Claim by Willam AmbrosyBARRY /~-. LINDAHL, ESQ.
CITY ATTORNEY
MEMO
To:
DATE:
RE:
Claimant
Mayor Roy D. Buol and
Members of the City Council
March 1, 2007
Claim against the City of Dubuque by William Ambrosy
Date of Claim
William Ambrosy
02/22/07
Date of Loss
Nature of Claim
02/01/07 Vehicle Damage
This is a claim in which the claimant alleges that while his automobile was parked on
Central Avenue near 8th Street, a City of Dubuque Police Department vehicle backed
into claimant's vehicle, damaging the front bumper cover.
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
Jeanne Schneider, City Clerk
Kim Wadding, Chief of Police
William Ambrosy
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
BARRY A. LINDAHL, E
CITY ATTORNEY
MEMO
To:
DATE:
RE:
Claimant
Mayor Roy D. Buol and
Members of the City Council
March 1, 2007
Claim against the City of Dubuque by William Ambrosy
Date of Claim
William Ambrosy
02/22/07
Date of Loss
02/01 /07
Nature of Claim
Vehicle Damage
This is a claim in which the claimant alleges that while his automobile was parked on
Central Avenue near 8th Street, a City of Dubuque Police Department vehicle backed
into claimant's vehicle, damaging the front bumper cover.
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
vJeanne Schneider, City Clerk
Kim Wadding, Chief of Police
William Ambrosy
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, 16. 2007 59PM CITV OF DBQ LEGAL DEPT No.
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 daim.
The claim must be filed with the City Clerk at City Hall, 50 West 13"' 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 wilt 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: William Ambrosy`
2. Address: 4471 Bennettviele Rd Zwingle, IA 520179.
Telephone Number 556-6930 / 563-543-6445
Date of Incident: 02/09/07
5. Time of Incident: 10:21
6. Location of Incident (Be specific):
Central Ave 1st parking spot south of Hendrick's drive way
8. What were weather conditions like?Clear and cold
9. Give name and address of any witnesses:
10. Did police investigate? .(If so, give names of officers.) Yes Douglas Springer
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 emdlavee's name.) car was parked by meter and a City pickup driven by David Haupert
backed into the front end while trying to leave the parking spot in front.
deb, ?6.. 2007 1.06PM CITY OF DBQ LEGAL DEPT No. 0116 P, 2
11, Was anyone injured? (If so, give names, addresses, and extent of injuries).
%:f_~~~
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.) `t ~)
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.)
i~~
15. ,Wy hat amour do you
from the City of
liter>> ~
l~ r
16. Why do you claim the
of Dubuque is responsible?
^_ntcc~? ~w'~U r.~t.~.
1.7. 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, end if so, in what amount?
Dated this 20th day of February 2007
(Signature)
(Print Name} -~ - ~ _
Date: 2/ 9/2007 04:42 PM
Estimate ID: 6603
Estimate Version: 0
Preliminary
Profile ID: CUSTOMIZED
MIKE FINNIN FORD
3600 DODGE STREET, DUBUQUE, IA 52001
(563 556-1010
Fax: (563) 690-1086
Tax ID: 14-1862673
Damage Assessed By: RICK STUMPF
Deductible: 0.00
Insured: WILLIAM AMBROSY
Mitchell Service: 910073
Description: 2004 Chrysler Pacifica
Body Style: 4D Wgn
VIN: 2C8GF68474R178912
Color: GOLD
Line Entry Labor Line Item Part Typel
Item Number Type Operation Description Part Number
1 AUTO BDY OVERHAUL FRT BUMPER COVER ASSY
2 001629 BDY REMOVE/REPLACE FRT UPR BUMPER COVER 5102341AB
3 AUTO REF REFINISH FRT UPR BUMPER COVER
4 000011 BDY REMOVEIREPLACE FRT LWR BUMPER COVER YM13AJ6AA
5 000030 BDY REMOVE/REPLACE FRT BUMPER LK:ENSE ATTACHMENT PKG 4857750AB
6 AUTO REF ADD'L OPR CLEAR COAT
7 933018 REF ADD'L OPR MASK FOR OYERSPRAY
8 AUTO ADD1 COST PAINT/MATERUILS
9 AUTO ADD'L COST HAZARDOUS WASTE DISPOSAL
Drive Train: 3.SL Inj 6 Cyl 4A AWD
* -Judgment Item
# -Labor Note Applies
C -Included in Clear Coat Calc
Add')
Labor Sublet
I. Labor Subtotals Units Rate Amount Amount
Body 2.7 51.00 0.00 0.00
Refinish 3.7 51.00 12.00 0.00
Taxable Labor
Labor Tax ~ 7.000 %
Labor Summary 6.4
Dollar Labor
Amount Units
2.7 #
240.00 INC #
c z.s
264.00 INC #
27.95 INC #
1.0
12.00 * 0.1""
100.80
1.80 "
Totals II. Part Replacement Summary Amount
137.70 T Taxable Parts 531.95
200.70 T Sales Tax ~ 7.000% 37.24
338.40 Total Replacement Parts Amount 569.19
23.69
362.09
ESTIMATE RECALL NUMBER: 2/ 9/2007 16:42:33 6603
UltraMate is a Trademark of Mitchell International
Mitchell Data Version: JAN_O7_A Copyright {C) 1994 - ZO05 MRchell Intemational
UltraMate Version: 6.0.020 All Rghts Reserved
Page 1 of 2
Date: 2/ 9/2007 04:42 PM
Estimate ID: 6603
Estimate Version: 0
Preliminary
Profile ID: CUSTOMIZED
III. Additional Costs
Non-Taxable Costs
Total Additional Costs
Amount IV. Adjustments
102.60 Insurance Deductible
102.60 Customer Responsibility
I. Total Labor:
II. Total Replacement Parts:
III. Total Additional Costs:
Gross Total:
IV. Total Adjustments:
Net Total:
Amount
0.00
0.00
362.09
569.19
102.60
1,033.88
0.00
1,033.88
This is a areliminarv estimate.
Additional changes to the estimate may be required for the actual reaair
ESTIMATE RECALL NUMBER: 2! 9!2007 16:42:33 6603
UltraMate is a Trademark of Mitchell International
Mitchell Data Version: JAN_07_A Copyri9M (C) 1894 -2005 Mitchell International
UltraMate Version: 6.0.020 All Rights Reserved
Page 2 of 2