The URL can be used to link to this page

Claim by Spring ConnollyClaim Form http://www.cityofdubuque.org/printer friendly.cfm?pageid=155 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 paid. 1. Name of Claimant:Spring Connlly 2. Address: 2542 Marquette Pl, Dubuque 3. Telephone Number: SL~-'j ~1 -~{1 ~ ~{{o„-.~~ f S63-S(~Y- ~gOb~Cril) 4. Date of Incident: 5/7/08 5. Time of Incident: 3:15 PM 6. Location of Incident (Be specific): Intersection of Windsor Ave & Henry St. A~/-.,r, v Sal-. 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 employee's name.) Give name and address of any witnesses: 10. Did police investigate? (If so, give names of officers.) VP,S ~ r`c..pc~~ was ~ke,n bti (~~ cc-f k4 I~ r~ryss 11. Wa-Was anyone injured? (If so, give names, addresses, and extent of injuries.) n -L ha,.~ had re ur~i e darJti. ~I~ ,~~ ;S ~nC rap.;-~. 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.) nn ~ 1i - t ls~Ce~~ ~ ~ i~ cxfTQ~ 1~2~ IC G 4~a` ~.~-}~t~nn.~l J rr ((~~ '' ~JJ ~6v A ~ ~ ~y ~~v ~ ~~ ho"f C OV-~~~~ 7'f~_ G4~t Wlw~ ~N.L ~ ~67~~ ~0 Ss . 13. What other damages do you claim, if any((? ~ ,/J 0.v-~ 0.~ O ~'~Aiw~~.^,c Q O C ,i IC f~i~~5~ Mi ~S~C ~ e ~ ~ ~ 0.r~(~1' ~q;n ci•.~ swat=~~,.~ rcla~cd ~ - is Iv~Ci 1 oft 5/14/2008 8:45 AM TGI+ ~Glt~ ~b S~ ~ an~ mar' -c-/1Q~ fly e 8. What were weather conditions like? !~.'~,r , ~r' y Claim Form http://www. cityofdubuque.org/printer_friendly.cfm?pageid=155 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 doppyou claim from the City of Dubuque?11 I t~'Q~ au-n~u-}r}' -~ ~A~Wt,i'yt~A (~ iL,G Y"'CDGI~r',(`Cn IGCC2Me/1,3~ ~~^ Z il~c~WtiSSerE wo~j 16. Why do you claim the City of Dubuque is responsible? (~~, P ~. i-Qi ~C~ i ~d ~,,~~ a~ ~~ ~„ ~~ ~ ; ~(1 1,~~, ~ ~~~ -~n„ 1 Vim- ~, ~ cl ,~ ~L ~IS ~R~~~n ~ d - ~~-' to i ~S ~1~1Ci /~ t 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 this ~~ day of 1 v \0~.~ , 20~. (Signature 1 ~~` (Print Name) -~ !~`~ ~ s~• ~~ ~; ~ ~ ~% _' -' r u ~-' -v .;~ = N D ~ 00 r-~,,.r 2 of 2 5/14/2008 8:45 AM rn 002 Daer CompanyName Printed At: Dubuque Police Department 06/0712008 03745 PM l—rifit7e7; blame • Last u FAIRCHILD 0 Page 1 Form #: 01-08-020512 Driver Information Exchange Report Dubuque Police Department 563-589-4410 First RILEY Middle PATRICK Suffix N Address 770 IOWA ST Gender I r Male City DUBUQUE T Number Class Stale ' Endorsements Restrictions C IA NONE NONE 001 Owner Company Name —� CITY OF DUBUQUE Slate IA err Zip 52001 Insurance Co. Name IOWA COMMUNITIES ASSURA insurance Policy C NOT LISTED Phone (663) 689-4415 x Insurance Co, Phone # (563) 689-4100 x Owner's Name - Last Address 60 W 13TH ST First Middle Suffix City DUBUQUE State IA Zip 62001- VIN No- 2FAHP71V38X132190 i License Plate # Drivers Name - Last u CONNOLLY N Address 2542 MARQUE I TE PL Year I Make 2008 I FORD • Slate IA Yes 2069 First SPRING Model CVC Most Damaged A ea 08 - LL,t Front lity I DUBUQtJ rK I ~del 1 Driver's License Number Class 1 State Endorsements Restrictions 1 insurance Co. Name T Female ! C 1IA , NONE NONE I Alt) CASUALTY f Ins ranee Policy C 91t,4192 tviwulA JOAN Suffix Owners Name - Last First CONNOLLY MATTHEW iMiddle JOHN Address city . 2642 MARQUETTE ; DUBUQUE YIN No. 2C3HD46J6WH146832 License Plate t 816PAM Year Make 1898 • CHRY I Slate Style 40 Vehicle Confguralion E 01 Approximate Cost to Repair or Replace 61,000.00 Date of Birth Phone 083) 582-4756 x insurance Co. Phone # (888) 244.8163 x 1r Suffix L State Zip IA 52001- Model CONCORDE LXI Year I Most Damaged Area 2008 E 06 - Rear Style 4D Vehicle Configuration 01 Approximate Cost fo Repair or Replace $1,000.00 C•:!u Ey j Accident occurred witnin corporate limits of (city) Dubuque-31 Dubuque-2100 Literal Description 0 I WINDSOR AVE and HENRY ST X-Coordinate 00691531 Lorni6 sni; yer.ar : it'.:L15 "NIA" Direction ;Nearest City "NIA" of i"NIA" R^,an Street or hcgir::av "N/A" Cistar:v r r:r, t ;Distance ..NIA" ' "NIA" ,rid "NIA' Y-Coo Jinate 04710165 Ai Intersection with. "NIA" '"Direction "N/A" 0f Milepost Number "N/A" Or Route (Cardinal) I Travel Direction "N/A" �afr:.�hle : �!t seclic oriJm�, ci eiln:ud dressing • WINDSOR • Officer CROSS, KYLE Law Enforcement Case Number I Dale of Accident 05107l2008 Time of Accident 16:16 Hrs. ____ _.. y~ /f - __ ~s ~ i w1A,~ i S- _ - ho~ _ C_' o,.~_ ~~'~Cd bccna.s~ _ .y- - .~ -~- -~C.~.. ~ ~,;~~ ~_ was 0. ~~ ~~ ~+4~ ~~S_, '05/12/2008 at 12:26 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: BILL PFAB #24443 Adjuster: Insured: MATT CONNOLLY Claim # Owner: MATT CONNOLLY Policy # Address: 2542 MARQUETTE PL Deductible: DUBUQUE, IA 52001 Date of Loss: Day: (563)564-1467 Type of Loss: Point of Impact: Job Number: Inspect ABRA - DUBUQUE Business: (563)556-0696 Location: 3400 CENTER GROVE DR DUBUQUE, IA 52003 Insurance Company: Days to Repair 1998 CHRY CONCORDE LXI 6-3.2L-FI 4D SED WHITE Int: VIN: 2C3HD46J6WH146832 Lic: Prod Date: 02/1998 Odometer: Air Conditioning Rear Defogger Tilt Wheel Cruise Control Intermittent Wipers Climate Control Keyless Entry Theft Deterrent/Alarm Dual Mirrors Console/Storage Traction Control Clear Coat Paint Power Steering Power Brakes Power Windows Power Locks Power Driver Seat Power Passenger Seat Power Mirrors Power Trunk/Tailgate AM Radio FM Radio Stereo Cassette Search/Seek Equalizer Infinity Sound System Anti-Lock Brakes (4) Driver Air Bag Passenger Air Bag 4 Wheel Disc Brakes Leather Seats Bucket Seats Automatic Transmission Overdrive Full Wheel Covers NO. OP. DESCRIPTION --------- QTY --------------------------- EXT. PRICE LABOR PAINT 1 ---------- QUARTER PANEL --- ---------------------------- 2 Repl RT Quarter panel 1 312.00 16 5 3 2 3 Add for Clear Coat 0 . . 0.00 0.0 1 3 4 BACK GLASS . 5 R&I Back glass Chrysler 0 0.00 Incl 0 0 6 REAR DOOR . . 7 Blnd RT Outer panel 0 0.00 0.0 1 2 8 R&I RT Handle, outside white 0 . 0.00 0.3 0 0 9 R&I RT Door glass Chrysler green 0 . 0.00 0.5 0.0 tint 1 05/12/2008 at 12:26 PM Job Number: 24443 PRELIMINARY ESTIMATE 1998 CHRY CONCORDE LXI 6-3.2L-FI 4D SED WHITE Int: -------- NO. -------- -------- OP. -------- ------------------------------- DESCRIPTION -------------------- ------------------------ QTY EXT. PRICE LABOR -------- PAINT 10* R&I ----------- RT Water shield ------ 0 ------- 0.00 - ---------- 0.2 -------- 0.0 11 REAR BUMPER 12* Repl Qual Recy Parts bumper assy 1 281.25 1.5 3.2 +25~ 13 Add for Clear Coat 0 0.00 0.0 1.3 14 Deduct for Rear Bumper R&I 0 0.00 -1.1 0.0 15 TRUNK LID 16* Repl Qual Recy Parts trunk lid 1 218.75 0.5 3.7 assy +25~ 17 Overlap Major Adj. Panel 0 0.00 0.0 -0.4 18 Add for Clear Coat 0 0.00 0.0 0.7 19 Repl Nameplate "Winged Victory" 1 79.85 0.3 0.0 20 0 Repl Nameplate "CHRYSLER" light 1 24.25 0.3 0.0 quartz 21 Repl Nameplate "CONCORDE LXi" gold 1 70.25 0.3 0.0 22 REAR BODY & FLOOR 23 Repl RT Rail assy 1 200.00 s 8.5 1.0 24# Rpr UNIBODY SET UP /MEASURE 0 0.00 2.0 F 0.0 25# Rpr UNIBODY REALIGN R REAR 0 0.00 2.0 F 0.0 26# EST WAS NOT COMPLETE DUE TO 1 0.00 0.0 0.0 - POSS TOTAL LOSS ------------- ----------------- Subtotals =_> ------ 1 ------- 186.35 - ---------- 31.8 -------- 15.2 Parts 1186.35 Body Labor 27.8 hrs @ $ 52.00/hr 1445.60 Paint Labor 15.2 hrs @ $ 52.00/hr 790.40 Frame Labor 4.0 hrs @ $ 56.00/hr 224.00 Paint Supplies -------------------- 15.2 ------ hrs @ --- $ 33.00/hr 501.60 SUBTOTAL ---- - ---------- $ -------- 4147.95 Sales Tax -------------------- $ ------ 3646.35 -- @ 7.0000 255.24 GRAND TOTAL ----- - ---------- $ -------- 4403.19 ADJUSTMENTS: Deductible 0.00 ----------------------------------------------- CUSTOMER PAY $ 0.00 INSURANCE PAY $ 4403.19 WARRANTY VALID ONLY WITH ORIGIONAL COPY OF YOUR RECEIPT PARTS SUBJECT TO INVOICE NO GUARANTEE ON RUST ALL PARTS NEW, UNLESS OTHERWISE NOTED WARRANTY VALID ONLY WITH ORIGIONAL COPY OF RECEIPT. PARTS SUBJECT TO INVOICE. NO GUARANTEES ON RUST. ALL PARTS NEW, UNLESS OTHERWISE SPECIFIED. 2 '05/12/2008 at 12:26 PM 24443 Job Number: PRELIMINARY ESTIMATE 1998 CHRY CONCORDE LXI 6-3.2L-FI 4D SED WHITE Int: Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from the Guide DR3NH98, CCC Data Date 04/01/2008, 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) 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. 3 StiuM IN~Q Y' t ~ _ Y . ~ S Cam' .. Ui ,/~`,~ Q~l~(~ ~4i ~G~~ ~~ 1 W~~~aS ~ ~l i 1 ~ ~+ q Qt~l.~ ~ ~ ~'b `~ ~0.~ ~ul~ ~ ~0.i^t~~ yt 1:t7'-1'Me ~ ~~ _ _____ Trial Court Case Summary http://www.iowacourts.state.ia.us/ESAW ebApp/TV iewCaseCivil?n... Summary Title: DUBUQUE vs. FAIRCHILD, RLLEY P Trial Court Case ID Orig~natin_g o ~ tv Created Tr-X 1Vficrofilm Ref 01311 DUSTA0006469 DUBUQUE 05/09/2008 Disposition Status. Disposition Reo .erred Date Date VIOLATIONS 05/14/2008" HANDLED BY CLERK 1 of 1 5/14/2008 11:35 AM Charges lofl http://www.iowacourts.state.ia.us/ESAWebApp/TViewCharges Charges, Dispositions, Sen#enc~s Title: DUBUQUE vs. FAIRCHILD, ,RILEY P Case: QI'31 LDUSTAOQQb469 (DUBUQUE] .Defendant:. FAIRCHILD, RILEY PATRICK Count 01 C~rge Charge: DU/32-321.288. Description: FAIL TO MAINTAIN.. .CONTROL- Offense Date: 05/07/2008 Adjudication: Arrest Date: Against Type:... Charge: Description: Adj,: Adj.Date: Adj:Judge: , Comments• Sentence Charge:. Description: .Sentence Dater null Sentence: APPeaI: Sen.Judge: , Facility Type: Attorney: .Restitution: Drug:. Extradition: Lic.Revoked: DDS: Batterer: Fine Amount: Duration:. Comment: __ __ _._ __. __ CN=John Q Public,O=JUDICIAL Lo on Re isterry j Certain details of case data are only shown to subscribers. You may logon at this time if you are a subscriber, or you may be become a subscriber by registering at this time. There is a $25.00 per month subscription fee. For exclusive use by the Iowa Courts © State of Iowa, All Rights Reserved 5/14/2008 11:37 AM Trial Case Details Filings Filings Title: DUBUQUE.vs. FAIRCHILD, RILEY P Case:~01311DUSTAOOQ6469 (DUBUQUE) Wiled-~v http://www.iowacourts.state.ia.us/ESAWebApp/TViewFilings Filed ' ~~ Action Date... u an ated Date VIOLATIONS 05/1.4/2008 05/14/2008 05/14/2008 HANDLED BY CLERK WRITTEN PLEA OF .FAIRCHILD. 05/12/2008 05/14/2008 05/14/200$. .GUILTY RILEY PATRICK TRAFFIC TICKET 05/09/2008 05/13/2008 _05/13/2008. FILING CN=John Q Public,O=JUDICIAL Logon Register Certain details of case data are only shown to subscribers. You may logon at this time if you are a subscriber, or you may be become a subscriber by registering at this time. There is a $25.00 per month subscription fee. For exclusive use by the Iowa Courts © State of Iowa, All Rights Reserved 1 of 1 5/14/2008 11:37 AM