Claim by Andy BradleyCopyrighted
May 3, 2021
City of Dubuque Consent Items # 2.
City Council Meeting
ITEM TITLE: Notice of Claims and Suits
SUMMARY: Andy Bradley for vehicle damage; Allyssa Krier for vehicle damage.
SUGGESTED Suggested Disposition: Receive and File; Refer to City Attorney
DISPOSITION:
ATTACHMENTS:
Description Type
Claim by Andy Bradley Supporting Documentation
Claim by Allyssa Krier Supporting Documentation
Confidential
This communication and any attachments may contain information which is confidential
and privileged by law and is for the use of the designated recipient. If you are not the
intended recipient, you are hereby notified that you have received this communication in
error, and that any review, disclosure, dissemination, distribution or copying of its contents
is prohibited. Please notify City of Dubuque immediately by telephone at (563)-589-4120 of
your receipt of these items and destroy the communication and any attachments
immediately. Further disclosure of this information may violate state and federal
restrictions.
Confidential information may include the following:
1) Social Security Number(s)
2) Medical/Health Information
3) Personnel/Disciplinary Information
4) Bank Account Information
5) Financial Information
6) Credit Card Numbers
If any documentation you desire to submit to the City of Dubuque contains any of the items above
this cover sheet must be attached directly to the confidential information and indicate the type of
information that is included.
I, N/A , hereby certify that the attached documents
include the following protected information:
Social Security Number(s) Bank Account Information
Medical/Health Information Financial Information
Personnel/Disciplinary Information Credit Card Number(s)
I understand that this information may be distributed within the City organization or to agents of the
City for processing and I hereby authorize the City to act accordingly taking all precautions to
protect my information from unnecessary distribution.
N/A
Signature
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: Andy Bradley
2. Address: 13847 Mueller Parkway
City: Sherrill
3. Telephone Number: 563-590-5347
4. Date of Incident: 4/l/2021
5. Time of Incident:
State: Iowa Zip: 52073
6. Location of Incident (Be specific): John F Kennedy Road Measuring 222 feet south from Asbury
Road and John F Kennedy Road
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 incident involved 3 vehicles, my son Jackson Bradlev was
(vehicle, which was the 3rd vehicle
involved in the incident (unit 3). Below is the narrative from the "Investigating Officer's Report of Motor
Accident" case number 2021-002168 by Officer Phil Friedman Badge 52:
Unit 1 was S/B in the west lane on JFK just south of the Asbury/JFK intersection. Unit 2 was behind unit 1 also
S/B in the west lane on JFK just south of the Asbury/JFK intersection. Unit 3 was behind unit 2 also S/B in the
west lane on JFK just south of the Asbury/JFK intersection. Due to water main break in the area and cold
temperature ice had formed all over the road. Unit 1 began losing control and was able to stop her vehicle but
due to the ice unit 2 rear ended her then unit 3 rear ended unit 2. No citations issued at this time due to the
drastic and sudden road conditions changes.
Please note there is video of the accident from the local traffic cameras that was reviewed by the Police
Department. (I also have a copy, it's to large to e-mail but I can supply it if needed.)
I have attached the following documents as supporting information:
Investigating Officer's Report of Motor Vehicle Accident (5 pages)
Drivers Information Exchange Report
Wenzel Towing bill (for towing from the accident)
Obies Towing & Service center bill (for initial repairs & towing)
Kens Auto Body repair estimate for remaining damage
2 pictures of vehicle from the scene.
Additional pictures for estimate (after tire, headlight and turn signal have been repaired.) I can supply more if
needed.
8. What were weather conditions like? Clear, except where the accident occurred. The road was icv
there due to a water main break.
9. Give name and address of any witnesses: Names and address of witnesses are in the attached
Motor Vehicle Accident report
10. Did police investigate? (If so, give names of officers.)
Yes, Officer Phil Friedman Badge 52
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
Not to my knowledge
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.)
Damage occurred to the front and driver's side of my 2001 Ford Explorer Sport Trac. Damage to the tire,
headlights, turn signals, front body/bumper area, hood and drivers side fender. There is an attached picture
from the scene, the headlight, turn signal, and tire have already been replaced as reflected in additional
pictures. Attached is a receipt for towing, repairs completed to Tire headlight and turn signal as well as an
estimate for additional/remaining body damage.
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.)
I have put in a claim for 1 of the 2 towing bills. No payment received yet but I expect it to be $85. State Farm
Agent Lane Madsen 563-582-6942
15. What amount do you claim from the City of Dubuque? $4654.87
16. Why do you claim the City of Dubuque is responsible? The accident was due to the icy road
conditions caused by the water main break. There was no warning or indication that the water
main was leaking onto the road causing unsafe condition. Road conditions that morning were
completely clear, except here due to the water main issue.
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 I day of `fie : 20i.
gnature)
(Print Name)
(Rev. 5/18)
Filing a Claim
When Should I File a Claim?
If youhave sustained an injury or damage for which you believe the City or one of its employees is responsible, you
may file a claim against the City.
How Do I Request a Claim Form?
In order to obtain a claim form, please contact or visit one of the following City offices:
City Clerk's Office
City Hall
50 W. 13th St.
Dubuque, IA 52001
563.589A120
City Attorney's Office
Harbor View Place, Ste. 330
300 Main St.
Dubuque, IA 52001
563.583.4113
Can I Send In Additional Information with the Claim Form?
Yes. It is recommended that you send in as much information as possible with your claim form in order to expedite
the investigation of the claim. This includes, but is not limited to, estimates, receipts, medical bills, pictures and any
other information you feel may berelevantto your claim. It is also recommended that you send in copies of these
items and keep the originals for your records.
What Happens After I File My Claim?
Once a claim has been received and file -stamped by the City Clerk, it is forwarded to the City Attorney's Office for
investigation. Claims involving personal injury or substantial property damage will be forwarded to the City's claims
agency for investigation. You will receive a letter from the City Attorney's Office indicating that your claim has been
forwarded to the claims agency. This letter will also contain the claims agency's contact information.
A claims adjuster will then contact you regarding your claim. At that point, any questions regarding your claim
should be addressed to the claims adjuster. All other claims will be forwarded to the appropriate City department for
investigation. After speaking with employees and consulting department records, the department manager/
supervisor will make a recommendation as to whether the claim should be approved or denied.
Based on that information, the City Attorney will then make a recommendation to the City Council as to whether the
claim should be approved or denied. If the City Attorney recommends that the claim be denied, you will receive a
copy of the department manager/ supervisor's report along with the City Attorney's report to the City Council.
If the City Attorney recommends that the claim be approved, you will receive the City Attorney's report to the City
Council as well as a release form to be signed and returned to the City Attorney's Office. These are only
recommendations. It is important to note that the final decision on all claims is made by the City Council.
No employee of the City has the authority to make any representation to you as to whether your claim will or will not
be paid. If the City Council approves the claim for payment at its City Council meeting, a check will be mailed to you
provided the City Attorney's Office has received your signed release form.
What if My Claim Is Denied by the City Council?
The City Council makes its determination at City Council meetings, which are held the first and third Monday of
each month. We recommend writing a letter to the City Council Indicating why your claim should not be denied and
any additional information that you have to support your claim.
It is not necessary to appeal the City Attorney's recommendation for denial of your claim before the City Council
makes its determination, however, you may do so. You are invited to attend the City Council meeting when your
claim will be decided; however, your attendance is not mandatory and you still have the right to appeal the City
Council's decision any time after it has been made.
If your claim or appeal is denied, you have the option of filing a lawsuit in a court of appropriate jurisdiction.
How Long Do I Have to Wait Before my Claim is Resolved?
The length of time it takes to investigate and resolve a claim depends largely on the nature of the claim and the
amount of damages Involved. Some claims may take a few weeks to resolve, while others may take longer. If you
wish to check on the status of your claim or if you have any questions or concerns about the process, contact the
City Attorney's Office at 563.583.4113.
How Long Do I Have to file a Claim?
You may file a claim at any time. However, if your claim is denied by the City Council and you wish to file a lawsuit,
you should be aware that state law may limit the time in which to file a lawsuit.
`, Driver Information Exchange Report
DUBUQUE POLICE DEPARTMENT
(563) 589-4410
Driver's Name - Last
First
Middle
Suffix
Age
Gender
U
KONZEN
LAINIE
PAIGE
16
FEMALE
N
Address City
State
Zip
Home/Cell Phone Number
1
1975 MARION ST DUBUQUE
IA
52003.0000
(563) 543.8358
T
CDL?
Driver's License Number
Class
State
Endorsements
Restrictions
Insurance Co. Name Insurance Co. Phone #
NO
323AP1071
C
IA
Y
PROGRESSIVE (800) 776.4737 -
001
Insurance Policy #
Owner Company Name
13061725
Owner's Name - Last
First
Middle
Suffix
KONZEN
MICHAEL
WILLIAM
Address Ciry
State
Zip
Vehicle Configuration
1975 MARION ST DUBUQUE
IA
520037137
VIN No. Year
Make Model
Style
Color
3N1AB61 E67L723587 2007
NISSAN -NISS SENTRA
4D
WHI
License Plate #
State
Year
Most Damaged Area
Approximate Cost to Repair or Replace
JYW398 IA
2021
1$3,500.00
Driver's Name - Last
First
Middle
Suffer
Age
Gender
U
HEIDERSCHEIT
JACKSON
WILLIAM
17
MALE
IN
Address Ciry
_
State
Zip
Home/Cell Phone Number
1
13975 SHERRILL RD SHERRILL
IA
52073.0000
(563) 552.8837
T
CDL?
Driver's License Number
Class
State
Endorsements
Restrictions
Insurance Co. Name Insurance Co. Phone #
NO
228AN0600
C
IA
Y
GRINNELL MUTUAL (877) 467.2252
002
Insurance Policy#
Owner Company Name
9400220937
Owner's Name - Last
First
Middle
Sufis
HEIDERSCHEIT
LISA
ANN
Address City
State
Zip
Vehicle Configuration
13975 SHERRILL RD SHERRILL
IA
520739619
VIN No. Year
Make
Model
Style
Color
4M2CU97G69KJ01841 2009
MERCURY-MERC
MNR
SW
GRY
License Plate #
State
Year
Most Damaged Area
Approximate Cost to Repair or Replace
JKF306 IA
2021
$10,000.00 '
Driver's Name - Last
First
Middle
Suffix
Age
Gender
U
BRADLEY
JACKSON
ANDREW
17
MALE
N
Address City
State
Zip
Home/Cell Phone Number
I
13847 MUELLER PKWY SHERRILL
IA
52073.0000
(563) 552-8816-"
T
CDL?
Driver's License Number
Class
State
Endorsements
Restrictions
Insurance Co. Name Insurance Co. Phone #
NO
192AN9395
C
IA
STATE FARM (563) 582-6942
Insurance Policy# _
003
Owner Company Name
2126382F2515
Owner's Name - Last
First
Middle
Suffix
BRADLEY
ANDREW
MICHAEL
Address City
State
Zip
Vehicle Configuration
13847 MUELLER PARKWAY SHERRILL
IA
52073
VIN No. Year
Make
Model
Style
Color
1 FMZU77E71 UA32195 2001
FORD -FORD
EXPLORER
TK
RED
License Plate #
State -
You
Most Damaged Area
Approximate Cost to Repair or Replace
HBR679 IA
2 1
$5,000.00
County
Accident occurred within corporate limits of (city)
DUBUQUE-31
DUBUQUE-2100
_
Litersl Description
IJOHN F KENNEDY RD MEASURING 222 FEET SOUTH FROM ASBURY RD AND JOHN F KENNEDY RD
X-Coordinate Y-Coordinate
00687266 I04709100
If accident occurred outside of city
Direction
Nearest City
Route (Cardinal)
limits show general vacinity:
of
Trnvel Direction
On Road, Street, or Highway: At
Intersection with:
Distance
Direction
Distance Direction
Milepost
Number
and
of
Or
Definable intersection, bridge, or railroad crossing
Officer
Badge No. Law
Enforcement Case Number
Date of Accident
Time of Accident
OFFICER PHIL FRIEDMAN
52 2021.002168
04/01/2021
07:19 Hrs.
INVESTIGATING OFFICER'S REPORT
Sheet 1 of 5
Form 4433003 (11-13) OF MOTOR VEHICLE ACCIDENT
Law Enforcement Case Numbers:
MAIL REPORTS TO: Iowa Department of Transportation, Office of Driver Services, P.O. Box 9204, Des Moines, Iowa 50306-9204
2021-002168
Date of Accident
107:19
Time of Accident
IDUBUQUE-31
County
Accident occurred within corporate limits of (city)
04101/2021
Hrs.
DUBUQUE - 2100
Driver's Name - Last
First
Middle
U
KONZEN
LAINIE
PAIGE
N
Address
City
State
Zip
1
1975 MARION ST
DUBUQUE
IA
152003-0000
T
Date of Birth
1323AP1071
Driver's License Number COL.
Citation Charge 1
Citation Charge 2
1
09/24/2004
Yes
No
Male Female
State
Class Endorsements
Restrictions
Citation Charge 3
Citation Charge 4
IA
C
IY
O
Alcohol Test Given:
Test Results:
Drug Test Given: Test
Result:
Re -exam: Yes No
Reason for Re -Exam Request:
1
1
O Q
Owner's Name - Last
First
Middle
KONZEN
MICHAEL
WILLIAM
Address
City
State
i Zip
1975 MARION ST
DUBUQUE
IA
52003-7137
License Plate No.
State Year
VIN:
Color
Year Make
Model
Style
JYW398
IA 2021
3N1AB61E67L723587
WHI
2007 NISS
SENTRA
14D
Trailer Plate No.
State Year
VIN:
Tow
Towed
To
2
ITow#
Tpprox.CosttoRepairorReplace
00.00
Insurance Company Name
Insurance Co. Phone Number Insurance
Policy Number
PROGRESSIVE
(800) 776.4737 13061725
Initial Travel Direction
Veh. Act.
Cargo Body Type
Veh. Defect
Point of Initial Impact
Most Damaged Area
Extent of Damage
Total Occ. in Veh.
03
101
IVeh.Config.
01
101
01
06
106
4
1
Special Veh. Func Emergency
Status Bus
Use
Driver Condition
Vision Obscured
Contributing Circumstances Driver (up to two) Driver
Distractions
Speed Limit
01 01
101 01
1 88 02
135
Traffic Controls Horizontal
Alignment
Vertical Alignment
SEQUENCE First
Event
Second Event
Third Event
Fourth Event
Most Harmful Event
01 01
101
1OFEVENTS 33
I
33
Carrier Name/Lessee
C
0
Street Address
City
State
Zip Code
M
M
Number of Axles
Gross Vehicle Weight Rating
US DOT Number
MC Number
Underride/Override
E
1-NONE
R
Haz Mat Involvement
Haz Mat Placard
Placard Number
Haz. Mat Released
Haz Mat Class
Haz Mat Name
C
1
Trailer Plate:
State
Year
VIN
A
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Phone Number: (563) 543-8358
5
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INVESTIGATING OFFICER'S REPORT
Sheet 2 of 5
Form 4433003 (11-13) OF MOTOR VEHICLE ACCIDENT
Law Enforcement Case Numbers:
MAIL REPORTS TO: Iowa Department of Transportation, Office of Driver Services, P.O. Box 9204, Des Moines, Iowa 50306-9204
2021-002168
Date of Accident
Time of Accident
IDUBUQUE-31
County
Accident occurred within corporate limits of (city)
04/01/2021
07:19 Hrs.
DUBUQUE - 2100
Driver's Name - Last
First
Middle
U
HEIDERSCHEIT
JACKSON
WILLIAM
N
Address
City
State
Zip
1
13975 SHERRILL RD
SHERRILL
IA
52073-0000
T
Date of Birth
Driver's License Number CDL
Citation Charge 1 Citation
Charge 2
2
09/24/2003
228AN0600
Yes
No
Male Female
State
Class Endorsements
Restrictions
Citation Charge 3 Citation
Charge 4
0!
IA
C
Y
0 O
Alcohol Test Given:
Test Results:
g Test Given: Test
Result:
Re -exam: Yes No
Reason for Re -Exam Request:
1
rru
O Q
Owner's Name - Last
First
Middle
HEIDERSCHEIT
LISA
ANN
Address
City
State
Zip
13975 SHERRILL RD
SHERRILL
IA
52073-9619
License Plate No.
State Year
VIN:
Color
Year
Make
Model
Style
JKF306
IA 2021
4M2CU97G69KJ01841
GRY
2009
MERC
MNR
SW
Trailer Plate No.
State Year
VIN:
Tow
Towed To
Approx.Cost toRepair orReplace
2
iTow#
$10,000.00
Insurance Company Name
Insurance Co. Phone Number
Insurance Policy Number
GRINNELL MUTUAL
(877) 467-2252
9400220937
Initial Travel Direction
Veh. Act.
Veh. Config.
103
Cargo Body Type
101
Veh. Defect Point
of Initial Impact
Most Damaged Area
Extent of Damage
Total Occ. in Veh.
03
01
01 12
06
I
4
1
Special Veh. Func Emergency
Status Bus
Use
Driver Condition
Vision Obscured
Contributing Circumstances Driver (up to two) Driver
Distractions
Speed Limit
01 01
01 101
88 02
35
Traffic Controls Horizontal
Alignment
Vertical Alignment
SEQUENCE First
Event
Second Event
Third Event
Fourth Event
Most Harmful Event
01 01
01
OF EVENTS 33
33
33
Carrier Name/Lessee
C
O
Street Address
City
State
Zip Code
M
M
Number of Axles
Gross Vehicle Weight Rating
US DOT Number
MC Number
Underride/Override
E
1-NONE
R
Haz Mat Involvement
Haz Mat Placard
Placard Number
Haz. Mat Released
Haz Mat Class
Haz Mat Name
C
1
Trailer Plate:
State
Year
VIN
A
o
a
L
a
o
a
L
W
o
V
Trailer Plate:
State
Year
VIN
N
a
2
F
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State
Plate Year
VIN
x
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Phone Number: (563) 552-8837
5
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DRIVER OF UNIT 2
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Name
Phone Number
DOB:
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Address
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DOB:
Address
Transported to:
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INVESTIGATING OFFICER'S REPORT
Sheet 3 of 5
Form 4433003 (11-13) OF MOTOR VEHICLE ACCIDENT
Law Enforcement Case Numbers:
MAIL REPORTS TO: Iowa Department of Transportation, Office of Driver Services, P.O. Box 9204, Des Moines, Iowa 50306-9204
2021-002168
Date of Accident
107:19
Time of Accident
IDUBUQUE-31
County
Accident occurred within corporate limits of (city)
04/01/2021
Hrs.
DUBUQUE - 2100
Driver's Name - Last
First
Middle
U
BRADLEY
JACKSON
ANDREW
N
Address
City
State
Zip
I
13847 MUELLER PKWY
SHERRILL
IA
152073-0000
T
Date of Birth
Driver's License Number
CDL
Citation Charge 1
Citation Charge 2
3
06/26/2003
192AN9395
Yes No
Male Female
State
Class Endorsements
Restrictions
Citation Charge 3
Citation Charge 4
IA
C
Q
Alcohol Test Given:
Test Results:
Drug Test Given:
Test Result:
Re -exam: Yes No
Reason for Re -Exam Request:
1
1
0
Owner's Name - Last
First
Middle
BRADLEY
ANDREW
MICHAEL
Address
City
State
Zip
13847 MUELLER PARKWAY
SHERRILL
IA
52073
License Plate No.
State Year
VIN:
Color
Year Make
Model
Style
HBR679
IA 2021
1FMZU77E71UA32195
RED
2001 FORD
EXPLORER
ITK
Trailer Plate No.
State Year
VIN:
Tow
Tow # Towed
To
Approz. Cost to Repair or Replace
2
$5,000.00
Insurance Company Name
Insurance Co. Phone Number Insurance
Policy Number
STATE FARM
(563) 582.6942 2126382F2515
Initial Travel Direction
Veh. Act.
Veh. Config.
Cargo Body Type
Veh. Defect
Point of Initial Impact
Most Damaged Area
Extent of Damage
Total Occ. in Veh.
01
01
102
101
01
12
112
4
1
Special Veh. Func Emergency
Status Bus
Use
Driver Condition
Vision Obscured
Contributing Circumstances Driver (up to two) Driver
Distractions
Speed Limit
01 01
101 101
88 02
135
Traffic Controls Horizontal
Alignment
Vertical Alignment
SEQUENCE First
Event
Second Event
Third Event
Fourth Event
Most Harmful Event
01 01
01
OF EVENTS 33
33
Carrier Name/Lessee
C
O
Street Address
City
State
Zip Code
M
M
Number of Axles
Gross Vehicle Weight Rating
US DOT Number
MC Number
Underride/Override
E
1-NONE
R
Haz Mat Involvement
Haz Mat Placard
Placard Number
Haz. Mat Released
Haz Mat Class
Haz Mat Name
C
I
Trailer Plate:
State
Year
VIN
o
c
a
o
2
L
o
N
V
o
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N
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a
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m
N
3
x
F
C
2
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Trailer Plate:
State
Year
VIN
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Converter Dolly
Dolly Plate:
State
i Plate Year
VIN
C
O
Q
W
La
Ft
m
0
Phone Number: (563) 552-8816
5
99
03
1 1
01
1
01
01
P
DRIVER OF UNIT 3
Transported to: Transported
by:
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Name Phone
Number
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INVESTIGATING OFFICER'S REPORT OF
Sheet 4 of 5
Form 4433003 (11-13) MOTOR VEHICLE ACCIDENT Law
Enforcement Case Numbers:
MAIL REPORTS TO: Iowa Department of Transportation, Office of Driver Services, P.O. Box 9204, Des Moines, Iowa 50306-9204 2021-002168
Date of Accident
Time of Accident
County
Accident occurred within corporate limits of (city) Legal
FP,,vateL
❑
04/01/2021
07:19 Hrs.
DUBUQUE - 31
DUBUQUE - 2100 Intervention?❑rty?
O
Literal Description
County: Route:
C
JOHN F KENNEDY RD MEASURING 222 FEET SOUTH FROM ASBURY RD AND JOHN F KENNEDY RD 31
A
X Coordinate:
If accident occurred outside of N NE E SE S SW W NW
T
city limits show general vicinity O Q 0 0 0 00 0 of nearest city 687265.937
1
On Road, Street or Highway:
At Intersection with:
Y Coordinate:
O
N
4709100
Note: Unless accident occurred at an intersection which is completely described above, use the space below to give the exact
location from a milepost or definable intersection, bridge, or railroad crossing, using two distances and directions if neccessaryof If
Divided Highway, Provide Route
NNE E SE S SW W NW N NE E SE S SW W NW (Cardinal)
Travel Direction
00000000 and I00000000
NB SBA WBB
(EBB
(O
0 Q O
Milepost Definable intersection,
Number Or bridge, or railroad crossing
ACCIDENT ENVIRONMENT
ROADWAY CHARACTERISTICS
Location of First Harmful Event 01 Weather Conditions (up to two)
Major Contributing Circumstances Environment 98
Manner of Crash/Collision 03 01
Roadway 02
o
t
m
E
m
E
o
0
Light Conditions 1 Surface Conditions 03
Type of Roadway Junction/Feature 01
o
Q
F
_
w
o
o
E
v
FRA No.
X
>'
ig
z
c
a
o
C
n
rn
S
O
2
c
N
9
First Harmful Event (Crash)
WORKZONE
Yes N
Activity
Location
Type
Workers Present
33
RELATED?
0+
o
to
z
¢
0
n
ci
Cn
o
Name 001
Phone Number DOB:
N
O
NM
Address: Alcohol Test Given Test Results: Drug Test Given Result Charged Yes No
OQ
OT
Transported to: Transported by:
Name
R
Phone Number DOB:
SAddress:
Alcohol Test Given Test Results:
Drug Test Given Result
Charged Yes No
no
STransported
to:
Transported by:
N P
If Property other than
Object Damaged Estimate
of Damage
O R
vehicles damaged explain
N O
Owner's Last Name
First Name
Middle Name
Phone Number
VP
E E
Address
City
State
Zip Code
Was owner or tenant notified?
H R
1= Yes 2= No 9= Unknown
I T
If Property other than
Object Damaged Estimate
of Damage
C Y
vehicles damaged explain
U
Owner's Last Name
First Name
Middle Name
Phone Number
LD
M
Address
City
State
Zip Code
Was owner or tenant notified?
R G
1= Yes 2= No 9= Unknown
Last Name
First Name Address
City
State
Zip Code Phone
Number
W
I
Last Name
First Name
Address
City
State
Zip Code Phone
Number
T
N
Last Name
First Name
Address
City
State
Zip Code Phone
Number
E
S
Last Name
First Name
Address
City
State
Zip Code Phone
Number
S
Last Name
First Name
Address
City
State
Zip Code Phone
Number
Is This a Secondary Crash?
Type of Primary Incident
Roadway Clearance Date
Incident Clearance Date
Y 0 N Q
04/01/2021
04/01/2021
Signature of Officer Badge
Number
Time Officer Notified of Accident
Roadway Clearance Time
Incident Clearance Time
OFFICER PHIL FRIEDMAN 52
07:20 Hrs.
07:43 Hrs.
07:43 Hrs.
Name of Agency Date
of Report
Time Officer Arrived At Scene
Total Roadway Clearance Time
Total Incident Clearance Time
DUBUQUE POLICE DEPARTMENT 04/01/2021
07:23 Hrs.
000:23
000:23
Report Reviewed By Date
of Review
Invest' ation made at scene?
Other Technical Investigating Agency
BOCK, LUKE 04/01/2021
Y N
Form 4433003(11-13)
INVESTIGATING OFFICER'S REPORT
OF MOTOR VEHICLE ACCIDENT
MAIL REPORTS TO: Iowa Department of Transportation, Office of Driver Services, P.O. Box 9204, Des Moines, Iowa 50306-9204
A
G
R
A
M
N
A
R
R
A
T
I
V
E
ASBURY RD
JFK RD
Sheet 5 of 5
Law Enforcement Case Numbers:
2021-002168
Unit 1 was S/B in the west lane on JFK just south of the Asbury/JFK intersection. Unit 2 was behind unit 1 also S/B in the west lane on JFK just south of the
Asbury/JFK intersection. Unit 3 was behind unit 2 also S/B in the west lane on JFK just south of the Asbury/JFK intersection. Due to water main break in the area
and cold temperature ice had formed all over the road. Unit 1 began losing control and was able to stop her vehicle but due to the ice unit 2 rear ended her then unit
3 rear ended unit 2. No citations issued at this time due to the drastic and sudden road conditions changes.
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OBIE'S TOWING & SERVICE CENTER, INC.
21375 US HWY 20 W
EAST DUBUQUE, IL 61025
Phone # (815) 747-6449
Fax # (815) 747-2116
Bill To
ANDY BRADLEY
13847 MUELLER PARKWAY
SHERRILL, IOWA 52073
Invoice
Date
Invoice #
4/2/2021
23825
E mail
Year/Make/Model
Plate #
Vin #
Odometer
obiesservice@gmail.com
200o FORD
Service Code
Description
Labor/Parts
Amount
TOWING
TOW
6o
6o.00
PARTS
USED LEFT FRONT HEADLIGHT ASSEMBLY
30
30.00T
PARTS
USED LEFT FRONT MARKER LIGHT ASSEMBLY
30
3o.00T
PARTS
ELECTRICAL SUPPLIES
6.99
6.99T
LABOR
LABOR TO INSTALL HEADLIGHT AND MARKER LIGHT
75
75.00
ASSEMBLY
PARTS
255/70/16 CROSSWIND TIRE
123.99
123.99T
PARTS
NEW VALVE STEM
3.99
3.99T
LABOR
LABOR TO MOUNT AND BALANCE TIRE
20
20.00
EPA
DISPOSAL FEE FOR OLD TIRE
5
5.00
SHOP SUPPLIES
SHOP SUPPLIES
6.65
6.65T
I hereby authorize the above repair work to be done along with the necessary materials.
You and your employee's may operate above vehicle for purposes of testing, inspection,
Sales Tax (7.75%) $15.63
or delivery at my risk. An express mechanics lien is acknowledged on above vehicle to
secure the amount of repairs thereto. It is also understood that you will not be hold
responsible for loss or damage to cars or articles left in cars in case of fire, theft, or any
other cause beyond your control.
Subtotal $361.62
Shop Supplies: This is a charge to cover the folllowing: rags, chemicals,
lubricants,special fluids, floor swept, misc, bolts, nuts and other hardware. The charge
is calculated at 7% of labor $.
Total $377.25
Date:
Estimate ID:
Estimate Version:
Preliminary
Profile ID:
Quote ID:
Ken's Auto Body
598 Central Ave., Dubuque, IA 52001
(563) 557-4413
Fax: (563) 557-4415
Email: kensautobodyl@aol.com
Damage Assessed By: Ken Jaeger
Classification: None
Deductible: UNKNOWN
Owner: ANDY BRADLEY
Address: 13847 MUELLER PARK WAY, SHERRILL, IA 52073
Telephone: Home Phone: (563) 590-5347
4/16/2021 11:27 AM
4895
0
Mitchell
84571488
Mitchell Service: 914626
Description: 2001 Ford ExplorerSportTrac
Body Style: 4D Ut Drive Train: 4.OL Inj 6 Cyl 4WD
VIN: 1 FMZU77E71UA32195
OEM/ALT: O Search Code: None
Options: PASSENGER AIRBAG, POWER LOCK, POWER WINDOW, POWER STEERING, AIR CONDITION
AM/FM STEREO, DRIVER AIRBAG, SKID PLATES, ANTI -LOCK BRAKE SYS.
ALUM/ALLOY WHEELS, CD PLAYER, POWER ADJUSTABLE EXTERIOR MIRROR, CASSETTE PLAYER
PRIVACY GLASS, FIRST ROW BUCKET SEAT, CLOTH SEAT, 4 WHEEL DRIVE, REAR BENCH SEAT
Line
Item
Entry Labor
Number Type
Operation
Line Item
Description
Part Typel
Part Number
Dollar
Amount
Labor
Units
1
AUTO
BOY
OVERHAUL
Frt Bumper Assy
1.1 #
2
401176
BDY
REMOVE/REPLACE
Frt Bumper Cover
" QUAL REPL PART
224.00 `
INC #
3
AUTO
REF
REFINISH
Frt Bumper Cover
C
2.3
4
400009
BDY
REMOVE/REPLACE
Frt Bumper Cover Reinforcement
1L5Z 17757 KA
234.43
INC
5
400016
BDY
REMOVE/REPLACE
Grille Opening Reinforcement
" QUAL REPL PART
152.00 `
INC #
6
AUTO
REF
REFINISH
Grille Opening Reinforcement
C
1.6
7
400024
BDY
REMOVE/REPLACE
L Headlamp Assembly
" QUAL REPL PART
72.00 `
INC #
8
AUTO
BDY
CHECKIADJUST
Headlamps
0.4
9
400038
BDY
REMOVE/REPLACE
L Park/Signal Lamp Lens & Housing
" QUAL REPL PART
42.00 `
INC #
10
400053
BDY
REMOVE/REPLACE
Hood Panel
" QUAL REPL PART
544.00`
1.2 #
11
AUTO
REF
REFINISH
Hood Outside
C
2.8
12
AUTO
REF
REFINISH
Add For Hood Underside
C
1.4
13
400151
BDY
REMOVE/REPLACE
L Fender Panel
" QUAL REPL PART
529.00'
4.5 #
14
AUTO
REF
REFINISH
LFender Outside
C
1.7
15
AUTO
REF
REFINISH
L Add To Edge Fender
C
0.5
16
401240
BDY
REMOVE/REPLACE
L Fender Reinforcement
Qual Recycled Part
25.00"
17
400158
BDY
REMOVE/REPLACE
L Fender Apron Assy
" QUAL REPL PART
36.00 '
INC
18
400769
REF
BLEND
L Frt Door Outside
C
1.0
19
400787
BDY
REMOVE/INSTALL
L Frt Door Mirror
0.2 #
20
401977
BDY
REMOVE/INSTALL
L Frt Otr Door Belt Moulding
0.3 #
21
400841
BDY
REMOVE/INSTALL
L Frt Otr Door Handle
0.3 #
22
400843
BDY
REMOVE/INSTALL
L Frt Door Lock Cylinder
0.2 #
23
400844
BDY
REMOVE/INSTALL
L Frt Keyless Entry Pad
0.2 #
24
AUTO
REF
ADD'L OPR
Clear Coat
2.7
25
AUTO
ADD'L COST
Paint/Materials
602.00 "
ESTIMATE
RECALL
NUMBER: 04/1612021 11:27:52
4895
Mitchell Data
Version:
OEM: APR_21_V
Copyright (C) 1994 - 2021 Mitchell International
Page 1
of 2
Software Version:
7.1.241
All Rights Reserved
26 AUTO ADD'L COST Hazardous Waste Disposal
- Judgment Item
# - Labor Note Applies
C - Included in Clear Coat Calc
Estimate Totals
Date:
4/16/2021 11:27 AM
Estimate ID:
4895
Estimate Version:
0
Preliminary
Profile ID:
Mitchell
Quote ID:
84571488
5.00 '
Add'I
Labor Sublet
1. Labor Subtotals Units Rate
Amount Amount
Totals
11. Part Replacement Summary
Amount
Body 8.4 65.00
0.00 0.00
546.00 T
Taxable Parts
1,858.43
Refinish 14.0 65.00
0.00 0.00
910.00 T
Parts Adjustments
6.25
Sales Tax @ 7.000%
130.53
Taxable Labor
1,456.00
Labor Tax
@ 7.000 %
101.92
Total Replacement Parts Amount
1,995.21
Labor Summary 22.4
1,557.92
III. Additional Costs
Amount
IV. Adjustments
Amount
Taxable Costs
607.00
Customer Responsibility
0.00
Sales Tax
@ 7.000 %
42.49
Total Additional Costs
649.49
Paint Material Method: Rates
Init Rate = 43.00 , Init Max Hours = 99.9, Addl Rate = 0.00
I. Total Labor:
1,557.92
II. Total Replacement Parts:
1,995.21
III. Total Additional Costs:
649.49
Gross Total:
4,202.62
IV. Total Adjustments:
0.00
Net Total:
4,202.62
This is a preliminary estimate.
Additional changes to the estimate may be required for the actual repair.
ESTIMATE RECALL NUMBER: 04/16/2021 11:27:52 4895
Mitchell Data Version: OEM: APR_21_V
Copyright ICI 1994 - 2021 Mitchell International Page 2 of 2
Software Version: 7.1.241 All Rights Reserved
City of Dubuque
City Council Meeting
Consent Items # 3.
Copyrighted
May 3, 2021
ITEM TITLE: Disposition of Claims
SUMMARY: City Attorney advising that the following claims have been referred to
Public Entity Risk Services of Iowa, the agent for the Iowa Communities
Assurance Pool: Andy Bradley for vehicle damage; Allyssa Krier for
vehicle damage.
SUGGESTED Suggested Disposition: Receive and File; Concur
DISPOSITION:
ATTACHMENTS:
Description
I CAP Referral
Type
Supporting Documentation
THE CITY OF
DUB E N N D H a
Masterpiece on the Mississippi
JONI MEDINGER
LEGAL ADMINISTRATIVE ASSISTANT
To: Mayor Roy D. Buol and
Members of the City Council
DATE: 4/19/2021
RE: Claim Against the City of Dubuque by Andy Bradley
Claimant Date of Claim Date of Incident Nature of Claim
Andy Bradley 4/19/2021 4/1/2021 Vehicle Damage
This is a claim in which claimant alleges claimant's vehicle was damaged due to an
accident caused by ice from a watermain break.
This claim has been referred to Public Entity Risk Services of Iowa, the agent for the Iowa
Communities Assurance Pool.
cc: Michael C. Van Milligen, City Manager
John Klostermann, Public Works Director
Any Bradley
OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA
SUITE 330, HARBOR VIEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001-6944
TELEPHONE (563) 589-4113 / FAX (563) 583-1040 / EMAIL jmedinge@cityofdubuque.org