Claim Moore, BillCLAIM 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: Bill Moore
2. Address: 2209 Hoyt
3. Telephone Number: (319) 556 7043
4. Date of Incident: 2-7-01
5. Time of Incident: 8:15 P.M.
6. Location of Incident (Be specific): 2209 Hoyt
Parking on street 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.)
About 8:15 on 2/7/01 Paul Herman's City truck ran into the side of my Blazer. No one was in vehicle and no one was injured, just damaged car (See estimate)
8. What were weather conditions like? Very Icy
9. Give name and address of any witnesses: None
10. Did police investigate? (If so, give names of officers.)
Yes, Slight 28c
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.)
See Estimate
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 estimates
16. Why do you claim the City of Dubuque is responsible?
My car was parked legally, no one else was around and my car was hit. There was only 1 person 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 payment from that source, and if so, in what amount?
Dated at Dubuque, Iowa this 11th day of Feb. , 20 .
/s/ William A. Moore
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
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
PAID.
1. Name of Claimant: ~
2. Address: ?
3. Telephone Number: (~/ ?3 S5~ -70~'_~
4. Date of Incident: ~-.7-O/
/
Location of incident. (Be speoifio)
7. DESCRIBE ACCIDENT OR OCCURRENCE THAT CAUSED INJdKY OR DAMAGE.
(Give full details upon which you base your claim, if a City
employee was involved, give the employee's name.)
8. What were weather conditions like?
/
/
9. Give name and address of any witnesses.
w
10. Did police investigate? (If so, give names of officers.)
I
11. Was anyone injured? (If so, give name, address and extent of
injuries.)
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.
14.
What other damages do you claim, if any?
Have you been compensated for any part or all of your claim by
a~y insurance cempany? (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
17. Have you made a.ny claim against anyone el~e for damages as a
result of this zncident? /~O
If yes, give name and address: -- ---~ ~
is responsible?
18.
If the answer to Question 17 is yes, have you received
payment from that source, and if so, in what amount?
any
Dated aJ~ Dubuque,
Iowa, this i'1 day of
(Revised January, 2000)
( S i~natur e )
(Print Name;
AUTO ACCIDENT INFORMATION
{ L~-ATION
DR_I.vI~II' S
'DATE OF BIRTH
~D~SS
STATE
ZIP CODE
DRZv~'S LICENSE NUHBER
STATE
TYPE RESTRICTIONS
STATE ZIP CODE
V~I~ELIC~SE
STA~/YEAR
V~':- I'~'ZLE ~ YEAR. BODY
Y COLOR
- IB~utqANCE C~PANY
INVEST~AT~N~ Ol~F~c~t (S)
V~N NUMB~.
RAthE NO.
JOE WELBES AUTO SHOPPE
2085 Jansen Street
Dubuque, Iowa 52001
319-582-2076
REPAIR ESTIMATE
BILL TO: BILL MOORE
DUBUQUE, IOWA
PH. 556-7043
Make: CHEVROLET V~N~e.. :
ModeL- S-10 BLAZER Co~.
1989
02/10/2001
TU-TONE
PARTS AND MA TERIALS
QTY. PARTS DESCRIPTION PRICE EACF AMOUNT
NEW 1 LT H/L DOOR $13.50 $13,50
NEW 1 LT SIDE MARKER LIGHT $12.20 $12,20
NEW I LF FENDER $225.00 $225.00
NEW 1 LEFT W/O MLDG $29.00 $29.00
NEW 1 PARTIAL STRIPE KIT $40.00 $40,00
Total par~s and materials: 319.70
LABOR Ta~ rate: 6.00 % Tax: 19.18
HOURS DESCRIPTION RATE/HOUR AMOUNT
REPAIR 3.0 STRAIGHTEN HOOD $38.00 $114.00
REFINISH 2.9 REFINISH HOOD $38,00 $110.20
R&R 4.2 REMOVE & REPLACE FENDER $38.00 $159.60
REFINISH 2.6 REFINISH & EDGE FRT FENDER $38.00 $98.80
R&I 0.3 REMOVE & INSTALL FENDER MLDG $38.00 $t 1.40
R&R 0.3 REMOVE & REPLACE W/O MLDG $38.00 $11.40
R&I 0.3 REMOVE & INSTALL NAME PLATE $38.00 $11.40
REPLACE 0.5 STRIPE ~.00 $19.00
REFINISH 1.5 BLEND FOR COLOR MATCH $38.00 $57.00
REFINISH 0.8 TU-TONE $38.00 $30.40
REFINISH 2.0 CLEARCOAT $38.00 $76.00
Tot~ ~x~ 699,20
Ta~rate: 6.00 % Tax: 41.95
Sub To~: $1,080.03
PAINT
HOURS DESCRIPTION I RATE/HOUR I AMOUNT
8.3 Pa NT & MATER ALS t 23.001 190.90
HIDDEN DAMAGE LEFT OPEN Amount due: [ 1,270,93
NO GUARANTEE ON RUST REPAIR
PARTS PRICES SUBJECT TO CHANGE
WILSON BROS. DODGE
90 JFK ~
DUBUQUE, IA 52002
PHONE: (319)583-5781
CD LOG NO 970-1 DATE 02/08/01
SHOP: WILSON BROS AUTO BODY
ADDRESS: 90 JFK
' FED TAX ID 420779647
CITY STATE: DUBUQUE, IA
ZIP: 52002-
INSP DATE:
CONTACT:
PHONE 1:
PHONE 2:
FAX:
02/08/01
(319)582-6969
(319)556-6928
OWNER: MOORE, BILL
ADDRESS: 2209 HOYT
CITY STATE: DUB, IA
ZIP: 52001-
HOME PHONE:
(319) 556-7043
POINT OF IMPACT: 4
LIC%:
BODY COLOR: RED/SILVER
CONDITION: GOOD
STATE:
VIN:
MILEAGE:
ACCTNG CTL#:
1GNCT18Z6K0104063
*=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 D~/~LAGE
EC=ECONOMY PART
ET=LABOR PARTIAL REPLACE
L=REFINISH
TE=PART/PARTIAL REPLACE
UP=UNRELATED PRIOR DAMAGE
1989 CHEVROLET S10 BLAZER STD 2DR UTILITY U8402A/G OPTNS F/34IL
OPTIONS: TWO-STAGE - INTERIOR SURFACES
POWER STEERING
TWO-STAGE - EXTERIOR - OPTION 3
4-WHEEL DRIVE
OP GDE MC DESCRIPTION MFG.PART NO.
E 0039 DOOR,HEADLAMP LT 15591585 GM PART
E 0063 LAMP, SIDE MARKER LT 929917 GM PART
I 0083 PANEL,HOOD REPAIR
L 0083 09 PANEL, HOOD REFINISH
E 0103 FENDER, FRONT LT 15961503 GM PART
L 0103 FENDER, FRONT LT REFINISH
RI 0267 MLDG, FENDER LOWER L/F R&I ASSEMBLY
E 0111 MLDG,WHEEL OPENING LT 15700223 GM PART
RI 0091 01 NAMEPLATE,FENDER LT R&I ASSEMBLY
TE 0013 01 STRIPE ASSEMBLY LT PART/PARTIAL REPL
L M16 COLOR BLEND REFINISH
I M60 HAZARD. WSTE. REM. SUBLET REPAIR
L TWO TONE REFINISH
13 ITEMS
PRICE AJ% HOURS R
13.50 0.2 1
12.20 1
2.5'1
4.14
225.00 4.2 1
2.54
0.2 1
29.00 0.3 1
0.21
41.00 0.3'1
* 2.0*4*
4.00' *1'
* 0.8*4*
MC MESSAGE (S)
PAgE 1
1989 CHEy~QL~T Sl0 BLAZER STD 2DR UTILITY
OD LO~ NO 970-1
01 CALL DEALER FOR EXACT PART NUMBER / PRICE
09 INCLUDES 0.6 HOURS MAJOR PANEL TWO-STAGE ALLOWANCE
FINAL CALCUIJ~TIONS & ENTRIES
GROSS PARTS
PAINT MATERIAL
PARTS TOTAL
TAX ON PARTS @
6.000%
320.70
235.00
555.70
19.24
LABOR RATE REPLACE HRS REPAIR HRS
i-SHEET METAL 40.00 5.4 2.5 316.00
2-MECH/ELEC 48.00
3-FRAME 45.00
4-REFINISH 40.00 9.4 376.00
5-PAINT MATERIAL 25.00
LABOR TOTAL 692.00
TAX ON LABOR @ 6.000% 41.52
SUBLET REPAIRS 4.00
TAX ON SUBLET @ 6.000% 0.24
TOWING
STORAGE
GROSS TOTAL
1,312.70
NET TOTAL
1,312.70
ADP SHOPLINK UB303 ES CD LOG 970-1 DATE 02/08/01 03:56:30PM R6.1
PXN:N/00/00/00/00 CUM:/// HOST LOG
COPYRIGHT 1999, AUTOMATIC DATA PROCESSING, INC.
CD 01/01
1.6 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.
PAG~E 2