Claim by David BuseBARRY A. LINDAHL, ESQ.
CITY ATTORNEY
MEMO
To: Mayor Roy D. Buol and
Members of the City Council
DATE: March 28, 2007
RE: Claim against the City of Dubuque by David T. Buse
Claimant Date of Claim Date of Loss Nature of Claim
David T. Buse 03/26/07 01/31/07 Vehicle Damage
This is a claim in which the claimant alleges that while his vehicle was parked in front of
2833 Burden Avenue, a City of Dubuque Police Officer backed up his squad car and
struck the back bumper of claimant's vehicle.
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
David T. Buse
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
~.tat~tt rvttu
CLAIf,~ AGAIhIST THE CITY OF DUBUQUE, 14V1fA
t u rJ. ~. a vi i.
i~v~
~~w.
This written report constitutes your claim against the City of Dubuque, Iowa. You should complete thus form in
full and attach any additions! information that supports your claim.
The claim must be filed with the City Clerk at City Hatl, 50 West 13a` St., Dubuque, [A 52001. tt m11 then be
referred to the appropriate department for investigation and to the City Attorney's Office. Once that
irrvestgatior, is completed, a report and recommendation wilt tTe submitted to the City Coundl. You wilt be
provided with a copy of that report and recommendation.
The final decision on alt claims is made by the City Coundl. 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.
t. Narne of Claimant ~'J~ l~ (t~ 1 115 ~-
2. Address: ~~,~ ~ ~r~TZiJ d. r,y ~ v t .
3_ Telephone Number ~ S ~ ~ ~ '7 ~ h
4. Date of Inddent: ~ " 3 ~ -
5. Time of Incident ~S' . 3
6. Location of Incident (Be spedfic}: ~ ~ r^ tc~f ~-~ t h '~V'~~' O~ V/I y ~ cr~,sa ~
C~ ~~33 ~v~ee~t ~~
7. Describe the acadent or occurrence that caused injury or damage. (Give full details upon which you~se
your claim. if a City employee was involved, give the employee's name.}
rr~~' ~f 11ff Q
~~3~'(Cew, ~ in~.G~ ~' a52 ~ ~ ~!kS CA'rC~W17~"i~ot ~' ~y ~ ~
~ c
,~ (o~ ~ ~-~-~ 1~ U~^dt ~. +~Je -I-~ -I- a^.4-~~~ c ti e c.~ v.ic ~ ~.~ -~
~ cr,
8_ What were weather condrfions like? ~ ~~~~ ~ C~~~-vJ ~
S. Give name and address of any ur~-esses: , !~ ~ Gc: i ?~t/~ ~ S c? ,~ '~ ~ ~?':
~N~~~ ~9 ~
10_ Did police investigate? (If so, give names of officers.}
T ~' S ~~c c. P~_ ,~~^ e yr r~G:/ fate ~St~-
-~:
11_ Was anyone injured? ([f so, give names, addresses, and ea~tent of injuries.}
-_ /E.1v
0
-,.r
~ -~
a
m
N ~~
`~' ~-n
-°
,o
w
12 Was any damage done to property? ([f so, describe property and the extent of damages. Attach estimates
of damages or describe basis for ascertaining extent of damage.)
c9 c
~~'~~ a~,z~r A~,~~~~ k ~J OJ - ~ ~Gc~'~,j,r/t C ~c
[/ n
13. Wnat aver damages d/ yo;r claim, if any % ~~ N {~
httn://ww«.citvofdubuaue.orJ~rinter frientllv.cfn~?oa~eicl=155 2/2/2007
rage ~ or ~
14. Have you been compensated for any part or all of your claim by any insurance company? (If so, eve
name and address of insurance company and amount paid.)
~~
15_ What amount do you claim from the City of Dubuque? ~~ ~ %
16. Why do you claim the City of Dubuque is responsible? y~a f C Pte`' ~~ .sZ~"
CIC~~i~fed' ~v ~~c ~cc~c,~«f ~6`te~ ht c~~rtt
17. Have you made any claim agair-st anyone else for damages as a result of this incident? (tf 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 this °~ b day of ~~~ G ~ „ 2Q~
~ ~ ~ ~~
(Signature}
(Pn~nt tdarrre}
pLetet this page
httrj~//www citvnfdnh~inve ~rtr/nrit~ter frienr€[v cfin?na«eic(=i 55 2/2/20t~7
Date:
Estimate ID:
Estimate Version:
Preliminary
Profile lD:
AVALON BODY SHOP, INC.
20680 HWY 52N , RICKARDSVILLE, IA 52039
(563) 552-1656
Fax; (563) 552-1658
Tax ID: 42-1360561
Damage Assessed By: MERLIN WILGENBUSCH
2/ 5/2007 02:50 PM
5785
0
Mitchell
WE HAVE THE CAPABILITY TO E-MAIL DIGITAL PICTURES OF DAMAGE TO YOU!!!
Type of Loss: Property Damage
Date of Loss: 1/31/2007
Deductible: 0.00
Claimant: DAVE BUSE
Address: 2833 BURDEN, DUBUQUE, IA 52001
Telephone; Home Phone: (563) 556-0918
Owner. DAVE RUSE
Address: 2833 BURDEN, DUBUQUE, IA 52001
Telephone: Home Phone: (563) 556-0918
Arrival Date: 2/ 5!2007
Mitchell Service: 911623
Line
Item
1
2
3
4
5
6
7
8
Description: 1999 Ford Taurus SE VehiGe Production Date: 5/99
Body Style: 4D Sed Drive Train: 3.OL inj 6 CyI AO
VIN: 1FAFP53UXXA259123 License: 931 MJN IA
Color. AMAZON GREEN MET.
Options: POWER DOOR LOCKS, CRUISE CONTROL
Entry Labor Line Item Part Type/
Number Type Operation Description Part Number
101294 BDY REMOVE/REPLACE REAR BUMPER COVER *` QUAL REPL PART
AUTO REF REFINISH REAR BUMPER COVER
102139 BDY REMOVE/REPLACE REAR BUMPER ADHESIVE NAMEPLATE F8DZ 17E939 BA
900500 REF * REFINISH/REPAIR TINT TO MATCH Existing
936014 ADD'L COST FLEX ADDITIVE
AUTO REF ADD'L OPR CLEAR COAT
AUTO ADD'L COST PAINT/MATERIALS
AUTO ADD'L COST HAZARDOUS WASTE DISPOSAL
* -Judgment Item
C -Included in Clear Coat Calc
ESTIMATE RECALL NUMBER: Z/ 5/2007 14:50:55 5785
UltraMate is a Trademark of Mitchell International
Mitchell Data Version: JAN_07_A Copyright (C) 1994 - 2005 Mftchell International
UltraMate Version: 6.0.020 All Rights Reserved
Dollar Labor
Amount Units
184.00' 1.6
C 2.9
18.27 0.1
1.0'
12.00
1.2
153.00'
2.60 '
Page 1 of 2
• Date: 2J 5!2007 02:50 PM
Estimate ID: 5785
• Estimate Version: 0
Preliminary
Profile ID: Mitchell
Add'I
Labor Sublet
I. Labor Subtotals Units Rate Amount Amount Totals II. Part Replacement Summary Amount
Body 1.7 51.00 0.00 0.00 86.70 T Taxable Parts 202.27
Refinish 5.1 51.00 0.00 0.00 260.10 T Sales Tax @ 7.000% 14.16
Taxable Labor 346.80 Total Replacement Parts Amount 216.43
Labor Tax @ 7.000 % 24.28
Labor Summary 6.8 371.08
III. Additional Costs Amount IV. Adjustments Amount
Non-Taxable Costs 167.60 Insurance Deductible 0.00
Total Additional Costs 167.60 Customer Responsibility 0.00
I. Total Labor: 371.06
II. Total Replacement Parts: 216.43
III. Total Additional Costs: 167.60
Gross Total: 755.11
IV. Total Adjustments: 0.00
Net Total: 755.11
This is a areliminarv estimate.
Additional chan ces to the estimate may be rea uired for the actual reaair.
Point(s) of Impact
7 Left Rear Comer (P)
Insurance Co: CITY OF DUBUQUE
AVALON BODY SHOP INC, agrees to perform repairs which serve to
restore the damaged vechicle to its preloss condition relative to
safety, functions and appearance and futher agrees to warranty
workmanship for a period of three (3) years; plus PPG or Autocolor
Lifetime Paint Performance Guarantee for as long as the customer owns
the vechicle from date of completion of repairs.
ESTIMATE RECALL NUMBER: 2/ 512007 14:50:55 5785
UltraMate is a Trademark of Mitchell International
Mitchell Data Version: JAN_07_A Copyright (C) 1994 - 2005 Mitchell International
UltraMate Version: 6.0.020 All Rights Reserved
Page 2 of 2