Claim by Marlene BoothTHE CITY OF
DuB E
Masterpiece on the Mississippi
BARRY LINDAHL
CITY ATTORNEY
To:
DATE:
RE:
Claimant
MEMORANDUM
~~ ~~
Mayor Roy D. Buol and
Members of the City Council
January 9, 2008
Claim Against the City of Dubuque by Marlene Booth
Date of Claim
Marlene Booth
01 /07/08
Date of Loss
08/25/07
Nature of Claim
Vehicle Damage
This is a claim in which the claimant alleges that her vehicle, which was parked near the
intersection of West 17th Street & West Locust Street, was struck by a City of Dubuque
police squad car..
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
Kim Wadding, Chief of Police
Marlene Booth
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 / EnnAIL 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 W. 13t" 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:
2. Address:
3. Telephone Number: ~/ ~ -- %~- ~l~'S~ v
4. Date of Incident: ~d~r~ ~ ~-~ :~ -~ ~yr~ ~
5. Time of Incident:
6. Location of Incident (Be specific): ~~~ ~ ~ b- ~ ~~~ O C'~~~-
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.)
8. What were weather conditions like? (~/C
9. Give name and address of any witnesses: ~C~~
10. Did police investigate? (If so, give names of officers.)
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
!y
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.)
., _.
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.)
15. What amount do you claim from the City of Dubuque?
16. WhY do you claim the City of Dubuque is respAnsible?
17. Have you made any claim against anyone else for damages as a result of this incident?
(If yes, give name and address.) , n~
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 3 day of ~ 20
~V~ ~r ~~~h'~ ~u~-~
(Rev. 1100 & 7/01)
Signature)
(Print Name)
~l 'an~ngnQ
2~T~~C? ~,~`1a~ 1'~ ~4~
9Z ~Z ~d L- Plat 80
CJ~~~i~~~~!
Date: 1/3/200811:50 AM
Estimate ID: 20374
Estimate Version: 0
Preliminary
Profile ID: Mitchell
K & H AUTO BODY, INC.
820 31st Ave. S.W., Cedar Rapids, lA 52404
(319-364-6191
Fax: (319)364-7471
Tax ID: 42-0945230
Damage Assessed By: Demry Booth
Deductible: UNKNOWN
OWNER: MARLENE BOOTH
Address: 514 NORTHVIEW DR ,CEDAR RAPIDS, IA 52214
Telephone: Work Phone: (319) 364.6191 Home Phone: (319) 43&1994
MitcheN Service: 918489
Description: 1996 Buick Regal Custom
Body Style: 4D Sed Drive Tra1n: 3.iL Inj 6 Cyl AO
VIN: 2G4W652M811436696
Line Entry Labor Line Item Dollar Labor
Item Number Type Operation Description Part Type Amourrt Units
1 600289 BDY REMOVEIREPLACE L REPLACE TAIL LAMP Qual Recycled Part 106.25 * 0.3
2 "** END OF ATG SECTION ***
3 800688 BDY REMOVEIREPLACE REAR BUMPER COVER Remanufachrred 247.00 * 2.0 9
4 AUTO REF REFINISH REAR BUMPER COVER C 2.3
5 800700 BDY REMOVEIREPLACE REAR BUMPER COVER ADHESIVE MLDG New 20.58 0.2
6 AUTO REF ADD'L OPR CLEAR COAT 0.9
7 AUTO ADD'L COST PAINTIMATERIAL3 96.00 *
8 AUTO ADD'L COST HAZARDOUS WASTE DISPOSAL 2.00 *
* -Judgment Item
# -Labor Note Applies
C -Included in Clear Coat Calc
Add'I
Labor Sublet
I. Labor Subtotals Units Rate Amount Amount Totals
Body 2.5 49.00 0.00 0.00 122.50 T
Refinish 3.2 49.00 0.00 0.00 156.80 T
Taxable Labor 279.30
Labor Tax ~ 6.000 % 16.76
Labor Summary 5.7 296.06
11. Part Replacement Summary
Taxable Parts
Sales Tax Q 6.000X
Total Replacement Parts Amount
ESTIMATE RECALL NUMBER: 01103/200811:50:31 20374
UlbaMate is a Trademark of Mitchell lr~ternational
Mitchell Data Version: DEC 07_A Copyright (C)1994 -2005 Mitchell International
UltraMate Version: 6.0.028 All Rights Reserved
Amount
373.83
22.43
398.28
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