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