Claim by John ButcherTHE 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
John Butcher
June 11, 2009
Claim Against the City of Dubuque by the John Butcher
Date of Claim
06/11 /09
Date of Loss
06/09/09
Nature of Claim
Vehicle Damage
This is a claim in which claimant alleges that while he was attempting to exit the Stn
Street ramp at the south exit, the exit arm came down prematurely and scraped the
driver's side of claimant's vehicle.
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
John Butcher
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, 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 13"' 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 wilt not be paid.
1. Name of Claimant: ~n~_GM ~ S ~ ~~rFc.~.~„•-
2. Address: ~~~ ~1~ ~r~c? ~~~n_~,=~~.}{~~ ~,)ii`Ct~'
3. Telephone Number: ~(~~ ~. Sj`)(. <7L .~s
4. Date of Incident: ~~ti~u ~'
5. Time of Incident: ~~•~~ ~ /''1. /~
6. Location of Incident (Be specific): ~ ~ S~<c'~- !'G~IC.ni ~6.ti/~ ~~~ ~~ 1~
7. Describe the 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.)
8. What were weather conditions like? L cG~ ~' ~: -N ~ ~ ~v C~~c.~yY s
9. Give name and address of any witnesses: 1.5 ~t.~~F6, ~F-~~~~,~~ ~~j. ~ Kii~i-•_~^
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L~..~ce [~s~-.~-~ ~;~~ ~C~a~ ~~/.~„~ / .4%r''iP. ~ C/'L~,F:®tifri ~i/~ t:t~ ~~~i ~ /~-F7r;'2'ihP,-r~,
-~ r~ ~
10. Did police~jinvestigate? (If so, give names of officers.) /~;~'
11. Was anyoone injured? (If so, give names, addresses, and extent of injuries.)
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12. Was any damage done to property? (If so, describe property and the extent of damages. Attach estimates of
damages orl~describe bas1is for ascertaining extent of damage.) y
~`f~~'~_,r! ~G,Gh6xc~`~rt~0~/,~~.~~ <kc/.ir ~' i~~,..~}-c:r~~F~e ~r,~~, ~~ol~c~-F~y~G.~~
( s~~,~ lV"'a''.+, lam' r~, c ~t; 4~~~I~~f <t'iT,gc~i.~~'
13. What other damages do you claim, if any? /V•:~,J~
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? ~ ~~ 7(_.
16. Why do you claim the City of Dubuque i//s responsible?~f '-e ~s.~~ ~~n ~ ~. ~~
~f l~.n c L. ~,{-~~ CtK...fsF 43 5 "~ ~i.Lk~S~~IJ
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?
Dated this /V~ day of ~~~ , 20 C,~i .
(Signat
(Print Name)
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WILLIS AUTO BODY
' ',~ 1982 ROCKDALE RD
DUBUQUE, IA 52003
PHONE: 563-583-9329
CD LOG NO 10-1 DATE 06/09/09
SHOP: WILLIS AUTO BODY
ADDRESS: 1982 ROCKDALE RD.
CITY STATE: DUBUQUE, IA
ZIP: 52003-
EMAIL: MARKWILLIS58@AOL.COM
OWNER: BUTCHER, JJ
ADDRESS: 622 BAJA DR
CITY STATE: EPWORTH, IA
ZIP: 52045
POINT OF IMPACT: 7
LIC#: 9571F STATE: IA
BODY COLOR: DK ~~
CONDITION: GOOD m oU
DRIVEABLE: YES
*=USER-ENTERED VALUE
EC=REPLACE ECONOMY
UM=REMAN/REBUILT PRT
OE=REPLACE PXN OE SRPLS
TE=PARTL REPL PRICE
I=REPAIR
TT=TWO-TONE
N=ADDITIONAL LABOR
AA=APPEAR ALLOWANCE
INSP DATE:
CONTACT:
PHONE l:
FAX:
HOME PHONE:
06/09/09
MARK WILLIS
(563)583-9329
(563)583-9329
(563)876-9683
TYPE OF LOSS: /DRV
VIN: 1GNET16S966143408
MILEAGE:
ACCTNG CTL#:
VEH. INSP#:
E=REPLACE OEM
UE=REPLACE OE SURPLUS
EU=REPLACE SALVAGE
PC=PXN RECONDITIONED
ET=PARTL REPL LABOR
L=REFINISH
CG=CHIPGUARD
RI=R&I ASSEMBLY
RP=RELATED PRIOR
NG=REPLACE NAGS
UC=RECONDITIONED PRT
EP=REPLACE PXN
PM=PXN REMAN/REBUILT
IT=PARTIAL REPAIR
BR=BLEND REFINISH
SB=SUBLET
P=CHECK
UP=UNRELATED PRIOR
2006 CHEVROLET TRAILBLAZER EXT LS 4DOOR WAGON 6CYL GASOLINE 4.2
CODE: U8434A/E OPTNS S/24KAJLMOQ
OPTIONS:
TWO-STAGE - EXTERIOR SURFACES TWO-STAGE - INTERIOR SURFACES
4-WHEEL DRIVE BUMPER COVER MOUNTED FOG LAMPS
PRIVACY GLASS LUGGAGE RACK
TRACTION CONTROL SYSTEM OVERHEAD CONSOLE
CRUISE CONTROL
OP GDE MC DESCRIPTION
E 1107 RAIL,LUGGAGE RACK
I 0460 MLDG,TAILGATE UPPER
R10460 MLDG,TAILGATE UPPER
L 0460 13 MLDG,TAILGATE UPPER
MFG.PART N0.
LT 15254141 GM PART
REPAIR
R&I ASSEMBLY
REFINISH
PRICE AJo Bo HOURS R
284.60 1.6 1
1.0*1
0.5 1
1.3 4
PAGE 1
06/09/09
2006 CHEVROLET TRAILBLAZER EXT LS 4DOOR WAGON
CD. LGG •NO 10-1
ECM60 HAZARD. WSTE. REM. ECONOMY PART 2.00* 1
N buff r quar ADDNL LABOR OPERA 0.3*1*
6 ITEMS
MC MESSAGE(S)
13 INCLUDES 0.6 HOURS FIRST PANEL TWO-STAGE ALLOWANCE
FINAL CALCULATIONS & ENTRIES
GROSS PARTS 284.60
OTHER PARTS 2.00
PAINT MATERIAL 45.50
PARTS & MATERIAL TOTAL 332.10
TAX ON PARTS @ 7.OOOo 20.06
LABOR RATE REPLACE HRS REPAIR HRS
1-SHEET METAL 55.00 2.1 1.3 187.00
2-MECH/ELEC 65.00
3-FRAME 65.00
4-REFINISH 55.00 1.3 71.50
5-PAINT MATERIAL 35.00
LABOR TOTAL 258.50
TAX ON LABOR @ 7.000$ 18.10
SUBLET REPAIRS
TOWING
STORAGE
GROSS TOTAL 628.76
NET TOTAL 628.76
SHOPLINK U9956 ES CD LOG 10-1 DATE 06/09/09 05:09:30PM R6.37 CD 05/09
PXN: Y/00/00/00/00/00 CUM 00/ 00/00/00/00 GEOCODE 52003
HOST LOG
(C) 1998 - 2008 AUDATEX NORTH AMERICA, INC.
0.7 HRS WERE ADDED TO THIS EST. BASED ON AUDATEX TWO-STAGE REFINISH FORMULA.
PAGE 2
06/09/09