Claim by Misty Streif
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. 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 AUTHpRITY TO MAKE ANY REPRESENTATION TO
YOU AS TO WHETHER YOUR CLAIM WILL OR WILL NOT BE PAID.
1. Name of Claimant: Misty L. Streif
2. Address: 253 N. Monroe St. Lancaster, WI 53813
3. Telephone Number: ~ ~ g ` ~ ~3 ° ~ ~ ~~
4. Date of Incident: ~ ~- 1 D - O ~
.~
5. Time of Incident: ~~`?^„^
6. Location of Incident (Be specific): ,~ ' I V - ~~ Lam(. I/l ~'~-~l~ ~ ~~ ~~~ ~
-~
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.)
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~ ~ ~ V C'~ tit ~ ~tl~ ~F ~ c~ I~ rt-(~' (~,~ ~' a~ Vu-u ~l-e ~t.~"C Cie .
8. What were weather conditions like? (,~G~( ~titi ~wp~ Gt ~-ti.~ ~ttC !~ - ~
9. Give name and address of any witnesses: ~C-Vl~ tND~~ C I~~C~ei-~'C_v ~ ~'~-~ v-~%U ~C~~
10. Did police-investigate? (If so, give names of officers.) ~~'~ S~ ~0 ~
~n ~
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
r I ~~
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?
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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. What amount do you claim from the City of Dubuque?
~VLtfi ~ ~~1%i,~`~' V l~ c,~
16. Wh do you claim the City of Dubuque is responsible?
`f" ~~ta ~~.t CIS G) ~,i v r.f~ ,c .c ~ ~ o-F ~ C.P l~ ~t~~ ~ 1/J~-~, ~~
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 at Dubuque, Iowa this ~?7 day of ~ti ~~ ~~~ 20~.
Signature)
(Rev. 1 /00 ~ 7/01)
Name)
'dl '~~~ngc~p
6Z ~Zf bid L h N~f 8fl
C.l~~\l~~~c~
BRYHAN'S BODY & PAINT SPECIALISTS INC.
1175 US HWY 61 NORTH, PO BOX 86
LANCASTER, WI. 53813
608-723-6800 FAX: 608-723-7392
"YOU'LL LIKE OUR GUARANTEE"
CD LOG NO 7928-1 DATE 12/18/07
SHOP: BRYHAN'S BODY & PAINT SPECIA INSP DATE: 12/18/07
ADDRESS: 1175 HWY 61 N CONTACT: JIM BRYHAN
P.O. BOX 86 PHONE 1: (608)723-6800
CITY STATE: LANCASTER, WI FAX: (608)723-7392
ZIP: 53813-
OWNER: STREIF, MISTY
CITY STATE: LANCASTER, WI
ZIP: 53813
POINT OF IMPACT: 13
HOME PHONE: (608)723-2876
RENTAL ASSISTED: YES
LIC#: 717-CKS
BODY COLOR: SILVER
CONDITION:
DRIVEABLE: YES
*=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
OWNER WILL NEED RENTAL CAR.
OWNER REQUEST NEW PARTS
STATE: WI VIN: 1GKDT13S842230394
MILEAGE: 20,001
ACCTNG CTL#:
VEH. INSP#:
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
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
2004 GMC ENVOY SLE 4DOOR WAGON 6CYL GASOLINE 4.2
CODE: U7213A/C OPTNS S/24KPL
OPTIONS:
TWO-STAGE - EXTERIOR SURFACES TWO-STAGE - INTERIOR SURFACES
4-WHEEL DRIVE CRUISE CONTROL
FRAME MOUNTED TRAILER HITCH
OP GDE MC DESCRIPTION MFG.PART N0. PRICE AJ$ Bo HOURS R
-- --- -- ----------- ------------ ----- --- -- ----- -
RI 0041 HEADLAMP ASSY,HALOG LT R&I ASSEMBLY 0.6 1
RI 0042 HEADLAMP ASSY,HALOG RT R&I ASSEMBLY 0.3 1
PAGE 1
12/18/07
2004-GMC ENVOY SLE 4DOOR WAGON
CD LOG NO 7928-1
E 0083 PANEL,HOOD 12478014 GM PART 342.32 1.8 1
L 0083 13 PANEL,HOOD REFINISH 5.6 4
3.0 SURFACE
1.2 EDGE
0.6 TWO STAGE SETUP
0.8 TWO STAGE
RI 0019 MLDG,HOOD FRONT R&I ASSEMBLY INC 1
RI 0086 PAD, INSULATOR HOOD R&I ASSEMBLY 0.3 1
BR 0103 FENDER, FRONT LT BLEND REFINISH 1.2 4
0.8 BLEND
0.4 TWO STAGE
BR 0104 FENDER, FRONT RT BLEND REFINISH 1.2 4
0 . 8 BLEND
0.4 TWO STAGE
EC M14 CORROSION PROTECTION ECONOMY PART 0.3*4
SB M60 HAZARD. WSTE. REM. SUBLET REPAIR 3.00* 1
N M66 COLOR, SAND & BUFF ADDNL LABOR OPERA 0.8*1*
11 ITEMS
MC MESSAGE(S)
13 INCLUDES 0.6 HOURS FIRST PANEL TWO-STAGE ALLOWANCE
FINAL CALCULATIONS & ENTRIES
GROSS PARTS 342.32
PAINT MATERIAL 265.60
PARTS & MATERIAL TOTAL 607.92
TAX ON PARTS & MATERIAL @ 5.5000 33.44
LABOR
1-SHEET METAL
2-MECH/ELEC
3-FRAME
4-REFINISH
5-PAINT MATERIAL
LABOR TOTAL
TAX ON LABOR
SUBLET REPAIRS
TAX ON SUBLET
TOWING
STORAGE
GROSS TOTAL
NET TOTAL
1,308.34
1,308.34
SHOPLINK U8349 ES CD LOG 7928-1 DATE 12/18/07 04:30:40PM R6.37 CD 11/07
PXN: Y/00/00/00/00/00 CUM 00/00/00/00/00 GEOCODE 53813
HOST LOG
(C) 1998 - 2007 AUDATEX NORTH AMERICA, INC.
2.2 HRS WERE ADDED TO THIS EST. BASED ON AUDATEX TWO-STAGE REFINISH FORMULA.
PAGE 2
12/18/07
.2004'GMC ENVOY SLE 4DOOR WAGON
CD LAG NO 7928-1
--------------------------------------------------------------------------
THIS ESTIMATE HAS BEEN PREPARED BASED ON THE USE OF ONE OR MORE REPLACEMENT
PARTS SUPPLIED BY A SOURCE OTHER THAN THE MANUFACTURER OF YOUR MOTOR VEHICLE.
WARRANTIES APPLICABLE TO THESE REPLACEMENT PARTS ARE PROVIDED BY THE
MANUFACTURER OR DISTRIBUTOR OF THE REPLACEMENT PARTS RATHER THAN BY THE
MANUFACTURER OF YOUR MOTOR VEHICLE.
"MOTOR VEHICLE REPAIR PRACTICES ARE REGULATED BY CHAPTER ATCP 132, WIS. ADM
0. CODE, ADMINISTERED BY THE BUREAU OF CONSUMER PROTECTION, WISCONSIN DEPT. OF
AGRICULTURE, TRADE AND CONSUMER PROTECTION, P.O. BOX 8911, MADISON, WISCONSIN
53708-8911. "
PAINT & WORKMANSHIP GUARANTEED AS LONG AS YOU OWN VECHICLE
(RUST IS NOT INCLUDED)
YOU'LL LIKE ARE GUARANTEE
WHERE EXCELLENT COLLISION REPAIR IS NO ACCIDENT.
PERMISSION TO START REPAIRS: DATE:
RATE REPLACE HRS REPAIR HRS
52.00 3.0 0.8 197.60
69.00
65.00
52.00 8.3 431.60
32.00
629.20
@ 5.5000 34.61
3.00
@ 5.5000 0.17
PAGE 3
12/18/07
.200~r GMC ENVOY SLE 4DOOR WAGON
CD LAG NO 7928-1
--------------------------------------------------------------------------
THIS ESTIMATE HAS BEEN PREPARED BASED ON THE USE OF ONE OR MORE REPLACEMENT
PARTS SUPPLIED BY A SOURCE OTHER THAN THE MANUFACTURER OF YOUR MOTOR VEHICLE.
WARRANTIES APPLICABLE TO THESE REPLACEMENT PARTS ARE PROVIDED BY THE
MANUFACTURER OR DISTRIBUTOR OF THE REPLACEMENT PARTS RATHER THAN BY THE
MANUFACTURER OF YOUR MOTOR VEHICLE.
"MOTOR VEHICLE REPAIR PRACTICES ARE REGULATED BY CHAPTER ATOP 132, WIS. ADM
0. CODE, ADMINISTERED BY THE BUREAU OF CONSUMER PROTECTION, WISCONSIN DEPT. OF
AGRICULTURE, TRADE AND CONSUMER PROTECTION, P.O. BOX 8911, MADISON, WISCONSIN
53708-8911. "
PAINT & WORKMANSHIP GUARANTEED AS LONG AS YOU OWN VECHICLE
(RUST IS NOT INCLUDED)
YOU'LL LIKE ARE GUARANTEE
WHERE EXCELLENT COLLISION REPAIR IS NO ACCIDENT.
PERMISSION TO START REPAIRS: DATE:
PAGE 3
12/18/07
LANCASTER AUTO BODY, LLC.
` -" 1221-37 S. MADISON ST.
LANCASTER, WI 53813
PH: 608-723-4132 FX: 608-723-4133
FED I.D. #: 39 1977550
CD LOG NO 3330-1 DATE 12/18/07
SHOP: LANCASTF".??UTO BODY LLC INSP DATE: 12/18/07
ADDRESS: 1221-37 .' ""'H MADISON ST. CONTACT: DAVID THOLE
CITY STATE : LANCAST?:: ,, '~~I PHONE 1 : ( 608) 723-4132
ZIP: 53813- FAX: (608)723-4133
OWNER: STREIF, T"ISTY HOME PHONE: (608)723-2876
ADDRESS: 253 N. T"^":?OE ST.
CITY STATE: LANCAST" ''I
ZIP: 53813
POINT OF IMPACT: 3
LIC#: 717-CKS STATE: WI VIN: 1GKDT13S842230394
BODY COLOR: SILVEr MILEAGE:
CONDITION: GOOD ACCTNG CTL#:
DRIVEABLE: YES
PROD.DATE: 10/03
*=USER-ENTERED VAT"~
EC=REPLACE ECUNOM"
UM=REMAN/REBUILT F"
OE=REPLACE PXN OE :' " " `'
TE=PARTL REPL PRIG;
I=REPAIR
TT=TWO-TONE
N=ADDITIONAL LABO'-'
AA=APPEAR ALLOWAP?" "~
VEH. INSP#:
PAINT CODE:
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
2004 GMC ENVOY S "'~'~OR WAGON
CODE: U7213A/C 0 .~/24KPL
OPTIONS:
TWO-STAGE - EXT~
4-WHEEL DRIVE
FRAME MOUNTED T;
:'URFACES
~. ?BITCH
OP GDE MC DESCRY
E 0083 PANEL,HO
L 0083 13 PANEL,z'
6CYL GASOLINE 4.2
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
TWO-STAGE - INTERIOR SURFACES
CRUISE CONTROL
MFG.PART N0. PRICE
12478014 GM PART 342.32
REFINISH
3.0 SURFACE
1.2 EDGE
0.6 TWO STAGE SETUP
0.8 TWO STAGE
AJ% Bo HOURS R
1.8 1
5.6 4
PAGE 1
12/18/07
20.04 GMC ENVOY ~~
CD LC3G NO 3330-1
•N M17 COVER C'
SB M60 HAZARD.
4 ITEMS
M"
1 ='
FINAL CALCULATION.`'
GROSS PARTS
PAINT MATERIA?.
PARTS & MATERIAL T
TAX ON PARTS
LABOR
1-SHEET METAT
2-MECH/ELEC
3-FRAME
4-REFINISH
5-PAINT MATER
LABOR TOTAL
TAX ON LABOR
SUBLET REPAY'
TAX ON SUBLET
TOWING
STORAGE
GROSS TOTAL
NET TOTAL
SHOPLINK UG184 ES "
PXN: Y/00/00/00/00
HOST LOG
(C) 1998 - 2007 AU'
1.4 HRS WERE ADDE'~
THIS ESTIMATE IS F
OR LABOR WHICH MAY
HAS BEEN STARTED, '
INSPECTION MAY BE
CONTINGENCIES. PA F.
FOR IMMEDIATE ACC'
"~'~OR WAGON
"`~ERIOR ADDNL LABOR OPERA
',. REM. SUBLET REPAIR 3.00*
0.2*4
1
":'SAGE (S )
",U DES 0.6 HOURS FIRST PANEL TWO-STAGE ALLOW ANCE
''.'.?ES
342.32
185.60
527.92
"RIAL @ 5.500% 29.04
RATE REPLACE HRS REPAIR HRS
52.00 1.8 93.60
72.00
62.00
52.00 5.6 0.2 301.60
32.00
395.20
@ 5.5000 21.74
3.00
@ 5.500% 0.17
977.07
977.07
'''~ 3330-1 DATE 12/18/07 02:54:52PM R6.37 CD 11/07
°~ 00/00/00/00/00 GEOCODE 53813
r'ORTH AMERICA, INC.
".TS EST. BASED ON AUDATEX TWO-STAGE REFINISH FORMULA.
"' OUR INSPECTION AND DOES NOT COVER ADDITIONAL PARTS
UIRED AFTER THE WORK HAS BEEN STARTED. AFTER THE WORK
DAMAGED PARTS WHICH ARE NOT EVIDENT ON FIRST
.RED. NATURALLY, THIS ESTIMATE CANNOT COVER SUCH
ES SUBJECT TO CHANGE WITHOUT NOTICE. THIS ESTIMATE IS
PAGE 2
12/18/07