Claim Schneider, JeanneCLAIM AGAINST THE CITY OF DUBUQUE, IOWA
This written report constitutes your claim against the City of Dubuque, Iowa.
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. 13th 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: Jeanne Schneider
2. Address: 2080 Mullen Road - Dubuque, IA 52001
563-556-0418
3. Telephone Number:
4. Date of Incident: March 5, 2002
5. Time of Incident: 3:00 p.m.
6. Location of lncident (Be specific): City Hall on south side of build~n9
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.)
Large ice cycle fell from roof of City Hall onto front end of
my car
8. What were weather conditions like? C1 ear
9. Give name and address of any witnesses: Ken TeKippe, Gus ?sihoyos, Dawn Lang
10. Did police investigate? (If so, give names of officers.) No
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
No
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.)
Dented hood of car - see attached estimate
13. What other damages do you claim, if any?. None
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.)
No
15. What amount do you claim from the City of Dubuque? $1,353.82
16. Why do you claim the City of Dubuque is responsible? City knew of the probl em
from previous experience andfailed to correct the situation or to warn
employees not to park in that area
17. Have you made any claim against anyone else for damages as a result of this incident?
(If yes, give name and address.)
No
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 8th day of March ., 20 02
/s/ Jeanne Schneider
J // (Signature)
(REV. 1/00 & 7/01)
V1 'enbnqna
eo!i.iO s,;i elO
(Print Name)
Date: 3/6/2002 03:21 PM
Estimate ID: 335
Estimate Version: 0
Preliminary
Profile ID: Mitchell
RUNDE CHEVROLET INC.
780 RT. # 35 NORTH EAST DUBUQUE, IL 61025
(815) 747-3011
Fax: (815) 747-7721
Tax ID: 36-4320504
Damage Assessed By: MIKE RUNDE
Accident Date: 3/6~2002
Deductible: UNKNOWN
Insured:
Address:
Telephone:
JEANNE SCHNEIDER
2080 MULLEN RD. DUBUQUE, IA 52001
Home Phone: (563) 556-0418
Mitchell Service: 918497
Description: 2000 Chevrolet Monte Carlo SS
Body Style: 2D Cpe
VIN: 2GIWXI2KIY9298451
Color: DK BLUE MET
Drive Train: 3.8L Inj 6 Cyl AO
Line Entry Labor
item Number Type Operation
Line Item
Description
Part Type! Dollar Labor
Part Number Amount Units
1 800068 BDY REMOVE/REPLACE
2 AUTO REF REFINISH
3 AUTO REF REFINISH
4 800177 REF REFINISH
5 800178 REF REFINISH
6 900500 BDY* REMOVE/REPLACE
7 900500 BDY* REPAIR
8 900500 BDY* REPAIR
9 AUTO REF ADD'L OPR
10 AUTO ADD'L COST
11 AUTO ADD'L COST
HOOD PANEL 12455066 GM PART 449.00 1.0
HOOD OUTSIDE C 2.9
HOOD UNDERSIDE C 1.4
R FENDER OUTSIDE C 2.1
L FENDER OUTSIDE C 2.1
STRIPES L & R FENDERS **Qual Repl Part 25.00 * 0.6*
WASH VEHICLE FOR REPAIRS Existing 0.4*
CLEAN & DETAIL Existing 0.6*
CLEAR COAT 2.6*
PAINT/MATERIALS 288.60 *
HAZARDOUS WASTE DISPOSAL 5.55 *
Judgement Item
- Included in Clear Coat Calc
Add'l
Labor Sublet
I. Labor Subtotals Units Rate Amount Amount Totals
Body 2.6 40.00 0.00 0.00 104.00
Refinish 11,1 40.00 0.00 0.00 444.00
Il. Part Replacement Summary
Taxable Parts
Sales Tax
6.250%
Non-Taxable Labor 548.00
Total Replacement Parts Amount
Labor Summary 13.7 548.00
ESTIMATE RECALL NUMBER: 3/6/2002 15:21:40 335
UltraMate is a Trademark of Mitchell International
Mitchell Data Version: MAR 02 A Copyright (C) 1994 - 2000 Mitchell International
UltraMate Version: 4.7.007 All Rights Reserved
Page I
Amount
474.00
29.63
503.63
of 2
Date: 3/6/2002 03:2'1 PM
Estimate ID: 335
Estimate Version: 0
Preliminary
Profile ID: Mitchell
lie Additional Costs
Taxable Costs
Sates Tax
6.250%
Amount
288.60
18.04
IV. Adjustments
Customer Responsibility
Non-Taxable Costs
5.55
Tota[ Additional Costs
312.19
I. Total Labor:
0. Total Replacement Parts:
III. Total Additional Costs:
Gross Total:
IV. Total Adjustments:
Net Total:
This is a preliminary estimate.
Additional chan,qes to the estimate may be required for the actual repair.
Amount
0.00
548.00
503.63
312.f9
1,363.82
0.00
1,363.82
ESTIMATE RECALL NUMBER: 3/6/2002 15:21:40 335
UltraMate is a Trademark of Mitchell International
Mitchell Data Version: MAR_02_A Copyright (C) 1994 - 2000 Mitchell International
UltraMate Version: 4.7.007 All Rights Reserved
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