Claim by Rosemarie OrbellTHE 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:
RE:
Claimant
February 8, 2008
Claim Against the City of Dubuque by Rosemarie Orbell
Date of Claim
Rosemarie Orbell
02/06/08
Date of Loss
Nature of Claim
12/29/07 Personallnjury
This is a claim in which the claimant alleges that a snow plow struck her vehicle while it
was parked at the Dubuque Regional Airport long-term parking lot.
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
Bob Grierson, Airport Manager
Rosemarie Orbell
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
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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 of be paid.
1. Name of Claimant: -~`~ ~
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2. Address:
3. Telephone Number ~ ~~-`'' ~ ~~ ~ 7 - y` ~ 3 ~
4. Date of Incident: ,~`LX" ~ ~ ~ y~. ~ ~ ~ ~
5. Time of Incident: ~-~G~ ~ -5~~~~J ~~ ~ ~'~`~~T-~"~~J~~
6. Location of Incident (Be specific):
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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
the employee's name.) r
JD-~ ~~ ~-9 /~ 111_ ~ /~-~'~~ ~-- "~ wo ~ ~~ ~
8. What were weather conditions like? ,. , =-
9. Give name and address of any witnesses: ~ ~ ~~ ~. C~~ q
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~/ v !1 ~ ~ E~_-2~'~ /~ a Cn O~ ~r
10. Did police investigate? (If so, give names of officers.) `~
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
12. Was any damage done to property? (If so, describe property and the extent
of damages. Attach a timates 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 ,mount do you claim from the City of Dubuque?
16. Why do you claim the City of Dubuque is res onsible?~
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 this day of , 201 ,2~~~rlc~tl(~
(Signature) 9+~ :~~ ~b g_ 8380
(Print Name)
Feb 07 08 11:47a Orbell 815 777 9832 p.l
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11. w~anyone injured? (If so, give names, addresses, and extent of injuries).
12. Was any damage done #o property? (If so, describe property and the extent
of damages. Attache 'mates of damages or describe basis for aseertaini/ng~
extent of damage.) /~ / ~ ~ . //~~.:~_ 7
13. What other damages do you claim, if any? ~
14. Have you~been compensated for any part or all of your Gaim by any
Insurance company? (If so, give name and address of insurance company and
amount paid.) ~~
_._.-~
15. What mount do you claim from the City of Dubuque?
16. Why d you claim the Ci of Dubuque is res onsible? i
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 t4 Question 17 is yes, have you received any payment from that
source, and if so, in what amount?
Dsted thi ADD ~ day of ~r D~[..~'~ % , 2o~n~ngnp .
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(Signature) 9h =I1 Wb 9- 83~ 80
(Print Name) Q~/~~~~~
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RICHARDSON MOTORS
• ~ ~ 1475 J.F.K. ROAD
DUBUQUE, IA 52002
PHONE: (563) 582-5411 FAX: (563) 582-4129
FEDERAL ID: 42-0813744
CD LOG NO 4013-1 DATE 02/04/08
SHOP: RICHARDSON MOTORS INSP DATE: 02/04/08
ADDRESS: 1475 JOHN F. KENNEDY RD CONTACT: JASON CHARLEY
CITY STATE: DUBUQUE, IA PHONE l: (563)582-5411
ZIP: 52002- FAX: (563)582-4129
OWNER: ORBELL, ROSEMARIE HOME PHONE: (815)777-9832
ADDRESS: 203 BLACKHAWK TRACE
CITY STATE: GALENA, IL
ZIP: 61036
POINT OF IMPACT: 10
LIC#: STATE: VIN: 2G4WD532X51279702
BODY COLOR: SILVER 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
2005 BUICK LACROSSE CXL 4DOOR SEDAN
CODE: 53403B/A OPTNS K/24
OPTIONS:
TWO-STAGE - EXTERIOR SURFACES
OP GDE MC DESCRIPTION
-- --- -- -----------
E 0517 COVER, REAR BUMPER
L 0517 13 COVER, REAR BUMPER
E 0567 ABS,REAR ENERGY
SB M60 HAZARD. WSTE. REM.
4 ITEMS
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
6CYL GASOLINE 3.8
TWO-STAGE - INTERIOR SURFACES
MFG.PART NO.
12336061 GM PART
REFINISH
10333248 GM PART
SUBLET REPAIR
PRICE AJ% B°s HOURS R
----- --- -- ----- -
517.39 1.6 1
3.7 4
91.69 INC 1
3.00* 1*
MC MESSAGE(S)
13 INCLUDES 0.6 HOURS FIRST PANEL TWO-STAGE ALLOWANCE
FINAL CALCULATIONS & ENTRIES
2005 BUICK LACROSSE CXL 4DOOR SEDAN
CD LOG NO 4'0'13=1
GROSS PARTS 609.08
PAINT MATERIAL 118.40
PARTS & MATERIAL TOTAL 727.48
TAX ON PARTS @ 7.000% 42.64
LABOR RATE REPLACE HRS REPAIR HRS
1-SHEET METAL 51.00 1.6 81.60
2-MECH/ELEC 60.00
3-FRAME 55.00
4-REFINISH 51.00 3.7 188.70
5-PAINT MATERIAL 32.00
LABOR TOTAL 270.30
TAX ON LABOR @ 7.000°s 18.92
SUBLET REPAIRS 3.00
TAX ON SUBLET @ 7.000% 0.21
TOWING
STORAGE
GROSS TOTAL 1,062.55
NET TOTAL 1,062.55
SHOPLINK UN189 ES CD LOG 4 013-1 DATE 02/04/08 02:11:45PM R6.37 CD 01/08
PXN: Y/00/00/00/00/00 CUM 00/00/00/00/00 GEOCODE 52002
EDU: 0201 HOST LOG
(C) 1998 - 2007 AUDATEX NO RTH AMERICA, INC.
1.1 HRS WERE ADDED TO THIS EST. BASED ON AUDATEX TWO-STAGE REFINIS H FORMULA.