Claim by Carl F. LangeTHE CITY OF
DUB UE MEMORANDUM
Masterpiece on the Mississippi
TRACEY STECKLEIN
PARALEGAL
To:
DATE:
RE:
Claimant
Carl F. Lange
)dE›
Mayor Roy D. Buol and
Members of the City Council
March 26, 2010
Claim Against the City of Dubuque by Carl F. Lange
Date of Claim Date of Loss
03/24/10
cc: Michael C. Van Milligen, City Manager
John Klostermann, Street & Sewer Maintenance Supervisor
Carl F. Lange
Nature of Claim
03/18/10 Vehicle Damage
This is a claim in which claimant alleges that as he was parked at the City greenhouse
at 2241 Lincoln Avenue, his vehicle was struck and damaged by a City Public Works
pickup truck.
This claim has been referred to Public Entity Risk Services of Iowa, the agent for the Iowa
Communities Assurance Pool.
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. 13 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.
1. Name of Claimant:
2. Address: 2 C2
3. Telephone Number: _5'.1 3 -
4. Date of Incident: ,3//f //e
5. Time of Incident: /92--
,,2 30 /7/
6. Location of Incident (Be specific):
//)
8. What were weather conditions like?
9. Give name and address of any witnesses:
10. Did police investigate? (If so, give names of officers.)
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
/eep
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.
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.)
( 2 ,ta-t42_ 4-1t,c a. (4 ,e2yydL „Aeg
\JMJ j /gym-t 4
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.)
(Rev. 1/00 & 7/01)
r
15. What amount do you claim from the City of Dubuque?
16. Why do you claim the City of Pubu qu is�ons 1 ?
Dated at Dubuque, Iowa this day of , 20 4
a vvcdee-nrc--
(Signature)
ty r (Print Name)
17. Have you made any claim against anyone else for damages as a result of this incident?
(If yes, give name and address.)
v� D
18. If the answer to Question 17 is yes, have you received any payment from that source,
and if so, in what amount?
om
Year
2008
Make
Chrysler
Model
Town &Country LX Van
Color
Trim
Unit Number
License Plate #
Mileage
Serial #NIN#
2A8HR44H78R842070
Sup
Seq
Qty
Labor
Type
Labor
Op
Description
Part
Type
Part
Number
List
Price
Extended
Price
Labor
Units
1
1
Ref
Ref
Refinish Side Body
Panel Outside L
Exist
1.0*
2
1
Body
Repair
Panel, Outer Rear
Side Body L
Exist
T
1.5#*
3
1
Ref
Ref
Refinish Liftgate
Outside Add for
Inside
Exist
1.3
4
1
Body
Rem/Ins
R&I Liftgate Handle
Exist
.3#
5
1
Body
Rem/Ins
R&I Lock Cylinder
Exist
.2#
6
1
Body
Rem/Rep
Glass kit
New
$30.00 T
$30.00
*
7
1
Body
Repair
Shell, Liftgate
Exist
T
4.01#*
8
1
Ref
Ref
Refinish Liftgate
Outside
Exist
2.5
9
1
Body
Rem/Rep
Nameplate, Liftgate
(Adhesive) "TOWN
& COUNTRY LX"
New
5113422A
A
$31.00 T
$31.00
.2
10
1
Body
Rem/Ins
flex fuel
Exist
T
.3*
Estimate - Preliminary
Estimate Prepared by:
Accident Date:
Date of Loss:
Arrival Date:
Type of Loss:
Policy Number:
Claim Number:
Version 2.0
Database Edition CPL 10 -02
Insured:
Duehr Auto Body Repair
19051 Balltown Rd.
Sherrill, IA, 52073
Tel: 563 -552 -2019 Fax: 563 -552 -2237
duehrautobody @yousq.net
Tax ID: 030495385
Appraised for:
Contact: Carl Lange
Address: 2260 Green Street, Dubuque Ia,
52001
Notes: Home (563)583 -1314
Date: 3/24/2010
Estimate #:
P -Page logic not included.
Page 1 of 3
Sup
Seq
Qty
Labor
Type
Labor
Op
Description
Part
Type
Part
Number
List
Price
Extended
Price
Labor
Units
11
1
Glass
Remllns
Glass, Liftgate
w/Defroster Tint
Chrysler
Exist
T
2.5#*
12
1
Body
Rem/Rep
Lamp, Combination
Town & Country L
New
5113201A
B
$98.00 T
$98.00
.3
13
1
Ref
Ref
Refinish Rear Cover
Exist
2.6
14
1
Body
Rem/Rep
Cover, Rear (P) w/o
Parking Sensor Town
& Country 2008
New
1BG78TZ
ZAB
$342.00 T
$342.00
1.5
15
1
Body
Rem/Rep
add flex additive
New
$12.00 T
$12.00
*
16
Clear Coat
1.5*
17
Mask for Overspray
.2*
18
Hazardous Waste
$5.00
$5.00
19
Paint Materials
$311.50
* - Judgement Item
# - Labor Note Applies
Labor
Body 8.3 Hrs @ $54.00 $448.20
Refinish 7.4 Hrs @ $54.00 $399.60
Glass 2.5 Hrs @ $54.00 $135.00
Labor Total $982.80
The above is an estimate based on our inspection and
does not cover any additional parts or labor which may
be required after the work has started. Occasionally,
worn or damaged parts are discovered which may not
be evident on the first inspection. Because of this, the
above prices are not guaranteed. Quotations on parts
and labor are current and subject to change.
Parts
Parts Subtotal
Less Adjustments
Parts Total
Additional Costs and Operations
Addl. Costs /Ops Total $408.30
Tax
Tax Total
Totals
Labor Tax @
Parts Tax @
Sub Total:
Customer Resp.
Net Total
7.00%
7.00%
This is a preliminary estimate. Additional changes to the estimate may be required for the actual repair.
RepairMate does not automatically include items required by many business repair partners. This application
2008 Chrysler Town &Country LX
Version 2.0
Database Edition CPL 10 -02
P -Page logic not included.
$513.00
$513.00
$68.79
$35.91
$104.70
$2,008.80
$0.00
$2,008.80
Page 2 of 3
allows the author to manually enter line items such as overlap deductions.
Version 2.0
2008 Chrysler Town &Country LX
P -Page logic not included.
Database Edition CPL 10 -02 Page 3 of 3
Damage Assessed By: DALE WILGENBUSCH
Deductible:
Claim Number:
Owner:
Address:
Telephone:
Description:
Body Style:
VIN:
Mileage:
Options:
Line Entry Labor
Item Number Type
1 101717 REF
2
3 101283 BDY
4 101752 REF
5 101764 BDY
6 900500 BDY *
7 900500 GLS *
8 101412 BDY
9 AUTO REF
10 101437 BDY
11 101762 BDY
12 101453 GLS
13 101513 BDY
14 101769 BDY
15 101537 BDY
16 AUTO REF
17 936014
18 AUTO REF
ESTIMATE R
Mitchell Data
UltraMate Version:
0.00
UNKNOWN
CARL LANGE
2260 GREEN STREET, DUBUQUE, IA 52001
Home Phone: (563) 583 -1314
Operation
REFINISH
REPAIR
REFINISH
REMOVE/INSTALL
REMOVE/INSTALL
REMOVE/REPLACE
REPAIR
REFINISH
REMOVE/REPLACE
REMOVE/INSTALL
REMOVE/INSTALL
REMOVE/REPLACE
OVERHAUL
REMOVE/REPLACE
REFINISH
ADD'L COST
ADD'L OPR
Avalon Body Shop Inc.
20680 Hwy 52 N, Rickardsville, IA 52039
(563) 552 -1656
Fax: (563) 552 -1658
Email: avalonbs @yousq.net
Tax ID: 42- 1360561
Date: 3/23/2010 05:01 PM
Estimate ID: 6971
Estimate Version: 0
Preliminary
Profile ID: Mitchell
WE HAVE THE CAPABILITY TO E —MAIL DIGITAL PICTURES OF DAMAGE TO YOU!!!
Mitchell Service: 911022
2008 Chrysler Town&Country LX Vehicle Production Date: 7/08
Van 121" WB Drive Train: 3.3L Inj 6 CyI 2WD
2A8HR44H78R842070 License: 97622
15,250
VEHICLE ANTI - THEFT, CD CHANGER, PASSENGER AIRBAG, DRIVER SIDE AIRBAG, POWER LOCK
POWER WINDOW, POWER STEERING, REAR WINDOW DEFOGGER, MANUAL AIR CONDITION
TILT STEERING COLUMN, ANTI -LOCK BRAKE SYS., TIRE INFLATION /PRESSURE MONITOR
POWER ADJUSTABLE EXTERIOR MIRROR, FRONT AIR DAM, TINTED GLASS
FIRST ROW BUCKET SEAT, SECOND ROW BENCH SEAT, KEYLESS ENTRY, SLIDING VAN DOOR
THIRD ROW SEAT, CLOTH SEAT, DRIVER SIDE SLIDING VAN DOOR
ADAPTIVE AUTOMATIC TRANSMISSION, TACHOMETER, AUTOMATIC HEADLIGHTS
SIDE HEAD CURTAIN AIRBAGS, MP3 PLAYER
Line Item
Description
L Van Side Panel Outside
----refinish in jamb only
L Van Side Panel
Add For Liftgate Inside
Liftgate Handle
remove and retape FLEXFUEL emblem
URATHANE GLASS SEAL KIT
Liftgate Shell
Liftgate Outside
Liftgate Adhesive Nameplate
Liftgate Trim Panel
Liftgate Glass
L Rear Combination Lamp
Rear Bumper Cover Assy
Rear Bumper Cover
Rear Bumper Cover
FLEX ADDITIVE
Clear Coat
ECALL NUMBER: 03/23/2010 17:01:37 6971
Version: OEM: FEB_10_V UltraMate is a Trademark of Mitchell International
Copyright (C) 1994 - 2010 Mitchell International
7.0.017 All Rights Reserved
Part Type/
Part Number
Existing
Existing
** QUAL REPL PART
Existing
5113422AA
Existing
5113201AB
1AE62TZZAB
Dollar Labor
Amount Units
C 1.0*
1.5* #
C 1.3
0.3 #
0.00 0.3* r
30.00 * 0.0*
4.0*#
C 2.5
31.00 0.2
INC
2.5 #r
98.00 0.3
1.5
344.00 INC
C 2.6
12.00 *
2.2
Page 1 of 3
19 933005
20 933018
21 900500
22 AUTO
23 AUTO
24 AUTO
BDY
REF
BDY *
Addl
Labor Sublet
I. Labor Subtotals Units Rate Amount Amount Totals
Body 8.8 56.00 6.00 0.00 498.80 T
Refinish 9.6 56.00 8.00 0.00 545.60 T
Glass 2.5 56.00 0.00 0.00 140.00 T
Taxable Labor 1,184.40
Labor Tax @ 7.000 % 82.91
Labor Summary 20.9 1,267.31
III. Additional Costs
ADD'L OPR
ADD'L OPR
ADD'L LABOR OP
ADD'L COST
ADD'L COST
ADD'L COST
RESTORE CORROSION PROTECTION
MASK FOR OVERSPRAY
NIB & BUFF
Paint/Materials
Shop Materials
Hazardous Waste Disposal
* - Judgment Item
# - Labor Note Applies
C - Included in Clear Coat Calc
r - CEG R&R Time Used For This Labor Operation
Estimate Totals
Amount
Non - Taxable Costs 377.98
Total Additional Costs 377.98
Paint Material Method: Rates
Init Rate = 36.00 , Init Max Hours = 99.9, Addl Rate = 0.00
Date:
Estimate ID:
Estimate Version:
Preliminary
Profile ID:
Existing
Total Replacement Parts Amount
IV. Adjustments
Insurance Deductible
Customer Responsibility
I. Total Labor:
II. Total Replacement Parts:
III. Total Additional Costs:
Gross Total:
IV. Total Adjustments:
Net Total:
This is a preliminary estimate.
Additional changes to the estimate may be required for the actual repair.
AVALON BODY SHOP INC, agrees to perform repairs which serve to restore
the damaged vechicle to its preloss condition relative to safety,
functions and appearance. We futhermore agrees to warranty workmanship
plus PPG /Autocolor Lifetime Paint Performance Guarantee for as long
ESTIMATE RECALL NUMBER: 03/23/2010 17:01:37 6971
Mitchell Data Version: OEM: FEB_10_V UltraMate is a Trademark of Mitchell International
Copyright (C) 1994 - 2010 Mitchell International
UltraMate Version: 7.0.017 All Rights Reserved
3/23/2010 05:01 PM
6971
0
Mitchell
6.00 * 0.2*
8.00 *
345.60 *
15.00 *
5.38 *
0.5*
II. Part Replacement Summary Amount
Taxable Parts 503.00
Sales Tax @ 7.000% 35.21
538.21
Amount
0.00
1,267.31
538.21
377.98
2,183.50
2,183.50
Page 2 of 3
0.00
0.00
as the customer owns the vechicle.
ESTIMATE RECALL NUMBER: 03/23/2010 17:01 :37 6971
Mitchell Data Version: OEM: FEB 10 V
UltraMate Version: 7.0.017
UltraMate is a Trademark of Mitchell International
Copyright (C) 1994 - 2010 Mitchell International
All Rights Reserved
Date: 3/23/2010 05:01 PM
Estimate ID: 6971
Estimate Version: 0
Preliminary
Profile ID: Mitchell
Page 3 of 3
VI(EST:BENp
A tYNAt bj1uDANGt'COryMNT-
. X(ei! Bend ] �Sai va 3 Ii tsiir a »tr C i
• ;1900 S.!ISih ue'1 We r Bend. \'[ 57495 •
Tra 1.4877t.922.5246.
►,f,,
2 4 -YOUR H�IfRGENCY WORRY- FREE;DRIVING 365 A
• - ROADSIDE NFTW Y EAR IN THE;U CANADA •
POLICY NUMBER: HHI _5257183 13
POLICY PERIOD: :. 05/14/2009 to 05/14/2010
ENSURED,: CARL F LANGE &:.MARY'A
:0 \ktepGreth Vie# ' Saco(
VEHICLE• DESCRIPTION: .: '`
2008 CHRY - TOWN & :COU. 2A8HR44H78R842070