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Claim by John and Angela Oberfoell May 26, 2009 MS JEANNE SCHNEIDER, CITY CLERK CITY HALL-CITY CLERK'S OFFICE 50 WEST 13TH STREET DUBUQUE, IA 52001 Your Claim Number: unknown Your Insured: City of Dubuque Our Claim Number: 7214200433270115200901 Our Insured: John and Angela Oberfoell Dear Claims, / % ~~%~ ,, ~'' ~ ~j~i~ !~~ ~~ l J `'~ rr c ~ -c .~~ c _ -~` ~ T-! ~C ~ ~... iTi : D - ..~ Enclosed are the supporting documents for this subrogation claim. The total amount of our claim is $1897.91. This amount includes our insured's deductible of $500.00. We will reimburse our insured their deductible upon receipt of your payment. Our investigation has determined that your insured is 100% liable. Please review the referenced materials and call me at the number provided with any questions you may have. Thank you for your prompt attention to this matter. Otherwise, I will expect payment of our claim within 20 days. Thank you for your assistance. Sincerely, _ ~~~~,,~~ , Jeanette Plascencia Recovery Representative Allied Property and Casualty Insurance 1100 Locust ST Dept. 2019 Des Moines IA 50391-2019 515-508-5143 Fax 866-313-0537 plascej @nationwide.com 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.) ~, U~ T t~~~~~~~ i1 fb ~~ l~ti r s Qua li-~~'~- 13. What other damages do you claim, if any? L.U'l,k-etc x.%1'1 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.) 15. What amount do you claim from the City of Dubuque? ~ ~~ X97.91 Gu~cZ ~~ ~ ~ .~ ~,Q ~ ~. ~ ~~7 ~! ~ `_~~~_.~_ 16. Why ~o you claim the City f Dubuq a is responsible? _ 17. Hive 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? Dated at Dubuque, Iowa this a~ day of 20 ~c . C~~~~. E~~12~g" nature 7~~~f~Uy 337 ~ ~ S~cf~ (Print Name) (Rev. 1 /00 & 7/01) o ~ ~ti o ~ ,~ ° c ~ ~ ~ ~ rn ° ~ oO~W ~ ~ r y ~ coOU Q N y ca~~oo •~ M ~ ~ ¢ N ~ G 00 a p Q Q L~, c ,~ ¢' ~ ~ ~ o N ~ ^" N y ~ N .fl y ~ A C ~ Q" ~+ . ~oa.iw U , x ,~ ~ a ~o~ s :: u ~ee U ~o U ~, C ~ O ^I ~ N ~' Q °° v ,~ ~ ~; ~ a~°° U °' ~ 8 A E-1 Q ~-y ~ y ti O 44~ "" O y a> ~--i O W N O ~ ~ ~ N O M ~" N r1 ¢ bq O .--. Q' N O ~ (V tom. y N ,__, O 4-i s. N ~ L .O x~~ e~~ .~ .., •~ Uo:U 0 0 0 0 N W A H N O U Ol O N O M O N O M O d' O H O ~ N .-i w Q ~ H .-1 a a a a 0 0 0 0 0 U U U U U rn rn 0 0 0 0 N N a I I N Ol M N ~ O I I F ~n ri V1 0 0 TJ S-1 S-I S-I N v ~ ~ ~ x x x w ro ro ro ,~ x m oa m ~ W ~ b b ~ ro ro ro ~ H ^ ^ ^ h f N O~ N N (`'1 I~ r yk O M f~7 M O ~ M Q~ .11. N lD f`1 N U m m m m W o 0 0 0 .~C o 0 0 0 U o 0 0 0 rn rn m rn 0 0 0 0 0 0 0 0 N N N N N .-~ Ol M W N O e-V .i I I I I N ul M M Q O O O O 6~ .-i N N M 01 N ~ M I~ C d' OD Ol r-I rl N M .~ rl r-1 ri ri w a ~ ~ ~ ~ N a~ an f~ a Q O O (V N H 04/24/2009 AT 09:26 AM JOB NUMBER: 10924 24443 ABRA - DUBUQUE FEDERAL ID #:420782245 DBA: ANDERSON-WEBER INC 3400 CENTER GROVE DR DUBUQUE, IA 52003 (563)556-0696 FAX: (563)556-1899 SUPPLEMENT OF RECORD 6 WITH SUMMARY WRITTEN BY: RICK KELLY 04/24/2009 09:26 AM ADJUSTER: ADJUSTER UNKNOWN (800)532-1212 ASSIGNMENT TYPE: 75 INSPECT AND REPAIR INSURED: ANGIE OBERFOELL OWNER: ANGIE OBERFOELL ADDRESS: 1515 CERRO DR DUBUQUE, IA 52001 EVENING: (563)583-5083 CLAIM #72142004332701150901J/O11 POLICY #721420043327 DEDUCTIBLE: $500.00 DATE OF LOSS: 01/15/2009 AT 09:30 PM TYPE OF LOSS: COLLISION POINT OF IMPACT: 12. FRONT INSPECT ABRA - DUBUQUE LOCATION: 3400 CENTER GROVE DR DUBUQUE, IA 52003 INSURANCE NATIONWIDE ENTERPRISE COMPANY: 1100 LOCUST ST DES MOINES, IA 50391 BUSINESS: (563)556-0696 BUSINESS: (800)532-1212 DAYS TO REPAIR 2003 TOYO CAMRY LE 4-2.4L-FI 4D SED BLACK INT:GREY VIN: 4T1BE32K93U212141 LIC: 530REP IA PROD DATE: 04/2003 ODOMETER: 72821 5 SPEED TRANSMISSION OVERDRIVE BUCKET SEATS CLOTH SEATS RECLINING SEATS POWER STEERING TILT WHEEL POWER BRAKES REAR DEFOGGER POWER WINDOWS FULL WHEEL COVERS AM RADIO FM RADIO STEREO CASSETTE SEARCH/SEEK CD PLAYER POWER LOCKS AIR CONDITIONING CRUISE CONTROL DRIVER AIR BAG PASSENGER AIR BAG CONSOLE/STORAGE INTERMITTENT WIPERS POWER MIRRORS DUAL MIRRORS BODY SIDE MOLDINGS CLEAR COAT PAINT NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT 1# RENTAL 8.5 X 1.5= 12.8 / 1 8 = 2 DAYS 2# 3# 4 FRONT BUMPER 5 O/H BUMPER ASSY 1.9 N 6* RPR BUMPER COVER US BUILT W/O FOG 3.0* 2.6 LAMP 7 ADD FOR CLEAR COAT 1.0 N 8# SUBL 4 WHEEL ALIGNMENT 1 64.95 T 1 04/24/2009 AT 09:26 AM 24443 JOB NUMBER: 10924 SUPPLEMENT OF RECORD 6 WITH SUMMARY 2003 TOYO CAMRY LE 4-2.4L-FI 4D SED BLACK INT:GREY ------- NO. --- ------------------------------------- OP. DESCRIPTION -------------------------------- QTY EXT. PRICE LABOR PAINT 9# SUBL LKQ HAZARDOUS WASTE DISPOSAL 1 4.00 10 SOl QUARTER PANEL 11* SO1 RPR RT QUARTER PANEL 2.5* 2.4 12 SO1 ADD FOR CLEAR COAT 1.0 13 SO1 REAR LAMPS 14 SO1 R&I RT COMBO LAMP ASSY 0.4 15 S03 REAR BUMPER N 16** S03 REPL QUAL REPL PARTS BUMPER COVER 1 211.00* 1.5 3.0 US BUILT B70% 17 S03 ADD FOR CLEAR COAT 1.2 18 S03 FRONT LAMPS 19 S03 REPL LT REPAIR BRACKET 1 12.23 0.4 20# S04 PROPERLY EXECUTED REPAIR 1 AUTHORIZATION AND 21# S04 DIRECTION TO PAY SECURED AND 1 IN SHOP FILE 22# S04 THIS IS FINAL BILL 1 X 23# S05 REFN CLEAR COAT REDUCTION -0.7 24 S06 REAR SUSPENSION N 25 S06 REPL RT RR LATERAL ARM 1 135.90 M 1.0 M N 26# S06 SUBL 4 WHEEL ALIGNMENT 1 64.95 T 27# S06 PROPERLY EXECUTED REPAIR 1 AUTHORIZATION AND 28# S06 DIRECTION TO PAY SECURED AND 1 IN SHOP FILE 29# S06 THIS IS FINAL BILL 1 X 30# 506 SEE NOTES 1 SUBTOTALS =_> 493.03 10.7 10.5 LINE 6 DAMAGE TO THE LOWER RF AND LF. ALSO THERE IS DAMAGE TO THE LT UPPER PART OF THE BUMPER. LINE 8 CUSTOMER RAN OVER A POLE LINE 16 CUSTOMER ELECTED TO HAVE BUMPER REPLACED INSTEAD OF REPAIRING. TOOK BETTERMENT TO COVER DIFFERENCE IN COS T OF BUMPER LINE 25 CUSTOMER CAME BACK COMPLAING OF IT NO T DRIVING STRAIGHT. THE REAR END WAS ALL OVER THE PLAVE. THE ARM BROKE. IT GOT BENT FROM THE ACCIDENT AND BROKE BECAUSE ITS UNDER PRESSURE WHEN DRIVING. LINE 26 2ND ALIGN AFTER THE ARM WAS REPLACED. 2 04/24/2009 AT 09:26 AM 24443 JOB NUMBER: 10924 SUPPLEMENT OF RECORD 6 WITH SUMMARY 2003 TOYO CAMRY LE 4-2.4L-FI 4D SED BLACK INT:GREY ESTIMATE NOTES: CUSTOMER BROUGHT VEHICLE IN AT TIME OF REPAIR. SHE INDICATED SHE WENT THROUGH DITCH AND BARB WIRE DURING ACCIDENT AND TALKED WITH NATIONWIDE ABOUT DAMAGE TO REAR OF VEHICLE RICK, SINCE VEHICLE WENT THROUGH THE DITCH WE WILL RELATE, THANKS. THANK YOU, MIKE RISDAL MD CLAIMS MANAGER - BRRP ALLIED INSURANCE 1100 LOCUST ST. DEPT. 2016 DES MOINES, IA 50391-2016 RISDALM@NATIONWIDE.COM ALLIED INSURANCE, A NATIONWIDE COMPANY....."WE'RE ON YOUR SIDE"! PARTS 363.13 BODY LABOR 9.7 HRS @$ 52.00/HR 504.40 PAINT LABOR 10.5 HRS @$ 52.00/HR 546.00 MECHANICAL LABOR 1.0 HRS @$ 64.00/HR 64.00 PAINT SUPPLIES 10.5 HRS @$ 32.00/HR 336.00 SUBLET/MISC. 129.90 ------------------- SUBTOTAL ------- ----- --- ---------- $ -------- 1943.43 SALES TAX $ 1607. 43 @ 7.0000% 112.52 GRAND TOTAL $ 2055.95 ADJUSTMENTS: DEDUCTIBLE 500.00 QUAL REPL PARTS BUMPER CO B70% 158.04 CUSTOMER PAY $ 658.04 INSURANCE PAY $ 1397.91 WARRANTY VALID ONLY WITH ORIGIONAL COPY OF YOUR RECEIPT PARTS SUBJECT TO INVOICE NO GUARANTEE ON RUST ALL PARTS NEW, UNLESS OTHERWISE NOTED 3 04/24/2009 AT 09:26 AM 24443 JOB NUMBER: 10924 SUPPLEMENT OF RECORD 6 WITH SUMMARY 2003 TOYO CAMRY LE 4-2.4L-FI 4D SED BLACK INT:GREY THE LIMIT OF YOUR COVERAGE IS THE ACTUAL CASH VALUE OF YOUR AUTO OR ITS DAMAGED PARTS AT THE TIME OF LOSS. FAIR MARKET VALUE, AGE AND CONDITION OF YOUR DAMAGED VEHICLE WILL BE CONSIDERED WHEN DETERMINING THE ACTUAL CASH VALUE OF A LOSS. CERTAIN PARTS LOSE VALUE OR DEPRECIATE BECAUSE OF AGE, CONDITION, AND/OR WEAR AND TEAR. BETTERMENT IS THE INCREASE IN VALUE OF A VEHICLE OR ANY OF ITS PARTS AS A RESULT OF REPLACING CERTAIN PARTS DAMAGED IN A LOSS. IF THE REPLACEMENT OF CERTAIN PARTS RESULTS IN AN INCREASE IN VALUE TO YOUR VEHICLE OR ANY OF ITS PARTS, A DEDUCTION FOR BETTERMENT MAY BE MADE TO YOUR LOSS PAYMENT TO REFLECT THE ACTUAL CASH VALUE YOU ARE OWED UNDER YOUR POLICY. THIS ESTIMATE HAS BEEN PREPARED BASED ON THE USE OF AFTERMARKET CRASH PARTS SUPPLIED BY A SOURCE OTHER THAN THE MANUFACTURER OF YOUR MOTOR VEHICLE. ANY WARRANTIES APPLICABLE TO THESE REPLACEMENT PARTS ARE PROVIDED BY THE MANUFACTURER OR DISTRIBUTOR OF THESE PARTS RATHER THAN THE MANUFACTURER OF YOUR VEHICLE. WARRANTY VALID ONLY WITH ORIGIONAL COPY OF RECEIPT. PARTS SUBJECT TO INVOICE. NO GUARANTEES ON RUST. ALL PARTS NEW, UNLESS OTHERWISE SPECIFIED. ESTIMATE BASED ON MOTOR CRASH ESTIMATING GUIDE. UNLESS OTHERWISE NOTED ALL ITEMS ARE DERIVED FROM THE GUIDE ARM8521, CCC DATA DATE 03/02/2009, 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. 04/24/2009 AT 09:26 AM JOB NUMBER: 10924 24443 SUPPLEMENT OF RECORD 6 WITH SUMMARY 2003 TOYO CAMRY LE 4-2.4L-FI 4D SED BLACK INT:GREY NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT ------- ADDED ITEMS ------- 24 S06 REAR SUSPENSION N 25 S06 REPL RT RR LATERAL ARM 1 135.90 M 1.0 M N 26# S06 SUBL 4 WHEEL ALIGNMENT 1 64.95 T 27# S06 PROPERLY EXECUTED REPAIR 1 AUTHORIZATION AND 28# S06 DIRECTION TO PAY SECURED AND 1 IN SHOP FILE 29# S06 THIS IS FINAL BILL 1 X 30# S06 SEE NOTES 1 SUBTOTALS =_> 200.85 1.0 0.0 LINE 25 CUSTOMER CAME BACK COMPLAING OF IT NOT DRIVING STRAIGHT. THE REAR END WAS ALL OVER THE PLAVE. THE ARM BROKE. IT GOT BENT FROM THE ACCIDENT AND BROKE BECAUSE ITS UNDER PRESSURE WHEN DRIVING. LINE 26 2ND ALIGN AFTER THE ARM WAS REPLACED. ESTIMATE NOTES: CUSTOMER BROUGHT VEHICLE IN AT TIME OF REPAIR. SHE INDICATED SHE WENT THROUGH DITCH AND BARB WIRE DURING ACCIDENT AND TALKED WITH NATIONWIDE ABOUT DAMAGE TO REAR OF VEHICLE RICK, SINCE VEHICLE WENT THROUGH THE DITCH WE WILL RELATE, THANKS. THANK YOU, MIKE RISDAL MD CLAIMS MANAGER - BRRP ALLIED INSURANCE 1100 LOCUST ST. DEPT. 2016 DES MOINES, IA 50391-2016 RISDALM@NATIONWIDE.COM ALLIED INSURANCE, A NATIONWIDE COMPANY....."WE'RE ON YOUR SIDE"! PARTS 135.90 MECHANICAL LABOR 1.0 HRS @$ 64.00/HR 64.00 SUBLET/MISC. 64.95 SUBTOTAL $ 264.85 SALES TAX $ 264.85 @ 7.0000s 18.54 TOTAL SUPPLEMENT AMOUNT $ 283.39 5 04/24/2009 AT 09:26 AM 24443 JOB NUMBER: 10924 SUPPLEMENT OF RECORD 6 WITH SUMMARY 2003 TOYO CAMRY LE 4-2.4L-FI 4D SED BLACK INT:GREY NET COST OF SUPPLEMENT ESTIMATE 661.92 RICK KELLY SUPPLEMENT SOl 938.70 DAVE BIGELOW SUPPLEMENT S02 55.64 DAVE BIGELOW SUPPLEMENT S03 177.65 DAVE BIGELOW SUPPLEMENT S04 0.00 RICK KELLY SUPPLEMENT S05 -61.35 RICK KELLY SUPPLEMENT S06 283.39 RICK KELLY JOB TOTAL $ 2055.95 $ 283.39 CUSTOMER PAY $ 658.04 INSURANCE PAY $ 1397.91 WARRANTY VALID ONLY WITH ORIGIONAL COPY OF YOUR RECEIPT PARTS SUBJECT TO INVOICE NO GUARANTEE ON RUST ALL PARTS NEW, UNLESS OTHERWISE NOTED THE LIMIT OF YOUR COVERAGE IS THE ACTUAL CASH VALUE OF YOUR AUTO OR ITS DAMAGED PARTS AT THE TIME OF LOSS. FAIR MARKET VALUE, AGE AND CONDITION OF YOUR DAMAGED VEHICLE WILL BE CONSIDERED WHEN DETERMINING THE ACTUAL CASH VALUE OF A LOSS. CERTAIN PARTS LOSE VALUE OR DEPRECIATE BECAUSE OF AGE, CONDITION, AND/OR WEAR AND TEAR. BETTERMENT IS THE INCREASE IN VALUE OF A VEHICLE OR ANY OF ITS PARTS AS A RESULT OF REPLACING CERTAIN PARTS DAMAGED IN A LOSS. IF THE REPLACEMENT OF CERTAIN PARTS RESULTS IN AN INCREASE IN VALUE TO YOUR VEHICLE OR ANY OF ITS PARTS, A DEDUCTION FOR BETTERMENT MAY BE MADE TO YOUR LOSS PAYMENT TO REFLECT THE ACTUAL CASH VALUE YOU ARE OWED UNDER YOUR POLICY. THIS ESTIMATE HAS BEEN PREPARED BASED ON THE USE OF AFTERMARKET CRASH PARTS SUPPLIED BY A SOURCE OTHER THAN THE MANUFACTURER OF YOUR MOTOR VEHICLE. ANY WARRANTIES APPLICABLE TO THESE REPLACEMENT PARTS ARE PROVIDED BY THE MANUFACTURER OR DISTRIBUTOR OF THESE PARTS RATHER THAN THE MANUFACTURER OF YOUR VEHICLE. WARRANTY VALID ONLY WITH ORIGIONAL COPY OF RECEIPT. PARTS SUBJECT TO INVOICE. NO GUARANTEES ON RUST. ALL PARTS NEW, UNLESS OTHERWISE SPECIFIED. 6 04/24/2009 AT 09:26 AM 24443 JOB NUMBER: 10924 SUPPLEMENT OF RECORD 6 WITH SUMMARY 2003 TOYO CAMRY LE 4-2.4L-FI 4D SED BLACK INT:GREY ESTIMATE BASED ON MOTOR CRASH ESTIMATING GUIDE. UNLESS OTHERWISE NOTED ALL ITEMS ARE DERIVED FROM THE GUIDE ARM8521, CCC DATA DATE 03/02/2009, 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. 04/24/2009 AT 09:26 AM JOB NUMBER: 10924 24443 SUPPLEMENT OF RECORD 6 WITH SUMMARY 2003 TOYO CAMRY LE 4-2.4L-FI 4D SED BLACK INT:GREY ALTERNATE PARTS USAGE AFTERMARKET PARTS AFTERMARKET SELECTION METHOD: AUTOMATICALLY LIST NO. OF TIMES USER WAS NOTIFIED THAT AN AFTERMARKET PART WAS AVAILABLE: 0 NO. OF AFTERMARKET PARTS THAT APPEAR IN THE FINAL ESTIMATE: 1 OPTIONAL OEM PARTS OPTIONAL OEM SELECTION METHOD: MANUALLY LIST NO. OF TIMES USER WAS NOTIFIED THAT AN OPTIONAL OEM PART WAS AVAILABLE: 0 NO. OF OPTIONAL OEM PARTS THAT APPEAR IN THE FINAL ESTIMATE: 0 RECONDITIONED PARTS RECONDITIONED SELECTION METHOD: MANUALLY LIST NO. OF TIMES USER WAS NOTIFIED THAT A RECONDITIONED PART WAS AVAILABLE: 9 NO. OF RECONDITIONED PARTS THAT APPEAR IN THE FINAL ESTIMATE: 0 RECYCLED PARTS NO. OF TIMES USER WAS NOTIFIED THAT A RECYCLED PART WAS AVAILABLE: 9 NO. OF RECYCLED PARTS THAT APPEAR IN THE FINAL ESTIMATE: 1 8 Jan 21 09 05:O1p ~~ !~ i--~ p.l ~rA4ri5 MAIL REPORTS TO: ~OW1 ©epar#ment of Transportateon L i ew Enforcement Case Number. on reef 2AOS love DeF~~ of Trartsporial olliw of Ddver sarvicea ~~ INVESTIGATING OFFICERS REPORT 01-09-21$4 Pak Far MRII, 100 Euclid Avenue P.o. eax 9204 ~~ OF MOTOR VEHICLE ACCIDEN7~; L I eger NeniiOrt?~ M Pnvata Pro eR 7 ^ Dea Moines, bwa `•D30S-9204 e p y Date dAxident Time of Accident County q AcddeM noe'~red within corporate limits of J t Lacadan Literal Deserlption ~ 01!15109 21:36 Hrs. Dubuque - 31 Dubuque -2100 KANE ST ~ a accident occurred ouls'ide o} cdy snits " " show general vidnlty "pijA" of nearest city WA C On Road, 34eat, or Highvray! At Intarsec0at will[ A KANE "NfA" I T Note; Unless eetiderttoatured at an Inlasacllon whicFr la cOmplekly descrfied ebOVe, use the apace below to give the exact X-Coordinate: 40688539 I 100ation frcm a milepost or definable intersection, tuidgo, or railmad crossing, ruing My 3stancea and directions iF necessary. Dblance Direction Distance DireeCdfon Y-Coordinate:04709816 ~ N 500 Ft 7-W and "WA" "NIA" of 11 D1Ntlee Highway, Provide Route Milepost Number DeMable krlefxctlor4 bridge, w railroad crosskfg (Ca.-ainaq TravN Direction ^wA., Or KANE AND TINA RIDGE "WA" DlvefsName-Last First Mlddls Suffer Phone BLOCKLINGER MARK ANTHONY 563 589-4250 x Address City State Zp 3089 KANE l:T DUBUQUE IA 531101.0000 Date of Birth Drivers ucerBe Number Cifelion Chmge Code 1 Citation Crtarye 1 12f12f1958 982AA7715 Ci Ch 2 b Gender Stele Crass Endorsement s Reslrictbns n age lat Citation Chazge Cade 2 Male IA A LN NONE Citation Charge Cade 3 Citation Charge 3 AlcdhclTest DngTest Givsn7 Test Results: Given? Tsst ResuRS: Cileticn Charge Code 4 Gtalion Charge 4 1 • None 1 -None U Seating Posilion0l Injury Status 5 Cc.•upaN Proledicn9 AiNag Depitrymertt 5 .4iroag Switch Status 9 Ejectim 1 Ejedion Path 1 Trapped 1 N rnnsponoc to: Tiansparted bY: I rllA NfA . . Owners Name-Last Firal Mtdtlle Suffoc Company T R DMSION GY TY ~ OF DUEiUQUE, WA E I 001 Addnsss 1300 MAIN City DUBUQUE Slate lA ZIP 52001 Irsvrartce Co. Noma Insurance Polity 8 License Plate At Slate Year CITY OF DU@UQUE 847a0 IA 2020 VIN NO Year brake Model Style Tow# Approximate Cost td . ~FVHBXAK4SQ154973 2001 FRGT 7K NO Repair or Repleee Initial'-ravel Vehicle Speed Pan: of Mcst Damaged Extant of Underddel Privale2 ^ Dtrecdon 4 Aotbn 01 Limk 2$ InitiallmpaU 09 Area D9 Damage 2 Override 1 !I~!~ S$OO.OD Total TroRic Vehlek Cargo Body Vehicle Driver Vision Cor:1dG.Drtg Ckcumstanws, Ocet+pents 1 Cont•tlls 01 Cantlg. 21 Type D3 Detect D1 Condition 1 Obscured 01 Dnvx(uptOtivo) 27 SEQUENCE OF EVENTS Frsl Event 38 Second Evert Third Every. Fourth Even[ Most Harmful Evenl(Oyvehidey 38 Commercial Trailer Atached to State Year Attached la Slate Year Emergency Emergency Cleanse Plate # Pcwef Unit: Trailer Unil; Vehicle Type 1 Status 3 Carrier Name Address Qty Stets Zip US DOT q or MC # Number of Gross VehiGe P acard # Hazardous Meterlae Axles Weight Eating Released? it p•oparty aver thzn abject Damaged Estimate of Was owner or vettides damaged explain GUIDE WIRE POLE D~'~e 52,500.00 tenant notified? Yes uvners Name- as: rst rd k ~ Sufnx omparr~• er Neme ALLIANT ENERGY Street or RFD City Stale Zip Cada 8000 CHAVENELLE ROAD DUBUCIUE IA 52002 ACCIDENT ENVIRONMENT ROAAWAY CHARACTERESTICS YVOR1tZONE RELATED'+ SEIX.ENCE OF EVENTS Major Contributing Cireumstanoes: No Location of First Harmful Everd 1 VJeafher Conditons Environment 1 Locagen Flea! Harmful Event of Cr^sh Manner of CraahlColliaion g (up to two) 01 Road++ay D7 Typo {use codas 11.42 only) 38 LigN Conditions 4 Surface Condklons 4 Type of Restiv+sy JunalortlFeaare 01 Weavers Presets? ~-. [~ i~ ~_ .~ 3 ~ -~~~~ ~I ~S~2c~~~~~ l~~L ~` Printed At: Dubuque Police Department 011161200912:01 AM Page 1 Form ~: 01-09-2154 ~~ .~ 41!21 Y10094:30:23 PM [Central Standard Time] OHLEWAPP0719 1022 1k1-00 Jan 21 09 OS:Olp p.2 1840 KANf D . -~ ->i. A G R A It1 DRAWING N07 iii SCALE NARRATIVE Describe what happened (referta vehicles by number) UNff 1 WAS WESTBOUND ON KANE STREET WITH THE BOX UP AFTER DUMPING SNOW, AND CAUGHT A GUIDE WIRE, SNAPPING THE POLE. PffOTOS TAKEN OF DAMAGE TO TRUCK AND POLE. NO INJURIES REPORTE)7. DAILY INSPECTION LOG OF UNIT 1 LOOKED AT, AND IT STATED "LOOKS GOOD, OLD SCRATCHES." WHEN ASKED SPECIFICALLY IF THE SCRATCHES THAT LOOKED LEKE THEY WERE CAUSED BY A STEEL CABLE WERE THERE AT TIME OF INSPECTION, OR[VER STATED " I DONT KNOVJ." yy ness one-Last Irst Middle Sulfix t HAMMEL KEVIN MICHAEL T Address City Slate TJp Cade N C 18D0 SARAH DUBUQUE IA 82001 S Home Phone # YJoM Phone B 5 (~) b80-0200 z Officer BadOe No. Time ONioer Uofiiled o' Accident Tme O.Yrcer ArrivedAt Scene CROSS JOEL 31 21 ~6 Hrs. 21:42 rirs. Named. Aseney Date of Report InvesligaCwn T.I. A Dubuque Police Department 01/1 512 0 0 9 made at scene? Y08 Repcn RevieHed By. Date e ' ved AgenrySpecific Other Tedmical Inve:ll0ation /~ncy NO Printed At: Dubuque Police Department 01J1612D09 12:01 AIY{ Page 2 Form ~; 01.09-216d 4 1L21r2009 4:30:23 PM [Central Standard Time] OHLEWAPP0779 7d22 00-00 Jan 21 09 05:O1p p.3 ~~ '/ 11 ~ cn vx+ D A 2 vTi ) c T v~ C ;n p f1 i n rA- K n f M A Q n ~ n' _ pi 1 _ ~ oe ~ m i p a z C A n - v ~_ O ~v ^+ v O n ~7 ,~ O _ r -~ - a ~ ~ D > T n~ "' `~ m m o m m o n o z c c_ = v+ ~ c a ~ s O++) y ~ A n ti m Z i m y b O C Z ~ 1"~ ~ r+~ Y rn m "~ _ ^ A N O ~ A ~ ~ `. - D ~ -1 ~ 2 2 G7 9 b C s ~ T ~ A ....~ $ P O C N ~ N ~ 7 ~ ~ T O p m N ~ m c A rn y i m D ~ m P 7 Vi 'o 2 A ~ N c, ~ - O ~ s r~ a ~ ~ v, n o m ~ n ro» ~ p 3 0 r n C a C ~ _ n ~ ~n _ ~ rn N m m ^' a ~ rn O a y r- 9 O G ~ C D r+ni ~ r r~ > c ~ ~ 7+ p o ~ m ~~ I 'n v a `~ > = { T ~ ~ s + ~ S v+ !/~ ~ N ~ ~ K N "~ v m a -~ ~ C ~ V I ~ m ~ T O - ~? ` _ a '+1 rn n - ~ ~ ~ - z -., i N rn c"~ 2 ° O rr'+ a ~ ~ a D - ~ a -, ,,, o - - c r °a o in c = ~ r~.+ ~? o N ; -- ~ s p s C m G z c y t y O = -. v b „ ? 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