Claim Banowetz, DelCLAIM 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: Del Banowetz
2. Address: 4487 Dodge Dubuque IA
`
3. Telephone Number: 563 557 2640
4. Date of Incident: Feb 2 04
5. Time of Incident: Aprox 5:00 P.M.
6. Location of Incident (Be specific): On Pennsylvania Ave. @ 2 blocks east of JFK Dub. 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.)
While I was parked hedded west with a Bronken Front Right Wheel waiting for a Wrecker the snow plow side swiped me.
8. What were weather conditions like? Light snow
9. Give name and address of any witnesses:
None
10. Did police investigate? (If so, give names of officers.)
No
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, the rear bumper and left side of pickup box was damaged
13. What other damages do you claim, if any?
To replace rear bumper and left side of pickup with proper vinal lettering and painted as it was.
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.)
Whatever it takes to repair the damage (see Estimates) plus rental of truck for the time that the repair is done which is about 4 days.
15. What amount do you claim from the City of Dubuque?
I was very visible and had my 4way flashers on. I could not drive my truck for it was broke down.
16. Why do you claim the City of Dubuque is responsible?
No
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 24 day of Feb. , 2004.
/s/ Del Banowestz
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
c-c.~~9'~
CLAIM AGAINST THE CITY OF DUBUQUE, IOWA A¿'Ý~
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: r¡) ~ ð!> ~ ~
2. Address: If if g 7 D r>rl r -'" f1 fA b :tA-
3. Telephone Number: 'S'6 j J:) ~- 7 /. 6 c¡ 0
4. Date of Incident: F ~ b 2-- - ~ j/
5. Time of Incident:
Any'" if
,
S'C> GJ P /Þf
6. Location of Incident (Be specific): 0 i1 P ¿f"/ It S ¡ vi/d ... .'<4: ,4.....¿ cl bCl'-'CI
.2..Bloc.h:R l~drr oJ- j-fK" ()wb:Z::-A
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.)
Wh.'-{£-. 1: >vd-S Pdd'{~d I-I~cic:l.eol k,eIJ-
wÌrn rI 3ih...k €-vI Fr ¡;",'Jt R"Lc¡ b 'f- Vv h .¿ ~I ,w d I't- ,\ /A 7' f- (; i-
d IA/V~c-h~v hp $:.1-1"""'" Pic?",-, <;"l'd.e s.~'Þ~d U4~ ~
8. What were weather conditions like?
L.\rIr She-""'"
9. Give name and address of any witnesses:
/11 () .. .¿
\
10. Did police investigate? (If,SO, give names of officers.)
'\ /V cJ
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
i/Vo
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.)
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L ~-ft ~ I:J .¿
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Boy
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13. What other damages do you claim, ifany? -¡- (J ~ -( P I d ( ... R ..¿d v IB tA "" P ev
i L.e..f, 'ß1~.e ö+ P.'d1....n lA.o/th Pvo/(¡~v 11,'..,,:,./ Le1-[--t:¡.,I.,,¡
'. I
j Pôt-Fh-d-~ ~ó (--1 t.<.-«-S ,
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.)
-L:V ~
15. What amount do you claim from the City of Dubuque? 'Jf/ ~~4
v.'"i/:'/-e
1101-
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MdJ ¡wi 4 fov'7 r-l ciS h evs () h . J: u:;uoM
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ivvv-Æ.
17. Have you made any claim against anyone else for damages as a result of this incident?
(If yes, give name and address.)
A/O
18. If the answer to Question 17 is yes, have you received any payment from that source,
and if so, in what amount?
'-.1(
day of r-~ 17
.20~.
Dated at Dubuque, Iowa this
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(Print Name)
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(Rev. 1/00 & 7/01)
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FED ID #42-0813744
RICHARDSON MOTORS
1475 J.F.K. ROAD DUBUQUE, IA 52002
(563) 582-5411
Fax: (563) 582-4129
Damage Assessed By: JASON CHARLEY
Deductible: UNKNOWN
owner enviroone lawns
Address: 4487 dodge street dub, IA 52003
Telephone: Home Phone: (563) 557-2640
Description: 1988 GMC Pickup C3500
Body Style: 2D Pkup 8' Bed 131" WB
VIN: 1GTGC34KSJE515895
Une Entry Labor
~ Number Type
1 540060 BDY
2 AUTO REF
3 AUTO REF
4 900500 BDY'
5 900500 BDY'
6 540280 BOY
7 AUTO REF
8 500589 MCH
9 AUTO BOY
10 545130 BDY
11 AUTO REF
12 933018 REF
13 AUTO
14 AUTO
Operation
REMOVEIREPLACE
REFINISH
REFINISH
REMOVEIREPLACE
REMOVEIREPLACE
REPAIR
REFINISH
ALIGN
OVERHAUL
REMOVEIREPLACE
ADD'L OPR
ADD'L OPR
ADD'L COST
ADD'L COST
Mitchell Service: 915489
Dale: 212712004 03:42 PM
Estimate ID: 9180
Estimate Version: 0
Preliminary
Profile 10: Milchell
Drive Train: 5.7L Inj 8 Cyl2WD
Une Item
Description
L PICKUP BED SIDE PANEL ASSY
L BED OUTER PANEL
L BED SIDE PANEL INSIDE
SEAM SEALER
LETTERING
PICKUP BED FLOOR
BED FLOOR COMPLETE
FOUR WHEEL
REAR BUMPER ASSY
REAR BUMPER FACE BAR
CLEAR COAT
MASK FOR OVERSPRA Y
PAINTIMATERIALS
HAZARDOUS WASTE DISPOSAL
oM
. - Judgement Item
# - Labor Note Applies
C -Included in Clear Coat Calc
ESTIMATE RECAll NUMBER: 21271200415:42:09 9180
UllraMaIe is a Trademark of Mitchellintemational
Milchell Data Version: MAR 04 A Copyright (C) 1994 - 2003 MìtcheIIlntemational
UllraMale Version: 5.0.021 - AD Rights Reserved
Part Type!
Part Number
15160491 GM PART
New
New
Existing
15025374 GM PART
Dollar Labor
Amount Units
-~
671.80 14.5 #
C 3_7
C 1.8
22.00' 0.0'
150.00 . 0.0'
3.0'#
C 4.3 #
1.1
0.8
295.97 INC
3.1
0.2"
6.00'
367.65 .
6.00'
Page 1 of 2
I. Labor Subtotals
Body
Refinish
Mechanical
Labor Summary
Units Rate
18.3 46.00
13.1 46.00
1.1 53.00
Taxable Labor
Labor Tax
32.5
III. Additional Costs
Taxable Costs
Sales Tax
Non-Taxable Costs
Total Additional Costs
Add'!
Labor
Amount
0.00
6.00
0.00
@
@
Sublet
Amount Totals
0.00 841.80 T
0.00 608,60 T
0.00 58.30 T
7.000%
1,508.70
105.61
Date: 212712004 03:42 PM
Estimate 10: 9160
Estimate Version: 0
Preliminary
Profile 10: Mitchell
II, Part Replacement Summary
Taxable Parts
SaiesTax @
7.000%
Amount
1,139.77
79.78
1,614.31
7.000%
Amount
6.00
0.42
367.65
Total Replacement Parts Amount
1,219.55
374.07
IV. Adjustments
Customer Responsibility
Amount
0.00
I.
II.
III.
Total Labor:
Total Replacement Parts:
Total Additional Costs:
Gross Total:
1,614.31
1,219.55
374.07
3,207.93
IV.
Total Adjustments:
Net Total:
0.00
3,207.93
This is a preliminarv estimate.
Additional chanQes to the estimate mav be required for the actual repair.
ESTIMATE RECALL NUMBER: 2/271200415:42:09 9180
UItraMate is a Trademark of Mitchetllntemafional
Mitchell Data Version: MAR 04 A Copyright (C) 1994 - 2003 Mitchell International
UltraMate Version: 5.0.021 - All Rights Reserved
Page 2 of 2
Date: 3/ 4/2004 04:03 PM
Estimate ID: 5813
Estimate Version: 0
Preliminary
Profile ID: Mitchell
Riley's Auto Sales Co.
Damage Assessed By: KEITH KNIPPER
Deductible: UNKNOWN
4455 Dodge Sl Dubuque, IA 52003
(563) 588-2326
Fax: (563) 588-9286
Tax ID: 42-0957277 EPA#: 1AD051003184
Insured: ENVIRO LAWN LLC
Address: 4487 DODGE ST DUBUQUE, IA 52003
Telephone: Home Phone: (563) 557-2640
Description: 1988 GMC Pickup C3500
Body Style: 2D Pkup 8' Bed 131" WB
VIN: 1GTGC34K6JE515995
Line Entry Labor
~ Number Type
1 539890 BDY
2 540060 BDY
3 AUTO REF
4 AUTO REF
5 540190 BDY
6 540210 BDY
7 900500 BDY*
8 545573 BDY
9 AUTO BDY
10 545250 BDY
11 900500 BDY*
12 AUTO REF
13 933005 BDY
14 AUTO
15 AUTO
Operation
REMOVE/INSTALL
REMOVE/REPLACE
REFINISH
REFINISH
REMOVE/REPLACE
REMOVE/REPLACE
REMOVE/REPLACE
REMOVE/REPLACE
REMOVEIREPLACE
REMOVE/REPLACE
REMOVE/INSTALL
ADD'L OPR
ADD'L OPR
ADD'L COST
ADD'L COST
Mitchell Service: 915489
Drive Train: 5.7L Inj 8 Cyl2WD
Line Item
Description
BED ASSEMBLY
L PICKUP BED SIDE PANEL ASSY
L BED OUTER PANEL
L BED SIDE PANEL INSIDE
L FRT PICKUP BED BRACE
L REAR PICKUP BED BRACE
DECALS LEFT SIDE
REAR BUMPER FACE BAR
REAR ADD W/IMPACT STRIPS
REAR BUMPER STEP PAD
TOPPER
CLEAR COAT
RESTORE CORROSION PROTECTION
PAINT/MATERIALS
HAZARDOUS WASTE DISPOSAL
* - Judgement Item
# - Labor Note Applies
C - Included in Clear Coat Calc
ESTIMATE RECALL NUMBER: 3/4/200416:00:225813
UltraMate is a Trademark of Mitchellintemational
Mitchell Data Version: MAR_04_A Copyright \C) 1994 - 2003 Mitchell International
UltraMate Version: 5.0.021 All Rights Reserved
Part Type/
Part Number
15160491 GM PART
15606811 GM PART
15530905 GM PART
New
15025375 GM PART
15607160 GM PART
Existing
Dollar Labor
Amount Units
~-
INC
671.80 14.5 #
C 3.7
C 1.8
11.83 0.2
6.85 0.2
150.00* 1.5*
375.00 1.1
0.3
48.64 INC
2.0"
2.2
0.3'
15.00"
207.90 *
3.85"
Page 1 of 2
Date: 3/4/200404:03 PM
Estimate ID: 5813
Estimate Version: 0
Preliminary
Profile ID: Mitchell
Add'i
Labor Sublet
I. Labor Subtotals Units Rate Amount Amount
Body 20.1 46.00 15.00 0.00
Refinish 7.7 46.00 0.00 0.00
Totals
939.60 T
354.20 T
II. Part Replacement Summary
Taxable Parts
Sales Tax @
7.000%
Amount
1,264.12
88.49
Taxable Labor
Labor Tax
@
7.000 %
1,293.80
90.57
Total Replacement Parts Amount
1,352.61
Labor Summary
27.8
1,384.37
III. Additional Costs
Taxable Costs
Sales Tax
@
7.000%
Amount
3.85
0.27
IV. Adjusbnents
Customer Responsibility
Amount
0.00
Non-Taxable Costs
207.90
Total Additional Costs
212.02
I.
II.
III.
Total Labor:
Total Replacement Parts:
Total Additional Costs:
Gross Total:
1,384.37
1,352.61
212.02
2,949.00
IV.
Total Adjusbnents:
Net Total:
0.00
2,949.00
This is a preliminary estimate.
Additional chanqes to the estimate mav be required for the actual repair.
THIS DAMAGE REPORT IS BASED ON OUR INSPECTION AND DOES NOT COVER ANY
ADDITIONAL PARTS OR LABOR WHICH MAY BE REQUIRED AFTER THE WORK HAS
BEEN OPENED UP THE INSURANCE COMPANY WILL BE NOTIFIED,
WE FEATURE A THREE YEAR WORKMANSHIP LIMITED WARRANTY - SEE OUR
WRITTEN WARRANTY FOR COMPLETE DETAILS.
LIFETIME PAINT PERFORMANCE GUARANTEE USING APPROVED PPG AND A
THREE YEAR GUARNATEE ON OVERALL WORKMANSHIP IS VALID FOR AS
LONG AS YOU OWN THE VEHICLE STATED HEREIN,
x
ESTIMATE RECALL NUMBER: 3/41200416:00:22 5813
UltraMate is a Trademark of Mitchell International
Mitchell Data Version: MAR_04_A Copyright (C) 1994 - 2003 Mitchell International
UltraMate Version: 5.0.021 All Rights Reserved
Page 2 of 2