Claim by Zachary MattisonC
BARRY A. LINDA L, ESQ.
CITY ATTORNEY
MEMO
To:
DATE:
RE:
Claimant
Mayor Roy D. Buol and
Members of the City Council
June 20, 2007
Claim against the City of Dubuque by Zachary Mattison
Date of Claim
Zachary Mattison
06/15/07
Date of Loss
05/14/07
Nature of Claim
Vehicle Damage
This is a claim in which the claimant alleges that a city tree fell on and damaged his
parked vehicle, which was parked in front of 765 Boyer Street.
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
Gil Spence, Leisure Services Manager
Zachary Mattison
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 Form
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http://www.cityofdubuque.org/index.cfm?pageid=l SS
Home Paae :Departments :City Clerk :Claims aaainst the City : CIaIm FOrtTI ~/J~//~
City Clerk ~`{~~~/ ~'
First floor of City Hall, 50 W. 13th Street ~~~'1 r `l~
Phone: (563) 589-4120
Fax: (563)589-0890 -
Hours: 8 a.m. to 5 p.m. Monday through Friday G/I`L,
Email: lschneidCaacityofdubugue.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 representat`io_n t-o you as to whethe~r /your claim will or will not be paid.
1. Name of Claimant. ~Q C~~r loy'u r~~'t~SCj -'L
2. Address: / ~ ~ ~f/LJ ~V-' ~p~7' ¢~.'t'
3. Telephone Number: ~ O 1~ ~ 4 Z- ~
4. Date of Incident: /t~ '~
5. Time of Incident: C•L-t 9'V /~4f'i5'~^- /~ ~ /n '
6. Location of Incident (Be specific): l1 u`~i ~ ~ CfW' re,-C~cLe.~, C"~
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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.)
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.~ ~ 8. What were weather conditions like? YU t ~ rr /I ^7 /
9. Give name and address o any witnesses: ~Gl,t/ 1 ~ !'h~.I'k~w.~ °- i (vS ~ E,Y
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10. Did police investigate? (If so, give names of officers.) '--
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11. WAas~ anyone injured? (If so, give names, addresses, and extent of injuries.) ! C; . F ~ n ~ 1
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12. Was any damage done to property? (If so, describe property and the extent of damages. Attach estimates of
'dajmages or describe basis for ascertaining extent of~da(mage.) _ I C ~ ,~~ _ ,,(~
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1 of 2 S/21 /2007 11:24 AM
Claim Form
http://www.cityofdubuque.org/index.cfm?pageid=155
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^offinsurance company and amount paid.)
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15. What amount do you claim from the City of Dubuque? C~i`Y~~ 0.S
16. Why do you claim the City of Dubuque is responsible? ~"T UPS `~~l ~
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17. Have you made any claim against anyone else for damages as a result of this incident? (If yes, give name
and address.)
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18. If the answer to Question 17 is yes, have you received any payment from that source, and if so, in what
amount?
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Home Paoe :Departments :City Clerk :Claims against the Citv : C~~Ifll FOt'tll
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City Hall, 50 West 13th Street, Dubuque, Iowa 52001
2 of 2 5/21 /2007 11:24 AM
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06/11/2007 at 01:53 PM
30799
Job Number:
BRINEYER ADTO BODY
License #:30799 Federal ID #:421438480
10709 COLLISION DR.
DUBUQUE, IA 52001
(563)583-4456 Fax: (563)583-1838
PRELIMINARY ESTIMATE
Written By: BOB COOK
Adjuster:
Iaaured: ZACH MATTISON Claim #
Owner: ZACH MATTISON Policy #
Address: 765 BOYER Deductible:
DUBUQUE, IA 52001 Date of Losa:
Day: Type of Losa:
Evening: Point of Impact:
Inspect
Location:
Insurance
Company: Days to Repair
1990 FONT BONNEVILLE LE 6-3.8L-FI 4D SED Int:
VIN: 1G2HX54C3L1259164 Lic: Prod Date: Odometer:
Air Conditioning Tinted Glass Body Side Moldings
Dual Mirrors Clear Coat Paint Power Steering
Power Brakes AM Radio FM Radio
Stereo Search/Seek Cloth Seats
Split Bench Seats Recline/Lounge Seats Automatic Transmission
Overdrive Deluxe Wheel Covers
-------------------------------------------------------------------------------
NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PRINT
1 TRUNK LID
2* Rpr Lid 2.0 2.5
3 Add for Clear Coat 1.0
4 QUARTER PANEL
5 Repl LT Filler door manual 1 52.60 0.3 0.3
6 Add for Clear Coat 0.1
7# Rpr LEFT 1/4 NO RUST 2.0 2.5
8 ROOF
9* Rpr Roof panel w/o sunroof 2.5 4.0
10 Overlap Major Non-Adj. Panel -0.2
11 Add for Clear Coat 0.8
12 FENDER
13* Rpr LT Fender 1.0 2.7
14 Overlap Major Adj. Panel -0.4
15 Add for Clear Coat 0.5
-------------------------------------------------------------------------------
Subtotals =_> 52.60 7.6 13.8
Parts 52.60
Body Labor 7.8 hrs @ $ 51.00 /hr 397.80
Paint Labor 13.8 hrs @ $ 51.00 /hr 703.80
Paint Supplies 13.8 hrs @ $ 30.00 /hr 414.00
----------------------------------------------------
SUBTOTAL $ 1568.20
Sales Tax $ 1154.20 @ 7.0000 ~ 80.79
----------------------------------------------------
GRAND TOTAL $ 1648.99
ADJUSTMENTS:
Deductible 0.00
----------------------------------------------------
CUSTOMER PAY $ 0.00
INSURANCE PAY $ 1648.99