Claiim by Roger JonesBARRY A. LINDAH
CITY ATTORNEY
MEMO
To:
DATE:
RE:
Claimant
Roger Jones
Mayor Roy D. Buol and
Members of the City Council
June 18, 2007
Claim against the City of Dubuque by Roger Jones
Date of Claim
Date of Loss
Nature of Claim
06/14/07
05/31 /07
Vehicle Damage
This is a claim in which the claimant alleges that as he was traveling west on West 11t"
Street, a City of Dubuque Keyline bus entered the intersection of West 11t" Street and
Prairie Street, striking 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
Jon Rodocker, Transit Manager
Roger Jones
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
__ __
-- ~
Jun. 11. 2007 4:47PM CITY OF 66Q LEGRL DEPT No, 1158 P. 3 _
_
~1~~
. .. ~~
CLAILVX AGAINST TAE GIT`1~ QF ~U~UQ~U'E, IC;h~'~r~~ ~~ /~
~~~
This written report constitutes your claim .against the City of Dubuque, lowr~. Y+~u
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 Oity Hall, 5Q West 13th St.,
Dubuc~ue,1~4 a2g01. It will then be referred to the appropriate department t+~ r
investigation end to the City Attorney's Office. Once that investia~ation is
cornpl~ted,'a!report and recommendation will be submitted to the City Cou~i:; 1.
You will be',provided with a copy of that report and recommendation.
The find d ~cision on all claims is made by the City Council. No E:mpioyee r.+1` ih~~
City of "Dub~glue has the authority to make any representation to you as tc;
whether your claim will or will not be paid.
1. Name of (Claimant: d ~ ~" ~'» e ~' .--_._~._
~
//
~~~~ ~~ //
2. Address: ~ ~ v(/r r~f~~.r r Gt~n ~ ~u bc~d ~z e ~~-
- ~`~? ~ o j
3. Telephone Number <S(~ 3 -' y'S -' ®(p S ~ _~.---------
4. Date of incident: 5-3~- o !- -- - ,___..__-
5- Time of incident: (P rid d~'`'~-_ - .. ----.--.-~--------
6. location of Incident {Be specific):
7.'Desci•ibe the accident or occurrence that caused injury or damage. (Give,, f~~I
details upanwhich you base your claim. If a City ~:mpioyee was involved, c;ii~r+~
the employee's ram
~. Give name and address of any witnesses:
10. Did p Gce investigate? {If so, give names of officers-)
~v_~~ ~, h..~ ,z r Case ~' C7- ~a.~~'S _ ..._.---
8. What were weather conjiitions Like?
~E~`FIVFD
N 07 JUN 14 PM 12~ 04
City Ci~~ re's uxfi~e
Du~u~~e, IA
rf
o~
C
fD _
O
O
a~
S
d
7
a~
Jun. 11. 2007 4:47PM CITY DF DBQ LEGAL DEPT No. 1158 P. 4
1`1. Was anyone injured? (If so, give names, addresses, and extent of injurie;~~).
12. Wes any domage done to property? (If sa, describe property and the extE~i,f;
of damages. A~tafch estimates of damages ar describe basis fQr ascertaining
extent of damage.)
13. What dtheridi~mages do you claim, if any?
14. Mave you been compensated for any part ar ell of your claim by any
insurarlee company? (If so, give name and address of in;~urance company an~:~
amount paid.)
~~
- ~~-----
15. What amount do you claim from the City of Dubuque'?
16. Why do' you claim the City of Dubuque is respans
'17. Have you made any claim against anyone eise for dammages as a result of
this incident? (If'yes, give r}ame and address.) .
1$. (f the answer to Question 17 is yes, have you received any payment from tfi;~~t
source, and~if so', in what amount?
Dated this /' '~ day f ~^-2~ _~, 2a~
( ig ture)
' o ~ ~r ~~~
(Print Name)
Allstate®
You're in good hands.
G52-2
0~5f31/'2007 at 03:50 PM
24443
Job Number:
ABRA - DUBUQUE
Federal ID #:420782245
DBA: ANDERSON-WEBER INC
3400 CENTER GROVE DR
DUBUQUE, IA 52003
(563)556-0696 Fax: (563)556-1899
PRELIMINARY ESTIMATE
Written By: KEN GREEN #24443
Adjuster:
Insured:
Owner:
Address:
Day:
Inspect
Location:
Insurance
Company:
ROGER JONES JR.
561 WILBUR LANE
DUBUQUE, IA 52001
(563)583-9220
1995 CHEV BERETTA 6-3.1L-FI 2D CPE BURGANDY Int:
Days to Repair
VIN: 1G1LV15M8SY314539 Lic: 274 ROO IA Prod Date: 06/1995 Odometer: 102727
Air Conditioning Tinted Glass Body Side Moldings
Dual Mirrors Custom Interior Clear Coat Paint
Power Steering Power Brakes Power Locks
AM Radio FM Radio Stereo
Search/Seek Anti-Lock Brakes (4) Driver Air Bag
Cloth Seats Bucket Seats Recline/Lounge Seats
5 Speed Transmission
------------------- Overdrive
----
NO. OP.
---------------------- -------------------------
DESCRIPTION -------------------------------
QTY EXT. PRICE LABOR PAINT
-
1# REPAIR -------------------------
COST EXCEEDS VALUE -----
1 --------------------
0.00 X 0.0 ------
0.0
2# 0 0.00 0.0 0.0
3# EXTENS
----------------------- IVE DAMAGE RIGHT FRONT
--------------------- 1 0.00 0.0 0.0
----
Subtotals =_> ----- --------------------
0.00 0.0 ------
0.0
Parts
---------------------
-----
----- 0.00
GRAND TOTAL
---------------------
----- ---------------
$ ------
0.00
CUSTOMER PAY --------------------
$ ------
0.00
WARRANTY VALID ONLY WITH ORIGIONAL COPY OF YOUR RECEIPT PARTS SUBJECT TO
INVOICE NO GUARANTEE ON RUST ALL PARTS NEW, UNLESS OTHERWISE NOTED
Claim #
Policy #
Deductible:
Date of Loss:
Type of Loss
Point of Impact:
1
0'51`3'1/2007 at 03:50 PM
24443
Job Number:
PRELIMINARY ESTIMATE
1995 CHEV BERETTA 6-3.1L-FI 2D CPE BURGANDY Int:
Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived
from the Guide DE1CN87 Database Date 05/2007, CCC Data Date 05/2007, and the parts selected are
OEM-parts manufactured by the vehicles Original Equipment Manufacturer. OEM parts are available
at OE/Vehicle dealerships. OPT OEM (Optional OEM) or ALT OEM (Alternative OEM) parts are OEM
parts that may be provided by or through alternate sources other than the OEM vehicle
dealerships. OPT OEM or ALT OEM parts may reflect some specific, special, or unique pricing or
discount. OPT OEM or ALT OEM parts may include ~~Blemished" parts provided by OEM's through OEM
vehicle dealerships. Asterisk (*) or Double Asterisk (**) indicates that the parts and/or labor
information provided by MOTOR may have been modified or may have come from an alternate data
source. Tilde sign (~) items indicate MOTOR Not-Included Labor operations. Non-Original
Equipment Manufacturer aftermarket parts are described as AM, Qual Repl Parts or Comp Repl Parts
which stands for Competitive Replacement Parts. Used parts are described as LKQ, Qual Recy
Parts, RCY, or USED. Reconditioned parts are described as Recon. Recored parts are described
as Recore. NAGS Part Numbers and Benchmark Prices are provided by National Auto Glass
Specifications. Labor operation times listed on the line with the NAGS information are MOTOR
suggested labor operation times. NAGS labor operation times are not included. Pound sign (#)
items indicate manual entries. Some 2006 vehicles contain minor changes from the previous
year. For those vehicles, prior to receiving updated data from the vehicle manufacturer, labor
and parts data from the previous year may be used. The Pathways estimator has a complete list
of applicable vehicles. Parts numbers and prices should be confirmed with the local dealership.
CCC Pathways - A product of CCC Information Services Inc.
2