Claim by Laddie_Carol Sula_ __ _ _ __
~~~^ ~ r~ ~ _ /~'1//
/ ,i , ~
• ~-_ - ~,T~~~
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: ~ 1~,~) ~ ~C,j L/~- .r L'!~-r~o ~ f Lu-~r~-
2. Address: ~ ~ ~,S- i~-r~,~c/,2/t~ S t
3. Telephone Number ~~ ~-- -S ~ ~ ~-- ~f ~~~~
4. Date of Incident: ~~ -- ~' - ~~
5. Time of Incident: ~• 3
6. Location of Incident (Be specific): nn
/G-/~~)/L~'T fig/~ 1t7~ L/ 5~.. - C~ la'X ~i972A~P a' ~C.7 (s C/,~ ~J
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.)
Rc~~~e
n r~
~`6~
J ca-/ ft) D /~ r7 /_ ~ (~ ~ n ~-,~ _ _ /~D ~ i C' .~.' /'~-1N r--_ / / L--~.' /_~ i X O ~
C ~t sz ~ ~~c~ -~ 2 ~ o yL. - Td ~ /f C-Gi~ T7f/ti-~S c~y ~T
8.1W/hat were weather conditions like?
f/[/ C. ~~ L> ~Gi~: % ~ GCJ /~ ~~ ~o ff ~(.~i /L~ !J J ~/~ ~ /2/7~ ~G~ r
9. Give name and address of any witnesses:
~~C-~h~~~~1~~ o~ C'd~.~v~,~ d~= L~~1/>t.~ f /~y'3~~~r,~ ~f c.c/~cc_
10. Did police investigate? (If so, give names of officers.)
r - ~~ .c/ 1~ i X llst ~ ~ l
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
A/ ~~
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
i~
13. What other damages do you claim, if any?
~l/~~e+~
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.)
~v
15. What amount do you claim from the City of Dubuque?
f~L~rN'k ~t-r,n nuct~F' r n~~rct~Q ('. ~~' p ~-
16. Why do you claim the City of Dubuque is responsible?
~~ p c l v[ ~ i.~ /fir' Jr~ e~ Y Y
17. Have you made any claim against anyone else for damages as a result of
this incident? (If yes, give name and address.)
N~`n
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 d
di ~~nb~G~CI
(~ atur
L ~'I,,Di~' ,J _ ~uc!¢ 8~t :~, 6~d Sz ~nr 8L
(Print Name)
~~~°~.I~~~~
Date: 6/23/2008 11:59 AM
HANLEY AUTO BODY
1030 Century Circle, Dubuque, IA 52002
(563) 583-7220
Fax: (563) 583-8355
Damage Assessed By: Robert Hanley
Deductible: UNKNOWN
Owner: Laddie Sula
Address: 1375 Aubum, Dubuque, IA 52001
Telephone: Home Phone: (563) 557354
Mitchell Service: 910373
Description: 1990 Volvo 240 DL
Body Style: 4D Sed
Line Entry Labor Line Item Part Type/
kem Number Type Operation Description Part Number
1 002160 BDY REPAIR HOOD PANEL Existing
2 AUTO REF REFINISH HOOD OUTSIDE
3 020900 BDY REPAIR ROOF PANEL Existing
4 AUTO REF REFINISH ROOF PANEL
5 025470 BDY REPAIR LUGGAGE LID PANEL Existing
6 AUTO REF REFINISH LUGGAGE LID OUTSIDE
7 AUTO REF ADD'L OPR CLEAR COAT
8 AUTO ADD'L COST PAINT/MATERIALS
9 AUTO ADD'L COST HAZARDOUS WASTE DISPOSAL
Estimate ID: 1929
Estimate Version: 0
Preliminary
Profile ID: Mitchell
Drive Train: 2.3L Inj 4 Cy14A
" -Judgment Item
C -Included in Clear Coat Calc
Add'1
Labor Sublet
I. Labor Subtotals Units Rate Amount Amount Totals II. Part Replacement Summary
Body 6.0 48.00 0.00 0.00 288.00 T
Refinish 11.0 48.00 0.00 0.00 528.00 T Total Replacement Parts Amount
Taxable Labor 816.00
Labor Tax @ 7.000 °~ 57.12
Labor Summary 17.0 873.12
III. Additional Costs Amount IV. Adjustments
Non-Taxable Costs 335.00 Customer Responsibility
Total Additional Costs 336.00
ESTIMATE RECALL NUMBER: 06/23/2008 11:59:01 1929
UltraMate is a Trademark of Mitchell Intemational
Mitchell Data Version: MAY_08_A Copyright (C) 1984 - 2005 Mitchell International
UltraMate Version: 6.0.029 All Rights Reserved
Dollar Labor
Amount Units
3.0*
C 3.0
1.0*
C 3.3
2.0*
C 2.4
2.3
330.00 *
5.00
Amount
0.00
Amount
0.00
Page 1 of 2
pan~asaa s;y6~ Iltl 820'0'8 :uols~aA a;eWe~;I~
Z ;o Z abed leuol;ewa3ul IIa4o3!W 9002 - is686 (~l 3461~~(do~ d gp ~tlyy :uols~aA a;ea Ila4oa!W
leuol;eu~a;ul IIa4oL!W;o H~ewape~l a sl a;eyye~;Ift
8286 60:69:66 8002!£2/90 :2138WfIN'i'Itl~3?J 31tlWI1S3
•ne a~ den;oe ay; ~o; pain a~ aq ew a~ewi;sa ay; o; sa ueya ~euoi~ppy
•a~ewi;sa euiuaya~ a si siyl
ZL'80Z` 6 :le7ol laN
00'0 :s;uau~snfPtl lelol 'AI
26'802`6 :le;ol sso~~
00'9££ :s;sod leuo!;!PPtl le;ol 'III
00'0 :shed;uawaaelda~{ le;ol 'll
ZL'EL8 ~~o4e'llelol 'I
IlaUo3!W ~OI alyo~d
IVeulw!la~d
0 :uols~ap a;ewl;s3
6266 :QI a;ewl;s3
Wtl 69:66 8002/£Zt9 :a;ea