Claim by Heather PriceTHE CITY OF
DUB E MEMORANDUM
Masterpiece on the Mississippi
BARRY LINDAHL ~~
CITY ATTORNEY
To: Mayor Roy D. Buol and
Members of the City Council
DATE: December 21, 2007
RE: Claim Against the City of Dubuque by Heather Price
Claimant Date of Claim Date of Loss Nature of Claim
Heather Price 12/13/07 12/12/07 Vehicle Damage
This is a claim in which the claimant alleges that the rim and tire on her vehicle were
damaged after she drove over a pothole at the intersection of Loras Boulevard and
North Grandview Avenue.
This claim has been referred to Public Entity Risk Services of Iowa, the agent for the Iowa
Communities Assurance Pool.
BAL:tIs
cc: Michael C. Van Milligen, City Manager
Jeanne Schneider, City Clerk
John Klostermann, Street & Sewer Maintenance Supervisor
Heather Price
OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA
SUITE 330, HARBOR VIEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001-6944
TELEPHONE (563) 583-4113 / FAx (563) 583-1040 / EMAIL balesq@cityofdubuque.org
CLAIM 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 West 13th St.,
Dubuque, IA 52001. It will then be referred to the appropriate department for
investigation and to the City Attorney's Office. 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:
%10'1
2. Address: ~ ~~t--~ ~ ~'.1~ ,~~~~ n
3. Telephone Number ~~~~ ` ~~ ~ ~' ~
4. Date of Incident: ~ ~ ~ ~ `( ~~
5. Time of Incident: ~ ~~' ~;~~~ll-'1
6. Location of Incident (Be specific):
1 ~ ~~~ n.~~C _ ICJ C~ c~ ~C ~~ ~ ~ ~ ~ ~ n ~ ~ ~~ ~~~~
7. Describe the accident or occurrence that caused injury or damage. (Give full
details upon which you base your claim. If a City employee was involved, give
9. Give name and address of ttany w-tn [sses:
10. Did police investigate? (If so, give names of officers.)
8. What were weather conditions like?
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
0
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.
~ 1 ~- `~ ~
~ 1
13. What other damages do you claim, if any?
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.) ~ ¢T
15. What amount do you claim rom the City of Dubuque?
16. V~/hv do you claim the City of Dubugpe is responsible?
17. Have you made any claim against anyone else for damages as a result of
this incident? (If yes,' give nar~e~a~i address.)
18. If the answer to Question 17 is yes, have you received any payment from that
source, and if so, in what am ~ n~
Dated this'~~ ~ day of ~ ~~`~ , 20 (1 { .
J ~'! '~n~rgr~Q
(Signature) 9 ~ :+~ Idd £ 1030 LO
~C`.~~~~~~f,~C~
(Pri to Name) C1~I~~I=~J~L~
\~C~~, ~~C~ ~~~ C~~~~~~1
Date: 12113/2007 02:52 PM
Estimate ID: E7919
Estimate Version: 0
Preliminary
Profile ID: Mitchell
KRUSE-WARTHAN Pontiac, Nissan, BMW
600 Century Drive, Dubuque, IA 52002
(563)583-7345
Fax: (563)588-3874
Tax ID: 420655341
Damage Assessed By: GAYLE PURMAN
Deductible: 0.00
Claim Number: DRIVE UP
Insured: HEATHER PRICE
Mitchell Service: 911495
Description: 2003 Oldsmobile Alero GLS
Body Style: 4D Sed Drive Train: 3.4L Inj 6 Cyl 4A FWD
VIN: 1G3NF52E73C127907
Options: ALUMIALLOY WHEELS, AUTOMATIC TRANSMISSION, POWER DRIVER SEAT
Line Entry Labor Line Item Part Type/ Dollar Labor
Item Number Type Operation Description Part Number Amount Units
1 102357 BDY REMOVEIREPLACE WHEEL 88955428 GM PART 639.25 0.3
2 900500 MCH* REMOVEIREPLACE TIRE ** QUAL REPL PART 148.50 * 0.0*
3 900500 MCH * ADD'L LABOR OP MNT AND BALANCE Sublet 30.00 * 0.0*
4 900500 MCH* ADD'L LABOR OP WHEEL ALIGNMENT Sublet 69.95 * 0.0*
* -Judgment Item
1. Labor Subtotals Units Rate
Body 0.3 51.00
Mechanical 0.0 65.00
Taxable Labor
Labor Tax
Labor Summary 0.3
Add'I
Labor
Amount
0.00
0.00
Sublet
Amount
0.00
99.95
~ 7.000
Totals
15.30 T
99.95 T
115.25
8.07
123.32
II. Part Replacement Summary
Taxable Parts
Sales Tax
Total Replacement Parts Amount
III. Additional Costs Amount IV. Adjustments
Total Additional Costs 0.00 Insurance Deductible
Customer Responsibility
ESTIMATE RECALL NUMBER: 1211312007 14:52:30 E7919
UltraMate is a Trademark of Mitchell International
Mitchell Data Version: NOV_07_A Copyright (C) 1994 - 2005 Mitchell International
UltraMate Version: 6.0.028 All Rights Reserved
7.000%
Amount
787.75
55.14
842.89
Amount
0.00
0.00
Page 1 of 2
Date: 12N 312007 02:52 PM
_ Estimate ID: E7919
Estimate Version: 0
Preliminary
Profile ID: Mitchell
I. Total Labor: 123.32
II. Total Replacement Parts: 842.89
III. Total Additional Costs: 0.00
Gross Total: 966.21
IV. Total Adjustments: 0.00
Net Total: 966.21
This is a preliminary estimate.
Additional changes to the estimate may be required for the actual repair.
THIS DAMAGE REPORT IS BASED ON OUR INSPECTION AND DOES NOT
COVER ANY ADDIONAL PARTS OR LABOR WHICH MAY BE REQUIRED AFTER
THE WORK HAS BEEN OPENED UP THE INS,WILL BE NOTIFIED.
WE FEATURE A THREE YEAR WORKMANSHIP LIMITED WARRANTY- SEE OUR WRITTEN
WARRANTY FOR COMPLETE DETAILS.(EFECTIVE 10-01-01)
ESTIMATE RECALL NUMBER: 12/13/2007 14:52:30 E7919
UltraMate is a Trademark of Mitchell International
Mitchell Data Version: NOV_07_A Copyright (C) 1994 - 2005 Mitchell International Page 2 of 2
UltraMate Version: 6.0.028 All Rights Reserved