Claim by Walter BurkeTHE 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: January 9, 2008
RE: Claim Against the City of Dubuque by Walter Burke
Claimant Date of Claim Date of Loss Nature of Claim
Walter Burke 01/03/08 12/11/07 Vehicle Damage
This is a claim in which the claimant alleges that his vehicle mirror was torn from his
parked vehicle by a passing City of Dubuque snow plow truck.
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
Walter Burke
OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA
SUITE 330, HARBOR VIEW PLACE, 3OO MAIN STREET DUBUQUE, IA 52001-6944
TELEPHONE (563) 583-4113 / FAx (563) 583-1040 / EMAIL balesq@cityofdubuque.org
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CLAIM AGAINST THE CITY OF DUBUQUE, IOW ~•, ~ ~~`j~,
This written report constitutes your claim against the City of Dubuque, Iowa. Y u
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: ~~G. ~~ z~ /~ U~' ~c% _
2. Address: ~ ~,2 ~ L ~~ ~Il ~ d9~ ~ ~ ~~
3. Telephone Number ~Lo ~ S ~~ - O°~~ ~
4. Date of Incident: % ~, ' // ~~
5. Time of Incident: C U' y j ~-i--~ °7-y JCL--~U f~''"'
6. Location of Incident (Be specific):
7. Describe the accident or occurrence that caused injury ordamage. (Give full
details upon which you base your claim. If a City employee was involved, give
the employee's name.)
~.
t T v2 ti ~ ~~t r = r- ••
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8. What were weather conditions like?
S n~ ° w 1 N ~- ~- SL.,F~ rT I ~.•.I ~ /3-T 71-r~ 7-~ ~`,-~ ~ . %Jc ~ -~ ~ S ~ v s~ o ~.~ S~'~,« ~'
9. Give name and address of any witnesses:
10. Did police investigate? (If so, give names of officers.)
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
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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.)
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13. What other damages do you claim, if any?
IVn~~
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.)
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15. W t amount d2 you claim from the City of Dubuque?
~ S g T iy y N y~.r ~' ~~y ~, ~_'r ~
16. Why do you claim the City of Dubuque is responsible?
13~ G/1U S ~ ~ ~1~C~ / = O '~=/J OF 7'~/-=~~= 7'~° UG,~S
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IV ~2 /4 ~~ St ,> c, L, 1~/~ t'r ~ ~1',•i4 r%.l~ r P~-~. L G~5 ~i9-r/Zic~ D
C9/~! GF..rl ~!¢~l !9CrR~) ~til ~% G ~ v f F O f= T~tL ~P~,~=D v;= l2r~S ~ 1'~'dcezr( r
17. Have you made any claim against anyone else for damages as a result of
this incident? (If yes," give name and address.)
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18. If the answer to Question 17 is yes, have you received any payment from that
source, and if so, in what amount?
Dated this __ ~,__ day of ~~~/ , 20
dl ~n~ngn~
(Signature)
s~ :z~ ~a ~- gar so
f,~~-~~~~ ~v~K~
(Print Name) CJ~~\I~J c~
IJU~3UC~fil~~;r I f''. '~;2!~Ci~'
F'IIUN1~: (56~i) 582-5411 F~'AX: (.,6.5) ~~~~~-47.1
FEDERAL ID: 42-0H13`i49
CD LOG NO 3735-1 DATE 12/19/07
SHOP: RICHARDSON MOTORS INSP DATE:
ADDRESS: 1475 JOHN F. KENNEDY RD PHONE l:
CITY STATE: DUBUQUE, IA FAX:
ZIP: 52002-
OWNER: BURKE, WALTER
POINT OF IMPACT: 0
LIC#: STATE: 'VIN:
BODY COLOR: MILEAGE:
CONDITION: ACCTNG CTL#:
*=USER-ENTERED VALUE
EC=REPLACE ECONOMY
UM=REMAN/REBUILT PRT
OE=REPLACE PXN OE SRPLS
TE=PARTL REPL PRICE
I=REPAIR
TT=TWO-TONE
N=ADDITIONAL LABOR
AA=APPEAR ALLOWANCE
E=REPLACE OEM
UE=REPLACE OE SURPLUS
EU=REPLACE SALVAGE
PC=PXN RECONDITIONED
ET=PARTL REPL LABOR
L=REFINISH
CG=CHIPGUARD
RI=R&I ASSEMBLY
RP=RELATED PRIOR
12/14/07
(563)582-5411
(563)582-4129
NG=REPLACE NAGS
UC=RECONDITIONED PRT
EP=REPLACE PXN
PM=PXN REMAN/REBUILT
IT=PARTIAL REPAIR
BR=BLEND REFINISH
SB=SUBLET
P=CHECK
UP=UNRELATED PRIOR
1998 GMC S15 JIMMY SLE 4DOOR WAGON 6CYL GASOLINE 4.3 VORTEC
CODE: U8623A/D OPTNS H/24DEVGIMNOQWZ
OPTIONS:
TWO-STAGE - EXTERIOR SURFACES
ELEC REMOTE CONTRO.-i~ MIRRORS
LUGGAGE Fc~~CK
I<E:AR WIPr~R
AIR CONI?I'i'1ONINr
CRUISE CONTROL
OVERHEAF~ CnNSOI~E
,~., ~, ,I
~%.
2 ITEM`,
,. , i I
~;.,.. 'i'. ~~. ,.I-~.~.
TWO-STAGE - INTERIOR SURFACES
POWER. DOOR LOCKS
HEATED TAILGATE GLA:~~:.;
TILT STEERING WHEEL.
AtITOI4IATI'.' '1'I;ATIS
REMOTE KEYLESS EN'I'RY SYSTEA9
~_''
IZ7 IF~I'IP~ i St?
O . _`~ 4
I hC,. (:
. ! c,; <; P, C~;MC <~~ 7. ~ J 1 Ml'~!Y S 1.1? ~! 1)OOk GJA" ;(~R
- PAINT MA7'E,R1A]~ ] Fi. 0C
PAR`I':~ & MA'1'ERlAL TOTAL 182.0
I'AX ON PART S @ 7 . 0 0 0-~~ 11.6 ~
LABOR RATE REPLACE HRS REPAIR HRS
~~ 1-SHEET METAL 51.00 0.7 35.70
2-MECH/ELEC 60.00
3-FRAME 55.00
4-REFINISH 51.00 0.5 25.5C
5-PAINT MATERIAL 32.00
LABOR TOTAL 61.20
TAX ON LABOR @ 7.000% 4.28
SUBLET REPAIRS
TOWING
STORAGE
GROSS TOTAL 259.12
NET TOTAL 259.12
SHOPLINK UN189 ES CD LOG 3735-1 DATE 12/14/07 01:11:28PM R6.37 CD 11/07
PXN: Y/00/00/00/00/00 CUM 00/00/00/00/00 GEOCODE 52002
EDU: 1201 HOST LOG
(C) 1998 - 2007 AUDATEX N ORTH AMERICA, INC.
~•
Damage Assessed By: john klotz
Deductible: UNKNOWN
Insured: welter barks
Date: 12!14/2007 12.38 PM
Estimate ID: 4637
Estimate Version: 0
Preliminary
Pmfile ID: Mitchell
BIRD CHEVROLET
3255 UNIVERSITY AVE, DUBUQUE, IA 52001
(563) 583-9121
Faz: (563) 556-4482
Tae ID: 42-0400210
Mitchell Service: 912493
Description: 1998 GMC Jimmy SLE
Body Style: 4D Ut 107" WB Drive Train: 4.3L Inj 6 Cy14WD
VIN: 1GKDT13W6W2521952
Options: POWER WINDOWS, CRUISE CONTROL, AUTOMATIC TRANSMISSION
Line Entry Labor Line Item Part Type! Dollar Labor
Item Number Type Operation Description Part Number Amount Units
1 203157 BDY REMOVE/REPLACE L FRT DOOR POWER MIRROR ASSY 15151119 GM PART 166.02 0.5 #
2 AUTO REF REFR~TISH L FRT DOOR MIRROR C 0.7
3 203165 BDY REMOVE/INSTALL L FRT DOOR TRIM PANEL INC
4 AUTO REF ADD'L OPR CLEAR COAT 0.1
5 AUTO ADD'L COST PAINT/MATERIALS 24.80
6 AUTO ADD'L COST HAZARDOUS WASTE DISPOSAL 0.80 *
* -Judgment Item
# -Labor Note Applies
C -Included in Clear Coat Calc
I. Labor Subtotals
Body
Refinish
Labor Summary
Unite Rate
O.b 52.00
0.8 52.00
Taxable Labor
Labor Tae
1.3
Add'1
Labor Sublet
Amount Amount
0.00 0.00
0.00 0.00
(~ 7.000 %
Totals II. Part Replacement Summary
26.00 T Taxable Parts
41.60 T Sales Tae ® 7.000%
67.60 Total Replacement Parts Amount
4.73
72.33
III. Additional Costa Amount IV. Adjustments
Non-Taxable Costa 25.60 Customer Responsibility
Total Additional Coate 25.60
ESTIMATE RECALL NUMBER: 12/14/2007 12:38:38 4637
U1traMate is a Trademark of Mitchell International
Mitchell Data Version: NOV 07 A Copyright (C) 1994 - 2005 Mitchell International
UltrytMate Version= 6.0.028 All Rights Reserved
Amount
166.02
11.62
177.64
. ~----~
Page 1 of 2
Date: 12!14/2007 12:38 PM
Estimate ID: 4637
Estimate Version: 0
Preliminarg
Profile ID: Mitchell
I. Total Labor:
II. Total Replacement Parts:
III. Total Additional Costs:
Grose Total:
IV. Total Adjustments:
Net Total:
This is a preliminary estimate.
Additional changes to the estimate may be required for the actual repair
ESTIMATE RECALL NUMBER 12/14/2007 12:38:38 4637
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
72.33
177.64
25.60
275.57
0.00
275.57
Page 2 of 2