Claim, Lovett, ScottCLAIM
AGAINST THE
CITY OF DUBUQUE
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 Street, Dubuque, Iowa 52001-4864. It will then be
referred by the City Council to the appropr_iate 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.
T~U~ FINAL DECISION ON ALL CLAIMS IS MADE BY THE CITY COUNCIL.
NO EMPLOYEE OF THE CITY OF DUBUQUE HAS THE AUTaORITY TO MAKE ANY
REPRESENTATION TO YOU AS TO WHETHER YOUB CLAIM WILL OR WILL NOT BE
PAID.
1. Name of Claimant: Scott Lovett
2. Address: 2325 Radford Road #11
Telephone Number: 583 5273
Date of Incident: 12-18-00
Time of Incident: 5:29 P.M.
Location of incident. (Be specific) About 20 feet into the Hill St. entrance into 20
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.)
I was at the Hill St. entrance to 20 and when trying to enter I stopped since I
was getting no traction and then was rear ended by the police vehicle.
8. What were weather conditions like? ~V
9. Give name and address of any witnesses. --
10. Did police investigate?
Yes, Off. Folger
T=a/ r-
~
11. Was anyone injured? No
injuries.)
,nO
(If so, give names of officers.)
so, give name, address and extent of
12. Was any damage done to property? (If so, describe property
and the extent of damage. Attach estimates of damages or
describe basis for ascertaining extent of damage.)
13.
14.
What other damages do you claim, if any?
Have you been compensated for any part or all of your claim by
~y insurance company? (If so, give name and address of
insurance company ~d amount paid.)
What amount do you claim from the City of D~uque?
15. $3057.29
16.
Why do you claim the City of Dubuque is responsible?
17.
Have you made any claim against anyone else for damages as a
result of this incident? [/~O
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 wha= amount?
Dated at Dubuque,
(Revised
January, 2000)
Iowa, this 16 day of May
(Signature)
/s/ Scott Lovett
(Print Name)
01/31/2001 at 09:55 PM
24443
Job Number:
ABRA - DUBUQUE
Federal ID ~:420782245
DBA: ANDERSON-WEBER INC
3400 CENTER GROVE DR
DUBUQUE, IA 52003
(319)556-0696 Fax: (319)556-1899
PRELIMINARY ESTIMATE
Written by: KEN GREEN %24443
Adjuster: CITY OF .DUBUQUE
Insured:
Owner: SCOTT LOVETT
Address: 2325 RADFORD RD
DUBUQUE, IA 52002
Day: (319)583-5273
Claim ~
Policy %
Deductible:
Date of Loss:
Type of Loss:
Point of Impact: 6.
Rear
Inspect
Location:
Insurance
Company:
Days to Repair
1991 CHRY IMPERIAL 6-3.3L-FI 4D SED GOLD Int:
VIN: 1C3XY56ROMD211857 Lic: TXH 304 WI Prod Date:
Air Conditioning
Cruise Control
Climate Control
Bumper Guards
Clear Coat Paint
Power Windows
Power Passenger Seat
Power Trunk
4 Wheel Disc Brakes
Recline/Lounge Seats
Rear Defogger
Intermittent Wipers
Tinted Glass
Dual Mirrors
Power Steering
Power Locks
Power Antenna
Anti-Lock Brakes (4)
Cloth Seats
01/1991 Odometer: 152469
Tilt Wheel
Auto Level
Body Side Moldings
Padded Landau Roof
Power Brakes
Power Driver Seat
Power Mirrors
Driver Airbag
Split Bench Seats
NO. OP. DESCRIPTION QTY EXT. PRICE LANOR PAINT
1
2*
3
4
5
6
7
8'
9
10
11
12
13
REAR BUMPER
Algn Face bar 0 0.00 1.0 0.0
REAR LAMPS
Repl LT Tail lamp assy 1 250.00 0.4 0.0
Repl LT Lamp bezel 1 43.45 0.0 0.0
Repl Rear body panel upper 1 690.00 1.0 1.3
Add for Clear Coat 0 0.00 0.0 0.5
TRUNK LID
Repl Lid 1 610.00 1.5 2.5
Overlap Major Adj. Panel 0 0.00 0.0 -0.4
Add for Clear Coat 0 0.00 0.0 0.4
Add for Underside(Complete) 0 0.00 0.0 1.3
Repl Molding 1 86.75 0.3
01/31/2001 at 09:55 PM Job Number:
24443
PRElIMInARY ESTIMAT~
19~1 CHRY IMPERIAL 6-3.3L-FI 4D SED GOLD Int:
NO, OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT
14 Repl Nameplate "CHRYSLER" 1 24.45
15 Repl Nameplate "ABS" t 26.00
16' Rpr RT Hinge 0 0.00
17' Rpr LT Hinge 0 0.00
18 QUARTER PANEL
19 Blnd RT Quarter panel 0 0.00
20~ Rpr LT Quarter panel 0 0,00
21 Overlap Major Adj. Panel 0 0.00
22 Add for Clear Coat 0 0.00
23 REAR BODY & FLOOR
24* Rpr Rear body panel 0
25 Overlap Major Adj. Panel 0
26 Add for Clear Coat 0 0,00
27~ Subl TAPE STRIPE 1 38,00
28# Subl HAZARDOUS W3LSTE DISPOSAL 1 4.00
T
X
0.3 0.0
0.3 0.0
1.0 0.3
1.O 0.3
0.0 0.9
4.0 1.7
0.0
0.0 0.3
2.5 1.5
0.0 -0.4
0.0 0.2
0.0 0.0
0.0 0.0
Subtotals ==> 1772.65 13.3 10.0
Estimate Notes:
CAR H/LS PRIOR DAMAGE TO R H MIRROR & L F PENDER HAS EXTENSIVE DAMAGE
Parts 1730.65
Body Labor 13.3 hrs @ $ 38.00/hr 505.40
Paint Labor 10.0 hfs @ $ 38.00/hr 380.00
Paint Supplies 10.0 hrs @ $ 24.00/hr 240.00
Sublet/Misc, 42.00
SUBTOTAL $ 2898.05
Sales Tax $ 2654.05 @ 6.0000% 159.24
GRAND TOTAL $ 3057.29
ADJUSTMENTS:
Deductible 0.00
CUSTOMER PAY $ 0.00
INSUP~ANCE PAY $ 3057.29
WARRANTY VALID ONLY WITH ORIGIONAL COPY OF YOUR RECEIPT PARTS SUBJECT TO
INVOICE NO GUARANTEE ON RUST ALL PARTS NEW, UNLESS OTHERWISE NOTED