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Claim - Gotto, RhondaCLAIM 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:m Rhonda Gotto 2. Address: 401 First St SW, Epworth, IA 52045 3. Telephone Number: 319 876 3292 4. Date of Incident: 12/29/00 5. Time of Incident: between 11 a.m. & 5 p.m. 6. Location of Incident (Be specific): 2465 Hillcrest Rd. - (Hillcrest Family SErvices) - Pathways on street, 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.) My 1997 Toyota Camry was parked across from the pathways unit at Hillcrest on Hillcrest Road. We'd gotten 5 inches of snow Thursday into Friday 12/29, and several city snow plows passed on Friday. My side view mirror was hit (from opposite way of direction parked by a snow plow. Weather was 5 " snow, continuing through that day - Friday. 8. What were weather conditions like? See above 9. Give name and address of any witnesses: No witnesses 10. Did police investigate? (If so, give names of officers.) Officer Latham CR# 00-47362 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, my side view (driver side) mirror was damaged. Estimate $164 from ABRA Auto Repair. 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? $164 16. Why do you claim the City of Dubuque is responsible? Due to the weater conditions (snow amount and slipper conditions) plows were out that day. Judging from the location of my car and how the mirror was hit (from opposite) I'm sure snow plow was responsible. 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 6th day of January , 2001. /s/ Rhonda Gotto (Signature) (Print Name) (Rev. 1/00 & 7/01) CLAIM AGAINST THECITY OF DUBUQUE This~rrittenreport 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 ONALL CLAIMS IS MADE BY THE CITY COUNCIL. NO EMPLOYEE OF THE CITY OF DUBUQUE HAS T~R AUTHORITY TO MAKE ANY' REPRESENTATION TO YOU AS TO WHETHER YOURCLAIM WILL OR WILL NOT BE PAID. 2. Address= g6) 3. Telephone Number: e Date o~ incident: Time of Incident: (~ive~ full ~etails upon. which ~ou base ~our cla~, If a Cit~ ~ployee was involved, ~ive the ~ployee's n~e.) Se 10. Did police investigate? (If so, give names of officers.) 11. Was anyone injured? injuries.) (If so, give name, address and extent of 12. Was any damage done to property? 13. (If so, describe property and the extent of d~m~ge. Attach estimates of damages or describe basis for ascertaining extent of damage.) What other damages do you claim, if any? 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.) What amount do you claim from the City Of Dubuque? 14. 15. 16. Why do you claim the City of Dubuque is responsible? 17. have. you ma~ ~y c~a~m a~a~ns~ a~one e~se ~or d~es as a result of this incident~ If yes, give n~e ~d address: ~. .If the an~we= to Question ~? .is _~e~, .h~v~ you .received any p~e~t f~6m:that?'-~urce, and if so, in. what amount? Dated at' Dubuque~ Iowa, 20 O/ .. (Signature) (Prin~ Name) 01/03/2001 at 12:10 PM 24443 ABRA - DUBUQUE Federal ID ~:420782245 DBA: ANDERSON-WEBER INC 3400 CENTER GROVE DR DUBUQUE, IA 52003 (319)556-0696 Fax: (319)556-1899 Job Number: PRELIMINARY ESTIMATE Written by: KEN GREEN ~24443 Adjuster: Insured: RONDA GOTTO Owner: RONDA GOTTO Address: 401 1ST ST S W EPWORTH, IA 52045 Day: (319)557-7222 Day: (319)557-4388x722 Inspect Location: Claim ~ Pollcy # Deductlble: Date of Loss: Type of Loss: Point of Impact: Company: Days to Repair 1997 TOYO CAMRY LE 4-2.2L-FI 4D SED lB2 Int: VIN: 4T1BG22K4VU085001 Lic: 644 AXZ IA Prod Date: Rear Defogger Intermittent Wipers Dual Mirrors Power Brakes Power Mirrors Passenger Airbag Recline/Lounge Seats Air Conditioning Cruise Control Body Side Moldings Power Steering Power Locks Driver Airbag Bucket Seats Odometer: 68306 Tilt Wheel Tinted Glass Clear Coat Paint Power Windows Anti-Lock Brakes (4) Cloth Seats NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT i FRONT DOOR 2* Repl LT Mirror assy power w/o heat, 1 131.92 0.6 0.0 Subtotals ==> 131.92 0.6 0.0 Parts 131.92 Body Labor 0.6 hfs @ $ 38.00/hr 22.80 SUBTOTAL $ 154.72 Sales Tax $ 154.72 @ 6.0000% 9.28 GP-A/qD TOTAL $ 164.00 ADJUSTMENTS: Deductible 0.00 01/03/2001 at 12:10 PM Job Number: 24443 1997 TOYO CAMRy LE 4-2.2L-FI 4D SED lB2 Int: CUSTOMER PAY $ 0.00 INSUR3LNCE PAY $ 164.00 WARRANTY VALID ONLY WITH ORIGIONAL COPY OF YOUR RECEIPT PARTS SUBJECT TO INVOICE NO GUARANTEE ON RUST ALL PARTS NEW, UNLESS OTHERWISE NOTED Esti~te based on MOTOR CP~ASH ESTIFLKTING GUIDE. Won-asterisk(*) items are derived from the Guide Al{MS509. Database Date 11/2000. Double asterisk (**) items indicate parts supplied by a supplier other t~an the origi~l equipment ~ufacturer. Poku/d sig~ (~) item~ indicate m~u~l entries. CAPA items have been certified for fit ~a~d flr~sk by the Certified Auto Parts Association. NAGS Part ~u~bers, Prices and La~or Times are provided frc~ National Auto Glass Specifications, Inc. Pathways - A product of CCC Inforu~tion Services Inc.