Claim by Adolph PetrilloTHE CTfY OF
DUB E MEMORANDUM
Masterpiece on the Mississippi
BARRY LINDAHL 1
CITY ATTORNEY /fy~
To: Mayor Roy D. Buol and
Members of the City Council
DATE
RE:
Claimant
June 17, 2008
Claim Against the City of Dubuque by Adolph Petrillo
Date of Claim
Date of Loss Nature of Claim
Adolph Petrillo 06/13/08
06/06/08 Vehicle Damage
This is a claim in which claimant alleges that that his vehicle was damaged after a limb
fell from a City tree located in front of 2279 St. John Drive .
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
Bob Fritsch, Park Manager
Adolph Petrillo
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
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 v~rill or will ^ot b;> Nai .
1. Name of Claimant:
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2. Address: ~~ ~~ S~ '~ ~~ n ~ r. ~~~ , Zf~- S~Cba
3. Telephone Number ~ (~ ~ -- S ~~to ~ ~d~ ~'
4. Date of Incident: / - ~ - /)~ w-or
5. Time of Incident: I~ e,}~~-P,e ~ y/- ~d h ~t ~4-- ~ •' Oa c•~ w,
6. Location of Incident (Be specific):
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8. What were weather conditions like?
9. Give name and address of any witnesses:
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10. Did police investigate? (If so, give names of officers.)
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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
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
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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
extent of damage.) , , ; ,
13. What other damages do you claim, if any?
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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.)
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15. What amount do you claim from the City of Dubuque?
16. Why do you claim the City of Dubuque is responsjble?
17. Have you made any claim against anyone else for damages as a result of
this incident? (If yes, give name and address.)
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18. If the answer to Question 17 is yes, have you received any payment from that
source,. and if so, in what amount?
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Dated this ~~ day of ~ ~Q. , 20 C7F . ~ `'' c,,~ ~~,7
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.~ TOYS DONE RIGHT
1006 central ave
DUBUQUE, IA, 52001
Te1:563-552-1601 Fax:563-552-2207
Tax ID:131-023992
Estimate -Preliminary
Estimate Prepared by: Appraised for:
Accident Date:
Date of Loss: Date: 6/10/2008
Arrival Date: Estimate#:
Type of Loss:
Policy Number:
Claim Number:
Owner:
Contact: ADOLPH PETRILLO
Address: 563-5 56-9007
Year Make Model Color Trim
1987 Chevrolet Monte Carlo SS Coupe
Unit Number License Plate # Mileage Serial#NIN#
Sup Seq Qty Labor Labor Description Part Part List Extended Labor
Type Op Type Number Price Price Units
1 1 Ref Ref Refimish Hood Exist 3.3
Outside
2 1 Body Repair Panel, Hood 81-88 Exist 1.0*
3 1 Ref Ref Refinish Fender Exist 2.4
Outside R
4 1 Body Repair Fender w/o LS Exist 1.0#*
1981-88 R
5 1 Body Rem/Rep Antenna, Power New 22048583 $139.14 T $139.14 1.0#
1983-88 w/o Motor
6 1 Body RemlRep Mast, Fixed Black New 15087886 $33.51 T $33.51 .6#
7 1 Ref Ref CUSTOM PAINT Exist 1.0*
[FROST BLUE
PEARL OVER
WHITE]
8 1 Ref Ref CLEAR COAT Exist .5*
9 Paint Materials $230.40
* -Judgement Item
# -Labor Note Applies
Labor
Body 3.6 Hrs @ $52.00
Parts
$187.20 Parts Subtotal
Less Adjustments
$172.65
Version 2.0 P-Page logic not included.
Database Edition CPL 08-04 Page 1 of 2
' Refmish 7.2 Hrs @ $52.00 $374.40
• .>.abor Total $561.60
The above is an estimate based on our inspection and
3oes not cover any additional parts or labor which may
be required after the work has started. Occasionally,
worn or damaged parts are discovered which may not
be evident on the first inspection. Because of this, the
above prices are not guaranteed. Quotations on parts
and labor are current and subject to change.
Parts Total $172.65
Additional Costs and Operations
Addl. Costs/Ops Total $230.40
Tax
Labor Tax @ 7.00% $39.31
Parts Tax @ 7.00% $12.09
Tax Total $51.40
Totals
Sub Total: $1,016.05
Customer Resp. $0.00
Net Total $1,016.05
This is a preliminary estimate. Additional changes to the estimate may be required for the actual repair.
RepairMate does not automatically include items required by many business repair partners. This application
allows the author to manually enter line items such as overlap deductions.
1987 Chevrolet Monte Carlo SS
Version 2.0 P-Page logic not included.
Database Edition CPL 08-04 Page 2 of 2
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