Claim, Zelinskas, EllenCLAIM 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: Ellen Zelinskas
2. Address: 125 S. Hill St., Dubuque, IA 52003
3. Telephone Number: 319 582 8736
4. Date of Incident: 12 11 00 / 12 12 00
5. Time of Incident: Late Monday night & 6:45 A.M. Tuesday
6. Location of Incident (Be specific): Across the street from my above residence (125 S. Hill St. Dubuque
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.)
My auto and my husband's were both legally parked (1989 Honda Accord) on the street when both struck by City Snowplow. Large tire marks in snow show exact path taken. See photos.
8. What were weather conditions like?
Snowy
9. Give name and address of any witnesses:
10. Did police investigate? (If so, give names of officers.)
Yes, Officer Friedman Badge #52 Case #004481-0
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.)
Left front door mirro and area below it. See attached Dan Kruse Pontiac, Nissan, BMW Repair Est. $653.85
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.)
No
15. What amount do you claim from the City of Dubuque?
$653.85
16. Why do you claim the City of Dubuque is responsible?
1989 Honda Accord - my vehicle was legally parked on the street and operator of the City of Dubuque Snow plow got
too close - not allowing enough clearance, striking my auto breaking Driver's Side Mirror & damaging door.
17. Have you made any claim against anyone else for damages as a result of this incident?
(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 what amount?
Dated at Dubuque, Iowa this 15th day of December , 2001.
/s/ Ellen Zelinskas
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
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 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 F~KE ANY
REPRESENTATION TO YOU AS TO W~tETHER YOUR CLAIM WILL OR WiLL NOT BE
PAID.
1. Na~e of Claimant: ~L&EN
3. Telephone N~e::
4. Date of Incident: ]~-~1-00 /
6. Location of incid~t. (Be specific)
7. DESCRIBE ACCIDE~ OR OCC~RENCE T~T CAUS~ IN~Y OR D~GE.
(Give full details upon which you base your cla~. If a City
~ployee was involved, ~ive the ~.loyee's )~
8. what were weather conditzons like? SN~
9. Give n~e ~d address of any witnesses.
10. Did police investigate? (If so, give names of officers.)
11. Was anyone injured? (If so, give name,
injuries.)
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. 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 a~ount paid.)
15. What amount do you claim from the City of Dubuque?
16.
Why do you claim the City of Dubuque is responsible?
ave you ~de any claim aga~ns~ anyone else for d~a~es as a
result of this incident? ~0
If._yes, .give n~e and' address:
17.
18. If the
payment
answer to Question 17 is yes, have you received any
from that source~ and if so, in what
Iowa, this
(Revised January, 2000)
(Print Name)'
Date: 12/12/00 08:29 AM
EStbllats ID: 1120
Estimate Version: 0
Preliminary
Profile ID: Mitchell
Dan Kruse Pontiac, Nissan, BlVlW
600 Century Drive Dubuque, IA 52002
(319) 8~3-7~4S
Fax: (319) 583-7349
Damage Assessed By: Dave DeMo,ss
Deductible: UNKNOWN
Insured: ELLEN ZELINSKAS
Description: 1989 Honda Accord LXi
p. nr~y Style: 4D Sed
VIN: JHMCA5540KC097168
I~F~chell Service: 91,7129
Ddve Traim 2.0L Inj 4 Cyl 5M
Line Entry Labor
Item Number Type Operation
Line Item
Description
Part Number
Dollar Labor
Amount Units
718390 BDY
AUTO REF
719130 BDY
719230 BDY
720890 BDY
AUTO REF
AUTO
AUTO
REPAIR L FRT DOOR SHELL
REFINISH L FRT DOOR OUTSIDE
REMOVE/REPLACE L~r, RT DOOR POWER MIRROR
REMOVE/REPLACE .i/C FRT DOOR MOULDING
REMOVE/INSTALL L FRT DOOR OUTSIDE HANDLE
ADD'L OPR CLEAR COAT
ADD1. COST PAINT/MATERIALS
ADD'L COST HAZARDOUS WASTE DISPOSAL
Existing
ORDER FROM DEALER
79322-SE3-A13
Existing
4.0*
C 2.3
172.00
49.10 0,3
0.3*#
0,9'
73.60 *
3.60 *
* - Judgement Item
# - Labor Note Applies
C - Included in Clear Coat Calc
[keboy Subtnta~s Units
Body 6.3 38.00
~finish 3.2 38.00
Addl
Labor Sublet
Rate Amount Amount
Taxabls Labor
LaborTax
Totals
Labor Summary
O,O0 0.00 201.40 T
0.00 0.00 121.60 T
6.000%
323,00
19.38
342.33
II. Part Replacement Summary
Taxable Parts
Sales Tax
Total Replacement Parts Amount
ill Additional Costs
Non-Taxable Costs
T~tal Additional Costs
Amount
77.10
77.10
IV. Adjustments
Customer Responsibility
ESTIMATE RECALL NUMBER: 17J12/00 08:20::~t~.
Ultra Trademark of Mitchell International
MItchell Data Version: DEC_00_A Copyright (C) 1994 -2000 Mitchell International
UltraMste Version: 46.004 AIl Rights Reserved
9.000%
Page I
Amount
221.10
13.27
234.37
Amount
0.00
of 2
Date: 12/'12/00 08:25 AM
Estimate ID: 1120
Estimate Version: 0
Preliminary
Profile iD: Mitchell
I. Total Labor:
IL Total P~eplacern~nt Parts:
lie Total Additional Costs:
Gross Total:
IV. Total Adjustments:
Net Total:
This is a preliminary estimate.
Additional chanaes to the estimate may be required for the ac~al repair.
THIS DAMAGE REI~ORT IS BASED ON OUR INSPECTION AND DOES NOT
CO~E/~ ~ -ADDIONAL PARTS OR LABOR WHICH MAY BE REQUIRErs, AFTER
· ~I~,1~1~ ~ BE~lq OPEI~D ~ THE INS/~ILL BE NOTIFIED.
342.38
234.37
77.10
653.85
0.00
~' ~3~$
ESTIMATE R~L NUMBER:. 12/12/00 08:20:24 1120
UitraMate is a Trademark of Mitchell Iqternational
MitchelIData Version: DEC_00_A Copyright (C) 1994 - 2000 Mitchell International
Ult~ ,r~Mate. Version: 4A,~04 All Rights Reserved
Page 2
of 2