Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Claim Taggert, Kevin T.
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. 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: Kevin T. Taggart 2. Address: 100 Lindberg Terrace 3. Telephone Number: 563 583 1784 4. Date of Incident: March 9th, 2002 5. Time of Incident: sometime before 1:30 P.M. 6. Location of Incident (Be specific): Color Box Parking Lot, 2150 Kerper Blvd. 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.) The road closed Sign from Fengler Overpass blew across Kerper Blvd. into Color Box Parking Lot and hit my truck. 8. What were weather conditions like? Windy 9. Give name and address of any witnesses: Bruce Frommelt, 790 Hawkeye Heights Dubuque, IA 10. Did police investigate? (If so, give names of officers.) Yes , Officer Ryan 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.) Just my truck 13. What other damages do you claim, if any? See attached estimates 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? $709.98 + this is the lowest estimate 16. Why do you claim the City of Dubuque is responsible? Because the Sign wasn't secured properly ( Negligence) 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 12th day of March, 2002. , 20 . /s/ Keven T. Taggart (Signature) (Print Name) (Rev. 1/00 & 7/01) 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= ~ 2. Address: /O~ ~-/~/~/~/ 3. Telephone Number~ 4. Date of Incident: ~~ 5. Time of Incident: 6. Location of lncident (Be specific): (~O~Ot~ ~©~ '~'P,~'~'~ 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 empl°yee'sname')-T'~ ~0~ C~[C)%/~L~ S/~ ~H F~i::~/~ ~/~i~ 8. What were weather conditions like? ~,k~ 9. Give name and address of any witnesses: 10. L~?d police inv~_estigate~ ,{If so, give names of officers.) 11. Was anyone injured? (If so, give names, addresses, and extent of injuries). 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. ~,hat amount do you claim from the City of Dubuque? 16. Why do you claim the City of Dubuque is responsible? 17. Have you made any claim against anyone else for damages as a result of this incident? (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 at Dubuque, Iowa this ~;~'~'~ (Rev. 1/00 & 7/01) dayof [~,~Cj}~. , 200~. (Print Name) FAX 319 $89 4497 DUBUOUE POLICE Dubuque Police Depmttment Law Enfo~ement Center EO. Box 875 Dubuque, Iowa 52004-08?$ Phone [319) 589-4410 Fax O19) 5894497 INSURED/DRIVERS: ACCIDENT/LOSs LOCATION: Thank you for your ~nclosed payment of $- Report requested i~ attached No report o.,.~ecord with this department $"/~ ~ ~harge for this repoxt. ~ 001 KW4i Sincerely, Klm Waddir~g Chief'ofPolic~ e~CZ 03/12/2002 TT.~ OB:SS F.~-~ 319 $$9 4497 DUBUQt~ POLICE ~002 SIGN BLEW INTO SIDE OF TRUCK Date: 3/11/02 04:32 PM Estimate ID: 6210 Estimate Vemion: 0 Preliminary Profile ID: CUSTOMIZED BIRD CHEVROLET 3255 UNIVERSITY AVE. P.O. BOX 67 DUBUQUE, IA 62001 (563) 583-9t21 Fax: (563) 556-4482 Tax ID: 42-0400210 Damage Assessed By: JOHN KLOTZ JR. Deductible: UNKNOWN Owner KEVIN TAGGART Address: 100 ENDBERG TERRACE BUBUQUE, IA 52001 Mitchell Service: 916492 Description: 1994 Chevrolet St0 LS Body Style: 2D PkupXCb 6' Bed 122" WB VlN: 1GCDT19W2R8172678 Mileage: 71,456 Color: BLACK Options: 4WD OR AWD Drive Train: 4.3L Inj 6 Cyl 4WD License: 256FFB Line Entry Labor Item Number Type Operation Line Item Description I 619450 REF BLEND 2 631130 REF REFINISH 3 623730 BDY REMOVE/REPLACE 4 623850 BDY REMOVE/REPLACE 5 626010 REF REFINISH 6 AUTO REF ADD'L OPR 7 933012 REF ADD'L OPR 8 AUTO ADD'L COST 9 AUTO ADD'L COST L OTR CAB SIDE PANEL L FRT DOOR OUTSIDE L FRT DOOR NAMEPLATE L FRT DOOR POWER MIRROR ASSY L BED OUTER PANEL CLEAR COAT STRIPE PAINT/MATERIALS HAZARDOUS WASTE DISPOSAL Part Type~ Part Number Dollar Labor Amount Units ORDER FROM DEALER 15150851 GM PART C 0.8 C 2.1 14.30 0.t t3t.00 0.6 # C 2.2 t.5 15.00' 0.3* 171.60 * 6.94 * * - Judgement Item # - Labor Note Applies C - Included in Clear Coat Calc ESTIMATE RECALL NUMBER: 3111102 16:28:22 6210 UltraMate is a Trademark of MItchell International Mitchell Data Version: MAR_02_A Copyright (C) 1994 - 2000 Mitchell Intemational UitraMate Version: 4.7.007 All RIghts Reserved Page I of 2 Date: 3/tti02 04:32 PM Estimate ID: 6210 Estimate Version: 0 Preliminary Profile ID: CUSTOMIZED I. Labor Subtotals Units Body 0.7 45.00 Refinish 6.9 45.00 Add'l Labor Sublet Rate Amount Amount Totals 0.00 0.00 31.50 T 15.00 0.00 325.50 T Taxable Labor Labor Tax ~ 6.000 % Labor Summary 7.6 357.00 21.42 378,42 II. Part Replacement Summary Taxable Parts Sales Tax Total Replacement Pads ~unt 6.000% IlL Additional Costs Non-Taxable Costs Total Additional Costs Amount IV. Adjustments t77.54 Customer Responsibility t77.54 I. Total Labor:. II. Total Replecernent Parts: III. Total Additional Costs: Gross Total: IV. Total Adjustments: Net Total: This is a preliminary estimate. Additional changes to the estimate may be required for the actual repair. PARTS PRICES ARE S~BJECT TO CH~.NGE Amou~ 145.30 8.72 154.02 378.42 t54.02 t77.54 709.98 0.00 709,98 ESTIMATE RECALL NUMBER: 3/11102 16:28:22 6210 UitraMate is a Trademark of Mitchell International Mitchell Data Version: MAR_02_A Copyright (C) 1994 - 2000 Mitchell International UitmMate Version: 4.7.007 All Rights Reserved Page 2 of 2 FED ID #42-0813744 Date: 3/t tl02 04:22 PM Estimate ID: 6149 Estimete Vemlen: 0 Preliminary Profile ID: CUSTOMIZED RICHARDSON MOTORS 1475 J.F.K. ROAD DUBUQUE, IA 52002 (563) 582-5411 Fax: (563) 582-4t29 Damage Assessed By: AL COGHLAN Deductible: UNKNOWN Ow~ter KEVIN TARRART Address: 100 UNDBERG TERR DUBUQUE, IA 52001 Mitchell Service: 916492 Body Style: VIN: Op~ons: 1994 Chevrolet St0 LS 2D PkupXCb 6~ Bed 122" WB 1GCDT19W2R8172678 4WD OR AWD Drive Train: 4,3L Inj 6 Cyl 4WD Une Entry Labor Item Number Type Operation Line Item Description Part Number Amount Units t 631148 BDY REPAIR 2 AUTO REF REF~kSH 3 630937 BDY REMOVE/REPLACE 4 630942 BOY REMOVE/REPLACE 5 626010 REF REFINISH 6 900500 BDY* REMOVE/REPLACE 7 AUTO REF ADD'L OPR 8 933017 REF ADD'L OPR 9 933018 REF ADD'L OPR t0 AUTO ADD'L COST tl AUTO ADD'L COST L FRT DOOR REPAIR PANEL L FRT DOOR OUTSIDE R FRT DOOR MIRROR ASSY L FRT DOOR POWER MIRROR ASSY L BED OUTER PANEL STRtPE CLEAR COAT COLOR SAND & BUFF MASK FOR OVERSPRAY PAINTRJIATERIALS HAZARDOUS WASTE DISPOSAL Existing 15757185 t$757205 New GM PART GM pART 1.0'# C 2-t 83.75 0.6 # 366.00 0.6 # C 2-O* 12-00' 0.2* 1.2 4.00* 0.3' 137.80 * 6.00 * * - Judgement Item # - Labor Note Applies C - Included in Clear Coat Calc ESTIMATE RECALL NUMBER: 3/11102 16:16:10 6149 UitraMate is a Trademart( of Mitchell intemetlenal Mitchell Data Version: MAR_02_A Copyright (C) 1994 - 2000 Mitchell Intemaflona! Ult~aMa~e Version: 4.7.007 All Rights Reserved Page I of 2 Date: 3/1'l/02 04:22 PM Estimate ID: 6149 Estimate Version: 0 Preliminary Profile ID: CUSTOMIZED Body 2.4 42.00 Refinish 6.t 42.00 Add'l Labor Sublet Rate Amount Amount Tota~ 0.00 0.00 t00.80 4.00 0.00 260.20 Taxable Labor Labor Tax Labor Summary 8.5 36t 2t .66 382.66 IlL Additional Costs Taxable Costs Sales Tax Non-Taxable Costs Total Additional Costs ~ 6~00% 0.36 137.80 144.16 Part Replacement Summary Taxable Parts Sales Tax Total Replacement Paris Amount Customer Responsibility L Total Labor: II. Total Replacement Paris: IlL Total Additional Costs: Gross TOtM: IV. Total Adjustments: Net Torah 46'1.75 27.71 489,,46 Amount 382.~ 48946 1;016.28 0.0~ 1,01628 This is a preliminary estimate. Additional chanqes to the estimate may be reauired for the actual repair. ESTIMATE RECALL NUMBER: 3/1tl02 t6:16:10 6149 UltmMete is a Trademark of Mitchell Intematlenal Mitchell Data Version: MAR_02_A Copyright (C) t994 - 2000 MItche~l Intsmafional U~TaMats Version: 4.7.~07 All Rights Reserved Page 2 of 2