Claim by Jim JonesTHE CITY OF
DUB E c MEMORANDUM
rpiece on the Mi issippi ~~'
BARRY LIND H~L
CITY ATTORNEY
To: Mayor Roy D. Buol and
Members of the City Council
DATE: December 11, 2007
RE: Claim Against the City of Dubuque by Jim Jones
Claimant Date of Claim Date of Loss Nature of Claim
Jim Jones 12/10/07 12/03/07 Vehicle Damage
This is a claim in which the claimant alleges that a City of Dubuque fire truck struck his
parked 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
Dan Brown, Fire Chief
Jim Jones
OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA
SUITE 330, HARBOR ~/IEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001-6944
TELEPHONE (563) 583-4113 / FAx (563) 583-1040 / EMAIL balesq@cityofdubuque.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 W. 13t" St., Dubuque, IA 52001.
It will then be referred by the City Council to the appropriate department for investigation.
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: ~~
2. Address: .~
--~
3. Telephone Number: ~~ , 3 - ~S`~oZ - 3 7 a ~
4. Date of Incident:~~ . 4 ,~ ~ o
5. Time of Incident: ~~, ~~
6. Location of Incident (Be specific): ~~J , G Citi-e,
7. DESCRIBE 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:
10. Did police investigate? (If so, give names of officers.) i~~~
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
8. What were weather conditions like? ~ -Zccrz~
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 extent of damage.)
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.)
15. What amount do you claim from the City of Dubuque? ~ j/~,/ ~~
16. Why do yoy~claim the City~f Dubuque is res
17. Have you made any claim against anyone else for damages as a result of this incident?
(If yes, give name and address.) /y ~
18. If the answer to Question 17 is yes, have you received any payment from that source,
and if so, in what amount?~~
Dated at Dubuque, Iowa this O Z day of ~~_ 20Q
(Signature)
_~~ i ~ ~ , `~ O/~/~..s' (Print Name)
(Rev. 1 /00 & 7/01) ~/~ " ~~i !0/i1GClQ
L S~ I bid O t 03a LO
C1~/\#~J~c-~
~~ Driver Information Exchange Report
Dubuque Police Department
563-589-4410
~- Driver's Name -Last
~ First Middle Suffuc Date of Birth
1
U BREITBACH JEFFRY 02/28/1959
A
k N Address City
~ State Zip Phone
( 11009 OAKLAND FARMS RD DUBUQUE IA 52003 (563) 880-1303 x
~ . Gender Drivers License Number Class State Endorsements. Restrictions Insurance Co. Name Insurance Co. Phone #
r Male 944ZZ9481 D IA 2 NONE CITY OF GUBUQUE (563) 588-4169 x
001 Owner Company Name Insurance Policy # / /
CITY OF DUBUQUE - ! /
Owner's Name -Last Firs! Middle Su~x
Address City State Zip
50 W. 13TH DUBUQUE IA 52001-
VIN No. Year Make Model Style Vehicle Configuration
4S7AT8L02M0003289 1991 SPR GA26-2142 FIRE TRUCK 88
License Plate # State Year Most Damaged Area Approximate Cost io Repair or Replace
78151 IA 2008 04 -Right Rear 5500.00
Drivels Name -Last Firs Middle Suffoc Date of Bkth
U JONES JAMES CECIL 11/13/1845
N _
Address City State Zip Phone
~ 2333 BURR OAK DUBUQUE IA 52002-0000 (563) 582-3722 x E
.r Gender Drivels License Number Class State Endorsements Restrictions Insurance Co. Name Insurance Co. Phone #
Male 982ZZ4620 C,M IA NONE NONE ALLIED (800) 282-1446 x
002 Owner Company Name Insurance Policy #
PP00007286618.2
Owners Name -Last First Middle Suffix
JONES JAMES CECIL
Address City State Zip
2333 BURR OAK DUBUQUE IA 52002-0000
VIN No. Year Make Model Style Vehicle Configuration
1GCEK18T54E188011 2004 CHEV SLV PK 02
License Plate # State Year Most Damaged Area Approximate Cost to Repair or Replace
459AYD IA 2007 08 -Left Front $500.00
County Accident occurred within corporate limits of (city)
Dubuque-31 Dubuque-2100
Literal Description
CENTRAL AVE
X-Coordinate Y-Goordinate
00691818 04708168
If accident occurred outside of city Direction Nearest City Route (Cardinal
limits show general vacinity: "N/A" "N/A" of "N/A" Travel Direction SB
On Road, Street, or Highway: At intersection with:
CENTRAL "N/A"
Distance Direction Distance Direction Milepost Number
30 Ft 1-N and "N/A" "NIA" of "NIA" Or
Definable intersection, bridge, or railroad crossing
8TH ST
Officer
WEI Badge No. Law Enforcement Case Number Date of Accident
~ Time of Accident
DEMANN, JUSTIN 48 01-07-53419
12103!2007 15:46 Hrs.
Date: 12/ 6/2007 09:22 AM
Estimate ID: 4606
Estimate Version: 0
Preliminary
Profile ID: Mitchell
BIRD CHEVROLET
3255 UNIVERSITY AVE, DUBUQUE, IA 52001
(563) 583-9121
Faa: (563) 556-4482
TaaID: 42-0400210
Damage Assessed By: john klotz
Deductible: UNKNOWN
Insured: JIM JONES
Address: 2333 BURR OAK DR, DUBUQUE, IA 52002
Telephone: Home Phone: (563) 582-3722
Mitchell Service: 915496
Description: 2004 Chevrolet Pickup Silverado K1500 LS
Body Style: 4D Pkup%Cb 6' Bed 143" WB Drive Train: 5.3L Inj 8 Cy14WD
VIN: 1 GCEK 19T54E 188011
Options: 4WD Oft AWD, AIR CONDITIONING, POWER DOOR LOCKS, CRUISE CONTROL
AUTOMATIC TRANSMISSION
Line Entry Labor
Item Number Type
1 AUTO BDY
2 507818 BDY
3 507362 BDY
4 507819 BDY
5 AUTO REF
6 504819 BDY
7 500291 BDY
8 504948 BDY
9 AUTO REF
10 AUTO REF
11 AUTO
12 AUTO
Line Item Part Type!
Operation Description Part Number
OVERHAUL FRT BUMPER COVER ASSY
REMOVE/REPLACE FRT BUMPER FACE BAR 19150310 GM PART
REMOVE/REPLACE L FRT OTR BUMPER BRACE 15184118 GM PART
REMOVE/R,EPLACE FRT UPR BUMPER COVER 89025820 GM PART
REFINISH FRT MOULDING CAP
REMOVE/REPLACE FRT BUMPER AIR DEFLECTOR ORDER FROM DEALER
REMOVE/INSTALL L FENDER WHEEL OPENING FLARE
REPAIR L FENDER WHEEL OPENING FLARE Existing
REFINISH L WHEEL OPENING FLARE
ADD'L OPR CLEAR COAT
ADD'L COST PAINT/MATERIAIS
ADD'L COST HAZARDOUS WASTE DISPOSAL
Dollar Labor
Amount Units
2.5 #
361.37 INC #
22.19 0.2 #
199.60 INC #
C 1.2
98.24 INC #
0.3
0.5*
C 1.0
0.4
80.60 *
2.60 *
* -Judgment Item
# -Labor Note Applies
C -Included in Clear Coat Calc
Add'1
Labor Sublet
I. Labor Subtotals Units Rate Amount Amount Totals II. Part Replacement Summary Amount
Body 3.5 52.00 0.00 0.00 182.00 T Taxable Parts 681.40
Refinish 2.6 52.00 0.0(1 0.00 135.20 T Sales Tax ~ 7.000% 47.70
Taxable Labor 317.20 Total Replacement Parts Amount 729.10
Labor Tax ~ 7.000 % 22.20
Labor Summary 6.1 339.40
ESTIMATE RECALL NUMBER: 12/06/2007 09:22:30 4606
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