Claim Garner, Daniel M. Jr.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: Daniel M. Garner, Jr
2.Address: 2308 Prince St.
`
3. Telephone Number: 556 2852 / 582 1915
4. Date of Incident: Feb. 7, 2004
5. Time of Incident: 2:20 P.M.
6. Location of Incident (Be specific): Parked in front of 2535 Windsor the Plow backed into vehicle while parked.
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.)
At approx. 2 p.m. I viewed the plow truc,k on the odd side of Windsor Ave. to clean the Street. I moved the vehicle around the block while the truck cleaned. I parked where I was and william Liebfried was at last 10-15 ft ahead of me and he backed
straight into my vehicle while it was parked and I was honking the horn.
8. What were weather conditions like?
cold, but clear visually.
9. Give name and address of any witnesses:
Vincent Tuzar 2534 1/2 Windsor Ave. observed from his apartment window (563) 582 1915
10. Did police investigate? (If so, give names of officers.)
Yes, Officer Ehlers came to scene
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.)
Yes, damage to front grill and hood. Estimate attached.
13. What other damages do you claim, if any?
Use of Rental Car
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
15. What amount do you claim from the City of Dubuque?
Approximately $2000 in damage plus cost of rental car while mine is being fixed.
16. Why do you claim the City of Dubuque is responsible?
Negligence on part of City Employee while driving a city Plow Truck. He did not look in his mirrors or stop when he stated that he heard me
honking.
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 11th day of February, 2004.
/s/ Daniel M. Garner, Jr.
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
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: -~ /') /~ /
2. Address: ~~ ~ ~/~
3. Telephone Number: ~ --
4. Date of Incident: ~, ~
5. Time of Incident: ~,' ~ ~
6. Location of Incident (Be specific): ~
full detail~ upon which you base your claim. If a City employee was involved, give the
e Oyee s name. ~ ,
8. What were weather conditions like?
9. Give name and address of any witnesses:
10. Did po~ic~/investigat~?~ :'d ~:JIf so, give~F:names of officers.):~ ~m ~ ~q~ .
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 dama[j~s.
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 corn pany and amount paid.)
15. What amount do you claim from the City of Dubuque?
16. Why do you claim tlie City of Dubuque is responsible?
17. Have you made any claim against anyone~lse for damages
(If y~s, give name and address.) /:~
as a result of this incident?
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 // day of
(Signature)
./-~, ~/ /':4
(Print Name)
(Rev. 1/00 & 7/01)
JOE WELBES AUTO SHOPPE
2085 Jansen Street
Dubuque, Iowa 52001
Ph. 563 582-2076
ESTIMATE OF REPAIRS
BILL TO: STACYGARNER
2534 1/2 WINDSOR AVE.
DUBUQUE, IOWA
PH. 582-1915
Make: CHEVROLET Date: 02/09/2004
M~:x~e/: MALIBU V~iN..~. WHITE
Yeac 2001 1 G1 NE52J816170334
I
PARTS AND MATERIALS
QTY. PARTS DESCRIPTION PRICE EACE AMOUNT
AFT/MKT 1 --RT BUMPER COVER $222.00 $222.00
AFT/MKT 1 --RT BUMPER REIF $145.00 $145.00
NEW 1 JPPER SUPPORT $18.60 $18.60
NEW 1 -IOOD PANEL $371.56 $371.56
NEW 1 :~RILLE $135.41 $135.41
NEW 1 ;ENTER GRILLE MLDG (GOLD) $142.12 $142.12
NEW 1 !EMBLEM $6.25 $6.25
Total parts and materials: $1,040.94
LABOR Tax rate: 7.00 % Tax: $72,87
HOURS DESCRIPTION RATE/HOUR AMOUNT
O/H 2.2 :::)VERHAUL FRT BUMPER $42.00 $92.40
REFINISH 2,6 REFINISH FRT COVER (RUBBERIZED) $42.00 $109.20
R&R 1.0 REMOVE/REPLACE HOOD PANEL $42.00 $42.00
REFINISH 2.7 REFINISH HOOD $42.00 $113.40
REFINISH 1,4 ADD FOR UNDERSIDE $42.00 $58.80
R&R 0.3 REMOVE/REPLACE GRILLE $42.00 $12.60
ADJ. 0.5 AIM LAMPS $42.00 $21.00
REFINISH 2.5 CLEARCOAT $42,00 $105.00
REFINISH 1.0 BLEND FENDERS FOR COLOR MATCH $42,00 $42.00
Total labor~. $596.40
Tax rate: 7.00 % Tax: $41.75
Sub Total $1,751.95
PAINT
HOURS I DESCRIPTION
6.3 PAINT & MATERIALS
HIDDEN DAMAGE LEFT OPEN
NO GUAPJLNTEE ON RUST REPAIR
PARTS PRICES SUBJECT TO CHANGE
RATE/HOUR I AMOUNT
$26.00 $163.80
Amountdue: $t,915.75