Claim - Vollenweider, JohnCLAIM 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: John Vollenweider
2. Address: 3453 Glen Cove Lane, Dubuque IA 52002
3. Telephone Number: 319 588 1039
4. Date of Incident: 1-4-2001
5. Time of Incident: 11:45 AM
6. Location of Incident (Be specific):
Alley east 58 Bluff St.
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.)
Garbage truck backed into my vehicle while I was parked
8. What were weather conditions like?
Clear
9. Give name and address of any witnesses:
10. Did police investigate? (If so, give names of officers.)
Dubuque Police Officer Ehlers Badge 22
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.)
My vehicle sustained damage - 2 estimates are attached
13. What other damages do you claim, if any?
Possibly a rental vehicle while my vehicle is in body shop.
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?
Amount on estimate from Bird Chevrolet $1145.29
16. Why do you claim the City of Dubuque is responsible?
Garbage truck drive by City employee backed into my vehicle and damaged my vehicle. My vehicle was legally
parked and unattended when it was hit.
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 .
/s/ John Vollenweider
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
CLAIM AGAINST TEE CITY OF DUBUQU~~ ~
This ~rittel% report constzt%~te~ your claim
aga nsf the City
Dllbuq%~.e, !O%~a. YOU should con, plate this fo~ in full and attach
The~ Cl~i~a must be file~ with the City Clerk at City Hall, 50
~,,'ai~t 3.3th Street, Dubuque, Ic'~a 52001-4864. It will th~n be
p~covld, ed %~i~h a copy of that r~port and rec~endation.
Tl~if: FYi,[AL DECISION ON ALL CLAIMS IS MADE BY THE CITY COUNCIL,
i']0 k'MPLO'Y~]E OF THE CITY OF DUBUQUE ~S THE AUTHORITY TO ~EE ~
REPi~)~TkT~0M TO YOU AS TO ~I.:~ER YO~ C~IM WILL OR WILL NOT BE
PAID,
~, 'f~m~ of In~Ldent:_./ .......
D}:~SCt~Y'BE ACCZD~IT OR OCCDaR~;~C~ TH~.T CAUSED INJURY OR DAMAGE.
(C~].V,~ !ull d~t~ils upon ~hich you base you~ ~la~. If a City
employee w~ involved, give the ~ployee's
...... t weather cond~t,.~on~ llke?
~!. ~ive n~ae ~n~ addre~ of any witnesses.
!0, Did police investigate? (If ~o, ~iva names of officers.)
ll. ~fas anyon~ injured? (If ~o, ~ive name, addre~ and extent
5AN-04-OI THU 01:35 ?~ DUBUQUE OiTY CLERK FAX NO, 3195890890 P, 02
~.gas s~ny damag? doae to l:.rc;.perty? (If sO, describe property
and t,5¢ extent of d~ge. Attach estimates of d~mage~ or
do~¢c~'ib~ basis for ascertainin~ exten~ of d~aBe.)
13. ~hat other d~.~es do yo%% ela;[m~ iE any?
13 I'n ,
!5 W~ab ~Ou~t do yo~ cl~i~ fro~. the Ci~
2,6. ~'~y do you cla~ the City of D~u~e ii responsible?
If yam, give n~e ~nd addcesz:
18. :ff bhe an~:iwer to Queatio.u 17 is yes, have you Seceived any
pa~,enb ~o~ t~at source, and if'
~0.~.~. .... , ...... . --,
Date: 114/01 02:52 PM
Estimate iD: 4345
Estimate Version: 0
Preliminary
Profile ID: CUSTOMIZED
BIRD CHEVROLET
3255 UNIVERSITY AVE. P.O. BOX 57 DUBUQUE, IA 62001
(319) 5~3-9t21
Fax: (319) 556-4482
Damage Assessed By: JOHN KLOTZ JR.
Deductible: UNKNOWN
Owner JOHN VOLLENWEIDER
Address: 3453 GLENCOVE DUBUQUE, IA 52001
Telephone: Home Phone: (319) 588-1039
Description:
Body Style:
VIN:
Mileage:
Coter:
Mitchell Service: 913493
1996 Chevrolet Monte Carlo LS
2D Cpe
2GIW1N12MTT9101134
29,395
RED
Drive Train:
3.1L Inj 6 Cyl AO
253AXL
Line Entry Labor
Item Number Type Operation
Line Item
Desc~{piion
Part Type/
Part Number
Dollar Labor
Amount Units
I 300024 BDY REMOVE/REPLACE
2 AUTO REF REFINISH
3 300026 BDY REMOVE/REPLACE
4 300027 BDY REMOVE/REPLACE
6 300033 BDY REMOVE/REpLACE
6 302006 BDY REMOVE/REPLACE
7 AUTO BDY CHECKIADJUST
8 300070 BDY REPNR
, 9 AUTO REF ADD'L OPR
10 AUTO ADD'L COST
11 AUTO ADD'L COST
BUMPER/GRILLE COVER
BUMPER/GRILLE COVER
UPR BUMPER/GRILLE MOULDING
LWR BUMPER/GRILLE MOULDING
BUMPER/GRILLE EMBLEM
R COMBINATION LAMP ASSEMBLY
HEADLAMPS
R COMBINATION LAMP MOUNTING FRAME
CLEAR COAT
PAINT/MATERIALS
HAZARDOUS WASTE DISPOSAL
10186940
10178403
10176789
10254988
10420376
Existing
GM PART
GMPART
GMPA~
GMP~T
GMP~T
338.00 1.5
C 2.4
132.00 INC
48.25 INC
17.25 {NC #
235.00 0.3
0.4
0.0'#
1.0
88A0 *
2,72 *
* - Judgement Item
# - Labor Note Applies
C - Included in Clear Coat Calc
ESTIMATE RECALL NUMBER: 114/01 14:41:37 4345
UltraMate is a Trademark of Mitchell International
Mitchell Data Version: DEC_00_A Copyright (C) 1994 - 2000 Mitchell International
UitraMnte Version: 4.6.004 AIl RIghts Reserved
Page I of 2
L Labor Subtotals Units
Body 2.2 40.00
Refinish 3A 40,00
Addq
Labor Sublet
Rate Amount Amount
Totals I1.
0.00 0.00 88.00 T
0.00 0.00 136.00 T
Taxable Labor
Labor Tax ~ 6,000 %
Labor Surmflery
224,00
13,.44
237.44
10. Additional Costs
Non-Taxable Costs
Total Additioirlal Costs
Date: 1/4~0'J 02:52 PM
Estimate ID: 4345
Estimate Version: 0
Preliminary
Profile ID: CUSTOMIZED
Part Replacement Surmesry
Taxable Parts
Sales Tax ~
Total Replacement Parts Amount
Amount IV. Adjustments
91.12 Customer Responsibility
9t.t2
I. Total Labor:
II. Total Replacement Parts:
IlL Total Additional Costs:
IV. Total AdjuStments:
Net Total:
This is a preliminary estimate.
Additional chanqes to the estimate may be required for the actual repair.
6.000%
Gross Total:
PARTS PRICES ARE SUBJECT TO CHANGE
Amonnt
770.50
46.23
816.73
0.00
237~14
816.73
91.12
1,145.29
0.00
1,145.29
ESTIMATE RECALL NUMBER: 114~01 14:41:37 4345
UltraMate is a Trademark of Mitchell International
Mitchell Data Version: DEC_00_A Copyright (C) 1994 - 2000 Mitchell International
UitraMate Version: 4.6.004 All Rights Reserved
Page 2
of 2
SHOP CONTACT:
YAGER AUTO BODY INC
4488 DODGE STREET DUBUQUE, IA 52003
FEDER3~L ID ~ 42-1131724
PHONE: 319-557-7376 FAX: 319-557-1709
CD LOG NO 0004601 DATE 01/04/01
JAMIE YAGER
Page
INSP DATE 01/04/01
OWNER JOHN VOLLENWEIDER
ADDRESS 3453 GLENCOVE LN
CITY STATE DUBUQUE IA
ZIP 52002
INS CO
CLAIM#
POLICY~
LOSS DATE
1996 CHEVROLET MONTE CARLO/LS
LIC%
BODY COLOR
2DR COUPE
HOME PHONE
WORK PHONE
CONTACT
PHONE
CLAIM REP
DEDUCTIBLE
VIN
MILEAGE
(319)588-1039
(319)
2G1WW12M7T9101134
DAMAGE REPORT
LINE REPAIR DESCRIPTION
t REPLACE NEW PART
2 REFINISH
3 REPLACE NEW PART
4 REPLACE NEW PART
5 REPLACE NEW PART
6 ADDN'L OPERATION
7 REPAIR/ALIGN
ADJ%
FRONT BUMPER COVER
FRONT BUMPER COVER
FRT BUMPER COVER MLDG
FRT BMPR COVER EMBLEM
RIGHT HALOGEN HEADLAMP AS
HEADLAMPS AIM
RIGHT HEADLAMP MTG BRKT
PARTS$
338.00
132.00
17.25
235.00
LABORS
76.00
140.00
8.00
12.00
20.00
20.00*
TOTALS
PARTS
PAINT MATERIAL
BODY LABOR- SM
MECH/ELEC LABOR-ME
FRAME- FR LABOR
REFINISH-RF LABOR
SUELET
TOWING
STOP~AGE
TAX
ESTIMATE TOTAL
722.25
87.50
136.00
.00
.00
140.00
.00
.00
.00
59.90
1,145.65