Claim by Sheena GillenTHE CITY OF
DUB E MEMORANDUM
Masterpiece on the Mississippi
TRACEY STECKLEIN
PARALEGAL
.,3p
To: Mayor Roy D. Buol and
Members of the City Council
DATE: March 1, 2010
RE: Claim Against the City of Dubuque by Sheena Gillen
Claimant Date of Claim Date of Loss Nature of Claim
Sheena Gillen 02/25/10 01/04/10 Vehicle Damage
This is a claim in which claimant alleges that a City of Dubuque snowplow truck struck
the driver's side mirror of her vehicle which was parked in front of 2335 Rosedale
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
Sheena Gillen
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 West 13 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: ,_)\Alibla CiV
2. Address: LI S I C1 1,04-X \)
3. Telephone Number 5 (0) - V12 q02
4. Date of Incident:
5. Time of Incident:
6. Location of Incident ( e s ecific):
k i ova ( * .I11-Yri0 Se )004 OK? POYCIA031 .
'11
( (2 tflo
I+IAl
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 a ' e.)
1 e.ii / . /. kJA* L4 i Li Ls CA i • it
� ''� r
1.i. . & /I / Li I ■kr I ,/ i J1nara • Ir
8. What were weath r conditions lik
bk74 i'uf - c'1�
9. Give name and address of any witnesses:
10. Did po ' e investigat ? f so, give names of officers.)
�p , 024 bal loq C
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.)
P,p/5 5` C .Q Vy ip b( 106
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.)
/U0
15. What amount do you claim from the City of Dubuque?
I 37.co
t 6. Why do you claim the City of Dubuque is responsible?
pC t`_p a C_I- L xierire Itia cl 0-- Cj \)ei 1iCf Cifl
1 J
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?
Dated this 2: day of ki9`
(Signature)
Sei7, 1/m
(Print Name)
, 20) O
dl 'entngno
90410 s,iaio 43
Wd SZ 83.E Ol
Q3A18O31
u
N
T
001
Driver's Name - Last
LEIBFRIED
First
WILLIAM
Middle Suffix
Address
1300 GARFIELD AVE
Cit,
DUBUQUE
I State
IA
Zip
52001 - 0000
Home/Cell Phone
(563) 582 - 1043 x
Gender
Male
Class
B
State
IA
Endorsements
NONE
Restrictions
NONE
Insurance Co. Name Insurance Co. Phone #
CITY OF DUBUQUE
Insurance Polk./ #
J
Owner Company Name
Owner's Name - Last
CITY OF DUBUQUE
First
Middle
Suffix
Address
50 W 13TH ST
City
DUBUQUE
I State
1 IA
Zip
52002 -
VIN No.
1FDXF47F52EA51333
Year
2002
Make
FORD
Model
Style
TK
Vehicle Configuration
05
License Plate #
8$21b
State
IA
Year
2020
Most Damaged Area
99 - Unknown
Approximate Cost to 'Repair or Replace
$0.00 i
Driver's Name - Last
LI
Firs
Middle
Suffix
Date of Birth
N Address
City
State
Zp
Home /Cell Phone
T Gender
I Driver's License Number
Class State
Endorsements
NONE
Restrictions
NONE
Insurance Co. Name Insurance Co. Phone #
ALLIED (563) 556 - 6661 x
002 Owner Company Name
Insurance Policy #
PPGM0021987734
Owner's Name - Last
GILLEN
First
JOHN
Middle
PHILLIP
Suffix
I
Address
5114 PELICAN DR
City State
DUBUQUE I IA
Zip
52001 -
VIN No.
1FAFP34301W131218
Year
2001
Make 1 Model
FORD 1 Futr
Style I - cle C Dnt yuration
1 4D LC.**
License Plate #
868AXW
State
IA
Year
2010
Most Damaged Area
07 - Left Side
_ J
Approximate Cost IL, Repair or Pepl-,_e
$100.00
County
Dubuque - 31
Accident occurred within corporate limits of (city)
Dubuque - 2100
X Coordinate
00689123
Literal Description
ST AMBROSE ST
If accident occurred outside of city
limits show general vacinity: "N /A"
On Road, Street, or Highway:
ROSEDALE
Distance
"N /A"
Officer
STEWART, JEFF
Direction
"N /A"
and
Definable intersection, bridge, or railroad crossing
"N /A"
71° 't's
Driver Information Exchange Report
Direction
"N /A" of
Distance
"N /A"
Dubuque Police Department
563 -589 -4410
Nearest City
"N /A"
Badge No.
64C
Printed At: Dubuque Police Department 01/04, .0 03:04 PM
Direction
"N /A"
Y Coordinate
04708247
At Intersection with:
ROSEDALE AND ST. AMBROSE
of
Milepost Number
"N /A" Or
Law Enforcement Case Number 1 Date of Accident
01 - 10 - 420 01/04/2010
Route tCardinal)
Travel Direction
Page 1 Form #: 01- 10-420
"N /A" -
Time of Accident
14:41 Hrs.
Damage Assessed By: Rick Stumpf
Deductible:
Claim Number:
Insured:
Address:
Telephone:
Description:
Body Style:
VIN:
Color:
Options:
Line Entry Labor
Item Number Type
Mike Finnin Ford
0.00
9093
SHENA GILLEN
4519 LARK DR., DUBUQUE, IA 52001
Home Phone: (563) 542 -5621
3600 Dodge Street, Dubuque, IA 52003
(563) 556 -1010
Fax: (563) 690 -1086
Email: bodyshop@finninautos.com
Tax ID: 14- 1862673
# - Labor Note Applies
2001 Ford Focus SE
4D Sed
1 FAFP34301 W131218
BLUE
VEHICLE ANTI - THEFT, PASSENGER AIRBAG, DRIVER SIDE AIRBAG, POWER LOCK
POWER WINDOW, POWER STEERING, POWER BRAKE, REAR WINDOW DEFOGGER
MANUAL AIR CONDITION, CRUISE CONTROL, ALUM /ALLOY WHEELS, CD PLAYER
POWER ADJUSTABLE EXTERIOR MIRROR, FRONT AIR DAM, TINTED GLASS
FIRST ROW BUCKET SEAT, KEYLESS ENTRY, SECOND ROW FOLDING SEAT
REAR HEATING, VENTILATION & AIR CONDITIONING, CLOTH SEAT
REMOTE DECKLID OR TAILGATE RELEASE
Operation
Mitchell Service: 910626
Line Item
Description
1 002540 BDY REMOVE /REPLACE L Frt Door Mirror Assy
2 004243 BDY REMOVE/INSTALL L Frt Door Trim Panel
ESTIMATE RECALL NUMBER: 02/15/2010 14:30:17 9093
Mitchell Data Version: OEM: JAN_10_V UltraMate is a Trademark of Mitchell International
Copyright (C) 1994 - 2010 Mitchell International
UltraMate Version: 7.0.016 All Rights Reserved
Date: 2/15/2010 02:30 PM
Estimate ID: 9093
Estimate Version: 0
Preliminary
Profile ID: Mitchell
Drive Train: 2.0L Inj 4 Cyl 16 Valve 4A FWD
Part Type/
Part Number
6S4Z 17683 BA
Dollar Labor
Amount Units
56.00 0.3 #
0.4
Page 1 of 2
1
•
Add9
Labor Sublet
I. Labor Subtotals Units Rate Amount Amount Totals II. Part Replacement Summary Amount
Body 0.7 55.00 0.00 0.00 38.50 T Taxable Paris 56.00
Sales Tax @ 7.000% 3.92
Taxable Labor 38.50
Labor Tax @ 7.000 % 2.70 Total Replacement Parts Amount 59.92
Labor Summary
III. Additional Costs
Total Additional Costs
Estimate Totals
0.7 41.20
Amount IV. Adjustments Amount
0.00 Insurance Deductible 0.00
I. Total Labor: 41.20
11. Total Replacement Parts: 59.92
III. Total Additional Costs: 0.00
Gross Total: 101.12
IV. Total Adjustments: 0.00
Net Total: 101.12
This is a preliminary estimate.
Additional changes to the estimate may be required for the actual repair.
ESTIMATE RECALL NUMBER: 02/15/2010 14:30:17 9093
Mitchell Data Version: OEM: JAN_10_V UltraMate is a Trademark of Mitchell International
Copyright (C) 1994 - 2010 Mitchell International
UltraMate Version: 7.0.016 All Rights Reserved
Date: 2/15/2010 02:30 PM
Estimate ID: 9093
Estimate Version: 0
Preliminary
Profile ID: Mitchell
Customer Responsibility 0.00
Page 2 of 2
Damage Assessed By: john klotz
Deductible: 0.00
Claim Number: 8235
Labor Summary
Insured: SHEENA GILLEN
* - Judgment Item
# - Labor Note Applies
BIRD CHEVROLET
3255 UNIVERSITY AVE, DUBUQUE, IA 52001
(563) 583-9121
Fax: (563) 556-4482
Tax ID: 42-0400210
Mitchell Service: 910626
Description: 2001 Ford Focus SE
Body Style: 4D Sed Drive Train: 2.0L Inj 4 Cyl 16 Valve 4A FWD
VIN: 1FAFP34301W131218
OEM/ALT: 0 Search Code: None
Options: VEHICLE ANTITHEFT, PASSENGER AIRBAG, DRIVER SIDE AIRBAG, POWER LOCK
POWER WINDOW, POWER STEERING, POWER BRAKE, REAR WINDOW DEFOGGER
MANUAL AIR CONDITION, CRUISE CONTROL, ALUM/ALLOY WHEELS, CD PLAYER
POWER ADJUSTABLE EXTERIOR MIRROR, FRONT AIR DAM, TINTED GLASS
FIRST ROW BUCKET SEAT, KEYLESS ENTRY, SECOND ROW FOLDING SEAT
REAR HEATING, VENTILATION & AIR CONDITIONING, CLOTH SEAT
REMOTE DECKLID OR TAILGATE RELEASE
Line Entry Labor Line Item Part Type/ Dollar Labor
Item Number Type Operation Description Part Number Amount Units
1 002540 BDY REMOVE/REPLACE L Frt Door Mirror Aasy 6S4Z 17683 BA 56.00 0.3 #
2 004243 BDY REMOVE/INSTALL L Frt Door Trim Panel 0.4
3 900500 BDY* REPAIR POLISH SCRATCHES Existing 0.5*
Estimate Totals
Add'l
Labor Sublet
I. Labor Subtotals Units Rate Amount Amount Totals II. Part Replacement Summary Amount
Body 1.2 57.00 0.00 0.00 68.40 T Taxable Parts 56.00
Sales Tax @ 7.000% 3.92
Taxable Labor 68.40
Labor Tax (4 7.000 % 4.79 Total Replacement Parts Amount 59.92
1.2 73.19
ESTIMATE RECALL NUMBER: 02/15/2010 14:46:26 8235
Mitchell Data Version: OEM: JAN_10_V UltraMate is a Trademark of Mitchell International
Copyright (C) 1994 - 2010 Mitchell International
UltraMate Version: 7.0.016 All Rights Reserved
Date: 2/15/2010 02:46 PM
Estimate ID: 8235
Estimate Version: 0
Preliminary
Profile ID: Mitchell
Page 1 of 2
Date: 2/15/2010 02:46 PM
Estimate ID: 8235
Estimate Version: 0
Preliminary
Profile ID: Mitchell
III. Additional Costs Amount IV. Adjustments Amount
Total Additional Costs 0.00 Insurance Deductible 0.00
ESTIMATE RECALL NUMBER: 02/15/2010 14:46:26 8235
Mitchell Data Version: OEM: JAN_10_V UltraMate is a Trademark of Mitchell International
Copyright (C) 1994 - 2010 Mitchell International
UltraMate Version: 7.0.016 All Rights Reserved
Customer Responsibility 0.00
I. Total Labor: 73.19
II. Total Replacement Parts: 59.92
III. Total Additional Costs: 0.00
Gross Total: 133.11
W. Total Adjustments: 0.00
Net Total: 133.11
This is a preliminary estimate.
Additional changes to the estimate may be required for the actual repair.
Page 2 of 2