Claim, Klinkhammer, TimothyCLAIM AGAINST THE CITY OF DUBUQUE, IOWA
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 W. 13th 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: Timothy Klinkhammer
2. Address: 1170 Race St., Dubuque, IA 52001
3. Telephone Number: 563 583 3905
4. Date of Incident: 11 9 01
5. Time of Incident: 10:55 A.M.
6. Location of Incident (Be specific): 1170 Race St. , Dubuque, IA
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.)
City Bus Hit my Parked Car - Melvin Schumacher
8. What were weather conditions like? Clear
9. Give name and address of any witnesses: None
10. Did police investigate? (If so, give names of officers.)
Yes, Dubuque PD - J. Roth Baddge 58A
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.)
Yes - 1995 Dodge Dakota Pickup
13. What other damages do you claim, if any?
None
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.)
No
15. What amount do you claim from the City of Dubuque?
16. Why do you claim the City of Dubuque is responsible?
Bus Driver Hit my 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
18. If the answer to Question 17 is yes, have you received any payment from that source, and if so, in what amount?
Dated at Dubuque, Iowa this 9th day of November , 2001 .
/s/ Timothy Klinkhammer
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
CLAIM AGAINST THE CITY OF DUBUQUE, IOWA
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 W. 13~h St., Dubuque, IA 52001.
It will then be referred by the City Council to the appropriate department for Investigation.
Once that investigation is c°mpleted, a report end 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. NameofClalman,...~'7~¢~? fl/~/~,~./~,~__.
3. Telephone Number:_ ~-'~'~ ~0'~'"~.5
4. Date of lncident: ///"~ '~ /'
6. Location of Incident (Be specific):
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.)
8. What were weather conditions like? (/~,~-,
g. Give name and address of any witnesaes:__/~//'~-
10. Did po_li~ J_nvqstigate?. (If so, give_~na~me,s j)f off]cerj~.)
11, Was anyone injured? (If so, give names, addresses, and extent of injuries).
12. Was any damage done to property? (If ~o, describe property and the extent of damages,
Attach estimates of damages or describe basis for ascertaining extent of damage.)
13. What other damages do you claim, if
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.)
15. What amount do you claim from the City of Dubuque?
16. Why do you claim the City of Dubuque Is responsible? t~t .~P;r,,'"~-, /~ ~',/'
17. Have you made any claim against anyone else for damages as a result of this incident?
(If yes, give name and address.) .~
ff~the:~r~wer to Question 17 is yes, have you received any payment from that source,
_nd~ ~so,'~n~ _w~h~ at amount?
(Signature)
(Prln[ Name)
· (Rev. 1/00 & 7/01)
Date: 11/12101 t2:tl PM
Estimate ID: 2485
Estimate Version: 0
Preliminary
Profile ID: Mitchell
AVALON BODY SHOP, INC.
20680 HWYS2N RICKARDSVILLE, IA 52039
(563) 552-t 656
Fax: (563) 552-1658
Tax ID: 42-1360561
Damage Assessed By: MERLIN WILGENBUSCH
WE HAVE THE CAPABILITY TO E-MAIL DIGITAL PICTURES OF DAMAGE TO YOU! ! !
Condition Code: Good
Date of Loss: 11/9/01
Deductible: UNKNOWN
Owner TIM KLINKHAMMER
Address: t t70 RACE ST DUBUQUE, IA 52001
Telephone: Home Phone: (563) 583-3905
Arrival Date: tt112/0t
Description: 1995 Dodge Dakota
Body Style: 2D PkupXCb 6' Bed 13t" WB
VlN; t BTGL23X2SS385501
Mileage: 64,856
Color:. WHITE/SILVER
Mitchell Service:
913520
Vehicle Production Date: 6195
Drive Train: 3.9L Inj 6 Cyl 2WD
License: 456 AXW IA
Line Entry Labor Line Item Part Type/
item Number Type Operation Description Part Number
Dollar Labor
Amount Units
t 309580 BDY REMOVE/REPLACE
2 300090 BDY REMOVE/REPLACE
3 900500 BDY* REMOVE/INSTALL
4 330310 BDY REPAIR
6 AUTO REF REFINISH
6 300304 BDY REMOVE/INSTALL
7 300514 BDY REMOVE/INSTALL
8 300518 BDY REMOVE/REPLACE
9 334843 BDY REMOVE/REPLACE
10 335450 BDY REMOVE/INSTALL
11 933000 REF ADD'L OPR
12 AUTO REF ADD'L OPR
13 933005 BDY ADD'L OPR
'[4 933018 REF ADD'L OPR
15 AUTO ADD'L COST
16 AUTO ADD'L COST
f 7 AUTO ADD'L COST
R INSTALL BED SIDE PANEL STRIPE
R STRIPE TAPE BODY SIDE
TOPPER
R PICKUP BED SIDE PANEL
R BED SIDE PANEL OUTSIDE
R WHEEL OPENING FLARE
R FRT PICKUP BED ADHESIVE SIDE MLDG
R REAR PICKUP BED ADHESIVE SIDE MLDG
R COMBINATION LAMp ASSEMBLY
REAR BUMPER ASSY
TWO TONE
CLEAR COAT
RESTORE CORROSION PROTECTION
MASK FOR OVERSPRAY
PAINT/MATERIALS
SHOP MATERIALS
HAZARDOUS WASTE DISPOSAL
4798720
Existing
Existing
Existing
5EF90LX9
**Qua] Repl Part
0.2
106.00
0.5*
6.0* #
C 3.0
0,3
0.3*
59.60 0.3
42.00' 0.3
1.9'
f .9'
1.2
3.00 * 0.2*
6.00 *
130,00 *
rs.00 *
2.08 *
* - Judgement Item
fi - Labor Note Applies
C - Included in Clear Coat Calc
ESTIMATE RECALL NUMBER: 11112/01 12:10:48 2485
UltraMate is a Trademark of Mitchell International
Mitchell Data Version: NOV_01_A Copyright (C) t 994 - 2000 Mitchell International
UitraMate Version: 4.7.007 All Rights Reserved
Page I of 2
Data: tt112/01 12:11 PM
Estimata ID: 2485
Estimate Version: 0
Preliminary
Profile ID: Mitchell
I. Labor Subtotals Units
Body 9.t 40.00
Refinish 5.2 40,00
Add'l
Labor Sublet
Rate Amount Amount
Totals
3.00 0.00 367.00 T
6.00 0.00 214.00 T
Taxable Labor 581.00
Labor Tax ~ 6.000 % 34.86
Labor Summary 14.3
615.86
IlL Additional Costs
Non-Taxable Costs
Total Additional Costs
II. Part Replacement Summary
Taxable Parts
Sales Tax ~
Total Replacement Parts Amount
Amount IV. Adjustments
147.08 Customer Responsibility
147.08
6.000%
Amount
207.60
12.46
220.06
Amount
0.00
I. Total Labor:.
II. Total Replacement Parts:
III. Total Additional Costs:
Gross Total:
615.86
220.06
147.08
983.00
IV. Total Adjustments:
Net Total:
This is a preliminary estimate.
Additional chan,qes to the estimate may be required for the actual repair.
Point(a) of Impact
$ Right Rear Corner (P)
AVALON BODY SHOP INC, agrees to perform repairs which serve to
restore the d~m~ged vechicle to its preloss condition relative to
safety, functions and appearance and futher agrees to warranty
workmanship for a period of three (3) years; plus PPG or Autocolor
Lifetime Paint Performance Guarantee for as long as the customer owns
the vechicle from date of completion of repairs.
0.00
983.00
ESTIMATE RECALL NUMBER: 11112/01 12:10:48 2485
UltraMate is a Trademark of Mtichell International
Mitchell Data Version: NOV_01_A Copyright (C) t 994 - 2000 Mitchell International
UltraMate Version: 4.7,007 All Rights Reserved
Page 2 of
WILSON BROS. DODGE
90 JFK
DUBUQUE, IA 52002
PHONE: (319)583-5781
CD LOG NO 1471-1 DATE 11/12/01
SHOP:
ADDRESS:
CITY STATE:
ZIP:
WILSON BROS AUTO BODY
90 JFK
FED TAX ID 420779647
DUBUQUE, IA
52002-
INSP DATE:
CONTACT:
PHONE 2:
FAX:
11/12/01
(319)556-6928
OWNER: KLINKHAMMER,
ADDRESS: 1170 RACE
CITY STATE: DUB, IA
ZIP: 52001-
TIM
HOME PHONE:
(563)583-3905
POINT OF IMPACT: 11
LIC#:
BODY COLOR: WHITE/SILVER
CONDITION:
STATE:
VIN:
MILEAGE:
ACCTNG CTL%:
1B7GL23X2SS385501
*=USER-ENTERED VALUE
EC=REPLACE ECONOMY
TE=PARTL REPL PRICE
I=REPAIR
TT=TWO-TONE
N=ADDITIONAL LABOR
AA=APPEAR ALLOWANCE
E=REPLACE OEM
EU=REPLACE SALVAGE
ET=PARTL REPL LABOR
L=REFINISH
CG=CHIPGUARD
RI=R&I ASSEMBLY
RP=RELATED PRIOR
NG=REPLACE NAGS
EP=REPLACE PXN
IT=PARTIAL REPAIR
BR=BLEND REFINISH
SB=SUBLET
P=CHECK
UP=UNRELATED PRIOR
1995 DODGE DAKOTA STD 2DOOR EXT CAB
CODE: N8414A/E OPTNS B/24G
6CYL GASOLINE 3.9
OPTIONS:
TWO-STAGE - EXTERIOR SURFACES
POWER STEERING
TWO-STAGE
INTERIOR SURFACES
OP GDE MC
E 0139 01
I 0390
L 0390 09
TT 0390 12
E 0458
RI 0394
EC 0538
N M14
SB M60
RI
RI
EC
DESCRIPTION
STRIPE ASSEMBLY RT
PANEL, BEDSIDE OUTER RT
PANEL, BEDSIDE OUTER RT
PANEL, BEDSIDE OUTER RT
MLDG, BEDSIDE PANEL R/R
FLARE,WHEEL OPENING RT
TAILL~/4P ASSEMBLY RT
CORROSION PROTECTION
HAZARD. WSTE. REM.
MUDFLAP
TOPPER
SHOP SUPPLIES
MFG.PART NO. PRICE AJ% B% HOURS R
4741714 91.25 1.6 1
REPAIR 8.0'1
REFINISH 4.2 4
TWO TONE 1.3 4
5EF90LX9 59.60 0.3 1
R&I ASSEMBLY 0.3 1
ECONOMY PART 42.00* 0.1 1
ADDNL LABOR OPERA 8.00* 0.2*4*
SUBLET REPAIR 4.00* *1'
R&I ASSEMBLY 0.3'1'
R&I ASSEMBLY 0.8'1'
ECONOMY PART 2.50* *1'
PAGE 1
-1~95 DODGE DAKOTA
CD LOG NO 1471-1
12 ITEMS
STD 2DOOR EXT CAB
MC MESSAGE(S)
01 CALL DEALER FOR EXACT PART NUMBER / PRICE
09 INCLUDES 0.6 HOURS MAJOR PANEL TWO-STAGE ALLOWANCE
12 INCLUDES 0.4 HOURS MAJOR PANEL TWO-TONE ALLOWANCE
FINAL CALCULATIONS & ENTRIES
GROSS PARTS
OTHER PARTS
PAINT MATERIAL
PARTS TOTAL
TAX ON PARTS @
6.000%
LABOR
1-SHEET METAL
2-MECH/ELEC
3-FRAME
4-REFINISH
5-PAINT MATERIAL
LABOR TOTAL
TAX ON LABOR
SUBLET REPAIRS
TAX ON SUBLET
TOWING
STORAGE
RATE
40.00
48.00
45.00
40.00
25.00
150.85
52.50
142.50
345.85
12.20
GROSS TOTAL
NET TOTAL
REPLACE HRS REPAIR HRS
3.4 8.0 456.00
5.5 0.2 228.00
684.00
@ 6.000% 41.04
4.00
@ 6.000% 0.24
10:48:58AM R6.2
ADP SHOPLINK UB303 ES CD LOG 1471-1 DATE 11/12/01
PXN:N/00/00/00/00 CUM:/// HOST LOG
COPYRIGHT 2000, AUTOMATIC DATA PROCESSING, INC.
1.2 HRS WERE ADDED TO THIS EST. BASED ON ADP TWO-STAGE REFINISH
1,087.33
1,087.33
CD 10/01
FORMULA.
PAGE 2