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Claim by Clark W. Wolff CC; C~T¥ HANAGER BAHRY LINDAHL CINDY STE~NHAUSER ~EN TE~PPE CLAIM AGAINST THE CITY OF DUBUQUERIcH RUSSELL 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 13th Street, Dubuque, Iowa 52001-4864. 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: Clark W. Wolff 2. Address: 15 So. Main Street, Dubuque, IA 52001 Telephone Numbers: Please contact Attorney David Clemens of Reynolds & Kenline, LLP., 222 Fischer Bldg., Dubuque, IA 52004-0239 319-556-8000 4. Date of Incident: January 12, 2001and thereafter. 5. Time of Incident: N/A 6. Location of incident. (Be specific) 378 Main Street, Dubuque, IA 52001 10. DESCRIBE ACCIDENT OR OCCURRENCE THAT CAUSED INJURY OR DAMAGE.(Give fuel details upon which you base your claim. If a City employee was involved, give the employee's name.) Construction of Fourth Street parking ramp. Specifically, the pdmary cause is thought to be the improper installation of the augercast piles, but other causes may surface. What were weather conditions like? N/A Give name and address of any witnesses. Clark W. Wolff, 15 So. Main Street, Dubuque, Iowa. Additional witnesses will be identified at a Pater date. Did police investigate? (If so, give names of officers.) No, this is not a criminal matter. 11. Was anyone injured? (If so, give name, address and extent of injuries.) No. 12. Was any damage done to property? (If so, describe property and the extent of damage. Attach estimates of damages or describe basis for ascertaining extent of damage.) The walls near the rear of my building have developed severe cracks. Any estimate of damage, and what it will cost to rectify the situation, cannot be determined at this time and are premature. 13. What other damages do you claim, if any? I also claim damages due to loss of value of the building, loss of profits, and other miscellaneous and undetermined costs, 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? Damages are premature and undetermined at this time. 16. Why do you claim the City of Dubuque is responsible? The City of Dubuque is responsible as they own the property where the parking ramp is being constructed and hired the contractor to build the parking ramp. 17. Have you made any claim against anyone else for damages as a result of this incident? Not at this time. 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 /~' day of March, 2001. Clark W. Wolff (Print Name) C~