Claim Nigg, Nona R. - Mrs. James NiggCLAIM 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: Nona R. Nigg (Mrs. James Nigg)
2. Address: 1631 Ashton Pl
3. Telephone Number: 319 588 0427
4. Date of Incident: 2/8/2001
5. Time of Incident: 5:53 a.m.
6. Location of Incident (Be specific): in front of my house at 1631 Ashton Pl.
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.)
1997 Chev Pickup salt truck operated by Kenneth G. Lang bumped and scraped against my parked car, a 1998 Ford Taurus: Plate #774 AX4-IA
8. What were weather conditions like? Icy
9. Give name and address of any witnesses:
None
10. Did police investigate? (If so, give names of officers.)
Yes, Steve Radloff, Badge #32A
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.)
Yes, dmage to rear quarter outer panel, rear quarter fuel door, rear bumper cover -
passenger 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?
Amount stated on body shop estimate enclosed
16. Why do you claim the City of Dubuque is responsible?
Kenneth G. Lang employed by City as the pickup driver, reported to the Police that he was responsible and police notified me.
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 9th day of February , 2001.
/s/ Mrs. Nona R. Nigg
(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:
4. Date of Incident:
5. Time of Incident:
6. Location of incident. (Be specific)
DESCRIBE ACCIDENT OR OCCURRENCE THAT CAUSED INJURY OR DAMAGE.
7. I {Give full details upon which you base your claim. If a City
employee was involved, give the employee's name.)
// ¢ ,, - a , / '-,'
v ' - - U ; / -' /
8. W~at were weather conditions like? t'c ~/
/
9. Give na~e and address of any witnesses.
10. Did police investigate?
11.
/
Was anyone injured?
injuries. )
(If so, give names of of~C~rs.~ _-~
(If SO, give name, address *n~__~t,~ of:
12. Was any damage done to property? (If so, describe property
and the extent of damage. Attach estLmates of damages or
describe basis for ascertaining extent of d~unage.)
£
!
'
Have you been compensated for any part or all of your claim by
any insurance company? (If so, give n~une and address of
insurance company and amount paid. )
14.
15. What amount do you claim from the City of Dubuque?
16. Why do you claim the City of Dubuque is responsible?
· U / '
U ' ! : ~ '
17. Have you made any claim against anyone else for damages as a
result of this incident? ~{2
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?
2001.
(Revised January, 2000)
/(S=gnature)
Print Name)
DRIVER EXCHANGE INFORMATION
Owner's Name - Last
NIGG
Address
1631 ASHTON PLACE
Yew Make
1998 FORD
Plate State Plate Year
IA 2001
i Driver's Name - Last
LANG
Address
' 2933 BURLINGTON STREET
Gender License
Male
Restrictions/Endorsements Complied With?
Yes
Owner's Name - Last
Address
50 WEST 13TH STREET
Yoar Make
1997 CHEV
Plate State Plate Year
IA 2001
First
KENNETH
Dubuque Police Department
(319) 589-4410
City
DUBUQUE
Class/Type
B
Unit 001
Middle
GEORGE
License State
IA
Insurance. Company
SELF INSURED (CITY DBQ)
First Middle
Model
PICKUP
Plate Number
64441
Suffix Work Phone Home Phone
(319) 589-4250 x (319) 588-0354 x
State Zip Code Date of Birth
IA 62001
Licence EndorsementsLicense Restrictions
N NONE
Insurance Policy Number
City
DUBUQUE
S e
TRUCK
VIN Number
1GBJK34F9VF008640
State
IA
Insurance Company's Phone Number
(319) 589-4100 x
Suffix Company Owner's Name
CITY OF DUBUQUE
Zip Code
62001-
Approximate Cost to Repair or Replace
Vehicle Type
Maintenance ! Construction Vehicle
Damaged Area(s) of Vehicle
Driver's Name - Last
Address
• Gender
License Number
First
Unit 002
Middle
Cily
Class/Type License Stale
Restrictions/Endorsements Complied With? Insurance Company
COTTINGHAM & BUTLER
First
NONA
Model
TAURUS
Plate Number
774AXU
Cr:ty
DUBUQUE
Middle
R
Suffix Work Phone
State Zip Code
Home Phone
(319) 588-0427 x
Date of Birth
License Endorsements License Restrictions
NONE - NONE
Insurance Policy Number Insurance Company's Phone Number
Style
4-DR
VIN Number
1FAFP52U1WG208838
Suffix Company Owners Name
State Zip Code Approximate Cost to Repair or Replace
IA 52001- 51,500.00
Vnh:cic Type
Passenger Car
Damaged Area(s) of Vehicle
03,04
' County
;Dubuque-31
Accident occurred within corporate limits of (city)
Dubuque - 2100
Literal Description
"N/A„
X Coordinate
• "NM"
Y Coordinate
"N/A"
if Accident Occurred Outside of I Direction
City Limits Show General Vacinity "N/A" � „NIA„ af
Nearest City
"N/A"
j On Road, Street or Highway
r ASHTON PLACE
Road Class
4 - City Street
At IntersectIon With
"N!A"
Distance Direction
' 75 Ft , 1-N and
Detinabie Intersection, Bridge, or Railroad Crossing
! ASHTON PLACEIDECORAH STREET
•• Road Class
"N/A"
Distance
Direction
"NIA"
Milepost Number
of "N/A"
or
Officer's Name
RADLOFF, STEVE
I, $ 2 -t
s1--r5
Badge No Case No
32A 01-04717
Date of Accident Time of Accident
02/08/2001 05:53
C5 / ' - WOO
eye,0•,ar 581-
Printed At: At: Dubuque Police Department
Page 1 Case ti: 07-c4717
Date: 2! 8/64 02:53 PM
Estimate ID: 4260
Estimate Vereion: 0
Prefiminary
Profi!e !D: DUBUQUE
MIKE FINNIN FORD, INC.
3600 DODGE STREET DUBUQUE, IA 52003
(319) 558-1910
Fax: (319) 556-5249
Tax ID: 42-1074463
Damage Assessed By: RICK STUMPF
Deductible: UNKNOWN
Insured: NONA NIGG
Address: 1631 ASHLAND DUBUQUE, IA 52001
Telephone: Home Phone: (319) 688-0247
Description: 1998 Ford Taurus SE
Body Style: 4D Sed
VIN: 1FAFP52U1WG208638
Mitchell Service: 911623
Drive Train:
3.0L Inj 6 Cyi AO
Line Entry Labor
Item · Number Type Operation
Line Item
Description
I 100907 BDY REPAIR
2 AUTO REF REFINISH
3 100911 BDY REMOVE/REPLACE
4 101288 BDY REMOVE/INSTALL
5 101294 BDY REPAIR
6 AUTO REF REFINISH
7 AUTO REF ADD'L OPR
8 AUTO ADD'L COST
9 AUTO ADD'L COST
R QUARTER OUTER PANEL
R QUARTER PANEL OUTSIDE
R QUARTER FUEL DOOR
REAR BUMPER COVER
REAR BUMPER COVER
REAR BUMPER COVER
CLEAR COAT
PAINT/MATERIALS
HAZARDOUS WASTE DISPOSAL
* - Judgement Item
# - Labor Note Applies
C - Included in Clear Coat Calc
Part Type/
Part Number
Existin§
F6DZ 54405A20 A
Existing
Dollar Labor
Amo~[ Units
2.5' #
C 3.0
25.43 0.3 #
t.0
2.0*
C 2.9
t.0
~92.50 *
3.00 *
Add'l
Labor Sublet
I. Labor Subtotals Un,ts Rate Amount Amount Totals IL
Body 5.8 40.00 0.00 0.00 232.00 T
Refinish 7.7 40.00 0.00 0.00 308.00 T
Taxable Labor 540.00
Labor Tax @ 6.000 % 32.40
Labor Summary 13.8 572.40
ESTIMATE RECALL NUMBER: 2/8/01 14:50:17 4260
UltraMate is a Trademark of Mitche~ ~nterP. atio[~[
Mitchell Data Version: FEB_01_A Copyright (C) 1994 - 2000 Mitchell internstio~e~
UltraMate Version: 4.6.004 All Rights Reserved
Pan ~eplacement Summar~
Ta×sbJe Parts
Sales Tax ~
Tote~ Replacement Parts Ameunt
0.009%
25.t~
t.5~
PAGe I of 2
IlL Additional Costa
Non-Taxable Costa
Total Additional Costa
Date: 2/810~. 02:53 PM
Estimate iD: 4250
Estimate Version: 0
Preliminary
Profile iD: DUBUQUE
Amount ~V, Adjustments
'~ 95.50 Customer Responsibiiif~y
'~95.50
Total Labor:
Tot. al Replacsmel]t p~"~:
To~al Additional Cos[s:
Total Adjustments:
Net Total:
This is a~e!imina~
Additional chanoes to the estimate may be recLuired for the actt~a repair.
26.$4
195.50
794.54
794.54
ESTIMATE RECALL NUMBER: 2/8/01 14:50:17 4260
UltraMata is a Trademark of Mitchell
Mitchell Data Version: FEB_0t_A Copyright (C) 1994 - 2000 Mitchell
UltraMate Version: 4.6.004 All Righta Reservec~
P~ge 2 of
2
Date: 2/2/01 10:13 AM
Estimate ID: 1329
Estimate Version: 0
Pralirninary
Profile ID: Mitche8
Dan Kruse Pontiac, Nissan, BMW
900 Century Drive Dubuque, IA 92002
(319) ~3-7~4~
Fax: (319) 683-7349
Damage Assessed By: Dave DeMoss
Deducible: UNKNOVCq~
Insured: NONA NIGG
Description: 1999 Ford Taurus SE
Body Style: 4D Sed
VIN: 1FAFP92U1WG208638
Mitchell Service: 911623
Drive Train:
3.0L Inj 6 Cyl AO
Line Entry Labor
Item Number Type Operation
Line Item
Description
Part Type/
Prat Number
Dollar Labor
Amount Units
I 102182 BDY REPAIR
2 AUTO REF REFINISH
3 100911 BDY REMOVE/REPLACE
4 101288 BDY REMOVE/INSTALL
$ 101294 BDY REPAIR
6 AUTO: REF REFINISH
7 AUTO REF ADD'L OPR
8 AUTO ADDI_ COST
9 AUTO ADD'L COST
R SIDE BODY PANEL ASSEMBLY
R SIDE BODY PANEL
R QUARTER FUEL DOOR
REAR BUMPER COVER
REAR BUMPER COVER
REAR BUMPER COVER
CLEAR COAT
PAINTIMATERIALS
HAZARDOUS WASTE DISPOSAL
* - Judgement Item
# - Labor Note Applies
C - Included in Clear Coat Calc
Existing
F6DZ 54400A26 A
Ex]sting
3,0*
C 6.2
25.13 0.3 #
1.0
3.0'
C 2.9
3.i*
305.00 *
3.80 *
Add'l
Labor Sublet
I. Labor Subtotals Units Rate Amount Amount Totals
Body 7.3 40.00 0.00 0.00 292.00 T
Refinish 12.2 40.00 0.00 0.00 488.00 T
Taxable Labor TS0.00
Labor Tax ~ 6.000 % 46.80
Labor Summary 19.6 826.80
IL Part Repleceraent Summary
Taxable Parts
Sales Tax ~
Total Repleceraent Parts Amount
IlL Additional Costs Amount IV. Adjustments
Non=Taxable Costs 308.50 Customer Responsibility
Total Additional Costs 308.90
ESTIMATE RECALL NUMBER: 2/8/01 10:1t:36 1329
UltraMate is a Trademark of Mitchell International
Mtichefi Data Version: FEB_01_A Copyright (C) 1994 - 2000 Mitchell bltaraational
Ul~aMate Version: 4.6.004 AIl Rights Reserved
Page I
Amount
29.13
1.51
Amount
'0.00
of 2
Date: 2/2/01 10:13 AM
Eatimate ID: 1329
Estimate Version: 0
Prsliminary
Profile ID: Mitchell
I. Total Labor:
IL Total Replacement Parts:
IlL Total Additional Costs:
Gross Total:
IV. Total Adjustments:
Nat Total:
This is a pmliminaw estimate.
Additional chanqes to the estimate may be required for the actual repair.
qAMAGEREPORT IS BASED ON OUR INSPECTION AND DOES
NOT
nooi.,.m~ P~TS O~ Za~UR W~IC~ ~Z ~E REQ~I~D ~T~a
'£~-1~ WO~ ~ ~ OPE~ ~ T~ INS,~ ~ NOTIFIED.
826.80
26.64
308.50
t,161.94;-
0.00
1,161.94
ESTIMATE RECALL NUMBER: 2/11/~1 10:11:36 1329
UltraMnte is a Trademark of Mitchell International
Mitchell Data VersiOn: FEB._01_A Oo, l~yr~ht (C) 1994 - 2000 Mitchell International
UfiraMate Version: 4.6.004 All Rights Reserved
page 2 of, 2