Claim by Theresa DeutschCLAIM 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 AUTHORITY TO MAKE ANY REPRESENTATION TO YOU
AS TO WHETHER YOUR CLAIM WILL OR WILL NOT BE PAID.
1. Name of Claimant: Theresa Deutsch
2. Address: /3467 Hillcrest Rd. Appt. #4, Dubuque, IA 52002
'ter Gu6
/ ~~y_ Q ~ -
3. Telephone Number: ~! , ~ 7`~fJ C D~D
4. Date of Incident: ~-`~~ ~" DO
5. Time of Incident: /D ° ~O Q- H'f
r
6. Location of Incident (Be specific): Intersection of Hillcrest Rd. and Keyway Rd. at stop sign
(near Gallery Properties Apartment complex)
~~
1
/ ~
CC~~ ''-
7. DESCRIBE ACCIDENT OR OCCURRENC THA~ CAUS~Y OR DAMAGE. (Give
full details upon which you base your claim. If a City employee was involved, give theft,'
employee's name.) `~,
,~. - -
DGC~.~ ~c~. c~-~~~,_~ ~.~,~_l~lc CQ~,, ~~~
~--.-
~---~--Wfiat were weather conditions like? ~~~~(..- 1 ~tti,.-z/ , f 2~~~" ~.-;-~~'~-~~~~-L~Z.~.-~ .~-~~
9. Give name and address of any witnesses: ~ ~~ ~ ~ ~
10. Did police investigate? (If so, give names of officers.)
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
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 as ertaining extent of damage.)
1~ ~ ~ ~~
~._-ems-- i~r~ /~ ~~.~ ~o,,, .. ~/l,~ ae /~ v a~ ~~~~ ~~
,~,~.~ ~ ~~ , ~ ~-~~ X001 h~'-~~~ ~~~.
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 amount do you claim from the City'of Dubuque?
16. _Why do.you claim the City„of Dubuque is respopsible?
17. Have you mace 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?
20~c~
Dated at Dubuque, Iowa this ~~ day of ~2~~~/ ,
~u~~
(Rev. 1100 & 7/01)
ignature)
nt Name)
~i'1 'u.~1~t~~~~Q
~~IJ~C? . '; t:~!r~ ~
. ; 1~
~~'z'~d 8zs~~so
02/25/2008 at 02:05 PM
24443
ABRA - DUBUQUE
Federal ID #:420782245
DBA: ANDERSON-WEBER INC
3400 CENTER GROVE DR
DUBUQUE, IA 52003
(563)556-0696 Fax: (563)556-1899
PRELIMINARY ESTIMATE
Written By: DAVE BIGELOW #24443
Adjuster:
Insured: THERESA DEUTSCH Claim #
Owner: THERESA DEUTSCH Policy #
Address: 3467 HILLCREST RD #4 Deductible:
DUBUQUE, IA 52002 Date of Loss:
Cellular: (319)240-4132 Type of Loss:
Business: (563)588-7000x3038 Point of Impact:
Inspect
Location:
Job Number:
Insurance
Company: Days to Repair
2001 HOND ACCORD LX 4-2.3L-FI 4D SED BEIGE Int:
VIN: 1HGCG56461A082281 Lic: Prod Date: Odometer: 119278
Air Conditioning Rear Defogger Tilt Wheel
Cruise Control Intermittent Wipers Body Side Moldings
Dual Mirrors Console/Storage Clear Coat Paint
Power Steering Power Brakes Power Windows
Power Locks Power Mirrors AM Radio
FM Radio Stereo Search/Seek
CD Player Driver Air Bag Passenger Air Bag
Cloth Seats Bucket Seats Recline/Lounge Seats
Automatic Transmission
------------------------- Overdrive
--------------- Full Wheel Covers
N0. OP.
------------------------- ---------
DESCRIPTION
--------- -------------------------------
QTY EXT. PRICE LABOR PAINT
1 REAR --------------
LAMPS ------------------------ -------
2* Repl LT Lens
------------------------- & housing
----------------------- 1 78.33 1.0
---- 0.0
Subtotals =_> --------------------
78.33 1.0 -------
0.0
Parts 78.33
Body Labor
--------------------- 1.0 hrs @ $ 52.00/hr 52.00
SUBTOTAL -------------------------
$ ------
130.33
Sales Tax.
--------------------- $ 130.33 @ 7.0000%
----- 9.12
GRAND TOTAL --------------------
$ ------
139.45
1
02/25/2008 at 02:05 PM
24443
Job Number:
PRELIMINARY ESTIMATE
2001 HOND ACCORD LX 4-2.3L-FI 4D SED BEIGE Int:
ADJUSTMENTS:
Deductible 0.00
----------------------------------------------------
CUSTOMER PAY $ 0.00
INSURANCE PAY $ 139.45
WARRANTY VALID ONLY WITH ORIGIONAL COPY OF YOUR RECEIPT PARTS SUBJECT TO
INVOICE NO GUARANTEE ON RUST ALL PARTS NEW, UNLESS OTHERWISE NOTED
Estimate based on MOTGR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived
from the Guide ARG4422, CCC Data Date 02/02/2008, 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) 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.
2