Claim by Mary L. VanNattaTHE CITY OF
DUB E
Masterpiece on the Mississippi
TRACEY STECKLEIN
PARALEGAL
To:
DATE:
RE:
Claimant
MEMORANDUM
~~
Mayor Roy D. Buol and
Members of the City Council
March 17, 2009
Claim Against the City of Dubuque by the Mary L. VanNatta
Date of Claim
Mary L. VanNatta
03/16/09
Date of Loss
Nature of Claim
02/25/09 Vehicle Damage
This is a claim in which claimant alleges that her vehicle was damaged when it was
struck by a large rock while the vehicle was parked in City of Dubuque Parking Lot #2,
space #22, at 9th 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
Tim Horsfield, Parking Systems Supervisor
Mary L. VanNatta
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
__
. ~~
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CLAIM AGAINST THE CITY OF DUBUQUE, IOV+~I~C~'~r~r~F
This written report constitutes your claim against the City of Dubuc(i~~ Fl(.,P uld
complete this form in full and attach any additional information that supports your c'ia7n:
+~ ~ , r
The Claim must be filed with the City Clerk at City Hall, 50 W. 13t" St., ~ c~ttb,~l/~g;~1. It
will then be referred by the City Council to the apprapria#e departm ~~=;I~e~igation.
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:
~ X30 ~~- ~ ickE yi e, ~~~~~
2. Address: ~~-5 ~ldr-~V1 ~}-1/~ ~~ X U l~ ltill
3. Telephone Number: ~0" ~ t<Dg- 3~J~O~
4. Date of Incident: /1" ~1~ - (,)C
5. Time of Incident: ~et"lt}e-2VL ~.~~ ' ~~ ~ 1~1'i"1
6. Location of Incident (Be specific}: ~~ +~ ~~~" ~ ~ r~GZr 1 nl S~(~-C~ ~~~
~ 5- ~ u h ~c.(,t:e.- ,
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.)
when
~t~ o r Cu`~cl
8. What were wea
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-~e.,~ ~c. uJ ~1e _ _l a.rcL_ d ev~-f
Q-~' ~S
Sera 1? O~n `~~ ~aSS~SQ~- (.t,~ir~ ~
r condit~ns like? Ul) Q.~n'1 ~ oS i~h V
9. Give name and address of any witnesses:
10. Did police investigate? (If so, give names of officers.)
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
~~
n
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.)
\~ e `~ - ~) ~~vY1GtA~ ~ Y~~~ ;x,00 ~ ~ h e-/y Tm i~a-(a- -fv -~61~-
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door ~ u~r~dnvt/ -` Sew ~-~l~c~..f~ a~c'l~-('DSQd
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.)
?~o
15. What amount do you claim from the City of Dubuque?
~ ~ ~ ~~ ~ 5
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 ye~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 amaunt?
Dated at Dubuque, Iowa this ~~ day of )~~~~0.-V CAL 20 ~1CT
ignature)
(Rev. 1 /00 & 7/01)
Print Name)
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LENS PAINT N PLACE
COLLISION REPAIR CENTER
3530 COUNTY HHH
KIELER, WI 53812
PHONE: 608-568-3366
"" PRELIMINARY ESTIMATE "`
RO# 1342
Owner
Owner JOHN VAN NAT7'A
Address: 245 NORTH AVE
City State Zip: DICKEYVILLE, WI 53808
Inspecticxri
Repalnti
Vehtcle
Inspection Date: 03/09!2009 10:16 AM
Primary Impact: Right Side
Appraiser Name: RYAN KIELER
City State Zip: Kieler, WI 53812
Repairer: LENS PAINT N PLACE
Address: BOX 104
3530 COUNTY HHH
City State Zip: KIELER, WI 53812
Emai I: lenspnt~pcii.net
2008 Chevrolet Impala LT 50TH Anniv 4 DR Sedan
6cyl Gasoline 3.3
4 Speed Automatic
Options
Lic.Plate:
Lic Expire:
van Irrspilt
Condition: Excellent
Ext. Color: RED JEWEL
Ext. Refinish: Thres-Stage UserDefined
Ext. Paint Code: 301N
AM/FM CD Ptayer
Aluminum/Alloy Wheels
Auto-Leveling Headlamps
Centsr Console
Dual Airbags
Emergency S.O.S. System
Head Airbags
Keyless Entry System
Lighted Entry System
Power Brakes
Power Steering
Rear Window Defroster
Sport Suspension
Theft Deterrent System
Traction Control System
XM Satellite Radio
Air Conditioning
Anti-lock Brakes
Bucket Seats
Cruise Control
Dual Power Seats
Floor Mats
Heated Front Seats
Leather Seats
MP3 Player
Power Door Locks
Power Windows
Rem Trunk-UGate Release
Strg Wheel Radio Control
Tilt Steering Wheel
Trip Computer
03/09/2009 10:15 AM
WorlcR)ay:
Home/Evening: (608)568-3368
FAX:
Inspection Type:
Secondary Impact:
Appraiser License #
FAX:
Contact: RYAN KIELER
Work/Day: (608)568-3366
Home/Evening:
FAX: (608)568-3887
Lic State: WI
VIN: 2G1 WV58K281321612
Mileage Type: Actual
Code: U4173B
Int. Color:
Int. Refinish:
Int. Trim Code:
Alarm System
Auto Headlamp Control
Cargo/Trunk Net
Daytime Running Lights
Dual Zone Auto A/C
Halogen Headlights
Intermittent Wipers
Leather Steering Wheel
OnStar System
Power Mirrors
Rear Spoiler
Remote Starter
Tachometer
Tinted Glass
Wood Interior Trim
0311 012009 1 0:03 AM Page t o/ 3
' 2008 Chevrolet Impala LT 50TH Mniv 4 DR Setlan 03!09/200910:15 AM
Claim #
Damages
Line Op Guide MC
Description
MFR.Part No.
Price
ADJ% B%
Hours
R
1 I 208 Door Shell,Front RT Repair 3.0* SM
2 L 208 Door She1l,Front RT Refinish 3.1 RF
3 RI 198 MIdg,Front Door Belt RT R & I Assembly 0.9 SM
4 RI 230 Mirror,0uter R!C RT R & I Assembly INC SM
5 E 216 Glass,Front Door T RT 10338538 GM Part $361.72 0.8 SM
6 RI 228 Handle,Front Door Otr RT R & I Assembly 0.2 SM
7 BR 414 Pnl,Rear Door Outer RT Blend Refinish 1.0 RF
8 RI 375 MIdg,Rear Door Belt RT R & I Assembly 0.2 SM
9 RI 306 Handle,RR Door Outer RT R & I Assembly 0.6 SM
10 L M14 Corrosion Protection Refinish $10.00* 0.0* RF
11 EC M17 Cover Car Exterior Replace Economy $8.00* RF
11 Items
Estimate Total 8~ Entries
Gross Parts $361.72
Other Parts $18.00
Paint Materials $143.50
Parts 8 Material Total $523.22
Tax on Parts & Material @ 5.500% $28.78
Labor Rate Replace Hrs Repair Hrs Total Hrs
Sheet Metal (SM) $55.00 2.7 3.0 5.7 $313.50
MechlElec (ME) $69.00
Frame (FR) $69.00
Refinish (RF) $55.00 4.1 4.1 $225.50
Paint Materials $35.D0
Labor Total 9.8 Hours $539.00
Tax on Labor @ 5.500% $29.65
Gross Total $1,120.65
Net Total $1,120.65
Alternate Parts Yi00/00/00/00!00 CUM 00/00!00/00100 Zip Code: 53812 Audatex Host
SPPL Yes Zip Code: 53812 Default
Audatex Estimating 5.0.623 ES 03H0/2009 10:03 AM REL 5.0.623 DT 02!0112009 DB 03/08/2009
Copyright (C) 2008 Audatex North America, inc.
1.0 HRS WERE ADDED TO THIS ESTIMATE BASED ON AUDATEX'3 THREE-STAGE REFINISH FORMULA.
USER DEFINED THREESTAGE EXT. THRESHOLD OF 1.0 HRS WAS CALCULATED IN THIS ESTIMATE.
Op Codes
* =User-Entered Value E =Replace OEM NG = Replace NAGS
EC =Replace Economy OE = Replace PXN OE Srpls UE =Replace OE Surplus
ET = Partiaf Replace Labor EP =Replace PXN EU =Replace RecyGed
TE =Partial Replace Price PM= Replace PXN RemaNReblt UM= Replace Raman/Rebuilt
L =Refinish PC = Replace PXN Reconditioned UC =Replace Reconditioned
TT =Two-Tone SB =Sublet Repair N =Additional Labor
BR = Blend Refinish I =Repair IT =Partial Repair
CG= Chipguard RI = R & I Assembly P =Check
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03110/200910:03 AM Page 2 of 3