Claim Garbett, Brent CLAIM AGAINST THE CITY OF DUBUQUE~qOWA
Thls.w. ritte.n' report, constitutes your claim against theCity of Dubuque, Iowa.~l~
comple[e this mrm Jn full and attach any additional information that supports you~'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: '~ ~,~T' ~_-_-_-_~ ?,~---~-T
3. Telephone Number:
4. Date of Incident:
5. Time of Incident:
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
employee's name.) ~-~ ~{-UrV~_0~. ~-~ ~ [-~-I~ ~jiL. [,{j.~j~_ ~)l/R J[~)
8. What were weather conditions like?
g. Give name and address of any witnesses:
10. Did police investigate? (If so~ give ~ames 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.)
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.)
15. What amount do you claim from the City of Dubuque?
16, Why ao you ?laim the City'o! D~buque is res~mw~-Fe?
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?
Dated at Dubuque, Iowa this
dayo 0
(Signature)
{Print Name)
(Rev. 1/00 & 7/01)
Date: 08,'27/2003 09:51 AM
Estimate ID:. 7855
Estimate Ven~on: 0
Preliminary
P~ofile ID: DUB- AiM
MIKE FINNIN FORD
3600 DODC-~ STREET DUBUQUE, IA 52003
(563) 556-1010
FaX: (663) 696-1086
Tax ID: 14-1862673
Damage Assessed By: RICK STUMPF
Deductible: UNKNOWN
Insured: BP, lENT GARIBEI-I'
Address: 1738 HEEB DUBUQUE, IA 52001
Telephone: Home Phone: (309) 269-8439
Mitchell Service: 911495
Oescripl~on:
Body Style:
VIN:
options:
1999 Oldsmobi~ Aiero GL
2DCpe Drive Train: 2AL Inj 4 Cyl 4A
1G3NL12T3XC3795','7
ALUM/ALLOY WHEEL.S, AIR CONDITIONING, POWER STEERING, POWER WINDOWS
POWER DOOR LOCKS, TILT STEERING WHEEL, CRUISE CONTROl., ELECTRIC DEFOGGER
AUTOMATIC TRANSMISSION, AM-FM STEREO/CDPLAYER(SINGLE)
Line Entry Labor Une Item Part Type/ Dollar Labor
Item Numbe~ Type OperaUon DescripUon Part Number Amount Units
I 900500 BDS * REPAIR REMOVE YELLOW pAINT BOTH SIDES Sublet
2 900500 BDS* REPAIR POLISHANDWAX Sublet 100.00' 0~0'
* - Judgement Item
Labor Subtotals
Bdy-S
Add'l
Labo; Sublet
Units Rate Amount Amount TOfMS
0.0 52.00 0.00 500.00 500.00 T
Taxable Labor 500.00
Labor Tax ~ 7.000 % 35~00
0.0 535.00
IL Part Replacement S~
Total Replacement Parts Amount
Amount
0.00
III. Additional Costs Amount IV. Adjustments Amount
Total Add-~onal Costs 0.00 Customer ResponsitaTity 0.00
ESTIMATE RECALL NUMBER: 08/27/2003 09:48:32 7855
UltraMate is a Trademark of Mitchell bttemationai
Mitchell Data Version: AUG_03_A Copyright (C) 1994 - 2002 Mitchell International
UltraMate Version: 4,8.012 All Rights Reserved
Page I of 2
Date: 09/27/2003 09:51 AM
EstLmate ID: ;855
Est~eate Version: 0
Preliminary
PFofile ID: DUn. A/M
L Total Labor:
IL Total Replacement Parts:
IlL Total Ad, ditional Costs:
Gross Total:
535.00
0.00
535.00
IV. Total Adju~:
Net Tc~al:
0.00
535,00
This is a preliminarv estimate.
Additional changes to the estimate may be required for the actual repair.
THIS ESTIMATE HAS BEEN PREPARED BASED ON THE USE OF AFTEI~RKET CRASH
PARTS SUPPLIED BY A SOURCE OTHER T~AN '£~-n~ MANUFACTURER OF YOUR MOTOR
VEHICLE. AN1' WARRANTIES APPLICABLE TO THESE PARTS ARE PROVIDED BY THE
MANUFACTUktER OR DISTR.LkSUI~)R OF '£~n~SE PARTS RA'i'~Z~k( THAN THE
MANu~'ACTURER OF YOUR MOTOR VEHICLE.
WARNING: Accidental air hag deployment is posstble. Personal injury may result_ Avoid area near s~earing wheel
and instrmnent panel even if air hags have deployed. DuaI-Mage air bag modules may be present that could
c(mtain an undeployed stage. When disposing ora deployed dual-stage air bag, always treat it as a 'live" module,
Sea apprepriai0e MITCHELL® AIR BAG SERVICE & REPAIR MANUAL, or OEM information.
ESTIMATE RECALL NUMBER: 08/27/2003 09:48.32 78~5
UltraMete is a Trademark of MitchaB Internat~nal
Mitchell Data Version: AUG_03_A Copyright (C) 1994 - 2002 Mitchell Intarnstional
UltraMate Version: 4.8.012 AB Rights Reserved
Page 2
of 2
Date: 08/27/2003 09:55 AM
Estimate ID: 7856
Estimate Version: 0
Prelimir~ry
Profile ID: Mitchell
MIKE FINNIN FORD
3600 DODGE STREET DUBLJQUE, IA 52003
(963) 556-1010
Fax: (563) 690-1086
Tax I~. 14-1862673
Damage Assessed By: RICK STUMPF
Deductible: UNKNOWN
Insured: BRENT GARBETT
Mitchell Service: 911495
DescripUon: 1999 Oldsmobile Alero GL
Body Style: 2D Cpe Drive Train: 2AL Inj 4 Cy! 4A
Options: ALUM/ALLOY WHEELS, AIR CONDITIONING, POWER STEERING, POWER WINDOWS
POWER DOOR LOCKS, TILT STEERING WHEEl., CRUISE CONTROL, ELECTRIC DEFOGGER
AUTOMATIC TRANSMISSION, AM-FM STEREO/CDPLAYER(SINGLE)
Line Entry Labor line If~m Part Type/
item Number Type Operation Description Part Number
Dollar Labor
Amount Units
1 900500 REF * REFINISH/REPAIR COMPLETE PAINT JOB Snt)let
* - Judgement Item
Remarks
IF YELLOW PAINT IS NOT REMOVED SOON IT POSSABLY WOULD REQIURE A
COMPLETE PAINT JOB
Add1
Labor Sublet
i. Labor Subtotals Units Rate Amount Amount
Refinish 0-8 45.00 0.00 2,400.00
Taxable Labor
Labor Tax ~ 7.000
Labor Summary 0.0
Totals
2,400.00 T
2,4O0.OO
168.00
2,568.00
ill. Add~onat Costs Amount
Totai Add~Uonal Costs 0.00
II. Part Relflacernent Summary
Total Replacement Parts Amount
IV. Ad-jus~ments
Customer Responsibility
0.00
Amount
0.00
ESTIMATE RECALL NUMBER: 08/27/2003 09:52:53 7866
UItraMate is a Trademark of Mitchell International
Mitchell Data Version: AUG_03_A Copyright (C) 1994 - 2002 Mitchell international
UltraMate Version: 4.8.012 All k~Jghts Reserved
Page 1 of 2
Date: 08/27/2003 09:55 AM
Estimate ID: 7856
E~[~.~ate Version: 0
Prelimk~ary
Protile ID: Mitchell
I. Total Labor:
II. Total Replacement Parts:
Ill. Total Additional Costs:
Gross Total:
2,668.00
0.00
0.00
2,568.00
Total
Net Total:
0.00
2,$68.00
This is a preliminary estimate.
Additional chanqes to the estimate may be required for the actual repair.
WARNING: Accidental air bag deployment is pos~ble. Personal injury may tess[ Avoid area neet steedng wheel
and instrument panel event if air begs have deployed. Dual-stage air bag modules may be present ~hat could
contain an ur, deployed 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: 08~27/2003 09.52:53 7856
UltraMate is a Trademark of Mitchell International
Mitchell Data Version: AUG_03_A Copyright (C) 1994 - 2002 Mitchell Inte~al
UltraMate Version: 4.8.012 All Ri~ Reserved
Page 2 of 2
Date: 8/27/2003 09:49 AM
Estimate ID: 534
Estimate Version: 0
Preliminary
Profile ID: Mitchell
Dan Kruse Pontiac, Nissan, BMW
600 Century Dubuque, iA 52002
(,663) ,683-7345
Fax: (~663) 588-3874
Damage Assessed By: Dave DaMoss
Deductible: UNKNOWN
Address:
Telephone:
BRENT GARBETT
1738 HEEB ST APT2 DUBUQUE, IA 52001
Home Phone: (309) 269-8439
Mitchell Service: 911495
Desr~ption:
Body Style:
V1N:
Options:
1999 Oldsmobile Aiero GL
2D Cpe Drive Train: 2AL inj 4 Cyl 4A
IG3NLI2T3XC379577
ALUM/ALLOY WHEELS, AIR CONDITIONING, POWER STEERING, POWER WINDOWS
POWER DOOR LOCKS, TILT STEERING WHEEL, CRUISE CONTROL, ELECTRIC DEFOGGER
AUTOMATIC TRANSMISSION, AM-FM STEREOICDPLAYER(SINGLE)
Line Entry Labor Line Item Part Type/
Item Number Type Operation Description Part Number
I 100184 BDY REMOVE/REPLACE R FENDER SPLASH SHIELD 22618670
2 100185 BDY REMOVE/REPLACE L FENDER SPLASH SHIELD 22618671
3 100186 BDY REMOVE/REPLACE R FENDER LINER 22639914
4 100187 BDY REMOVE/REPLACE L FENDER LINER 22639915
5 101427 BDY REMOVE/REPLACE R ROCKER MOULDING 12335367
6 AUTO REF REFINISH R ROCKER MOULDING
7 900500 BDY * REPAIR REMOVE PAINT FROM L AND R SIDES Existing
8 t0t~428 BDY REMOVE/REPLACE L ROCKER MOULDING 12335368
9 AUTO REF REFINISH L ROCKER MOULDING
"10 AUTO REF ADD'L OPR CLEAR COAT
11 AUTO ADD'L COST PAINT/MATERIALS
12 AUTO ADD'L COST HAZARDOUS WASTE DISPOSAL
GM PART
GM PART
GM PART
GM PART
GM PART
GM PART
* - Judgement Item
# - Labor Note Applies
C - Included in Clear Coat Calc
Dollar Labor
Amount Units
24.12 0.2 #
24.12 0.2 #
40.65 0.t #
40.65 0.1 #
110.68 0.6
C t.2
8.6"
110.68 0.6
C 1.2
0.5*
78.30 *
3.50 *
ESTIMATE RECALL NUMBER: 8/27/2003 09:41:24 534
UltraMate is a Trademark of Mitchell International
Mitchell Data Vorsinn: AUG_03_A Copyright (C) 'IS94 - 2002 Mitchell International
UitraMate Version: 4.8.0t2 AIl Rights Reserved
Page
of 2
Data: 8/27/2003 09:49 AM
Estimata ID: 534
Estimate Version: 0
PrsFmdnary
Profile iD: Mitchell
L Labor Subtotals Units
Refinish 2.9 45.00
Add'l
Labor Sublet
Rate Amount A~nount
Totals
0.00 0,00 44t.00 T
0.00 0.00 t30.50 T
Taxable Labor
Labor Tax ~ 7.000 %
Labor Summary 12.7
571.50
40.01
611.5t
II. Part Replacement Summary
Taxable Paris
Sales Tax ~
Total Replecament Parts Amount
Amount
350,90
24.56
375.46
Ill. Additional Costs
Non-Taxabta Costs
Total Addiifonal Co~s
Amount IV. Adjustments
8t.80 Customer ResponsibiliLy
8t.80
Amount
0.00
I. Total Labor:
Ii. Total Replacement Parts:
Ill. Total Additional Costs:
Gm~s Total:
611.51
375.46
81.80
1,068~7
IV. Total Adjustments:
Net Total:
5.00
1,068.77
This is a preliminary estimate.
Additional chart;les to the estimate may be required for the actual repair.
THIS DAM~6~ i~EPORT IS B~SED ON OUR INSPECTION AND DOES NOT
COVER AN~ ADDIONAL PARTS OR LABOR WHICE M~]~ BE REQUIRED AFTER
THE WOP. K HAS BEEN OPENED UP THE INS,WILL BE NOTIFIED.
WE FEATURE A T~REE ZEAR WORt~A~NSHIP LIMITED WARRANTY- SEE OUR WRITTEN
~ FOR COMPLETE DETAILS. (EFECTIVE 10-01-01)
WARNING: Accidental air bag deployment is possible. Personal injury may result. Avoid ama near staering wheel
and instrument panel even if air bags have deployed. Dual-stage air bag modules may be present that could
contain an undepteyed stage. When disposing of a deployed dual-stage air bag, always treat it as a "live" modula.
See appropriate MITCHELL® AIR BAG SERVICE & REPAIR MANUAL, or OEM information.
ESTIMATE RECALL NUMBER: 8/27/200309:41:24 534
UitraMate is a Trademark of Mitchell International
Mitchell Data Version: AUG_03_A Copyright (C) 1994 - 2002 Mitchell International
UItrsMate Version: 4.&012 AIl Rights Reeewed
Page 2 of