Claim by Mary C. LeGrandTHE CITY OF
DUB UE MEMORANDUM
Masterpiece on the Mississippi
TRACEY STECKLEIN
PARALEGAL
To: Mayor Roy D. Buol and
Members of the City Council
DATE: June 23, 2010
RE: Claim Against the City of Dubuque by Mary C. LeGrand
Claimant Date of Claim Date of Loss Nature of Claim
Mary C. LeGrand 06/21/10 05/27/10 Vehicle Damage
This is a claim in which claimant alleges that her vehicle was struck by rocks from a
riding lawn mower that was being driven by a City employee in the ditch in front of
Lowes at 4100 Dodge Street.
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, Street & Sewer Maintenance Supervisor
Mary C. LeGrand
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 / Erma_ 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 West 13 St., Dubuque, IA 52001. It will then be referred to
the appropriate department for investigation and to the City Attorneys Office. 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.
Thor 1. Name of Claimant: / / /(,�(' ( , .Lc 6/'L kw/
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2. Address:
3. Telephone Number: Sea 7 -- 56 3) (03 work!
4. Date of Incident: .. �
5. Time of Incident: % (; 00 /`7
6. Location of Incident (Be specific): ! l3 /) 7'_ o Loo c_
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7. Describe the 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.) c�
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8. What were weather conditions like? 5 (.1 h 119'
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9. Give name and address of any witnesses:
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. Attac.,tMatekof,
damages or describe basis for ascertaining extent of damage.) L p c
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13. What other damages do you claim, if any? /) () 1) (,
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.)
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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 responsible? row J 1 o
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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?
Dated this , / day of
ACE.
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(Signature)
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(Print Name)
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05/28/2010 at 09:36 AM
24443
Insured: MARY LEGRAND
Owner: MARY LEGRAND
Address: 13166 WEST CLAY DR
DUBUQUE, IA 52002
Evening: (563)581 -0743
Business: (563)556 -3163
Inspect ABRA - DUBUQUE
Location: 3400 CENTER GROVE DR
DUBUQUE, IA 52003
ABRA - DUBUQUE
Federal ID #:420782245
DBA: ANDERSON -WEBER INC
3400 CENTER GROVE DR
DUBUQUE, IA 52003
(563)556 -0696 Fax: (563)556 -1899
PRELIMINARY ESTIMATE
Written By: RICK KELLY
Adjuster:
Insurance CITY OF DUBUQUE
Company: Days to Repair
2007 HYUN SANTA FE 4X4 LIMITED 6- 3.3L -FI 4D UTV SILVER Int:GREY
VIN: 5NMSH73E57H052090 Lic: 769HZZ IA Prod Date: 11/2006 Odometer: 15701
Air Conditioning
Cruise Control
Keyless Entry
Body Side Moldings
Console /Storage Overhead Console
Fog Lamps Rear Spoiler
Power Steering Power Brakes
Power Locks Power Driver Seat
Heated Mirrors AM Radio
Stereo CD Player
Driver Air Bag Passenger Air Bag
Front Side Impact Air Bag 4 Wheel Disc Brakes
Stability Control Leather Seats
Automatic Transmission 4 Wheel Drive
Aluminum /Alloy Wheels
Rear Defogger
Telescopic Wheel
Alarm
Dual Mirrors
NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT
1 FRONT DOOR
2* Rpr RT Outer panel
3 Add for Clear Coat
4* R &I RT Body side mldg
5 R &I RT Belt w'strip
6 R &I RT Mirror assy w/o heated
glass black
1
0
0
0
0
0
Job Number:
Claim #
Policy #
Deductible:
Date of Loss:
Type of Loss:
Point of Impact: 2. Right Front Pil
Business: (563)556 -0696
Tilt Wheel
Intermittent Wipers
Steering Wheel Controls
Privacy Glass
Luggage /Roof Rack
Clear Coat Paint
Power Windows
Power Mirrors
FM Radio
Anti -Lock Brakes (4)
Head /Curtain Air Bags
Traction Control
Heated Seats
Overdrive
0.00
0.00
0.00
0.00
0.00
1.0
0.0
0.4
0.3
0.4
2.2
0.9
0.0
0.0
0.0
05'28'/2010 at 09:36 AM Job Number:
24443
PRELIMINARY ESTIMATE
2007 HYUN SANTA FE 4X4 LIMITED 6- 3.3L -FI 4D UTV SILVER Int:GREY
Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived
from the Guide ARR1061, CCC Data Date 05/03/2010, and the parts selected are OEM -parts
manufactured by the vehicles Original Equipment Manufacturer. OEM parts are available at
OE /Vehicle dealerships. OPT OEM (Optional OEM) or ALT OEM (Alternative OEM) parts are OEM parts
that may be provided by or through alternate sources other than the OEM vehicle dealerships.
OPT OEM or ALT OEM parts may reflect some specific, special, or unique pricing or discount. OPT
OEM or ALT OEM parts may include "Blemished" parts provided by OEM's through OEM vehicle
dealerships. Asterisk ( *) or Double Asterisk ( * *) indicates that the parts and /or labor
information provided by MOTOR may have been modified or may have come from an alternate data
source. Tilde sign ( -) items indicate MOTOR Not - Included Labor operations. Non- Original
Equipment Manufacturer aftermarket parts are described as AM, Qual Repl Parts or Comp Repl Parts
which stands for Competitive Replacement Parts. Used parts are described as LKQ, Qual Recy
Parts, RCY, or USED. Reconditioned parts are described as Recond. Recored parts are described
as Recore. NAGS Part Numbers and Benchmark Prices are provided by National Auto Glass
Specifications. Labor operation times listed on the line with the NAGS information are MOTOR
suggested labor operation times. NAGS labor operation times are not included. Pound sign ( #)
items indicate manual entries. Some 2010 vehicles contain minor changes from the previous year.
For those vehicles, prior to receiving updated data from the vehicle manufacturer, labor and
parts data from the previous year may be used. The Pathways estimator has a complete list of
applicable vehicles. Parts numbers and prices should be confirmed with the local dealership.
CCC Pathways - A product of CCC Information Services Inc.
3