Linda Lucey Claim
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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.
",'!'~.~,._<::la;.~~~st be filed with the City Clerk at!Eity Ha~.:l.~ 50
(--W-est...ut1;L.E.~;:'fae5~ Dubuque, Iowa 52001-4864. It will then be
'-Te-ferred 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.
CLAIM AGAINST THE CITY OF DUBUQUE
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: ).j ;.i '- ,J:~/r' h /
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Address: //~/(/,/, /'( /".-(' , /7///(~.--:;;' /y[....!.ct!...-t-<,/
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Telephone Number: :./ '7_ '. -,~ '/'-- ~1' '}-7/,
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Date of Incident: /. /l. '.--(/(;
Time of Incident:_.,,::/, /<.:!-!:.~_
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6. Location of incident.
7. DESCRIBE ACCIDENT OR OCCURRENCE THAT CAUSED IN Y OR DAMAGE.
(Give full details upon which you base your claim. If a City
employee was involved, give the employee's name.)
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Give name and address of any witnesses. ///:;",./p:, ////?A"'<./"4~;../
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Did police investigate? (If so, give names of officers.)
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What were weather conditions like?
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11. Was anyone injured? (If so, give name, address and extent of
injuries.)
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12.
Was any damage done to property? (if so, describe property
and the extent of damage. Attach estimates of damages or
describe basis for ascertaining extent of damage.)
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13.
What other damages do you cla~, 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.)
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15. What amount do you claim from the City of Dubuque?
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16. Why do you claim the City of Dubuque is responsible?
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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 yae, have you received QUY
payment from that source, and if so, in what amount?
Dated at Dubuque, Iowa, this
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(Revised January,
2000)
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10/11/2000 at 06:39 PM
30799
Job Number:
BRIMEYER AUTO BODY
License #:30799 Federal ID #:421438480
10727 JOHN F. KENNEDY RD
DUBUQUE, IA 52001
(319)583-4456 Fax: (319)583-1838
PRELIMINARY ESTIMATE
written by: ERIC WINCH #
Adjuster:
Insured: DAN LUCEY
Owner: DAN LUCEY
Address: 11461 ROBIN HOOD DR
DUBUQUE, IA 52001
Day: (319)557-8920
Claim #
Policy #
Deductible:
Date of Loss:
Type of Loss:
Point of Impact: 10. Left Front pil
Inspect
Loca tion: _
Insurance
Company:
Days to Repair
1996 DODG B2500 4x2 RAM VAN 6-3.9L-FI 3D VAN WHITE Int:
VIN: UNK
Intermittent wipers
power Steeri ng
Driver Airbag
Lic:
Dual Mirrors
power Brakes
Hiback Bucket
Prod Date:
Odometer:
clear Coat Paint
Anti-Lock Brakes (2)
Seats
NO.
OP.
DESCRIPTION
QTY EXT. PRICE LABOR
PAINT
1
2
DOOR
Repl LT Mirror assy electric
1
230.00
0.3
Subtotals ==>
230.00
0.3
0.0
parts
Body Labor
0.3 hrs @ $ 38.00/hr
230.00
11.40
SUBTOTAL
Sales Tax
$
$
241.40 @ 6.0000%
241. 40
14.48
GRAND TOTAL
$ 255.88
ADJUSTMENTS:
Deductible
0.00
CUSTOMER PAY
INSURANCE PAY
$ 0.00
$ 255.88
1
BARRY A. LINDAHL, E
CORPORATION COUNSEL
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MEMO
To:
Mayor Terrance M. Duggan
and members of the City Council
Date:
October 25, 2000
Re:
Claim of Linda Lucey
Claimant
Date of Claim Date of Loss Nature of Claim
Linda Lucey
10/13/00 9/25/00 vehicle damage
This is a claim for damages to the claimant's parked car,
which it sustained when a City bus struck its mirror at 1515 Delhi
Street.
According to the report of Transit Manager Mark Munson, the
claim is correct as filed. It is therefore the recommendation of
the Legal Department that this claim, in the amount of $255.88, be
paid by the Finance Director and submitted to I CAP for
reimbursement.
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BAL/cg
Enclosure
cc - Mr. Mark Munson
cc - Ms. Linda Lucey
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196 CYCARE PLAZA DURUQUR IOWA 52001
TELE 319583.4113 FAX 319 583-1040
e-mail balesq@mwcLnet