Claim Liddle, GreggCLAIM 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: Gregg Liddle
2. Address: 2415 Knob Hill
3. Telephone Number: 583 7622
4. Date of Incident: March 8, 2003
5. Time of Incident: 8:30 A.M.
6. Location of Incident (Be specific): City - Parking Lot (Saturday)
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.)
The Low Pole was NOT visible and I drove forward.
8. What were weather conditions like? Partly cloudy
9. Give name and address of any witnesses: Leah Liddle (spouse) 2415 Knob Hill
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?
$466.51
16. Why do you claim the City of Dubuque is responsible?
The posts were too short to allow proper visability.
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?
N/A
Dated at Dubuque, Iowa this 6th day of June, 2003.
/s/ Gregg W. Liddle
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
JUN-08-03 FRI 07:46 AM DUBUGUE OITY OLERK FAX NO, 883 689 0890 P, 02
This written report constitutes your claim against the City of Dubuque, Iowa. You sl:~-uld
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 ls 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. Na me o f Claim ant:~~R.__Z./~_~_~
2. Address: .... ,-~.¢/-,/~-- ~"_'~7,~¢,,~
3. 'Telephone Number:__L~-¢¢-:~ '?ge ~ '>-.---
4. Date of Incident: ___~~. ¢~. - ,~-~,¢~ ~ - __
5. 'Time of Incident: ~." ~'0
6. Loc~,tion of Ir~¢ident (Be specific):_ O-¢/-.2-~' _--__~/./
7. DESCRIBE ACCIDENT OR OCCURRENCE '['HAT CAUSED INJURY OR DAMAGE. (Give
full details upon which you base your claim. If a City employee was involved, give the
8. What were weather conditions like?___
9. Give name and address of any witnesses:
Did police investigate? (If so, give names ct officers.)
11. W~s anyone injured? (If so, give names, addresses, and extent of injuries).
JUN-06-03 FRI 07:48 ~M DUBUQUE OITY OL~RK FflX NO, 583 588 0890 P, 03
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 da you claim from the City of Dubuque?
18. 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.)
Dated at Dubuque, Iowa this
18. If the answer to Question 17 is yes, have you received any payment from that source,
and ii' so, in what amount? /6/'///-
day o~ __~_~-~--__ ., 20 ~,'~
(Signature)
(Rev, 1100 & 7101)
~$/29/1994 81:29 131955~92@ ~ZLS~N ~ROS P~GE 82
wILSON BROS. DODGE
90 JFK
DUBUQUE, IA 52002
PHONE; (563)583-5781 FAX: (563)556-6928
FED TAX ID: 420779647
CD LOG NO 2496-1
DATE 06/06/03
SHOP: WILSON BROS AUTO BODY INSP DATE:
ADDRESS: 90 JFK cONTACT:
CITY STATE: DUBUQUE, IA PHONE 2:
ZIP: 52002- FAX:
OWNER: LIDDLE, GREG
ADDRESS: 2415 KNOB HILL
CITY STATE: DUBUQUE, IA
ZIP: 52003-
HoPZE PHONE:
06/06/03
ROGER AUDERER
(563)583-5781 EXT 230
(563)556-6928
(000) 583-7622
POINT OF IMPACT: 3
LIC#:
BODY COLOR: PIAROON
CONDITION: EXCL
*=USER-ENTERED VALUE
Ec=REPtJ~CE ECONOMY
EU=REPLACE SALVAGE
pM=PXN REMAiN/REBUILT
IT=PARTIAL REPAIR
BR=BLEND REFINISH
SB=SUBLET
P=CHECK
UP=UNRELATED PRIOR
2000 DODGE DAZ<OTA
STATE:
VIN:
MILEAGE:
ACCTNG CTL~:
1B7GG22N4YS631994
38,383
E=REPLACE OEM
UC=RECONDITIONED PRT
EP=REPLACE PXN
TE=PA.RTL REPL PRICE
I=REPAIR
TT=TWO-TONE
N=3%DDITiONAL LABOR
AA=APPEAR ALLOWANCE
NG=REPLACE NAGS
UM=REMA2~/REBUILT PRT
pC=PXN RECONDITIONED
ET=PA~RTL REPL LA~OR
L=REFINISH
CG=CHIPGUkRD
Rt=R&I ASSEMBLY
RP=RELATED PRIOR
SLT 2DOOR EXT CAB 8CYL GASOLINE 4.7
CODE: N8424A~D OPTNS N/24K
OPTIONS:
TWO-STAGE - EXTERIOR SURFACES
4-WHEEL DRIVE
TWO-STAGE -
OP GDE MC DESCRIPTION MFG.PART NO.
E 0006 BUMPER, FRONT UPPER 55255845
E 0039 BRKT,FRONT BUMPER M RT 55076530AB
EC SHOP SUPPLIES ECONOMY PAt~.T
INTERIOR SUREACES
PRICE AJ% B% HOURS
320.00 1.4
54.60 INC
2.50~
3 ITEMS
FINAL CALCULATIONS & ENTRIES
GROSS P/tRTS
OTKER PARTS
PARTS TOTAL
TAX ON PARTS @
6.000%
374.60
2.50
377.10
22.63
PAGE
-2000 DODGE DAKOTA
CD LOG NO 2496-1
1319556692@
SLT 2DOOR EXT CkB
WILSON BROS
P~E
LABOR
1-SHEET M]E Ti~J~
2-MECH/ELEC
3- FRA/~E
4-REFINISH
5-PAINT M]kTERIAL
LABOR TOTAL
TAX ON LABOR
SUBLET REPAIRS
TOWING
STORAGE
RATE
45.00
52.00
52.00
45.00
27.00
REPLACE ERS
REPAIR HAS
6.000%
GROSS TOTAL
NET TOTAL
ADP SHOPLINK UB303 ES CD LOG 2496-1 DATE 06/06/03 03:17:24PM R6.3
HOST LOG
(C) 1998 - 2002 ADP CLAIMS SOLUTIONS GROUP, INC.
63.00
63.00
3,78
466.51
466.51
CD 05/03
LIFETIME W/~RANTY ON PAINT ONE YEAR ON WORKMANSHIP NO WARRANTY ON RUSTWORK
PAGE 2