Claim by Jennifer BriesMasterpiece on the Mississippi
TRACEY STECKLEIN
PARALEGAL
To: Mayor Roy D. Buol and
Members of the City Council
cc: Michael C. Van Milligen, City Manager
Tim Horsfield, Parking Systems Supervisor
Jennifer Bries
MEMORANDUM
DATE: July 26, 2010
RE: Claim Against the City of Dubuque by Jennifer Bries
Claimant Date of Claim Date of Loss Nature of Claim
Jennifer Bries 07/21/10 07/14/10 Vehicle Damage
This is a claim in which claimant alleges that her vehicle was struck by a rock which fell
from the bluff while she was parked in the 8 th Street Parking Lot.
This claim has been referred to Public Entity Risk Services of Iowa, the agent for the Iowa
Communities Assurance Pool.
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
1. Name of Claimant:
2. Address: .3
/ j / / r ` J
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.
T7 ,')/J /tf r
3. Telephone Number: s`b - v? U 7
4. Date of Incident:
/7!J S'71.
7. DESCRIBE ACCIDENT OR OCC
a6 /0
5. Time of Incident: L 40 r 'Pre ? ..3o
GU/jePJ Z 0 0ou / /e0 U 70 r us Z /ii
6. Location of Incident (Be specific): ' "
te)
.� rof %Cr 7 �
Q 1, ,9 roe
/
c r << 7nre n /' /'^ f ' ? e 41/2/ C/ec.,!), ^
RENCE 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.)
/? / ooS�Q& ? E?r -c s,d€ //'J /X E— Zac,k 7Xe r- c/. 1J? CJ's /, l_
rrixlt!/�) i t� 7 /e. .C�Cy n/Yj l �� /141,1r ( ft) C.� e_te$S/e ! /!�J/ ( ✓ d »/
f.� G.r��L rc noc� P rock 4 'o,p 7A t. o Biter Cc' €fd See / 7_
8. What wer weather conditions like? 1f >aI i' �!
9. Give name and address of any witnesses:
10. Did police investigate? (If so, give names of officers.)
e.e — Mat 27, /I 11) n /a " 31 95
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.)
5 J1-) /moot, !' /(2/2)(-,i erc s feo/ f 04 r-
/9A y aaP c c 09 ,v fit'• p�f .a/i f94jp � i efc.re.s c..0 c/ Se , ri t G e ./d for lgedr,
13. WVhat 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.)
J O
15. What amount do you claim from the City of Dubuque?
ever ; 7 / 7`c0 Cv S / Ao e 7c;A (° / ` - ye.
16. Why do you claim the City of Dubuque is responsible?
,6er ause.. -- Pr 7 ,n) � d - 7 e )221:1P /c perk f %erP_ a"lot
- wc_g 17. Have you made any claim against anyone else for damages as a result of this incident?
(If yes, give name and address.)
GO
. 'f-.- -- /fir !S
(Rev. 1/00 & 7/01)
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 17 day of , 20 /0.
(Signature)
(Print Name)
di 'entngnG
80410 9N
9C :ZtWd IZ1flf 01.
Year
2005 I
Make
Chrysler
Model
I Sebring Sedan
Color
I Trim
Unit Number
License Plate #
Mileage
Serial#/VIN#
1 C3EL46X05N537068
Sup
Seq
Qty
Labor
Type
Labor
Op
Description
Part
Type
Part
Number
List
Price
Extended
Price
Labor
Units
1
1
Ref
Ref
Refinish Door
Outside R [BLEND
FOR COLOR
MATCH]
Exist
1.0*
2
1
Body
Rem/Ins
R &I Rear View
Mirror R
Exist
.51#
3
1
Body
Rem/Ins
R&I Outer Belt
Moulding R
Exist
.3
4
1
Body
Rem/Ins
Moulding, Side
(Adhesive) White
w/o Chrome (a)
2002 -05 R 04 -05
Exist
.2
5
1
Body
Rem/Ins
R &I Outside Handle
R
Exist
.61
6
1
Ref
Ref
Refinish Door
Outside R
Exist
2.0
7
1
Ref
Ref
Refinish Door
Outside Add for
Jambs & Interior R R
Exist
1.0
8
1
Body
Rem/Rep
Panel, Repair R
03 -06
New
4814548A
D
$235.00 T
$235.00
6.3#
Estimate Prepared by:
Accident Date:
Date of Loss:
Arrival Date:
Type of Loss:
Policy Number:
Claim Number:
Version 2.0
Database Edition CPL 10 -05
Owner:
TOYS DONE RIGHT
1006 central ave
DUBUQUE, IA, 52001
Tel: 563 -552 -1601 Fax: 563 -552 -2207
Tax ID: 26-1404014
Estimate - Preliminary
Contact: Jennifer Bries
Address: 563-542-2078
Appraised for:
Date: 7/19/2010
Estimate #:
P -Page logic not included.
Page 1 of 3
Sup
Seq
Qty
Labor
Type
Labor
Op
Description
Part
Type
Part
Number
List
Price
Extended
Price
Labor
Units
9
1
Body
Rem/Ins
Moulding, Side
(Adhesive) White
w/o Chrome 2002 -05
R 04 -05
Exist
T
.2
10
1
Body
Rem/Rep
Clean And Retape
Side MLds
New
$15.00 T
$15.00
.5*
11
1
Ref
Ref
Refinish Rt 1/4 panel
[BLEND FOR
COLOR MATCH]
Exist
1.5*
12
1
Body
Repair
Rocker Panel, Sill R
01 -05
Exist
2.5
13
1
Ref
Ref
Refinish Rt Rocker
panel
Exist
1.5*
14
1
Body
Rem/Rep
Refinish Rt Rocker
Innner Panel
New
1.0*
15
1
Body
Rem/Rep
Cover for overspray
New
$15.00 T
$15.00
.5*
16
1
Body
Rem/Rep
Rust proof repair area
New
$10.00 T
$10.00
.2*
17
1
Body
Rem/Rep
Panel bonding
materails
New
$35.00 T
$35.00
18
1
Ref
Ref
Clear coat
Exist
1.0
19
Paint Materials
$280.00
* - Judgement Item
# - Labor Note Applies
Labor
Body
Refinish
Labor Total
Version 2.0
12.8
8.0
Hrs @
Hrs @
$55.00
$55.00
$704.00
$440.00
$1,144.00
Tax Total
Totals
Net Total
2005 Chrysler Sebring
Parts
Parts Subtotal
Less Adjustments
Parts Total
Additional Costs and Operations
Addl. Costs/Ops Total $280.00
Tax
P -Page logic not included.
Labor Tax @
Parts Tax @
7.00%
7.00%
$310.00
$310.00
$80.08
$21.70
$101.78
Sub Total: $1,835.78
Customer Resp. $0.00
$1,835.78
Database Edition CPL 10 -05 Page 2 of 3
ABOVE IS AN ESTIMATE BASED ON OUR
INSPECTION AND DOES NOT INCLUDE ANY
ADDITIONAL PARTS OR LABOR WICH MAY BE
REQUIRED AFTER WORK HAS BEEN STARTED
WHICH INCLUDES PARTS PRICE CHANGES
This is a preliminary estimate. Additional changes to the estimate may be required for the actual repair.
RepairMate does not automatically include items required by many business repair partners. This application
allows the author to manually enter line items such as overlap deductions.
Version 2.0
2005 Chrysler Sebring
P -Page logic not included.
Authorization for Repairs:
Signature Date
Database Edition CPL 10 -05 Page 3 of 3