Claim by Duane WilleTHE CITY OF
DuB E
Masterpiece on th,
BARRY LIN
CITY ATTOf
To:
DATE:
RE:
Claimant
MEMORANDUM
Mayor Roy D. Buol and
Members of the City Council
September 12, 2007
Claim Against the City of Dubuque by Duane J. Wille
Date of Claim
Duane J. Wille
09/05/07
Date of Loss
08/25/07
Nature of Claim
Vehicle Damage
This is a claim in which the claimant alleges that his vehicle, which was parked near 395
West 17th Street, was struck by a City of Dubuque police squad car as police were
responding to an emergency and lost control of the squad car.
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
Kim Wadding, Chief of Police
Duane J. Wille
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
~~'~
WA ~~~~~
CLAIM AGAINST THE CITY OF DUBUQUE, IO
~~/lam
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 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 wil! 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:
2. Address:
3. Telephone Number ~~(~~ ~"
4. Date of Incident:
-- r~,~ _.
5. Time of Incident:
6. Location of Inciden
ific):
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8. hat yver~ weather cQnhi~on~ like?
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9. Give name and address of any witnesses:
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,l. WIMP.
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10. Did police nv stigate? If so, ive names of ~}ff'cers.)
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
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
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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 of insurance company and
amount paid.)
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15. W~~ amqun~lo you claim from the City of Dubuque?
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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?
~-
Dated this ~_ day of
ignature)
[ 1~.~01 r~ e ~ ~C.,
(Print Name)
~t0 ~Ol i~b S- d3S LO
-~J~r`~i~~~~1
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
17. Have you made any claim against anyone else for damages as a result of
this incident? (If yes,' give name and address.)
Y1 ~
Date=
Estimate ID~
Estimate Version
Preliminary
Profile ID=
BIRD CHEVROLET
3255 UNIVERSITY AVE, DUBUQUE, IA 52001
X563) 583-9121
Fax X563) 556-4482
TaxID~ 42-0400210
Damage Assessed By. john klotz
Deductible UNKNOWN
Insured DUANE WILLE
9/ 4/2007 10=45 AM
4176
0
Mitchell
Mitchell Service= 914493
Description- 1997 Chevrolet Cavalier RS
Body Style 2D Cpe Drive Train= 2.2L Inj 4 Cy13A FWD
VIN 1G1JC1245VM162399
Optiona~ AIR CONDITIONING, AUTOMATIC TRANSMISSION
Line
Item Entry Labor
Number Type
1 400042 BDY
2 400060 BDY
3 AUTO BDY
4
5 400087 BDY
6 400225 BDY
7 AUTO REF
8 AUTO REF
9
10 400226 BDY
11 400229 BDY
12 400233 BDY
13 400237 BDY
14 400756 BDY
15 AUTO REF
16 400966 BDY
17 AUTO REF
18 AUTO REF
19
20 AUTO REF
21 AUTO
22 AUTO
Line Item Part Type/ Dollar Labor
Operation Description Part Number Amount Units
REMOVE/REPLACE FRT BUMPER COVER 22573779 GM PART 86.86 1.8 #
REMOVE/REPLACE L H/LAMP ASSEMBLY Qual Recycled Part 75.00 *INC
CHECK/ADJUST HEADLAMPS 0.4
LINE MARKUP °25.00 18.75
REMOVE/REPLACE L MARKER LAMP ASSEMBLY 5978063 GM PART 29.26 INC #
REMOVE/REPLACE L FENDER PANEL Qual Recycled Part 125.00 * 1.2 #
REFINISH L FENDER OUTSIDE C 2.0
REFINISH L FENDER EDGE C 0.5
LINE MARKUP °•625.00 31.25
REMOVE/REPLACE FENDER MUDGUARD 12365988 GM PART 24.99 #
REMOVE/REPLACE L FRT UPR FENDER BRACKET 22647131 GM PART 8.32 0.1
REMOVE/REPLACE L FRT FENDER SPLASH SHIELD 22659743 GM PART 31.39 INC #
REMOVE/REPLACE L FENDER LINER 22613215 GM PART 5421 INC #
REPAIR L SECTION ROCKER PANEL 2.0*#
REFINISH L ROCKER PANEL C 1.4
REMOVE/R,EPLACE L FRT DOOR SHELL Qual Recycled Part 250.00 * 4.8 #
REFINISH L FRT DOOR OUTSIDE C 1.8
REFINISH L FRT ADD FOR JAMB5 & INSIDE C 1.0
LINE MARKUP °i625.00 62.50
ADD'L OPR CLEAR COAT 1.8
ADD'L COST PAINT/MATERIALS 263.50
ADD'L COST HAZARDOUS WASTE DISPOSAL 6.00 *
* -Judgment Item
# -Labor Note Applies
C -Included in Clear Coat Calc
ESTIMATE RECALL NUMBER 09/04/2007 10=45.00 4176
U1traMate is a Trademark of Mitchell International
Mitchell Data Version= AUG_07_A Copyright LC) 1994 - 2005 Mitchell International Page 1 of 2
U1traMate Version 6.0.026 All Rights Reserved
Date: 9/ 4/2007 10:45 AM
Estimate ID: 4176
Estimate Version: 0
Preliminary
Profile ID: Mitchell
Add'1
Labor Sublet
I. Labor Subtotals Units Rate Amount Amount Totals II. Part Replacement Summary Amount
Body 10.3 52.00 0.00 0.00 535.60 T Taxable Parts 685.03
Refinish 8.5 52.00 0.00 0.00 442.00 T Parts Adjustments 112.50
Sales Tax ® 7.000% 55.83
Taxable Labor 977.60
Labor Tax (~3 7.000 % 68.43 Total Replacement Parts Amount 853.36
Labor Summary 18.8 1,046.03
III. Additional Coats Amount IV. Adjustments Amount
Non•Taxable Coats 269.50 Customer Responsibility 0.00
Total Additional Costa 269.50
I. Total Labor: 1,046.03
II. Total Replacement Parts: 853.36
III. Total Additional Coate: 269.50
Gross Total: 2,168.89
IV. Total Adjustments: 0.00
Net Total: 2,168.89
This is a preliminary estimate.
Additional changes to the estimate may be required for the actual repair.
ESTIMATE RECALL NUMBER: 09104!2007 10:45:00 4176
U1traMate is a Trademark of Mitchell International
Mitchell Data Version: AUG_07 A Copyright (C) 1994 - 2005 Mitchell International Page 2 of 2
U1traMate Version: 6.0.026 All Rights Reserved
~~ Driver Information Exchange Report
Dubuque Police Department
563-589-4410
Driver's Name -Last First Middle Suffix Date of Birth
U BOWERS JAMIE LEE 05/23/1984
N Address Ci
U
a
770 IOWA STREET D
BUQUE IA 52001 (563) 5894410 x
1. Gander Drivers License Number Gass State Endorsements Restrictions Insure Co. Name Insurance Co. Phone #
Female 609YY7355 C A NONE NONE S~ L~ ~ ~ `c
001 Owner Company Name
CITY OF DUBUQUE Insurance Policy #
g1
0
.
Owner's Name -Last First Middle Strf(bc ~~ /~ ~ f f 1 /
`~~ ~(-
Address City State Zip
770 IOWA STREET DUBUQUE IA 52001-
VIN No. Year Make Model Style Vehicle Corfguraton
2FAHP71W16X122831 2006 FORD CROWN VIC 4DR 01
License Plate # State Year Most Damaged Area
A
p
x
to Cost to Repatr or Replace
T8694 IA 2008 02 -Right Front S
S
O
~
Driver's Name -Last First Middle Suffix Date of Birth
U
N
I Address City State Zip Phone
T Gender Driver's License Number Class State Endorsemerrls Restrictions Insurance Co. Name Insurance Co. Phone #
NONE NONE NATIONWIDE MUTUAL INS (800) 282-1446 x
002 Owner Corr
ar
N
r
p
ry
a
ne Insurance Policy#
PPGM0017606439-1
Owner's Name -Last First Middle Suffer
WILLE DUANE JOSEPH 3
Address
U
te
395 W. 17TH STREET BUQUE A 52001-
VIN No. Year Make Model Style Vehicle Configuration
1G1JUC1246VM162399 1997 CHEV CAVALIER 2DR 01
License Plate # State Year Most Damaged Area Approximate Cost to Repair or Replace
141SXX IA 2008 07 -Left Side 52,500.00
Driver's Name -Last First Middle Suffer Date of Birth
U
N
I '~re~ GtY State Zip Phone
.r Gender Driver's License Number Gass State Endorsemrerrts Restrictions Iruuranoe Co. Name Insurance Co. Phone #
IA NONE NONE
003 Owner ~~nY Name Insurance Policy#
Owner's Name -Last First Middle Suffoc
Address Cily State Zip
VIN No. Year Make Model Style Vehicle Configuration
2G4B52MST1436696 1996 BUIC REGAL CUSTOM 4DR 01
License Plate # State Year Most Damaged Area Approximate Cost to Repair or Replace
316JST A 2008 06 -Left Rear 5250.00
County Accident occurred within corporate limns of (city)
Dubuque-31 Dubuque-2100
Literal Description
"NIA"
X-('.oordirate Y-Coordinate
"~A" "N/A"
ff acddent oa;umed outside of aty Direction Nearest City Route (CardinaQ
limits show ger~ral vaanity: "N/A" "N/A" of "N!A" Travel Direction "N/A"
On Road, Street, or Highway. At Intersection with:
W. 17TH STREET ^N/A^
Distance Direction Distarae Direction Milepost Number
75 Ft 3-E and "N/A" "N/A" of "N/A" Or
Definable intersection, txidge, or railroad crossing
W. 17TH STREET AND W. LOCUST
Officer Badge No. Law Enforcement Case Number Date of AoadeM Time of Acaderrt
SCHMIT, MICHAEL LT3 07-37225 08/25/2007 01:42 Hrs.
Printed At: Dubuque Police Department 08/26!2007 03:29 AM Page 1 Form #: 077225