Claim by Kenneth R. BoothTHE CITY OF
DUB UE MEMORANDUM
Masterpiece on the Mississippi
TRACEY STECKLEIN
PARALEGAL
-iziD
To: Mayor Roy D. Buol and
Members of the City Council
DATE: August 6, 2010
RE: Claim Against the City of Dubuque by Kenneth R. Booth
Claimant Date of Claim Date of Loss Nature of Claim
Kenneth R. Booth 08/02/10 07/22/10 Property Damage
This is a claim in which claimant alleges that a hole was punctured into the windshield
of his vehicle which was parked at 450 Bluff Street after a limb fell from a City tree.
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
Kenneth R. Booth
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 your claim will or will not be paid.
1. Name of Claimant: ken >1e 2 R LY'j
2. Address: '_J `� S Sf
3. Telephone Number: 5t1 557 - 1
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4. Date of Incident: — `^ y ` l� E) 01 0
5. Time of Incident: E f Li A. /l1-
6. Location of Incident (Be specific): L 5C B1 Lt.
7. Describe the accident or occurrence that caused injury or damage. (Give full details upon which you base your
claim If a City employee w s involved, G ive the employee's name.)
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8. What were weather conditions like? W I n Ct 7
9. Give name and address of any witnesses: -1,1 4 Z- )) iI /
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10. Did police investigate? (If so, give names of officers.)
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? Jv (1Q_
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? 11 15 1 1 • 17
16. Why do you claim the City of Dubuque is responsible? 1+ a Ct t TreF- .
17. Have you made any claim against anyone else for damages as a result of this incident? (If yes, give name and
address.)
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 this day of i4 20 I y
4 ..e, 62/8,/C
(Signature)
/ 0600 f
(Print Name)
YAGER AUTO BODY INC
4488 DODGE ST
DUBUQUE, IA 52003 -2600
PHN: 563 557 7376 FAX: 563 557 1709
"` PRELIMINARY ESTIMATE
Owner
Inspection
Repairer
Vehicle
Owner: KEN BOOTH
Inspection Date: 07/29/2010 01:04 PM
Appraiser Name: CJ YAGER
Repairer YAGER AUTO BODY Contact: YAGER AUTO BODY
Address: 4488 DODGE ST Work/Day: (563)557 -7376
City State Zip: Dubuque, IA 52003 Work/Day:
Email: bodyshop@yagerauto.com
2009 Hyundai Elantra GLS 4 DR Sedate
4cyl Gasoline 2.0
4 Speed Automatic
Lic.Plate: VIN: KMHDU46D29U704340
Mileage: Mileage Type Actual
Ext. Refinish: Two -Stage Int. Refinish: Two -Stage
07/19/2010 02:08 PM
Damages
Line Op Description ADJ% B% Price Labor
1 Sublet Repair Windshield,ShaOed $367.90
2 Replace OEM MIdg,W /S Gamish RT $21.56 $10.00
3 Additional Labor Glass Clean Up $25.00
Totals
Parts
Body Labor
Sublet Repairs
Tax
Estimate/MOW
Insurance Pay:
Customer Pay:
3 Items
Audatex Estimating 6.0.353 ES V/30/2010 10:44 AM REL 6.0.353 DT 07/01/2010 DB 07/15/2010
$21.56
$35.00
$367.90
$454.17 PAID
50.00
THIS ESTIMATE HAS BEEN PREPARED BASED ON THE USE OF AFTERMARKET CRASH PARTS
SUPPLIED BY A SOURCE OTHER THAN THE MANUFACTURER OF YOUR MOTOR VEHICLE.
ANY WARRANTIES APPLICABLE TO THESE REPLACEMENT PARTS ARE PROVIDED BY THE
07/30/2010 10:44 AM Page 1 of 2