Claim Noel Brian CCLAIM 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: Brian C Noel
2. Address: 2755 Postosi Dr
3. Telephone Number: 319-557-7354
4. Date of Incident: 1-23-01
5. Time of Incident: 3:24 PM
6. Location of Incident (Be specific): University & Alpine
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.)
Brian was headed north on University and stoped for the vehicle ahead of him to turn when he was rearended by Nathan L Tyler - Officer
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.) Folger, badge #30A
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.)
Damage to Brians 94 Chevy S-10 estimates will follow
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?
16. Why do you claim the City of Dubuque is responsible?
The officer rear ended Brian while he was stopped
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 24th day of January , 2001
J~N-24-OI {4ED 09:-40 ~I~-
DUBUQUE OITY OLERK
FhX NO, 3195890890 P, O1
C.LA]..M z~GAINS~7 ,~E~,, C!T~ OF DITBUQUE
Thi,~;~ ~.,~ri%;ten r~;,port: const.~ tute~ your claim against the City of
Du]'~u~e~ io%Ja, You should co~,~p],ete t. hi~ form in full and attach
an.V ~...~l. lti¢.o.~l in£ormation thst [~uDDorts your claim.
?h~,~ C].~.im ~us(~ be filed w'ith the City Clerk at City Hall, 50
l~e,?A 13th St:~'e~t, ]~ubu~e, I~%wa 52001-4864. It will then be
r~f~.~rr'ed by the City cou-acil to the appropriate Depar~ent for
ir~v.i~stig,:~tio~. 0~%c~ theft invo~ti~,tion is completed, a report and
reCOa~:~n,'lr~tf, on ~,~ill be s~mitted to th~ City Co~eil. You w~ll b~
Ift:~ ~ lt~-~L D'ECISIOI{' ON ALL CLAIb~S IS MADE BY THE CITY CO~CIL.
>tO .... ~.J~.[.~O~,,~*' '-~"~' OF T~I~ CiTY OF DHk[UQ~~, ~S THE AUTHORITY TO ~E ~
[{!,~!%EB~4",FATION TO YOU AS TO %~ =TAEI. YOUR C~IM WILL OR WILL NOT BE
0+0s;
J _-,,,.a,,3..-_o 1
3~.V prn.
Loc~:icnl of incident. (k,~e specific)'
........... i_'L...,.£~__
(Giw~ full d,a~t~{l~ upo~1%,:hich you base your claim. If a City
:~ (~ . D ~ l (~ t~)OlJl, Oe i~vestigate? (if so, give nsmes of o~ficers.)
1Z. Wa~ ~yon~ i~ured? (If ~o, 9~ve n~m, a~ess and extent of
J~N-24-O1 NED 09r40 ~- DUBUQUE CITY OLERK FA× NO, 3195890890 P, 02
1:2.
13. %,}'ha~.: Other da~.qes do yo~ claim, if any?
you been co=~pens=ted for any part or all of your claim by
you c.~.m, im fr(~m th~ City of Dubuque?
Why do yol~ cl~.~im the City o~ Dubuql%e is responsible?
~av~ y~'u ~{.a,~/e any clai~ ;:.gai~k~t snyone else for dama~e~ as a
~:'&~zult of this i~lcident? /%/0
If the ;~.n~wer to Questions 19 is yes, have you received any
(Si~netur e)
Da'm: 1/24/01 02:03 PM
Estimate ID: 4466
Estimate Version: 0
Preliminary
Pro,de ID: Mitchell
BIRD CHEVROLET
3255 UNIVERSITY AVE. PO, BOX 57 DUBUQUE, IA 62001
(319) 683-9121
Fax: (319) E56-4482
Damage Assessed By: JOHN KLOTZ JR.
Deductible: UNKNOWN
Owner BRYAN NOEL
Address: 2765 PATOSI DUBUQUE, IA 52003
Telephone: HomePhone: (319)5~9.6997
Mitchell Sewice: 916492
Description: 1994 Chevrolet S1~ LS
Body Style: 2D Pkup 6' Bed 188" tNB
VIN: 1GCDTt4WIRKl~0240
Options: 4 WHEEL DRNE
Drive Train: 4.3L InJ 6 Cyl 4WD
Line Entry Labor Line ~ Part Type/ Dollar Labor
Item Number Type OperaUon DescdpUon Prat Number AJnount Units
I 629820 REF REFINISH R REAR BUMPER. EXTENSION C 0.6
2 629830 REF REFINISH L REAR BUMPER EXTENSION C 0.6
3 AUTO BDY OVERHAUL REAR BUMPER ASSY
4 629800 BDY REMOVE/REPLACE REAR BUMPER FACE BAR 12389361 GM PART 199.80 INC
6 AUTO REF REFINISH REAR FAGE BAR C 1.1
6 629920 BDY REMOVE/REPLACE R REAR BUMPER STEP PAD 16647618 GM PART 8.60 INC
? 629930 BDY REMOVE/REPLACE L REAR BUMPER STEP PAD 15647617 GM PART U0 INC
8 629940 BDY REMOVE/REPLACE R REAR OTR BUMPER BRACKET 16647614 GM PART 8~3 INC
9 829960 BDY REMOVE/REPLACE L REAR OTR BUMPER BRACKET 1G~47613 GM PART 8.33 INC
10 AUTO REF ADDI. OPR CLEAR COAT 0.7
11 AUTO ADD'L COST PAINT/MATEPJALS 78.00
12 AUTO ADD1. COST HAZARDOUS WASTE DISPOSAL 2.52 *
* - Judgement Item
C - Included in Clear Coat Calc
E$11MATE RECALL NUMBER: 1/24/01 14:01:39 4465
UltraMate is a Trademark of Mitchell leternaiisnai
Mltchail Data Version: JAN_OI_A Copyright (C) 1984 - 2000 Mitchell Int~Tmtlonai
U~aMate Version: 4.6.004 All Rtghts Reserved
Page I of 2
Date: 1124/01 02.03 PM
Estimate I~ 4466
Estbnate Version: O
Preliminary
Profile ID: Mitchell
Labor Subtotals Un~s Rate
Body 0.9 42.0~
Refinish 3,0 42.00
Taxable Labor
Labor Tax
Labor smmnary 3.9
m. Additional Co~s
N~n-Taxable Co,ts
Total Additional Costs
Add'l
Labor SuMet
Amount Amount Totals
0,00 0,00 37.80 T
0.0e 0,00 126.00 T
163,80
6.000 % 9.83
173.63
Part Replacement Su,alMry
Taxable PaS
Sales Tax ~
Total Replacement Parts Amount
Amount N. Adjustments
$0,02 Customer Responsibility
90.52
I. Total ~
II. Total Replacement Parts:
III. Total Addlt~nal C~ite:
Gross Tntal:
232.86
13.97
246.83
0,00
173,03
246,03
80.52
60038
IV. Total AdJuslments:
Net Total:
0,00
50~,08
This is a oreliminarv estimate.
Additional chanaes to the estimate may be required for the actual repair.
PARTS PRICES ARE SUBJECT TO C~ANGE
ESTIMATE RECALL NUMBER: t/24~114:0t:39 4466
ultraMate Is a TrademaH(of M~ Intem~dmt~
Mitchell Data Version: J~_0 I_A Copyright (C) 1994 - 2~Wdtchell International
UBraMate Version: 4,6.004 Afl Rights Resm~ed
Page 2 of
FED ID #42-0813744
Date: t/24/(H 02:25 PM
EsSmate ID: 41t7
Estimate Version: 0
Pmllmln~
Profile ID: Mitchell
RICHARDSON MOTORS
t475 J.F.K, ROAD DUBUQUE, IA 52002
(319) 582-5411
Fax: (319) ~82-4t29
DamageAs~e~dBy: JEFFL~CK
Deductible: UNKNOWN
Insured: BRAIN NOEL
Address: 2755 POTOSI ST DUBUQUE, IA 52003
Mitchell Sm~lce: 916492
DoscrtptJon: 1994 Chevrolet 810 L8
Body Style: 2D Pkup G' Bed t08" WB
VIN: ¶GCDTt4WtRKt30240
OpUons: 4WHEEL DRIVE
Drive Trsin: 4.3L I~ 6 Cyl 4WD
Une Entry Labor
Item Number Type OperaUon
I 601987 REF REFINISH
2 600535 REF REFINISH
3 601488 BDY REMOVE/REPLACE
4 AUTO BDY OVERHAUL
5 629900 BDY REMOVE/REPLACE
6 AUTO REF REFINISH
7 629930 BDY REMOVE/REPLACE
0 ~29S40 BOY ~E¥OVEn~EPL.ACE
~1 629950 BDY REMOVE/REPLACE
10 AUTO REF ADD'L OPR
~1t 933018 REF ADD'L OPR
t2 AUTO ADD'L COST
t3 AUTO ADD'L COST
Une Item
Description
VALANCE PANEL
BED TAILGATE OUT~IDE
HINGE SHAFT
REAR BUMPER ASSY
REAR BUMPER FACE BAR
REAR FACE BAR
L REAR BUMPER STEP PAD
R REAR OTR BL/MPER BRACKET
L REAR OTR BUMPER BRACKET
CLEAR COAT
MASK FOR OVERSPBA¥
PAINT/MATERIALS
HAZARDOUS WASTE DISPOSAL
*-.~udgement Item
~. ~clud~ in Clear Coat Ca;c
Part Type/ Dollar Labor
Part Number Amount Unite
';596t603 GM PART
12389361 GM PART
15647~17 GM PART
15647614 GM PART
15647613 GM PART
C 0.8
C 1.9
8.77 0.t
O.9
199OO INC
C 1.1
8.60 INC
8,33 lNG
O.3*
t 27,.40 *
6.00'
ESTIMATE RECALL NUMBE~ t/24/0t 14:t7:08 4t17
U~t~Mat~ 18 a Trademan~ of MRchell Intemat]oflal
Mitchell Data Version: JAN_0t_A Copyright (C) 1994- 2000 Mitchell International
UltraMate Version: 4,6,004 AH Rights Reserved
Page t of
Date: t/24~01 02:25 PM
Est]mats ID: 4117
Est]matsVersion: 0
Pmllmlnai7
Profile ID: MitchMI
I. Labor Subtotals
Refinish
Labor Summmy
IlL Additional Costs
Taxable Co. is
Units Rate
1.0 40~0
5,2 40.00
Taxable Labor
Labor Tax
Sales Tax
Non-Taxable Co,ts
Total Additional Costs
Add'l
Labor
Amount
0,00
0.00
6.OO0 %
6.000%
Sublet
Amount
0.00
0.00
Totals
40.00
208.00
248,00
lZL88
262.88
6.~
0.~
1~.~
133.76
II. Part Replece~ent Summary
T Taxable Pa(cs
1' Sales Tax
Total Replacement Parts Amount
cu~tom~* RespoflsibilKy
6.000%
Amount
IL Total Replacement Par~:
IlL Total Additional Costs:
Gro~s Total:
247.0t
133,?B
643.66
Totsl Adjustments:
Net Total:
This is a Dreliminarv estimate.
Additional chanqes to the estimate may be reauirecl for the actual repair.
ESTIMATE RECALL NUMBER: 1/24~01 14:t7:08 4117
UltraMats is a Trademark of Mitchell Inb)rnatlonal
MltchMI Data Vi~st~m: JAN_01_A Copy~ght (C) 1994 - 2000 Mitchell letsmatlonal
UltraMats Version: 4.6.004 All Rights Reserved
Page 2 of 2
01/23/2001 at 10:33 PM
30799
3ob Number:
BRIM~YER AUTO BODY
License #:30799 Federal ID #:421438480
10727 3OHN F. KENNEDY RD
DUBUQUE, IA 52001
(319)583-4456 Fax: (319)583-1838
PReLIMINARy ESTI~TE
Written by: ERIC WINCH #
Adjuster:
Insured: BRIAN NOEL
Owner: BRIAN NOEL
Address: 2755 POTOSI
DUBUQUE, lA 52003
Day: (319)543-2103
Claim #
Polic-~ #
Deductible:
Date of Loss:
T~pe of Loss:
Point of Impact: 6.
Rear
Inspect
Location:
Insurance
Company:
Days to Repair
1994 CHEV T10 4X4 6-4.3L-FI 2D SHORT BLK Iht:
VIN: 1GCDT14W1RK130240 Lic: Prod Date: Odometer:
Intermittent Wipers Tinted Glass Dual Mirrors
Clear Coat Paint Power Steering Power Brakes
Anti-Lock Brakes (4)
NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT
1 REAR BUMPER
2 O/H rear bumper 1.2
3 Repl Face bar production w/step 1 199,00 Incl. 1.5
4 Add for clear coat 0.6
5 Repl RT Outer bracket 1 7.60 Incl.
6 Repl LT Outer bracket 1 7.60 Incl.
7 Repl RI Inner bracket 1 7,60 Incl.
8 Repl LT Inner bracket 1 7.60 Incl.
9 Repl RT Step pad 1 8.60 Incl.
10 Repl LT Step pad 1 8.60 Incl.
tl Repl Filler 1 32.75 0.4 1,0
12 Add for Clear Coat 0.4
N 13# Rpr BUFF TAILGATE 1.0
14 Repl LT Extension w/o molding 1 42.75 0.3 0,5
15 Add for clear Coat 0.1
subtotals ==> 322.10 2.9 4.1
Line 13 : OPEN TO REFINISH
01/23/2001 at 10:33 PM
30799
1994 CHEV
Job Number:
P~ELIMINARY ESTIMATE
T10 4X4 6-4.3L-FI 2D SHORT BLK Int:
Parts
Body Labor
Paint Labor
Paint Supplies
Body Supplies
322.10
2.9 hrs ~ $ 40.00/hr 116.00
4.1 hrs ~ $ 40.00/hr 164.00
4.1 hfs ~ $ 25.00/hr 102.50
1.0 hrs ~ $ 2.50/hr 2.50
SUBTOTAL $ 707.10
Sales Tax $ 602.10 ~ 6.0000% 36.13
GRAND TOTAL $ 743.23
AD3USTMENTS:
Deductible 0.00
CUSTOMER PAY $ 0.00
INSURANCE PAY $ 743.23
Estimate based on MOTOR CRASH ESTIMATING GUIDE. Non-asterisk(*) items are derived from the Guide
DR1GD94. Database Date 9/2000. Double asterisk(**) items indicate parts supplied by a supplier
other than %he 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,