Claim by John Peiffer Copyrig hted
March 15, 2021
City of Dubuque Consent Items # 2.
City Council Meeting
ITEM TITLE: Notice of Claims and Suits
SUM MARY: John Peiffer for vehicle damage.
SUGGESTED Suggested Disposition: Receive and File; Referto CityAttorney
DISPOSITION:
ATTACHMENTS:
Description Type
Claim by John Peiffer Supporting Documentation
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CLAIM AGAINST THE CITY OF DUBUQUE, IOWA �!
This written report constitutes your claim against the City of Dubuque, lowa. You should li�
complete this form in full and attach any additional information that supports your claim. I
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The Claim must be filed with the City Clerk at City Hall, 50 W. 13t" St., Dubuque, IA 52001. It j
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 ;i
City Council. You will be provided with a copy of that report and recommendation. �j
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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 70 MAKE ANY REPRESENTATION TO YOU �
AS TO WHETHER YOUR CLAIM WILL OR WILL NOT BE PAID. r;
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1. Name of Claimant: �C�y1V'1 ��4��C"�Y' ;;
2. Address: ��� ���G�1�(G- �f ��
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City: ���i�l�i�. State: Zip: �� '� ��,
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3. Telephone Number: ��� C��� °�.-��� ,r'�
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4. Date of Incident: �' ��` � �
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5. Time of Incident: � ��`��'�� ;�
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6. Location of Incident (Be specific): � ��!�,,�,��' 4�` ��-�1'�t� �� �-�"f �l� �
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7. DESCRIBE ACCIDENT OR OCCURRENCE THAT CAUSED INJURY OR DAMAGE. (Give 'J
full details upon which you base your claim. If a City employee was involved, give the ��
employee's name.) h
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8. What were weather conditions like°? '��1, ' vi:t�.f� �ii �.,I' ��
9. Give name and address of any witnesses:
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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). �
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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.)
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13. What other damages do you claim, if any? �
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14. Have you been compensated for any part or all of your claim by any insurance I
company? (If so, give name and address of insurance company and amount paid.) I
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15. What amount do you claim from the City of Dubuque?
16. Why do you claim the City of Dubuque is res onsible? I��
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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, I��,
and if so, in what amount? i
Dated at Dubuque, lowa this � day of �o ��� , 20`�� . '�
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. 1'rintetlAC WriU�lUt FuLlt:t UCPHKIMEN�" 11�8/20L �:SF pM Paqa � rif '� Form#;� 2021-001'166 �
,,�-�►� Driver Informati��, �xch�r��� R�por�
�„ DUBUQUE POLICE DEPARTMEN7 �
(563}589-4410
Driver's Name-Last First Middle Suffix Age Gender �
U GREENW04D .IOHN MICHA�L 56 MALE
� Address Gity State Zip HomelCell Phone Number �
I l,9(l0 PENNSYLVANIA P;VE DII�JQIE IA 52t102=f10�Q (563�663-1421
� I T CDL? Driver's License Number Class St�4� Endorsements lRestrieti�ns Insur�nce Co,Name insurance Co.Rnene�
YES 773AAU625 A IA LNP dM JI��lVACOMMtJNITiES,�B�UR,4iVCE (515}802�4?51 �
I��� dwner Company Name 7�, Insuranc�Policy# I
CITY OF DUBUQUE �
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dwner's Name-Lest , First Middle SuFfix • `
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` I Address -� Gity State Zip Vehicle Confi�uration f
� 50 W 13TH ST. DUBUQIIE , JA 52(101 . 02 ''
f VIN No. Year Make Model Style Golar � �
I 3C7WDTBT��u232226 I20`i� R,�NI-RAftA R"s5qp �B r���i
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,__ r_._ _.,_r .._____-- . _ .__.�.- ....,.
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� IH52$5 � I I �, - ,_.� I$O.OU ..�� . __...,���a„c,� ��F�ace j
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IDriver's Name-Last First Middle Suffix Age Cender
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I �1 Address City State Zip HomelCell Phane Number
� (563)663-2961
� CDL? I�river's License Number Class St�fe Endor�ements�Restrie4ion� In�ur�r�ce Go.Name Insuranee Co.Phone� g
I NONE �
��� Owner Gompany Name Insur�tiriee P�licy�
Owner's Name-Last First Middle Suffix
PEIFFER' JQNATHdN DAVILI
Address City StaYe Zip Vehicle Gonfiguration
7363 WASHINGTON S7 NEW VI�NNA IA 52D657710 03 1
VIN No. Year Make Model Sryle Color
�FNiCliO3�38YCC88�37 2R"u8 ��R�-FC3�t� EC�' SW GRN
License Plate# State Year Most Dam�g�d Area �?ppr�ximate C��t to R�pair or Re�iace
DEX931 IA 202'I 10-FRONT D�IVER SIL1E $1,2pU,0� 0
County Accident occurred within Farpor�te limits of(city) , i
DUBUQUE-3i DUBUGtUF-210L1 �
Literal Description I
ATLANI'IC ST ANa CL1S7�i�ST ' � � �
X-Coordinate Y-Coordinate
U0689886 04707766:
If accident occurred outside of ciiy Directien Nearest Gity ' Route(t;ardinaij
limits show general vacinity: of Tr�vel Direction
C1n Road,Street,or Highway: At InE�rsection with: !
Dishance Directian Distance Direeti�n Milepost Num6er I
I and I af I Or I
Definable intersection,bridg�,or railroad crossing �
Officer Badge No Law E,:forc�menE e Numb�r Date of,=,cciden4 Tirri�afAcciaent �
dFFICERJACOE�WUfVIP'AL 51 2t17��!�Q�i�p�� U2119f202'i C78:52 Hrs.
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Date: 3/8/2021 03:40 PM �
Estimate ID: '1186 ��
Estimate Version: 0
Preliminary
Protile ID: Mitchell
Quote ID: 82387847
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Mike Finnin Collisican Center ;
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3600 DODGE,DUBUQUE,IA 52003 N
(563)556-1010 ext.257 ;
Fax: (563)690-1086 �
Email: bodyshop@mikefinnin.com
Tax ID: 14-1862673 If
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Damage Assessed By: Rick Stumpf '
ClassificaYion: Audit �
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Deductible: UNKNOWN f��
Insured: JOHN PEIFFER
Address: 1275 ATLANTIC,DUBUQUE,IA 52001 'j
Telephone: Home Phone: (563)663-2961 I+'
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Mitchell Service: 910883
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Description: 2008 Ford Escape XLT
Body Style: 4D Ut Drive Train: 3.OL Inj 6 Cyl 2WD f;
VIN: 1 FMCU03138KC68137 '!
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OEM/ALT: O Search Code: None
Options: PASSENGER AIRBAG,POWER DRIVER SEAT,POWER LOCK,POWER;WINDOW,POWER STEERING il,
REAR WINDOW DEFOGGER,AIR CONDITION,REAR WItdDOW WIPER,CRUISE CONTROL �
TILT STEERING COLUMN,AM/FM STEREO,DRIVER AIRBAG ��
FRONT SIDE AIRBAG WITH HEAD PROTECTION,ANTI-LOCK BRAKE SYS.,TRACTION CONYROL III
FOG LIGHTS,ALUMIALLOY WHEELS,TIRE INFLATION/PRESSURE MONITOR,AUXILIAI2Y INPIJT
CD PLAYER,POWER ADJUSTABLE EXTERIOR MIRROR,PRIVACY GLASS I�
FIRST ROW BUCKET SEAT,CLOTH SEAT,51DE AIRBAGS,AUT�MATIC HEADLIGHTS '�
SECOND ROW SIDE AIRBAG WITH HEAD PROTECTION,MP3 PLAYER �
ELECTRONIC ST�ABILITY CON'fROL,KEYLESS E4VTRY SYSTEM,REAR BENCH SEAT ,�
ROLLOVER PROTECTION SYSTEM ii
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Line Entry Labor Line Item Part Type/ Dollar Labor
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Item Number Type Operation Description Part Number Amount Units ii�
1 AUTO BDY OVERHAUL Frt Bumper Cover Assy 2.6 � �'
2 000007 BDY REMOVE/REPLACE Frt Bumper Cover 8L8Z 17D957 CPTM 404.08 6NG # I�
3 AUTO REF REFINISH Frt Bumper Cover C 3.2 �
4 000011 BDY REMOVE/REPLACE L Frt�umper Reinforcement 8L8Z 17E814 B 18.57 INC # �
5 AUTO BDY REMOVE/INSTALL Frt Bumper Cover ENC �
6 000015 BDY REMOVE/REPLACE L Frt Bumper Opening Cover 8L8Z 17E810 A 23.37 INC
7 000168 BDY REMOVE/REPLACE L Fender Panel 8L8Z 16006 A 165.60 1.7 # �
8 AUTO REF REFINISH L Fender Outside C 2.1
9 AUTO REF REFINISH L Add To Edge Fender C 0.5
10 000177 BDY REMOVE/REPLACE L Fender Liner 8L8Z 16103 B 29.75 9NC #
11 002214 BDY REMOVE/REPLACE L Fender Adhesive Nameplate 7L8Z 7842528 A 11.92 0.1 �
12 000196 BDY REMOVE/REPLACE L Lwr Frt Body Splash Shield 8L8Z 16103 A 43.1� 0.3 �
13 000274 BDY f2EMOVE/REPLACE Alloy Wheel Remanufactured 224.00 � 0.3
14 003685 BDY REMOVE/REPLACE Wheel Tire Pressure Sensor 9L3Z 1A189 A 83.62 g
15 001188 REF BLEND L Frt Door Outside C 1.0 �
16 002083 BDY REMOVE/INSTALL L Frt Door Mirror 0.3 �
17 002085 BDY REMOVE/INSTALL L Frt Otr poor Belt Moulding 0.2
18 002089 BDY REMOVE/INSTALL L Frt Door Trim Panel INC
19 002197 BDY REMOVE/INSTALL L Frt Keyless Entry Pad 0.6 #
ESTIMATE RECALL NUIVIBER: 03/08/2021 15:33:32 1186
Mitchell Data Version: OEM: FEB 21 V
Copyright(C)1994-2021 Mitchell International Page 1 of 2
Software Version: 7.1.240 All Rights Reserved
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Date: 3/812021 03:40 PM E
Estimate ID: 1186 �
Estimate Version: 0
Prelaminary i
Profile ID: Mitchell i
Quote ID: 82387847 (
20 002097 BDY REMOVE/INSTALL L Frt Otr poor Handle 0.3 #
21 936014 ADD'L COST Flex Additive g,pp * i�;
22 AUTO REF ADD'L OPR Clear Coat
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23 933005 BDY ADD'L OPR Restore Corrosion Protection 10.00 * 0.2*
24 933018 REF ADD'L OPR Mask For Overspray 12.00 * 0.2'�
25 900500 BDS* ALEGN FRONT SdJSPENSION Sublet 89.95 * 0.0* I�
26 AUTO ADD'L COST PaintlMaterials 422.40 * I�
27 AUTO ADD'L COST Hazardous Waste Disposal 4.00 * �
* -Judgment Item �
#- Labor Note Applies
C - Included in Clear Coat Calc
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�stimate Totals �
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Add'I
Labor Sublet �
1. Labor Subtotals Units Rate Amount Amount Totals II. Part Replacement Summary Amount
Body 6.6 69.00 10.00 0.00 465.40 T Taxable Parts 1,004.09 '
Bdy-S 0.0 69.00 0.00 89.95 89.95 T Sales Tax @ 7.000% 70.29 �
Refinish 9.0 69.00 12.00 0.00 633.00 T �,j
Total Replacement Parts Amount 1 074.38
�'axable Labor � 1,188.35 � � ��
Labor Tax ac 7.000% 83.18 �
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Labor Summary 15.6 1,271.53 �i
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III. Additional Costs Amount IV. Adjustments Amount il
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Taxable Costs 434.40 Customer Responsibility 0.00
Sales Tax @ 7.000% 30.41 ;I
Total Additional Costs 464.81 fl
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Paint Material Method:Rates
Init Rate=48.00 ,Init Max Hours=99.9,Addl Rate=0.00
�I. Total Labor: 7,271,5$ �
II. Total Replacement Parts: 1,074.3$
III. Total Addi4ional Costs: 464.81 �:
Gross Total: 2,810J2
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IV. Total Adjustments: 0.00
Net Totaf: 2,8'{0.72
This is a preliminar�estimate. �
Additional chanqes to the estimate mav be required for the actual repair. f'
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ESTIMATE RECALL NUMBER: 03/08/2021 15:33:32 1186 �
Mitchell Data Version: OEM: FEB 21 V
Copyright(C)1994-2021 Mitchell International Page 2 of 2
Software Version: 7.1.240 All Rights Reserved ��
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Copyrig hted
March 15, 2021
City of Dubuque Consent Items # 3.
City Council Meeting
ITEM TITLE: Disposition of Claims
SUMMARY: CityAttorneyadvising thatthe following claims have been referred to
Public Entity Risk Services of lowa, the agent forthe lowa Communities
Assurance Pool: John Peiffer for vehicle damage.
SUGGESTED Suggested Disposition: Receive and File; Concur
DISPOSITION:
ATTACHMENTS:
Description Type
ICAP Referral Supporting Documentation
THE CTTY OF
DUB E MEMORANDUM
Masterpiece on the Mississzppi
� ONI MEDINGER
LEGAL ADMINISTRATIVE ASSISTANT
To: Mayor Roy D. Buol and
Members of the City Council
DATE: March 10, 2021
RE: Claim Against the City of Dubuque by John Peiffer
Claimant Date of Claim Date of Incident Nature of Claim
John Peiffer 3/6/2021 2/19/2021 Vehicle Damage
This is a claim in which claimant alleges claimant's vehicle was struck by a City truck.
This claim has been referred to Public Entity Risk Services of lowa, the agent for the lowa
Communities Assurance Pool.
cc: Michael C. Van Milligen, City Manager
John Klostermann, Public Works Director
John Peiffer
OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA
SUITE 330, HARBOR VIEW PLACE, 3OO MAIN STREET DUBUQUE, IA 52001-6944
TE�EPHONE (563)589-4113/Fax (563)583-1040/EMai� jmedinge@cityofdubuque.org