Claim by Camille BlackbournTHE CITY OF
DUB E MEMORANDUM
Masterpiece on the Mississippi
TRACEY STECKLEIN
PARALEGAL
To: Mayor Roy D. Buol and
Members of the City Council
DATE:
RE:
Claimant
July 15, 2009
Claim Against the City of Dubuque by the Camille Blackbourn
Date of Claim
Camille Blackbourn
07/07/09
Date of Loss
06/23/09
Nature of Claim
Vehicle Damage
This is a claim in which claimant alleges that her vehicle was struck by a minibus in front
of 901 West 3~d Street.
This claim has been referred to Public Entity Risk Services of Iowa, the agent for the Iowa
Communities Assurance Pool.
cc: Michael C. Van Milligen, City Manager
Jon Rodocker, Transit Manager
Camille Blackbourn
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 / EnnAIL tsteckle@cityofdubuque.org
~~~ ~~~
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~o you as to whether your claim will or will not be paid.
1. Name of Claimant:
2. Address: d
3. Telephone Number:
4. Date of Incident:
5. Time of Incident:
6. Location of Incident (Be s ecific): ~ r~" lw/~-~~
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? ~ ~~~ v ~k-1/L=-yt~~,n~ ~~
9. Give name and address of any witnesses: LQ ~ (~,p,Lt ~l.~.t/EJ - ~//~
10. Did police investigate? (If so, give names of officers.)
11. Was anyone injured? {If so, give names, addresses, and extent of injuries.)
7 w
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.)
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13. What other damages do you claim, if any? Y L
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.) T
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15. What amount do you claim from the G/ity of Dubuque?C~_~1~~ i~z[,a ~~.
17. Have you made any claim against anyone else for damages
address.)
111 (7
a result of this incident? (If yes, give name
G%2~~~L/l v
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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
of
20~~
(Signature)
~ "'~~' (~' - Y ~
(Print Name)
16. Why do you claim the City of Ddbuque is responsible? //~ ~,~ / ~~.~/~/~ /~~.,// yo
~P JCt.C~haurK
" i'~1 ~/o~J~Q /
Date:
Estimate ID:
Estimate Version:
Prelirrtinary
Profile ID:
Hanley Auto Body Inc.
1030 Century Circle, Dubuque, U\ 52002
(563) 683-7220
Fax: (663) 683-8355
Damage Assessed By: Robert Hanley
Deductible: UNKNGWN
Owner: Camille Bladcbourn
Address: 2233 Carter Road, Dubuque, IA 52001
Telephone: Work Phone: (663) 556-1161 Home Phone: (583) 588-0820
MltcheN Service: 811484
Description: 2001 Chevrolet Malibu LS Vehicle Production Date: 10/00
Body Style: 4D Sed Drive Train: 3.1L Inj 6 Cyl 4A
VIN: 1GiNE62J21B171141 License: 733 NBA IA
Mileage: 72,753
Color: Tan
Options: ALUMIALLOY WHEELS, POWER WINDOWS, CRUISE CONTROL
Une Entry Labor Line Item
Item Number Type Operation Description
1 100014 REF REFINISH FRT BUMPER COVER
2 100015 BDY REMOVFJINSTALL FRT BUMPER ASSY
3 100276 MCH ALKaN FRONT SUSPENSION -M
4 100283 MCH REMOVE/REPLACE L FRT SUSP WHEEL HUB -M
5 AUTO REF ADD'L OPR CLEAR COAT
6 AUTO ADD'L COST PAINTtMATERIALS
7 AUTO ADD'L COST HAZARDOUS WASTE DISPOSAL
" • Judgment Item
# -Labor Note Applies
C -Included in Clear Coat Calc
ESTIMATE RECALL NUMBER: 06/24/2009 08:15:08 2116
Mitchell Data Version: MAY_08 V UltraMate is a Traderrwrk of MitcMll International
Copyright (C)1984 - 2009 MltcheN International
UltraMata Version: 6.7.022 All Rights Reserved
6/24!2009 Q8:16 AM
2116
0
Mitchell
Part Type/
Part Number
`* QUAL REPL PART
Dollar Labor
Amount Units
C 2.6
1A #
1.3
132.00 * 1.1 #
1.0
108.00 *
5.00
Page 1 of 2
Date: 6/24/2008 08:15 AM
Estimate ID: 2116
Estimate Version: 0
Preliminary
Profile ID: Mitchell
Estimate Totals
Add'I
Labor Sublet
I. Labor Subtotals Units Rate Amount Amount Totals II. Part Replacement Summary Amount
Body 1.4 48.00 0.00 0.00 67.20 T Taxable Parts 132.00
Refinish 3.6 48.00 0.00 0.00 172.80 T Sales Tax ~ 7.00016 8.24
Mechanical 2.4 48.00 0.00 0.00 115.20 T
Total Replacement Parts Amount 141.24
Taxable Labor 355.20
Labor Tax ~ 7.000 96 24.86
Labor Summary 7A 380.06
111. Additional Costs Amount N. Adjustments Amount
Non-Taxable Costs 113.00 Customer Responsibility 0.00
Total Additional Costs 113.00
i. Total Labor: 380.06
II. Total Replac~nent Parts: 141.24
III. Total Additional Costs: 113.00
Gross Total: 634.30
IV. Total Adjustments: 0.00
Net Total: 634.30
This is a areliminarv estimate.
Additional chances to the estimate may be required for the actual reaair.
ESTIMATE RECALL NUMBER: 06/2412008 08:16:08 2116
Mitchell Data Version: MAY_08_V UltraMate is a Trademark of Mitchell International
Copyright (C)1884 - 2009 Mitchell International Page 2 of 2
UttraMate Version: 6.7.022 All Rights Reserved
06/24/2009 at 08:27 AM
24443
Job Number:
ABRA - DUBUQUE
Federal ID #:420782245
DBA: .ANDERSON-WEBER INC
3400 CENTER GROVE DR
DUBUQUE, IA 52003
(563)556-0696 Fax: (563)556-1899
PRELIMINARY ESTIMATE
Written By: RICK KELLY
Adjuster:
Insured: CAMILLE BLACKBOURN
Owner: CAMILLE BLACKBOURN
Address: 2233 CARTER RD
DUBUQUE, IA 52001
Evening: (563)588-0820
Claim #
Policy #
Deductible:
Date of Loss
Type of Loss
Point of Impact:
Inspect ABRA - DUBUQUE
Location: 3400 CENTER ~:~ROVE DR
DUBUQUE, IA 52003
Insurance
Company:
2001 CHEV MALIBU LS 6-3.1L-FI 4D SED TAN Int:TAN
Days to Repair
vIN: 1G1NE52J216171141 Lic: 733NBA IA Prod Date: 11/2000 Odometer: 75755
Air Conditioning Rear Defogger Tilt Wheel
Cruise Control Intermittent Wipers Keyless Entry
Dual Mirrors Console/Storage Fog Lamps
Clear Coat Paint Power Steering Power Brakes
Power Windows Power Locks Power Driver Seat
Power Mirrors Power Trunk/Tailgate AM Radio
FM Radio Stereo Cassette
Search/Seek CD Player Anti-Lock Brakes (4)
Driver Air Bag Passenger Air Bag Cloth Seats
Bucket Seats Automatic Transmission Overdrive
Aluminum/Alloy Wheels
-----------------------
----
-------------------
--------
----------------
NO. OP. ---------
DESCRIPTION
---------------------------- QTY
--- EXT. PRICE LABOR
-------------------- PAINT
--------
----------------
1 ----
FRONT BUMPER
2* Rpr Bumper cover 0 0.00 1.0 3.0
3 Add for Clear Coat 0 0.00 0.0 1.2
4 O/H bumper asst' 0 0.00 1.9 0.0
5# Subl 2 WHEEL ALIGNMENT 1 44.95 T 0.0 0.0
6 FRONT SUSPENSION
7** Repl Qual Repl Parts LT Hub & 1 132.00 m 0.9 M 0.0
bearing
8# Subl HAZARDOUS WASTE DISPOSAL
- 1
--- 4.00 T 0.0
-------------------- 0.0
--------
---------------- -------------------------------
Subtotals =_> 180.95 3.8 4.2
Business: (563)556-0696
1
06/24/2009 at 08:27 AM
24443
Job Number:
PRELIMINARY ESTIMATE
2001 CHEV MALIBU LS 6-3.1L-FI 4D SED TAN Int:TAN
Parts 132.00
Body Labor 2.9 hrs @ $ 55.00/hr 159.50
Paint Labor 4.2 hrs @ $ 55.00/hr 231.00
Mechanical Labor 0.9 hrs @ $ 66.00/hr 59.40
Paint Supplies 4.2 hrs @ $ 35.00/hr 147.00
Sublet/Misc.
---
- 48.95
-
-
--------------
SUBTOTAL ------ ----- -- -- ----------
$ -------
777.85
Sales Tax $ 630. 85 @ 7.0000 44.16
--------------------
GRAND TOTAL ------ ----- -- -- ----------
$ -------
822.01
ADJUSTMENTS:
Deductible
------------- 0.00
-------
CUSTOMER PAY ------ ----- -- -- ----------
$ -------
0.00
INSURANCE PAY $ 822.01
WARRANTY VALID ONLY WITH ORIGIONAL COPY OF YOUR RECEIPT PARTS SUBJECT TO
INVOICE NO GUARANTEE ON RUST ALL PARTS NEW, UNLESS OTHERWISE NOTED
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.
2
f[3bNT
&Xm~
+LBufiper WlPads SQblft
tit taint Stl'lliW i
Or ttrera
hru
3 m. LEA
__..-._.-~
Fender, Frt. _~_ su41M ~ 3errice i
or rain~rs ___._
hire RIGM1'-
sym.
Fender, Frt. sut:iit
Or ~dnt Sarrloo t
Or Nwn
Partr
®umFer Aba. tender Shield
_~_______- ~ _ Fender Shield ~.
fender l;xt.
Fonder Mld Saae,_
Fender Stripe
~
_`_ T
~_ Fonder Ext.
Fandar Mld . Side
Fender Stripe
_
_ Fender Mld Fender Mld .
Bum r Relnf. ~~ - -
6ufi r 9rkt. Side Light Asmbly ~ Sitle U'yht Asmbly
Bumper Cushion Headterrt ~ _ Haadtem
V
l
c Headlamp Door ' Headlamp pry _ _„
_
a
an
e
8uinper Gd. Sealer Gram ~
____- .~_
_~_ Sealed Beam
tt. g tem Park Light ~ s Park Li t
Forme Cowl - -- --- Cowl ---,_---- --
Cress Member Door Front __ Door. Front
Whral -^^_ Odor Hlnsa , Door Huse __
Mub CaP Disc Door Penal ~ _ Door Panel ___ __--- _~
Lr. Cont. Arm Door Stripe Door Stripe
Door M!d DOar Mkt .
Ltp. Cont. Arm
r r-
~ ~-- _~
~+ ^ -- _ i- Center Post ~-~
~ Center Post
~ -_
Duar Rear _ Door Reer
____
Bumper Filler _
^`-Door Mldg_-_-_.
_~_-
--- ~-- _
---. Door Mld ^_-- -- -„--
Grille - _
~-r~ -
Grliie Panet
~ ~ --
Grill Partel Mld ~ _ ___ __ _
Rocker Penel~
~ Rocker Penal s
- -- -= Rocker Mid . ' _
- - Rocker Mldg• _-
_ Floor - .
~ Fbor
-~- - !~ Do La
--
--- Dos Las
_ Qwr. Panel -._ I
T
-_---~ Quar. Panel
Alr Condenser - Quar. Ext. _-~
~ Quar. Ext.
RaChar System Quar. Wheel house ~,___
° __ Quar. Wheel How
-
Marne P!at~ M]dg S,de
4uar. _~ __ Quar. NNdg. Side ._M._ _~
~.
Baffls, UpPsr _-_ ___ _
Quar. Mld ~ Quar. Mldg.
Lack Piathy Lr. Quar. Stripe - Quar. Striua __
~_ Leck Plate, U S!tle Light Asmbly °
~ S{de Light Asmnl
_- __ „~,
Hood T~ ~ Tail Light -_.- ~__- 7ai1 Light ~ _,___,
Hand Hinge REAR
_.__ MISC.
~-
Hod! Lock _ BtJm_~er ~ _
~ _ Il~t Panel _
Ornament, bumper Abs. Front Seat
Red. Sup. Pumper Cushion ____ _
~ _ ___ Front Seat Ad'. ~„
Rad. Coro --- ---- ----- - _
Bumper Reln!. _ ~
- Top
Anti Frea:e _ -
- Bumper 8rkt. Haediining
Rid. Moses 9umper Gd. - _ _ 'fop Vinrf
Fan Buds R_ _
Bum
Der FiiSer __ ~
~__ __-. TI_ro Xs Wurn _~
Fan Shroud __
_
_
Valance ~ Painti
_
Fan Bait _
~ - _
t-- Lower Panel Aerial _ - _
Water YamO ~_
Floor _ Rust Proof ~ _~
Water F'ump Pulley `- _
Trunk lid - Battery
MOtar Mts. _
~ Trunk MlclH
- -
- ;
-
~a wasTe DtsposaL a~ar;~
S~
___
Lle. Light -- PARTS (Prk:ea SuD)aCt To IfiroPoe) J . Q I^
T
. SERVICES •~HR$
~0 H l as A
_ __ _
'
Windslfield SUBLfS
OR PAINTINQ
Gas Tank-
Frame
~
$(j9 TOTAL F
~J ~ >~
~_ _
Wheel _ _
~_ ~..__-_ _
TAX /
~, k•
' flub e, Drum ~ PAINT-MATRL•HDMI {.~`0 , f d
Axle ,
rin
S
p GRAND TOTAL -T ~ 4 .1c
~ppraieer
e^ymbols:
A-Align N•Nwr OPApen P-Paint i HEREBY AUTHORIZE THE A84YE REPAfRS
S•Stralghten R-Replace OM-Overhaul
t 'd bZ£B-9SS-£9S ~'LS ~60 6(l SZ aanr
HART" A~[..TTQ BODY & PAINT ~AMAS~ a~PO~T
84Q CEDAR CROSS RUAD UIJBUQL~., IOWA ~2Q0? PRICES guBJEGT TCr CHANGE
PH.Q1~E: (563) 556-9323 F.5,~1: (553) 556-8324 IMms ClRGLED err hat le tlfet0®1 in
our aalnian, aro not par' of this CbSnt.