Claim by John and Shirley WhiteTHE CITY OF
DUB E
Masterpiece on the
BARRY LIND
CITY ATTOR
MEMORANDUM
To: Mayor Roy D. Buol and
Members of the City Council
DATE: February 19, 2008
RE: Claim Against the City of Dubuque by John & Shirley White
Claimant Date of Claim Date of Loss Nature of Claim
John & Shirley White 02/18/08 02/08/08 Vehicle Damage
This is a claim in which the claimant Shirley White alleges that as she was stopped in
her vehicle on Palm Court at Pennsylvania Avenue, a City of Dubuque Keyline bus
attempted to turn left onto Palm Court from Pennsylvania Avenue, and struck the front
driver's side door of claimant's vehicle.
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
Jon Rodocker, Transit Manager
John & Shirley White
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
~-~Feb, 18, 2008a 3:35PNI~~'State Farm
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Insurance ~ ~ ~ ' ~• ~~~N=~fNo~ rP, ~~
9340 2
Feb. 13. 2008 5:39PM CITY OF DBO LEGAL DEPT No,26i5 P. 2/3
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 bs filed with the City Clsrtc at Ctty Hall, SO W.13`" St, Dubuque, IA 52001. It
will then be referred by the Cfty Council to the appropriate department for investigation.
Once that investigation is completed, a report and recommendation will b® submitted to the
City Council. You will be provided with a copy of that reportand recommendation.
THE 1=1NAL DECISION ON ALL CLAIMS IS MADE BY THE CIt1f COUNCIL. NO EMPLOYEE OP
THE CITY of oUBUQUE HAS THE AUTHORITY TO MAKE ANY REPRESENTATION TO YOU
AS TO WHETHER YOUR CLAIM WILL OR WILL NOT BE PAID.
1. Name of Clairnanti oh ~' ~
2. Address: / "1 '7'7 ~ ~ fn ~'~ ~.- 6
3. Telephone Number: ~ ~(0 3 - ~ 8 3-- ~ ~R.~
4. Date of Incident: b~ ~ $ " O
5. Time of Incident: ~ ~ ~ ~ ~ ~ ' n
B. location of incident (Be specific): ~-~ ~" ~ n ns v~ n : e
i.~. N ~ ~ . e e~ c.r ~ a CS (~ I
-'15y~V4nle
51'; d Cz~to knd -i~F~ CSR
8. What were weathee conditions
. '~ ' K: n S m r Q0. R
to O
9. Dive name and address of any witnesses: '~ ~ b~~ r ..,n~Q 6~ eZy oRn rca.A~
10. Did police investigate? (If so, give names of officers ~ ,
.rte ~ ~~.~p~4".e, ~ol;Ce .ne{~'d n~~~ bl-n~-S'79~ 6F~:~
11. Was anyone inured? (If so, give names, addresses, and extent of injuries). fZ~ i ~ y
~~,;,~c~ - t~%
7, DESCRIBE ACCIDENT OR OCCURRINCE THAT CAUSED INJURY OR DAMAGE. (Give
full details upon which you bes0 your claim. If a City employee was involved, give the
employee's name.)
~tt~Feb. 18. 2008^ 3:35PM~itli~State Farm Insurance.•7~~i,~list•~1i r~~.No. 9340iii~P, 3~;•
Feb. 13. 2008 5=39PM CITY OF D80 LEGaL DEPT No. 2815 P. 3/3
12. Was any damage done to property? {If so, describe property and the extant 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.)
n/v
1l3. What amount do you claim from the City of Dubuque?
~ ''1 CQS?,~nl~
16. Why do you ciairn the City of Dubuque Is respot)sibla?
17. Have you made any claim against anyone else for damages as a result of this incident?
(If yea, give name and address.)
l\/ U
18. It the answer to Gvestion 17 is ysa~ have you received any payment from that source,
and I! so, in what amount?
Dated at Dubuquo, Iowa this day of ~ 20,x.
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Fe b, 18. 2008 3:35PM State Farm Insurance
02/08/2008 at 02:19 PM
18174
RILEY AUTO SALES
Federal ID #:420957277
4455 DODGE STREET
DUBUQUE, IA 52003
(563)566-2326 Fax: (563)583-1327
PRELIMINARY ESTIMATE
Written By; DAVE DEMOBS
Adjustex:
Insured: JOHN WHITE Claim #
Owner: JOHN WHITE Policy #
Addreee: 1777 PALM CT Deductible:
DUBUQUE, IA 52001-3035 Dat® of Logs:
Day: (563)556-4389 Type of Lvsa:
Evening: (563)583-6795 point of Impact:
Inspect
Location:
No. 9340 P. 4
Job Number:
Insurance
Company: Days to Repair
1998 DODG STRATUS ES 6-2.5L-FI 4D SED WHITE Tnt:
VIN: 1B3EJ56H3WN298219 Lic: MIMISW Prod Dato: ~ Odomet®z;
Aix Conditioning Rear Defogger Tilt Wheel
Cruise Contx'ol Intermittent Wipers Body Side Moldings
Dual M~,rrors Console/Storage Fog Lamps
Clear Coat Paint flower Steering Power Brakes
Power Windows Power Locks Power Mirrors
AM Radio FM Radio Stereo
Cassette Search/Seek Anti-Lock Brakes (9)
Driver Air Bag Passenger Air Bag Cloth Seats
Bucket Seats Automatic Transmissio n Overdrive
Aluminum/Alloy Wheels
N0. OP. DESCRIPTION
~----------- QTX EXT. PRICE LABOR PAINT -
1 ------
FRONT DOOR --- -----------------~-----------
2* Rpr LT Door shell 2.0 2.2
3 Add for Clear Coat 0.9
4 R&I LT Belt w'strip 0.3
5 Repl LT Side molding 1 3/e" wide 1 80.10 0.3 0.5
paint/match
6 Repl LT Nameplate 1 31.95 0
2
7 R&I LT Mirror power .
0.4
8 R&I LT Handle, outside 0.4
9 REAR DOOR
10 Repl LT Side molding 1/2~~ wide 1 50.0.0 0.3 O.Q
white
11# CORRISION PROTECTION 1 10.00 0.3
12# CAR COVER 1 5.00
1
Fe b, 18, 2008 3;36PM State Farm Insurance No. 9340 P. 5
02/08/2008 at 02:19 PM Job Number:
18179
PRELIMINARY ESTIMATE
1998 DODG STRATUS ES 6-2.5I~--FI 9D SLD WHITE Int:
NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT
--------
13# HAZARDOUS WASTE DISPOSAL - ---
1 -------
3.50 ----------- --------
Subtotals =~> 180.55 4.2 4 0
Parts 180.SS
Body Labor 4.2 hrs @ $ 51.00/hr 219.20
Paint Labor 4.0 hrs @ $ 51.00/hz 209.00
Paint Supplies 9.0 hrs @ S 32.00/hr 128.00
SUBTOTAL -$ 726.75
Sales Tax ~ $ 598.75 @ 7.0000 41.91
GRAND TOTAL - - $ 768 66
ADJUSTMENTS:
Deductible 0.00
-----$----0 00
CUSTOMER PAY
INSURANCE PAY $ 768.66
THIS ESTIMATE IS BASED ON A VISUAL INSPECTION AND DOES NOT INCLUDE ADDITIONAL
PARTS OR LABOR THAT MAY BE REQUIRED TO COMPLETE REPAIRS. PART PRICES ARE
CURRENT AND SUBJECT TO INVOICE.
WE FEATURE A LIFETIME WORKMANSHIP LIMITED WARRANTY - SEE OUR WRITTEN WARRANTY
FOR COMPLETE DETAILS,
LIFETIME PAINT PERFORMANCE GUARANTEE USING APPROVED PPG PRODUCTS AND A LIFETIME
GUARANTEE ON OVERALL WORKMANSHIP IS VALID AS LONG AS XOU THE VEHICLE STATED
HEREIN.
2
Fe b. 18. 2008 3:36PM State Farm Insurance No. 9340 P. 6
02/08/2008 at 02;19 PM
18174
Job Number:
PTtELIMINARY E3TIblATE
1998 DoDG STRATUS ES 6-2.5L-FI 4D SED WHITE Int;
Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from
the Guide DE3PM95, CCC Data Date 01/01/2008, 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) ox ALT OLM (Alternative OEM) parts are OEM parts that may be provided by or
through alternate sources other than the OEM vehicle dealerships. OPT OEM yr ALT OEM parts may
rnf.lect some specific, special, or unique pricing or discount. OPT OEM or AT,T 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
been modified or may have come from an alternate data source. Tilde sig ro( )d d ems indicatey 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, Qua1 Recy Parts, RCY, or USED. Reconditioned parts aro 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
fzom 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.
3
Feb, 18. 2008^ 3:34PM~State Farm Insurance No, 9340rP. lt?~ri
Feb. 13. 2008 5:39PM CITY OF D90 IEGAI DEPT No. 2815 P. I/3
"~o ~ TRACEY $TECKLEIN
FAX
02/13/2008 4:30 PM
~~'~e: John WhitO
Buesing ~ Astociatos
Fax No; (563) 566.6717
Ra: City of Dubuque Claim Form
Pages: 3 (including cover sheet)
To Whom It May Concern;
I would appreciate it if you would please give the following City of Dubuque
claim form to John Whits.
Thank you.
c~ ~~';p
c? 1~..~
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5uirE 3(0, HARBOR VIEW~1ACEr~t~.m-1 rREE7~GU9000E, IA 52001-8944
TEI.EPNONE 583 583-4113 Ax 683) 683.104 ! EnM~L tgteckfe@)cityofdubuque.orq