Claim, Lange, Kenneth & JaneCLAIM 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 W. 13th St., Dubuque, IA 52001. It will then be referred by the City Council to the appropriate department for investigation. 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: Kenneth A. & Jane J. Lange
2. Address: 1036 Bonnie Ct. - Dubuque, IA 52003
3. Telephone Number: 563 588 9207
4. Date of Incident: 6/04/02
5. Time of Incident: 10:55 A.M.
6. Location of Incident (Be specific): Matthew John Drive, Dubuque, Iowa - Construction Site
7. DESCRIBE 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.)
Philip A. Schoenberger, City Employee, was driving City Owned Garbage Truck and
struck our 2000 Chevrolet S-10 Pickup that was legally parked.
8. What were weather conditions like?
Slight Rain, Wet & Muddy
9. Give name and address of any witnesses:
10. Did police investigate? (If so, give names of officers.)
Yes - City of Dubuqe - Officer Pregler #65
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
None
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.)
2000 Chevrolet S-10 Pickup
13. What other damages do you claim, if any?
$2,750 for diminished value ($250 deductible) (truck rental - Runde)
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.)
Yes - for the direct damage by: West Bend Mutual Insurance Co., West Bend, WI.
15. What amount do you claim from the City of Dubuque?
Ins. Company will subrogate for their damage. Our claim is for the diminshed value. $250 Deductible; Truck Rental Runde Chev.
16. Why do you claim the City of Dubuque is responsible?
Our vehicle was legally parked and not running. City Vehicle slid into the front of our vehicle.
17. Have you made any claim against anyone else for damages as a result of this incident?
(If yes, give name and address.)
No
18. If the answer to Question 17 is yes, have you received any payment from that source, and if so, in what amount?
Dated at Dubuque, Iowa this 13th day of June , 2002.
/s/ Kenneth A. Lange
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
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'-addifional information that SUlSports your ~laim,
The Claim must be filed with the City Clerk at City Hall, 50 W. 13th St., Dubuque, IA 52001.
It will then be referred by the City Council to the appropriate department for investigation.
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.
3. Tel. ephone Number:
4. Date of Incident:.
5.:Time of Incident:
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. NameofClaimant:~'~,~_~/-/ /. ~'/ "-?~"~ ~
2. Address: /~ ~/~.'-~ -- ~u~.~, ~ .~
6. 'Location of Incident (Be specific): /~7/'/¥'r=z~J ~--'~/v/~J .~./dE. ~
7..'DESCRIBE ACCIDENT OR OCCURRENCE THA~ C~USED INJURY OR. DAMAGE. (Give
full details upon which you base your claim. If a City employee was involved, give the
employee's name.)~ -- ~
/ ~,
9, Give name and address 0f anywitnesses:
10. ~id poise inv~tigate? (If~o, give names of officers.)
/
11. Was anyon~ injured? (If so, giv~ 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 extent of damage.)
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 nameand addresS'of insurancecompany and amount paid.)
15. What amount do you claim from the City of.Dubuque?/~5, ~/~ ~/~
16. Why de~~'of D~buque is respOnsible?
17. Have you made any claim against anyone else for damages as a result of this incident?
(If yes, gi~ame and.addreSs.) , '
18. If the answer to QueStion 17 is yes, have you received any payment from that ~ource,
and if-so,-tn what amount~ ..... ' , .
Da~ at~k,~ Iowa this / day of
~ . (sigr~at~re)
,/ (Print Name)
(Rev. 1/00 & 7/01)
RUNDE CHEVROLET INC.
780 RT. # 38 NORTH EAST DUBUQUE, IL 61026
(815) 747-3011
Fax: (815) 747-7721
Tax ID: 36-4320504
Damage Assessed By: MIKE RUNDE
Accident Date: 6/5/2002
Deductible: UNKNOWN
Owner KENNETH LANGE
Address: 1036 BONNIE CT DUBUQUE, IA 52003
Telephone: Work Phone: (563) 580-0208
Home Phone: (563) 588-9207
Mitchell Service:
Description: 2000 Chevrolet S10 LS
Body Style: 20 PkupXCb 6' Bed 122" WB
VIN: 1GCDT19WOY8241575
Mileage: 15,355 I
Color: BLACK
Options: 4WD OR AWD
916492
Drive Train:
~'~ Date: 61 512002 12:06 PM
Estimate ID: 418
Estimate Version: 0
Preliminary
Profile ID: Mitchell
4.3L Inj 6 Cyl 4WD
Line Entry Labor Line Item
Item Number Type Operation Description
I 900500 BDY* REPAIR
2 900500 BDY* REPAIR
3
4 600049 REF REFINISH
5 600080 REF REFINISH
6 AUTO BDY OVERHAUL
7 600106 BDY REMOVE/REPLACE
8 600152 BDY REMOVE/REPLACE
9 600176 BDY REMOVE/REPLACE
10 631188 BDY REMOVE/REPLACE
11 AUTO REF REFINISH
12 630177 BDY REMOVE/REPLACE
t3 AUTO BDY CHECK/ADJUST
14 630178 BDY REMOVE/REPLACE
15 603200 BDY REMOVE/REPLACE
16 AUTO REF REFINISH
17 AUTO REF REFINISH
18 603270 BDY REMOVE/REPLACE
19 603280 BDY REMOVE/REPLACE
20 603290 BDY REMOVE/REPLACE
21 603310 BDY REMOVE/REPLACE
22 600575 BDY REMOVE/REPLACE
23 603590 BDY REMOVE/REPLACE
24 601080 BDY REMOVE/REPLACE
25 900500 MCH* REMOVE/REPLACE
26 900500 MCH* REMOVEIREPLACE
27 900500 MCH* REMOVE/REPLACE
Part Type/ Dollar Labor
Part Number Amount Unite
TOWING
**** RENTAL TRUCK -- RECEIVED, 6-5-02
**** $30.00 PER PLUS 5% TAX
FRT FACE BAR
FRT AIR DEFLECTOR
FRT BUMPER ASSY
FRT BUMPER FACE BAR
FRT BUMPER AIR DEFLECTOR
L FRT BUMPER BRACE
GRILLE
GRILLE
R FRT COMB LAMP ASSEMBLY
HEADLAMPS
L FRT COMB LAMP ASSEMBLY
HOOD PANEL
HOOD OUTSIDE
HOOD UNDERSIDE
HOOD PRIMARY LATCH
HOOD PRIMARY LATCH BRACKET
HOOD SECONDARY CATCH
HOOD RELEASE CABLE
COOLING RADIATOR SUPPORT
COOLING SUPPORT
OTR FRONT BODY BAFFLE
REFRIGERANT & OIL
ENGINE OIL
TRANS FLUID
Sublet 45.00 * 0.o*
Existing 0.O*
C 0.9
C 1.0
1,3 #
15007664 GM PART 281.20 INC
ORDER FROM DEALER 109.20 INC #
15716713 GM PART 20.30 INC #
15090744 GM PART 190.90 0.3
C 1.0
16526218 GM PART 285.30 INC #
0.4
16526217 GM PART 258.30 INC #
12389408 GM PART 309,60
C 2.5
C 1.3
15757371 GM PART 38.85 INC
15672319 GM PART 6.30 0.1
15039095 GM PART 5.93 INC
15732159 GM PART 11.13 0.3
15009394 GM PART 290.00 4.8 #
15732160 GM PART 58.75 INC
ORDER FROM DEALER 30,40 INC #
New 48.00 * 0.O*
New 2.00 * 0.0'
New 2.00 * 0.0'
52472963 GM PART 486.50 INC
28 600636 BDY REMOVE/REPLACE COOLING RADIATOR
ESTIMATE RECALL NUMBER: 6/5/2002 12:05:58 418
UltraMate is a Trademark of Mitchell International
Mitchell Data Version: MAY 02 A Copyright (C) 1994 - 2000 Mitchell Internafional
UltraMate Version: 4.7.007 All Rights Reserved
Page I of 3
29 900500 MCH*
30 603960 BDY
31 6OO749 BDY
32 900500 BDY*
33 900500 BDY*
34 600648 BDY
35 604630 MCH
36 604650 MCH
37 AUTO MCH
38 606160 BDY
39 606330 BDY
40 AUTO REF
41 AUTO REF
42 606340 BDY
43 AUTO REF
44 AUTO REF
45 630354 BDY
46 900500 REF *
47 900500 MCH*
48 900500 MCH*
49 900500 BDY*
50 601564 MCH
51 601565 MCH
52 601574 MCH
53 601575 MCH
54 601278 FRM
56 601281 FRM
56 610130 MCH
57 900500 BDY*
58 612790 MCH
59 600896 BDY
60 600898 BDY
61 AUTO REF
62 AUTO
63 AUTO
REMOVE/REPLACE
REMOVE/REPLACE
REMOVE/REPLACE
REMOVE/REPLACE
REPAIR
REMOVE/REPLACE
REMOVE/REPLACE
REMOVE/REPLACE
REMOVE/REPLACE
REMOVE/REPLACE
REMOVE/REPLACE
REFINISH
REFINISH
REMOVE/REPLACE
REFINISH
REFINISH
REMOVE/REPLACE
REFINISH/REPAIR
REPAIR
REMOVE/REPLACE
REMOVE/REPLACE
REMOVE/REPLACE
REMOVE/REPLACE
REMOVE/REPLACE
REMOVE/REPLACE
REPAIR
REPAIR
ALIGN
REPAIR
REMOVE/REPLACE
REMOVE/REPLACE
REMOVE/REPLACE
ADD'L OPR
ADD'L COST
ADD'L COST
Date: 6/5/2002 12:o6 PM
Est]mate ID: 418
Estimate Version: 0
Preliminary
Profile ID: Mitchell
-M
COOLANT
UPR COOLING SHROUD
LWR COOLING SHROUD
LABEL, "NOTICE",AIRBAG,DEXCOOL
LABEL, EMISSIONS & BELT ROUTING
COOLING FAN CLUTCH
A/C REFRIGERANT RECOVERY -M
AIR COND CONDENSER -M
EVACUATE & RECHARGE AIC -M
W/ANTENNA
R FENDER PANEL
R FENDER OUTSIDE
R FENDER EDGE
L FENDER PANEL
L FENDER OUTSIDE
L FENDER EDGE
R FENDER WHEELHOUSE PANEL
REFINISH RT WHEELHOUSE PNL
BLEED POWER STEERING
POWER STEERING FLUID
UNDERCOATING
DISABLE & ENABLE AIR BAG SYSTEM
AIR BAG SYSTEM DIAGNOSIS -M
R FRT AIR BAG SENSOR -M
L FRT AIR BAG SENSOR -M
R FRAME BRACKET
L FRAME BRACKET
FRONT SUSPENSION -M
CLEAN & DETAIL
STEERING TUBE -M
AIR CLEANER ASSEMBLY
AIR CLEANER BRACKET
CLEAR COAT
PAINT/MATERIALS
HAZARDOUS WASTE DISPOSAL
New 25.00' 0.5*
15010203 GM PART 10.29 INC #
15736666 GM PART 20.06 INC #
15150239 10.25' 0.1'
Y8241575 10.25' 0.0'
15154901 GM PART 154.28 0.2 #
0.3
52474647 GM PART 345.23 ]NC
1.4
0.3
12472736 GM PART 316.80 1.8 #
C 1.6
C 1.0
12377871 GM PART 316.80 1.8 #
C 1.6
C 1.0
15050577 GM PART 87.00 0.4 #
Existing 0.8*
Existing 0.3*
New 4.00 * 0.0'
New 4.00 * 0.4*
0.5
0.5 #
16240655 GM PART 85.00 INC #
16240665 GM PART 98.50 INC #
Existing 1.0' #
Existing 1.0'#
1.9
Existing 0.5*
15159570 GM PART 31.37 1.0
25099892 GM PART 112.00 0.3
25171130 GM PART 16.38 0.1 #
2.5*
397.80 *
7.65 *
* - Judgement Item
# - Labor Note Applies
C - Included in Clear Coat Calc
Add'l
Labor Sublet
Labor Subtotals Units Rate Amount Amount Totals
Body 14.1 42.00 0.00 4S.00 637.20
Refinish 15.3 42.00 0.00 0.00 642.60
Frame 2.0 44.00 0.00 0.00 88.00
Mechanical 6.9 66.00 0.00 0.00 389.40
Non-Taxable Labor 1,757.20
Labor Summary 37.3 1,757.20
II. Part Replacement Summary
Taxable Parts
Sales Tax ~
Total Replacement Pa~s Amount
Amount
4,048.87
6.250% 253.05
4,301.92
ESTIMATE RECALL NUMBER: 6/5/2002 12:05:58 4t8
UIt~aMate is a Trademark of Mitchell International
Mitchell Date Version: MAY_02_A Copyright (C) 1994 - 2000 Mitchell International
UltraMate Version: 4.7~007 All Rights Reserved
Page 2 of 3
Preliminary
Profile ID: Mitchell
III. Additional Costs
Taxable Costs
Sales Tax
Non-Taxable Costs
Total Additional Costs
6.250%
Amount
397.80
24.86
7.65
430.31
IV. Adjustments
Customer Responsibilk'y
L Total Labor:
[L Total Replacement Parts:
Ill. Total Additional Costs:
Gross Total:
Amount
0.00
1,757.20
4,301.92
430.31
6,489.43
IV. Total Adjustments:
Net Total:
0.00
6,489.43
This is a preliminary estimate.
Additional changes to the estimate may be required for the actual repair.
ESTIMATE RECALL NUMBER: 6/612002 12:05:58 418
UltraMate is a Trademark of Mitchell International
Mitchell Data Version: MAY_02_A Copyright (C} 1994 - 2000 Mitshell International
UitraMate Version: 4.7.007 All Rights Reserved
Page 3 of 3
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