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Claim by Jean HeimTHE CTTY OF DUB E Masterpiece on the BARRY LIND CITY ATTOR To: DATE: RE: Claimant Jean Heim MEMORANDUM Mayor Roy D. Buol and Members of the City Council July 27, 2007 Claim against the City of Dubuque by Jean Heim Date of Claim 07/25/07 Date of Loss 07/18/07 Nature of Claim Vehicle Damage This is a claim in which the claimant alleges that during a rainstorm that occurred on July 18, 2007, a rock fell from the bluff located above the City 9t" Street parking lot, striking and damaging her 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 John Klostermann, Street & Sewer Maintenance Supervisor Jean Heim 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 / EnnAIL balesq@cityofdubuque.org Claim Form Page l af.2 i .~~~ i ,' CLAIIVI AC~AIN~T THE CITY i~F L)~1E31.ft~lJlM, I~V1fA 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 Hatl, 50 West 13~' St., Dubuque, IA 52401. It will then be referred to the appropriate department for irnestigation and to the City Attorney's Office. Once that investigation is completed, a report and recommendation wiN be submitted to the City Council. You will be provided with a copy of that report and recommendation. The fine! dedsion on al! claims is made by the Gity Coundl. No employee of the City of Dubuque has the authority to make any representation to you as to whether your claim will or witl not be paid. 1. Name of Claimant: ~P_ r ~Q,'~ Yv. 2. Address: 3. Telephone Number: S$ ,3 -=~~ f}~~ v 4. Date of Inddent: ~ ~ ~ $ ~~''% 5. Time of Incident: (~ ~ ~~ C? - 'gyp. ©O C2 r.., __ _ _ 6. t_ocation of Inddent (8e spedfic): / J ~/ m e ~e r ~',,,r.~~.~¢w• ~>^-r rr,;g r ~.i nc r, IPeserye o~ S QctC~ ~--- 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.) ~'Q/~ev~ ~~~G ,~erfl i ~ ~ Si c~P G7~' ~~ ~'r- ~ QA~2Y~ ©Ae ~~' ~-he ~~ ce C.ela~ati ~arr'e ~.ar ~4P~ 1'yi2 otter 1~ie ~Li~he ~ ~.hr~l ~' ~ / .:ODQ ~ ., _S.D ~ 40~-- ,die ec,~_(// ,be~ ~/1~ Leh (= 30 - ~l °4' o ~rs~ i3. What were weather conditions like? Q ~ v~ /yLIcJ~~ S, [;Q/.~,fh~g„ CIO~~i~ //QY~ 9. Give name and address of any witnesses: ___ i ~/~r,^~ e Nei4~ ~,~~i~ Lu~c/~° q ~Prn reY (~~% C-~ ~n ~~ e SOl% n~ r P~ f~'I~ n~r 'Tm i ~ /~i~ ~eYO /~e~a i /'e r'" 10. Did police investigate? (If so, give names of officers.} e S 11. Was anyone injured? (If so, give names, addresses, and extent of injuries.) ~~ 12. Was any damage done to property? (If so, descxibe property and the extent of damages. Attach estimates of damages or describe basis for ascertaining extent of damage.) ~~ ~ ~ ~ f L~~/~t~ ~~~K ~cbr, . 13. What other damages do you claim, if any? _ /llh http://www.cityofdubuque.arg/printer friendly.cftn?pageid=l SS 7/20/24U7 Claim Form Page 2 of 2 14. Have you been compensated for any part or all of your Gaim by any insurance company? (If so, give name and address of insurance company and amount paid.) Ne 15. What amount do you Gaim from the City of Dubuque? ~ rIOD. ~(~ 16. Why do you claim the City of Dubuque is responsible? _ ~cGUSe ~ A2c.c ~/ ~e~~ye~y~i~ ~ I7~e ~e r ~-/mil' ~ Qhc/ i ~ w~ s ~., i'~cf~ ~~Q f ~'m 'ham c~~wh ~r~h, ~~e ~/u -F'F 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 ~) u~ ~ u; , 20~ ..e~tv ~n (Signature) ~eQ h 11/e~ m (Print Name) print this page ,.=; 4~ c~ `~.! ~ ~ c ~r' r a _-~ -V ` 7~ `,~ -.... C ~ ~ ~"' ~ ~; _ cb ..._ http://www.cityofdubuque.org/printer_friendly.cfin?pageid=155 7/20/2007 ~~~ d-~'-~,'ce y ~v~.s ~!e o~r~ ~ !~© ~~~ceor ~O Gee-yt~-s ~ r,. --~-! e r; 9 ~ -~' ~ s SG ~~ r d©o ~ ,~c~ca u s ~ 7''/I 2 YL Lc..~Q. S ~ ~~? ! 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Date: 7/20/2007 03:17 PM Estimate ID: 4021 Estimate Version: 0 Preliminary Profile ID: Mitchell BIRD CHEVROLET 326b UNIVERSITY AVE, DUBUQUE, IA 52001 (563)583-9121 Fax: (563) 556-4482 Tax ID: 42-0400210 Damage Assessed By: john klotz Deductible: UNKNOWN Insured: JEAN HEIM Mitchell Service: 917493 Description: 2000 Chevrolet Venture LT Body Style: VanPassExt 120" WB Drive Train: 3.4L Inj 6 Cyl FWD VIN: 1GNDX03E8YD 188816 Options: POWER WINDOWS, CRUISE CONTROL Line Entry Labor Line Item Part Type! Dollar Labor Item Number Type Operation Description Part Number Amount Units 1 701724 REF REFINISH R OTR ROCKER PANEL C 1.0* 2 701745 BDY REPAIR R ROCKER OUTER PANEL -S Eavsting 2.0* 3 REAR SECTION ONLY 4 70078b BDY REPAIR R FRT DOOR SHELL Existing 2.0*# 5 AUTO REF REFINISH R FRT DOOR OUTSIDE C 2.3 6 700791 BDY REMOVE/INSTALL R FRT REAR VIEW MIRROR INC # 7 701546 BDY REMOVE/INSTALL R FRT BELT MOULDING 0.9 # 8 701548 BDY REMOVE/INSTALL R FRT LWR DOOR MOULDING 0.3 9 700860 BDY REMOVE/INSTALL R FRT OTR DOOR HANDLE 0.3 # 10 AUTO REF ADD'L OPR CLEAR COAT 1.2 11 AUTO ADD'L COST PAINT/MATERIAIS 139.50 12 AUTO ADD'L COST HAZARDOUS WASTE DISPOSAL 4.50 * -Judgment Item # -Labor Note Applies C -Included in Clear Coat Calc Add'1 Labor Sublet I. Labor Subtotals Units Rate Amount Amount Totals Body 5.5 52.00 0.00 0.00 286.00 T Refinish 4.5 52.00 0.00 0.00 234.00 T Taxable Labor 520.00 Labor Tax C~ 7.000 96 36.40 Labor Summary 10.0 556.40 II. Part Replacement Summary Total Replacement Parts Amount Amount 0.00 ESTIMATE RECALL NUMBER: 07/20/2007 15:17:50 4021 U1traMate is a Trademark of Mitchell International Mitchell Data Version: JUL_07 A Copyright (C) 1994 - 2005 Mitchell International Page 1 of 2 U1traMate Version: 6.0.026 All Rights Reserved RICHARDSON MOTORS 1475 J.F.K. ROAD .1 DUBUQUE, IA 52002 -• PHONE: (563) 582-5411 FAX: (563) 582-4129 FEDERAL ID: 42 -0813744 CD LOG NO 3173-1 DATE 07/20/07 SHOP: RICHARDSON MOTORS INSP DATE: 07/20/07 ADDRESS: 1475 JOHN F. KENNEDY RD CONTACT: JASON CHARLEY CITY STATE: DUBUQUE, IA PHONE 1: (563)582-5411 ZIP: 52002- FAX: (563)582-4129 OWNER: HEIM, JEAN HOME PHONE: (563)583-3045 ADDRESS: 12606 JFK RD CITY STATE: DUB, IA ZIP: 52002 POINT OF IMPACT: 0 LIC#: STATE: VIN: 1GNDX03E8YD188816 BODY COLOR: MILEAGE: CONDITION: ACCTNG CTL#: *=USER-ENTERED VALUE EC=REPLACE ECONOMY UM=REMAN/REBUILT PRT OE=REPLACE PXN OE SRPLS TE=PARTL REPL PRICE I=REPAIR TT=TWO-TONE N=ADDITIONAL LABOR AA=APPEAR ALLOWANCE E=REPLACE OEM UE=REPLACE OE SURPLUS EU=REPLACE SALVAGE PC=PXN RECONDITIONED ET=PARTL REPL LABOR L=REFINISH CG=CHIPGUARD RI=R&I ASSEMBLY RP=RELATED PRIOR CUSTOMER REQUEST PRIOR RUST NOT INCLUDED IN BID NG=REPLACE NAGS UC=RECONDITIONED PRT EP=REPLACE PXN PM=PXN REMAN/REBUILT IT=PARTIAL REPAIR BR=BLEND REFINISH SB=SUBLET P=CHECK UP=UNRELATED PRIOR 2000 CHEVROLET VENTURE LS 4DOOR PASS. VAN EXTENDED 6CYL GASOLINE 3.4 CODE: U6522B/D OPTNS E/24BCDVEGFWTM OPTIONS: TWO-STAGE - EXTERIOR SURFACES REMOTE KEYLESS ENTRY SYSTEM POWER WINDOWS LEFT SLIDING SIDE DOOR HEATED TAILGATE GLASS OVERHEAD CONSOLE TWO-STAGE - INTERIOR SURFACES POWER DOOR LOCKS HEATED REMOTE CONTROL MIRRORS PRIVACY GLASS REAR WIPER CRUISE CONTROL OP -- GDE --- MC DESCRIPTION -- --- MFG.PART NO. T 0208 -------- DOOR SHELL, FRONT ------------ RT REPAIR L 0208 13 DOOR SHELL, FRONT RT REFINISH RI 0261 MLDG,FRONT DOOR LOW LT R&I ASSEMBLY PRICE AJo B$ HOURS R ----- --- -- ----- - 1.5*1 3.7 4 0.4 1 2000 CHEVROLET VENTURE LS 4DOOR PASS. VAN EXTENDED CD LOS. NO 3173-1 RI Q229 MIRROR,OUTER R/C LT R&I ASSEMBLY RI Q227 HANDLE, FRONT DOOR 0 LT R&I ASSEMBLY I b390 PANEL,BODYSIDE REAR RT REPAIR L 0390 PANEL,BODYSIDE REAR RT REFINISH spot in 7 ITEMS MC MESSAGE(S) 13 INCLUDES 0.6 HOURS FIRST PANEL TWO-STAGE ALLOWANCE FINAL CALCULATIONS & ENTRIES PAINT MATERIAL PARTS & MATERIAL TOTAL LABOR 1-SHEET METAL 2-MECH/ELEC 3-FRAME 4-REFINISH 5-PAINT MATERIAL LABOR TOTAL TAX ON LABOR SUBLET REPAIRS TOWING STORAGE GROSS TOTAL NET TOTAL RATE REPLACE HRS 51.00 1.9 60.00 55.00 51.00 5.7 32.00 0.3 1 1.2 1 1.0*1 2.0 4 182.40 182.40 REPAIR HRS 2.5 224.40 290.70 515.10 7.OOOo 36.06 733.56 733.56 SHOPLINK UN189 ES CD LOG 3173-1 DATE 07/20/07 02:56:39PM R6.37 CD 07/07 PXN: Y/00/00/00/00/00 CUM 00/00/00/00/00 GEOCODE 52002 EDU: 0708 HOST LOG (C) 1998 - 2007 AUDATEX NORTH AMERICA, INC. 1.4 HRS WERE ADDED TO THIS EST. BASED ON AUDATEX TWO-STAGE REFINISH FORMULA. ~0.Ve ~~ ~Qr Cie ~r-~- '7~~~~c ~ c.- ~ ~~-. Q l'ir~E ~~ ~ /~ ~~ j • Richardson DNPBRC -~ Bulb`.'Gdlllac GMC T[uek Honda FE EfOEEIAMCE ALLIANCE' Drop off. Relax. Pickup. Jason Charley Body Shop Manager Body Shop Hours: 8 a.m. - 5 p.m. Mon. -Fri Business 563-582-5411 1475 John F. Kennedy Rd. Toll Free 888-806-5411 Dubuque, Iowa 52002 Fax 563-582-4129 jcharleyr~richardsonmotors.com