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Claim by Mark LangeBARRY A. LINDAHL, ESQ. CITY ATTORNEY MEMO To: Mayor Roy D. Buol and Members of the City Council DATE: February 28, 2007 RE: Claim against the City of Dubuque by Mark Lange Claimant Date of Claim Date of Loss Nature of Claim Mark Lange 02/21/07 02/1507 Vehicle Damage This is a claim in which the claimant alleges that his vehicle, which was parked near the intersection of Dell and Avon Streets, was struck by a City recycling truck. This claim has been referred to Public Entity Risk Services of Iowa, the agent for the Iowa Communities Assurance Pool. BAL:tIs cc: Michael C. Van Milligen, City Manager Deanne Schneider, City Clerk Paul Schultz, Solid Waste Management Supervisor Mark Lange OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA SUITE 330, HARBOR VIEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001-6944 TELEPHONE (563) 583-4113 / FAx (563) 583-1040 / EMAIL balesq@cityofdubuque.org Feb-20-07 04:32P Claim Form City Clerk First floor of City HaA, 50 W. 13th Street Phone: (563) 589-4120 Fax:(563)589-0890` Hours: 8 a.m. to 5 p.m. Monday through Friday Email: j>~-n~id~citvo~tubp<q~ie,4rg CLAIM AGAINST THE CITY OF DUBUQUE, IOWA P_Ol Pagc 1 oY3 © Enter Key l.il:K lari t'i<1~`f Ali This written report constitutes your claim against the City of Dubuque, Iowa. You should compte fuU and attach any additional information that supports your claim. The Gaim must be filed with the City Clerk at City Hall, 50 West 13th St., Dubuque, IA 52001. It referred to the appropriate department for investigation and to the City Attorney's Office. Once ~ is completed, a report and recommendation will be submitted to the City Council. You will be prc copy of that report and recommendation. The final decision on all Gaims is made by the City Council. No employee of the City of Dubuqu authority to make any representatioln to you as to whether your claim will or will not be paid. ~" _ 1. Name of Claimant: Mark Lange 2. Address: 326 Monroe Ct., Dubuque 3. Telephone Numger. 563-556-9219 o 4. Date of Incident: 2/15/07 5. Time of Incident: 9:01 a.m. 6. Location of Incdent (fie speafic): Dell and Avon 7. Describe the accident or occurrence that caused injury or damage. (Give full details upon whi your _cla1i'm. K a City employee was iln~volved, give the employee's name.) Unknown how accident happened when Mark's daughter came to her car, the police were there. The city vehicle hit 96 Cavalier. Drive was Alvy Kennedy. 8. What were weather conditions like? Clear 2/snow on ground 9. Give name and address of any witnesses: 10. Dlid police inve~s-tigate? (If so, give names of officers.) Yes, Fairchild badge #121 http://www.cityofdubuque.orb;/index.cfm?pageid=155 2/20!2007 Horne_Pape :Departments : City_Cierk :Claims against the Clty_: Clalr>rt FOrt11 Feb-20-07 O4:33P Claim Form P.O2 Page 2 of 3 11. Was anyone injured? (lf so, give names, addresses, and extent of injuries.) ~~~ 12. Was any damage done to property? (If so, describe property and the extent of damages. Atl damages or describe basis for ascertaining extent of damage.) 13. What other damages do you claim, if any? ~~ 14. Have you been compensated for any part or al( of your claim by any insurance company? (f i and address of ~isurance company and amount paid.) A~,, 15. What amount do you daim from the City of Dubuque? ~~ ~ 1 • ~~ 16. Why do you claim the City of Dubuque is responsible? ~(lh~ ~ ~,aa'L~n~~C~ 17. Nave you made any daim against anyone else for damages as a result of this incident? (If y and address.) 18. If the answer to Question 17 is yes, have you received any payment from that source, and if amount? Dated this oZ_~ day of ~C.~3 Q ~ A ~ ~ , 20 d ~~. {Signa~tufr~e) (Print Name) Nome, Pale : Daaartmenks :City Clerk :Claims against the City : Ci~aln't ~fl['f11 http://vwvw.cityofdubuque.org/index.cfm?pageid=155 2/20/2007 Feb-20-07 04:33P a w av ~. civ~s va •.~u t u roll PIV. 02/16/?.007 at 05:28 PM Job Vrunbcr: 24493 A9RA - Dtl8D'QVS Federal ID x:420782295 DBA: At3DERSON--WEBER INC 3400 C&NTER GROVE OA DUBUQUE, IA 52003 (563)556-0696 Fax: (563)556-1899 PREI.IblINART E:STIMaITE Written 8y: DAVE: BIGELOW Adjuster: Insured: MARK LANGE Ow'[ner: MAiiK LANCiE Address: 326 MONROB CT Y][3BUpUE, IA 52003 Day: (563)556-9219 In9pect A$RA - DUBUQUE iocation: 3400 CENTER GROVE DR DUBUQUE, IA 52003 ClaS.a ~ Policy IF Dec~ctiblo Data of Loss: Type of ions: Point o~ Im~aet: Tatsuzancta PUIILIC .ENTITY C:o~any: 1996 CHEV CAVALIE:Ft 4-2.27.-fI 4D SED RED Int: Busiuaas: (563}556-0696 Days to Re~~air P_03 r. uc VIN: lG1JCS248T7259266 Lic: 085NEQ IA Psod Date: adoa-etar: 10I185 Intermittent Wipers Tinted Glass Dual Mirr ors Glean Coat Paint Power Steering Power Dra kes Anti-Lock Brakes (4} Driver Rir Bag Passenger Air Bag Cloth Beaks SuckEt Seats Recline/L ounge Scats 5 Speed Ttan~mission Overdrive NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT 1 REAR BUMPER 1** Repl RECOND Bumper cover painted 1 147.00 1. ..6 2.6 3 Add for Clear Caat 0 0.00 0.0 1.0 4 rut t0 fit sedan 0 0.00 0.4 0.0 S REAR LAMPS 6 Repl RT Tail lamp Assy cuter 1 105.80 Incl. 0.0 7 QU7IRTER PANEL 8 R~pl Fuel door 1 55.59 Incl. 0.3 9 Add Pon Clear Coat 0 0.00 Q.0 0.1 10 Repl RT Quarter panel 1st design I 603.26 12.5 2.8 11 Add for Clcar Coat 0 0.00 0.0 1.1 1?. Deduct for Rear Bumper R&Z 0 0.00 -1.3 0.0 Subtotals -=> 921.65 ]3.2 _ 7.9 1 Feb-20-07 04:33P I Li! iJ V I IIVII V1'.ll f U 02/16/?.007 at OS:?_A PM 29943 1 11f1 ifVa fob dumb?r: P.04 a• Vv pRELU~rwsY ~s~r~~-r>z 1996 CHEV CAVALIER 4-2.2L-~'Z 4D S>~D RED Int: Parts 931.65 Body Labor 13.2 hrs C~ $ 51.00/hr 673.20 Paint Labor 7.9 hrs @ S 51.OOIhr 402.90 Paine Supplies 7.9 hrs C+ S 31.00/hz 249.90 SUDTOT'AL S 2232.65 Sales Tax $ 1987.75 ~ 7.000Oa 139.14 GRAND TOTAL S 2371.79 Av3U3TMENTS: Aeduct:ible 0.00 CDSTOMFaft PAY $ 0.00 INSURANCE PAY $ 23?1.79 WAR1t1+iNTY VALID 01~LY WITH ORIGIONAL COPY OF YOUR RECEIPT FARTS SUB,TECT TO LNVOICf~~ NO GUARANI'1;1r ON RUST ALL FARTS NF.W, UNLESS OTHERWISE NOTED WARRANTY VALID ONLY WITEI ORIGIONAI~ COPY 06' RECEIPT. PART'S 5UBJf:CT TO INVQICE. NO GUAit11NTEES c)N RDST. 71LL PARTS NEW, UNLESS OTI31~RWiSE SPECII'IrD. 7;::~1'im~ltc based on MOTOR C1tASFi ESTTMaTZNG GUIDE. Unless otherwiso noted all items are derived lrcm the Gui.dr DR1CL95 U~,tabase Datc 01/2007, CCC Data Date 02/2087, and Lhc+ parf.s selected are OF'N-parts rlanutartured by the vehicles Original Equi.pmLnt ManuLacturer. OL•M parts era available at OE/Vehicle dcalerSYli.p5. OPT 4~~M (Optional OEM) or ALT OEM (Alternative OEM} parts ar.e OLM parts that laay be provided by or through altornat2 Souxca9 other than th~^ OEM vehicle dealal::,hips. OPT OE:M or ALT pi'M parts tray reflect' some sQeciPic, SpFCial, or unique pricing or discount. OPT OE`i ur ALT OEM parts may SnCluda "Blemished" parts provided by 0~'.M's through OEM vehicle dealerships- Asterisk (+} or Double Asterisk (y~j indicator that the parts and/or labor inl.vrmation provided by MOTOR may have been modi.fled or may have come from as alternate data source. Ti1dc sign ,-j items indieflLrv MOTOR Not-Included I.Sbor aperaLions. Non-Original E;quipmcnt MarluLacturer oftermarket pares are described as AM, Qual Repl Yarts or (:omp Repl tarts which stalldr. for Competitive Repl~icemcnt Parts. Used pacts are described as LKQ, Quai Recy ParCa, RCY, of USED. Re~ondi.tioned parts aze described a9 Recon. Recored parts arc described as Rccere. BAGS Part Numbers and 8enchmazk Prices are provided by National Aul-o Glass ~pecSf.icntions., f.abor operation times listed on ttte li.nc with Chi Ni1GS information ar.E MOTOR suflryr+5ted labor operation times. NAGS laY,or opcratioa Limes are not incl»drd. Pound sign (f} itel~iv indicate n1~I1:11aI «ntric,;. Some 2006 vehicles Contain minor changes from the (Irevious year. For thoac vehicles, prior to zeceiving updated data from the vehic]o manufactuzcr, labor and pane data fzom tYle proviou9 year may bH ilsed_ The Pathways estitnatot has a complete list of ~IpplicaGle vehicles. Parts numbers dnd pziccs should be confirmed wiCY. the loC•)1 dealership. CCC P~Chways - A product nl' CCC In:oYmaLion Services Znc. 2 Feb-20-07 O4:34P . rv av vi uvn v, •v. , u 0?./1612007 rat 05:2fi PM 29443 .,.~ .,..~ P _ 05 t. vT Job Vumb~r: PREL3Z3INARX ESTIMATE 2996 CFIEV c:AVALIER 4-2 .2L-FI 4D S£D AED IAt: ALTERNAI£ PARTS SUPPLIERS 2 RECOND 8ttmper Over painted Past No. GM110051.OR Key3tone - NWPP ($00)747-2500 2900 KBRPRA BLVD. (563}55b-5030 DCIBU4U3~:, IA 52001 Price S14?.00 3 Feb-20-07 O4:34P P.O6 FEB-15-07 THU 02;41 Pli FAX N0. ~'. UZ ~ !'n' i r ~ ACCIDE~IY ZltFOItxATfoat ~~ ~ ~ j ~? q a~ ~~BJ~~ DAI98it=S LICE1tSE ~itTlmE~ S?A1~ s TIPB XYST81CTI0KS ~-i ~"- Q " o~ue s ~nn~sss ~i73d~7 ~T~~ CI'fT STASB ZI! CADL V~L LICElt3E SY~.IY AGE PASS ~~ - ~~ ~~c co~l~ ix c~o~~r vix xvr~sE>t ~ 7ti y~-s ~ ~~ ~~G~~~ ~~ ~~-~