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Claim by Martha SchmidBARRY A. LINDAHL, ESQ CITY ATTORNEY MEMO To: DATE: RE: Claimant ~I~~ Mayor Roy D. Buol and Members of the City Council April 25, 2007 Claim against the City of Dubuque by Martha Schmid Date of Claim Martha Schmid 04/25/07 Date of Loss 04/06/07 Nature of Claim Vehicle Damage This is a claim in which the claimant alleges that as she was traveling east on Geraldine Drive, a City of Dubuque Public Works employee driving a refuse truck proceeded from the stop sign on Patricia Ann Drive at Geraldine Drive and struck the passenger rear side 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 Don Vogt, Public Works Director Martha Schmid OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA SUITE 330, HARBOR VIEW PLACE, 3O0 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 Gity 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 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: ~M ~!(L~}-~- ~~c-(~-+'>~ ~ -~ 2. Address: ~ LAS-e_2.c t, S- ~ ~ ~ ~ j'~~~ 3. Telephone Number ~3 ~~S"-' 4. Date of Incident: L{ ICQ l 0 ~ 5. Time of Incident: 1 l "• U ~ 6. Location of incident (Be specific): ~ ~~~ C~P f ~~ C~' ~~0~-~afen~ Qr' 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 emaiovee's name.) 9. Give name and address of any witnesses: ©hn 17Y_~f Khc~rn I-7 Zy (~e-raa.~~e'n -52~y ~;s~3- 0 10. Did police investigate? If so, give names of officers.) 8. What were weather conditions like? ~~ he - 11. Was anyone injured? (If so, give names, addresses, and extent of injuries). N~ 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.) ~~ 13. What other damages do you claim, if any? ~) orye_ 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.) ND 15. What amount do you claim from the City of Dubuque? 16. Why do you claim the City of Dubuque is respons-ib~le~,?~ 17. Have you made any claim against anyone else for damages as a result of this incident? (If yes, give name and address.) N~ 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 y n,;g , 20C~ ~j-~ anbngnp a~~~~C~ s,w~~ ~l!~ (Signature) ~ Z :ZI Nd EZ add LO m ~-~-~- ~ (Print Name) Q,~f~~~~~~ Profile ID: Mitchell BIRD CHEVROLET 3255 UNIVERSITY AVE, DUBUQUE, IA 52001 (563) 583-9121 Fax: (563) 566-4482 Tax ID: 42-0400210 Damage Assessed By: john klutz Deductible: UNKNOWN Insured: DOUGLAS SCHMID Address: 500 LAUREL, DUBUQUE, IA 52003 Telephone= Home Phone: (563) 583-8445 Mitchell Service: 917493 Description: 2003 Chevrolet Venture LT Body Style= VanPasaExt 120' WB VIN: 1GND%03E43D217303 Mileage: 66,405 Color SILVER Options: POWER WINDOWS, CRUISE CONTROL Line Entry Labor I~e~m Number Type ` 700920 REF _ 700936 BDY 3 700985 BDY 4 701991 REF 5 702007 BDY 6 AUTO REF 7 AUTO REF 8 AUTO REF 9 702655 BDY 10 702656 BDY 11 AUTO REF 12 701456 BDY 13 AUTO REF 14 701483 BDY 15 70397b BDY 16 AUTO REF 17 704199 BDY 18 AUTO REF 19 AUTO 20 AUTO Drive Train: 3.4L Inj 6 Cyl FWD License: 526NBA Line Item Part Type/ Dollar Operation Description Part Number Amount BLEND R SIDE DOOR OUTSIDE REMOVE/INSTALL R DOOR MOULDING REMOVE/INSTALL R OTR DOOR HANDLE BLEND R UPR VAN SIDE PANEL OUTSIDE REMOVE/REPLACE R LWR QUARTER VAN SIDE PANEL 89025399 REFINLSH R LWR VAN SIDE PANEL OUTSIDE REFINISH R LWR VAN SIDE PANEL EDGE REFINISH R ADD FOR JAMBS REMOVE/REPLACE R QUARTER BELT REINF PANEL 12455141 REMOVE/REPLACE R REAR OTR QUARTER REAR CORNER PII.LAR 89045599 REFINISH R OTR REAR CORNER PILLAR, REPAIR, REAR BODY PANEL Existing REFINISH REAR BODY PANEL REMOVFJREPLACE R REAR COMBINATION LAMP ASSEMBLY 10353280 REMOVE/R.EPLACE REAR BUMPER COVER 12335622 REFINISH REAR BUMPER COVER REMOVElREPLACE R REAR BUMPER COVER ADHESIVE MLDG 10339931 ADD'L OPR CLEAR COAT ADD'L COST PAINT/MATERIAIS ADD'L COST HAZARDOUS WASTE DISPOSAL * -Judgment Item # -Labor Note Applies C -Included in Clear Coat Calc GM PART 237.29 GM PART 182.59 GM PART 311.99 GM PART 70.96 GM PART 484.54 GM PART 102.60 Labor Units C 0.9 0.3 0.7 # C 0.6 9.2 C 1.9 C 0.3 C O.b 1.0 2.5 C 1.0 2.0*# C 1.2 INC 0.5 C 2.3 0.1 2.3 337.90 6.00 * ESTIMATE RECALL NUMBER: 4l19J2007 12:41:10 3700 U1traMate is a Trademark of Mitchell International Mitchell Data Version: MAS O7 A Copyright (~ 1994 -2005 Mitchell International Page 1 of 2 U1traMate Version- 6.0.021 All Rights Reserved Date: 4119/2007 12:41 PM Estimate ID: 3700 Estimate Versioa: 0 Preliminary Pmfile ID: Mitchell ~"""`~`" Add'1 ~ Labor Sublet I. Labor Subtotals Unite Rate Amount Amount Totals II. Part Replacement Summary Amount Body 16.3 52.00 0.00 0.00 847.60 T Taxable Parts 1,389.97 Refinish 10.9 52.00 0.00 0.00 566.80 T Sales Tax ® 7.00096 97.30 Taxable Labor 1,414.40 Total Replacement Parts Amount 1,487.27 Labor Taa ® 7.000 % 99.01 Labor Summary 27.2 1,513.41 III. Additional Costs Amount IV. Adjustments Amount Non-Taxable Costa 343.90 Customer Responsibility 0.00 Total Additional Costs 343.90 I. Total Labor: 1,513.41 II. Total Replacement Parts: 1,487.27 III. Total Additional Costa= 343.90 Grces Total 3,344.58 IV. Total Adjustments: 0.00 Net Total: 3,344.58 This is a preliminary estimate. Additional changes to the estimate may be required for the actual repair. lte. .,,~,,. `~STIMATE RECALL NUMBER: 4/19/2007 12:4110 3700 U1traMate is a Trademark of Mitchell International Mitehnll Tlnta Vnrcinn: MAR (1? A ('.nn..,~ohf (f!1 7QQd - 20A.r. M;M6o11 Tn4n,~,.n+innol Ps~oo 2 of 2