Claim by Susan E. Craven~~, ' /
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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'h 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: Susan E. Craven
2. Address: 16361 Coventry Lane, Dubuque, IA 52001
3. Telephone Number: S ~ 3 - Sr~! `/ SSA / "'~`
4. Date of Incident: ~ ' C~- c~ ~
5. Time of Incident: ~ ~ ~ ~ A m L
6. Location of Incident (Be specific): ~ Kr~~A~t ~i~ 5 lL6->n~ A/ ~,tn ~ K ~1
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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.)
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8. What were weather conditions like? >> ti n..v
9. Give name and address of any witnesses: i(Jv~,U_Q
10. Did police investigalte? (If so, give names of)o/ffic{ers.)
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 extent of damage.)
13. What other damages do you claim, if any? ~--rcrr~_
14. Have you been compensated for any part or all of your claim by any insurance company? (If so, give name and
addre®®ss of insurance company and amount paid.)
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15. What amount do you claim from the City of Dubuque? ~ ~ ~~ G , (o ~
16. Whyldo you claim the City of Dubuque is responsible? ~/iN9,6 ~8 C'.i~c, ~,~,,[/t iy~
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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?
Dated this ' r' ~. day of ~¢. , 20 a`i.
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(Signature)
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TOYS DONE RIGHT
1006 central ave
DUBUQUE, IA, 52001
Te1:563-552-1601 Fax:563-552-2207
Tax ID: 26-1404014
Estimate -Preliminary
Estimate Prepared by:
Accident Date:
Date of Loss:
Arrival Date:
Type of Loss:
Policy Number:
Claim Number:
Owner:
Appraised for:
Date: 6/10/2009
Estimate#:
Contact: Sue Craven
Address: 588-9551
Year Make Model Color Trim
2006 GMC Envoy SLE Utility
Unit Number License Plate # Mileage Serial#/VIN#
1GKDT13S462142509
Sup Seq Qty Labor Labor Description Part Part List Extended Labor
Type Op Type Number Price Price Units
1 1 Ref Ref Refinish Hood Exist 2.7
Outside
2 1 Body Repair Panel, Hood Exist ,g
Chevrolet 04-07
3 1 Ref Ref Refinish Fender Exist 2,2
Outside L
4 1 Body Repair Fender Chevrolet L Exist 1.01#
04-07
5 1 Ref Ref Refinish Door Exist 2.3
Outside L
6 1 Body Repair Shell Assy, Door L Exist ,~#*
7 1 Body RemMs R&I Outer Belt Exist ,~
Moulding L
8 1 Body Repair Mirror Assy, Rear Exist ,31#*
View (a) w/o SS
Model 2006 w/o
Signal Lamp Power L
[ clean off mark on
mirror]
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Database Edition CPL 09-OS Page 1 of 3
pup Seq Qty Labor Labor Description Part Part List Extended Labor
Type Op Type Number Price Price Units
9 1 Body Rem/Ins Moulding, Side Exist ,5
(Adhesive) 2006-07
(P) w/o North Face
Edition L
10 1 Body Rem/Rep Nameplate New 15256750 $23.37 T $23.37 .2
(Adhesive) 2006-08
"ENVOY" L OS-08
11 1 Ref Ref Clear coat Exist 1.3*
12 1 Body Rem/Ins R&I Rear View Exist ,~
Minor Power L
13 1 Body Rem/Ins R&I Outside Handle Exist .4~#*
L
14 1 Body Rem/Rep Moulding, Side New 15100759 $71.34 $71.34 .1
Reveal L
15 Paint Materials $297.50
* -Judgement Item
# -Labor Note Applies
Labor
Body 4.7 Hrs @ $55.00
Refmish 8.5 Hrs @ $55.00
Labor Total
$94.71
$297.50
$50.81
Totals
Parts
$258.50 Parts Subtotal
$467.50 Less Adjustments
$726.00 Parts Total
Additional Costs and Operations
Addl. Costs/Ops Total
Taz
Labor Tax @ 7.00%
Parts Tax @ 7.00%
Tax Total
Sub Total: $1,170.66
Customer Resp. $0.00
Net Total $1,170.66
Version 2.0
Database Edition CPL 09-OS
2006 GMC Envoy SLE
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Page 2 of 3
$94.71