Claim Walgamuth SusanCLAIM 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: Susan A Walgamuth
2. Address: 320 N Hill St Dub Ia 52001-6503
3. Telephone Number: 319-556-7853
4. Date of Incident: Jan 5 2001
5. Time of Incident: approx 5:15 - 5:30 PM
6. Location of Incident (Be specific): At my residence at 320 N Hill St Car was parked in front of my residence.
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.)
A city bus driven by Dave Kruse hit my car, putting a large dendt in the foor, below rear view miror and tearing of the rear view mirror on drivers side.
8. What were weather conditions like? cold but normal
9. Give name and address of any witnesses:
10. Did police investigate? (If so, give names of officers.) No, bus driver said he couldn't reach police dept. I called police on following sunday
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 my car - large gauge in door below rear view mirror and tearing mirror completely off. drivers 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? See attached estimates
16. Why do you claim the City of Dubuque is responsible? City fo dubuque bus hit my parked car at 320 N Hill st
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 15th day of January , 2001
CLAIM 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
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
Name of Claimant:
Address: 3~0
Telephone Number:
Date of Incident:
PAID.
2.
3.
4.
5.
6.
Time of Incident:
DESCRIBE ACCIDENT OR OCCURRENCE THAT CAUSED INJURY O~ DAMAGE.
(Give full details upon which you base your claim. If a City
~ployee was involved, give the ~ployee's n~e.)
~at were we-~..er conditions like?
Give n~e ~d address of any witnesses.
10. Did police investigate? (If So, give names of officerS.)
injuries. )
12o 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.
14.
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.)
15. What amount do you claim from the City of Dubuque?
16. Why do you claim the City of Dubuque is 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
pa~t from that source, ~d if so, in what
Dated at Dubuque, Iowa, this
200~
(Revised January, 2000)
(Print Name~
Date: It1510'~ 12:19 PM
Estimate ID: 4173
Estimate Version:
Preliminary
Profile ID: DUBUQUE
Damage Assessed By:
MIKE FINNIN FORD, INC.
3600 DODGE STREET DUBUQUE, IA 52003
(319) 556-1016
Fax: (319) 556-5249
Tax ID: 42-1074463
RICK STUMPF
Deductible: UNKNOWN
Address:
Telephone:
SUSAN WALGAMUTH
320 NORTH HILL DUBUQUE, tA 52001
Home Phone: (319) 556-7853
Description: 1989 Ford Probe GL
Body Style: 2D HB
ViN: 1 ZVBT20CSK5274934
Mitchell Service: 910617
Drive Train: 2.2L Inj 4 Cy~ 4A
Line Entry Labor
item Number Type Operation
t 009900 REF BLEND
2 020250 BDY REMOVE/REPLACE
3 AUTO REF REFINISH
4 AUTO REF REFINISH
5 020340 BDY REMOVE/REPLACE
6 020660 BDY REMOVE/REPLACE
7 023570 REF BLEND
8 AUTO REF ADD'L aPR
9 AUTO ADD'L COST
10 AUTO ADD'L COST
Line Item
Description
L FENDER OUTSIDE
L FRT DOOR REPAIR PANEL
L FRT DOOR OUTSIDE
L FRT ADD FOR JAMBS
L FRT DOOR ADHESIVE MOULDING
L FRT DOOR POWER MIRROR
L QUARTER PANEL OUTSIDE
CLEAR COAT
PAiNT/MATERiALS
HAZARDOUS WASTE DISPOSAL
Part Type/ DOiIaF Labor
Part Number Amount Units
C
E92Z 5t 20201 A 278.00 4.5
C 2.2
C 0.5
ORDER FROI~ DEALER 69.76 0.1
E92Z 17662 D '~49~31 0.7
C 1.0
t.6
157.50 ~
3.00 *
* - Judgement Item
C - included in Clear Coat Calc
Add'l
Labor Sublet
I, Labor Subtotals Units Rate Amount Amount Totals
Body 5.3 40.00 0.00 0.00 212,00 T
Refinish 6.3 40.00 0.00 0.00 252.00 T
Taxable Labor 464.00
Labor Tax ~ 6.000 % 27.84
Labor Summary 11.6 491.84
Il.
Part Replacement Summary
Taxable Parts
Sales Tax
To[a[ Replacement Parts Amount
6.O0O%
497.07
29.82
526.89
ESTI~ATE RECALL NUMBER: 1/15/01 12:15:57 4173
UItraMate is a Trademark of Mitchell international
Mitche!~ Data Version: JAN_01_A Copyright (C) 1994 - 2000 Mitchell Intsmatio~,al
UltraMate Version: 4.6.004 Ail Rights Reserved
I of 2
Date: 'Ut5101 !2:19 PM
Estimate ID: 4173
Estimate Version: 0
Preliminaqz
Profile ID: DUBUQUE
Ill.
Additiona/Costs Amount iV. Adjustments Amount
Non-Taxable COSTS 160,50 Customer Respons)bii)~ 0.00
Totsl Additional Costs 160,50
L Totsl Labor: 491.84
ii. Total Replacement Par'ts: 526.89
ill Total Additiona) Costs: 160.50
Gross Totai: 1,179.23
IV. Total Adjustments: 0.00
Net To~[: 1,179.23
This is a preliminary estimate.
Additional chanqes to the estimate mav be required for the actual repair,
ESTIMATE RECALL NUMBER: 1/15/01 12:15:57 4173
UltraMate is a Trademark of Mitchell international
Mitche[[ Data Version: JAN_01_A Copyright (C) 1994 - 2000 Mitchell International
UltraMate Version: 4.6.004 All Rights Reserved
Page 2 of 2
Date: 1/15/01 11:18 AM
Estimate ID: 1316
0
Preliminary
Profile ID: Mitchell
Hanley Auto Body Inc.
1030 Century Circle Dubuque, IA 52002
(319) 583-7220
Fax: (319) 583-8355
Damage Assessed By: Robert Hanley
Deductible: UNKNOWN
Owner Susan Walgamnth
Address: 320 No~th Hill
Telephone: Home Phone: (319) 555-7853
Mitchall Service: 910617
Description: 1989 Ford Probe GL
Body Style: 2D HB
Drive Train: 2.2L inj 4 Cyl 4A
Line Entry Labor
Item Number Type Operation
Line Item
Description
Part Type/
Part Number
Dollar Labor
Amount Units
009900 REF REFINISH
020180 BOY REPAIR
AUTO REF REFINISH
020660 BDY REMOVE/REPLACE
AUTO REF ADD'L OPR
AUTO ADD'L COST
AUTO ADD'L COST
L FENDER OUTSIDE
L FRT DOOR SHELL
L FRT DOOR OUTSIDE
L FRT DOOR POWER MIRROR
CLEAR COAT
PAINT/MATERIALS
HAZARDOUS WASTE DISPOSAL
Existing
E92Z 17682 D
C 2A
3.0*
C
149.31 0.7
1.3
137.50 *
$.00 *
* - Judgement Item
C - Included in Clear Coat Calc
Add'l
Labor Sublet
L Labor Subtotals Units Rate Amount Amount Totals
Bedy 3.7 40.00 0.00 0.0~ 148.00 T
Refinish 5.5 40.00 0.00 0.00 220.00 T
Taxable Labor 368.00
Labor Tax ~ 6.000 % 22.08
Labor Summary 9~. 390.08
IlL Additional Costs Amount
Non-Taxable Costs 142.50
Total AddKlonal Costs 142.50
Part Replacement Summary
Taxable Parts
Sales Tax
Total Replacement Parts Amount
IV. Adjustments
Customer Responsibility
6.000%
Amount
149.3t
8.96
t58.27'
Amount
0.00
ESTIMATE RECALL NUMBER: 1/lg01 11:15.02 1316
UitraMate is a Trademark of Mitchell International
Mitchell Data Version: JAN_OI_A Copyright (C) 1994 - 2060 Mitchell International
UltraMate Version: 4.6.004 All Rigb~s Reserved
Page I of 2
Date: 1115/01 11:18 AM
Estimate ID: t316
0
Preliminary
Profile ID: Mitchell
I. Total Labor:
II. Total Replacement Parts:
III. Total Additional Costs:
Gross Total:
390.08
158.27
t42.50
090.85
IV, Total Adjustments:
Net Total:
0.00
690.85
This is a preliminary estimate.
Additional chanqes to the estimate may be required for the actual repair.
ESTIMATE RECALL NUMBER: 1115/01 11:15:02 1316
UltraMate is a Trademark of Mitchell International
Mitchell Data Version: JAN_01_A Copyright (C) 1994 - 2000 Mitchell Ihtemational
UitraMate Version: 4.6.004 All Rights Reserved
Page 2 of 2