Claim by Linda BeauTHE 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
Linda Beau
July 31, 2009
Claim Against the City of Dubuque by the Linda Beau
Date of Claim
07/31 /09
Date of Loss
07/17/09
Nature of Claim
Vehicle Damage
This is a claim in which claimant alleges that the right rear shock on her vehicle was
damaged after she struck a pothole between the 11th and 13th blocks of Locust 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
John Klostermann, Street & Sewer Maintenance Supervisor
Linda Beau
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 13t" 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: ,cam
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2. Address: a, (o'~ 'a ~~~n..u.crJZ~s~t~Y ~ ~~'k c,,~ i~Q ~-+'~
3. Telephone Number
4. Date of Incident:
5. Time of Incident:
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6. Location of, Incident (Be specific):
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~C~,~17
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 condition like? ~ ~~ _ ~~ ~~
9. Give name and address of any witnesses:
10. Did police inve$tigate? (If so, give names of officers.)
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11. Was anyone 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 or describe basis for ascertaining
extent of damage.) ~ ~ ~~ ~ ~ _ ~ ~_
13.~/hat the amages 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.) . 1
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15. What amount do ou claim from t e Cit of Du uq ?
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16. Why do you claim t e City of D buq a is esp nsible?
'f7. Hav~'y made any claim against anyone else for damages as a result of
this incid1ent? (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?
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Dated this ~ day of ~~ , 20~.a~ ~
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(Signature) ~ =" -~
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(Print Name) `~'
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Customer Invoice TIRES PLUS
053685 Service Advisor:
07/18/2009 DUBUQUE IA 04 KURT
. 4103 MCDONALD DR 563.584.0341
BEAU, LINDA
2672 GARNAVILLO DR
DUBUQUE, IA 52003-8016
563.584.0369
Store # 244270
DUBUQUE, IA. 52002
2008 FORD FOCUS SE [RED]
4-121 2.OL DOHC
Lic #: 801 JRP IA Vin #: 1 FAHP33NX8W116053
In: 07/18/09 7:15AM Mileage: 9,597
Out: 07/18/09 8:59AM
RETAIL SALE
Descrietion Rev Hist Unit Extended Job
- - - - - - - - - - - - - - - - - - -
---
: VEHICLE INSPECTION : - - /Article # ID
- Qt
--~- Price
---- Price
-- Total
CHECK REAR FOR CLUNKING NOISE (RIGHT SIDE)
3 04 --- ----
14.99
VEHICLE INSPECTION
LBR-DISC DISCOUNT :VEHICLE INSPECTION : 7028789 07TN 1 19.99 19.99
COURTESY CHECK 7001671 07T -1 5.00 -5.00
COURTESY CHECK 04
BRAKE INSPECTION 7046930 07TS 1 N/C N/C
Symptom:- 04
BRAKE INSPECTION
SHOCKS 7003147 07TS 1 N/C N/C
RIGHT REAR SHOCK WAS BENT AND TOP OF SHOCK 1 04
208.64
LEAKING. „
SHOCK LABOR ~
SHOCKS SHOCKS 7015792 07TS 2 15.00 30.00
OIL CHANGE 7030066 07TN 2 89.32 178.64
PKG: 01 SYNTHETIC BLEND OIL CHANGE UP TO 5 Qts 1,3 04
OIL CAP 4.5 QTS.
OIL VISC SAE 5W-20 Premium Synthetic Blend Motor Oil
OIL CHANGE LABOR
5W30 SYNTHETIC BLEND UP TO 5QTS 7029718 07TS 1 9.00 9.00
TF335 OIL FILTER 7000614 07TN 1 12.00 12.00
USED FILTER RECYCLING CHARGE 7058149 07TN 1 3.99 3.gg
PKG: 02 TIRE ROTATION LOF 7075051 07NN 1 2.50 2.50
TIRE ROTATION W / L
O
F
.
.
.
PRT-DISC DISCOUNT OIL CHANGE 7021369 07TS 4 N/C N/C
LBR-DISC DISCOUNT OIL CHANGE 7001674 07T -1 15.99 -15.99
Discount Tax: Taxable $-9.00 Non-Taxable $-2.50 7001674 07P -1
11.50
-11.50
STANDARD ALIGNMENT SERVICE
Symptom:- 1 04
64.99
ALIGNMENT SERVICE
LBR-DISC DISCOUNT STANDARD ALIGNMENT 7004578 07TS 1 74.99 74.99
SERVICE 7001681 07T -1 10.00 -10.00
BASIC-TIRE INST/BAL/STD VALVE-PKG
TIRE INSTALLATION 2 04
20.00
WHEEL BALANCE LABOR 7015016 07TS 4 N/C N/C
LBR-DISC DISCOUNT BASIC-TIRE INST/BAUSTD 7006010 07TS 4 8.00 32.00
VALVE-PKG 7001665 07T -1 12.00 -12.00
Technician(s):
07 BRIAN WELTER
Payment History:
Cash Tendered
340.13 Summary:
Total Tendered
340
13 Parts 178.64
Change Due .
3
00 Labor 129.98
.
. Shop Supplies 6.90
, Sub-Total 315.52
Tax (7.00%) 21.61
.~,.,. a ..~_ -.,.,...~-.n. ~..
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v?ibV'1,1.~'3r~5~~1JS,G~1'7l
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Total _ , .
$337.13
Page..G.oY;. ,
. {° - sae reverse side .or ~Narr~~ty ~nrormatior
Inv1 081219.304012
)I
I .~ ('t 3 t~
6 (1
Hubcap Missing Y N Windshield Cracked Y N Scratches/Dents N
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MILEAGE: Lic. # State Inspection Due Month near
VISUAL
INSPECT
OK SUG REO SCHED.
MAINT
+ WHY RECOMMENDED +
TIRE SIZE: SPEED
/ RUN FLAT Y
RATING
'
VIPER BLADES ^ FRONT ^REAR F 1 ~
'''``^~~~ `f"l~
/
(/ ~ i ` )
L
TPMS Y -N
1EAD LIGHTS I R `
v
TREAD DEPTH
AINI LIG
TS { TURN
LICENSE VISUAL
INSPECT 32 nds FWD ^ RWD ^4WD/A
H ^
^ BRAKE ^
^ PARKING
SIGNAL PLATE _ O SUG REQ OUTER INNER
11R FILTER LEFT' FRONT
/r/ EDGEWEAR ^ CRACKING
L~I IN `
PSI O
'ABIN ;
/ 7{
/
J UPPING
~ ^ NAILS
\IR FILTER 7 U ~
{
/ TS ^ REPAIRABLE
'CV VALVE I ^ IRREGULARITY ^ NON-REPAIRABLE
~ RIGHT FR NT ^ EDGEWEAR ^ CRACKING
NASHEI-i FLUID ~ I IfJ:
` PSI OUT: CUPPING ^ NAILS
{
DIL LEVEL
J )
~ ^ CUTS ^ REPAIRABLE
d ^ IRREGULARITV ^ NON-REPAIRABLE
'OWER STR. -~
=LUID LEVEL RIGHT REAR ^ EDGEWEAR ^ CRACKING
dASTER CYL FLUID
-EVEL
^ BRAKE INSPECTION I I
~ ~ P I¢¢¢L~~~T: ~
~` ~ CUPPING
~ curs ^ NAILS
^ REPAIRABLE
3RAKE FLUID FLUSH TEST STRIP FAILURE Y N
t 4 ^ IRREGULARITY ^ NON-REPAIRABLE
TRANS. SERVICE ^ FLUSH LEFT REAR ^ EDGEWEAR ^ CRACKING
AUTO /MANUAL ^ PAN SERVICE PSI'1N: PSI OUT: CUPPING ^ NAILS
'OOLANT ~ U
^ CUTS
^ REPAIRABLE
JEVEL /FLUSH TYPE ~ ^ IRREGULARITY ^ NON-REPAIRABLE
:OOLANTHOSES i ^ UPPER ^ LOWER ^ BYPASS ^ HEATER
SPARE
^ EDGEWEAR
^ CRACKING
SECTS ^ V ^ALT ^PS BELTS PSI IN: PSI OUT: ^ CUPPING Q NAILS
^SERP ^A/C ^AP 1 2 3 4 ^ curs ^ REPAIRABLE
3ATTERY i
D-18TEST
GOOD ^ MARGINAL ^ REPLACE
^ IRREGULARITY
^ NON-REPAIRABLE
ACCESSORIES ^ CABLE ENDS/CABLES ^ NEG ^ HOLD DOWNS TIRE MAINTENANCE ^ ROTATION ^ BALANCE
3ATTERYGARD ^ CORROSION ^ PREVENTIVE ALIGNMENT CHECK
RIDE HEIGHT SPEC ACTUAL
I I ~
~ ~ ~ ~ • • •
~ ~ ~
INSPECT V
ISUAL
SCHED.
~ WHY RECOMMENDED ~
VISUAL
WHY RECOMMENDED
O
SUG
RED.
MAINT. + +
INSPECT SUG REQ
1
START /CHARGE
-EST ALIGNMENT CHECK RIDE HEIGHT SPEC ACTUAL
3ELTTENSIONER ~ ~
_
I .
, .
>PARK PLUGS LF
RF
~ .
FRONT PADS
"
=UEL FILTER 32N0~ 32"os •+
FRONT CALIPERS
~ ABS Y N
=UEL SYSTEM WORN
WORN
SERVICE LF ROTOR ROTOR
GNITION WIRES FRONT ROTORS
ACHINE TO: DIS RD:
/ALVE COVER ACT
ACT
3ASKET .
.
'OWERSTEERING ^ PRESSURE ^ RETURN REAR Pnos~ LR ~ RR
M
10SE o9
32
05 32"
TIMING BELT REAR CALIPERS/ OR OR
ABS Y N
WHEEL CVL. WORN
WORN
~ DRUMS/
REAR LR DRUM/ROTOR RR DRUM/ROTOR
ROTORS
MACHINE TO: DISCARD:
EXHAUST SYSTEM ^ INTERMEDIATE PIPE ^ MUFFLER ^ TAILPIPE
ACT. ACT.
~ , ~ . HARDWARE/ ^ FRONT ^ REAR
ADJUSTERS
U-JOINT ^ FRONT ^REAR REAR CLEAN /
ADJUST
IDLER/PITMAN ARM ^ IDLER ^ PITMAN WNEELBEARINGREPACK WHEEL BEARING FRONT BEARINGS/ FRONT
BEARINGS/SEALS REPACK REAR SEALS REAR
CENTER LINK BRAKE HOSE(S) ^ LF ^ RF
^ LR ^ RR
BUSHINGS ^ CONTROL ARM ^ SWAY BAR ^ FRONT
^REAR pgRKING CABLES LEFT ^ RIGHT ^ FRONT
LINK PINS ^FRONT ^LEFT ^RIGHT NOT
^REAR ^LEFT ^RIGHT
TIE ROD ENDS
^ L OUT ^ L IN ^ R IN ^ R OUT ^ SLEEVE(S) I
~ ~ ~ C L ~ I j l (f ~•
BALL JOINTS ^ L UPPER ^ R UPPER
^ L LOWER ^ R LOWER SPEC _ ACTUAL
RACK & PINION (
ASSEMBLY ,J~. ~ ~ ~ y
CV BOOTS ^ L OUT ^ L IN ^ R IN ^ R OUT ]]~•jj
CV JOINTS ^ L OUT ^ L IN ^ R IN ^ R OUT
STRUTS ^FRONT ^LEFT ^RIGHT
^REAR ^LEFT ^RIGHT
SHOCKS ^ FRONT ^ LEFT ^RIGHT
EAR ^LEFT IGHT
REPAIR / RE C ENT SUGGESTED
1) CLOSE TO END OF USEFU L LIFE
2) ADDRESS CUSTOM ER RE QUEST/NEED/CONVENIENCE
3) COMPLY WITH MA NUFAC TURER RECOMMENDATION
~I ~I I~~nrvwlt,N n~~urvnvlovuAnuN rnum enrenlence I INSPECTED BY RE-INSPECTED BY
1