Claim Weidenbacher, Thomas J.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. 13th 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: Thomas J. Weidenbacher
2. Address: 807 Liberty Ave. Dubuque, IA
3. Telephone Number: 582 2139
4. Date of Incident: 2 11 -3
5. Time of Incident: 3:45
6. Location of Incident (Be specific):
Blanche Street, Dubuque, IA
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.)
Truck Number 3252
I was coming down Blanche very slow because of the weather conditions. As I rounded the curve the plow truck was coming up. I was forced into the ditch.
If I would not have done soI would have been hit head on.
8. What were weather conditions like? blowing snow & slippery
9. Give name and address of any witnesses: John Lanser, 747 Blanche Street, Dubuque, IA
10. Did police investigate? (If so, give names of officers.)
No
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
No
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.)
See attached estimate
13. What other damages do you claim, if any?
None
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.)
No
15. What amount do you claim from the City of Dubuque? $1650.42
16. Why do you claim the City of Dubuque is responsible?
Because truck driver was driving too fast for conditions and apparently could not stop and was in middle of st.
17. Have you made any claim against anyone else for damages as a result of this incident?
(If yes, give name and address.)
no
18. If the answer to Question 17 is yes, have you received any payment from that source, and if so, in what amount?
Dated at Dubuque, Iowa this 12 day of February, 2003
/s/ Thomas James Weidenbacher
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
CLAIM AGAINST THE CITY OF DUBUQUE,-IOWA '
This written report constitutes your claim against the City of Dubuque, !o~. 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. 13th 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: ~-~-~ { W ~-~-~
q
2. Address:
' ~/
3. Telephone Number:
4. Date of Incident:
5. Time of Incident:
6. Location of Incident (Be specific):
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 ~ { r~ ~c~ /I c<m ~'~
: ~hat were weather condiiions like?
9. Give name and address of any witnesses;
10. Did .~1~ investigate? (If so, give names of officers.)
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?
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?
17. Have you made any claim against anyone else for damages as a result of this incident?
(If yes, give name and address.) ~ O
18. If the answer to Question 17 is yes, have you received any payment from that source,
and if so, in what amount?
Dated at Dubuque, Iowa this
'~ {$ig nature)
(Print Name)
(Rev. 1/00 & 7/01)
Date: 2/12/03 10:t9 AM
Estimate ID: ~430
Estimate Version: 0
Preliminary
Profile ID: Mitchell
LENNY VALENTINE & SONS, INC.
923 PERU RD DUBUQUE, IA 52001-8604
(563) 588-4659
Fax: (563) 588-4650
TWO CONTINENTAL FRAME MACHINES
GENESIS II COMPUTERISEDMEASURING SYSTEM
PRICE IS EASY TO BEAT/QUALITY IS NOT
UNIBODY SPECIALISTS
Damage Assessed By: WAYNE VALENTINE
Deductible: UNKNOWN
Owner THONAS WEIDENBACHER
Address: 807 LIBERTY DUBUQUE, IA 52001
Telephone: HomePhone: (563)582-2139
Mitchell Service: 911621
Description: 1996 Ford Pickup F150 XL
Body Style: 2D PkupXCb 7' Bed 139" WB
VIN: IFTEXI4H2TKA14420
Drive Train: 5.8L Inj 8 Cyl 4WD
Line Entry Labor
Item Number Type Operation
Line Item
Description
I AUTO BDY OVERHAUL
2 101140 BDY REMOVE/REPLACE
3 AUTO BDY REMOVE/REPLACE
4 101260 BDY REMOVE/REPLACE
5 101270 BDY REMOVE/REPLACE
6 101280 BDY REMOVE/REPLACE
7 101290 BD¥ REMOVE/REPLACE
8 107479 FRM REMOVE/REPLACE
9 111530 MCH ALIGN
l0 137090 BDY REPAIR
11 AUTO REF REFINISH
12 145590 BDY REMOVE/REPLACE
i3 138820 BDY REPAIR
i4 i38828 BDY REPAIR
15 138850 BDY REMOVE/REPLACE
16 900500 BDY* REMOVE/REPLACE
17 900500 BDY* REMOVE/REPLACE
18 AUTO REF ADD'L OPR
i9 AUTO ADD'L COST
20 AUTO ADD'L COST
21 AUTO ADD'L COST
FRT BUMPER ASSY
FRT BUMPER FACE BAR
FRT ADD W/BUMPER PAD
R FRT BUMPER REINFORCEMENT
L FRT BUMPER REINFORCEMENT
R FRT BUMPER MOUNTING ARM
L FRT BUMPER MOUNTING ARM
FRAME FRONT CROSSMEMBER -F
FRONT SUSPENSION -M
R PICKUP BED SIDE PANEL ASSY
R BED SIDE PANEL OUTSIDE
R PICKUP BED WHEEL OPENING MOULDING
R FRT PICKUP BED ADHESIVE SIDE MLDG
R REAR PICKUP BED ADHESIVE SIDE MLDG
R PICKUP BED DECAL
TAPE STRIPE
REPAIR MUD FLAPS
CLEAR COAT
PAINT/MATERIALS
SHOP MATERIALS
HAZARDOUS WASTE DISPOSAL
ESTIMATE RECALL NUMBER: 2/12/03 10:09:01 4430
UltraMate is a Trademark of Mitchell International
Mitchell Data Version: FEB_03_A Copyright (C) 1994 - 2002 Mitchell International
UltraMata Version: 4.8.012 All Rights Reserved
Part Type/ Dollar Labor
Part Number Amount Units
1.3
F3TZ 17757 AB 223,00 INC
0,3
F2TZ 17A792 A 28.60 INC
F2TZ 17A792 B 28.60 INC
F2TZ 17752 A 28.25 INC
F2TZ 17752 B 28.25 INC
ORDER FROM DEALER 5t.20 0.6
2.4
Existing 5.5' #
C 3.2
E7TZ 9829164 A 53.58 0.3
Existing 0.5*
Existing 0.5'
ORDER FROM DEALER 17.30 0,2 #
New 125.00' 0.5*
New 2.0*
1.3
130.50 *
16,25 *
3.38 *
Page 1 of 2
* - Judgement Item
# - Labor Note Applies
C - Included in Clear Coat Calc
Date: 2/12103 10:19 AM
Estimate ID: 4430
Estimate Version: 0
Preliminary
Profile iD: Mitchell
I. Labor Subtotals
Body
Refinish
Frame
Mechanical
Add'l
Labor Sublet
Units Rate Amount Amount
11.1 44.00 0.00 0.00
4.5 44.00 0.00 0.06
0.6 50.00 0.00 0.00
2.4 50.00 0.00 0.00
Taxable Labor
Labor Tax ~ 6.000 %
Labor Summary t8.5
III. Additional Costa
Taxable Costs
Sales Tax
Non-Taxable Costa
Total Additional Costs
6.000%
Totals I1. Part Replacement Summary
488.40 T Taxable Parts
198,00 T Sales Tax
25.00 T
120.00 T Total Replacement PartaAmount
831.40
49.88
881.28
Amount
3.38
0.20
146.75
150.33
IV. Adjustmenta
Customer Responsibility
6.000%
Amount
583.78
35.03
618.81
Amount
0.00
I. Total Labor:
II. Total Replacement Parts:
III. Total Additional Costa:
Gross Total;
IV. Total Adjustments:
Net Total:
This is a preliminary estimate.
Additional chanqes to the estimate may be required for the actual repair.
881.28
618.81
150.33
1,650.42
0.00
1,650.42
WARNING: Accidental air bag deployment is possible. Personal injury may result. Avoid area near steering wheel
and instrument panel even if air bags have deployed. Dual-stage air bag modules may be present that could
contain an undeployed stage. When disposing of a deployed dual-stage air bag, always treat it as a "live" module.
See appropriate MITCHELL® AIR BAG SERVICE & REPAIR MANUAL, or OEM information.
ESTIMATE RECALL NUMBER: ?J12/03 10:09:0t 4430
UltraMate is a Trademark of Mitchell International
Mitchell Data Version: FEB 03 A Copyright (C) 1994 - 2002 Mitchell International
UltraMate Version: 4.8.012 All Righta Reserved
Page 2
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