Claim Mesch KimCLAIM AGAINST THE CITY OF DUBUQUE
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
reco~unendation 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 '£~ AUTHORITY TO MAKE ANY,
REPRESENTATION TO YOU AS TO WHETHER YOUR CLAIM WILL OR WILL NOT BE
PAID.
1. Name of Claimant: KIM MESCH
2. Address: 432½ EMMETT STREET, DUBUQUE, IA 52001
3. Telephone Number: 319-556-3351 Home 319.557-0511 Work Niqhts
4. Date of InCident: January 25, 2002
5. Time of Incident: 11:11 AM
6. Location of incident. 432 Emmett, Dubuque, Iowa
DESCRIBE'ACCIDENT OR OCCURRENCE THAT C~USED INJURY OR DAMAGE.
(Give full details upo= which you base-your claim. If a City
employee was involved, give the eu~ployee, s name.)
Auto was proper~y parked when struck by a garbage truck owned
by City of Dubuque and driven by Michael K. Clancy, 925 Kerper
Blvd., Dubuque, IA · ~ ~-
What were weather conditions like? Sunny and clear
Give kame and address of any witnesseS.Names u~known, Other
city employess' on truck with ~i%er
10. Did police investigate? (If so, give names of officers.)
Yes, Schmeichel, Badge No. 37
11.
Was anyone injured? (If so, give name, address and extent of
injuries.)
No
12. Was any damage-done to property? (If so, describe property
and the extent of d~mage. Attach estimates of damages or
describe basis for ascertaining extent of daa~ge.)
1998 Dodge Neo~ - Right front bumper
$367.41
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.)
15. What amount do you claim from the City 6f Dubuque?
$367.41
16. Why do you claim the City of Dubuque is responsible?
H~it properly parred car.
17.
Have-you ~de. any~ c~aim against anyone else~for damagesas a
result of this incident? No
If yes, give name and address:
If the answer =o Question 17 is Yes, h_a~e.y~u received any
paym~n~ frou%~that' ~ource, and if so, in what amouut?
Iowa, this 26th day of January
(Revised January, 2000)
(Si~=ature) ' '
Kim Mesch
(Print Name)
WILSON BROS. DODGE
90 JFK
DUBUQUE, IA 52002
PHONE: (319)583-5781
SHOP:
ADDRESS:
CITY STATE:
ZIP:
CD LOG NO 953-1
WILSON BROS AUTO BODY
90 JFK
FED TAX ID 420779647
DUBUQUE, IA
52002-
DATE 01/25/01
INSP DATE:
CONTACT:
PHONE 1:
PHONE 2:
FAX:
01/05/01
JASON CHARLEY
(319) 582-6969
(319) 583-5781 E~ 230
(319) 556-6928
OWNER: MESH, KIM
ADDRESS: 432 1/2 EMMETT
CITY STATE: DUB, IA
ZIP: 52001-
HOME PHONE:
(319)556-3351
POINT OF IMPACT: 9
LIC%:
BODY COLOR:
CONDITION:
RED
STATE:
VIN:
MILEAGE:
ACCTNG CTL#:
1B3ES47C2WD566557
*=USER-ENTERED VALUE
EU=SALVAGE PART
IT=LABOR PARTIAL REPAIR
N=ADDNL LABOR OPERATION
AA=APPEARANCE ALLOWANCE
RI=R&I ASSEMBLY
E=NEW PART
EP=SEE PX REPORT
I=REPAIR/ALIGN/SUBLET
P=CHECK
RP=RELATED PRIOR DAMAGE
EC=ECONOMY PART
ET=LABOR PARTIAL REPLACE
L=REFINISH
TE=PART/PARTIAL REPLACE
UP=UNRELATED PRIOR DAMAGE
1998 DODGE NEON HIGHLINE 4DR SEDAN N1823B/D OPTNS K/24AI
OPTIONS: TWO-STAGE - EXTERIOR SURFACES
TINTED GLASS
TWO-STAGE - INTERIOR SURFACES
POWER STEERING
OP GDE MC DESCRIPTION
I 0017 01 COVER, FRONT BUMPER
L 0017 09 COVER.,FRONT BUMPER
E 0019 RET,FRT BUMPER COVER
E 0107 SKIRT, INNER FENDER
I M60 HAZARD. WSTE. REM.
EC MISC CLIPS. ETC
EC SHOP SUPPLIES
MFG.PART NO. PRICE
REPAIR
REFINISH
LT 5263821 5.75
LT 5256933 19.85
SUBLET REPAIR 4.00*
ECONOMY PART 5.00*
ECONOMY PART 2.50*
AJ%
HOURS R
1.0'1
3.64
1.1 1
0.31
*1'
*1'
*1'
7 ITEMS
MC MESSAGE(S)
01 CALL DEALER FOR EXACT PART NUMBER / PRICE
09 INCLUDES 0.6 HOURS MAJOR PANEL TWO-STAGE ALLOWANCE
FINAL CALCULATIONS & ENTRIES
GROSS PARTS
25.60
PAGE 1
19~8 D~'DGE NEON
CD LOG NO 953-1
HIGHLINE 4DR SEDAN
OTHER PARTS 7.50
PAINT MATERIAL 86.40
PARTS TOTAL 119.50
TAX ON PARTS @ 6.000% 1.99
LABOR RATE REPLACE HRS REPAIR HRS
i-SHEET METAL 38,00 1.4 1.0 91.20
2-MECH/ELEC 48.00
3-FRAME 41.00
4-REFINISH 38.00 3.6 136.80
5-PAINT MATERIAL 24.00
LABOR TOTAL 228.00
TAxX ON LABOR @ 6.000% 13.68
SUBLET REPAIRS 4.00
TAX ON SUBLET @ 6.000% 0.24
TOWING
STORAGE
GROSS TOTAL
367.41
NET TOTAL 367.41
ADP SHOPLINK UB303 ES CD LOG 953-1 DATE 01/25/01 02:22:54PM R6.1
PXN:N/00/00/00/00 CUM:/// HOST LOG
COPYRIGHT 1999, AUTOMATIC DATA PROCESSING, INC.
CD 01/01
1.1 HOURS WERE ADDED TO THIS ESTIMATE BASED ON ADP'S TWO-STAGE REFINISH
FORMULA: 20% OF REFINISH HOURS, AFTER OVERLAP, PLUS 0.6 HOURS FOR THE FIRST
MAJOR PANEL, WHERE NOTED.
PAGE 2
01/25/2001 at 08:23 PM
24443
Job Number:
ABP. A - DUBUQUE
Federal ID ~:420782245
DBA: AiqDERSON-WEBER INC
3400 CENTER GROVE DR
DUBUQUE, IA 52003
(319)556-0696 Fax: (319)556-1899
PRELIMINARY ESTIMATE
Written by: KEN GREEN ~24443
Adjuster:
Insured: KIM MESH
Owner: KIM MESH
Address: 432 1/2 E~ETT ST
DUBUQUE, IA 52001
Day: (319)556-3351
Claim %
Policy ~
Deductible:
Date of Loss:
Type of Loss:
Point of Impact:
Inspect
Location:
Company:
Days to Repair
1998 DODG NEON HIGHLINE 4-2.0L-FI 4D SED RED Iht:
VIN: 1B3ES47C2WD566557 Lic: Prod Date:
Rear Defogger Intermittent Wipers
Clear Coat Paint Power Steering
Driver Airbag Passenger Airbag
Bucket Seats
NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT
1
2
3*
4
5
6
7
8
9
10%
11%
Odometer: 30568
Body Side Moldings
Power Brakes
Cloth Seats
Subtotals ==> 32.90 2.8 3.9
FRONT BUMPER
R&I R&I bumper assy 0 0.00 1.0 0.0
Rpr Cover assy smooth finish w/o f 0 0.00 1.5 2.4
Add for Clear Coat 0 0.00 0.0 i.0
Repl LT Cover assy side bracket 1 5.75 0.0 0.0
Repl Cover assy screw 1 1.10 0.0 0.0
Repl LT Cover assy rivet front 1 2.20 0.0 0.0
FENDER
Repl LT Fender liner 1 19.85 0.3 0.0
Subl HAZARDOUS WASTE DISPOSAL 1 4.00 X 0.0 0.0
COLOR TINT 1 0.00 T 0.0 0.5
01/25/2001 at 08:23 PM Job Number:
24443
PRELIMINARY ESTIMATE
1998 DODG NEON HIGHLINE 4-2.0L-FI 4D SED RED Iht:
Parts 28.90
Body Labor 2.8 hfs @ $ 38.00/hr 106.40
Paint Labor 3.9 hfs @ $ 38.00/hr 148.20
Paint Supplies 3.9 hfs @ $ 24.00/hr 93.60
Sublet/Misc. 4.00
SUBTOTAL $ 381.10
Sales Tax $ 283.50 @ 6.0000% 17.01
GRAND TOTAL $ 398.11
ADJUSTMENTS:
Detectible 0.00
CUSTOMER PAY $ 0.00
INSURANCE PAY $ 398.11
WARP~ANTY VALID ONLY WITH ORIGIONAL COPY OF YOUR RECEIPT PARTS SUBJECT TO
INVOICE NO GUARANTEE ON RUST ALL PARTS NEW, UNLESS OTHERWISE NOTED
Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from
the Guide DR3PL95 Database Date 11/2000 and the parts selected are OEM-parts mm=~ufactured by the
vehicles Original Equipment Manufacturer. Asterisk {*) or Double Asterisk (**) indicates that the
parts and/or labor information provided by MOTOR m~y b~ve been modified or may ~ave come from an
alternate data source. Non-Original Equipment Manufacturer aftermarket parts are described as
or Q~al Repl Parts. Used parts are described as LKQ, Qual Racy Parts, RCY, or USED. Reconditlone~
parts are described as Recon. Recored parts are described as Recore. NAGS Part Numbers and Prices
are provided from National Auto Glass Specifications, Inc. Pound si~ (~) items indicate
entries.
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