Claim by Mary ZapfTHE CITY OF
DUB E
Masterpiece on the
BARRY LIND
CITY ATTOR
To:
DATE:
RE:
Claimant
Mary Zapf
MEMORANDUM
Mayor Roy D. Buol and
Members of the City Council
September 9, 2008
Claim Against the City of Dubuque by Mary Zapf
Date of Claim
09/08/08
Date of Loss
08/25/08
Nature of Claim
Vehicle Damage
This is a claim in which claimant alleges that as she was traveling east on 22"d Street,
her vehicle was struck by a City of Dubuque Police squad car that was traveling south
on Washington Street.
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
Kim Wadding, Chief of Police
Mary Zapf
OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA
SUITE 330, HARBOR VIEW PLACE, 3OO MAIN STREET DUBUQUE, IA 52001-6944
TELEPHONE (563) 583-4113 / FAx (563) 583-1040 / EnnAIL balesq@cityofdubuque.org
Claim Form
CLAIM AGAINST THE CITY OF DUBUQUE, IOWA
Yage 1 of L
~'C' h~ ~
~ti~ ~~`~
78 Sri -8 P~112~ 5.~
This written report constitutes your claim against the City of Dubuque, Iowa. YQU tsholal~ cQm~lete,! i firm in
full and attach any additional information that supports your claim. L+I`y~ ~--+~~`+~'~ ~ U+"~~
L~u~~a~~~, ~A
The claim must be filed with the City Clerk at City Hall, 50 West 13th St., Dubuque, IA 52001, tt 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 {a~sAto whether your claim will or will not be paid.
1. Name of Claimant: S~ S 0 '"`a-~L L
2. Address: ~4 ~ 07~ p~'p~, ~~"r` ~i~ Y~C7 ~ ~~
3. Telephone Number: O w ~ ~ 3 ~ ' ~ ~' ~`~
4. Date of Incident: ~~ -~ ~ , ~'"UL3
5. Time of Incident: 1.~ ~ ~l~ ~m 1, ~
6. Location of Incident (Be specific): c~ c ` fir- Vv GAS ~vy -il`~-~ ~ ,~~~~
~~ ~ -- ..
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.) ~
uppv -- ,, U ~ ~G'~ t~ S~ _ u-~---5 Uri
8. What were weather conditiorlS like?
9. Give name and address of any witnesses:
10. Did police inveslItigate? (If so, give names of officers.) `i
11. Was anyone injured? 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 describ basis for ascertaining extent of damage.)
13. What other damages do you claim, if any?
http://www.cityofdubuque.org/printer_friendly.cfm?PageID=155 9/3/2008
(aaim Form
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? ~ ~~ ~ 31 " '~Cl
16. Why do you claim the City of Dubuque is responsible? ~ (.~`L ''~l~ llL'~ °~
t'age L or ~
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?
L1~ ~a-- P~;- ~ ~ ~~ ~3,_ s9
Dated this ~ day of ~~~ , 20~~
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(Print Name)
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print this page
http://www.cityofdubuque.org/printer_friendly.cfm?PageID=155 9/3/2008
U. S. A. A.
9800 FREDERICKSBURG RD
' P. O. BOX 659463 SAN ANTONI O, TEXAS 78265
PHONE: (800) 531-8154
CD LOG NO 307 -0 DATE 08-27-08
ESTI MOTE
CLAI M I NFORM1M1ATI qV
CLAIM # 000000007
COMPANY USAA
INSURED MARY C ZAPF
CLAI MANT
FI LE HNDLR
LOSS PAYEE
I NSPECTI ON
COMPANY ADA OF EASTERN IA
TYPE FI ELD
PRI MARY Pq REAR END LEFT
APPRAISER NAME IQVW ADA-CEDAR RPD
WORK PHONE (319) 665-6166
ADDRESS 85 EAST ZELLER
CI TY STATE NORTH LI BERTY
ZIP 52317-
OiMVE R
ZAPF, MARY C
1697 ROCKDALE RD
DUBUQUE IA 52003-8783
POLI CY # 000659122
CLAIM REP 09000/00006
LOGS DATE 08-25-08
LOSS TYPE COLLI SI ON
FI LE # 47464RP
ACCT # 001
SECOND Pp
FAX (319) 665-6170
INSP DATE 08-26-08
I A LOCATI ON OWNER'S REST DENCE
CITY STATE DUBUQUE
WORK#(563) 588-1674
HOME#(563) 588-1674
REPAI R
ATTN RI CK OR DAVE
ABRA- DUBUQUE
3400 CENTER GRWE RD
DUBUQUE IA 52003-
SHOP PHONE (319) 556-0696
VEHI CLE
2001 BUICK CENTURY CUSTOM 4 DR SEDAN
6CYL GASOLI NE 3. 1
OPT I ONS
TWo-STAGE - EXTERI OR SURFACES
DRI VER POWER SEAT
CRUISE CONTRq_
S HOP L I C#
CAR I N
CAR OUT
REPAIR 8 DAYS
REG. ID 42-0782245
FAX (319) 556-1899
TW~STAGE - I NTERI OR SURFACES
ANTI-LOCK BRAKE SYSTEM
BODY COLOR MAROON M LEAGE 57,245
CCAVDI TI ON GOOD VIN 2G4W652J 811224576
LI CENSE # 309 AVM CODE 5243
LI CENSE STATE I A VEH INSP #
-1-
IA
2001 BUICK CENTURY CUSTOM 4 DR SEDAN DATE OS-27-08
CLAIM # 000000007 LOG 307 -0
REMARKS:
ANY SUPPLEMENT TO THIS CLAIM MUST HAVE PRIOR APPROVAL FROM ADA ®319-665-6166.
APPRAISER RICK POAGE CELL # 319-551-6307
THE VEHI CLE WI LL BE I N THE SHOP 7 TO 8 WORKI NG DAYS
VEHI CLE DRI VABLE: YES
DATE OWNER WAS CONTACTED ON: 8 26/08
ghNER ADVI SED a= COMPLETED ESTI MATE qV: 8/27J08
DATE ASSI GNMENT W4S RECEI VED ON: 8/26/08
VEHI CLE PRODUCTI ON DATE: 11-00
DATE VEHI CLE WAS INSPECTED ON: 8/26/08
OP CODES:
* = USER-ENTERED VALUE
EC =ALTERNATE REPL PART
EU =RECYCLED PART
PM~= PXN REMAN/REBUILT
I T = PARTI AL REPAI R
BR =BLEND REFI NI SH
SB =SUBLET
P =CHECK
UP =UNRELATED PRIOR
E = REPLACE OEM
UC = RECONDI TI ONED PRT
EP = ALTERNATE REPL PART
TE = PARTL REPL PRICE
I = REPAI R
TT = TUVI'~TONE
N = ADDI TI ONAL LABOR
AA = APPEAR ALLOWANCE
NG = REPLACE NAGS
UM = REMANJREBUILT PRT
PC = PXN RECONDI TI ONED
ET = PARTL REPL LABOR
L = REFI NI SH
CG =CHI PGUARD
RI = R&I ASSEMBLY
RP = RELATED PRI OR
OP GDE MC DESCRI PTI ON MFR. PART NO. PRI CE Al % B% HOURS R
--
E ---
0907 -- -----------
COVER, REAR NHEEL
LT ------------ -----
9594869 GM PART 84.46 --- -- --- -- -
1
BR 0287 DOOR SHELL, REAR LT BLEND REFI NI SH 1. 9 4
0. 9 BLEND
0.6 TWp-STAGE SETUP
0.4 TWt1-STAGE
RI 0378 ML DG, REAR DOOR SCAL LT R&I ASSEMBLY 0. 4 1
RI 0315 ML DG, REAR DOOR BELT LT R&I ASSEMBLY 0. 3 1
RI 0255 ML DG, REAR DOOR SI DE LT R&I ASSEMBLY 0. 3 1
RI 0305 HANDLE, RR DOOR OUTE LT R&I ASSEMBLY 0. 5 1
I 0353 ML DG ASSY, BACK GLASS REPAIR 0. 3* 1
»ROPE OFF ML DG. FOR PANEL RE FI NI SH
I 0444 PANEL, QUARTER LT REPAIR 12. 0* 1
L 0444 PANEL, QUARTER LT REFI NI SH 2. 5 4
2.1 SURFACE
0.4 TN~O-STAGE
I 0129 PANEL, QUARTER LONER LT REPAIR 2. 0* 1
L 0129 PANEL, QUARTER LONER LT REFI NI SH 0. 4 4
0.3 SURFACE
0.1 TNO-STAGE
L 0397 DOOR, FUEL FI LLER LT REFI NI SH 0. 4 4
0.3 SURFACE
0.1 TWC~STAGE
RI 0397 DOOR, FUEL FI LLER LT R&I ASSEMBLY 0. 2 1
RI 0418 POCKET, FUEL FI LLER LT R&I ASSEMBLY 0. 4 1
I 0437 PNL, QTR-RR PAN LT REPAIR 1. 0* 1
-2-
2001 BUICK CENTURY CUSTOM 4 DR SEDAN DATE 08-27 -08
CLAIM # 000000007 LOG 307 -0
L 0437 PNL, QTR-RR PAN LT REFI NI SH 0. 4 4
0.3 SURFACE
0.1 TIND-STAGE
I 0391 07 PNL,IMiEELHOUSE OUTE LT REPAIR 1. 0*1
L 0391 PNL, 1MiEELHOUSE OUTE LT REFI NI SH 0. 5 4
0.4 SURFACE
0. 1 TVI~STAGE
RI 0525 PNL, REAR COMPT TRI M LT RBI ASSEMBLY 0. 3 1
I 0479 LI D, REAR DECK REPAIR 0. 3* 1
L 0479 LI D, REAR DECK REFI NI SH 2. 6 4
2.2 SURFACE
0.4 TVI~STAGE
RI 0375 PNL, LID FI NI SH R&I ASSEMBLY 0. 5 1
I 0589 PAN, REAR FLOOR REPAIR 1. 0* 1
L 0589 10 PAN, REAR FLOOR REFI NI SH 0. 8*4
0.5* SURFACE
0. 3 TV40-STAGE
RI 0533 TAI LLAMP ASSEMBLY LT R&I ASSEMBLY 0. 3 1
UC 0573 COVER, REAR BUMPER RECONDI TI ONED PRT 263. 00* 1. 3 1
»KE YSTONE AUTOMdTIVE 800-747- 2500
L 0573 COVER, REAR BUMPER REFI NI SH 3. 0 4
2.5 SURFACE
0. S TWIG-STAGE
E 0517 ML DG, REAR BUMPER CONE 10269363 GM PART 39.16 IN C 1
E 0454 LETTERS, RR BUMPER CON 25677720 GM PART 25.42 0. 2 1
E 0549 SHI ELD, BMPR CVR SPL LT 10444739 GM PART 37. 09 IN C 1
EC MD7 PI NSTRI PES-TAPE ALTERNATE REPL PA 15. 00* 0. 4*1
EC M14 CORROSI ON PROTECTI ON ALTERNATE REPL PA 10. 00* I NC*4
EC M17 COVER CAR EXTERIOR ALTERNATE REPL PA 5.00* INC*4
I M18 'SET-UP AND MEASURE REPAIR 2.0*3
I M19 REALI GN CONTROL POI NTS REPAIR 2. 0* 3
»SI DE PULL ~ LEFT REAR WiEELHOUSE
SB M60 HAZARDOUS WASTE REMOVA SUBLET 4.00* 1
SB 4JWiEEL ALI GNMENT SUBLET 64. 95* 1*
37 ITEMS
MC MESSAGE
07 STRUCTURAL PART AS I DENTI FI ED BY I -CAR
10 INCLUDES AUDATEX TI ME TO CLEAR ENTIRE PANEL.
FI NAL CALCULATI ONS & ENTRI ES
PARTS
GR06S PARTS $ 186.13
OTHER PARTS $ 293.00
PAI NT MATERI AL $ 412. 50
ADJ USTMENTS DI SCOUNT MARKUP
PARTS & MATERI AL TOTAL $ 891. 63
-3-
2001 BUICK CENTURY CUSTOM 4 DR SEDAN DATE 08-27-08
CLAIM # 000000007 LOG 307 -0
TAX ON PARTS & MATERI AL ~ 7. 000% $ 62. 41
LABOR RATE REPLACE HRS REPAIR HRS
1-SHEET METAL $ 52. 00 5. 2 17.6 S 1, 185. 60
2-MECH/ELEC $ 55.00
3-FRAME $ 56.00 4.0 $ 224.00
4-REFI NI SH $ 52. 00 12.5 $ 650. 00
5-PAI NT $ 33. 00
LABOR TOTAL $ 2,059.60
TAX ON LABOR ® 7. 000% $ 144. 17
SUBLET REPAIRS $ 68.95
TAX ON SUBLET ® 7.000% $ 4.83
TOW NG
STORAGE
GR06S TOTAL $ 3, 231. 59
LESS: DEDUCTI BLE $ 200. 00-
NET TOTAL $ 3, 031. 59
PXN Y/00/OOJ00/00/00 CUM 00/00/00/00/00 GEOCODE: 52317 IOW4
PXS NO
AUDATEX PENPRO W)412 ES LOG307 -0 08-27-08 08:10:08
REL 4.12.30 DT 07!08
(C) 1993 - 2007 AUDATEX NORTH AMERI CA, INC.
3. 0 HRS IhERE ADDED TO THIS EST. BASED ON AUDATEX' S TW5-STAGE REFI NI SH FORMULA.
THIS ESTIMATE HAS BEEN PREPARED BASED ON THE USE OF AFTERMARKET CRASH PARTS
SUPPLIED BY A SOURCE OTHER THAN THE MANUFACTURER OF YOUR MOTOR VEHICLE.
ANY WARRANTIES APPLICABLE TO THESE REPLACEMENT PARTS ARE PROVIDED BY THE
MANUFACTURER OR DISTRIBUTOR OF THESE PARTS RATHER THAN THE MANUFACTURER
OF YOUR VEHI CL E.
DI SCLAI ME R: ' FAI LI NG TO PRESENT THIS ESTI MATE TO THE REPAI RI NG GARAGE BEFORE
REPAIR MAY RESULT I N ADDI TI ONAL EXPENSE TO YOU. ANY SUPPLEMENT TO THI S
ESTI MATE MUST BE AUTHORI ZED BY A USAA APPRAI SER. '
NOTI CE: 'REPAI RS TO THIS VEHI CLE MAY REQUI RE SPECI FI C UIELDI NG EQUI PMENT AS
RECOMMENDEb BY THE MANUFACTURER.'
-4-
2001 BUICK CENTURY CUSTOM 4 DR SEDAN DATE 08-27-08
CLAIM # 000000007 LOG 307 -0
GROSS TOTAL
LESS: DEDUCTI BLE
ESTI MATE SUMMARY PAGE
I CM{4 ADA-CEDAR RP D
$ 3, 231. 59
$ 200. 00-
NET TOTAL
$ 3, 031. 59
AUDATEX PENPRO 1h0412 ES LOG307 -0 08-27-08 08:10:08
REL 4. 12. 30 DT 07/08
( C) 1993 - 2007 AUDATEX NORTH AMERI CA, INC.
I F ALTERNATI VE QUALITY REPLACEMENT PARTS HAVE BEEN I NCLUDED I N THI S APPRAI SAL,
THE SOURCE FOR THESE PARTS HAS ALSO BEEN DISCL06ED. IF ALTERNATIVE QUALITY
REPLACEMENT PARTS AS LI STED ON THIS APPRAI SAL ARE ULTI MAYFLY USED I N THE
REPAIR OF YOUR VEHI CLE, THE WARRANTY ON SUCH PARTS W LL BE EQUAL TO, OR
GREATER THAN, THE PARTS BEI NG REPLACED, AS STATED I N USAA' S LI MI TED PARTS
WARRANTY. USAA WARRANTS THAT THE PARTS USED ON YOUR VEHICLE W LL BE OF LIKE
KI ND AND QUALI TY, FUNCTI ON, FIT, SAFETY AND CORR061 ON PROTECTI ON AS THE PART
OR PARTS THEY REPLACE. USAA I DENTI FI ES CAPA-CERTI FI ED PARTS FOR SHEET METAL
REPLACEMENT PARTS SUBJ ECT TO CAPA-CERTI FI CATI ON.
-S-
PAY STATUS CLFD35 PG 1
MARY C ZAPF 00065-91-22 6 DOL 08-25-08 L/R 00000007 BA IA
PI0501I-INA~DLATE PRINT REQUEST WAS SUCCESSFUL
7101. 04 AUT CL 000008 OC IA D 08528 02 CLSD S 07693 86 ASGN
TOTAL LOSS= 0
• *** CLAIM COVERAGE/RESERVE STATUS ***
COV=COLL• SUIT= 0 CLMT= 00 C/L= 000 SPECRES=CLSED 08/08 ST-PAY= 3,231.59
TOTAL= TOTAL= 3,231.59
BANK DRAFT NR ISSUE-DT PAYEE AMOUNT MODE CLEARDT
*** CLAIM STRAIGHT PAY DRAFT SUMMARY ***
39 09165531 08/29/08 MARY C ZAPF 200.00 EFT
39 09146056 08/28/08 MARY C ZAPF 3,031.59 ATE
TRANSACTION - PSWD:
PFI=HELP 3=INTR 5=CNCL 6=0DOC 6=MENU 9=FLASH 12=PGBK
9800 Fredericksburg Road
~~ ` San Antonio, Texas 78288
~(
USAA® .
CITY OF DUBUQUE
50 W 13TH ST
DUBUQUE IA 52001
Reference: Claim Form
CITY CLERK, CITY ATTORNEY,
I am writing regarding the claim referenced below.
September 3, 2008
Enclosed please find your claim form, and USAA claims documents to support our claim of
$3,231.59.
Policyholder: Mary C. Zapf
Reference ##: 659122-7101-7-7643
Date of loss: August 25, 2008
Loss location: Dubuque, Iowa
YOUR VEHICLE: POLICE CAR
YOUR EMPLOYEE: OFFICER BRIAN JOBGEN
You may submit correspondence or questions to me. My contact information is:
Address: USAA Subrogation
PO Box 659476
San Antonio, TX 78265
Fax: (800) 531-8669
Phone: 1-800-531-8722, ext. 7-9485
Sincerely,
Carol A. Fahy
Subrogation Department
United Services Automobile Association
659122 • 7 • IA • 08/25/08 • 7643 - 86 - C200 - DM01776