Claim Bauer, Jodie LCLAIM 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: Jodie L. Bauer
2. Address: 2520 Jackson St. Dubuque, IA 52001
3. Telephone Number: (563) 583 6090
4. Date of Incident: July 4, 2003
5. Time of Incident: 3:30 A.M. Sometime during early morning
6. Location of Incident (Be specific): Tree located between 2508 Jackson, & 2520 Jackson. Car Was parked on Street.
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.)
I parked my car on Jackson St. between 2508 & 2520 Jackson. Sometime during the early morning a storm developed, causing a tree limb to fall on my car damaging rear passenger door.
8. What were weather conditions like? Weather conditions were fine until severe sotrm developed.
9. Give name and address of any witnesses: Dennis & Julie Bauer (parents) 2520 Jackson, Dubuque, IA 52001
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.)
Rear - passenger door of 1999 Pont. Grand AM SE1 has been dented and paint has been scratched.
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?
721.29
16. Why do you claim the City of Dubuque is responsible?
Maintenance of the tree is City of Dubuque' responsibility.
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 day of July, 2003. .
/s/ Jodie L. Bauer
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
12. Was any damage done to property? (if so, describe property and the extent of damages.
AttacJ~ estimates~f 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.) I~1
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
day of
, 20 ~-~.
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
07/07/2003 at 11:08 Ak4
30799
Job Number:
BRIMEYER AUTO BODY
License $:30799 Federal ID $:421438480
10727 JO~N F. KE~rNEDY RD
DUBUQUE, IA 52001
(563)583-4456 Fa-x: (563)583-1838
written by: ERIC WINCH
Adjuster:
Insured: JODIE BAUER
Owner: JODIE BAUER
Address: 2520 JACKSON
DUBUQUE, IA 52001
Day: (563)583-6090
Ty~e Of LOSS:
Right Qtr Post
1999 PONT GPd%ND AM SE1 6-3.4L-FI 4D SED RED Iht:
VIN: 1G2NE52E2XC528360 Lic: Prod Date:
Air Conditioning
Cruise Control
Dual Mirrors
Clear Coat Paint
Power Windows
Anti-Lock Brakes (4)
Cloth Seats
Aluminum/Alloy Wheels
Rear Defogger
Intermittent Wipers
Traction Control
Power Steering
Power Locks
Driver Air Bag
Bucket Seats
Days to Repair
odometer: 60000
Tilt Wheel
Body Side Moldings
Fog Lamps
Power Brakes
Power Mirrors
Passenger Air Bag
Recline/Lounge Seats
NO. OP. DESCRIPTION QTY EXT. PRICE L~/BOR PAINT
1 REAR DOOR
2* Rpr RT Outer panel 5.--0 2.0
3 Add for Clear Coat 0.8
4 R&I RT Belt w'strip SE 0.3
5 R&I RT Handle, Outside 0.3
6 R&I R&I trim panel 0.4
7 QUARTER PANEL
8* Rpr RT Quarter panel 1.--5 2.0
9 Overlap Major Adj. Panel -0.4
10 Add for Clear Coat 0.3
11% Repl LIFT TAPE BACKGLASS 1 2.50 0.3
12 OTHER CHARGES
13~ E.P.C. 1 3.00
Sllbtotals ==> 5.50 7.8 4.7
Parts 2.50
Body Labor 7.8 hrs ® $ 44.00/hr 343.20
Paint Labor 4.7 hrs @ $ 44.00/hr 206.80
Paint Supplies 4.7 hfs @ $ 27.00/hr 126.90
Other Charges 3.00
SUBTOTAL $ 682.40
Sales Tax $ 555.50 @ 7.0000% 38.89
GRAND TOTI~L $ 721.29