Claim by Clayton WeeseTHE CITY OF
DuB E
Masterpiece on th Mississippi
L
BARRY LIN A
CITY ATTOR EY
MEMORANDUM
To: Mayor Roy D. Buol and
Members of the City Council
DATE: February 19, 2008
RE: Claim Against the City of Dubuque by Clayton Weese
Claimant Date of Claim Date of Loss Nature of Claim
Clayton Weese 02/18/08 02/17/08 Vehicle Damage
This is a claim in which the claimant alleges that a City of Dubuque snow plow truck
struck his vehicle which was parked in front of 611 West 17th Street.
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
Clayton Weese
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 / EnnAIL balesq@cityofdubuque.org
C ' ~ ~ ^~.
~" /
~,;,~ ~ ~,
/~; ~„~
CLAIM AGAINST THE CITY OF DUBUQUE, IOWA ~r~'~:
~~~
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 AUTHORITY TO MAKE ANY REPRESENTATION TO YOU
AS TO WHETHER YOUR CLAIM WILL OR WILL NOT BE PAID.
Name of Claimant:
2. Address: h ~ ~ ~/ ) ~ ~~'
3. Telephone Number: ~(~ ~ ~(.; - ~ ~ 19 r'~ r _5 (e ~ S ~~ - ~' a ~(
4. Date of Incident: ~e , h 1 7 ~
e
5. Time of Incident: ~ ~ ~
6. Location of Incident (Be specific): ~ ~j ~ rn (l ~ ~ ~ ~ ~ e,
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.)
`~ r ~~
~P _j'?:~a ,~
----r
8. What were weather conditions like? ~ n ~ ~) ~1 ~ -~. ~ U ~ -~ ~. 1 c~ ~ S r~ ~, ,.: ,` nr
9. Give name and address of any witnesses: ~~~ l~n ~,.'~ ~ n ,. ~ti~ t .~J~..~;~ r„ ~~r~ t c 55 ,~ ~ ~~ I ~ w' ~ ~~
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 estimates of damages or describe basis for ascertaining extent of damage.)
J t a, ~ ~- '' GtiT~li ( e~ h ~ C.' ~~
13. What other damages do you claim, if any? l A , ~ ~ c 1 ~ h. ~ ~~ ~ ~ i'Ylc~,~ F
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.)
What amount do you claim from the City of Dubuque?
16^ Why do you claim the City of Dubuque is responsible?
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 at Dubuque, Iowa this ~~ day of I-" ~-'- ~. 20~'cSf.
gnature)
(Rev. 1 /00 ~ 7/01)
~ ~~~
nt Name)
n ~°
~'~
~ ~- ~ i
A .
f
-~i~ ~ 1~
~
(
Driver Information Exchange Report
Dubuque Police Department
563-589-4410
U
Drivers Name - Last
SHAFFER
Fars;
TERRANCE
Middle
LEE
Suffix
N
l
Address
925 KERPER BLVD
' City
I DUBUQUE
State
IA
Z p
52001
Phone
, (563) 589-4250 x
T
Gender
Male
Driver's License Number
Class
A,M
State
IA
Endorsements' Restrictions
NONE I NONE
Insurance Co.
IOWA COMMUNITIES
Name
Insurance Co. Phone #
ASSURA (663) 589-4260 x
001
Owner C,:rnpany Name
CITY OF DUBUQUE
Insurance Policy
#
Owner's Name - Last
First
Middle
Suffix
Address
925 KERPER BLVD
City
DUBUQUE
Stale
IA
Zip
52001-
VIN No
1FVABTDC95DU79558
Year
2005
Make
i FRGT
I Model
I
Style Vehicle Configurations
TK f 12
License Plate #
88721
State
IA
Year
2020
Most Damaged
01 - Front
Area
Approximate Cost to Repair or Replace
. $O,Or
U
Driver's Name - Last
WEESE
First
CLAYTON
Middle
EARNEST
I Suffix
1
Date of Birth
N
l
Address
611 W 17TH ST
City
DUBUQUE
State
IA
Zip
62001-0000
Phone
(663) 495-5919 x
T
r002
Gender
Male
Driver's License Number
Class
C
I Slate
1 IA
Endorsements
NONE
Restrictions
NONE
Insurance Co. Name Insurance Co. Phone #
PROGRESSIVE CASUALTY (800) 925-2886 x
Owner Company Name
Insurance Policy #
109914290
Owner's Name - Last
WEESE
First
CLAYTON
Middle
EARNEST
Suffix
Address
611 W 17TH ST
City
DUBUQUE
State
IA
Zip
`52001-0000
VIN No.
1B7HE16X9P5177823
Year
. 1993
Make
DODG
Model
XXX
Style
PK
Vehicle Configuration
02
License Plate #
098SXX
State
IA
Year
2008
Most Damaged Area
04 - Right Rear
Approximate Cost to Repair or Replace
6700.00
County
Dubuque-31
I Accident occurred
Dubuque
Within corporate limits of (city)
-2100
Literal Description
W 17TH ST
X-Coordinate
00690836
Y-Coord inate
04708618
' If accident occurred outside of city
limits show general vacinity: "NIA"
Direction
"NIA" of
Nearest City
"NIA"
I Route (Cardinal)
Travel Direction "N/A"
On Road, Street, or Highway:
W 17TH ST.
Af Intersection with:
"NIA"
Distance
30 Ft
Direction
17-W and
Distance
"Ni/A"
Direct -on
"N/A" al
Milepost Number
"NIA" Or
Definable intersection, bridge, or railroad crossing
CATHERINE ST
Officer
HUBERTY, BROOKE
Badge No
36
Law Enforcement Case Number
01-08-7417
Date of Accident
02/17/2008
Time of Accident
14:18 Hrs.
Printed At: Dubuque Police Department 02/1712008 02:42 PNl Page 1
Form #:01.08-7417
MAK YEAR MO L ^ / [y~ CO R IDENTIFICATION NO. MILEAGE LICENSE NO
• ~ HABERKORN AUTO CENTER ~9'S~r9-i~4 2 0 q
602 PERU ROAD DUBUQUE, IOWA 52001 PHONE (319) 556-8872 `fit
OW ADDRESS DATE /~,! ~/ '19
FRONT OF C
KEV
HRS. SUBLET 8
MATERIAL
PARTS
LEFT SIDE
Kev
HRS. SUBLET &
MATERIAL
PARTS
RIGHT SIDE
KEV
HRS. SUBLET 8
MATERIAL
PARTS
BUMPER HEADLIGHT HEADLIGHT
BUMPER BRKT. COMPOSITE COMPOSITE
BUMPER GUARD
GRILL PARKING, LIGHT PARKING, LIGHT
GRILL FENDER, FRONT FENDER, FRONT
GRILL MLDG. FENDER, APRON FENDER, APRON
FENDER MLDG. FENDER MLDG.
GRAVEL SHIELD FENDER MLDG. FENDER MLDG.
WINDSHIELD FENDER MLDG. FENDER MLDG.
HEADER PANEL FENDER MLDG. FENDER MLDG.
DOOR, FRONT DOOR, FRONT
COWL DOOR, MLDG. DOOR, MLDG.
RAD. SUPPORT DOOR GLASS DOOR GLASS
RAD. CORE VENT GLASS VENT GLASS
ANTIFREEZE CENTER POST CENTER POST
FAN BLADE
FAN SHROUD DOOR, REAR DOOR, REAR
DOOR, MLDG. DOOR, MLDG.
DOOR GLASS DOOR GLASS
HOOD
HOOD HINGES
HOOD MLDG. ROCKER PANEL ROCKER PANEL
ROCKER MLDG. ROCKER MLDG.
FLOOR FLOOR
ORNAMENT 1/4 PANEL 1/4 PANEL ~, j) ~~,
NAME PLATE 1/4 PANEL 1/4 PANEL
LOCK PLATE, LR. 1/4 PANEL 1/4 PANEL
LOCK SUPT. WHEEL HOUSE WHEEL HOUSE
1/4 MLDG. 1/4 MLDG.
REAR OF CAR ,,
BUMPER ~
BUMPER BRKT. ~"GGG~t' ~, ~ '' ~ r 1
BUMPER GUARD TAILLIGHT TAILLIGHT ~ '7 ~ C~
TAILLIGHT TAILLIGHT
TAILLIGHT TAILLIGHT
GRAVEL SHIELD TAILLIGHT TAILLIGHT
LOWER PANEL BACK-UP LIGHT BACK-UP LIGHT
FLOOR BACK-UP LIGHT BACK-UP LIGHT
TRUNK LID CLEAR COAT , S
TRUNK HINGE CLEAN-UP
TRUNK MLDG. LABOR HRS.
MISC. ITEMS PARTS ~+! Q 1J
TOP IDENTIFICATION PAINTING
LICENSE LIGHT FRAME KEY TOWING
TIRES MATERIAL ~ Q ~D
HUBS CAPS N NEW HAZARDOUS ,( O1Y
R REPAIR wnsrE .l ((//
WHEEL DISC. OH OVERHAUL
A ALIGN
P PAINT TAX
S SUBLET
TOTAL 3 ~~ 3
The above is an estimate based on our inspection and does not cover additional parts or labor which may be required after work has begun. Occasionally, when work Is
opened up, we discover worn, broken or damagetl parts not evident in the first inspection. Quotations on pans antl labor are current antl subject to change.
ESTIMATED BV WORK AUTHORIZED BY
ESTIMATE
02/18/2008 at 09:50 AM
30799
BRIMEYER AUTO BODY
License #:30799 Federal ID #:421438480
10709 COLLISION DR.
DUBUQUE, IA 52001
(563)583-4456 Fax: (563)583-1638
PRELIMINARY ESTIMATE
Written By: BOB COOK
Adjuster:
Job Number:
Insured: CLAYTON WEESE Claim #
Owner: CLAYTON WEESE Policy #
Address: 611 W 17 TH ST Deductible:
DUBUQUE, IA 52001 Date of Loss:
Day: Type of Loas:
Evening: Point of Impact:
Inspect
Location:
Insurance
Company: Days to Repair
1993 DODG W150 4X4 6-3.9L-FI 2D LONG Int:
VIN: Lic: Prod Date: Odomete r:
Tinted Gla ss Dual Mirrors Clear Coa t Paint
Power Stee ring Power Brakes AM Radio
FM Radio Stereo Anti-Lock Brakes (2)
5 Speed Tr ansmission 4 Wheel Drive Overdrive
N0. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT
1 REAR BUMPER
2 Repl Bumper standard chrome 1 205.00 0.5
3 REAR LAMPS
4 Repl RT Tail lamp assy all 1 84.35 0.5
5 PICK UP BOX
6* Rpr RT Outer panel 3.5 3.6
7 Add for Clear Coat 1.4
8# Repl DECAL 1 15.00 0.2
9# R&I SIDE MLDG 0.3
10# RETAPE MLDGS 1 5.00 0.3
11# R&I FLARE 0.5
12# MASKING COVER 1 5.00
13# BRAKE LITES STAY ON OPEN 1
14 OTHER CHARGES
15# E.P.C. 1 5.00
-
--------- -------- ------------------------
Subtotals ---------------------
=_> 319.35 ----- --
5.8 -- ----
5.0 --
Parts 314. 35
Body Labor 5.8 hrs @ $ 53.00/hr 307. 40
Paint Labor 5.0 hrs @ $ 53.00/hr 265. 00
Paint Supplies 5.0 hrs @ $ 32.00/hr 160. 00
Other Charges 5 .00
--------------
SUBTOTAL ---- ------- ----- -------- --
$ ----
1051. ---
75
Sales Tax $ 891.75 @ 7.0000 ~ 62 .42
--------------
GR.AND TOTAL ----------------- - -------- --
$ ----
1114. ---
17
ADJUSTMENTS:
Deductible 0 .00
--------------
CUSTOMER PAY --------------------- - - -- --
$ ----
0 ---
.00
INSURANCE PAY $ 1114. 17
1