Claim Hilvers, Timothy B.
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CLAIM AGAINST THE CITY OF DUBUQUE, IOWA J,t '/ 5-
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: Timothy B. Hilvers
2. Address: 1332 Birchwood Lane
`
3. Telephone Number: 608 732 7358 (nights) 563 589 6695 (days)
4. Date of Incident: 29 Sep. 06
5. Time of Incident: 7:20 AM
6. Location of Incident (Be specific):
Roosevelt St. Approximately 100-200 yards from interseciton of Peru Rd. See Attachment.
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.)
Refer to attached Police report describing incident. Damage was incurred by my vehicle due to improperly maintained tree.
8. What were weather conditions like? Overcast
9. Give name and address of any witnesses: Matt Schoenberg, driver of First Supply Truck.
10. Did police investigate? (If so, give names of officers.)
Yes, Officer Jason Hoerner.
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, damage to right headlight, right mirrow, hood, right side, (various locations) and front bumper. See
attached repair estimate from Cuba City Collision.
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?
$1,686.11 (One Thousand Six Hundred Eighty Six)
16. Why do you claim the City of Dubuque is responsible?
City tree was not properly trimmed to allow clearance.
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 26th day of October, 2006. , 20 .
/s/ Timothy B. Hilvers
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
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 ilPpropriate 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:~""'D-Y\-'1 ~, H',I\lees
2. Address: /)3). ~~r-('~vJooJ L"-NL-
3. Telephone Number bO'b -,1~-13S8 (,,'\~kh) 5~3-S8'l- 6''\~ (,10..1<)
5. Time of Incident:
~q- ~- 01"
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4. Date of Incident:
6. Location of Incident (Be specific):
. ~O:::4~~ )-t~ ~ef'C";M~h.lr
, ..:. t <<,,,,,,- f "R. J.
100 - :10<' :e:f'{ S'
S.H. .-. tt""ht .
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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 were weather conditions like?
Q"q-c<\.s-T"
9. Give name and address of any witnesses:"
;\\,,,-It { \'oe..",- h4'" - J{';.-<-r o-f f=,rs1 ~J~\l+(,J'k.
10. Did police invewate? (If so, give names of officers.)
'I~ s. f)' '.:.u- ~(CN\. Hoc.r-(\~
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
IJo
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
e~ent of damage.) .
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13. What other damages do you claim, if any?
JJl7Y\A.
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 paitj
o .
15. Wbat amount do you
~ j ~,. "
st
16. Why do you claim the City of Dubuque is resP~)n~~
(; 1r3l"U. ~" no't rr"~....... \[--fr,,,,,
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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.)
)Jc .
18. If the answer to Question 17 is yes, have you received any payment from that
source, and if so, in what amount?
11- -L
Dated this ).., day of Oc. ~b~
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(Signature) '1
~""'-" ~ 15. H , \VE!.fS
(Print Name)
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OCT 12 2006 THU 02:56 PM
FAX NO.
P. 02
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This written report con.titutes your clilm against the City of Dubuque. Iowa. You should complete this form in 5-IfP~
fUll and attach any edditionellnformetlon thit supports your claim. 1--
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COpy
CLAIM AGAINST THE CITY OF DUBUQUE, IOWA
The Claim must be filed with the City Clerk at City Hali, .0 West 13th St., Dubuque, IA 52001. It will then be
referred to the approprl819 department for investigation end to the city Attorney's Office. Once that
Investigation is completed, a report end recommendation will be submitted to the city council. You will b.
provided with i copy of that report and recommendation.
The flnal deCision on all clam. js made by the City CounCil. No employee of the City of DUbuque hiS the
authority to meke eny representation to you as to whether your cialm will or will not be paid.
1. Name of Claimant: \=\(s\ C)1l~l?lu, LLC'_
2. Addr.ss: ;l 'i [') D... v,.e..r ~ C ~~I A .
3. Telephone Number: "In"':l,. h 'f,:J. - \ <f.q z:J
4. Dato of InCident: q- .aCl ~ [) L:,
.. TIm. of Incident: "l '. 30 AM..
6. Location of Incident (Be spaclfic): ~ (JDS t',\I-e.l Ie C\.J{!""""; I ()C'l ''fa.fA>.
'a.U'r,o. ? {" tll 0.. d .
7. Describe the eccldent or oocurrence that ceused injUry or damage. (Give full de\llil. upon which you base
your claim. If a City employee was l!Wolved, give the employeelJs name.)
See (A+n.c..t-...)
10. Did police Investlgete? (If so, give names of officers.)
:)n';6r1 tiner-net Ca.~-t" ~ 0&,-Llt.jD,':J1
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8. What were weather conditions like? ") I :..;; k(J..f" ~ ~ '" r 0.', ~
a. GIV9 name and address of any wnnesses: ,."., J 1/'" r
,
11. Was anyone Injured? (If so, give <names, addresoes, and extent of Injuries).
AI 0 pop r<OYla~' nJ""1
12. Was eny damege done 10 property? (If so, de.cribe property and the extent of damilges. Atlech estimates
of damages or describe basis for aaalrtalnlng extent of damage.)
S-e-e a +-I-r,r \.;-ed,
13. Whet other damages do you Claim, If any?
/6
COpy
hLtp:llwww.cityofdubuque,orglprinterjriendlY .cfm?PageID~15 5
09129/06
OCT. 12-200~.JHU 02: 57 PM
FAX NO,
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14. Have you bean compensated for any perl ar all af yaur ctaim by any insurance company? (If sa, give
nama and address of Insurance campany end amaunt paid.)
, NO
15. What "maunt de yeu c1lim from the City 0.1 Dubuque?
Jl tjry J. '6()
15. Wlly de yeu claim the City af Dubuque Is r.sponsible? (!., ~-..l -\- r ~ r:? \. VI <::.
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17. Heva yau made any claim .gainst anyane alsa for da",age..s 8 result althl.lncldent? (II yes, give'n8",e
Ind address.)
18. II the answer to Questien 17 Is yes, hava yau received any Ply",ent fro", that aaurea, "nd II so,ln what
amount'?
Dated this
I I ~ayol O"..j....,~
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(prtnt Neme)
grlnUhis.pall.
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http://www.cityofdubuque.org/printerjriendly.cfm?PageID-155
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09/29/06
OCT l2100DHU 02: 57 PM
FAX NO.
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FIRST SUPPLY
The Midwesl', Premier Dirtrlbut~r I Since 1897
copy
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Attachment
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#7
At approximately 7:30 am on 9-29-06 our First Supply LLC city delivery driver
was delivering a whirlpool- tub/shower unit. He was driving on Roosevelt;
approximately 100 yards before Peru Rd. The shower unit clipped low hanging tree.
Tree broke off and hit car that was drivina: behind our flat bed truck. Car owner Tim
Hilvers.
# 12
When measured with tub/shower unit on truck from ground up to top of unit
measures 10.5 feet, impact on unit occurred at 9.5 feet.
Our cost of tub/shower whirlpool unit is $772.80 per attached invoice*.
Damage to whirlpool- tub/shower unit
Top comer "' piece broken off, with crack in unit running I foot vertical OD unit.
Noticed damage to Tim Hilvers vehicle = Tim is filing his own claim.
Attached you will find page 1 of the pollce report we filed with Officer Jason Hoerner. .
We were unable to obtain a copy of page 2 (the detail of the police report) the reCord
department at the Law enforcement center said it is considered "Investigative
information" and to obtain the second page we must have it subpoenaed -even though we
filed the report.
COpy
F"" Supply ,Le I ~400 Korper ~I.d.. po 8., 88, Dubuque, I~ S200.-0088 I Phone: (563) 582-1895 'ox: (563) 582-0612
www.llupply.com
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CUBA CITY COLLISION
119 W. CALHOUN ST.
CUBA CITY, WI 53807
OFFICE: 608-744-8890 FAX: 608-744-7373
ID # 39-1828105
SHOP:
ADDRESS:
CITY STATE:
ZIP:
CD LOG NO 2791-1
DATE 10/02/06
CUBA CITY COLLISION
119 WEST CALHOUN STREET
CUBA CITY, WI
53807-
INSP DATE:
PHONE 1:
FAX:
OWNER:
ADDRESS:
CITY STATE:
ZIP:
HILVERS, TIM
1332 BIRCHWOOD LN
HAZEL GREEN, WI
53811
POINT OF IMPACT: 2
LIC#: 302-AHJ
BODY COLOR: MAROON
CONDITION:
*=USER-ENTERED VALUE
EC=REPLACE ECONOMY
UM=REMAN/REBUILT PRT
OE=REPLACE PXN OE SRPLS
TE=PARTL REPL PRICE
I=REPAIR
TT=TWO-TONE
N=ADDITIONAL LABOR
AA=APPEAR ALLOWANCE
HOME PHONE:
10/02/06
(608)744-8890
(608)744-7373
(608)732-7358
DAYS TO REPAIR: 0
STATE:
VIN:
MILEAGE:
ACCTNG CTL#:
E=REPLACE OEM
UE=REPLACE OE SURPLUS
EU=REPLACE SALVAGE
PC=PXN RECONDITIONED
ET=PARTL REPL LABOR
L=REFINISH
CG=CHIPGUARD
RI=R&I ASSEMBLY
RP=RELATED PRIOR
2000 CHEVROLET IMPALA LS 4DOOR SEDAN
CODE: U4163B/A OPTNS K/24ADEGHILUMN
2GIWH55K5Y9162114
97,242
NG=REPLACE NAGS
UC=RECONDITIONED PRT
EP=REPLACE PXN
PM=PXN REMAN/REBUILT
IT=PARTIAL REPAIR
BR=BLEND REFINISH
SB=SUBLET
P=CHECK
UP=UNRELATED PRIOR
6CYL GASOLINE 3.8
OPTIONS:
TWO-STAGE - EXTERIOR SURFACES
BUMPER COVER MOUNTED FOG LAMPS
REMOTE KEYLESS ENTRY SYSTEM
ANTI-LOCK BRAKE SYSTEM
CRUISE CONTROL
FRONT SIDE IMPACT AIRBAGS
TWO-STAGE - INTERIOR SURFACES
HEATED REMOTE CONTROL MIRRORS
REAR SPOILER
TRACTION CONTROL SYSTEM
OVERHEAD CONSOLE
STRG WHEEL MTD RADIO CONTROLS
OP GDE MC DESCRIPTION MFG. PART NO. PRICE AJ% B% HOURS R
----------- ------------ ----- ----- -
RI 0006 FRONT BUMPER COVER R&I R&I ASSEMBLY 2.3 1
I 0006 COVER,FRONT BUMPER REPAIR 2.0*1
L 0006 13 COVER,FRONT BUMPER REFINISH 3.7 4
EC 0042 HEADLAMP ASSY,HALOG RT ECONOMY PART 197.00* INC 1
N 0973 HEAD LAMPS AIM ADDNL LABOR OPERA 0.4 1
PAGE 1
2000 CHEVROLET IMPALA
~CD LOG NO 2791-1
LS 4DOOR SEDAN
BR 0083
I 0104
L 0104
I 0327 07
L 0327 10
RI 0230
L 0230
E 0349
EC M03
EC M17
SB M60
PANEL, HOOD
FENDER, FRONT
FENDER, FRONT
PANEL ASSY,BODY SID
PANEL ASSY,BODY SID
MIRROR, SPORT R/C
MIRROR, SPORT R/C
EMBLEM, QUARTER PANE
FLEX ADDITIVE
COVER CAR EXTERIOR
HAZARD. WSTE. REM.
BLEND REFINISH
RT REPAIR
RT REFINISH
RT REPAIR
RT REFINISH
RT R&I ASSEMBLY
RT REFINISH
RT 10424490 GM PART
ECONOMY PART
ECONOMY PART
SUBLET REPAIR
21.71
5.00*
3.00*
3.00*
1. 8 4
3.0*1
2.2 4
1.5*1
2.9*4
0.7 1
0.6 4
0.2 1
1*
1*
1
16 ITEMS
MC MESSAGE (S)
07 STRUCTURAL PART AS IDENTIFIED BY I-CAR
10 INCLUDES AUDATEX TIME TO CLEAR ENTIRE PANEL
13 INCLUDES 0.6 HOURS FIRST PANEL TWO-STAGE ALLOWANCE
FINAL CALCULATIONS & ENTRIES
GROSS PARTS
OTHER PARTS
PAINT MATERIAL
PARTS & MATERIAL TOTAL
TAX ON PARTS & MATERIAL @
5.500%
21.71
205.00
324.80
551.51
30.33
LABOR
1-SHEET METAL
2-MECH/ELEC
3-FRAME
4-REFINISH
5-PAINT MATERIAL
LABOR TOTAL
TAX ON LABOR
SUBLET REPAIRS
TAX ON SUBLET
TOWING
STORAGE
RATE
49.00
65.00
65.00
49.00
29.00
REPLACE HRS
3.2
REPAIR HRS
6.9 494.90
11.2
548.80
@
1,043.70
5.500% 57.40
3.00
5.500% 0.17
@
GROSS TOTAL
1,686.11
NET TOTAL
1,686.11
SHOPLINK U5781 ES CD LOG 2791-1 DATE 10/02/06 04:47:59PM R6.37 CD 09/06
HOST LOG
(C) 1998 - 2006 AUDATEX NORTH AMERICA, INC.
3.1 HRS WERE ADDED TO THIS EST. BASED ON AUDATEX TWO-STAGE REFINISH FORMULA.
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PAGE 2
Exhibit 2
~
Exhibit 3
.
c
Exhibit 5
Exhibit 6
Exhibit 9
Exhibit 10