROOF
IOverhead Console Stereo Luggage/Roof Rad<
� CONVENIENCE Search/Seek SEATS
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9/18/2023 4:20:57 PM 030799 Page 1
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Preliminary Estimate
Customer: BOGE,7ILL Job Number:
2021 TOYO 4Runner SRS 4WD 4D UN 6-4.OL Gasoline Sequential MPI
Line Oper Descriptlon Part Number Qty Extended Labor Paint
Price$
1 HOOD
2 * Rpr Hood w/o scnop(HSS) � 1 0 2.8
3 Add for Clear Coat 1.1
4 # Color llnt 1 1.0
5 OTHER CHARGES
6 # E.P.C. 1 5.00
SUBTOTALS 5.00 1.0 4.9
ESTIMATE TOTALS
Category Basls Rate Cost$
Parts 0,00
8ody Labor 1.0 hrs @ $75.00/hr 75.00
Paint Labor 4.9 hrs @ $75.00/hr 367.50
Palnt Supplles 4.9 hrs p $50.00/hr 245.00
Other Charges 5.00
Subtotal 692,50
Sales 7ax $692.50 @ 7.0000% 48,48
� Grand Total 740.98
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