Claim by Kyle Coohey~~~,
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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 not be laid.
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1. Name of Claimant: Kyle Coohey
2. Address: 406 Clarke Dr. #1
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3. Telephone Number ~ j ~~ ~ ~ ~
4. Date of Incident: ~ ~ ~ ~ I ~ C~
5. Time of Incident: ~'~~ ~ ~~
6. Location of Incident,~Be sp~cjfic): 800 block of wilson St. between 852 and 810 Wilson
8. What were weather conditions like?
9. Give name and address of any witnesses:
10. Did police investigate? (If so, give names of officers.)
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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
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?
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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. W at amount d you claim from the City Qf Daabu~~? 7
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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,
source, and if so, in what amount?
r have you received any payment from that
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Dated this 10th day of February, 2008
(Sign ture) Kyle Coohey
(Print ame) Kyle Coohey
01/02/2008 at 12:58 PM
30799
Job Number:
BRIMEYER AUTO BODY
License #:30799 Federal ID #:921938480
10709 COLLISION DR.
DUBUQUE, IA 52001
(563)583-4456 Fax: (563)583-1838
RELATED PRIOR DAMAGE
Written By: KEVIN SMITH
Adjuster:
Insured: KYLE COOHEY
Owner: KYLE COOHEY
Address: 406 CLARK DR #1
DUBUQUE, IA 52001
Evening: (563)582-2267
Claim #
Policy #
Deductible:
Date of Loss:
' Type of Loss:
Point of Impact:
Inspect
Location:
Insurance AMERICAN FAMILY INSURANCE
Company:
Days to Repair
1997 FORD TAURUS GL 6-3.OL-FI 4D SED WHITE Int:
VIN: 1FALP52U2VG110977 Lic: 8269080 IL Prod
Air Conditioning Rear Defogger
Intermittent Wipers Tinted Glass
Console/Storage Clear Coat Paint
Power Brakes Power Windows
AM Radio FM Radio
Search/Seek Driver Air Bag
Cloth Seats Bucket Seats
Automatic Transmission Overdrive Odometer: 162671
Date:
Tilt Wheel
Dual Mirrors
Power Steering
Power Mirrors
Stereo
Passenger Air Bag
Recline/Lounge Seats
Full Wheel Covers
N0. OP.
-------- DESCRIPTION
----------------------- QTY EXT PRICE LABOR P
---- AINT
-----------------
1 FRONT
N 2* Rpr LT Door
3 Add for DOOR
shell
Clear Coat
9.0
1.6
0.7
------------------------- -------Subtotals =_> 0.00 4.0 2.5
Line 2 REFINISH FROM THE MLDG DOWN
0.00
Parts
Body Labor
4.0
hrs @ $
51.00/hr
204.00
Paint Labor 2.5 hrs @ $ 51.00/hr 127.50
Paint Supplies 2.5 hrs @ S
------- 30.00/hr
----------- 75.00
-----
------------------- ------- - $ 906.50
SUBTOTAL $ 331.50 @ 7.0000°s 23.21
Sales Tax -- ---------
------------------- ------- ------ $ 429.71
GRAND TOTAL
Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from
the Guide DE2JN96, CCC Data Date 12/01/2007, and the parts selected are OEM-parts manufactured by
the vehicles Original Equipment Manufacturer. OEM parts are available at OE/Vehicle dealerships.
OPT OEM (Optional OEM) or ALT OEM (Alternative OEM) parts are OEM parts that may be provided by or
through alternate sources other than the OEM vehicle dealerships. OPT OEM or ALT OEM parts may
reflect some specific, special, or unique pricing or discount. OPT OEM or ALT OEM parts may
include "Blemished" parts provided by OEM's through OEM vehicle dealerships. Asterisk (*) or
Double Asterisk (**) indicates that the parts and/or labor information provided by MOTOR may have
been modified or may have come from an alternate data source. Tilde sign (-) items indicate MOTOR
Not-Included Labor operations. Non-Original Equipment Manufacturer aftermarket parts are described
as AM, Qual Repl Parts or Comp Repl Parts which stands for Competitive Replacement Parts. Used
parts are described as LKQ, Qual Recy Parts, RCY, or USED. Reconditioned parts are described as
Recond. Recored parts are described as Recore. NAGS Part Numbers and Benchmark Prices are
provided by National Auto Glass Specifications. Labor operation times listed on the line with the
NAGS information are MOTOR suggested labor operation times. NAGS labor operation times are not
included. Pound sign (#) items indicate manual entries. Some 2006 vehicles contain minor changes
from the previous year. For those vehicles, prior to receiving updated data from the vehicle
manufacturer, labor and parts data from the previous year may be used. The Pathways estimator has
a complete list of applicable vehicles. Parts numbers and prices should be confirmed with the
local dealership.
CCC Pathways - A product of CCC Information Services Inc.
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