Claim McMullen, KathleenCLAIM 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: Kathleen McMullen
2. Address: 1308 Curtis St.
3. Telephone Number: 319 588 2316
4. Date of Incident: 2 09 01
5. Time of Incident: 9:22 a.m.
6. Location of Incident (Be specific): 1308 Curtis St., Dubuque IA 52003
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.)
Snowplow ripped mirror off of 98 Toyota as it was parked in front of my house. Snowplow was clearing street.
8. What were weather conditions like? Snowing and snow on ground.
9. Give name and address of any witnesses:
None
10. Did police investigate? (If so, give names of officers.)
Yes - Riley Fairchild
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, Mirror on 97 Toyota Estimate for repair $193.88
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?
$193.88
16. Why do you claim the City of Dubuque is responsible?
Tore mirror off of my car with snowplow.
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 28th day of February, 2001. , 20 .
/s/ Kathleen McMullen
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
CLAIM AGAINST THE
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.
2. Address:
3. Telephone
4. Date of Incident:
5. Time of Incident:
%.-
6. Location of incident. (Be specific)
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.)
What were weather conditions like? ~N~0~%Vl.%
Give name and address of any witnesses. ~ ~)~o_~
o%% o%
10. Did police investigate? (If so,
11. Was anyone injured? (If so, give name,
injuries. )
give names of officers.)
address and extent of
Was any d~mage 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 damage6 do you claim, if any?
Have you been compensated for any part or all of your claim by
any insurance company? (If so, give na~e and address of
insurance company and a~ount paid.)
15.
16.
Whet amount do you claim from the City of Dubuque?
\c%,%%
Why do you claim the City of Dubuque is responsible?
17.
resultHave you madeof thisanYincident?claim agains~ ~nyone else for damages as a
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
(Revised January, 2000)
day
DRIVER EXCHANGE iNFORMATION
Dubuque Police Department
(319) 589-4410
Jnit 001
Middle
LOUIS
Driver's Name - Last Fffst
I DRISCOLL ROGER
I Address City
I 5062 SARATOGA RD DUBUQUE
i Gender License Number Class/Type
Male 479452975 A
i Restrictions[Endorsements Complied With? ~nsurance Company Yes
I Owner's Name - Last First
Middle
! CITY OF DUBUQUE
Address
925 KERPER BLVD
DUBUQUE
I Year Make Model Style
1999 INTL TK
Plate State Plate Year Plate Number VIN Number
IA 2020 83;'95 1HTSCAANTXH611813
Suffix Work Phone Nome Phone
· (319) 588-2751 x
State Zip Code Date of Bgth
IA 52002 0000 10/02/1939
License State License Endorsements License Reslrictiens
IA N NONE
Insurance Policy Number I~surance Company's Phone Number
Suffix
State
IA
Company Owner's Name
Zip Code Approximate Cost to Repair er Replace
52001-
Vehicle Type
Maintenance / Construction Vehicle
Damaged Area(s) of Vehicle
I CourtLy Accident occurred within corporate limits of (city)
I Dubuque - $1 Dubuque - 2100
Literal Description
! "N/A"
X Coordinate Y Coordinate
"N/A .... N/A"
ff Accident Occurred Outside of ! Direction Nearest City
i City Limits Show General Vacinity "N/A" I "N/A" of N/A
~ On Road, Street or Highway i Road Class
! CURTIS STR'EET 4 ~ City Street
At I~tersectien With Road Class
"N/A" "N/A"
;Distance i Direction IDistance l Direction , Milepost Number
; "N/A" "N/A" and "N/A .... N/A" of "N/A" or
I?efinable Intersection, Bridge, or Railroad Crossing
! "N/A"
i Officer's Hame I Badge No Case No Date of Accident Time of Accident
FAIRCHILD, RILEY 12A i 01-04833 02/09/2001 09:22
Printed At: Dubuque Police Department Page t Case #: 01-04833
BUTCH VALENTINE
ESTIMATE
Valentine Bros. Body Shop
1250 WASHINGTON ST. · DIAL (319) 556-3484
DUBUQUE, IOWA 52001
TERRY VALENTINE
Name '/~"~! //1//4; ~/[.~,~ ,/...~""/~/' Date ~'~ -- /~ ~/
Address /Z~ ~15 ~, Phone ~¢~
Model ~ ~¢~ ~J License No.
Estimate of Material and Labor Required Material Labor
~TI~Tt SHt~ ~D ~P~IR ~Dtt
This estimate is bas~ on our insp~ion and does not ~ver additional material or
labor which may be r~ulmd after the work has been started. A~r the work has
startS, damag~ material which was not evidentsuchOn first inspedionThismay be dis-
covered. Naturally this ~timate cannot cover contingencies, estimate is/ ~
for immediate a~pta~.
Grand T~,]
This Work Authorized by
Date: 021t310t 02:43 PM
Estimate ID: 294t
Estimate Version: 0
Preliminary
Profile ID: Mitchell
I. Labor Subtotals Units
Body 0.6 40.00
Refinish 0.8 40.00
Add'l
Labor Sublet
Rate Amount Amount
Totals
0.00 0.00 24.00 T
0.00 0.00 32.00 T
Taxable Labor
Labor Tax ~ 6.000 %
Labor Summary t .4
56.00
3.36
59.36
Il.
Part Replacement Summary
Taxable Parts
Sales Tax ~
Total Replacement Parts Amount
6.000%
III. Additional Costs
Taxable Costs
Bales Tax
Non-Taxable Costs
Total Additional Costs
6.000%
Amount
0.60
0.~4
20.80
21.44
IV. Adjustments
Custemer ResponsibllK7
I. Total Labor:
g. Total Replacement Parts:
III. Total Additional Costs:
Gross Total:
IV. Total Adjustments:
Net Total:
This is a preliminary estimate.
Additional chan.qes to the estimate may be required for the actual repair.
Amount
138.54
8.31
t46.85
Amount
0.00
59.36
t46.85
21.44
227.65
0.00
227.65
ESTIMATE RECALL NUMBER: 02/t3/0t t4:t5:43 2944
UltraMate is a Trademark of Mitchell International
Mitche6 Data Version: FEB_01_A Copyright (C) 1994 - 2000 Mitchell International
Ula'aMate Version: 4.6.004 All Rights Reserved
Page 2
of 2
Date: 02/13/01 02:43 PM
Estimate ID: 294t
Estimate Version: 0
Preliminary
Profile ID: Mitchell
LENNY VALENTINE & SONS, INC.
923 PERU RD DUBUQUE, IA 5200t-8604
(319) 688-4659
Fax: (3t9) 588-4650
TWO CONTINENTAL FRAME M~CHINES
GENESIS II COMPUTERISED MEASURING S]~STEM
PRICE IS EASY TO BEAT/QUALIT~ IS NOT
~IBOD]~ SPECIALISTS
Damage Assessed By: DICK VALENTINE
Deductible: UNKNOWN
Owner KATHY MC MULLEN
Address: 1308 CURTIS DUBUQUE, IA 52003
Telephone: Home Phone: (319) 588-23t6
Description: t998 Toyota Camry LE
Body Style: 4D Sed
VIN: 4Tt BG22KtWU323890
Mitchell Service: 9'1475t
Drive Train: 2.2L Inj 4 Cyi 4A
Line Entry Labor
item Number Type Operation
I 401620 BDY REMOVE/REPLACE
2 REF REFINISH/REPAIR
3 401660 BDY REMOVE/INSTAI~L
4 933002 REF ADD'L OPR
5 AUTO ADD'L COST
6 AUTO ADD'L COST
Line Item
Description
L FRT DOOR POWER MIRROR ASSY
L FRT DOOR POWER MIRROR ASSY
L FRT DOOR TRIM PANEL
CLEAR COAT
PAINT/MATERIALS
HAZARDOUS WASTE DISPOSAL
Part Type/ Dollar Labor
Part Number Amount Units
87940-AA020-G0 138.54
20.80 *
0.6~ *
0.2 #
0.5*
0.4
0.3*
* - Judgement Item
# - Labor Note Applies
ESTIMATE RECALL NUMBER: 02/13/0t 14:15:43 2941
UltraMate is a Trademark of Mitchell International
Mitchell Data Version: FEB_01_A Copyright (C) 1994 - 2000 Mitchell International
Ui~'aMate Version: 4.6.004 All Rights Reserved
Page t of 2