Claim by Molly FreiburgerCLAIM 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: Molly Freiburger
2. Address: 602 Cty 2 Hazel Green WI 53811
3. Telephone Number l ~ ` ~~
4. Date of Incident: ~ ' Z~~ y I
5. Time of Incident: ~ ~ 2 ' ~ 1~'m
Location of Incident (Be specific): Parking ramp on 5th & Iowa (pink ramp)
5th St. exit.
9. Give name a
dres~any witnesses:
10. Did police inve te? (If so, give na,mmes of officers.)
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
8. What were weather conditions like?
-~Aa.Q
11. Wks 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
ovicr~4 of rl~m~nc \
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.)
n~
15. ~ a~n~u~t d~~ claim from the City of Dubuque?
16.~hy do you claim the City of Dy~uq~e is responsiblE?
!1 A ~~/' . 1 ~ n. f/-'il A n n it -~-= i A w ~~ ~ A
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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Dated this _~ day of , 20~. ~ ~~-~v" ~~~
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RUNDE CHEVROLET
780 ROUTE 35 NORTH
EAST DUBUQUE, IL 61025
PHONE (815) 747-3011 FAX (815) 747-7238
FED TAX I.D. 36-4320504
"""' PRELIMINARY ESTIMATE'**
08!29/2009 05:29 AM
Owner
Inspection
Owner: MOLLY FREIBURGER
Address: 602 COUNTY Z
City State Zip: Hazel Green, WI 53811
Email: mlfreiburger@frontiemet.net
Inspection Date: 08/29/2009 05:29 AM
Repairer
Vehicle
Repairer: RUNDE CHEVROLET INC.
Address: Rt. 780, Hwy 35 North
City State Zip: East Dubuque, IL 61025
Email: mrunde@rundechevrolet.com
2006 Chevrolet Uplander LT1 4 DR Pass. Van Extended
6cyl Gasoline 3.5
4 Speed Automatic
Lic Expire:
Prod Date:
Veh Insp#
Condition:
Ext. Color: GREEN
Ext. Refinish: Two-Stage
Options
Home/Day: (608)748-4525
FAX:
Inspection Type:
Contact:
Work/Day: (815)747-3011
FAX: (815)747-7238
Cell:
VIN: 1 GNDV33L16D212098
Mileage: 38,834
Mileage Type: Actual
Code: U6533C
Int. Color:
Int. Refinish: Two-Stage
7 Passenger Seating AM/FM CD Player Alarm System
Aluminum/Alloy Wheels Anti-lock Brakes Cargo/Trunk Net
Cruise Control Dual Air Conditioning Dual Airbags
Head Airbags Heated Power Mirrors Intermittent Wipers
Keyless Entry System Lighted Entry System MP3 Player
OnStar System Overhead Console Picnic Tray(s)/Table(s)
Power Brakes Power Door Locks Power Drivers Seat
Power Sliding RH Door Power Steering Power Windows
Privacy Glass Rear Entertainment Systm Rear Heater
Rear Seat Audio Controls Rear Window Defroster Rear Window Wiper/Washer
Roof/Luggage Rack Side Airbags Sliding Driver Side Door
Stability Cntrl Suspensn Strg Wheel Radio Control Tachometer
Theft Deterrent System Tilt Steering Wheel Tinted Glass
Traction Control System Trip Computer Velour/Cloth Seats
Damages
Line Op Guide MC Description MFR.Part No. Price ADJ% B% Hours R
1 I 209 Pnl,Front Door Outer LT Repair 0.5' SM
» SCRATCHES TOP OF DOOR
2 L 209 13 Pnl,Front Door Outer LT Refinish 3.7 RF
08/29/2009 05:53 AM --
Page 1 of 3
2006 Chevrolet Uplander LT1 4 DR Pass. Van EMended
Ctaim #
2.6 Surface
0.6 Two-stage setup
0.5 Two-stage
3 RI 267 W/Strip,Beit Outer LT R 8 1 Assembly
4 RI 239 W/Strip,Frt Door Glass LT R ~ I Assembly
5 RI 231 Pnl,lnner Door Trim LT R & I Assembly
6 RI 315 MIdg,Front Door Lower LT R & I Assembly
» RETAPE
7 RI 229 Mirror,Outer R/C LT R ~ I Assembly
8 RI 643 Handle, Front Door Otr LT R & I Assembly
9 I 289 Pnl,Rear Door Outer LT Repair
» SCRATCHES TOP OF DOOR
10 L 289 Pnl,Rear Door Outer LT Refinish
2.3 Surface
0.5 Two-stage
11 RI 317 MIdg,Sliding Door Lowe LT R & I Assembly
» RETAPE
12 RI 307 Pnl,Sldg Dr Inner Trim LT R & I Assembly
13 RI 416 Handle,Sliding Dr Oute LT R & I Assembly
14 I 550 Spoiler, Roof Repair
» ROOF RACK SCRATCHES
15 L 550 Spoiler, Roof Refinish
1.5 Surface
0.3 Two-stage
16 RI 550 Spoiler, Roof R & I Assembly
17 RI 1144 Luggage Rack R & I LT R & I Assembly
18 RI 1145 Luggage Rack R & I RT R & I Assembly
19 I 387 Panel,Bodyside Outer LT Repair
» DENTS TOP OF L SIDE PNL
20 L 387 Panel,Bodyside Outer LT Refinish
0.9 Surface
0.2 Two-stage
21 RI 395 Glass,Bodyside Tinted LT R & I Assembly
22 RI 533 Taillamp Assembly LT R & I Assembly
23 I "' UNSEEN DAMAGE OPEN Repair
24 SB W/SHIELD Sublet Repair
25 SB R&I L SLIDING DOOR GLASS Sublet Repair
26 I TINT COLOR Repair
27 EC CAR COVER Replace Economy
27 Items
MC Message
08!29!2009 05:29 AM
0.2 SM
1.0 SM
INC SM
0.5' SM
0.9 SM
0.4 SM
0.5' SM
2.8 RF
0.5" SM
0.5 SM
0.5 SM
0.5' SM
1.8 RF
0.5 SM
0.2 SM
0.2 SM
3.0" SM
1.1 RF
1.0 SM
0.3 SM
0.0' SM'
$388.42" 0.0' SM'
$90.00" 0.0' SM'
0.5" SM'
$5.00' 0.3' SM'
13 INCLUDES 0.6 HOURS FIRST PANEL TWO-STAGE ALLOWANCE
Estimate Total & Entries
Other Parts $5.00
Paint Materials $300.80
Parts 8 Material Total
Tax on Parts 8 Material @ 6.750%
Labor Rate Replace Hrs Repair Hrs Total Hrs
Sheet Metal (SM) $51.00 7.0 5.0 12.0 $612.00
Mech/Elec (ME) $74.00
Frame (FR) $58.00
Refinish (RF) $51.00 9.4 9.4 $479.40
Paint Materials $32.00
Labor Total 21.4 Hours
Sublet Repairs
Gross Total
Net Total
Alternate Parts No
Recycled Parts NOT REQUESTED
$305.80
$20.64
$1,091.40
$478.42
$7,896.26
$1,896.28
UJ: JJ AM
Page 2 of 3
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2006 Chevrolet Uplander LT1 4 DR Pass. Van Extended
Claim #
08!29/2009 05:29 AM
Audatex Estimating 6.0.025 ES 08/29/2009 05:53 AM REL 6.0.025 DT 07/01/2009
Copyright (C) 2008 Audatex North America, Inc.
2.1 HRS WERE ADDED TO THIS ESTIMATE BASED ON AUDATEX'S TWO-STAGE REFINISH FORMULA.
Op Codes
=User-Entered Value
EC =Replace Economy
ET =Partial Replace Labor
TE =Partial Replace Price
L =Refinish
TT =Two-Tone
BR = Blend Refinish
CG= Ctripguarct
AA =Appearance Allowance
E =Replace OEM
OE = Replace PXN OE Srpls
EP =Replace PXN
PM = Replace PXN RemanlReblt
PC =Replace PXN Reconditioned
SB =Sublet Repair
I =Repair
Rt = R & t Assembly
RP =Related Prior Damage
NG = Replace NAGS
UE =Replace OE Surplus
EU =Replace Recycled
UM= Replace Reman/Rebuilt
UC =Replace Reconditioned
N =Additional Labor
IT =Partial Repair
P =Check
This report contains proprietary information of Audatex and may not be disclosed to any third party (other than the
insured, claimant and others on a need to know basis in order to effectuate the claims process) without Audatex's
~~ ~'~1x prior written consent.
Copyright (C) 2008 Audatex North America, Inc.
Audatex Estimating is a trademark of Audatex North America, Inc.
08/29/2009 05:53 AM Page 3 of 3