Claim by Audrea WalshTI-IE CITY OF
DUB E
Masterpiece on the Mississippi
BARRY LINDAHL
CITY ATTORNEY
MEMORANDUM
M` \~°
To: Mayor Roy D. Buol and
Members of the City Council
DATE: July 18, 2008
RE:
Claimant
Audrea Walsh
Date of Claim
Date of Loss
Nature of Claim
07/1708
07/07/08
Vehicle Damage
This is a claim in which claimant alleges that her vehicle was damaged after driving over
a manhole cover which was not completely secured over the manhole.
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
John Klostermann, Street & Sewer Maintenance Supervisor
Audrea Walsh
Claim Against the City of Dubuque by Audrea Walsh
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
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AGAINST THE CITY OF DUBU UE IOW~-
CLAIM
This written report constitutes your claim against the City of Dubuque, Iowa: You
should complete this form in full and attach any additional informprd~ia~t7 p~9 t~: ~~
supports your claim.
The claim must be filed with the Cit Clerk at Cit Hall, 50 West 1 ~ ~'~`" ~` ~ `"~ ~`f~c,e
Y y 3 ~ ,~~ L'~
Dubuque, IA 52001. It will then be referred to the appropriate depart ~'~''
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. CA's. ~ ~.
1. Name of Claimart:~Ut c.~ Y ~ / ,,4 f .S ~ D~ 'j 1 as ~
2. Address: 020 ~..~ 1~~~~, 9~~
3. Telephone Numbers ~.~~ S~~ - 5~~~~v1-
4. Date of Incident: ..7 - ~7 -- ~ ~
5. Time of Incident: ~ ~+ ®~' P~
_._ ~_ . ~.
6. Location of Incident (B.e specific):
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S ~ nJ ,` vim. >f i h /~ ~`~ -~ 1 ~.> c, ""~`o~c~c roC r `!-t !. c d~ ~ ~. s .
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.)
.:
SA`hn -~._ A- ~ ..t.~/~ ~ rJ c? ~-/, r /z _ ~ i ~ ~ c9f fix p,PR
ln1 ~~1 ~~-- g-- ~~ o - f- `t'I ~' 1 `c~ ~ -~-'~'~ z ~y~.~ d .jai p ~- f'~.~. ~-- : f /3 ~4-~1C r,~.i „
8. What were weather conditions like?
~.~~c,~ri~ Da~,U 2i~.f~J
- 0. Give name and address of any witnesses: - ___
N~ N -e_
10. Did police investigate? (If so, give names of officers.)
~ n R r !1 R'~ ~ ~ ~ .v ,~~, p.-t_ ~~~Fic_.~ , ~ .D ° D ,u c -~ ,Q c' j`•
., "~ ~ 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 ascertaining
extent of damage.)
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4~ ~,q.z,~t L3Li ~, o,.~~.~ ~~~ ~/ °~~ A-/S"a ~S~-i ln.~ f-e 1,
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 responsible?
K L~~l i r -c ,~L Y-h-~z ~n ~{-,//, a /z Z ~-/r1~1 0~ acs P of ~r~~y~ a/~
~ ~-~ n•1 ~ I~.4-off ~ : -2 -Z li~J~:,!-~ ~/ dhrf+r/.~ci~ i~h }' C.¢-2 I.JvGi i1i ~/~°t' S~~c~-,'(•~~'.J
`Ti(~ a r~ ~ c ~P lr ~. k/r.~ c~/L S~ ~ tr- ~-~ e : f i4 ~ r9 ~-,~ e. +; (#~ S~ w~` PFF Usk l e N -~ n rc.N a% ~ M+Z K/?
17. Have you made any claim against anyone else for damages as a result of ~' ~^' P~rs~~, ~~ '~
this incident? (If yes, give name and address.) t~*f~N ;~
~~~ ~d ~
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 '~~ / y , 20~
(Signature)
~~ c~l h-~ ~ (~/,.~-/.sue.
(Print Name)
r
' Date: 7/ 9/2008 01:51 PM
~ Estimate ID: E8508
Estimate Version: 0
Preliminary
Profile ID: CUSTOMIZED
KRUSE-WARTHAN Pontiac, Nissan, BMW
800 Century Drive, Dubuque, IA 52002
(583)583-7345
Fax: (583)588-3874
Tax ID: 420655341
Damage Assessed By: GAYLE PURMAN
Deductible: 0.00
Claim Number: DRIVE UP
Insured: TAMMY WALSH
Mitchell Service: 911623
Description: 1999 Ford Taurus SE
Body Style: 4D Sed Drive Train: 3.OL Inj 8 Cyl 24 Valve AO
VIN: 1FAFP53S5XG249059
Options: POWER DOOR LOCKS, CRUISE CONTROL
Line .Entry Labor Llneltem Part Type/ Dollar Labor
Item Number Type Operation Description Part Number Amount Units
1 100963 BDY OVERHAUL BUMPER/GRILLE ASSY 3.7 #
2 100991 BDY REPAIR BUMPERIGRILLE COVER Existing 3.5*#
3 AUTO REF REFINISH BUMPER/GRILLE COVER C 3.1
4 101548 BDY REMOVE/REPLACE BUMPER/GRILLE SPLASH SHIELD F7DZ 8327 AA 83.53 INC
5 100267 MCH REMOVE/REPLACE R LWR FRT SUSP CONTROL ARM ASSY -M FBDZ 3078 AA 119.98 1.2 #
8 MAY HAVE MORE DAMAGE WONT KNOW UNTIL ALIGNMENT!
7 900500 MCH * ADD'L LABOR OP 4 WHEEL ALIGNMENT Sublet 89.95 * 0.0*
8 101288 BDY REMOVE/INSTALL REAR BUMPER COVER 1,0
9 101294 BDY REPAIR REAR BUMPER COVER Existing 2.0*
10 AUTO REF REFINISH REAR BUMPER COVER C 2,g
11 AUTO REF ADD'L OPR CLEAR COAT 1 g*
12 AUTO ADD'L COST PAINT/MATERIALS 249.80
13 AUTO ADD'L COST HAZARDOUS WASTE DISPOSAL 3.50 *
" -Judgment Item
# -Labor Note Applies
C -Included in Ciear Coat Calc
ESTIMATE RECALL NUMBER: 07/09/2008 13:47:58 E8508
UltraMate is a Trademark of Mitchell International
Mitchell Data Version: MAY 08_A Copyright (C) 1994 - 2005 Mitchell International
UltraMate Version: 6.0.029 All Rights Reserved
Kruse-Warthan
Dubuque Auto Plaza
600 Century Drive
Dubuque, lA 52002
Bus: 563-583-7345 Gayle Turman
Toll Free: 800-373-CARS BoAr Shop Mmmger
Fax:563-583-7349 i
Email: gaylepurman@dubuqueautoplaza.mm
PONTIAC
Page 1 of 2
l'
Date: 71912008 01:51 PM
' Estimate ID: E8508
~ Estimate Version: 0
Preliminary
Profile ID: CUSTOMIZED
Add'I
Labor Sublet
1. Labor Subtotals Units Rate Amount Amount Totals II. Part Replacement Summary Amount
Body 10.2 52.00 0.00 0.00 530.40 T Taxable Parts 183.51
Refinish 7.8 52.00 0.00 0.00 405.60 T Sales Tax @ 7.000% 12.85
Mechanical 1.2 65.00 0.00 89.95 167.95 T
Total Replacement Parts Amount 196.36
Taxable Labor 1,103.95
Labor Tax @ 7.000 % 77.28
Labor Summary 19.2 1,181.23
III. Additional Costs Amount IV. Adjustments Amount
Non-Taxable Costs 253.10 Insurance Deductible 0.00
Total Additional Costs 253.10 Customer Responsibility 0.00
I. Total Labor: 1,181.23
II. Total Replacement Parts: 196.36
III. Total Additional Costs: 253.10
Gross Total: 1,630.69
IV. Total Adjustments: 0.00
Net Total: 1,630.69
This is a preliminary estimate.
Additional changes to the estimate may be required for the actual repair.
THIS DAMAGE REPORT IS BASED ON OUR INSPECTION AND DOES NOT
COVER ANY ADDIONAL PARTS OR LABOR WHICH MAY BE REQUIRED AFTER
THE WORK HAS BEEN OPENED UP THE INS,WILL BE NOTIFIED.
WE FEATURE A THREE YEAR WORKMANSHIP LIMITED WARRANTY- SEE OUR WRITTEN
WARRANTY FOR COMPLETE DETAILS.(EFECTIVE 10-01-01)
ESTIMATE RECALL NUMBER: 07/09/2008 13:47:58 E8508
UltraMate is a Trademark of Mitchell International
Mitchell Data Version: MAY_08_A Copyright (C) 1994 - 2005 Mitchell International
UltraMate Version: 6.0.029 All Rights Reserved
Page 2 of 2
orD IDI.OS-
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DUBUQUE POLICE DEPARtMENT CH( ) INCIUENt C N0.
iNCWEtiLREP.lII ] ~ ~ ~ _ ~ f ~ ~%
PEOESIRlAN INJURY PHYSICAL AGILITY EYEGLASSES TYPf FOUIwEAR rvPE VICTIM -FIRM R/S/DUB
unER ABUTT-1NG PROPERTY ADURESS vICT M•S noD 55 CIIY PHONE qU! _
:CUPANt ABUttING PRUPER(Y kA5 YICi1M FAMILIAR TIITIT LOCATION -NOW lOCA11UN OF INl'IDENf BUSINESS PIIUNE NU.
_ '7~~ 'V'V~ 4. CSC-. ~> S
FAIRER COND[fI0N5 SURFACE CONOItiUNS LlGHtING CONDITIONS VICTIM OCCUPATION EMPLUYEJt-SCH00 AITEN)ED HOURS
ADUIIIOIIAL DESCRIP11011 OF AREA uAIE AIU !!ME OCCURREN E OAfE ANU TIME EPORIED
a~~L ~ -~
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COMPIAINk~t ,~, R/S/D 8 7
VICTIM'S ACTIYI11E5 GUIIIG FRUM TO ADDRESS CITY PIIUNE IIU.
Ail INJURIES NATURE OF INJURY A1tENDING PHYSICIAN DEniil REPOR[. LU1A11011 OF BODY
TAKEN TO TRANSPORTED BY MEDICAL FXAMIt1ER IIOTIFIED TIME NUT[FIEU LIME ARRIVED
CONDIITON ( ) H80 1 1 INTOXICATED ALCOSfNSOR TIME AND DATE BODY REMOVED 8Y ~ 11MC OF REMOVAL
f l ~~R 11 TMfL t T DRUGS
DAMAGE CIT[ PROPERLY CIIY PAUPERIY DAMAGED
ESIIMAiEU Ctl51
APPARENT CAUSE OF OEAIII ADDItIUTIAL ( 1
1NYESTIGATIOTI
DESCRIPTION Of OAIIAGE ANIMAL COMPLAINT NATURE OF CUIIPLAINI/INJURY
REFERRED TO DISPOSITION
RESPONSIBLE PER5011 R/S/DOB TYPE ANIMAL COLOR/MARKINGS SEX AGE NAME RABIES TAG NU.
ADDRESS CITY OWNER'S NAME OWNER'S ADDRESS
RESPONSIBII[1Y ( ) YES DESCRIBE VEHICLE INFORMnflON E MUU L SIY E
ADHITIED ( ) NO L72/~ ~(/R(i{.j .5,~ ~/,~(/G~,~c
YEA / YC rT ~ 1`~~.1 L I~~(~+ T1' // C t-' :.5`E~-'v'~7
INSURANCE CARRIER YfN fOHED BY
INSURANCE CARRIER ADDRESS OPERATOR/PERSON IN CONTROL NAME ADURESS
ARREST-CHARGE UuNER NAME ~~ ~ ~+ AODAE55
/ S~1 rr) ,C
OE5CRI8E ACTION OF RESPONSIBLE PERSON CAUSING UAMAf,E Pl10TOGRAPiIS NAME/GAUGE tIM£ aHO UATE
EPORIING_OFFICfrR{5)
UATE REPORT F4tLED_, SUPS
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