Claim by Erin FitzsimmonsTHE CITY OF
DUB 7E MEMORANDUM
Masterpiece on the Mississippi
TRACEY STECKLEIN
PARALEGAL
To: Mayor Roy D. Buol and
Members of the City Council
DATE: July 20, 2010
RE: Claim Against the City of Dubuque by Erin Fitzsimmons
Claimant Date of Claim Date of Loss Nature of Claim
Erin Fitzsimmons 07/1910 07/14/10 Vehicle Damage
This is a claim in which claimant alleges that a sign in the Museum of Art parking lot,
located at 729 Bluff Street, fell onto claimant's vehicle, damaging the hood and the
windshield of her 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
Marie Ware, Leisure Services Manager
Don Vogt, Public Works Director
Erin Fitzsimmons
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 West 13`" St., Dubuque, IA 52001. It will then be referred to
the appropriate department for investigation and to the City Attorney's 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 yo claim will or will not be paid.
1. Name of Claimant:
2. Address: ! —7 ci2
3. Telephone Number:
4. Date of Incident:
5. Time of Incident:
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6. Location of Incident (Be specific): I l c_ j i � X
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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.)
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8. What were weather conditions like? `•, i
9. Give name and address of any witnesses:
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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. 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?
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? `;' �� 0 1 `''� `
0, -17
16. Why do you claim the City of Dubuque is responsible? ( r,Gt J r J
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17. Have you made any claim against anyone else for damages as a result bf this incident? (If yes, give name and
address.)
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(Signature)
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(Print (Print name)
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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?
1/161— Car, 1(C CL ( Q
Dated this day of , 20
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171
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CD ON
Damage Assessed By: BILL THILL
Deductible: 0.00
Claim Number: na
Insured:
Address:
Telephone:
Description:
Body Style:
VIN:
Mileage:
OEM /ALT:
Options:
Line Entry Labor
Item Number Type
1 104225 BDY
2 104227 BDY
3 AUTO REF
4 105071 BDY
5 100063 BDY
6 AUTO REF
7 AUTO REF
8 105163 BDY
9 105165 BDY
10 104737 REF *
11 AUTO REF
12 104738 BDY
13 AUTO REF
14 104336 GLS
15 900500 BDY
16 900500 REF *
17 103688 REF
18 105600 BDY
19 105602 BDY
20 105604 BDY
21 105606 BDY
KRUSE - WARTHAN Nissan, Pontiac, BMW
ERIN FITZSIMNONS
729 BLUFF, DUBUQUE, IA 52001
Home Phone: (563) 451 -1667
Operation
OVERHAUL
REPAIR
REFINISH
REMOVE /INSTALL
REMOVE /REPLACE
REFINISH
REFINISH
REMOVE /INSTALL
REMOVE /INSTALL
REPAIR
REFINISH
REPAIR
REFINISH
REMOVE /REPLACE
REPAIR
REFINISH /REPAIR
BLEND
REMOVE /INSTALL
REMOVE/INSTALL
REMOVE/INSTALL
REMOVE /INSTALL
600 Century Drive, Dubuque, IA 52002
Email: bthili @dubuqueautoplaza.com
Tax ID: 420655341
Mitchell Service: 911368
Line Item
Description
Frt Bumper Cover Assy
Frt Bumper Cover
Frt Bumper Cover
L Frt Combination Lamp
Hood Panel
Hood Outside
Add For Hood Underside
L Frt Fender Mudguard
L Frt Stone Guard
R Frt Fender Panel
R Frt Fender Outside
L Frt Fender Panel
L Frt Fender Outside
WIShield Glass
WINDSHIELD PILLAR
WINDSHIELD PILLAR
L Frt Door Outside
L Frt Door Window Frame MIdg
L Frt Otr Belt Moulding
L Frt Rear View Mirror
L Frt Air Deflector
ESTIMATE RECALL NUMBER: 07/1612010 08:06 :06 E10460
Mitchell Data Version: OEM: JUN_10_V UltraMate is a Trademark of Mitchell International
Copyright (C) 1994 - 2010 Mitchell International
UltraMate Version: 7.0.021 All Rights Reserved
Date: 7/16/2010 08:06 AM
Estimate ID: E10460
Estimate Version: 0
Preliminary
Profile ID: * Mitchell
•
/1
2004 Volkswagen New Beetle GLS
2D Cony Drive Train: 2.0L Inj 4 Cyi 5M FWD
3VWCM31Y74M310086
89,000
0 Search Code: None
VEHICLE ANTI - THEFT, PASSENGER AIRBAG, DRIVER SIDE AIRBAG, POWER LOCK
POWER WINDOW, POWER STEERING, REAR WINDOW DEFOGGER, MANUAL AIR CONDITION
CRUISE CONTROL, TILT STEERING COLUMN, HEATED EXTERIOR MIRROR
ANTI -LOCK BRAKE SYS., FOG LIGHTS, ALUM /ALLOY WHEELS, REMOTE FUELDOOR RELEASE
POWER ADJUSTABLE EXTERIOR MIRROR, FRONT AIR DAM, TINTED GLASS
FIRST ROW BUCKET SEAT, SECOND ROW BENCH SEAT, KEYLESS ENTRY
REAR HEATING, VENTILATION & AIR CONDITIONING, OUTSIDE TEMPERATURE GAUGE
TACHOMETER, SIDE AIRBAGS, PASSENGER AIRBAG CUTOFF SWITCH /SENSOR
REMOTE DECKLID OR TAILGATE RELEASE, DAYTIME RUNNING LIGHTS
Part Type/
Part Number
Existing
1C0 823 031 M
Existing
Existing
FW02386GYY
Existing
Existing
7 7 �
Dollar Labor
Amount Units
4.6 #
2.5* #
C 2.5
INC
333.60 1.2
C 2.2
C 1.1
0.2
0.2
0.5* #
C 1.6
2.5* #
C 1.6
313.45 2.5 #
1.0*
2.0*
C 0.8
0.3
0.3
1.1 #
0.3
Page 1 of 3
Date: 7/16/2010 08:06 AM
Estimate ID: E10460
Estimate Version: 0
Preliminary
Profile ID: * Mitchell
22 100917 BDY REMOVE /INSTALL L Frt Door Handle 0.3 #
23 AUTO REF ADD'L OPR Clear Coat 2.5*
24 AUTO ADD'L COST Paint/Materials 503.20 *
25 AUTO ADD'L COST Hazardous Waste Disposal 3.50 *
Add'I
Labor Sublet
I. Labor Subtotals Units Rate Amount Amount Totals II. Part Replacement Summary Amount
Body 14.5 55.00 0.00 0.00 797.50 T Taxable Parts 647.05
Refinish 14.8 55.00 0.00 0.00 814.00 T Sales Tax @ 7.000% 45.29
Glass 2.5 55.00 0.00 0.00 137.50 T
Labor Summary
III. Additional Costs
* - Judgment Item
# - Labor Note Applies
C - Included in Clear Coat Calc
Estimate Totals
Taxable Labor 1,749.00
Labor Tax @ 7.000 % 122.43
31.8 1,871.43
Non - Taxable Costs 506.70
Total Additional Costs 506.70
Paint Material Method: Rates
Init Rate = 34.00 , Init Max Hours = 99.9, Addl Rate = 34.00
Amount IV. Adjustments Amount
1. Total Labor: 1,871.43
II. Total Replacement Parts: 692.34
III. Total Additional Costs: 506.70
Gross Total: 3,070.47
IV. Total Adjustments: 0.00
Net Total: 3,070.47
This is a preliminary estimate.
Additional changes to the estimate may be required for the actual repair.
Total Replacement Parts Amount 692.34
Insurance Deductible 0.00
Customer Responsibility 0.00
THIS DAMAGE REPORT IS BASED ON OUR INSPECTION AND DOES NOT
COVER ANY ADDIONAL PARTS OR LABOR WHICH MAY BE REQUIRED AFTER
THE WORK HAS BEEN OPENED UP. THE INSURANCE COMPANY WILL BE NOTIFIED.
WE GUARANTEE OUR COLLISION REPAIR WORKMANSHIP FOR AS LONG AS YOU OWN
YOUR VEHICLE.
ESTIMATE RECALL NUMBER: 07/16/2010 08:06:06 E10460
Mitchell Data Version: OEM: JUN_10_V UltraMate Is a Trademark of Mitchell International
Copyright (C) 1994 - 2010 Mitchell International
UltraMate Version: 7.0.021 Alt Rights Reserved
Page 2 of 3