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Claim by Terry MozenaTHE CITY OF DUB E MEMORANDUM Masterpiece on the Mississippi BARRY LINDAHL ~ I~ CITY ATTORNEY To: Mayor Roy D. Buol and Members of the City Council DATE: RE: Claimant October 26, 2007 Claim Against the City of Dubuque by Terry Mozena Date of Claim Terry Mozena 10/15/07 Date of Loss 10/05/07 Nature of Claim Vehicle Damage This is a claim in which the claimant alleges that while driving past a construction site at 2520 Pennsylvania Avenue near Irving School, a rock struck his vehicle which claimant alleges occurred during the drilling at the construction site. According to John Klostermann, Street & Sewer Maintenance Supervisor for the City of Dubuque, the project foreman at the construction site had the fleet maintenance supervisor inspect the damage to claimant's vehicle the day of the incident. The maintenance supervisor reported that the damage to the vehicle was consistent with the filed claim. It is therefore the recommendation of John Klostermann to approve this claim for the amount of the lower submitted estimate of $355.71. The City Attorney's Office concurs with this recommendation. BAL:tIs cc: Michael C. Van Milligen, City Manager Jeanne Schneider, City Clerk John Klostermann, Street & Sewer Maintenance Supervisor Terry Mozena 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 mv~~ NST THE CITY OF DUBUQUE, IOWA ~~l CLAIM AGAI I ;~~/~s This written report constitutes your claim against :the City of Dubuque, owa. Yo ~ 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 5200.1. 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: ~/~ IVIO~-~C,,l/~ G 2. Address: ~~~ W . c 3l~'~ 3. Telephone Number ~ ~ ~ _ 4. Date of Incident: 5. Time of Incident: ~ a ~ M 6. Lc~ation of Incident (Bed specific): 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.) 9. Give name and address of any witnesses: ~ ff, in ij 10._ Did police investigate? ~If so, give names of officers.) r ~, ~D '" 8. What were weather conditions like? S 11. W,,as anyone injured? (If so, give names, addresses, and extent of injuries). 13. alVhat 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.) ~~ 15. What amount do you claim from the City of Dubuque? 16. Why do you claim the Cit of Dubuqu is responsible? S L° ~L' 17. Have you made any claim against anyone else for damages as a result of thi i cident? (If yes,' give name and address.) 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 ('~C`~o~DPJf" , 200 7 (Signature) T~ r~~~~a (Print Name) dl ''~~-cnGnQ 871?~~; ~:~°',a~'r3 ~~~~ S S ~Z Wd S 1100 CO 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 10/12/2007 at 12:08 PM 18174 Job Number: RILEY AUTO SALES Federal ID #:420957277 4455 DODGE STREET DUBUQUE, IA 52003 (563)588-2326 Fax: (563)588-9286 PRELIMINARY ESTIMATE Written By: DAVE DEMOSS Adjuster: Insured: TERRY MOZENA Owner: TERRY MOZENA Address: 900 WEST 3RD ST DUBUQUE, IA 52001 Other: (563)556-7270 Claim # Policy # Deductible: Date of Loss: Type of Loss: Point of Impact: Inspect Location: Insurance Company: 2007 SUBA OUTBACK 4-2.5L-FI 4D WGN Int: Days to Repair VIN: 4S4BP610977323511 Lic: Prod Date: Odometer: Air Conditioning Rear Defogger Tilt Wheel Cruise Control Intermittent Wipers Keyless Entry Rear Window Wiper Theft Deterrent/Alarm Body Side Moldings Dual Mirrors Roof Console Luggage/Roof Rack Fog Lamps Rear Spoiler Clear Coat Paint Power Steering Power Brakes Power Windows Power Locks Power Driver Seat Power Mirrors Power Trunk/Tailg ate AM Radio FM Radio Stereo Search/Seek CD Player Anti-Lock Brakes (4) Driver Air Bag Passenger Air Bag Front Side Impact Air Bag 4 Wheel Disc Brakes Positraction Cloth Seats Bucket Seats Heated Seats 5 Speed Transmiss ----------------- ion Overdrive ------- Aluminum/Alloy Wheels N0. OP. ----------------- ---------------------------- DESCRIPTION QTY ----- --------------------------- EXT. PRICE LABOR PAINT 1 ------------------------------ FRONT DOOR --------------------------- 2* Rpr RT Door shell w/Outback (HSS) 0.5 2.0 3 Add for Clear Coat 0.8 4 R&I RT Upper molding w/o GT 0.3 Limited, Outback diamond gray 5 R&I RT Lower molding GT Limited & 0.3 Outback green 6 R&I RT Belt w'strip 0.2 7 R&I RT Mirror assy Outback I black 0.3 8 R&I RT Handle, outside Outback I 0.3 black 1 10/12/2007 at 12:08 PM 18174 Job Number: PRELIMINARY ESTIMATE 2007 SUBA OUTBACK 4-2.5L-FI 4D WGN Int: ---------------------------------------------- NO. OP. DESCRIPTION ---------------- QTY EXT. PRICE ---------------- --------- LABOR --------- -------- PAINT -------- ---------------------------------------------- 9# CAR COVER 1 5.00 10# CORRISION PROTECTION 1 4.00 ----- -------- ---------------------------------------------- Subtotals =_> ---------------- 9.00 ---- 1.9 2.8 Parts 9.00 Body Labor 1.9 hrs @ $ 51.00/hr 96.90 Paint Labor 2.8 hrs @ $ 51.00/hr 142.80 Paint Supplies 2.8 hrs @ $ 32.00/hr 89.60 ------ ------------------- SUBTOTAL ---------------- --------- $ -- 338.30 Sales Tax $ 248.70 @ 7.0000% 17.41 ------------------- GRAND TOTAL ---------------- --------- $ -------- 355.71 ADJUSTMENTS: Deductible 0.00 ------------------- CUSTOMER PAY ---------------- --------- $ -------- 0.00 INSURANCE PAY $ 355.71 THIS ESTIMATE IS BASED ON A VISUAL INSPECTION AND DOES NOT INCLUDE ADDITIONAL PARTS OR LABOR THAT MAY BE REQUIRED TO COMPLETE REPAIRS. PART PRICES ARE CURRENT AND SUBJECT TO INVOICE. WE FEATURE A LIFETIME WORKMANSHIP LIMITED WARRANTY - SEE OUR WRITTEN WARRANTY FOR COMPLETE DETAILS. LIFETIME PAINT PERFORMANCE GUARANTEE USING APPROVED PPG PRODUCTS AND A LIFETIME GUARANTEE ON OVERALL WORKMANSHIP IS VALID AS LONG AS YOU THE VEHICLE STATED HEREIN. 2 10/12/2007 at 12:08 PM 18174 Job Number: PRELIMINARY ESTIMATE 2007 SUBA OUTBACK 4-2.5L-FI 4D WGN Int: Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from the Guide ARL7523, CCC Data Date 09/01/2007, 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 Recond. 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. 3 MITSUBISHI ILE~ DAVE DEMOBS Body Shop Manager 563.588.2326 877.588.2326 Fax 563.588.9286 _ davedemoss®rileyauto.com Date: Estimate ID: Estimate Version: Preliminary Profile ID: 10/12/2007 12:17 PM 7208 0 Mitchell Mike Finnin Ford 3600 Dodge Street, Dubuque, IA 52003 (563) 556-1010 Fax: (563)690-1086 Tax ID: 141762673 Damage Assessed By: Rick Stumpf Deductible: 0.00 Claim Number: 7208 Insured: TERRY MOZENA Address: 900 WEST THIRD, DUBUQUE, IA 52001 Telephone: Home Phone: (563) 556-7270 Mitchell Service: 910313 Description: 2007 Subaru Outback 2.5 XT Limited Body Style: 4D Wgn Drive Train: 2.5L Turbo Inj 4 Cyl SA AWD VIN: 4S46P610977323511 Color: SILVER Options: ALUM/ALLOY WHEELS, AUTOMATIC TRANSMISSION, POWER DRIVER SEAT Line Entry Labor Item Number Type Operation 1 001773 BDY REPAIR 2 AUTO REF REFINISH 3 003379 BDY REMOVEANSTALL 4 003381 BDY REMOVE/INSTALL 5 003363 BDY REMOVEANSTALL 6 003371 BDY REMOVEANSTALL 7 AUTO REF ADD'L OPR 8 933005 BDY ADD'L OPR 9 933018 REF ADD'L OPR 10 AUTO ADD'L COST 11 AUTO ADD'L COST Line Item Description Part Type/ Dollar Part Number Amount Labor Units R FRT DOOR SHELL R FRT DOOR OUTSIDE R FRT OTR BELT MOULDING R FRT REAR VIEW MIRROR R FRT DOOR TRIM PANEL R FRT OTR DOOR HANDLE CLEAR COAT RESTORE CORROSION PROTECTION MASK FOR OVERSPRAY PAINT/MATERIALS HAZARDOUS WASTE DISPOSAL * -Judgment Item # -Labor Note Applies C -Included in Clear Coat Calc ESTIMATE RECALL NUMBER: 10/1212007 12:17:43 7208 UltraMate is a Trademark of Mitchell International Mitchell Data Version: SEP_07_A Copyright (C) 1984 - 2005 Mitchell International UltraMate Version: 6.0.027 All Rights Reserved Existing 1.0*# C 2.0 0.3 0.3 # INC 1.3 # 0.8' 3.00 * 0.1* 15.00 * 0.2* 89.60 5.00 Page 1 of 2 Date: 10/12/2007 12:17 PM Estimate ID: 7208 Estimate Version: 0 Preliminary Profile ID: Mitchell Add'I Labor Sublet 1. Labor Subtotals Units Rate Amount Amount Totals II. Part Replacement Summary Amount Body 3.0 52.00 3.00 0.00 159.00 T Refinish 3.0 52.00 15.00 0.00 171.00 T Total Replacement Parts Amount 0.00 Taxable Labor 330.00 Labor Tax @ 7.000 % 23.10 Labor Summary 6.0 353.10 111. Additional Costs Amount IV. Adjustments Amount Non-Taxable Costs 94.60 Insurance Deductible 0.00 Total Additional Costs 94.60 Customer Responsibility 0.00 I. Total Labor: 353.10 II. Total Replacement Parts: 0.00 III. Total Additional Costs: 94.60 Gross Total: 447.70 IV. Total Adjustments: 0.00 Net Total: 447.70 This is a preliminary estimate. Additional changes to the estimate may be required for the actual repair. ESTIMATE RECALL NUMBER: 10/1212007 12:17:43 7208 UltraMate is a Trademark of Mitchell International Mitchell Data Version: SEP_07_A Copyright (C) 1994 - 2005 Mitchell International Page 2 of 2 UltraMate Version: 6.0.027 All Rights Reserved