Claim by John Eby 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, IOWA ���1(,{�� \J��r�,
This written report constitutes your claim against the City of Dubuque, lowa. 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. 13t" 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. Name of Claimant: J o h n E b y
2. Address: 1 7 5 A I p i n e S t .
City: D u b u q u e State: IA Zip: 52001
3. Telephone Number: 5 6 3-6 6 3-71 2 0
4. Date of Incident: A u g u s t 1 6 , 2 0 2 3
5. Time of Incident: u n k n o w n
6. Location of Incident (Be specific): 1 7 5 A I p i n e S t .
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.)
tree limb from dying tree fell on the roof of my Toyota Prius. Assessed damage is $4375.53. Insurance will cover
$3375.53. Our deductible is $1000. We would like to request reimbursement for the deductible.
8. What were weather conditions like? W i n d y , b u t n o t s e v e r e
9. Give name and address of any witnesses:
10. Did police investigate? (If so, give names of officers.)
no
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
no
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.)
significant damage to roof of car—roof partially caved-in
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.)
yes, insurance will cover most of the cost ($3375.53)
15. What amount do you claim from the City of Dubuque?
$1000 (deductible from assessed damage)
16. Why do you claim the City of Dubuque is responsible?
tree was on the greenway on street, next to the car
17. Have you made any claim against anyone else for damages as a result of this incident?
(If yes, give name and address.)
No. Only registered the claim with State Farm Insurance.
18. If the answer to Question 17 is yes, have you rec3eived any payment from that source,
and if so, in what amount?
not yet, but anticipating it soon.
Dated at Dubuque, lowa this 3 day of September , 2023_.
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, Abl'a — �UbUC�Ue Workfile ID: f7ed6927
Federal ID: 42-0782245
When You're Ready State ID: IA
3400 Center Grove Dr., Dubuque, IA 52003 Resale Number: 31-007262
.. __ , � � Federal EPA: IAR000004861
Phone: (563) 556-0696 State EPA: NA
FAX: (563) 556-1899 License Number: 433840
BAR: na
Preliminary Estimate
Customer: EBY, 70HN
Written By: Chad Hahn
Adjuster: Team, Express, (855)341-8184 Business
Insured: EBY,JOHN Policy#: Claim #: 15-54T7-52D01
Type of Loss: Comprehensive Date of Loss: 8/17/2023 9:00 AM Days to Repair: ,@f �
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Point of Impact: 27 Roof
Owner: Inspection Location: Insurance Company:
EBY,JOHN Abra-Dubuque STATE FARM INSURANCE COMPANIES
175 ALPINE ST 3400 Center Grove Dr. STATE FARM -ALL
DUBUQUE, IA 52001 Dubuque,IA 52003 Bloomington
(563)663-7120 Cell Repair Facility
(563) 599-6582 Evening (563) 556-0696 Business
VEHICLE
2006 TOYO Prius 4D H/B 4-1.SL Hybrid SFI SILVER
VIN: JTDKB20U167506602 Interior Color: Mileage In: 1 Vehicle Out:
License: ESX135 Exterior Color: SILVER Mileage Out:
State: IA Production Date: 6/2006 Condition: Good Job #:
TRANSMISSION Overhead Console RADIO Bucket Seats
Automatic Transmission CONVENIENCE AM Radio WHEELS
POWER Air Conditioning FM Radio Aluminum/Alloy Wheels
Power Steering Intermittent Wipers Stereo PAINT
Power Brakes Tilt Wheel Search/Seek Clear Coat Paint
Power Windows Cruise Control CD Player OTHER
Power Locks Rear Defogger SAFETY Traction Control
Power Mirrors Keyless Entry Drivers Side Air Bag Rear Spoiler
Heated Mirrors Message Center Passenger Air Bag California Emissions
DECOR Steering Wheel Touch Controls Anti-Lock Brakes(4)
Dual Mirrors Rear Window Wiper SEATS
Console/Storage Climate Control Cloth Seats
8/23/2023 2:47:54 PM 433840 Page 1
Preliminary Estimate
Customer: EBY, JOHN
2006 TOYO Prius 4D H/B 4-1.5L Hybrid SFI SILVER
Line Oper Description Part Number Qty Extended Labor Paint
Price$
1 ELECTRICAL
2 Repl Antenna mast 8630952040 1 74.33 0.1
3 * R&I Holder m 0.5
4 VVINDSHIELD
5 R&I Windshield Toyota from 4/05 Incl.
6 RESTRAINT SYSTEMS
7 R&I RT Head air bag m 0.5
8 R&I LT Head air bag m 0.5
9 ROOF
10 * Repl Roofpanel 6311147020 1 929.89 16.0 3.0
Note: Time deducted for sublet glass R&I
11 Add for Clear Coat 1.2
12 Repl Center reinf rear 6314347020 1 48.76 1.0 0.2
13 Add for Clear Coat 0.1
14 Repl Rearreinf 6314447010 1 50.83 1.0 0.2
15 Add for Clear Coat 0.1
16 Repl Rearheader 6310547010 1 227.24 1.5 0.3
17 Add for Clear Coat 0.1
18 R&I R&I headliner Incl.
19 Repl RT Roof molding 7555547020 1 61.95 Incl.
20 Repl LT Roof molding 7555647020 1 61.95 Incl.
21 PILLARS,ROCKER&FLOOR
22 * Rpr LT Center pillar(HSS) 5 4_0 1_4
23 Add for Clear Coat 0.3
24 LIFT GATE
25 R&I R&I liftgate assy Incl.
26 MISCELLANEOUS OPERATIONS
27 # Hazardous Waste Removal 1 5.00
28 # Cover Car 1 5.00
29 # Corrosion Protection 1 10.00 T
30 # Repl Panel Bond Adhesive 1 25.00 T
31 # Repl Seam Sealer/Caulk 1 10.00 T
32 # Weld-Through Primer 1 10.00 T
33 # Refn Prime and Block 0.6
34 # Repl Glass Install Kit 1 25.00 T
35 # Subl R&I Glass 1 125.00
SUBTOTALS 1,669.95 25.1 7.5
NOTES
Prior Damage Notes:
HAIL
8/23/2023 2:47:54 PM 433840 Page 2
Preliminary Estimate
Customer: EBY,JOHN
2006 TOYO Prius 4D H/B 4-1.5L Hybrid SFI SILVER
ESTIMATE TOTALS
Category Basis Rate Cost$
Parts 1,589.95
Body Labor 25.1 hrs @ $66.00/hr 1,656.60
Paint Labor 7.5 hrs @ $66.00/hr 495.00
Paint 7.5 hrs @ $44.00/hr 330.00
Miscellaneous 80.00
Pre-Tax Discount -1.5% -62.27
Subtotal 4,089.28
Sales Tax $4,089.28 @ 7.0000% 286.25
Grand Total 4,375.53
Deductible 1,000.00
CUSTOMER PAY 1,000.00
INSURANCE PAY 3,375.53
Register online to check the status of your claim and stay connected with State FarmO. To register, go to ht��;wwwstat:efz�rm.r,orrai
and select Check the Status of a Claim. If you are already registered,thank you!
WARRANTY VALID ONLY WITH ORIGIONAL COPY OF YOUR RECEIPT PARTS SUBJECT TO INVOICE NO
GUARANTEE ON RUST ALL PARTS NEW, UNLESS OTHERWISE NOTED
8/23/2023 2:47:54 PM 433840 Page 3
Preliminary Estimate
Customer: EBY, JOHN
2006 TOYO Prius 4D H/B 4-1.5L Hybrid SFI SILVER
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 AEM8545, CCC Data Date 06/16/2023, and potentially 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 (OEM) 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 labor 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. O/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.
8/23/2023 2:47:54 PM 433840 Page 4
Preliminary Estimate
�ustomer: EBY,]OHN
2006 TOYO Prius 4D H/B 4-1.5L Hybrid SFI SILVER
*****INSURANCE COMPANY DISCLOSURES AND CUSTOMER NOTIFICATIONS*****
THE FOLLOWING DISCLOSURE APPLIES TO THOSE PARTS IDENTIFIED AS NON-OEM ON THE
ESTIMATE:
"THIS ESTIMATE HAS BEEN PREPARED BASED ON THE USE OF AFTERMARKET CRASH PARTS SUPPLIED
BY A SOURCE OTHER THAN THE MANUFACTURER OF YOUR MOTOR VEHICLE. ANY WARRANTIES
APPLICABLE TO THESE REPLACEMENT PARTS ARE PROVIDED BY THE MANUFACTURER OR
DISTRIBUTOR OF THESE PARTS RATHER THAN THE MANUFACTURER OF YOUR VEHICLE"
8/23/2023 2:47:54 PM 433840 Page 5
Chad Hahn
CUSTOMER SERVICE MANAGER
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AUTO BODY REPAIR OFAMERICA
3400 Center Grove Drive
Dubuque,IA 52003
DIRECT:(563)556 0696 FAX (563)556-1899
EMAIL:chahn@abraauto.com l�.r�1�'
I ��
Confidential
This communication and any attachments may contain information which is confidential and
pri�ileged by law and is for the use of the designated recipient. If you are not the intended
recip�ent, you are �ereby notified that you ha�e recei�ed this communication in error, and
that any review, disclosure, dissemina#ion, distribu#ion or copying of its contents is
prohibit�d. Pleas� notify City of Dubuque immediately by te(ephone at (563)-589-4120 of your
receipt of these items and destroy the communicat�on and any attachments immed�ately.
Further disclosure of this information may �iolate state and federal restrictions.
Confidential information may includ� the folfowing:
1) Social Security Number(s)
2) Medical/Health Informatio�
3) PersonnellDisciplinary Infarmation
4) Bank Account Information
5) Financiai Information
6) Credit Card Numbers
Ef any documentation you desire to submit to the City of Dubuque contains any of the items abo�e
this cover sheet must be attached directly to the confidential information and indicate the type ofi
infiarmation that is included.
I, John Eby , hereby certify that the attached documen#s
include the follow�r�g protected infiormation:
Social Securi#y Number(s} Bank Account lnfarmation
MedicallHealth Informatian Financial Inforr�ation
Personr�ellDisciplinary Information Credit Card Number(s)
� understand that this infarmation may be distributed within the City organization or to agents of tf�e
City for pracessing and I hereby authorize the City to ac# accordingfy taking all precautions to protect
my information from unnecessary distributian.
���z�/z�
Signature / Da#e
(
Copyrighted
October 2, 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: John Eby for vehicle damage
SUGGESTED Suggested Disposition: Receive and File; Concur
DISPOSITION:
ATTACHMENTS:
Description Type
OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA
SUITE 330, HARBOR VIEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001-6944
TELEPHONE (563) 589-4113 / FAX (563) 583-1040 / EMAIL jmedinge@cityofdubuque.org
M E M O R A N D U M
J O N I M E D I N G E R
LEGAL ADMINISTRATIVE ASSISTANT
TO: Mayor Brad M. Cavanagh and
Members of the City Council
DATE: 9/22/2023
RE: Claim Against the City of Dubuque by John Eby
Claimant Date of Claim Date of Incident Nature of Claim
John Eby 9/3/2023 8/16/2023 Vehicle Damage
This is a claim in which claimant alleges Claimant’s vehicle was damaged when a tree
limb on City property fell onto it.
This claim has been referred to Public Entity Risk Services of Iowa, the agent for the Iowa
Communities Assurance Pool.
cc: Michael C. Van Milligen, City Manager
Steve Fehsal, Park Division Manager
John Eby