Claim Nauman, Gary M.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. 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: Gary Nauman
2.Address: 2828 Shiras Ave.
3. Telephone Number: 563 582 6918
4. Date of Incident: between noon and 5:30 P.M.
5. Time of Incident: Between noon and 5:30 P.M.
6. Location of Incident (Be specific):
Keyline Bus Barn - Employee Parking
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 hood on the pickup I was driving to work was scratched by luggage from Greyhound patrons. (There have been numerous damage to other employees vehicles).
8. What were weather conditions like? Sunny
9. Give name and address of any witnesses:
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.)
13. What other damages do you claim, if any?
The hood of my pickup was severely scratched. I am attaching a estimate for the repair of the hood.
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?
$343.69
16. Why do you claim the City of Dubuque is responsible?
I was told by the Transit Manager to file the claim with the City.
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 15th day of July, 2003.
/s/ Gary M. Nauman
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
CLAIM AGAINST THE CITY OF DUBUQUE,s-IOWA '
This written report constitutes your claim against the City of Dubuque, Iowa.
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:
2. Address:
3. Telephone Number:
4. Date of Incident:
5. Time of Incident:
6. Location of Incident (Be specific):
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.)
8. What were weather conditions like?
9. Give name and address of any witnesses:
10. Did police investigate? (If s~e names of officers.)
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.)
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.)
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 Dqb.uque, Iowa this
~ -,~ ~,~
day of
, 20 °3.
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
Date: 71t4/03 03:55 PM
Estimate ID: 4914
0
P~ellminary
Profile ID:
Mitchell
Hanlsy Auto Body Inc.
1030 Century Circle DubUqUe, IA 52002
(563) 583-722O
Fax: (563) 583-8355
Da, .=ge Assessed By: Robert Hantey
Owner Gary Nauman
Address: 2828 Shiras
Telephone: Home Phone: (500) ~82-6918
Mitchell Service: 913520
Description: 1994 Dodge Dakota
Body Style: 2D Pkup 8' Bed 123' WB
Options: V8 ENGINE
Drive Train: 5.2L In] 8 Cyl 2WD
Line Ent~ Labor
item Number Type Operation
Une item
Description
Pa~t 'rype~
Part Number
Dollar Labor
Amount Units
I 309310 BDY ~EPAIR
2 AUTO REF REFINISH
3 AUTO REF ADD1. OPR
4 AUTO ADD'L COST
5 AUTO ADD'L COST
HOOD PANEL
HOOD OUTSIDE
CLEAR COAT
PAINT/MATERIALS
HAZARDOUS WASTE DISPOSAL
Existing
1.0'
C 3~
1.2
1~0'
*-Judgementltem
C-Included in ClearCoatCa~
Add'l
Labor Sublet
I. Labor Subtotals Units Rate Amount Amount Totals
Body 1.0 4200 0.00 0.00 42.00 T
Refinish 4,2 4200 0.00 0.00 176,40 T
Taxable Labo~ 210.40
Labor Tax ~ 7.000 % 16~9
Labor St. lm,ary 5.2 233,00
Ill. Additional Costs Amount
Non-Taxable Costs 110,00
Total AddllJonel Costs 110.00
IL Prat Replacement Summary
Total Replacement Parts Amount
IV. Adjustments
Customer Responsibility
Amount
Amount
0.00
ESTIMATE RECALL NUMBER: 7114/03 15'~54:10 4914
UltraMste is a Trademark of Mitchell Intemntlonal
Mitehell Date Version: JUL_00_A Copyright (C) 1994 - ?.002 Mitehell Internsttenal
4~8.012 AIl Rights Reserved
Page t of 2
Date: 7114/03 03:55 PM
EsthTmte ID: 4914
Preliminary
Profile ID: Mitchell
I. Total Labor;,
II. Total Replacement Parts:
IlL Total Additional Costs:
Gross Total:
233,69
O.6O
t10.0~
343,69
IV. Total Adjustments:
Net Totel:
This is a preliminary estimate.
Additional ch-~--.~e=- to the estimate may be required for the actual repair.
WARNING: Accidental air beg deployment Is possible. Personal injury may result. Avoid area near steering wheel
and instrument panel even if air bags have deployed. Dual.stage air bag modules may be present that could
contain an undeployed stage. Wheat dispo~ of a deployed dual*stage air bag, always treat it as a "live" module.
See appropaiate MITCHELL® AIR BAG SERVICE & REPAIR MANUAl., or OEM irrFormation,
ESTIMATE RECALL NUMBER: 7/14/03 15:64:10 4914
UttraMate is a Trademark of Mitchail International
Mitchail Date Vers~n: JUL_03_A Copyright (C) 1994 - 2002 Mitchell International
4.8.012 AIl R~jhts Rasewed
P~ge 2 of 2