Claim Mueller, Thomas JCLAIM 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: Thomas J. Mueller
2 Address: 2650 Broadway
`
3. Telephone Number: 563 583 8719
4. Date of Incident: 3 20 04
5. Time of Incident: 11:50 AM
6. Location of Incident (Be specific): 15th & Central
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.)
I had to stop at green light because of merging traffic and was hit from behind by a Police Officer on duty.
8. What were weather conditions like? Sunny 50 degrees
9. Give name and address of any witnesses:
10. Did police investigate? (If so, give names of officers.)
Russ Stecklein
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
Thomas Mueller bruised elbow, neck and back discomfort.
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.)
Ford Explorer had 4000 damage - see attached est.
13. What other damages do you claim, if any?
Medical bills
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.)
4000-4400 for truck plus medical
15. What amount do you claim from the City of Dubuque?
I was hit from behind by a Police Officer on duty.
16. Why do you claim the City of Dubuque is responsible?
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 24th day of March, 2004. .
/s/ Thomas J. Mueller
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
Nar,n 2004 11 :48AM BARRY A LINDAHL, ESQ I. Jtü;ffi~'.'..~n-...
'3 d.ýi{D~ D2l fL1i/f11
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: --yv¡ f)1NV'1 S J VYìu.eJ t!2f
2. Address: ;¿ b5 '() -:&- f')(\ Aw CÀ- ~
3. Telephone Number: "S<ó3- 58'3- 3') (CJ
4. Date of Incident: 3 ~ ,;¿ 0 ~ [) L-{
I r ;S ð AVv\..
5. Time of Incident:
6. Location of Incident (Be specific):
t.5 -f'^. rt-
(1æV\i4-iI"e-l
7. DESCRIBE ACCIDENT OR OCCURRENCE THAT CAUSED INJURY OR DAMAGE. (Give
full deta¡¡:s upon which you bãse you; cla;m. !f:: City employee was invo!ved, give the
employee's name.) 'I ..L I
-Í f-r' d to S-{" P ö--t b~1A. 1:'1 ~r ~ c?\\,) ç.A'-
J' ý'fuX7; ") Trcc4; ( M d \,.)«-;c; hA- JJJ D '" he1 ,'VI. <?l h~
0... <P~ (C L.'¿ a{~. W-v- f'J'^-..J)v+1
8. What were weather conditions like? .j (; "V) {
9. Give name and address of any witnesses:
50"
1 O. Did polìèe investigate? (If so, give names of officers.)
«\15S
5t.e c-[(1iz ,tL-1
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
----;l\O\1!\Ú9 ff\v{J lIe.-r- f:>(u;7.e<1 t,(bl\\,J N{~k t',V\.r:~
bit J)15LV(~+vJ-
.Mar,n 2004 11:49AM
BARRY A LINDAHL, ESQ
No,3949
p, 3/3
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.)
----.<- ~r& C'ilf'(IÚ~ -~
~ A -hlvL- t:.- $. ~
£..(000.
Dc-1M. <.."\] J
13. What other damages do you claim, if any?
MLGcA ß,,\lf
14. Have you been compensated for any part or all, of your claim by any insurance
company? (If so, give name 'ànd address of insurance company and amount paid.)
NO
15. What amount do you claim from the CIty of Dubuque? '7ÔOD - L/ttoo 4..--
-r;cn:./C{ fJlvf /!'\.c.d/c-c.!
~ l{ *rc~
{) 0+1
16. Why do you claim the City. of Dubuque is responsible? .-L (, 'Ie. .s
V.e. n; hi b'{ . G{ Si6/ ~( -( ð.fJ~C£.d- D""-
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 thatßource;
and If so, in what amount?'
Dated at Dubuque, Iowa this
,)'1
day of
~~. ..20~.O .
~
~ure)
~f)~tf~ l!V\Oe;( [{l r
(Pri ame)
Vi
80 :2 i.jd t¡Z ;:¡VH:¡O
(Rev. 1100 & 7101)
03/\I:::JJ::ki
'---"-
.~--
Fann 433003
01-01
~; ~..,:,~;r~'r",".portati.n f4r"'lowa Depa.rt. ment Of Transportation
:;:~eF~ii~:~:,"o"oN~::dA,.n", ""'iiÌ1Þ" INVESTIGATING OFFICER'S REPORT
~~' ~~::"',owo 50306-9204 OF MOTOR VEHICLE ACCIDENT
Shoo'
,
,
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0
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y.co.,din".,
Fe"
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If Di,ided Highway! P"",de Route
(Ce"'",I) Tm,.1 Dire"'.n
~~!~ô"
end
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Zip
~'ty
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Pas, Nag,
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,.hictes demaged """Iein D~eged
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(last,Ficst,MI"Ie)
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SEQUENCE OFEVENT
Fi",E,.n!
Ughl Cond"o..
LJ LU
LJ S,ria" Con"'on, LJ
WORK ZONE RELATED?
Mej~Contrlb",ngCi=m'te"""" . 0 Yes 0 No
E""ronmenl U LJ Lo"hon
Roedway LU LJ Type
LU LU Se",nd E,.nt
LU LU Thl'" E'enl
LU LU Fo""" E,.nl
ACCIDENT ENVIRONMENT
Lo"fionofFi,,'Henn,"IE,.nt LJ W..th"Cond",on, LU
("p to two)
---------------
TypeofRoad~yJ"_"'Fest"re LU LJ Wo",e"Pre..nt?
LU LU ~~';.~::;w "'ent
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Menne,.rCm,hICotloion
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< 1"V'
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y
, Date: 31221200401:19 PM
¡:Stimate 10: 9245
EStimãlè Version: 0
'Preliminary
Profile 10: Milchell
FED ID *42-0813744
RICHARDSON MOTORS
1475 J.F.K. ROAD DUBUQUE,IA 52002
(563) 582-6411
Fax: (563) 582-4129
Damage Assessed By: JASON CHARLEY
Deductible: UNKNOWN
Owner tom mueller
Address: 2650 broadway dub, IA 52001
Telephone: Work Phone: 1563) 599-$783
,"
Home Phone: (563) 583.8719
Mitchell Service: 918622
Description: 1998 Ford Explorer Sport
Body Style: 2D Ut 102" WB Drive Train: 4.0L In] 6 CyJ 4WD
VIN: 1FMYU24E3WUC55229
Options: ALUM/ALLOY WHEELS, AIR CONDITIONING, POWER WINDOWS, POWER DOOR LOCKS
CRUISE CONTROL, AUTOMATIC TRANSMISSION, AM-FM STEREO/CDPLAYER(SINGLE)
Line Entry Labor Line Item Part Type! Dollar Labor
Item Number Type Operation Description Part Number Amount Units
~-
1 802555 BDY REMOVEIREPLACE EXHAUST MUFFLER WIPIPE F67Z 6230 BAA 212.87 0.7
2 900500 BDY' ADD'L LABOR OP HEATRE SHAPE RTQTR MLD Existing 0.6"
3 802785 BDY REPAIR R QUARTER OUTER PANEL ExiSting 0.5"#
4 AUTO REF REFINISH R QUARTER PANEL OUTSIDE C 3.4
5 802786 BDY REPAIR L QUARTER OUTER PANEL existing 0.5'/1
6 AUTO REF REFINISH L QUARTER PANEL OUTSIDE C 3.0
7 801075 BDY REMOVEIREPLACE WIPOWER LOCKS 0.3
8 804326 BDY REMOVE/REPLACE LlFTGATE SHELL XL2Z 7840010 BA 708.70 5.5 #
9 AUTO REF REFINISH LlFTGA TE OUTSIDE C 2.4
10 AUTO REF REFINISH ADD FOR JAMBS & INSIDE C 1.0
11 802890 BDY REMOVEIREPLACE LlFTGATE ADHESIVE NAMEPLATE F87Z 7842528 PA 22.50 0,1
12 802899 BDY REMOVEIREPLACE LlFTGATE ADHESIVE NAMEPLATE F87Z 9842528 EA 1U8 0.1
13 801216 BOY REMOVEßNSTALL R REAR COMBINATION LAMP 0.3
14 801217 BDY REMOVEßNSTALL L REAR COMBINATION LAMP 0.3
15 AUTO BDY OVERHAUL REAR BUMPER ASSY 1.5
16 803729 BDY REMOVEIREPLACE REAR BUMPER FACE BAR Qual Recycled Part 350.00" INC
17 SMART PARTS QOUTE#79856
18 LINE MARKuP %0.25 0.88
19 900500 BOY" REMOVE/REPLACE REAR SILL PLATE F5TZ7842624D 2I!.58" 0.3"
20 AUTO REF ADD'L OPR CLEAR COAT : 2.6
21 933005 BDY ADD'L OPR RESTORE CORROSION PROTECTION 6.00' 0.2"
22 933006 FRM ADD'L OPR FRAME/RACK SET UP , 2.0"
23 933018 REF ADD'LOPR MASK FOR OVERSPRAY 6.00' 0.2'
24 933034 FRM ADD'L OPR PULL FOR SAG 15.0'"
25 FRAME IS BACK AND DOWN ON BOTH SIDES
26 AUTO ADD'L COST PAINT/MATERIALS 353.40"
ESTIMATE RECALL NUMBER: 3/221200411:10:57 9245
UltraMate is a Trademark 01 Mitchellintemalional .
Mitchell Data Version: A~04_A Copyright IC) 1994 - 2003 Mitchell International ." ,P"!I" 1 of 2
UltraMate Version: 5.0.021 All Rights Reserved
27
AUTO
ADD'L COST
HAZARDOUS WASTE DISPOSAL
Date: 3/22/2004 01:19 PM
Estimate 10:; 9245
Estimate Version: 0
Prermrinary
Prome ID: Mitchell
6.00'
. -Judgement Item
# - Labor Note Applies
C -Included in Clear Coat Calc
I. Labor Subtotals
Body
Refinish
Frame
0,
Add1
Labor Sublet
Units Rate Amount Amount Totals
10.8 46.00 6.00 0.00 502.80 T
12.6 46.00 .6.00 0.00 585.60 T
17.0 53.00 0.00 0.00 901.00 T
II. Part Replacement Summary
Taxable Parts
Parts Adjustments
SalesTax @
Amount
1,341.53
0.88
93.97
1.000%
Taxable Labor
Labor Tax
@
1.000 %
1,989.40
139.26
Total Replacement Parts Amount'
1,436.38
Labor Summary
40.4
2,128.66
w. Additional Costs
Taxable Cost.
Sales Tax
@
7.000%
Amount
6.00
0.42
IV. Adjusbnents
Customer ResponsibHity
Amount
0.00
Non-Taxable Costs
353.40
Total Additional Costs
359.82
I.
It
W.
Total Labor:
Total Replacement Parts:
Total Additional Costs:
, Gross Total:
2,128.66
1,436.38
359.82
3,924.86
IV.
Total Adjustments:
Net Total:
0.00
3,924.88
This is a preliminary estimate.
Additional chanQes to the estimate mav be required for the actual repair.
ESTIMATE RECALL NUMBER: 3122/2004 11:10:57 9245
UltraMate is a Trademark of Mitchell International
Mitchell Data Version: APR 04 A Copyright IC) 1994 - 2003 Mitchell International
UltraMate VerSion: 5.0.021 - All Rights Reserved
Page 2 of 2
. "~'
,MAR-22-2Ø04 01:0; ph ~FIHHIH BOÐY$HOP
\. V....
f!.¡V'"
563 690 10B6
P.01
Dale: 212M_01:82PM
EII-.IO: 2T.
ell_.VomDn: a
-...,
Proftle 10: Machin
MIKE FINN IN FORD
- DOOGI! 8TRUT DUBUQlJE.1A 1200'
10'10""0'0
F.., ceu'"O.lm
T..ID'. '..1"2113
DIm... A.....ld 8y: RICK STUMPF
Doduc\lble: UNKNOWN
lnllUl1td: TOM MUELLI!II
-....: 2UOIIROAIIWAY DUBUQUE, IA 12001
Tllephonl: Wort -.: I-I&ft.e,o
"- Phone: I.IS, 1..-1".
MIIoM" S.",lcl: 1'1822
Desa1pllon: 1m Ford II_pion. Sport
8ody 1ItyIe: 20 \11102" we an.. T..in: I.DL 1nj I CyI.WO
VIN: 'FMYUJ.ESWllCOO221
Option.: ALUM/ALLOY WHHLS. AIR CONDITIONING, POWER WINDOWS, POWER DOOR LOCKS
CIM8E CONTROL. AUTOMATIC TRANSMISSION. AM-FM STEREOICDPLA Yl!R(StNOLE
LIn."'"
Deocrlpllon
REAR 8UfM'ER I. LAMPe
REMO\/I!/REPLACE REAR REPUl.CE BUMPER
UNE MARKUP 1120,00
-END OF ATO SECTION '"
EXKAUIIT
. _0 BOY REMOVEIREPLAC! EXHAUIIT MUFFLER-
MANUAL ENTRIES
HEAT RESHAI'!! liT QUATER PANEL MLDG
QUARTER PANEL
R QUARTER OUTI!R PANEL
R QUARTER PANEL OUTSIDE
L QUARTER OUTER PANEL
L QUARTER PANEL OUTSIDE
LIfTGATE
LIFTOATI! III1I!LL
LIFTQATEOUT8tDE
ADO FOR JAMBS I.IN8IDE
UFTOATI! ADHESIVE NAMEPUl.TI!
LlFTGATI! ADHEIN! NAM!PLATI!
REAR BODY
11 IIOaln BOY REMOI/!/REPUl.CE REAR BODY SILL PANEL
'1 REF REFINISH RIAR CROSSMEMBER
REAR LAMPS
17 80UM BDY REMOV£I\N8TALL RCOM8INAT1ONLAMPUSEMBLY
18 nZl" 8DY RlMOVI!IINSrALL LCOMBtNATIONLAMI'ASSEMBLY
REAR BUMP&R
.. _f' BOY OVERHAUL REARBUMPERASSY
ESTIMATE RECALL NUM_: ,- 1':02:". 2'"
UllnlMII. to , T,.- oI_ø 1nI....-
~:ir-A Copytlght \CI :..~..¡::~ I_II
Li"" Entry L.bor
~ ~!Ie... _Ion
..11202 80Y
_100 BDY .
REPAIR
0
,
I
I
lOrn BOY
REF
I12rn BOY
REf
REPAIR
REFINI1IH
RlPAm
REfINISH
10
11
12
13
I.
RIlMOVI!/REl'LACE
REFINISH
REF1NI8H
RlMOVE/REPLACE
IlIIMOVEJREPLACE
10UH BOY
REf
REF
milD BOY
10'" 8OY
MfteMnOatav.rolon:
un..-. V.rolan:
P." Typo!
P""-
au." -,clod Part
F17% IUD BAA
ExI8IIng
E_isting
E.11l1ng
XLJZ _10 8A
FI7Z TMU" PA
mz _.H EA
An 711- A
"
II_toting
1!II,1tIIna
00II.. LoIJor
~ !:!!!!!-
280,10' tNC "
I""
21U7
0,7
, 0'"
0;1."
C S¡4
0.'"
C 1,0
'OUD u"
CIA
C 1;0
22.10 oa
'1." M
".17
UII
1:0
0;3.
0."
liD
P_1011
IMAR-~2~2004 01:04 PM
FINNIN BODY SHOP
563 690 1086
P.02
0...: 3I221_81,02'M
E_IO:. 174 '
£11- V_IOn: 0
l'nllimlniry
ProilelO'. _8
2Ø
21
22
23
24
21
ZI
Ref
13SO1J!1 BOY
n3m fRM
933011 REF
8330" FRM
AOJ)"\. CPR
AOD'L CPR
AOD'L OPR
AOO'L OPR
ADO'L OPR
AOO'L COST
AOO'L COST
ADDITIONAL OPERATIONS
CLEAR COAT
RESTORE CORROBION PROTECTION
fRAMElRACI( SET UP
MA81( fOR OVERBPRAY
PULL FOR SAG
PAINT/MATERlAL8
HAZARDOU8 WASTE OISPO8AL
2.1
4.01 ' O,Z"
2...
12.00' 1.2'
11.0'
STUO'
I.".
. - Judgement Item
II - Labor Note Applies
C . Included In Clear Coat Calc
Add'
Llbor aubl.'
I. L-- .!!!!!!!. ~ ~ Amoun' ~ H. Part RepIocomenlS"""'ry
lI<MIy 14.7 8.00 4.""., D."" 7G...I T - T...IM P.".
_loft 13.1 41.10 12.00 O.GO HUOT Ports Ad uoImonIO
Fr8IM 17.1 II." 0.00 0.00 HUIT sa... T.. .
Amoum
1.371:12
lUG
102.10
7,-
T...1IIo L_'
Llbor Tu
.
UGGy,
2,1H.1O
1"'"
URAl
T_I"",,-P--
1._.72
LIbor Summory
41.1
lB. _II Colt.
Non-T._Coot.
Amount
u;:¡¡-
IV, Ad U1ImonI.
C- R8opanItbI y
Amount
--¡¡o
T"""-C-
211.20
I.
a,
m.
Totll Lllbor: '
Totol R....- P-
T \1181 AddIIIoftlll Coots:
- Tot'"
UGUI
""0.72
HUO
4.442.40
IV.
Tot.. ~:
Not T_,
O,VII
4.4420'0
This is . oNliminarv HUmatlt.
Additiona' chanaea to the a.timata mav be l'8CIulred for the lIdue' Noair.
E8T1MATI! RECALL NUMBER, 1I2JIZOM 11:02,M 274 .
IIItroM.,./t. Tr",-~" Ma-.ntomotIolIIIl
"'ft_1I Dol. V,mOft: MAR.IN.!' copyright (CI1," .I8OS Mitchoa 1111_-
UltroMate V",""n: I.O,UI Aft RIght. R...rved
""lie 2 01 I
..