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Claim by Hagar Ent. LLC (James Gross)THE CITY OF DUB E Masterpiece on the Mississippi MEMORANDUM TRACEY STECKLEIN PARALEGAL To: Mayor Roy D. Buol and Members of the City Council DATE: July 1, 2009 RE: Claim Against the City of Dubuque by the Hagar Ent., LLC Claimant Date of Claim Date of Loss Nature of Claim Hagar Ent., LLC 06/26/09 06/02/09 Property Damage This is a claim in which claimant alleges that the credit union building located at 66 West 32"d Street was struck and damaged by a City of Dubuque refuse truck. This claim has been referred to Public Entity Risk Services of Iowa, the agent for the Iowa Communities Assurance Pool. cc: Michael C. Van Milligen, City Manager Paul Schultz, Resource Management Coordinator James Gross, Hagar Ent., LLC 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 / ENnAIL tsteckle@cityofdubuque.org ~'~~/~j~~,~ i ~~~ 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 West 13"' St., Dubuque, IA 52001. 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: __[I~Q~~-1~ r~c,T, ~. ~.C 2. Address: ~~~ _~ //~_ ~~I~CF~r~ ~lQ~:~ ~/c' 3. Telephone Number. ~~,C+ ?j ~ ,~ ~ ~ -- ~ ._s ~ .~ 4. Date of Incident: _ ~ ~_ / Lr> ~ 5. Time of Incident: 7 rP < ~ ~I/ ~~Z 6. Location of Incident (Be specific): b ~ ~Ll ~ Z r. i ~C , ~~~ 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.) 8. What were weather conditions likes ©f~1.'a/( C-~A,~' 9. Give name and address of any witnesses: 10. Did police investigate? (If so, give names of officers.) 1 . y .~ / '1 t ~~~~~~~ 'f ~ 4 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 daim, if any? 14. Have you been compensated for any part or all of your daim by any insurance company? (If so, give name and address of insurance company and amount paid.) 15. What amount do you daim from the City of Dubuque? 16. Why do you daim the City of Dubuque is responsible? 17. Have you made any daim against anyone else for damages as a result of this incident? (If yes, give name and address. ) ~/r . 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 ~ h day of V ~ c ~ , 20 G~ ~'. 'nature) ~ (Print Name) C7 ° ~ `c ~ ~.:... r- ~ Cr ~-- , - ,. -. r~~ ~ rn :T~ ~, , -~ ~: ~~~ rv C ~~ w ~~ ...~~ %.- ~~ u U N 4, Driver Information Exchange Report 41110 Dubuque Police Department 563-589-4410 Driver's Name - Last SEVERSON Address 1920 LINCOLN T Gender Dr umber //��//{{ Male 001 Owner Company Name CITY OF DUBUQUE First TONY City DUBUQUE Middle JON Suffix State IA IWO Zip 52001 Class B State IA Endorsements NONE Restrictions NONE Owner's Name - Last First Insurance Co. Name IA COMM ASSURANCE POOL Insurance Policy # ICAP 0300 Middle Suffix Phone (563) 543-6352 x Insurance Co. Phone o (563) 5894346 a Address 50 W. 13TH ST. VIN No 1 FVABXAK61 HJ17239 License Plate # 84837 Year 2001 State IA Make FRGT Year 2009 City LDUBUQUE Model FL80 Most Damaged Area OS - Rear State IA Zip 52001- Style TK If Property other than R R vehicles damaged explain Q M Owner's Name - Last P E A_ Object Damaged BUILDING Estimate of Damage $900.00 Vehicle Configuration 21 Approximate Cost to Repair or Replace $0.00 Was Owner or Tenant Notified? Yes First Middle Suffix R G Street or RFD T E 66 W. 32ND County Dubuque -31 City DUBUQUE Company Owner's Name CREDIT UNION CENTER State Zip Code IA 52001 Accident occurred within corporate limits of (city) Dubuque -2100 Literal Description W 32ND ST and E 32ND ST and US 0052 I CENTRAL AVE X-Coordinate 00690314 if accident occurred outside of city limits show general vacinity: "NIA" On Road, Street, or Highway. 66 W. 32ND Distance 75 Ft Y-Coordinate 04710948 Direction "NIA" of Nearest City "NM" Direction 7-W At Intersection with: "NIA" Route (Cardinal) Travel Direction "N/A" and Definable Intersection, budge, or railroad crossing 32ND/CENTRAL Offices STAIR, JUSTIN Distance "NIA" Direction "NIA" of Milepost Number "NIA" Or Badge No. 54A Law Enforcement Case Number 01-09-24523 Date of Accident 06/02/2009 Time of Accident 07:14 Hrs. Printed At: Dubuque Police Department 0610212009 09:43 AM Page 1 Form #: 01-09-24523 J®~n ~Vl~ite ~est~rat~ol~~ WOODWORKING AND MASONRY Hagaz Enterprises LLC 2345 Clark Crest Dr. Dubuque, Ia. 52003 cost estimate Credit union building wet 32 nd street Repair front of building resulting from garbage truck accident Materials aluminum surface boazd Aluminum trim and soffit paint and surface sealer total $1245.00 Labor for install Total $1124.00 Clean-up and removal total $98.00 Grand Total $2467.00 ohn ite st John White 409 BURCH ST Dubuque, IA 52001 Cell 563-580-0957