Claim, Schnee, Barbara J,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: Barbara J. Schnee
2. Address: 2257 Chaney #6
`
3. Telephone Number: 563 543 6488
4. Date of Incident: 7/27/06
5. Time of Incident: 9:30 to 11:00
6. Location of Incident (Be specific): In parking lot at 2257 Chaney mini bus driver
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.)
Your driver droppoed lady off in (Apt #5) & was trying to turn around - hit my car & backed in f? decks across the parking lot. Charles John Lee, 421 Woodland Rd.
Dubuque, IA 52001
8. What were weather conditions like? very good
9. Give name and address of any witnesses:
10. Did police investigate? (If so, give names of officers.) Yes, John Hefel
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, back bumper & tail light & tail light panel
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?
For time and gas $1,000.00
16. Why do you claim the City of Dubuque is responsible? The driver Charles Lee works
for city, plus officer Hefel said ther was silver paint on the mini bus.
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 31st day of July, 2006. , 20 .
/s/ Barbara J. Schnee
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
, $@~~~
CLAIM AGAINST THE CITY OF DUBUQUE;'IOWAg;~!a.J
This written report constitutes f~6J;:::blaim against the City of Dubuque, Iowa. YoJ:~
complete this form in full and ~tt~ch,}\ny additional information that supports your claim.
, , " ,) I
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 (Ch'yct~uncil to the appropriate department for investigation.
Once that investigation is complliteB','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 WIL 0 BE PAID.
6. Location of Incident (Be specific):
~j~~ ~ ~
'!~r~f?
1. Name of Claimant: '
2. Address: ~
3. Telephone Number:
4. Date of Incident:
5. Time of Incident:
.~~~
7. DESCRIBE ACCIDENT OR OCCURRENCE THAT CAUSED INJURY OR DAMAGE. (Give
was involved, give the
,il. ;;;q
,-.~!c!3
8.
9. Give name and address of any witnesses:
10.
icers.)
11.
s, addresses, and extent of injuries).
,~
12. Was any damage done to property? (If so, describe property and the extent of damages.
Attach estimates of damages describe basis for ascertaining extent of da age.)
i-
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.)
/V'-1,r-
15.
What amou~t dO, you claim from trrity of Dubuque?
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 s;>ubu~~e, Iowa this ~ day of
(S' atu~
J3o..l--hClA'I J..
(Print Name)
e -€-
(Rev. 1/00 & 7/01)
.
Date: 71271200604:05 PM
Estimate 10: 6195
Estimate Version: 0
Preliminary
Profile 10: Mnchell
MIKE FINNIN FORD
Damage Assessed By: RICK STUMPF
Deductible: 0.00
3600 DODGE STREET DUBUQUE, IA 52001
(563)556-1010
Fax: (563) 690-1086
Tax 10: 14-1862673
Insured: BARB SCHNEE
Address: 2257 CHANEY RO APT6 DUB, IA 52001
Telephone: Home Phone: (563) 543-6488
Mnchell Service: 915529
Description: 2004 Chrysler PT Cruiser
Body Style: 40 Wgn Drive Train: 2.4L Inj 4 Cyl4A FWD
VIN: 3C4FY48B24T305945
Mileage: 8,173
Options: ALUM/ALLOY WHEELS, AIR CONDITIONING, POWER WINDOWS, POWER DOOR LOCKS
CRUISE CONTROL, AUTOMATIC TRANSMISSION, AM-FM STEREOICOPLAYER(SINGLE)
Line Entry Labor
Item Number Type
1 502628 BOY
2 AUTO REF
3 502840 BOY
4 501288 BOY
5 502392 BOY
6 AUTO REF
7 AUTO REF
8 933005 BOY
9 933018 REF
10 AUTO
11 AUTO
Operation
REPAIR
REFINISH
REMOVE/REPLACE
REMOVE/INSTALL
REPAIR
REFINISH
AOO'L OPR
AOO'L OPR
AOO'L OPR
AOO'L COST
AOO'L COST
Line Item
Description
R QUARTER OUTER PANEL
R QUARTER PANEL OUTSIDE
R REAR COMBINATION LAMP
REAR BUMPER ASSY
REAR BUMPER COVER
REAR BUMPER COVER
CLEAR COAT
RESTORE CORROSION PROTECTION
MASK FOROVERSPRAY
PAINTIMATERIALS
HAZARDOUS WASTE DISPOSAL
Part Type!
Part Number
Existing
Ooliar Labor
Amount Unlle
3.0*#
C 2.1
80.70 0.2
1.2 #
1.0*
C 2.0
1.2
12.00 * 0.3*
12.00 * 0.3*
148.40*
2.65*
5288742AG
Existing
. - Judgement Item
# - Labor Note Applies
C - Included In Clear Coat Calc
ESTIMATE RECALL NUMBER: 71271200616:05:23 6195
Ultra~ is a Trademark of Mltchelllntematlonal
Mitchell Data Version: JUL_06_A Copyright IC) 1994 . 2003 Mnchelllntematlonal
UltraMate Version: 5.0.215 All Rights Reserved
Page 1 of 2
.
Date:
Estimate 10:
Estimate Version:
Preliminary
Profile 10:
7/27/200604:05 PM
6195
o
.
M~chell
Add"
labor Sublet
I. Labor Subtotals Units Rate Amount Amount
~ ~
Body 5.7 48.00 12.00 0.00
Refinish 5.6 48.00 12.00 0.00
Totals
285.60 T
280.80 T
566.40
39.65
606.05
II. Part Replacement Summary
Taxable Parts
Sales Tax @
7.000%
Amount
80.70
5.65
Taxable labor
labor Tax
Total Replacement Parts Amount
86.35
@ 7.000%
labor Summary 11.3
III. Add~ional Costs
Non-Taxable Costs
Amount
151.05
IV. Adjusbnents
Insurance Deductible
Amount
0.00
Total Additional Costs
151.05
Customer Responsibility
0.00
I.
II.
III.
Total labor.
Total Replacement Parts:
Total Add~ional Costs:
Gross Total:
606.05
86.35
151.05
843.45
IV.
Total Adjusbnents:
Net Total:
O.Ql;
843045"
This is a preliminary estimate.
Additional chanaes to the estimate mav be reauired for the actual repair.
ESTIMATE RECALL NUMBER: 7/271200616:05:23 6195
UItraMate Is a Trademal1< of Milchelllntematlonal
Mitchell Data Version: JUL_06_A Copyright (C) 1994 - 2003 Milchelllntemational
UItraMate Version: 5.0.215 All Rights Reserved
Page 2 of 2
"
, ,
Date:
Estimate 10:
Estimate Version:
Preliminary
Profile 10:
Riley's Auto Sales Co.
Damage Assessed By: Dave DeMoss
Deductible: UNKNOWN
4455 Dodge St. Dubuque, IA 52003
(563) 588-2326
Fax: (563) 588.9286
Tax 10: 42-0957277 EPA #: 1AD051003184
Insured: BARB SCHNEE
Address: 2257 CHANNEY RD APT 6 DUBUQUE, IA 52001
Telephone: Home Phone: (563) 543-6488
Mitchell Service: 915529
Description: 2004 Chrysler PT Cruiser
Body Style: 40 Wgn Drive Train: 2.4L Inj 4 Cyl4A FWD
VIN: 3C4FY 48B24T305945
Options: ALUM/ALLOY WHEELS, AIR CONDITIONING, POWER WINDOWS, POWER DOOR LOCKS
CRUISE CONTROL, AUTOMATIC TRANSMISSION, AM-FM STEREO/CDPLAYER(SINGLE)
Line Entry Labor
Item Number Type
---
1 502628 BOY
2 AUTO REF
3 502840 BOY
4 501287 BOY
5 502392 BOY
6 AUTO REF
7 AUTO REF
8 933005 BOY
9 933018 REF
10 AUTO
11 AUTO
Operation
REPAIR
REFINISH
REMOVE/REPLACE
REMOVE/INSTALL
REPAIR
REFINISH
ADD'L OPR
ADD'L OPR
ADD'L OPR
ADD'L COST
ADD'L COST
Line Item
Description
R QUARTER OUTER PANEL
R QUARTER PANEL OUTSIDE
R REAR COMBINATION LAMP
REAR BUMPER COVER
REAR BUMPER COVER
REAR BUMPER COVER
CLEAR COAT
RESTORE CORROSION PROTECTION
MASK FOR OVERSPRA Y
PAINT/MATERIALS
HAZARDOUS WASTE DISPOSAL
. . Judgement Item
# - labor Note Applies
C - Included in Clear Coat Calc
ESTIMATE RECALL NUMBER: 7/27/200616:13:21 7113
UltraMate Is a Trademark of Mitchell International
Mitchell Data Version: JUL_06_A Copyright (C) 1994 - 2003 Mitchelllntematlonal
UltraMate Version: 5.0.215 All Rights Reserved
Part Type/
Part Number
Existing
5288742AG
Existing
7/27/200604:13 PM
7113
o
Mitchell
Dollar labor
Amount Units
1.5*#
C 2.1
80.70 0.2
1.0
1.5*
C 2.0
1.2
10.00' 0.3'
5.00*
159.00'
2.65'
Page 1 of 2
Date:
Estimate 10:
Estimate Version:
Preliminary
Profile 10:
7/27/200604:13 PM
7113
o
Mitchell
Add'l
labor Sublet
r. Labor Subtotals Units Rate Amount Amount
Body 4.5 49.00 10.00 0.00
Refinish 5.3 49.00 5.00 0.00
Taxable Labor
Labor Tax @ 7.000 %
Labor Summary 9.8
Totals
230.50 T
264.70 T
495.20
34.66
529.86
II. Part Replacement Summary
Taxable Parts
Sale. Tax @
7.000%
Amount
80.70
5.65
Total Replacement Parts Amount
86.35
III. Additional Costs
Taxable Costs
Sales Tax
@
7.000%
Amount
2.65
0.19
IV. Adjustments
Customer Responsibility
Amount
0.00
Non-Taxable Costs
159.00
Total Additional Costs
161.84
I.
II.
III.
Total Labor:
Total Replacement Parts:
Total Additional Costs:
Gross Total:
529.86
86.35
161.84
778.05
IV.
Total Adjustments:
Net Total:
0.00
778.05
This is a Dreliminarv estimate,
Additional chanaes to the estimate mav be reauired for the actual reDair.
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: 7/27/200616:13:21 7113
UltraMate is a Trademark of Mitchell International
Mitchell Data Version: JUl_06_A Copyright (C) 1994 - 2003 Mitchell International
UltraMate Version: 5.0.215 All Rights Reserved
Page 2 of 2