Claim by Debbie KiefferTHE CITY OF
DUB E MEMORANDUM
Masterpiece on the Mississippi
BARRY LINDAHL ,~`~
CITY ATTORNEY 1`
To: Mayor Roy D. Buol and
Members of the City Council
DATE:
RE:
Claimant
December 22, 2008
Claim Against the City of Dubuque by the Debbie Kieffer
Date of Claim
Debbie Kieffer
12/18/08
Date of Loss
12/11 /08
Nature of Claim
Vehicle Damage
This is a claim in which claimant alleges that as she was traveling south on Elm Street
near the intersection of 17th Street, a City of Dubuque snow plow truck ran the stop sign
at 17th Street and struck claimant's vehicle..
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 & Maintenance Supervisor
Debbie Kieffer
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
i
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 will or will not be paid.
1. Name of Claimant:_1
2. Address: ~~3 ~ ~~(~ ~f ~~,, n-~,~-i--I- x-14 S~C~ S ~/
3. Telephone Number S~~ - ~ ~ ~ ~ ~ RQ
4. Date of Incident: I ~-- ~ ~ ~ v ~
5. Time of Incident: ~ LG 11 t 3
6. Location of Incident (Be specific): ~, ,.~
7. Describe the accident or occurrence that caused injury or damage. (Give full
details upon which you bash your claim. If a City employee was involved, give
the employee's name.) S v ~~t~,
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8. What wgre weather conditions like?
9. Give name and address of any witnesses.: --
10. Did police inve'sltigate? (If so, give names of officers.)
~~c~ Son ~rC' ~ ~ ~ '!~ ~ ~ '~ca c ~ ~ ~ ~ ~
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
r~ ~~
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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13. What other damages do you claim, if any?
61 ~ n.~
14. Have you been compensated for any part or all of your claim by any
insurance company? (If so, give neme and address of insurance company and
amount paid.)
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15. What amount do you claim from the City of Dubuque?
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16. Why do you claim the City of Dubuque is responsible?
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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 '(~ E'_ r ~~~~,r 20 c~~.~~ ~/~ i
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(Signature) ~ ~;- ~'
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(Print Name)
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11. Was anyone 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
extent of damage.)
~1;~
13. What other damages do you claim, if any?
61 ~ ~,~.
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?
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16. Why do you claim the City, of Dubuque is responsible?
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? ~,
C7 00
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Dated this ~ b day of ~~~
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~~m.~e~r , 20 ~~-~ `` _
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(Signature) _
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(Print Name)
~~ Driver Information Exchange Report
Dubuque Police Department
563-589-4410
I Driver's Name -Last
U OBERHOFFER First Middle
Suffix Date of Birth
-
N Address STEVEN ~ RUSSELL ~_ 1 12/12/1954
600 PIPER CT
I City
DUBUQUE State
~A -
Zip
5
Phone
T Gender
M
l
Driver's License Number
Class State
Endorsements
Restrictions _
Insurance Co
N 2001-D000 (563)556-2064 x
a
e 962ZZ6895
001 Owner Company Name
B IA
NP
B .
ame
IOWA COMMUNITIES ASSURA
Insurance Co. Phone #
(563) 589-4250 x
CITY OF DUBUQUE Insurance Policy #
~ Owner's Name- Last
First ~_ -
~ rviiddle Suffix
Address City
50 W. 13TH ST DUBUQUE State Zip
VIN No.
Year
Make
Model IA 52001-
1 HTWGAAT58J635339 2008 INTL Style
999 Vehicle Configuration
License Plate #
110628
State
Year TL
Most Damaged Area 06
IA 2099 99 -Unknown Approx imate Cost to Repair or Replace
Driver's Name -Last
Fir
st _ __ $0.00
U KIEFFER
DEBORAH Middle
JEAN suffix Date of Birth
N Address
803 MAP ~ 0 8/1 211 9 5 6
City St
t
LE STREET
I
~ LAMOTTE a
e Zip Phone
Gender Driver's License
Number
Class St
t
E _ _ IA ~ 52054 (563) 451-8790 x
T
Female 773YY2574 a
e ndorsements R estrictions Insurance C o. Name
002 Owner Company Name C IA NONE N ONE GRINNELL SELECT Insurance Co. Phone#
(877) 467-2252 X
Insurance Policy #
Owner's Name -Last 9400089219-ELITE
ARENSDORF First
GLENN Ivlidtlle Suffix
Address
I 803 MAPLE ST PO BOX 84
1 VIN No LEO
City --
LA MOTTE state Zip
_ IA 52054-
.
I 1C3EL4SJX4N366081 Year Make
?0('4 C:HRY Model
SEB I St^le
Vehi;leConfiguration ~
__
License Plate #
038TMX _
~ State Year Most Damaged Area _ ~!y l u,
IA 2009 03 -Right Sidra Approximate Cost to Repair or Rep ca e
_
County - -- __ __ $3,000. 00
Dubuque - 31 Acntlent occurred wit hin corporate limits of (city)
C Duque - 2100
Literal Description
E 17TH ST and ELM ST
X-Coordinate
00691819 ____
Y-Coordinate
Ifaccident occurred outside of city 04709046
limits show general vacinity:
"N/q" Direction
"N!A" I Nearest City
of "N/A"
Route (Cardinal}
On Road, Street, or Highway: - _ Travel Direction "N/q°
ELM ST ' At Intersection with: "-
Distance
Direction
N/A" NIA"
Distance
"
" E. 17TH ST
Direction Milepost Number
and
NIA
Definable intersection, bridge
or railroad cros
i "NIA"
of
"NIA" Or
,
"N!A" s
ng
---
Officer
HOERNER, JASON Badge No.
81 Law Enforcement Case Number
~
--_-- Date of Accident
_I _ Time of Accident
D1-08-56844 12!1112008 14:13 Hrs. ~
Printed At: Dubuque Police Department 12!11!2008 D2:40 PM
Page 1 Form #: 01.08.56844
WILLIS AUTO BODY
1982 ROCKDALE RD
DUBUQUE, IA 52003
PHONE: 563-583-9329
CD LOG NO 1259-1 DATE 12/11/08
SHOP: WILLIS AUTO BODY
ADDRESS: 1982 ROCKDALE RD.
CITY STATE: DUBUQUE, IA
ZIP: 52003-
EMAIL: MARKWILLIS58@AOL.COM
OWNER:
ADDRESS:
CITY STATE:
POINT OF IM
LIC#:
BODY COLOR:
CONDITION:
ARENSDORF, GLEN
803 MAPLE
LA MOTTE, IA
PACT: 3
038 TMY STATE:
SILVER
GOOD
*=USER-ENTERED VALUE
EC=REPLACE ECONOMY
UM=REMAN/REBUILT PRT
OE=REPLACE PXN OE SRPLS
TE=PARTL REPL PRICE
I=REPAIR
TT=TWO-TONE
N=ADDITIONAL LABOR
AA=APPEAR ALLOWANCE
INSP DATE:
CONTACT:
PHONE 1:
FAX:
HOME PHONE:
VIN:
MILEAGE:
ACCTNG CTL#:
12/11/08
MARK WILLIS
(563)583-9329
(563)583-9329
(563)773-8790
1C3EL46JX4N366081
62, 000
E=REPLACE OEM
UE=REPLACE OE SURPLUS
EU=REPLACE SALVAGE
PC=PXN RECONDITIONED
ET=PARTL REPL LABOR
L=REFINISH
CG=CHIPGUARD
RI=R&I ASSEMBLY
RP=RELATED PRIOR
2004 CHRYSLER SEBRING LX 4DOOR SEDAN
CODE: M2563A/D OPTNS B/24A
OPTIONS:
TWO-STAGE - EXTERIOR SURFACES
ELEC REMOTE CONTROL MIRRORS
NG=REPLACE NAGS
UC=RECONDITIONED PRT
EP=REPLACE PXN
PM=PXN REMAN/REBUILT
IT=PARTIAL REPAIR
BR=BLEND REFINISH
SB=SUBLET
P=CHECK
UP=UNRELATED PRIOR
4CYL GASOLINE 2.4
TWO-STAGE - INTERIOR SURFACES
OP GDE MC DESCRIPTION MFG.PART NO.
BR0104 13 FENDER, FRONT RT BLEND REFINISH
EU0208 DOOR ASSEMBLY, FRONT RT SALVAGE PART
L 0208 DOOR SHELL,FRONT RT REFINISH
RI0236 MLDG,FRONT DOOR SID RT R&I ASSEMBLY
EU0288 DOOR ASSEMBLY, REAR RT SALVAGE PART
L 0288 DOOR SHELL,REAR RT REFINISH
RI0310 MLDG,REAR DOOR SIDE RT R&I ASSEMBLY
I 0390 PANEL,QUARTER RT REPAIR
L 0390 PANEL,QUARTER RT REFINISH
EU0566 BUMPER ASSEMBLY, REAR SALVAGE PART
PRICE AJ% B% HOURS R
2.0 4
250.00*+33.00 2.5 1
3.6 4
0.3 1
200.00*+33.00 2.2 1
3.5 4
0.3 1
1.0*1
2.4 4
200.00*+33.00 1.4 1
PAGE 1
12/11/08
2004 CHRYSLER SEBRING LX 4DOOR SEDAN
~°D LOG NO 1259-1
L 0566 COVER, REAR BUMPER REFINISH
ECM03 FLEX ADDITIVE ECONOMY PART
ECM17 COVER CAR EXTERIOR ECONOMY PART
ECM60 HAZARD. WSTE. REM. ECONOMY PART
14 ITEMS
3.2 4
8.00* 4
15.00* 4
5.00* 1
MC MESSAGE(S)
13 INCLUDES 0.6 HOURS FIRST PANEL TWO-STAGE ALLOWANCE
FINAL CALCULATIONS & ENTRIES
OTHER PARTS 678.00
LINE ITEM MARKUP 214.50+
PAINT MATERIAL 779.10
PARTS & MATERIAL TOTAL 1,671.60
TAX ON PARTS @ 7.000% 62.48
LABOR RATE REPLACE HRS REPAIR HRS
1-SHEET METAL 55.00 6.7 1.0 423.50
2-MECH/ELEC 65.00
3-FRAME 65.00
4-REFINISH 55.00 14.7 808.50
5-PAINT MATERIAL 53.00
LABOR TOTAL 1,232.00
TAX ON LABOR @ 7.000% 86.24
SUBLET REPAIRS
TOWING
STORAGE
GROSS TOTAL 3,052.32
NET TOTAL 3,052.32
SHOPLINK U9956 ES CD LOG 1259-1 DATE 12/11/08 04:21:39PM R6.37 CD 11/08
PXN: Y/00/00/00/00/00 CUM 00/00/00/00/00 GEOCODE 52003
HOST LOG
(C) 1998 - 2008 AUDATEX NORTH AMERICA, INC.
3.2 HRS WERE ADDED TO THIS EST. BASED ON AUDATEX TWO-STAGE REFINISH FORMULA.
PAGE 2
12/11/08