Claim by Jeremy MosesBARRY A. LINDAHL, ESQ. ~'~J~I ~D
CITY ATTORNEY /~-f
MEMO
To:
DATE:
RE:
Claimant
Mayor Roy D. Buol and
Members of the City Council
March 23, 2007
Claim against the City of Dubuque by Jeremy Moses
Date of Claim
Jeremy Moses
03/19/07
Date of Loss
03/15/07
Nature of Claim
Vehicle Damage
This is a claim in which the claimant alleges that a City Keyline bus struck his parked
vehicle while it was parked in front of 2970 Wildwood Drive.
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
Jon Rodocker, Transit Manager
Jeremy Moses
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
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 13~h 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: ~--~ ~ ~ ~~"`~ Yn ~ s ~-
2. Address: `7 0 ~ w . C e.-~-I-f ~ 5-~. ~~ ~ ~~k~; ~t o 1 ~ S zo~(5
~~
3. Telephone Number~~~3~ 5 ~c - 3 ~'~ a ~3 c<<< (sue) ~(~ U - z 7 s ~ i-c,.-.-.
4. Date of Incident: (~ 3 / ~ 5 / 2 c ~ ~
5. Time of Incident: 13 e ~ Z h ~ s.
6. Location of Incident (Be specific):
IN , \ C` u~ t+ 0 , ~ r , 1. n ~ cv.'~ O -~ ~~ p r r -~--rv~ ~-~ ~o ..~ : ~ c~ ti. ~ Z ~l 1 6
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.)
l~ L ~ ~ ~, ~ ~ S ~ti `~ S C l Y : V : nl~ b -~ c.-., d ~ ~ ~ /h „~ !? r1 ~ ~c c u~ r
~~ 2~~b ~ti: l~~
- ~ a 5 ~ C ~"~ s~-h a r~ !-- ~' ~ i"t n ~ r`. S .. t {~"z C~a.~e -r~J e~ ~ vv~
6`r~~ ~ .. J ~~ 5 j G`{ `~.wr~ ¢.~ ~ ~.a c\ ~1ig~'i~ w-.--<< ~c-~..w. ~J i? r
8. What were weather conditions like?
9. Give name and address of any witnesses:
~G w`. ~,.eS$~S ~ja...> ~L {,,~~,ri~. -4c V~k ~rtO...~ I..zc~
10. Did polic(^e/investigate? 1(If so, Cgive names of officers.)
~E' S ~ T- ~F . C ~r , U S \ ~. r~ J ~ °a . r ~' crv~..'~ 'j.E `-~'l^-~ S~L'r~
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
~3
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~xtent of damage.)
Y~ ~ ~ Y'~'~- h nor ~ ~: o-n ~ ~ c : J ~ f ,S ; c2 ~,..ri G l . d3 cn./r~,~T
L~~l-. ~ ire.. a-Y-~ rZ.L/~'~.
13. What other damages do you claim, if any?
1~~ne
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
5. What amount do you claim from the City of Dubuque?
2. Z -7 o I ~ ~. c~ ~ -~ e.v~.~ ~
i _ / ~ t,
LQ~]' ` i (' 1 fSl O ~'t^"~, ca ~C 5 ~, li.'l t- U Y Sr ce /~ WYt ~ ~ -i ~ CGL'(~ VJ ~. S ~ ~ ¢'r~
v
o`~`~-c '~-•
16. Why do you claim the City of Dubuque is responsible?
C~~., I~iK.S CEt:3er ~w~k ~~ 1~va~1~c n_A~ ~~zd Cwr.
.~ , ,
17. Have you made any claim against anyone else for damages as a result of
this incident? (If yes, give name and address.)
~a
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 ~ `~~ day of )'`~~~-~^ ~ 20 °~ ~ bl ~~"~~~GnQ
~~i~a c,'~aal~ ~!~
ature) SO ~£ i~d 6 I ~l~IW LO
S e.. r ,~,., !~ ~' S ~ S
(Print Name) CJ~/11~J~~J
Date:
Estimate ID:
Estimate Version:
Preliminary
Profile ID:
Dan Kruse Pontiac, Nissan, BMW
600 Century, Dubuque, IA 52002
(563) 583-7345
Fax: (563)588-3874
Tax ID: 420655341
Damage Assessed By: GAYLE PURMAN
Deductible: 0.00
Claim Number: 1
Insured: JEREMY MOSES
Address: 701 WEST CENTRE ST, GARNIVILLO, IA 52049
Telephone: Home Phone: (563) 580-3933
Mitchell Service: 913493
Description: 1998 Chevrolet Monte Carlo LS
Body Style: 2D Cpe
VIN: 2G1 W W12MXW9165995
Options: CRUISE CONTROL
Drive Train: 3.1L Inj 6 Cyl AO
3/1912007 02:30 PM
7208
0
Mitchell
Line
Item Entry Labor
Number Type
Operation Line Item
Description Part Typel
Part Number Dollar
Amount Labor
Units
1 300024 BDY REMOVE/REPLACE BUMPERIGRILLE COVER 10186940 GM PART 250.48 1.5
2 AUTO REF REFINISH FRT BUMPER/GRILLE COVER C 2.4
3 302007 BDY REMOVEIREPLACE L COMBINATION LAMP ASSEMBLY *' QUAL REPL PART 163.00 * 0.3
4 AUTO BDY CHECKIADJUST HEADLAMPS 0.4
5 300078 BDY REMOVEIREPLACE L MARKER LAMP ASSEMBLY 5978475 GM PART 22.84 INC #
6 300083 REF BLEND HOOD OUTSIDE C 1.1
7 300208 REF BLEND R FENDER OUTSIDE C 0.9
8 302183 BDY REMOVE/REPLACE L FENDER PANEL ** QUAL REPL PART 228.00 * 1.9 #
9 AUTO REF REFINISH L FENDER OUTSIDE C 2.2
10 AUTO REF REFINISH L FENDER EDGE C 0.5
11 300223 BDY REMOVE/REPLACE L FENDER LINER 10426598 GM PART 37.04 INC
12 300235 BDY REMOVEIINSTALL L LWR FENDER MOULDING Existing 0.3
13 RB~R Time Used in R8~I Operation
14 300484 BDY REMOVEIREPLACE WHEEL 12368868 GM PART 179.00' 0.3
15 900500 MCH' ADD'L LABOR OP MNT AND BALANCE *' QUAL REPL PART 15.00 * 0.0'
16 900500 MCH' ADD'L LABOR OP WHEEL ALIGNMENT Sublet 69.95 * 0.0*
17 300958 REF BLEND L FRT DOOR OUTSIDE C 1.0
18 300992 BDY REMOVE/INSTALL L FRT REAR VIEW MIRROR INC #
19 300994 BDY REMOVEIINSTALL L FRT BELT MOULDING 0.6 #
20 300996 BDY REMOVEIINSTALL L FRT LWR DOOR MOULDING 0.4
21 301702 BDY REMOVEIINSTALL L FRT DOOR TRIM PANEL INC
22 301084 BDY REMOVEIINSTALL L FRT OTR DOOR HANDLE 0.T #
23 AUTO REF ADD'L OPR CLEAR COAT 2.3'
24 AUTO ADD'L COST PAINT/MATERIALS 312.00 *
25 AUTO ADD'L COST HAZARDOUS WASTE DISPOSAL 3.50
ESTIMATE RECALL NUMBER: 3/19/2007 14:30:15 7208
UltraMate is a Trademark of Mitchell International
Mitchell Data Version: FEB_07_A Copyright (C) 1994 - 2005 Mitchell International Page 1 of 2
UltraMate Version: 6.0.021 All Rights Reserved
Date: 3119/2007 02:30 PM
Estimate ID: 7208
Estimate Version: 0
Preliminary
Profile ID: Mitchell
'` -Judgment Item
# -Labor Note Applies
C -Included in Clear Coat Calc
Add'I
Labor Sublet
I. Labor Subtotals Units Rate Amount Amount Totals II. Part Replacement Summary Amount
Body 6.4 50.00 0.00 0.00 320.00 T Taxable Parts 895.36
Refinish 10.4 50.00 0.00 0.00 520.00 T Sales Tax @ 7.000% 62.68
Mechanical 0.0 65.00 0.00 69.95 69.95 T
Total Replacement Parts Amount 958.04
Taxable Labor 909.95
Labor Tax @ 7.00 0 % 63.70
Labor Summary 16.8 973.65
III. Additional Costs Amount IV. Adjustments Amount
Non-Taxable Costs 315.50 Insurance Deductible 0.00
Total Additional Costs 315.50 Customer Responsibility 0.00
1. Total Labor: 973.65
II. Total Replacement Parts: 958.04
III. Total Additional Costs: 315.50
Gross Total: 2,247.19
IV. Total Adjustments: 0.00
Net Total: 2,247.19
This is a preliminary estimate.
Additional changes to the estimate may be required for the actual repair.
THIS DAMAGE REPORT IS BASED ON OUR INSPECTION AND DOES NOT
COVER ANY ADDIONAL PARTS OR LABOR WHICH MAY BE REQUIRED AFTER
THE WORK HAS BEEN OPENED UP THE INS,WILL BE NOTIFIED.
WE FEATURE A THREE YEAR WORKMANSHIP LIMITED WARRANTY- SEE OUR WRITTEN
WARRANTY FOR COMPLETE DETAILS.(EFECTIVE 10-01-01)
ESTIMATE RECALL NUMBER: 3/19/2007 14:30:15 7208
UltraMate is a Trademark of Mitchell International
Mitchell Data Version: FEB_07_A Copyright (C) 1994 - 2005 Mitchell International Page 2 of 2
UltraMate Version: 6.0.021 All Rights Reserved
Date=
Estimate ID=
Estimate Veraion~
Preliminary
Profile ID=
BIRD CHEVROLET
3255 UNIVERSITY AVE, DUBUQUE, IA 52001
(563) 583-9121
Fax (563) 556-4482
TaxID~ 42-0400210
Damage Assessed By= john klotz
Deductible UNKNOWN
Insured Jeremy moaes
Address= 701 w centre, garnavillo, IA 52049
Telephone= Home Phone= (563) 580.3933
Mitchell Service= 913493
Description. 1998 Chevrolet Monte Carlo LS
Body Style 2D Cpe Drive Train 3.1L Inj 6 Cyl AO
VIN 2G1WW12MXW9165995
Mileage= 115,000
Color= pewter
Options CRUISE CONTROL
3/19/2007 01=46 PM
3588
0
Mitchell
Line
Item Entry Labor
Number Type
Operation Line Item
Description Part Type/
Part Number Dollar
Amount Labor
Units
1 300024 BDY REMOVE/R.EPLACE BUMPERlGRILLE COVER ** QUAL REPL PART 212.00 * 1.5
2 AUTO REF REFINISH FRT BUMPER/GRILLE COVER C 2.4
3 300027 BDY REMOVE/REPLACE LWR BUMPER/GRILLE MOULDING 10176789 GM PART 47.15 INC
4 302007 BDY REMOVE/R.EPLACE L COMBINATION LAMP ASSEMBLY ** QUAL REPL PART 163.00 * 0.3
b AUTO BDY CHECK/ADJUST HEADLAMPS 0.4
6 302183 BDY REMOVE/R.EPLACE L FENDER PANEL ** QUAL REPL PART 228.00 * 1.9 #
7 AUTO REF REFINISH L FENDER OUTSIDE C 2.2
8 AUTO REF REFINISH L FENDER EDGE C 0.5
9 300223 BDY REMOVE/REPLACE L FENDER LINER 10426598 GM PART 37.04 INC
10 302786 BDY REMOVE/INSTALL L FENDER ADHESIVE MOULDING Existing 0.1
11 R&R Time Used in R&I Operation
12 300488 BDY REMOVE/REPLACE WHEEL Remanufactured 179.00 * 0.3
13 300334 BDY REMOVE/REPLACE WHEEL VALVE STEM 274288 GM PART 2.00
14 300502 BDY REMOVE/REPLACE WHEEL HUB CAP 9593412 GM PART 48.97
15 300344 MCH ALIGN FRONT SUSPENSION -M 1.0
16 300958 REF BLEND L FRT DOOR OUTSIDE C 1.0
17 300992 BDY REMOVEQNSTALL L FRT REAR VIEW MIRROR INC #
18 300993 BDY REMOVE/INSTALL R FRT BELT MOULDING 1.0 #
19 300994 BDY REMOVEQNSTALL L FRT BELT MOULDING 0.6 #
20 301084 BDY REMOVE/INSTALL L FRT OTR DOOR HANDLE 0.7 #
21 AUTO REF ADD'L OPR CLEAR COAT 1.8
22 AUTO ADD'L COST PAINT/MATERIALS 244.90
23 AUTO ADD'L COST HAZARDOUS WASTE DISPOSAL 6.00
ESTIMATE RECALL NUMBER= 3!19/2007 13~45~33 3588
U1traMate is a Trademark of Mitchell International
Mitchell Data Version FEB_07~, Copyright (C) 1994 - 2005 Mitchell International Page 1 of 2
U1traMate Version 6.0.021 All Rights Reserved
Date: 3/19/2007 01:46 PM
Estimate ID: 3585
Estimate Version: 0
Preliminary
Profile ID: Mitchell
* -Judgment Item
# -Labor Note Applies
C -Included in Clear Coat Calc
Add'1
Labor Sublet
I. Labor Subtotals Unite Rate Amount Amount Totals II. Part Replacement Summary Amount
Body 6.8 52.00 0.00 0.00 353.60 T Taxable Parts 917.16
Refinish 7.9 52.00 0.00 0.00 410.80 T Sales Tax @ 7.000% 64.20
Mechanical 1.0 62.00 0.00 0.00 62.00 T
Total Replacement Parts Amount 981.36
Taxable Labor 826.40
Labor Tax @ 7.000 % 57.85
Labor Summary 15.7 884.25
III. Additional Costa Amount IV. Adjustments Amount
Non-Taxable Costa 250.90 Customer Responsibility 0.00
Total Additional Costa 250.90
I. Total Labor: 884.25
II. Total Replacement Parts: 981.36
III. Total Additional Coats: 250.90
Grose Total: 2,116.51
IV. Total Adjustments: 0.00
Net Total: 2,116.51
This is a preliminary estimate.
Additional chafes to the estimate may be required for the actual repair.
ESTIMATE RECALL NUMBER: 3/19/2007 13:45:33 3588
U1traMate is a Trademark of Mitchell International
Mitchell Data Version: FEB_07_A Copyright (C) 1994 - 2005 Mitchell International Page 2 of 2
UltraMate Version: 6.0.021 All Rights Reserved