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Claim by Gina SeelingTHE CITY OF DUB E Masterpiece on the Mississippi MEMORANDUM TRACEY STECKLEIN PARALEGAL To: Mayor Roy D. Buol and Members of the City Council DATE: RE: Claimant Gina Seeling January 28, 2009 Claim Against the City of Dubuque by the Gina Ann Seeling Date of Claim 01 /22/09 Date of Loss 01 /04/09 Nature of Claim Vehicle Damage This is a claim in which claimant alleges that a City of Dubuque snowplow truck lost control and slid down Samuel Street, striking claimant's vehicle which was legally parked in a private driveway on Samuel 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 John Klostermann, Street & Sewer Maintenance Supervisor Gina Seeling 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 tsteckle@cityofdubuque.org G~~~ 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 ~ 2. Address: 3. Telephone Number ~~OJ? - J C~1 ~ ~~ 4. Date of Incident: U[ 1 L y ~ 0 `1 5. Time of Incident: (~ ~ ~. (~ ~ b'Lf 6. Location of Incident (Be specific): lY1 tn~ t A C I ~ -~(~F' ~ 8. What were weather conditions like? 9. Give name and address of any witnesses: ~,~,+'` 10. Did police investigate? (If so, give names of officers.) 7. Describe the accident or occurrence that caused injury or damage. (Give full details upon which you baso' your claim. If a City employee was involved, give the Pmnhvee's name.l 11. Was injured? (If so, give names, addresses, and extent of injuries). I C.~ 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? /j ~ ~ D 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.) 0 15. What amount do you claim from the City of Dubuque? 16. Why do you claim the City of Dubuque is responsible? (I i~ D~ dc-v ~ ~ t c~ (u~'F U i~ln to C~r~ 17. Have you made any claim against anyone else for damages as a result of this incident? (If yes, give dame 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? 20 , ~, _ - ~~ ~~~~ (S 81 ~h ~~d 2Z Wit' 60 ~~n~ _ ~n ~ ~~~1 ~ n~ (Print Name) Jdll. ). MARS Mny 1c L O C A 7 f O N (J N l T 001 (J N I T 00 LUU7 L; IOrIYI iv o, LLly~r. I MAIL REPORTSTO: ~pyyg De artment of Transportation LaW Enforcem6nt GaseNUmber o~ IovrsDaperlmanloFTranspoAsllon offic=orDrSVarServices ~ P INVESTIGATING OFFICERS REPORT 01-09•D0463 P.O. Box 9204 Dee Moines, Iowa 50306.8204 OF MOTOR VEHICLE ACCIDENT dal rtval° Inlervenlion7~ Property? Dsls oI Accident Timo of Accident County Accident omurred within corporate Ilmlla of (city) Location Lilera(DeacrlDllon 0110GI09 06:12 Hrs. DubU ue - ]1 Dubuque • 2100 SAMUEL ST and SOUTHERN Ir accident occurred outside or dry limits AVE ahav geneisl vlclnllY °NfA" of nearest city "NIA" on Rosd, 91rea1, or Highway: Al Intersection vdlh: . 3AMUEl.ST SOUTHERN AVE Note: Unless accident occurred al en intors=dio)5 which le completely desclbed above, use the space below Id glue the exact ' x-Coordinate: 00691830 vaclions if necessary. Iocalion Irom a milepost or definable Inlereaclion, bridge, or railroad crossing, using tyro tlielencea and d Y-Coordinala: 04706911 Dlelence Direction DlBlence Dlrecllon "NlA" "N/A" and "NIA" "NIA" of If Divitled Highway, Provide Route MileDosl Number beflnable inlersedion, Dddge, or railroad dossing (Cardinal} Trsvel Dtrecllon " " „N1A" or "N!A„ td1A Dryers Name - Lsal Flml Middle 3utBx ROBERT Phone 587 689.0302 x POWERS JAME S Stele Zlp• Addrea8 1265 CLEVELAND AVENUE CIIY DU6U~UE IA 62001 Date o(Binh Dnvefe License Number Cilalion Charge Codo 1 Cilalion Charge 1 0 910 8/1 9 6] 458WW5644 Gtallon Chargo Code 2 Dilation Chsrga 2 Lender Slsla Clesa Endorae menle Reslriclions Male IA B N-L NONE Cilalion Charge code 3 Citation charge ] Alcohol Tcsl Drug Teel Coven? Test Reeults: Givon7 Tael Resuhs: Cilalion Charge Code 4 cilallon Charge 4 1•None 1-Non9 Sealing Position0l In}ury Statu^. 8 Occupant Prolaclion9 Airbag Deployment 6 Airbag 5wilch Slalus 9 Ejection 1 Election Pslh 1 Treppad 1 TrsnspoM1e la: Trsnaponed by. . Ovrnefs[Jame-Leal Flral Middlo Su(fx CITYrOFmDUeUQUE Address GIyy Slab DUBUQUE IA Zip 52001 50 W 13TH STREET Insurance Policy# License Plsle # Slalo Year Insurance Co. Name IA 2009 SELF IN3URE0 VIN No. YBar ~ MBka Modal Slylp " Tow ~ APDrnxlmale 6631 to Repairer RaDlaca 400 SFA PLOW tNTwbAAN59Jaa94eD 2006 International - INTL 7 NO Initial Trsvel Vehido Speed Point ar Mosl Damaged Exlanf of Undantde! Ad 1 • Privsle9 OD ^ SO Direction 1 Adlon 01 Limit 26 a InlUal Impact 02 Ares Damage 1 Over . Tolsl Traffic Vehido Cargo Body vehicle Oriyor Vision Contributing Clrcumalancos, Occupants 1 Con(rol: 01 Contlg. OS Type 11 Dafod 01 Condlllon 1 Ob=cured 01 Driver (up (o hva} 2B SEQUENCE OF EvENTB F(rsl Evcnf 29 Second Event Third Event FduAh Event Moel Harmful Event (by vahiGe) 23 Ccmmerclsl Trellar Attach=d to Stela Year At(a~ed to $tste Year Emergency Emergency vehicle Type 1 Stelua 3 tisanes Plate N Power Unil; Troller Unil: Carrier Nsma Address City ~ 3lsle 21D US DO7 # ar MC # Number of Gross Vehicle Plscsrd ii Hazardous Materials Ax)®; Waighf Raring Releaeed7 Drye(s Name - Lasl Fir1 Middle Su~x Pnana Cily Stale Lip Address IA Dale of BirtYr Drlvera License Number Cilalion L'har0a Cadet Cilalion Charge t Gcndcr Slate Class Endoraemenls Rosuidiona Cllellon Charge coda 2 Cilalion charge z NONE NONE Gi{alien Chsrga Code 3 Dilation Cherye 3 Alcohol Tesl Drug Teal Divan? Tesl Reaulla: Glen? Tesl Rasulls; Giiation Charge Code 9 Cilalion Charge 4 Seating Position Injury Slalu. Occupant Protection Airbsg Deployment Airbsg 3v~llch Slalus Ejection Eieclion PsOr Treppad Trsnaponed to: Trsnaponed by. me-Lase gNNo Sufi-rx OwnerGompanyNama GINA 5EELING Address 2 23078 CENTERVILLE City Stole LA MOT7E IA ZiP 6206d Insuranw Co. Name Insurance Polley # Llcanso Platen °lale Year 803T1CX IA 2009 STATE FARM MUTUAL 079919980616 '(ear Make VIN No Modal 51yte Tow# Approximate Coal to . 1HGGMeea46a170d51 2006 Hond a - HOND ACCORD 4 DR NO Repair or Replsca Inlliel7ravel VeniWe Speed Point of Mosl Damaged Exlenl of Undenidel O dd 1 Prlvate9 ^ §900 00 Direction Agion 12 Llmlt 25 ver a Initiallmpscl O6 Area 06 Dsmago 2 , Total Trsnlc Vehice Ceryo Body Vahlcle Driver Vlslon Obscured CanlrlDUting Citcrttnslances, Driver (up to Iwo) 2$ Occupsnle 0 'Controls 01 Conflg, 01 Type 01 Defacl 01 Gondhion SEQUENCE OF EvENT3 First 6venL 21 Second Event Third Evcnl Fourth Evank Mosl Harmful Event (Dy vehlGe) 21 Commercial Troller AI(a~+ed l0 Stale Year Atlacned In State Yea il r Emergency Emcrg=acfr Vehicle Typa 1 Slalus 3 License Plata 8 Power UniL• : Trailer Un Carrier Name Addreaa Cily Stele Zip US OUT # or MC p Number or Gross Vahlcle Placard # Hezsrdoua Materials Axles iNelphl Raring Relesse67 Printed At: Dubuque Police Dapattment 01/0512009 12:58.AM Page 1 Form #: 01.09.ODd63 ~~ Jdll• J• LUU7 L IUilvl u• LL 17 DrlveraName-Last Final Mitldle sutra vnone Ciry StaleLlp Address IA Dsla of Birth Dnvefs Llranse Number Carlton charge code t C3lellon Chsr9e 1 it Ch C i Gander slsla Clear Endorsements Resbiraicn- ode 2 c at on Citation cnerge nrgo 2 NONE NONE Chsllen Charge Code 3 Ci(alion Charge 3 Alcohol Teal DNO 7851 Given? Tacl Raaulle: Given? Teet Reaulla: CIIeUon Charge Codo 4 Cilallon Charge a U Sealing Peallion In)ury SISWe Occupant Protection Airbag Deployment A;rDag Switch Slalus F,leellon Eioclion Palh Trapped N I Tranaponed to: transported DY. OivnefeNeme,Lesl Fir~l Middle. Suflix O,vnerCompanyNarna T MORAN JOHN FRANCIS Addms: CiIY stale 2iP 003 dp5 SOUTHERN AVE DUBUQUE IA 620D1 Ineuranri~ Lo. Nsme In^.uranGa Policy iD License plate R Slala Year STATE FARM MUTUAL 082855BE1715 7d2AYC IA 2009 VIN No. Year Mske Model slyta Tow# Approximate Coal to 2 FA1=P73W3XX140196 1999 Ford • FORD GROWN VICTORIA 4 DR NO ~ Repair or Roplace Initial Travel vehicle speed Point of Mott Dsmsgad Extant of Undarrldel Priva[e? Direction Action 12 Llmll 25 Initlallmpacl 05 Area 06 Damage 2 Ovarrlde 1 ^ $500,00 Tolsl Traffic Vohide Cargo 9otYy vehicle Driver vislon• ConlrSbuling Circumalancas, Occupsnla q Cenlrole 01 Gonfig. 01 1YPe 01 Derecl 01 Condhlon DDaculed Driver (up to two) 28 SEUUENCE OF EVENTS Fir.-t Evanl 21 Sarnnd Event Third Event Fourth Evan1 Mast Harmul Event (by vehicle) 21 Cori,inarcisl Trsiler Attached to Slate Year Attsched to Slate Year Emergency Emergency License Plalcir Po~rai Unil: TrailorUni(: Vehicle Type 1 Stalu¢ 3 CairierNsme Atltlr6aa CiIY Stale Zip u3 DOT # ar MC # Number of Groes vehlele - Placard 8 Hazardous Mslerlela Axles Welghl Reling Relassed7 ACCIUEN7 ENVIRONMENT ROADWAY CHAF7ACTERISTICS WORKZONE RELATED9 SEQUENCE OF"EVENTS Msjor Conlribuling Clrcumslencea: No Location of FirCt Hsrrntul Event d Wealhar Conditions Environment 2 Locallon Flral Harmful Evcnl of Crrh Manner of CreshlGollision 7 (up to two) p3 Reedway 02 TYPa (uea codes 11-42 only) 1y Ught Condillona d Surface Londilicns 3 Type or Roadway JuncllonlFealure 01' Workers Present? SAMUEL ST D 0 I A I G 1 u - R A M 1 ~2 P IVATE bRIVEWAY 3 J SOUTHERN AVE NARRATIVE Describe what happened (refer to vehiclae by number UNIT 1, A SNOW PLOW, WAS TRAVELING NORTHBOUND ON SAMUEL STREET FRAM THE INTERSECTION WITH SOUTHERN AVENUE WHEN IT SLID BACKWARDS ON THE ICE AND COLLIDED WITH UNITS 2 AND 3 WHICH WERE PARKED LEGALLY IN A PRIVATE DRIVEWAY, Otlicer sedge No. Time Officer Notified of Accident T(ma Officer Arrived At scene BOWERS JAMIE a D6;16 Hra: OS;22 Hre. Neme o1 Agency Dale of Repon Inyesllgalion T.I, !L Dubuque Pollee De artment 0 110 4110 0 9 made al scene? R ev ed dY. ~r~~ Osle vie ©`~ Agency Speei(c Olhcrr Technical Invesligsllon Agency Pfntad At: Dubuque Police Depdrlmen(01lO5f2009 12:56 AM Page 2 Form #: 01-09-D008J 01/06/2009 at 01:50 PM 24443 ABRA - DUBUQUE Federal ID #:420782245 DBA: ANDERSON-WEBER INC 3400 CENTER GROVE DR DUBUQUE, IA 52003 (563)556-0696 Fax: (563)556-1899 PRELIMINARY ESTIMATE Written By: DAVE BIGELOW #24443 Adjuster: Insured: GINA SEELING Owner: GINA SEELING Address: 23078 CENTERVILLE RD LA MOTTE, IA 52054 Evening: (563)581-8088 Inspect ABRA - DUBUQUE Location: 3400 CENTER GROVE DR DUBUQUE, IA 52003 Insurance PUBLIC ENTITY Company: Claim # Policy # Deductible: Date of Loss Type of Loss: Point of I~act Job Number: 6. Rear Business: (563)556-0696 Days to Repair 2005 HOND ACCORD LX 4-2.4L-FI 4D SED SILVER Int: VIN: 1HGCM56445A170051 Lic: Prod Date: Odometer: 49769 Air Conditioning Rear Defogger Tilt Wheel Cruise Control Telescopic Wheel Inter mittent Wipers Keyless Entry Steering Wheel Controls Body Side Moldings Dual Mirrors Console/Storage Clear Coat Paint Power Steering Power Brakes Power Windows Power Locks Power Mirrors Power Trunk/Tailgate AM Radio FM Radio Stere o Search/Seek CD Player Anti- Lock Brakes (4) Driver Air Bag Passenger Air Bag Front Side Impact Air Bag Cloth Seats Bucket Seats Autom atic Transmission Overdrive Full Wheel Covers - --------------- ---------------- NO. OP. -------------------------------- DESCRIPTION ---- QTY ------- EXT. PR - - - --- ICE LABOR PAINT ------------------- ---------------- 1 -------------------------------- REAR BUMPER ---- --- - - - 2** Repl RECOND Bumper cover 1 274.00 1.2 3.0 3 Add for Clear Coat 0 0.00 0.0 1.2 4 TRUNK LID 5* Rpr Trunk lid 0 0.00 2.0 2.3 6 Add for Clear Coat 0 0.00 0.0 0.9 7 Repl Emblem "H" factory installed 1 16.58 0.2 0.0 8 Repl Nameplate "Accord" factory 1 15.70 0.2 0.0 installed 9 REAR LAMPS 10 R&I LT Tail lamp 0 0.00 0.3 0.0 1 .. 01/06/2009 at 01:50 PM 24443 Job Number: PRELIMINARY ESTIMATE 2005 HOND ACCORD LX 4-2.4L-FI 4D SED SILVER Int: --------- NO. ------- OP. ------------------------------- DESCRIPTION --------------- QTY EXT. PRICE --------- LABOR ------ -------- PAINT -------- --------- 11 ------- R&I ------------------------------- LT Turn & stop lamp ------ 0 ------- 0.00 -- --- 0.4 0.0 12 R&I RT Tail lamp 0 0.00 0.3 0.0 13 QUARTER PANEL 14* Rpr LT Quarter panel USA & Mex blt 0 0.00 3.0 2.8 15 Overlap Major Adj. Panel 0 0.00 0.0 -0.4 16 Add for Clear Coat 0 0.00 0.0 0.5 17# Subl BAG / COVER CAR 1 10.00 0.0 0.0 18# Subl HAZARDOUS WASTE DISPOSAL 1 4.00 T 0.0 0.0 19# Subl CORRISON PROTECTION 1 10.00 T 0.0 0.0 --------- ------- ------------------------------- Subtotals =_> ------ ------- 330.28 -- --------- 7.6 -------- 10.3 Parts 316.28 Body Labor 7.6 hrs @ $ 52.00/hr 395.20 Paint Labor 10.3 hrs @ $ 52.00/hr 535.60 Paint Supplies 10.3 hrs @ $ 33.00/hr 339.90 Sublet/Misc. 14.00 -------------------- SUBTOTAL ------ ------- -- --------- $ -------- 1600.98 Sales Tax $ 1261.08 @ 7.0000 88.28 GRAND TOTAL $ 1689.26 ADJUSTMENTS: Deductible 0.00 ---------------------------------------------------- CUSTOMER PAY $ 0.00 INSURANCE PAY $ 1689.26 WARRANTY VALID ONLY WITH ORIGIONAL COPY OF YOUR RECEIPT PARTS SUBJECT TO INVOICE NO GUARANTEE ON RUST ALL PARTS NEW, UNLESS OTHERWISE NOTED WARRANTY VALID ONLY WITH ORIGIONAL COPY OF RECEIPT. PARTS SUBJECT TO INVOICE. NO GUARANTEES ON RUST. ALL PARTS NEW, UNLESS OTHERWISE SPECIFIED. 2 01/06/2009 at 01:50 PM 24443 Job Number: PRELIMINARY ESTIMATE 2005 HOND ACCORD LX 4-2.4L-FI 4D SED SILVER Int: Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from the Guide ARG4437, CCC Data Date 12/01/2008, and the parts selected are OEM-parts manufactured by the vehicles Original Equipment Manufacturer. OEM parts are available at OE/Vehicle dealerships. OPT OEM (Optional OEM) or ALT OEM (Alternative OEM) parts are OEM parts that may be provided by or through alternate sources other than the OEM vehicle dealerships. OPT OEM or ALT OEM parts may reflect some specific, special, or unique pricing or discount. OPT OEM or ALT OEM parts may include "Blemished" parts provided by OEM's through OEM vehicle dealerships. Asterisk (*) or Double Asterisk (**) indicates that the parts and/or labor information provided by MOTOR may have been modified or may have come from an alternate data source. Tilde sign (-) items indicate MOTOR Not-Included Labor operations. Non-Original Equipment Manufacturer aftermarket parts are described as AM, Qual Repl Parts or Comp Repl Parts which stands for Competitive Replacement Parts. Used parts are described as LKQ, Qual Recy Parts, RCY, or USED. Reconditioned parts are described as Recond. Recored parts are described as Recore. NAGS Part Numbers and Benchmark Prices are provided by National Auto Glass Specifications. Labor operation times listed on the line with the NAGS information are MOTOR suggested labor operation times. NAGS labor operation times are not included. Pound sign (#) items indicate manual entries. Some 2009 vehicles contain minor changes from the previous year. For those vehicles, prior to receiving updated data from the vehicle manufacturer, labor and parts data from the previous year may be used. The Pathways estimator has a complete list of applicable vehicles. Parts numbers and prices should be confirmed with the local dealership. CCC Pathways - A product of CCC Information Services Inc.