Claim by Susan WelpMasterpiece on the Mississippi
TRACEY STECKLEIN
PARALEGAL
MEMORANDUM
lon
To: Mayor Roy D. Buol and
Members of the City Council
DATE: June 9, 2010
RE: Claim Against the City of Dubuque by Susan Welp
Claimant Date of Claim Date of Loss Nature of Claim
Susan Welp 06/07/10 06/01/10 Vehicle Damage
This is a claim in which claimant alleges that as she was stopped for the stop sign on
Center Grove at Cedar Cross Road, a City of Dubuque Maintenance Truck struck the
rear of claimant's vehicle.
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
Don Vogt, Public Works Director
Susan Welp
OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA
SUITE 330, HARBOR VIEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001 -6944
TELEPHONE (563) 583 -4113 / FAX (563) 583 -1040 / EMAIL tsteckle @cityofdubuque.org
////,-;
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. 13 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: , ^v.{ ‘->
2. Address: (1 C;c' ;P,k1 , .
3. Telephone Number: 1-13V-?-) -_ l ‘CA KS
4. Date of Incident: �Q \ � \ \ \rr
5. Time of Incident: \ \ j (A1
6. Location of Incident (Be specific):
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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.)
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B. What were weather conditions like? � Q y�r\,
9. Give name and address of any witnesses: ON A V l`, �� A„ A
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).
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? }9 ,
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?
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16. Why do you claim the City of Dubuque is responsible?
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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.)
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18. If the answer to Question 17 is yes, have you received any payment from that source,
and if so, in what amount?
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Dated at Dubuque, Iowa this day of r\ }r , 20 \
5.1 VD _Qie
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(Rev. 1/00 & 7/01)
(Signature)
(Print Name)
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06/01/2010 at 04:45 PM Job Number:
30799
Insured: SUE WELP
Owner: SUE WELP
Address: 637 JEFFERSON ST
DUBUQUE, IA 52001
Day:
Evening:
Inspect
Location:
Insurance -
Company:
1995 DODG NEON HIGHLINE 4
VIN:
Intermittent Wipers
Dual Mirrors
Power Steering
FM Radio
Passenger Air Bag
5 Speed Transmission
NO.
1
2
OP.
BRIMEYER AUTO BODY
License #:30799 Federal ID #:421436480
10709 COLLISION DR.
DUBUQUE, IA 52001
(563)583 -4456 Fax: (563)583 -1838
PRELIMINARY ESTIMATE
Written By: BOB COOK
Adjuster:
- 2.0L -FI 4D SED Int:
Lic: Prod Date:
Tinted Glass
Console /Storage
Power Brakes
Stereo
Cloth Seats
Overdrive
DESCRIPTION
REAR BUMPER
O/H rear bumper
3 ** Repl A/M CAPA Bumper cover smooth
finish
4 Add for Clear Coat
Subtotals ==>
Parts
Body Labor
Paint Labor
Paint Supplies
SUBTOTAL
Sales Tax
GRAND TOTAL
ADJUSTMENTS:
Deductible
CUSTOMER PAY
INSURANCE PAY
Claim #
Policy #
Deductible:
Date of Loss:
Type of Loss:
Point of Impact:
Days to Repair
Odometer:
Body Side Moldings
Clear Coat Paint
AM Radio
Driver Air Bag
Bucket Seats
Full Wheel Covers
QTY EXT. PRICE LABOR PAINT
1.2
1 268.00 Incl.
268.00
1.2
1 . 2 hrs ® $ 56.00/hr
3.4 hrs ® $ 56.00/hr
3.4 hrs ® $ 36.00 /hr
2.4
1. 0
3.4
268.00
67.20
190.40
122.40
$ 648.00
$ 525.60 @ 7.0000% 36.79
$ 684.79
0.00
$ 0.00
$ 684.79