Claim by Mike FassbinderTHE CITY OF
DUB E MEMORANDUM
Masterpiece on the Mississippi
BARRY LINDAHL ~ I~
CITY ATTORNEY ~~"
To: Mayor Roy D. Buol and
Members of the City Council
DATE:
RE:
Claimant
March 10, 2008
Claim Against the City of Dubuque by Mike Fassbinder
Date of Claim
Mike Fassbinder
03/05/08
Date of Loss
02/28/08
Nature of Claim
Vehicle Damage
This is a claim in which the claimant alleges that a City of Dubuque Keyline bus struck
and damaged his vehicle which was parked in front of 44 Stetmore 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
Jon Rodocker, Transit Manager
Mike Fassbinder
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
J - '1 ~ /
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CLAIM AGAINST THE CITY OF DUBUQUE, IOWA ,vr
This written report constitutes your claim against the City of Dubuque, Iowa. You 1M
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 13"' 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 paid.
1. Name of Claimant: /~' 11 I~ ~ ~t 5 ~ ~ f ~`~ c'~ ~ ~
2. Address: ~- 3 ~ ~ ~~ q ~'
3. Telephone Number_ S~ ~ ~- ~'~~ ~ ,~,-, S ~'o ~ gS7
4. Date of Incident: ~ ~ ~- g' ~O
5. Time of Incident: _ ~- 2 ~ q ~p~~x _
6. Location of Incident (Be specific):
t-~ c~ •^
U ~
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? pmnlnvaa'c narr,ca 1
s~ ~SS~
9. Give name and address of any witnesses:
T d , n , . C !~ , ~ r,, .,rr F` ., a.
10. id police investigate? (If so, give n
of officers.)
,.
S v~ ~ ~~ I n Ft
8. What were Bather conditions like?
11. V~las anyone injured? (If so, give names, addresses, and extent of injuries).
1'3. 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.) ) ,.~,
5. What amount do you
from #~~ City of Dubuque?,
spa
16.
of Dubuque
the
17. Have you made any claim against anyone else for damages as a result of
this inciflent? (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 , 20 ~
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(Signature)
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(Print Name)
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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
Driver Information Exchange Report
Dubuque Police Department
563-580-441 ❑
Drivers Name - Lasl
LESSEI
First
ANTONIO
Middle i
Suffix Date of Birth
u
N
Address
16462 LEWIS RD. #19
City
DUBUQUE
Slate
IA
Zip
52002
Pnone
(563) 589-4196 x
I
T
Gender Number
Male �
i
Class
C
Stale
IA
Endorsements
P
Restrictions
NONE
Insurance Co.
ICAP
Name
Insurance Co. Phcnr fi
(563) 589.4120 x
001
Owner Company Name
CITY OF DUBUQUE
Insurance Policy
0300
#
Owners Name - Last
First
'
Middle
Suffix
Address
50 W 13TH ST
City
DUBUQUE
State
IA
Zip
52001-
VfN No.
1FDXE45PSSHB14018
Year
2005
Make
FORD
Model
BSSN26
1 Style
VN
Vehicle Confif,:.i. ,
19
License Plate #
104313
Slate
IA
Year
2099
Most Damaged
04 - Right Rear
Area
1l.ld
I
Approximate Cost to Repair or Rar
5100.00
I
Drivers Name - Last
First
Middle
Suffix
Date of Birth
NAddress
City
'
State
Zip
Phone
1
T
Gender
Drivers License Number
Class
State
Endorsements
NONE
Restrictions
NONE
insurance Co. Name Insurance Co. Phone #
MEMBER SELECT INS. CO. (800) 779-5630 x
002
Owner Company Name
Insurance Policy #
AUT001693966
Owners Name - Last
FASSBINDER
First
MICHAEL
Middle
HUBERT
Suffix
Address
2397 PEARL STREET
A
City -.
DUBUQUE
State
IA
_
Zip
62002-
VIN No.
1GCEK19007E600619
Year
2007
Make
CHEV
Model 1 Style
SLV 1 Plc
Vehicle ConfigrJPGr.1
02 _ — -
License Plate 0
019MJN
State
IA
Year
2008
Most Dan aged Area
08 - Left Front
Approximate Cost to Repair or Replu. e
$250.00 —
County
- 31
Accident occurred
Dubuque
within corporate limits of (city)Dubuque
- 2100
Literal Description
STETMORE ST
X-Coordinate
00689718
Y-Coordinate
04706985
If accident occurred outside of city
limits show general vacinity: "N/A"
Direction j Nearest City
"NIA" of i "NA"
Route (Cardinal)
Travel Direction "NIA"
On Road, Street, or Highway:
STETMORE
At Intersection with:
"NIA"
Distance
15 Ft
Direction
1-N and
Distance
"N/A"
Direction
"NIA" of
Milepost Number
"NIA" Or
Definable intersection, bridge, or railroad crossing
THEISEN ST.
Officer
STAIR, JUSTIN
Badge No.
54A
Law Enforcement Case Number
01-08-9206
Dale of Accident
02/28/2008
Time of Accide• 4!
09:28 hrs
Printed At: Dubuque Police Department 02128f2008 01:35 PM
Page 1 Form #: 01-08-9206
• 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 4136-1 DATE 02/29/08
SHOP: RICHARDSON M OTORS INSP DATE: 02/28/08
ADDRESS: 1475 JOHN F. KENNEDY RD CONTACT: JASON CHARLEY
CITY STATE: DUBUQUE, IA PHONE 1: (563)582-5411
ZIP: 52002- FAX: (563)582-4129
OWNER: FASSBINDER, MIKE HOME PHONE: (563)580-5857
ADDRESS: 2397 PEARL
CITY STATE: DUBUQUE, IA
ZIP: 52001
POINT OF IMPACT: 0
LIC#: STATE: VIN: 1GCEK19007E500519
BODY COLOR: WHITE MILEAGE:
CONDITION: ACCTNG CTL#:
*=USER-ENTERED VALUE
EC=REPLACE ECONOMY
UM=REMAN/REBUILT PRT
aE=REPLACE PXN OE SRPLS
TERTL REPL PRICE
I=.AIR
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
MAY REQUIRE PAINTING IF BUFFING DOESN'T TAKE
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
2007 CHEVROLET CLASSIC K1500 LS 4DOOR EXT CAB 8CYL GASOLINE 5.3 FLEX
CODE: U8033D/I OPTNS Z/24XWHTUC
OPTIONS:
TWO-STAGE - EXTERIOR SURFACES
4-WHEEL DRIVE
HEATED BACK GLASS
AUTOMATIC TRANS
OP GDE MC DESCRIPTION
-- --- -- -----------
E 0411 MIRROR, OUTER R/C
PART # 25775875
N SAND AND BUFF BUMP,
SB ALIGNMENT
3 ITEMS
TWO-STAGE - INTERIOR SURFACES
LEFT REAR ACCESS DOOR
AIR CONDITIONING
CRUISE CONTROL
MFG.PART NO. PRICE AJo B% HOURS R
------------ ----- --- -- ----- -
RT 15226945 GM PART 128.94* 0.7 1
FE ADDNL LABOR OPERA
SUBLET REPAIR 64.99*
1.0*1*
2*
2007 CHEVROLET CLASSIC K1500 LS 4DOOR EXT CAB
CD LOG NO 4136-1
FINAL CALCULATIONS & ENTRIES
GROSS PARTS 128.94
PARTS & MATERIAL TOTAL 128.94
TAX ON PARTS @ 7.000% 9.03
LABOR RATE REPLACE HRS REPAIR HRS
1-SHEET METAL 52.00 0.7 1.0 88.40
2-MECH/ELEC 62.00
3-FRAME 57.00
4-REFINISH 52.00
5-PAINT MATERIAL 32.00
LABOR TOTAL 88.40
TAX ON LABOR @ 7.000% 6.19
SUBLET REPAIRS 64.99
TAX ON SUBLET @ 7.000% 4.55
TOWING
STORAGE
GROSS TOTAL 302.10
NET TOTAL 302.10
SHOPLINK UN189 ES CD LOG 4136-1 DATE 02/29/08 01:15:23PM R6.37 CD 02/08
PXN: Y/00/00/00/00/00 CUM 00/00/00/00/00 GEOCODE 52002
EDU: 0215 HOST LOG
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