Claim by Charlotte Hansen 02_19_09THE CTTY OF
DUB E
Masterpiece on the Mississippi
TRACEY STECKLEIN
PARALEGAL
MEMORANDUM
To: Mayor Roy D. Buol and
Members of the City Council
DATE: February 21, 2009
RE: Claim Against the City of Dubuque by the Charlotte Hansen
Claimant Date of Claim Date of Loss Nature of Claim
Charlotte Hansen 02/19/09 02/13/09 Vehicle Damage
This is a claim in which claimant alleges that a City of Dubuque snowplow truck struck
her vehicle while it was parked in front of 1844 Atlantic 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
Charlotte Hansen
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 tsteckle@cityofdubuque.org
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 W. 13t" 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: ~ ~.~v~'u, G~~` ,~-~ 7~~ c~~'~,~1-~,~~~-
2. Address: ``3 ry ,Q-° ~. ~ -~.~` ~~.-e, ~-~ ~,.:~'~
3. Telephone Number: _-?~~~ ~- s T~-t '1 l~ _3 _4' `~ ~3 f ~-~ ~ ~'s'
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4. Date of Incident: '~~~ , / "?, ~~ c/~. % i~ ~/ ~ '~ c~;~ ~~~~i t°
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5. Time of Incident: ~~~ ~.~„~;~~~ .~/("'~~~1~-
6. Location of Incident (Be specific):
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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.) , .~
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10. Did police investigate? (If so, give names of officers.)
11. Was anyone injurred? (If so, give names, addresses, and extent of injuries).
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8. What were weather conditions like? ~ ,..,~, - ~:~~, ~ ~- ~~
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9. Give name and address of any witnesses: `~~~ v' Y~X ,~V1 c~ < ~ ~ ~ ~.-(~~~~~ ~~ i°`"c,~ i^ ~ 1 1~i
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 name and address of insurance company and amount paid.)
,,,
1~. What amount do you c~ 'm from the City of Dubuque?
16. Why do you claim the City of Dubuque is responsible? ~_ ~ ,ti,7 _ . ~~,~,_ __ ,i
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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.)
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 at Dubuque, Iowa this day of ~ `.~~~- 20 ~ ~ ~_ cJ ,:~
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)ODGE OF DUBUQUE, LLC
~ 0 KENI~: FLY RD
3UQUE, Ir. 52001
781 Fa::: ( 563) 556-6:_ 28
PRELIMINARY ESTIMATE
Written By: TEi'.RY FORTMANN
Adjuster:
Insured: CHARLOTTE HANSEN
Owner: CHARLOTTE HANSEN
Address:
Day:
Evening:
Insp®ct
Location:
Insur~~c~
Company:
Claim #
Policy #
Deductible:
Date of Loss:
Type of Loss:
Point of Impact:
r~
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~
0
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c. ~ TI
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?QOl 4LbS ALF~RO ~~, 9-2. 9L-F'1 9D SED 3::~• ;
VxXJ: 1~3NL,52r1'01-C1~i7949 ~,ics Prod Date: oddttt~tar:
Air Cond~.tiCninc~ Rehr befCg~r,-:° 'l'ilt t~il;F~:•
G~°t~5.se Conl:rol lntermittor}c= ,diE~ers _~:eyl,~~ :;_t~_L.,.°
DUaI Mirrors Console/Stc,~=~-1 '" Tra~tic~f 'r~t~`~ ,1
Clear Coat Paint Power St•ee1= ii:~ -'owes E ~: , :c
Power Windows Power hocks . ,_~
:'ow_r ~,~_
Power Trunlc/Tailgate AM Radio _
rI.1 Rad~ •
Stereo Search/See}: ~~D Pla~-~~r
Anti-Lock Brakes (4) Driver Air ?~.:~ Pass~_nc~~r ,-_i~- ;~-~~
4 Wheel Disc Brakes Cloth Seat; P,uck:at ~~=its
Recline/Lounge Seats Automatic T~a~s.mission Overdri•~_
Full Wheel Covers
NO. OP. DESCRIPTION ~~,". ~ -----
, ~ ~ „I~ i, ~;,~ -----------
PAT:;
------------
1 FENDER -----------
2* Rpr LT Fender _ L
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3 Add for Clear Coat .
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4 FRONT DOOR
5 * Rpr LT Door shel l - - ., -,
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6 Overlap Major Adj. Panel -- .
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7 Add for Clear Coat
8 Repl LT Body side mldg i ~~ ~;~, _ ~
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9 Add for Clear Coat .
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10 Repl LT Mirror asst' w/ele~•-_~ _ i ;7
5; ,
,
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11 Add for Clear Coat .
~
12 REAR DOOR -
13* Rpr LT Door shell to 12/1 iC - -, ,
14 Overlap Major Adj . P;:~ '~ ----- -
~=J~IN TERRY FORTMArtN
L7l7~7G- 13orly Shop Alnt+nger
Of DUbuyue 90 Ka,vreenrRn ~ Dcer(~c'4IA52(XI2
(563) 583-5781
02/16/2009 at 10:27 AM
94524
TURPIN DODGE OF DUBUQUE, LLC
90 KENI~:EDY RD
DUBUQUE, IY 52001
(563)583-5781 Fa::: (563)556-6=28
PRELIMINARL ESTIMATE
Written By: TEF.R`l FORTMANN
Adjuster:
Insur~,d: CHARLOTTE HANSEN
Owner: CHARLOTTE HANSEN
Addr®ssz
Day'
Evening:
Claim #
Policy #
Deductible:
Date of Loss:
Type of Loss:
Point of Impact:
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2001 ®LD~S ALER® CL 4®2.4L~R~'T 4D SED ~;'?`:
,Job .. _..;•b~_ _ .
DU,/~ k~ ~;EI~~I~.`.
i~IN: 1~3NL~2T01C187449 L~.c: P~°od Date: Oclomc~te~°:
A~.r Coz~di~;~.oz~i~~g Rear Defo€~frt~° ril€ (Ji.E- F;,'_
Cruise Cot°itx`ol ~rlterntittet~t~ `rV1Z~ers :•~eyl~~t, _ ~t_i.=~,
~~ral Mirrors Console/Stc>~--„-IR:, 'Prac'_ici~. ~•~.,:~~:-,~l
Clear Coat Paint Power Steep _;; _t ~vwe_ F,- , s
Power Windows Power Locks _'owez~ [~t_ ? ~,z-s
Power Trunk/Tailgate AM Radio ~~~1 Fadi
Stereo Search/Seep: ~D Plal-:' z
Anti °L,ock Brakes ( 4 ) Driver Air ?~~-, ~ Pass Inc ~~ =~ ~- Bag
4 Wheel Disc Brakes Cloth Seats Bucket t; ~~aCs
Recline/Lounge Seats Automatic Transmission Overdri~ ~
Full Wheel Covers
NO. OP. DESCRIPTION '"
QTY m a~~
E.•;_ . ~ i,ICi~; .,--~
a.~O
PAI~I'P
1 ---
FENDER ------- ------- --------
2* Rpr LT Fender
- -,
L ~,
3 Add for Clear Coat -- 0,
4 FRONT DOOR
5* Rpr LT Door shell ~ 2 ~
6 Overlap Major Adj. Panel _0 ;,
7 Add for Clear Coat ~,~:
8 Repl LT Body side mldg "! J7
:?1 0
7
9 Add for Clear Coat . ... ~ .
~, ,
10 Repl LT Mirror assy w/elee~~~ic _ L)~•53 ,,J
11 Add for Clear Coat ~ ,`
12 REAR DOOR
13* Rpr LT Door shell to 12/=1r~J0 ~~ - ~
;.
14 Overlap Major Adj. Pan •
_n.;
02/16/2009 at 10:27 AM
94524 ~?o_ ..-.._ . _ .
PRELIMINAR~f iSTIMATE
2001 OLDS ALERO GL _ ,-FI ~ O SE_ Ir.
-------
--- __ _
----
DESCRIPTION -,~ • - -----
---~5------
------ -
_. -
Add for Clear Coat -------------
16 REAR BUMPER ~•
17* Rpr Bumper cover
-18 Add for Clear Coat = =-~~
19# FRONT END ALIGNMENT =-~'
20# CAR COVER - - --
HAZARDOUS WASTE - J•'~~. r
---21#--------------------------------- -~ .,.~..
Subto, ~ --------------- __----------
Parts
Body Labor _
-.E ~~irs ~~ --•7
s
-
Paint Labor _
„
~_'B.0
~~
Mechanical
. ...1 t~r~ ~: ~~ ~~•
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Paint Supp . 1 . ~ hr~ C y- _ . 5
Sublet/Miss. --- ~ , _
SU~iTOTA, - . _ _ - -- _. _
Sales T~i~.
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1
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,
...:.. ... .
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A D~J` U S'I'Ni ~; i~1 `1' ;
Deduct~b
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----_--
CUSTOMER Pr. --_
INSURANCE ? .
~,
02/16/2009 at 10:27 AM
94524
PRELIMINAF'! c:STIMATE
2001 OLDS ALERO GL _ ::~-FI 4D 5E-~ Int
Estimate based on MOTOR CRASH ESTIMATING GUIDE. ;s otf~•s~>>e -
-
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