Claim Sawvell, TheresaCLAIM 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: Theresa Sawvell
2. Address: 656 W 11th St.
3. Telephone Number: 563-582-9189
4. Date of Incident: 10- -04
5. Time of Incident: 6:30-6:35AM
6. Location of Incident (Be specific): On West 11th around the corner
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.)
City employee Mike Good
8. .What were weather conditions like? OK
9. Give name and address of any witnesses: Allen Sawvell
Theresa Sawvell 656 W 11th St Dubuque, IA 52001
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.)
{J;:jj,~" iC
fXk)c-hu{
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.)
!\JO
15. What amount do you claim from the City of Dubuque? 9,7:¿,tf I
16. Why do you claim the City of Dubuque is responsible#' <K/:3, L[ I
17. Have you made any claim against anyone else for damages as a result of this incident?
(If yes, give name and address.) . À
~\J
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
7
day of
0 () I)
,204'
"Y\i\ (J-..JJ.n ,<)"(¡ (in ~
(Signature) -
-TI\'fJ,CÝ~C¡ ~{A}(}¿I!
(Print Name)
(Rev. 1/00 & 7/01)
Question 7
A blue Dodge truck owner
by my husband was infront of
our house with flashers on
(forgot lunch box). Allen was by
his truck next to curb when
the bus just kept coming
hit my car and kept going
my husband ran down the
road almost a block. The bus
stopped right before the next
stop sign. The driver got out
Allen told him he hit a car
the driver very nice. Came
up to my car he said he
was sorry and gave me all
of the information I needed
to call the bus station
they would take care of it.
--
!
Date: 10129/200411:49 AM
Estimate ID: 832
Estimate Version: 0
Preliminary
Profile ID: Mitchell
MIKE FtNNIN FORD
3800 DODGE STREET DUBUQUE. IA 52001
(583) 556,1010
Fax: (563) 690,1086
Tax ID: 14,1882673
Damage Assessed By: RICK STUMPF
Deductible: UNKNOWN
Insured: THRESA SAWVELL
Address: 658 WEST 11th DUBUQUE,IA 52001
Telephone: Home Phone: (583) 582,9189
Mitchell Service: 918820
Description: 1995 Ford Taurus GL
Body Style: 4D Sed
VIN: 1FAL.Pf2U4SG282139
Drive Train: 3.0L In] 6 Cyl AO
LIne Entry Labor Line Item Part Type! Dollar Labor
~ Number Type Operation Description Part Number Amount Units
~-
QUARTER PANEL
828260 BDY REPAIR L QUARTER OUTER PANEL Existing 2.0.#
REF REFINISH L QUARTER PANEL OUTSIDE C 2.2
REAR LAMPS
835190 BDY REMOVE/REPLACE L COMBINATION LAMP ASSEMBLY F3DZ 13405 A 88,88 0,3
REAR BUMPER
4 836440 BDY REMOVElINSTALL REAR BUMPER ASSY 0.5
MANUAL ENTRIES
5 900500 REF' REMOVE/REPLACE PAINTED STRIPE New 0.5'
REAR BUMPER
6 836490 BDY REPAIR REAR BUMPER COVER Existing 1,5.
7 REF REFINISH REAR BUMPER COVER C 2,5
ADDITIONAL OPERATIONS
8 REF ADD'LOPR CLEAR COAT 1.4
9 933005 BDY ADD'LOPR RESTORE CORROSION PROTECTION 2.00. 0,1.
10 933018 REF ADD'L OP~ MASK FOR OVERSPRAY 12.00. 0.2"
11 ADD'L C<QfT PAINTIMATERIALS 184.80'
12 ADD'L CI?'T HAZARDOUS WASTE DISPOSAL 3.30.
. - Judgement Item
# - Labor Note Applies
C - Included In Clear Coat Calc
ESTIMATE RECALL NUMBER: 10I29l2OO411:49:20 832
UItraMate Is a Trademark of Mitchell International
Mitchell Data Version: OCT_O4_A Copyright (C) 1994, 2003 Mitchellintemational
UItraMate Version: 5,0.025 AD Rights Reserved
Page 1 of 2
Date: 10/29/200411:49 AM
Estimate 10: 832
Estimate Version: 0
Preliminary
Profile 10: Mitchell
Add'i
Labor Sublet
I. Labor Subtotals Units Rate Amount Amount Totals
Body 4.4 48.00 2.00 0.00 213.20 T
Refinish 6.8 48.00 12.00 0,00 338.40 T
II. Part Replacement Summary
Taxable Parts
Sales Tax @
7,000%
Amount
88.88
6.22
Taxable Labor
Labor Tax
@
7.000%
551.60
38,61
Totel Replacement Perts Amount
95.10
Labor Summary
11.2
590.21
III. Additional Costs
Non,TaxableCosts
Amount
188.10
IV. Adjustments
Customer Responsibility
Amount
0,00
Total Additional Costs
188.10
I.
II.
III,
Total Labor:
Total Replacement Parts:
Total Additional Costs:
Gross Total:
590,21
95.10
188,10
873.41
IV.
Total Adjustments:
Net Total:
0.00
873.41
This is a preliminary estimate.
Additional changes to the estimate mav be required for the actual repair.
ESTIMATE RECALL NUMBER: 101291200411:49:20 832
UItraMale is a Trademark of Mitchell International
Mitchell Data Version: OCT_O4_A Copyright (C) 1994,2003 Mitchell International
UItraMate Version: 5,0,025 All Rights Reserved
Page 2 of 2