Claim by Megan HefelTHE CITY OF
DUB ~ E
Masterpiece on the Mississippi ~
BARRY LINDAF
CITY ATTORNE
To:
DATE:
RE:
Claimant
Megan Hefel
MEMORANDUM
Mayor Roy D. Buol and
Members of the City Council
August 13, 2008
Claim Against the City of Dubuque by Megan Hefel
Date of Claim
08/12/08
Date of Loss
07/29/08
Nature of Claim
Vehicle Damage
This is a claim in which claimant alleges that the hood of her parked vehicle was
damaged after being struck by either a refuse or recycling truck.
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
Paul Schultz, Solid Waste Management Supervisor
Megan Hefel
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 / EnnAIL balesq@cityofdubuque.org
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CLAIM AGAINST THE CITY OF DUBUQUE, IOWA
This written report constitutes your claim against the City of Dubuque, Iowa. YouG4
should complete this form in full and attach any additional information thatn a,
supports your claim. 0~
~~ ~
The claim must be filed with the City Clerk at City Hall, 50 West 13th St.~ ~'. rv -~~
Dubuque, IA 52001. It will then be referred to the appropriate department fgr -~
investigation and to the City Attorney's Office. Once that investigation is ~ N ; i 1
completed, a report and recommendation will be submitted to the City GCiI. -• ~
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: N 1~~f ~ ~'~ ~ ~~~~
2. Address: ay~~ ~c~.~t)wLt Ka C+ v't/~~ ~ ~~~.accc~~
3. Telephone Number ~ ~ 3'" ~ ~ a " ~ ~ a'~
4. Date of Incident: `1 " ~~ " ~ 8
5. Time of Incident: ~~-~~'- 7~'~ ' I ~ ~ `~~
6. Location of Incident (Be specific
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.)
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8. What were weather conditions like? t
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9. Give name and address of arm witnesses: -
10. Did police inve~ate? (If so, ,give names of officers.)
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11. Was a~~ ne injured? (If so, give names, addresses, and extent of injuries).
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
Axtant of rtamanP 1
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.) ~~
15. What amount do you claim from the City of Dubuque?
$~v~C' GitJ
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16. Why do you claim the City of Dub
ue is responsible?
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17. Have you made an~ claim against anyone else for damages as a result of ~a n~ a ~ ~ S
this incidep~? (If yes, give name and address.) ~~°~, ~~ J .
18. If theNanswer to Question 17 is yes, have you received any payment from that
source, and if so, in what amount?
Dated this day of , 20 Og
(Signatu ) ~~~,( G~~f- f
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08/11/2008 at 12:26 PM
30799
Job Number:
BRIMEYER AUTO BODY
License #:30799 Federal ID #:421438480
10709 COLLISION DR.
DUBUQUE, IA 52001
(563)583-4456 Fax: (563)583-1838
PRELIMINARY ESTIMATE
Insured: MEGAN HEFEL
Owner: MEGAN HEFEL
Address: 2445 PALAMINO CR
DUBUQUE, IA 52001
Day:
Evening:
Inspect
Location:
Insurance
Company:
Written By: BOB COOK
Adjuster:
Claim #
Policy #
Deductible:
Date of Losa:
Type of Losa:
Point of Impact:
Days to Repair
1997 CHEV CAVALIER 4-2.2L-FI 2D CPE Int:
VIN: 1G1JC1248V732 8744 Lic: Prod Date: Odometer:
Intermittent Wiper s Dual Mirrors Console/Storage
Clear Coat Paint Power Steering Power Brakes
Anti-Lock Brakes ( 4) Driver Air Bag Passenger Air Bag
Cloth Seats Bucket Seats 5 Speed Transmissio n
Overdrive Full Wheel Covers
----
---
---------------------
-------
-----------------
N0. OP. ---------------------------
DESCRIPTION QTY EXT. PRICE LABOR PAINT
1 HOOD
2 Repl Hood 1 698.65 1.0 2.7
3 Add for Clear Coat 1.1
4 Add for Underside(Complete) 1.4
5 FENDER
6 Blnd RT Fender 0.9
7 Blnd LT Fender 0.9
8# MASKING COVER 1 5.00
9 OTHER CHARGES
10# E.P.C. 1 5.00
------
-------
----------------- -------------------------------
Subtotals =_> --- ---------------
708.65 1.0 7.0
Parts 703.65
Body Labor 1 .0 hrs @ $ 53.00/hr 53.00
Paint Labor 7 .0 hrs @ $ 53.00/hr 371.00
Paint Supplies 7 .0 hrs @ $ 32.00/hr 224.00
Other Charges
- 5.00
-------
--------------------
SUBTOTAL ---- --------------------
$ 1356.65
Sales Tax $ 1132.65 @ 7.0000 ~ 79.29
GRAND TOTAL $ 1435.94
ADJUSTMENTS:
Deductible 0.00
CUSTOMER PAY $ 0.00
INSURANCE PAY $ 1435.94
1