Claim Jaeger, RichardCLAIM 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: Richard Jaeger
2. Address: 1830 Amelia Dr., Dubuque, IA
`
3. Telephone Number: 557 9828
4. Date of Incident: 3/5/06
5. Time of Incident: 1:00 P.M.
6. Location of Incident (Be specific): 1830 Amelia Dr. in front of house
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.)
(Sunflower) Paul Schollmeyer was plowing snow in court across the street and he backed up on to Amelia
Drive to go back down the hill. In doing so his blade damaged the drivers side of our 1995 Pontiac Grand Prix.
8. What were weather conditions like? It was snowing
9. Give name and address of any witnesses:
10. Did police investigate? (If so, give names of officers.)
Yes, one week later after finding out the estimates were over $1000.00
Jeff Stewart - Case #06-10643
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, Driver's side of Pontiac Grand Prix, Estimates enclosed.
13. What other damages do you claim, if any?
None
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?
The entire amount to fix car or the value of the car.
16. Why do you claim the City of Dubuque is responsible?
Because the City of Dubuque employee driving the plow struck our parked vehicle.
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 15 dday of March, 2006.
/s/ Richard Jaeger
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
C-(i, ;1f; rl~ b
CLAIM AGAINST THE CITY OF DUBUQUE,IOWA ,Ji~~.
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: /?;cAa.rd ::..Ja~
2. Address: /'130 Arne_ha. Dr. - Du h'1i{f..
3. Telephone Number: .SS 7 - 9;( ,;)i
4. Date of Incident: .3 /5 /0 10
, .
5. Time of Incident: / .' 00 f).m.
I
6. Location of Incident (Be specific): / %30 A me.../ /0. !Jr .
/1} -Fran t rJ house..
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 naje.) .-;') /' (\ I . / .
{,)u-.n-P/OWif 1"'CI.I.I I dcnall fY1e.!J.e;~ L..ua..S_.{)/OWJf:1.1:/. ShoW
In courf across +he... Sfree-J:. a..n '--fJe. backed Uf!.. OIl-ro ,J4rn.e.-/ltz..-
III I Si
ciam~ed -/Ae.. dnVfr-., Side of (JU-r 19CJS A/1I1~G Grw-,d Pr/x.
8. What were weather conditions like? /1 Wa..s ShtJ (J.J /':.)
9. Give name and address of any witnesses:
10. Did police investigate? (If sf:. give names of officers.)
<1-" nne. /J..JC"ek /t1frY a+*r,;jl~ (JILT -t-Jx csftmo..k:s were. over JI/txJ().ClO
Je # S/wJo..r.+ -/ Cos-e 1:1 Oft, -10 'c./3
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.)
lfe5 - Dr;vpr5 -SIde o-jl /6nfiac. . brn.nnl f?-,)( -
!Sflrnr, fts f' /yjosed.
13. What other damages do you claim, if any?
NOh€..
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? --(he . en -1-, rf'_ aJrJ(){.JJI +
-10 !;x rt'lr Of"' --!f1e va../tu...- ()f me- car.
16. Why do you claim the City of Dubuque is responsible? & ell uSe +A-e~
C/I:J Dj) lJuJuJ.9W e...mpJr:!f"l ririvt";j -/he ploU) ..s-lrtlck
{)().y /Jo..rked Ve.-hirjC
I
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 /5
day of ---11[11 rr Jv
204.
(Signature)
M~ hfl ,vi X;:rv-
(Print Na
I' '"
.-'
(Rev. 1/00 & 7/01)
.
Date:
Estimate 10:
Estimate Version:
Preliminary
Profile 10:
3/ 9/2006 04:42 PM
6468
o
Mitchell
Lenny Valentine & Sons, Inc.
923 Peru Rd. Dubuque, IA 52001
(563) 588-4659
Fax: (563) 588-4650
TWO CONTINENTAL FRAME MACHINES
GENESIS II COMPUTERISED MEASURING SYSTEM
PRICE IS EASY TO BEAT/QUALITY IS NOT
UNIBODY SPECIALISTS
Damage Assessed By: DICK VALENTINE
Deductible: UNKNOWN
Owner RICK JAEGER
Address: 1830 AMILIA DR DUBUQUE, IA 52001
Telephone: Home Phone: (563) 557.9828
Mitchell Service: 918491
Description: 1995 Pontiac Grand Prix SE
Body Slyle: 20 Cpe
VIN: 1G2WJ12M2SF263947
Line Entry Labor
Item ~umber Typ~
1 824310 REF
2 826320 BOY
3 AUTO REF
4 826940 BOY
5 827210 BOY
6 AUTO REF
7 830930 BOY
8 AUTO REF
9 831700 BOY
10 AUTO REF
11 AUTO
12 AUTO
13 AUTO
Operation
REFINISH
REPAIR
REFINISH
REMOVE/REPLACE
REMOVE/REPLACE
REFINISH
REPAIR
REFINISH
REMOVE/REPLACE
ADD'L OPR
ADD'L COST
ADD'L COST
ADD'L COST
Drive Train: 3.1 L Inj 6 Cyl AO
Line Item
Description
L ROCKER MOULDING
L FRT DOOR SHELL
L FRT DOOR OUTSIDE
L FRT DOOR MOULDING
L FRT DOOR POWER MIRROR
L FRT DOOR MIRROR
L QUARTER OUTER PANEL
L QUARTER PANEL OUTSIDE
L QUARTER MOULDING
CLEAR COAT
PAINT/MATERIALS
SHOP MATERIALS
HAZARDOUS WASTE DISPOSAL
Part Typel Dollar labor
Part Number Amount Units
0.8
Existing 6.0* #
C 2.7
ORDER FROM DEALER 333.35 0.2
88896759 GM PART 102.36 0.3 #
C 0.6
Existing 6.0* #
C 2.1
ORDER FROM DEALER 139.00 0.2
1.6*
249.60 .
20.00 .
7.00*
. - Judgement Item
# - Labor Note Applies
C - Included in Clear Coat Calc
ESTIMATE RECALL NUMBER: 3/9/200616:42:57 6468
UltraMate is a Trademark of Mitchell International
Mitchell Data Version: FEB_06_A Copyright (C) 1994.2003 Mitchell International
UltraMate Version: 5.0.214 All Rights Reserved
Page 1 of 2
I. Labor Subtotals
Body
Refinish
Units
12.7
7.8
Rate
50.00
50.00
Taxable Labor
Labor Tax
Labor Summary 20.5
III. Additional Costs
Taxable Costs
Sales Tax
Non-Taxable Costs
Total Additional Costs
Add'l
Labor
Amount
0.00
0.00
Sublet
Amount
0.00
0.00
Date:
Estimate 10:
Estimate Version:
Preliminary
Profile 10:
31 912006 04:42 PM
6468
o
@ 7.000 %
@
7.000%
Mitchell
Totals II. Part Replacement Summary
635.00 T Taxable Parts
390.00 T Sales Tax @ 7.000%
1,025.00 Total Replacement Parts Amount
71.75
1,096.75
Amount IV. Adjustments
7.00 Customer Responsibility
0.49
259.60
277.09
I. Total Labor:
II. Total Replacement Parts:
III. Total Additional Costs:
Gross Total:
IV. Total Adjustments:
Net Total:
This is a preliminary estimate.
Additional chanaes to the estimate mav be reauired for the actual reoair,
ESTIMATE RECALL NUMBER: 319/200616:42:57 6468
UltraMate is a Trademark of Mitchell International
Mitchell Data Version: FEB_06_A Copyright (C) 1994 - 2003 Mitchell International
UltraMate Version: 5.0.214 All Rights Reserved
Amount
574.71
40.23
614.94
Amount
0.00
1,096.75
614.94
277.09
1,988.78
0.00
1,988.78
Page 2 of 2
. .
.
.
03/08/2006 at 03:32 PM
30799
BRlMEYER AUTO BODY
License #:30799 Federal 10 #:421438480
10709 COLLISION DR.
DUBUQUE, IA 52001
(563)583-4456 Fax: (563)583-1838
PREL~INARY ESTIMATE
Written By: BRIAN HOCHBERGER
Adjuster:
Insured: RICK JAEGER
Owner: RICK JAEGER
Address: 1830 AMELIA
DUBUQUE, IA 52201
Other: (563)557-9828
Inspect
Location:
Insurance
Company:
Claim #
Policy #
Deductible:
Date of Loss:
Type of Loss:
Point of Impact:
1995 PONT GRAND PRIX BE 6-3.1L-FI 2D ePE GREEN lot:
VIN: IG2WJ12M2SF263947 Lie: JAEGS89 IA Prod Date:
Air Conditioning Tilt Wheel
Intermittent Wipers Theft Deterrent/Alarm
Body Side Moldings Dual Mirrors
Clear Coat Paint Power Steering
Power Windows Power Locks
AM Radio Cassette
Passenger Air Bag 4 Wheel Disc Brakes
Bucket Seats Automatic Transmission
Aluminum/Alloy Wheels
NO.
1
2*
3
4
5**
6
7
8
9*
10
11
N
12
13
14
15*
16*
17
18
19*
20
21
N
22*
23
24
25
26*
27#
28~
OF.
DESCRIPTION
QTY EXT. PRICE LABOR
Rpr
DOOR
LT Outer panel
Add for Clear Coat
LT Belt molding front black
A/M LT Mirror power 1
Overlap Minor Panel
Add for Clear Coat
LT R&I trim panel
LT Body side mldg SE
Add for Clear Coat
LT Nameplate "GRAND" wlo 1
deluxe
LT Nameplate "PRIX" w/o deluxe 1
LT Nameplate "SE"
PILLARS, ROCKER & FLOOR
LT Rocker mOlding
LT Rocker moldinq
Add for Clear Coat
QUARTER PANEL
LKQ LT Body side mldg rear 1
Add for Clear Coat
LT Quarter glass GM, tinted
all
LT Quarter panel
Overlap Major Adj. Panel
Add for Clear Coat
WHEELS
LKQ LT/Rear Wheel aluminum, 1
type 1 15x6
MOUNT & BALANCE 1
CHECK REAR ALIGNMENT 1
Days to Repair
Job Number:
Odometer:
Cruise Control
Tinted Glass
Fog Lamps
Power Brakes
Power Mirrors
Driver Air Bag
Cloth Seats
Overdrive
85.00
26.83
19.98
30.00
179.00 m
12.50 T
39.99
7.0
0.7
0.3
0.4
1.0
0.2
0.2
0.2
0.4
0.5
0.5
2.0
8.0
0.3
168832
PAINT
2.5
1.0
0.5
-0.2
0.1
1.0
0.2
1.0
0:2
0.5
0.1
2.4
-0.4
0.4
-------------------------------------------------------------------------------
9.3
Line 21
Line 22
R&I
Repl
R&I
Rpr
Repl
Repl
R&I
R&I
Rpr
Repl
R&I
Rpr
Repl
Repl
Subtotals """">
393.30
OPEN TO BREAKAGE UPON REMOVAL PRESSURE ON GLASS
5 HRS BELOW MLDG
3 HRS ABOVE MLDG
1
21.7
, .
I
. 03/08/2006 at 03:32 PM
30799
Job Number:
PRELIMINARY ESTIMATE
1995 PONT GRAND PRIX SE 6-3.1L-FI 2D CPE GREEN lnt:
Parts 380.80
Body Labor 21.7 hrs @ $ 49.00/hr 1063.30
Paint Labor 9.3 hrs @ $ 49.00/hr 455.70
Paint Supplies 9.3 hrs @ $ 30.00/hr 279.00
Sublet/Misc. 12.50
SUBTOTAL
Sales Tax
$ 2191.30
$ 1912.30 @ 7.0000% 133.86
GRAND TOTAL
$ 2325.16
ADJUSTMENTS:
Deductible
0.00
CUSTOMER PAY
INSURANCE PAY
$ 0.00
$ 2325.16
Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from
the Guide DEIFD88 Database Date 02/2006, CCC Data Date 02/2006, and the parts selected are
OEM-parts manufactured by the vehicles Original Equipment Manufacturer. OEM parts are available at
DE/Vehicle dealerships. OPT OEM (Optional OEM) parts are OEM parts that may be provided by or
through alternate sources other than the OE/Vehicle dealerships. OPT OEM parts may reflect some
specific, special, or unique pricing or discount. Asterisk (*) or Double Asterisk (**) indicates
that the parts and/or labor information provided by MOTOR may have been modified or may have come
from an alternate data source. Tilde sign (-) items indicate MOTOR Not-Included Labor operations.
Non-Original Equipment Manufacturer aftermarket parts are described as AM, Qual Repl Parts or Comp
Repl Parts which stands for Competitive Replacement Parts. Used parts are described as LKQ, Qual
Recy Parts, RCY, or USED. Reconditioned parts are described as Recon. Recored parts are described
as Recore. NAGS Part Numbers and Benchmark Prices are provided by National Auto Glass
Specifications. Labor operation times listed on the line with the NAGS information are MOTOR
suggested labor operation times. NAGS labor operation times are not included. Pound sign (#)
items indicate manual entries. Some 2006 vehicles contain minor changes from the previous year.
For those vehicles, prior to receiving updated data from the vehicle manufacturer, labor and parts
data from the previous year may be used. The Pathways estimator has a complete list of applicable
vehicles. Parts numbers and prices should be confirmed with the local dealership.
CCC Pathways - A product of CCC Information Services Inc.
2