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Claim by David WillgingTHE 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 September 1, 2009 Claim Against the City of Dubuque by David Willging Date of Claim David Willging 08/31 /09 Date of Loss 08/25/09 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 cab and box of claimant's truck. 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 Tim Horsfield, Parking Systems Supervisor David Willging 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 .-, 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 W. 13t" St., Dubuque, IA 52001. It will then be referred by the City Council to the appropriate department for investigation. 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: L.J G V ~ 2. Address: ~ ~~ ~~ T~ 3. Telephone Number: ~b 4. Date of Incident: L ~ S 5. Time of Incident: - ~ 6. Location of Incident (Be specific): ~ ~~`~ ~ . ~ ~w Q u 3-SotIS" v /2-f..~ ~o.~ L V < <~- , M 7. DESCRIBE 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~ ~Q~~ 9. Give name and address of any witnesses: 10. Did police investigate? (If so, give names of officers.) y~S. _~Jyc~O 11.E /Was anyone injured? (If so, give names, addresses, and extent of injuries). /y C7 ~-~ ~C CJ ~ ~G `.. ~~ "~~ S> - i~ ~ = ' ~:? ~ ; CD 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? '- 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? 16. Why do you claim the City of Dubuque is responsible?~ r ~y7 0 ~~ 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? 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V C7 N Y J W O 4 •~ w Z a ~ 3 C' ~ y0 W ~ < C7 Z - ~ < ryt1 ~ W W J J Z ` T O O ° - a ~ ~ O m ~ N .'_ < c W c ~ ¢ u N W ~ _ ~ o N N r- W = W N J N W ^ ' V > d Z W O I ` < ~ _ N Q V CI" Y W ,~ I< N , _ N ~ C' J < ~ <'~ ~~ W o~~y ~. o z I m C W 44 I O Z O J ~ N O < U y Z V ;W < O V 4 1 .J ` W U ~ < O > Z O N 2 a J ~ O < W m W d W 7 O V < N C ._ Z O t Q ~ U K O O C a Q V N W -~ ~ m a V T a ~ a W -~ Z - Z ~ W O m N O O VI ~ Q C N o W .. U N N Z O _ > > W W ' G ~ W d O Q' O L W C ~. Y W c.7 N W O > Z CC ~ O N W ~ G 4 < O O m C ~' ~ < N C O ~ d t7 = Z O ~ ~ 4 a O a O O N .....~ ¢ W ~ W '-~ ¢. (= V V - "" > d W W C Q O I ~ = I = ~ ~ o ~ S - N ` O d ~ ~ C u OC u W ` ` ~. o O a V < a O Z V o -~ ~ m m W W ~ ~ ~t~ < N ~ O ~ W d N N V1 ~ Z 2 ` m Z N W z < G W ~ Z ~ V ~ m O W O r- aC ¢ N G CY O 3 V W v K < O W W O W O Z ~ ~ W Id' ti~ 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: Appraised for: Accident Date: Date of Loss: Date: 8/27/2009 Arrival Date: Estimate: Type of Loss: Policy Number: Claim Number. Owner: Contact: Dave Willging Address: 543-5095 Year Make Model Color Trim 2007 Chevrolet 'clcup Silverado LS Pickup Crew Ca Unit Number License Plate # Mileage Seriad~/VIN# Sup Seq Qty Labor Labor Description Part Part List Extended Labor Type Op Type Namber Price Price Units 1 1 Body RemMs R&I Combination Exist .3~# Lamp Assy L 2 1 Ref Ref Refinish Side Panel Exist 4.1* Assy 6 Foot Bed L 3 1 Body Repair Panel, Outer Side (a) Exist 3,pi#* 6 Foot Bed Panel, Outer Side L [top of box 4 1 Body Rem/Rep RBcI Lt frare mld and New ,~7+~ mud flap 5 1 Body Repair Repair Cab Cornier Exist l,p* 6 1 Ref Ref Refinish Lt Cab Exist 2.0* Conner 7 1 Ref Ref Refinish Door Exist 2.4 Outside L 8 1 Body Repair Shell Assy, Reaz Exist 1.0 Door L 9 1 Glass Rem/Ins Glass, Reaz Door Tint Exist 1.5 Chevrolet, GMC L 10 1 Ref Ref Refinish Door Exist 2.7 Outside Extended Cab L Version 2.0 P-Page logic not included. Database Edition CPL 09-06 Page 1 of 3 Sup. Seq Qty Labor Type Labor Op Description Part Type Part Number List Price Extended Price Labor Units 11 1 Body Repair Shell Assy, Front Door Extended Cab L Exist 2.(~# 12 1 Body RemMs R&I Outer Door Handle L Exist .7# 13 1 Body Rem/Ins R&I Lt Mirror Exist .5* 14 I Body Rem/Rep Clean & Detail New .~ I S 1 Ref Ref Clear coat Exist 2.0* 16 1 Body Rem/Rep Decal, Side Bed (Adhesive) "Z71" L New 25798302 $37.57 $37.57 .2 17 Paint Materials $462.0p * -Judgement Item # -Labor Note Applies Labor Body 9.9 Hrs @ $55.00 Refinish 13.2 Hrs @ $55.00 Glass 1.5 Hrs @ $55.00 Labor Total Parts $544.50 Parts Subtotal $726.00 Less Adjustments $82.50 Parts Total $1,353.00 e above is an estimate based on our inspection and ces not cover any additional parts or labor which may required after the work has started. Occasionally, orn or damaged parts are discovered which may not evident on the first inspection. Because of this, the hove prices are not guaranteed. Quotations on parts d labor are current and subject to change. $37.57 Additional Costs and Operations Addl. Costs/Ops Total Taz Labor Tax @ 7.00% Tax Total Totals $37.57 $462.00 Sub Total: $1,947.29 Customer Resp. $0.00 Net Total $1,947.29 Authorization for Repairs: Signature Date This is a preliminary estimate. Additional changes to the estimate may be required for the actual repair. 2007 Chevrolet Pickup Silverado LS C1500 Version 2.0 P-Page logic not included. Database Edition CPL 09-06 Page 2 of 3