Claim - Hess, Ronnie L.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. 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: Ronnie L. Hess
2. Address: 749 Vanderbilt, Dubuque, IA 52003
3. Telephone Number: 319 583 3385
4. Date of Incident: 12 29 00
5. Time of Incident: Between 6:15 PM and 10 PM
6. Location of Incident (Be specific): 1101 Central, 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.)
1991 Dodge properly parked when struck by a City owned snow plow - driver did not stop / reported to Dubuque Police Dept.
8. What were weather conditions like? Cloudy - snow covered
9. Give name and address of any witnesses:
None
10. Did police investigate? (If so, give names of officers.)
Yes, Dave Haupert 66A, Case 00-47403
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
None
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.)
Front panel, rear bumper, left side.
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?
$2600.00
16. Why do you claim the City of Dubuque is responsible?
My vehicle was properly parked when damaged.
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 4th day of January, 2001. , 20 .
/s/ Ronnie L. Hess
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
CLAIM AGAINST THE CITY OF DUBUQUE c~ityof~/
This written report constitutes your claim a~ainst the
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 Eall, 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 investi~atlon 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.
TEE FINAL DECISION ON ALL CLAIMS IS MADE BY TEE CITY COUNCIL.
NO EMPLOYEE OF TEE CITY OF DUBUQUE HAS TEE AUTHORITY TO MAKE ANY
REPRESENTATION TO YOU AS TO WHETEER YOUR CLAIM WILL OR WILL NOT BE
PAID.
1. Name of Claimant:
3. Telephone N~er:
4. Date of Incident:
5. Time of Incident:
6.
Location of incident. (Be specific)
k..
7. DESCRIBE ACCID~ OR OCC~RENCE T~T CAUSED IN~Y OR D~GE.
(Give full details upon which you base your claim. If a City
~ployee was involved, ~ive the ~ployee's n~e,)
8. ~at ~ere weather oonditions like? ~6[L~,I
9. Give n~e and address of any witnesses.
10. Did police investigate?
11. Was anyone injured?
injuries.)
(If So, 91ye names of offi ;q') os '-~
(If so, give n~e, address and e~&n%j~f ~
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 dmm~ges 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 nsane and address of
insurance company and amount paid.)
15. What amount do you claim from the City of Dubuque?
~&00 ,
16.
Why do you claim the City of Dubuque is responsible?
I
17.
Have you made any claim against anyone else for damages as a
result of this incident?_ Ho
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
20 D %,
(Revised January, 2000)
(Print Name)
Date: 01102/01 11:42AM
Estimate ID: 2853
Estimate Version: 0
Preliminary
Profile ID: Mitchell
LENNY VALENTINE & SONS, INC.
923 PERU RD DUBUQUE, IA 52001-8604
(319) 588-4659
Fax: (319) 588-4680
TWO CONTINENTAL FRAME M~CHINES
GENESIS II COMPUTERISED MEASURING SYSTEM
PRICE IS EAS]~ TO BEAT/QUALIT]~ IS NOT
UNIBOD¥ SPECIALISTS
Damage Assessed By: DICK VALENTINE
Deductible: UNKNOWN
Owner RONNIE HESS
Address: 749 VANDERBILT DUBUQUE, IA 52003
Telephone: Home Phone: (319) 583-3385
Description: 199t Dodge Dynasty
Body Style: 4D Sed
Mitchell Service: 918526
Drive Train:
3.3L Inj 6 Cyl AO
Line Entry Labor Line item Part Type/
Item Number Type Operation Description Part Number
Dollar Labor
Amount Units
900500 BDY* REPAIR
* - Judgement Item
COST OF REPAIRS EXCEEDS VALUE
ExL~ing
Add'l
Labor Sublet
I. Labor Subtotals Units Rate Amount Amount Totals
Labor Summary 0.0 0,00
IlL Additional Costs Amount
Total Additional Costs 0.00
II. Part Replacement Summary
Total Replacement Parts Amount
IV. Adjustments
Customer Responsibility
Amount
0.00
Amount
0.00
ESTIMATE RECALL NUMBER: 0t/02101 t t:38:28 2853
U firaMate is a Trademark of Mitchell international
Mitchell Data Version: DEC_00_A Copyright (C) 1994 - 2000 Mitche8 international
UltraMate Version: 4.6.004 All Rights Reserved
Page t
of 2
01/02/2001 at 05:25 PM 3ob Number:
30799
BRIME~q~R AUTO BODY
License #:30799 Federal ID #:421438480
10727 3OHN P. KENNEDY RD
DUBUQUE, IA 52001
(319)583-4456 Pax: (319)583-1838
PP~LIMINA~Y ESTIMATE
written by: ERIC WINCH #
Adjuster:
Insured:
Owner:
Address:
Day:
RONNIE HESS
RONNIE HESS
749 VANDERBIkT
DUBUQUE, IA 52003
(319)583-3385
Claim #
Policy #
Deductible:
Date of Loss:
Type of Loss:
Point of Impact:
Inspect
Location:
Company:
Days to Repair
1991 DODG DYNASTY 6-3.3L-FI 4D SED WHITE Iht:
VIN: 1B3XC46RBMD252727 Lie: Prod Date:
Rear Defogger Intermittent Wipers
Body side Moldings Bumper Guards
clear coat Paint Power steering
Power Trunk Driver Airbag
Odometer:
Tinted Glass
Dual Mirrors
Power Brakes
cloth Seats
NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT
1 FRONT BUMPER
2 R&t Bumper cover 0.8
3* Rpr Bumper cover 2.5 2.2
4 Add for Clear Coat 0.9
5 Repl Bumper cover cushion 1 50.50
6 PENDER
7* Rpr LT Fender w/o corner lamp 2.5 3.0
8 Add for clear Coat 1,2
9 Repl LT side molding front bright, 1 10.25 0.3
10 Repl LT side molding wheel opening 1 30.50 0.3
11 FRONT DOOR
12' Rpr LT Door shell 3,0 2.5
13 Overlap Major Adj. Panel -0.4
14 Add for Clear Coat 0.4
15 Repl LT Mirror electric remote 1 151.00 1.0
16 REAR DOOR
17 Rep] LT Molding side except LE, adh 1 19.75 0.3
18 QUARTER PANEL
19' Rpr LT Outer panel 8.0 1.7
01/02/2001 at 05:25 PM 3ob Number:
30799
1991 DODG DYNASl~ 6-3.3L-FI 4D SED WHITE Iht:
NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT
20 Overlap Major Non-Adj. Panel -0.2
21 Add for clear Coat 0.3
22 Repl LT Extension outer 1 72.50 0.7
23 Repl LT Molding side rear chrome, a 1 10.75 0.3
24 REAR BUMPER
25 O/H rear bumper 1.7
26** Repl RECOND Bumper cover 1 156.00 Incl. 2.2
27 Add for clear coat 0.9
28** Repl A/M Impact strip 1 34.00 Incl.
29 REAR LAMPS
30 Repl LT Tail lamp assy 1 93.50 0.4
31# **COST OF REPAIRS EXCEED
32# THE VALUE OF THE VEHICLE**
subtotals ==> 628.75 21.8 14.7
Parts
Body Labor
Paint Labor
Paint Supplies
Body supplies
628.75
21.8 hrs @ $ 40.00/hr 872.00
14.7 hrs @ $ 40.00/hr 588.00
14.7 hfs ~ $ 25.00/hr 367.50
16.0 hrs ~ $ 2.50/hr 40.00
SUBTOTAL $ 2496.25
Sales Tax $ 2088.75 ~ 6.0000% 125,33
GRAND TOTAL $ 2621.58
ADJUSTMENTS:
oeductible 0.00
CUSTOMER PAY $ 0.00
INSURANCE PAY $ 2621.58
Estimate based on MOTOR CRASH ESTIMATING GUIDE. Non-asterisk(*) items are derived from the Guide
DE3PF88. Database Date 10/2000. Double asterisk(**) items indicate parts supplied by a supplier
other than the original equipment manufacturer. Pound sign (#) items indicate manual entries.
CAPA items have been certified for fit and finish by the Certified Auto Parts Association. NAGS
Part Numbers, Prices and Labor Times are provided from National AUtO Glass Specifications, Inc.
Pathways - A product of ccc Information Services Inc.
Driver's Name - Last First Middle
Address City
Gender License Number Class/Type
RestdsttenstEndorsements Complied With? Insurance Company
DRIVER EXCHANGE INFORMATION
Dubuque Police Department
(319) 589-44t0
Unit 001
Owner's Name - Last First
Address City
Year Make Model Styte
Plate State Plate Year Plate NUmber V]N Number
License State
Suffix Work Phone Home Phone
State Zip Code Date of Birth
License Endorsements License Restrictions
NONE NONE
insurance Policy Number
Middle
Insurance Company's Phone Number
Suffix Company Owner's Name
State Zip Code Approximate Cost to Repair or Replace
$0.00
Vehicte Type
Damaged Arriacs~ of Vehicte
Unit 002
Ddver's Name - Last
Address
Fimt Middle
city
Suffix Work Phone Home Phone
(319) 582-1043 x
State ZioCode Dateof Birtl-
Gender License Number ClassF~ype
Restdsttens/Endorsemente Complied W~th? Insurance Company
FARMERS INSURANCE
LEIBFRIED
Address
2820 PINARD
Year Make
1996 DODG
Plate State Plate Year
IA 2001
Address
Ddver's Name - Last
First Middle
GERALDINE
C~
DUBUQUE
Model Style
NEON PLDS42 4D
Plate Number VIN Number
352AWC 1 B3ES47C1 TD600158
NONE NONE
11029847883 (319) 583-8881 x
State
IA
52001 - $300.00
07
Unit 003
First Middle
city
Suffix Work Phone Home Phone
(319) 583-3385 x
State ZJr Code Dateof Birth
Gender License Number CJasstType
Restricttens/Endorsements Complied With? Insurance Company
HERRIG INSURANCE
Owner's Name - Last First
HESS RONNIE
Address
749 VANDERBILT
Yea~ Make Modst
1991 DODG DYN
Ptete State Plate Year Ptete Number
IA 2001 051GZB
Middle
L
city
DUBUQUE
Style
4D
VIN Number
'IB3XC46R8MD252727
License S~ate License Enaorsemems License Restrictions
NONE NONE
Insurance Policy Number Insurance Company's Phone Number
4106418501 (319] 556-1499 x
Suffix Company Owner's Name
State Zip Code Approximate Cost to Reoair or Replace
IA 52003- $700.00
Vehiste Type
Passenger Car
Damaged Area(s) of Vehicle
05,06,07
Printed At: Dubuque Police Departmenl Page 'I Case #: 00~L7403
County ' Accident occurred within coq~orate limits of (city)
I Du.bdque - 3t Dubuque - 2'100' ~
Li~eral Description
"N/A"
-- "N/A"
[~X~oordinate Y Coordinate
"NIA"
Direction Nearest City
of
If Accident Occurred Outside of
C[~ Limits Show General Vacinity "N/A"
On Road, Street or Highway Road Class
CENTRAL AVENUE 4 - City Street
At Intersection With Road Class
"NIA .... N/A"
200 Ft 5-S and "N/A .... NIA" of "N/A"
Definable Intersection, Bridge, or Railroad Crossing
CENTRAL AND 12TH STREET
Officer's Name Badge No Case No Date of Accident Time of Accident
HAUPERT DAVE 66A 00-47403 12/2912000 22:11
Printed At: Dubuque Polfce Department Page 2 Case #: 00-47403