Claim McNally, Valerie A.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. 13th 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.
1. Name of Claimant: Valerie A. McNally
2. Address: 1102 Deerfield Drive Iowa City, IA 52246
`
++-++++++++++++++
3. Telephone Number: (319) 337 2306
4. Date of Incident: Monday, July 14, 2003
5. Time of Incident: 3:09 P.M.
6. Location of Incident (Be specific): 25th Street & Central, Dubuque, IA
7. DESCRIBE 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.)
City Employee Dean Robert Mattoon, who was sitting in his Ford Ranger Truck at the corner of above intersection, backed into my 2000 Toyota Camry while attempting to give a cement truck who was turning right onto 25th St. from Central more room to make his turn. Mr. Mattoon's vehicke tore my left (driver side) side mirror
off my car and scraped the protective strip (molding) of the drivers door with the bumper of his truck.
8. What were weather conditions like? Sunny
9. Give name and address of any witnesses:
My brother, a passenger in my vehicle: Martin C. Wing, 26th & Central, A & B Tap 2nd floor apartment, 563 582 9303
10. Did police investigate? (If so, give names of officers.)
Case #03-28814 Officer: Morrissette Badge number: 77B
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
No.
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.)
My Toyota Camry has rigidly attached side Power mirrors. The one on the driver's side was pulled off the car, separating molding from the car door/window area, leaving it dangling by
electrical wires. The left front door trim panel was gouged by the truck bumper as his truck backed into my vehicle. His back right tail light
cover broke.
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.)
No, we have not been compensated by any insurance company. Upon returning to Iowa from our vacation, we paid for the repairs out of our money, using the least expensive estimate from
Abra Auto Body & Glass, I>C>
15. What amount do you claim from the City of Dubuque?
$328.76
16. Why do you claim the City of Dubuque is responsible?
Because a city vehicle driven by a city employee backed into my car while I was sitting stationery behind him. He was
trying to commodate a large vehicle who was trying to make a wide right turn onto 25th St. & did not look to
see my vehicle behind him before he backed up.
17. Have you made any claim against anyone else for damages as a result of this incident?
(If yes, give name and address.)
No
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 15th day of August , 2003.
/s/ Valerie A. McNally
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
CLAIM AGAINST THE CITY OF DUBUQUE¢IOWA
This written report constitutes y~i~f~g~inst the City of Dubuque, Iowa. You shoUld
complete this form in full and attach any additional information that supports your claim.
03 AUG2! ~-~3:02
The Claim must be filed with the City Clerk at City Hall, 50 W. 13th St., Dubuque, IA 52001.
It will then be referred by the (~,, ~.O~u~, ,m..'l~0~,~i~e appropriate department for investigation.
Once that investigation is comple.~,_~,~'p,O~, and recommendat ~n 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
YOUAS TO WHETHER YOUR CLAIM WILL OR WILL NOT BE PAID.
1. Name of Claimant: Vo~[¢~¢'i6. A, MC~k~CLlJ-~
2. Address: ll¢% ~e~(~[~ ~r,u~ ~oCm
3. Telephone Number: ~q~ ~-~D~
4. Date of Incident:
~0
5. Time of Incident: .~ ~ ,p, ~'~,
6. Location of Incident (Be specific):
7. DESCRIBE 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
e~ployee's name.) ...... ;ro~ ;~*~,e~
8. What were weather conditions like? x~ ~m~ sc~ ~ pre*et*we
9. Give name and address of any witnesses: ~ br~+~r; ~ ~as~er ~ o~r ~
J0. Did police investigat~ Of so, gi~e names of officer~
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
DO
12. Was any damage done to property? (If so, describe property and the extent of damages.
A~'{ach estimates of damages or describe basis for ascertaining extent of damage.)
13. What other damages do you clmm, ~f any? ~ b r~
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 c~amm ~r3m the uky of Dubuque. ~'¢¢m /-~ ~
1~. ~av~ you ~ade any cla~ ~gainst anyone else for damages as a result of t~is, in, dent?
18. I~ th~ answer to Ouestion 17 ~ ~s, have ~ou received an~ pa~mont from that
and ff ~o, in ~hat amounl~
Dated at Dubuque, Iowa this
(Rev. 1/00 & 7/01)
(Print Name)
miles ~) 0 0 0 0 0 0 0 of J~ea~estcity
or 0 0 0 0 0 ~ O, 0 and ~r 0 Ot 0 0 0 0 0 0 of
Pdva~
PrNate?
ItllJl
Charge 1. 3.
Mode
JAddress
USc~OT#°r~ I I t I I 1 I ~ rGrossVehicle
c~7, State,
RFD J & ~ Code
ACCIDENT ENVIRONMENT J ROADWAY CHARACTeRISTiCS WORK ZONE RELATED?
Manner of CmshlCollisior L-J I I J ~adw,,y I I I J J Type
IJghiCondilions J ] SuffaceOondiflons L~J JlypeofRoadwayJunct~WFeatum] LJ Work~sP~ement?
t Vehicle Ty~eL] Status L[
I llll' Fir~ Event
I ] II I I ~o~E~
~ ~ ~ FimtH~m~vento~(
Date: 7/24/03 04:27 PM
Estimate iD: 5764
Estimate Version: 0
Preliminary
Profile ID: Collision
Damage Assessed By:
ABRA AUTO BODY & GLASS
t420 Willow Creek Court, Iowa City, IA 52246
(319) 354-4554
Fax: (319) 354-9536
DA~DYORK
Deductible: UNKNOWN
Owner PAUL MCNALLY
Address: 1102 DEERFIELD DR. IOWA CITY, IA 52246
Telephone: Home Phone: (319) 337-2306
Mitchell Service: 91476'1
Description: 2000 Toyota Camry XLE
Body Style: 4D Sed
VIN: 4Ti BF28K4YU096434
Drive Train:
3.0L Inj 6 Cyl 4A
Line Entry Labor Line Item Part Type/
Item Number Type Operation Description Part Number
Dollar Labor
Amount Units
t 403985 BDY REMOVE/REPLACE
2 401610 BDY REMOVE/REPLACE
3 40t 660 BDY REMOVE/INSTALL
L FRT DOOR ADHESIVE MOULDING
L FRT DOOR POWER MIRROR ASSY
L FRT DOOR TRIM PANEL
75732-AA050-E0
87940-AA010-E0
105.34 0.4
t57.76 0.2 #
0.4
# - Labor Note Applies
Labor Subtotals
Body
Labor Summary
Add'l
Labor Sublet
Units Rate Amount Amount Totals II.
t.0 50.00 0.00 0.00 50.00 T
Taxable Labor 5~00
Labor Tax @ 5.000% 2.50
t.0 52.50
III. Additional Costs Amount
Total Additional Costs 0.00
Part Replacement Summary
Taxable Parts
Sales Tax @
Total Replacement Parts Amount
IV. Adjustments
Customer Responsibility
I. Total Labor:
0. Total Replacement Parts:
10. Total Additional Costs:
Gross Total:
ESTIMATE RECALL NUMBER: 7/24/03 16:27:32 5764
UltraMate is a Trademark of Mitchell International
Mitchell Data Version: JUL_03_A Copyright (C) t994 - 2002 Mitchell International
UltraMate Version: 4.8.012 All Rights Reserved
Amount
263.10
5.000% 13.16
276.26
Amount
0.00
/ 270.~0
/ o.oo
Page 1 of 2
Date: 7124/03 04:27 PM
Estimate ID: 5764
Estimate Version: 0
Preliminary
Profile ID: Collision
IV. Total Adjustments:
Net Total:
This is a preliminary estimate.
Additional chan.qes to the estimate may be required for the actual repair.
WARNING: Accidental air bag deployment is possible. Personal injury may result. Avoid area near steering wheel
and instrument panel even if air bags have deployed. Dual-stage air bag modules may be present that could
contain an undeployed stage. When disposing of a deployed dual-stage air bag, always treat it as a "live" module.
See appropriate MITCHELL® AIR BAG SERVICE & REPAIR MANUAL, or OEM information.
ESTIMATE RECALL NUMBER: 7/24/03 16:27:32 5764
UltraMate is a Trademark of Mitchell International
Mitchell Data Version: J U L_03_A Copyright (C) 1994 - 2002 Mitchell International
UltraMste Version: 4,8.012 All Rights Reserved
Page 2
of 2
JUL 24, 2003 COUNTER SALES
Store 01 PARTS01
PORT 5004 2525
IATVOICE~ CUST 9 NAI4E PHONE PAY
99 HOUSE WHOLESALE CASH
LN# PART~ / DESCRIPTION QORD QSHP SALE CORE
1 75732-A3k050-B0 MOULDING, FR D 1 1 106.14
2 87940-AA050-B0 MIRROR ASSY, 0 1 1 183.67
AVAI LIST WAR_R CORE
BN1 TRADE STS SRC
BN2 COST GRP ALTER
NEW~ OLD#
REi~ARKS
A=ADD)(D=DE~TE)(E=ENTER)(CR=CONS REACH)(M=MODIFY)(N=NBRS)(TAB)
CTR# PL
502 2
EXTENDED TC PL
106.14 S 2
~ 183.67 IO 2
TOTAL 289.81
/o L · ~O
Auto Body & Glass
1420 Willow ~eek ~.
Iowa Ci~, ~ 52246
319)3544554 F~: (319) 354-9536
'AUL MCNALLY
102 DEERFIELD DR.
)WA CITY, IA 52246
omc: (319) 337-2306
Work:
Est.: DAVID YORK
Date: 8/8/2003
Vlake: 2000 Toyota
Model: Camry
Style: 4D Sed
License:
~olor:
VIN No.: 4T1BF28K4YU096434
Mileage: 0
~Unknown Insurance*
RO #000477
Final Bill Page I of 1
Phone:
Claim #:
Date of Loss:
gource: Mitchell UltraMate® EMS
*** THANK YOU FOR CHOOSING ABRA AUTO BoDy & GLASS ***
Line Line Items [ Price Labor I Paint Other
C I Repl L FRT DOOR ADHESIVE MOULDING 105.34 ~ 0,4 B
C2 ~ Repl L FRT DOOR POWER MIRROR ASSY 157.76 ~ 0.2 B
C 3 R&I L FRT DOOR TRIM PANEL 0.4 B
Totals Total $
Parts, Foreign Or) 263.10
Parts Total 263.10
Labor, Body (B) 1.0 ~ $50.00 50.00
Labor Total 50.00
Subtotal 313.10
SALES TAX (Rate =5.000%) 15.66
Total 328.76
Customer Due 328.76
I hereby authorize the above repair work to be done along with necessary materials. You and your employees may operate vehicle for purposes
of testing, inspection or delivery at my own risk. An express mechanic's lien is acknowledged on vehicle to secure the mount of repairs
thereto. You will not be held responsible for loss or damage to vehicle or articles left in vehicle in case of fire, thef, accident or any other cause
beyond your control.
SIGNED X DATE __