Claim Sutter, MarkCLAIM 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: Mark Sutter
2. Address: 135 Wisconsin Ave. E. Dub., IL 61025
`
3. Telephone Number: 815 747 7727 or 563 542 6778
4. Date of Incident: 10-25-06
5. Time of Incident: Approx. 1:20 P.M.
6. Location of Incident (Be specific): Payton Dr. & Northwest Arterial
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 was stopped at Stop Sign to turn on to the Arterial and the Keyline Bus Driven by James Melloy Drive into my truck hitting me in the right rear.
8. What were weather conditions like? Good
9. Give name and address of any witnesses: None
10. Did police investigate? (If so, give names of officers.)
Yes - Officer 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, Right rear of my bumper and right rear quarter panel.
13. What other damages do you claim, if any?
I was 20 minutes late for work.
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?
Estimate of repairs.
16. Why do you claim the City of Dubuque is responsible?
Because your driver acknowledged he was in the wrong. I was stopped at the Stop Sign, and the Police cited your driver with the ticket.
No
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 Dubuque, Iowa this 26th day of October, 2006.
/s/ Mark Sutter , 20 .
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
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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 West 13th St.,
Dubuque, IA 52001. It will then be referred to the appropriate department for
investigation and to the City Attorney's Office. 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: ~//" "-- 'S</#e/
2. Address: /'.~ /r ~:')r"'c/1. 5>/'7 /7/e ~d~ /Z. k/~5
3. Telephone Number $S-:7~7-7u 7 c:J/, 0~s-5~ -67;:!)
4. Date of Incident: ,///-.;10:: 06
5. Time of Incident: .,4/I??r:JX, /,,;;o,;:JA
6. Loc.ati~of Incident (Be specific):
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7. Describe the 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.)
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8. What wer~ weather conditions like?
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9. Give name and address of any witnesses:
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10. Did police investigate? (If so, give names of officers.)
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11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
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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.)
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13. What other damages do you claim, if any?
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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.)
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18. If the answer to Question 17 is yes, have you received any payment from that
source, and if so, in what amount?
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10/26/2006 at 08:24 AM Job Number:
24443
ABRA - DUBUQUE
Federal 10 #:420782245
DBA: ANDERSON-WEBER INC
3400 CENTER GROVE DR
DUBUQUE, IA 52003
(563)556-0696 Fax: (563)556-1899
PRELIMINARY ESTIMATE
Written By: DAVE BIGELOW
Adjuster:
Insured: MARK SUTTER Claim #
Owner: MARK SUTTER Policy #
Address: 155 WISCONSIN Deductible:
EAST DUBUQUE, IL 61025 Date of Loss:
Evening: (815) 747-7727 Type of Loss:
Business: (563) 582-7201 Point of Impact:
Inspect
Location:
Insurance PUBLIC ENTITY
Company: Days to Repair
1989 CHEV K15 4X4 FLEETSIDE 8-5.7L-FI 20 SHORT BLACK Int:
VIN: 1GCDK14K9KE172367 Lie: Prod Date: Odometer: 141969
Dual Mirrors Clear Coat Paint Power Steering
Power Brakes 5 Speed Transmission 4 Wheel Drive
Overdrive
NO.
OP.
DESCRIPTION
QTY EXT. PRICE LABOR
PAINT
1 REAR BUMPER
2 Repl Face bar non production chrome 1 376.07 0.7 0.0
3 REAR LAMPS
4 R&I RT Combo lamp assy Fleetside 0 0.00 0.5 0.0
5 PICK UP BOX
6* Rpr RT Side panel w/o dual wheel 0 0.00 2.0 3.5
7 Add for Clear Coat 0 0.00 0.0 1.4
8* R&I RT Body side mldg w/4WD, 1 0 0.00 0.3 0.0
ton black
9 Repl RT Decal 4X4 w/o bow tie 1 27.66 0.3 0.0
silver & red
Subtotals ==>
403.73
3.8
4.9
1
. ,
10/26/2006 at 08:24 AM
24443
Job Number:
PRELIMINARY ESTIMATE
1989 CHEV K15 4X4 FLEETSIDE 8-5.7L-FI 20 SHORT BLACK Int:
Parts
Body Labor
Paint Labor
Paint Supplies
3.8 hrs @ $ 49.00/hr
4.9 hrs @ $ 49.00/hr
4.9 hrs @ $ 30.00/hr
403.73
186.20
240.10
147.00
SUBTOTAL
Sales Tax
$
830.03 @
$
7.0000%
977.03
58.10
GRAND TOTAL
$ 1035.13
ADJUSTMENTS:
Deductible
0.00
CUSTOMER PAY
INSURANCE PAY
$ 0.00
$ 1035.13
WARRANTY VALID ONLY WITH ORIGIONAL COPY
INVOICE NO GUARANTEE ON RUST
OF YOUR RECEIPT
ALL PARTS NEW, UNLESS
PARTS SUBJECT TO
OTHERWISE NOTED
Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived
from the Guide DOIGH88 Database Date 10/2006, eee Data Date 10/2006, 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) or ALT OEM (Alternative OEM) parts are OEM
parts that may be provided by or through alternate sources other than the OEM vehicle
dealerships. OPT OEM or ALT OEM parts may reflect some specific, special, or unique pricing or
discount. OPT OEM or ALT OEM parts may include "BlemishedH parts provided by OEM's through OEM
vehicle dealerships. Asterisk (*) or Double Asterisk (**) indicates that the parts and/or labor
information provided by MOTOR may have been modified or may have corne 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.
cee Pathways - A product of eee Information Services Inc.
2
X-Coordinate
00688870
If accident occurred outside of city
limits snow general vacinity:
On Road, Street, or Highway:
PAYTON DR
Distance Direction Distance
10 Ft 7.W and "N/A"
Definable intersection, bridge, or railroad crossing
NW ARTERIAL
~.
U
N
I
T
001
Driver's Name - Last
MELLOY
Address
8185 VALLEY FORGE ROAD
Gender
Male.
Driver's license Number
-7T3YY2143
ONner Company Name
CITY OF DUBUQUE
Owner's Name - last
Address
50 W.13TH ST
VINNo.
lFDXE45P55HB18959
License Plate #
104314
U
N
I
T
002
Driver's Name - Last
SUTTER
Address
138 WISCINSIN AVE
Gender
Male
Driver's License Number
S38055664104
Owner Company Name
Ovmer's Name - Last
SUTTER
Address
135 WISCINSIN AVE
VINNo.
lGCDK14K9KE172357
License Plate #
585960
County
Dubuque - 31
Literal Description
PAYTON DR
OffICer
HEFEL, JOHN
... --------------'.---
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e
Driver Information Exchange Report
Dubuque Police Department
563-589-441 0
Middle
VINCENT
-i
,
Phone
(553) 589-4196 x
Insurance Co. Phone #
(563)"89-4170 x
Insurance Co. Name
10WA-cOMMUNITIESl'om.:
Insurance Policy #
Middle
Suffix
-
I
,
----1
Zip
52001.
Style
BUS
Vehicle Configuration
18
Approximate Cost to Repair or Replace I
~
Middle
R
Phone ~
(818) 747 -7727 x
Insurance Co. Phone #
(800) 926-2886 x I
Insurance Co. Name
PROGRESSIVE CASUALTY
Insurance Policy #
47040777 -7
Suffix
~
I
Middle
R
Zip
61028-
Style
PICK UP
Vehicle Configuration
02
Approximate Cost to Repair or Replace
Accident occurred within corporate limits of (city)
Dubuque - 2100
j
------.1
"N/A" j
"N/A"
j
: Route (Cardt:'l~I)
Travel Direction
Milepost Number
"N/A"
Or
Law Enforcement Case Number
01-05-48200
Date of Accident
10/25/2006
Time of Accident
12:42 Hrs.
ti~ 1l;fb;eI1e-y
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ft7a y
Printed At: Dubuque Police Department 10126/2006 01 :22 PM
Page 1
Form j: 01-0&-48200