Claim by Camille BlackbournLES M. BLAIR III t
PAUL J. FITZSIMMONS
STUART G. HOOVER t
MATTHEW L. NOEL
Dubuque City Council
Ms. Jeanne Schneider, City Clerk
City Hall- City Clerk's Office
50 West 13 Street
Dubuque, IA 52001
RE: Camille Blackbourn Claim
Claim No. ICP03097A1
Dear Council Members:
BLAIR & FITZSIMMONS, P.C.
ATTORNEYS AT LAW
850 White Street
Dubuque, Iowa 52001 -7035
Telephone: 563 -588 -1970
Facsimile: 563 -556 -4033
Website: www.blairfittsimmons.com
October 1, 2010
I respectfully write to request a review of Ms. Blackbourn's claim against the city
for damages that occurred to her 2001 Chevrolet Malibu when it was struck and damaged
by one of the City buses.
I have been in touch with the Iowa Communities Insurance Pool adjuster and City
Attorney Barry Lindahl. The claim report that Ms. Blackbourn filed with the City shows
two estimates, one for $822.01 and another one for $740.64. The Insurance Pool has
offered $150.00 to settle the matter. Enclosed is a copy of the claim report and these
estimates.
Ms. Blackbourn would like to get this claim resolved and would appreciate your
consideration in resolving this matter. If requested, we certainly can present our case in
front of the full council. Thank you for your prompt attention to this matter.
Enclosures
BTB /vn
Copy to: Mr. Barry A. Lindahl, City Attorney
Very truly yours,
Brady. Boffeli
Blair Fitzsimmons, P.C.
BRADLEY T. BOFFELI
FRANK D. GILLOON III
CHRISTOPHER M. SOPPE
t ALSO LICENSED IN ILLINOIS
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CLAIM AGAINST THE CITY OF DUBUQUE, IOWA
8. What were weather conditions like?
9. Give name and address of any witnesses: (P v ( r� .1.t rY P t1P
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10. Did police investigate? (If so, give names of officers.)
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11. Was anyone injured? (If so, give names, addresses, and extent of Injuries.)
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This written report constitutes your daim 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 l3 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 an ail claims is made by the Cily Council. No employee of the City of Dubuque has the authority to
make any representatio ("you as to whether your claim will or will not be paid.
1. Name of Claimant: °%{ iil/t t) l ( ( � l C ( 1-- X1 {' A t
2. Address: �) ,¢-- j 2 � Ca. 4 - (7 v AD U j ,_ r ` A
I
3. Telephone Number ` . .;6) / / G, / it � �Lr Q ' .�'
4. Date of incident: / ;17.> / U
5. Time of Incident: (.ir' ' f / (r 1( ) , • n/i
6. Location of incident (Be specific): j 11 /6• 4 . 0 v( L j4 4.?" L(, )/ (a /e..-
.,
OO1 413'C .51 'pe -f' L =' _ - cam. 5 - 478e -1
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.)
11.L1 tA.-A..1 Let c"- L .2.E .) L L L' i C t.Lr� 141 _., . ?.
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12. Was any damage done to properly? (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./7
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?C`O
`tom - 6e-2
18. Why do you claim the City of DJtSuque is responsible?
Ld rt Tree
17. Have you made any claim against anyone else for damages ' s a give esy
(If (
Incident? h
this result of this Inci, g name
address.)
Dated this ' " day of
(Signature)
(Print Name)
Vi "
krb
,20
ill of MxitlenM lf yes, n ame
18. If the answer to Question 17 is yes, have you received any payment from that source, and if so, in what amount?
Blackbourn
2001 Malibu
Tom
6/25/09
06/24/2009 at 08:27 AM Job Number:
24443
Insured:
Owner:
Address:
Evening:
Inspect ABRA - DUBUQUE
Location: 3400 CENTER GROVE DR
DUBUQUE, IA 52003
Insurance
Company:
2001 CHEV MALIBU LS 6 -3
VIN: 1G1NE52J216171141
Air Conditioning
Cruise Control
Dual Mirrors
Clear Coat Paint
Power Windows
Power Mirrors
FM Radio
Search /Seek
Driver Air Bag
Bucket Seats
Aluminum /Alloy Wheels
NO. OP.
ABRA - DUBUQUE
Federal ID #:420782245
DBA: .ANDERSON -WEBER INC
3400 CENTER GROVE DR
DUBUQUE, IA 52003
(563)556 - 0696 Fax: (563)556 - 1899
PRELIMINARY ESTIMATE
Written By: RICK KELLY
Adjuster:
CAMILLE BLACKBOURN Claim #
CAMILLE BLACKBOURN Policy #
2233 CARTER RD Deductible:
DUBUQUE, IA 52001 Date of Loss:
(563)588 -0820 Type of Loss:
Point of impact:
.1L - FI 4D SED TAN Int :TAN
Lic: 733NBA IA Prod Date:
Rear Defogger
Intermittent Wipers
Console /Storage
Power Steering
Power Locks
Power Trunk /Tailgate
Stereo
CD Player
Passenger Air Bag
Automatic Transmission
DESCRIPTION
1 FRONT BUMPER
2* Rpr Bumper cover
3 Add for Clear Coat
4 0/H bumper assy
5# Subl 2 WHEEL ALIGNMENT
6 FRONT SUSPENSION
7 ** Repl Qual Repl Parts LT Hub &
bearing
8# Subl HAZARDOUS WASTE DISPOSAL
Subtotals = =>
1
Business: (563)556 -0696
Days to Repair
11/2000 Odometer: 75755
Tilt Wheel
Keyless Entry
Fog Lamps
Power Brakes
Power Driver Seat
AM Radio
Cassette
Anti -Lock Brakes (4)
Cloth Seats
Overdrive
QTY EXT. PRICE LABOR
0 0.00
0 0.00
0 0.00
1 44.95 T
1 132.00 m
1 4.00 T
180.95
1.0
0.0
1.9
0.0
PAINT
3.0
1.2
0.0
0.0
0.9 M 0,0
0.0 0.0
3.8 4.2
06/24/2009 at 0827 AM Job Number:
24443
PRELIMINARY ESTIMATE
2001 CHEV MALIBU LS 6-3.1L-FI 4D SED TAN Int:TAN
Parts 132.00
Body Labor 2.9 hrs @ $ 55.00/hr 159.50
Paint Labor 4.2 hrs @ $ 55.00/hr 231.00
Mechanical Labor 0.9 hrs @ $ 66.00/hr 59.40
Paint Supplies 4.2 hrs @ $ 35.00/hr 147.00
Sublet/Misc, 48.95
SUBTOTAL
Sales Tax
$ 777.85
$ 630.85 @ 7.0000% 44.16
GRAND TOTAL $ 822.01
ADJUSTMENTS:
Deductible 0.00
CUSTOMER PAY
INSURANCE PAY
2
$ 0.00
$ 822.01
WARRANTY VALID ONLY WITH ORIGIONAL COPY OF YOUR RECEIPT PARTS SUBJECT TO
INVOICE NO GUARANTEE ON RUST ALL PARTS NEW, UNLESS OTHERWISE NOTED
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
MANUFACTURER OR DISTRIBUTOR OF THESE PARTS RATHER THAN THE MANUFACTURER OF YOUR
VEHICLE.
WARRANTY VALID ONLY WITH ORIGIONAL COPY OF RECEIPT. PARTS SUBJECT TO INVOICE.
NO GUARANTEES ON RUST. ALL PARTS NEW, UNLESS OTHERWISE SPECIFIED.
06/24/2009 at 08:27 AM Job Number:
24443
PRELIMINARY ESTIMATE
2001 CHEV MALIBU LS 6- 3.1L -FI 4D SED TAN Int:TAN
Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived
from the Guide DR1CP97, CCC Data Date 06/01/2009, 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 LEO, 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 2009 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.
CCC Pathways - A product of CCC Information Services Inc.
3
Damage Assessed By: Robert Hanley
Deductible: UNKNOWN
Owner: Camille Blackboum
Address: 2233 Carter Road, Dubuque, IA 62001
Telephone: Work Phone: (683) 558.1181
Description:
Body Style:
VIN:
Mileage:
Color:
Options:
Line Entry Labor
item Number Type
1 100014 REF
2 100016 BDY
3 100276 MCH
4 100283 MCH
5 AUTO REF
8 AUTO
7 AUTO
Hanley Auto Body Inc.
1039 Century Circle, Dubuque, IA 52002
(683) 683 -7220
Fax: (563) 58341355
Mitchel Service: 911494
Home Phone: (663) 5880820
2001 Chevrolet Malibu LS
4D Sed
101NE52J218171141
72.753
Tan
ALUM/ALLOY WHEELS, POWER WINDOWS, CRUISE CONTROL
Operation
REFINISH
REMOVE/INSTALL
ALIGN
REMOVE/REPLACE
ADD7.OPR
ADD'L COST
ADD'L COST
• - Judgment Item
# - Labor Note Applies
C - Included in Clear Coat Caic
Line item
Description
FRT BUMPER COVER
FRT BUMPER ASSY
FRONT SUSPENSION
L FRT SUSP WHEEL 11118
CLEAR COAT
PAINT/MATERIALS
HAZARDOUS WASTE DISPOSAL
Vehicle Production Date:
Drive Train:
License:
ESTIMATE RECALL NUMBER: 05/24/2009 08:15:08 2115
Mitchell Data Version: MAY 09 V UltraMate is a Trademark of Mitchell International
Copyright (C) 1994 - 2009 Mitchell international
UltraMate Version: 8.7.022 Ali Rights Reserved
Date: 6124/2009 08:15 AM
Estimate ID: 2116
Estimate Version: 0
Preliminary
Profile ID: Mitchell
10/00
3.1L Inj 6 CyI 4A
733 NBA to
Part Type/ Dollar Labor
Part Number Amount Units
C 2.8
1A #
1.3
" QUAL REPL PART 132.00 * 1.1 #
1.0
108.00
500
Page 1 of 2
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Fender Ext.
Fender Mug 5ieo
Fond*/ Midi. Side
Fender St? • to
Yoder Strl • 0
Fend.? ABds.
Fender Bldg.
Bumper Reint.
Pumper Britt
Side I. t Asmb
Side Giant Aambly
Bumper Cushion
H..dlamp
Headlamp
Villsnce
N.adktmp Door
H •tamp Dr
•
Bum r Gd.
Salted Beam
Sealed Ream
F_N. Bistam
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Park OW
Park Llaht
Mme
Cowl
I
Crass Member
Dow, Front
Door. Front
WnaM
Door Hines
Door Hin
Hub • lee
Door Pa
Dow --
Lt. Cant Arm
Deer Stripe
Deer Stripe
Dow Mle5S.
Door Mldd.
Up. Cant. Arrn
Center Peet
Canter Poet
Diver Rear
Door Rear
evmpor Filler
Poor MIdF.
boor Mid
Grills
Grillo Panel
Grill Panel Wide.
Rook., Panel
Rooster Panel
Recker Mtdit.
Recker. MWt.
F loor
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Guar. Penal
Air Condenser
Guar. Ext.
Guar. Ext.
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Quar. Wheel Hasse
Quar. Wheel WHO
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Guar. tAd5Sida
Guar. MS.
Battik Upper
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Guar. Stripe
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Lack Plata, U •.
Side U itt Aamai
Sid• LI Pam -
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Hood Nin
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MISC.
Mold Lock
-
Bumper
Bumper Abs.
SUMO.' CUlmen
fist Panel
F ron t Seat
Front keel Ad„
Ornament
Rad. Su .
Rod. Co.
Dumper Ratnt.
Tsp
Pram
Bumps, Brkt.
Bumper Gd.
Headlining ,
• RIP Vinyl
_apj
Red. Hoses
Fan Glad.
Dumper floor
The H. Wort
!an Shroud
Vance
Lower Panel
Paint n�
Aerial
u b
Fan Bost
Water Puma
..
Floor
Rust Proof
Water Pump Pulley
Trunk Lid
Battery
Meter Mts.
Trunk Mldg,
J" -- Cf 3---
i V A. • 0 d
IPA WASTE DISPOSAL CHARGE
PARTS (Pekes swot Te krona)
Uc. Light
SERVICESV.JHRS. ere HR.
y JJ d 0
SUBLET OR PAINTING
wtndsntold
cos Tank
Forme
SUB TOTAL
.S'.3'... €1 4
Whew
TAX
r 7 9.01
AiHue d ovum
I O'
PAINT•MATRLMOW.
1.1 t0
Axle
,
Sadie
GRANO TOTAL
:72 f1.
HART AUTO BODY & PAINT
800 CEDAR CROSS ROAD DUBUQUE, IOWA 52003
PHONE: (563) 556 -3323 FAX: (563) 5564324
topraleer - x__
Symbols, a• A.At i o an N. q aepuc .Ds n P.P I HEREBY AUTHORIZE THE ABOVE REPAIRS
I'd lase- sss -sss
DAMAGE REPORT
PRICES SUBJECT TO CHANGE
Roma CIRCLED are not in Me teal, In
our epin:on, are not Tort or title ob
eLS:60 Go Sa unr