Claim by Carolyn CallahanTHE CITY OF
DuB E
Masterpiece on the Mississippi
MEMORANDUM
TRACEY STECKLEIN
PARALEGAL I~"
To: Mayor Roy D. Buol and
Members of the City Council
DATE:
RE:
Claimant
February 4, 2009
Claim Against the City of Dubuque by the Carolyn Callahan
Date of Claim
Carolyn Callahan
01 /30/09
Date of Loss
Nature of Claim
01/28/09 Vehicle Damage
This is a claim in which claimant alleges that her vehicle was struck by a bus as she
was parked on a side street near Hoover School.
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
Jon Rodocker, Transit Manager
Carolyn Callahan
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
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
ext t of dama e.)
13. What other damages do you claim, if any?
l ~`~~
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.)
/ZU __
15. WlIhat amLount d^o~/JVOU~cIa/i/m from the City of Dubuque?
16.~Why do you laim the City of Dub/uque is responsible?
%i~i, . ~ 1i; ~;>.~ Iii/~ /1l ,- Jig .-.',-;-,2.~ /l, i ~~
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?
Date~f this J~~ day of ~_ /7LrG r
Sigmatu ) .~
(Print N me)
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1.
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: .~ ~ ~~ ~ ' ) ~l G'/l ~
2
2. Address: 'J ~~ ~~ ~'%,~' ~ ~ ~ a'~' j ~ .5~0 L
3. Telephone Number ~;~ ' ~~~G
4. Date of Incident: l ~ ~ ~ 7
U
5. Time of Incident: ~ ~ ~v
6 ocation of I ident (B specific):
~t 1 r' - .~..1? D~~
8 What were weather conditions like? /~ /'
/J ~G ~ ~C~~L ~/~ ~~J ~1/l ~' 6l fit ~~
~~ G`/i_°
9. Give nam and ress of y 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 bast your claim. If a City employee was involved, give
Damage Assessed Bye john klotz
Deductible 0.00
Claim Number 6985
BIRD CHEVROLET
3255 UNIVERSITY AVE, DUBUQUE, IA 52001
(563)583-9121
Fax (563) 556-4482
Tax ID~ 42-0400210
Insured= CAROLIN CAT.T.AHAN
Address 3424 CRESTWOOD, DUBUQUE, IA 52002
Telephone Home Phone (563) 588-0790
Mitchell Service 918497
Description 2003 Chevrolet Impala LS
Body Style 4D Sed
VIN 2G1WH52K639155735
Options= ALUM/ALLOY WHEELS, CRUISE CONTROL
Line Entry Labor
Item Number Type
1 800881 BDY
2 AUTO REF
3 800899 BDY
4 800915 BDY
5
6 803305 BDY
7 801912 BDY
8 AUTO REF
9 800963 BDY
10 803315 BDY
11 AUTO REF
12 801067 BDY
13 801077 BDY
14
15 801091 BDY
16 802413 BDY
17 AUTO REF
18 802083 BDY
19 801338 GLS
20 801543 BDY
21 801577 BDY
22 AUTO REF
23 933019 BDY
24 AUTO
25 AUTO
Date 1/28/2009 02.22 PM
Estimate ID~ 6985
Estimate Version= 0
Preliminary
Profile ID~ Mitchell
Drive Train 3.8L Inj 6 Cy14A FWD
Line Item Part Type/
Operation Description Part Number
REPAIR L FRT DOOR SHELL Existing
REFINISH L FRT DOOR OUTSIDE
REMOVE/INSTALL L FRT OTR BELT MOULDING
REMOVE/INSTALL L FRT DOOR ADHESIVE MOULDING Existing
R&R Time Used in R&I Operation
REMOVE/R.EPLACE
REMOVE/R.EPLACE
REFINISH
REMOVEQNSTALL
REPAIR
REFINISH
REMOVE/INSTALL
REMOVE/INSTALL
REMOVE/INSTALL
REPAIR
REFINISH
REMOVE/REPLACE
REMOVE/INSTALL
REMOVE/INSTALL
REMOVE/INSTALL
ADD'L OPR
ADD'L OPR
ADD'L COST
ADD'L COST
Dollar Labor
Amount Units
1.0*#
C 2.1
1.0 #
0.2
0.2
INC #
C 0.5
0.3 #
0.5*
C 1.8
0.7 #
0.2
L FRT DOOR ADHESIVE NAMEPLATE 10427321 GM PART 25.97
L FRT DOOR REAR VIEW MIRROR 10331492 GM PART 168.50
L FRT DOOR MIRROR
L FRT OTR DOOR HANDLE
L REAR DOOR SHELL Existing
L REAR DOOR OUTSIDE
L REAR OTR BELT MOULDING
L REAR DOOR ADHESIVE MOULDING Existing
R&R Time Used in R&I Operation
L REAR OTR DOOR HANDLE
L SIDE BODY PANEL ASSEMBLY -S Existing
L SIDE BODY PANEL COMPLETE
L QUARTER ADHESIVE EMBLEM 10424491 GM PART
L QUARTER GLASS
L REAR COMBINATION LAMP
REAR BUMPER ASSY
CLEAR COAT
TAPED STRIPE
PAINT/MATERIALS
HAZARDOUS WASTE DISPOSAL
ESTIMATE RECALL NUMBER 01/28/2009 14.2250 6985
Mitchell Data Version DEC_08_A U1traMate is a Trademark of Mitchell International
Copyright (C) 1994 - 2008 Mitchell International
Ul~Mate Version- 6.7.018 All Rights Reserved
0.3 #
0.5*#
C 5.1 #
32.00 0.2
2.0 #
0.3
0.5*
2.3
18.00 * 0.3*
413.00
6.00 *
Page 1 of 2
Date: 1/28!2009 02:22 PM
Estimate ID: 6985
' Estimate Version: 0
Preliminary
~ X Profile ID: Mitchell
* -Judgment Item
# -Labor Note Applies
C -Included in Clear Coat Calc
Estimate Totals
Add'1
Labor Sublet
I. Labor Subtotals Units Rate Amount Amount Totals II. Part Replacement Summary Amount
Body 6.2 55.00 18.00 0.00 359.00 T Taxable Parts 226.47
Refinish 11.8 55.00 0.00 0.00 649.00 T Sales Tax (~3 7.000% 15.85
Glass 2.0 58.00 0.00 0.00 116.00 T
Total Replacement Parts Amount 242.32
Taxable Labor 1,124.00
Labor Tax C~3 7.000 % 78.68
Labor Summary 20.0 1,202.68
III. Additional Costa Amount IV. Adjustments Amount
Non-Taxable Costs 419.00 Insurance Deductible 0.00
Total Additional Costa ~ 419.00 Customer Responsibility 0.00
I. Total Labor: 1,202.68
II. Total Replacement Parts: 242.32
III. Total Additional Costs: 419.00
Gmsa Total: 1,864.00
N. Total Adjustments: 0.00
Net Total: 1,864.00
This is a preliminary estimate.
Additional chances to the estimate may be required for the actual repair.
ESTIMATE RECALL NUMBER: 01/28/2009 14:22:50 6985
Mitchell Data Version: DEC_08 A U1traMate is a Trademark of Mitchell International
Copyright CC) 1994 - 2008 Mitchell International Page 2 of 2
U1traMate Veraion~ 6.7.018 All Rights Reserved