Claim by Donald BergMasterpiece on the Mississippi
TRACEY STECKLEIN
PARALEGAL
MEMORANDUM
To: Mayor Roy D. Buol and
Members of the City Council
DATE: September 24, 2010
RE: Claim Against the City of Dubuque by Donald Berg
Claimant Date of Claim Date of Loss Nature of Claim
Donald Berg 09/23/10 09/10/10 Vehicle Damage
This is a claim in which claimant alleges that his vehicle which was parked in the
Dubuque Humane Society parking lot was struck by a City bus.
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
Barbara Morck, Transit Manager
Donald Berg
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
/%P17,
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.
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1. Name of Claimant: .Dc -nc. I CIc't'C
2. Address: 52 3 / C ( SS i C G� h �a Q c'i /�e , t V/ 5 5 ,p c
3. Telephone Number 6 C8'- ..54q -66
4. Date of Incident: 1 b i 2 o O
5. Time of Incident:
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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?
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9. Give name and address of any witnesses:
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6. Location of Incident (Be specific):
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10. Did police investigate? (If so, give names of officers.) (7
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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 dams e.)
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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?
16. Why do you ff laim the City of Dubuque is responsible?
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17. Have you made any claim against anyone else for damages as a result of
this inci nt? (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?,
Date • this 3 day of S tI7 , 20 / C/ Q
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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? Of so, describe property and the extent
of damages. Attach estimates of damages or describe basis for ascertaining
extent of dams e.)
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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?
16. Why do youlaim the City of Dubuque is responsible?
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17. Have you made any claim against anyone else for damages as a result of
this inci nt? (If yes, give name and address.)
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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?,
Date • this 3 day of S , 20 /Cam' Q °
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SHOP:
OWNER: BERG, DON
ADDRESS: 5231 CLASSIC LN
CITY STATE: PLATTEVILLE, WI
ZIP: 53818
POINT OF IMPACT: 10
LIC #:
BODY COLOR: WHITE
CONDITION:
*= USER - ENTERED VALUE
EC= REPLACE ECONOMY
UM =REMAN /REBUILT PRT
OE= REPLACE PXN OE SRPLS
TE =PARTL REPL PRICE
I= REPAIR
TT= TWO -TONE
N= ADDITIONAL LABOR
AA= APPEAR ALLOWANCE
OPTIONS:
TWO -STAGE - EXTERIOR SURFACES
4 -WHEEL DRIVE
POWER DOOR LOCKS
REAR BUMPER
TILT STEERING WHEEL
CRUISE CONTROL
OP GDE MC DESCRIPTION
PLATTEVILLE COLLISION CENTER INC.
1280 E MINERAL ST.
PLATTEVILLE, WI 53818
PHONE: 608 348 4656 FAX: 608 - 348 -2802
TAX ID #39- 1184803
STATE:
2001 DODGE RAM 250/2500 SLT 4DOOR EXT CAB
CODE: N8207B /C OPTNS X /24FZBAYGCDH
I 0554 BUMPER,REAR STEP REPAIR
L 0554 13 BUMPER,REAR STEP REFINISH
N 0553 REAR BUMPER ASSY R &I ADDNL LABOR OPERA
E 0573 PAD,REAR BUMPER STE RT 55034460 28.20
ECM60 HAZARD. WSTE. REM. ECONOMY PART 5.00*
5 ITEMS
MC MESSAGE(S)
CD LOG NO 1841 -1
E= REPLACE OEM
UE= REPLACE OE SURPLUS
EU= REPLACE SALVAGE
PC =PXN RECONDITIONED
ET =PARTL REPL LABOR
L= REFINISH
CG= CHIPGUARD
RI =R &I ASSEMBLY
RP= RELATED PRIOR
MFG.PART NO.
DATE 09/21/10
INSP DATE:
CONTACT:
HOME PHONE:
VIN:
MILEAGE:
ACCTNG CTL #:
09/21/10
JEFF
(608)349 -6000
NG= REPLACE NAGS
UC= RECONDITIONED PRT
EP= REPLACE PXN
PM =PXN REMAN /REBUILT
IT= PARTIAL REPAIR
BR =BLEND REFINISH
SB= SUBLET
P =CHECK
UP= UNRELATED PRIOR
6CYL 5.9L TURBO DIESEL
TWO -STAGE - INTERIOR SURFACES
HEATED REMOTE CONTROL MIRRORS
POWER WINDOWS
FOUR WHEEL ANTI -LOCK
AIR CONDITIONING
PRICE AJ% B% HOURS R
2.0 *1
2.0 4
0.5 1
0.2 1
1
PAGE 1
09/21/10
2001 DODGE RAM 250/2500 SLT 4DOOR EXT CAB
CD LO'G NO 1841 -1
13 INCLUDES 0.6 HOURS FIRST PANEL TWO -STAGE ALLOWANCE
FINAL CALCULATIONS & ENTRIES
GROSS PARTS 28.20
OTHER PARTS 5.00
PAINT MATERIAL 72.00
PARTS & MATERIAL TOTAL 105.20
TAX ON PARTS & MATERIAL @ 5.500% 5.79
LABOR RATE REPLACE HRS REPAIR HRS
1 -SHEET METAL 56.00 0.2 2.5 151.20
2- MECH /ELEC 70.00
3 -FRAME 65.00
4- REFINISH 56.00 2.0 112.00
5 -PAINT MATERIAL 36.00
LABOR TOTAL 263.20
TAX ON LABOR @ 5.500% 14.48
SUBLET REPAIRS
TOWING
STORAGE
GROSS TOTAL 388.67
NET TOTAL 388.67
SHOPLINK U9587 ES CD LOG 1841 -1 DATE 09/21/10 02:28:28PM R6.37 CD 07/10
PXN: Y /00 /00 /00 /00 /00 CUM 00 /00 /00 /00 /00 GEOCODE 53818
HOST LOG
(C) 1998 - 2008 AUDATEX NORTH AMERICA, INC.
0.8 HRS WERE ADDED TO THIS EST. BASED ON AUDATEX TWO -STAGE REFINISH FORMULA.
PAGE 2
09/21/10