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Claim by Stacy TreanorTHE CITY OF DUB Masterpiece on the Mississippi TRACEY STECKLEIN PARALEGAL E MEMORANDUM To: Mayor Roy D. Buol and Members of the City Council DATE: August 18, 2010 RE: Claim Against the City of Dubuque by Stacy Treanor Claimant Date of Claim Date of Loss Nature of Claim Stacy Treanor 08/12/10 07/23/10 Vehicle Damage This is a claim in which claimant alleges that as she drove over a manhole on West Locust Street, the manhole cover flew off and struck and damaged the driver's side door of the 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 John Klostermann, Street & Sewer Maintenance Supervisor Stacy Treanor 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 13th 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: `Ttn C j I i MAO 2. Address: d1 1 �) � /2 iVeVaAcc. 3. Telephone Number: 5i6 - t) ( "1 1 C 4. Date of Incident: 5. Time of Incident: J cuYl 6. Location of Incident (Be specific): riCAA1(\ t ' e h ■ l Pre o , -)Q. llc` ( \A\ -\ en N c',:-,t Lc cu;,k 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.) was di' lvin On �Cr•( () St tPr c�( s. on; Kic La k)( c t W! d and O. ri Cv•Er Fiemi GCt cinA bc, t ,r bc.c* d r I Vej cc'_ dLCr L lY (T( 8. What were weather conditions like? fail 0,1 CAC 9. Give name and address of any witnesses: f�' 10. Did police investigate? (If so, give names of officers.) C 11. Was anyone injured? (If so, give names, addresses, and extent of injuries.) Y U 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.) , dent cu V,r\`, c i ac C' v bcAt .l Uk(' rI Jt).( e der i 0 crz C Cl 0- C Cfc 5 = Ci> (D .tit 3 }� L‘'• t �� CD m m n IT% rn 0 13. What other damages do you daim, if any? 14. Have you been compensated for any part or all of your daim by any insurance company? (If so, give name and address of insurance company and amount paid.) 10c 15. What amount do you claim from the City of Dubuque ?$ 4)S% , bt 16. Why do you claim the City of Dubuque is responsible? If \AJO ci p rclxe f � +1'lr� 1AI fi rn j c a r 17. Have you made any daim 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? Dated this a day of (Signature) StCIC 1/4.) 1 r'e_c4 (Print Name) 08/12/2010 at 12:18 PM 30799 Insured: STACY TREANOR Owner: STACY TREANOR Address: 975 1/2 NEVADA DUBUQUE, IA 52001 -1244 Day: (563)690 -1484 Cellular: (563)451 -7107 Inspect Location: Insurance - Company: 2002 OLDS ALERO GLS 6 -3 VIN: 1G3NF52E72C220893 Air Conditioning Cruise Control Dual Mirrors Fog Lamps Power Brakes Power Driver Seat AM Radio Cassette Premium Radio Passenger Air Bag Bucket Seats Aluminum /Alloy Wheels NO. OP. BRIMEYER AUTO BODY License #:30799 Federal ID #:421438480 10709 COLLISION DR. DUBUQUE, IA 52001 (563)583 -4456 Fax: (563)583 -1838 PRELIMINARY ESTIMATE Written By: BOB COOK Adjuster: .4L -FI 4D SED GREEN Int: Lic: G750703 Prod Rear Defogger Intermittent Wipers Console /Storage Clear Coat Paint Power Windows Power Mirrors FM Radio Search /Seek Anti -Lock Brakes (4) 4 Wheel Disc Brakes Automatic Transmission DESCRIPTION 1 QUARTER PANEL 2* Rpr LT Quarter panel SOPT REINISH DOG LEG 3 Add for Clear Coat 4 REAR DOOR 5# REFINISH BELOW MLDG 6* Rpr LT Door shell from 1/2/01 7 Overlap Major Adj. Panel 8 Add for Clear Coat 9 FRONT DOOR 10* Rpr LT Door shell 11 Overlap Major Adj. Panel 12 Add for Clear Coat 13# REFINISH BELOW MLDG 14# CAR COVER 15# Repl CORRISION PROTECTION 16 OTHER CHARGES 17# E.P.C. Subtotals =_> Parts Body Labor Paint Labor Paint Supplies Other Charges SUBTOTAL Sales Tax 1 Claim # Policy # Deductible: Date of Loss: Type of Loss: Point of Impact: Date: Odometer: Tilt Wheel Keyless Entry Traction Control Power Steering Power Locks Power Trunk /Gate Release Stereo CD Player Driver Air Bag Leather Seats Overdrive QTY EXT. PRICE LABOR PAINT 1 1 1 1 1 Job Number: Days to Repair 5.00 5.00 0.2 5.00 15.00 3.7 hrs @ $ 56.00/hr 4 . 7 hrs @ $ 56.00/hr 4.7 hrs @ $ 36.00 /hr 0.5 1.5 2.5 0.5 0.6 1.5 -0.4 0.2 1.5 -0.4 0.2 3.7 4.7 10.00 207.20 263.20 169.20 5.00 $ 654.60 $ 485.40 @ 7.0000% 33.98 08/12/2010 at 12:18 PM Job Number: 30799 2 PRELIMINARY ESTIMATE 2002 OLDS ALERO GLS 6- 3.4L -FI 4D SED GREEN Int: GRAND TOTAL $ 688.58 ADJUSTMENTS: Deductible CCC Pathways - A product of CCC Information Services Inc. 2 0.00 CUSTOMER PAY $ 0.00 INSURANCE PAY $ 688.58 Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from the Guide DR1DG99, CCC Data Date 07/01/2010, 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.