Claim by Tim O'MaraTHE CTTY OF
DUB E
Masterpiece on the Mississippi
TRACEY STECKLEIN
PARALEGAL
To:
DATE:
RE:
Claimant
Tim O'Mara
MEMORANDUM
Mayor Roy D. Buol and
Members of the City Council
September 28, 2009
Claim Against the City of Dubuque by Tim O'Mara
Date of Claim
09/25/09
Date of Loss
07/17/09
Nature of Claim
Vehicle Damage
This is a claim in which claimant alleges that a City of Dubuque Leisure Services
employee backed his vehicle into claimant's vehicle.
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
Gil Spence, Leisure Services Manager
Tim O'Mara
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.
G~i~ti
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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.
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1. Name of Claimant: ~~:. t
2. Address:
3. Telephone Number S$g • b~ 4 ~
4. Date of Incident: ~1~ 3 • 0~1
5. Time of Incident: ~:.5~ ~r~
6. Location of Incident (Be specific): ~~~ t ~'~~t~.
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.)
8. What were weather conditions like?
9. Give name and address of any witnesses: .,
10. Did police investigate? (If so, give names of officers.)
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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.)
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15. What amount do you claim from the City of Dubuque?
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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.)
Thr' .
18. If the answer to Question 17 is yes, have you received any payment from that
source, and if so, in what amount?
Dated this (,o k>4. day of S~ , 20 0 °~ . n
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CITY OF DUBUQUE
50 W. 13th St.
Dubuque, IA 52001
Date ~. -. - ...F ~.4
L
ICAP Certificate #003
Vehicle. Physical Damage /Vehicle Liability Claim Report
Department Contact '~"`~ ~~ ~`:~-°_,~ ~yPhone # 563-589-4263
', ~ ~`' ~ '
Loss Location ~~ ~ ( ~_ E ~n ~ ~ t~ ~ ~° ~ ~ ~ ~ _ ;~ c~ ?~~~ ~ _
Date of Loss ~ ~ Time of Loss ~ y~ :_ ~ ~ ¢''"~~
-~
Accident Facts ~ ~ j P~G{ !~ -r~';~'~ j yt '~~ %" ;`` r`~ ~1 /?'!~ ~` ~i ''
~-
~, ~ ~~ a ~ ~" ~r
City Vehicle
^ Yes [}'f~lo ^ Pending Driver Charged
ICAP Insurance Carrier
~~.; ~ w,~ ~ _ 'Year/Make/Model
~. Q
~. n . J :: t,. ~ `.. ~ ` ~.
Other Vehicle
^ Yes o ^ Pending
yr
~ ~~ ~~ r~s . s-~.~a ~r ~ ~ ~ y~
Vehicle Number not applicable
Vehicle Location J L. 'n / ~ ~'
Name of Driver '~ ;~' ' ~ ~ ~`1 ~ ~~
Driver License # ~~ ~ ~ Y w ~ `~
City of Dubuque Owner ~' ~^~f7 r ,~',~' .. {s ..~
~"'~ Is Vehicle Driveable?~,~'?~,~
Was the City of Dubuque's vehicle used with permission? [Yes ^ No ^ Not Applicable
Accident Witnesses and Phone # ~ ~, ~ ~~~ ~ " ~ ~~~
Police Department Report #
Attach, if Available
Non-City Driver Address and Phone # 7 G 7 /1„/ ;~ v~~~~ ~ "` ~ ~ f .1 `~i'"~
Report completed by ~~~~, , F= f ;, ~-~
Submit two written estimates on City vehicle.
NOTE: State report required WITHIN A 72 HOUR PERIOD if total
damages equal $1,000 or more or there is bodily injury.
Mail or Frank O'Connor, O'Connor & Associates Phone 563-557-7440
Fax to: 305 Locust St., Dubuque, IA 52001 Fax 563-583-9142
Form sent to: ^ Legal Department ^ Finance Department ^ O'Connor & Associates
Last Revised: January 2005
. RICHARDSON MOTORS
' ~ 1475 J.F.K. ROAD
DUBUQUE, IA 52002
PHONE: (563) 582-5411 FAX: (563) 582-4129
FEDERAL ID: 42 -0813744
CD LOG NO 6361-1 DATE 09/09/09
SHOP: RICHARDSON MOTORS INSP DATE: 09/09/09
ADDRESS: 1475 JOHN F. KENNEDY RD CONTACT: JASON CHARLEY
CITY STATE: DUBUQUE, IA PHONE 1: (563)582-5411
ZIP: 52002- FAX: (563)582-4129
OWNER: OMERA, TIM HOME PHONE: (563)588-0498
ADDRESS: 767 NEVADA
CITY STATE: DUBUQUE, IA
ZIP: 52001
POINT OF IMPACT: 6
LIC#: STATE: VIN: 2G4WS52J211274342
BODY COLOR: GOLD MILEAGE:
CONDITION: ACCTNG CTL#:
*=USER-ENTERED VALUE
EC=REPLACE ECONOMY
UM=REMAN/REBUILT PRT
OE=REPLACE PXN OE SRPLS
TE=PARTL REPL PRICE
I=REPAIR
TT=TWO-TONE
N=ADDITIONAL LABOR
AA=APPEAR ALLOWANCE
E=REPLACE OEM
UE=REPLACE OE SURPLUS
EU=REPLACE SALVAGE
PC=PXN RECONDITIONED
ET=PARTL REPL LABOR
L=REFINISH
CG=CHIPGUARD
RI=R&I ASSEMBLY
RP=RELATED PRIOR
NG=REPLACE NAGS
UC=RECONDITIONED PRT
EP=REPLACE PXN
PM=PXN REMAN/REBUILT
IT=PARTIAL REPAIR
BR=BLEND REFINISH
SB=SUBLET
P=CHECK
UP=UNRELATED PRIOR
2001 BUICK CENTURY CUSTOM 4DOOR SEDAN 6CYL GASOLINE 3.1
CODE: S2433B/E OPTNS M/24G
OPTIONS:
TWO-STAGE - EXTERIOR SURFACES TWO-STAGE - INTERIOR SURFACES
ANTI-LOCK BRAKE SYSTEM
OP GDE
-- --- MC DESCRIPTION
-- ----------- MFG.PART NO.
---
- PRICE AJo Bo HOURS R
RI0041
HEADLAMP ASSY,HALOG
LT -
-------
R&I ASSEMBLY ----- --- -- -----
0.3 -
1
BR0103 13 FENDER, FRONT LT BLEND REFINISH 1.9 4
BR0187 PANEL,ROCKER LT BLEND REFINISH 0.7 4
EU0207 DOOR ASSEMBLY, FRONT LT SALVAGE PART 250.00*+33.00 2.9 1
doors from samrt parts #3061063
L 0207 DOOR SHELL, FRONT LT REFINISH 3.5 4
EU0287 DOOR ASSEMBLY,REAR LT SALVAGE PART 250.00*+33.00 3.4 1
L 0287 DOOR SHELL, REAR LT REFINISH 3.2 4
BR0444 PANEL, QUARTER LT BLEND REFINISH 1.3 4
RI0533 TAILLAMP ASSEMBLY LT R&I ASSEMBLY 0.3 1
2001,BUICK CENTURY CUSTOM 4DOOR SEDAN
eD LUG~NO 6361-1
N M17 COVER CAR EXTERIOR ADDNL LABOR OPERA 6.00* 0.2*4*
SBM60 HAZARD. WSTE. REM. SUBLET REPAIR 6.00* 1*
N clean up used doors ADDNL LABOR OPERA 2.0*1*
12 ITEMS
MC MESSAGE(S)
13 INCLUDES 0.6 HOURS FIRST PANEL TWO-STAGE ALLOWANCE
FINAL CALCULATIONS & ENTRIES
OTHER PARTS
LINE ITEM MARKUP
PAINT MATERIAL
PARTS & MATERIAL TOTAL
TAX ON PARTS @
LABOR
1-SHEET METAL
2-MECH/ELEC
3-FRAME
4-REFINISH
5-PAINT MATERIAL
LABOR TOTAL
TAX ON LABOR
SUBLET REPAIRS
TAX ON SUBLET
TOWING
STORAGE
GROSS TOTAL
RATE REPLACE HRS
55.00 6.9
64.00
59.00
55.00 10.6
35.00
7.000
REPAIR HRS
2.0
506.00
165.00+
378.00
1,049.00
46.97
489.50
0.2 594.00
1,083.50
@ 7.000 75.85
6.00
@ 7.OOOo 0.42
2,261.74
NET TOTAL 2,261.74
SHOPLINK UN189 ES CD LOG 6361-1 DATE 09/09/09 04:29:21PM R6.37 CD 08/09
PXN: Y/00/00/00/00/00 CUM 00/00/00/00/00 GEOCODE 52002
EDU: 0901 HOST LOG
(C) 1998 - 2008 AUDATEX NORTH AMERICA, INC.
2.7 HRS WERE ADDED TO THIS EST. BASED ON AUDATEX TWO-STAGE REFINISH FORMULA.
ichardson ~Pom-'
PEE/OEMRNCf ALLI~N CE'
Buick Cadillac GMC Truck Honda Drop off. Relax. Pickup.
Jason Charley
Body Shop Manager
Body Shop Hours: 8 a.m. - 5 p.m. Mon. -Fri
Business 563-582-5411 1475 John F. Kennedy Rd.
Toll Free 888-806-5411 Dubuque, Iowa 52002
Fax 563-582-4129 jcharley~richardsonmotors.com